Palliative care, as an emerging discipline, is rapidly advancing in China. However, progress in quality management has been relatively slow, hindering the homogeneity of palliative care services in a certain degree. This article takes the Shanghai Palliative Care Service Management Center as an example, outlines its practical model and achievements in the field of quality management since its establishment, and further analyzes the existing problems based on the city-wide palliative care service quality evaluation results. The article summarizes relevant experiences and offers corresponding insights, enriching research cases and practical support in the quality management of palliative care, which may have practical application value for enhancing the homogeneity of palliative care services in the region.

Objective:To evaluate the curative effect and adverse reactions of compound acid, alpha hydroxyl acid (AHA), and salicylic acid (SA) in the treatment of mild to moderate acne.Methods:A total of 105 patients admitted in Suzhou Municipal Hospital from August 2019 to May 2020 were divided into three groups randomly and treated with compound acid, AHA and SA, once every 3 weeks, 4 times totally. The efficacy was evaluated before treatment, 3 weeks after 1 time, 2 times, 3 times, and 4 times. The number of non-inflammatory lesions (comedos) and inflammatory lesions (papules or pustules) were recorded. VISIA image was used to record the patient＇s facial characteristics before treatment and 3 weeks after 4 times. The occurrence of adverse reactions was recorded.Results:Three groups were all safe and effective. The efficiency of non-inflammatory lesions showed that there was no statistically significant difference between the 3 groups (χ 2= 4.58, P=0.101). The effective rate of inflammatory lesions in the compound acid and SA groups were higher than that of AHA group, and the difference was statistically significant (χ 2=6.45, P=0.040). After 4 times, the clinical data of purpurin, red area, and spot in compound acid and SA groups were higher than those before treatment, and the difference was statistically significant ( P<0.05). While in the AHA group, the purple matter was higher than that before treatment after 4 times, the difference was statistically significant ( t=3.506, P=0.010), and the change in the red area was not statistically significant ( P>0.05). Conclusions:The compound acid is safe and effective in treating mild and moderate acne. It is effective for acne inflammatory and non-inflammatory lesions. It has less adverse reactions and is worthy of clinical application.

Tryptophan 2,3-dioxygnease 2 (TDO2) is specific for metabolizing tryptophan to kynurenine (KYN), which plays a critical role in mediating immune escape of cancer. Although accumulating evidence demonstrates that TDO2 overexpression is implicated in the development and progression of multiple cancers, its tumor-promoting role in esophageal squamous cell carcinoma (ESCC) remains unclear. Here, we observed that TDO2 was overexpressed in ESCC tissues and correlated significantly with lymph node metastasis, advanced clinical stage, and unfavorable prognosis. Functional experiments showed that TDO2 promoted tumor cell proliferation, migration, and colony formation, which could be prevented by inhibition of TDO2 and aryl hydrocarbon receptor (AHR). Further experimentation demonstrated that TDO2 could promote the tumor growth of KYSE150 tumor-bearing model, tumor burden of C57BL/6 mice with ESCC induced by 4-NQO, enhance the expression of phosphorylated AKT, with subsequent phosphorylation of GSK3

Objective To evaluate the efficacy and safety of posaconazole for preventing invasive fungal disease (IFD) in the aplastic anemia patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Methods A total of 46 aplastic anemia patients received allogeneic HSCT. They were treated with oral posaconazole 200 mg, three times a day from HSCT pretreatment to granulocyte recovery after transplantation. G test and GM test were done 1, 2 and 4 weeks after the end of posaconazole treatment, and chest CT scan repeated 4 weeks after the end of posaconazole treatment. Posaconazole prophylaxis was defined as successful if there were no clinical manifestations indicative of fungal infection. Results All the 46 patients experienced neutropenia. The median of absolute neutrophil count (ANC) nadir was 0.02 (0-0.05)×109/L for a median time of 10 (8-19) days. The median duration of posaconazole prophylaxis was 26 (15-41) days. Neutropenic fever was reported in 45 patients, which lasted a median time of 5 (1-13) days. Six patients (13.3％ of the patients with neutropenic fever) failed to respond to the empirical treatment of broad spectrum antibiotics with persistent fever over 7 days. Their treatment was switched to short-term empirical treatment with broad spectrum antifungal agents. However, subsequent G test, GM test and chest CT showed negative results. None of the six patient was consistent with IFD diagnosis. Breakthrough fungal infection was not considered. Oral posaconazole solution was resumed for preventing IFD. G test, GM test and chest CT scan did not show any sign of fungal infection 1, 2 and 4 weeks after the end of posaconazole prophylactic treatment in all the 46 patients, proving the success of oral posaconazole in preventing IFD. Posaconazole was not discontinued due to adverse drug reaction in any patient. Conclusions Posaconazole is effective for preventing IFD in the aplastic anemia patients receiving HSCT with good safety profile and few adverse reactions.

