Objective To observe the effect of physiotherapy on knee osteoarthritis. Methods 40 knee osteoarthritis patients were dividedinto treatment group (n=20) and control group (n=20). The control group accepted conventional therapy, acupuncture and moxibustion,fumigation, massage, etc. The treatment group accepted physiotherapy in addition, including strength training and joint activity training.They were assessed with Lysholm Knee Scoring Scale (LKSS) and Visual Analogous Scale (VAS). Results The scores of LKSS and VASimproved in both groups after treatment, and improved more in the treatment group than in the control group (P<0.01). Conclusion Physiotherapycan further improve the stability of knee and release the pain in knee osteoarthritis patients.

OBJECTIVE:To study the improvement effect of Z-Guggulsterone(Z-GL)on blood coagulation and vascular endo-thelial functions of acute blood-stasis model rats and its mechanism. METHODS:40 rats were randomly divided into normal group,model group,positive group(Aspirin tablet,50 mg/kg)and Z-GL low-dose and high-dose groups(25,50 mg/kg),with 8 rats in each group. They were given relevant medicine intragastrically every 12 h,and normal group and model group were given constant volume of normal saline intragastrically for consecutive 7 times. After the fifth administration,except for normal group, those groups were given adrenalin hydrochloride subcutaneously+ice-cold water to induce acute blood-stasis model. Within 30 min after the last administration,aorta abdominalis sample were selected to detect the coagulation parameters [prothrombin time(PT), thrombin time (TT),activated partialthromboplastin time (APTT),fibrinogen (FIB)],and pathological changes of carotid artery were observed. Human umbilical vein endothelial cells (HUEVCs) were divided into blank group (normal saline),model group (normal saline) and Z-GL low-concentration and high-concentration groups (25,50 μmol/L). After culturing for 24 h,the cells were exposed to glucose and oxygen deprivation for 6 h in model group and Z-GL groups. The expression of p-eNOS protein was detected. Other cells were selected,grouped,administrated and treated as above cells,and the NO level of these cells were detect-ed. RESULTS:Compared with normal group,PT,TT and APTT were all shortened in model group,while FIB content was in-creased (P<0.01);vascular endothelium was injured,and endothelial cells fell off from the wall. Compared with model group, PT,TT and APTT were prolonged in administration groups,while FIB content was decreased(P<0.05 or P<0.01);vascular en-dothelium injury was relieved. Results of p-eNOS protein and NO levels determination showed that compared with model group, p-eNOS protein and NO levels were increased in Z-GL groups(P<0.05 or P<0.01). CONCLUSIONS:Z-GL can significantly im-prove coagulation and vascular endothelium functions of blood-stasis model rats,and its mechanism may be associated with the acti-vation of eNOS and the increase of NO level.

Objective To provide a simple, convenient, and safe anesthesia method for the establishment of a M1 segment of middle cerebral artery occlusion model in rhesus monkey or other large laboratory animals.Method Twenty male rhesus monkeys weighing 7-11 kg (ages 7-9 years) from Academy of Military Medical Sciences were used in this study.Sumianxin injection combined with 0.1 mg/kg ketamine was given before endotracheal intubation (ID:4.5-5.5#).The animals were then transported to an interventional operation room, where the intravenous access was established and a urinary catheter was inserted into the urinary bladder.Mechanical ventilation was used during the surgery, propofol was continuously injected in a speed of 2-4 mg/kg/h, and Sumianxin-ketamine could be given if necessary to maintain adequate anesthesia depth.The dose was adjusted according to vital signs of the rhesus such as body movements, physiological parameters, and demand of surgery.Brain MRI examination was performed before and after thrombolysis.Anesthetic injection was suspended and the animals were allowed to have a spontaneous breathing every time before the MRI text.Heart rates, temperature, non-invasive blood pressure, and SpO2 were monitored during the whole surgery.Blood samples were taken from the radial artery for blood gas analysis after anesthesia induction and during operation.Results All the 20 animals underwent the operation successfully, no animal had restlessness, respiratory depression, arrhythmia and other serious complications.At the end of the study, animals awake soon.Fifteen of them survived longer than 24 hours, only 5 died from serious cerebral hemorrhage and larger cerebral infarction.Conclusions General endotracheal anesthesia is safe for rhesus monkeys during such interventional operation and MRI examination.

