Health management is the intrinsic requirement to build and embody a harmonious society. While health management provides strong human resources for the development of a harmonious society, a harmonious society promotes the health management. Health management plays a significant role in the construction and development of a harmonious society in terms of reducing risks to the health, improving the quality of life, lowering medical cost, lightening the socio-medical burden, enhancing awareness of health, improving the national health conditions, protecting health resources, and promoting a sustainable social development. Health is an important component of social productive forces, and health management is an essential prerequisite for the harmonious development of society. There would be no real harmonious society without effective health management.

Objective To discuss the value of tension-free hernia repair to recurrent inguinal hernia in elderly patients.Methods 38 eases with recurrent inguinal hernia in elderly patients were treated with shaped polyproplene tension-free hernioplasty.Results All eases were operated successfully.In the follow-up period ranged from 6 to 42 months.No Serious postoperation complications were found,no recurrent case recurred.This treatment is effective.Conclusion Tension-free hernia repair has many advantages,such as safety,easily manipulation,minimal invasion,rapid recovery,lower recurrence.It is a perfect and ideal surgical operation for the recurrent inguinal hernia in elderly patients.

Objective To discuss the diagnosis and treatment of primary adrenal lymphoma(PAL).Methods Two cases of PAL were retrospectively analyzed and the literature was reviewed.Results One patient received laparoscopic right adrenalectomy and was diagnosed as B cell Non Hodgkin's lymphoma by pathology.Immunohistochemical stains showed positive for CD20 (B cell originmarker) but negative for CD3.0ne cycle CHOP ( eyclophosphamide,doxorubicin,vincristine,andprednisone) chemotherapy was given post operation but the patient died three months after operationbecause of dyscrasia.Another patient received 2-stage bilateral laparoscopic adrenalectomy.Immuno histoehemical staining demonstrated positive CD3 (T cell origin marker) activity,but negative CD20 ac tivity and T cell Non l lodgkin's lymphoma was confirmed.Then the patient received four cyclesCHOP chemotherapy and was in good condition during S months follow up.Conclusions PAL is arare disease and has a poor prognosis.Most reported PAL patients who received only one therapeuticmodality have unsatisfactory survival rates.A combination of therapeutic modalities such as surgeryfollowed by chemotherapy and/or radiotherapy may improve prognosis for patients with PAL than sin gle modality therapy.

Objective To investigate the feasibihty and effectiveness of the fluorescence in situ hybridization(FISH)technique in the diagnosis of renal pelvic tumor.Methods FISH technique were used to detect the abnormalities of chromosome 3,7,17 and 9 p16 from 20 people without malignancy.The morning's first urine were availahled from 15 patients with hematuria and suspected of renal mass by imaging,then were studied by FISH technique and urine cytology respectively.The sample was considered positive if two or more probes results were higher than the criteria,or one probe had two or more abnormal results.Results Eight of 15 patients with hematuria were renal pelvic urothehal carcinoma,5 were renal clear cell carcinoma,1 was renal chromophobe cell carcinoma,1 was xanthogranulomatous pyelonephritis,confirmed by pathology.All of the 8 renal pelvic carcinoma were considered positive by FISH technique,while only 1 was considered positive by urine cytology.The variation rate of chromosome 3,7,17 were 100%(8/8)and chromosome 9 p16 was 75%(6/8).Six of 7 non-renal pelvic carcinoma were negative by FISH technique,but all Were negative by urine cytology.Conclusion FISH technique is a non-invasive and effective method for the diagnosis of renal pelvic tumor,and it's more sensitive than urine cytology.

The contents of cholesterol in a number of vegetable oils were determined by saponification-gas chromatography ( FID) . There was quite a large possibility that cholesterol peak was seriously interfered by saponification-gas chromatography ( FID) , so it was difficult to set a cholesterol content value to differentiate vegetable oil from waste oil. Solid phase extraction ( SPE) sample pretreatment was chosen and the process conditions were optimized. The optimal conditions were as follows:0. 25 g of oil samples, 20 mL of 0. 6%ethyl ether-hexane ( V/V) as eluent ( get rid of fatty acid glycerides) and 20 mL of 15% ethyl ether-hexane ( V/V) as eluent ( obtain cholesterol) . An obvious cholesterol-content-difference between vegetable oils and waste oils was found by SPE-GC. The detected cholesterol contents in 84 vegetable oil samples were all less than 50 μg/g and the contents of 11 waste oil samples among the 13 waste oils were greater than 50 μg/g. Therefore, cholesterol content in vegetable oil of more than 50 μg/g could be determined as suspected waste oil, not vice versa by SPE-GC. The correlation coefficient R2 was 0. 9999 in 0-760 mg/L concentration range, and the detection limit was 6. 0 μg/g. Relative standard deviations at two concentration levels of 17. 7 and 695 mg/L were 1. 6% and 1. 5% respectively. The recovery was 103%.

