The authors first of all make it clear that the establishment of regional medical centers in rural areas was based on the role displayed by the People's Hospital of Jinxiang County in meeting the needs of rural residents for medical services, the great importance attached to rural residents by the central government and the local governments at various levels, and the changes in the needs of rural residents for medical services. Then they argue in greater detail that the establishment of regional medical centers in rural areas is beneficial to more efficiently allocating the limited resources in rural areas, thus reducing the economic burden of and benefiting rural residents; it is also beneficial to more efficiently using the health resources technically and to enhancing the awareness of administration, quality and service delivery within the hospital.

Objective To determine the feasibility of using a special auditory intervention to detect intraoperative awareness in children under general anesthesia. Methods Thirty-four ASA Ⅰ or Ⅱ children aged 5-15 yr weighing 16-73 kg undergoing scoliosis were enrolled in this study.Intraoperative wake-up test was performed during operation.Two easily identified animal noises(60 dB,lasting 15 s)were played through head phones before induction of anesthesia and immediately after the intraoperative wake-up test. Children were interviewed on the 1st and 5th-7th days after surgery to assess their awareness of intraoperative wake-up test and special auditory intervention. Results Four children were excluded from the study because of restlessness during the intraoperative wake-up test or their refusal to be interviewed. From the remaining 30 children,4 children were suspected to be aware of intraooperative wake-up test. Awareness was comfirmed in 3 children and suspected in one child.The incidence of awareness of intraoperative wake-up test was 10%.But only one of them could tell the animal sound played during the wake-up test.All the patients in this study had explicit recall of the animal noises played before induction of anesthesia.Conclusion Special auditory intervention can not detect intraoperative awareness in children unnder general anesthesia.

BACKGROUND: Uncoupling of major histocompatibility complex (MHC) is the main cause for transplantation rejection, and it is the best way to prevent transplantation rejection by induce immunological tolerance of the recipient to the donor organ. Self-tolerant T cells can be obtained by negative selection in thymus, whether the intrathymic injection of allogenic antigen can get the immunological tolerance to the antigen?OBJECTIVE: To observe the effects of intrathymic injection of allogenic antigen on inducing immunological tolerance in nerve transplantation.DESIGN: A comparative observation.SETTINGS: Department of Immunology, Harbin Medical University; Department of Orthopaedics, Fourth Clinical Hospital of Harbin Medical University.MATERIALS: Thirty donor C57BL/6 mice (H-2b), male, aged from 6-8 weeks, weighing 18-22 g, were purchased from the Veterinarian Institute of Heilongjiang Province; While 60 recipient Balb/c mice (H-2b) female, aged from 6-8 weeks, weighing 18-22 g, from Beijing Experimental Animal Center. MHC (H-2b) antigen was prepared by the Department of Immunology, Harbin Medical University, and the concentration of protein was 4.4 g/L.METHODS: The experiments were carried out in the Department of Immunology, Harbin Medical University from June to November 2002. The recipient Balb/c mice were randomly divided into four groups: intrathymic injection group, syngenic transplantation group, allogenic transplantation group and immunosuppressant drug group. MHC (H-2b) antigen was extracted from splenic cells of donor C57BL/6 mice and injected intrathymically into recipient Balb/c mice (H-2d). Two weeks later, the sciatic nerve was transplanted to the recipient mice. Mixed lymphocyte reaction and delayed-type hypersensitivity (DTH) were detected at 3 weeks after transplantation.MAIN OUTCOME MEASURES:The differences of mixed lymphocyte reaction and DTH were compared among the groups.RESULTS: All the 30 donor C25BL/6 mice (H-2b) and 60 recipient Balb/c mice (H-2d) were involved in the analysis of results.①Results of mixed lymphocyte reaction: The cell proliferations in the syngenic transplantation group and intrathymic injection group were obviously lower than that in the allogenic transplantation group [(546.1±75.1), (2 668.3±533.8), (3 101.3±429.1), (4 312.3±534.1) minutes-1, P＜0.05].②Results of DTH: The thicknesses difference between two pads in the syngenic transplantation group and intrathymic injection group were obviously lower than that in the allogenic transplantation group [(41.1±3.7), (72.1±5.1), (57.6±11.3), (86.2±13.2)μm, P＜0.05].CONCLUSION:The intrathymic injection of donor H-2b antigen could induce immunological tolerance of nerve transplantation.

