Objective Through analyzing the status quo of mental health service in Hunan province in 2002 to put forward policy suggestions for health management department. Methods Applying descriptive methods to analyze the status quo of mental health service. Results Mental health resources in Hunan province was insufficient and the utilization of health resources was low. Conclusions Setting up mental health management section; Increasing the funds for health service; Strengthening the training of professionals; exploiting the service field of related specialities and developing community mental health.

Objective To investigate the therapeutic effect and possible mechanism of adenosine A2A receptor agonist (CGS21680) combined with bone marrow mesenchymal stem cells (BMMSC) transplantation in acute liver failure (ALF).Methods Fifty male C57BL/6 mice, 6-8 weeks old, were fed with standard diet for 1 week and randomly divided into 5 groups according to random number table: healthy control group (n=6), model group (n=11), BMMSC group (n=11), CGS21680/BMMSC group (n=11) and CGS21680 group (n=11).Except healthy control group, the other mice were injected with D-GalN and lipopolysaccharide (LPS) to establish ALF model.Ten hours later, CGS21680/BMMSC group and CGS21680 group were injected intraperitoneally with adenosine A2A receptor agonist CGS21680 (2.1 mg/kg).In addition, the BMMSC group and CGS21680/BMMSC group were injected BMMSC (1×10.6) through tail vein.After 24 hours, pathological changes of liver tissue was observed by hematoxylin and eosin staining.The change of proportion of mouse splenic Treg among CD4+T lymphocytes was detected by flow cytometry.Toll-like receptor (TLR)4 and nuclear factor (NF)-κB expression levels in liver tissue were detected by real-time fluorescence quantitative polymerase chain reaction (PCR) and Western blot.One-way analysis of variance (one-way ANOVA) and SNK-q test was conducted for data analysis.Results Serum IL-6 levels were (23.67±2.97) pg/mL in healthy control group, (151.47±6.03) pg/mL in model control group, (72.10±3.74) pg/mL in BMMSC group, (53.35±2.50) pg/mL in CGS21680/BMMSC group and (84.85±3.25) pg/mL in CGS21680 group.The differences between healthy control group and the other 4 groups were all statistically significant (t=46.02, 25.51, 19.58 and 34.03, respectively, all P<0.01).Serum TNF-ɑ levels were (24.62±3.19) pg/mL in healthy control group, (102.25±2.10) pg/mL in model control group, (54.71±2.23) pg/mL in BMMSC group, (42.20±4.72) pg/mL in CGS21680/BMMSC group and (81.76±3.50) pg/mL in CGS21680 group.The differences between healthy control group and the other 4 groups were all statistically significant (t=46.49, 19.97, 7.72 and 29.57, respectively, all P<0.01).The differences of spleen Treg proportion in healthy control group were statistically significant compared with model control group, BMMSC group, CGS21680/BMMSC group and CGS21680 group (t=51.67, 12.22, 5.91 and 18.21, respectively, all P<0.01).The differences of TLR4 mRNA levels of liver tissue in healthy control group were statistically significant compared with model control group, BMMSC group, CGS21680/BMMSC group and CGS21680 group (t=26.31, 21.33, 13.24 and 27.14, respectively, all P<0.05).The differences of NF-κB mRNA level of liver tissue in healthy control group were statistically significant compared with model control group, BMMSC group, CGS21680/BMMSC group and CGS21680 group (t=16.56, 16.34, 7.83 and 13.11, respectively, all P<0.05).The differences of TLR4 protein level in liver tissue of healthy control group were statistically significant compared with model control group, BMMSC group, CGS21680/BMMSC group and CGS21680 group (t=35.60, 10.38, 6.05 and 18.02, respectively, all P<0.05).The differences of liver NF-κB protein level in the healthy control group were statistically significant compared with model control group, BMMSC group, CGS21680/BMMSC group and CGS21680 group (t=10.80, 7.30, 4.61 and 13.24, respectively, all P<0.05).Conclusions Adenosine A2A receptor agonist combined with BMMSC can significantly up-regulate the proportion of Treg cells in acute liver failure mice and inhibit the TLR4/NF-κB pathway activation, with both coordinated regulation, and further inhibit the liver inflammation.

