Objective:To analyze whether medical insurance and environment protective behaviors could alleviate the influence of environmental pollutions on individual health status.Methods:Using the data of CGSS(2010) to conduct the empirical analysis based on Logit model.Results:Residents' choice on medical insurance and environment protective behaviors could alleviate the damage of environmental pollutions on health.Compared with the young and middle-aged,the elderly effectively alleviated the damage brought by environment pollutions through participating medical insurance.Compared with the low-educated individuals the high-educated inviduals' choices for environment protective behavior could effec tively release the damages brought by environmental pollutions.Conclusion:The government should advocate environmental protective behaviors,provide full coverage of medical insurances to let individuals alleviate the damages of environmental pollutions by their rational choice.More emphasis should be paid to the damage of environmental pollutions on the elderly group and individuals with lower education.

0.05), higher than those in the nighttime (t=3.63,3.16;P

Objective To study the role of changes of oropharyngeal microflora in pathogenesis of post-traumatic ventilator-associated pneumonia (VAP). Methods Forty-five patients with post-traumatic VAP treated with intubation and mechanical ventilation were involved in the study.Microbiologic cultures and drug-sensitivity test of oropharyngeal secretions,subglottic secretions,sputum from deep airway and gastric fluid samples were performed at days 1,3,7 and 14 after mechanical ventilation.The stool samples were collected to detect the coccus and bacillus ratio and the fungus.The concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions were compared. Results The main pathogens for VAP patients were gram-negative bacilli.The study showed an increase in aspects of the positive rate of etiology cultures of subglottic secretions,sputum and gastric fluid samples,the concordance rate of microflora among subglottic secretions,sputum,gastric fluid and oropharyngeal secretions and the number of ESBL + and multi-resistant bacteria,along with the prolonged mechanical ventilation. Conclusions The changes of oropharyngeal microflora are closely associated with the development of VAP.The enterobacteria in the gastric cavity always reversely colonize in the oropharynx and the retrograde stomach-pharynx-lower respiratory tract infection is a major infection route of VAP.

Objective To comparethe effects of four different emergency fixation methods for the open tibiofibular fractures on the treatment and prognosis of the multiple trauma patients. Methods A comparative study was carried out on the effect offour different early fixation methods on the fracture and the multiple trauma in aspects of the short-term indicators including mortality rate,acute respiratory distress syndrome(ARDS),fat embolism syndrome(FES),multiple organ dysfunction syndrome (MODS),ICU stay and the long-term indicators including wound healing time,fracture healing time,rate of joint function recovery and fracture complications in 43 multiple trauma patients. Results The locked intramedullary nail wag better than the other fLxation methods including the calcaneal traction,the gypsum external fixation and the internal fixation with steel plate and extemal fixation support in most indexes(P<0.05,0.01). Conclusion The locked intramedullary nail can significantly decrease the incidence rate of complications and obtain sound fracture healing for the patients with multiple trauma combined with open tibiofibular fractures(types Gnstilo Ⅰ,Ⅱ and Ⅲa).

Objective To explore the risk factors of lower limb deep vein thrombosis (DVT) in patients with traumatic fractures so as to provide references for prevention of DVT. Methods A total of 1 068 patients with traumatic fractures were involved in the study to analyze the incidence of DVT under 43 risk factors including general state, injury type, fracture condition and operation and screen significant factors for multiple factor analysis. Results The total incidence rate of DVT in 1 068 patients was 12.0%. The univariate analysis showed that male patients at age ＞60 years, with BMI≥25 kg/m2, history of smoking, lack of exercises, history of diabetes, hypertension, coronary artery disease and cerebrovascular disease had higher incidence rate of DVT. In different injury types, the fall injury caused the highest incidence rate of DVT (45.6%). There were different DVT rates for different fracture position,with the highest incidence rate of DVT for femur shaft fracture (20.5%). The incidence rate of DVT was 51.7% for fractures of more than three parts, 14.2% for fractures of two parts and only 3.7% for sole part. The incidence rate of DVT for comminuted fractures was higher than the overall rate. The operation duration, massive transfusion during operation and epidural anesthesia were related with the increase of incidence of DVT. Multivariate analysis found nine independent risk factors and showed that the more risk factors were, the higher incidence of DVT was. Conclusions The risk factors of DVT for traumatic fractures include age ＞60 years, BMI≥25 kg/m2, history of smoking, fall injury, more than three parts of fractures, comminuted fractures, operation duration ＞ 2 hours, massive transfusion during operation and epidural anesthesia.

