Objective:To analyze the histopathological characteristics of peri-implant soft tissue in re-constructed jaws and the changes after keratinized mucosa augmentation(KM A)with free gingival graft(FGG).Methods:Twenty patients were enrolled in this study.Five patients of them,who were perio-dontal and systemic healthy and referred for crown lengthening before restoration with healthy keratinized gingiva collected were enrolled as healthy controls.15 patients of them were with fibula or iliac bone flaps jaw reconstruction(10 with fibula flap and 5 with iliac flap),who were referred to FGG and implant exposures before restoration.Soft tissue was collected before FGG in reconstructed jaws,and in 5 patients(3 with fibula flap and 2 with iliac flap)8 weeks after FGG if a second surgery was conducted.Histologi-cal analysis with hematoxylin-eosin stain and immunological analysis to interlukin-1(IL-1),interlukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were performed.Results:Thickness from the bottom of stratum basale to the top of stratum granulosum and thickness of keratinized layer in reconstructed jaws were significantly lower compared with that of natural healthy keratinized gingiva[0.27(0.20,0.30)mmvs.0.36(0.35,0.47)mm,P＜0.05;16.49(14.90,23.37)μm vs.26.37(24.12,31.53)μm,P＜0.05].In the reconstructed area,thickness from the bottom of stratum basale to the top of stra-tum granulosum increased after KMA with FGG[0.19(0.16,0.25)mm vs.0.38(0.25,0.39)mm,P=0.059]and the thickness of keratinized layer significantly increased after KMA with FGG[16.42(14.16,22.35)μm vs.28.57(27.16,29.14)μm,P＜0.05],which was similar to that in the con-trol group.Furthermore,the number of positive cells of IL-1,IL-6 and TNF-α significantly increased after KMA[0.67(0.17,8.93)vs.11.00(9.16,18.00);13.00(8.50,14.14)vs.21.89(15.00,28.12);0.22(0.04,0.63)vs.2.83(1.68,5.00),respectively,P＜0.05]as well as the average optical density value[0.15(0.14,0.17)vs.0.18(0.17,0.21);0.28(0.26,0.33)vs.0.36(0.33,0.37);0.23(0.22,0.29)vs.0.30(0.28,0.42),respectively,P＜0.05],which was similar to that in the healthy keratinized gingiva.Conclusion:The lack of rete pegs and inflammato-ry factors were common in soft tissue with jaw reconstruction.FGG can improve the quality of the epithe-lium and may improve the stability of the mucosa around implants.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective To investigate the current health status of the targeted recipients of the precision poverty alleviation program in Taiziwan Village, Shazhenxi Town, Zigui County and explore its influencing factors, and to provide reference for the formulation of local health poverty alleviation policies. Methods A cluster sampling method was used to investigate 115 poverty alleviation recipients aged 18 and above in Taiziwan Village. The status of ^“physiological health^” and ^“mental health^” was investigated using the international general SF-36 (Chinese version) health scale. Results The survey subjects were mainly the people with advanced age, low education background and suffering from chronic diseases. Except for the physiological function score being more than 70 points, the scores of other dimensions were all 60 points around. The scores were 61.74±19.86 points for physical health and 59.05±16.91 points for mental health, respectively. People aged 60 and above scored lower in all dimensions than those aged under 60. Factors that affected both physical and mental health of the whole population were advanced age and chronic diseases. While the factors that affected physical health of people aged 60 and above were chronic diseases, the factors that affected mental health were chronic diseases and a long interval between children's home visits. Conclusion The health status of people aged 60 and above is worse than that of people aged below 60. Their physical health is affected by chronic diseases, and their mental health is affected by chronic diseases and children's visit cycles. While formulating poverty alleviation policies for physical health, an attention should also be paid to mental health.

Objective To compare the efficacy and adverse reactions of desloratadine citrate disodium tablets and loratadine dispersible tablets in treatment of patients with allergic rhinitis,and their influence on leukotriene B4(LTB4),interleukin-4 (IL-4),interleukin-10 (IL-10) and interferon gamma (INF-γ).Methods From June 2015 to June 2016,a total of 110 patients with allergic rhinitis in the Second People's Hospital of Cangnan County were selected and randomly divided into control group and observation group according to the digital table,with 55 cases in each group.The control group was given loratadine dispersible tablets,while the observation group was given desloratadine citrate disodium tablets.Both two groups were treated for 14 days.The clinical efficacy,adverse reactions and changes of LTB4,IL-4,IL-10,INF-γ levels before and after treatment were compared between the two groups.Results The total effective rate of the observation group was 94.5 ％,which was significantly higher than 80.0％ of the control group(x2 =6.310,P ＜ 0.05).The incidence rate of adverse reactions in the observation group was 16.4％,which was similar to 20.0％ in the control group.Before treatment,there were no statistically significant differences in LTB4,IL-4,IL-10,INF-γ levels between the two groups (all P ＞ 0.05).After 2 weeks of treatment,the levels of LTB4,IL-4,IL-10 and INF-γ in the observation group were (67.74 ±10.15) ng/L,(52.37 ± 5.12) μg/L,(81.26 ± 11.78) μg/L,(94.47 ± 7.87) μg/L,respectively,which in the control group were (80.32 ± 9.97) ng/L,(62.95 ± 5.45) μg/L,(96.32 ± 11.57) μg/L,(86.74 ± 7.63) μg/L,respectively,there were statistically significant differences between the two groups (t =7.124,5.262,4.654,3.718,all P ＜ 0.05).Conclusion Both desloratadine citrate disodium tablets and loratadine dispersible tablets can effectively treat patients with allergic rhinitis,improve the symptoms and physical signs,reduce the levels of LTB4,IL-4 and IL-10,increase the level of INF-γ,and the adverse reactions are less and slight,but the efficacy of desloratadine citrate disodium tablets is better than loratadine dispersible tablets.

