Although high-efficiency targeted delivery is investigated for years, the efficiency of tumor targeting seems still a hard core to smash. To overcome this problem, we design a three-step delivery strategy based on streptavidin-biotin interaction with the help of c(RGDfK), magnetic fields and lasers. The ultrasmall superparamagnetic iron oxide nanoparticles (USIONPs) modified with c(RGDfK) and biotin are delivered at step 1, followed by streptavidin and the doxorubicin (Dox) loaded nanosystems conjugated with biotin at steps 2 and 3, respectively. The delivery systems were proved to be efficient on A549 cells. The co-localization of signal for each step revealed the targeting mechanism. The external magnetic field could further amplify the endocytosis of USPIONs based on c(RGDfK), and magnify the uptake distinctions among different test groups. Based on photoacoustic imaging, laser-heating treatment could enhance the permeability of tumor venous blood vessels and change the insufficient blood flow in cancer. Then, it was noticed that only three-step delivery with laser-heating and magnetic fields realized the highest tumor distribution of nanosystem. Finally, the magnetism/laser-auxiliary cascaded delivery exhibited the best antitumor efficacy. Generally, this study demonstrated the necessity of combining physical, biological and chemical means of targeting.

Objective:To explore surgical techniques and summarize surgical experience of the paraumbilical flap pedicled with deep inferior epigastric vessels for the repiration of soft tissue defects in pelvic area.Methods:Between August, 2006 and August, 2018, 8 patients with soft tissue defects and bone exposure were treated with paraumbilical flap pedicled with deep inferior epigastric vessels. There were 6 males and 2 females with the average age of 35.3 (range, 12-47) years. The defects were caused by car accident in 5 cases, by high falling injury in 1 case, by soft tissue necrosis after malignant schwannoma resection in 1 case, and by soft tissue necrosis after pelvic operation of open reduction internal fixation in 1 case. The defects located at iliac spine in 5 cases, at tuber ischii in 1 case, and at buttock and perineal region in 1 case. The size of the wounds ranged from 11.0 cm×6.0 cm to 22.0 cm×8.0 cm. The size of the flaps ranged from 13.0 cm×7.0 cm to 29.0 cm×12.0 cm. The followed-up was made by outpatinet service, telephone or WeChat.Results:All flaps survived, and the wound infection was controlled. The followed-up time ranged from 12 to 46 (mean 26) months. All flaps survived uneventfully, and the texture and elasticity of the flaps were good. There were no recurrence of infection, and no ventral hernias occurred in donor sites.Conclusion:The transfer of paraumbilical flap pedicled with deep inferior epigastric vessels is a reliable method to repair large soft tissue defects in iliac spine, perineal region, buttock and tuber ischii.

OBJECTIVE: To understand the mental health status of subway employees, and to explore the relationship among their mental health, psychological capital and work engagement. METHODS: Using the typical sampling method, a total of 2 758 subway employees from a rail transit group Co., Ltd in a city were selected as the study subjects. The Symptom Check List 90, Psychological Capital Questionnaire, and Utrecht Work Engagement Scale were used to investigate the mental health, psychological capital and work engagement of the study subjects. RESULTS: The screening positive rate of mental disorder of the study subjects was 15.6%(431/2 758), and the median scores of mental health, psychological capital, and work engagement were 108, 109, and 62 points, respectively. The mental health scores of the study subjects were negatively correlated with their psychological capital and work engagement scores [Spearman correlation coefficient(r_S) were-0.55 and-0.57, respectively, P<0.01]. The psychological capital score was positively correlated with the work engagement score(r_S=0.70, P<0.01).Mental health played a partial mediating role in the influence of psychological capital on work engagement(mediating effect was 0.07, 95% correlation coefficient: 0.06-0.08, P<0.01). CONCLUSION: The mental health status of the subway employees is good. Psychological capital of subway employees can not only directly affect work engagement, but also indirectly affect work engagement by influencing mental health.

