By stratified random sampling method, 10 000 residents were investigated with the questionnaire in Fangzhuang community of Beijing, 9497 valid questionnaires were collected with a return rate of 94. 97%. The results showed that two main purposes for patients to use the community health services were to seek consultation (29. 8% ) and to get prescription (28. 2% ). The three main reasons for residents to choose community health services were the convenience, less medical expenses and more clear explanation from doctors, followed by the personal trust in the doctors.

Objective To compare the dosimetric difference of volumetric modulated arc therapy (VMAT) plans for the loco-regionally advanced nasopharyngeal carcinoma (NPC) patients using 6 MV X-ray flattening filter-free (FFF) and flattening filter (FF) modes.Methods Ten previously treated patients with loco-regionally advanced nasopharyngeal carcinoma were retrospectively included and replanned using FFF and FF VMAT,respectively.Meeting all clinical criteria,the dose-volume histograms (DVH),dose distribution of target volume and organs at risk (OARs),target conformity index (CI),total monitor unites (MUs) and treatment time were compared across the plans.Results VMAT plans suing either FFF and FF modes can meet the clinical objectives.The maximum and mean target dose of FFF VMAT plans were significantly higher than that of FF VMAT plans (t =-0.31,-O.35,P ＜ O.05).Yet the planning target volume (PTV) CI of FF mode was slightly better than of FFF mode (t =5.42,P ＜0.05).The maximum doses of lenses in FFF VMAT plans were lower than that of FF VMAT plans (t =25.87,17.45,P ＜ 0.05),and other OARs displayed no significant difference.The mean total MUs of FFF and FF VMAT plans were (699 ± 16) and (628 ± 12) MUs respectively.The mean treatment time of two modes were consistent (about 2 min).Conclusions The plan qualities of FFF and FF VMAT plans were comparable and both clinically acceptable.The OARs at the edge of radiation field,such as lens,could be spared better using FFF VMAT mode.The total MUs of FFF VMAT plans were higher than FF VMAT plans,yet were delivered within the same time.

Objective To investigate muli-leaf collimator (MLC)-defined small field output factors calculated by the treatment planning system (TPS), and to study the measuring method of small field output factors verified by 0.015 cc PinPoint ionization chamber.Methods Eight medical accelerators for intensity-modulated radiation therapy (IMRT) were investigated in Henan province, and TPS-calculated output factors for various small fields (6 cm ×6 cm,4 cm ×4 cm,3 cm ×3 cm and 2 cm ×2 cm) were compared with published values recommended by IAEA.If the relative deviation was more than ± 3％ for the 2 cm ×2 cm field size and ±2％ for the fields of 6 cm ×6 cm, 4 cm ×4 cm and 3 cm ×3 cm, which was beyond the scope of IAEA allowed, the output factors will be measured and verified using 0.015 cc PinPoint ionization chamber and Unidos electrometer.Results TPS-calculated small field output factors for eight medical accelerators were compared with published values.The relative deviation of small field output factors for five pieces of equipment, which accounted for 62.5％ of the total, met the IAEA's requirement, while the other three, which accounted for 37.5％ of the total, did not.After measuring with PinPoint ionization chamber, the results from only three pieces of equipment met minimum IAEA's requirement.Conclusions MLC-defined small field output factors calculated by TPS for some medical accelerators in Henan need to be measured and corrected using micro-ionization chamber, and the measured values could be taken as the basis of radiation treatment planning.

