Policy circumstance plays a pivotal role in transformation of barefoot doctor to village doctor.The resources support fromregime and economic organizationmanagement system, the workpoint system for income from collective economy and politics culture of serving people under the policy circumstances of the People′s Com-mune, lay a firm foundation for rise and development of barefoot doctors.However, the village self-governance re-gime began with Household Contract Responsibility System changed all elements above and ultimately prompt trans-formation from barefoot doctor to village doctor.

Objective To investigate the influence of the high-flux hemodialysis (HFD) on inflammatory factors [C-reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)] and serum brain natriuretic (BNP) in patients before and after hemodialysis.Methods Fifty patients with MHD were enrolled in our hospital in 2013 and divided randomly into HD group (n =25),and HFD group (n =25).Serum CRP,IL-6,TNF-α,and BNP were measured in patients before and after the first hemodialysis session and after the treatment for 6 months later.Results Serum CRP,IL-6,and TNF-α in HD group after the first dialysis session and after the treatment for 6 months were statistically insignificant (P ＞0.05).In HD group,serum BNP was decreased after the first hemodialysis session and the treatment for 6 months later,the decreases was statistically significant (P ＜0.01 or P ＜0.05).In HFD group,serum CRP,IL-6,and TNF-α were decreased after the first treatment,the decreases were statistically insignificant (P ＞ 0.05).However,after the 6 mouths,the decreases were statistically significant (P ＜ 0.05).Serum BNP was decreased after the first hemodialysis session and the treatment for 6 months later,the decrease was statistically significant(P ＜ 0.01).Between two groups,the different time-point and the interaction of two groups and the different time-point,the discrepancy above them were statistically significant (P ＜0.01).Conclusions The high-flux hemodialysis can eliminate more inflammatory factors such as CRP,IL-6,TNF-α,and serum BNP in patients with uremia.Serum BNP Helps to adjust the dry weight in time,relieve cardiac load and reduce the incidence of heart failure.High-flux hemodialysis is one of the ways of treatment that reduce the morbidity of the heart failure.It can improve prognosis of the patients with MHD.

Objective To investigate the effect of mindfulness-based stress reduction on job burnout of nurses.Methods By convenience sampling method,a questionnaire survey was conducted among 90 nurses in a third-grade and level-A general hospital in Zhengzhou.The nurses were randomly divided into the control group and the intervention group with 45 nurses in each group.Nurses in the intervention group were intervened under the mindfulness-based stress reduction,but nurses in the control group received psychological guidance and research method courses.The job burnout level of both groups of nurses was assessed before the treatment and 8 weeks after the treatment respectively.Results After the intervention,the factor scores of emotional exhaust,depersonalization decreased and personal achievement score increased.The incidence rate of job burnout significantly decreased.Conclusions The mindfulnessbased stress reduction therapy can relieve nurses' job burnout.

Objective To evaluate the role of spinal nicotinamide-adenine dinucletide phosphate (NADPH) oxidase in the development and maintenance of neuropathic pain (NP) in rats.Methods Twenty-four pathogen-free healthy male Sprague-Dawley rats,aged 200-250 g,were divided into 3 groups (n =8 each) using a random number table:sham operation group (S group),NP group and NADPH oxidase inhibitor group (NI group).The left sciatic nerve was exposed but not ligated in group S.The left sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1 mm intervals with 4-0 silk thread to establish the NP model in group NP.In group NI,the NP model was established at 3 days after intrathecal catheterization,and NADPH oxidase inhibitor 5 μg/10 μ1 was injected intrathecally once a day for 7 consecutive days starting from 30 min before operation.The mechanical paw withdraw threshold (MWT) was measured at 1 day before operation and 1,3,5 and 7 days after operation.The rats were sacrificed at 8 days after operation,and the spinal cord was removed for determination of NeuN positive cells (by immuno-histochemistry) and expression of NADPH oxidase (by Western blot).Results Compared with group S,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly decreased in NP and NI groups,the expression of NADPH oxidase was upregulated in group NP,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Compared with group NP,the MWT at each time point after operation and ratio of NeuN positive cells at 8 days after operation were significantly increased,and the expression of NADPH oxidase was down-regulated in group NI (P＜0.05).Conclusion Up-regulated expression of spinal NADPH oxidase is involved in the development and maintenance of NP in rats.