BACKGROUND:Bone marrow mesenchymal stem cells have the chemotaxis and homing role that promotes immune system reconstruction, eliminate residual lesions and prevent recurrence in patients.
OBJECTIVE:To observe therapeutic effect of human bone marrow mesenchymal stem cells transplantation into high-metastatic potential hepatocellular carcinoma animal models on metastatic potential of high-metastatic potential hepatocellular carcinoma.
METHODS:Nude mouse models of high-metastatic potential hepatocellular carcinoma were established in vivo. In the experimental group, 5×105 cells were injected via the tail vein on day 7 after tumor inoculation, twice a week. In the control group, cellculture medium, 0.2 mL per mouse, was injected by the tail vein. After the start of the experiment, tumor volume was measured every 4 days. After tumor inoculation for 14 days, 21 days, 28 days, 35 days, 42 days, animal models were sacrificed, and then tumor mass and body mass were recorded to calculate the inhibition rate. PCR was employed to detect osteopontin, bone sialoprotein, and integrinα Ⅴ mRNA expression, as wel as bcl-2, bax, caspase3 mRNA expression.
RESULTS AND CONCLUSION:The inhibition rate of tumor mass showed the best results in week 3. As time went on, the tumor inhibition rate was gradual y decreased. Metastasis-related biological factors showed a gradual down-regulated trend, indicating the polarization of tumor apoptotic indexes, that is, anti-apoptotic factor, bcl-2, showed a decreasing trend, while apoptotic factors, bax and caspase3, appeared to have a gradual y increased trend. These findings suggest that human bone marrow mesenchymal stem cells effects to inhibit high-metastatic potential hepatocellular carcinoma animal models appear to vary with time. After human bone marrow mesenchymal stem cells transplantation for 3 weeks, the inhibition performance on high-metastatic potential hepatocellular carcinoma is the best, and then it weakens with time. Human bone marrow mesenchymal stem cells are found to inhibit the metastatic potential of hepatocellular carcinoma.

Under National Health Insurance system ( NHI) , Taiwan implemented “Family Physician Integrat-ed Health care Plan” by focusing on the key functions of primary medical institutions and family physicians. This plan had continuously strengthened the family physician system and the quality of integrated health care provision. Taiwan’s achievements and experiences were valuable for Mainland China. This paper first introduced the health sys-tem and health care provision system of primary medical institutions in Taiwan from the aspects of financing, pay-ment, health care delivery system structure, and market-capture institutions. Then, we made a comprehensive intro-duction on the policy objectives, organization structures, operation system, service schemes and health insurance pay-ment system of this plan. Finally we proposed the suggestion for integrated health care provision system in Mainland China. It is of vital importance that government should design the integrated service provision system by focusing on the key functions of family physicians. It is also of equal significance that the health administrative departments should cooperate with health insurance administrative departments to gain sufficient policy and funding resources for the plan’s successful implementation.

0.05).There was remarkable low signal intensity on T2-weighed imaging and no evident artifacts for molecular probe when the concentration of Fe2+ was 20 mg/L.The least number of labeled cells detected by MR in vitro was 6?106 when the concentration of Fe2+ was 20 mg/L.Conclusion:Molecular probe,SPIO-OCT,can effectively label breast cells which express SSTR.The reasonable Fe2+ concentration of labeled cells and imaging was 20 mg/L.There is a correlation between MR signal intensity in vitro and the number of labeled cells.

Objective To develop a Gd-based MR probe containing arginine-glyeine-aspartic acid (RGD)motif to reveal integrin avβ3 receptor-expressed tumor.Methods Commercially available HYNICRGD conjugate with co-ligand EDDA was labeled with GdCl3,and the mixture was isolated and purified by solid phase extract(SPE)to get the entire probe Gd-EDDA-HYNIC-RGD.Human HCC cell line BEL-7402 was cultured and the cells harvested and suspended then subcutaneously inoculated into athymic nude mice for tumor growth.In vitro cell binding assay to integrin avβ3 receptor and cell viability experiments were conducted.Then in vivo,imaging of the three arms of xenografts were performed by MR scan with a dedicated animal coil at baseline and time points of 0.30,60,90 mninutes and 24 hour post-intravenous injection(P.i.) via the tail vein.Three arms of nude mice then were sacrificed for histological examination to confirm the imaging results.Results Gd-EDDA-HYNIC-RGD was successfully isolated by SPE and validity was verifled on signal enhancement througll in vitro and in vivo experiments.The T1 relaxation rate of the probe is 3.31 mmol/s:It is well tolerated to living cells when the concentration of the probe is below 0.1 μmol/ml;both BEL-7402 Hunlan Hepatocellular Carcinoma cell Iine and the tumor expressed avβ3receptor;The RGD-iigand was observed specificly binding with avβ3 receptor in vitro;The nude mice model bearing HHCC was well estabhshed.The signal intensity(SI)at the tumor site were 2247.6±39.0 at baseline and 2820.9±35.2 at 90 min p.i.respectively,the SI at 90min increased less than 25%of baseline,which is statistically different(t=-38.031,P＜0.05);while the SI at muscle site were 1824.2±32.8 and 1845.8±27.2 respectively,which is not statistically different(t=-1.424,P＞0.05);The signal to time curve for probe-administrated group is straightforward over time in the span of 0 to 90 minute p.i.while the control arms do not show such tendency.Conclusion Gd-EDDA-HYNIC-RGD has the potential to used as an MR probe detecting integrin avβ3 receptor-expressed tumor.This work may offer possibility of early detection and differentiation of specific tumors.

