Based on the lessons and experience from the country's fight against SARS, the paper analyzes the problems and shortcomings in its public health emergency reaction. It also describes the pubhc health systems set up in America, Britain and Japan in response to emergent events. With regard to the building up of a public health emergency system that conforms to the situation in China, the following proposals are put forward: (1)establishing effective command networks, such as setting up a national crisis management commission and formulating corresponding laws and regulations and crash programs; (2)establishing unimpeded information networks, such as setting up a national disease monitoring and reporting system and urban symptom monitoring systems; and (3)establishing tight prevention and treatment networks, with the network of prevention being composed of the headquarters, disease prevention and control institutions, medical institutions, health supervision institutions, experts commissions, and cooperation centers for tackling key problems in science and technology.

Objective To investigate the mechanism of venous reverse-flow flap in the differentperiod after operation.Methods The rabbits wero randomly allocated into 3 groups.In group A,including saphenous artery and venae commutante.In group B,saphenous artery without venae commutante.In group C,surface seeping and saphenous artery and venae commutante.Flap appearance,intravenous pressure,vessel diameter,mierocircular and histological examination were mea8ured.Results The difference of introvenous pressure between group A.B and C was obvious.Reverse flow WaS found in group A and C group through microcirculation observation 2 hours post-operation.Venous valve lose efficacy while the vessel diameter wes at maximum just after the pressure peak.Conclusion Venous retrograde return in reverse-flow island flaps can be achieved more easily through"incompetent valves route"than through "communicating and collaterall by pass route".By pass route is a supplementary way.Surface seeping Can slighfly relieve the venous pressure but can cause infection.

Objective To investigate the patterns of change in thyroid functional parameters ( serum TSH,FT3, and FT4 ) in patients with papillary thyroid cancer (PTC) before and after the initial 131I treatment for thyroidal remnant ablation. Methods Seventy-four PTC patients, treated with 3.7 GBq 131 I therapy, were divided into two groups, group A with serum TSH＜30 mIU/L and group B with serum TSH ≥30 mIU/L the day before 131I treatment. Five days after the treatment, the patients were re-examined for serum FT3, FT4, and TSH levels.Results In group A (22 cases), 5 days after the 131I ablation treatment, FT4significantly increased by 88% and FT3 by 87%, while TSH decreased by 87% (all P＜0. 05 ), and 45% (10/22)cases manifested the signs of transient thyrotoxicosis. In group B (52 cases)after treatment, individual variance of FT3 and FT4 was obvious,with FT4 decreased by 13% and FT3 decreased by 14% ( both P＜0. 05 ), while TSH slightly increased by an average of 6% ( P＞0.05 ). Conclusion After the initial 131 I ablation therapy for thyroidal remnant, the thyroid hormone levels in some PTC patients significantly increase while in others may slightly decrease in the early stage. The supplementary and suppressive therapy after 131I ablation for PTC patients might be individualized depending on the thyroid hormone determination.

Studies have confirmed that homocysteine is associated with ischemic stroke. This article reviews the correlation between homocysteine and ischemic stroke risk, etiological type, severity, outcome, as well as the research progress of reducing homocysteine to prevent ischemic stroke.

OBJECTIVETo describe the diagnosis and surgical management of coronary artery aneurysm.

METHODSBetween October 1996 and May 2000, 6 patients with coronary artery aneurysm underwent surgical treatment. Of these patients, 3 had Kawasaki disease and 3 coronary artery fistula. All patients underwent coronary artery bypass grafting. Three patients had aneurysms resected and fistulous ostium closed. One patient received aortic valve replacement.

RESULTSThere were no deaths and later death, nor major complications during the hospital stay. The results of follow-up were satisfactory.

CONCLUSIONSCoronary artery aneurysm is rare and its prognosis is poor. Early diagnosis and operation are necessary. The aneurysm should be resected, the coronary artery should be bypassed, and other associated diseases should be treated properly.