Objective To analyze the clinical and pathological features of breast cancer in patients over 80 years old, to discuss the individualized treatment plan and further to provide foundation for clinical treatment . Methods Data of 58 breast cancer patients over 80 years old were retrospectively analyzed .They were treated from Jun.2008 to May.2014 and the diagnosis was confirmed by pathology after surgery .They were followed up by telephone.Results Among the 58 cases, invasive cancer accounted for 94.8%(55/58), in which triple-negative breast cancer accounted for 29.1%(16/55), and human epidermal growth factor receptor 2(HER2)pos-itive breast cancer accounted for 7.2%( 4/55 ) .Stage III breast cancer accounted for 24%( 14/58 ) .67.2%(39/58)patients underwent breast resection , 55.2%(32/58)patients underwent axillary treatment , 17.2%(10/58)patients received chemotherapy , and 51.7%(30/58) patients received endocrine therapy .Seven cases had recurrence and 3 cases died of the disease .Conclusions Breast cancer in elderly patients has its special clinical and pathological features .It has longer course , relatively late stage , and more complications .It has higher pro-portion of triple-negative breast cancer and lower proportion of positive HER 2.Elderly breast cancer patients are less tolerant to chemotherapy , thus surgery and endocrine therapy are the main treatment .

Objective To evaluate the role of glycogen synthase kinase-3 beta (GSK-3β) in spinal cord ischemia/reperfusion (I/R) injury in rats.Methods Forty-eight male Sprague-Dawley rats,aged 3 months,weighing 250-300 g,were randomly divided into 3 groups (n =16 each) using a random number table:sham operation group (group S),group I/R and I/R+ GSK-3β inhibitor LiCl group (group LiCl).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 300 mg/kg.Spinal cord ischemia was induced by 45 min occlusion of the abdominal aorta followed by reperfusion.In I/R and LiCl groups,normal saline 5 ml and LiCl 15 mg/kg were injected,respectively,via the caudal vein at 30 min before ischemia.The animals were sacrificed at 48 h of reperfusion and the lumbar segment (L4-6) of spinal cords was removed for microscopic examination and for determination of neuronal apoptosis in the anterior horn of the spinal cord (by TUNEL),and the expression of interleukin-6 (IL-6),IL-8 and IL-10 was detected (by immunohistochemistry).The apoptosis rate was calculated.Results Compared with group S,the apoptosis rate was significantly increased,IL-6 and IL-8 expression was upregulated,and IL-10 expression was down-regulated in I/R and LiCl groups.Compared with group I/R,the apoptosis rate was significantly decreased,IL-6 and IL-8 expression was down-regulated,IL-10 expression was up regulated,and the pathological damage was attenuated in LiCl group.Conclusion Activated GSK-3β is involved in the development of spinal cord I/R injury possibly by promoting synthesis and release of inflammatory factors in rats.

Objective To determine the perioperative risks of partial hepatectomy by determining the preoperative liver functional reserve in patients with hepatocellular carcinoma (HCC),and to compare the model for end-stage liver disease (MELD) score with the Child-Pugh classification in predicting prognosis.Methods We reviewed the clinical data of 202 patients with HCC who underwent partial hepatectomy.The MELD score and the Child-Pugh classification were determined preoperatively.Results The incidence of postoperative liver dysfunction happened in 44.0％ of Child A patients,50％ in Child B patients,41.6％in patients with a MELD score below 14,and 91.7％ in patients with a MELD score of ＞ 14.The difference between the rates of postoperative liver dysfunction in patients with a preoperative MELD score above 14 and below 14 was significant (P ＜ 0.05),while that between patients with Child-Pugh A and B was insignificant (P ＞ 0.05).The incidences of postoperative liver dysfunction in patient with a MELD ＜ 8,8 ≤ MELD ≤ 14,MELD ＞ 14 were 38.2％,57.6％ and 91.7％,respectively,indicating that there was a positive co-relationship between the MELD score and the incidences of liver dysfunction.The Spearman rank correlation test showed the MELD score was significant correlated with the Child-Pugh score (r =0.404 ; P ＜ 0.05).The areas under the ROC curves of the MELD score and the Child-Pugh score were 0.703 and 0.587 (P ＜ 0.05).Conclusions The MELD score predicted postoperative liver dysfunction more accurately than the Child-Pugh classification.HCC patients undergoing partial hepatectomy with a preoperative MELD score ＞ 14 had a high perioperative risk.To ensure the safety of partial hepatectomy,HCC patients with a preoperative MELD score ＞ 14 requires active preoperative preparation,bringing the score near to or less than 14.