Objective To discuss the diagnosis and treatment of Cushing's disease without remission after transsphenoidal surgery.Methods 12 patients of Cushing's disease without remission after transsphenoidal surgery were investigated in this retrospective study.There were 2 males and 10 females with an average age of 36 (21-46) years old.Cushing's disease was diagnosed with the typical symptoms and signs of Cushing's syndrome,endocrinological examination and CT or MRI.Transsphenoidal surgery was performed in all patients.None of the patients achieved remission after operation.Serum and urinary free cortisol (UFC)were still elevated 3 months after operation.Subtotal adrenalectomy combined with pituitary radiotherapy were performed in 5 patients,single subtotal adrenalectomy in 4,pituitary radiotherapy in 2 and bilateral adrenalectomy with adrenal autotransplantation in 1 patient.Results Those receiving subtotal adrenalectomy combined with pituitary radiotherapy had no recurrence or Nelson's syndrome during 20 years of follow-up,but 4 patients receiving single subtotal adrenalectomy recurred after 2 to 9 years after operation.2 patients achieved remission with pituitary radiotherapy 1 to 2 years later without recurrence during 5 years of follow-up.One patient who underwent bilateral adrenalectomy with adrenal autotransplantation needed steroid replacement and Nelson's syndrome occurred during 2 years of follow-up because transplanted adrenal gland had no function.Conclusion The diagnosis of Cushing's disease should be reconfirmed for patients without remission after transsphenoidal surgery and the treatment should be individualized based on the results of operation,pathology and imaging.

Aim To investigate the effect of puerarin(Pue)on the experimental insulin resistance(IR)and the mechanism of Pue-treated metabolic syndrome(MS).Methods IR rat model was induced by i.v.small dosage streptozotocin(STZ)and high fatty diet.The effect of Pue on insulin sensitivity was studied by reformed hyperinsulinism euglycemia clamp technique(HEPC)on IR rats.Results The basic blood glucose(BBG),basic blood plasma insulin(BINS)and stable basic blood plasma insulin(SINS)of IR rats induced by high-fat feed were higher than those of control group,and those of the group treated by Pue were observably lower than those of IR model group.In HECT text,the average rate of glucose injection of IR model group was lower than that of control group from 60 min to 120 min,but the rate of high dose and middle dose of Pue group was significantly higher than that of IR model group.Conclusion The results suggest that Pue can improve the insulin sensitivity,and reduce basic blood glucose and blood plasma insulin of the experimental insulin resistance rats.

Objective To discuss the clinical feasibility and significance of retroperitoneal laparoscopic adrenalectomy for bilateral macronodular adrenal hyperplasia.Methods 9 patients with bilateral macronodular adrenal hyperplasia received retroperitoneal laparoscopic operations.5 cases had the typical clinical manif(e)stetions of Cushing's syndrome and 4 patients presented hypertension or diabetes mellitus without any sign of Cushing's syndrome.Body mass index was 18.8-31.2,with 25.0 as the average.Serum cortisol was 544-1746 nmol/L,with 984 nmol/L as the average.Urinary free cortisol (UFC) was 347-1989 nmol/24h with 1129 nmol/24h as the average.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.The size of the adrenal gland was 6 cm × 5 cm × 4 cm to 10 cm × 6 cm× 3 cm,with 8 cm× 5 cm × 4 cm as the average.Results One patient underwent retroperitoneal laparoscopic bilateral adrenalectomy with replantation of adrenal gland tissue in scrotum,1patient underwent right lateral adrenalectomy combined with left subtotal adrenalectomy,4 patients underwent right lateral adrenalectomy ( 1case was converted to open surgery due to hemorrhage),and 3 patients underwent left lateral adrenalectomy.The average operation duration was 116 min,ranging from 60 to 165 min.The estimated average intraoperative blood loss was 110 ml,ranging from 20 to 600 ml.No severe complications like injury in great vessels or organs happened during the operation.Pathological diagnosis showed nodular or adenomatoid hyperplasia of adrenal cortex.The average postoperative follow-up was 58 months,ranging from 12 to 84 months.Clinical symptoms of Cushing's syndrome disappeared after surgery in the 5 cases with typical clinical features of Cushing's syndrome.Body weight and blood glucose recovered to normal level for those 4 cases presenting body weight increasement,hypertension or diabetes mellitus.2 cases with right lateral adrenalectomy received left adrenalectomy 33 and 41months after the first operation due to recurrence of Cushing's syndrome.Conclusions Retroperitoneal laparoscopic adrenalectomy for bilateral macronodular adrenal hyperplasia is technically feasible in experienced hands. Unilateral adrenalectomy can relieve most of the Cushing's symptoms.Bilateral adrenalectomy or unilateral adrenalectomy combined with contralateral subtotal adrenalectomy can be performed if the symptoms are not improved or recurred after unilateral adrenalectomy.

