Objective: To assess the trend of early beta receptor blocker (β-blocker) application (with 24h of admission) for acute myocardial infarction (AMI) patients in western rural China from 2001 to 2011. Methods: A 2-stage random sampling design was performed. The 1st stage: a simple random sampling was used to identify participating hospitals and the 2nd stage: a systematic random sampling approach was conducted in 3 specific years of 2001, 2006 and 2011 to take case study for central medical information abstraction. The changing trends and impact factors of early β-blocker application for AMI patients in western rural area were assessed by multivariate model analysis. Results: 35 hospitals were sampled and 33 of them were finally participated. With necessary exclusion, a total of 486 AMI patients without β-blocker contraindication were enrolled for 2 groups: Suitable group, the patients were suitable for early β-blocker application, n=247 and High risk group, the patients with the high risk for shock occurrence, n=239. The application rates for β-blocker within 24h of admission at 2001, 2006 and 2011 in Suitable group were 19.06%, 54.30% and 56.20%, Ptrend=0.0020; in High risk group were 31.53%, 59.49% and 69.62%, Ptrend=0.0001. In Suitable group, the patients with history of hypertension (OR=1.87, 95% CI 1.06-3.29), smoking (OR=1.97, 95% CI 1.11-3.48) or admitted in 2006 (OR=2.93, 95% CI 1.22-7.03) and 2011(OR=4.67, 95% CI 2.06-10.59) had the higher chance to use β-blocker within 24h of admission. Conclusion: Application of β-blocker within 24h of admission in AMI patients presented the increasing trend in western rural China from 2001 to 2011, while there was still difference from the guideline recommendation. Improved normative application of β-blocker is helpful to enhance the quality of care and prognosis in AMI patients.

Objective: To assess trends of β-blocker use within 24h of admission in ideal candidates with acute myocardial infarction (AMI) in eastern urban China from 2001 to 2011. Method: A 2-stage random sampling design was performed. In the first stage, a simple random-sampling was used to identify participating hospitals. In the second stage, a systematic sampling was conducted in 2001, 2006 and 2011 to select cases from the participating hospitals. Data was obtained by central medical record abstraction. 10-year trend and predictors of early β-blocker application were assessed with weighted calculation for each year to represent the overall situation of eastern urban China. Results: 35 hospitals were sampled and 32 of them were finally participated. With necessary exclusion, 1399 ideal candidates were included in this analysis. The early weighted β-blocker application rates in 2001, 2006 and 2011 were 64.7%, 69.7%, and 60.9% respectively, P=0.0447 for trend. Patients with chest pain at admission (OR=2.22, 95% CI 1.19-4.13), higher systolic blood pressure (OR=1.40, 95% CI 1.11-1.77) or faster heart rate (OR=2.01, 95% CI 1.58-2.55) were more likely to use β-blocker; in contrast, compared with NSTEMI patients, STEMI patients seemed less likely to receive such treatment (OR=0.55, 95% CI 0.37-0.81). Conclusion: The early β-blocker therapy in eastern urban China is suboptimal for ideal AMI patients who could benefit from it. The application pattern has not been changed from 2001 to 2011 which might be related to physicians' misunderstanding of relevant evidence or guidelines. Our study may help to create an important target to improve the quality of AMI care.

Objective:To assess capacity of cardiovascular disease diagnosis and treatment service in primary health care (PHC) in Beijing-Tianjin-Hebei region.Methods:From September to December 2016, document acquisition and abstraction and in-person interviews were conducted on 327 PHC institutions and their medical staff from 43 districts/counties in the Beijing-Tianjin-Hebei region to comprehensively assess their infrastructure and services, human resources, health information system and drug availability related to cardiovascular disease diagnosis and treatment.Results:⑴ Infrastructure and services: 30.0% Community Health Center (CHC) and 100.0% Township healthcare center (THC) provided inpatient services, 20.5%, 98.1% village clinic (VC) could not provide blood glucose tests and lipid tests, respectively; ⑵ Human resources: in CHC, THC or CHS, 19.6% doctors' educational levels were below the requirement for a licensed assistant doctor, and in VC, 32.4% doctors' educational levels were below the requirement for village doctors. 56.3%CHC、THC and CHS, 99.5% VC could not provide government-funded " four insurances and one allowance" for non-registered staff, and 30.0% village doctors had exceeded 60 years old; ⑶ Health information system: 40.0% CHC, 41.7% THC, and 0 VC had electronic medical record (EMR), respectively; ⑷ Drug availability: 71.9% PHC institutions stored all four types of antihypertensive drugs [angiotensin-converting enzyme inhibitors/angiotensin receptor blockors (ACEIs/ARBs), β-blockers, calcium channel blockers (CCBS), diuretics], and 2.1% did not have any.Conclusions:The capacity of cardiovascular disease diagnosis and treatment services in PHC institutions in Beijing-Tianjin-Hebei region are fair in general, but efforts should still be made to enhance the infrastructure construction, improve the remuneration packages of PHC doctors, promote the comprehensive ability of PHC doctors, optimize the layout of urban and rural health resources, strengthen the information construction, and improve the joint development of medical system in the three cities and provinces.

