Objective: To analyze the current situation and problems of primary health care personnel since the new round of China's health care reform, and to provide a reference for stabilizing the primary health care personnel. Methods: This paper uses descriptive statistical analysis to calculate Gini coefficient and Theil index in order to ana-lyze the equity in headcount, structure and distribution of primary health care personnel among all health care institu-tions nationwide. Results: Between 2008 and 2013, the number of primary health care personnel significantly in-creased and their quality was improved. Moreover, although the Gini coefficient and Theil index of primary health care personnel continuously decreased in China's eastern, central and western provinces the difference inside the east-ern China is the main factor affecting the overall difference. Conclusions:Not only the problems of insufficient num-ber and loss of personnel still coexist in the primary health care personnel in China, but also there are other issues such as the structural imbalance of professional titles is especially prominent, the urban-rural and regional gaps are still large, etc. The main reasons for these issues are related to the irrational incentive mechanism, the inefficiency of the synergistic effects of administrative staffing policy and some reform measures, etc. This paper suggests further re-forming the income distribution system and improving primary governance capability in order to strengthen the policies to synergically attract and stabilize primary healthcare personnel.

Objective To learn the business operations of the pilot county-level public hospitals chosen for the 2014 experiment,which were subsidized at different levels in the financial subsidy mechanism reform.Methods County-level public hospitals from 109 counties were sampled as pilots from two provinces of the eastern,central and western regions of China.Descriptive analysis and correlation analysis were made to study their business operations at various subsidy levels.Results Proportional differences in the governmental financial subsidy level make a difference in the revenue and expenditure of county-level public hospitals.The higher the subsidy proportion,the lower the annual average of the total workload of the hospital(P <0.01),the less the inpatient expenditure per hospitalization(P =0.01),and the lower the drug proportion as well(P <0.01 ).Conclusions Financial subsidy plays a key role in the financial balance and business operation of such hospitals.Hence the government is proposed to guarantee its financial subsidy responsibility,to build a long-term financial subsidy mechanism.

This paper compared the practice and service mode of general practitioners ( GPs) from a selection of typical countries and regions and discovered that GPs from most of the countries were self-employed, with various forms of employment, freedom to practice and work in different institutions;fixed practices were supplemented, and service types were transformed from individual services to the multi-disciplinary team of services. Result: GPs’ free-dom to practice in different institutions requires a certain social environment and circumstances. The multi-disciplina-ry team of practices has become the development direction for the service modes of GPs. GPs have played different roles in establishing the referral system in the health systems of different countries. Consequently, the paper suggests that establishing a diverse and relaxed practice environment to provide conditions for the transformation of the service mode of GPs. The construction of a multi-disciplinary team to promote changes in community service modes was must be strengthened. Health insurance regulations should be encouraged to establish the gatekeeper system and realize a grading of systems. Social capital should be encouraged to organize general medical services to promote the develop-ment of the health care industry.

Objective To evaluate the clinical value of transrectal ultrasound(TRUS)guided biopsies of the prostate cancer(PCA)with serum prostate specific antigen(PSA)level less than 4 μg/L.Methods Fifty-nine patients suspected PCA were underwent TRUS guided-biopsy.The ultrasonographic features of lesions and prostate gland were observed.The PSA,PSA density(PSAD),F/T(free/total PSA ratio),prostatic volume(PV)were compared between PCA group and non-PCA group,and further analyzed the sensitivity and specificity of PSAD and F/T at different thresholds for PCA diagnosis.Results In 59 patients,16 were proved to be cancer by pathological examination,the positive detection rate was 27%.In these 16 patients,12 had lesions on ultrasound,which locatqed in outer gland.The rich vascularity was observed in PCA more than in benign and precancerous lesion.There were statistical significant differences in PSA,PSAD,F/T,PV between PCA and non-PCA groups.When selecting threshold of PSAD and F/T were 0.09 and 0.20,respectively,there were the highest diagnostic specificity and sensitivity.The diagnostic specificity and sensitivity of PSAD were higher than those of F/T.Conclusions TRUS guided biopsies of the prostate is one of the most efficient methods for detection of PCA with PSA level less than 4μg/L.Combining TRUS features with PSA parameters can further increase positive detection rate of PCA.

