Objective:To explore the productivity of township health services in Guangzhou. Methods:We use a nonparametric Malmquist index approach to analyze total factor productivity change in Guangzhou’s township health service. The panel data was collected between 2009 and 2013. Results: The average growth rate of Guangzhou’s township health service was 18 . 7% from 2009 to 2013 . This growth was mainly due to improved technical progress but not technical efficiency. Pure technical efficiency and scale efficiency have not developed simultaneously. Conclusion:The change in the total factor productivity was positively affected by technical progress, not by strategic management and business decisions inside township health centers.

BACKGROUND:Acupuncture point matching is little reported in the electroacupuncture for cerebral ischemia-reperfusion injury.
OBJECTIVE:To explore the influence of electroacupuncture acupoints selected by orthogonal experiment on rats with cerebral ischemia reperfusion and extracel ular signal regulated kinase (ERK) signal pathway.
METHODS:150 Sprague-Dawley rats were randomly divided into five groups:sham operation group rats were exposed the middle cerebral artery only;models of cerebral ischemia reperfusion were established in the rats in model and orthogonal groups. Then rats in the orthogonal groups 1 (Baihui (DU 20), Quchi (LI 11), Zusanli (ST 36), and Chize (LU 5)), 2 (Baihui (DU 20), Zusanli (ST 36), Chize (LU 5), and Sanyinjiao (SP 6)) and 3 (Hegu (LI 4), Zusanli (ST 36), Chize (LU 5) and Sanyinjiao (SP 6)) were given electroacupuncture at acupoints selected by orthogonal experiment, respectively.
RESULTS AND CONCLUSION:Compared with the model group, in al orthogonal groups, the neurological function deficit scores were decreased, infarct volume was smal er, the number of microvessel density in the ischemia region and the p-ERK expression level in the cortex and hippocampal CA1 region of ischemic hemisphere were increased, and significant changes were found in the orthogonal group 3. These findings indicate that electroacupuncture at points of Hegu (LI 4), Zusanli (ST 36), Chize (LU 5) and Sanyinjiao (SP 6) selected by orthogonal experiment can significantly reduce the infarct volume of cerebral ischemia-reperfusion injury in rats possibly by regulating the ERK signaling pathway.

Objective To evaluate the effect of YunKe on bone metabolism of patients with rheumatoid arthritis (RA). Methods A total of 108 RA patients were divided into YunKe group (n = 72), non-YunKe group (n = 36), and 54 controls. The bone mineral densities (BMDs) of the wrists, hips and lumbar spines were measured by dual-energy X-ray absorptiometry. Moreover , the expression of cross-linked N-telopeptides of type I collagen (NTX) in the serum was detected for statistically analyzing the difference between YunKe group and non-YunKe group. Results In RA group, the BMDs of wrist, hip and lumbar spine declined compared with that of control group (P < 0.001, respectively). In YunKe group, the BMDs of wrist, hip and lumbar spine after 6 months all were improved with statistically significance (P < 0.01, respectively); The differences also were statistically significant when compared with those in non-YunKe group (P < 0.01, respectively). In YunKe group, NTX level in the serum declined after 3 months of the treatment. The difference was statistically significant when compared with that in non-YunKe group (P < 0.001), but the difference disappeared 6 months later. Conclusions The BMD of wrist joints is low and declines in RA patients significantly. The treatment withYunKe improves the BMDs of the wrist , hip and lumbar spine and decreases the serum NTX. This study proposed that YunKe could inhibit the chronic loss of bone mass induced by RA.

Objective To construct a programmed cell death ligand 1(PD-L1) co-expression network in lung squamous cell carcinoma,screen potential PD-L1 co-expression biomarkers,and try to find the genes and pathways participating in PD-L1-regulated tumor immune response.Methods The lung squamous cell carcinoma dataset extracted from TCGA was used to screen the co-expression genes of PD-L 1 at the whole-genome transcriptional level by Venny analysis,and the target genes were screened by multiple types of cluster and molecular network analysis to construct a PD-L1 co-expression network.Results A total of 126 genes moderately co-expressed with PD-L1 were retrieved,most of them are plasma membrane targeting genes participating in immune response.Three transcription factors (IRF2/NFKB1/IRF1) were involved in more than 30％ the regulation of the PD-L1 genes transcription.By screening the core molecules of co-expression of PD-L1 gene set and analyzing the connectivity of network node,6 network nodes genes with the highest connectivity were retrieved as follows:IFNG,JAK2,STAT1,CTLA4,CD80 and CCR5.Analysis of the relations of the different expression levels of these genes to the survival situation of patients with lung cancer revealed that CCR5 was a significant prognostic marker.Analysis of the PD-L1 expression and CCR5 gene spectrum data showed the Pearson correlation coefficient is 0.47(P＜0.05);GO-BP cluster analysis showed that the function of CCR5 mainly focused on immune regulation,T cell regulation and signal transduction,in accordance with the PD-L1 function of network regulation.Conclusions The main nodes of PD-L1 co-expressing gene set are immune-related molecules,among which IFNG/CCR5/NFKB1 play the most significant regulatory effects in the gene network.This finding lays a foundation for the research and immunotherapy for lung squamous cell carcinoma.

