ObjectiveTo explore feasibility study of the Montreal cognitive assessment (MoCA) in detecting subcortcial vascular cognitive impairment-no dementia(VaCIND-S).MethodsSeventy-five Chinese Han were assessed by the MoCA and MMSE.40 met criteria for VaCIND -S and 35 were considered cognitively normal.ROC curve analyses were performed to determine optimal sensitivity and specificity.ResultsNo differences were found between groups on age,gender,education degrees.According to their MoCA scores,cognitive impairments including memory,visuospatial,executive function,attention,language,and orientation sub-scores in VaCIND-S ( (0.43 ± 1.01),(2.21 ± 1.19),(2.11 ± 1.13),(4.66 ± 1.48),(4.42 ±1.31),(4.86 ± 1.12)) significantly decreased compared with those in controls( (2.93 ± 1.36),(3.29 ± 1.06),(3.53 ±0.93),(5.94 ±0.24),(5.44 ± 0.71 ),(5.80 ± 0.48 ) ) (P ＜ 0.05 ).The MMSE scale was insensitive to cognitive impairment as compared with MoCA scale.Using cut-off score of 23.5,the MoCA exhibited excellent sensitivity (0.971 ) and specificity (0.789).ConclusionMoCA is a more sensitive instrument than the MMSE for the detection of VaCIND-S and warrants further investigation regarding its applicability in large and varying ethnic population.

Objective To investigate the expression and significance of Insulin like growth factor-ⅡmRNA binding protein3 (IMP3) in gastrointestinal stromal tumors (GIST). Methods One hundred and fifteen cases of GIST were subjected to immunohistochemical staining for IMP3 (SP method) and ki67 (iVisionTM method ). The relationship between IMP3 expression with clinicopathologic parameters and Ki67 proliferation indexes were analyzed. In situ hybridization detection of IMP3 mRNA was performed in 20 cases of GIST positive. Results The expression rate of IMP3 was 56.2%(65/115) in GIST positive. A significant correlation can be found between IMP3 expression and tumor of infiltration , coagulative necrosis , metastasis , nuclear atypia , diameter , mitotic count , risk grade of NIH (P < 0.05), while there was no significant correlation between IMP3 and gender, age, primary location, categories of cell type (P>0.05). There was positive correlation of IMP3 expression and Ki67 labeling indexes by Spearman analysis. Positive expression with IMP3 can be observed in 3 cases of recurrence.It may play important role in invasive and development and may be an important factor of prognosis in GIST.

OBJECTIVE To investigate the mechanisms for carbapenem resistance in clinical isolates of Pseudomonas aeruginosa from surgical intensive care unit(SICU).METHODS The minimal inhibitory concentrations(MICs) of various antibiotics were detected with agar dilution method;their ?-lactamases were extracted,types of their enzymes were identified and then their physical and chemical characteristics were studied by three dimentional extract test and isoelectric focusing(IEF) electropheresis;primers specific to IMP and VIM genes were utilized to amplify the metallo-?-lactamase genes.The levels of outer membrane protein OprD2 were measured by Western blot.RESULTS Forty one strains were resistant to imipenem from 49 strains of P.aeruginosa isolated from SICU during 3 years.Among them,34 isolates were found to produce high level of AmpC enzymes.Eight produced extended-spectrum ?-lactamases(ESBLs) at the same time.2 produced ESBLs only.No metallo-?-lactamases were detected.The activity of enzymes in the imipenem resistant group(74.32?53.42) was statistically different from the sensitive one(8.7?16.16,P

The expression of paired immunoglobulin-like receptor B (PirB) in normal and injured spinal cord of rats was investigated. The SD rat hemi-sectioned spinal cord injury (SCI) model was established. Before and 1, 3, 7, 10 days after SCI, the spinal cord tissues were harvested, and Western blot and immunohistochemistry were used to examine the expression and location of PirB. The results showed that the expression level of PirB in the normal spinal cord of SD rats was low. At the first day after SCI, the expression of PirB was obviously increased, and that in the injured spinal cord from the first day to the 10th day was significantly higher than in the normal spinal cord. The positive expression of PirB in neurons from different regions of gray matter of the injured spinal cord was seen. It was concluded that the expression of PirB in the normal spinal cord of rats was low. The expression of PirB in SCI was significantly increased till at least the 10th day.

