Objective To investigate the early diagnostic value and cost‐effectiveness analysis of common inflammatory markers , including interleukin‐6 (IL‐6 ) , procalcitonin (PCT ) and C‐reactive protein (CRP) in cirrhotic patients with infectious fever .Methods From January 2012 to January 2015 , cirrhotic patients hospitalized in liver center of First Affiliated Hospital ,Fujian Medical University who were excluded with community‐acquired infections and developed fever 48 hours after admission were selected .According to having infection or not ,they were divided into infection group and non‐infection group .White blood cell count (WBC) ,neutrophil percentage (N % ) ,IL‐6 ,PCT ,and CRP at admission (baseline) and at the time point of fever were recorded .The diagnostic threshold of WBC ,N% ,IL‐6 , PCT ,and CRP for infectious fever in cirrhotic patients were analyzed by receiver operating characteristic analysis curve (ROC) .The cost‐effectiveness (C/E) of those biomarkers were compared .Results A total of 299 cases were enrolled ,with 162 in infection group and 137 in non‐infection group .Two hundred and forty‐four were male and 55 were female .The mean age was 55 .1 ± 13 .0 years .Upon the onset of fever , WBC ,N% ,IL‐6 ,PCT ,and CRP of infection group were all significantly higher than those of non‐infection group (all P< 0 .05) .The area under the curve of IL‐6 for infectious fever was 0 .939 (95% CI 0 .910 - 0 .968) ,which was significantly higher than those of PCT and CRP (Z = 5 .718 and 9 .048 , respectively ,both P< 0 .01) .The optimal cut‐off point of IL‐6 was 184 .5 ng/L ,with the sensitivity of 85 .2% and specificity of 94 .9% .C/E value was 38 .3 for N% ,and 51 .2 for CRP . However ,both specificity and specificity of CRP and N % were low .C/E value was 389 .0 for PCT and 63 .4 for IL‐6 .IL‐6 had the highest sensitivity (85 .2% ) and specificity (94 .9% ) among all the biomarkers .Conclusions Compared to PCT and CRP ,IL‐6 has the highest sensitivity and specificity with lower cost‐effectiveness for diagnosis of infectious fever in cirrhotic patients .

ObjectiveTo present the experiences of f re e graft transplantation two-stage urethroplasty for hypospadias repair.Methods58 cases of hypospadias including 10 subcoronal,36 pen ile shaft,9 scrotal and 3 perineal were treated with free full-thickness skin graft or(and) buccal mucosa graft transplantation two-stage urethroplasty.Of th e 58 cases,45 were new cases and 13 had had previous failed surgeries.Single for eskin graft was used in 35 cases,single postauricular skin graft in 8,single b uccal mucosa graft in 6,foreskin grafts combined with postauricular skin grafts in 6 and foreskin grafts combined with postauricular skin grafts and buccal muc osa grafts in 3.ResultsOf 58 cases after the first-st age operation,56 were successful(97%) with grafts healing well,2 foreskin grafts got gangrened.After the second-stage operation,5 cases failed with newly for med urethras ruptured due to infection,8 complicated by fistulas whereas 43 case s healed well(77%).ConclusionsFree graft transplantati on two-stage urethroplasty for hypospaedias repair is a kind of effective treat ment with broad indication,comparatively high success rate,less complications an d good cosmatic results,being indicated for different types of hypospadias repa ir.

Preventing and curing emergency infectious diseases,such as A H1N1 influenza,is a public health practice,and its relevant ethical problems are pubic health ethical problems,mainly manifesting as the conflicts between individual interests and public interests,individual freedom and quarantine,individual privacy right and releasing partial medical information,and choosing one's own doctors and compulsory treatment.The core of the issue is that individual interests should be submitted to the public interests,and at the same time government and society should respect individual's freedom,privacy and right of health.

