Hepatocellular carcinoma （HCC） most often develops in patients with liver disease characterized by chronic non-resolving inflammation. The inflammatory response is mainly derived from innate immune cells， and tumor-associated macrophages （TAMs） play an important role in the development of tumors．It is usually chemotactic from mononuclear progenitor cells in the blood to tumor tissue， then is induced by the tumor microenvironment and further develops into TAMs. They play an important role in promoting tumor growth，angiogenesis and tumor invasion and inducing tumor tissues to form an environment without inhibition mechanisms. As the relationship between TAMs and malignant tumors becomes clearer， TAMs are beginning to be seen as therapeutic targets. The heterogeneity of TAM subtypes and their origin and dynamic phenotype during the initiation and progression of HCC has been partially unraveled. It further forms the base for developing therapeutic agents by decreasing the population of TAMs via blocking recruitment of bone marrow-derived monocytes and functionally reprograms TAMs to anti-tumoral behavior. This review focuses on the preclinical evolution and hitherto clinical trials for TAM-targeted therapy in HCC.

Objective:To explore the value of s-detect combined with elastography in the differential diagnosis of benign and malignant breast tumors.Methods:The ultrasound diagnosis data of 136 patients with breast mass examined by ultrasound in the First Affiliated Hospital of Shantou University Medical College from April 2018 to January 2020 were retrospectively analyzed. The breast lesions diagnosed as BI-RADS 3 or above were analyzed by conventional ultrasound, strain elastic imaging strain ratio (SR) and S-Detect Computer-aided Diagnosis (CAD) technology successively and were used for cross-sectional study. The corresponding benign and malignant judgment results were obtained, and the efficacy of individual diagnosis and combined diagnosis were compared and analyzed.Results:Conventional ultrasound, SR, S-Detect alone and conventional ultrasound+SR, conventional ultrasound+S-detect, conventional ultrasound + S-detect +SR combined diagnosis of breast tumors, the area under the receiver operating curve (AREA under the receiver operating curve) Characteristic curve, AUC) were 0.776, 0.839, 0.802, 0.861, 0.832 and 0.870, respectively. SR, S-Detect, conventional ultrasound +SR, conventional ultrasound + S-detect and conventional ultrasound +SR+ S-detect were compared with conventional ultrasound group, Z values were 1.49, 0.70, 2.76, 2.52, 2.96, respectively, and P values were 0.137, 0.484, 0.006, 0.012 and 0.003, respectively. The difference was statistically significant. The accuracy of conventional ultrasound +S-Detect+SR was the highest (84.1%), compared with pathological results, its Kappa value was 0.687, showing the strongest consistency. Conclusion:S-detect combined with strain elastography assisted by conventional ultrasound can significantly improve the diagnostic efficiency of benign and malignant breast tumors.

To evaluate the loyalty and its influential factors for outpatients with high-end medical services in a comprehensive grade-A tertiary hospital.
 Methods: A total of 3 196 outpatients from July 2017 to June 2018, who visited the International Medical Department of a comprehensive grade A tertiary hospital, were investigated by a self-designed loyalty questionnaire. The Cronbach's alpha coefficient was 0.893. A third-party organization conducted the survey and 1 883 valid questionnaires were collected. Chi-square test and logistic stepwise regression model was used to analyze the influential factors for patients' loyalty.
 Results: The loyalty of outpatients with high-end medical services was 95.8%, and the satisfaction of all aspects of outpatient service was more than 94%. After adjusting for sex, age, the protective factors were diagnostic and therapeutic effect (OR=5.45, P<0.001), service level of nurses (OR=3.91, P=0.044), doctors' skills of communication and explanation (OR=2.95, P=0.046), degree of convenience (OR=3.04, P=0.038) and visits in recent three months (OR=2.11, P=0.008).
 Conclusion: The loyalty of outpatients with high-end medical services in a comprehensive grade A tertiary hospital is relatively high. Significant diagnostic and therapeutic effect, good service of nurses, good skills of communication and explanation, convenience and multiple visits are related to high loyalty.
Ambulatory Care ; Humans ; Outpatients ; Patient Satisfaction ; Surveys and Questionnaires ; Tertiary Care Centers

