Primary biliary cirrhosis (PBC)is an autoimmune disease.Ursodeoxycholic acid (UDCA)is the only safe and effective drug for the treatment of PBC,as proved by randomized controlled clinical trials,so it is advocated as first-line therapy.Alternative therapies are urgently needed for patients with poor response to UDCA.In addition to the efficacy of UDCA,the classification of alternative and adjuvant therapies for UDCA nonresponders and the latest research progress in these therapies are reviewed;the efficacy of existing drugs and treat-ment prospects are evaluated,but more long-term clinical studies are needed to confirm the efficacy of immunosuppressants such as budes-onide and etanercept and other drugs.A number of novel molecular therapies for PBC are also undergoing clinical trials.There is currently no consensus on the medical treatment for patients with poor response to UDCA.Although studies have shown that some drugs can improve liver function and liver biochemistries,there is no definitive evidence that they improve long-term outcome.

BACKGROUND:Cam-type femoroacetabular impingement can impose elevated mechanical loading in the hip, and may eventual y result in hip osteoarthritis, while mechanical mechanism on how this deformity leads to osteoarthritis is stil unclear.
OBJECTIVE:To analyze intra-articular mechanical environment of Cam-type femoroacetabular impingement in hip joint using three-dimensional finite element method, and to further understand the features of pathological mechanics.
METHODThree-dimensional geometry models of normal and Cam-type femoroacetabular impingement joints were constructed using Mimics and Hypermesh software with the CT data of normal hip joint. These hip models were imported into LS-DYNA analysis system, then dynamic loads and motions for standing up and sitting down were applied to al joint models. Intra-articular cartilage contact pressures and stresses were analyzed in normal hip joint and hip joint with Cam-type femoroacetabular impingement.
RESULTS AND CONCLUSION:Based on CT data, models of normal hip joint and hip joint with Cam-type femoroacetabular impingement including articular cartilage for three-dimensional finite element analysis were accurately constructed. Peak contact pressures were 4.43 and 4.59 MPa at the anterosuperior region of the acetabular rim during sitting down and standing up. The peaks of Cam-type femoroacetabular impingement hip joint were 14.96 and 14.86 MPa. Peak pressures and stress concentration were found at the anterosuperior area of acetabular rim. High contact pressure at the acetabular cartilage may be the mechanical mechanism of osteoarthritis induced by Cam-type femoroacetabular impingement.

Objective:To analyze the clinical applicability of the sixth edition of nursing measures classification in children's general surgery, to provide a basis for standardizing clinical nursing terms and to promote the clinical use of standardized terminology of nursing measures.Methods:The research method of this study was mapping method. The electronic nursing records of the general surgery of Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from October 1st to December 31st, 2018, including the records of care records for free entry and the records of nursing measures related to medical orders were selected. The degree of matching between electronic care records and classification of nursing measures (sixth edition of nursing measures classification) was compared with conceptual consistency. Difficulties and time-consuming analysis of the characteristics of the standardized care measures obtained by matching.Results:A total of 4 560 independent electronic care records mapped 86 treatments in seven areas. Among them, 98.84% (4 507/4 560) of the nursing records were completely matched with the nursing measures, 0.83% (38/4 560) of the nursing records were partially matched with the nursing measures, and 0.33% (15/4 560) of the nursing records did not match the nursing measures. Difficulty and time-consuming were expressed as standard deviation, which were 2.20±0.45 and 2.03±1.25 respectively.Conclusions:The classification of nursing measures can be used to describe the daily behavioral activities of the children's general surgery nurses, and can also solve the standardization problem of the nursing records in the presentation, and is suitable as a standardized nursing language for the nursing records of children's general surgery.

