Objective To investigate hospital staffs' appraisals on public hospitals reform.Methods 890 medical staffs were randomly investigated by questionnaire,to learn their comments on the implementation of reform measures,public-benefit nature and reform outcomes of the reform,as well as problems found with the government and improvement suggestions,and difficulties encountered in such a reform.Results The hospital staffs' appraisals on the reform tend to be low,as 36.4％ of them hold that the reform is less effective in its outcomes or a mere formality (19.8％).The staff blamed the lack of system breakthrough (67.9％),lack of financial support (61.1％),and insufficient support from the doctors as stakeholders (49.1 ％),for most of the problems of the reform.Conclusion It is suggested to win over support of the medical staff for the reform; to improve the laws and policies related to the reform; and to establish an effective supervision system for public hospitals.

Objective To explore the short?term functional outcomes of the reconstruction of the proximal humerus by re?verse shoulder arthroplasty after tumor rescetion. Methods 8 patients who underwent reverse shoulder arthroplasty after tumor resection between January 2013 and December 2014. 5 were female and 3 were male, mean aged was 38 years old (25-61). 2 chon?drosarcomas and 6 giant cell tumors. Enneking stageing of 2 cases with chondrosarcoma were stageⅠB and stageⅡB. 6 giant cell tumors were Campanacci stage 3, meanwhile 3 cases had pathological fractures. The deltoid and axillary nerve were intact in all patients by image analysis before the operation. The proximal humerus was resected according to Malawer typeⅠresection. Then reverse shoulder arthroplasty reconstruction and bone graft was performed. The follow?up was scheduled, and the patient received X?ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant?Murley score and musculoskel?etal tumor society(MSTS) score was recorded. Results The mean duration of the operation was 2.7 h (2-3.5 h). The bleeding in the operation was 510 ml (300-850 ml). The mean length of humerus resection was 8 cm (6-10 cm). The allografts were used in 7 cases and reimplantation after tumor bone deactivation was used in one. The latissimus dorsi transfer were performed in 2 cases. The rotator cuff were resected 1-1.5 cm from the great and lesser tubercles. The follow?up was 13 months (3-26 months). No infec?tion, dislocation, or loosening of prosthesis was found by the last follow?up. The X?ray showed the case who received reimplanta?tion after tumor bone deactivation had achieved bone union 1 year postoperation,7 cases received allograft had still nonunion at the host?graft junction. Bone resorption were found in all cases in different extent but the prosthesis were stable. No local recur?rence of the tumor was found. At last follow?up, active abduction was 155° (100°-175° ) and active forward elevation was 150° (115°-170°) and Constant?Murley score was 76%(68%-87%). The MSTS score was 92%(87%-97%). Conclusion The func?tional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor rescetion was satisfied in early period. The reverse shoulder arthroplasty can be used in younger patient, but long?term results need further study.

Objective To measure the expression of La-related protein 1 (LARP1) in gastric carcinoma and investigate its relationship with the biologic behavior of gastric carcinoma.Methods Expression of LARP1 protein in 30 gastric carcinoma tissues and para-carcinoma tissues and 30 normal gastric specimens was detected by immunohistochemistry.Results The mean density of LARP1 expression in gastric carcinoma (0.19-± 0.13) was significantly higher than that in adjacent tissues (0.07 ± 0.12) and normal tissue (0.01 ± 0.03) (P ＜ 0.01).Along with the increasing of TNM stage,LARP1 in gastric carcinoma tissue expression was significantly increased (stage Ⅰ vs.Ⅱ vs.Ⅲ + Ⅳ =0.06 ± 0.07 vs.0.20 ± 0.12 vs.0.30 ± 0.08,P =0.001) and lymph node metastasis in patients with LARP1 expression levels than those without lymph node metastasis (0.22 ± 0.12 vs.0.11 ± 0.14,P =0.038).The amount of expression in poorly differentiated carcinoma LARP1 is significantly higher than that in high grade carcinoma (0.24 ± 0.12 vs.0.12 ± 0.12,P =0.022),but has no correlation with age or gender of patient.It has no correlation with the size and location of tumor.Conclusions LARP1 is overexpres sed in gastric carcinoma and para-carcinoma tissues.It is significantly related to the malignant biological behavior of gastric cancer and may play an important role in the carcinogenesis and development of gastric carcinoma.