Objective To discuss the application of double contrast enhanced ultrasonography in the diagnosis of micro vessel formation on gastric cancer.Methods 52 cases of patients with gastric cancer who scheduled for elective tumor resection on our hospital from August 2015 to October 2017 were enrolled in the study.Oral ultrasonic contrast agent,and intravenous contrast agent were used to assess the preoperative condition.The image feature of gastric ultrasound imaging was observed,and the time-intensity curve (TIC) parameters of gastric lesions and normal gastric were recorded,the relationship of gastric carcinoma TIC parameters and the expression of micro vessel density (MVD),vascular endothelial growth factor (VEGF) expression were analyzed.Results Comparison of gastric lesions and normal gastric tissue,there were statistically significant difference on the basic strength (BI),enhanced intensity (EI),peak intensity (PI),perfusion time (WIT) (P ＜ 0.05);Correlation analysis showed that EI,PI were positively correlated with MVD,BI,WIT was negatively correlated with MVD (P ＜ 0.05);EI,PI were positively correlated with VEGF,BI was negatively correlated with VEGF (P ＜ 0.05).Conclusions Gastric ultrasound imaging technology can accurately assess the blood perfusion characteristics of gastric carcinoma,with a certain value on the gastric cancer angiogenesis evaluation.

Objective To reduce the incidence of peritoneal dialysis related peritonitis for patients in rural area and to improve management quality of peritoneal dialysis center.Methods We established multidisciplinary collaborative research group involving departments of nephrology,nutrition,infection,and quality control.Risk factors of peritoneal dialysis related peritonitis in rural patients were analyzed,and prevention measures were designed.The rate of peritoneal dialysis related peritonitis in 89 patients after implementation was analyzed.Results The rate of peritoneal dialysis related peritonitis was decreased from 43 patient·month per time to 67 patient ·month per time.Conclusion The compound pathway can effectively reduce the rate of peritonitis,improve patient satisfaction,and prolong dialysis age.

Objective The expression of chemokine C-X-C motif ligand 13 (CXCL13) within liver in primary biliary cholangitis (PBC) patients is significantly increased, but its origin and mechanism is not clear yet.The study aimed to investigate the expression of CXCL13 in the liver of mice through establishing a mouse model of PBC.Methods C57BL/6 mice were randomly divided into experiment group (n=20) control group(n=10).The mice in the experimental group were intraperitoneally injected with polyriboinosinic polyribocytidylic acid (Poly I:C) while the mice in control group were injected with PBS of the same volume.The level of serum AMA was quantified by ELISA and intrahepatic inflammatory cells were assessed by HE staining.Kupffer cells, liver sinusoidal endothelial cells, and infiltrating lymphocytes in the liver of mice were collected by in situ perfusion enzyme digestion and magnetic bead separation methods.The transcriptional level of intrahepatic CXCL13 in liver tissues and cell subpopulations were detected by qPCR.Results The serum AMA titers of the mice in experiment group increased gradually with the prolonging of modeling time and the positive rates at the 4th, 8th, and 12th week after the first injection of Poly I:C were 5.9%, 52.9% and 76.5% respectively.While the serum AMA titers of the mice in control group were at a lower level through the modeling process, with only 2 mice presenting a little higher level above positive cutoff value at the 12th week.The results of HE staining in liver tissues of both groups showed that there were a great amount of intensely infiltrating inflammatory cells in the mice of experimental group while no inflammatory cell infiltration were found in the mice of control group.The separation purity of Kupffer cells and liver sinusoidal endothelial cells in the mice of experiment group tested by flow cytometry were 76%-80%, 68%-72% respectively.Compared with the CXCL13 mRNA level in Kupffer cells [2.34(0.22-8.64)], the expression levels in liver sinusoidal endothelial cells and infiltrating lymphocytes declined[0.27(0.03-1.64), 0.05(0-0.22), P<0.05].Conclusion The chemokine CXCL13 is predominantly produced by Kupffer cells in the liver of PBC mice established by Poly I:C injection.

Objective To study the feasibility and clinical effect of trans umbilical single incision laparoscopic right hemicolectomy for right hemicolon carcinoma.Methods The clinical data of 35 patients with right hemicolon carcinoma were retrospectively analyzed,the 15 cases were received the trans umbilical single incision laparoscopic right hemicolectomy (single incision group) and 20 cases were received laparotomy right hemicolectomy (laparotomy group).The clinical indexes were compared between the 2 groups.Results The length of incision,intraoperative bleeding volume,passage of gas by anus time,feeding time,hospitalized time in single incision group were significantly better than those in laparotomy group [(5.5 ± 0.6) cm vs.(17.6 ± 2.2) cm,(84.0 ± 31.1) ml vs.(155.5 ± 43.1) ml,(2.00 ± 0.76) d vs.(3.75 ± 0.63) d,(5.3 ± 0.6) d vs.(6.5 ± 0.6) d,(9.3 ± 1.4) d vs.(13.5 ± 1.5) d],the operation time in single incision group was significantly longer than that in laparotomy group [(238.4 ± 19.3) min vs.(165.3 ± 25.8) min],there were statistical differences (P ＜ 0.05).There was no statistical difference in number of incision lymph node between the 2 groups (P ＞ 0.05).Postoperative complication in single incision group occurred in 2 cases,postoperative complication in laparotomy group occurred in 3 cases,there was no statistical difference (P ＞0.05).The follow-up time was 1-55 months,the median follow-up time was 28 months,local recurrence and distant metastasis were found in 2 cases in single incision group,and 4 cases was found in laparotomy group,there was no statistical difference (P ＞ 0.05).Conclusions Single incision laparoscopic right hemicolectomy for right hemicolon carcinoma is safe and feasible,which has the advantages of minimal trauma,aesthetic outlook,less bleeding,quick recovery and short hospitalization time,etc.It can be developed in the hospital which has some basis of laparoscopic surgery.

