Objective To explore the effect of the joint teaching rounds of the multidisciplinary radiotherapy.Methods 54 clinical college students of Grade 2013 was selected as the control group,adopting the traditional single teaching ward round model,while 58 clinical college students of Grade 2014 was selected as the research group,adopting the multidisciplinary joint radiation operation mode.By contrasting the satisfaction questionnaire,calculating and delineating the target volume error rate and the theory examination results,the effect of teaching ward round was evaluated.Results ①According to the survey,the research group's satisfaction in teaching methods,stimulating students' enthusiasm for learning,improving their clinical thinking ability and consolidating the knowledge (respectively 91.38％,86.21％,82.76％,93.10％),was higher than that of the control group (75.93％,68.52％,62.96％,77.78％),and the difference was statistically significant (chi square values were 4.95 5.05,6.25,5.36;P＜0.05).②The research group's pass rate in delineation of Gross Target Volume (GTV) and the Clinical Target Volume (CTV) was (82.76％,86.21％),higher than that of the control group (53.70％,62.96％),and the difference was statistically significant (chi square values were 14.36,9.48;P＜0.01).③Research group's score in clinical Three Basics and oncology theory achievement was(88.75 ± 5.23) and (82.72 ± 3.69),higher than the control group [(81.88 ± 613),(80.74 ± 3.25) points],and the difference was statistically significant (t=6.40 respectively,3.01;P＜ 0.05).Conclusion Radiotherapy department's multi-disciplinary joint ward round helps to improve the teaching quality.

Public hospitals are the backbone of China's healthcare,shouldering critical tasks of ensuring health of the Chinese people at large.Their reform,therefore,should enhance and coordinate the balance between public welfare and efficiency of public hospitals as much as possible.Such a “separated ownership/operation” reform in the management system reform of public hospitals can raise their operational and management efficiency,so as to maximize their performance of public benefits.Based on the basic theory of separated ownership and operation,authors of the paper proposed policy recommendations for such a reform upon the analysis of the four optional patterns separated ownership and operation of public hospitals.

Objective To understand the levels of plasma endothelin (ET) and calcitonin gene-related peptide (CGRP) in cough variant asthma(CVA) patients, and to investigate their correlation and clinical implications. Methods Thirty CVA patients,30 typical bronchial asthma patients and 25 healthy controls were recruited. Three milliliter limosis venous blood were drawn from each patient to measure the levels of plasma ET and CGRP by radioimmanity. Results ①The levels of ET in the CVA group and typical bronchial asthma group were higher than that in healthy controls (P < 0.01). Their values were (103.58±28.66) ng/L, (129.37±27.28) ng/L and (72.63±21.52)ng/L, respectively. The levels of CGRP in the CVA group and typical bronchial asthma group were (7.62±2.56) ng/L and(6.63±2.09)ng/L The level of CGRP in the healthy controls group was (21.60±3.29) ng/L. The first two groups were lower than the latter(P < 0.01). However, there was no significant difference between the CVA group and typical bronchial asthma group(P >0.05). ②ET and CGRP were negatively correlated in both CVA group(r= -0.819,P<0.05) and typical bronchial asthma group(r= -0.738,P<0.05). Conclusions ET and CGRP were negatively correlated in both CVA group and typical bronchial asthma group, which means that ET and CGRP were a couple of antagonistic factors participated in the regulation of CVA, and may play an important role in the process of CVA.

