Questionnaire survey(n=147)and group interview(n=13)were used for this investigation.Our results showed that 66.7%of participants considered"heavy work burden and insufficient specialists"to be the main challenge.Half of comingnity healthcare providers were not satisfied with thepayment systerm.We suggest that the overall-consideration of community healthcare service development in urban and suburb areas and 4 kinds of performance pattems should be strengthened:the perfommnce appraisal and quality control schemes should be modified;and the employee headcount in community healthcare centers or transferred employees'salary should be moderately increased in the fumre.

Objective To explore the trend of changes of Th1 and Th2 cytokines within 6 months after adult liver transplantation (LT). Methods Twenty-three patients from Tianjin First Center Hospital were chosen as the patient group with an average age of (52.7 ± 7.6), range from 37 to 63 years old, including 21 males and 2 females. Twenty healthy staffs from Tianjin First Center Hospital formed the control group (C) with 15 males and 2 females whose average age was (31.0 ± 6.1) ranged from 22 to 24 years old. The patient group was treated with tacrolimus after LT as main immunosuppressive drug. The peripheral blood at time points before (T0) and 1 month (T1), 3 months (T3), 6 months (T6) after LT at 9:00 AM were collected. The blood sample was also collected form control group but only one time. Levels of IL-2, IFN-γ, IL-10 and TGF-βwere detected by ELISA. Results (1) The concentration of IL-2 showed a continuous up-going trend, which was not such obvious between T1 and T0, and until T3 reached a higher concentration than T0. The concentration at T6 was higher than T0 and T1. There were no significant differences in concentrations of T0 to T3 between patient group and control group, while T6 reached a higher concentration in patient group than that of the control group. (2) The concentration of IFN-γexperienced a shortly down-going trend from T0 to T3, and started rising, reached the peak at 3 months after the operation, then started its down-going trend. There were no significant differences in the concentrations of IFN-γfrom T1 to T6, and T3 reached a higher concentration than T1 while T6 was lower than T3. Only at T3, the concentration of IFN-γwas higher in patient group than that of control group. (3) There were no significant differences in the concentrations of IL-10 at various time points in patient group, and there were no significant differences in the concentrations of IL-10 at different time points between two groups (P>0.05). (4) The concentration of TGF-βshowed a gradual decline after the operation, and reached its bottom at T6, and which was lower than T0 to T3. Compared with the control group, the down-going trend was not such obviously at T0 and T1, and the concentration was down at T3 and T6(P<0.05). Conclusion Our results suggest that there is a tendency of an increasing Th1 cytokine expression at early stage in post-transplantation, while the TGF-βof Th2 cytokine is a decreasing trend. This tendency may associate with the autoimmunity response caused by LT and the immunosuppressive drugs.

Objective To analysis the influence of component design and related surgical technique on knee range of motion (ROM) after total knee replacement using Innex knee system. Methods Between September 2003 and December 2005, 88 patients with 98 knees had consecutively undergone posterior cruciate-sacrificing TKA with Innex systems. The posterior condylar offset, post-operative tibial slope and knee ROM were measured in 63 patients (70 knees). The relationship of the change in posterior condylar offset and postoperative tibial slope with knee ROM was assessed using a scatterplot graph and Pearson's regression analysis. According to change of posterior condylar offset, which was measured by postoperative minus preoperative posterior condylar offset, patients were divided into 4 groups. The preoperative body mass index,flexion contracture, knee ROM, HSS score and the postoperative knee ROM of four groups were evaluated.Results The mean knee ROM had improved from 96.2°±11.9° preoperative to 109.8°±13.0° at final followup. The mean pre- and post-operative posterior condylar offset was (24.0±3.5) mm and (24.5±3.3) mm, respectively. The mean postoperative tibial slope was 5.5°±1.8°. There was statistical correlation between the difference in the posterior condylar offset and the change in knee ROM after TKA and no correlation between the postoperative tibial slope and knee ROM postoperatively. The preoperative body mass index, flexion contracture, knee ROM, HSS score did not show difference among four groups. There was a statistically difference in postoperative knee ROM among groups. Conclusion Restoration of posterior condylar offset is important to the maximum range of postoperative knee ROM when Orthopedic surgeons perform TKA with Innex systems.There was no correlation between the postoperative tibial slope and postoperative ROM.