The objective of the study is to find out the effect of shark chondroitin on T lymphocyte subsets in cancer patients. Patients were divided into two groups. One group was treated with chemotherapy alone, and the other group was treated with chemotherapy plus shark chondroitin. Using immunofluorescence technique, T lymphocyte subsets in the peripheral blood were determined in two groups before and after chemotherapy. The results showed that CD4(+)/CD8(+) ratio increased in the patients received shark chondroitin. In the chemotherapy group, CD3(+) had no change, but CD4(+) decreased while CD8(+) increased significantly. The results suggest that shark chondroitin could enhance immune function in cancer patients, especially during chemotherapy.

OBJECTIVETo investigate the effect of Nutrition MCT and Nutrition MF enteral nutrition on nutritional status of patients after major abdominal operation.

METHODSIn a double- blinded and randomized cross- cover study, Nutrition MCT and Nutrition MF enteral nutrition were fed in patients when the gut function restored after operation. The total calorie was 104.6 kJ(25 kcal) x kg(-1) x d(-1) and the period of full dose of enteral nutrition was 5 days. The blood samples were collected before operation,before enteral nutrition and the sixth day after full dose of enteral nutrition for the measurement of pre- albumin, total protein,albumin, transferrin and triglyceride. The urine, stool and drainage fluid were collected to analyze nitrogen balance.

RESULTSThe plasma protein and fat were obviously dropped in patients after abdominal operation and improved after the enteral nutrition support in two groups. However, the pre- albumin level increased more in patients of Nutrition MCT than Nutrition MF.

CONCLUSIONNutrition MCT can obviously improve the nutritional status of patients after major abdominal operation.

Abdomen ; surgery ; Adult ; Aged ; Cross-Over Studies ; Double-Blind Method ; Enteral Nutrition ; methods ; Female ; Humans ; Male ; Middle Aged ; Nutritional Status ; Proteins ; therapeutic use ; Triglycerides ; therapeutic use

The essence of endogenous turbidity in Chinese medicine (CM) is different from cream, fat, phlegm, retention, damp, toxicity, and stasis. Along with the development of modern scientific technologies and biology, researches on the essence of endogenous turbidity should keep pace with the time. Its material bases should be defined and new connotation endowed at the microscopic level. The essence of turbidity lies in abnormal functions of zang-fu organs. Sugar, fat, protein, and other nutrient substances cannot be properly decomposed, but into semi-finished products or intermediate metabolites. They are inactive and cannot participate in normal material syntheses and decomposition. They cannot be transformed to energy metabolism, but also cannot be synthesized as executive functioning of active proteins. If they cannot be degraded by autophagy-lysosome or ubiquitin-prosome into glucose, fatty acids, amino acids, and other basic nutrients to be used again, they will accumulate inside the human body and become endogenous turbidity. Therefore, endogenous turbidity is different from final metabolites such as urea, carbon dioxide, etc., which can transform vital qi. How to improve the function of zang-fu organs, enhance its degradation by autophagy-lysosome or ubiquitin-prosome is of great significance in normal operating of zang-fu organs and preventing the emergence and progress of related diseases.
Autophagy ; Humans ; Medicine, Chinese Traditional ; Proteasome Endopeptidase Complex

OBJECTIVETo explore the gene polymorphisms of ApoAI-75 Msp1, ApoB Msp1, ApoCIII Sst1, LRP5, and ApoE genotypes in two pairs of semi different modes of hepatitis B for HBV markers.

METHODSThe patients are divided into 9 groups. There were a total of 720 cases, 80 patients in each group, The patients was carried out by SnaPshot method (single-base multilocus micro-sequencing), and different genotypes of each locus were conducted by the method of sequencing in order to support the final evidence of the accuracy of test results.

RESULTSThere was association between gene polymorphisms of ApoAI-75Msp1 and ApoE and different modes of two pairs of semi-hepatitis B (P < 0.05), while there wasn't any association between gene polymorphisms of ApoB-Msp1, ApoCIII-Sst1, LRP5 and different modes of two pairs of semi-hepatitis B (P > 0.05).

CONCLUSIONThe gene polymorphism of ApoAI-75Msp1 and ApoE was associated with the different modes of HBV markers.

