The theory of multiple streams,a vehicle of public policy analysis in the West,was used to analyze the policy development at Beijing′s suburban village clinics.This approach can clarify the issue steams,policy streams,and political streams,as well as the links between them,as a reference for standardized and quickened development such clinics.

In the early 20th century,the term Nursing was introduced into China.In 1884,with the arrival of the first batch of missionary nurse,modern nursing initiated by Nightingale was introduced into China and greatly changed the way of care.The missionary nurses were full of enthusiasm for the spreading Gospel of Christ,the love for nursing care and the empathy for Chinese people;and encountered the lack of staff and material,the mis-understanding and resistance from the local people and other multiple tests.With the untiring effort of them and the trained local nurses,China had led the international care in nursing education and practice standard.Based on this,nursing in Shandong gradually rose and had an unprecedented development as a new medical subject.By clearing up and consulting Chinese and English historical materials,this paper reviewed the 60 years of the mission-ary nurses in China,saw the early development of nursing in our country from the budding and development of Shandong nursing and provided more insights for understanding and solving the complex problems contemporary Chinese nursing faces.

Objective To evaluate the sonographic features of testicular adrenal rests tumors in minor males. Methods The sonographic feature of pathologically or clinically confirmed testicular adrenal rests tumor in 13 minor males was retrospectively analyzed;we analyzed the number, morphology and size of affected testis; the involvement of testicular mediastinum; lesion location; the growth pattern, shape, boundaries, size, internal echo and blood supply of lesions. Results All of the 13 cases were bilateral and there were 26 lesions in all, 5 cases (5/13, 39%) had normal testicular size and morphology, testicular mediastinum were seen in 12 cases (12/13, 92%);26 (26/26, 100%) TARTs were all located near the testicular mediastinum or the testis hilar;21 (21/26, 81%) lesions had irregular shape while 5 (5/26, 19%) lesions were round;26 (26/26, 100%) lesions all had clear boundary but had no echo envelope;the lesion size was (1.5 ± 1.0) cm in average;13 (13/26 , 50%) lesions showed homogeneous hypoecho, 11 (11/26, 42%) lesions showed inhomogeneous hypoecho and 2 (2/26, 8%) lesions showed inhomogeneous isoecho; 19 (19/26,73%) lesions displayed rich blood supply and 7 (7/26, 27%) lesions displayed scarce blood supply. Conclusion The sonographic appearance of TART in minor males was characteristic, ultrasonography has important clinical value.

The performance appraisal (PA) system establishment in scientific research institutes on traditional Chi-nese medicine (TCM) plays an important role in the management of TCM research work, which can set up both well-defined guidance and favorable appraisal regimen for scientific researchers, so that leads to the accomplishment of the scientific objectives. However, current PA system establishment has fallen seriously behind the real demand in most TCM research institutes. As a result, there is a serious lack of a mature, efficient, standardized, propagable PA system in TCM research field. In this paper, we tried to discuss the current situation and key issues in building modern PA system in TCM research institutes. The PA system development in scientific research institutes on TCM was pointed out. The PA system should be based on existed referenced similar platforms, with full consideration on professional features and Chinese culture. The PA system establishment should be with most science, systematicness, objectivity, and guidance. The PA system should also be established to evaluate the scientific researchers equitably, guide the scientific trend, provide proper institute, and promote scientific research.

Objective To compare the expressions of Beclin 1 and its 11 interacting proteins in subcutaneous fat and visceral fat,and to observe the expressions of these genes in 3T3-L1 adipocytes differentiation process.Methods In 3T3-L1 adipocytes,cells were harvested at day 0,2,4,6,8 in differentiation process,and then proteins or mRNAs were obtained and followed with Western blot and realtime PCR.Mice tissue proteins or mRNAs were detected with Western blot and realtime PCR.Results In 3T3-L1 adipocytes differentiation process,expressions of LC3,Beclin 1,and TNFAIP3 continued to rise,expression of BIRC5 was high to low,FEZ1 continued at a low level.In mice,expressions of LC3,Beclin 1,YWHAQ,FEZI,BAD,WAC,TNFAIP3,and GOPC in visceral fat were significantly higher than those in subcutaneous fat,while expression of SLAMF1was higher in subcutaneous fat.Conclusion Autophagy plays an important role in 3T3-L1 differentiation process and may be tissue-specific in visceral fat and subcutaneous fat.

