Objective： The aim of this study was to investigate the efficacy and toxicity of single agent topotecan(second line) or topotecan＋ cisplatin (first line) in the treatment of the patients with small cell lung cancer (SCLC). Methods： Ninety-seven patients were evaluated efficacy and toxicity in 100 eligible patients in a multiple center clinical trail. Topotecan was administrated as a second line single agent in 38 relapse SCLC patients and the dose of topotecan was 1.25 mg· （ m2· d） -1 for 5 days and repeat every 3 weeks. Topotecan＋ cisplatin regimen was used in the chemonaive SCLC patients and the dose of topotecan was reduced to 1 mg· （ m2· d） -1 for 5 days and the cisplatin was 80 mg· （ m2· d） -1 for one dose. Results： The response rate was 37.5％ as second line chemotherapy in relapse SCLC, including complete response of 3.1％ and the partial response 34.4. The response rate was 79.6％ (complete response,22.4％ and partial response,57.1％ ) when cisplatin was combined with topotecan in the chemonaive SCLC patients. Bone marrow suppression was the main toxicity of topotecan and Grade Ⅲ -Ⅳ neutropenia and thrombopenia was observed in 39.9％ and 31.6％ respectively in single agent regimen and 61.0％ and 39.9％ in combined regimen respectively. The non-hemotological toxicity was mineral. Conclusion： Topotecan may be an effective drugs for the patients with SCLC when used as the first or the second line regimen, and more efficacy when combine with cisplatin. The main toxicity of topotecan is hemotological toxicity.

DRG payment reform is an important means to control the unreasonable growth of medical expenses, improve the quality of medical services and achieve a win-win situation among three sides of hospitals, medical insurance and patients. This study adopted the Smith policy implementation process model to analyze the difficulties in the DRG policy implementation process from four aspects(idealized policies, policy implementation institutions, target groups, and policy environment), including the deviation between policy connotations and actual needs; the interest objectives of all parties were not completely aligned, the target group lacked a sense of identity, and the social impact and technological support needed to be improved. It was suggested that optimization should be carried out from four dimensions: policy supply coordination and precision, performance evaluation and personnel literacy, target group cognitive level and participation willingness, and policy implementation environment and atmosphere, in order to synergistically promote the effective implementation of DRG policies.

OBJECTIVETo investigate the anxiety state in high school students and related factors in order to get reasonable suggestions for prevention.

METHODSThe mental health test (MHT) for high school students, and the living environmental and parental style were used in this study.

RESULTSMHT served as an assessment scale of anxiety. The efficiency sample was 3,050, aged 11 to 18 years old. The level of total anxiety and its each contents was low to moderate (0.24 to 0.54). The percentage of moderate to high of total anxiety was 16.7%, the percentage of moderate to high of each anxiety aspects were 8.8%-21.8%. The mostly high aspects were self-blame, schooling anxiety, social anxiety and over sensitiveness. In general, the girls' anxiety level was higher than boys', but the boys' lonely feeling was higher than the girls'. The total score of anxiety was decreased with age. Except of the over sensitiveness, the decrease tendency of each anxiety contents was significant in boys. For girls, the lonely feeling was deceased and the over sensitiveness increased with age. The age of fifteen seems as a significant changing age. The related disadvantage factors of students' anxiety were: the low education level, the parents' anxiety and depression characters, the authoritarian or neglecting parental style, the often contradiction parental styles between mother and father, parents often quarrel, the experience of often being scalded and physical punishment, lacking in care of others when in difficulties.

CONCLUSIONSThe schooling pressure should be decreased to an appropriate level. The students' self-confidence and social ability should be emphasized. Good family environments and the support outside the family should be quite important for adolescents' mental health, these factors might decrease the adolescents' anxiety.

Adolescent ; Anxiety ; epidemiology ; prevention & control ; psychology ; Child ; China ; epidemiology ; Family Relations ; Female ; Humans ; Interpersonal Relations ; Male ; Students ; psychology ; statistics & numerical data

OBJECTIVETo investigate the differential expression of apoptosis associated gene Bcl-2 and Bax through cell cycle and its possible clinical meaning.

METHODSThe prostate cancer cell line PC-3 was synchronized in M, G1, S and G2 phase using modified thymine deoxyriboside blockage and high pressure N2O technique. The efficiency of synchronization was detected by flow-cytometry. RT-PCR and Western blot methods were used to examine the expression of Bcl-2 and Bax in mRNA and protein level.

