Shanghai district and county health system performance evaluation conceptual frameworkwas proposed based on health services system performance assessment frameworks raised by some countries and international organizations,and combined with Shanghai district and county health system characteristics.This framework contains two first grade indices and seven second grade indices:In the long term goals,'health','satisfaction' and 'disease risk protection' are the county's longterm effects of health system performance assessment dimensions; in the medium-term goals,the'accessibility','cost',' efficiency' and 'quality' are the county' s medium-term effects of health system performance assessment dimensions.This study aimed to evaluate Shanghai county health system's overall performance.Further study is needed in constructing its third grade indices.

Objective To explore the characteristic and clinical meaning of myocardial bridge in patients with multi-slice spiral CT(MSCT) coronary angiography.Methods 875 patients with suspected or diagnosed coronary artery disease were studied with MSCT coronary angiography,579 cases were male and 296 cases were female,ranged from 30~87 years old in age with average of 60 years old.The heart was scanned with retrospectively ECG-gated,reconstruction from phase for all original tomographic source images at 30%~40% R-R phase interval according to heart rate ≥75 bpm and at 40%~50% R-R phase interval according to heart rate ≤75 bpm.The images of maximum intensity projection,multiplanar reconstruction and vulume reconstruction were gained to show left and right main coronary artery and their main branchs on mulliple angle.Results The myocardial bridges were detected in 89 cases,the positive rate was 10.2%,36 cases(40.5%)had different grade stenosis(≤50%).The myocardial bridges located at middle segment of anterior descending artery(79.8%),the thickness of myocardial bridge was 0.06~0.55 cm,the atherosclerosis plaques were found in 20 cases,the vascular stenosis was approximate to 50%.39 cases with simple myocardial bridges had angina,21 cases hadn’t angina.23 cases with myocardial bridges accompanied by coronary artery atherosclerosis had angina.Conclusion MSCT coronary angiography may clearly detect the myocardial bridge,which can provide more worthy information for clinical diagnosis and treatment.

Objective To observe the levels of Livin and Caspase-3 in renal tissue of rats following acute paraquat (PQ) poisoning and the intervention effects of ulinastatin (UTI) . Methods Fifty-four Sprague-Dawley (SD) rats were randomly divided into three experimental groups: control group (group A),PQ poisoning group (group B) and UTI group (group C) (n = 18 in each group) . Rats in group B and group C were administered intragastrically with 80 mg/kg PQ, and rats in group C were treated with 100,000U/kg ulinastatin injected intra-psritoneally once a day; and rats in group A were administered intragastrically with the same volume of saline instead of PQ. At 24, 48, 72 hours after poisoning, the levels of Livin in renal tissue were detected by Westen blotting and the levels of Caspase-3 were detected by immunohistochemistry 24, 48, and 72 hours after poisoning, and the histopathological changes of renal tissue were observed at the same time. Results In the group A, the structure of renal tissue was distinct. In the group B, the distinctness of the structure of renal tissue declined significantly, and swelling, edema and vacuolar degeneration were observed 24 h after poisoning, and pathological changes became more and more obvious keeping pace with time elapsing, and sometimes karyopyknosis appeared and celluar structures disappeared with involvement of renal glomerulus and medulla. These pathological changes were significantly lessened in rats of group C. In the group A, there was little Caspase-3 in renal tissue of rats. Twenty-four hours after poisoning, the caspase-3 in renal tissue of rats of group B was found on the membrane and in the kytoplasm of renal tubular epithelial cells of cortical part. Compared with group B, the level of Caspase-3 in renal tissue of rats of group C decreased significantly to lower level (P ＜0. 01 ) . Compared with group A,the levels of Livin in renal tissue in rats of group B and group C increased significantly at all different intervals (P ＜0. 01 ), and as group B was compared with group C, the difference was statistically significant (P ＜0. 01 ) . Conclusions The main pathologyical changes of renal injury induced by PQ are epithelial swelling, vacuole degenerateion and necrosis. Caspase-3 is involved in the process of renal injury. UTI has a protective effect on the renal tissue of rats following paraquat poisoning through up-regulating the level of Livin and down-regulating the level of Caspase-3, however, the regulation mechanism as well as the pathway is still needed to further study.