Dermatomyositis with malignancy is a subtype of dermatomyositis, and the concurrence of malignancy is a major factor for poor prognosis of dermatomyositis. Malignancy usually occurs within 1 year before or after the diagnosis of dermatomyositis. Compared with classic dermatomyositis, dermatomyositis with malignancy mostly occurs in patients aged>50 years, and is typically characterized by the heliotrope sign, skin necrosis and presence of myositis-specific antibodies such as anti-transcriptional intermediary factor-1γ and anti-nuclear matrix protein-2 antibodies, etc. Thorough screening for malignancy or close monitoring and follow-up are necessary in patients with dermatomyositis.

Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P<0.05). AT of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were (84.98±13.77) ms, (87.33±16.36) ms, (90.77±12.05) ms. AT of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were (78.23±21.24) ms, (82.31±18.24) ms, (84.29±23.01) ms. There was no statistically signiifcant difference between the two groups (t=1.696, 1.904, 1.835, all P>0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.901, P>0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.833, P>0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.

Objective:To investigate the number of necroptotic renal tubular epithelial cells in renal tissues of patients with chronic kidney disease (CKD) and the correlation with clinicopathologic parameters, and explore its role in the progression of the excessive loss of renal tubular cells and chronic kidney injury.Methods:Renal tissue samples from 60 patients (18-65 years old) with CKD proven by kidney biopsy in the First Affiliated Hospital of Hainan Medical University from June 2017 to June 2019 were collected. According to internationally accepted K/DOQI guidelines, the patients were divided into 1-4 stages of CKD, with 15 cases in each stage. The number of necroptotic renal tubular epithelial cells in patients with different stages of CKD was detected using receptor-interacting protein 3 (RIP3) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) fluorescent staining, and the expression of RIP3 and MLKL, marker protein of necroptosis, was detected by immunohistochemistry. Pearson correlation analysis was used to analyze the correlation between the percentage of necroptotic renal tubular epithelial cells and clinicopathologic parameters. In addition, the expression of angiotensinogen Ⅱ receptor (AT2R) in renal tissue and its correlation with the percentage of necroptotic renal tubular epithelial cells were analyzed.Results:With the development of CKD, the structural destruction of renal tubules in patients with CKD was gradually aggravated, and the renal tubules in the corresponding areas were atrophied, accompanied by worsening interstitial fibrosis. The adjacent renal tubules were focally dilated and numerous protein tubules were seen in the tubules. Importantly, renal tubular injury score in second and third stage of CKD was significantly higher than that in control group (both P<0.01). TUNEL+RIP3 immunofluorescence staining results showed that the percentage of TUNEL/RIP3 double positive renal tubular epithelial cells (necroptotic renal tubular epithelial cells) in renal tubules of the second and third stage of CKD was higher (all P<0.01). Immunohistochemical results showed that RIP3, MLKL and AT2R proteins were mainly expressed in cytoplasm of renal tubular epithelial cells, and the expression of RIP3, MLKL and AT2R in renal tubular epithelial cells was higher in the second and third stage of CKD patients (all P<0.05). Pearson correlation analysis showed that the percentage of necroptotic renal tubular epithelial cells was positively correlated with blood urea nitrogen ( r=0.514, P=0.003), serum creatinine ( r=0.507, P=0.019), serum cystatin C ( r=0.571, P=0.026), serum uric acid ( r=0.592, P=0.008), renal tubules injury score ( r=0.901, P<0.001), renal interstitial fibrosis index ( r=0.700, P=0.001) and the expression of AT2R protein in renal tissue ( r=0.715, P=0.001). Conclusions:As CKD progresses, necroptosis of renal tubular epithelial cells in CKD patients occurs. The necroptotic cell death may be an important factor leading to renal tubular epithelial cell excessive death and the progression of chronic kidney injury. Furthermore, necroptosis of renal tubular epithelial cells may be related to the high expression of AT2R in kidney tissue.

OBJECTIVETo construct and characterize the TGF-β1, induced epithelial-mesenchymal transition (EMT) model of keloid epithelial cells in vitro, and to investigate the expression of epithelial stem cells related surface markers in keloid epithelial cells during EMT induction.

METHODSThe epithelial cells from 3 keloid samples of ears were cultured in vitro and induced by transforming growth factor betal (TGF-β1, 1 ng/ml) for 5 days, which was the experimental group, the same cells untreated were considered as the negative control group. The expressions of EMT-associated markers and regulative genes were detected using immunofluorescence staining, real-time PCR and western blot analysis. Then the surface markers of epithelial stem cells were detected using real-time PCR. Statistical significance was determined using Independent-Samples t Test, a p value less than 0. 05 was considered statistically significant.

