To compare the performances of community family physicians in different patterns of chronic disease management.From June 2011 to April 2012,3 different models (A,B,C) of chronic disease management were employed for a total of 4972 patients.Statistics analyses were performed.The number of participants,session and average effective working time were different.In terms of standard management of hypertension,diabetic management rate and non on-site management rate,model C was superior to models A and B (P ＜ 0.01).And model A had the lowest rate of non on-site management (P ＜0.05).Though with each own advantage,three models are complementary.But model C reflects the residents' self-management concept of chronic disease.

Objective To investigate the effects of hippocampal?sparing intensity?modulated radiotherapy ( IMRT) on dose distribution of target volume and organs at risk ( OARs) in locally advanced nasopharyngeal carcinoma. Methods A retrospective dosimetric analysis was performed among 11 patients with locally advanced nasopharyngeal carcinoma. The MONACO ? v5. 10 Treatment Planning System was used to design three treatment plans:routine volumetric modulated arc therapy ( VMAT ) , hippocampal?sparing VMAT, and nine fixed?fields IMRT. The D98%, D50%, D2%, Dmean , conformity index ( CI ) , and homogeneity index (HI) of planning target volume (PTV) and PTVnx as well as dose distribution of the hippocampus and OARs were evaluated. Using single factor analysis of variance,two group comparative was LSD or paired t?test. Results For the above three plans,the D2% values of PTVnx were ,7 513,and 7 462 cGy,respectively (P=0. 016);the D98% values of PTV were 5837,5812,and 5914 cGy,respectively (P=0. 029);the average D2% values of PTV were 7 399,7 380,and 7 333 cGy,respectively ( P=0. 047);the HI values of PTV were 0. 239,0. 241,and 0. 220,respectively (P=0. 016);the V10 values of the brain stem were 97. 2%,88. 1%,and 90. 3%,respectively ( P=0. 001);the V20 values of the brain stem were 74. 2%, 62. 3%,and 67. 1%,respectively ( P=0. 032);the V30 values of the brain stem were 50. 9%,35. 8%,and 45. 5%, respectively ( P= 0. 020 );the V40 values of brain stem were 24. 4%, 14. 4%, and 23. 3%, respectively ( P=0. 018);the Dmean values of hippocampus were 1 518,899,and 896 cGy,respectively ( P=0. 000);the D40% values of hippocampus were 1 379,642,and 639 cGy,respectively ( P=0. 000);the V10 values of the hippocampus were 54. 1%,25. 1%,and 3. 8%,respectively ( P=0. 000);the V20 values of the hippocampus were 26. 2%, 12. 6%, and 12. 0%, respectively ( P=0. 001 ) . Conclusions Hippocampal?sparing VMAT and nine fixed?fields IMRT can significantly reduce the dose to the hippocampus without affecting dose distribution of target volume and OARs. VMAT may be superior to IMRT because VMAT can simultaneously reduce the dose to the brain stem.

Objective To explore the influence of DaHuang on renal expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in diabetes mellitus rats. Methods After the DM rat model was made, 24 DM rats were selected randomly and divided into a model group (12 DM rats) and a Rhubarb group group were given pure water in equal amount every day. 8 weeks later, kidney was cut to make pathological slice and method of SP immunohistochemistry was adopted for staining. Observed the expression of ICAM-1 and VCAM-1. Result The renal expression of ICAM-1 and VCAM-1 in the rhubarb group and the model group were obviously increased compared with the normal group (P<0.05). The renal expression of ICAM-1 and VCAM-1 in the rhubarb group was obviously weaker than the normal group(P<0.05). Conclusion Rhubarb could obviously inhibit the renal expression of ICAM-1 and VCAM-1 in diabetes mellitus rats and protect kidney of diabetes mellitus rats.

