Objective:Under the premise of the policy of everybody has medical insurance,it discussed the integration plan of the basic medical insurance system for urban and rural residents in Tibet about the problems and the countermeasures.Methods:Descriptive and contrastive methods were used to analyze the status of urban and rural medical system operation in Tibet.Results:The problem of unbalanced development of urban and rural medical and health services in Tibet and the management of post-merger were put forward.Conclusion:It was necessary to put forward policy recommendations from the aspects of horizontal co-ordination,multi-sectoral collaborative management,unified medical insurance information management system,hierarchical diagnosis and treatment mechanism,perfect Tibetan medicine reimbursement catalog,one system and multiple files and vertical co-ordination,and gradually realize the urban and rural medical insurance in Tibet System integration.

Objective To observe the changes of pleth variability index ( PVI) and central venous pressure ( CVP) in patients undergo-ing resection operation of brain neoplasms,and the correlation of PVI with CVP was investigated. Methods Forty-two patients ( ASA Ⅱ~Ⅲ grade) undergoing elective resection operation of brain neoplasms were included in the study. PVI was monitored continously with Masio Radical-7 pulse oximeter after patient entering operative room. CVP was monitored after central venous catheterization placed with regional an-esthesia. Total intravenous anesthesia was chosen. CVP and PVI were recorded at the time of entering operative room,operation began,and 30 minutes,60 minutes,90 minutes,120 minutes after the beginning of operation. Results The correlation coefficient of PVI with CVP was 0. 201 under spontaneously breathing ( at patient entering operative room before anesthesia) and was 0. 237 under mechanical ventilation. Conclusion Correlation of PVI and CVP is lower. The value of PVI might need further research for guiding volume management.

Objective:To explore the effects of cognitive-behavioral group therapy on relieving social anxiety of medical students and thus improve the communication ability of medical students. Methods: The medical students with social anxiety in our school were randomly divided into two groups. The subjects in the control group and the experiment group were given with the routine mental health education and the cognitive-behavioral group therapy respectively. The cognitive, emotional, and behavioral levels were measured before and after intervention using Interaction Anxious-ness Scale ( IAS ) , Fear of Negative Evaluation Scale ( FNE ) , Social Avoidance and Distress Scale ( SAD) , and in order to evaluate the effects of cognitive-behavioral group therapy. Results:After the intervention of cognitive-behavioral group therapy in medical students, all the three levels of anxiety were im-proved significantly in the experimental group than those in the control group ( P<0 . 05 ) . Conclusion:Cognitive-behavioral group therapy could effectively decrease the level of social anxiety for medical students.

Objective To discuss the value of double-row allograft bone suture anchor in repair of rotator cuff injury. Methods Under assistance of arthroseope, 16 cases of rotator cuff lesions were repaired by using double-row allograft bone suture anchors. There were 10 males and 6 females at average age of 44 years (32-58 years). According to Bigliani classification, there were 6 cases of small ruptures, 8 medial ruptures and 2 large ruptures. After rotator cuff was trimmed and acromial bone was re-shaped under arthroscopy, 2 bone anchors attached to suture lines were implanted in the attachment point of rotate cuff of humerus greater tuberosity side by side. Then, the 4 ends of the 2 suture lines were vertically sutured through tendon of supraspinatus mnscle and tied separately, crossing the 4 ends of 2 knots and penetrated each 2 ends into one bone anchor. Finally, these 2 bone anchors were embedded into 2 predrilled bone holes which were parallel to the former 2 anchors and lower in humerus greater tuberosity. Thus, a web was formed and overlapped on the ruptured rotator cuff. The number of bone anchors was according to the size of rupture. Results All cases were followed up for average 14 months (6-23 months). The mean UCLA score was (21.30±5.6) points preoperatively and (32.4±5.8) points postoperatively. The function of shoulders recovered well, with no pain, recurrence or pulling out of bone anchor. Function was excellent in 10 cases, good in 5 and fair in 1. Conclusions As for repair of rotator cuff injury, double-row bone-anchors under arthroscope can provide a tendon-bone interface better suited for biologic healing of rotator cuff. Bone suture anchor can not leave any foreign object residual and costs less.