Apoptosis of cancer cells between the gastric and intestinal-type human gastric carcinoma were compared in terms of the expression of oncogene MDM2 and CD68, the histological types, the infiltration depth, and lymph node metastasis. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay was employed to stain apoptotic cells. Histochemical method(AB-PAS) was applied to stain mucus that is neutral or acidic in nature. Immunohistochemical method (SABC) was used to detect expression of MDM2 and CD6. The results showed that the mean apoptosis index (AI) of total 48 cases was 8.60+/-2.60. AI in the 30 intestinal type cases was significantly higher than that in the 18 gastric type cases (t=4.67, P<0.01). In the 30 intestinal type cases, the spontaneous apoptosis index of MDM2 negative cases was significantly higher than that of the positive cases (t=7.16, P<0.01). And in the 18 gastric type cases, the same result was found. (t=11.39, P<0.01). The MDM2 positive ratio in gastric type cases was higher than that in intestinal type cases (chi2=4.68, P<0.05). There is no significant difference in AI between cases of lymph node metastasis and non-metastasis cases in intestinal type cases (t=0.26, P>0.05). But in the gastric type cases, a significant difference existed (t=5.87, P<0.01). A significant difference in lymph node metastasis ratio was found between the two gastric carcinoma types (chi2=4.48, P<0.05). The CD68 expression ratio in the 30 intestinal type cases was much lower than that in the 18 gastric type cases (t=4.29, P<0.01). AI of 25 MDM2-positive cases was much lower than that of the 23 MDM2-negative cases (t=7.80, P<0.01). CD68 positive ratio in the 25 MDM2-negative cases was much lower than that in the 23 negative cases. The difference was statistically significant (t=10.90, P<0.01). Except for few cells scattering within the cancer nest, most CD68 positive cells infiltrated in the interstitium around the cancer tissue. In the high-AI cases, CD68-positive cells increased. And the CD68-positive cells decreased in low-AI cases (r=0.96, P<0.01). Logistic regression analysis suggested that among the control variables, only AI was a statistically significant factor in the regression model (chi2=9.64, P<0.01). We concluded that (1) the spontaneous apoptosis index in gastric-type cases of gastric carcinoma was significantly lower than that in intestinal type cases; (2) AI in the two types was influenced by the expression of MDM2 and lymph node metastasis, but no visible connection was found between AI and the infiltration depth or histological types; (3) in the intestinal type cases, AI and the CD68-positive cells increased in MDM2-negative cases.

Objective To study the clinical value of color Doppler ultrasound in carotid endarterectomy ( CEA) .Methods Forty-five patients with CEA were examined and analyzed by TCD and CDFI.The position, range,character,diameter,stenosis rate were measured by CDFI and collateral flow by TCD before CEA.The intraop-erative CDFI was applied to confirm the flow and the flaps in carotid artery.TCD monitoring of middle cerebral blood flow in CEA to assess whether use shunt technique and cerebral hyper-perfusion.CDFI was applied to assess patency and intimal hyperplasia of carotid artery.Results Seventeen low echo plaques,twelve high echo plaques and sixteen hypoechogenicity echo plaques in forty-five patients with internal carotid stenosis were found by color Doppler ultra-sound.Blood flow volume increased significantly in the ispilateal internal carotid arteries and middle cerebral arteris after operation.Carotid artery restenosis was not found by color Doppler ultrasound after CEA.Conclusion Applica-tion of color Doppler in CEA is valuable in the diagnosis of internal carotid stenosis,intraoperative monitoring and in the evaluation of effect.

