Objective To learn the cognitive appraisal of the necessary conditions for the medical services delivery synergy by doctors at county and township levels,and to provide evidence for the health policy in question.Methods One county-level public hospital and one township hospital were randomly sampled from five sampled counties of Yancheng city in Jiangsu province for a field survey.The questionnaire was designed to cover such dimensions as institutional,information,service,interpersonal and management,in an effort to learn the cognitive appraisal of such doctors on such aspects as the two-way referral between county-township medical institutions,medical information sharing,good personnel relationships of medical workers,service collaboration,and necessity of inter-agency physician teams. Results These doctors in general presented different appraisal for two-way referral between county-township medical institutions,medical information sharing,service collaboration,good inter-personnel relationships and necessity of inter-agency physician teams.Those of lower academic titles considered it necessary to set up inter-agency physician teams(χ2=6.723,P<0.05);while county public hospitals′physicians considered that two-way referral between county-township medical institutions and inter-county agency information sharing as necessary to achieve the synergy of medical services delivery (P<0.05);most township physicians considered that good personnel relationships and service collaboration as necessary to achieve the synergy (P<0.05 ).Conclusions The characteristics of county and township physicians′appraisal of the necessary conditions for synergy of medical services delivery deserve attention,for improvement of their appraisal of two-way referral and information sharing among institutions.

Objective To investigate the clinical effect of high dose of calcitriol on end-stage renal disease (ESRD) in patients with secondary hyperparathyroidism (SHPT). Methods The clinical data of patients with ESRDcomplicated with SHPT were retrospectively analyzed. According to the treatment method were divided into control group and observation group, the control group were given conventional dose of calcitriol treatment, the observation group were treated with high dose of calcitriol. The differences of calcium and phosphorus levels, parathyroid hormone (PTH) level and quality of life were observed between the two groups before and after treatment. Results The serum phosphorus, calcium and calcium-phosphorus product in two groups of patients before treatment had no significant difference. After treatment, the above indicators decreased in two groups of patients compared with those before treatment, and the observation group was significantly lower (P<0.05). Before treatment, there was no difference in the levels of PTH between the two groups. After treatment, the level of PTH in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). There was no significant difference in quality of life between the two groups before treatment. After treatment, the quality of life in the two groups were higher than before treatment, and the observation group was significantly higher (P<0.05). Conclusion High dose of calcitriol has good therapeutic effect for ESRD patients with SHPT and can significantly improve the patient's calcium and phosphorus and PTH levels, improve the quality of life of patients.

E-selectin is an inducible adhesion molecule,and it is correlated with various molecules during cerebral ischemia/reperfusion injury.This article mainly reviews the relationship between E-selectin and intracellular adhesion molecule-1,tumor necrosis factor-?,NF-kB,leucocyte function-associated antigen-1 in cerebral ischemia/reperfusion injury,so as to provide assistance for E-selectin in the prevention,diagnosis and treatment of ischemic cerebrovascular disease.

Background A preliminary study determined an application of manganese ion eyedrops in tracing observation of visual system in vivo,but whether manganese ion has toxic effects on ocular anterior segment tissues is still unclear.Objective This study was to investigate the toxic effects of different concentrations of manganese ion eyedrops on ocular anterior segment tissues.Methods Thirty-two clean New-Zealand white rabbits were divided into 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group and normal control group according to random number table.The experimental eye was randomly chosen from each rabbit for eyedrops application.The manganese ion eyedrops at concentration of 1.00 mol/L,0.50 mol/L or 0.25 mol/L was topically administered in any lateral eye of each rabbit in the 1.00 mol/L MnCl2 group,0.50 mol/L MnCl2 group,0.25 mol/L MnCl2 group,and normal saline solution was used in the same way in the normal control group.In 2 hours,1 day and 3,7,14,21,28 days after eyedrops application,the irritative response of ocular surface was examined under the slit lamp microscope,and corneal damage was evaluated by corneal fluorescence staining,and corneal endothelial cell density (ECD) and corneal thickness were assessed using corneal specular microscope.The eyeball samples were prepared in 3,7,14 and 28 days after eyedrops application and hematoxylin and eosin staining was performed for histopathological examination of conjunctiva,cornea,trabecular meshwork and ciliary body tissue.The use and care of experimental animals complied with the Statement of ARVO.Results Severe hyperemia and edema in palpebral conjunctiva appeared in the 1.00 mol/L MnCl2 group and 0.50 mol/L MnCl2 group,and the symptoms reached a maximum level 1 day after eyedrop application and disappeared 7 days after eyedrops application in the 1.00 mol/L MnCl2 group.These symptoms were milder in the 0.50 mol/L MnCl2 group in comparison with the 1.00 mol/L MnCl2 group.There were no ocular irritative response in the 0.25 mol/L MnCl2 group.Significant differences were found in the corneal fluorescence scores among the groups 2 hours,1 day,3 and 7 days after eyedrop application (X2 =17.350,19.200,12.200,10.140,all at P＜0.05),with the highest score in the 1.00 mol/L MnCl2 group.The ECD was not significantly different among the groups and different time points (Fgroup =0.38,P＞0.05;Ftime =1.79,P＞0.05).The corneal thickness value was significantly different among the groups and different time points (Fgroup =18.22,P＜0.05;Ftime =116.75,P ＜ 0.05).The corneal thickness value was elevated during 2 hours to 3 days after administration of eyedrops in the 1.00 mol/L MnCl2 group and closed to normal from 7 days to 28 days.The corneal thickness value was higher from 2 hours to 14 days than that in 28 days after administration of eyedrops in the 1.00 moL/L MnCl2 group,and the corneal thickness value was higher in 2 hours to 1 day than that in 28 days after administration of eyedrops in the 0.50 mol/L MnCl2 group (all at P＜0.05).Inflammatory cell infiltration and stromal edema were exhibited in conjunctival,trabecular meshwork and ciliary body tissue in the 1.00 mol/L MnCl2 group 3 days and 7 days after eyedrops application,and only inflammatory cell infiltration in conjunctival tissue in the 0.50 mol/L MnCl2 group 3 days after eyedrops application.No obvious abnormity was seen in the 0.25 mol/L MnCl2 group.Conclusions 1.00 mol/L manganese ion eyedrops has a remarkable toxic effect on ocular anterior segment tissue in rabbit.With the lowing of drug concentrations,the toxic effects were reduced.The manganese-enhanced MRI using 0.25 mol/L manganese ion eyedrops is feasibility bacause of its non-toxicity to ocular tissues.