A 55-year-old male patient presented with plaques on the face for more than 20 years,and no immunodeficiency diseases were diagnosed.Skin examination showed large areas of pink plaques on the nose,bilateral cheeks and upper oral lips with slight desquamation,verrucous hyperplasia on the dorsal area of the nose,and a bean-sized verrucous protuberance on the tip of the nose.Histopathological examination of the skin lesions revealed pseudoepitheliomatous hyperplasia in the epidermis and hyphae-like structures in the stratum corneum.Moreover,there was diffuse infiltration of inflammatory cells in the dermis,which mainly included neutrophils,lymphocytes,histiocytes and multinucleated giant cells.Periodic acid-Schiff (PAS)-positive spore-like structures were observed in the multinucleated giant cells.Culture of the lesional tissues on Sabouraud dextrose agar (SDA) medium showed grey-brown villous colonies.Microculture on the potato dextrose agar (PDA) medium yielded dark septate hyphae and pycnidia filled with a large number of spores.Microsphaeropsis arundinis was identified by fungal molecular biological techniques.The patient was diagnosed with cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis.The patient was treated with CO2 laser for the removal of verrucous protuberance on the tip of the nose,and oral itraconazole capsules at a dose of 200 mg twice a day.After 3-month treatment,the skin lesions subsided and the drug was withdrew.During 6-month follow-up,no relapse occurred.

Objective To survey the mental health status of rural-to-urban migrant workers in Shanghai.Methods The survey subjects were selected from migrant workers in Shanghai with a multi-stage stratified cluster sampling method.The Symptom Check List ( SCL-90 ) scores were used for evaluation of metal health status.Results The prevalence of mental health problem of 5 626 rural-to-urban migrant workers in Shanghai was 18.8% ( 1 058/5 626 ).The mean total score of SCL-90 was 114.86 ±31.21.Compulsive-obsessive, interpersonal sensitivity, hostility ranked the top three among 9 factors, with scores of 1.37 ±0.43, 1.31 ±0.43 and 1.30 ±0.41 respectively.The mean total scores and scores of 9 factors of rural-to-urban migrant workers in Shanghai were lower than those of Chinese adults norm the mean total scores(129.96 ±38.76) ( t =-15.34, -3.84 --24.08 respectively, all P <0.01) .There were significant differences in mental health among migrant workers with different age , education , marital status , living conditions and occupation (all P<0.05).Conclusion The prevalence of mental health problems in Shanghai rural-to-urban migrant workers is high, with are related to their age, education, marital status, living conditions and occupation.

Objective To compare the performance of 2％ (w/v) agarose gel,2％ (w/v) Metaphor agarose gel and 10％(w/v) nondenaturating polyacrylamide gel in the PCR-restriction fragment length polymorphism (RFLP) analysis of mycobacterial heat shock protein 65 (hsp65) gene.Methods This study included 8 Mycobacteria strains,including clinical isolates and standard strains of Mycobacteria tuberculosis and Mycobacterium intracellulare.Bacterialsuspension of these strains was prepared with the concentration of bacterial cells varying from 10 to 106per milliliter.PCR was performed to amplify the hsp65 gene with a pair of universal primers followed by the digestion of amplicons with two restriction endonucleases,BstE Ⅱ and Hae Ⅲ.Then,the restriction enzyme-digested fragments were subjected to electrophoresis in 2％ agarose gel,2％ Metaphor agarose gel and 10％ nondenaturating polyacrylamide gel respectively.Results As analysis of variance showed,the three gel electrophoresis methods were statistically different in sensitivity for the RFLP analysis of mycobacterial hsp65 gene (F =36.379,P ＜ 0.01).Least significance difference (LSD) procedure revealed that the 2％ agarose gel-based electrophoresis was less sensitive than the 2％ Metaphor agarose gel-and 10％ non-denaturing polyacrylamide gel-based electrophoresis (both P ＜ 0.01),and no significant differences were observed between the 2％ Metaphor agarose gel-and 10％ non-denaturing polyacrylamide gel-based electrophoresis (P ＞ 0.05).Conclusion The 2％ Metaphor agarose gel-and 10％nondenaturating polyacrylamide gel-based electrophoresis methods appear to be more sensitive than the 2％ agarose gel-based electrophoresis method for the PCR-RFLP analysis of mycobacterial hsp65 gene.