Objective To study the pro-invasive effect of irradiation on human glioblastoma cell line U87 and its possible mechanism.Methods Cultured U87 cells received different doses of irradiation (0,2,and 4 Gy).The change in cellular invasiveness was measured using the real-time cell analyzer system.The activities of matrix metalloproteinase-2 (MMP2) and matrix metalloproteinase-9 (MMP9) in U87 ceils were measured by gelatin zymography before and after irradiation.The content and distribution of intracellular β-catenin after irradiation were determined by immunohistochemistry.The mRNA levels of Wnt/β-catenin target genes were measured by real-time quantitative PCR.Results After irradiation,the invasiveness of U87 cells increased significantly (P ＜ 0.01),which was dose-dependent within a certain dose range; the activities of MMP2 and MMP9 in U87 cells increased significantly (P =0.031 for MMP2 ; P =0.004 for MMP9) ;the content of β-catenin in U87 cells increased significantly (P ＜ 0.01),with translocation from the cell membrane and adherens junctions to the nucleus; the mRNA levels of Wnt/β-catenin-related genes (FZD7 and TCF1) increased significantly (P ＜ 0.01),and the transcription of Wnt/β-catenin target genes,especially those related to migration and invasion such as MMP2,MMP7,MMP9,and CD44,was significantly enhanced (P ＜ 0.05).Conclusions Irradiation can promote the invasion of glioblastoma U87 cells,possibly by activating the Wnt/β-catenin pathway and enhancing the transcription of migration-and invasion-related genes.

OBJECTIVE:To systematically review the effects of long-term oral low-dose of azithromycin on pulmonary func-tion and clinical signs of patients with stable COPD. METHODS:Retrieved from PubMed,Medline,CJFD,VIP and Wanfang da-tabase,randomized controlled trials(RCTs)about long-term oral low-doses of azithromycin for stable COPD were collected. After quality evaluation according to modified Jadad scale,Meta-analysis was conducted by Rev Man 5.2 statistical software. RESULTS:A total of 13 RCTs were included,involving 1207 patients. Meta-analysis showed that,long-term oral low-doses of azithromycin could significantly improve FEV1[SMD=0.78,95%CI(0.62,0.93),P<0.001],FEV1%[SMD=0.81,95%CI(0.61,1.00),P<0.001],FEV1/FVC [SMD=3.91,95%CI(2.58,5.24),P<0.001] and 6MWD[SMD=23.74,95%CI(21.20,26.18),P<0.001] in sta-ble COPD patients,meanwhile significantly reduce dyspnea score [SMD=-1.15,95%CI(-1.60,-0.71),P<0.001],quality of life score [SMD=-1.82,95%CI(-2.74,-0.90),P<0.001] and 24 h sputum volume[SMD=-18.68,95%CI(-24.79,-12.56), P<0.001],with statistical significance. CONCLUSIONS:Long-term oral low-doses of azithromycin can improve pulmonary func-tion,dyspnea,activity tolerance and quality of life in acute exacerbation of COPD patients.

Objective To investigate the efficacy of TACE combined with radiofrequency ablation (RFA) in treatment of advanced hepatocellular carcinoma.Methods A total of 72 patients with advanced hepatocellular carcinomas were analyzed retrospectively,including 35 patients underwent TACE combined with RFA (combined group),37 patients underwent single TACE (control group).After the operation,the short-term effect,the changes of liver function,serum alpha-fetoprotein (AFP) level,the complication and the long-term survival rates of the two groups were compared.Results The total effective rate of the combined group (29/35,82.86％) was significantly higher than that of control group (20/37,54.05％;P=0.009).In the combined group,the AFP reduced to (102.19±32.13)μg/L,and the control group reduced to (218.46±49.87)μg/L,which had statistical difference (P＜0.001).The survival rates of 1-year,2-year and 3-year in the combined group were 82.86 ％,54.29 ％,34.29 ％ with a median survival time of 25 months;while in the control group those were 54.05％,32.43％,13.51％ with a median survival time of 16 months;there were statistically significant differences in the survival rate between two groups (P=0.009).After treatment,the hepatic functions of both group had a transient change,and 2 weeks after the operation,there was no significant difference between the two groups (all P＞0.05).Conclusion The combination of TACE and RFA is an effective method for the treatment of advanced hepatocellular carcinoma.