Objective To investigate the distribution and antibiotic resistance profile of clinical isolates in the First Hospital of Qiqihar during 2015.Methods Antimicrobial susceptibility test was carried out according to a unified protocol using automated system from January 1,2015 to December 31,2015.The results were analyzed with WHONET 5.6 software according to the 2014 breakpoints of Clinical and Laboratory Standards Institute.Results A total of 5 162 clinical isolates were collected,of which 28.1％ (1 450/5 162) were gram-positive cocci and 71.9％ (3 712/5 162) were gram-negative bacilli.About 36.5％ (255/698) ofS.aureus isolates and 81.4％ (180/221) of coagulase negative Staphylococcus isolates were resistant to methicillin.No S.aureus and coagulase negative Staphylococcus isolate were found resistant to vancomycin or linezolid.Enterococcus isolates showed low resistance to vancomycin and linezolid.One strain of E.faecium was found resistant to vancomycin.ESBLs were produced in 39.9％ (298/747) ofE.coli,26.1％ (294/1 127) ofKlebsiella spp.,and 15.6％ (12/77) ofP mirabilis strains.The Enterobacteriaceae strains were less resistant to imipenem,beta-lactam/beta-lactamase inhibitor combination and amikacin.About 36.6％ (163 / 445) of A.baumannii isolates and 1.8％ (13/715) of P.aeruginosa isolates were extensively drug-resistant strains.Conclusions Antibiotic resistance poses a serious threat to clinical practice,to which more attention should be paid.Clinical microbiology lab should make more efforts to provide better support to clinical therapy.

Objective:To analyze the prophylactic use of antibiotics during the perioperative period of typeⅠincision operation in a cancer hospital in order to promote the safe, effective and rational use of antibiotics. Methods:The rationality of 480 cases of typeⅠincision operation from January to December in 2013 and from January to December in 2014 was evaluated respectively, and the analy-sis and comparison were performed on the prophylactic use of antibiotics. Results: Through the pharmaceutical intervention including the special evaluation carried out by clinical pharmacists, the use of antibiotics gradually reached the rational level. Conclusion: The participation of clinical pharmacists in the use management of antibiotics in typeⅠincision operation can improve the rationality of the drugs used in clinic.

Objective To evaluate the early diagnosis value of procalcitonin (PCT) in severe brain damage combined with pul‐monary infection .Methods The brain injury patients in the hospital from January to October 2014 were enrolled in the study and divided into infectious group whose infection had occurred within 5 days after admitting to hospital and non‐infectious group who had not suffered from infection .The blood samples of the patients were collected within 2 h and 3 days after admitting to hospital and detected for PCT concentration .The Early diagnosis value of PCT in brain damage combined with pulmonary infection was e‐valuated and compared with white blood cells (WBC) ,neutrophile granulocyte(N)and hypersensitive C‐reactive protein(hs‐CRP) . Results The incidence of pulmonary infection within 5 days of severe brain injury was 22 .9% (41/179) .There were statistically differences of PCT ,WBC ,N and hs‐CRP between infectious group and non‐infectious group(P< 0 .05) .The areas under curve (AUC) of PCT ,WBC ,N and hs‐CRP were 0 .83 ,0 .80 ,0 .78 and 0 .82 respectively .The combination of PCT+WBC+ hs‐CRP had the highest diagnostic value since its AUC was 0 .87 .PCT had a satisfied diagnostic veracity since it had good sensitivity ,specificity and positive predictive value in the diagnosis of brain damage combined with pulmonary infection .Conclusion PCT could be an ear‐ly diagnosis indicator in severe brain damage combined with pulmonary infection ,and the diagnostic veracity is higher when com‐bined with WBC and hs‐CRP .An antimicrobial treatment is recommended when PCT concentration of brain damage patient rises , especially when combined with WBC and hs‐CRP concentration elevating .