Objective To understand the short-term effect of practice skill training for general practitioners in Guangdong province and to provide scientific basis for improving the training strategy. Methods According to the training outline (Outline of job-transfer training for general practitioner in primary health institutions (trial))of the Ministry of Health,job-transfer training was provided for a total of 451 primary care doctors in economically undeveloped cities for one year. All trainees were investigated before and after training by questionnaire,which were designed by ourselves and included practical skill level and satisfaction degree.SPSS 13.0 software was used to do statistical analysis and data were processed by description analysis,t test,ANOVA and correlation analysis. Results Average self-evaluation scores of practical skills were 136.37 ±21.74 and 169.39 ±17.12 before and after training with significant differences (t=29.028,P=0.000). Scores of all types of practical skills after training were significantly higher than those before training (P<0.000 1). Total satisfaction rate was 91.6%and students were not well satis-fied with training environment and training guarantee. Fac-tors influencing the effect of training included educational background,professional title,doctors' de-sire of training,whether taking part in the general practitioner training or not. The effect of practical training was positively correlated with total satisfaction (r=0.162,P=0.037). Conclusions Remark-able results of practice skill training have been achieved. In the future,more chances for practice should be provided for trainees and contents of skill training should be designed according to the need of community health service,and more attention should be paid to the training project management.

Objective To survey village doctors'knowledge,demand and behavior of health management,to provide scientific evidence for village people's health self-management.Methods Prepared a self-designed question-naire and make it completed by 106 village doctors chosen at random from 106 different villages in the eight towns in Guangzhou's two mountainous districts.Results The average age of the village doctors was(50.9 1 ±7.84)years, 36.79% of them had the ultimate diploma of a health technical school,and the average knowledge rate of health man-agement was 30.09%.There was remarkable difference among the 3 age groups which disclosed statistic value(χ2 =112.900,P =0.000).The 35-44 age group was the highest in the knowledge rate of health management (52.61%). The doctors with a ultimate technical diploma vary in the knowledge rate (the highest was 47.44%),which also had statistic value(χ2 =112.900,P =0.000).Only 2.83% of the village doctors believed that their health management skill can completely meetthe current demand and 3.77% can.18.87% believed that training about health management was very meaningfuland 25.47% meaningful.63.21% (most required by the health bureau) expected to receive training.16.98% didn't receive such training in the recent year because they thought it was un-necessary or not available.11.32% of the village doctors were willing to pay for the health management training,while 97.17% had never taken such training on their own expenses.Conclusion Village doctors are mostly elderly,low-educated,and insufficient in the professional knowledge of health management.Without the corresponding motivations and regulations,they are not enthusiastic about the training.It is suggested that the local authorities pay more attention to the buildup of the village health stations and improve the structure,knowledge,and earning of the village doctor group so as to ensure the effective health management service for the masses in villages.

Hypertension is a common chronic disease which can lead to cardiac, cerebrovascular and renal damage; it is seriously harmful to human health. Cardiovascular disease caused by hypertension has become the first cause of death of residents in our country, the burden of disease has become more and more serious, how to manage hypertension has become an important public health issue in our country. In this review, the development and current situation of the community health management of hypertension at home and abroad are described and analyzed, the experience and practice worthy of learning are summarized to provide evidence for the prevention and control of hypertension in community.

AIM:To explore the relationship and molecular mechanism between microRNA-21(miR-21) and Schwann cells ( SC) following peripheral nerve injury.METHODS: The mRNA expression of miR-21 and phosphatase and tensin homologue deleted on chromosome ten ( PTEN) in animal model were detected by real-time PCR.The over-ex-pression of miR-21 and inhibition of miR-21 expression in the Schwann cells according to transfection of lentiviral vectors were performed, the nonspecific miRNA was used as a negative control ( NC) .The cell apoptosis was measured by flow cy-tometry.The mRNA expression of miR-21 and PTEN in the cells was detected by real-time PCR.The protein expression of PTEN and cleaved caspase-3 was determined by Western blot.RESULTS: The level of miR-21 was significantly higher and the mRNA level of PTEN was significantly lower in the model of nerve injury than those in control group.miR-21 over-expression decreased the number of apoptotic Schwann cells compared with NC-SC.The mRNA expression of PTEN was down-regulated by over-expression of miR-21.The protein expression of PTEN and cleaved caspase-3 was down-regulated by over-expression of miR-21 (P<0.05).CONCLUSION: miR-21 may play an important role in the peripheral nerve injury through inhibiting apoptosis of Schwann cells by down-regulating the expression of PTEN.

