Molecular targeted therapy has become a new hot spot with the in -depth basic research on advanced biliary tract cancer (ABTC).Phase ⅡandⅢtrials of the molecular targeted therapies for ABTC are summarized to provide new insights into clinical practice. Phase II trials have shown that vascular endothelial growth factor receptor inhibitor and mitogen-activated protein kinase inhibitor do not ex-hibit good anti-tumor activity,but epidermal growth factor receptor (EGFR)inhibitor has proven to be safe and effective in the treatment of ABTC.The only multicenter,open-label,randomized,controlled phase Ⅲ trial has shown that nilotinib combined with gemcitabine and oxaliplatin,as the first-line chemotherapy for ABTC,cannot significantly increase the overall survival in patients.Subgroup analysis has shown that standard chemotherapy combined with nilotinib can significantly increase the progression-free survival in patients.These results indicate that EGFR inhibitor is effective to control the progression of ABTC,suggesting that EGFR might be a novel therapeutic target.

Objective To solve the problem of army hospital expenditure over budget software controlling.Methods In the army hospital accounting reckoning system,database trigger mechanism was used to intelligently control expenditure over budget.Results Expenditure was controlled strictly and intelligently.Financial problems were checked effectively.Conclusion The methods that automatically control budget by trigger is simple and effective.It enhances budget management of hospital effectively.

Objective Probe application value of CHN(the standards of skeletal maturity of hand and wrist for Chinese-CHN method)bone age in judicial identification,and analyze factors and related problems which influence its accuracy.Methods 522 patients participated in judicial identification of living age estimation.Two posteroanterior radiographs for the left wrist were shot with respective exposure value for all patients.And two oblique radiographs were added.Bone ages were estimated according to CHN method.Result Among 522 cases were 489 males and 33 females.Bone ages of 129 males reached to tiptop of CHN-18.4 and average bone age of other male patients is 16.5.Bone ages of 14 females reached to tiptop of CHN-17.3 and average bone age of other female patients is 15.7.Among 522 cases there were 388 patients with their CHN bone ages above 16.0,about 74.3%.The group of data indicates that multiple factors can influence accuracy of bone age estimation.Among them change of radiograph position and angle influenced estimation accuracy most.Conclusion If radiographs of high quality can be acquired,CHN method can be proficiently used,and radiologists can pay attention to the effect on estimation accuracy of epiphysis classification by change of radiograph position and angle,then CHN bone age can mostly meet requirements of living age estimation.

Objective To estimate fairness in the financial contributions of suburban households of Shanghai to the health system and the situation throughout the country. Methods A household survey was conducted to obtain data on health expenditure and government health input, which was then analyzed by means of the index for and methodology of fairness in the financial contributions of households in the performance assessment of the health system as introduced by the WHO. Results The coefficient of fairness in the financial contributions of households to the health system was estimated to be 0.735 and the rate of cooperative medical care coverage was positively related to the fairness. Conclusion The fairness level of the financial contributions of suburban households of Shanghai to the health system tallies with the level estimated by the WHO for China while the national level is lower. The calculations of government subsidy for household health, as recommended by the WHO in estimating fairness in the financial contributions to the health system, do not conform to the actual situation in China.

Objective To analysis the relation between diet,physical activities and chronic disease.Methods Collecting and analyzing the data of 3 673 Tianjin residences selected randomly as sample in 2002 China National Health and Nutrition Examination Survey.Dietary pattern and prevalence of chronic diseases were obtained,as well as the relative risk of diet,physical activities on chronic diseases including obesity,hypertension,diabetes and hyperlipidemia.Results The prevalent rates in Tianjin adults were 26.8% for obesity,3.07% for hypertension,32.2% for hyperlipidemia and 3.7% for diabetes.Main dietary problems among them were higher intake of oil and salt,lower intake of vegetable and fruit.The percentages of energy from fat ≥30% and watching TV≥3 hours/d were risk factors for overweight/obesity,hypertension,diabetes and hyperlipidemia with OR values as 2.04(95%CI:1.53～3.04),2.00(95%CI:1.13～3.57),2.22(95%CI:1.66～2.98),1.64(95%CI:1.18～2.31);1.89(95%CI:1.32～2.70),1.79(95%CI:1.48～2.16),1.47(95%CI:1.33～1.78)and 1.45(95%CI:1.28～1.65).Physical exercises ≥30 minutes /d was a protective factor for those four chronic diseases with OR values as 0.42(95%CI:0.28～0.68),0.60(95%CI:0.40～0.89),0.50(95%CI:0.35～0.80),0.61(95%CI:0.44～0.93)respectively.Intake vegetable and fruit ≥500 grams /d could reduce the risk for obesity and hyperlipidemia,OR values were 0.60(95%CI:0.40～0.89)and 0.47(95%CI:0.30～0.72).Conclusion There was a strong relation between diet,physical activities and chronic diseases in Tianjin sampled people.It should strengthen health promotion with balanced diet and good physical activity for the chronic diseases prevention.