Adult ; Coronary Aneurysm ; diagnosis ; mortality ; surgery ; Coronary Artery Bypass ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Vascular Fistula

Objective To investigate the role and potential mechanism of high mobility group box-1 protein (HMGB1) on improving the chemosensitivity of gemcitabine-resistant pancreatic cancer PANC1 ceils.Methods Gemcitabine-resistant pancreatic cancer PANC1 (PANC1-GR) cell line was established by using increased gradient concentration of gemcitabine.The si-HMGB1-PANC1 and si-HMGB1-PANC1-GR cells were established by the transfection with HMGB1 siRNA using liposome.The 50％ inhibitory concentration (IC50) and Resistance index (RI) of gemcitabine in 4 PANC1 cell lines with or without HMGB1 siRNA transfection were determined and calculated by CCK-8 assay.Western blot assay was used to detect the protein expression of HMGB1 in PANC1 and PANC1-GR cells and the expression of autophagy marker protein Beclin1 in the 4 PANC1 cell lines.Flow cytometry assay was used to evaluate the apoptosis rate of 4 pancreatic caner cell lines.Results The gemcitabine-resistant pancreatic cancer cell line PANC1-GR was successfully established,which could grow stably and passage in media with 100 μmol/L gemcitabine.The IC50 of gemcitabine in PANC1,PANC1-GR,si-HMGB1-PANC1,and si-HMGB1-PANC1-GR cells lines were (4.7 ±0.4) μmoL/L,(166.5 ± 13.6) μmol/L,(3.2 ± 0.3) μmol/L,and (52.4 ± 8.4) μmol/L,respectively.The IC50 in PANC1-GR wassignificantly higher than that in PANC1,while the IC50 in the transfected cells was significantly lower than that in untransfected cells,and the differences were both statistically significant (bothP ＜ 0.01).The RI value of gemcitabine in transfected and untransfected PANC1-GR cells was 35.4 and 16.4.The relative protein levels of HMGB1 in PANC1 and PANC1-GR were 0.17 ± 0.08 and 0.38 ± 0.11.The expression of HMGB1 in PANC1-GR was obviously higher than that in PANC1,and the difference was statistically significant (P＜0.01).The relative protein levels of Beclin1 in PANC1,PANC1-GR,si-HMGB1-PANC1 and siHMGB1-PANC1-GR cells were 2.68 ± 0.23,3.28 ± 0.15,0.68 ± 0.23 and 0.78 ± 0.11,which in two transfected cells was greatly lower than those in untransfected cells.The apoptosis level was (34.58± 3.14)％,(79.56±3.58)％,(19.41± 1.53)％,and (34.57±2.94)％.The apoptosis level in the 2 transfected cell lines were significantly higher than those in the 2 untransfected cell lines,and the differences were both statistically significant (P ＜ 0.01).Conclusions The inhibition of HMGB1 could improve the chemosensitivity of gemcitabine in pancreatic cancer PANC1 cells,which might be mediated by the activation of autophagy.

Objective To evaluate the prognostic significance of the candidate selection Hangzhou criteria for liver transplantation of HCC patients undergoing hepatectomy.Methods 199 HCC patients undergoing hepatectomy between 2009 and 2011 were enrolled retrospectively.Predictors of survival were identified using the Kaplan-Meier method.The disease state was staged by the Hangzhou criteria (HC) and Milan staging systems.Calculating the area under the receiver operating characteristic (ROC) curve (AUC) evaluates the discriminatory ability for the prediction of survival of both staging system.Results Portal vein thrombosis,poor differentiation,and tumor size (＞ 8 cm) were independent risk factors for survival after hepatectomy.Milan criteria and Hangzhou criteria functioned well in predicting tumor-recurrence.For 1-year AUROC,the AUROC for Milan criteria and Hangzhou criteria are 0.602 and 0.741,respectively.For 3-year AUROC,the AUROC for Milan criteria and Hangzhou criteria are 0.643 and 0.733,respectively.Conclusions The HC were shown to be a promising survival predictor in a Chinese cohort of HCC patients after hepatectomy.