Objective:To investigate and analyze the effect of ubiquitin-editing protein A20 on monocytes activity in patients with ventilator-associated pneumonia (VAP).Methods:Twenty-four VAP patients (VAP group) and twelve healthy controls (control group) were included from the First Affiliated Hospital of Zhengzhou University between February 2019 and September 2019. Peripheral blood mononuclear cells (PBMCs) and bronchial alveolar lavage fluid (BALF) (both infection site and non-infection site) were collected from VAP patients, while PBMCs were collected from healthy controls. A20 level in CD14 + monocytes were measured. CD14 + monocytes and CD4 + T cells were purified from VAP patients. CD14 + monocytes were transfected by A20 siRNA. Transfected CD14 + monocytes were directly/indirectly co-cultured with autologous CD4 + T cells. The secretion of interferon-γ (IFN-γ) and interleukin-17 (IL-17) by CD4 + T cells was investigated. Transfected CD14 + monocytes were directly/indirectly co-cultured with NCI-H889 cells. Cytotoxicity, and cytokines/granzyme B level, and tumor necrosis factor-related apoptosis inducing ligand (TRAIL)/Fas ligand (FasL) level was assessed. Student t test or SNK-q test was used for comparison. Results:VAP group had elevated percentage of circulating CD14 +A20 + cells than control group [(66.14±19.62)% vs. (52.52±13.71)%, P<0.05], and also had increased A20 mean fluorescence intensity (MFI) than control group [(268.0±72.56) vs. (197.4±60.01), P<0.05]. The percentage of CD14 +A20 + cells in BALF from infection site was higher than from non-infection site in VAP group [(66.14±19.62)% vs. (52.52±13.71)%, P<0.05], while A20 MFI in infection site was also up-regulated compared with non-infection site [(268.0±72.56) vs. (197.4±60.01), P<0.05]. In direct contact co-culture, A20 siRNA transfected CD14 + monocytes, which were purified from peripheral blood and BALF of VAP patients, induced elevated percentage of IFN-γ and IL-17 secreting CD4 + T cells than un-transfection or control siRNA transfection ( P<0.05). However, there were no significant differences of CD4 +IFN-γ + or CD4 +IL-17 + percentages among un-transfection, control siRNA transfection, and A20 siRNA transfection ( P>0.05). A20 siRNA transfected CD14 + monocytes, which were purified from peripheral blood and BALF of VAP patients, induced increased target cell death in both direct and indirect contact co-culture than un-transfection or control siRNA transfection ( P<0.05). Tumor necrosis factor-α, IL-6, granzyme B level and TRAIL MFI was also up-regulated ( P<0.05). There was no remarkable difference of target cell death between direct and indirect contact co-culture ( P>0.05). Conclusions:A20 was increasingly expressed in monocytes of VAP patients, and might dampen the activity of monocytes.

Objective To determine the rate of hemorrhagic complications and the possible risk factors in transrectal ultrasound(TRUS)guided prostate biopsies.Methods TRUS guided prostate biopsies were carried out in 252 patients.Chi-aquare test,t test,conditional Logistic regression were used to comparatively analyze the risk factors(age,presence of prostate cancer,the volume of prostate,arterial hypertension,diabetes mellitus,use of acetylsalicylic acid and anticoagulant,number of samples)between hemorrhagic patients and non-hemorrhagic groups.Results Hematuria was the most frequent sing in all complications,corresponding to 19.1% of the cases.According to the general feature analysis between two groups,age and the volume of the prostate were significant different.Multiple factor Loigistic regression analysis showed that patients with or without hemorrhagic complications were significant differences in age(OR=0.97,95% CI:0.942～1.000)and the volume of the prostate(OR=0.989,95% CI:0.9790～0.999).Patients with or without hematuria were significant differences in presence of prostate cancer(OR=0.479,95% CI:0.236～0.975),the volume of the prostate(OR=0.987,95% CI:0.976～0.999)and use of acetylsalicylic acid and anticoagulant(OR=3.589,95% CI:1.133～11.366).Conclusions TRUS guided prostate biopsy is a safe and effective procedure.Age and the volume of prostate are influencing factors for hemorrhagic complications.Presence of prostate cancer and the volume of prostate are influencing factors for hematuria.Use of acetylsalicylic acid and anticoagulant are risk factors for hematuria after biopsy.