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Objective To identify the pathogens of 50 cases of fungal corneal ulceration by using semi-nested PCR amplification of ITS2 region.Methods Fifty isolates of fungal corneal ulceration and 3standard fungal strains cultures were collected and their DNAs were extracted.Their ITS2 regions were amplified by semi-nested PCR and sequenced.The results were compared with the nucleotide sequences in the NCBI GenBank.The pathogens of the fungi were identified and their distribution were analysed.Results The sequences results of the 3 standard fungal strains were consistent with the information in the GenBank.The pathological microorganisms of 50 cases of fungal corneal ulceration were:24 Fusarium (48％),including 17 Fusarium solani,6 Fusarium oxysporum and 1 Fusarium verticillioide; 10 Aspergillius (20％),including 5 Aspergillius flavus,3 Aspergillius sydowii and 2 Aspergillius nidulans; 6 Penicillium (12％),including 2 Penicillium citreo-viride,2 Penicillium multicolor and 2 Penicillium oxalicum ;5 Candida (10％),including 3 Candida albicans and 2 Candida parapsilosis; 3 Cladosporium (6％),including 2 Cladosporium herbarum and 1 case of Cladosporium cladosporioides ; 1 case of Neurospora crassa (2％) ;1 Alternaria alternata(2％).Conclusion Semi-nested PCR amplification of ITS2 region was proved to be a fast,simple and accurate method to identify pathogens of fungal corneal ulceration,and may be useful for personalized treatment and epidemiological investigation of local fungi.

Objective To investigate the correlativity between secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP) findings and pathological severity in a swine chronic
pancreatitis (CP) model. Methods Thirty-nine swine were divided randomly into control group (n=12) and experimental group (n= 27). In experimental group, the main pancreatic duct (MPD) was incompletely ligated to establish the model of obstructive CP. In control group, laparotomy was performed but without ligating the MPD. At the 4th, 8th and 12th week after modeling, one third swine of each group were undergone a series of dynamic sMRCP scans before (0 min) and at 1, 3, 5, 7, 9, 11 min after administration of secretin (0.6 μg/kg). And the MPD diameter and duodenum filling (DF) degree were measured. All survivals were sacrificed to pathological examination including HE and Van Gieson staining for histopathological grading. According to pathological severity, swine were divided into normal group, mild CP group and moderate to severe CP group. MRI features and indexes, including baselined diameter (BD), end diameter (ED), maximum diameter (MD), the largest expansion rate (LER), time to peak (Tpeak) and end change rate of pancreatic duct and duodenal filling (DF) scores were measured. The relationships between pathological grading and sMPCP indexes were analysed. The comparison of sMRCP data among the 3 groups were used ariance analysis, χ2 test and U test. Correlations between sMPCP indexes and pathological severity were tested using Spearman rank correlation coefficients. The diagnostic efficiency of sMRCP indexes were evaluated by ROC method. Results (1) In experimental group, 22 CP models were established and 19 CP swine (mild CP, n= 8; moderate and severe CP, n=11) were performed sMRCP successfully. Eleven swine in normal group were obtained satisfactory MRCP images. (2) sMRCP results:BD of 3 groups were (1.56 ± 0.46),(2.95 ± 1.17),(7.41 ± 1.91) mm, respectively. ED were (1.49 ± 0.31),(2.96 ± 1.17) and (7.37±1.90) mm, respectively. MD were (2.39±0.43),(3.91±1.27) and (7.86±1.87)mm, respectively. The median of LER were 42.10%, 34.85% and 6.58%, respectively. The median of DF scores were 3, 3, 2, respectively. The differences of above indexes have statistically significance (P values were all<0.01). There were correlation between sMRCP indexes (BD, ED, MD, LER and DFscores) and pathological severity (r values were 0.89, 0.92, 0.90,-0.85,-0.66, respectively and P values were all<0.01). Tpeak and end change rate of pancreatic duct had no significant differences (P values were>0.05),and no correlation with pathological severity(P values were all>0.05).For differential diagnosis between normal and mild CP, the area under ROC of BD, ED, MD, LER and DFscores were 0.915, 0.977, 0.926, 0.778 and 0.472, respectively and differential diagnosis between mild CP and moderate to severe CP group, the area under ROC were 0.966,0.966,0.960,1.000 and 0.915, respectively. Conclusions sMRCP findings of CP have characteristics and could be used for in vivo evaluation on the CP pathologic grades.

