Objective To analyze the policy support of rural doctors for the essential medicine system,and explore the main influence factors and mechanism affecting the support degree.Methods 621 rural doctors from five cities in Shandong province were subject to a stratified random sampling for a quantitative questionnaire,to build a hypothesis model of policy support of rural doctors,which is verified using factor analysis and path analysis.Results 59.1% of rural doctors support the essential drugs policy.It was found that the essential medicine factor,the factor to influence the practitioner,and the supporting policy factor had a direct impact on policy support of rural doctors,with the effect of 0.305, 0.1 59 and 0.135 respectively;Essential medicine factor and the supporting policy factor indirectly influence the policy support of rural doctors through the factor to influence practitioners,with the effect of 0.065 and 0.032 respectively.Conclusion The essential medicine system needs to emphasize such rationality as the quality,list and pricing of essential medicines;it is imperative for the government to better oversee the purchase and supply of essential drugs,to cater to the interests of rural doctors,to encourage the enforcement of the system,and promote the development of village clinics.

Objective To explore the electrophysiological properties and the disparity of visual cortical neurons in developing rats. Methods Whole cell patch clamp recording and intracellular labeling of brain slices were performed on rats at postnatal 14 and 28 days. The electrophysiological data were analyzed according to the cellular input resistance and resting membrane potential. Results When the input impedance of visual cortical neurons(IR) was lower, increased peak value of postsynaptic currents(PSCs), prolonged rise and decay time were found. At postnatal 14th day(before eyes opened), the intermediate cells and mature cells were 59.2% and 14.9% respectively, but at postnatal 28th day(14 days after eyes opened), the mature cells and immature cells were 62.5% and 12.5% respectively. Conclusion During the period of postnatal development, the visual cortical neurons become mature gradually, but maturation is not completely correlated with age.

Objective To investigate the clinical efficacy and safety of ultra pulse CO2 laser combined with collagen dressing in treatment of cutaneous amyloidosis.Methods A total of 68 cases of primary cutaneous amyloidosis patients according to the different treatment methods was divided into two groups:the control group (n =33 cases) that was given acitretin capsules oral and topical compound flumetasone ointment packet treatment,and observation group (n =35 cases) with ultra pulse CO2 laser combined with collagen dressing external treatment.Two groups were observed in patients with curative effect and adverse reaction.Results Disease of integral observation group after treatment was significantly lower than the control group(t =3.12,P ＜0.05).The observation group had the efficiency of [88.6％ (31/35)] that was significantly higher than that of control group[17/33(51.5％),x2 =11.23,P ＜.0.01].The observation group had significantly shorter healing time [(5.38 ± 1.81) d] compared to the control group [(10.75 ±2.06)d,t =11.39,P ＜ 0.01].The observation group did not have recurrence,which was significantly different from the control group (x2 =4.90,P ＜ 0.05).Conclusions Ultra pulse CO2 laser combined with collagen dressing in treatment of primary cutaneous amyloidosis is a kind of effective treatment methods with remarkable curative effect and less adverse reactions.It is worthy of clinical application.

Objective To explore the effect of the improved abdominal rotation card method in insulin injection. Methods A total of 100 hospitalized diabetes patients were randomly divided into control group (n=50) and observational group (n=50) according to the random number method. In the control group, insulin was injected to the subcutaneous tissue of abdomen with traditional method annular rotating method. Insulin was injected using improved abdominal rotation card method in the observational group. Compare accuracy and mastery rate of injection site rotation between the two groups. Compare fasting blood glucose (FBG), postprandial 2H blood glucose (PBG), HbA1c, the incidence of hypoglycemia and endermic induration between the two groups after three months. Results The nurses in the observation group had higher accuracy rate of the injection site rotation compared to the control group [98.6%(690/700) vs. 38.6%(270/700),χ2=584.66, P<0.01]. Mastery rate of the injection site rotation for the patients in the observation group were significantly higher than the control group [70.0% (35/50) vs. 20.0% (10/50), χ2=25.74, P < 0.01]. The incidence of endermic induration were significantly lower in observation group compared to the control group [2.0% (1/50) vs.16.0% (8/50), χ2=5.98, P < 0.01]. The incidence of hypoglycemia were significantly lower in observation group compared to the control group [4.0%(2/50) vs. 16.0%(8/50),χ2=4.00, P<0.01]. Conclusions The new abdominal rotation method in insulin injection can be a safe and effective therapy in patients with type 2 diabetes.