Objective:To screen out the potential key genes of endotoxin tolerance (ET), and to provide theoretical and experimental evidence for treatment and prognosis of sepsis.Methods:①Experiment 1 (gene chip and bioinformatics analysis): ET related data set GSE47783 was downloaded from the Gene Expression Omnibus (GEO). The data set was obtained from lipopolysaccharide (LPS) stimulated mouse macrophages to establish sepsis model (LPS group) and ET model (ET group). IDEP 0.92 software was used to screen differential expressed gene (DEG) between the two groups, analyze gene ontology (GO), and locate the main functions and signaling pathways of differential genes. The protein-protein interaction (PPI) network of DEG was constructed by the Search Tool for the Retrieval of Interacting Genes Database (STRING) to screen core genes hepatitis A virus cell membrane protein receptor 2 (HAVCR2) for following up validation study. ②Experiment 2 (reproduction of mouse macrophage RAW264.7 model): RAW264.7 cells were cultured in vitro, the ET model (ET group, cells were cultured with 10 μg/L LPS for 24 hours and then with 100 μg/L LPS for 4 hours) and sepsis model (LPS group, cells were cultured with 100 μg/L LPS for 4 hours) were reproduced by LPS stimulation. Phosphate buffer saline (PBS) group was given equal volume of solvent PBS for 4 hours. The mRNA and protein expressions of HAVCR2 were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blotting. ③Experiment 3 (RAW264.7 cells transfected with HAVCR2 lentiviral vector): to further clarify whether HAVCR2 was involved in the formation of ET, after knockdown of HAVCR2 in RAW264.7 cells by lentiviral short hairpin RNA (shRNA) technology, the ET model (HAVCR2 --ET group) was constructed again, and the control group (ET group) without knockdown of HAVCR2 was set up. RT-qPCR method was used to detect the mRNA expressions of macrophage polarization key proteins [arginase 1 (ARG1), CD206, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), nitric oxide synthase 2 (NOS2)] in cells. Results:①Experiment 1: a total of 1 013 DEG were identified, compared with LPS group, 521 genes were up-regulated and 492 genes were down-regulated in ET group. The function of these DEG was to increase biosynthesis and reduce inflammatory reaction. Signal pathways were mainly enriched in Janus kinase/signal transducers and activators of transcription (JAK/STAT) , NOD like receptor, Toll-like receptor (TLR), TNF, hypoxia inducible factor-1 (HIF-1). The first up-regulated HAVCR2 in the ET group was selected as the target of the study. ②Experiment 2: the results of in vitro experiment showed that the mRNA expression of HAVCR2 after high-dose LPS stimulation was down-regulated as compared with PBS group, and the mRNA expression of HAVCR2 in ET group was significantly higher than that in LPS group (2 -ΔΔCT: 1.10±0.10 vs. 0.60±0.10, P < 0.05). The results of Western blotting were consistent with RT-qPCR results. ③Experiment 3: the mRNA expressions of ARG1 and CD206 in HAVCR2 --ET group were significantly lower than those in ET group [ARG1 mRNA (2 -ΔΔCT): 0.50±0.10 vs. 1.00±0.10, CD206 (2 -ΔΔCT): 0.73±0.10 vs. 1.00±0.10], and the mRNA expressions of TNF-α and IL-1β were significantly higher than those in ET group [TNF-α mRNA (2 -ΔΔCT): 2.20±0.10 vs. 1.00±0.10, IL-1β mRNA (2 -ΔΔCT): 9.00±0.10 vs. 1.00±0.10), with significant differences (all P < 0.05). There was no significant difference in the expression of NOS2 mRNA between the two groups. Conclusion:HAVCR2 is involved in the regulation of inflammatory factors downstream of sepsis and the formation of ET, which is expected to become a new therapeutic target of sepsis.

ObjectiveTo explore the effect of sustained spinal cord compression on spinal cord injury (SCI).MethodsTwenty four dogs underwent sustained spinal cord compression for 30 minutes (group A), 90 minutes (group B) and 180 min (group C) with a device designed by the authors for weight loading spinal compression, and anthor four dogs as the control group (group D) only underwent surgical operation without SCI. Cortex somatosensory evoked potentials (CSEP) were monitored during all the procedure of making model. The changes of pathologic histology, imaging and behavior examination of all animals were observed.ResultsThe lesion degrees gradually increased from group A to group C (P<0.01), and there was similar outcome in MRI imaging. The behavior improvement in group A was more significantly than that in groups B and C (P<0.05).ConclusionSustained spinal cord compression aggravates the extent of SCI process, and the decompression must be taken as soon as possible.

