Objective To investigate the current situation of occupational burnout of doctors in west China and to explore the relationships among burnout,social support and work-family conflicts.Methods 611 doctors in west China were assessed by Chinese Maslach burnout inventory( CMBI),social support rating scale(SSRS) and work-interference-with-family and family-interference-with-work questionnaire.Results 14.1％ of the doctors in west China got high scores on emotional exhaustion(EE),49.4％ of them high scores on depersonalization(DP) and 33.1％ high scores on reduced personal accomplishment (RPA) ; 27.3％ experienced mild burnout,43.7％ moderate burnout and 3.3％ severe burnout.Doctors who had worked for 5 ～ 10 years and those for 11 ～ 20 years experienced greater EE.Those doctors with bachelor or master degree and intermediate or senior titles got highest level of depersonalization.Doctors in second-class hospitals got highest scores of depersonalization,and those who worked in first-class hospital experienced the highest sense of achievement.Logistic regression analysis showed that social support was a protective factor for burnout,but the conflict between work and family was a risk factor.Conclusion The status of occupational burnout among the doctors in west China is in a grave condition,the balance between family and work,and social supporting is crucial for doctors to resist the occupational burnout.

Objective To reveal inpatient service utilization and medical burden in disease-caused poor rural families,for policy references.Methods By means of convenience sampling method,face-toface interview was made to inpatients from such families in Miyi County of Sichuan Province,Binhai County of Jiangsu Province and Xingtai County of Hebei Province.Results Totally 453 effective questionnaires were collected,with an effective rate of 96.7％.Respondents feature low income and fund raising capability,while 75.3％ of them pay their inpatient costs out-of-pocket,17.7％ pay with loans from others and 7.1％ pay by financial assistance from relatives;but they tend to go to higher level hospitals and have higher financial burdens for diseases.Conclusions Rural hospitalization resources should be optimized and integrated,levels of the New Rural Cooperative Medical System be improved,the catastrophic health care system be perfected and the health insurance coverage be gradually expanded for the low-income and marginalized population.

Nischarin is a novel protein interacting with integrin ?5 subunit.A series of studies have indicated that Nischarin plays an important role in inhibiting tumor cells migration and invasion.Meanwhile it may also serve as the functional I1-imidazoline receptor.To study this protein will be in favour of understanding the biological mechanisms of inhibiting cell migration and developing novel drugs such as inhibitors for tumor invasion.The article mainly reviews the recent progress in studies on Nischarin.

Objective To explore the impact of levels of serum IL-17,Leukotriene B4 and IgE on pathogenesis of childhood asthma.Methods Totally 60 children with asthma acute exacerbation ( 29 children with mild asthma,31 children with moderate-severe asthma) were selected as study group,24 healthy children were selected as control group.Serum IL-17 and LTB4 were measured with euryzemLinked immunosorbent assay,serum IgE was determined with enzyme-linked fluoroimmuneassay by pharmacia CAP Sytem,PMN was determined with automatic blood analyser,pulmonary function was measured in the study group.Results ( 1 ) The level of serum IL-17 ( 1.15 ± 0.10 μg/L,2.80 ± 2.30 μg/L,0.83 ± 0.10 μg/L),LTB4 (2.22 ± 1.01 μg/L,8.79 ± 9.36 μg/L,1.94 ± 1.13 μg/L) and IgE( 123.70 ±86.94 μg/L,322.27 ±332.28 μg/L,24.27 ±7.64 μg/L) were significantly different among mild asthma group,moderate-severe asthma group and control group( P ＜ 0.001 ).( 2 )The N％ of mild asthma group,moderate-severe asthma group and study group were( 55.06 ± 1 1.15 ) ％,( 64.44± 11.87)％,(47.96 ± 13.52)％,L％ were(42.20 ± 11.04)％,(33.93 ± 10.02)％,(49.65 ± 13.02)％,and there were significant differences in N％ and L％ between study group and control group( P ＜ 0.05 ).( 3 ) There were significant positive correlations between the serum IL-17 levels and IgE,LTB4 and IgE,IL-17 and LTB4 in asthmatic children( P ＜0.05).(4) There were significant negative correlcations between the level of serum IL-17,LTB4 and FEVI,PEF( P ＜0.001 ).There were significant positive correlations between serum IL-17,LTB4 and N％ (P ＜0.001 ).(5)There were not correlations between the level of serum IgE and FEV1,PEF and N％in asthmatic children( P ＞0.05 ).Conclusion The levels of serum IL-17,LTB4 and IgE participated in pathogenesis on asthmatic children patients.

OBJECTIVETo investigate the clinical effects and operative options for the treatment of Forestier disease.

