Based on the immunophenotype, B cell lymphoma can be distinguished into different isoforms, which have different incursions. Cyclin D1 has been detected in a wide variety of lymphoid and myeloid malignancies, which expression in B-cell tumors on an expanded group of lymphomas that included MCL, B-CLL, diffuse large B-cell lymphomas (DLBCL), marginal zone lymphoma (MZL), reactive hyperplasia group. Bcl-2 itself is highly expressed in the majority of B-cell lymphomas [follicular lymphoma (FL), DLBCL].Both of them play an important role in differential diagnosis of B cell lymphoma. So its sensitivity and specificity of test facility have crucial clinical value.

Objective:To study the impact factors of psychological distress in patients with first diag-nosed lung cancer.Methods:The cross-sectional study was applied to newly diagnosed lung cancer pa-tients who received treatments in Cancer Center of West China Hospital of Sichuan University in Chengdu from June 201 3 to March 201 5 by distributed questionnaires.The general information of the patients,the hospital anxiety and depression scale (HADS)and distress management screening measure (DMSM) were included in the questionnaire to evaluate the states of distress,pain and the factors related to the distress of the patients.Results:The survey investigated a total of 390 patients with first diagnosed lung cancer,including 291 male patients and 99 female patients.The proportion of the patients with positive anxiety symptom was 26.7% (1 04 /390),with positive depression symptom was 27.7% (1 08 /390), and with positive distress symptom was 30.0% (1 1 7 /390).On the top five problem list of DMSMwere worry,disease treatment,breathing,pain and sleep.The Spearman correlation analysis showed that an-xiety score,depression score,and the pain intensity were positively correlated with the distress.Multiple linear regression analysis showed that gender (β=-0.209,P =0.003),age (β=-0.098,P =0.042),chronic disease (β=0.378,P <0.001 ),and pain score (β=0.1 00,P =0.029)could affect the distress of the patients.Smoking (β=0.1 1 1 ,P =0.041 )could affect the anxiety of newly diagnosed lung cancer patients.Conclusion:The gender,age,chronic disease and pain score of the patients are the independent factors of the psychological distress of first diagnosed lung cancer patients.Smoking is the predictive factors of the patients with anxiety.Controlling the pain intensity and the clinical process of chronic disease of the patients actively,solving the sleep and breathing problem and helping the patients to quit smoking progressively could alleviate the psychological distress of the patients.

Objective To analyze influencing factors of physicians' turnover intention at public county hospitals from career stage perspective.Methods Physicians career life was divided into three stages according to professional ranks and titles.The sample was drawn using stratified multistage random methods from public county hospitals in Shandong province and 677 questionnaires were completed,giving a 90.3％ valid response rate.Data were analyzed using multi-group stepwise linear regression.Results The percentage of responders with middle and high-level turnover intention was 23.0％and 6.5％ respectively,and there was no statistically significant difference in turnover intention across three stage subgroups.In physicians at stage 1,the most important factors to predict turnover intention were superiors ' appreciation (r =-0.22,P ＜ 0.05) and payment rationality (r =-0.21,P＜0.05),while in physicians at stage 2,the most important predicting factors were autonomy (r=-0.39,P＜0.05)and learning demand(r=-0.22,P＜0.05),and in physicians at stage 3 were career development(r=-0.31,P＜0.05)and autonomy(r=-0.21,P＜0.05).Conclusion Autonomy and workload are common factors of turnover intention with different predicting power across three career stages.Physicians adjust their career needs to self-actualization with development of career stage,so welltargeted incentives should be taken to stabilize the medical staff of public county hospitals.