Objective To explore the manifestation of pancreatic metastases (PM)using contrast‐enhanced ultrasound (CEUS). Methods Eleven patients with PM confirmed by pathology or CT/MRI combined with clinical data were analyzed retrospectively. The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed. Results The primary malignant tumors included lung cancer(n=6), breast cancer(n=1), renal clear cell carcinoma(n=1), gastric cancer(n=1), rectal cancer(n=1)and leiomyosarcoma of uterus(n=1). Eight patients had one lesion and three were multiple. The maximum lesion diameter was 2. 0-5. 0cm. Eight of the 11 patients showed hypoechoic on conventional US. Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US. In the early stage of CEUS, two patients showed hyper‐enhancement, six showed iso‐enhancement and 3 showed hypo‐enhancement I.n the late stage of CEUS, nine patients (9/11) showed hypo‐enhancement. Seven patients showed homogeneous enhancement S.ix patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS. Conclusions PM showed certain characteristics on CEUS. The hyper‐or iso‐enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.

The M and NP genes of H5N1 avian influenza virus (A/chicken/Hubei/489/2004) were amplified by RT-PCR from viral RNA,and cloned into pMD 18-T vector respectively.The expression plasmid containing the M gene (pHM6-m) or the NP gene (pHM6-np) was then constructed by inserting the M or NP gene into the pHM6 eukaryote expression vector; the constructed plasmid was then sequenced.32 BALB/c mice (6-week-old) were divided into four groups at random.Three groups of BALB/c mice were inoculated one time the intramuscular route with either 30 μg of plasmid pHM6-m,30 μg of plasmid pHM6-np or the mixture of plasmid pHM6-m (15 μg ) and pHM6-np(15 μg) respectively.A additional group of mice were injected with 100 μ1 PBS as controls.Two weeks later,all mice were challenged with homologous H5N1 avian influenza virus,and observed in the following 12 days.The survival rates of mice in the pHM6-m group,the pHM6-np group and mixed plasmids group were 62.5% ,25.0% and 50.0%,respectively.Results showed that effective protection could be provided by either pHM6-m or pHM6-np,but pHM6-m provided a better protective effect than pHM6-np.

Objective To summarize the manifestation of solid pseudopapillary tumor of the pancreas (SPTP) on ultrasound and contrast-enhanced ultrasound (CEUS) and to investigate the diagnostic value of CEUS. Methods The ultrasound and CEUS images of six patients with SPTP confirmed by pathology were reviewed. According to CEUS record,the enhanced and wash-out time,enhanced speed and degree of tumor were analyzed. Results On ultrasound, SPTP presented as solid, well-circumscribed masses, usually heterogeneous in echo texture, and some of them contained macro-calcification. On CEUS, the tumor enhanced simultaneously or slightly late compared with normal pancreatic tissues. The contrast agent washed out quickly in all tumors than in normal pancreatic tissues. The enhanced degrees were equal to or less than that of the normal pancreatic tissues. Some tumors showed capsule and septum enhancement. Conclusions The manifestation of SPTP on CEUS had some features and may be helpful for differentiation diagnosis combine with ultrasound.

Objective To investigate the efficacy and safety of different optimal therapy strategies for hepatits B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients with suboptimal response to peginterferon-α-2a (peg-IFN-α-2a) at 24 weeks.Methods This open-label,single-center and prospective clinical observational study was conducted in Department of Infectious Diseases at Shanghai Changhai Hospital between January 2009 and December 2011.The cases of HBeAg-positive CHB with suboptimal response to peg-IFN-α-2a at week 24 were enrolled.Based on virological markers and patient preference,patients were treated with either peg-IFN-α-2a add-on adefovir dipivoxil (ADV) or switch-to telbivudine (LdT).Hepatitis B virus (HBV) virological and serological data were collected at week 12,24 and 48 after the initiation of optimal therapy.Adverse reactions were also monitored.Therapeutic efficacy was compared between two groups of patients before and after treatment by x2 test.Kruskall Wallis test and Mann-Whitney test were used for analysis of continuous variables.Results Among 193 HBeAg positive CHB patients treated with interferon,67 had suboptimal response and were enrolled.Forty five cases received peg IFN-α-2a add-on ADV treatment and 22 cases received switch-to LdT treatment.After 48 weeks of optimized therapy,the total tBeAg seroconversion rate was 25.3 ％.The rates of HBeAg loss,HBV DNA negative and alanine aminotransferase normalization were 26.8％,73.1％ and 83.5％,respectively.The peg-IFN-α-2a switch-to LdT strategy had better HBV DNA inhibition efficiency compared with the peg-IFN-α-2a add-on ADV strategy at week 12,24 and 48 (P=0.00,0.00 and 0.01,respectively).However,there was no significant difference of HBV DNA negative rate between two groups at week 48 (x2 =0.01,P=0.89).The obviously intolerable adverse reaction was not reported in two optimized strategy groups.Conclusions The 48-week optimized treatment for HBeAg positive CHB with suboptimal response to peg-IFN-α-2a at week 24 could achieve a higher HBeAg seroconversion rate.The switch-to LdT strategy may have better HBV DNA inhibition efficiency.Both strategies show satisfactory safety and tolerance.

