ObjectiveTo analyze the characteristics of plantar pressure of diabetic patients during gait cycle, and to design a offloading insole with variable stiffness. MethodsThe plantar pressure experiment was carried out and a database including 157 subjects was established. The differences of plantar pressure distribution were analyzed among diabetic patients with and without peripheral neuropathy, and healthy people. The insole pressure area was divided, and porous units were filled in different insole areas according to the pressure gradient. The fed-calf-insole finite element model of diabetic patients was constructed. The simulation analysis of different insole schemes was carried out under the conditions of push-off, footheel-strike and dynamic neutrality posture, and to explore the most reasonable insole stiffness design. ResultsCompared with the healthy group, the percentage of peak pressure and high pressure in the left and right heel areas of diabetic neuropathy patients showed a decreasing trend, in which the left peak pressure was significantly reduced by 11% (P = 0.026) and the percentage of high pressure was significantly reduced by 9.8% (P = 0.02). When the porous elements of 2.5 MPa and 1.9 MPa were used in the high pressure area of the insole metatarsal and high pressure area of the heel, the peak plantar pressure of footheel-strike, dynamic neutral and push-off was reduced by 42.4%, 27.4% and 26.4%, and the peak stress of the soft tissue was reduced by 49.8%, 43.6% and 25.1%, respectively. ConclusionThere is a higher risk of ulcer in the metatarsal region than in the heel region for diabetic patients. The variable stiffness insoles based on the optimization of plantar pressure and internal stress under multi-posture can effectively reduce the peak pressure of plantar and peak stress of soft tissue during walking, which provides a reference for the design of variable stiffness insoles.

Objective An X-shaped cushioning insole with variable stiffness was designed to explore its effects on plantar pressure and internal stress of diabetic patients with toe amputation. Methods Based on CT images, the feet-calf finite element model of diabetic patients with toe amputation was established, and the insole was divided into different areas according to distribution characteristics of the planter pressure. The three-dimensional (3D) printed cushioning insole with an X-shaped sandwich structure was designed. The modulus of the sandwichstructure was changed by changing thickness of the sandwich structure panel. For simulation analysis, the divided area was filled with the X-shaped sandwich structure with different modulus. Results The peak plantar pressure of diabetic patients with toe amputation was in calcaneal region, and the combined insoles with 1. 2 mpanel thickness in toe area, 1. 4 mm panel thickness in metatarsal area, 2. 0 mm panel thickness in middle area and 1. 6 mm panel thickness in heel area had the best decompression effect. Compared with bare feet, the peak pressure in heel area of the insole, the peak pressure in phalangeal head area and the stress in plantar softissues were reduced by 40. 18% , 31. 7% , and 50. 44% , respectively. Conclusions The 3D printed insoles with variable stiffness can effectively reduce surface pressure and internal stress of the sole and reduce probability of the 2nd toe amputation

OBJECTIVE To provide emp irical evidence for relevant decision makers in China to formulate and improve policies related to children ’s medicine use . METHODS Based on the purchase data （Jul. 2016-Jun. 2019）of 18 tertiary children ’s hospitals，the availability of medicines included in the 7th edition of WHO Model List of Essential Medicines for Children （WHO EMLc）and their influential factors were investigated according to standard medicine investigation method recommended by the WHO and Health Action International . RESULTS A totally 189 active ingredients listed in the 7th edition of WHO EMLc were available at 18 tertiary children ’s hospitals in China ，which referred to 229 medicines. The availability of Budesonide inhalation suspension，oral rehydration salt ，Immunoglobulin for injection and Water for injection was 100%. In each quarter from Jul . 2016 to Jun . 2019，the availability of more than half of the medicines exceeded 50%，and the availability of the medicines remained basically stable in each quarter . The overall availability of cardiovascular system medicines and blood system medicines was the highest，while that of antiparasitic medicines and dermatology medicines was lower . There were 28 medicines（12.2%）that were not approved for use in children in China ，the use of which were off -label. The medicines which had been approved for children and which were included in national essential medicine list had a significantly higher availability （P＜0.05）. CONCLUSIONS The availability of essential medicines for children is generally better at tertiary children ’s hospitals in China . But the use of some essential medicines in children are off -label. In order to ensure the safety and the availability of essential medicines for children ，it is suggested to introduce China ’s essential medicines list for children ，to promote clinical trials in children for commonly used medicines，and to updete the drug manual in time .