Objective To investigate the effect of genistein on Notch-1, SHH and HHIP gene expression and on the cell cycle and proliferation of of BxPC3 cells. Methods Human pancreatic cancer cell line BxPC3 was cultured. The BxPC3 cells were treated with genistein and then the total RNA and protein were extracted. RT-PCR was used to detect the expression of Notch-1 mRNA, SHH mRNA and HHIP mRNA. Noteh-1 and SHH protein was determined by western blotting. MTT assay was used to detect proliferation of BxPC3 cells. The cell cycle of BxPC3 cells was measured by Propidium iodide (PI) and flow cytometry. Results The inhibiting rate was 67.17%±2.32% when BxPC3 cell lines were treated by 20μg/ml genistein for 48 hours. Notch-1 mRNA was down-regulated from 2.454±0.068 to 1.304±O.169 ; SHH mRNA was down-regulated from 0.959±0.023 to O.472±0.077 ; HHIP mRNA was up-regulated from 0.625±O.158 to 1.761±0.121. Notch-1 protein expression was down-regulated from 1.361±0.109 to 0.760±0.114; SHH protein expression was down-regulated from 0.265±0.018 to 0.129±0.013. (52.77±9.47)% cells were hindered in G2/M stage. Conclusions Genistein could down-regulate Notch-1 expression and inactivate Hedgehog signaling pathway and inhibit the proliferation of pancreatic cancer cells.

Objective To investigate the common risk factors of primary hepatocellular cancer (PHC) in Guizhou province . Methods The group case-control study was adopted .The main related-factors of primary PHC in Guizhou provincial population and the relation between drinking combined hepatitis B viral infection with the PHC occurrence were analyzed by the unconditional Logistic regression analysis and the stratification analysis .Results Drinking(OR=2 .948 ,95% CI 2 .096-4 .146 ,P=0 .000) ,eco-nomic status 5 years ago(OR=0 .386 ,95% CI 0 .279 -0 .534 ,P= 0 .000) ,family history of PHC(OR= 2 .402 ,95% CI 1 .372 -4 .206 ,P=0 .002) ,cigarette smoking (OR=3 .468 ,95% CI 2 .265 -5 .311 ,P=0 .000) ,chronic liver disease(OR= 1 .502 ,95% CI 1 .054-2 .141 ,P=0 .024) ,HBV infection(OR=31 .999 ,95% CI 19 .318 -53 .002 ,P=0 .000) and diabetes mellitus(OR=4 .750 , 95% CI 2 .761-8 .171 ,P=0 .000) ,the differences between the patients group and the control group had statistical significance ;the OR value of drinking combined with HBV infection was 96 .903(95% CI 35 .265-266 .275 ,P=0 .000) .Conclusion HBV infection is still the common risk factor of PHC in Guizhou provincial population .Drinking can increase the risk in the individuals infected with HBV .

Objective To observe the expression of survivin and Aurora B in human pancreatic cancer BXPC3 cells after the treatment of sulindac and to explore the potential mechanism. Methods MTr assay was used to determine the effect of sulindac on the proliferation of the BXPC3 cells. RT-PCR was used to detect the expression of mRNA level of survivin and Aurora B, western blot was used to detect protein expression of survivin and Aurora B Thr-232. Cell cycle and apoptosis were detected by flow eytometry (FCM). Results The BXPC3 cells were inhibited by sulindac in a dose and time-dependent manner; the expression of mRNA of survivin and Aurora B were both significantly decreased from 1.5644 and 0.6554 to 0. 4372 and 0.1132 (P< 0.01), the expression of survivin protein and the phosphorylation of Aurora B Thr-232 were also decreased from 1.2735 and 0.4680 to 0.2126 and 0.2546 (P<0.01); the proportion of cells in the G0/G1 phase was increased from (56.65±1.93)% to (70.58±3.21)% (P<0.01). Conclusions Sulindac had inhibitory effects on the growth of BXPC3 cells, the possible mechanism was via decreasing the expression of survivin which depressed the activity of Aurora B, then the CPC was influenced. The most of the cells were blocked in the G0/G1 phase, and the cells' mitosis was inhibited.