Objective:To investigate the mechanism of levosimendan on acute kidney injury after cardiopulmonary resuscitation (CPR) in rats.Methods:Twenty-five healthy adult male SD rats were randomly divided into three groups: control group ( n=5), levosimendan group ( n=10) and experimental group ( n=10). A cardiac arrest-cardiopulmonary resuscitation model was established using smothering method in the experimental group and levosimendan group. The levosimendan group was treated with levosimandan during and after resuscitation, while the experimental group was given equivalent volume of saline solution during and after resuscitation, and the control group was only given equivalent volume of saline without performance of CPR. The rats in the three groups were sacrificed at 6 h after resuscitation. The serum and kidney tissue samples were collected. Serum biochemical indicators [serum creatinine (Scr), blood urea nitrogen (Bun), interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)] were measured. HE staining and Paller score were used to identify the degree of kidney damage. Apoptosis was estimated by TUNEL staining. Western blot was used to detect the expression levels of phosphorylation of extracellular regulated protein kinases (p-ERK). One-way analysis of variance was used to compare the mean values of normally distributed measurement data between groups. Comparisons between groups were performed using the least significant difference t-test. Results:Scr (85.02±1.31) μmol/L, Bun (7.36±0.13) mmol/L, Paller score (7.3±0.2), IL-1β (302.20±17.35) pg/mL, IL-6 (564.60±23.24) pg/mL and TNF-α (1346±83.73) pg/mL in the experimental group were significantly higher than those of the control group [(15.94±0.96) μmol/L, (2.95±0.18) mmol/L, (0.7±0.2), (7.27±0.44) pg/mL, (51.30±2.87) pg/mL, and (10.39±0.52) pg/mL] (all P<0.01). Compared with the experimental group, Scr (63.88±2.01) μmol/L, Bun (5.45±0.47) mmol/L, paller score (4.8±0.2), IL-1β (78.61±3.66) pg/mL, IL-6 (297.90±13.64) pg/mL and TNF-α (276.2±20.18) pg/mL were significantly decreased in the levosimendan group (all P<0.01). TUNEL staining showed that levosimendan could improve the apoptosis of renal cells ( P<0.01). The expression of p-ERK protein in the levosimendan group was significantly higher than that in the experimental group ( P<0.01). Conclusions:Lovosimendan could attenuate acute kidney injury following cardiac arrest and cardiopulmonary resuscitation via suppression apoptosis. The mechanism of levosimendan protective effect might be associated with activation of ERK signaling pathway.

Objective:To investigate the correlation between different serum uric acid (SUA) levels and impaired fasting glucose (IFG) in adults.Methods:From March 2019 to February 2020, 5006 adults in Wuxi area of Taihu Sanatorium in Jiangsu Province were selected as subjects. Quintile method was divided into the following five groups: Q1: SUA<270 μmol/L, Q2: 270 μmol/L SUA 318 μmol/L or less, Q3: 319 μmol/L ≤SUA≤360 μmol/L, Q4: 361 μmol/L SUA 410 μmol/L or less, and Q5: SUA>410 μmol/L. Correlation was analyzed by logistic analysis, with IFG as the outcome index, five SUA groups as the observation index, and gender, age, body mass index (BMI), blood lipid, and blood pressure as confounding factors. Three logistic regression analysis models were constructed to explore the relationship between different SUA level groups and IFG risk, as well as the influence of BMI on the risk correlation between SUA and IFG.Results:The BMI, DBP, FPG, TC, TG, and LDL-C all increased with the increase in SUA level; however, HDL-C gradually decreased with the increase in SUA level (P<0.01). The SUA levels among the five groups were positively correlated with fasting blood glucose level in the IFG group ( r=0.589, P<0.001). After adjusting for age, sex, and BMI, SUA level was strongly associated with fasting glucose in the IFG group ( r=0.534, P<0.001). After further adjustment for blood lipid and blood pressure, the correlation persisted ( r=0.523, P<0.001). With Q1 as the control group, the calculated OR values of IFG risk were 1.199, 2.660, 2.784 and 3.629, respectively. After further adjustment for various confounding factors, the calculated OR values of each group were 1.130, 2.389, 2.350 and 2.895, respectively. The IFG risk in the group with SUA level in the corresponding Q2 and Q5 groups was 1.13 times and 2.90 times higher, respectively, than that in the normal group, indicating that with the increase in SUA level, the IFG risk in the population increased. With the increase in BMI and SUA levels after BMI stratification, the mean fasting glucose level increased ( P<0.001). Conclusion:The SUA level and IFG risk are closely related. Increased SUA level increases IFG risk, and SUA and IFG are associated with weight gain, which should be paid attention to.