BACKGROUND: The transcription factor Runx2 is the key factor that regulates osteogenic differention and bone development. It has been reported that the C2C12 mesenchymal cells can be induced to differentiate into osteoblasts by Runx2 overexpression, but the molecular mechanism of induction is stil largely unclear. OBJECTIVE: To investigate the role of the members of the miR-376 family during Runx2-induced osteogenic differentiation in C2C12 cells. METHODS: The expression of the members of the miR-376 family was detected by real-time quantitative PCR at different time points using C2C12/Runx2Dox sub-line with conditional Runx2 expression. In miR-376b-3p-transfected C2C12/Runx2Dox cells, the expression of osteoblast markers, such as alkaline phosphatase and osteocalcin, was detected by real-time quantitative PCR, and the alkaline phosphatase activity was also examined by alkaline phosphatase staining. The putative miR-376b-3p targets were commonly predicted by online tools (miRanda, miRWalk and TargetScan). The functional classification of these putative targets was performed by DAVID Bioinformatics Resources database. RESULTS AND CONCLUSION: The expression of miR-376b-3p was significantly increased during Runx2-induced osteogenic differentiation of C2C12 cells, but the expression of other members was not changed. Transfection of miR-376b-3p mimic upregulated alkaline phosphatase expression, but had no effect on osteocalcin expression. The alkaline phosphatase activity was also increased by transfection of miR-376b-3p. The functional classification of miR-376b-3p putative targets showed that miR-376b-3p is involved in the skeleton development, indicating the role of miR-376b-3p in osteoblast differentiation. Taken together, these results suggest that Runx2 promotes early osteogenic differentiation in C2C12 cells by regulating the expression of genes related to osteogenic differentiation through upregulation of miR-376b-3p.

Objective To assess the efficacy,side effects and perinatal outcome of nifedipine compared with other antihypertensives for treating severe preeclampsia in pregnant women. Methods Randomized controlled trials (RCTs) that comparing nifedipine with other antihypertensives for severe preeclampsia were searched in PubMed,EMBase,Cochrane library,CNKI and VIP database etc( till January 2012).The quality of the included RCTs was evaluated,and Meta-analvsis was performed with Rev Man 5.1software.Results Nine trials were included,involving 386 women in the nifedipine group,and 378 women in other antihypertensives group.Compared with other antihypertensives,nifidepine was associated with greater effective control of blood pressure ( OR =2.65,95％ CI:1.65 -4.25,P ＜0.01 ).There was no clear difference in the time needed to control blood pressure ( W.M D =- 3.64,95％ CI:- 10.90 - 3.61,P =0.32 ).Nifedipine could prolong gestation better than other antihypertensives ( WMD =5.14,95％ CI:3.29-6.99,P ＜0.01 ).There were no clear differences in maternal side effects headache (P =0.28),palpitation ( P =0.06 ),and nausea vomiting ( P =0.28 ).No noticeable difference was found between the two groups in the Apgar score at five minutes ( WMD =- 0.21,95％ CI:- 0.32 - 0.91,P =0.72),neonatal respiratory distress syndrome ( OR =1.24,95％ CI:0.57 - 2.67,P =0.59 ),or perinatal deaths ( OR =0.49,95％ CI:0.22 - 1.11,P =0.09 ).Conclusion Nifedipine is associated with greater effective control of blood pressure and prolongation of gestation,with no additional neonatal respiratory distress syndrome or perinatal deaths,compared with other antihypertensives for women with severe preeclampsia.

Objective: To investigate the value of lipid accumulation product (LAP) and visceral fat index (VAI) for prediction of metabolic syndrome (MS). Methods: Based on the 2018 Survey on Chronic Diseases and Risk Factors in Yantai City of Shandong Province, residents at ages of 45 years and older were sampled, and subjects' age, disease history, waist circumstance (WC), body mass index (BMI), blood pressure and blood lipid were collected to calculate LAP and VAI. MS was diagnosed with the a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity (JIS definition) and the recommended criteria proposed by the Chinese Diabetes Society (CDS) of Chinese Medical Association (CDS criteria), and the values of LAP and VAI for MS screening were evaluated using the receiver operating characteristic (ROC) curve analysis. Results: Totally 9 366 subjects were enrolled, including 4 340 men (46.34%) and 5 026 women (53.66%), and had a mean age of (54.49±9.73) years. According to the CDS criteria, the prevalence of MS was 24.58%, and LAP and VAI showed areas under the ROC curve (AUC) of 0.837 (95%CI: 0.828-0.846) and 0.751 (95%CI: 0.739-0.762), sensitivities of 78.82% and 63.31% and optimal cut-off values of 44.64 and 1.86 for screening of MS. According to the JIS definition, the prevalence of MS was 35.26%, and LAP and VAI showed AUC values of 0.842 (95%CI: 0.834-0.850) and 0.790 (95%CI: 0.780-0.800), sensitivities of 75.73% and 68.42% and optimal cut-off values of 42.01 and 1.67 for screening of MS. Conclusions Both LAP and VAI are effective for screening MS among middle-aged and elderly residents, and LAP presents a higher accuracy than VAI.

