Objective To learn the suitability and validity of readmission service at counties and townships in rural China.Methods Seven pilot counties were randomly selected from the eastern,middle and western areas of China,and five diseases of the respiratory infection and cerebral system were set as the targets,while 600 target inpatient readmitted who had any of the five target diseases from 2012 to 2013 in such counties were selected from the NRCMS database.With expert consultation and empirical evaluation,the fitness of the days of stay at township hospital and necessity of hospitalization at county hospitals were evaluated for such target inpatients.Results 64.7％ of the target inpatients were found with unfit days of stay at township hospitals,mostly too short;59.0％ of the target inpatients' hospitalization at county hospitals were found with serious risk factors during their hospitalization;18.5％ of the inpatients were found with unnecessary hospitalization.Conclusions Hierarchical medical system can enhance the efficiency of the heahhcare system,but the current validity of readmission is poor,so is the fitness of days of stay at township hospitals,and the quality of the referral pattern.These problems mostly result from poor medical competence at township hospitals and high autonomy of patients in seeking medical service anywhere in the country.

Objective To investigate the clinical significance of soluble intercellular adhesion molecule‐1 and inflammatory factors (CRP ,IL‐17) in elderly patients with colorectal carcinoma .Methods The expression of sICAM‐1 ,CRP and IL‐17 in 76 ca‐ses of elderly patients and 32 cases of youg patients with colorectal cancer were detected by enzyme linked immunosorbent assay be‐fore and after surgery ,and to analyze its clinical significance correlated with pathological parameters .Meanwhile ,60 cases of healthy were controls .Results The serum levels of IL‐17 and sICAM‐1 were higher in patients with different ages of colorectal cancer than those of the normal control group (P<0 .05) ,and the concentrations of the two group after operation were significantly lower than those of the normal control group (P<0 .05) .The CRP levels of the young group and old group were similar to that of the normal control group (P>0 .05) .The level of CRP before operation in the young group was higher than that in the normal control group (P<0 .05) .The levels of serum IL‐17 and sICAM‐1 were significantly different between the young and the old group(P<0 .05) , while the CRP level was similar in the two groups (P>0 .05) .The serum levels of sICAM‐1 and IL‐17 in colorectal cancer patients were associated with the degree of differentiation ,depth of invasion ,lymph node metastasis and TNM staging (P<0 .05) .The level of CRP was significantly correlated with the depth of invasion ,lymph node metastasis and TNM staging (P<0 .05) .Conclusion The serum levels of sICAM‐1 ,CRP and IL‐17 reflect the invasion and metastasis of colorectal cancer in a certain extent ,which play important roles in predicting the development and prognosis of colorectal cancer .

Objective To study the responsible genes of psoriasis vulgaris on chromosome 1q21 in Chinese Han population.Methods Thirty-six families with psoriasis vulgaris,including 92 patients and 98 normal relatives,aged from 12 to 81 years with an average age at 44 years,were enrolled in this study.Blood samples were obtained from all the participants and subjected to DNA extraction.A genome scan was performed with eight microsatellites distributing over chromosome 1q21-1q23.1.Evidence for linkage disequilibrium was assessed with extended transmission disequilibrium test(ETDT)program and Genehunter software.Results Three short tandem repeat markers were found to be associated with psoriasis vulgaris.With Genehunter,evidence for linkage disequilibrium between D1S2345 and psoriasis was found with the NPL value being 1.735(P=0.0329).Moreover,ETDT revealed that the 97-bp allele of D1S2346 and 283-bp allele of D1S484 were preferentially delivered to affected descendants(P＜0.05).Conclusion Chromosome 1q21 contains genes associated with psoriasis vulgaris in Chinese Han population.

