Objective To investigate the effect of cinobufacin on P53,PTEN and HIF-1αin patients with advanced lung cancer.Methods 100 cases with advanced lung cancer were divided into two groups.control group(n=50) were treated with routine treatment, experiment group(n=50) on the base of the control group with 0.3 g cinobufacin,3 times per day oral.P53, PTEN, HIF-1α,tumor marker,survival rate and mortality were compared after the treatment.Results Compared with the control group,the serum levels of P53, HIF-1αexpression level was lower(P<0.05),PTEN expression level was higher (P<0.05),CEA,NSE,CYFRA21-1,CA125 were lower(P<0.05);the survival rate was higher, the mortality was lower(P<0.05). Conclusion Cinobufacin can regulate the advanced lung cancer patients serum P53, PTEN and HIF-1αlevels and reduce the tumor markers levels, improve the survival rate.It is of great importance for clinical treatment of advanced lung cancer.

Objective To study how to reduce the complication rate of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods A retrospective analysis was made on clinical data of 158 cases of acute cholecystitis treated by LC from September 2001 to December 2003. Results Operations were accomplished laparoscopically in 151 cases, while conversions to open surgery were required in 7 cases (1 case of Mirizzi’s syndrome, 2 cases of gallbladder carcinoma, 1 case of cholecystoduodenal fistula, 2 cases of "ice-like" adhesions in the Calot triangle, and 1 case of common bile duct stones). Open re-exploration was performed in 1 case because of biliary leakage. Intraoperative cholangiography (IOC) was successfully conducted in 10 cases, 3 of which were found common bile duct stones. Out of the 3 cases, 2 cases underwent an intraoperative endoscopic sphincterotomy and 1 received a conversion to open choledochotomy with T-tube drainage. Conclusions When utilizing LC for acute cholecystitis, the rate of conversion and the incidence of complication may be reduced as long as the patients were properly selected, the principles of safety were abided by, and the intraoperative cholangiography was performed routinely.

Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate and primary health care utilization in Feixi county increased. Conclusion:Both the“bottom-up” exploration approach and “from point to area” implementation strategy adopted by Feixi county have not only been the core content of primary health care system’s comprehensive reform, but also effectively leveraged the other aspects of the reform. They have played an important role in deepening medical reform and establishing institutional mechanism of health care system.

Objective:To analyze reverse effects induced in the implementation process of“primary health care strengthening” policies, and the innovative initiatives and countermeasures raised in primary health care system’s comprehensive reform of Feixi county. Method:Based on the principles of Critical Discourse Analysis ( CDA) , this paper designs its analytical framework for policy analysis. Results:Many reverse effects appeared in the implementa-tion process of “primary health care strengthening” policies. However, through improvements in terms of manpower upgrading, network building, working conditions and management mechanisms, Feixi county has successfully strengthened the capacity building for primary health care institutions. Conclusions:The expected and unexpected re-sults should be evaluated systematically when the policies are being implemented, and local governments need to pro-ceed according to local conditions in order to prevent unintended reverse effects from happening.

The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.

OBJECTIVETo observe the changes in the morphology and distribution of substance SP and calcitonin-gene related peptide nerves in the anterior pituitary of scalded rats.

METHODSThe rats inflicted 30% TBSA degree scalding of the back were employed as the model. The SP and CGRP peptide nerve fibres in the anterior pituitary were observed by immunohistochemistry staining during different postburn time points: 1, 2, 6, 10, 12, 24 and 72 postburn hours (PBHs). The areas of coverage of SP and CGRP nerve fibers were determined respectively in the anterior pituitaries by image analysis.

RESULTSThe morphology of the two peptide nerve fibers exhibited obvious changes under microscope. The numbers of SP and CGRP nerve fibers increased by 85.7% and 60.5%, respectively at 1 PBH when compared with those in control group. Moreover the varicosities and branches of the nerve fibers in scalded rats increased obviously at 1 PBH and decreased sharply at 2 PBH, bouncing back to near normal level at 24 PBH. reaching image analysis revealed that the changes in the areas of coverage of two peptide nerve fibers were correlated positively with each other. The basic trends of the changes were an increase at 1 PBH, a decrease thereafter, reaching the lowest level at 12 PBH with a rebound later.