METHODSFrom June 2005 to May 2012, 8 patients with progressive dysphagia due to Forestier disease were treated through anterior approach, their clinical data were retrospective analyzed. There were 6 males and 2 females, aged from 65 to 83 years old with an average of 73 years. Among the patients, osteophytes removal was performed in 3 cases, osteophytes removal with discectomy and fusion was performed in 2 cases, osteophytes removal with corpectomy and fusion was performed in 3 cases. According to Bazaz dysphagia score to assess the improvement of the patients' symptoms before and after operation.

RESULTSAll patients were followed up from 12 to 40 months with the mean of 18.5 months. Seven cases were asymptomatic and 1 case had mild symptom in the last follow-up. Radiographs showed the space enlargement between vertebral body and trachea.

CONCLUSIONIt is effective to treat patients with progressive dysphagia due to Forestier disease through surgical method. And the operative options depend on the stability of cervical spine and the neurological symptoms of the patients.

Aged ; Aged, 80 and over ; Female ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; diagnosis ; etiology ; surgery ; Male

A total of 200 outpatients with congenital urogenital abnormalities were recruited.Peripheral blood from each patient had mixed lymphocyte culture and chromosome karyotype was analyzed.Among them,22 (11％) cases showed abnormal chromosomal karyotypes.The aberrations included abnormal chromosome number (n =13),abnormal chromosome structure (n =8) and sex reversal syndrome (n =1).Chromosomal aberrations are important causative factors of congenital urogenital abnormalities.

Objective:To comparison of three different beta blockers on murine hemangioma (EOMA cells) cells in vitro and in vivo effects.Preliminary study on the therapeutic effect of propranolol on vascular tumor in mice and possible mechanisms , provide a reference for beta blockers in the treatment of infantile hemangioma .Methods: Comparative study on the effects of three kinds of different β-receptor blockers---metoprolol, propranolol and butoxamine , on the proliferation and apoptosis of Mouse Hemangioendothelioma Endothelial cell (EOMA cells) was conducted in vitro.EOMA cells were cultured in vitro,randomly divided into different groups,propranolol and timolol were added into the medium respectively ,after 24 h intervention.MTT assay and acridine orange staining assay were conducted respectively to detect cell viability and apoptosis level .EOMA cells were transplanted into nude mice in vivo.Tumor volume growth to 100 mm3 ,animals were randomly divided into 4 groups respectively ,the control group ,metoprolol group,Bhutto Samin group and propranolol group ,drug group according to 2 mg/( kg? d) oral gavage ,control group were given an equal volume of saline ( NS ) , every two days measurement tumor volume size .Serum levels of tumor necrosis factor alpha ( TNF-α) and vascular endothelial growth factor ( VEGF ) were detected by enzyme linked immunosorbent assay ( ELISA ) in the end of the experiment.Results:For propranolol,after 24 h treatment,significant differences of cell viability and apoptosis were noted (P<0.05) at the concentration of 50 μmol/L,while continuing to increase to 800 μmol/L,the cell survival rate decreased sharply to close to 10%. Acridine orange staining at the 50 μmol/L group after 24 h revealed many apoptotic cells .For metoprolol and butoxa mine ,significant differences of cell viability and apoptosis were noted ( P<0.05 ) at the concentration of 100 μmol/L,while continuing to increase to 800μmol/L,the cell survival rate decreased sharply to close to 20%.It was significantly higher than propranolol group at the same concentration ( P<0.05 ) .It showed a similar trend in acridine orange staining .In vivo experiments showed that the end of the experiment of metoprolol , butoxamine group and propranolol drugs in mice tumor volume , respectively ( 1 642.8 ±89.3 ) , ( 1 529.3 ± 119.1) and (752.7±46.5)mm3,significantly lower than the control group of mice tumor volume of (2 023.3±123.0) mm3(P<0.001).Metoprolol,butoxamine mice and propranolol drugs group ,serum VEGF levels for (606.5±105.8 ) pg/ml,(534.3±243.2 ) pg/ml and (420.1±123.7) pg/ml, significantly lower than the PBS control group [(825.8±145.7) pg/ml,(P<0.05)],the TNF alpha result was followed by(301.3±62.3) pg/ml,(305.1±53.8) pg/ml and (288.8±59.5) pg/ml,significantly lower than the normal control group [(444±100.4) pg/ml,P<0.05].Conclusion:Three kinds of beta-blockers can effectively inhibit EOMA cells proliferation and induce apoptosis in vitro, the role of propranolol more significantly than butoxamine and metoprolol .Three kinds of beta blockers restrain the growth of the hemangioma in vivo ,in which the inhibitory effect of propranolol is stronger than the metoprolol and butoxa mine.Three kinds of beta blockers can lower the levels of VEGF and TNF-αin vivo.Indicating that propranolol on vascular tumor in mice may be one of the mechanisms of β1 and β2 receptor synergy effect and its mechanism in the treatment of hemangioma may be associated with VEGF and TNF-α.