ObjectiveTo evaluate the role of p38MAPK signaling pathway in the up-regulation of heme oxygenase-1 (HO-1) expression in the lung tissue in rats with acute lung injury (AL1) induced by endotoxic shock.MethodsForty-eight male SD rats,aged 8 weeks,weighing 180-200 g,were randomly divided into 4 groups ( n =12 each):control group ( group C ) ; endotoxic shock group ( group LS );endotoxic shock +SB203580 (a specific p38MAPK inhibitor) group (group LSS) and SB203580 group (group SB).Normal saline 0.5ml was injected via the femoral vein in groups C and SB,while LPS 10 mg/kg (in 0.5 ml normal saline) was injected via the femoral vein in groups LS and LSS.When MAP was decreased to 75％ of baseline value,10％ dimethyl sulfoxide (DMSO) 0.1 ml was infused via the femoral vein in groups C and LS,while SB203580 5 mol/kg (in 10％ DMSO 0.1 ml) was infused via the femoral vein at a rate of 0.01 ml/min in groups LSS and SB.Arterial blood samples were obtained at 6 h after LPS or normal saline was given for blood gas analysis and oxygenation index (PaO2/FiO2) was calculated.Then the rats were sacrificed and the lungs were removed for microscopic examination.The pathological changes of the lung were scored.The lung water content was calculated.The MDA content,SOD activity,and expression of HO-1 mRNA and protein,p38MAPK protein and phospharylated p38MAPK (p-p38MAPK) protein were determined.ResultsCompared with group C,the oxygenation index and SOD activity were significantly decreased,the pathological score,lung water content and MDA content were significantly increased,and the expression of HO-1 mRNA and protein and p-p38MAPK protein was significantly up-regulated ( P＜0.05),while no significant change was found in p38MAPK protein expression in groups LS and LSS,and no significant change was found in the indexes mentioned above in group SB (P＞0.05).Compared with group LS,the oxygenation index and SOD activity were significantly increased,the pathological score,lung water content and MDA content were significantly decreased,the expression of HO-1 mRNA and protein was significantly up-regulated,and p-p38MAPK protein expression was down-regulated ( P＜0.05),and no significant change was found in p38MAPK protein expression in group LSS ( P＞0.05).ConclusionThe inhibition of p38MAPK signaling pathway can lead to the up-regulation of HO-1 expression in lung tissues in rats with ALI induced by endotoxic shock.

Objective To explore the effects of movement on hippocampal β-amyloid protein ( Aβ ) and amyloid precursor protein (APP) in senescence-accelerated and senescence-prone (SAMP8) mice, and the mechanism by which movement improves learning and memory in mice with a model of Alzheimer's disease. Methods Forty 3-month-old SAMP8 mice were divided randomly into a movement group and a control group. The movement group was trained with a running wheel 10 min daily, 5 days a week in the first month, and 20 min daily in the second month. Morphological changes in the hippocampus were observed under the microscope after HE staining. The expression of Aβ in the hippocampus was detected by immumohistochemical methods and APP mRNA expression was detected by RT-PCR two months later. Results HE staining showed neuron degeneration and death, chromatin condensation and vacuolar degeneration in the hippocampus of the 5-mouth-old SAMP8 mice of the control group. The movement group showed less neuron degeneration and death, and the morphology of most cells was normal The expression of Aβ in the hippocampus of the 5-month-old SAMP8 mice in the movement group was significantly lower than that in the control group. APP mRNA expression levels in the movement group were also significantly lower.Conclusions Movement can delay neuron degeneration and down-regulate Aβ and APP mRNA expression levels in the hippocampus of SAMP8 mice. It may be an important mechanism by which movement improves learning and memory in mice with a model of Alzheimer's disease.

A survey on the prevalence of irritable bowel syndrome (IBS) was conducted in 595 adults from Changzheng Community of Shanghai. The results showed that 73 out of 595 subjects had irritable bowel syndrome (according to the Rome Ⅲ criterion) with a prevalence rate of 12.3%. There were significant differences in prevalence of IBS among residents with different ages and jobs, and with or without depression (P < 0. 05, or 0. 01). The findings indicate that the prevalence rate of IBS is high in community,so attention should be paid in general practice.