Objective To learn the cognitive appraisal of the necessary conditions for the medical services delivery synergy by doctors at county and township levels,and to provide evidence for the health policy in question.Methods One county-level public hospital and one township hospital were randomly sampled from five sampled counties of Yancheng city in Jiangsu province for a field survey.The questionnaire was designed to cover such dimensions as institutional,information,service,interpersonal and management,in an effort to learn the cognitive appraisal of such doctors on such aspects as the two-way referral between county-township medical institutions,medical information sharing,good personnel relationships of medical workers,service collaboration,and necessity of inter-agency physician teams. Results These doctors in general presented different appraisal for two-way referral between county-township medical institutions,medical information sharing,service collaboration,good inter-personnel relationships and necessity of inter-agency physician teams.Those of lower academic titles considered it necessary to set up inter-agency physician teams(χ2=6.723,P<0.05);while county public hospitals′physicians considered that two-way referral between county-township medical institutions and inter-county agency information sharing as necessary to achieve the synergy of medical services delivery (P<0.05);most township physicians considered that good personnel relationships and service collaboration as necessary to achieve the synergy (P<0.05 ).Conclusions The characteristics of county and township physicians′appraisal of the necessary conditions for synergy of medical services delivery deserve attention,for improvement of their appraisal of two-way referral and information sharing among institutions.

Objective To investigate the clinical effect of high dose of calcitriol on end-stage renal disease (ESRD) in patients with secondary hyperparathyroidism (SHPT). Methods The clinical data of patients with ESRDcomplicated with SHPT were retrospectively analyzed. According to the treatment method were divided into control group and observation group, the control group were given conventional dose of calcitriol treatment, the observation group were treated with high dose of calcitriol. The differences of calcium and phosphorus levels, parathyroid hormone (PTH) level and quality of life were observed between the two groups before and after treatment. Results The serum phosphorus, calcium and calcium-phosphorus product in two groups of patients before treatment had no significant difference. After treatment, the above indicators decreased in two groups of patients compared with those before treatment, and the observation group was significantly lower (P<0.05). Before treatment, there was no difference in the levels of PTH between the two groups. After treatment, the level of PTH in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). There was no significant difference in quality of life between the two groups before treatment. After treatment, the quality of life in the two groups were higher than before treatment, and the observation group was significantly higher (P<0.05). Conclusion High dose of calcitriol has good therapeutic effect for ESRD patients with SHPT and can significantly improve the patient's calcium and phosphorus and PTH levels, improve the quality of life of patients.

Objective: To investigate the expression of vasculogenic mimicry (VM) in endometrial carcinoma tissues and its rela-tionship with the clinicopathologic features and prognosis of the disease. Methods: A total of 267 paraffin-embedded endometrial carci-noma specimens of patients with complete follow-up data were collected from the Shijiazhuang Bethune International Peace Hospital between January 2005 and June 2014. CD31-PAS dual staining was performed to identify the VM structure. Tissue samples were then divided into VM-positive and VM-negative groups. CD133 expression was detected by immunohistochemical streptavidin peroxidase method. Results: Among the 267 endometrial carcinoma patients, 65 cases (24.3%) were VM positive. VM formation was closely corre-lated with the International Federation of Gynecology and Obstetrics Staging (χ2=9.987, P=0.002), histodifferentiation grade (χ2=11.795, P=0.001), myometrial invasion depth (χ2=5.499, P=0.019), vascular cancer embolus (χ2=22.599, P<0.001), and lymph node me-tastasis (χ2=7.848, P=0.005). Kaplan-Meier survival curve analysis showed that survival time was significantly shorter in the VM-posi-tive group (median survival time was 51 months) than in the VM-negative group (median survival time was 100 months) (χ2=70.973, P<0.001). Moreover, CD133 expression was significantly higher in the VM-positive group [75.4% (49/65)] than in the VM-negative group [58.9% (119/202)] (χ2=5.720, P=0.017). Conclusion: VM is closely correlated with the pathogenesis, development, and malignancy of endometrial carcinoma. Furthermore, VM is one of the important indexes influencing the prognosis of this disease. Therefore, CD133-positive cells may contribute to VM formation.

AIM: To study the effect of nasal mucosal tolerance to E-selectin on cerebral ischemia-reperfusion injury.METHODS: Two different doses(single and booster) of E-selectin or PBS were dropped into membrana mucosa nasi of rats.The middle cerebral artery occlusion(MCAO) model referring to Zea Longa method with modifications was performed 48 h after the last dose of E-selectin or PBS.After 2 h ischemia and 22 h reperfusion,the numbers of CD3+CD4+T-lymphocyte and CD3+CD8+T lymphocyte subgroup in the blood were examined with flow cytometry.Rats were killed,then part of the animals was used to measure the cerebral infarction volume by TTC staining.mRNA expressions of E-selectin,ICAM-1 and lymphocyte function-associated antigen-1(LFA-1) were determined by RT-PCR and activity of SOD was determined by xanthinoxidanse method in ischemic cortex of the other part of animals.RESULTS: The ratio of the numbers of CD3+CD4+T-lymphocytes and CD3+CD8+T-lymphocytes increased in E-selectin single pretreatment group(P

The obese children are increasing at a surprisingly high annual rate of 9.1 percent in China.Meanwhile children are lack of health consciousness and self-protection,thus obese children are more vulnerable towards obesity.Since parents are responsible for their children's daily lives and behaviors,the health education of obesity should be started with those parents with obese children.This paper calls to carry out health education aimed at parents of obese children through multiple means such as community health services,taking advantage of public media and establishing specific clubs,in order to effectively control the increase of obese children.

