Objective To investigate change of TLR4 in OLETF (Otsuka Long-Evans Tokushima fatty) rats with in-sulin resistance (IR), and to study the effect of pioglitazone (PIO) on the expression of TLR4, and to explore the possible mechanisms of the PIO reducing the risk of cardiovascular diseases. Methods Twenty four OLETF rats were fed with high-fat diet for 20 weeks to establish the IR model then they were randomly assigned into two groups:the model group (group M), in which the rats were fed with high-fat diet;the PIO group (group P), in which the rats were fed with PIO in addition to high-fat diet . Control group include 12 OLETF rats fed with normal diet (group NC). After 20 weeks of drug intervention, plasma levels of FINS (Fasting INSulin), FBG (Fasting Blood Glucose), blood lipid, IL-18 and TLR4 were assessed in every group. Results Comparing with group NC, FBG, Blood lipid, IL-18 and TLR4 were significantly increased in group M(P＜0.05 or P＜0.01), comparing with group M, FBG, Blood lipid were improved in group P, and serum IL-18, TLR4 were signifi-cantly lower in the group P than that in group M(P＜0.05 or P＜0.01). Conclusion TLR4 may be involved in IR by pro-moting inflammatory response, and PIO can significantly improve IR and inflammatory, and reduce the risk of cardiovascular diseases by inhibiting the expression of TLR4.

Objective:To investigate the influence of Mannan Peptide combined with 5-Fu on the proliferation and apoptosis of HepG2 cells and to explore the related mechanism.Methods:HepG2 cells were divided into four groups:the control group,5-Fu group,Mannan Peptide group and combination group.Cell proliferation was evaluated by MTT assay.Flow cytometry was used to examine the cell cycle,proliferation index(PI)and apoptosis ratio.The expression of Bcl-2 protein in each group was analyzed by immunocytochemical method.Results:The inhibitive effect of 5-Fu plus Mannan Peptide was significantly stronger than that of Mannan Peptide alone,in a time-and dose-dependent manner. Cells were treated with medicine for 48 hours.Compared with cells in the control group and 5-Fu group,the percentage of cells in G_0/G_1 stage and the apoptosis ratio in the combination group were increased(P<0.01).In immunocytochemical analysis,the combination of Mannan Peptide and 5-Fu could significantly decrease Bcl-2 protein level(P<0.01).Conclusion:The combination of Mannan Peptide and 5-Fu can synergistically suppress the proliferation and induce apoptosis of human hepatoma HepG2 cells.The mechanism might be associated with down-regulation of Bcl-2 protein expression.

Objective:To promote the application of the best evidence in the prevention of venous thrombosis in patients with lung cancer in thoracic surgery, so as to improve the nursing management, elevate the nursing quality and reduce the incidence of venous thrombosis.Methods:High quality literature guidelines related to perioperative venous thromboembolism prevention of lung cancer were searched and screened, and the evidence was extracted. Combined with clinical background, nursing strategies were generated through expert demonstration meetings and used as clinical review indicators. On the basis of evidence-based i-PARIHS as the theoretical framework, through the establishment of core groups, removal of existing obstacles, education and training and quality control, the evidence was applied to the clinical practice effectively, and the data were collected by means of on-the-spot observation and consulting cases, and the effect of evidence application was evaluated from the three aspects including system, nurses and patients.Results:Systemically speaking, in the process of evidence application, the department established the standards and procedures for perioperative venous thromboembolism prevention of lung cancer patients, improved thrombus risk assessment tools, made educational materials, brought thrombus prevention into the scope of quality control, and optimized the organizational environment with full consideration of manpower and materials. For nurses, after the application of evidence, the scores of nurses' knowledge, attitude and practice of venous thromboembolism prevention were (17.6 ± 1.8), (17.4 ± 1.8), (18.8 ± 1.2), (53.8 ± 2.9) respectively, which were higher than those before the application of evidence (12.0 ± 2.9), (14.5 ± 2.8), (11.6 ± 2.7), (38.3 ± 5.1), the differences were significant ( t values were -11.40 - -3.90, all P<0.05). For patients, the incidence of venous thromboembolism before the application of evidence was 4.7% (19/403), and venous thromboembolism after the application of evidence was 0 (0/118), and the difference was statistically significant ( χ2 value was 5.774, P<0.05). Conclusions:The best evidence of perioperative venous thromboembolism of lung cancer on the basis of evidence-based is of great scientificity. Its application on clinical practice could effectively optimize the systematic organizational environment, standardize nursing behavior, improve nursing quality, and reduce the occurrence of venous thromboembolism in patients with lung cancer surgical procedures.

