uate and should be standardized.

Objective To evaluate effectiveness of prevention and treatment for patients with chronic obstructive pulmonary disease (COPD) for one year at community health-care service (CHS)centers. Methods A quasi-experiment design was used to evaluate effectiveness of community management for patients with COPD who visited and registered at Xiaokunshan and Xinbang CHS centers in Songjiang district of Shanghai in 2008, with COPD patients from Xiaokunshan community CHS center as management group and those from Xinbang as control. Measures for community management included training for local general practitioners in essential knowledge of COPD prevention and treatment, allocation of necessary drugs for COPD treatment, and health education for COPD patients and their family members. No special measures were taken for control group except routine treatment. Results A total of 132 patients were diagnosed as COPD according to their pulmonary function on 2008, 61 at Xiaokunshan and 71 at Xinbang CHS canters.One hundred and two patients, 47 at Xiaokunshan and 55 at Xinbang, finished one-year follow-up. Five patients from Xiaokunshan who were smokers at their first visits and three of them quitted smoking after oneyear management. Meanwhile, none of nine smoked patients from Xinbang quitted smoking in the same period. There was no statistically significant difference in symptom scores, pulmonary function, and forced expiratory volume at the first second (FEV1) between patients in the two groups during one-year follow-up.Average score of quality of life in patients at Xiaokunshan dropped to 39. 12 after one-year management from 46. 96 at their first visits, and that in patients at Xinbang increased to 62. 11 from 56. 55 (P＜0.01).Average six-minute walking distance (6-MWD) in patients at Xiaokunshan reduced to 354. 26 meters after one-year management from 361.66 meters at their first visits, meanwhile that in patients at Xinbang reduced to 351.18 meters from 398.07 meters (P =0. 008). Scores of functional dyspnea in patients at Xiaokunshan fell to 0.34 from 0.40 at their first visit, meanwhile that in patients at Xinbang increased to 1.00 from 0.95(P =0.038). During the one-year follow-up, 13 patients at Xiaokunshan and 53 at Xinbang visited emergency departments for treatment, and four at Xiaokunshan were hospitalized and none died, and five at Xinbang were hospitalized due to acute exacerbation of COPD and four of them died. Conclusions The study suggests that strengthening prevention and treatment for COPD patients at community level by general practitioners, patients themselves and their family members can improve their quality of life, reduce emergency visits and hospitalization, alleviate dyspnea symptoms and delay the decline of 6MWD.

Objective To observe the clinical effect of etomidate combined with propofol on laparoscopic cholecystectomy.Methods Eight patients undergoing laparoscopic cholecystectomy cho sen from March 2015 to April 2016 in our hospital,falling into ASA Ⅰ or Ⅱ grades,randomly divided into four groups,20 in each.Group A was administered of propofol (2 mg/kg);group B etomidate (0.3 mg/kg);group C etomidate (0.15 mg/kg) combined with propofol (1 mg/kg);group D etomidate (0.1 mg/kg) combined with propofol (1.5 mg/kg).Systolic blood pressure,diastolic blood pressure and heart rate of the four group were compared at the following six time points:before anesthesia induction(T0),1 min before intubation (T1),the intubation moment (T2),1 min after intubation (T3),5 min after intubation (T4),15 min after intubation (T5).The serum of four groups were collected at the time before anesthesia induction (T0),30 min after anesthesia induction (Tb),2 h after induction of anesthesia (Tc) and 24 h after anesthesia induction(Td).Aldosterone,cortisol and adrenocorticotropic hormone in serum were tested by radioimmunoassay.The incidence of adverse reactions such as injection pain and myoclonus during induction,and postoperative nausea and vomiting of the four groups were recorded and compared.Results Compared with T0,HR,SBP at T1,T4 and T5 were significantly decreased in group A (P＜0.05).SBP at T2 were significantly increased in group B (P＜0.05),and SBP at T1 and T5 were significantly decreased in group C (P＜0.05).There was no significant difference of HR at T1,T2,T3,T4 and T5 in group B and C.Compared with T0,HR,SBP at T1,and T5 were significantly decreased in group D (P＜0.05).There was no significant difference in hemodynamics among the four groups.Compared with T0,the levels of Cor and ALD at Tb and Tc were decreased in group B and C (P＜0.05).And the level of ACTH of B and C in Tc were significantly increased (P＜0.05).Compared with group A,the levels of Cor and ALD of group B and C were significantly decreased at Tb and Tc (P＜0.05).Compared with group B,the levels of Cor and ALD of group C and D showed less decrease at Tb and Tc (P＜0.05).And compared with group C,the levels of Cor and ALD of group D showed less decrease at Tb and Tc (P＜0.05).Conclusion Etomidate combined with propofol induced can reduce the side effects induced by propofol or etomidate alone,which is an ideal way of anesthesia induction.

Purpose To explore the feasibility of dual source CT virtual unenhanced replacing conventional plain scan in parotid gland mass examination.Materials and Methods Thirty-five parotid gland mass (38 focus) confirmed through dual source CT and surgical operative pathology in the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed,including 13 pleomorphic adenoma parotid,14 adenolymphoma (17 focus),5 malignant tumor and 3 inflammatory lesions.All patients received conventional plain scan and dual energy enhanced scan.Liver virtual unenhanced software was adopted to obtain virtual unenhanced image in arterial phase and concordance of parotid gland mass displayed on conventional plain scan and virtual unenhanced images was compared.Normal parotid tissue,focal area,salivary gland,thoracic paraspinal muscle,average CT value of lower jawbone,signal noise ratio noise ratio (SNR),contrast noise ratio noise ratio (CNR),image quality score,radiation dose and effective dose (ED) for conventional plain and virtual unenhanced were compared.Results Subjective image quality score for conventional plain scan and virtual unenhanced was 4.34 ± 0.80 and 4.17 ± 0.82,respectively;and difference between the two was of no statistical significance (P＞0.05).Average CT value difference of angulus mandibulae thoracic paraspinal muscle,submandibular gland and normal parotid for 35 patients with parotid space-occupying lesions with conventional plain scan and virtual plain scan was of no statistical difference (P＞0.05).The average CT value of conventional plain scan parotid mass and mandible compared with the virtual plain scan,the difference was statistically significant (P＜0.05).SNR difference for parotid gland mass was of statistical significance (P＜0.05).Difference of CNR between the two groups was of no statistical significance (P＞0.05).ED of virtual plain scan was lower than that of conventional plain scan and the difference was of statistical significance (P＜0.05).The reduced radiation dose was about 38.6％.Conclusion Conventional plain scan and virtual unenhanced are of highly concordance in examination and diagnosis of parotid gland mass and radiation dose for virtual unenhanced is less.

Autophagy is an intracellular degradation process that maintains cellular homeostasis. It is essential for protecting organisms from environmental stress. Autophagy can help the host to eliminate invading pathogens, including bacteria, viruses, fungi, and parasites. However, pathogens have evolved multiple strategies to interfere with autophagic signaling pathways or inhibit the fusion of autophagosomes with lysosomes to form autolysosomes. Moreover, host cell matrix degradation by different types of autophagy can be used for the proliferation and reproduction of pathogens. Thus, determining the roles and mechanisms of autophagy during pathogen infections will promote understanding of the mechanisms of pathogen‍‒‍host interactions and provide new strategies for the treatment of infectious diseases.
Autophagy ; Bacteria ; Host-Pathogen Interactions ; Lysosomes ; Signal Transduction