To determine clinical and pathologic profiles for anaplastic large cell lymphoma (ALCL).
 Methods: The clinical data of 22 patients with ALCL were analyzed retrospectively. Therapentie effect of different treatment strategies on ALCL was evaluated.
 Results: The median age for these patients was 32(9-70) years old and the patients with positive ALK accounted for 68.2% (15/22). All patients underwent chemotherapy, including regiments of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), CHOPE (CHOP plus etoposide) or BEACOP (CHOP plus etoposide and bleomycin). Fourteen (63.6%) patients achieved initial complete remission (CR) and the CR rate for patients with ALK+ was significantly higher than that of patients with ALK- (P<0.05), while the age, gender, stage, beta 2-microglobulin (2-MG) level, lactate dehydrogenase (LDH) level, B symptoms had no significant effect on the rate of CR (P>0.05). After a median follow-up of 41 (2-150) months, 12 patients were overall survival, the median progression free time was 22.5 (2-150) months, and the age, gender, stage, IPI index, ALK expression level, beta 2-MG level, LDH level, and B symptoms had no significant effect on the rate of overall survival (P>0.05).
 Conclusion: ALK-positive occurs mainly in ALCL patients. The chemotherapy is still the main treatment, and CHOPE regimen is a better initial treatment scheme because the most patients show good prognosis.
Adolescent ; Adult ; Age Factors ; Aged ; Alkaline Phosphatase ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Bleomycin ; administration & dosage ; Child ; Cyclophosphamide ; administration & dosage ; Doxorubicin ; administration & dosage ; Etoposide ; administration & dosage ; Female ; Humans ; Lymphoma, Large-Cell, Anaplastic ; drug therapy ; enzymology ; mortality ; Male ; Middle Aged ; Prednisone ; administration & dosage ; Prognosis ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Vincristine ; administration & dosage ; Young Adult

Objective To investigate the pathogenic and clinical features of bloodstream infections in patients with hematological malignancies for improving clinical treatment.Methods A total of 92 patients with hematological malignancy and positive blood culture treated during the period from September 2011 to September 2016 were analyzed,including clinical manifestations,treatment and prognosis.The distribution and antibiotic resistance of pathogens were also investigated.Results Of the 92 patients with bloodstream infection,64.1％ had underlying agranulocytosis.All patients had fever.Septic shock was found in 45.7％ cases.Elevated procalcitonin was detected in 82.6％ cases.The 107 isolates from blood stream included 75 (70.1％) strains of gram negative bacteria,27 (25.2％) strains of gram positive bacteria,and 5 (4.7％) strains of fungi.Escherichia coli showed higher resistance rate to ceftriaxone (80.9％) and levofloxacin (91.3％).Klebsiella pneumoniae (31.2％) and Acinetobacter baumannii (50.0％) strains showed relatively high resistance to imipenem.Gram positive bacteria were still sensitive to vancomycin and linezolid.Overall,35 (38.0％) patients died.The initial empirical treatment regimen had significant impact on patient outcome (P＜0.05).The mortality rate of initial carbapenem-based empirical treatment was slightly lower (28.6％ vs 46.2％) than that of non-carbapenem-based initial regimen,but the difference was not significant (P=0.163).Conclusions The outcome is poor in patients with hematological malignancy complicated with bloodstream infection.The main pathogen is gram negative bacteria in such infections,associated with high antibiotic resistance.The emergence of carbapenem resistance is an issue of concern.The effectiveness of initial empirical therapy may have significant effect on patient outcome.