Objective To investigate the positive influence of telephone follow-up on primiparas′exclusive breastfeeding during puerperal period. Methods By using convenience sampling method, 90 primiparas were selected who had given birth in the integration ward of our hospital from October to December 2015 as the control group, and 60 primiparas were selected who had given birth in the integration ward of our hospital from December 2015 to January 2016 as the experimental group. For the experimental group, every 2 weeks, a telephone follow-up was executed according to primiparas′parturition time after leaving hospital. For the control group, telephone follow-up was not executed. The influence of periodic telephone follow-up on primiparas′ exclusive breastfeeding was observed. Results The exclusive breastfeeding rate of primiparas in the experimental group was increased as the telephone follow-up was executed. It was up to 91.7%(55/60) 6 weeks since parturition. The exclusive breastfeeding rate of primiparas in the control group was 71.1% (64/90). The difference was significant (χ2=9.28, P<0.01). Conclusions Periodic telephone follow- up according to necessity provides breastfeeding publicity and guidance after parturition, maintaining the continuous education and caring for the primiparas after leaving hospital which efficiently increased the pure breastfeeding rate of primiparas during puerperal period.

Objective To investigate the quality control circle's effect assessment about improving the successful rate of intervening adding the non-doctor advised formulated milk powder for the newborn baby rooming-in in obstetric ward, decrease the nonmedical indication formula milkadding,and improve the rate of exclusive breastfeeding. Methods Found quality control circle group,analyze all the different elements which influence the success of nurse's intervening of adding the non-doctor advised formulated milk powder for the newborn baby in room-in system,target the theme,make the policy and implement it, compare the success rate of intervening adding the non-doctor advised formulated milk powder for the newborn baby rooming-in before and after quality circle's activity. Results Increase the success rate of nurse's intervening of adding the non-doctor advised formulated milk powder for the newborn baby rooming-in from 32.5%(13/40)before improvement to 70.7%(341/482), the target rate was 96.7%. Conclusions The quality circle's activity increases the success rate of nurse's intervening of adding the non-doctor advised formulated milk powder for the newborn baby rooming-in, while it enhances the comprehensive capability of nurse,and strengthens the clinical nursing specialty's quality.

OBJECTIVE:To observe clinical efficacy and safety of tanshinone combined with limbal stem cells transplantation in the treatment of pterygium. METHODS:Totally 97 cases (118 eyes) of primary pterygium admitted into our hospital during Feb. 2010-Sept. 2014 were analyzed retrospectively,and divided into observation group (48 cases,57 eyes) and control group (49 cases,61 eyes). Both groups received autologous limbal stem cell transplantation. The control began to give Tobramycin and dexamethasone eye drops 1-2 drop 1 week before surgery,every 4-6 h one times. Observation group was given Tanshinone cap-sules 0.5 g,po,tid,one week before surgery,for 3 months. Repair time of corneal epithelium and local symptom regression time were compared between 2 groups. Corneal astigmatism and corrected visual acuity were observed in 2 groups before and 1,3 months after surgery. The occurrence of recurrence and ADR was analyzed statistically in 2 groups. RESULTS:The repairing time of corneal pithelial and local symptom regression time in observation group were significantly shorter than control group,with statis-tical significance (P<0.05). There was no statistical significance in corneal astigmatism and corrected visual acuity between 2 groups before and one month after surgery (P>0.05). 1,3 months after surgery,corneal astigmatism of 2 groups was decreased significantly and corrected visual acuity was increased significantly than before surgery,and 3 months after surgery the observation group was significantly better than the control group,with statistical significance (P<0.05). The recurrence rate of observation group was 3.51%,which was significantly lower than 14.75% of control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Tanshinone combined with autol-ogous limbal stem cell transplantation in the treatment of pterygium can shorten the time of corneal epithelial repair and local symp-toms,restore the visual function of patients and reduce recurrence rate with good safety.

