Objective: To analyze the cluster effect of urban health care expenditure and the impact of carbon emissions. Methods:Calculating spatial correlation Moran index and building spatial panel econometric model. Results: There are significant spillover effects of health care expenditure from 2007 and 2010; per capita carbon emissions, per capita income and age structure significantly affect health care expenditure. Conclusions:It is needed to pay more attention to environmental protection.

To study on the association between the different levels of C-peptide of type 2 diabetes and colorectal adenoma and cancer risk.We detected the concentration of serum C-peptide in 45 type 2 diabetes who were diagnosed as colorectal adenoma and cancer.It showed that serum C-peptide level was higher in type 2 diabetes with colorectal adenomas and cancer than without colorectal adenomas and cancer.The serum C-peptide level may have relationship with colorectal adenomas and cancer.

Objective:To report the diagnosis and surgical treatment of a special type of Maisonneuve injury.Methods:A total of 4 patients were treated at Department of Orthopaedics, Beijing Chao Yang Hospital from January 2015 to July 2019 for Maisonneuve injury. They were 3 males and one female, aged from 34 to 61 years (average, 45.3 years). All injuries were closed, initially manifested as posterior dislocation of the ankle on X-ray films and X-ray and CT re-exams after manual reduction showed fine reduction with no obvious fracture of the ankle joint. Consequently the diagnosis of their Maisonneuve injury was missed in emergency visits, but re-exams in outpatient visits showed separation of distal tibiofibular syndesmosis. All the patients were treated by restoration of the fibular length, fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate functional recovery of the ankle joint at 12 months after operation.Results:All the 4 patients were followed up for 12 to 14 months (average, 12.7 months). The fractures united after 110 to 185 days (average, 149.3 days). No post-operative complications like infection, delayed union or nonunion were observed. The AOFAS score at 12 months ranged from 82 to 96 points (average, 90.5 points), giving 3 excellent and one good cases.Conclusions:The Maisonneuve injury which is clinically manifested as posterior dislocation of the ankle with no obvious fracture of the ankle joint is likely to be missed in clinical diagnosis. Therefore, X-ray exam of the full length tibia and fibula should be taken in physical examination after reduction for the patients with simple posterior dislocation of the ankle. Once the special type of Maisonneuve injury is diagnosed, surgical treatment is indicated. Satisfactory treatment efficacy can be achieved by fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament.

Objective To investigate the prevalence rate of nosocomial infections and the use of antibacterial agents in Zhejiang Cancer Hospital.Methods The cross-sectional survey on nosocomial infections was conducted among inpatients in Zhejiang Cancer Hospital on August 11,2011 and June 19,2012.The differences in prevalence rates of nosocomial infections,purposes of antibacterial agents use (for treatment,for prevention,or for both treatment and prevention),methods of medication (single or combined medication),and pathogen detections between 2011 and 2012 were analyzed with x2 test.Results There were 854 and 886 patients enrolled in the study in 2011 and 2012,and the prevalence rates of nosocomial infections were 5.27％ (45/854) and 5.08％ (45/886),respectively (x2 =0.186,P ＞ 0.05).Lower respiratory tract infection was the most common nosocomial infections both in 2011 and 2012,which accounted for 28.89％ and 36.96％ of all infections,respectively; and there was no significant difference in infection sites between 2011 and 2012 (x2 =1.415,P＞0.05).Totally 154 out of 854 patients (18.03％)in 2011 and 186 out of 886 patients (20.99％) in 2012 received antibacterial agents,and single medication was the most common.There were no significant differences in the purposes and methods of medication between 2011 and 2012 (x2 =1.994 and 3.042,P ＞ 0.05).Pathogen detections were performed in 56 out of 59 patients (94.92％) and 57 out of 65 patients (87.69％) who received antibacterial agents for treatment in 2011 and 2012,respectively.The most common pathogens were Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumanni.Conclusion The prevalence rate of nosocomial infection in Zhejiang Cancer Hospital is of the satisfactory level,which is due to the good management of antibacterial agents use.

Objective To evaluate the early diagnosis value of MRI combined with DSA in cirrhotic nodules (regenerative nodules, dysplastic nodules) becoming small hepatocellular carcinoma. Methods 40 patients diagnosed as cirrhosis and whose liver nodules detected by ultrasound were followed up as MR dynamic study. All patients were followed up by three dynamic contrast-enhanced MR scanning once every 3 months,and the changes of cirrhotic nodules were observed and analyzed in the signal. If MRI suggested cancerous nodules cirrhosis, hepatic artery DSA would be carried out. Results 40 patients were followed up for 1.5 to 3 years,all patients MR nodules were found in liver regeneration. Follow-up process, the dysplastic nodules were founded in 28 cases and the small hepatocellular carcinoma were founded in 18 patients. 16 cases of 18 patients with small hepatocellular carcinoma carried out routine DSA all had typical of hepatic arterial blood supply and angiogenesis, and were given to Integrated Traditional and Western intervention simultaneously. Conclusion Combined use of MRI-DSA in the evaluation of cirrhotic nodules had a definite value, and could find smaller hepatocellular carcinoma,provide the basis for smaller hepatocellular carcinoma therapy.