Background Diclofenac sodium eye drops,pranoprofen eye drops and bromfenac sodium hydrate eye drops are three clinical commonly used nonsteroidal anti-inflammatory drugs(NSAIDs).The variation of cytoxicity among these drugs and whether the cytoxicity is related to the supplements are also unknown.Objective This study was to compare the cytotoxicity of three non-steroidal anti-inflammatory eye drops and their active components with cultured human corneal epithelial cells (HCECs) in vitro,and to discuss toxic origins of these drugs.Methods HCECs were cultured in different drugs with the final concentration of 0.10％,0.05％,0.02％ and 0.01％.Cell proliferation was evaluated by MTT assay.Then,0.002％ eye drops (1∶50) was added,and the migration and damage of the cells were deceted by transwell migration assay and lactate dehydrogenase (LDH) assay.Results The cytotoxicity of three nonsteroidal anti-inflammatory eye drops on HCECs was concentration-dependent (all at P=0.00).Diclofenac sodium eye drops showed the most dominant effects on the proliferation,migration and damage of HCECs among the three eye drops,while bromfenac sodium eye drops showed the least effect on the cell damage (proliferation:Fdrug =20.25,P=0.00;migration:F =103.43,P =0.00;damage:Fdrug =164.16,P =0.00).Compared with the eye drops,their active components showed less cytoxicity.Pranoprofen appeared the least effects on the proliferation,migration and damage of HCECs (proliferation:Fdrug =332.27,P =0.00;migration:F =332.27,P =0.00;damage:Fdrug=154.83,P=0.00).Conclusions The cytotoxicity ofdiclofenac sodium eye drops is more obvious than that of pranoprofen eye drops or bromfenac sodium hydrate eye drops.The cytotoxicity of the three eye drops originates from their supplements or the interaction between the supplements and active components.

Objective:To investigate the status of work performance among rural doctors in Shanxi province and the factors related to their performance.Methods:From July to September 2019, 528 rural doctors in Shanxi province were selected by multi-stage stratified cluster sampling for the survey. Their job competency, job performance, psychological capital and burnout were evaluated. The structural equation model was used to construct the job performance analysis based on post competency.Results:The total score of post competency of rural doctors in Shanxi province was (188.6±20.3), and the total score of job performance was (71.3±11.5), both of which were in the middle level. The structural equation model was well fitted [goodness-of-fit index (GFI)=0.958, normal fix index (NFI)=0.920, adjusted goodness-of-fit index (AGFI)=0.910, root mean square error of approximation (RMSEA)=0.076]. Post competency, psychological capital and job burnout had direct effects on job performance ( P<0.05), with influence coefficients of 0.64, 0.35 and -0.25, respectively. Job competency indirectly affected job performance through psychological capital and job burnout ( P<0.05). Conclusion:The study suggest that higher post competency would facilitate to improve the work performance of rural doctors.

Objective　To study the expressions of some apoptosis related to genes in lung tissues and their relationship to the pathogenesis in rats to hypoxic pulmonary hypertension (HPH). Methods　A total of 60 rats were employed and equally divided into 5 groups, i.e. control, HPH, hemin, Tin Protoporphyrin (Snpp) and low concentration CO groups. Of them, the rats from middle 3 groups were treated with hypoxia under normal pressure for 7 h in every day, 3 weeks except Sunday. Hemin and Tin Protoporphyrin (Snpp) were given half an hour before hypoxia while low concentration CO after 2 h of hypoxia. The expression of bcl-2, bax, Fas and Fas ligand (FasL) were detected with immunohistochemical staining, in situ cell death detection, DNA fragment detection, and in situ hybridization. Results　In low concentration CO and hemin group, typical DNA ladder bands and apoptotic cells were found in lung tissues, and the expressions of Fas, FasL, bax, and bcl-2 mRNA were increased in the epithelial cells of alveoli, vascular and bronchial walls. And the expression of bcl-2 mRNA was decreased than in hypoxic group. Conclusion　CO can regulate the expression of bcl-2, bax, Fas and FasL, these apoptotic genes may involve in the regulation of cell apoptosis of lung tissues under HPH and play important roles in the genesis and development of chronic obstructive lung disorders.