OBJECTIVE: To study the curative effect and prognosis of salvage surgery performed for recurrent laryngocarcinoma. METHOD: The clinical data of 43 patients with salvage surgery for recurrent laryngocarcinoma hospitalized in Nanfang Hospital between 2003 and 2011 were analyzed retrospectively. Survival analysis was performed by using Kaplan-Meier method and prognosis factors were analyzed by Log-rank test. RESULT: After salvage surgery, 10 (23.3%) patients developed postoperative complications. Pharyngocutaneous fistula and infection occurred in 8 (18.6%) patients. Kaplan-Meier analysis showed that patients survived for 3-year (n = 32) and 5-year 25) after salvage surgery were 56.3% and 32.0% respectively. Univariate analysis indicated that clinical stage in the first diagnosis was significantly correlated with 3 year overall survival (P < 10.05). Local recurrence of laryngeal cavity group and preservation of laryngeal function group had a good prognosis respectively, but no sig nificant difference between them. CONCLUSION Salvage surgery is a good choice for recurrent laryngeal carcinoma. Outcomes of these patients were correlated with clinical stages. Laryngeal function preserving surgery for local recurrent laryngeal carcinoma can achieve a expected curative effect and prognosis.
Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Prognosis ; Retrospective Studies ; Salvage Therapy ; Treatment Outcome

Objective To investigate the clinical efficacy of biological amniotic membrane for otoscpic repair of traumatic perforation of tympanic membrane. Methods Otoscpic repair was performed on the patients with tympanic membrane perforation which was not healed for 6 months. The efficacy was observed postoperatively. Results The success rate of the procedure was 97.37%, except that one patient was not healing by first intention due to wound infection. Conclusions Biological amniotic membrane is definitely efficacious in the surgical repair of perforation of tympanic membrane. Otoscpic sugical repair is less invassive and has a higher success rate.

OBJECTIVE: To evaluate the clinical value of heterogeneous acellular dermalmatrix with autologous bone meal in open tympanoplasty. METHOD: Twenty-eight cases (30 ears) with middle ear cholesteatoma were trea- ted by open tympanoplasty and repaired by heterogeneous acellular dermalmatrix autologous bone meal on study team. Twenty-two cases (22 ears) with middle ear cholesteatoma were treated by open tympanoplasty on control team. All patients were followed up for 12 to 18 months and assessed the fuction postoperatively. RESULT: The re- construction of external auditory canal structure is close to normal, and no narrow happens on study team. The rate of dry ear was about 90%. All cases had no recurrence of cholesteatoma. CONCLUSION Application of decellu- larized dermal matrix with autologous bone meal can rise early to cover the wound, promote wound healing and to reduce the external auditory canal, reduce the effect of granulation and scar formation. It is a kind of method of repair to be promoted.
Acellular Dermis ; Biological Products ; Cholesteatoma, Middle Ear ; surgery ; Cicatrix ; Ear Canal ; surgery ; Humans ; Minerals ; Postoperative Period ; Recurrence ; Tympanoplasty ; methods ; Wound Healing

Objective To investigate the feasibility of prophylactic cranial irradiation with hippocampal avoidance (HA-PCI) in non-small cell lung cancer (NSCLC).Methods The clinical data of 56 patients with brain metastases of NSCLC who were treated from 2011 to 2014 were collected.Brain metastases and the hippocampus were delineated on T1 W1 contrast-enhanced MRI,and the distance between brain metastases and the hippocampus was analyzed;an HA-PCI regimen was also developed,and the distribution of the metastases in planning target volume (PTV) low-dose regions around the hippocampus was analyzed.Results None of the 139 metastases involved the hippocampus.There were 6(4.3％) and 18 (12.9％) metastases within 5 mm and 10 mm,respectively,outside the hippocampus.In the HA-PCI regimen,the D50％ and D2％ of PTV were 25.6 Gy and 27.1 Gy,respectively.Dmean and D2％ for the hippocampus were 7.4 Gy and 9.9 Gy,respectively;D50％ within 0-5.0 mm,5.1-10.0 mm,and 10.1-15.0 mm outside the hippocampus was 10.3 Gy,15.1 Gy,and 20.5 Gy,respectively.Conclusions HA-PCI may be feasible theoretically,but this needs to be confirmed by the intracranial failure pattern in patients with long-term survival.