Objective To analyze the toxicity of dose adjusted-BEACOP (DA-BEACOP,classic CHOP regimen plus etoposide and (or) bleomycin with or without rituximab) regimen for poor-prognosis lymphoma.Methods 89 patients with poor-prognosis lymphoma who had been treated in-patient at Peking University Third Hospital during August 2002 and February 2012 were retrospectively studied.All patients received at least 1 cycle of DA-BEACOP regimen.Results 3-4 grade adverse events were observed in 74 (83.1％) patients,most of which was myelosuppression (73 cases,82.0 ％).There was not death related with the treatment.Compared to male patients,female patients suffered higher rates of grade 3-4 of toxicity (94.2 ％,33/35 vs 75.9 ％,41/54) (P =0.024).The rate of grade 3-4 of hematological toxicity in patients who were pretreated with ≥3 cycles of chemotherapy than that in patients receiving≤2 cycles of chemotherapy (95.9 ％,47/49 vs 75.0 ％,30/40) (P =0.004),while the rate of 3-4 hematological toxicity in pret-radiotherapy posed patients was higher than that in their counterparts who did not receive radiotherapy (95.9 ％,47/49 vs 75.0 ％,30/40) (P =0.022).Conclusion The DA-BEACOP regimen showed manageable toxicity in patients with poor-prognosis lymphoma.

Objective To study the use of the quality control circle(QCC)for patients suf-fering from sleep apnea hypopnea syndrome(OSAHS).Methods The control group was given rou-tine nursing interventions after surgery.The observation group was carried by QCC method.Re-sults The days of staying in hospital,medical costs,and complications in the observation group were lower in the control group,health knowledge score,degree of satisfaction and curative effect were all higher than that in the control group P <0.01).Conclusion The standardized man-agement based on QCC can improve the quality of nursing and promote mental rehabilitation of pa-tients with 0SAHS.

Objective To study the use of the quality control circle(QCC)for patients suf-fering from sleep apnea hypopnea syndrome(OSAHS).Methods The control group was given rou-tine nursing interventions after surgery.The observation group was carried by QCC method.Re-sults The days of staying in hospital,medical costs,and complications in the observation group were lower in the control group,health knowledge score,degree of satisfaction and curative effect were all higher than that in the control group P <0.01).Conclusion The standardized man-agement based on QCC can improve the quality of nursing and promote mental rehabilitation of pa-tients with 0SAHS.

Adielectrophoresis-basedmicrofluidicchipappliedtocellspatterningisdesignedandfabricated, and it demonstrates non-contact and batch manipulation of cells. The microfluidic chip employs a PDMS microchannel and two ITO electrodes, which are designed as astep shape. The distribution of electric field caused by the microelectrodes is simulated by finite element simulation software, COMSOL. The position of the maximum intensity of electric field is also determined. The ITO microelectrodes and the PDMS microchannel are fabricated using MEMS fabrication process. After oxygen plasma surface treatment, the PDMS microchannel and glass substrate with the ITO microelectrodes are aligned and bonded to form experimental microfluidic chip. Through DEP experiment with the varying frequencies, DEP response of yeast cells is examined, and the electric field frequency of the both positive and negative DEP responses are confirmed. The results showed that yeast cells in solution conductivity of 60 μS/cm had negative DEP movement at the frequency of 1 kHz to 10 kHz, positive DEP movement at the 500 kHz to 10 MHz, and no DEP movement at the 50 kHz. Under the condition of the sinusoidal potential of 8Vp-p and the electric field frequency of 5 MHz, the yeast cells were aligned into chains along the step edge of microelectrodes.

Objective Ti study the applicatiin if the clinical nursing pathway in patients with sleep apnea hypipnea syndrime (OSAHS).Methods The patients were divided inti 2 griups.The cintril griup was applied riutine nursing interventiins after surgery while the ibser-vatiinal griup was cinducted by clinical nursing pathway.Results The average hispitalizatiin time and medical cists were much liwer in ibservatiinal griup while awareness if diseases if pa-tients and degree if satisfactiin were higher in the ibservatiinal griup.The difference was statisti-cally significant(P <0.01).Conclusion The standardized management based in clinical nursing pathway can imprive the quality if nursing and primite mental rehabilitatiin if patients with 0SAHS.