BACKGROUND:There are so many studies about ovariectomized rats at present, but the research on the change rules of bone mass, bone turnover markers, estrogen levels and their correlation in different periods of ovariectomized rats is rarely reported. OBJECTIVE:To analyze the change rules of bone mass, bone turnover markers, estrogen level and their correlation in different periods of ovariectomized rats. METHODS: Thirty-four 3-month-old female Sprague Dawley rats were randomly divided into three groups: baseline group, ovariectomized group and sham operated group. At the beginning of the experiment, the rats in the baseline group were sacrificed, then rats in the ovariectomized group and sham operated group were executed at 4, 8, 12 weeks postoperative respectively. The bone mineral density, bone mass content, area of different zones of the L1-3 lumbar vertebrae and femurs were detected by dual-energy X-ray absorption method, and meanwhile the serum levels of type I procolagen amino-terminal pro-peptide, I colagen carboxy-terminal peptide and estrogen were determined by ELISA. At last, we analyzed the correlation between body mass, bone mineral densityin vitro, type I procolagen amino-terminal pro-peptide, I colagen carboxy-terminal peptide and estrogen levels and the age of ovariectomized rats. RESULTS AND CONCLUSION: (1) The bone mineral density and bone mass content of the lumbar vertebral and femurs in the ovariectomized group were significantly lower than those in the sham operated group and baseline group at the 4th week after operation (P < 0.05). The bone mineral density and bone mass content in the ovariectomized group were ameliorated obviously at the 8th and 12th weeks compared with those at the 4th week after operation (P < 0.05). The bone mass loss was highest in the L1 and intertrochanteric regions. (2) Serum levels of type I procolagen amino-terminal pro-peptide and I colagen carboxy-terminal peptide in the ovariectomized group were significantly higher than those in the baseline group and sham operated group at the 4th week after operation, but there was no difference at the 8th and 12th weeks. (3) The serum estrogen level in the ovariectomized group was prominently lower than that in the sham operated group and baseline group at the 8th and 12th weeks after operation (P < 0.01 at the 8th week,P < 0.05 at the 12th week). (4) The age was positively correlated with body mass and bone mineral density of the lumbar vertebrae and femursin vitro, while the serum levels of type I procolagen amino-terminal pro-peptide and I colagen carboxy-terminal peptide were negatively correlated with the bone mineral density of the lumbar vertebrae and femurs in vitro (P < 0.01). These results suggested that the bone mass of the lumbar vertebrae and femurs in ovariectomized rats was decreased rapidly firstly, and then rose slowly with time; the bone mass in the L1 and intertrochanteric regions lost seriously; the bone turnover markers showed a significant increase at the beginning of ovariectomy and reduced gradualy to normal condition, while the estrogen level was increased at the first month after ovariectomy and then decreased rapidly. In addition, the body mass, bone turnover markers and estrogen level were associated with the change of bone mass.

BACKGROUND: It is a hotspot that calcium phosphate and calcium sulphate as the main ingredients are combined with one or more other materials to improve or increase the performance of bone tissue engineering scaffolds. OBJECTIVE: To introduce the research advance of these two kinds of scaffolds in bone tissue engineering. METHODS: The articles related to the bone tissue engineering published during January 2000 to June 2015 were retrieved from CNKI and PubMed databases by computer. The key words were “bone tissue engineering, scaffold, calcium phosphate, calcium sulphate, vascularization” in Chinese and English, respectively. ESULTS AND CONCLUSION: Calcium phosphate and calcium sulfate are characterized as having good biocompatibility, biodegradability, osteoconductivity and complete bone substitutability. However, single use of calcium phosphate or calcium sulfate scaffold has certain disadvantages, both of which are difficult to ful y meet the requirements of the bone defect repair. Improvement can be acquired in the mechanical strength, injectability and biodegradability, as wel as drug-loading and pro-angiogenesis of the scaffold in combination with other materials. In the basal and clinical research, we should explore and develop ideal scaffolds in on the basis of therapeutic aim. However, most of the scaffold studies are stil at the extracorporeal and animal experiment stage, and the comparative studies on composite scaffolds and optimal proportion of those composite scaffolds stil need to be further investigated.