Objective To evaluate the calculation and report of detection index and the statistics analysis of group comparison in high risk group,a problem of medical science study.Methods Relevant literature was consulted so that the methods could be listed of the detection index and the current statistic analysis of group comparison in high risk group.Results The current report about detection ratio and the statistics analysis of group comparison in high risk group proved to be mistaken,and the statistics analysis of group comparison was not the comparison of detection ratios in high risk group.Conclusions It is necessary to calculate and report the detection ratio when expressing the detection index.The statistics difference should be tested about constituent ratio in the group comparison,after excluding patient group.At the same time,some explanation should be given by the author in the composition.

Obiective To evaluate the efficacy of health package for the nurse in train evacuation, Methods The self-manufactured new mobile health package for the nurses provides shortcut and completed equipment in various basic nursing care, therapic procedure, condition observation, emergency aid and treatment for nursing staff who performed transportation in train evacuation.Results The potable health package can play an important role in several medical support training and have special mission. Conclusion The health package has mobile applicability and operability, which is an important equipment for successful medical support training.

BACKGROUND: Simple drug therapy can not acquire satisfactory effects in treatment of fungal keretitis. At present, penetrating keratoplasy (PKP) has been considered a primary means to cure the fungal keratitis to save eyeball and vision.OBJECTIVE: To evaluate the clinical efficacy of PKP in the treatment of high-risk fungal keratitis.DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Ophthalmology, Affiliated Hospital of Qingdao University Medical University between January 2000 and January 2007.PARTICIPANTS: A total of 51 patients (51 eyes) with high-risk fungal keratitis who underwent PKP in the Affiliated Hospital of Qingdao University Medical College were recruited into this study. Of these patients, 12 suffered from perfored, 35 from hypopyon, 8 from complicated cataract prior to surgery, and 5 from complicated glaucoma.METHODS: All patients received antifungal and antibacterial treatments prior to surgery and underwent PKP within 4 days following admission. After surgery, antifungal and antibacterial treatments were performed locally and systemically. All patients were followed-up for 6--24 months.MAIN OUTCOME MEASURES: Postoperative visual acuity, recurred fungal infection, rejection of implants, secondary glaucoma, and ulceration of implant.RESULTS: ① Of 51 patients, 18 were followed-up for 6-12 months, 2 for 13-18 months, and 8 for 19-24 months. ② A total of 49 (96.1%) out of 51 patients preserved the eyeballs and the visual acuity improved to different degrees in 48 (94.1%) patients. ③ After surgery, fungal infection recurred in 6 eyes (11.6%), 4 of which were controlled by antifungal medication and 2 was enucleated because of uncontrolled endophthalmitis. Graft rejection was found in 18 (35.3%) eyes, 13 of which recovered transparent by medication and 5 received secondary PKP. Graft ulceration was present in 4 (7.84%) eyes, 3 of which were cured and the remaining one was re-grafted because of severe endothelial cell loss. Secondary glaucoma appeared in 7(13.7%) eyes, and the intraocular pressure was controlled medically and surgically. Complicated cataract occurred in 6 (11.8%) eyes, 3 of which underwent cataract extraction. Most complications were successfully controlled. In the final follow-up period, 45 (88.2%) grafts were transparent.CONCLUSION: PKP is an effective approach to preservation of eyeballs and restoration of visual function in patients with high-risk fungal keratitis, which can not be treated by conservative therapy.

Objective:To understand the characteristics of the callers with the diagnosis of mental disorders called Beijing Psychological Crisis Hotline for help,in order to provide specific psychological intervention services for them in future.Methods:From December 2002 to December 2008,24217 different callers'data collected from a computer-based operating system of the Beijing Psychological Crisis Hotline were analyzed.According to their self-reported of having the diagnoses of mental disorder or not,the callers were divided into the ones with diagnosis (n=6516)and the ones without diagnosis (n =17701).The callers'demographic characteristics,their main counseling problems and the suicide-related factors in the two groups were compared.Results:The top five main counseling problems in the group with diagnosis were mental problems,the mental illness related knowledge,the problems of family relationships,working problems and interpersonal problems.Mental problem ranked first in both groups.Compared to the group without diagnosis,the diagnosed ones were more likely to be found in such group of people as women,aged between 20 -29 and 30 -44,having 10 or more years of education and the unem-ployed.The results of the assessments of 11 suicide-related risk factors showed that callers with diagnoses had higher prevalence of most suicide-related factors than those in the other group(P <0.001 or 0.05),which included suicidal intention and behavior while calling,history of attempted suicide,severe depressive symptoms,severe physi-cal illness,history of being abused,afraid of being attacked,suicidal history of relatives or associates,severe of hopeless.Conclusion:The hotline counselors should be aware of the necessity of assessing the severity of depres-sion and other suicide-related factors for the callers with mental disorder diagnoses before providing any psychologi-cal intervention.Moreover,except for providing interventions on the callers'psychiatric problems,the hotline coun-selors should also identify and help to deal with the stress events in their lives.