Objective To study the applications and outcomes of using autogeneic cartilage in hearing recon-struction surgery in patients with chronic otitis media or cholesteatoma .Methods A total of 165 patients (173 ears) in whom autogeneic cartilage was used were analyzed retrospectively .Forty -three patients (48 ears) had simple tympanic membrane perforations ,61 patients (61 ears) had cholesteatomas including 12 retraction pockets ,23 pa-tients (23 ears) had tympanoscleroses and 38 patients (41 ears) had otitis media with granulations .The cartilage grafts were used for tympanic perforation reparing in 133 patients (139 ears) ,for ossiculoplasty in 102 patients (104 ears) ,for attic reconstruction in 31 patients (31 ears) and for canal wall reconstruction of external auditory canal in 3 patients (3 ears) .The auditory outcome (0 .5 ,1 ,2 ,and 4 kHz pure tone average hearing threshold ,the average air-bone gap) and local architecture status were followed up for 1 year after surgery .Results In 133 patients (139 ears) with tympanic perforation ,the rate of successful repair of a tympanic membrame perforation in one -stage was 97 .84% with perforation repair in 136 ears and postoperative perforation in 3 ears .In 102 patients (104 ears) of os-siculoplasty ,there was no ossicular prostheses prolapse .In 31 patients (31 ears) of attic reconstruction ,no local graft shift or collapse was found .In 3 patients (3 ears) of external auditory canal repair ,no canal wall collapse occurred . In myringoplasty group (43 patients ,48 ears) ,preoperative and postoperative air -bone gap (ABG) was 23 .8 ± 3 .1 dB and 11 .6 ± 8 .7 dB ,respectively .In cholesteatoma group (61 patients ,61 ears ) ,preoperative and postoperative ABG were 39 .2 ± 24 .7 dB and 19 .0 ± 12 .1 dB ,respectively .In tympanosclerosis group (23 patients ,23 ears) ,pre-operative and postoperative ABG were 31 .2 ± 12 .4 dB and 19 .8 ± 11 .2 dB ,respectively .In otitis media with granu-lation group (38 patients ,41 ears) ,preoperative and postoperative ABG were 41 .6 ± 9 .9 dB and 15 .3 ± 13 .4 dB ,re-spectively .Conclusion Autogeneic cartilage is very valuable in hearing reconstruction surgery ,especially in compli-cated tympanic perforation ,combination with ossiculoplasty prostheses ,or reconstruction of mastoid cavity or exter-nal call wall defect .

Objective To investigate the application effect of stone basket in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi. Methods The clinical data of 96 patients with upper ureteral calculi were retrospectively analyzed, all patients underwent ureteroscopic holmium laser lithotripsy. Forty-eight cases used the stone basket in the operation process (observation group), and 48 cases did not use the stone basket in the operation process (control group). The operation time, length of stay, success rate of lithotripsy, stone residual rate and incidence of postoperative complication were compared between 2 groups. Results The patients of 2 groups successfully completed surgery. There were no statistical differences in operation time, length of stay and incidence of postoperative complication between 2 groups (P>0.05). The success rate of lithotripsy in observation group was significantly higher than that in control group: 97.92% (47/48) vs. 75.00% (36/48), and the stone residual rate was significantly lower than that in control group:4.17%(2/48) vs. 18.75%(9/48), and there were statistical differences (P<0.05). Conclusions The stone basket in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi can thoroughly remove stones. It reduces the incidence of residual stones, does not affect the safety of the operation, and has good clinical value.

C1q /TNF-related proteins (CTRPs)belong to the same category of C1q /TNF-related protein family,mainly secreted by adipose tissue and widely expressed in human and rodent.Their function turned out to be metabolic modulation,cardiovascular system protection and suppression of inflammation.But for metabolic modulation,enhancing the synthesis of glycogen,promoting fatty acid uptake and oxidation,in-creasing insulin sensitivity is the major role of CTRPs playing in governing the metabolism.Each CTRP has its own unique tissue expression profile and nonredundant function in regulating sugar and /or fat metabo-lism.In this review we focus on the recent progress about the metabolic function of CTRPs.

Objective To evaluate the influence of age on the surgical risk and prognosis for elderly patients who suffered from lumbar spinal stenosis.Methods A total of 129 patients above 70 years old with lumbar stenosis from January 2015 to August 2018 were divided into 4 groups by age:younger than 69 years,70-74 years,75-79 years and 80 years and above.50 patients below 69 years old were chosen at random as control group.Different parameters such as operation methods,predicted complication rate (POSSUM score),actual complication rate,number of operation levels,operation time,surgical blood loss,occult blood loss,total hospital stay,postoperative hospital stay,hospital cost and the ODI score in 3 months followup were recorded.The surgical risk and prognosis of elderly patients were analyzed by comparing the differences of above parameters between different age groups.Results There was no significant correlation between different age groups and surgical methods (F=15.637,P=0.208).The operation time and surgical blood loss both showed no significant difference between 4 groups.The predicted incidence of complications (POSSUM score) in group older than 80 years old (38.5％+12.34％) and 75-79 years old (41.1％+ 11.82％) were higher than the group younger than 69 years old (28.4％+ 15.44％).There was no significant difference between the two groups over 75 years old,and there was no significant difference between the 70-74 years old group and the other three groups.The actual incidence of complications was 43.75％ in group over 80 years old,42.86％ in group 75-79 years old and 42.03％ in group 70-74 years old.The actual complication rate of the group younger than 69 years was lower than other three groups,and the three other groups showed no significant difference between each other.The totally hospital stay and numbers of operation levels in groups 75-79 and 80 years and above were higher than groups 70-74 and 69 years and below.There was no significant difference in those parameters between groups 75-79 and 80 years and above,and between groups 70-74 years and 69 years and below.The ODI scores between 4 groups also showed no significant difference.Conclusion The risk of surgery for lumbar disc stenosis patients older than 75 years has increased,but the patient's surgical outcome has not decreased.Old age should not be a key factor in determining whether a patient is suitable for surgery.