Objective:To observe the therapeutic effect and safety of warfarin on patients with atrial fibrillation. Methods:A total of 126 patients with atrial fibrillation from our hospital during Jun 2012-Jun 2013 were selected. According to hiding number random method,they were divided into aspirin group (n=63)and warfarin group (n=63).Coagulation function,blood lipid levels and end-point events were compared between two groups.Results:Compared with aspirin group,after treatment,there were significant reductions in levels of total cholesterol [(5.8 ±0.5)mmol/L vs.(5.2±0.7)mmol/L],triglyceride [(2.6±0.4)mmol/L vs.(2.4±0.3)mmol/L]and low density lipoprotein cholesterol [(2.7±0.5)mmol/L vs.(2.4±0.3)mmol/L],significant rise in level of high den-sity lipoprotein cholesterol [(1.1±0.2)mmol/L vs.(1.3±0.2)mmol/L],prothrombin time [(28.3±11.7)s vs. (36.9±10.4)s]and it′s international normalized ratio [(1.9±0.4)vs.(2.4±0.5)]in warfarin group,P <0.05 all.Incidence rate of endpoint events such as cerebral infarction and peripheral artery embolism etc.in warfarin group was significantly lower than that of aspirin group (3.17% vs.23.81%,P <0.01).The incidence rates of complications were 23.81% and 26.98% in warfarin group and aspirin group respectively,and they had no signifi-cant difference,P >0.05. Conclusion:For atrial fibrillation,the therapeutic effect and safety of warfarin is better than that of aspirin,is worth extending.

Objective To compare the efficacy and safety of two kinds of homemade sirolimus-eluting stents (Firebird and Excel) for treatment of acute ST segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI). Methods The 249 consecutive patients with STEMI who underwent PCI were randomly divided into two groups: Excel group (n=136) and Firebird group (n=113). They were followed up for 6-24 months, and coronary angiography was reviewed average 12 months later. The primary endpoints were major adverse cardiac events, including death, reinfarction and target vessel revascularization. The second endpoints included late luminal loss and restenosis 12 months after treatment. Results There were no significant differences in baseline data, coronary arterial lesion before operation, and immediateness condition after PCI between the two groups (all P＞0.05). Within follow-up, there were 2 (1.47%) death cases and 1 (0.88%) death case, 1 (0.74%) and 1 (0.88%) nonfatal myocardial infarction case, 2 (1.47%) and 2 (1.77%) target vessel revascularization cases in the two groups respectively (all P＞0.05). There were no significant differences in late luminal loss of in-stent and in-segment, the rates of in-stent restenosis, in-segment restenosis and stent thrombosis, the in-stent minimal lumen diameter and in-segment minimal lumen diameter between the two groups (all P＞0.05). Conclusions The two kinds of homemade sirolimus-eluting stents may have similar efficacy and safety in patients with STEMI treated with primary PCI.

Objective To determine whether field triage would reduce median contact-to-device ( C2D ) time in patients with ST-segment elevation acute myocardial infarction ( STEMI ) . Methods Consecutive patients with STEMI underwent primary percutaneous coronary intervention( PCI) from March 2010 to February 2014 in Shanghai Pudong Gongli Hospital were analyzed. Patients were divided into two groups. A total of 121 patients were admitted by field triage and 101 patients by non-field triage. The primary study point was C2D time and the study points secondary included ( door-to-balloor, D2B) time, peak Troponin I ( TnI) levels, hospital mortality and 30 days follow-up mortality. Results Baseline and procedural characteristics between the two groups were comparable. Comparing to non-field triage group, the C2D time was reduced [(92. 0 ± 56. 0)min vs. (131. 0 ± 61. 0)min,P﹤0. 01]. The D2B time was lower in the field triage group vs. the non-field triage group [(55. 0 ±26. 0)min vs. (96. 0 ±31. 0)min,P﹤0. 01]. The percentage of patients with C2D time less than 90 minutes increased significantly from 85. 1% to 98. 3%( P﹤0. 01 ) in the field triage group. Peak TnI level was significantly reduced in the field triage group [(23. 5 ±22. 0) μg/L vs. (43. 5 ± 39. 0) μg/L,P﹤0. 01]. In-hospital mortality and 30 days follow-up mortality did not significantly differ between the 2 groups (3. 3% and 3. 0%, P=0. 885;3. 3% and 5. 0%, P=0. 544, respectively). Conclusions In STEMI patients, field triage was associated with significantly reduced C2D and D2B times.