Objective: To explore the application and affecting factors of clopidogrel loading therapy in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) in china in 2006 and 2011. Methods: Based on “China patient-centered evaluative assessment of cardiac events retrospective study of acute myocardial infarction”, we collected clinical information of STEMI patients with PCI in 2006, 2011 and analyzed clopidogrel loading therapy status in different years and different hospitals. According to clopidogrel doses, the patients were divided into 2 groups: Clopidogrel 300mg group, the patients received a single dose of clopidogrel ≥300mg while <450mg and Clopidogrel 600mg group, the patients received a single dose of clopidogrel ≥450mg while ≤600mg. The relevant factors affecting clopidogrel loading therapy status were identiifed by binary Logistic regression analysis. Results: A total of 2481 eligible patients were enrolled and their mean age was (60.9 ± 12.0) years including 21.4%female. From 2006 to 2011, the overall application of clopidogrel loading was (51.0% vs 47.4%), the ratio for patients in Clopidogrel 300mg group was (43.1% vs 39.2%), in Clopidogrel 600mg group was (7.8% vs 8.2%), allP>0.05. In 2006, the hospital median rate of clopidogerl application was 44.4% (IQR 21.8% to 69.0%) and in 2011, it was 48.1% (IQR 25.0% to 70.8%),P=0.940. Binary logistic regression analysis showed that the patients were admitted within 12 hours of onset, with primary PCI and treated in central region had the higher rates of clopidogrel loading therapy. Conclusion: Clopidogrel loading therapy was seriously inadequate in STEMI patients with PCI, variation was across hospitals and the status was similar between 2006 and 2011. Clopidogrel loading therapy should be improved.

Objective:To investigate the expression level of synaptophysin (Syn), tissue neuronal cell adhesion molecule 56 (CD56) and chromogranin A (CgA) in 92 primary esophageal small cell carcinoma (PESC) and to explore its repationship with clinicopathological features and clinical outcome. Methods:Immunohistochemical studies of CD56, CgA, and Syn were performed in 92 paraffin-embed-ded tissues with clinical-related information obtained from 500,000 esophageal and gastric cardia carcinoma databases established by Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. Binary logistic regression was used to analyze the correlations of CgA, Syn, and CD56 expression with clinicopathological features. Kaplan-Mei-er survival analysis and Cox proportional hazards regression models were performed for univariate and multivariate survival analyses. Log-rank test was used to compare the difference in survival rates. Results:The CgA-positive expression rate in PESC at lower segment of esophagus (72.2%) was higher than those at the middle and lower segments (41.1%, 10.0%) (P=0.001). The expression level of CD56, CgA, and Syn was not correlated with gender (P=0.262, 0.998, 0.931), age (P=0.250, 0.998, 0.703), tumor invasion (P=0.253, 0.997, 0.061), and lymph node metastasis (P=0.767, 0.998, 0.613). Univariate analysis showed no survival influence in patients with and without lymph node metastasis (P=0.563). Multivariate survival analysis showed that patients with PESC mixed squamous cell car-cinoma (HR=2.58;95%Cl, 1.11-5.98) and higher CgA protein expression (HR=1.87;95%Cl, 1.02-3.43) exhibited a longer survival time than those with pure PESC and without CgA expression. Conclusion:Tissue CgA level was associated with tumor location in PESC. His-tological type and tissue CgA expression were independent important prognostic factors, and lymph node metastasis exerted no influ-ence on survival in PESC.

Objective To study the incidence of implantation metastasis of breast cancer in vacuum-assisted breast biopsy (VABB) needle tract in Chinese patients and evaluate the effect of neoadjuvant chemotherapy on needle tract metastasis following VABB. Methods The breast cancer patients with established diagnosis by VABB were divided into two groups to receive open surgery or neoadjuvant chemotherapy prior to open surgery. The incidence of needle tract metastasis, disease-free survival (DFS) and overall survival (OS) were compared between the two groups. Results A total of 214 patients were enrolled, among whom 94 directly underwent surgeries and 120 had neoadjuvant chemotherapy before surgery. The two groups showed no significant differences in the incidence of needle tract metastasis (3.2%vs 0.8%, P=0.206), DFS (P=0.221), or OS (P=0.531). Conclusion The incidence of needle tract metastasis is low after VABB, and neoadjuvant chemotherapy does not increase this risk.

Objective To study the incidence of implantation metastasis of breast cancer in vacuum-assisted breast biopsy (VABB) needle tract in Chinese patients and evaluate the effect of neoadjuvant chemotherapy on needle tract metastasis following VABB. Methods The breast cancer patients with established diagnosis by VABB were divided into two groups to receive open surgery or neoadjuvant chemotherapy prior to open surgery. The incidence of needle tract metastasis, disease-free survival (DFS) and overall survival (OS) were compared between the two groups. Results A total of 214 patients were enrolled, among whom 94 directly underwent surgeries and 120 had neoadjuvant chemotherapy before surgery. The two groups showed no significant differences in the incidence of needle tract metastasis (3.2%vs 0.8%, P=0.206), DFS (P=0.221), or OS (P=0.531). Conclusion The incidence of needle tract metastasis is low after VABB, and neoadjuvant chemotherapy does not increase this risk.