Objective To evaluate the impact of respiratory motion on lung dosimetry using 4D-CT during lung cancer radiotherapy.Methods Ten cases were randomly selected from non-small cell lung cancer (NSCLC) patients treated in our department.The 4D-CT machine was adopted for simulation before treatment and 10 respiratory phases were obtained for each patient.Target volumes were delineated on the maximum intensity projection (MIP) images,and plans were generated on average intensity projection (ALP) images.Plans were transferred to CT images of each respiratory phase,and we calculated the dosage on lungs and subsequently evaluated the volume dosage to lungs and the entire body.Results The mean dosage to lungs are greatly affected by the respiratory phase.This difference also depended on tumor location.When it was inside the lung,the average dosage shows the same trend as the respiratory motion,with the change rate of 2.18％,which was less than the change of lung volume 4.49％ (t =4.189,P ＜ 0.05).When the tumor was located nearby the lung,the mean dosage showed the opposite trend with respiratory motion,with the change rate of 3.76％,which was also less than the change of lung volume 4.49％ (t =25.007,P ＜ 0.05).The effect of respiratory motion on V5,V10,V20 of body was small,and the magnitude of change for whole body dosages were 0.47％,0.28％,0.17％ respectively,which was smaller than the change of lung volume 4.49％ (t =11.371,11.188,11.377,P ＜ 0.05).Volume dose of lung V5,V10,V20 and lung volume change trends were the same,and the magnitude of change for lung volume dosages were 2.39％,1.91％,1.80％ respectively,and were smaller than the change of lung volume 4.49％ (t =2.279,2.298,2.485,P ＜ 0.05).Conclusions The mean dosage to lungs shows a great difference between different respiratory phases.More attention should be paid when evaluating the lung volume during treatment planning.

Objective To evaluate the pre- and intra-operative risk factors associated with delayed weaning from ventilator during the early postoperative period in patients undergoing liver transplantation.Methods Two hundred and twelve patients (152 male, 60 female) aged 22-69 yr undergoing liver transplantation from Sept 2004to Aug 2006 were enrolled in this study and were divided into 2 groups according to the time when the patients were weaned from ventilator: normal weaning group (Group A, the patients weaned from ventilator within 24 h after operation) and delayed weaning group (Group B, the patients weaned from ventilator more than 24 h after operation). Routine anesthesia wes performed. Blood and blood products were transfused according to the guidelines for blood transfusion to maintain the mean arterial pressure (MAP)≥60 mm Hg during operation. Sixteen preoperative variables (age＞64 yr, gender, BMI ≥ 30kg/m2, PaO2＜75 mm Hg,pleural effusion, a history of asthma, smoking, drinking alcohol, coronary artery disease, diabetes mellitus, encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepatopulmonary hypertension) and 7 intraoperative variables (duration of operation, duration of anhepatic stage, transfusions of RBC,fresh frozen plasma (FFP), crystalloid and colloid, and urine output＜ 1 ml·kg-1·h-1) were recorded and compared between the two groups.Results There were significant differences in 9 preoperative variables (age ＞ 64 yr, PaO2＜75 mm Hg, pleural effusion,encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepato-pulmonary hypertension) and 5 intraoperative variables (transfusions of RBC, FFP, crystalloid and colloid, and urine output＜1 mi·kg-1·h-1) between the two groups (P＜0.05 or 0.01). And logistic regression analysis showed that 5preoperative variables (age＞64 yr, PaO2＜75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, and moderate hepato-pulmonary hypertension) and 2 intraoperative variables (transfusion of RBC and urine output＜1 ml·kg-1·h-1) were confirmed to be associated with delayed weaning from ventilator.Conclusion Such variables es age ＞ 64 yr, preoperative PaO2 ＜ 75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, moderate hepato-pulmonary hypertension, transfusion of RBC during operation and urine output ＜ 1 ml· kg-1 · h-1 are associated with delayed weaning from ventilator during early postoperative period after liver transplantation.