Objective Primitive neuroectodermal tumor (PNET) is a rare malignant small round cell tumor .This paper aimed to study the clinical and pathological features of primary pulmonary primitive neuroectodermal tumor . Methods We collected 2 cases of primary pulmonary PNET to review the clinical and pathological features .Immunohistochemical staining was used to detect immune mark-ers, and fluorescence in situ hybridization (FISH) was applied to detect EWS translocation. Results 2 patients were aged 33 years and 17 years.Microscopically, the tumor cell was composed of single small round cells in diffusion or in distribution of sheets or beams , with scant cytoplasm , oval or spindle-shaped nucleus , high mitotic count .Irregular tumor necrosis scattered in the tumor along with visi-ble rosette structure.Immunohistochemical study showed that the tumor cells were positive for CD 99, FLI-1 and Syn, while CKpan, EMA, Desmin, CgA, TTF1, CD34 were negative.EWS/FLI1 translocations were detected positive in both the cases .2 patients died 7 months and 32 months after operation , respectively . Conclusion Primary pulmonary PNET is rare , so the selection of appropriate im-mune markers (CD99, FLI-1, Syn) and FISH for the detection of EWS translocation helps to improve the accuracy of diagnosis .

Purpose To detect the expression of NKX2. 2 protein in gastrointestinal, pancreatic and esophageal neuroendocrine tumors and the correlation between the expression of NKX2. 2 and the clinicopathologic parameters. Methods 41 cases of gastrointestinal, pancreatic and esophageal neuroendocrine tumors were collected. The expression of NKX2. 2, Syn and CgA in neuroendocrine tumor samples were checked by using immunohistochemical staining. Results The positive expression of NKX2. 2 protein was localized in the nucleus. NKX2. 2 protein showed positive staining in neuroendocrine tumors of the seven original sites. In the four cases of normal pancreatic islet cells also showed strongly diffuse positive nuclear staining. The positive rates of NKX2. 2, Syn and CgA protein in the small intestine, rectum, pancreatic neuroendocrine tumors were 100%, 100% and 46. 7%, respectively. The positive rates of NKX2. 2 in foregut, midgut and hindgut were 30% and 87% (χ2 = 11. 09, P=0. 001). Positive NKX2. 2 protein expression was not associated with gender, age group, grade, tumor size and lymph node metastasis. Conclusion NKX2. 2, as a new type of neuroendo-crine markers, is obviously superior to CgA in the diagnosis of neuroendocrine tumors in the small bowel, rectum and pancreas. NKX2. 2, Syn and CgA, a panel approach may be beneficial to enhance diagnostic accuracy of the neuroendocrine tumors.

