Policy circumstance plays a pivotal role in transformation of barefoot doctor to village doctor.The resources support fromregime and economic organizationmanagement system, the workpoint system for income from collective economy and politics culture of serving people under the policy circumstances of the People′s Com-mune, lay a firm foundation for rise and development of barefoot doctors.However, the village self-governance re-gime began with Household Contract Responsibility System changed all elements above and ultimately prompt trans-formation from barefoot doctor to village doctor.

Objective To evaluate the efficacy of entecavir treatment in chronic hepatitis B virus ( HBV ) infected patients with mild hepatic dysfunction and marked pathological injury.Methods One hundred and fifty five chronic hepatitis B ( CHB) patients with HBV DNA>1.0 ×104 U/mL admitted in Lishui People’ s Hospital during January 2008 to October 2011 were enrolled in the study.Patients were divided into three groups: those with serum ALT <2 ×ULN and liver inflammation injury ≥G2 and/or fibrosis stage≥S2 were in observation group ( n=75 ); patients with ALT ( 2-5 ) ×ULN were in control group 1 (n=38);patients with ALT>5 ×ULN were in control group 2 (n=42).All patients were given entecavir (0.5 mg, 1/d, p.o) treatment.ALT normalization rates, HBV DNA negative rates, HBeAg negative conversion rates and seroconversion rates at 12-, 24-,48-, 96-and 144-week were observed and compared among groups.Variance analysis andχ2 test were performed for measurement data and numeration data, respectively.Results ALT normalization rates in observation group were 86.7%, 90.7%, 90.7%, 92.0%and 96.0%at 12-, 24-, 48-, 96-and 144-week, which were higher than those in control group 1 (χ2 =2.04, 2.15, 2.78, 2.69 and 2.47, P <0.01), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.53,2.42,2.09,2.24 and 2.32,P>0.05) . HBV DNA negative rates in observation group were 70.7%, 78.7%and 82.7%at 12-, 24-and 48-week, which were higher than those in control group 1 (χ2 =4.56, 4.23 and 4.28, P<0.05), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.75, 2.62 and 2.98, P>0.05).HBeAg negative conversion rates in observation group were 6.6%, 21.3%and 25.3%at 48-, 96-, and 144-week, which were higher than those in control group 1 (χ2 =4.68, 4.78 and 5.01, P<0.05), but no statistically significant difference was observed between observation group and control group 2 (χ2 =2.24, 2.57 and 2.13, P>0.05).HBeAg seroconversion rate in observation group was 4.0%at 24-week, which were higher than that in control group 1 (χ2 =2.87, P <0.05), but the seroconversion rates at 96-and 144-week were lower than those in control group 2 (χ2 =2.92 and 3.14, P<0.05).Conclusion The efficacy of entecavir treatment for HBV infected patients with mild hepatic dysfunction and marked pathological injury is satisfactory.

ObjectiveTo investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU).Methods A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled. They were randomly divided into two groups by computer generated random numbers table, eachn = 70. The patients in observation group received midazolam 1μg·kg-1·min-1 for sedation, and 1 mg/mL remifentanil for analgesia with 0.05 mg/kg intravenous bolus, then continuous infusion of 0.02-0.10 mg·kg-1·h-1. The patients in control group received midazolam for sedation only. The data were recorded as follows: the main indices for observation included the occurrence of delirium and its duration; the second item for observation was consumption of drug for sedation, followed by the mean arterial pressure (MAP) before and after sedation, the time of wake-up, duration of mechanical ventilation, the length of ICU stay, and 28-day fatality rate. The 28-day survival was analyzed by Kaplan-Meier survival curve.Results The dosage of remifentanil used in observation group was (98.6±24.9) mg/d, the dosage of midazolam was significantly lower than that of the control group (mg/d: 160.6±33.3 vs. 178.9±43.4, t = 2.829,P = 0.005), the incidence of delirium was obviously lower than that of the control group [22.9% (16/70) vs. 57.1% (40/70),χ2 = 15.700,P< 0.001], and the time of delirium was slightly shorter than that of the control group (hours: 162.9±78.0 vs. 194.8±117.3,t = 0.947,P = 0.348). Among the patients with delirium, the dosage of dexmedetomidine used in observation group was significantly less than that of the control group (mg/d: 0.54±0.11 vs. 0.64±0.14,t = 2.112,P = 0.041). The MAP before sedation was similar as the MAP after sedation in both groups, and there was no significant difference between observation group and control group [mmHg (1 mmHg = 0.133 kPa), before treatment: 84.7±16.2 vs. 89.5±37.7, after treatment: 82.3±10.7 vs. 80.8±13.9, bothP> 0.05]. There was no significant difference in the time of waking-up between observation group and control group (hours: 2.3±0.9 vs. 2.4±0.8,t = 0.487,P = 0.627). The duration of mechanical ventilation (hours: 143.4±138.3 vs. 163.9±158.9, t = 0.812,P = 0.418), the length of ICU stay (days: 8.8±7.7 vs. 10.0±7.8,t = 0.917,P = 0.361) and 28-day fatality rate [11.4% (8/70) vs. 20.0% (14/70),χ2 = 1.941,P = 0.245] in observation group were slightly lower than those of the control group without significant difference. Kaplan-Meier survival curve showed that the cumulative 28-day survival rate in observation group was slightly higher than that of control group (χ2 = 1.647,P = 0.199). ConclusionAnalgesia based on sedation may reduce the occurrence of delirium and its severity, furthermore, even if delirium occurs, it may be less severe.