Objective To know the primary effect of nutrition intervention in farmers. Methods The questionnaires were used to do baseline and evaluation survey. The intervention ways were used in trial group, including holding lectures, posting posters, sending out healthy material, quizzes with prizes, recommending salts low in sodium to each family, training to make healthy food by the chef; but there were no measures in control group. Results There were statistical significance in healthy awareness of nutrition, exercises and chronic diseases between two groups after intervention; However, the average intake amounts of vegetables did not reach the recommendation of diet guidelines; After intervention, the intake frequency of vegetables and fruits had statistical significance between before and after intervention in trial group, and also had statistical significance in two groups. Conclusion The awareness of healthy knowledge and attitudes has been obvious improvement, but the diets and life styles of farmers have no obvious change. The diet structure and behavior of farmers have been increasingly rational but not enough. The farmers have started to increase the intake times of vegetables and fruits and built up the conception of eating more vegetables and fruits.

In order to investigate the change in and relationship between endothelin 1(ET 1) and nitric oxide(NO) in hypoxic pulmonary hypertension(HPH),the content of ET 1 and NO in plasma and lung tissue homogenate, the expression and localization of ET 1, constitutive and inducible nitric oxide synthase(cNOS,iNOS) using immunohistochemistry in HPH of rats were assayed. The effect of NOS inhibitor nitro L arginine methyl ester(L NAME) on the content of ET 1 was also studied. The results showed that the content of ET 1 and NO in plasma of the HPH rats were significantly higher than that of controls; positive expression of ET 1 and iNOS were enhanced in the endothelium of vessels, the epithelium of bronchi and the smooth muscle of vessels and bronchi,but the expression of cNOS weakened The content of ET 1 in plasma and lung tissue homogenate were increased after administration of L NAME. The results indicate that in the normal animals, NO may suppress the secretion of ET 1. The increased ET 1 may play an important role in the development of HPH, and the induced iNOS may be the result of functional adaptation to chronic hypoxia.

Objective·To investigate the effects of insulin-like growth factor 1 on prion encoding gene (PRNP) expression and amyloid precursor protein (APP) metabolism of PC12 cells. Methods·After PC12 cells were treated with 20, 40, 80 ng/mL IGF-1 for 24 h, real-time PCR was used to detect the mRNA expression levels of PRNP, and Western blotting was used to detect the protein levels of AKT, phosphorylation of AKT (pAKT), ERK and phosphorylation of AKT (pERK). The level of β-amyloid 42 (Aβ42) in supernatant fluid was detected by ELISA. Results·Compared with the blank control group, the expression of PRNP mRNA in Alzheimer's disease (AD) model group was increased significantly (P<0.01). The expression of PRNP mRNA was significantly increased after cells were treated with 40 and 80 ng/mL IGF-1 for 24 h (P<0.01). There was no significant difference in APP protein expression among AD model group and three IGF-1 treatment groups (P>0.05). Compared with the blank control group, the level of Aβ42 in supernatant fluid of model group was decreased significantly with the increasing of IGF-1 concentration. The expression level of Aβ42 was decreased significantly in 40 and 80 ng/ml IGF-1 treatment group (P<0.05). The expression of AKT/pAKT, ERK/pERK in AD model group was significantly increased along with the increasing of IGF-1 concentration (P<0.05). Conclusion·IGF-1 could regulate the expression of PRNP gene and effect the metabolism of APP, which may be associated with PI3K/AKT, MAPK/ERK1/2 signaling pathway.

A typical investigation on third-tier general hospitals, third-tier specialty hospitals, second-tier district or county central hospitals, urban community hospitals, and rural township health centers in Shanghai was conducted so as to examine the responsiveness of outpatients and inpatients to the health system. Most of the patients surveyed said that they could get prompt attention and that they had convenient access to medical information from the community or the mass media. More than half of the inpatients and outpatients thought that they had autonomy with regard to treatment and a greater number of patients made their own choices of doctors and nurses. Most of the patients were willing to talk freely with their doctors about their confidential medical history and could get rational explanations about their conditions from the doctors. The results indicate that reform of the health system in Shanghai has attached importance to the responsiveness of patients and that good effects have been achieved.

Objective To study the protective effect of resveratrol on endothelial cells injury induced by oxidized low-density lipoprotein (oxLDL) and its protective mechanism. Methods The injured model was established by endothelial cell treated with oxLDL. In the experiment, endothelial cell were cultured in vitro and divided into seven groups which were: control group; solvent (DMSO) group, oxLDL group, quercetin plus oxLDL group, Reseveratrol-L (0.5 mol/L), M(5 mol/L), H(50 mol/L) plus oxLDL group respectively. Endothelial cells were incubated with 200?g/ml oxLDL for 18 hours in the absence or presence of various concentrations of resveratrol and quercetin. The apoptotic index was detected by flow cytometric. Meanwhile, the content of Malondialdehyde (MDA), and the activity of SOD, GSHPX in the culture medium and homogenate of endothelial cells were measured. Results Incubation of endothelial cells with oxLDL for 18 h elicited a significant increase in the percent of apoptotic endothelial cells, in control group, the percent of apoptotic cells is 7.6?0.6, however in oxLDL group, it increased to 41.4?2.3, furthermore, oxLDL induced the increase of the contents of MDA, and accompanied by the decrease in the activity of SOD, GSHPX in the endothelial cells, the difference of was significant as compared with control group. Pretreatment of resveratrol with 0.5～50 mol/L decreased these oxLDL-induced changes, in Reseveratrol with 50 mol/L group, the percent of apoptotic cells decreased to 13.0?1.5, the difference of was significant as compared with oxLDL group (P