Objective To compare the influence of aging on apoptosis and the expression of apoptosis-related protein in adult and aged male Wistar rat hearts after acute coronary artery occlusion. Methods The acute myocardial infarction rat model was established by left anterior descending(LAD)occlusion.A total of 115 adult and aged rats,aged 6-24 months,were included in the study.The rats were divided into 4 groups:aged model group,aged control group,adult model group and adult control group.Animals were killed 1,3,5 hours,1 and 7 days after coronary occlusion.Hemodynamic parameters[heart rate(HR),left ventricular systolic pressure(LUSP),left ventricular end-diastolic pressure(LVEDP),±dp/dtmax)]were obtained from each group at every time points.The apoptosis and necrosis of myocardium were detected with TUNEL way and TTC stain.The expressions of Bcl-2 and Bax were analyzed with immumohistochemical stain. Results DNA fragmentation occured 1 hour after coronary occlusion and apparently peaked earlier in the aged than in the adult rat hearts.At 3 hour,the apoptotic index of aged model group was obviousily higher than that in adult model group[(51.90±23.15)%us.(18.67±17.15)%,P<0.01].The basal levels of Bcl-2 and Bax were higher in the aged than in the adult rat hearts.The expression of Bcl-2 in aged model group and adult model group were 2.7±0.9 and 1.8±0.8,P<0.05.The expression of Bax in aged model group and adult model group were 6.2±2.9 and 4.2±1.5,P<0.05. Conclusions The ability of aged rats to resist ischemia is poor,aging may alter the expressions of Bcl-2 and/or Bax,increase cardiomyocyte apoptosis,thereby,enhance the myocardial dysfunction during acute myocardial infarction.

E-selectin is an inducible adhesion molecule,and it is correlated with various molecules during cerebral ischemia/reperfusion injury.This article mainly reviews the relationship between E-selectin and intracellular adhesion molecule-1,tumor necrosis factor-?,NF-kB,leucocyte function-associated antigen-1 in cerebral ischemia/reperfusion injury,so as to provide assistance for E-selectin in the prevention,diagnosis and treatment of ischemic cerebrovascular disease.

Background A preliminary study determined an application of manganese ion eyedrops in tracing observation of visual system in vivo,but whether manganese ion has toxic effects on ocular anterior segment tissues is still unclear.Objective This study was to investigate the toxic effects of different concentrations of manganese ion eyedrops on ocular anterior segment tissues.Methods Thirty-two clean New-Zealand white rabbits were divided into 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group and normal control group according to random number table.The experimental eye was randomly chosen from each rabbit for eyedrops application.The manganese ion eyedrops at concentration of 1.00 mol/L,0.50 mol/L or 0.25 mol/L was topically administered in any lateral eye of each rabbit in the 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group,and normal saline solution was used in the same way in the normal control group.In 2 hours,1 day and 3,7,14,21,28 days after eyedrops application,the irritative response of ocular surface was examined under the slit lamp microscope,and corneal damage was evaluated by corneal fluorescence staining,and corneal endothelial cell density (ECD) and corneal thickness were assessed using corneal specular microscope.The eyeball samples were prepared in 3,7,14 and 28 days after eyedrops application and hematoxylin and eosin staining was performed for histopathological examination of conjunctiva,cornea,trabecular meshwork and ciliary body tissue.The use and care of experimental animals complied with the Statement of ARVO.Results Severe hyperemia and edema in palpebral conjunctiva appeared in the 1.00 mol/L MnCl2 group and 0.50 mol/L MnCl2 group,and the symptoms reached a maximum level 1 day after eyedrop application and disappeared 7 days after eyedrops application in the 1.00 mol/L MnCl2 group.These symptoms were milder in the 0.50 mol/L MnCl2 group in comparison with the 1.00 mol/L MnCl2 group.There were no ocular irritative response in the 0.25 mol/L MnCl2 group.Significant differences were found in the corneal fluorescence scores among the groups 2 hours,1 day,3 and 7 days after eyedrop application (X2 =17.350,19.200,12.200,10.140,all at P＜0.05),with the highest score in the 1.00 mol/L MnCl2 group.The ECD was not significantly different among the groups and different time points (Fgroup =0.38,P＞0.05;Ftime =1.79,P＞0.05).The corneal thickness value was significantly different among the groups and different time points (Fgroup =18.22,P＜0.05;Ftime =116.75,P ＜ 0.05).The corneal thickness value was elevated during 2 hours to 3 days after administration of eyedrops in the 1.00 mol/L MnCl2 group and closed to normal from 7 days to 28 days.The corneal thickness value was higher from 2 hours to 14 days than that in 28 days after administration of eyedrops in the 1.00 moL/L MnCl2 group,and the corneal thickness value was higher in 2 hours to 1 day than that in 28 days after administration of eyedrops in the 0.50 mol/L MnCl2 group (all at P＜0.05).Inflammatory cell infiltration and stromal edema were exhibited in conjunctival,trabecular meshwork and ciliary body tissue in the 1.00 mol/L MnCl2 group 3 days and 7 days after eyedrops application,and only inflammatory cell infiltration in conjunctival tissue in the 0.50 mol/L MnCl2 group 3 days after eyedrops application.No obvious abnormity was seen in the 0.25 mol/L MnCl2 group.Conclusions 1.00 mol/L manganese ion eyedrops has a remarkable toxic effect on ocular anterior segment tissue in rabbit.With the lowing of drug concentrations,the toxic effects were reduced.The manganese-enhanced MRI using 0.25 mol/L manganese ion eyedrops is feasibility bacause of its non-toxicity to ocular tissues.