Objective To investigate the effect of total flavonoids from astragalus complanatus (FAC) on attenuating lung injury resulted from paraquat (PQ) poisoning by inhibiting excessive endoplasmic reticulum stress (ERS) and c-Jun N-terminal kinase (JNK) pathway in rat.Methods Forty-eight Sprague-Dawley (SD) rats were randomly divided into six groups (n=8 in each group),including control group,model group,dimethyl sulfoxide (DMSO) vehicle control group,and FAC in low,medium,and high dosage groups.The model was reproduced by giving PQ 80 mg/kg orally to induce lung injury.The rats in control group were treated with saline by gavage.The rats in DMSO group were given 10％ DMSO 20 mL/kg by gavage 2 hours before intraperitoneal injection of PQ,and those in FAC low,medium and high dosage groups received 40,80,160 mg·kg-1· d-1 of FAC solution intraperitoneally after the PQ administration.The rats were sacrificed 72 hours after giving PQ,and the left lung tissue was harvested 72 hours after the reproduction of experimental model.The ratio of wet/dry weight (W/D) and total lung water content (TLW) were determined.The pathohistological changes of the left lung was observed under light microscope,and scored with alveolar damage index of quantitative assessment (IQA).The mRNA expressions of JNK and glucose regulated protein 78 (GRP78) were determined by reverse transcription-polymerase chain reaction (RT-PCR),and the protein expression of JNK,phosphorylation-JNK (p-JNK),and GRP78 were determined by Western Blot.Results Compared with control group,the W/D ratio,TLW and IQA were increased significantly in model group and DMSO group,and the mRNA expressions of JNK and GRP78 and the protein expressions of JNK,p-JNK and GRP78 were markedly increased.Compared with the model group,the W/D ratio,TLW and IQA,and the expressions of JNK mRNA and p-JNK protein were significantly decreased in the FAC groups,especially in FAC high dosage group [W/D ratio:3.0 ± 0.3 vs.5.5 ± 0.5,TLW:2.2 ± 0.3 vs.4.7 ± 0.4,IQA:(15.4 ± 3.0)％ vs.(40.0 ± 5.7)％,JNK mRNA:0.21 ± 0.08 vs.0.82 ±0.27,p-JNK protein:0.31 ±0.09 vs.0.78 ±0.25,all P＜0.O1].The mRNA expression of GRP78 and the protein expressions of JNK and GRP78 were highly expressed in FAC low,medium and high dosage groups,and there was no significant difference compared with those in model group (GRP78 mRNA:0.54 ± 0.18 vs.0.74 ± 0.20,JNK protein:0.76 ± 0.27 vs.0.80 ± 0.28,GRP78 protein:0.51 ± 0.18 vs.0.69 ± 0.21,all P＞0.05).Conclusions PQ induces excessive ERS in the lung tissue resulting in lung injury.FAC has a protective effect on lung against PQ injury,and it may be related with inhibition JNK pathway in ERS.

Objective Paraquat(PQ) is an effective herbicide which is widely used in agricultural production .PQ poisoning is frequently seen in humans with the lung as the target organ ,but the poisoning mechanisms is not very clear .Studies show that endoplasmic reticulum stress(ERS) is closely associated with poisoning , but there are few reports on the relationship between ER stress and PQ poi-soning.This article was to investigate the effects of ERS-induced apoptosis and total flavonoids from astragalus complanatus (FAC) in a-cute lung injury(ALI) following paraquat poisoning in rats . Methods A total of 30 adult healthy Sprague-Dawley (SD) rats were ran-domly divided into 3 groups:control group, ALI group, ALI+FAC group and ALI+saline group.Biochemical method was applied to de-tect superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) in lung tisssue,TdT-mediated dUTP nick end labeling (TUNEL) assay in observing lung apoptosis, Western blotting and real-time PCR(RT-PCR) in detecting the changes in expressions of C/EBP homologous peotein (CHOP), activating transcription factor 4 (ATF4) and X-box binding protein 1 (XBP) following ALI, and HE staining in observing the pathological changes of lung tissue . Results Compared with control group , the expression of MDA content was enhanced in ALI group ([3.26 ±0.24] vs [5.04 ±0.36],P<0.01), along with significantly decreased activity of SOD and CAT ([300.26 ±35.69] vs [187.21 ±25.66]), ([5.78 ±1.28] vs [2.15 ±1.12],P<0.01), increased cell apoptosis , upregulated pro-tain level of CHOP ([0.74 ±0.20] vs [0.23 ±0.07],P<0.01) and mRNA expression of ATF4, XBP1 and CHOP.However, FAC sig-nificantly attenuated ALI following PQ , as showed by reduced MDA content , enhanced activity of SOD and CAT , decreased cell apopto-sis, inhibited protain level of CHOP and mRNA expression of ATF 4, XBP1 and CHOP ([5.04 ±0.36] vs [3.99 ±0.27],P<0.01). Furthermore, the activity of SOD and CAT were higher in FAC pretreatment group than those in ALI group ([ 0.74 ±0.20 ] vs [0.42 ±0.11],P<0.01). Conclusion From the research, ERS-induced cell apoptosis is involved in ALI following PQ , and the protec-tive role of FAC in lung tissue following PQ is due to its effect in atten-uating ERS-induced apoptosis .