Objective The purpose of the study was to investigate the changes and clinical significance of matrix metalloproteinase (MMP)-1,MMP-3,tissue inhibitor of metalloproteinase (TIMP),interleukin (IL)-1,tumor necrosis factor (TNF)-α and transforming growth factor(TGF)-β in juvenile idiopathic arthritis (JIA).Methods Thirty-two JIA subjects and 28 controls (traumatic arthritis patients) were included into this study.The MMP-1,MMP-3,TIMP,IL-1,TNF-α and TGF-β level in the serum and synovia were assessed by ELISA.The WBC count,the level of CRP,ESR,RF were also detected.Independent t-test and Pearson's analysis were adopted for data analysis.Results ① The level of MMP-1,MMP-3,IL-1 and TNF-α in the serum was (158±67) ng/ml,(212±89) ng/ml,(39±19) pg/ml,(26±10) pg/ml respectively,which was significantly higher than that of the control group (all P＜0.05) ; the ratio of MMP-3/TIMP-1 (0.86±0.32) was higher in the study group than that of the control group (P＜0.05),while the value of TIMP-1,TGF-β was (248±88),(17±9) ng/ml respectively,which was lower than that of the control group (P＜0.05).The value of seral MMP-3,MMP-3/TIMP-1 was positively correlated with that of WBC,CRP,ESR in the JIA group (all P＜0.05).② The value of MMP-1,MMP-3,IL-1 and TNF-α in the synovia was (216±78) ng/nl,(766±291)ng/ml,(56±21) pg/ml,(36±14) pg/ml respectively,which was higher than that of the control group (all P＜0.05); the ratio of MMP-3/TlMP-1 (2.68±0.89) was higher than that of the control group (P＜0.05),while the value of TIMP-1,TGF-β was (286±88) ng/ml,(12±4) ng/ml respectively,which was lower than that of the control group (all P＜0.05).③ The value of MMP-1,MMP-3,TIMP-1,IL-1 and TNF-α in the synovia was higher than that in the serum (all P＜0.05),while the value of TGF-β was lower than that in the serum (P＜0.05).Conclusion The value of MMP-1,MMP-3,IL-1 and TNF-α increases both in the serum and synovia,while the value of TIMP-1 decreases.The value of TGF-β decreases,which may have protective effect on JIA.The ratio of MMP-3/TIMP-1 in the serum is positively correlated to inflammation parameters,which may be used to judge the activity of illness in JIA.

OBJECTIVE: To study the protective efffects of Chailing Guiqi Decoction (CLGQD) combined with lumbrukinase on renal function in rats with adriamycin nephropathy. METHODS: Thirty-six SD rats were randomly divided into four groups: normal control group, untreated group, simvastatin-treated group and CLGQD -treated group. Adriamycin nephropathy was induced by intravenous injection with 5 mg/kg adriamycin. After seven-day treatment, quantitative measurement of 24-h urine protein was determined with trichloroacetic acid, and serum total protein (TP), albumin (Alb), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), creatinine (Cr) and blood urea nitrogen (BUN) were assessed using automatic biochemistry analyzer. The pathomorphological changes of renal tissues were observed with light and electron microscopes. RESULTS: In the untreated group, the 24-h urine protein excretion, serum TC, TG, LDL, Cr and BUN were significantly higher than those in the normal control group (P<0.05 or P<0.01), while the serum TP, Alb, HDL were significantly lower than those in the normal control group (P<0.01). In the CLGQD-treated group, the 24-h urine protein excretion, serum TC, TG, LDL, Cr and BUN were significantly lower as compared with those in the untreated group (P<0.05 or P<0.01), while the serum TP, Alb and HDL were significantly higher as compared with those in the untreated group (P<0.05 or P<0.01). The pathomorphological findings of the renal tissues under the light microscope in the untreated group showed focal segmental glomerulosclerosis in a few of glomerulus, degenerated and swelled proximal tubular epithelial cells, proteins in cast formation in some renal tubules and scattered fibrosis in interstitial tissues of the kidney, while the electron microscope images showed the fusion of foot processes in glomerular epithelial cells. The pathomorphological changes in the CLGQD-treated group were slighter than those in the untreated group. CONCLUSION: CLGQD combined with lumbrukinase can reduce proteinuria, regulate lipid metabolism, protect renal function, and delay progressive renal damage in rats.