Objective To explore effective ways for community health service institutions to change patients' health service seeking patterns. Methods Yuetan Community Health Service Center of Fuxing Hospital affiliated to Capital Medical University and 9 community health service stations under its subordination in the 1996～2002 period were selected as a representative of the community health service institutions to be studied and intervened while the headquarters of Fuxing Hospital in the same period was selected as a representative of the third-tier hospitals to be studied. A comparison was made between the two in outpatient volume change. Questionnaires were distributed randomly to residents of the Yuetan area where Fuxing Hospital is located in order to study their health service seeking behaviors each year from 1996 to 2002. Results As a result of hard work in the 6 years, Yuetan Community Health Service Center saw a steady increase in outpatient volume whereas the headquarters of Fuxing Hospital witnessed a steady decrease in outpatient volume. Survey via questionnaires sent randomly to permanent residents of the Yuetan area indicated a change in residents' health service seeking patterns. Conclusion It is effective and viable for community health service institutions to change patients' health service seeking patterns through providing social-psychological-biological community medical services, enhancing health education and setting up a two-way referral system with third-tier hospitals.

Aim To observe effects of breviscapine on lymphocyte proliferation and K562 cell death caused by doxorubicin.Methods The cell proliferation was tested by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)assay,the p53/bcl-2 expression were assessed by western blotting,cell apoptosis was quantitated by Histone/DNA ELISA and flow cytometry,cytochrome C release was determined by ELISA,caspase-8 and caspase-3 activation were examined by colorimetric assay.Results Breviscapine could obviously enhance mouse lymphocyte proliferation and its resistance to doxorubicin,promote growth inhibition,cytochrome C release,caspase-8 and caspase-3 activation in K562 cells which were caused by doxorubicin,upregulate radio of p53/bcl-2 expression,and increase cell apoptosis.Conclusion Breviscapine was able to enhance antitumor effect of doxorubicin,the major mechanism by which breviscapine could promote sensitivity of tumor cell to chemotherapeutic agents might be related to activated apoptosis signal way.

Objective To evaluate the role of using non-invasive ventilation with bi-level positive airway pressure (BiPAP) in order to reduce the need of re-intubation in pediatric patients with respiratory failure after cardiac surgery. Method From January 2007 to December 2007, 25 patients aged from three months to 11 years with median 2.3 years operated on for cardiac surgery with respiratory insufficiency after extubation and re-intubation indicated were enrolled in this study. They were put on non-invasive nasal (mask) BiPAP ventilation before re-intubation. The arterial blood gas, A-aDO2 and PaO2/FiO2 were measured. In addition, clinical data including heart rate, respiratory rate, and the product of heart rate and systolic pressure were recorded before and after BiPAP. The software SPSSD 13.0 was used to process by ANOVA test for statistical analysis. Meanwhile, the outcome of these patients was analyzed. Results Twenty-five patients with 30 episodes of respiratory insufficiency were treated with BiPAP ventilation with median duration of 1.96 days ranged from 0.03 to 12 days. Of these respiratory failure episodes, 25 ones (83.3%) could be controlled by BiPAP and the needs of re-intubation were avoided. Five episodes of respiratory failure in 4 patients could not be quelled and the endo-tracheal tubes were inserted in these patients. All patients were saved with a median of mechanical ventilation duration of 3.4 days and ICU stay of 10.6 days. No major complications were observed. The heart rate, respiratory rate and the rate-pressure product were decreased significantly one hour after BiPAP (P < 0.05 all). Meanwhile, patients showed rapid improvement of oxygenation. The pH, SpO>2 and PaO2/FiO2 were increased significantly and A-aDO2 was decreased significantly (P < 0.05 all). The PaCO2, was decreased significantly four hours after BiPAP (P < 0.05). Conclusions Non-invasive nasal mask BiPAP can be used safely and effectively in children after cardiac surgery to improve oxygenation/ventilation, decreasing the work of breathing. It may be particularly useful in patients with high risk of re-intubation.

Aim To observe the protective effects of breviscapine against lung fibrosis and investigate its possible mechanism.Methods Effects of breviscapine on cell proliferation,activation and extracellular matrix secretion were examined in mouse embryonic lung fibroblast L929 cells in vitro.The mouse model of bleomycin-induced lung fibrosis was used to assess the protective effect of breviscapine against lung fibrosis.Results In vitro,breviscapine had no cytotoxicity directly on L929 cells,however,it could suppress cell proliferation,activation and secretion of laminin(LN) and collagen Ⅰ(ColⅠ) induced by transforming growth factor beta1(TGF-?1) in L929 cells.In vivo,breviscapine could prevent increase in serum TGF-?1 and decrease in superoxide dismutase(SOD),peroxidase(POD) and catalase(CAT) in mice with lung fibrosis caused by bleomycin.In addition,breviscapine was able to reduce pulmonary hydroxyproline,collagen,malondialdehyde(MDA)and TGF-?1 in lung fibrosis mice.Conclusion Breviscapine has protective effect against lung fibrosis and the possible mechanism is to enhance antioxidative defense activities and prevent TGF-? signal.

