ObjectiveTo investigate the effects of metformin on the immune functions of immature dendritic cells （imDCs） and the underlying mechanisms. MethodsMouse bone marrow-derived imDCs were treated with different concentrations of metformin. The working concentration and treatment time of metformin in this study were determined based on the results of cell apoptosis and cell viability assays. The effects of metformin on the phagocytic capacity of imDCs was evaluated using an antigen endocytosis assay. The expression of cluster of differentiation 205 （CD205）， the polymerization of filamentous actin （F-actin）， and the underlying regulatory mechanisms were investigated through flow cytometry， laser confocal fluorescence microscopy， and Western blot. ResultsThe working concentrations of metformin were 1， 2， 4 mmol/L for 24 h determined by the apoptosis and cell viability assays.Metformin significantly suppressed the phagocytic capacity of imDCs， down-regulated the expression of the mannose receptor CD205 on the cell surface， which was closely associated with phagocytic function； metformin inhibited the RhoA-ROCK1-LIMK1-Cofilin signaling pathway， which inhibited the polymerization of F-actin and disturbed its dynamic remodeling of imDCs. ConclusionMetformin can inhibit the expression of CD205 and disrupt the remodeling of F-actin， thereby suppressing the antigen-capturing capacity of imDCs.

Objective To explore the management of nursing adverse events based on JCI evaluation criteria, and to establish a voluntary, non-punitive nursing adverse event reporting system.Methods From January 2014 to December 2015, 680 hospital nurses implemented JCI standards, revision of nursing adverse events management system, created online of nursing adverse events reporting system, to all nursing staff of adverse event management knowledge training and improvement before the analysis of the implementation of the JCI standard, adverse event reporting process and treatment measures of awareness, took the initiative to report rate, nursing adverse events incidence, patient satisfaction rate.Results Before and after nursing staff of adverse event reporting procedure and disposal method of awareness to improve the rate of 39.43% implementation, nursing staff to take the initiative to report to enhance the rate of 7.54%,the incidence of nursing adverse events to reduce the rate of 0.07%,the patients' satisfaction rate increased by 6.15%,there were statistically significant differences(x2=13.50,10.15,12.09,231.51,all P<0.05).Conclusion Nursing adverse events management constructed based on JCI accreditation standards is helpful to avoid the occurrence of nursing adverse events, to improve the rate of patients' satisfaction to nursing, to create a secure hospital atmosphere.

Objective To explore the effects of self-management intervention on the self-management ability and health service utilization of patients with chronic obstructive pulmonary disease (COPD). Methods A total of 84 COPD patients in stable condition with permission of being discharged in respiratory department of a tertiary comprehensive hospital in Wenzhou city,were selected as research objects from May to November 2014 by convenience sampling method,and were randomly divided into the intervention group (n=42) and the control group (n=42). Patients in the control group received routine care,while patients in the intervention group received self-management intervention and all patients were followed up. The self-management scale of chronic obstructive pulmonary disease was used investigate the self-management status of patients three months,six months and 12 months after intervention. The times of emergency services and the times of re-hospitalization were also recorded.Results The self-management ability of patients at the third month,sixth month and 12th month after intervention in the intervention group was significantly improved compared with the control group (P<0.05). There was no significant difference in the aspect of health service utilization at the third month after intervention between two groups (P>0.05);the times of health service utilization in the intervention group at the sixth month and 12th month after intervention were less than the control group (P<0.05).Conclusions Self-management intervention can improve the self-management ability of patients with COPD in stable period,and reduce the times of emergency visits and re-hospitalizations. It is an effective method for the management of chronic diseases.

Objective To explore the value of virtual touch tissue quantification (VTQ ) in the diagnosis of pancreas early damage of patients with hyperuricemia(HUA) .Methods Sixty‐five cases of patients with normal glucose tolerance and HUA (HUA group) and 42 cases of patients with HUA and impaired glucose tolerance (IGT group) were included in the study ,and other 150 health subjects were taken as control group .After routine ultrasound examination ,the pancreas shear wave velocity values (Vs) of different groups were measured by VTQ technology ,and the results were analyzed .Results Compared with the control group ,the rate of the abnormai ultrasonogram of pancreas in IGT group showed obvious increasing trend but there was no significantly difference between the other groups(both P >0 0.5) .The Vs of the normal control group ,HUA group ,and IGT group were (1 2.1 ± 0 1.5)m/s ,(1 4.1 ± 0 1.3)m/s and (1 5.9 ± 0 1.5)m/s ,respectively .The Vs of HUA group and IGT group were higher than that of the control group (both P <0 0.5) ,and the Vs of IGT group was significantly higher than that of HUA group ( P <0 0.5) .Conclusions Hyperuricemia may cause pancreas damage ,and with the disease progress ,the pancreas damage became more serious ,and VTQ technology may play an important role on the diagnosis of pancreas early damage in HUA patients .