Apolipoprotein A-I ; genetics ; Apolipoprotein C-III ; genetics ; Apolipoproteins ; genetics ; Apolipoproteins B ; genetics ; China ; Genotype ; Hepatitis B ; genetics ; Humans ; Polymorphism, Genetic

AIMTo establish a method to determine the isotope ratios of 13C to 12C of dehydroepiandrosterone and its metabolites in urine, for detecting the source of dehydroepiandrosterone or its metabolites.

METHODSPreliminary separation of endogenous anabolic androgenic steroids could be achieved using solid phase extraction, enzymolysis and thin layer chromatography. The source of dehydroepiandrosterone and other endogenous anabolic androgenic steroids could be detected by their delta values with gas chromat ography-combustion-isotope ratio mass spectrometry.

RESULTSThe 5 values of some metabolites of dehydroepiandrosterone reduced after the administration of dehydroepiandrosterone preparation. In these cases the data indicated that exogenous anabolic androgenic steroids were administrated.

CONCLUSIONThe source of dehydroepiandrosterone or its metabolites in urine could be detected by measuring their delta values with this method.

Adult ; Androstane-3,17-diol ; urine ; Androsterone ; urine ; Chromatography, Thin Layer ; methods ; Dehydroepiandrosterone ; metabolism ; Doping in Sports ; Etiocholanolone ; urine ; Female ; Gas Chromatography-Mass Spectrometry ; methods ; Humans ; Male ; Pregnanetriol ; urine ; Substance Abuse Detection ; methods

Objective To explore the personalized treatment options and clinical results obtained by our hospital for different parts of bone destruction of different degrees of bone giant cell tumor.Methods Retrospective analysis from January 2005 to December 2014,according to the giant bone cell tumor diagnosis and treatment procedures used in thehospital to take wide resection or intralesional curettage and adjuvant therapy for the treatment of primary limb long bone giant cell tumor 281 cases.There were 150 males and 131 females,with overall age from 14 to 71 years and an average of 35.10 yearsold.The distal ulna was 9 cases.The distal radiuswas 26 cases.The proximal humerus was 19 cases.The distal humerus was 2 cases.The proximal femur was 38 cases.The distal femur was 95 cases.The proximal tibiawas 59 cases.The distal tibiawas 10 cases.There were 19 proximal fibula cases,3 distal fibula cases and 1 case of multiple giant cell tumor of bone.We chose curettage and/or adjuvant therapy or wide resection,then with bone cement,allograft or autograft,prostheses to reconstructionaccording to tumor site,the degree of destruction,pathological fractures.The x2 test and Cox regression analysis were used to detect the statistic differences.The KaplanMeier survival analysis was used to count the disease-free survival.The relationship between tumor location,destruction degree,Campanacci grading,pathological fractures,treatment methods at different stages and recurrence were analyzed.Results A total of 281 patients with long bone giant cell tumor were included in the follow-up study,including 37 pathological fracture and 244 non-fracture.According to the author's giant cell tumor diagnosis and treatment process,122 patients received a wide resection,159 cases were treated with curettage ± adjuvant therapy.23 patients had postoperative recurrence,the recurrence rate was 8.19％.The recurrence time after operation ranged from 9 to 75 months (average 30.95 months).There was no significant difference between the recurrence rate of lesions around the knee and other parts (x2=0.370,P=0.240).In the non-pathologic fracture group,the recurrence rate was significantly lower in the large section compared with curettage surgery (x2=9.393,P=0.002).Of the patients with intralesional surgery,126 patients reconstructed with cement and 28 patients reconstructed with autograft/allograft bone to rebuild mechanical stability.There were 14 recurrence cases (14/126,11.11％) in the bone cement group and 8 recurrence cases (8/28,28.57％) in the bone graft group.The recurrence rate in the bone cement group was significantly lower than that in the simple bone graft group (x2=5.846,P=0.017).The patients with lesion less than 50％,4 had recurrences (4/55,7.27％),12 recurrences occurred (12/76,15.79％) in more than 50％ and less than 75％ of the cross-sections,and if the lesion was more than 75％ cross-sectional area,4 cases of recurrence (4/113,3.54％).There was no significant difference in the proportion of bone destruction between different cross-sections in affecting tumor recurrence.The recurrence rate of Campanacci Grade Ⅲ patients was significantly higher than that of Campanacci Grade Ⅱ patients with curettage surgery (x2=9.909,P=0.002).Only 1 of the patients with pathological fracture had recurrence (1/37,2.70％),the recurrence rate was significantly lower than that the curettage group (x2=11.972,P=0.001).Among the early patients,79 cases (63.71％) were cured by surgery and 17 cases were relapsed,while in the last 5 years 80 cases (50.96％) were cured by surgery and 6 cases were relapsed,In two different periods,the curettage recurrence rate was significantly decreased (x2=9.246,P=0.003).Conclusion By selecting personalized treatment options for different patients,it is possible to increase the proportion of patients who maintain their knee joints while reducing the local recurrence rate,providing doctors and patients with a choice of treatment options.