Objective To investigate the role of PI3-kinase-Akt-endothelial nitric oxide synthase (PI3KAkt-eNOS) signaling pathway in the attenuation of myocardial ischemia-reperfusion (I/R) injury by sevoflurane postconditioning in rats.Methods Fifty healthy male Wistar rats weighing 250-280 g aged 2-3 months were randomly divided into 5 groups ( n =10 each):sham operation group (group S),I/R group,sevoflurane postconditioning group (group Spo),sevoflurane postconditioning + dimethyl sulfoxide (DMSO) group (group Spo + D),and sevoflurane postconditioning + LY294002 (a specific PI3K inhibitor) group (group Spo+ L).I/R was produced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 120 min reperfusion in anesthetized rats.In group Spo,sevoflurane was inhaled for 5 min after the end-tidal concentration reached 2.5％-3.0％ at 1 min before reperfusion.In group Spo + L,LY294002 0.3 mg/kg in 0.02％ DMSO was injected intravenously at 5 min before reperfusion,and then sevoflurane postconditioning was performed.In group Spo + D,0.02％ DMSO equal to the volume of LY294002 was injected intravenously at 5 min before reperfusion,and then sevoflurane postconditioning was performed.Arterial blood samples were taken at 120 min of reperfusion for determination of the levels of creatine kinase isoenzyme MB (CK-MB),lactate dehydrogenase (LDH) and cardiac Troponin Ⅰ (cTnI).The myocardial infarct size (IS) and area at risk (AAR) were measured and IS/AAR ratio was calculated.The rats were sacrificed at 120 min of reperfusion and the myocardial tissues in the area at risk were taken for determination of the expression of Akt,phosphorylated Akt (p-Akt),eNOS and phosphorylated eNOS (peNOS) by Western blot.The ratios of p-Akt/Akt and p-eNOS/eNOS were calculated.Results Compared with group S,the levels of CK-MB,LDH and cTnI,IS/AAR ratio,p-Akt/Akt ratio and p-eNOS/eNOS ratio were significantly increased in the other groups ( P ＜ 0.05 or 0.01 ).Compared with group I/R,no significant change was found in the parameters mentioned above in group Spo+ L (P ＞ 0.05),and the levels of CK-MB,LDH and cTnI and IS/AAR ratio were significantly decreased,and the ratios of p-Akt/Akt and p-eNOS/eNOS were significantly increased in groups Spo and Spo + D ( P ＜ 0.05 or 0.01 ).There was no significant difference in the parameters mentioned above between group Spo and group Spo + D (P ＞ 0.05).Conclusion PI3K-Akt-eNOS signaling pathway mediates the attenuation of myocardial I/R injury by sevoflurane postconditioning in rats.

Objective To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the treatment of transplanted renal artery stenosis (TRAS)-induced renal dysfunction and hypertension. Methods Between July 1998 and January 2007, PTA was performed on 16 patients with RTAS. Color Doppler uhrasonography preceded the intra-arterial angiographic investigation,with false-negative results in 18. 75 % of patients. Sixteen cases of TRAS were examined at 1 st week,6th month and 13 years after PTA. Hypertension improvement was defined as mean arterial pressure decrease of at least 15 % from the pre-PTA value. Graft function was evaluated by SCr levels, and the improvement was defined as a 20% change. Results Angioplasty was technically feasible in 100 %.Sixteen patients with RTAS were cured clinically. During the follow-up period, graft function was improved in 81.25 %, 68. 75 %, 62. 5 %, 56. 25 %, 50 % of patients respectively at 1st week, 6th month and 1-3 years after PTA. The blood pressure was decreased in 62. 5%, 75 %, 75 %,56. 25 %, 50 % of patients respectively, but no patient remained hypotensor medication free.Conclusion PTA improved renal dysfunction and hypertension induced by TRAS, and it is a safe and effective treatment for TRAS.