Objective To explore the risk and treatment of laparoscopic cholecystectomy(LC) in patients with liver cirrhosis and cholelithiasis.Methods To summarize the clinical data of 28 patients with liver cirrhosis and cholelithiasis.The patients were repeated right upper quadrant pain,including 4 cases of gallbladder neck stones incarcerated,gallbladder effusion.Among them,there were 20 cases of hepatitis B cirrhosis,5 cases of schistosomiasis cirrhosis,3 cases of alcohol.Results There were 6 patients with hemorrhage during operation.Among them,5 patients were treated with gelatin sponge,hemostatic gauze and bio-glue spray to stop bleeding,1 case was transferred to open surgery because of bleeding.The remaining 27 cases of LC were successful.Complications occurred in 8 patients,3 cases of increased liver function abnormalities,1 case of upper gastrointestinal bleeding,1 case of mild hepatic encephalopathy,2 cases of significant ascites formation,1 patient underwent subtotal resection of the gallbladder with Hartmanns bag,and bile was found in the ascites after surgery,but the bile disappeared after five days.All patients with complications after symptomatic treatment were cured,no death,no major bleeding and liver failure,bile duct injury,severe biliary fistula and other serious complications.Conclusion Although the risk of LC in patients with liver cirrhosis is higher than that in the general population,with the help of current high-tech surgical instruments,we can safely accomplish this with an improved surgical procedure.As these patients require high technical requirements of surgery,surgeons must have a wealth of experience and familiar laparoscopic liver and gallbladder anatomy.

Objective To analyze the perioperative clinical characteristics of non-small cell lung cancer ( NSCLC ) complicated with dermatomyositis ( DM) . Methods Six cases of NSCLC complicated with DM received lobectomy and lymph node dissection by video-assisted thoracoscopic surgery. The same kind of operations were carried out in another six NSCLC cases without DM in the same period. The twelve cases in two groups were 1 ∶ 1 matched study. The operation time, operative blood loss, postoperative pneumonia or atelectasis rate, postop-erative wound recovery, thoracic drainage in postoperative three days, incidence of postoperative atrial fibrillation, perioperative hospital stay were compared between the two groups. Results In operative time, blood loss and thoracic drainage volume in postoperative three days, there was no significant difference in two groups (P>0. 05). In paients with and without DM, the occurrence rate of atrial fibrillation was respectively 50. 00% (3/6) and 16. 66% (1/6), the occurrence rate of postoperative pneumonia or atelectasis was respectively 50. 00%(3/6) and 16. 66% (1/6), and postoperative hospital stay was respectively (16. 28 ± 3. 61) d and (11. 11 ± 2. 92) d. It was of significant differences (P<0. 05). Conclusion Compared with NSCLC patients without DM, postoperative atrial fibrillation and pneumonia or atelec-tasis occured more often in the DM cases. And patients with DM have longer hospital stays.

Objective To assess effects of stress dynamic CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CCTA) on the diagnosis of myocardial perfusion defects in coronary artery disease (CAD). Methods Patients with CAD diagnosed by CCTA underwent ATP stress CT-MPI examination. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (SPECT-MPI) was performed within one week and set as the reference standard. CT-MPI results were qualitatively analyzed, and myocardial blood flow (MBF), myocardial blood volume (MBV) as well as time to peak (TTP) were quantified according to CT-MPI. Effects of CCTA, CT-MPI, and CT-MPI combined with CCTA on predicting myocardial perfusion defects were assessed in comparison with NMPI. Results Thirty patients [(54.8±8.4)years] were enrolled in our study, 20 were men (68%). MBF [(79.3±18.0) versus (135.1± 35.2) ml·100 ml-1·min-1] and MBV [(8.9±2.9) versus (13.8±8.9) ml/100 ml] were significantly decreased in hypoperfused segments compared with normal segments, while TTP was increased in hypoperfused segments [(13.9 ± 2.5)s] compared with normal segments [(9.1 ± 2.1)s] (t=0.302, 0.866 and 0.024 respectively, all P values<0.01). The sensitivity, specificity of CT-MPI for identifying segments with perfusion defects were 91.3%(147/161), 84.6%(281/332), respectively. On a per-vessel basis, the area under the receiver operating characteristic curve for predicting myocardial perfusion defects were 0.635(95%CI:0.517—0.753) for CCTA, 0.709(95%CI:0.599—0.819)for CT-MPI, and 0.837(95%CI:0.749—0.925)for CT-MPI combined with CCTA, respectively. Conclusions The performance of stress dynamic CT-MPI in the diagnosis of myocardial perfusion defects in CAD was good. One-stop examination of CT-MPI combined with CCTA improves the diagnostic accuracy for identifying flow-obstructing stenosis.

