Objective To propose the cause and management of necrosis in reversed island flap or distally-pedicled flap. Methods From June 2000 to June 2009, 120 cases with skin and soft tissue defect were repaired using reversed island flap or distally-pedicled flap. In 12 cases the flaps partial necrosis, to analysis the cause of necrosis. Results One hundred and eight cases survived completely in 120 patients,flap necrosis in 12 cases. 3 cases fully necrosis, in which venous disorders cause flap necrosis in 2 cases, arterial blood disorder caused necrosis of flap in 1 case. Partial necrosis in 9 cases, in which dorsal metacarpal artery reversed island flap in 1 case, digital artery reversed island flap in 1 case, posterior tibial artery reversed island flap ankle epithelial branch in 4 cases, medial leg perforating branches of reversed island flap in 1 case, superficial peroneal nerve vascular reversed island flap island flap in 1 case, distally-pedicled based sural neurocutaneous flap in 1 case, after debridement and dressing change subeschar healed in 7 cases, by the other flaps were cut close to rerepair necrotic wounds in 2 cases. Conclusion Blood circulation barrier is the main reason to flap necrosis, improper handling of pedicle is another important reason of flap necrosis,which cannot be ignored.

Objective: To analyze the equity of benefit which residents with different income get from Urban Employee Medical Insurance ( UEMI) and New Rural Cooperative Medical System (NCMS). Methods: Data used in this study is based on the forth household health service survey in Shanxi province. The indirectly standardization method and concentration index were employed to analyze the horizontal inequity index of benefit rate and benefit degree. Results:The horizontal inequity index of benefit rate and benefit degree in UEMI are 0.0524 and 0.0025, and the horizontal inequity index of benefit rate and benefit degree in NCMS are 0.2312 and 0.3228. Conclusion: The urban residents get the equal benefit from UEM, and there were pro-rich horizontal inequities of benefit rate and benefit degree in NCMS.

nitrite nitrogen(0.006?10-9/a).Conclusion The carcinogenic toxicant pollution in water collected from sampling site 2 is serious,so it is can not be used as the drinking water source.

Objective To evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic variables including central venous pressure (CVP),mean arterial pressure (MAP) and heart rate (HR) in patients with central respiratory failure treated by mechanical ventilation.Methods Thirty two neurosurgical patients with central respiratory failure,male 19,female 13,mean age (58.8 ± 13.9)years,GCS ≤ 8 points,were enrolled in this prospective,self-control study between June 1,2009,and May 31,2011.Patients were excluded in cases of severe cardiopulmonary disorders,pericardial diseases,person machine confrontation,administration of vasoactive drugs,and hypervolemia or hypovolemia.On admission to neurosurgical intensive care unit,all patients were mechanically ventilated in the mode of synchronized intermittent mandatory ventilation.Hemodynamic effects of six randomly set levels of end-expiratory pressures (0,3,6,9,12,15 cm H2O,every 10 min,1cm H2O =0.098 kPa) were studied in all patients.CVP,MAP and HR were recorded at each of the six end-expiratory pressure levels.One-way analysis of variance and simple linear regression model were used for data analysis.Results The levels of central venous pressure were elevated with increase in end-expiratory pressures.CVP levels were positively correlated with the levels of PEEP (R =0.468,P =0.000),with a simple linear regression equation expressed as:CVP (cm H2O) =7.870 +0.344 ×PEEP (cm H2O),The levels of MAP showed no statistically significant changes at different PEEP levels (F =1.390,P =0.227).No linear correlation between MAP,HR and PEEP levels was found (R =0.042 and 0.160,P =0.413 and 0.002).Conclusions CVP values would be overestimated during mechanical ventilation at different PEEP levels in mechanically ventilated patients due to central respiratory failure,positive correlation existed between CVP values and PEEP levels,whereas MAP was unaffected by different PEEP levels.This study could probably offer a quantitative reference for correct assessment of such a hemodynamic variable as CVP for mechanically ventilated patients without discontinuance of PEEP.Further studies are needed to determine whether these findings could be confirmed in a prospective manner.

Objective To investigate the effectiveness and safety of low-intensity warfarin anticoagulation in over 80-year-old patients with nonvascular atrial fibrillation (NVAF). Methods The 180 NVAF patients aged over 80 years were randomly assigned into 2 groups: 90 patients in lowintensity warfarin anticoagulation group (target value of INR 1.6-2.0), the other 90 patients in standard-intensity warfarin anticoagulation group (target value of INR 2. 0-3.0). All patients were followed up in outpatient-department for one year. Main outcome measures included the incidence rates of bleeding and thromboembolic events, and secondary outcome measures included the warfarin dosage and times of INR＞3.0. Results The incidence rate of thromboembolic events was 4.4% (4/90) in low-intensity group and 3.3% (3/90) in standard-intensity group with no statistically significant difference between these two groups (P＞0. 05). However, the incidence rate of hemorrhage was significantly lower in low-intensity group than in standard-intensity group [5.6% (5/90) vs. 16.7%(15/90), P＜0. 05]. Meanwhile the warfarin dosage was significantly lower in low-intensity group than in standard-intensity group [(1. 55±0. 63) mg vs. (2.31±0.57) mg, P＜0.05]. The times of INR＞3.0 were less in low-intensity group than in standard-intensity group (P＜0. 05). Conclusions Therapy with low-intensity warfarin anticoagulation in NVAF patients aged over 80 years may be equally effective as, but safer than that with standard-intensity warfarin.