Objective To establish the three-dimensional (3D) finite element (FE) model of thoracolumbosacral T1-S spine based on the computed tomography (CT) images of patients with scoliosis and study its dynamic characteristics. Methods The established scoliotic model was validated by axial compression and shear loading, and the predicted responses were in good agreement with the experimental data. The modal and harmonic analyses were performed using the ABAQUS software, and during the harmonic analysis, the dynamic response of the model was collected at frequencies 5 Hz and 10 Hz. Results From the modal analysis, the first fourth-order modal was extracted. The first- and second-order resonant frequencies of the model were 1.097 Hz and 1.384 Hz, respectively, and the vibration mode was longitudinal bending and lateral bending, respectively. The distribution of the second- and third-order modal resonant frequencies were 5.688 Hz and 28.090 Hz, and the vibration mode was vertical vibration and twisting around the long axis, respectively. The peak amplitude in the harmonic analysis appeared near the modal frequencies, and the average amplitude of vertebral body of the lateral convex segment was larger than that of other segments of the scoliotic spine. Under the vibration frequencies of 5 Hz and 10 Hz, the stress inhomogeneously concentrated on the concave and convex sides of the segments of the vertebral deformity as well as on the intervertebral disc. Conclusions The segments of the spinal deformity in patients with scoliosis were the weak links of their spines and more vulnerable to damage in a vibrating environment. Patients with scoliosis should avoid a vibrating environment, particularly in a sensitive frequency range. The research outcomes provide methodological assistance and mechanical analysis references for the protection, rehabilitation treatment, and clinical pathological studies of patients with scoliosis.

The purpose of this study is to reveal the protective effect of rib cage on scoliotic spine by comparing the different effect of rib cage on the stability of normal spine and Lenke1 scoliotic spine. Firstly, according to X-ray computed tomography (CT) image data, four spinal finite element models (SFEMs), including normal spine without rib cage (N1), normal spine with normal rib cage (N2), scoliotic spine without rib cage (S1) and scoliotic spine with deformed rib cage (S2), from the first thoracic vertebrae to the sacral vertebrae (T1～S) were established. Secondly, the natural vibration characteristics of the four SFEMs were obtained by modal analysis. Finally, the maximum vibration amplitudes of the four SFEMs under external excitation were obtained by steady-state analysis. As shown in results, compared with N1, the maximum deformation of N2 segment T4～T6 in the -axis (coronal axis), -axis (sagittal axis) and -axis (vertical axis) directions decreases by 38.44%, 53.80% and 33.72%, respectively. Compared with S1, the maximum deformation of S2 segment T4～T6 in the -axis direction, -axis direction and -axis directions decreases by 44.26%, increases by 32.80% and decreases by 49.23%, respectively. As it can be seen, for normal spine, the rib cage can improve the stability of the whole spine in three directions; for the Lenke1 scoliotic spine, the rib cage can reduce the vibration of the scoliotic spine in the -axis and -axis directions and improves the stability of the whole spine in the two directions, while in the -axis direction, for the serious severe anteversion of scoliotic spine, the deformed rib cage exacerbates the vibration of the scoliotic spine in this direction and destroys the stability of the scoliotic spine in the -axis direction. This study reveals the biomechanical characteristics of rib caged influence on the stability of the scoliotic spine and it has guiding significance for the study of daily protection methods and protective tools for scoliotic patients.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Rib Cage ; Scoliosis ; physiopathology ; Spine ; Thoracic Vertebrae ; Tomography, X-Ray Computed ; Vibration