Objective: To investigate the expression of vasculogenic mimicry (VM) in endometrial carcinoma tissues and its rela-tionship with the clinicopathologic features and prognosis of the disease. Methods: A total of 267 paraffin-embedded endometrial carci-noma specimens of patients with complete follow-up data were collected from the Shijiazhuang Bethune International Peace Hospital between January 2005 and June 2014. CD31-PAS dual staining was performed to identify the VM structure. Tissue samples were then divided into VM-positive and VM-negative groups. CD133 expression was detected by immunohistochemical streptavidin peroxidase method. Results: Among the 267 endometrial carcinoma patients, 65 cases (24.3%) were VM positive. VM formation was closely corre-lated with the International Federation of Gynecology and Obstetrics Staging (χ2=9.987, P=0.002), histodifferentiation grade (χ2=11.795, P=0.001), myometrial invasion depth (χ2=5.499, P=0.019), vascular cancer embolus (χ2=22.599, P<0.001), and lymph node me-tastasis (χ2=7.848, P=0.005). Kaplan-Meier survival curve analysis showed that survival time was significantly shorter in the VM-posi-tive group (median survival time was 51 months) than in the VM-negative group (median survival time was 100 months) (χ2=70.973, P<0.001). Moreover, CD133 expression was significantly higher in the VM-positive group [75.4% (49/65)] than in the VM-negative group [58.9% (119/202)] (χ2=5.720, P=0.017). Conclusion: VM is closely correlated with the pathogenesis, development, and malignancy of endometrial carcinoma. Furthermore, VM is one of the important indexes influencing the prognosis of this disease. Therefore, CD133-positive cells may contribute to VM formation.

Objective To compare the influence of aging on apoptosis and the expression of apoptosis-related protein in adult and aged male Wistar rat hearts after acute coronary artery occlusion. Methods The acute myocardial infarction rat model was established by left anterior descending(LAD)occlusion.A total of 115 adult and aged rats,aged 6-24 months,were included in the study.The rats were divided into 4 groups:aged model group,aged control group,adult model group and adult control group.Animals were killed 1,3,5 hours,1 and 7 days after coronary occlusion.Hemodynamic parameters[heart rate(HR),left ventricular systolic pressure(LUSP),left ventricular end-diastolic pressure(LVEDP),±dp/dtmax)]were obtained from each group at every time points.The apoptosis and necrosis of myocardium were detected with TUNEL way and TTC stain.The expressions of Bcl-2 and Bax were analyzed with immumohistochemical stain. Results DNA fragmentation occured 1 hour after coronary occlusion and apparently peaked earlier in the aged than in the adult rat hearts.At 3 hour,the apoptotic index of aged model group was obviousily higher than that in adult model group[(51.90±23.15)%us.(18.67±17.15)%,P<0.01].The basal levels of Bcl-2 and Bax were higher in the aged than in the adult rat hearts.The expression of Bcl-2 in aged model group and adult model group were 2.7±0.9 and 1.8±0.8,P<0.05.The expression of Bax in aged model group and adult model group were 6.2±2.9 and 4.2±1.5,P<0.05. Conclusions The ability of aged rats to resist ischemia is poor,aging may alter the expressions of Bcl-2 and/or Bax,increase cardiomyocyte apoptosis,thereby,enhance the myocardial dysfunction during acute myocardial infarction.