Objective To investigate the correlativity between elasticity modulus and pathological severity in chronic pancreatitis (CP).Methods Twenty-one pigs were divided randomly into experimental group (n=18) and control group (n=3) using random number method.The main pancreatic duct (MPD) was incompletely ligated to establish the CP model.In control group, MPD was not ligated.The animals were killed in batches at 4th, 8th and 12th week after surgery.The pancreatic tissue was taken for elasticity modulus test and pathological examination, and the pigs were classified into control, mild, moderate and severe groups based on the severity of fibrosis.Cell density, fat infiltration and extracellular edema were observed and classified into mild and severe.The difference of elasticity modulus among different groups were compared by Variance analysis, the correlation between pancreatic fibrosis and elastic modulus was analyzed with Spearman correlation analysis, and ROC curve was used to evaluate its efficacy of diagnosing CP.Results Sixteen CP models were established successfully expected for 2 deaths (mild, n=7;moderate, n=2 and severe, n=7).All of the control group (n=3) showed normal pancreas.The elasticity modulus of control, mild and moderate to severe group were 0.4268±0.0566, 0.3203±0.0518 and 0.2235±0.0685, respectively.The difference between the groups was statistically significant (F=13.658,P<0.01), and the elastic modulus and pathological grade had a negative correlation (r=0.969, P<0.01).AUC of elasticity modulus for differentiating normal and mild CP was 1.000, the best critical value was 0.3807, and both the sensitivity and specificity of the diagnosis were 100%.AUC for differentiating mild and moderate to severe CP was 0.8730, the best critical value was 0.2646, and the sensitivity and specificity of the diagnosis were 85.7% and 77.8%, respectively.The pancreatic elasticity modulus of low parenchymal cell density group and high parenchymal cell density group were 0.1931±0.0373 and 0.3485±0.0655, respectively, which in the high cell density group was significantly higher than that in the low cell density group (t=-5.719, P<0.01).The elasticity modulus of negative infiltration or slight fatty infiltration group and severe fatty infiltration group were 0.3401±0.0697 and 0.1855±0.0344, respectively, which in the negative infiltration or slight infiltration group was significantly higher than that in severe infiltration group (t=5.102, P<0.01).The elasticity modulus of negative or mild cell edema group and moderate to severe cell edema group were 0.2760±0.0825 and 0.3024±0.1056, respectively;there was no statistically significant(t=-0.586, P >0.05).Conclusions The elasticity modulus can be used to detect the pathological changes of CP, and evaluate the CP pathologic grades.

BACKGROUND AND OBJECTIVES: This study aims to investigate the significance of changes in the expression 11β-hydroxysteroid dehydrogenase (11β-HSD) and glucocorticoid receptor (GR) for the development of Kawasaki disease (KD). SUBJECTS AND METHODS: Real-time polymerase chain reaction was performed to determine the mRNA expression levels of GR and 11β-HSD in peripheral blood monocytes, both in the acute phase of the disease and after treatment. Western blotting was performed to determine the protein expression levels of GR and 11β-HSD. RESULTS: The expression levels of GRβ, GRβ, and 11β-HSD1 mRNA in the acute phase were significantly higher than levels at baseline (p<0.01) and after treatment (p<0.05). The 11β-HSD2 mRNA levels were lower in the acute phase than in the normal group (p<0.01), and they were significantly higher after treatment than before (p<0.01). Western blot results were consistent with the real-time PCR results. The coronary artery lesion group exhibited significantly different 11β-HSD2 expression levels from that of the group with normal coronary arteries (p<0.01). CONCLUSION: GR and 11β-HSD expression changes in the acute phase of KD are important factors for regulating inflammatory responses in KD.
Blotting, Western ; Coronary Vessels ; Monocytes ; Mucocutaneous Lymph Node Syndrome* ; Oxidoreductases* ; Real-Time Polymerase Chain Reaction ; Receptors, Glucocorticoid* ; RNA, Messenger

Objective To study the value of regulated upon activation,normal T-cell expressed and secreted (RANTES) and macrophage migration inhibitory factor (MIF) in the prediction of cognitive dysfunction associated with Parkinson disease (PD). Methods A total of 62 PD patients who received treatment in our hospital from January 2020 to January 2022 were recruited. All patients were treated with levodopa for 5 months. The levels of RANTES,MIF,interleukin-6 (IL-6),and tumor necrosis factor (TNF)-α were measured by enzyme-linked immunosorbent assay. Results Among the 62 PD patients,21 (33.87%) developed cognitive dysfunction after 5 months of levodopa treatment. The levels of RANTES,MIF,IL-6,and TNF-α were significantly lower in patients with cognitive dysfunction than in those without cognitive dysfunction (P<0.05). A multiple regression model was established with the basic data of patients as covariates and the presence or absence of cognitive dysfunction as the dependent variable. Adjustment was made for family history of PD,clinical subtype,comorbidity of hypertension,smoking history,course of disease,sex,and age. The results showed that serum RANTES,MIF,IL-6,and TNF-α levels were independent risk factors for cognitive dysfunction in PD patients (P<0.05). The receiver operating characteristic(ROC) curve showed an area under the ROC curve(AUC) of 0.798 for serum RANTES level to predict cognitive dysfunction in PD patients,with specificity,sensitivity,and Youden index of 0.743,0.705,and 0.448,respectively. The AUC was 0.802 for serum MIF level in the prediction of cognitive dysfunction in PD patients,with specificity,sensitivity,and Youden index of 0.552,0.973,and 0.525,respectively. The combination of serum RANTES and MIF had an AUC of 0.958 in predicting cognitive dysfunction in PD patients. Conclusion High levels of serum RANTES and MIF are risk factors for cognitive dysfunction in PD patients. In clinical practice,serum RANTES and MIF levels can be determined to predict the risk of cognitive dysfunction for early intervention and treatment.