BACKGROUND: Studies have shown that propofol enables a reduction in the number of adult rat mesenchymal stem cells, while the cell differentiation is also significantly inhibited. OBJECTIVE: To explore whether liver X receptors (LXRs) can reverse the inhibitory effects of propofol on bone marrow mesenchymal stem cells. METHODS: Fifteen healthy C57/BL6 mice were randomized into three groups, 5 of which served as blank control group (intraperitoneally treated with normal saline), 5 as propofol treatment group (intraperitoneally treated with 60 mg/kg propofol), and 5 as propofol + LXRs agonist treatment group (intraperitoneally injected with 10 μL/g LXRs at the 1st day, and then injected with 60 mg/kg propofol at the 2nd day). The mice in the three groups were killed at 1-3 hours after treatment to isolate and culture bone marrow mesenchymal stem cells. Cell counting kit-8 and cloneformation assay were used to evaluate the abilities of cell proliferation and self-renewal; induced differentiation experiments in vitro were used to evaluate the differentiation ability of cells into adipocytes, osteoblasts and chondrocytes; real-time quantitative PCR was used to detect the expression of differentiation related molecules andNotch signal. RESULTS AND CONCLUSION: In the propofol-treated mice, cell viability and clone forming ability as well as adipogenic, osteogenic and chondrogenic differentiation of cells decreased significantly compared with the blank control group (P <0.05), while LXR agonists could reverse these effects significantly (P < 0.05). Notch signal expressions showed no difference among three groups prior to induced differentiation. The expression levels differentiation related molecules downregulated significantly after propofol treatment (P < 0.05), but upregulated significantly after treatment with LXR agonists (P < 0.05). Notch signaling inhibitor treatment could significantly inhibit the multi-directional differentiation of bone marrow mesenchymal stem cells in the three groups. All these findings indicate that activated LXRs can reverse the inhibitory effects of propofol on bone marrow mesenchymal stem cells.

Objective Toobservetheindication, safetyandefficacyofanew immunosuppressant Rituximab in kidney transplantation. MethodsFive patients, who were diagnosed as antibody mediated rejection (AMR) from December 2010 to June 2011, were treated with single dose of Rituximab (500 mg) and followed up for 6 months. The clinical data, such as age, gender, onset of illness, induction therapy, maintaining therapy, allograft function, change of PRA, opportunistic infection and other complications were collected and retrospectively analyzed to evaluate the safety and efficacy of Rituximab used in AMR patients. ResultsAfter Rituximab therapy, all the patients had improved renal function measured by sera creatinine level: 4 cases retumed to normal, and 1 keep stable. Series of allograft biopsy demonstrated obviously reduced C4d deposition in nephridial tissue after treatment. One patient developed CMV viremia, another had urinary infection, but no one had lifethreatening infection during the follow-up period. The survival rate of human and allograft was both 100 ％. Conclusion Rituximab has a good efficacy and safety in treatment of AMR after renal transplantation.