Reduced sulfur compounds ( RSCs) are one of the main pollutant species in the atmosphere, so it is of great significance to develop a rapid and on-line approaches for their detection. In this study, a portable time-of-flight mass spectrometer ( TOF-MS) with magnetic field enhanced photoelectron ionization source was designed to detect RSCs. The photoelectron ionization source was induced from vacuum ultraviolet photons which generated from vacuum ultraviolet (VUV) lamp with energy of 10. 6 eV. The energy of photoelectrons was controlled by adjusting the extraction voltage to produce the photoelectron ionization, and an annular magnet was used in the ionization region to improve the ionization efficiency of photoelectrons. From the simulation result by SIMION software, it was found that the introduction of magnet field made the motion trajectroies of electrons in the helical motion increase and the convergence of electron at the ionization source was achieved. Experimental results showed that after introducing the magnet filed, the sensitivity of H2 S, SO2 and CS2 was improved by a factor of 5. 3, 9. 4 and 6. 9, respectively. With a detection time of 50 s, the limits of detection for H2S, SO2 and CS2 were 0. 14, 0. 52 and 0. 31 mg/m3(S/N=3), respectively. It could be concluded that the portable TOF-MS with magnetic field enhanced photoelectron ionization source has great potential to be applied for on-line monitoring of volatile sulfides at the emission source.

OBJECTIVETo screen tumor biomarkers in the plasma close related with hypopharyngeal carcinoma.

METHODSPooled plasma from 6 patients with hypopharyngeal carcinoma and 6 healthy individuals were collected. After removal of high-abundance plasma proteins, two-dimensional gel electrophoresis (2-DE) was performed to isolate the total proteins, and the protein spots with more than 2-fold differential expressions were detected by 2D analysis software followed by identification by MALDI-TOF/TOF mass spectrometer. Western blotting was performed to validate the expression level of α2-HS-glycoprotein.

RESULTSA total of 11 differentially expressed protein spots were selected, including 5 upregulated proteins and 6 downregulated proteins. MALDI-TOF/TOF identified the upregulated proteins in hypopharyngeal carcinoma patients as alpha-2-HS-glycoprotein and haptoglobin and downregulated ones as Ig kappa chain C region and apolipoprotein A-I. Western blotting demonstrated that α-2-HS- glycoprotein expression level was consistent with that detected by 2-DE.

CONCLUSIONPatients with hypopharyngeal carcinoma show different plasma protein profiles from healthy individuals. These differentially expressed proteins may serve as potential specific tumor biomarkers for hypopharyngeal carcinoma.

Biomarkers, Tumor ; blood ; Blood Proteins ; metabolism ; Humans ; Hypopharyngeal Neoplasms ; blood ; Male ; Middle Aged ; Proteomics ; methods

OBJECTIVE: To analyze the imageology features of benign parapharyngeal space (PPS) tumors, and also to summarize our experience in removing PPS benign tumors through transoral approach. METHOD: A retrospective review was conducted to 48 patients with benign tumors in PPS during a 10-year period. CT were performed in all patients, and only a few required MRI. Transoral approach (33.3%) and transcervical (39.6%) were the most commonly performed surgical procedures followed by the transcervical-transparotid approach (27.1%). RESULT: CT scan and MRI often provided complementary information to help the surgeons delineate the size, precise location and likely cause of these tumors. After a follow-up of three years, only 2 of 48 patients had disease recurrence. The transoral approach described herein safely allowed for en bloc resection of most benign neoplasms. No significant complications attributed to the approach itself. CONCLUSION CT or MRI scan can distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures. The transoral approach safely provides access to some benign PPS tumors with a low rate of complications and recurrence as well as traditional transcervical approaches.
Adult ; Aged ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasms ; diagnosis ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Pharyngeal Neoplasms ; diagnosis ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult