Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.

Objective To evaluate the effects of chest wall reconstruction after tumor resection patients with chest wall defect. Methods From March 1999 to August 2008,28 patients with chest wall tumor underwent chest wall reconstruction.The number of rib resected was 3-6. Twenty-one huge chest wall defects underwent chest wall reconstruction using titanium alloy steel artificial rib. The materials for the soft tissue reconstruction include latissimus dorsi myocutaneous flap. Results No died of operation, postoperative respiratory function was good, no abnormal breathing exercises. Concurrent osseous tissue repair and rebuilt in 3 cases, the fluid recovered after conservative therapy. Followed-up 8-76 months,2 cases were lost, follow-up rate was 92.9% ,4 cases with benign tumor existed 7.8,7.2,5.4 and 3.6 years, 22 cases with malignant tumor after 1, 3, 5 years survival rate were 77.3% (17/22) ,63.2% (12/19),41.2% (7/17) respectively. Conclusion A favorable clinical outcome can be achieved by titanium alloy steel artificial rib reconstruction of chest wall.

Objective To explore the radical surgery for tetralogy of Fallot combined with right pulmonary artery stenosis.Methods Thirteen cases with tetralogy of Fallot combined with right pulmonary artery stenosis accepted radical surgery,among them 7 cases who-had a long right pulmonary artery stenosis accepted aortic transaction for radical surgery of tetralogy of Fallot;5 cases who had the entrance stenosis of the right pulmonary artery accepted right pulmonary artery patch expansion for radical surgery of tetralogy of Fallot;One case who had the distortion and stenosis after pulmonary shunt accepted the radical surgery for tetralogy of Fallot after seperation and expansion.Results There were no operation-related deaths,post-operative low cardic output and perfusion lung occurred for all the cases.Ten cases had grade 1 cardiac function and 3 cases had grade 2,respectively.Conclusion Right pulmonary artery stenosis increased the risks during the radical surgery for tetralogy of Fallot,but it is still the primary operation choice.

Objective To analyze current situation and problems of health manager training in the pilot training areas. Method With the recommendations of health administration deputies in the plot areas of Shanghai, Chongqing and Urumqi, 2 centers for community health services (CHSs) were selected in each area, 9 relative persons were interviewed, 3 focus group discussions (FGDs) involved 18 persons were held totally. The FGDs focused on such questions as“the general information of the training students”“the objectives and purposes of the training in each area”, and so on. Field investigation and qualitative analysis were used to investigate the status quo and main problems of the training of health manager in the pilot areas. Result The problems of the training of health manager existing in the pilot areas mainly are:part of teachers were not fully competent to the training of health manager, training of operant skill was insufficient, training course was not unified, the assessment mechanism was not perfect. Conclusion Optimizing the construction of teachers team, standardizing the training content, increasing the time of operating skills training, establishing a unified and standardized assessment mechanism are essential.

Objective To explore the effect of glucocorticoid receptor(GR)expression in rat hippocampus on cognitive function after traumatic brain injury(TBI). Methods The TBI model wag established in rats.Then,immunohistochemistry and Western blot were used to detect the GR expression and evaluate its relation with cognitire dysfunction by Morris water maze. Results Expression of hippocampal GR was down-regulated 4-10 days after TBI.Morris water maze test showed significant impairment of the cognitive function in rats. Conclusion There is correlation between expression change of hippocampal GR and cognitive dysfunction.

Objective To modify the methods of operation and establishment of cerebral ischemia rat models made by thread occlusion. Method We randomly divided 120 male SD rats into a common group (n = 50), an improvement group (n = 60) and a sham-operated group (n - 10). Rats in the common and improvement groups were made into models using the common and improvement methods separately. All models were evaluated on the basis of physical sign indices and 2,3,5-triphenyltetrazolium chloride (TTC) staining. The TTC staining results were taken as gold standards. Then, we compared the achievement ratios of the two groups, and computed the sensitivity and specificity of every physical sign index based on these standards. The χ~2 or correction χ~2 test was used to compare the ratios. Results (1) The achievement ratio in the improvement group was significantly higher than that in the common group (71.67% vs. 52.00%, P = 0.034). (2) The sensitivity of evaluation for both common and improvement methods was 98.55%. However, the specificity of evaluation for the improvement method was significantly higher than that for the common method (100.00% vs. 40.00%, P =0.000). Conclusions The establishment achievement ratio and evaluation correctness of models are obviously elevated by modification of the operation and establishment methods.