Background Evidences, from recent studies, suggested that Borna disease virus (BDV) infection might be associated with human neuropsychosis, especially psychiatric disorders including depressive disorder(DD). However, controversy existed about the association between BDV infection and pathogenesis of DD. This study was to explore further whether the infection of Borna disease virus (BDV) is associated with the pathogenesis of depressive disorder (DD).Methods The p 24 fragment of BDV RNA in peripheral blood mononuclear cells (PBMCs) from 60DD patients and 120 healthy volunteers was detected by nested reverse transcriptase polymerase chain reaction (nRT-PCR) combined with fluorescence quantitative polymerase chain reaction (FQPCR). Positive products were cloned and sequenced before being compared with Strain V and strain He/80, from humans and animals.Results The positive rate (5%, 3/60) of BDV p 24 in PBMCs from the DD patients was significantly higher than that (0%, 0/120) from healthy volunteers ( P＜0. 05). The gene sequence for the positive products showed BDV p 24 in PBMCs from DD patients in Chongqing was most homophylic with H1766 strain detected from iii horses (97.68%), with 2 situs mutations (nt 1675 T→C, nt 1678 C→T), and also similar to the standard strain V(96. 51%)and He/80(95.35 %), with basic exchanges limited to T- C and A→G.Conclusions There was BDV infection in the DD patients in China, which indicated that the pathogenesis of DD in human beings in Chongqing might be associated with the infection of BDV.

Background Elevated intraocular pressure leads to the loss of retinal ganglion cells and vigorous reaction of retinal glial cells.The expression of nestin in retinal glial cells secondary to hypertention and its significance are unclear.ObjectiveThis study aim to investigate the expression of nestin in retinal glial cells (RGCs) in ocular hypertention rats.Methods The ocular hypertention models were established by cauterizing the limbus-draining veins in the right eyes of 42 SD rats,and a conjunctival incision in the left eyes of the rats served as the sham group.The intraocular pressure (IOP) was measured with the Tono-Pen XL tonometer.The number of RGCs in the rats with ocular hypertention was counted.The expression of the nestin protein in RGCs was semi-quantitatively analyzed using Western by immunochemistry.Double immunofluorescence was carried out to evaluate the the confocal laser scaning microscope.Results Significant differences were found in the IOP between the model group and the sham group at various time points (P＜0.05).In 1 week to 3 weeks after operation,the number of RGCs significantly declined in the model group compared with the sham group (P＜0.05).Immunochemistry showed that from 2 hours through 1 week after operation,the expression of nestin was gradually enhanced in the model group in comparison with the sham group.Western blot revealed that the expression of the nestin protein reflected a similar tendency to that of immunofluorescence.The increased introcular pressure as manifested by the induced expression of nestin.Immunoelectron microscopy also confirmed the induced expression of nestin especially at their end-feet suggests a potential neuroprotective mechanism in neuronal degeneration.Nestin may be a useful biomarker for retinal injury study.

BACKGROUND:Thoracolumbar spine as highly concentrated stress, often prone to vertebral fractures. With the further development of the biomechanics and anatomical structure of the spine, posterior open reduction and internal fixation with pedicle screw has been widely accepted by clinicians. OBJECTIVE:To explore the clinical results and safety of percutaneous pedicle screw fixation system (Viper system) used in thoracolumbar compression fractures. METHODS:We retrospectively analyzed 40 patients with thoracolumbar compression fractures from Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital and Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from January 2013 to February 2014. According to the type of graft, patients were randomly divided into experiment group and control group, with 20 patients in each group. They were respectively subjected to Viper percutaneous pedicle screw fixation system and open reduction and pedicle screw fixation. RESULTS AND CONCLUSION:Al vertebra got bone unions. Operative time and time to bone union were shorter in the experiment group than in the control group. Moreover, intraoperative blood loss was less in the experiment group than in the control group. Cobb’s angle, height percentage of leading edge and wedge angle were similar between the two groups. However, at 12 months after internal fixation, height percentage of leading edge was lower in the experiment group than in the control group. Visual Analogue Scale scores and Oswestry Disability Index were noticeably improved after fixation in both groups. Visual Analogue Scale scores and Oswestry Disability Index were lower in the experiment group than in the control group immediately after fixation. These results suggest that compared with open reduction and pedicle screw fixation, Viper percutaneous pedicle screw fixation system for thoracolumbar compression fractures can stably restore the structure and function of spine, and does not increase perioperative complications.