Objective To investigate the effects of bone marrow-derived stem cells (BMMSC)on the expressions of inflammatory cytokines and Toll-like receptor (TLR)4 pathway in primary hepatic stellate cells (HSC)with direct and indirect contact coculture system.Methods Purified HSC were separately treated with LPS in the concentrations of 0,50,100 and 150 g/L for 48 h.Proliferation ratio was tested with cell counting kit-8 to determine the optimal concentration.HSC in LPS were divided into three groups,including HSC alone group,cocultured with BMMSC at 1∶1 group and cocultured with transwell group at the optimal concentration.The supernatants were collected to detect the concentrations of interleukin-6 (IL-6)and tumor necrosis factor (TNF)-α.Cells were further divided into seven groups, including BMMSC without LPS group,HSC without LPS group,BMMSC with LPS group,HSC with LPS group,BMMSC in transwell system group,HSC in transwell system group,all cells in transwell system group and direct contact system group.The mRNA expressions ofα-smooth muscle actin (α-SMA) and collagen I were detected by quantitative real-time PCR,and protein expressions of TLR4,myeloid differentiation factor 88 (MyD88)and nuclear factor-κB (NF-κB)were analyzed by Western blot.Data were analyzed with one-way ANOVA analysis.Results The proliferation rate of HSC in 50,100 and 150μg/L LPS were (129.77±11 .26)%,(162.90±13.15 )% and (55 .12 ±11 .6)%,respectively compared with HSC without LPS group.The differences were statistically significant (t =5 .91 ,10.70 and 8.65 , respectively,all P <0.05).The concentrations of IL-6 and TNF-αin HSC alone group,directly/indirectly cocultured group were (252.02 ±30.94)ng/L and (148.00 ± 10.27 )ng/L,(88.52 ±6.61 )g/L and (72.63±5 .54)ng/L,(103.74±7.14)ng/L and (81 .79 ±6.92 )ng/L,respectively.The differences between HSC alone group and directly/indirectly cocultured group were significant (t=12.66 and 15 .82, 11 .81 and 12.34,respectively,all P < 0.05 ).The directly and indirectly cocultured groups were significantly different (t=3.83 and 2.53,respectively,both P <0.05 ).The mRNA expressions of α-SMA and collagen I in HSC with LPS were remarkably increased compared with HSC without LPS (t =14.16 and 11 .84,respectively,both P <0.05 )and reversed by cocultured with BMMSC (t =11 .98 and 4.47,respectively,P <0.05).All cells in transwell group expressed moreα-SMA and collagen I than the direct contact group (t=3.70 and 3.19,respectively,P <0.05 ).The TLR pathway associated protein expressions,TLR4,MyD88,and NF-κB in HSC in transwell group were significantly down-regulated compared with HSC with LPS group.And all cells in transwell system had higher level of protein expressions compared with direct contact system (P < 0.05 ).Conclusions BMMSC are effective in inhibiting HSC activation and inflammatory cytokines excretion,which may be modulated through TLR4 pathway and cell to cell contact.