Objective To discuss the treatment efficacy and radiotherapy side effects of the preoperative long-course radiochemotherapy and preoperative short-course radiotherapy.Methods 64 patients with local advanced middle and low rectal cancer who got the treatment from April 2004 to April 2010 were analyzed retrospectively.40 patients got the preoperative long-course radiochemotherapy under the dose of DT 45-50 Gy/25 F,1.8-2.0 Gy/F,5 F/W,combining with the synchronous capecitabine chemotherapy (1 650 mg/m2,2 F/d,d1-14/d21-35),and accepted operation 4-6 weeks after the radiotherapy.The rest 24 patients underwent the preoperative short-course radiotherapy under the dose of DT 25 Gy/5 F,5 Gy/F,5 F/W,and got the operation in 2 weeks after the radiotherapy.Results The radical and anus reservation rates in preoperative long-course radiochemotherapy group [85.0 ％ (34/40),65.0 ％ (26/40)] were higher than those in preoperative short-course radiotherapy group [58.3 ％ (14/24),33.3 ％ (8/24)] (x2 =5.689,P =0.019;x2 =6.040,P =0.041).There were no significant differences between the two groups on the index of remission rates,radiation injury,surgical complications,and overall survival rate of 1,3,5 years (all P ＞ 0.05).Conclusions The remission rate and overall survival time between the preoperative long-course radiochemotherapy group and preoperative short-course radiotherapy have no significant difference.But the preoperative long-course radiochemotherapy may improve the anus reservation rate and the radical resection rate,without increasing the radiation injury and surgical complications.

In the study, the effects of Panax notoginseng saponins (PNS) on alveolar epithelial to mesenchymal transition (EMT) and extracellular matrix degradation were observed in a type of human alveolar epithelial cell, A549 cells, stimulated by TGF-beta1. Firstly, MTT method was applied to evaluation of cellular proliferation and found that PNS from 12.5 mg x L(-1) to 200 mg x L(-1) dosage could not inhibit significantly cellular proliferation. Then, cells were divided into five groups, normal group, TGF-beta1 group, TGF-beta1 + 50 mg x L(-1) PNS group, TGF-beta1 + 100 mg x L(-1) PNS group and TGF-beta1 + 200 mg x L(-1) PNS group. Normal cells were not stimulatec by TGF-beta1; TGF-beta1 cells were only stimulated by TGF-beta1 and the other cells were stimulated by TGF-beta1 with different doses of PNS, respectively. After stimulation, cells and supernatants were collected for assays. Cellular roundness was applied to quantitative evaluation of morphological change. Immunocytochemistry was applied to examine E-cadherion, a-SMA and FN proteins expression in the cells. Enzyme linked-immunosorbent assay was applied to MMP-9 and TIMP-1 levels. The results showed that EMT of A549 cells was induced by TGF-beta1, showing significant change of roundness, E-cadherion, alpha-SMA and FN (P < 0.05, P < 0.01). Compared to TGF-beta1, PNS significantly inhibited the changes of roundness (P < 0.05), FN and alpha-SMA (P < 0.05, P < 0.01) and not significantly inhibited the change of E-cadherion. Furthermore, MMP-9 levels were significantly increased by TGFbeta1 stimulation (P < 0.05), without significant change of TIMP-1. Compared with TGF-beta1, PNS could significantly increase MMP-9 level (P < 0.05) and decrease TIMP-1 levels (P < 0.05, P < 0.01). In conclusion, PNS could inhibit alveolar epithelial cell EMT induced by TGF-beta1, with increase of extracellular matrix degradation ability, which showed anti-fibrosis of lung ability.
Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Epithelial-Mesenchymal Transition ; drug effects ; Humans ; Matrix Metalloproteinase 9 ; metabolism ; Panax notoginseng ; chemistry ; Pulmonary Alveoli ; cytology ; drug effects ; metabolism ; Saponins ; pharmacology ; Transforming Growth Factor beta1 ; metabolism