Aim To study antiangiogenesis and antitumor of thalidomide.Methods In HUVECs, cell viability was determined by MTT assay;death type was observed by electron microscope; ratio of apoptosis was quantitated by flow cytometry.Angiogenesis was tested in chicken embryo chorioallantoic membrane.Effect of thalidomide on S_(180) was examined in homograft mice and microvascular counts were detected through immunochemical staining method.Results Thalidomide might inhibite the growth of HUVECs with a IC_(50) value of(22.91?1.74) ?mol?L~(-1),cells treated by thalidomide for 48 h displayed morphological characteristics of different stages associated with apoptosis,which were irregular nucleus, condensed chromatin, ballooning endoplasmic reticulum, apoptotic bodies,under electron microscope.Thalidomide might be able to cause apoptosis or necrosis of HUVECs in flow cytometry and raised positive of antiangiogenesis with increasing of dosage in chicken embryo chorioallantoic membrane. Thalidomide as a single agent might not significantly prevent tumor growth but decrease microvascular counts in tumors, however, in combination with cyclophosphamide, thalidomide could decrease dosage of cyclophosphamide and enhance antitumor of cyclophosphamide.Conclusion Thalidomide might hold back angiogenesis,as a single agent, could not significantly prevent S_(180) tumor from growing,but acted synergistically with cyclophosphamide.

In this paper, we present a virtual endoscopy (VE) for diagnosis of heart diseases, which is proved efficient and affordable, easy to popularize for viewing the interior of the heart. The dual source CT (DSCT) data were used as primary data in our system. The 3D structure of virtual heart was reconstructed with 3D texture mapping technology based on graphics processing unit (GPU), and could be displayed dynamically in real time. When we displayed it in real time, we could not only observe the inside of the chambers of heart but also examine from the new angle of view by the 3D data which were already clipped according to doctor's desire. In the pattern of observation, we used both mutual interactive mode and auto mode. In the auto mode, we used Dijkstra Algorithm which treated the 3D Euler distance as weighting factor to find out the view path quickly, and, used view path to calculate the four chamber plane.
Algorithms ; Endoscopy ; methods ; Heart ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Tomography, Spiral Computed ; methods ; User-Computer Interface

Objective To study the effect of human homologue of polycomb 2 (HPC2) on the growth of cervical cancer cells siha and the regulation of E7 gene.Methods HPC2 and E7 genes of siha cells were silenced by siRNAs respectively.Detected the expression of HPC2 gene and protein in siha cell lines after E7 gene silencing,cell proliferation activity and the rate of cell apoptosis.Results The expressions of HPC2 mRNA and protein were decreased in siha cells with E7 gene silencing,cell proliferation was inhibited,and apoptosis was increased,which was similar to HPC2 gene silencing.Conclusion HPC2 may be involved in the regulation of cell proliferation and apoptosis,and its expression may be closely related to E7 gene in SiHa cells.

Objective To evaluate the inductive effect of interferon-γ(IFN-γ) combined with tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) on programmed necrosis of the human immortalized keratinocyte cell line HaCaT,and to explore its mechanisms.Methods In vitro cultured HaCaT cells were divided into several groups:negative control group receiving no treatment,IFN-γ group treated with 50 μg/L IFN-γ,TRAIL group treated with 4 μg/L TRAIL,and cytokine combination group treated with 50 μg/L IFN-γ and 4 μg/L TRAIL or zVAD combination group pretreated with 40 μmo/L zVAD for 1 hour followed by the treatment with 50 μg/L IFN-γand 4 μg/L TRAIL.After 48-hour treatment,the morphology of HaCaT cells were observed under a light microscope,methyl-thiazolyl-tetrazolium assay was performed to evaluate the inhibitory effect of the treatment on the proliferation of HaCaT cells,and double staining flow cytometry to detect the necrosis of HaCaT cells.Meanwhile,real-time fluorescence-based quantitative PCR (qPCR) was conducted to determine the mRNA expression of receptor interaction protein kinase 3 (RIP3) and mixed lineage kinase domain-like protein (MLKL),Western blot analysis to determine the expression of RIP1,RIP3,MLKL proteins and their phosphorylated forms (pRIP1,pRIP3,pMLKL),immunofluorescent staining to observe the distribution of pRIP3 and pMLKL in HaCaT cells,and the level of reactive oxygen species (ROS) in HaCaT cells in the above groups was detected by the fluorescence probe DCFH-DA.Statistical analysis was carried out with SPSS 22 software by using one-way analysis of variance (ANOVA) for comparing indices among different groups,and least significant difference (LSD)-t test for multiple comparisons.Results After 48-hour treatment,HaCaT cells in the cytokine combination group and zVAD combination group showed necrosis-like morphologic features.Methyl-thiazolyl-tetrazoliumassay revealed significant differences in the survival rate of HaCaT cells among the IFN-γgroup,TRAIL group,cytokine combination group,zVAD combination group and negative control group (73.16％ ± 5.71％,81.46％ ± 4.68％,72.18％ ± 2.93％,69.67％ ± 3.24％ and 100％,respectively;F =24.34,P ＜ 0.001).The necrosis rate of HaCaT cells was notably higher in the cytokine combination group and zVAD combination group (9.86％ ± 1.31％,10.33％ ± 2.16％,respectively) than in the negative control group (5.26％ ± 0.91％,t =4.61,5.07,respectively,both P ＜ 0.05).qPCR revealed that the mRNA expression of RIP3 and MLKL significantly increased in the cytokine combination group and zVAD combination group compared with the negative control group (tRIP3 =0.99,1.84,tMLKL =1.51,2.17,respectively,all P ＜ 0.05).Western blot analysis suggested that the protein expression of RIP1,RIP3,MLKL,pRIP1,pRIP3 and pMLKL significantly increased in the cytokine combination group compared with the negative control group (all P ＜ 0.05),and the zVAD combination group showed significantly decreased caspase 8 expression and increased expression of the above proteins compared with the cytokine combination group.Fluorescence microscopy showed that enhanced green dot-like or clump-like fluorescent spots (representing pRIP3) could be observed in the cytoplasm,and red fluorescent spots (representing pMLKL) could be seen on the cell membrane in the cytokine combination group.The average fluorescence intensity of ROS was significantly higher in the cytokine combination group than in the negative control group (t =702.00,P ＜ 0.05).Conclusion IFN-γcombined with TRAIL can induce the programmed necrosis of HaCaT cells with increased level of ROS.