Objective To investigate the association of SPRR2E gene and psoriasis vulgaris by sequencing the DNA of Chinese Han psoriatic families. Methods DNA was extracted from the peripheral blood cells of thirty-two Chinese psoriatic families. The sequence of the SPRR2E encoding region was measured by ABI377 DNA Sequencer. The linkage disequilibrium was assessed by extended transmission disequilibrium test (ETDT) and GENEHUNTER software. Results An A/G polymorphism at nucleotide 156 of the SPRR2E encoding region was identified. There were three genotypes, including AA, GG and AG. Although the single nucleotide polymorphism (SNP) did not change the encoding of amino acid, the single nucleotide polymorphism locus was associated with psoriasis vulgaris by the ETDT analyzing. The A-allele was found to be transmitted more frequently than that of the G-allele. GENEHUNTER analysis was concordant with the results of the ETDT. Conclusion A single nucleotide polymorphism (SNP) in SPRR2E gene encoding region is associated with psoriasis vulgaris in Han Chinese population.

The MAPKs activation pathway consists of three protein kinases in activation sequence:MAPKs kinase kinases (MKKKs)→,MAPKs kinases (MKKs)→MAPKs and four pathways:extracellular signal-regulated kinase (MAPK~(ERK)),C-JUN N-terminal kinase (MAPK~(JNK)),MAPK~(P38) and MKKS/MAPK~(ERK5) activation pathways.It has been proved that MAPKs(ERK,JNK and P38) are acvtivated in the progress of morphine tolerance.Inhibitors of any element of MAPKs activation pathway may function as a potential clinical medicine for morphine tolerance.

Objective To preliminarily optimize the acupuncture protocol in treating migraine in acute stage. Method Ninety patients with migraine in acute stage were observed, with Visual Analogue Scale (VAS) as the evaluation index and an orthogonal design. Acupoints groups [Taiyang (EX-HN5), Fengchi (GB20), Taiyang (EX-HN5) and Fengchi (GB20)], insertion directions (perpendicular, downward penetration, and backward penetration), stimulation dosage (1 needle, 3 needles, and 5 needles) and acupuncture duration (30 min, 1 h, and 2 h), altogether 4 factors and 3 levels, formed up different acupuncture protocols to observe the analgesic efficacy in treating migraine in acute stage, so as to determine the role of the four factors (Chi-square test), advantage of the 3 levels (multiple comparisons) and the optimal grouping of the 4 factors and 3 levels. Result Acupoints group, insertion direction and stimulation dosage were the major factors in acupuncture analgesia, and the acupuncture duration was the secondary factor (P<0.05). The analgesic effect of Taiyang (EX-HN5) and Fengchi (GB20) was more significant than either Taiyang (EX-HN5) or Fengchi (GB20) (P<0.05). Penetration puncture from Naokong (GB19) towards Fengchi (GB20) (downward penetration) produced a more significant analgesic effect than from Fengchi (GB20) towards Wangu (GB12) and from Tianyou (TE16) towards Fengchi (GB20) (both backward penetration) (P<0.05). Acupuncture with Five needles and 3 needles (parallel horizontal insertion) were superior to that with 1 needle (P<0.05); acupuncture with 5 needles was better than that with 3 needles but without a statistical significance (P>0.05). Needle retaining for 2 h produced a better analgesic effect than retaining for 30 min and 1 h, but without statistical significances (P>0.05). Conclusion Taiyang (EX-HN5) plus Fengchi (GB20), downward penetration acupuncture, 5-needle parallel horizontal acupuncture, and 2-h needle retaining combine an optimal acupuncture protocol in treating migraine in acute stage. Nevertheless, 3-needle parallel acupuncture with 30-60-min needle retaining can also be chosen according to the condition of the patients.