Objective To investigate the risk factors and outcomes of acute kidney injury (AKI) in patients after intra--coronary stent implantation.Methods A retrospective and case control study was done with data analysis in 325 patients who underwent intra-coronary stent implantation from January 2010 to March 2011.The patients were divided into two groups as per the criteria of AKI identified on the 7th day after implantation of stent.The variables to be studied included:(1) age,gender,hypertension,diabetes,cerebrovascular disease,left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate,hyperuricemia,proteinuria,emergency operation,hydration,and medication (ACEI/ARB,statins) before operation; (2) dose of contrast media,operation time,hypotension during intra-operative period; and (3) postoperative:hypotension.The variables were analyzed with the process of One-way ANOVA and multivariate Logistical regression analysis.Consequently,the independent risk factors of AKI in patients after intra-coronary stent implantation could be found.Further,the prognosis of AKI patients was analyzed.Results Of the 325 patients,51 (15.7％) developed AKI.Compared the normal group,hospital stay (P ＜ 0.01 ) and in-hospital mortality (P ＜ 0.05) increased significantly in the AKI group.Monofactorial analysis showed that age,pre-operative laboratory and clinical data including left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration and emergency operation, and intraoperative information such as operation time and hypotension,and postoperative hypotension in AKI patients group were significantly different in comparison with control group ( P ＜ 0.05 ). Multivariate logistic regression analysis revealed that elderly age (OR =0.253),pre-operative proteinuria (OR =5.351 ),preoperative left ventricular insufficiency ( OR =8.704),eGFR ≤ 60 ml/ ( min · 1.73 m2 ) ( OR =6.677 ),prolonged operation time ( OR =1.017),intra-operative hypotension ( OR =25.245 ) were independent risk factors of AKI ( P ＜ 0.05 ).Conclusions AKI is a common complication and associated with increase in mortality after intra-coronary stent implantation.Increase in age,pre-operative proteinuria,pre-operative left ventricular insufficiency,pre-operative low estimated glomerular filtration rate,prolonged operation time,intra-operative hypotension are the independently risk factors associated with AKI.

The chemical ingredients of sediments from single Radix Aconiti Lateralis (Fuzi, in Chinese) decoction and Radix Aconiti Lateralis-Radix Glycyrrhizae (Gancao, in Chinese) decoction were evaluated separately by HPLC-MS for exploring their ingredients difference and discussing the mechanism of toxicity reduction of Fuzi-Gaocao herb-pair, even providing the experimental basis for extracting and purifying process of TCM preparations containing Fuzi-Gancao herb-pair. The sediments samples from single Fuzi decoction (FD) and Fuzi-Gaocao decoction (FGD) were prepared separately firstly. Then these samples were analyzed in the same chromatographic and mass spectrometry condition, estimating their HPLC-MS fingerprint and identifying their compounds by Q-TOFMS. As a result, 28 compounds in sediments samples from FD were obtained, among which 25 compounds and structures were confirmed. Besides, 36 compounds in sediments samples from FGD sample were obtained including 34 confirmed compounds and structures, among which there were 11 compounds from Gancao and 25 compounds from Fuzi. However, according to these confirmed compounds, alkaloids compounds in sediments samples from FGD were significantly different from that in sediments samples from FD. This result showed the fact that there would be some influences on alkaloid compounds in decoction after the combination of Gancao. In this study, the experiment basis of the mechanism of toxicity reduction of Fuzi-Gaocao herb-pair is provided. It also showed that much attention should be paid to the fact that there were great amount of alkaloid compounds, the effective compounds, in the sediments for which a comprehensive utilization in clinic and pharmaceutical process should be noted.

Objective To explore the clinical implication of serum Dectin-1 level in the non-agranulocytic patients with pulmonary aspergillosis. Methods Serum specimen were collected from the non-agranulocytic patients with pulmonary aspergillosis to determine the serum level of Dectin-1 with ELISA.The relationship between serum Dectin-1 level,the results of G test and galactomannan (GM)test of Aspergillus,and white blood cell count was analyzed.Results The serum Dectin-1 level was (427.2 ± 42.6)pg/mL in the patients with Aspergillus infection,and (280.8 ± 39.4)pg/mL in the control patients (P<0.05 ).Dectin-1 level was not correlated to white blood cell count,or the result of G test,or GM test. Conclusions Serum Dectin-1 level increases significantly in the non-agranulocytic patients with pulmonary aspergillosis, suggesting that Dectin-1 is an important anti-Aspergillus immune molecule.

Objective To explore the changing levels of serumIL-17 and Dectin-1 and their implication in non-neutropenic pa-tients with invasive pulmonary aspergillosis (IPA).Methods The clinical data were reviewed for 23 non-neutropenic patients with clinical diagnosis of IPA (IPA group),31 patients with clinical diagnosis of pneumonia (pneumonia group)and 51 healthy subjects(control group).The peripheral serum was collected to analyze IL-17 level by ELISA.Serum Dectin-1 level was also determined at the same time.Serum G test,GM test,WBC and CRP level were also assayed for the patients in IPA group.Pa-tient outcome was followed up and analyzed in terms of serum IL-17.Results The serum IL-17 level of the patients in IPA group was significantly higher than that in the control group (P <0.05).The serum IL-17 level in the pneumonia group was not significantly different from that in the control group (P >0.05).The serum Dectin-1 level in IPA group was significantly higher than that in the control group (P <0.05).For the patients in IPA group,serum IL-17 level was positively correlated to serum Dectin-1 level (r=0.81 ,P <0.05),while serum IL-17 and Dectin-1 levels were not correlated to the results of G test, GM test, WBC,CRP or patient outcome (P > 0.05 ). Conclusions Dectin-1 may be produced and Th17 cell immunity activated in response to Aspergillus fumigatus in-fection in non-neutropenic patients.And,serum Dectin-1 level is correlated with Th17 response.