Objectives:To explore the prevalence and correlates of attempted suicide among Beijing psycho-logical aids hotline callers,in order to provide knowledge of hotline-based suicide prevention.Methods:From De-cember 2002 to December 2008,all the effective callers who consulted themselves'psychological problem,by Bei-jing psychological aids hotline were interviewed by professional hotline operators during the consulting calling.Data of whether callers attempted suicidal behavior in 2 weeks prior to the calling,gender and other 5 demographic char-acteristics of callers were collected via hotline interview.A questionnaire including depression screening scale,com-mon psychiatric symptoms such as delusion,hallucination,etc.,a history of substance abuse or dependence,a histo-ry of suicidal behavior,having had acute or chronic life events,and severity of hopeless was used during hotline in-terview.Logistic regression model was used.Results:In 22 415 interviewed callers,362 (1.6%)callers (233 fe-males)reported that they attempted suicidal behavior in 2 weeks prior to the calling.After adjusted for demographic characteristics,prior suicidal behavior 2 weeks before calling (OR=4.43,95%CI:3.37-5.83),hopelessness (OR=2.01,95%CI:1.52-2.67),substance abuse (OR=1.97,95%CI:1.48 -2.62),acute negative life events (OR=1.94,95%CI:1.49-2.52),and severe depressive symptoms (OR=1.45,95%CI:1.08-1.95)were associatedwith attempted suicide among hotline callers.Conclusion:The rates of attempted suicide among hotline callers are probably high.Suicide prevention in hotline would shed light on improving coping skills for life events and sub-stance abuse problems for hotline callers.

Objective:To develop the Counseling Skills Rating Scale for Psychological Aids Hotline (CSRSPAH),an instrument to objectively assess the quality of process of counseling or intervention provided by hotline operators,and to test its validities and reliabilities.Methods:A draft of the scale,which consisted of 50 items under 5 dimensions,was designed in line with previous researches and the practice.In pilot study,supervisors at Beijing psychological aids hotline,assessed tape recorded sessions and gave feedbacks on the draft of the scale.The scale had been revised based on the pilot study.Twenty-eight items were deleted,and several items were rephrased.Finally,a scale which consisted of 22 items within 3 dimensions,i.e.counseling process,attitude,and communication skill,was developed.The scoring standards of the scale were also developed.To evaluate the IntraClass Coefficients (ICC) of the CSRSPAH,each of the tape records of 37 callings from 2005 to 2007 were assessed by 7 supervisors independently,using the scale.And the tape records of other 318 callings from 2013 to 2014 were also assessed by supervisors,using the CSRSPAH.The results of the 318 assessed callings were used to test the construct validities with the Confirmative Factor Analysis.The Cronbach a coefficients of the total score and three dimensions,the discriminant indices of every items,and correlations of each items and each dimensions were calculated,based on the 318 assessed callings.Results:One of the items (referral) was deleted due to excessive amount of missing data.Results of cortfirmative factor analysis of the remained 21-item scale revealed that the 3-factor construct structure of the scale was robust.The fitting indices of the confirm factor analysis were,x2/df=675.21/186,CFI =0.92,NNFI =0.91,RMSEA =0.10,SRMR =0.08.The Cronbach α coefficients of the total score,scores of counseling process,attitude,and communication skill,were 0.89,0.68,0.81 and 0.77,respectively.The ICCs of the inter-rater reliabilities of the total score and 3 dimensions of the scale were 0.67,0.59,0.59,and 0.67,respectively.The discriminant indices of all the 21 items ranged from 0.09 to 0.32.The correlation coefficients of scores of each items and scores of 3 dimensions and total scores were greater than 0.30,and reached statistical significance.Conclusion:The validities and reliabilities of the Counseling Skills Rating Scale for Psychological Aids Hotline are acceptable.The scale could be used in assessing the quality of hotline counseling or intervention,and related studies in the future.

Objective To analyze the compliance and the influencing factors of the children with congenital hypothyroidism (CH).Methods 231 children with CH were collected for this study.The questionnaire survey and referring the case were used to collect relative factors.According to regular follow -up treatment,the children were divided into two groups,one group was good compliance and the other one was bad compliance.The results were ana-lyzed by two -independent sample t -test,2 -test and unconditioned logistic regression analysis.Results (1)Blood TSH(χ2 =59.870,P =0.00) and blood FT4 (χ2 =6.468,P =0.01) were normal,short distance from the hospital (χ2 =16.375,P =0.00),level of education of their mothers was high(χ2 =7.483,P =0.02),and regular compli-ance treatment of children with CH(χ2 =7.483,P =0.024) was good.(2) Logistic stepwise regression analysis showed that serum TSH value(OR =17.135),the short distance(OR =1.692) and diagnosis of CH(OR =4.028) were introduced into the logistic regression model (all P <0.05).Conclusion It is essential to take measures actively and reinforce the management of children with long distance,low -educated,and the diagnosis of TSH.More-over,enhancing the regular treatment compliance of children with CH is the key to improve the growth and develop-ment status of children with CH.