Objective: This research is conducted to analyze the background, the main practices and the results of the synergistic service of health institutions in Changzhou city, as well as to provide references for promoting the construction of integrated medical and health service system.Methods: This paper uses qualitative interviews and questionnaires to collect information and analyzes the data based on synergetic management theory.Results:Changzhou city has tentatively achieved the synergy of its health institutions by introducing relevant policies, setting up healthcare unions at the municipal level, integrating internal resources among healthcare unions, establishing health information platform and feedback mechanism, etc.Conclusion: The regional synergistic service of health institutions can be effectively promoted by introducing policies at the municipal level, promoting the mutual sharing and communication on information, and integrating internal resources among healthcare unions.But, as there still exist problems such as the distribution of benefits is not perfect, the degree of synergy is not close, etc., thus, the government is suggested to expand the implementation scope of the close-type medical service synergy and further improve the distribution policy of benefits.

Objective To observe the toxicity of fangyouling after one month’s transdermal administration in rabbits and evaluate its security. Methods Forty rabbits were randomly divided into 4 groups including a control group and low,middle and high dose groups of fangyouling. The rabbits in the control group were administered with sunflower oil,and the other rabbits were administrated dermally with fangyouling of 50,300 and 2 000 mg/kg respectively once a day for 4 weeks. The general con?dition,the skin irritation reaction,body weight,food consumption,hematology,blood biochemistry,organ coefficients and his?topathological changes of all the rabbits were observed. Results There was no obvious effect on the general condition in all the rabbits. However,the mild skin irritation was observed in 2 rabbits of the middle dose group and 4 rabbits of the high?dose group. The decreases of body weight and food consumption were noted in the high dose group. No changes were detected of hema?tology,blood biochemistry or viscera pathological at all dose levels. Conclusion The dose of non?toxic response of fangyouling is 50 mg/kg at this study condition.

Human tumor necrosis factor-related apoptosis-inducing ligand (hTRAIL) might be developed as a novel anti-tumor drug due to its selective cytotoxicity in tumor cells. The predicted Macaca mulatta TRAIL (mmTRAIL) is highly homologous to hTRAIL in nucleotide acid as well as amino acid sequence, suggesting that mmTRAIL might induce apoptosis of human cancer cells. However, the cytotoxicity of mmTRAIL in human cancer cells has not been investigated. In this paper, it is reported that the gene encoding mmTRAIL has been cloned by using reverse-transcriptase polymerase chain reaction (RT-PCR) from monkey peripheral blood mononuclear cells (PBMCs) in our laboratory. Subsequently, an expression plasmid was constructed by inserting mmTRAIL gene into pQE30 plasmid. After induction by addition of Isopropyl β-D-1-Thiogalactopyranoside (IPTG), mmTRAIL was expressed. MmTRAIL was recovered from supernatant of sonicated bacteria by Ni-NTA agarose affinity chromatography. SDS-PAGE and gel filtration chromatography demonstrated that mmTRAIL forms trimer in solution. In vitro assays indicated that mmTRAIL was cytotoxic to human COLO205 tumor cells but not to normal cells at low concentration of nanomole. In addition, antitumor effect of mmTRAIL was evaluated in mice bearing human COLO205 tumor xenografts. Intratumorally injected mmTRAIL significantly inhibited growth of tumor grafts. These results suggested that mmTRAIL was valuable as candidate drug for cancer-targeted therapy.
Animals ; Antineoplastic Agents ; Apoptosis ; Cell Line, Tumor ; Cloning, Molecular ; Humans ; Leukocytes, Mononuclear ; Macaca mulatta ; Mice ; Plasmids ; TNF-Related Apoptosis-Inducing Ligand ; genetics ; metabolism ; Xenograft Model Antitumor Assays

