Actins ; metabolism ; Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; metabolism ; pathology ; Lymphatic Metastasis ; pathology ; Lymphatic Vessels ; metabolism ; pathology ; Male ; Middle Aged ; Vascular Endothelial Growth Factor C ; metabolism

Animals ; Anti-Inflammatory Agents, Non-Steroidal ; pharmacology ; Antioxidants ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Paeonia ; chemistry ; Platelet Aggregation Inhibitors ; pharmacology ; Propyl Gallate ; isolation & purification ; pharmacology

Objective To evaluate the current situation of two-way referral system by qualitative study.Methods The qualitative study was carried out in Department of General Internal Medicine of Peking Union Hospital and 4 clinics under Beijing Gaobeidian Community Health Center from June to December 2009.In-depth interview was conducted on 6 patients,who were referring from community health center to tertiary hospital and 16 general practitioners in the community.The method of thematic framework was used for data analysis.Results Only 1 of the 6 patients,who made the appointment,completed the two-way referral.From the view of the patients,the interrupt of the two-way referral was due to long-time waiting,inconvenient transportation to the hospital,availability of specialists,unsmooth process of referral and unsatisfied doctors.However,the community health service staff thought that difficulties of the two-way referral originated from the system,doctors,patients,and doctor-patient relationship.Sometimes patients distrusted doctors both in hospital and in community; communications between doctors or between doctors and patients were less efficient; patients had multiple choice for their primary care and they may go to any hospital freely bypass community-based referral system; patients had excessive expectation for medicine and doctors; some patients paid less attention to their own health,and so on.For improvement of the two-way referral system,the community health service staff proposed concrete measures in terms of relevant policy,the hospital,community health service,the doctors and patients; they emphasized the importance of upgrading their own communication ability and professional skills for primary care.Conclusions Many factors may influence successful implement of two-way referral,so it is necessary to improve the relevant policy and procedures and to upgrade medical staff in community.

To explore the population composition and the morbidities and treatment of hypertension and diabetes mellitus among the patients at 4 community healthy service stations at Gaobeidian,Chaoyang District of Beijing during the period of February 2009 to October 2010.A cross-sectional survey was conducted by self-reporting questionnaires.Most patients were above 40 years old,had a lower income level and education status and their treatment costs were mainly covered by social health insurance.Their incidences of hypertension and diabetes mellitus were high.Though most of them could recognize and treat their illnesses,the control rate remained non-satisfactory.Targeting incoming patients,community health service stations should take its advantages of managing chronic diseases and enroll more patients from local communities.

Objective To observe the changes of immunological parameters and the effects of intravenous immunoglobulin (IVIG) in children with idiopathic thrombocytopenic purpura (ITP),schonlein-Henoch purpura(HSP) and mucocutaneoas lymph node syn-drome(kawasaki disease, KD).Methods T cell subsets and serum immunoglobulins and complements were measured with the flow cytometry and enhanced trubidimetric immunoassay. Routine therapy combined with IVIG. Results CD3+ CD4+ T cells were de-creased in children with ITP accompanied by increased serum IgG;Serum IgA and CD3+ T cells were increased in children with HSP; CD3+ CD8+ T cells were decreased in children with KD. Clinical features were markedly improved after treatment with IVIG. It was noted that the incidence of damage to coronary artery decreased after the use of IVIG. Conclusions T cell subsets, serum immunoglobulins should undergo the clinical routine examinations in ITP,HSP and KD. Early administration of IVIG might be important to improve disease prognosis and shorten its course of treatment in children with three kinds of immunology related diseases.

Objective To discuss methods of decoration reconstruction for finger defect in emergency and to observe the elinical effects.Methods Of the 41 cases of finger injuries of different degrees,15 were repaired with part of the skin flaps of the big toenails or skin flaps of the second toenalis,8 were repaired with part of the skin flaps of the big toenails,7 were reeonstructed with the second tiptoes,11 were repaired with the abdominal skin flaps of the big toes or lateral flaps of the second toes.Results All the 41 fingers sur- vived.One skin flap of the big toe was somewhat swelling and a decorating operation was performed.The 4～18 months of follow-up visitation of the rest cases revealed good function and shapes.No obvious functional ab- norality was found in the donating feet.Conclusion Various kinds of decoration reeonstruetion for finger defects are available to recover the hand shape and function as much as possible.