Objective To evaluate the security and effectiveness of emerging sternal rigid plate by comparing with wires closure. Methods 60 patients who undergoing median sternotomy from two centers were enrolled in this study, 30 received wire cerclage( control group) and the other 30 received rigid plate fixation( experimental group) . Patients' sternal were closed with wires or rigid plates, and the painness, sternal union and status of wires or rigid plates were followed up and assessed one week, three months and six months after procedures. Results All patients survived and were followed up. 117 rigid plates were implanted. There was no significant difference in pre-operative data, post-operative painness, sternal union and status of wires and plates between control and experimental group. No patient reached the standard of clinical sternal union one week post-operation, but all patients reached the standard of clinical sternal six months post-operation. One patient in control group suffered sternal nonunion, movement and wound infection after sternotomy. Conclusion Compared to wire closure, sternal closure with rigid plates is the same safe and effective.

Objective To analyze the clinical effect through 20 adult atrial septal defect repair cases with totally thoracoscopic and summarize the experience of totally thoracoscopic cardiac surgeries.Methods From March 2014 to August 2016, 20 adult atrial septal defect cases repaired by totally thoracoscopic were enrolled in the study. Extracorporeal circulation was established by inserting artery pump tubes into the right femoral artery and vein tubes in to the right femoral vein, cold blood cardioplegia was perfused ante gradely through the aortic root in order to protect the myocardium, then atrial septal defect repair cardiac surgeries were implemented by perforating 3 holes through the right chest wall. Analyze the operation time, aortic cross clamping time, CPB time, amount of drainage, hospital stay, postoperative complications and so on.Results The operation time was 3.5~5.0 h, and the average level was (3.8 ± 0.5) h. The blocking duration of the ascending aorta ranged from 28 to 46 min, and the average level was (29.8 ± 8.2) min. The duration of extracorporeal circulation ranged from 86 to 108 min, and the average level was (80.6 ± 11.5) min. Ventilation time ranged from 5 to 8h, and the average level was (6.0 ± 0.8) h. The amount of thoracic drainage ranged from 100 to 260 ml, and the average level was (150.0 ± 35.0) ml. Hospital stay ranged from 6 to 9 days, and the average level was (6.5 ± 1.2) days. All the operations were completed successfully. There were no in-hospital death or serious post-operative complications. UCG performed 3~5 days after the operation revealed surgical results were satisfactory. Follow up to 1~28 months were available in all cases. During the period, the heart function was conifrmed asⅠ level.Conclusion Adult atrial septal defect repair surgeries with totally thoracoscope is safe and reliable and have advantages of less injury, rapid discovery, light pain, and less postoperative drainage.

Objective To compare the application effects of three methods,namely microscopic examination,antigen detec-tion(RDT)and nucleic acid test(PCR)in malaria detection between municipal and districts/counties centers for disease con-trol and prevention in Shanghai,and analyze the malaria detection ability of the laboratories in Shanghai. Methods The blood smears,whole blood samples,case review confirmation records and case data of malaria cases and suspected cases in Shanghai from 2012 to 2015 were collected by Shanghai Municipal Center for Disease Control and Prevention,and the detection results were analyzed and compared. Results A total of 212 samples with complete data were submitted by all districts(counties)in Shanghai from 2012 to 2015,the samples submitted by Jinshan Districts were the most(41.98%),and among the first diagnosis hospitals,those submitted by the tertiary hospitals were the most(82.07%). The submitted samples in the whole year were in-creased gradually from January to October. All the 212 samples were detected by three methods(the microscopic examination, RDT and PCR)in the laboratory of Shanghai Municipal Center for Disease Control and Prevention,and 167 were tested and con-firmed comprehensively as positives,accounting for 78.77%,and 45 were confirmed as negatives,accounting for 21.23%. The samples were detected by the method of microscopy and domestic RDT in the laboratories of the centers for disease control and prevention at district/county level,totally 153 were tested as positives,accounting for 72.17%,41 were unclassified,account-ing for 19.34%,53 were negative,accounting for 25.00%,and 6 were undetected,accounting for 2.83%. The coincidence of microscopic examination between the report hospitals and the centers for disease control and prevention at district/county level was 78.16%,and the coincidence between centers for disease control and prevention at district/county level and municipal level was 93.20%. The utilization rate of RDT in the laboratory of district/county level was 73.58%. The coincidence of RDT tests be-tween those domestic and imported was 93.59%. Compared with the detection results by municipal center for disease control and prevention,37 samples were misjudged by the laboratories of district/county level. Almost all(99.37%)of the confirmed malar-ia cases were imported overseas,including Africa(85.44%),Asia(13.92%)and America(0.63%). Conclusion The surveil-lance after malaria elimination in Shanghai should be carried out by combining with different detection methods and resource in-tegration.