Objective To investigate the clinical effects of different urinary diversion regimens after minimally invasive resection of bladder cancer. Methods 127 patients with muscular infiltrating bladder cancer from January 2010 to June 2015 were enrolled in this study. According to the patients' condition, they were divided into orthotopic ileal cystectomy group (58 cases), Bricker bladder surgery group (33 cases), ureteral skin ostomy group (36 cases), then compare the clinical data, postoperative complications and quality of life of the three groups. Results There was no significant difference in the ratio of sex, the distribution of age and tumor staging among the three groups. The operation time and postoperative hospital stay in orthotopic ileal cystectomy group were longer than those in the other two groups. The operation time and postoperative hospital stay of the Bricker bladder surgery group were longer than that in ureteral skin ostomy group, the difference was statistically significant; the bleeding in orthotopic ileal cystectomy group was more than the other two groups, and in Bricker bladder surgery group was more than ureteral skin ostomy group, the difference was statistically significant. There was no significant difference in the recovery time of intestinal function among the three groups. The recovery time of intestinal function in ureteral skin ostomy group was shorter than that in the other two groups, the difference was statistically significant. There was no significant difference in the incidence of short-term complications of the three groups of patients. The incidence of long-term complications of orthotopic ileal cystectomy group was significantly higher than the other two groups, the difference was statistically significant. The social function scores, and overall health score of orthotopic ileal cystectomy group were higher than the other two groups, the difference was statistically significance. Conclusion Without external device, closer to the characteristics of physiological urination, orthotopic ileal cystectomy holds higher postoperative quality of life, and higher incidence of long-term complications. With advantages of quick recovery and less complications, ureteral skin ostomy is best for patients who can not stand for long time surgery. It should choose the appropriate surgical approach for patients according to individuals' conditions.

OBJECTIVETo investigate the drug-resistant genes at hepatitis B virus (HBV) polymerase region during entecavir (ETV) treatment.

METHODSSerum samples from chronic hepatitis B patients with virologic breakthrough during enticavir therapy were studied. The resistant mutation patterns in the polymerase gene of hepatitis B virus were analyzed using the polymerase chain reaction (PCR)-sequencing method.

RESULTSETV resistance was detected from 19 out of 29 ETV-refractory patients, among whom 16 (84.2%) had a history of lamivudine-refractory. The mutation patterns were diverse, while rtL180 + rtM204 + rtT184 (58.6%, 17/29) was most common in patients with ETV genotype resistance. Four of 7 patients (7/29, 24.1%) with genotype B were detected to have ETV genotype resistance, while 15 of 22 patients (22/29, 75.9%) with genotype C were detected to have ETV genotype resistance. The rate of ETV genotype resistance was 57.1% (4/7) and 68.2% (15/22) in patients with genotype B and genotype C,while no statistical difference was found(P = 0.665).

CONCLUSIONSETV genotype resistance is more common in patients who have been refractory to ETV and lamivudine sequential treatment. rtM204+rtL180+rtT184 mutation is common in genotype B and C ETV resistance patients.

Adult ; Antiviral Agents ; therapeutic use ; DNA, Viral ; blood ; genetics ; DNA-Directed DNA Polymerase ; genetics ; Drug Resistance, Viral ; genetics ; Female ; Guanine ; analogs & derivatives ; therapeutic use ; Hepatitis B virus ; enzymology ; genetics ; Hepatitis B, Chronic ; drug therapy ; virology ; Humans ; Male ; Middle Aged ; Mutation ; Viral Proteins ; genetics ; Young Adult

BACKGROUNDIn qualitative diagnosis of bile duct stenosis, single diagnostic measure is difficult to make a correct diagnosis, to combine several diagnostic techniques may be helpful to make an accurate diagnosis. The aim of this study was to evaluate the value of intraductal ultrasonography (IDUS), endoscopic brush cytology and K-ras, P53 gene mutation in the early diagnosis of malignant biliary stricture.

METHODSFrom February 2012 to February 2013, 84 patients with suspected malignant biliary stricture were performed IDUS firstly, then endoscopic brush cytology and finally K-ras, P53 gene mutation detection, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of all above ways were evaluated and compared.

RESULTSOf 84 patients, 52 cases were ultimately diagnosed malignant biliary stenosis; of which, 9 cases had no recurrence or metastasis to other organs after radical operation during the follow-up period. IDUS combined with brush cytology and K-ras + P53 gene mutation detection had obvious advantage in the sensitivity, accuracy and negative predictive value than any other joint detection and single detection (the advantage was more significant compared with IDUS + brush cytology or any single detection P < 0.01). There were obvious statistical significance in the sensitivity and accuracy between IDUS + brush cytology + P53 or IDUS + brush cytology + K-ras and IDUS + brush cytology or IDUS (P < 0.05). There was no statistical significance in the sensitivity, specificity, positive predictive value, negative predictive value and accuracy between IDUS + brush cytology + P53 and IDUS + brush cytology + K-ras (P > 0.05).