AIM: To study the effect of nasal mucosal tolerance to E-selectin on cerebral ischemia-reperfusion injury.METHODS: Two different doses(single and booster) of E-selectin or PBS were dropped into membrana mucosa nasi of rats.The middle cerebral artery occlusion(MCAO) model referring to Zea Longa method with modifications was performed 48 h after the last dose of E-selectin or PBS.After 2 h ischemia and 22 h reperfusion,the numbers of CD3+CD4+T-lymphocyte and CD3+CD8+T lymphocyte subgroup in the blood were examined with flow cytometry.Rats were killed,then part of the animals was used to measure the cerebral infarction volume by TTC staining.mRNA expressions of E-selectin,ICAM-1 and lymphocyte function-associated antigen-1(LFA-1) were determined by RT-PCR and activity of SOD was determined by xanthinoxidanse method in ischemic cortex of the other part of animals.RESULTS: The ratio of the numbers of CD3+CD4+T-lymphocytes and CD3+CD8+T-lymphocytes increased in E-selectin single pretreatment group(P

The obese children are increasing at a surprisingly high annual rate of 9.1 percent in China.Meanwhile children are lack of health consciousness and self-protection,thus obese children are more vulnerable towards obesity.Since parents are responsible for their children's daily lives and behaviors,the health education of obesity should be started with those parents with obese children.This paper calls to carry out health education aimed at parents of obese children through multiple means such as community health services,taking advantage of public media and establishing specific clubs,in order to effectively control the increase of obese children.

BACKGROUND: The biliary stents commonly used in clinic are made of plastics and metal, both of which have some irresolvable defects. New type of material characterizing by great biocompatibility and degradation for the making of biliary stents needs to be found and studied.OBJECTIVE: To evaluate the biodegradation law and the change in radical force of five different mole-ratios of biliary stents made of poly (lactic-co-glycolic acid) (PLGA) in human bile in vitro.DESIGN, TIME AND SETTING: A Completely random design was performed at the Laboratory of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University between July and December 2006.MATERIALS: Five different mole-ratios of PLGA hiliary stents (90L/10G, 80L/20G, 70L/30G, 60L/40G, and 50L/50G) were provided by Dalgang Biological Science and Technology Co., Ltd., Jinan; Human fresh bile was obtained from the patients who underwent external drainage of bile in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University.METHODS: Thirty-two PLGA biliary stents of each proportion were respectively divided into eight groups, with four stents in each group. All of them were independently submerged into test tubes with 10 mL fresh human bile which were then placed in constant temperature oscillator. The temperature was set at 37 ℃. The bile was changed every day. After incubated for one week to eight weeks, the PLGA biliary stents were respectively taken out of test tubes from the first to the eighth group each week. They were washed with distilled water and dried in calorstat for 24 hours.MAIN OUTCOME MEASURES: ① Gross morphology, color and integrality of PLGA stents; ② Scanning electron microscope; ③ the mass and the radical force of PLGA stents.RESULTS: ① Five different mole-ratios of PLGA stents followed a similar changing law as to gross morphology: stents remained intact → stents became soft → the surface ofstents became coarse and cracked → stents collapsed → stents were degraded into pieces → stents were completely degraded. ② Before degradation: limpid stereo reticular structure of PLGA; One week after degradation: PLGA was corroded and the reticular structure was decreased; Three weeks after degradation: airspace was gradually disappeared and the reticular structure was further decreased; Five weeks after degradation: airspace and the reticular structure were completely damaged, which was in an indefinite form. ③ The mass loss of each proportion of PLGA stents gradually speeded up along with the time extension. Furthermore, with the content of PGA increasing, the mass loss of the stents became faster. The initial radical force was different among five different mole-ratios of hiliary stents. With the content of PLA increasing, the radical force of the stents became stronger.CONCLUSION: The material of PLGA possesses adjustable biodegradation and good mechanical feature, so it is suitable for preparation of biliary stents.

Orange peel was used as lowcost adsorbent in binding of Methylene Blue.The effects of equilibrium time,pH,dye concentration have been studied.Carboxyl,amine and phosphonate functional groups were present in the orange peel.The equilibrium time was 1 hour,the maximum adsorption capacities of the orange peel was 370.3?31.0 mg/g at pH 10.The Langmuir and Freundlich isotherms were well fitted in this biosorption system.Results showed relatively higher rate constant and biosorption capacities.These adsorption performance indicate the orange peel as a potentially economical adsorbent for dye removal.