Objective:To investigate the attitude towards task -shifting of mental health among non -psychiat-ric physicians of general hospitals in Guangzhou and to provide evidence for continuing education model and health policy making .Methods:A cross-sectional study was implemented among 1363 participants of 17 general hospi-tals from December 2012 to April 2013 in Guangzhou.Results:Among 1363 participants, there were 941 (69.6%) approved the concept of mental health task shift .Factors of attitude to the concept of mental health task shift include work 8-10 h/day (β=0.404, P=0.006), practice qualification (β=-1.345, P=0.016), less than 10%physical diseases combined with psychological or mental problems in clinical work (β=-0 .452 , P=0.014), demand of training cost/time(β=-0.596, P =0.021), get ready (β=1.436, P <0.001) and have little preparation (β=0 .694 ,P<0 .001 ) preparation for treating mental disorders at present work ( recognition and treatment).The possibility of participants′attitude toward task -shifting mental health is positive the highest (71.0%), followed by neutral (25.5%) and negative (3.5%).Conclusions:Strengthening non -psychiatric physicians′support for mental health task shift with respect to policy and legal levels in general hospitals , improving their recognition and preparation of mental disorders , as well as developing targeted training and courses are the highest priority .

Objective To explore the value of multi-slice computed tomography (MSCT) on the typing and staging of bronchiolitis obliterans (BO) in children.Methods Twenty-eight BO patients were recruited and underwent X-ray and MSCT from August 2012 to August 2015.The classification of MSCT signs and radiological manifestations in different stages of BO were discussed.Results Mosaic sign and bronchial wall thickening appeared in all cases and pulmonary atelectasis in 6 patients.MSCT signs were divided into 18 cascs of simple type and 10 of pneumonic type,respectively.Radiological imaging undergone after treatment for 2 ～ 4 weeks indicated that 20 patients turned normal,but 8 patients to chronic stage,including pulmonary interstitial fibrosis (7 cases),bronchoiectasis (6 cases),calcification in bronchial distal (3 cases) and pleural adhesions (2 cases).Conclusion Mosaic sign is a distinctive MSCT manifestation for BO in early phase,and CT typing and staging contribute to guiding the treatment.

Objective In order to explore the possibility of autologous transplantation of olfactory mucosa for spinal cord repair,the changes of autologous olfactory mucosa being transplanted into spinal cord and the effect of promoting axon regeneration in adult rats were investigated. Methods Forty male adult rats were divided into two groups randomly:olfactory mucosa transplantation and control groups.Olfactory mucosa (1*!mm+2) was taken from the posterior region of nasal septum,and this graft was transplanted into the posterior funiculus of cervical 1 segment of spinal cord and destructed the corticospinal tract(2*!mm?1^5*!mm).The control graft was derived from the respiratory lamina and then was grafted into the corresponding lesion.After being survived for 4-6 weeks,the animals were killed,the transplanted site was sectioned horizontally,immunofluorescence double labeled with the neurofilament(NF) and anti-NGFR-p75,investigated under the confocal microscope.Another set of slice was used immunohistochemistry to investigate the olfactory mucosa how to integrate with the surrounding tissue. Results The control lesions have the obvious hollow,no p75-positive reaction in the respiratory lamina and no NF-positive fibers grew through it;olfactory mucosa group showed that olfactory mucosa which is labeled p75-positive healed up with surrounded tissue,the hollow declined markedly,the labeled olfactory ensheathing cells(OECs) soakage into the nerve tissue.OECs induced a fine,unbranched,elongative growth of the cut CST axons.The axons were regenerated through the graft and continued to reenter into the caudal host part.Conclusion Autologous olfactory mucosa may be the donor which could repair the spinal cord injury for clinical situations.