Objective To investigate clinical manifestations,histopathological features and treatment of ulcerative colitis (UC) complicated by pyoderma gangrenosum (PG).Methods Data on clinical manifestations,auxiliary examination findings,treatment and prognosis were collected from 8 inpatients with UC complicated by PG in Peking Union Medical College Hospital between July 2009 and July 2016,and analyzed retrospectively.Results Of the 8 cases,5 were male,and 3 were female.Theaverage age of onset was 30.6 years and 35.1 years in males and females respectively.All the patients developed intestinal symptoms of UC before the onset of PG with an average time interval of 5 years.Moreover,all the patients had active total colonic type UC at the onset of PG,including 6 with moderately active UC and 2 with mildly active UC.PG manifested as painful ulcers in 8 patients,and affected lower limbs in 7 patients.Histopathological examination of skin lesions showed typical characteristics of vasculitis in 5 patients.Five patients were complicated by arthralgia.All the patients were treated with glucocorticoids and 5-aminosalicylic acid agents as the basic therapy,3 patients received extra treatment with immunosuppressive agents or minocycline,and 2 with infliximab.Conclusions PG is a severe skin manifestation of UC,commonly occurs in patients with total colonic type UC in the active stage,and mostly affects the lower limbs,with typical histopathological features of vasculitis.

Objective To assess the efficacy and safety of ketogenic diet(KD) on refractory epilepsy in children.Methods KD treatment was designed to observe the effects for 12 weeks.Totally 22 children with 16 boys and 6 girls were enrolled in the study.The epileptic syndromes included infantile spasms(13 cases),Lennox-Gastaut syndrome(4 cases),Dravet syndrome(2 cases),and the unclassified(3 cases).The KD was prepared according to the modified Johns Hopkins regimen.Urinary ketones were measured every day to ensure that ketosis state and parents′ diaries were kept to find out when it started to work and the change of seizure frequency.Effects of KD was evaluated by Engel standard.Blood chemistry was done at baseline,4 weeks and 12 weeks to analyze the effects of KD on metabolism.Side effects were monitored and treated.Results All cases completed the KD regimen for at least 2 weeks,19 cases for at least 4 weeks,and 10 cases for at least 12 weeks.Sixteen out of 22 children experienced the seizure reduction within 3 weeks(1-15 d),especially in the first week,and seizure free appeared within 5 weeks(1-32 d) in 8 cases.Overall,the diet achieved the seizure-free in 36.4%(8/22 cases) and an over 90% of seizure frequency reduction in 22.7%(5/22 cases).The efficacy of KD seemed not correlated with the sex,age,etiopathogenisis,and syndromes and so on.Blood chemistry suggested a normal range of glucose level at 4 weeks,though higher than that at the baseline.The blood triglyceride and total cholesterol level at 12 weeks increased strikingly,even beyond the normal range compared with the baseline.The side effects mainly including transient gastrointestinal symptoms and metabolic disturbances were mostly tolerable.Conclusions KD is probably a feasible therapy on refractory epilepsy in children,with quick and high efficacy and few side effects.

A cross-sectional survey on two-way referral using self-report questionnaire was conducted in a sample of 1423 residents living in 4 communities in Caobeidian area, Chaoyang District and 4 communities in Dongcheng District from April to July 2009. Among the residents who responded the questionnaire, 19.7% (88/446) from Gaobeidian and 8.2% ( 80/977 ) from Dongcheng District were referred to hospitals in 2008. And 30.7 % (27/88) in Gaobeidian and 43.8% (35/80) in Dongcheng District referred to hospital based on their own decision rather than doctors' recommendation; 45. 5% (40/ 88) in Gaobeidian and 45. 0% (36/80) in Dongcheng District of referrals were officiary processed by health institutions. The survey also showed that 57.6% and 59.4% of the respondents from the two districts preferred to free referral between community health service centers and hospitals.

Objectives:To explore the relationship between cyber bullying incident and psychological status of college students,and the effects of online social support and psychological resilience.Methods:Totally 608 college students (aged 17-25 years) were selected.They were investigated with the Cyberbullying Inventory (CI,including cyber bullying and cyber bullied),Symptom Checklist 90 (SCL-90),College Students' Online Social Support Scale (CSOSSS) and Connor-Davidson Resilience Scale (CD-RSIC).Results:Online social support partly mediated the relationship between cyber bullying dimension or cyber bullied dimension and psychological status,and the ratios of the mediating effects to total effects were 24.1％ and 22.0％ separately.Psychological resilience didn't moderate the relationship between cyber bullying dimension and psychological status (β =0.01,P ＞ 0.05),but moderated the relationship between cyber bullied and psychological status (β =-0.08,P ＜ 0.05).Conclusion:The cyber bullying and cyber bullied may be not only related to psychological status directly,but also related to social support indirectly through online.Psychological resilience could buffer the effect of cyber bullied on psychological status.