Group A β-hemolytic streptococcus (GAS),namely Streptococcus pyogenes,is one of the most im-portant human pathogen.GAS can cause skin and mucous membrane superficial infectious diseases,life -threatening invasive disease,toxin -mediated diseases and immune -related diseases.Antibiotic is an effective mean to control GAS infection.The β-lactam antibiotics remain the first -choice treatment for GAS infection and the macrolides are often recommended as a replacement therapy for β-lactam antibiotics allergic patients or a means to blocking GAS exotoxin product.But with the widespread use of macrolides autibiotics,macrolide -resistant GAS spread in the world. This paper will elaborate the situation of macrolide -resistant clones.

Objective To investigate the efficacies of laparoscopic sleeve gastrectomy + duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus (T2DM).Methods The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI) ＜ 30 kg/m2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed.Fifteen patients received laparoscopic sleeve gastrectomy + DJB (Sleeve + DJB group),and 27 received Roux-en-Y gastric bypass (RYGB group).The follow-up time for all the patients was more than 6 months.The decrease of BMI,complete remission of T2DM,decrease of fasting glycemia and glycosylated hemoglobin (HbAlc),postoperative nutritional condition and the incidence of complications of the 2 groups were compared.The measurement data were analyzed using the t test and the repeated measurement chi-square test.Results The operation time of the Sleeve + DJB group and the RYGB group were (137 ± 61)minutes and (89 ± 43) minutes,with significant difference between the 2 groups (t =6.158,P ＜ 0.05).No mortality and hemorrhage,bowel obstruction and anastomotic stenosis were detected.One patient was complicated with bile leakage in the Sleeve + DJB group,and was cured by conservative treatment 5 days later.The levels of fasting glucose before operation and at postoperative month 1,3,6 were (8.9 ± 0.7) mmol/L,(5.8 ± 1.3) mmoL/L,(5.6 ±1.8) mmol/L and (5.7 ± 0.3) mmol/L in the Sleeve + DJB group,and (9.9 ± 1.2) mmol/L,(6.9 ± 0.8) mmol/L,(6.6 ± 2.2) mmol/L and (5.6 ± 0.8) mmol/L,with no significant difference between the 2 groups (F =1.670,2.932,0.444,0.158,P ＞ 0.05).The levels of HbAle before operation and at postoperative months 1,3,6 were 7.4％± 1.4％,6.5％ ±0.6％,5.7％±0.5％,5.9％ ±0.6％ in the Sleeve + DJB group,and 7.7％± 2.0％,6.8％ ± 1.3％,5.7％±0.8％,5.6％ ± 1.1％ in the RYGB group,with no significant difference between the 2 groups (F =0.055,0.125,0.005,0.286,P ＞ 0.05).The remission rates of T2DM of the Sleeve + DJB group and the RYGB group were 14/15 and 74.1％ (20/27) at postoperative month 6,with no significant difference between the 2 groups (x2 =2.320,P ＞ 0.05).The decrease rate of BMI of the Sleeve + DJB group and the RYGB group were 18.2％±9.5％ and 21.2％ ± 4.9％,with no significant difference between the 2 groups (t =0.982,P ＞0.05).The numbers of patients with postoperative anaemia,avitaminosis and diarrhea were 0,0,2 in the Sleeve + DJB group and 3,2,6 in the RYGB group,with no significant difference between the 2 groups (x2=1.795,1.167,0.908,P ＞0.05).The BMIs of all the patients were above 19 kg/m2.Conclusion The effects and incidence of postoperative complications of Sleeve + DJB for the treatment of T2DM are comparable to those of RYGB.Sleeve + DJB has less interference on the nutritional condition of patients compared with RYGB.