CONCLUSIONSIDUS combined with brush cytology and K-ras, P53 gene mutation detection is better than the separate detection and contribute to the early diagnosis of malignant biliary stricture. Its more widespread use is recommended.

Aged ; Aged, 80 and over ; Bile Duct Diseases ; diagnosis ; genetics ; Bile Duct Neoplasms ; diagnosis ; genetics ; Bile Ducts ; pathology ; Constriction, Pathologic ; diagnosis ; genetics ; Female ; Genes, p53 ; genetics ; Genes, ras ; genetics ; Humans ; Male ; Middle Aged ; Mutation

Objective: To explore the related factors of myopia among children and adolescents in Yunnan Province, and to predict and evaluate the influencing factors, so as to provide a scientific theoretical basis for the prevention and control of myopia. Methods: From March 9 to 14, 2023, 848 students from 6 primary and secondary schools in Dali and Lijiang of Yunnan Province were selected by multi stage stratified random cluster sampling method for visual acuity detection and questionnaire survey on myopia related factors. Multivariate Logistic regression analysis was used to establish a Nomogram prediction model for the selected influencing factors. Results: The overall myopia rate of the respondents was 68.3%, the myopia rate of boys (63.4%) was lower than that of girls (72.9%), and the myopia rate of primary school students (46.7%) was lower than that of junior high school students (81.1%), and the difference was statistically significant（ χ 2=8.71, 108.07, P <0.05). Daily eye exercises, activities outside the teaching building during recess, having daily sleep time of 7-9 and >9 h, having both parents without myopia were negatively correlated with the occurrence of myopia in children and adolescents in Yunnan Province ( OR=0.64, 0.63, 0.56, 0.28, 0.48, P < 0.05 ). The reading and writing time after school ≥3 h per day and parents unrestricted time to play video games were positively correlated with myopia ( OR=1.94, 1.78, P <0.05). Based on the influencing factors, a Nomogram prediction model was established to quantitatively evaluate the risk of myopia. The results showed that greater risk for myopia was associated with sleep duration, parental history of myopia, and the time spent reading and writing after school every day. Conclusion Both genetic factors and environmental factors are related to myopia in children and adolescents. The prediction model of nomogram is beneficial for screening high risk factors of myopia and taking corresponding prevention and treatment measures.

Objective: To explore the pattern of change of axial length/curvatrue radius ratio (AL/CR) and associated factors in primary and secondary school students in Yunnan, so as to provide scientific basis and prospective guidance for early myopia intervention and control. Methods: A total of 685 students from grades 2 to 3 and grade 7 in 2 cities/counties in Yunnan Province were selected by multi stage stratified random cluster sampling method in 2020. All the participants were followed up twice with questionnaire of myopia related factors, uncorrected distance visual acuity, and refractive parameter measurement from October,2021 and March,2023,respectivelty. The distribution and change of AL/CR in different classes and groups were analyzed, and the influencing factos of AL/CR cumulative progression were explored using generalized linear model. Results: AL/CR ratio in primary school students was (2.95±0.09) at baseline, increased to (2.99±0.11) at the first follow up and (3.04±0.12) at the second follow up. AL/CR ratio in middle school students(3.08±0.13) at baseline, increased to (3.12±0.15) at the first follow up and (3.15±0.14) at the second follow up. The generalized linear model showed that after controlling for environmental factors, ethnicity ( β =-0.017) , cumulative progression of the SE ( β =-0.027) influenced the changes of AL/CR ratio among the primary school students, whereas the changes of AL/CR ratio were associated with baseline AL ( β =-0.005), baseline corneal curvatrue radius ( β =0.032) and cumulative progression of SE( β =-0.035) among middle school students ( P <0.05). Conclusions The AL/CR ratio of primary and secondary school students in Yunnan can be used to judge different refractive status types, but its variation is not only related to SE progression, but also affected by different ethnic groups and baseline ocular biological parameters. so the value of AL/CR application in assessing the progression of myopia needs to be further confirmed.