Objective: To study the expression of CD123 in bone marrow (BM) blasts of acute myeloid leukemia (AML) patients to explore the relationship between CD123 expression and therapeutic response and prognosis. Methods: This study retrospectively analyzed expression and distribution of CD123 in BM blasts in 137 cases of newly diagnosed AML (excluded M₃) , CD123 detected by flow cytometry≥20% was defined as positive, including 84 CD123⁺ AML and 53 CD123^- AML, efficacy and prognosis were compared between the two groups. Results: ① Among 137 patients, 84 were in group CD123⁺ (61.3%) , and 53 in group CD123^- (38.7%) . All 137 patients were classified into risk groups based on cytogenetic and molecular biology abnormalities. No significant differences were seen between the three risk groups with regard to their CD123 levels (χ²=0.861, P=0.650) . Compared with CD123^- group, the CD123⁺ group had higher WBC[47.7 (1.0-264.0) vs 22.4 (0.7-211.0) , z=-2.592, P=0.010]. ② The rates of first complete remission (CR1) and recurrence of CD123⁺ group were 54.8% (46/84) and 50.8% (32/63) , respectively; and CD123^- group were 73.6% (39/53) and 41.7% (20/48) , respectively. There was significant difference of CR1 between the two groups (χ²=5.121, P=0.027) , whereas no significant difference of the recurrence rate (χ²=0.911, P=0.340) . ③ The median dutations of OS between CD123⁺ group and CD123^- group were 20.0 (95%CI 13.1-26.9) months vs 44.0 (95%CI 23.6-47.3) months, respectively (χ²=5.874, P=0.015) ; The median durations of DFS were 7.8 (95%CI 1.4-14.1) months vs 18.6 (95%CI 0-39.7) months, respectively, no differences were observed between the two groups (χ²=2.939, P=0.086) . ④ CD123 retained an adverse prognosis value on DFS and OS within the intermediate group and patients ≤ 50 years older. Conclusions CD123 widely expressed in AML patients, which was an independent risk factor for CR1 and OS, which implicating its important role in evaluating the induction chemotherapy response and prognosis of AML.

Objective To analyze the effect and possible mechanism of propofol on proliferation and inva-sion of lung cancer cells. Methods Lung cancer cells were cultured and divided into experimental control group, groupL,group M and group H.The optical density of cancer cell was detected by CCK-8.Meanwhile,the difference of the proliferation of cancer cells in each groupwas determined after down-regulation gene.The change of inhibition rate in four groups was analyzed by Transwell test. The expression of MMP-2 and mRNA in different groups were compared by Western blot and Q-PCR. Results the results of CCK-8 test showed the cancer cell viability in H group was lowest and the inhibition ability increasedafter silencing MMP-2 gene(P<0.05); the invasion inhibition rate of the lung cancer cells treated with propofol was higher(P<0.05), and invasion inhibition rate in each group also rise after silencing MMP-2; Western blot and Q-PCR show that the MMP-2 expression level in group Mand group H were lowest(P<0.05).Conclusion Propofol may inhibit the proliferation and invasion of lung cancer cells and its mechanism may be associated with down-regulation MMP-2,which is expected to inhibit the proliferation of lung cancer invasion.

Objective To discuss the influence of Tongluo Baoshen Fufang (TBF) and its disassembled formulas on P-IRE1α, promoter of endoplasmic reticulum stress (ERS) and GRP78, molecular chaperone, in diabetic rats with hyperglycemic kidney injury induced by streptozocin (STZ).Methods Male SD rats were randomly divided into normal group and modeling group.The model of diabetes was established by applying intraperitoneal injection of STZ in model group.After successfully modeling, the modeling group was randomly divided into model group, valsartan group(8.93 mg/kg), TBF group(19.43 g/kg), Tongluo Baoshen Buxu group (TBB group,6.92 g/kg) and Tongluo Baoshen Jiedu group (TBJ group,12.5 g/kg).The general conditions of rat daily activities were observed in all groups.The expressions of p-IRE1α and GRP78 were analyzed semi-quantitatively by using immunohistochemistry and IPP software after 6 weeks and 16 weeks.Results P-IRE1α and GRP78 mainly existed in the cytoplasm of proximal and distal renal tubule cells and glomerular cells observed by light microscope.The results of semi-quantitative immunohistochemistry and IPP software showed that the expressions of P-IRE1α and GRP78 increased in model group compared with normal group after 6 weeks and 16 weeks.Compared with model group, the expressions of P-IRE1α and GRP78 decreased in valsartan group, TBF group, TBB group and TBJ group (P<0.05) after 6 weeks and 16 weeks.The comparison among valsartan group, TBF group, TBB group and TBJ group did not show difference(P>0.05).Conclusion The rat model of kidney injury induced by hyperglycemia has ERS activation.TBF and its disassembled formulas can take play a renal protective role through inhibiting ERS.It can be speculated that the central pathogenesis of diabetic hyperglycemic kidney injury is deficiency of the root and excess of the tip in Chinese medicine.