Objective To understand the distribution of medical resources in the various regions of Zhejiang so as to provide basis for furthering the rational allocation of health resources.Methods Using two-step cluster analysis based on intelligence cluster theories,medical resources in the 11 regions of Zhejiang were classified by calculating and comparing log-likelihood distances.Results The 11 regions were clustered into 4 different types of distribution according to AIC value,BIC value,and the principles of maximum distances and most optimal cluster and differentiation between the various types: type 1 included Hangzhou and Ningbo;type 2 included Zhoushan,Jinhua and Lishui;type 3 included Huzhou and Quzhou;type 4 included Wenzhou,Jiaxing,Shaoxing and Taizhou.Conclusion Medical resources in Zhejiang are unevenly distributed.The various regions there ought to take relevant measures to rationally allocate medical resources and improve the structure for the allocation of medical resources.

Objective To investigate the effect of plasma homocysteine (Hcy) levels and cognitive dysfunction on patients with type 2 diabetes and explore the other factors that affect cognitive function.Methods 80 patients with type 2 diabetes were selected as our subjects and they were divided into cognitive impairment group (38 cases),cognitive normal group (42 cases) according to a simple mental state scale(MMSE) score.The plasma Hcy,glycosylated hemoglobin,blood lipid,uric acid,24 h urine trace albumin were measured.Results Plasma Hcy concentration in diabetic cognitive dysfunction,non cognitive impairment group and normal control group respectively were(19.56 ± 5.23),(16.21 ± 3.27),(14.67 ± 4.27) tmol/L,and there was statistically significant difference(F =3.76,P ＜0.05).The plasma Hcy levels in diabetic cognitive impairment group was higher than that non-cognitive impairment group(P ＜ 0.05) and normal control group (P ＜ 0.01),The factors impaired cognitive function in patients with other factors included age,glycosylated hemoglobin,body mass index,diabetes duration and plasma Hcy levels,and there were negative correlation with MMSE score (r =-0.336,-0.285,-0.226,-0.392,-0.312 ; all P values were less than 0.05).Conclusion Patient's age,duration of diabetes,glycosylated hemoglobin and BMI can affect cognitive function in patients.Higher Hcy levels in patients with type 2 diabetes is a risk factor for cognitive impairment.

Objective:To examine the inhibitory effect and mechanism of niclosamide combined with low-dose cisplatin on adrenocor-tical carcinoma xenografts in nude mice. Methods:A SW-13 cell transplanted tumor model was first established in nude mice. The nude mice were then divided into the control group, niclosamide group, cisplatin group, and combined drug group. The groups were compared in terms of tumor body volume, tumor weight, and biochemical index. The cell apoptosis rate of the transplanted tumor tis-sue was detected by TUNEL assay, while Bcl-2 and caspase-3 protein expression in the transplanted tumor tissue was detected by im-munohistochemistry and Western blot. Results:The terminal tumor volume and weight of the combined drug group were lower than those of the niclosamide and cisplatin groups (all P<0.001). The white blood cell count of the cisplatin and combined drug groups were lower than that of the control group (all P<0.001). Meanwhile, no difference was observed between the cisplatin and combined drug groups (P=0.29). The creatinine and glutamic pyruvic transaminase of the cisplatin and combined drug groups were higher than those of the control group (all P<0.001), whereas no significant difference was observed in the levels of creatinine and alanine aminotransfer-ase between cisplatin and combined drug groups (all P>0.05). TUNEL test results showed that the cell apoptotic rate of the combined drug group was higher than that of the niclosamide group (P=0.004) and cisplatin group (P=0.005). Immunohistochemistry and West-ern blot test results showed that Bcl-2 expression in the combined drug group was lower than those of the niclosamide and cisplatin groups (all P<0.001), while caspase-3 expression in the combined drug group was the highest among those of other groups (all P<0.001). Conclusion:Niclosamide can enhance the inhibitory effect of low-dose cisplatin on the growth of adrenocortical carcinoma and has no additional side effects. This enhancement is probably related to the influence of niclosamide on Bcl-2 and caspase-3 expres-sion levels. Niclosamide promotes the apoptosis of the tumor cells by influencing Bcl-2 and caspase-3 expression.

BACKGROUND:Stem cels are induced to differentiate into endothelial-like cels that can be used for the treatment of diabetic lower extremity vascular disease. However, it is unclear whether these endothelial-like cels can completely replace endothelial cels to improve vascular disease and what are the differences between endothelial-like cels and endothelial cels. OBJECTIVE:To explore the differences and similarities between endothelial-like cels and human umbilical vein endothelial cels in the aspects of morphology, function, and viability. METHODS:Umbilical cord mesenchymal stem cels and umbilical vein endothelial cels were isolated, cultured and identified using flow cytometry and immunohistochemical method. Isolated umbilical cord mesenchymal stem cels were induced in DMEM-LG/F12 containing 10 μg/L vascular endothelial growth factor, 10 μg/L basic
fibroblast growth factor and 2% fetal bovine serum to differentiate into endothelial-like cels folowed by immunohistochemical identification. To compare endothelial-like cels with human umbilical vein endothelial cels, cel migration detection, active substance measurement and three-dimensional angiogenesis test were performed. RESULTS AND CONCLUSION:Isolated umbilical cord mesenchymal stem cels strongly expressed the surface markers of mesenchymal stem cels, and human umbilical vein endothelial cels strongly expressed CD31 and VWF. After induction, the umbilical cord mesenchymal stem cels were identified to highly express CD31 and VWF. Through cel migration, active substance and three-dimensional angiogenesis tests, endothelial-like cels were similar to endothelial cels in the function and activity, and superior to endothelial cels. Cite this article:Hao XJ, Hao HY, Zhu MJ, Yuan Z, Li WW, Chen J, Zhu LY. Endothelial-like cels versus human umbilical vein endothelial cels. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(1):83-88.