Objective: To investigate the influence of occupational aluminum exposure on cognitive function and glutamate receptor protein expression in peripheral blood lymphocytes in workers and the possibility of glutamate receptor being used as a biomarker for cognitive impairment in aluminum workers. Methods: From October to December, 2014, cluster sampling was performed to select 121 workers in aluminum electrolysis workshop as exposure group and 231 workers in thermoelectric workshop and logistics department as control group. Mini-Mental State Examination, clock drawing test, digit span test (DST) , verbal fluency test (VFT) , and Fuld Object-Memory (FOM) Evaluation were used to analyze cognitive function. Graphite furnace atomic absorption spectrophotometry was used to measure plasma aluminum level as an exposure indicator. Enzyme-linked immunosorbent assay was used to measure the content of glutamate receptor proteins in peripheral blood lymphocytes, including the subunits of N-methyl-D-aspartate receptor NR1, NR2A, and NR2B and metabotropic glutamate receptor 1 (mGluR1) . The correlation between cognitive function indices and the content of glutamate receptor proteins was analyzed. Results: There was no significant difference in plasma aluminum level between the control group and the exposure group (132.52±80.40 μg/L vs 182.88±72.32 μg/L, P>0.05) . According to the plasma aluminum level, the study subjects were divided into control group and low-, medium-, and high-level plasma aluminum groups, and there were significant differences in plasma aluminum level between these groups (all P<0.01) . The high-level plasma aluminum group had a significantly lower memory ability score than the control group and the low- and medium-level plasma aluminum groups (all P<0.05) . The high-level plasma aluminum group had lower DST and digital span forward (DSF) scores than the control group and the low-and medium-level plasma aluminum groups. The low-, medium-, and high-level plasma aluminum groups had lower digital span backward (DSB) scores than the control group. The medium-and high-level plasma aluminum groups had lower VFT scores than the control group and the low-level plasma aluminum group. The high-level plasma aluminum group had significantly lower expression of NR1 and NR2A proteins than the control group and the low-and medium-level plasma aluminum groups, and the medium- and high-level plasma aluminum groups had significantly higher expression of mGluR1 protein than the control group and the low-level plasma aluminum group (all P<0.05) . The expression of NR1 and NR2A proteins was negatively correlated with plasma aluminum level (r=-0.475 and -0.692, both P<0.05) , andthe expression of mGluR1 protein was positively correlated with plasma aluminum level (r=0.756, P<0.05) . The expression of NR1 protein was positively correlated with DSF, DSB, DST, and VFT scores (r_s=0.213, 0.249, 0.271, and 0.228, all P<0.05) , and the expression of NR2A protein was positively correlated with VFT score (r_s=0.206, P<0.05) . Conclusion Occupational aluminum exposure may affect workers’ memory function, and the expression of NR1 and NR2A in peripheral blood lymphocytes is correlated with cognitive function indices and can be used as biomarkers for cognitive impairment in aluminum workers.

OBJECTIVETo evaluate the effectiveness and safety of the meridian three-combined therapy for treatment of ordinary psoriasis.

METHODSA multi-central, randomized and positive drug controlled trial was adopted, and 233 cases were divided into an observation group of 116 cases and a control group of 117 cases. The observation group was treated with thread embedding at points, blood-letting puncture on the back of ear and auricular point pressing (i.e. meridian three-combined therapy). For thread embedding, 3-4 local points such ear points as Fei (CO14), Gan (CO12), Pizhixia (AT4), Shenmen (TF4) , cephalic and symmetric points of severe parts of the limb skin were selected according to the skin lesion position, and the treatment was given once each two weeks. For ear point tapping and pressing, 3-5 points were selected in each session. And the control group was treated with oral administration of Di yin Tablets, 5 tablets each time, twice each day. After treatment of 6 weeks, the clinical therapeutic effects, the score of skin lesion area, the scores for skin lesion severity and safety were compared in the two groups.

RESULTSThe markedly effective rate was 57.8 % in the observation group and 51.3% in the control group with no significant difference between the two groups (P>0.05); after treatment the scores for both the skin lesion area and the skin lesion severity were significantly decreased in the two groups compared with those before treatment (P<0.01), and with a significant difference between the two groups (P>0.05). And the incidence rate of the adverse reaction in the observation group was significantly lower than that in the control group.