Background and purpose:Cytotoxic T lymphocyte (CTL) plays a vital role in the process of anti-tumor immunology. The aim of this study was to investigate whether changes in concentration of IL-2 (50, 200 and 1 000 U/mL) would affect the sub-population and cytotoxic function of cells cultivated by peptide-specific CTL induction systemin vitro and also observe whether using the concentration of IL-2 at a range of 50-1 000 U/mL isbeneifcial to regulatory cells (Tregs) enrichment.Methods:Peripheral blood from 10 healthy donors and 10 cancer patients that were HLA-A2 positive, were collected in the study. HLA-A2 restricted CTL epitope P321 (ILIGETIKI) derived from COX-2 pulsed with different concentrations of IL-2 were used to induce peptides-speciifc CTLin vitro. Flow cytometry was performed to analyze the proliferative capability, the proportion of different T-cell subsets, and secretion of perforin, granzyme B and IFN-γ. IFN-γ secretion was assessed by ELISpot assay.Results:High concentration of IL-2 increased the proliferative activity. The percentage of CD4+ T cells of cancer patient group was signiifcantly higher than that of healthy donor group, while the percentage of CD8+ T cells of cancer patient group was signiifcantly lower than that of healthy donor group. And there was no signiifcant difference in the percentages of CD4+ T cells, CD8+ T cells and Tregs among groups with different IL-2 concentrations. No difference was seen in cytokine (perforin, granzyme B, IFN-γ) secretion capacity of CD8+ T cells. ELISpot study revealed that high-dose IL-2 resulted in the increasing of IFN-γ secretion.Conclusion:The sub-population and the function of cells cultured by peptide-speciifc CTL induction systemin vitro are not affected by different concentrations of IL-2. Furthermore, high concentrations of IL-2 (50-1 000 U/mL) do not provide the enrichment for Tregs. Higher concentration of IL-2 is likely to cause high secretion of IFN-γ in ELISpot assay. In order to exclude the distraction of NK cells or NKT cells, the concentration of 50 U/mL is better choice.

BACKGROUND:At present, the internal fixation and fusion surgical treatment of lumbar degenerative disease tends to diversify, but posterior lumbar interbody fusion within a single bilateral pedicle screw fixation is stil common in clinical practice; the two ways after treatment can achieve satisfactory clinical efficacy, but which way has advantages is stil controversial. OBJECTIVE:To evaluate the efficacy and safety of unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the repair of lumbar degenerative disease by a meta-analysis system. METHODS: According to the Cochrane Colaboration search strategy, we searched MEDLINE, PubMed, EMBASE, CBMdisc, CNKI, VIP and WanFang Data. Randomized controled trials concerned unilateral and bilateral pedicle screw fixation and single segment lumbar interbody fusion in the treatment of lumbar degenerative diseases. By two reviewers, in strict accordance with inclusion and exclusion criteria, literatures were screened, data were extracted, and the methodology quality of included trials was criticaly assessed. RevMan5.1 software was used for meta-analysis. RESULTS AND CONCLUSION: Six randomized controled trials involving 507 patients were included. The results of meta-analysis showed that fixed unilateral and bilateral pedicle screw between single lumbar fusion and surgery in the treatment of lumbar degenerative diseases, significant differences were detected in surgical time [WMD=-40.29, 95% CI (-43.79, -36.79)], intraoperative blood loss [WMD=-74.13, 95%CI (-86.13,-62.13)], length of hospital stay [WMD=-1.04, 95%CI (-1.30,-0.79)], final folow-up Visual Analogue Scale score [WMD=0.33, 95% CI (0.24, 0.42)], final folow-up Oswestry dysfunction index [WMD=-1.07, 95%CI(-1.57, -0.56)]; unilateral side was better than bilateral side (P < 0.000 1). There was no significant difference in complication rate [RR=0.54, 95% CI(0.25, 1.17)] and fusion rate [RR=0.53, 95%CI (0.22, 1.28)] (P=0.12 andP=0.16). These results suggested that unilateral and bilateral pedicle screw fixation and single lumbar fusion in the treatment of lumbar degenerative disease has achieved satisfactory results. Unilateral pedicle screw fixation can reduce operation time, intraoperative blood loss and length of stay. Visual Analogue Scale score and Oswestry dysfunction index improved significantly in a short period after treatment.

Objective To investigate the effect of radiation on the expressions of RANKL and OPG in osteoblasts in order to disclose the molecular mechanism of bone injury induced by ionizing radiation.Methods The osteoblasts were differentiated from MC3T3-E1 cells.After 2 or 4 Gy137 Cs γ-irradiation,the mRNA and protein expression levels of RANKL and OPG of osteoblast precursor and osteoblast were detected by real-time PCR and Western blot.Results The expressions of RANKL mRNA (t=5.41,P＜0.05)and protein(t=68.37,P＜0.01)were up-regulated after 4 Gy irradiation,while the expressions of OPG mRNA(t=5.20,7.02,P＜0.05)and protein(t=7.78,9.45,P＜0.05)were down-regulated after 2 and 4 Gy irradiation.Conclusions 2 and 4 Gy ionizing radiation alters RANKL/RANK/OPG pathway in osteoblasts,which may promote the osteoclast differentiation and maturation and hence promote bone resorption of osteoclasts.

Permeating the human culture education into specialized teaching in combina-tion with the specialized quality teaching lively is a useful way to improve the students’overall quality.This article will combine the two in the school teaching & the experimental teaching of pharmacognosy.It is a beneficial exploration for cultivating the pharmacy students’overall ability.

Objective To detect and analyse CRP level in rat chronic periodontitis and atherosclerosis compound model.Methods Sixty rats were randomly divided into four groups,15 in each group: Group A:control group;Group B:periodontitis group;Group C:atherosclerosis group;Group D:periodontitis and atherosclerosis group.Every group accepted the corresponding treatment.Pathological changes in periodontal tissue of experimental teeth and arterial vessels were observed.CRP level in serum was assayed by ELISA.Results Histopathological observation of periodontal tissue revealed: Obvious inflammation of periodontal tissue was observed in group B,D.Attachment loss levels in group B and D were higher than that of A,C groups(P