RESULTSThe mRNA expression of transcription factor snail2 and mesenchymal-specific marker vimentin increased significantly in TGF-β1, induced keloid epithelial cells (P < 0. 05), in which snail2 increasing from 0. 91 ± 0. 23 to 1. 69 ± 0. 10, and vimentin from 5. 86 ± 2. 07 to 24. 29 ± 5. 39. Whereas the mRNA expression of epithelial-specific marker E-cadherin decreased from 1. 06 ± 0. 19 to 0. 65 ± 0. 09. The mRNA expression of CD29 and Lgr6, two surface markers of epithelial stem cells, significantly increased after induction of the TGF-β1, (P < 0. 05), from 0. 55 ± 0. 14 and 1. 61 ± 0. 31 to 1. 19 ± 0. 12 and 3. 84 t 0. 62 respectively. In induced cells, the immunofluorescence results showed staining of E- cadherin became faint, but the number of positive staining cells of vimentin increased. Western blot confirmed the protein expression of E-cadherin weakened, and the vimentin and p-Smad3 enhanced (P < 0. 05).

CONCLUSIONSTGF-β1, initiated EMT in keloid epithelial cells by inducing the up-regulation of snail2, and TGF-β1,/Smad3 signaling pathway was involved in EMT. EMT could change the phenotype of epithelial stem cells in keloid.

Biomarkers ; metabolism ; Cadherins ; genetics ; metabolism ; Epithelial Cells ; drug effects ; physiology ; Epithelial-Mesenchymal Transition ; drug effects ; physiology ; Humans ; In Vitro Techniques ; Keloid ; pathology ; RNA, Messenger ; metabolism ; Signal Transduction ; Smad3 Protein ; genetics ; metabolism ; Snail Family Transcription Factors ; Transcription Factors ; genetics ; metabolism ; Transforming Growth Factor beta1 ; metabolism ; pharmacology ; Up-Regulation ; Vimentin ; genetics ; metabolism

Objective To assess the correlation and agreement of the mitral valve geometry parameters obtained by real-time three-dimensional transthoracic echocardiography ( RT-3D-TTE) and real-time three-dimensional transesophageal echocardiography ( RT-3D-TEE) . Methods RT-3D-TTE and RT-3D-TEE were performed on 29 healthy volunteers under conscious state and general anesthesia respectively . The mid-systole mitral valve parameters were analyzed by TomTec Imaging Systems . The repeatability test of the mitral valve parameters obtained by RT-3D-TTE was performed . The correlation and agreement of the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE were assessed , and then the differences of mitral valve parameters between the two methods were compared . The study was approved by the Shanxi Dayi Hospital Ethics Committee ( Approval no .YXLL-2015-040) . Results ① The mitral valve parameters obtained by RT-3D-TTE showed excellent intra- and interobserver reproducibility ,in intra-observer and inter-observer with ICC > 0 .8 for all the parameters ,and the Bland-Altman plots displayed the average differences of anterior-posterior ( AP) ,anterolateral-posteromedial ( ALPM ) ,annular circumference ( AC) ,three-dimensional annular area ( AA3D ) for intra- and interobserver were 0 .009 ± 0 .11 , - 0 .008 ± 0 .10 , - 0 .036 ± 0 .32 ,0 .030 ± 0 .36 in intra-observer and - 0 .018 ± 0 .09 ,0 .087 ± 0 .20 , - 0 .037 ± 0 .44 ,- 0 .016 ± 0 .62 in inter-observers ,respectively . ② There were close correlations ( r = 0 .566 - 0 .870 , P <0 .01) and good agreement ( ICC = 0 .719 - 0 .931 , P < 0 .01) between the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE . ③ The mitral valve parameters obtained by RT-3D-TTE were similar to those obtained by RT-3D-TEE .Among the parameters ,AP ,two-dimensional annular area ( AA 2D ) ,annular height ( AH) ,tenting volume ( TV) ,anterior leaflet length ( ALL) and posterior leaflet length ( PLL) had no statistically significant differences between the two methods ( P > 0 .05) . The rest of parameters including ALPM ,sphericity ( SPI) ,commissural diameter (CD) ,AC ,AA 3D ,nonplanarity angle ( NPA) ,tenting height ( T H) ,maximum annular displacement ( ADmax) and maximum annular displacement velocity ( ADVmax) had significant differences ( P < 0 .05) . Conclusions The mitral valve parameters obtained by RT-3D-TTE are highly reproducible and similar to those obtained by RT-3D-TEE ,and the two methods have close correlations and good agreement . Therefore ,RT-3D-TTE has higher potential clinical application value in the evaluation of mitral valve geometry .