Objective To study the effect of Chinese medicine combined with large dose interferon in the postoperative adjuvant therapy of malignant melanoma of the skin.Methods A high dose of interferon alpha-2b (GanLeneng) (1200 IU/per day) was used in 20 cases of malignant melanoma of skin for 7 days.One course of treatment was 3 months,8 consecutive courses of treatment and traditional Chinese medicine (0.25 g) were administered 1 hour before meals,2 times a day,taking three weeks per month.Results One patient in 20 cases of patients did not receive timely treatment and resulted in death.The remaining patients were were still live from 2012 to the present.Local and distant metastasis lesions disappeared during the course of treatment.Conclusions Traditional Chinese medicine combined with high-dose interferon in cutaneous malignant melanoma as adjuvant treatment plays an important role.

Objective To analyze the policy support of rural doctors for the essential medicine system,and explore the main influence factors and mechanism affecting the support degree.Methods 621 rural doctors from five cities in Shandong province were subject to a stratified random sampling for a quantitative questionnaire,to build a hypothesis model of policy support of rural doctors,which is verified using factor analysis and path analysis.Results 59.1% of rural doctors support the essential drugs policy.It was found that the essential medicine factor,the factor to influence the practitioner,and the supporting policy factor had a direct impact on policy support of rural doctors,with the effect of 0.305, 0.1 59 and 0.135 respectively;Essential medicine factor and the supporting policy factor indirectly influence the policy support of rural doctors through the factor to influence practitioners,with the effect of 0.065 and 0.032 respectively.Conclusion The essential medicine system needs to emphasize such rationality as the quality,list and pricing of essential medicines;it is imperative for the government to better oversee the purchase and supply of essential drugs,to cater to the interests of rural doctors,to encourage the enforcement of the system,and promote the development of village clinics.

Objective:To explore the role CD4+CD45RO+memory T cells in the pathogenesis of Hashimoto's thyroiditis (HT) by detecting the percentages of CD4+CD45RO+ memory T cells in peripheral blood mononuclear cells in peripheral blood of newly diagnosed HT patients. Methods:53HT patients and 43 matched healthy controls (HC) were included in this study. According to the thyroid functions,HT patients were divided into euthyroid subset(HT-A,n =15) ,subclinical hypothyroidism(HT-B,n=14) and overt hypothyroidism subset (HT-C,n=24). The percentages of CD4+CD45RO+memory T cells in PBMCs,as well as the level of serum IFN-γ and IL-17,and thyroid functions,and the titers of thyroid-specific autoantibodies (TPOAb,TgAb) were respectively detected by flow cytometry,ELISA,and ECLIA. Results:The percentages of CD4+CD45RO+ memory T cells in PBMCs,as well as the level of serum IFN-γ and IL-17,the titers of TPOAb,TgAb were all significantly higher than that in HC(P<0. 01). Bivariate correlation revealed that the percentages of CD4+CD45RO+ memory T cells positively correlated with the level of serum IFN-γ,TPOAb and TgAb(P<0. 01,P=0. 015,P<0. 01) in HT patients. Conclusion:The significant increase of CD4+CD45RO+memory T cells in peripheral blood of patients with HT suggested a role of CD4+CD45RO+ memory T cells in the pathogenesis of this disease.

The paper analyzed legally the following predicaments of legitimization of rural doctors in China:no legitimacy protection for their practice,vague criteria for practicing medicine,conflicts between legal regulations for medical practice and rural realities,and lack of a liability insurance system.The authors,based on an exploration of the legislative framework for rural doctors,made four corresponding legislative proposals as follows:to clearly define the legal scope and identity of rural doctors,to establish a qualification and employment system for rural doctors,to develop practicing norms applicable for rural doctors,and to set standards for their income.