Objective To analyze the results of screening for tuberculosis (TB) in health examination participants and study the spontaneous occurrence of TB in the subjects with strong positive reaction to tuberculin skin test (TST) in ten years. Method Totally 12 598 health examination participants without past TB history were selected, of whom 8 896 were college students, 2 496 migrant workers and 1 206 had close contacts with active TB patients. They were screened by TST with strong positive reaction. All of subjects with TST strong positive results received chest X-ray examination and sputum acid-fast bacteria detection. The subjects diagnosed to have TB were given regularly anti-tuberculosis drugs treatment and followed up for ten years. The 429 subjects without TB and no isoniazid preventive treatment were chosen to be followed up for ten years and spontaneous occurrence of TB in first three years and the fourth to tenth years respectively, as well as the recurrence of TB for the patients who received anti-tuberculosis regimen were recorded. Result Thirty-seven cases were diagnosed as TB by TST screening, and the total detection rate was 0.29% (37/12 598). Among them 11 were college students (0.12%, 11/8 896), 12 were migrant workers (0.48%, 12/2 496) and 14 were close contacts (1.16%, 14/1 206) respectively. The detection rates were different among the three groups (χ2=31.40, P=0.000). Among 897 strong positive subjects, the strong positive rate was 7.12%(897/12 598), 316 were college students (3.55%, 316/8 896), 388 migrants workers (15.54%, 388/2 496), and 193 close contacts (16.00%, 193/1 206) respectively. There was significant difference in strong positive rate among the three groups (χ2=583.04, P=0.000), and the strong positive rate of college students was lower compared with that of the migrant workers and the close contacts (χ2=483.51 and 344.11, P<0.01). In ten years, 54 subjects were diagnosed as TB in 429 subjects with strong positive reaction to TST, the spontaneous cumulative incidence rate was 12.58% (54/429). Among them, the cumulative morbidity rate was 9.21%(14/152) in college students, 9.58%(18/188) in migrant workers and 24.72%(22/89) in close contacts respectively. The spontaneous morbidity rate of close contacts was higher than that of college students and migrant workers(χ2=10.63 and 11.21, P<0.001); 75 were lost in 398 participants, the dropout rate was 18.84%(75/398). In first three years of follow-up, 31 were diagnosed TB in 429 participants, the cumulative incidence rate was 7.23% (31/429). Of them 9 were college students (5.92%, 9/152), 10 migrant workers (5.32%, 10/188) and 12 close contacts (13.48%, 12/89) respectively (χ2=6.60, P=0.037). In the fourth to tenth years of follow-up, 23 were diagnosed TB in 398 participants, the cumulative incidence rate was 5.78% (23/398), which was not significantly different compared with the cumulative incidence rate of the first three years (χ2=2.50, P=0.37). Tirty-seven patients received standard anti-tuberculosis drug therapy for one year, no one of them had recurrence at ten-year follow-up. Conclusion The migrant workers and close contacts are the high-risk populations for TB. All of them with strong positive response to TST results are susceptible to TB. So regular physical examination is recommended for them and health management should be strengthened.