OBJECTIVETo investigate the relationship between cytogenetic markers with World Health Organization (WHO) classification, disease progress and prognosis in cases with primary myelodysplastic syndromes (MDS).

METHODS298 patients with de novo MDS from the first affiliated hospital of medical school, Zhejiang University were enrolled in the retrospective analysis of WHO classification, karyotype, and prognosis. Follow-up study was also conducted.

RESULTSThe WHO classifications at first diagnosis were as follows: refractory cytopenia with unilineage dysplasia (RCUD), 18 cases; refractory anemia with ring sideroblasts (RARS), 8 cases; refractory cytopenia with multiline dysplasia (RCMD), 104 cases; refractory anemia with excess blasts-1, 76 cases; refractory anemia with excess blasts-2, 85 cases; MDS unclassified (MDS-U), 5 cases involved; and single del (5q), 2 cases. 39.6% of MDS patients carried karyotypic abnormalities. Among them, the frequency of numerical abnormalities, structural abnormalities and the existence of composite abnormalities were 45, 31, and 42, respectively. The composite abnormalities were unbalanced translocations and complex chromosomal abnormalities. The incidence of both karyotypic abnormalities and complex chromosomal abnormalities in RAEB group was higher than that in non-RAEB group (P<0. 05). An analysis based on IPSS-R Scoring System showed that advanced risk stratification (except the low-risk group) gradually enhanced the incidence of karyotypic abnormalities (P<0.05). In addition, the probability of evolution to leukemia increased with the higher IPSS-R score (P<0.05). In RAEB group, the cases with +8 chromosome, accounting for 19.5% of karyotypic abnormalities, had worse prognosis than those with normal chromosomes.

CONCLUSIONKaryotype was identified with an independent risk factor in MDS patients. Therefore, the information on cytogenetic analysis was critical for diagnosis, prognosis and individual treatment. MDS patients presenting+8 chromosome, an intermediate risk factor, were associated with a poorer outcome compared to cases with normal chromosomes in RAEB group.

Abnormal Karyotype ; Anemia, Refractory ; Chromosome Aberrations ; Chromosomes, Human, Pair 8 ; Follow-Up Studies ; Humans ; Karyotyping ; Myelodysplastic Syndromes ; Prognosis ; Retrospective Studies ; Risk Factors ; World Health Organization

Objective To investigate the status and risk factors of surgical site infection (SSI)in hospitals in Chi-na,so as to provide theoretical basis for the prevention and treatment of SSI.Methods Four types of surgeries (colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery)in 29 hospitals were monitored prospectively,risk factors for SSI were analyzed.Results A total of 6 309 surgical procedures were investigated,incidence of SSI was 1 .60%.Incidences of SSI in patients receiving colorectal surgery,abdominal hys-terectomy,femoral neck repair surgery,and vascular surgery were 4.47%(74/1 655 ),1 .03%(22/2 139),0.21 %(5/2 372),and 0.00% (0/143 )respectively.The incidences of SSI were different among different regions (χ2 =114.213,P <0.05).The most common SSI was superficial incisional infection,the next was deep incisional infec-tion.The major pathogens causing SSI were Escherichia coli ,Enterococcus spp .,coagulase negative staphylococ-cus ,Staphylococcus aureus ,and Klebsiella pneumoniae .The independent risk factors for SSI were male patients, long duration of surgery,and high NNIS score.Conclusion The risk of SSI is varied with different types of surger-ies.Male,long duration of surgery,and high NNIS score can increase the risk of postoperative SSI.

Objective To explore the incidence of surgical site infection (SSI)and compliance to bundled interven-tion measures,and evaluate the effect of bundled interventions on controlling SSI.Methods From October 2013 to September 2014,three types of surgeries (colorectal surgery,abdominal hysterectomy,and femoral neck repair sur-gery)in 29 hospitals in China were monitored,October 2013 to March 2014 was baseline investigated stage,April 2014 to September 2014 was intervention stage.Results A total of 6 166 episodes of surgeries were monitored,the incidence of SSI was 1 .64%,incidence of SSI following colorectal surgery,abdominal hysterectomy,and femoral neck repair surgery were 4.47%,1 .03%,and 0.21 % respectively.The P 75 time of three types of surgeries were 3,2,and 2 hours respectively.Compared with the baseline stage,the compliance to most intervention measures im-proved after intervention,the largest increase in the compliance to interventions was disinfection with chlorhexidine-containing disinfectant at surgical sites of colorectal surgery (increased by 29.09%),followed by preoperative shower of femoral neck repair surgery (increased by 26.24%),preoperative shower of colorectal surgery(increased by 22.95%),and skin preparation on the day of operation (increased by 20.75%).Incidences of SSI in three types of surgeries were not significantly different before and after intervention(all P >0.05).Conclusion The incidences of SSI are different among different types of surgeries,the compliance to most bundled intervention measures has im-proved to some extent after intervention,but effectiveness of intervention measures needs to be further observed.