Objective To explore the efficacy and safety of biological mesh during female anterior pelvic organ reconstruction.Methods The 68 consecutive women with symptomatic anterior vaginal wall prolapse in Beijing hospital from January 2010 to June 2013 were divided into two groups:6 cases underwent anterior vaginal wall repair with biological mesh,and 32 cases underwent vaginal approach to paravaginal repair.Preoperative and postoperative pelvic evaluations were performed with the POP-Q system.Patients were followed up at 1,3,6,12,24 months after operation.Objective cure was defined if the lateral sulci of the anterior vaginal walls were at grade 0 and firmly apposed to the lateral pelvic sidewalls.Results Among 68 patients,38 had grade Ⅲ and 30 had grade Ⅳ anterior vaginal wall prolapse.In all patients the anterior vaginal repair was performed successfully.The indexes of operation time,amount of bleeding,the postoperative retention time of catheter and hospital stay had no difference between biological mesh and vaginal approach groups [(88.1±18.3)min vs.(88.0±17.4)min,(140.3±77.6) ml vs.(141.3±64.9) ml,(5.30±1.79) d vs.(4.90±2.34) d,(5.53±2.00)d vs.(5.50±2.08)d,t=0.01,0.05,0.64,0.06,respectively,all P＞0.05].No complication happened during and after operation.No one relapsed in biological mesh group and 4 cases relapsed in paravaginal repair group.The relapse rate between two groups is statistically different(x2 =4.79,P＜0.05).Conclusions The anterior vaginal repair with biological mesh is effective during female anterior pelvic organ reconstruction,but the long-term outcome of biological mesh in pelvic floor construction needs further study.