Objective To survey on training for general practice backbone mentors in tertiary hospitals of Hebei province.Methods A questionnaire survey on training status was conducted among general practice backbone mentors in tertiary hospitals of Hebei Province.The survey items included the basic information,knowledge of general practice and its training,suggestions for mentors training and general practice discipline construction in tertiary hospitals.Results Total 208 questionnaires were distributed and 208 were retrieved with a recovery rate of 100％.Among 208 participants,all of them were over the age of 30;202 (97.1％) had bachelor degree or above;202 (97.1％) were attending doctors or above;165 (79.3％) had worked for more than 10 years;169 (81.3％) had no or little knowledge of general practice;159 (76.4％)had not received general practice training before;124 (59.6％) thought that general practitioners were not qualified as "gatekeeper" at present;and 192 (92.3％) worked in the hospitals providing standardized residency training.The training contents in general section were prioritized as clinical skills,community health service development and policy,rules for general practice standardized training,theoretical training,the present situation and countermeasure of general teaching,the doctor-patient relationship and medical ethics.The contents in training method section were prioritized as lecture series of clinical medicine,case discussion,seminar,distance education with classroom teaching.The suggestions for mentors training included:the exploration of standardized training model,perfecting continuing education system for general practice mentors,more attention to the training at community health service centers and the consummation of general practice system.The suggestions for general practice discipline construction were that more attentions should be paid by the government and the hospitals leaders,the general practice departments in tertiary hospitals should closely cooperate with community health service centers in training ofqualified general practitioners.Conclusions The specialists in tertiary hospitals of Hebei province do not have enough knowledge about general practice and do not quite understand the necessity of establishment of general practice department,so the training for general practice mentors should be strengthened and improved.Properly policy and more social resources from the government and the hospitals leaders will be helpful for construction of general practice discipline in general hospital.

Objective To investigate the effects of curcumin derivatives (C66) on proliferation and expressions of α-smooth muscle (α SMA) and Collagen Ⅰ in rat hepatic stellate cells (HSC) induced by transforming growth factor-β (TGF-β) in vitro and the relationship with cannabinoid receptor type 1 (CB1).Methods To determine the optimum time and concentration of C66,HSC-T6 cell line was cultured in vitro and divided into control group and groups with different doses of C66 (1 μmol/L,2 μmol/L,5 μmol/L,10 μmol/L,20 μmol/L).Cell proliferation was detected by Cell Counting Kit-8 assay.Then,according to the time and concentration of C66 above,cells were divided into 5 groups including control group,TGF-β only group,TGF-β combined with CB1 antagonist group,TGF-β combined with C66 group and TGF β combined with CB1 antagonist plus C66 group.Quantitative realtime polymerase chain reaction and western blot were used to assess the expressions of α SMA,Collagen Ⅰ,CB1,JNK and phosphorylation of JNK (p-JNK).The variance homogeneity of multiple samples was compared by LSD method.The variance was compared with Dunnett T3 test.One-way analysis of variance was performed to compare the mean values among the groups.Results The inhibitory effect of C66 on HSC-T6 proliferation was dose and time dependent.The optimum time and concentration were 48h and 10 μmol/L,respectively,with the inhibition rate of 54％.Compared with control group,expressions of α-SMA,collagen Ⅰ and CB1 were significantly elevated in TGF-β group (t=6.188,3.48 and 20.64,respectively,all P＜0.05).TGF-β1 could increase the relative mRNA expressions of CB1,collagen Ⅰ and α-SMA with significant differences (t =4.705,9.492 and 38.27,respectively,all P＜ 0.05).Compared with control group,p-JNK expression was significantly elevated in TGF-β group (t=9.567,P＜0.05).Conclusions C66 could inhibit the proliferation and collagen synthesis in HSC-T6 induced by TGF-β and the effect is strengthened when combined with CB1 antagonist,which may involve JNK phosphorylation.Our study provides a better understanding on the mechanism and a new target for treatment of liver fibrosis.