RESULTSThe synchronized rate of M, G1, S and G2 phase were 92.1%, 87.0%, 80.2% and 75.9% respectively. Bcl-2 was constitutively expressed through the cell cycle, but both the mRNA and protein expression level of Bcl-2 were very high in the G1 phase, dramatically decreased in M, S and G2 phase. The expression level of Bax had no change through the cell cycle.

CONCLUSIONSCell cycle could influence the expression level of Bcl-2 significantly but not Bax, these might have some clinical relevance.

Cell Cycle ; Cell Line, Tumor ; Gene Expression ; Humans ; Male ; Prostatic Neoplasms ; metabolism ; pathology ; Proto-Oncogene Proteins c-bcl-2 ; biosynthesis ; genetics ; RNA, Messenger ; genetics ; bcl-2-Associated X Protein ; biosynthesis ; genetics

OBJECTIVETo investigate cell apoptosis induced by survivin ASODN and clarify the precise mechanism of anti-apoptotic action of survivin.

METHODSCells of lung cancer cell line NCI-H446 were treated with survivin ASODN at different concentrations. The changes of survivin mRNA and protein expression were assessed by RT-PCR and Western blot assay. The apoptosis index (AI) and proliferation index (PI) were determined by flow cytometry (FCM). After 500 mmol/L survivin ASODN treatment, cells were stained with Rh123 to detect changes of mitochondrial membrane potential (deltapsim) by FCM. The concentration of cytoplasmic cytochrome c (cyt-c) was continuously determined by ELISA. Relative activities of caspase-9 and caspase-3 were assessed by colorimetric assay. The expression of caspase-8 protein was measured by Western blot assay. The apoptotic rates of lung cancer cells induced by survivin ASODN with or without mitochondrial permeability transition pole (MPTP) inhibitor CsA treatment were assessed by FCM.

RESULTSDown-regulated survivin mRNA was shown to be in dose-dependent and time-dependent manners. Its maximal effect was achieved at a concentration of 500 nmol/L for 72 h, at which mRNA was down-regulated by 62.7%, the expression of survivin protein in NCI-H446 cells was also obviously decreased. After treatment with survivin ASODN at concentration of 500 mmol/L for 72 h, AI was 48.35%, higher than that of control, lipofectin, NSODN, survivin ASODN 100 mmol/L and 300 mmol/L groups (3.75%, 3.41%, 4.69%, 19.85% and 34.39%, respectively). PI was 24.38%, lower than that of control, lipofectin, NSODN, survivin ASODN100 and 300 mmol/L groups (75.74%, 73.12%, 71.76%, 51.03% and 38.94%, respectively). Deltapsim was decreased in 9.54% of NCI-H446 cells treated with survivin ASODN for 3 h and 97.06% for 24 h. Following it, release of cyt-c from mitochondria to cytosol and activation of caspase-9 and caspase-3 increased significantly. The above mentioned indicators changed with a time-dependent and time diversity relationship. In the presence of CsA, the apoptotic rate of lung cancer cells induced by survivin ASODN was decreased significantly. No up-regrulation and activation in caspase-8 protein was observed.

CONCLUSIONSurvivin inhibits apoptosis via regulation of mitochondrial-dependent pathway. survivin ASODN can not only induce apoptosis but also inhibit cell proliferation through blocking the expression of survivin mRNA and protein.

Apoptosis ; drug effects ; genetics ; physiology ; Caspase 9 ; metabolism ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cyclosporine ; pharmacology ; Cytochromes c ; metabolism ; Cytosol ; drug effects ; enzymology ; metabolism ; Down-Regulation ; Humans ; Immunosuppressive Agents ; pharmacology ; Inhibitor of Apoptosis Proteins ; Lung Neoplasms ; genetics ; metabolism ; pathology ; Membrane Potential, Mitochondrial ; drug effects ; Microtubule-Associated Proteins ; genetics ; metabolism ; Neoplasm Proteins ; genetics ; metabolism ; Oligodeoxyribonucleotides, Antisense ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Transfection

OBJECTIVESTo investigate the clinical features of femoral neck fractures and analyze related causes.

METHODSThe clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed.

RESULTSA total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites.