Objective To investigate the curative effect of Sandplay therapy on attention deficit hyperactivity disorder (ADHD)preschool children co - morbid sleep disorder. Methods According to the random number generated by EXCEL software's RAND function,a total of 62 ADHD children co - morbid sleep disorder were randomly divi-ded into experimental group(n = 31)and control group (n = 31). The control group was treated with family behavior therapy and the experimental group was treated with sandplay therapy based on the family behavior therapy. With the Achenbach Child Behavior Check List (CBCL),Conners Parent Symptom Questionnaire (PSQ),Conner Concise Questionnaire (Conners Abbreviated Symptom Questionnaire,ASQ)and Children′s Sleep Habit Questionnaire(CSHQ),the overall curative effect was evaluated before and after treatment by their scores. Results The results of independent - samples t test showed that the scores of PSQ′s all factors,ASQ′s and CBCL′s total score,CSHQ′s total score and all factors had no significant difference between the two groups before the intervention (t conduct problem = - 0. 847,t learning problems =0. 504,t psychosomatic disorder = - 1. 008,t hyperactivity/ impulsion = - 0. 331,t anxiety = 0. 690,t hyperactivity index = 0. 757,t CBCL′s total score =- 0. 532,t ASQ′s total score = 0. 514,t CSHQ′s total score = 1. 132,t sleep impedance = - 0. 767,t sleep latency = - 0. 634,t sleep duration = 0. 150, tsleep anxiety = 0. 149,t sleep wake = 0. 417,t sleep disorder = 0. 709,t sleep apnea = 0. 950,t daytime sleepiness = 1. 530,all P > 0. 05). The scores of PSQ′s all factors,ASQ′s and CBCL′s total score,sleep impedance,sleep latency,sleep duration,sleep wake, daytime sleepiness and CSHQ′s total score all had significant differences between the two groups after the intervention(t conduct problem = - 3. 982,t learning problems = - 2. 258,t psychosomatic disorder = - 2. 470,t hyperactivity/ impulsion = - 4. 377,t anxiety =- 2. 684,t hyperactivity index = - 4. 249,t CBCL′s total score = - 3. 982,t ASQ′s total score = - 5. 576,t sleep impedance = - 3. 712,t sleep latency =- 2. 947,t sleep duration = - 2. 332,t sleep wake = - 6. 031,t daytime sleepiness = - 6. 256,t CSHQ′s total score = - 6. 706,all P < 0. 05). The results of analysis of variance of repeated measurement showed that PSQ behaviour problem,psychosomatic disor-der,hyperactivity and hyperactivity index scores of the main effects of intervention had significant difference (F conduct problem = 4. 966,F psychosomatic disorder = 5. 176,F hyperactivity/ impulsion = 4. 949,F hyperactivity index = 4. 926,all P < 0. 05);the main intervention effects of ASQ and CBCL′s total score had statistical difference (F CBCL = 4. 398,F ASQ = 4. 814,all P < 0. 05);the main intervention effects of sleep impedance,sleep duration,sleep wake and CSHQ′s total score had statistical difference (F sleep impedance = 5. 697,F sleep duration = 4. 467,F sleep wake = 6. 610,F CSHQ′s total score = 6. 016,all P <0. 05). There were significant differences in the characteristics of the initial sand table and the final sand table in the experimental group [traumatic subject:(4. 48 ± 1. 55)cases vs. (1. 23 ± 0. 81)cases,t = 8. 247;curing subject:(1. 77 ± 1. 09)cases vs. (4. 55 ± 1. 46)cases,t = 11. 274,all P < 0. 05]. Conclusion Sandplay therapy can effectively improve the core symptoms of preschool ADHD children co - morbid sleep disorders,which can be used as an early in-tervention.