ObjectiveTo study the metastructure volumes of medial temporal lobe in diagnosis the patients with Alzheimer's disease (AD) using 3 dimensional MRI.Methods23 AD patients according to DSM-Ⅳ criteria and 23 normal controls (NC) were examined with 3D-MRI.Hippocampus formation,amygdala,entorhinal cortex ( EC ),perirhinal cortex ( PC),and comu temporale were measured with 3D-MRI.ResultsSensitivity and specificity of diagnosis AD were 73.9％,97％ ( Hippocampus formation) ;39.1％,95.7％ (amygdala) ;73.9％,95.7％ (EC) ;95.7％,87.0％ (PC) and 34.8％,39.1％ ( cornu temporale).Overall discriminate function =cornu temporal × 3.887 + PC × 5.960 - EC × 0.074 + amygdale × 3.489 + hippocampus formation × 6.656- 22.449.Over-all-accuracy was 91.3％.ConclusionThe total volume of PC can better diagnosis the mild to moderate AD than other structure of medial temporal lobe.The changes of the medial temporal lobe volume could be used in diagnosis the patients with Alzheimer's disease.

Objective To investigate the effect of herpes simplex virus thymidine kinase/ganciclovir (HSV-TK/GGV)system driven by human alpha fetoprotein(AFP)enhancer on hepatocellular carcinoma(HCC)cells in vitro and in vivo.Methods HCC-specific eukarotypic expression vector carrying suicide gene driven by AFP enhancer(pAFP-cDNA3.1-TK)was constructed.The plasmid was trasfected to AFP-positive HepG2 cells and AFP-negative SMMC7721 cells by liposomes.Protein and mRNA expressions of TK were detected by RT-PCR or Western blot.The survival rates of HCC cells were detected by methyl thiazolyl tetrazolium assay.The effects of GGV on the in vitro proliferation,survival and apoptosis of HCC cells were observed,and the inhibitive effect of GGV on the survival of HCC cells in vivo was also detected.All data were analyzed by using the t test.Results The pAFP-cDNA3.1-TK was successfully constructed and transfected to the HCC cells.The protein and mRNA expressions of TK were detected in AFP-positive HepG2 cells.GGV dose-and time-dependently inhibited the growth and induced the apoptosis of HepG2 cells in vitro,but it had no effect on SMMC7721 cells.No protein or mRNA expression of TK was detected in the SMMC7721 cells.There was a significant difference on the inhibitory effects of GGV on HepG2 cells and SMMC7721 cells(t =2.58,2.73,3.12,P ＜0.05).GGV specifically inhibited the growth of AFP-positive HepG2 cells,and the inhibition rate was 46%;the growth of AFP-negative SMMC7721 cells was not influenced by GGV.There was a significant difference in the inhibitive effect of GGV on the growth of HepG2 cells and SMMC7721 cells(t = 3.36,P ＜ 0.05).Conclusion HSV-TK/GGV systemdriven by human APF enhancer kills APF-positive HCC cells and inhibits the growth of HCC cells.

BACKGROUND: Subsequent to liver transplantation, pulmonary infection and new drug resistant strain frequently appear due to complex pathophysiological changes and abuse of antibiotics.OBJECTIVE: To collect the clinical data of 6 cases who underwent liver transplantation, and analyze the prevention and treatment measures of pulmonary infection after liver transplantation.DESIGN, TIME AND SETTING: Retrospective case analysis, performed in the Department of Hepatobiliary Surgery,First People's Hospital of Guangzhou between January and December 2004.PARTICIPANTS: Six cases that underwent liver transplantation and received treatment in the First People's Hospital of Guangzhou were recruited in the present study. All 6 cases underwent selective homologous whole liver transplantation, 5cases underwent modified orthotopic piggyback liver transplantation, and only 1 underwent classical orthotopic liver transplantation.METHODS: The clinical data of the 6 cases were retrospectively analyzed. After transplantation, basic disinfection,isolation, infection-protection measures should be taken. In addition, etiological information was collected. Chest X-ray was underwent to know the lung at the early stage. Aseptic manipulating was strictly performed during sputum aspiration.Gastrointestinal decompression and non-obstructed drainage were maintained to prevent aspiration. Moreover, preventive anti-infective treatment against the bacteria, fungi, and viruses was performed.MAIN OUTCOME MEASURES: Pulmonary infection and curative effects subsequent to liver transplantation.RESULTS: Of the 6 cases, 5 presented with pulmonary infection, including 1 at 4-11 days after transplantation and 1 at 1day after transplantation. One case died of respiratory failure. The remaining 5 cases were cured after standardized anti-infection, respiratory therapy, sputum aspiration, and nutritional support.CONCLUSION: Application of effective antibiotics, aseptic operation in sputum aspiration, and unobstructed respiratory tract drainage are important measures for treating pulmonary infection subsequent to liver transplantation.