Objective To investigate the effect of psychological intervention on the patients with apnea syndrome sleep (SAS), and to investigate the effects of psychological intervention on the patients with poor mood, treatment compliance and quality of life. Methods Selected clinical data of 80 cases with sleep apnea syndrome patients treated in our hospi-tal from 1st May 2013 to 31st Jan 2014 and they were randomly divided into intervention group and control group, each group with 40 cases. Patients in each group received the traditional nursing mode, while the intervention group received the traditional nursing and received psychological intervention. Two groups of patients after intervened before and 9 months after the depression self rating scale self-rating depression scale(SDS), anxiety self-rating scale self rating anxi-ety scale (SAS) and concise Health Questionnaire(SF-36) were evaluated. Results There were no significant differences in SF-36, SAS and SDS in the two groups before intervention (P>0.05). The results of SF-36, SAS and SDS and treat-ment compliance in the intervention group were significantly different compared with control group, which was statisti-cally significant(P<0.01). Conclusion Psychological intervention can effectively relieve the anxiety of patients, improve the sleep quality of patients, improve the treatment compliance, so as to improve the quality of life of patients with SAS, it is worthy of clinical promotion.

Objective To investigate the effects of different types of anesthesia on the incidence rates of low-er respiratory tract infections of elderly patients in orthopedic department.Methods Clinical data from 445 elderly patients in orthopedic department were collected and retrospectively analyzed.We also investigated the relationship be-tween the types of anesthesia and the lower respiratory tract infections.Results The incidence rates of lower respira-tory tract infections were 23.08%in 169 cases,12.14%in 173 cases,and 4.85%in 103 cases after general anesthe-sia with tracheal intubation,intraspinal anesthesia,and nerve blocking anesthesia,respectively.There was statistically significant difference in the infection rates among the three groups (χ2 =13.784,P=0.001).Conclusion Different ways of anesthesia is critically correlated with the incidence of the lower respiratory tract infections in elderly patients.

Background and purpose:The clinical relevance of HBV infection with respect to diffuse large B cell lymphoma(DLBCL) patients and immune patterns of T lymphocyte subsets during chemotherapy remains unclear. This study aimed to identify the characteristics of T-cell mediated immunity in DLBCL patients with HBV infection, thereafter, to explore the possible cell-mediated immune mechanisms of HBsAg positive HBV infection on the survival of DLBCL. Methods:A total of 294 newly diagnosed DLBCL patients were enrolled in this cohort study. Four-color flow cytometric method was used to enumerate the absolute number of CD3+, CD4+, CD8+T lymphocytes and the CD4+/CD8+ratio in peripheral blood samples, at the onset of disease, 2-4, 4-6 and 6-12 months after the initiation of chemotherapy, individually. Results:The absolute number of CD3+, CD4+, CD8+T lymphocytes in both groups were similar at the onset of disease;the count of CD4+lymphocytes was lower in HBsAg positive group during 2 to 4 months after the initiation of chemotherapy, compared with that in the HBsAg negative group. During 4 to 12 months after chemotherapy, the CD4+/CD8+ratio in peripheral blood samples was significantly lower in HBsAg positive group. Conclusion:For newly diagnosed DLBCL patients who received chemotherapy, the dynamic nature of cell mediated immune response was characterized as a low counts of CD4+T lymphocyte during the ifrst several cycles of chemother-apy followed by a decreased circulating CD4+/CD8+ratio. Depressions of cell immunity after chemotherapy in HBsAg positive DLBCL patients were greater and prolonged.

Objective To evaluate a method of fast detection of the hematopoietic progenitor cell (HPC) in peripheral blood samples and explore for an appropriate cutoff value in prediction of adequate CD34+ cell in apheresis concentrate.Methods Peripheral blood samples and apheresis concentrate samples were collected from 27 auto-PBSCT patients receiving chemotherapy plus G-CSF mobilization (chemo group) and 17 patients receiving G-CSF alone (non-chemo group).CD34+ cell counts were determined by flow cytometry according to ISHAGE guideline and HPC counts were detected using Sysmex XE-2100 automatic hemocyte analyzer.The correlation between HPC and CD34+ cell counts in peripheral blood samples and apheresis concentrates were analyzed.Receiver operating characteristic (ROC) curves was used to determine the cutoff value in prediction of adequate CD34+ cell in apheresis concentrate.Results CD34+ cell counts in peripheral blood samples can be estimated by HPC counts (r =0.711,P =0.000,r =0.656,P =0.004).CD34+ cell counts =-0.829+0.648×HPC counts (in chemo group) or 45.033+0.460×HPC counts (in non-chemo group).HPC counts in the peripheral blood of auto-PBSCT patients were highly correlated with the CD34+ cell yield (r =0.602,P =0.001),CD34+ cell counts =1.106+0.046×HPC counts.When HPC in peripheral blood was ≥85/μl,the prediction of adequate CD34+ cells in the yield of apheresis (≥5×106/kg body weight) would have a sensitivity of 78 ％ and a specifity of 82 ％.Conclusion HPC counts in peripheral blood samples in auto-PBSCT patients can be used to determine the optimal time of apheresis and be used as a good marker to predict the stem cell in the yield.