Background: Disruption of tight junctions between intestinal epithelial cells followed by loss of barrier function is crucial for the pathogenesis and progression of a variety of gastrointestinal disorders.Aims: To investigate the protective effect of ulinastatin on hydrogen peroxide (H2O2)-induced intestinal epithelial barrier disruption.Methods: Model of intestinal epithelial monolayer barrier was established with Caco-2 cells in vitro,and then divided into four groups: blank control group (without any intervention),H2O2 group (500 μmol/L H2O2),low-dose (500 U/mL) and high-dose (3 000 U/mL) ulinastatin groups (ulinastatin + H2O2).Level of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were detected;transepithelial electrical resistance (TEER) and flux of sodium fluorescein were measured to assess the barrier function;expression and localization of two tight junction proteins,ZO-1 and occludin were evaluated by Western blotting and immunofluorescence;ultrastructure of tight junctions was observed by transmission electron microscopy (TEM).Results: Compared with the blank control group,treatment of Caco-2 cell monolayers with H2O2 resulted in increase in level of MDA,flux of sodium fluorescein and decrease in activity of SOD,TEER and expressions of ZO-1 and occludin (P all ＜0.05).TEM and immunofluorescence showed that the brusher border of Caco-2 cells in H2O2 group was destroyed,the cell-cell junction was vague and the localization of ZO-1 and occludin was discontinuous and the fluorescence intensity was extremely low.While in ulinastatin groups,especially the high-dose group,all the indices above-mentioned were significantly improved (P all ＜0.05).Conclusions: Ulinastatin protects intestinal epithelial monolayer barrier against H2O2-induced disruption at least partially by its antioxidant activity and modulating expression and localization of tight junction proteins.

OBJECTIVETo study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and procerus.

METHODS10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 x operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus.

RESULTS(1) AN was classified into I, II, III type according to its formation pattern. Type I (20%, 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type II (20%, 4/20 sides), the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type III (60%, 12/20 sides), the AN had two branches in the "Four Muscle Gap". (2) The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. (3) The branch of AN enters the depressor supercilii or procerus 2.19 to 4.28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6.89 to 9.38 mm below the medial canthus ligament.

CONCLUSIONSThe approach of denervation surgery for AN should be performed medial to the support ligation, between 2.19 mm above the medial canthus and 6.89 mm below the medial canthus.

Adult ; Cadaver ; Denervation ; Facial Muscles ; innervation ; Facial Nerve ; anatomy & histology ; surgery ; Female ; Humans ; Male

OBJECTIVETo investigate the effects of propofol combined with indomethacin on the contractile function of isolated human pulmonary arteries.

METHODSHuman pulmonary artery preparations were obtained from patients undergoing surgery for lung carcinoma. The intrapulmonary arteries were dissected and cut into rings under microscope for treatment with propofol or propofol combined with indomethacin. In each group, the rings were divided into endothelium-intact and endothelium-denuded groups and mounted in a Multi Myograph system. In propofol group, the rings were preconstricted by U46619 to induce a sustained contraction, and propofol (10-300 mmol/L) was then applied cumulatively. In the combined treatment group, the rings were pretreated with indomethacin (100 µmol/L) for 30 min before application of U46619 to induce sustained contraction, and propofol (10-300 µmol/L) was added cumulatively after the tension became stable.

RESULTSPropofol (10-100 µmol/L) induced constrictions at low concentrations and caused relaxations at higher concentrations (100-300 µmol/L) in the pulmonary artery rings with prior U46619-induced contraction. Propofol caused stronger constrictions in endothelium-intact rings [EC=4.525∓0.37, Emax=(30.44∓2.92)%] than in endothelium-denuded rings [EC=4.699∓0.12, Emax=(31.19∓5.10)%, P<0.05]. Pretreatment of the rings with indomethacin abolished constrictions, and the relaxation was more obvious in endothelium-intact group [pD=3.713∓0.11, Emax=(98.72∓0.34)%] than in endothelium- denuded group [pD=3.54∓0.03, Emax=(94.56∓0.53)%, P<0.05].

CONCLUSIONPropofol induces constriction at low concentrations and relaxation at high concentrations in human intrapulmonary arteries with U46619-induced contraction. Indomethacin abolishes the constriction induced by propofol in isolated intrapulmonary arteries, suggesting that propofol potentiates U46619-mediated pulmonary vasoconstriction by promoting the concomitant production of prostaglandin by cyclooxygenase in pulmonary artery smooth muscle cells, and the mechanism for its relaxation effect may partly depend on the endothelium.