Objective To summarize the clinical characteristics,diagnosis and treatment of autoimmune pancreatitis(AIP).Methods The retrospective descriptive study was adopted.The clinical data of 43 patients with AIP who were admitted to the First Affiliated Hospital of China Medical University between January 2010 and December 2014 were collected.All patients underwent laboratory tests and imaging examinations.For the patients who had the definite diagnosis of AIP,corticosteroid therapy was adopted,and for the patients who had the suspicion of pancreatic cancer,surgical operation was carried out.Observed indexes included clinical manifestations,laboratory findings,imaging findings,treatment,pathological findings and follow-up status.The follow-up of imaging examinations and laboratory tests via outpatient and inpatient examinations was performed on the patients until January 2016.Measurement data with skewed distribution were presented as average (range).Results (1) Clinical manifestations:of the 43 patients,33 demonstrated obstructive jaundice,19 had loss of weight,18 had upper abdominal pain and 5 had acute mild pancreatitis (the same patient with a variety of symptoms).Extrapancreatic organ involvement was detected in 23 of the 43 patients,including focal nephritis in 15 patients,sicca syndrome in 7 patients,pulmonary involvement in 5 patients,autoimmune thyroiditis in 5patients,hilar IgG4-associated cholangitis in 3 patients,retroperitoneal fibrosis in 3 patients and ulcerative colitis in 1 patient (the same patient with a variety of diseases).(2) Results of laboratory tests:17 patients underwent serum IgG4 detection and increased expression of IgG4 was found in 15 patients.(3) Imaging findings:all the 43patients underwent enhanced computed tomography (CT) scan of pancreas.Diffused enlargement of pancreas with appearance of sausage was observed in 34 patients and localized pancreatic head enlargement was observed in 9patients.Twenty patients had peripancreatic vascular involvement including stenosis or occlusion of splenic vein,stricture at the confluence of superior mesenteric vein,portal vein and splenic vein resulting in regional portal hypertension which led to gastric venous varices and splenomegaly.Three patients showed that superior mesenteric artery was surrounded by tissue masses with massive ascites.Five patients had pancreatic pseudocyst with splenic vein involvement and peripancreatic effusion.The abdominal CT examination of 15 patients with renal involvement showed renal cortical wedge or nodular lesions.Pulmonary inflammatory pseudotumor and interstitial pneumonia appeared in 5 patients,CT of whom showed solid pulmonary nodules or diffuse ground-glass opacities and patchy shadows in pulmonary interstitium.Thirty-two patients underwent magnetic resonance cholangiopancreatography and 28 patients underwent endoscopic retrograde cholangiopancreatography.The results showed the focal and diffuse or segmental stenosis of the main pancreatic duct were detected in 28 patients (diffuse stenosis in 23patients,local stenosis in 5 patients),stenosis of the intrapancreatic common bile duct in 32 patients,stenosis of hilar bile duct in 3 patients.Nine patients underwent endoscopic ultrasonography examination.The results showed 3 patients had hypoechoic mass in the head of pancreas and 6 patients had diffuse or heterogeneous hypoechoic of the pancreatic parenchyma.(4) Treatment status:of 43 patients,30 patients received initial steroid treatment.After steroid treatment,the clinical symptoms of 27 patients gradually improved and laboratory and imaging findings were both improved.Eleven patients didn 't receive initial steroid treatment,of whom 2 patients with obstructive jaundice underwent endoscopic biliary stent implantation,7 patients underwent surgical biliary drainage and 2 received neither endoscopic treatment nor surgical treatment.Two patients underwent pancreatoduodenectomy due to suspicion of pancreatic adenocarcinoma and were diagnosed as AIP based on postoperative pathological results and treated with steroid after operation.(5) Pathological examination:of the 43 patients,22 underwent pathological examination.Results of pathological examination of superficial lymph nodes showed lymph follicles hyperplasia,and immunohistochemistry staining showed massive IgG4 positive plasmocytes in 5 patients,supporting the diagnosis.Results of fine needle aspiration cytology in 15 patients showed no cytological evidence were detected in 14 patients and epithelial cells of malignant tumors in 1 patient.Results of pathological examination of surgical specimens showed dense infiltration of lymphocyte and immunohistochemistry staining showed massive IgG4 positive plasmocytes.(6) Follow-up status:of 43 patients,41 were followed up for an average time of 28 months (range,12-71 months).Of the 30 patients who received steroid treatment,27 had complete response and 3 had partial response.Of the 27 with complete response,4 patients relapsed during followup and were cured by continuous steroid treatment and extending treatment course,3 patients did not relapse,1 patient relapsed again,and long-term low dose steroid maintenance therapy was needed.The 3 patients with partial response were treated with mycophenolate mofetil for 6,4,4 months and imaging abmormalities disappeaved absolutely.Eleven patients received no steroid for the initial treatment,in whom 2 patients were lost to follow-up,1 patient with common bile duct jejunum anastomosis died in 1 year after surgery.In the other 8 patients,the imaging abnormalities were spontaneous remission or clinical and imaging manifestations were improved after steroid treatment and no recurrence was found.Two patients who underwent pancreatoduodenectomy due to suspicion of pancreatic adenocarcinoma received steroid treatment after operation and no recurrence was observed.Conclusion Clinicians should combine clinical manifestations,serological examination,imaging findings and pathological examination to make definite diagnosis of AIP and make differential diagnosis of pancreatic cancer to avoid unnecessary surgical treatment by misdiagnosis.