CONCLUSIONSThe incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Femoral Neck Fractures ; diagnosis ; diagnostic imaging ; epidemiology ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Young Adult

Objective:To identify the chemical constituents of Platycladi Cacumen before and after being carbonized. Method:Chemical constituents in 3 batches of Platycladi Cacumen and its carbonized products were identified and compared by ultra performance liquid chromatography-quadrupole-time of flight-mass spectrometry （UHPLC-QTOF-MS/MS）. Chromatographic separation was performed on an ACQUITY UPLC BEH C₁₈ column （2.1 mm×100 mm， 1.7 μm） with 0.1% formic acid aqueous solution （A）- acetonitrile （B） as mobile phase for gradient elution （0-3.5 min， 5%-15%B； 3.5-6 min， 15%-30%B； 6-6.5 min， 30%B； 6.5-12 min， 30%-70%B； 12-12.5 min， 70%B； 12.5-18 min， 70%-100%B； 18-22 min， 100%B）. The flow rate was 0.4 mL·min^-1 and the injection volume was 5 μL. Mass spectrometry was performed by an electrospray ionization， and the primary and secondary mass spectrometry data were collected with the full scan mode of positive and negative ions， the peaks containing MS/MS data were identified by self-established secondary mass spectrometry database and corresponding fragmentation law matching method. Result:A total of 77 and 76 substances with the same change trend were identified under positive and negative ion modes. After being carbonized， the disappeared components of Platycladi Cacumen were mainly amino acids， ketone aldehydes and other volatile components. Among newly produced components， there were 6 kinds of flavonoid aglycones （rhamnetin， 6，7，3'-trihydroxyflavone， 3，6，3'-trihydroxyflavone， 4'-hydroxy-2'-methyl-3，4，5-trimethoxychalcone， herbacetin and 3'，5'-dimethoxy-3，5，7，4'-tetrahydroxyflavone）， 3 kinds of coumarins （7-hydroxycoumarin， 7，8-dihydroxycoumarin and 8-acetyl-7-hydroxycoum-arin） and 3 kinds of benzoic acids （3-methylcatechol， pyrocatechol and chromone-3-carboxylic acid）. There were a total of 40 flavonoids （quercitrin， quercetin， kaempferol， etc.） among these identified chemical constituents. Conclusion:There are significant quantitative and qualitative changes in the chemical compositions of Platycladi Cacumen after being carbonized. The flavonoids， the identified main active ingredients， can provide data reference for further study on the material basis of efficacy changes of Platycladi Cacumen before and after being carbonized.

AIM To study the chemical constituents from the ethyl acetate fraction of Baccharis trimera(Less.)DC.METHODS The ethyl acetate fraction of B.trimera was isolated and purified by macroporous resin D101,Sephadex LH-20 gel,silica gel and other chromatographic techniques,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Twenty-three compounds were isolated and identified as 15,16-epoxy-15α-methoxy-ent-clerod-3-en-18-oic acid(1),13-epi-15,16-epoxy-15α-methoxy-ent-clerod-3-en-18-oic acid(2),methyltrineracetal(3),epimethyltrineracetal(4),trinerolide(5),15-epitrinerolide(6),18-methylmalonyl-7α-hydroxy-meth-yltrineracetal(7),18-methylmalonyl-7α-hydroxy-epimethyltriner-acetal(8),18-methylmalonyl-methyltrineracetal(9),18-methylmalonyl-epi-methyltrineracetal(10),methy 3,5-dicaffeoylquinate(11),8-dimetho-xyflavone(12),4',7-dihydroxy-5-methoxyflavanone(13),4-(3',4'-dihydroxycinna-moyl)-oxy-methy-lcinnamate(14),3',7-dihydroxy-4',6,8-trimethoxy-flavone(15),erigeroflavanone(16),nepetin(17),4,2',4',β-tetrahydroxy-6'-methoxy-α,β-dihydrochalcone(18),eugeniyl-O-β-D-glucoside(19),7-hydroxyl-5,6,3',4'-tetramethoxylflavone(20),phomoxanthone J(21),18-acetyl-7α-hydroxy-methyltrineracetal(22),18-acetyl-7α-hydroxy-epimethyltrineracetal(23).CONCLUSION Compounds 3-10 and 22-23 are epimers isolated from this plant for the first time.Compounds 11-16,18-21 are first isolated from genus Baccharis.