Aim To investigate the changes of plasticity and distribution in the lungs of asthmatic guinea pigs.Methods Guinea pigs were divided into asthma group and control group.Immunohistochemistry was used in this study to observe the changes of ERK1/2 and Elk phosphoryiation in the lungs of guinea pigs.Results There were significant changes in distribution of EPK1/2 and Elk in the lungs of asthma group.The positive cells were detected on the walls of respiratory bronchioles and alveolar ducts,especially on the smooth muscle layer and basement membrane.In addition,the numbers of positive cell were clearly increased in asthma group(P< 0.01). Conclusion There is close relationship between the EPK1/2 and Elk phosphoryiation and attack of asthma.It may be a reason for persistence and progress of asthma.

Objective To identify anal canal structures by dual plane transrectal ultrasound. Methods One anorectal specimen was observed by ultrasonography when needles were placed in different anal muscle layers respectively. Fifty patients with no anorectal or perianal diseases were examined by transrectal ultrasound to verify the sonographic features of anal canal, meanwhile the inner and outer sphincters and longitudinal combination muscle were measured. The ultrasound images of anal canal were compared with MR images. Fifty patients were divided into three groups according to the age: 25- 40 years old, 41 -55 years old,and ＞55 years old. Results The sonographic features of anal canal structures by transrectal ultrasound were identified. Anal canal sonographic images and MR images had consistency. The thickness of inner sphincter in each group was (0.19 ± 0.03)cm, (0.22 ± 0.02)cm, (0.24 ± 0.03)cm respectively,while outer sphincter (0.44 ± 0.03)cm, (0.49 ± 0.04)cm, (0.52 ± 0.04)cm, and longitudinal combination muscle (0.10±0.02)cm,(0.11 ± 0.02)cm,(0.11 ± 0.02)cm. Conclusions Transrectal ultrasound is a simple,efficient and non-invasive method to examine anal canal which can identify anal canal structures clearly.

Objective:To evaluate the efficacy and safety of sequential platinum regimen in young patients with diffuse large B-cell lym-phoma (DLBCL). Methods:Newly diagnosed young patients with DLBCL, who were hospitalized from January 2005 to June 2012 in the Affiliated Cancer Hospital of Zhengzhou University, were selected according to the requirements. The patients were divided into stan-dard and sequential platinum regimen groups. The remission rates were compared usingχ2 test, whereas the five-year survival rates between the two groups were compared using the Kaplan–Meier method. Multivariate survival analysis was performed using the Cox proportional regression. Subgroup analysis was conducted to select candidate patients for the sequential platinum regimen. Results:A total of 331 patients were enrolled in the study, in which 129 were provided with sequential platinum regimen and 202 were provided with the standard regimen. Sequential regimen yielded higher rates of complete remission (80%vs. 63%, P=0.001), five-year progres-sion-free survival (PFS;60%vs. 50%, P=0.014), and overall survival (OS;70%vs. 58%, P=0.016) than the standard regimen. Multivariate analysis revealed that sequential regimen was an independent prognostic factor for PFS (hazard ratio HR=0.635, P=0.012) and OS (HR=0.625, P=0.021). Subgroup analysis showed that patients with good prognosis and patients who did not receive rituximab benefited more from the sequential platinum regimen. Sequential platinum regimen did not increase the occurrence of adverse effects com-pared with the standard regimen. Conclusion:Sequential platinum regimen is a safe treatment that can improve the survival of young patients with DLBCL. Patients with good prognosis and patients who did not receive rituximab can benefit more from the treatment with sequential platinum regimen.

Objective To investigate the clinical efficacy and safety of re-radiotherapy combined with TS-1 (tegafur gimeracil oteracil potassium capsule) in treatment of local recurrent esophageal carcinoma.Methods A total of 63 esophageal carcinoma patients who recurred after the first course radiation treatment admitted to Jiangdu People's Hospital of Yangzhou during January 1,2012 to June 30,2015 were retrospectively analyzed.Twenty-seven of them treated with re-radiotherapy combined with TS-1 were deemed as the research group and 36 of them treated with radiotherapy alone were deemed as the control group based on different treatment.Then the clinical efficacy and adverse reactions of the two groups were compared.Results The objective response rates were 77.8％ (21/27) and 50.0％ (18/36) respectively in the research group and control group,and the difference was statistically significant (x2 =5.048,P =0.025).The median survival time in the two groups were 21.6 months and 13.7 months,the 1-year (74.1％) and 2-year (44.4％) survival rates of the research group were both higher than those of the control group (52.8％ and 30.6％,respectively),and the difference was statistically significant (x2 =6.086,P =0.013).The major adverse effects of the research group and control group during the treatment were radiation oesophagitis (92.6％ vs.80.5％),radiation pneumonia (18.5％ vs.19.4％),myelosuppression (96.3％ vs.77.8％) and gastrointestinal reactions (25.9％ vs.19.4％).Most of them were 1-2 grade,and there were no statistically significant differences (x2 =0.975,P =0.323;x2 =0.009,P =0.926;x2 =2.941,P =0.086;x2 =0.375,P =0.540).Conclusion The treatment of re-radiotherapy combined with TS-1 for local recurrent esophageal carcinoma can improve the efficacy and prolong survival period,and the adverse reactions are tolerable.