Objective To evaluate the local recurrence rate,limb function and complications of soft tissue sarcoma of thigh after muscle group resection.Methods Between January 2009 and August 2016,twenty-threepatients who were diagnosed as soft tissue sarcoma for the first time in our hospital,receiving thigh quadriceps muscle group resection,adductor muscle group resection or posterior compartment of the thigh resection were incorporated into this study.Patients who had received surgery of this lesion before,suffered from recurrent soft tissue tumor,had tumor involved multiple muscle groups which could not be resected completely,had sciatic nerve or femoral artery or vein affected by tumor or had distal metastasis were excluded.This retrospective study consisted of 12 male and 11 female.The age ranged from 20-80 with the average of 52.All the patients received CT and MRI of thigh to figure out the size of tumor,the invaded extension of the lesion and the specific muscle group involved.Chest CT scan and ultrasound of bilateral inguinal lymph nodes were arranged to exclude the tumor metastases.After all these examinations were done,needle biopsy with the guidance of CT scan was performed for the pathological diagnosis.The pathology included undifferentiated pleomorphic sarcoma (7 cases),rhabdomyosarcoma (2 cases),primitive neurotodermal tumor (1 case),synovial sarcoma (1 case),leiomyosarcoma (3 cases),fibrosarcoma (5 cases) and liposarcoma (4 cases).Sixpatients received quadriceps muscle group resection,eightpatients received adductor muscle group resection and the other 9 patients received posterior compartment of the thigh resection.Patients with undifferentiated pleomorphic sarcoma,leiomyosarcoma,primitive neurotodermal tumor and synovial sarcoma received postoperative adjuvant chemotherapy.None of patients received radiotherapy.After surgery,drainage tube of negative pressure was placed until the volume of drainage was less than 50 ml within 24 h.The affected thigh was bound up tightly.Intravenous antibiotics were used for 3 days to prevent from postoperative infections.Patients received quadriceps muscle group resection stayed in the bed for 4 weeks.After that they could walk with the protection of orthosis with unbending position.Other patients got out of bed after 2 weeks.All the complications after surgery were recorded.Reexaminations were arranged in 3,6,12 and 24 months after surgery separately.After that,reexamination was arranged every half a year.Chest CT scan was used to detect lung metastasis and ultrasound or MRI was arranged for local recurrence.Lower limb function after surgery was evaluated by MSTS scores.Results All the surgeries of muscle group excision were successfully completed.The duration of surgery ranged 1.5-3.5 h with the average of 2.2 h.The bleeding volume during surgery ranged 100-1 100 mL with the average of 313 mL.The follow-up was a mean of 41 months (range,17-108 months).None was lost to follow-up.The local recurrence rate was 4.3％ (1/23).One patient with undifferentiated pleomorphic sarcoma had positive surgical margin,who received posterior compartment of the thigh resection.Local recurrence occurred 6 months after surgery.Then he received expanded resection.Six patients had distant metastases,five patients for lung metastases,one patient for lung and inguinal lymph node metastases.Of these,five patients had died and one lived with the metastasis.The median MSTS score was 26.3 points (range,14-30 points).Specifically,the median musculoskeletal tumor society (MSTS) score was 28 points (range,21-30 points) for 9 patients with posterior compartment of the thigh resection,twenty-nine points (range,27-30 points) for 8 patients with adductor muscle group resection,and 20.3 points (range,14-24 points) for 6 patients with quadriceps muscle group resection.Five patients had complications,including local recurrence (1 case),hematoma (2 cases) and cutaneous necrosis (2 cases),all of which were settled by reoperation.The rate of complication was 21.7％.Conclusion Muscle group resection is an effective surgical treatment for soft tissue sarcoma of thigh,which could reduce the risk of local recurrence,apart from quadriceps muscle group resection,the other two muscle group resections have limited impact on lower limb function,additionally,thigh muscle group resection is a safe procedure with few complications.