Objective:To study the effect of related laboratory indexes such as glycosylated hemoglobin on the occurrence of complications in patients with type 2 diabetes mellitus, and to construct a nomogram model.Methods:The clinical data of 203 patients with 2 diabetes mellitus from May 2020 to April 2022 in Quzhou Hospital, Zhejiang Medical and Health Group were retrospectively analyzed. Among them, 64 patients had no diabetic complications (control group), and 139 patients had diabetic complications (complication group). The clinical data of the two groups were recorded, and the related influencing factors of complications in patients with type 2 diabetes were analyzed; receiver operating characteristic (ROC) curve was used to analyze the predicting value of significant indexes for the complications in patients with type 2 diabetes; multivariate Logistic regression analysis was used to analyze the independent risk factors of complications in patients with type 2 diabetes; R language software 4.0 "rms" package was used to construct the nomogram model for predicting the complications in patients with type 2 diabetes, the calibration curve was internally validated, and the decision curve was used to evaluate the predictive efficacy of the nomogram model.Results:The hypertension rate, hyperlipemia rate, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin in complication group were significantly higher in those in control group: 44.60% (62/139) vs. 20.31% (13/64), 48.92% (68/139) vs. 25.00% (16/64), (5.42 ± 0.68) years vs. (4.84 ± 0.51) years, (12.60 ± 2.80) mmol/L vs. (10.20 ± 1.90) mmol/L, (16.50 ± 3.10) mmol/L vs. (12.50 ± 2.90) mmol/L and (9.62 ± 1.33)% vs. (7.96 ± 0.85)%, and there were statistical differences ( P<0.01); there were no statistical differences in gender composition, age, body mass index, smoking rate, drinking rate, albumin and creatinine between the two groups ( P>0.05). ROC curve analysis result showed that the area under the curve of the course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin for predicting the complications in patients with type 2 diabetes were 0.725, 0.752, 0.830 and 0.861, respectively; the optimal cut-off values were 5 year, 11.8 mmol/L, 15.1 mmol/L and 9.23%. Multivariate Logistic regression analysis result showed that hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were independent risk factors of complications in patients with type 2 diabetes ( OR = 1.563, 1.692, 1.451, 1.703, 1.506 and 1.805; 95% CI 1.268 to 1.689, 1.483 to 1.824, 1.215 to 1.620, 1.402 to 1.903, 1.303 to 1.801 and 1.697 to 1.926; P<0.05). The hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin were used as predictors to construct a nomogram model for predicting the complications in patients with type 2 diabetes. Internal validation result showed that the nomogram model predicted the complications with good concordance in patients with type 2 diabetes (C-index = 0.815, 95% CI 0.796 to 0.843); the nomogram model predicted the complications in patients with type 2 diabetes at a threshold >0.18, provided a net clinical benefit, and all had higher clinical net benefits than hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin. Conclusions:The nomogram model constructed based on hypertension, hyperlipemia, course of disease, fasting blood glucose, postprandial 2 h blood glucose and glycosylated hemoglobin has better clinical value in predicting the complications in patients with type 2 diabetes.

In recent years, progress has been made in general practice education research with the integration of narrative medicine and general practice. The narrative medicine is conducive to upgrading the abilities of general practice residents in doctor-patient communication, disease management and clinical decision makings; it also conducive to improvement of their humanistic quality and doctor-patient relationship. This article reviews the application of narrative medicine in the general practice residency training, and discusses relevant problems and countermeasures.