Objectives: In this study,we evaluated the influence of different nutritional support routes and nutrients on the intestinal barrier function and bacterial translocation in rats with gut I/R injury. Methods: Sixty male Sprague Dawley rats were made ischemic by clamping the superior mesenteric artery for 30 minutes and were divided randomly into four groups of fifteen animals each,i.e.standard parenteral nutrition (PN),gln enriched TPN (G PN),common enteral nutrition (EN),and enteral immunonutrient (IEN) groups. All the rats received isocaloric nutrition support for seven days.Rats were killed after 7 days'nutrition support.Spleen,liver,mesenteric lymph nodes (MLN),and blood samples were collected for bacterial culture. Endotoxin levels in plasma were also measured.The permeability of intestine mucosa was assayed by D lactate level in plasma.The small intestine was removed for studies.Mucosal thickness,villous height,crypt depth and villous surface area were determined.The gut immune barrier function was evaluated by the immunohistochemical staining method. Results: Atrophy occurred in small intestinal mucosa in PN group.The mucosal thickness,villous height,crypt depth and villous surface area were decreased significantly in PN group compared with other groups ( P

Objective: To establish an HPLC method for the determination of codonoposide in Codonopsis lanceolata Benth. et Hook.F..Methods:The HPLC analysis was performed on a Kromasil C18column (250 mm×4.6 mm,5 μm). The mobile phase was 0. 1% phosphoric acid-acetonitrile (70∶ 30) and the flow rate was 1. 0 ml·min-1 . The detection wavelength was 203 nm and the column temperature was 30℃. Results:Codonoposide in Codonopsis lanceolata Benth. et Hook. F. had a good separation from the oth-er components, and a good linear relationship was obtained within the range of 1. 09-17. 41 μg( r=0. 999 9). The average recovery was 98. 46%(RSD=1. 64%, n=6). Conclusion: The method is practicable with promising repeatability, which can be applied in the content determination of codonoposide in Codonopsis lanceolata Benth. et Hook. F. .

Objective To investigate the regulation and the mechanism of Melatonin in calcium overload of pancreatic acinar cell in acute necrotizing pancreatitis (ANP). Methods Fifty-four Sprague-Dawley (SD) rats were equally divided into three groups:sham-operation group (SO group),ANP group (created with retrograde cholangiopancreatography injection of sodium taurocholate) and MT group (ANP model made after intra-peritoneal injection MT for 30 mins).Rats were sacrificed at 1,4 and 8hours after operation and pancreas tissues were underwent pathological examination.The free calcium concentration of pancreas tissues was determined by fluorescence minitoring method; and the expression of CaMK Ⅱ in pancreas tissues at mRNA and protein level was tested by real-time PCR and Western Blot.Results Pancreatic pathological injury in ANP groups was progressively severe as time extended,which was obviously ameliorated in MT group compared with ANP group (the t value of compared pathological score at 1,4 and 8 hour was:-7.95,-9.72 and -7.69,all P=0.00).Compared at same time point,the free Ca2+ concentration of pancreas tissues in ANP group was significantly higher than that of SO group (the t value of 1,4 and 8 hour was 13.09,18.58 and 16.56,all P=0.00).It was a little bit higher in MT group compared with that of SO group,however was significantly lower than that of ANP group (the t value of 1,4 and 8 hour was -10.03,-11.75 and -11.02,all P =0.00).Compared with SO group,the expression of CaMK Ⅱ at mRNA and protein level significantly increased in ANP group; MT significantly inhibited its expression.Conclusions The expression of CaMK Ⅱ may be inhibited by MT interfere,and then lower the calcium overload in pancreatic acinar cell,which play a role in pancreas tissue protection.