CONCLUSIONThe meridian three-combined therapy is effective and safe for treatment of ordinary psoriasis.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Bloodletting ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Meridians ; Middle Aged ; Psoriasis ; drug therapy ; therapy ; Young Adult

OBJECTIVETo investigate the accumulation of advanced glycation end products (AGE) and the inflammatory response of skin and wound in diabetic patients, and to analyze their relationship in vitro.

METHODSHistological staining and immunohistochemical staining was respectively performed on skin and wound tissue specimens collected from 10 patients with Type II diabetes mellitus (diabetes group) and 12 non-diabetic patients with skin injury (control group) to observe the arrangement of collagen and the distribution of inflammatory cells, and to determine the expression levels of AGE and its receptor (RAGE). Malondialdehyde (MDA) levels in skin and wound tissue homogenates were assayed by enzyme-linked immunosorbent assay. In vitro, human neutrophils were isolated and treated with RPMI-1640 culture medium or that containing AGE-human serum albumin in the concentration of 0.315, 0.625, 1.250 mg/mL, and they were identified as normal control (NC) group, low concentration (L) group, moderate concentration (M) group, and high concentration (H) group. Cell viability in each group was determined by MTT colorimetric assay, and the reactive oxygen species (ROS) in cell was measured with 2', 7'-dichlorofluorescein-diacetate. Data were processed with t test.

RESULTSCompared with those of skin in control group, collagens of skin tissues in diabetes group atrophied and disorderly arranged. Inflammatory cells in wounds in diabetes group were dispersed, in which collagens arranged loosely and irregularly, as compared with those of wounds in control group. Expression levels of AGE and RAGE of skin in diabetes group were higher than those in control group. In diabetes and control groups, especially in diabetes group, the numbers of RAGE-positive cells in wound tissue were more than those in skin tissue. Large amount of inflammatory cells with positive expression of RAGE were observed in diabetes group. MDA level of skin and wound tissue in diabetes group was respectively (6.3 ± 1.0), (7.1 ± 2.4) nmol per milligram protein, which were obviously higher than those in control group [(2.9 ± 1.0), (3.6 ± 1.4) nmol per milligram protein, with t value respectively 8.017, 4.349, P < 0.05 or P < 0.01]. Cell viability and ROS levels in neutrophils were increased in L, M, and H groups [(59 ± 8)%, (77 ± 5)%, (67 ± 6)% and 1.67 ± 0.14, 2.13 ± 0.17, 3.48 ± 0.48] as compared with those in NC group [(34 ± 5)% and 0.58 ± 0.06, with t value respectively 7.195, 14.890, 11.130 and 20.195, 24.905, 16.864, P < 0.05 or P < 0.01].

CONCLUSIONSAbnormal oxidative stress in diabetic skin leads to an atypical origin of wound repair. AGE-RAGE effect is a critical mediator for oxidative stress in diabetic wound tissue during wound healing.

Aged ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; metabolism ; pathology ; Female ; Glycation End Products, Advanced ; metabolism ; Humans ; Male ; Middle Aged ; Oxidative Stress ; Reactive Oxygen Species ; metabolism ; Receptor for Advanced Glycation End Products ; Receptors, Immunologic ; metabolism ; Serum Albumin ; metabolism ; Serum Albumin, Human ; Skin ; metabolism ; pathology ; Wound Healing

BACKGROUND:Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury.
OBJECTIVE:To explore the clinical efficacy of vertebral plate osteotomy+vertebra osteotomy+long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity.
METHODS:Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then fol owed up for 3 months to 2 years.
RESULTS AND CONCLUSION:After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60%and 98%, respectively. The pain relief rate was 64%, and the Oswestry Disability Index was 95%. There were no pul ed nails, broken nails and broken robs after implantation. These findings indicate that the combination of selective osteotomy technique and long-segment internal fixation can achieve stable fixation effects, prevent sagittal imbalance, and avoid the occurrence of pul ing nails, breaking nails and breaking robs caused by osteoporosis.