Objective To examine the 5-year incidence of tuberculosis in different populations with strongly positive tuberculin skin test (TST) receiving preventive administration of isoniazide.Methods A total of 12 598 subjects including 8 896 college students,2 496 migrant workers and 1 206 close contacts with active pulmonary were selected from January to December 2003.Subjects with strongly positive TST but without abnormal lung findings were divided into isoniazide group (given isoniazide for 10 months) and control group (not given any drugs).The incidence of tuberculosis in year 2-5 were observed and compared usingx2 test.Results Among 12 598 subjects,897(7.12％) had strongly positive TST,including 316 college students,388 migrant workers and 193 close contacts,and the TST strongly positive rates were 3.55％ (316/8 896),15.54％ (388/2 496) and 16.00％ (193/1 206),respectively.Migrant workers and close contacts had higher TST positive rates than college students (x2 =483.51 and 344.11,P ＜ 0.01).Among 897 TST-positive individuals,37 were diagnosed as tuberculosis,including 11 college students,12 migrant workers and 14 close contacts,and the tuberculosis rates in three populations were 0.12％ (11/8 896),0.48％ (12/2 496) and 1.16％ (14/1 206),respectively.Migrant workers and close contacts also had higher tuberculosis rates than college students (x2 =12.34 and 42.18,P ＜0.01).In the second follow-up year,9 out of 429 subjects in isoniazide group quit the study due to adverse reactions,and in the rest 420 subjects,9 (2.14％) were diagnosed as tuberculosis.The incidence of tuberculosis in three populations were 1.34％ (2/149),1.60％ (3/188) and 4.82％ (4/83),and no significant difference was found (x2 =2.92,P ＞ 0.05).While in the control group,31 out of 429 (7.23％) individuals were diagnosed as tuberculosis,and the incidence was higher than that in isoniazide group (x2 =12.69,P ＜ 0.01).During the next three follow-up years,23 individuals in isoniazide group drop out of the study,and in the rest 388 subjects,8 (2.06％) were diagnosed as tuberculosis.The incidence of tuberculosis in three populations were 1.41％ (2/142),2.35％ (4/170) and 2.63％ (2/76),and no significant difference was found (x2 =3.11,P ＞ 0.05).While in the control group,17 out of 398 (4.27％) subjects were diagnosed as tuberculosis,and the incidence was not of significant difference compared with that in isoniazide group (x2 =2.47,P ＞ 0.05).Conclusion Migrant workers and close contacts are high risk populations of tuberculosis,and preventive administration of isoniazid for 10 months may reduce the incidence of tuberculosis in the following 2 years.

Objective: To express the protein of HPV18E6 based on pET-32a(+) at high level and study the expression and significance of HPV18E6 proteins in laryngeal carcinoma. Methods: The HPV18E6 gene was amplified by PCR and cloned into pET-32a(+). The amplified fragment was inserted into the plasmid pET32a (+) that was digested with BamHⅠand Hind Ⅲ. The recombinant plasmid pET32/E6 was transformed into E.coli JM109 which was selected with ampicillin. The recombinant plasmids were successfully introduced into E.coli BL21(DE 3) and were induced by IPTG. SDS-PAGE and Western blot analysis were used to detect the confusion protein. Finally, the optimization of expression conditions, such as temperature, concentration of IPTG, was studied. Results: The recombinant plasmids were identified and confirmed with enzyme digestion and sequencing. The BL21(DE3) transformed recombinant plasmid pET32/E6 had expressed HPV18E6 recombinant protein effectively. The optimum conditions of expression were 37 ℃, 1 mmol/L IPTG. Conclusion:Prokaryotic expression vector pET-32a(+)-HPV18E6 was successfully constructed. The high-level expression of HPV18E6 was achieved in E.coli BL21(DE3).

Objective To investigate the anti-inflammatory/immune modulatory effects of high-expressing membrane bound M-CSF-hematopoietic malignant cells on macrophages. Methods After coculturing RAW264.7 and murine macrophage cell line with Namalwa-M, a cell line stably expressing mM-CSF, and companing with Nainalwa-V, a cell line stably transfected with the empty vector as the control, flow cytometry was used to detect the expression of the marker of alternatively activated macrophages, CD206, and intracellular expression of IL-10, IL-12, IL-6 and TNF-α to study the immunophenotype of RAW264.7; phagocytic assays to investigate their functional activity in vitro. Results RAW264.7 cocultured with Namalwa-M consistently showed high-level expression of CD206, which indicated activities of these macrophage cells were increased. Furthermore, these RAW264.7 expressing high levels of IL-10, TNF-a and low levels of IL-12, IL-6, as determined by intracellular staining were suggested that the phagocytic activity was increased. Functionally, RAW264.7 cocultured with Namalwa-M showed a higher level of phagocytic activity. Conclusion Macrophage generated in vitro after cocultured with mM-CSF-expressing hematopoietic malignant cell line could be transformed into abnormal macrophage with an immunophenotype defined as IL-10-high, IL-12-low, IL-6-low and TNF-α-high.