ABSTRACT:Objective To prepare polymeric nanomicelles capable of simultaneously loading doxorubicin (DOX) and Bcl‐2 small interfering RNA (Bcl‐2 siRNA ) , and to explore their in vitro cytotoxicity and cellular uptake in MCF‐7 human breast cancer cells .Methods Copolymer poly (ethylene glycol )‐g‐polyethylenimine‐g‐poly(γ‐benzyl‐L‐glutamate) was synthesized by the combination of reductive amination and carbodiimide methods , and its chemical structure was verified by 1 H NMR .Empty and drug‐loaded copolymeric nanomicelles were prepared by dialysis method and characterized by transmission electron microscope and dynamic light scattering .The ability of the nanomicelles to compress Bcl‐2 siRNA was measured by by agarose gel electrophoresis method . The release profiles of DOX and Bcl‐2 siRNA from the nanomicelles were explored by means of fluorescence spectrometry and dialysis method .The in vitro cytotoxicity and cellular uptake of DOX and Bcl‐2 siRNA co‐loaded nanomicelles in MCF‐7 human breast cancer cells were characterized by MTT assay and confocal laser scanning microscopy , respectively .Results The critical micelle concentration of the copolymer was about 4 mg/L ,and the sizes of self‐assembled empty and drug‐loaded nanomicelles were smaller than 200 nm .The drug‐loading efficiency and drug‐loading content of DOX in the nanomicelles were 88 .7% and 15 .1% ,respectively .The DOX‐loaded nanomicelles could efficiently compress Bcl‐2 siRNA when an N/P ratio was ≥64 .The zeta potential of DOX and Bcl‐2 siRNA co‐loaded nanomicelles was +30 mV .The release behavior of the cargoes from the nanomicells was pH‐sensitive , and the release of Bcl‐2 siRNA was more sensitive to acidic pH than that of DOX . The nanomicelles could simultaneously deliver DOX and Bcl‐2 siRNA into MCF‐7 cells , and the co‐delivered DOX and Bcl‐2 siRNA significantly increased the cytotoxicity of DOX (P<0 .05) .Conclusion The polymeric nanomicelles can co‐load DOX and Bcl‐2 siRNA and deliver them into MCF‐7 cells , and DOX in combination with Bcl‐2 siRNA can synergistically inhibit the growth of MCF‐7 cells and promote cell apoptosis ,suggesting that the nanomicells may be a promising carrier for the co‐delivery for chemotherapeutics and genes .

Objective To establish a monitoring and evaluation indicator framework in the context of malaria elimination in pilot areas in China,so as to further assess the malaria elimination work in the future. Methods Based on the consultancy, and according to the government documents such as Action Plan for Malaria Elimination in China (2010-2020),Technical Guidance for Malaria Elimination,Programme Evaluation on Malaria Elimination,the indicators were set up at both provincial and county levels and their application was conducted in Yunnan and Anhui provinces to assess the accountability,accessibility and applicability. Results An indicator framework was built up including four key components,which were input,process, output and impact indicators,in which 95 were provincial indicators and 98 were county indicators. The completion rate of the indicators of Yunnan and Anhui provinces were 94.7%(90/95)and 95.8%(91/95)respectively;and the completion rate of in?dicators of Tengchong and Feidong counties were 93.9%(92/98)and 92.9%(91/98)respectively. Conclusion The estab?lished indicator framework is reliable and applicable,which could effectively help to track the malaria elimination progress and identify gaps.

Objective Study the anti-tumor effects in vivo of AMH-D on S-180 cell lines, the synergistic effects of AMH-D and cyclophosphamide,and investigate the way and its strength of the effect. Provide the basis for the development of anti-cancer drug. Methods Kunming mice were transplanted with S-180 tumor cells subcutaneously in the right armpit. Intraperitoneal injection was done after randomization on the next day. Mice were killed on the eleventh day, and tumors were stripped and weighed. The tumor weight was used as indicator for analysis and evaluation. Results The results showed that AMH-D could effectively inhibit the growth of S180 cells transplanted tumor. The tumor inhibition rate was 50.45%at the dose of 150 mg/kg, with a dose-effect relationship. There were no obvious impacts on the growth of the weight of mice. The results showed that AMH-D had a synergistic effect combined with cyclophosphamide within a certain dose. Conclusion Fungus extract AMH-D has a great effect on anti-tumor in vivo of S180 cells transplanted tumor, and has a synergistic effect combined with cyclophosphamide within a certain dose.

After-class reading is one of the important activities in the college students' spiritual life.The interests,sorts of books,contents and quantities of their reading can reflect their ideological conditions and their value judgment.Based on the investigation and analysis on their after-class reading activities,we can discover problems and give appropriate guidance in time,hoping to promote the cultivation of good after-class reading atmosphere on campus. The results of this survey can provide reference for the humanistic quality education of medical students.