Objective To construct a eukaryotic expression system of IFN-λ,examine the expression of IFN-λand evaluate its bio-functions including anti-proliferation and anti-viral activity.Methods The genes of human IFN-λ1 /2 (hIFN-λ1 /2)were cloned from the mRNA of poly I∶C treated HuH-7 cells.The PCR product was examined with DNA sequencing.The genes of IFN-λ1 /2 were sub-cloned into pcDNA3 vector.The correct insertion of the gene IFN-λ1 /2 was identified with enzyme digestion.The constructed pcDNA3-IFN-λ1 /2 plasmids were transfected into COS-7 cells and IFN-λ1 /2 protein was checked in the supernatant and lysis of transfected cells using Western blotting analysis.The human esophageal carcinoma YES5 and T.Tn cells were treated with the IFN-λ1 /2 from the transfected cells and the proliferation of carcinoma cells were measured with CCK-8 kit.In the treated carcinoma cells,the apoptosis and antivirus related molecules such as caspase-3,ISG15 and MxA was analyzed with Western blotting or Quantitative real time PCR.Results The sequence of hIFN-λ1 /2 fragment matched that of the gene bank and the gene of the cytokines was inserted into pcDNA3 vector correctly.With Western blotting analysis,IFN-λ1 /2 protein was detected in the pcDNA3-IFN-λ1 /2 transfected COS-7 cells.The IFN-λ1 /2 from the transfected COS-7 cells inhibited the growth of YES5 and T.Tn cells, activated apoptosis related caspase-3,and up-regulated the anti-virus gene expression of ISG15 and MxA.Conclusion COS-7 cells can express IFN-λ1 /2 after transfection with pcDNA3-IFN-λ1 /2,suggesting that eukaryotic expression system of IFN-λis established.IFN-λ1 /2 from the system can perform bio-functions,such as proliferation inhibition,apoptosis induction and anti-viral gene up-regulation,which indicates that the system can contribute to further investigations of IFN-λbio-activity and its clinical application.

Objective To investigate the roles of a epoprostenol(PGI2) analog (Iloprost) in regulating the differentiation of CD4+ T cells to Treg cells and the possible mechanism.Methods Naǐve CD4+ T cells were isolated from human peripheral blood samples by using the magnetic-activated cell sorting (MACS) and then cultured under Treg-polarizing condition.The percentages of Treg cells and the expression of Foxp3 at mRNA level were respectively measured by using flow cytometry and RT-PCR for evaluation the effects of Iloprost on the differentiation of CD4+ T cells to Treg cells.The cAMP accumulation assay was used to detect the level of intracellular cAMP.Flow cytometry analysis was performed to detect the phosphorylation of signal transducer and activator of transcription 5 (STAT5).Results lloprost decreased the percentage of Treg cells and inhibited the expression of Foxp3 at mRNA level in a dose dependent manner (P＜0.05).However,the inhibitory effects of Iloprost were weakened when IP receptors were blocked by IP antagonist (CAY10449).A six-fold increase in the levels of intracellular cAMP in Treg cells was induced by Iloprost (P＜0.05) and a similar effect could be achieved by using a cAMP agonist,db-cAMP (P＞0.05).H-89,a protein kinase A inhibitor,inhibited the Iloprost-induced expression of cAMP in Treg cells.Moreover,Iloprost inhibited the IL-2 mediated phosphorylation of STAT5 (P＜0.05) and a similar effect could be achieved by using db-cAMP (P＞0.05).The Iloprost-mediated down-regulation of pSTAT5 was blocked by using H-89.Conclusion PGI2 could activate the cAMP-PKA signaling pathway by binding to the IP receptor,resulting in inhibited phosphorylation of STAT5 and suppressed differentiation of naǐve CD4+ T cells to Treg cells.