Objective:To evaluate the prognostic value of post-mastectomy radiation therapy (PMRT) in patients with axillary lymph node-positive breast cancer treated with breast conservation surgery and to establish the candidates for PMRT based on different pN stages and lymph node ratios (LNR). Methods:A retrospective analysis of the clinical data of the patients was conducted. The pa-tients had positive lymph nodes (n=152) between 1998 and 2007 and underwent breast conservation surgery. A comparison of the dis-ease-free survival (DFS) and overall survival (OS) rates was conducted based on LNR and pN staging and with PMRT as a prognostic factor. Results:A total of 152 cases were studied, of which 114 were pN1, 23 were pN2, and 15 were pN3. Among these cases, 114 had an LNR ranging from 0.01 to 0.20, 26 had an LNR from 0.21 to 0.65, and 12 had an LNR>0.65. Univariate analysis showed that the number of dissected lymph nodes, LNR, pN stage, estrogen and progesterone receptor status, and radiotherapy were the prognostic fac-tors for DFS and OS rates (P<0.05). Age and chemotherapy were prognostic factors only for OS rate (P<0.05). Multivariate analysis in-dicated that PMRT and LNR were independent prognostic factors of DFS and OS (P<0.05). The pN staging had no significant effect on DFS or OS (P>0.05). In the subgroup analysis, PMRT had significant effect on DFS and OS (P<0.05) in patients with pN1 and LNR<0.21. Conclusion:LNR is an independent prognostic factor in axillary lymph node-positive breast cancer patients treated with breast conservation surgery, and a candidate for PMRT should be established based on different LNR risks.

Axillary reverse mapping (ARM) is a technique used to map and preserve arm lymphatic drainage during axillary lymph node dissection (ALND) and/or sentinel lymph node dissection (SLND). As a result, the risk of arm lymphedema is reduced. ARM is an emerging technology for breast cancer surgery and currently in the clinical trial phase. In this article, related clinical trials conducted in recent years were reviewed and the displaying methods of ARM lymph nodes and lymphatic vessels were analyzed. The feasibility of retained ARM lymph nodes and lymphatic vessels was also evaluated. Furthermore, the clinical significance of ARM was evaluated in terms of the reduction of the incidence of upper extremity lymphedema after breast cancer surgery.

The overexpression of proto-oncogene protein c-pim-1 (Pim-1) in tumor tissue is related to the stage and prognosis.Recent studies indicate that Pim-1 plays a critical role in the proliferation and apoptosis of cells and the metastasis of tumor.Pim-1 acts as an essential factor in several signaling pathways and its expression and activation are regulated by many factors as well as affects others widely.As an influential factor in the occurrence and development of tumor,Pim-1 has been a potential target in oncotherapy.

Objective To investigate the protective effect of melatonin and its possible mechanism for repairing in the immature white matter damage due to brain hypoxia-ischemia (HI).Methods Forty-eight three-day SD rats after birth were randomly divided into 3 groups:sham-operated(SHAM) group,HI group and melatonin treatment(MT) group.Periventricular white matter damage (PWMD) to animal models were estabished according to Rice modeling.MT group was treated with melatonin pre-operatively,immediately postoperation,1 hour postoperation and 24 hours postoperation via intraperitoneal injection,and the other groups were injected with the same volume of dissolvent.The rats were executed by decollation after 2 days and 14 days.The histological changes in periventricular white matter were observed by HE staining and immunohistochemistry.Results For the 3 groups,the structure in ope-ration side of the white matter in the peripheral ventricles of the brain 2 days postoperation were significant different (P ＜0.05).The O4 positive cells decreased one by one/greatest in the SHAM group[(75.548 ± 7.333)/hpf] followed by MT group [(59.971 ± 3.635)/hpf],and HI group [(40.511 ± 2.848)/hpf] (P ＜ 0.05).The expression of Casepase-3 increased in the SHAM group (107.724 ± 10.266),MT group (132.289 ± 8.537),and HI group (202.168 ± 14.367),and the difference was statically significant (P ＜ 0.05).Ventricular index was greater in operation side of the white matter in the peripheral ventricles of the 14-day-brain in the SHAM group(0.928 ±0.063),MT group (1.813 ± 0.110),HI group (2.752 ± 0.201),increasingly,while absorbance value of myelin basic protein decreased one by one in sequence(39.504 ± 1.673,21.729 ± 1.614,11.344 ± 1.118).Conclusions MT plays a role in protecting the periventricular white matter via inhibiting the apoptosis of oligodendrocyte progenitor cell,and thus benefits the PWMD.

Objective:To retrospectively evaluate the prognostic risk factors of T1-2 stage breast cancer patients with one to three positive node(s) and their effects on the benefits of post-mastectomy radiation therapy (PMRT). Methods:We retrospectively analyzed 457 breast cancer patients with T1-2 stage and one to three positive axillary lymph nodes treated in our hospital between 2000 and 2002. The independent prognostic factors of the patients were calculated by the Cox proportional hazards model. The patients were fur-ther classified into high-risk and low-risk subgroups according to the risk factors to explore the benefit of PMRT on the prognosis of dif-ferent subgroups using survival analysis. Results:PMRT was not an independent beneficial factor of overall survival (OS) (HR=0.949;CI:0.435-2.074;P=0.896) or loco-regional recurrent free survival (LRRFS) (HR=0.611;CI:0.231-1.614;P=0.320) in all patients. Ex-tracapsular extension (ECE) and pathological grades were independent prognostic risk factors, and the benefits of PMRT were signifi-cantly different on the prognosis of high-risk subgroup patients (group ECE+OS:P=0.020, LRRFS:P=0.014;group GradeⅢOS:P=0.002, LRRFS:P<0.001). Meanwhile, PMRT failed to prolong the OS and LRRFS of low-risk subgroup patients (group ECE+OS:P=0.353, LRRFS:P=0.796;group GradeⅠtoⅡOS:P=0.267, LRRFS:P=0.589). Conclusion:ECE and gradeⅢwere the independent risk factors of death and loco-regional recurrence in the T1-2 breast cancer patients with one to three positive lymph node(s). PMRT was an effective adjuvant therapy to improve the prognosis of patients with high-risk factors. However, the benefit of PMRT had no sig-nificance in patients with ECE-or gradeⅠ-Ⅱ.

Liver disease during pregnancy is substantially different from common liver diseases, and it is very important to raise the awareness of such disease and improve the diagnostic level. The literature on liver disease during pregnancy published in recent years is reviewed in this article, and the research advances in the pathogenesis, diagnosis, and treatment of liver disease during pregnancy are summarized.

Objective To investigate the effects of rhein on insulin sensitivity of diabetic rats induced by high fat feeding and low dose streptozotocin (STZ), and the possible mechanisms. Methods (1) Fifty-five Wistar rats were randomly divided into normal control group (NC,n=15) and diabetes group (DM, n=40). The NC rats were fed with regular chow and DM rats were fed with high fat diet. Five weeks later, the DM rats were injected with STZ 30 mg/kg once. The 30 diabetic rats were randomly divided into two subgroups, diabetic control group (DM-C) and diabetic group treated with rhein (DM-T). DM-T rats received intragastric administration of rhein and DM-C rats were given equal doses of solvent. All rats were sacrificed eleven weeks later, the blood sample was collected. The body weight, fasting blood glucose (FBG), HbA1C, triglycerides (TG), tolal cholesterol (TC), glycosylated serum protein (GSP) and Fasting insulin (FINS) concentrations were examined.The insulin sensitive index (ISI) and homeostasis model assessment for insulin resistance (HOMA-IR) werecalculated. (2) The PPART and GLUT-2 expression in hepatic tissue were detected by immunohistoehemistry and Western-blot. Results At the end of experiment the FBG [(22.57±3.23 vs 7.11±1.44) mmol/L,P<0.01],HbA1C[(12.49±1.96 vs 8.36±0.84)%, P<0.01], TG [(0.89±0.29 vs 0.58±0.17)nunoL/L,P<0.01],GSP [(57.29±4.14 vs 13.43±2.70)μmoL/L, P<0.01] and tumor necrosis factor-α [TNF-α,(1.365±0.133 vs 1.233±0.159) μg/L, P<0.05] and the liver weight index (0.032±0.004 vs 0.024±0.002, P<0.01) in DM-C rats were higher than those in NC rats. Besides, the ISI of DM-C rats decreased [In(ISI),-5.46±0.61 vs -4.81±0.75, P<0.05] and HOMA-IR elevated [In(HOMA-IR),2.34±0.64 vs 1.70±0.78,P<0.05]. The expression of PPARγ [11 131.7(5 723.1-18 979.4) vs 48 782.1(21 576.7-108 829.5), P<0.01] and GLUT-2 (0.98±0.35 vs 1.29±0.27, P<0.05) of DM-C rats decreased markedly compared with NC rats. Compared with DM-C rats, FBG [(15.94±3.16) mmol/L], HbA1C[(10.51±1.74)%], GSP[(47-31±6.09) μmol/L] in DM-T and the In (HOMA-IR), (1.86±0.30) rats decreased (P<0.05 or P<0.01), and In (ISI), of DM-T rats increased (-4.97±0.29, P<0.05). The expressions of PPARγ [35 156.3(24 554.3-86 660.9)] and GLUT-2 (1.55±0.55) of DM-T rats were up-regulated markedly compared with DM-C rats (P<0.05 or P<0.01). Conclusion Rhein decreased FBG, HbA1C and GSP, and improved the insulin sensitivity in diabetic rats, which might be related to the up-regulated expressions of PPARγ and GLUT-2 in hepatic tissue.