Objective To get an understanding of the patient experience in public hospitals nationwide, and to evaluate the implementation of the Action Plan to Improve Health Care. Methods Supported by the mobile technology, from September 6, 2017 to December 15, 2018, the authors conducted an online survey that measured the satisfaction of both inpatients and outpatients at secondary and tertiary hospitals across the country. 15 questions from six dimensions including registration experience, patient-doctor communication, nurse-patient communication, the healthcare signage system, responsiveness of care providers and privacy protection were prepared for outpatients, while 20 questions from nine aspects such as nurse-patient communication, patient-doctor communication, pain management, medication communication, admission and discharge information, responsiveness of care-givers, food service, friendliness to patient family, and the healthcare signage system were directed at inpatients. Descriptive statistical analysis was used to describe the basic features of the data. Results 9.18 million valid responses from outpatients and another 5.38 million from inpatients were obtained. The overall satisfaction rate with outpatient services had reached a score of 90.45 points where nurse-patient communication stands out as the top-rated dimension and privacy protection gets the lowest rating. On the other hand, the inpatient satisfaction stands at a score of 93.01 with friendliness to patient family receiving the top score and patient-doctor communication the lowest. Conclusions Despite the positive feedback Chinese patients give on the outpatient care they receive, we should make efforts to improve the outpatient care environment, the wayfinding system, privacy protection, and responsiveness of care-givers.

OBJECTIVE： To study the improvement and anti-inflammation mechanism of Shenfu injection on lung tissue of endotoxin shock model rats. METHODS： Totally 48 rats were randomized into control group，model group，dexamethasone group （positive control，1 mg/kg） and Shenfu injection low-dose，medium-dose and high-dose groups （5，10，15 mL/kg），with 8 rats in each group. Except for normal group， other groups were given intraperitoneal injection of lipopolysaccharide （LPS） to induce endotoxin shock model. After modeling， each group was given relevant medicine once intraperitoneally. 24 h after medication， HE staining was used to observe pathological changes of lung tissue in rats and pathological scoring was conducted. RT-PCR was used to determine mRNA levels of P65 and P50 proteins related to NF-κB signaling pathway. Western blot assay was used to determine the expression levels of P65 and P50 proteins in lung tissue， and the expression levels of P65 protein in nucleus and cytoplasm of lung tissue were also determined. The level of TNF-α in plasma in rats were determined by ELISA. RESULTS： Compared with control group， alveolar septum became thicker， obvious vascular engorgement was found， and a large number of neutrophils infiltrated the interstitium in model group. Histopathological score， mRNA and protein expression levels of P65 and P50 in lung tissues were increased significantly （P＜0.01 or P＜0.001）； the protein expression of levels P65 in nucleus and cytoplasm and level of TNF-α in plasma were increased significantly （P＜0.001）. Compared with model group， alveolar structure of rats in dexamethasone group and Shenfu injection medium-dose and high-dose groups was complete， no obvious bleeding was observed， and the degree of inflammatory cell infiltration was improved significantly. Histopathological score， mRNA and protein expression levels of P65 and P50 in lung tissue and level of TNF-α in plasma were decreased significantly （P＜0.05 or P＜0.01 or P＜0.001）. The protein expression level of P65 in nucleus and cytoplasm of lung tissue were decreased significantly in dexamethasone group and Shenfu injection low-dose and medium-dose groups were decreased significantly （P＜0.05 or P＜0.01 or P＜0.001）. CONCLUSIONS： Shenfu injection can decrease mRNA and protein expression levels of P65 and P50 in lung tissue， level of TNF-α in plasma， and protect lung tissue of endotoxin shock rats.

OBJECTIVE：To investigate the intervention effect of Shenfu i njection（SFI）on the nuclear translocation of high mobility group box 1（HMGB1） in lipopolysaccharide （LPS）-induced RAW 264.7 cells. METHODS ： Using LPS-induced RAW264.7 cells as objects ，the histone deacetylase inhibitor RGFP 966 as positive control ，CCK-8 assay was used to screen drug dosage，and the effects of low ，medium and high doses （3，6，12 μL/mL）of SFI on HMGB 1 nuclear translocation in RAW 264.7 cells were observed by immunofluorescence method ；mRNA expression of HMGB 1 in RAW 264.7 cells were detected by real time fluorescent PCR. Western blotting assay was used to determine protein expression of HMGB 1 and Toll-like receptor 4（TLR4）；the expression of HMGB 1 were compared between nucleus and cytoplasm. The levels of HMGB 1，IL-1β and TNF-α in supernatant of cells were detected by ELISA. RESULTS ：In blank control group ，HMGB1 was mainly located in the nucleus ；after LPS induction， HMGB1 migrated from nucleus to cytoplasm. Compared with blank control group ， mRNA and protein （No.81760738） expression of HMGB 1， protein expression of TLR 4 in RAW264.7 cells as well as the levels of HMGB 1，IL-1β and TNF-α in supernatant of cells were increased significantly in LPS group （P＜0.01）. The protein expression of HMGB 1 was decreased significantly in nucleus while was in creased significantly in cytoplasm （P＜0.01）. After SFI treatment ，the nuclear translocation and secretion of HMGB 1 were inhibited in different degrees ；compared with LPS group ，mRNA and protein expression of HMGB 1 in administration groups ，protein expression of TLR 4 in RAW 264.7 cells of positive control group ，SFI medium- and high-dose groups as well as the levels of HMGB 1，IL-1β and TNF-α in supernatant of cells in administration groups were decreased significantly （P＜0.01）. In positive control group ，SFI medium- and high-dose groups ，the protein expressions of HMGB1 in nucleus were increased significantly ，while protein expressions of HMGB 1 in cytoplasm were decreased significantly （P＜0.01）. CONCLUSIONS ：SFI may inhibit the nuclear translocation and secretion of HMGB 1 in RAW 264.7 cells，thus avoiding the activation of inflammatory pathways and the production of inflammatory factors ，so as to reduce the inflammatory response induced by LPS.