OBJECTIVETo observe the effects of Astragalus and Angelica on bone marrow stem cells (BMSU) proliteratlon mn vitro and investigate its possible mechanism.

METHODSFive 200 to 220 g SD rats were fed with a high fat diet for 4 weeks and given 30 mg/kg streptozotocin (STZ) twice develop type II diabetes from July 2009 to February 2010. The rats with blood glucose concentrations of 16.7 mmol/L or more were considered diabetic. Bone Marrow Stem Cells (BMSC) were collected and isolated by density gradient centrifugation. The BMSC were divided into 4 groups,including empty control group, Astragalus group, Angelica group and Astragalus plus Angelica group. DMEM of 100 microl was added in empty control group. DMEM of 100 microl containing Astragalus (1100 mg/L), Angelica (1100 mg/L) and Astragalus (1100 mg/L) combine with Angelica(220 mg/L) were added in Astragalus group, Angelica group and Astragalus plus Angelica group respectively. The cell proliferation was detected by MTT method, and the concentration of VEGF in the supernatant was determined by ELISA. The VEGF expression was analyzed by Western Blot after 14 days incubation.

RESULTSThe BMSC proliferation and the VEGF concentration in the supernatant and the BMSC VEGF protein expression significantly increased in Astragalus group and Astragalus plus Angelica group compared to those of empty control group (P < 0.05 or P < 0.01). The above effects were more strong in Astragalus plus Angelica group (P < 0.05).

CONCLUSIONAstragalus with Angelica or used separately could promote BMSC proliferation. The mechanism might induce the VEGF protein expression in BMSC. And the independent use of Angelica has no above effect.

Angelica ; Animals ; Astragalus Plant ; Bone Marrow Cells ; cytology ; drug effects ; Cell Proliferation ; drug effects ; Diabetes Mellitus, Experimental ; drug therapy ; Hematopoietic Stem Cells ; cytology ; drug effects ; Male ; Plant Extracts ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A ; analysis

OBJECTIVETo investigate the incidence of testicular appendages, observe their morphology, and analyze their histopathological origins.

METHODSWe observed 67 testes in 54 patients (15 children and 39 adults) undergoing scrotal surgery, investigated the incidence of testicular appendages, and identified their histopathological origins. We used the Chi-square test to compare the findings from the children and adult patients, with P < 0.05 as statistically significant.

RESULTSThe detection rates of the appendix testis, appendix epididymis, paradidymis, vas aberrans superior, and vas aberrans inferior were 80.6% (54/67), 23.9% (16/67), 1.5% (1/67), 3.0% (2/67), and 1.5% (1/67), respectively. The incidence of testicular appendages was higher in children than in adults (93.3% vs 80.8%), but with no statistically significant difference (Chi2 = 1.339, P > 0.05), and that of the appendix testis and epididymis with pedicles was significantly higher in the former than in the latter (82.4% vs 54.7%, chi2 = 4.149, P < 0.05). Pathological examination showed that the appendix testis originated from the paramesonephric duct, while the appendix epididymis, paradidymis, vas aberrans superior, and vas aberrans inferior from the mesonephric duct.

CONCLUSIONTesticular appendages consist of five embryonic remnants, including appendix testis, appendix epididymis, paradidymis, vas aberrans superior, and vas aber- rans inferior. The appendix testis originates from the paramesonephric duct, and the other four from the mesonephric duct. The clinical implication of these testicular appendages is their tendency to torsion.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Epididymis ; pathology ; Humans ; Infant ; Male ; Middle Aged ; Testis ; pathology ; Young Adult