CONCLUSIONThe morphology and distribution of SP and CGRP nerve fibers of anterior pituitary in scalded rats exhibited obvious change after injury. Therefore, they might be involved in the functional modulation of systemic stress.

Animals ; Burns ; metabolism ; pathology ; Calcitonin Gene-Related Peptide ; metabolism ; Disease Models, Animal ; Female ; Male ; Nerve Fibers ; metabolism ; pathology ; Pituitary Gland, Anterior ; metabolism ; pathology ; Rats ; Rats, Sprague-Dawley ; Substance P ; metabolism

Objective To evaluate the clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) to the tumor center in the treatment of bulky cervical cancer with massive bleeding in the first course radiotherapy.Methods Twenty-one cases with bulky cervical cancer complicated with massive vaginal bleeding were enrolled.At the first three times of external irradiation,a high dose radiotherapy (15 Gy/3 fractions) was delivered to the tumor center (the region retracted 2 cm from the periphery of cervical mass),followed by conventional irradiation (2 Gy/fraction) in the posterior course.Conventional dose irradiation (46 Gy/23 fractions) was given to the tumor periphery and pelvic lymphatic drainage area throughout the whole course.Concurrent chemotherapy by cisplatin at a dose of 25 mg/m2 was delivered weekly.After the external irradiation,intracavitary radiotherapy was given (20 Gy/4 fractions).Results Within 24 h after the first course radiotherapy,the volume of vaginal bleeding was significantly decreased by 50％ and the bleeding was almost stopped within one week.The hemostasis rate was 100％.Conclusions SIB-IMRT into the center of bulky cervical cancer is an efficacious treatment of massive vaginal bleeding.

Objective:To study the relationship between IL-1β and TNFα expression and cell apoptosis in gingival tissue of the subjects with diabetes associated periodontitis(DAP).Methods:20 cases of DAP(group DAP) and 20 cases of health controls(group H)were included.The cell apoptosis and the ultrastructural changes in gingival tissue were observed by Tunnel staining and transmission electron microscope (TEM).IL-1β and TNFα expression in gingival tissue were detected by immunohistochemical staining.SBI,GI,PD and AL of the subjects were measured.The relationship between the level of IL-1β,TNFα and the cell appotosis was analyzed.Results:Apoptosis was obvious in prickle cells and basal cells of gingival tissue of DAP group.The percentage of apoptosis cells of DAP group was significantly higher than that of group H(P＜0.01).The expression of IL-1β and TNFα in group DAP was significant higher than that of group H (P＜0.01),and the mainly positive expression cells were macrophages,plasmocytes and lymphocytes.Conclusion:IL-1β and TNFα play a role in cell apoptosis in the gingival tissue of the patients with DAP.

Objective To discuss the sensitization effect of celecoxib in the radiotherapy and chemotherapy of patients with esophageal cancer,and its clinical application value.Methods According to the digital table,60 patients with esophageal cancer were randomly divided into observation group and control group,30 cases in ecah group.The control group was given conventional radiation and chemotherapy,the observation group received combination with celecoxib for radiotherapy sensitization.The clinical effect was compared between the two groups.Results The total effective rate of the observation group was 46.67％ (14/30),which was higher than 20.00％ (6/30) of the control group,the difference between the two groups was statistically significant (x2 =4.343,P ＜ 0.05).In the observation group,radioactive pneumonia occurred in 1 case,radioactive esophagitis in 2 cases,radioactive myocarditis in 1 case.In the control group,radioactive pneumonia occurred in 2 cases,radioactive esophagitis in 1 case,radioactive myocarditis in 2 cases,the differences between the two groups were statistically significant (x2 =0.350,0.350,0.350,all P ＞0.05).In the observation group,7 cases occurred nausea and vomiting,diarrhea in 1 case,bone marrow suppression in 5 cases,renal toxicity in 2 cases.In the control group,8 cases had nausea and vomiting,diarrhea happened in 2 cases,bone marrow suppression in 3 cases,renal toxicity in 1 case,there were no statistically significant differences between the two groups (x2 =0.088,0.350,0.576,0.350,all P ＞ 0.05).Conclusion Application of celecoxib in patients with esophageal cancer during the process of radiation and chemotherapy has sensitization effect,it can promote the esophageal cancer treatment effect,without increase in adverse reactions,it is worthy of popularization and application in clinic.