Objective To construct the performance evaluation framework for China′s health system,and provide evidences for enhancement of such evaluation and the health system.Methods Literature review and empirical research were combined with expert consultation to construct such an evaluation index system.Results In view of both international experiences and China′s specifics,an evaluation index system is built based on the generalized concept model of the health system,consisting of 4 class-1 indicators, 1 5 class-2 indicators and 6 9 class-3 indicators.Conclusions The generalized framework of health system performance evaluation fits such evaluation in China,and indicator optimization and understanding of the shortcomings with cautious explanation are of critical importance.This evaluation remains in its infancy in China,and there is a long way to go before a health system performance evaluation system can be built in China.

Objective To use enzyme-linked immunosorbent assay (ELISA) for measuring thrombospondin-1 (TSP-1),and to analyze its diagnostic value for prostatic carcinoma.Methods The possible difficulties and the way to solve the difficulties with ELISA spot were explored first.Three agents which could segregate idio-antigen and one technique which could depurate proteinum were designed and developed.The non- idio- proteinum cross reaction problems were solved and the routine method to measure TSP-1 with ELISA was set up successfully.The serum TSP-1 was measured in 14 patients with benign prostatic hyperplasia (BPH) and 18 patients with prostatic carcinoma.Results The TSP-1 values were (73.77±12.72)% and (121.86±-19.47)% in prostatic carcinoma group and benign prostatic hyperplasia group,respectively (t= 8.44,P＜0.01).The diagnostic sensitivity and specificity of TSP-1 and prostate specific antigen (PSA) for prostatic cancer were 92.7%,88.9% and 85.7%,66.7%,respectively (P＜0.01).The area under the receiver operating characteristic curve (ROC) of TSP-1 and PSA were 0.9663 and 0.7421 (P＜0.05).Conclusions The determination of TSP-1 with ELISA is feasible.TSP-1 is an ideal diagnostic parameter for prostatic carcinoma and it may distinguish BPH from malignant prostatic disease more exactly than PSA.

BACKGROUNDΔNp73 is an isoform of the p53 homologue p73, which lacks an NH₂-terminal transactivation domain and antagonizes the induction of gene expression by p53 and p73. The aim of this study is to investigate the expression of ΔNp73 mRNA in non-small cell lung cancer (NSCLC) and to analyse its relations with clinicopathologic factors and prognosis.

METHODSSemiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect the expression of ΔNp73 mRNA in 40 resected NSCLC specimens with the neighboring noncancerous tissue. The significance of ΔNp73 mRNA expression was analyzed statistically.

RESULTSΔNp73 mRNA was highly expressed in lung cancer tissues (62.7%, 32/51) while negative in neighboring noncancerous tissue. The expression of ΔNp73 mRNA was associated with pathological TNM stage (P=0.046), but not associated with age, gender, histological type and differentiation status. Survival of patients with high ΔNp73 mRNA was significantly poorer than those with low ΔNp73 mRNA levels (P < 0.001). Multivariate analysis revealed that ΔNp73 mRNA levels were a significant prognostic factor, independent of the other conventional prognostic factors.

CONCLUSIONSNSCLC has overexpression of ΔNp73 mRNA, which is closely related to TNM stages and prognosis of patients with NSCLC. These results suggest that measurement of ΔNp73 mRNA levels in tumor tissues might be useful as a promising predictor for the prognosis of patients with NSCLC.

BACKGROUNDTo assess the effects of exogenous p73 gene on chemosensitivity of wild-type p53 human lung adenocarcinoma cell A549 to cisplatin (DDP) and adriamycin (ADM).

METHODSRecombinant eukaryotic expression vector pcDNA3 containing full-length human wild-type p73α cDNA or p53 cDNA was transfected into A549 cells which had wtp53 by lipofectamine-mediated gene transfection. The chemosensitivity of tumor cells to DDP and ADM was observed before and after transfection.

RESULTSA549-p73α could stably express P73α protein. The P73α protein expression was significantly increased in A549-p73α than that in A549 and A549-pcDNA3. The growth and colony formation of A549-p73α were significantly inhibited compared with A549, A549-pcDNA3 and A549-wtp53. Flow cytometry and DNA fragmentation analysis showed apoptosis of A549-p73α cells was significantly increased. The IC₅₀ values for DDP and ADM were reduced to approximate 1/6 and 1/70 in A549-p73α cells compared with A549 cells respectively..

CONCLUSIONSExogenous p73 gene is capable of enhancing the sensitivity of wild-type p53 human lung adenocarcinoma cell A549 to chemotherapeutic drugs. It is probably for p73 to be used in the treatment of p53-resistant tumors.