Objective To investigate the effect of hypoxic preconditioning on hepatocytes early growth response factor 1 ( EGR-1 ) in a rat liver autotransplantation. Methods The rat portal vein perfusion model was established for donor liver autotransplantation. Rats were then divided into group A:hypoxic preconditioning was done before transplantation; group B: rats undergoing liver transplantation without preconditioning; group C: Normal control group of rats. Liver histopathological changes, the mRNA expression of HIF-1, TNF-1 and the WB results of EGR-1 were compared between groups. Results The expression of HIF-1 α RNA determined in group A was more obvious than in group B and group C. Six hours after surgery, the expression in group A was significantly higher than that in group B (t =9. 601, df= 10, 2-tailed Sig = 0. 000, P<0. 05 ) ; Egr-1 protein expression in group A and group B increased after surgery,with that in group A being significantly lower than that in group B. The RT-PCR expression of TNF-α RNA in group B compared with group A and group C was more obvious. Six hours after operation, the expression of TNF in group B was significantly higher than that in group A ( t = -12. 067, df = 10, 2-tailed Sig =0. 000, P<0. 05 ). The expression of Egr-1 was positively correlated with that of TNF. A liver cell pathology showed less severe injury in structure of hepatic lobule, mild swelling of liver cells, no significant changes in liver tissue. Conclusions Hypoxic preconditioning adaptation in rat liver transplantation generates modest increase in EGR-1, and reduces the production of TNF and other inflammatory factors.

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) targeted treatment has been a standard therapy for advanced non-small cell lung cancer (NSCLC), but it is not tolerated well by all patients. In China, some studies have reported that traditional Chinese medicinal herbs (TCMHs) may increase efficacy and reduce toxicity when combined with EGFR-TKI, but outside of China few studies of this kind have been attempted.

Objective:To compare drug policies in Brazil, Russia, India, China, and South Africa (BRICs), sum-marize the experiences from the process of implementation and provide some suggestions to further improve the national drug policy in China. Methods:National drug polices of BRICs and experiences in the implementation of essential medicine policy were summed up systematically by means of systematic review. Results:Essential medicine policy and popular phar-macy are implemented in Brazil;Pharmaceutical separation system is established in Russia;the mode of essential medicine policy in Delhi is typical in India;Government of South African focuses on procurement and distribution of drugs. Although drug policies of BRICs have their own characteristics, the objective is to increase the public access to low-cost, high-quality drugs. Conclusions:Despite the BRICs have attained some achievements, they still face serious challenges in deep-ening the health care reform. Hence, they need to explore the measures continuingly consisting with their national condi-tions, and learn from the experiences of developed countries to further consolidate and improve the national drug policies.

With the rapid development of new technologies and global trade and increasing collaboration among countries worldwide,public health has become a global issue.Global health,as a new discipline,has been drawing more attention from both academia and governments.The Belt and Road (B&R) Initiative,proposed by China in 2013,aims to promote trade and resource exchange,including education,research,and health issues,with over 60 countries in Asia,Africa,and Europe.The B&R Initiative provides good opportunities for involved countries to address health problems jointly as well.In response to the B&R Initiative and to promote international collaboration on global health issues,"The 2017 Belt and Road Initiative Global Health International Congress & 2017 Chinese Preventive Medicine Association-Chinese Society on Global Health Annual Meeting" was held on September 24-27,2017 in Xi'an,China.Thus far,this is the largest high-quality international conference held in China that focused on the B&R Initiative global health issues.This article summarizes the background,key sessions and topics covered during the congress,important events and highlights different perspectives of the B&R Initiative and global health by invited experts from China and abroad.The conference included 17 sessions (3 keynote speech forums and 10 scientific sessions,3 young scholar forums,and a research poster session) and about 100 speakers,around 40 of which were leading experts outside of China.All the major sessions were held in English.More than 40 leaders and experts of health sectors from 13 countries presented their work in the congress.Approximately 400 delegates from 29 countries attended the congress.Delegates had extensive discussions about global health related issues,future cooperation and development in global health.The congress fostered international exchange and collaboration.

In order to detect the relationships of human laryngeal squamous cell carcinoma (LSCC) with the expression of Vascular Endothelial Growth Factor C (VEGF-C) and Vascular Endothelial Growth Factor Receptor-3 (VEGFR-3), we examined the level of VEGF-C and VEGFR-3 gene expression in the samples from 30 cases of normal laryngeal mucosa tissue (NLM), primary laryngeal carcinoma (PLC) and cervical lymph node (CLN) by using reverse transcription polymerase chain reaction (RT-PCR). The protein levels of VEGF-C and VEGFR-3 expression were also determined by Western blotting in 10 cases of NLM, PLC, CLN,respectively. We found that in the samples from the same patient, the VEGF-C and VEGFR-3 expression level is different among normal laryngeal mucosa tissue, primary laryngeal carcinoma and cervical lymph node. In primary laryngeal carcinoma, the level of VEGF-C and VEGFR-3 expression was significantly higher in lymph node positive group than in lymph node negative group, and this difference was the associated with the histological grade of differentiation (P < 0.05). The expression levels of VEGF-C and VEGFR-3 were not associated with age, sex, site and T stage (P > 0.5). These results suggest that there is a close relationship of LSCC with VEGF-C/VEGFR-3; and VEGF-C/VEGFR-3 may have the potential for use as an indicator with prognostic significance in dealing with LSCC.
Aged ; Biomarkers, Tumor ; biosynthesis ; Carcinoma, Squamous Cell ; metabolism ; Female ; Humans ; Laryngeal Neoplasms ; metabolism ; Male ; Middle Aged ; Prognosis ; Vascular Endothelial Growth Factor C ; metabolism ; Vascular Endothelial Growth Factor Receptor-3 ; metabolism