Objective:To compare the similarities and differences of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents by the empirical study .Methods:Based on the field research and secondary in -depth interviews to the related personnel in H County of Beijing .Re-sults:There had obvious difference of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents .Trust building mechanism between village doctors were mainly the trust of the similar social background , between the doctors in township health centers and city hospital were the trust based on reputation , institution-based trust , and relationship-based trust .Conclusion:The difference of re-gional and cultural between urban and rural areas ,the nature of medical institutions the relationship with doctors , reputation of medical institution and medical and health care system in urban and rural areas ,maybe the reasons that The difference of doctor -patient trust building mechanism between doctors in urban and rural areas .

Objective:To understand the current service capacity of village clinics in H District of Beijing, to find out the existing problems and deficiencies, and to provide the basis for the development of village health poli-cy. Methods:The census method was used to investigate all the village clinics in H District of Beijing, and 260 rural doctors were investigated. Purposive sampling method was used to select 3 townships in H District of Beijing and 6 villages in each township as the research field. Observation and in-depth interviews were used in this study, and the sample size was 18 rural doctors. Results: At present, the village clinic in H district of Beijing has the problems of low quality of personnel, lack of business premises, inadequate infrastructure, and poor service capaci-ty. Conclusion:In order to improve the service capacity of village clinic in H District of Beijing City, it is sugges-ted to establish human resources management system, improve the overall quality of rural doctors, manage systemat-ically and improve the level of resource allocation in village clinics.

Objective To investigate the feasibility and safety of transcatheter closure of coronary artery fistula (CAF)with Amplatzer vascular PlugⅡ(AVPⅡ)in pediatric patients.Methods Between June 2012 and October 2015,5 children aged 0.9 to 7.0 years old and weighted 10 to 21 kg with CAF were admitted to the Department of Pediatric Cardiology in Shandong Provincial Hospital Affiliated to Shandong University.Aortic root angiography was used first to confirm the origin,shape,branches,drainage and the diameter of the orifice of CAF by deploying the pigtail catheter.The AVPⅡwas retrogradely deployed into targeted artery through guiding catheter and aortic angiography was performed before releasing the plug.Results All the 5 children underwent transcatheter closure by AVPⅡsuccessful-ly.Two cases were involved with right coronary -right ventricular fistula,1 case of left anterior descending coronary -right ventricular fistula (residual fistula after surgical repair),and 1 case of left circumflex coronary -left atrial fistula. Four children had a single fistula,and 1 case had double fistulas.The diameter of the orifice ranged from 2.00 to 5.96 mm,and the selected occluders from 8 to 14 mm.The ratio of diameter of occluder to fistula orifice ranged from 2.3 to 3.4.All the patients were followed up for 4 to 44 months.Two patients developed instant minor and modera-te aortic re-gurgitation.No other complications such as thrombosis,embolization,residual shunt,arrhythmia,coronary dissection or perforation occurred.Conclusions Transcatheter closure of CAF by AVPⅡin pediatric patients is feasible and safe. Aortic regurgitation should be noted,especially during the procedure.

Objective To learn from various view points the team building of rural doctors in Beijing.Methods 84 village officials,rural doctors and villagers were enrolled from three townships in district H of Beijing,for an interview to learn the makeup and selection approach of rural doctors,and their recommendations on team building of these doctors.Results 76.19% of the interviewees prefer their own villagers as candidates for their rural doctor.Top three factors for their retention were their medical competence,geo-relations,and service attitude;60.71% of the interviewees held that the village committee should be the decision maker for appointment of rural doctors; in terms of team building,senior doctors emphasize retirement conditions,while new ones prefer training opportunities.Conclusions The topmost criterion for rural doctor candidates should be their medical competence,instead of sacrificing this criterion for geo-relations.The village committee and the villagers' congress should play a greater role of supervision and management of the rural doctors.Targeted incentives are recommended for the rural doctors in view of their retention.