Objective To investigate the clinical efficacy of methotrexate and mifepristone in treatment of ectopic pregnancy. Methods 58 cases with ectopic pregnancy admitted in the Second People's Hospital in Putuo district of Zhoushan city from February 2010 to February 2012 were randomly divided into observation group and control group,each had 29 cases. Control group were received methotrexate 1 mg/kg or 50 mg/m2 once a day by intramuscular injection,observation group were given both methotrexate and mifepristone treatment,the mifepristone was given one piece a day and each piece is 75 mg. the treatment success,b-HCG returned to normal time,normal pregnancy and the occurrence of complications were compared between two groups. Results The treatment success and normal pregnancy rate in observation group were significantly higher than control group(P<0.05),b-HCG returned to normal time was significantly shorter than control group (P<0.05 ). There were no obvious adverse reactions in both two groups, observation group had one light nausea,and control group had one light nausea and one case with alanine aminotransferase (ALT)slightly increased phenomenon,those patients were all back to normal on their own without treatment,the difference of adverse reaction rate between two groups was not significant. Conclusions Methotrexate and mifepristone has good efficacy and are safe and reliable in,treatment of ectopic pregnancy.

Objective To investigate the effect of healthcare cooperation model on the liver disease nursing specialist knowledge and quality of care .Methods The patients , from January 2012 to December 2013, with liver disease were implemented with the healthcare cooperation model .The patients from January to December 2011 were treated with routine care .The specialist nursing knowledge , healthcare cooperative attitude and physician care differences in staff satisfaction were compared .Results The scores of nursing specialist knowledge and practical operation after the implementation of the healthcare cooperation model were (92.36 ± 4.62) and (91.25 ±3.76), which were significantly higher than those of (85.78 ±5.02) and (85.32 ± 4.13) before the implementation (t=4.323, 4.116, respectively;P<0.05).The cooperative attitude scores of doctors and nurses were (65.36 ±10.46) and (64.33 ±11.27) after the implementation of the healthcare cooperation model, which were significantly higher than those of (52.36 ±8.28) and (51.98 ±9.75) before the implementation (t=5.986, 6.023, respectively;P<0.05).The rate of satisfaction of doctors, nurses and patients were 100.00%, 93.33% and 96.00% after the implementation of the healthcare cooperation model , which were significantly higher than those of 55.56%, 53.33% and 60.00% (χ2 =6.986, 7.129, 9.442, respectively;P<0.05).Conclusions The application of healthcare cooperation model can improve nursing specialist knowledge , and enhance nursing staff ’ s motivation and improve quality of care and satisfaction .It is worthy of promotion .

Objective To explore a method for earlier evaluating death toll based on a function relationship ( an increasing hour-increasing death index ( K value) followed with time (T) changing after catastrophic earthquake. Methods Information data of 10 typical occurrences of catastrophic earthquake obtained from China International Search and Rescue Team (CISAR) were analyzed. Total deaths were estimated according to the simulation function made by hour-increasing death index (K value) followed with time (T) changing. Expected value of the simulation function was assessed by statistical software SPSS version 17.0 to establish the model of simulation function.Results The length of time (T) to reach K maximum (Kmmax) was ( 12.94 ± 8.18) h and then the K value was gradually decreased. Kmax was symmetrically scattered within 2 T time.Estimated death toll (W) within 2 T was obtained from calculating the integration summation of the function to get a formula as W =∫∞ kf(t) dt.This Estimated death toll(W) numbers was correlated approximately with the death toll (M) from authoritative report (P ＜ 0.01 ).According to the regression analysis of model simulation curve,the predictive function of death toll within 2 T was M =W1.23 ×0.194.A determinant coefficient of this power function R2 was 0.88. Conclusions Earlier estimating death toll within about 12 h should be carried out by using the data of real-time information report system.