Objective To investigate the correlation between non-alcoholic fatty liver disease and serum and histological viral parameters in patients with chronic hepatitis B (CHB).Methods Clinical and laboratory data from patients with CHB who received liver biopsy from 2009 to 2015 were collected. Patients were divided into steatosis and non-steatosis groups based on the presence of steatosis in liver biopsies.Propensity score matching (PSM)was conducted to adjust the confounding bias including age, sex,body mass index (BMI),total cholesterol (TC)and triglyceride (TG).Correlation of liver fatty and viral parameters was compared between steatosis and non-steatosis groups.Student t test,χ2 test,rank sum test and Pearson correlation test were employed to analyze the data.Results A total of 874 patients with a mean age of (37.0±10.1)years were enrolled in the study,with 690 males and 184 females,and 270 (30.9%)patients were diagnosed with steatosis by liver biopsy.Age,gender,BMI,TC and TG were significantly different between the two groups before PSM (all P <0.05),but those were comparable after PSM (all P >0.05 ).Serum hepatitis B virus (HBV)DNA,hepatitis B surface antigen (HBsAg) level,proportion of hepatitis B e antigen (HBeAg )positivity,HBsAg and hepatitis B core antigen (HBcAg)immunohistological staining in liver tissue were not significantly different between steatosis and non-steatosis groups after PSM (all P >0.05).Patients in steatosis group were stratified into two groups according to the degree of steatosis confirmed by liver biopsies:mild steatosis group (F1 )and medium to severe steatosis group (F2-F4).The serum alanine aminotransferase (ALT),HBV DNA,HBsAg level, proportion of HBeAg positivity,immunohistological HBsAg and HBcAg staining in liver tissue between those two groups showed no differences (all P >0.05).The mean rank of liver inflammation and fibrosis in F1 group were 129.9 and 128.2,respectively,which were both significantly higher than those in F2-F4 group (105 .9 and 108.5 ,respectively;both P <0.05).Steatosis was negatively correlated with either inflammatory grade (r=-0.183,P =0.005)or fibrosis stage (r=-0.150,P =0.020).Conclusions There is no correlation between serum viral factors and hepatic steatosis. Hepatic steatosis is not associated with the expressions of HBsAg and HBcAg in liver tissue.The severity of steatosis is negatively correlated with both liver inflammation and fibrosis.

Objective:To evaluate the correlation of orbital computed tomography and incretion in patients with thyroid associated ophthalmopathy- Ⅰ. Methods : Seventy-six orbits of 38 patients with thyroid associated ophthalmopathy were evaluated by CT in respect to the density and the size of extraocular muscles, and 100 normal orbits of 50 healthy person were evaluated with the same indices for comparison. Results:There was significant difference in the density and the size of extraocular muscles between the patients and the healthy adults. The maximal size of extraocular muscles were positive correlation with T3,T4in TAO-Ⅰ, and negative correlation with TSH. Conclusion:The manifestation of orbital CT may be a good index in the following survey of thyroid associated ophthalmopathy-Ⅰ.

Objective:To explore the microRNA profile changes in the development of NKT cells.Methods: Differently developmental stage of NKT cells in mouse thymus were sorted by flow cytometry.Total RNA were extracted,reversely transcribed and pre-amplified.TaqMan low density microRNA assay and single real-time PCR were applied to detect the expression changes of microRNAs in the developmental process of NKT cells.Results: There were total 92 microRNAs whose expression changed significantly during the development and maturation of NKT cells.Among them,increasly expressed microRNAs were 71,including 36 microRNAs whose expression continuously increased;decreasly expressed microRNAs were 21,including 12 microRNAs whose expression continuously decreased.In addition,single real-time PCR analysis showed that the expression of Let-7f,miR-150,miR-24,miR-29 increased,while the expression of miR-223 and miR-155 decreased during the development and maturation of NKT cells.Conclusion: NKT development and maturation is accompanied by expression changes of large amount of microRNAs,indicating that specific microRNA regulates NKT development and function.