Objective To analyze the mammographic findings of triple-negative breast cancer [TNBC,which is estrogen receptor (ER) negative,progesterone receptor (PR) negative,and human epidermal growth factor receptor 2 ( HER2 ) negative ] and triple-positive breast cancer ( TPBC,which is ER positive,PR positive,and HER2 positive ),and to evaluate the relationship of immunohistochemologic receptor status and mammographic findings.MethodsThe immunohistochemistry results of 631 cases with breast cancers were reviewed,including 117 cases of TNBC and 44 cases of TPBC.All of the patients took mammography at initial diagnosis.We retrospectively evaluated the visibility,morphology,distribution and size of the lesion (masses and calcifications) and breast density on mammography of TNBC,and compared them with those of TPBC.The age onset and tumor sizes of TNBC and TPBC were compared by using Chi-square test and t test.ResultsThe visibility rate of TNBC and TPBC on mammography were 88.0％(103/117) and 90.9％ (40/44),and the difference between them was insignificant ( x2 =0.055,P ＞0.05).TNBC was more frequently associated with merely a mass (56/103) than TPBC (12/40) (x2 =6.860,P＜0.01 ),and the mean diameter of the mass of TNBC [ ( 2.6 ± 1.4 ) cm ] was larger than that of TPBC [(2.0 ± 0.6) cm](t =2.087,P ＜ 0.05). TNBC were less frequently associated with microcalcifications (37/103) than TPBC ( 24/40 ) ( x2 =7.423,P ＜ 0.01 ).Mammographic density and lesion visibility were similar between the two different immunophenotypes of breast cancers.The mean age of TNBC (52±9) was more than that of TPBC (48 ±8) (t =2.759,P ＜0.01).Infiltrating ductal carcinoma was the main pathologic type of both groups.Basal-like breast cancer accounted for 49％ (57/117 ) of TNBC while none happened in TPBC.ConclusionsTNBC shows merely a mass with indistinct margins,lager size and is less associated with microcalcifications.These mammographic features might be useful in diagnosing triple negative breast cancer.

Objective To investigate the changes of Treg cells,Th17 cells and related cytokines in pe?ripheral blood of patients with severe hand?foot?mouth disease( HFMD) in the initial stage of infection caused by Enterovirus 71 virus. Methods Thirty?five cases of severe HFMD children in the Fifth Hospital of Shijiazhuang from May 2013 to December 2013 were selected as the research subjects,including 27 cases of severe formed group and 8 cases of danger severe formed group. The frequencies of Th17 cells ( CD3+CD8?IL?17+) and Treg cells( CD4+CD25+Foxp3+) in peripheral blood were detected by flow cytometry in patients with severe HFMD and 31 healthy children(control group). Moreover the serum levels of interleukin 6(IL?6),interleukin 17(IL?17) ,interleukin 10( IL?10) ,interleukin 23( IL?23) ,and human transforming growth factorβ1 ( TGF?β1) were measured by ELISA. Results As compared with those in control group,the frequencies of Treg cells,ratio of Treg/Th17,serum levels of TGF?β1, IL?10 in severe HFMD groups were significantly decreased ( F=23. 23, 30. 88,10. 766,11. 680 respectively;P<0. 05) . However the frequency of Th17 cells,serum levels of IL?6,IL?17,IL?23 in severe HFMD groups were significantly increased( F=646. 81,5. 904,10. 557,3. 490 respectively;P<0. 05) . Conclusion The changes of Treg and Thl7 cells and related cytokines appear in peripheral blood of patients with HFMD in the initial stage of infection caused by Enterovirus 71 virus. The frequency of Treg cell is decreased,however,the frequency of Thl7 cells frequency is increased,as a result,which may spread inflammato?ry reaction and cause complication.

Objective To investigate the biological effects of exosomes secreted by KYSE410 cells on migration and invasion of KYSE410,KYSE510,YES2 cells and the possible mechanisms underlying the phenotype change.Methods The exosomes were isolated from the conditional supernatant of esophageal cancer cell line KYSE410 by ultracentrifugation.The morphology of exosomes was observed by transmission electron microscopy (TEM).Western blotting was used to detect the protein markers of exosomes.The uptaken of fluorescence-labeled KYSE410 exosomes by KYSE410,KYSE510 and YES2 was also recorded under confocal microscopy.Migration and invasion ability of the three esophageal carcinoma cell lines and the effects of exosomes from KYSE410 on migration and invasion of KYSE410,KYSE510 and YES2 cells were analyzed by Transwell chamber,respectively.The alteration of Wnt/β-catenin and PI3K/Akt pathway-related proteins were detected by Western blotting.Results The membrane structure of KYSE410 derived exosomes could be observed with its diameter ranged between 30-100nm.The invasion and migration ability of three esophageal cancer cells are KYSE410＞ KYSE510＞ YES2.KYSE410 exosomes promoted the migration and invasion of KYSE410,KYSE510 and YES2 cells.Conclusions Concentrated exosomes derived from the highly migratory and invasive esophageal cancer cell line KYSE410 promoted the migration and invasion potentials of itself and esophageal cancer cell lines KYSE510 and YES2,which possibly exerted the effects by activating Wnt/β-catenin and PI3K/Akt signaling pathways.