BACKGROUND:Whether long time exposure to the lead concentration which is withinthe state allowed range will cause any bad effects on people's health?OBJECTIVE: To investigate the nerve conducting velocity (NCV) and other biological indices of workers who are exposed to low concentration lead.DESIGN: It was an investigation and the subjects were workers exposed to low concentration lead.SETTING: Occupational Disease Department and Electrophysiological Department of Xinhua Affiliated Hospital of the Shanghai Second Medical University.PARTICIPANTS: In lead contact group were 66 heat treatment workers who were exposed to lead and received physical examination from September 2000 to October 2002. In control group were 40 office workers that worked at the same factory but were not exposed to lead.METHODS: Questionnaire and laboratory examination were adopted for measurement of NCV and other biological indices like blood lead, blood zinc protoaetioporphyrin (ZPP), blood free protoporphyrin (FPP) and hemoglobin content in the two groups. And the relative risk analysis was conducted.biological indices in both groups.RESULTS: All the 106 subjects entered analysis stage. In lead contact group there were 34 workers of more than 10 working years and the other ulnar nerve in those of over 10 working years were faster than those in control group [(50.11 ±4.76) m/s, (63.11±2.58) m/s vs (47.59±4.86)m/s,those of over 10 working years was higher than those of less than 10years [(0.568±0.28), (0.425±0.31) μmol/ L, P ＜ 0.05]. So was the FPP level [(2.24±0.32), (2.09±0.27) μmol/L, P ＜ 0.05] and urine lead level [(0.087±0.008), (0.083±0.007) μmg/L, P ＜ 0.05]. The ZPP level of those of over 10 working years was also higher than those less than 10 years [(1.42±0.33) μmol/L vs (1.25±0.35) μmol/L, P ＜ 0.05] and control [(1.42±0.33) μmol/L vs (1.22±0.44) μmol/L, P＜ 0.05]. The hemoglobin of those of over 10 working years was lower than those of less than 10 years [(12.26±4.5) g/L vs (14.55±4.81) μmol/L, P ＜ 0.05] and control [(12.26±4.5) g/L years presented abnormality in conducting sensory signals and the abnormality rate was 3% (1/32). Whereas four cases in those with more than 10working years did so and the abnormality rate was 12% (4/34). As for biological indices, one case in those less than 10 working years was beyond normal values (abnormality rate 3%) and five did so in those of over 10working years (abnormality rate 15%). It could be seen that changes in both NCV and biological indices of those of over 10 working years were more serious than those les than 10 years exposure with the relative risks of 4.1 and 5.3 respectively.CONCLUSION: Persistent exposure to lead not only alters biological indices but also damages nervous system in different degrees. Sensory verve of lower extremities and motor nerves of upper extremities are usually damaged first. Peripheral nerve injury is common in workers of over 10 working years. Because the regeneration of nervous system is poor, so the nerve injury is usually irreversible. Therefore the neuroelectrophysiological changes always predict early nerve injury and so neuroelectrophysiological monitoring can be adopted for prevention of nerve injury.

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Objective To systematically evaluate the role of laparoscopic living donor hepatectomy in living donor liver transplantation (LDLT).Methods A systematic literature search was conducted on Medline-Pubmed,Embase,Cochrane Library to find studies on laparoscopic living donor hepatectomy for LDLT.All extracted data were analyzed using the RevMan 5 software.Results Ten studies with a total of 1 059 participants were included in this analysis.Laparoscopic donor hepatecomy (LDH) was associated with significantly less intraoperative blood loss [SMD =-0.39,95％ CI (-0.73,-0.05),P ＜ 0.05],lower peak level of postoperative total bilirubin [SMD =-0.24,95％ CI (-0.47,-0.01),P ＜ 0.05]and longer operative time [SMD =0.50,95％ CI (0.04,0.96),P ＜0.05] when compared with those operated with open surgery.On subgroup analyses,hospitalization stay decreased in patients who underwent LDLT with grafts obtained by complete living donor hepatectomy (LDH) and left lateral sectionectomy (both P ＜ 0.05).LDH was comparable to open surgery in donor complication rates and in-hospital cost (P ＞ 0.05).There were no differences on the harvested liver graft size,ischemic time,recipient postoperative liver function and complications between the two groups (P ＞ 0.05).Conclusions Laparoscopic hepatectomy in living donor is a safe procedure for graft-harvesting,which improved the clinical outcomes of the donor,liver graft and recipient in LDLT.It has also the advantages of reduced blood loss,low peak levels of postoperative total bilirubin and short hospitalization stay.