Objective To investigate the value of intravital fluorescence microscopy in the observation of the changes of hepatic microcirculation in the rat model with hepatic cirrhosis and portal hypertension.Methods Seventy male SD rats were selected.According to the random number table,40 SD rats were randomly divided into the sham operation group,bile duct ligation (BDL) 2 weeks group,4 weeks group and 6 weeks group,there were 10 rats in each group,and the hepatic microcirculation of the rats was observed with intravital fluorescence microscope; the remaing 30 SD rats were randomly divided into the normal saline (NS) group,endothelin-1 (ET-1) group and the S-nitrosoglutathion (GSNO) group at 4 weeks later after the establishment of BDL model.The changes of hepatic microcirculation of the 3 groups were observed.All data were analyzed using the one-way analysis of variance (ANOVA) or paired samples t test.Results Nine rats died in the BDL model groups,and the survival rate was 85.0％ (51/60).All rats in the sham operation group were survived.The hepatic sinusoid diameters were decreased as time passed by.The hepatic sinusoid diameters of the BDL 2 weeks group,4 weeks group and 6 weeks group were (13.6 ± 1.0) μm,(8.8 ± 0.7) μm and (8.0 ± 0.5) μm,respectively,which were significantly shorter than (17.4 ± 1.0) μm of the sham operation group (t =5.86,18.24,15.57,P ＜ 0.05).The hepatic sinusoid densities of the BDL 2 weeks group,4 weeks group and 6 weeks group were (6.8 ±0.8)/ 200 μm,(4.3 ± 1.8)/200 μm and (4.0 ± 1.2)/200 μm,which were significandy lesser than (8.8 ± 0.5)/200 μm (t =3.25,2.77,2.12,P ＜ 0.05).At 15 minutes after injection of NS,the hepatic sinusoid diameter of the NS group was (7.2 ± 1.2) μm,which was significantly different from (6.9 ± 0.5) μm before injection of NS (t =0.89,P ＞ 0.05) ; the hepatic sinusoid density of the NS group before and after injection of NS were (6.6 ± 0.4) / 200 μm and (6.8 ± 1.4)/200 μm,with no significant difference(t =1.12,P ＞0.05).At 15 minutes after injection of ET-1,the hepatic sinusoid diameter of the ET-1 group was (5.4 ±0.5) μm,which was significantly different from (7.9 ± 0.6) μm before injection of ET-1 (t =7.39,P ＜ 0.05) ; the hepatic sinusoid density of the ET-1 group before and after ET-1 injection were (5.8 ± 1.2)/200 μm and (5.4 ± 1.8)/200 μm,with no significant difference(t =0.84,P ＞0.05).At 15 minutes after injection of the GSNO,the hepatic sinusoid diameter of the GSNO group was (11.4 ± 1.3) μm,which was significantly different from (7.5 ± 1.7) μm before injection of GSNO (t =5.95,P ＜ 0.05) ; the hepatic sinusoid density of the GSNO group before and after GSNO injection were(5.6 ± 0.8)/200 μm and (6.4 ± 1.6)/200 μm,with no significant difference (t =0.54,P ＞ 0.05).Conclusions The changes of hepatic microcirculation observed under intravital fluorescence microscope could reflect the progress of hepatic cirrhosis,and the changes of hepatic sinusoid diameters caused by drugs could be dynamically monitored under the intravital fluorescence microscope.

Objective To explore the treatment effect of peripherally inserted central catheter (PICC) in parenteral nutrition of infants and observation and nursing of its complication.Methods Clinical data of 32 cases of infants who underwent parenteral nutrition through PICC were analyzed.The nursing experience and observation and handling of common nursing problems were summarized.Results 2 cases failed catheterization,the others succeeded,1 case through scalp,2 cases through axillary,27 cases through basilic vein.2 cases completed TPN treatment with a second try of PICC.The shortest indwelling time of PICC was 3 days,the longest was 34 days.Catheter blockage happened in 1 case,leakage in 1 case,and catheter-related infections in 1 case.Conclusions Difficulty exists in application of PICC in infants,but the complications were less.The tube can be retained for a long time,which conforms to higher intravenous nutrition requirement of infants,and this method possesses wide application perspective.

Objective To determine the perioperative risks of partial hepatectomy by determining the preoperative liver functional reserve in patients with hepatocellular carcinoma (HCC),and to compare the model for end-stage liver disease (MELD) score with the Child-Pugh classification in predicting prognosis.Methods We reviewed the clinical data of 202 patients with HCC who underwent partial hepatectomy.The MELD score and the Child-Pugh classification were determined preoperatively.Results The incidence of postoperative liver dysfunction happened in 44.0％ of Child A patients,50％ in Child B patients,41.6％in patients with a MELD score below 14,and 91.7％ in patients with a MELD score of ＞ 14.The difference between the rates of postoperative liver dysfunction in patients with a preoperative MELD score above 14 and below 14 was significant (P ＜ 0.05),while that between patients with Child-Pugh A and B was insignificant (P ＞ 0.05).The incidences of postoperative liver dysfunction in patient with a MELD ＜ 8,8 ≤ MELD ≤ 14,MELD ＞ 14 were 38.2％,57.6％ and 91.7％,respectively,indicating that there was a positive co-relationship between the MELD score and the incidences of liver dysfunction.The Spearman rank correlation test showed the MELD score was significant correlated with the Child-Pugh score (r =0.404 ; P ＜ 0.05).The areas under the ROC curves of the MELD score and the Child-Pugh score were 0.703 and 0.587 (P ＜ 0.05).Conclusions The MELD score predicted postoperative liver dysfunction more accurately than the Child-Pugh classification.HCC patients undergoing partial hepatectomy with a preoperative MELD score ＞ 14 had a high perioperative risk.To ensure the safety of partial hepatectomy,HCC patients with a preoperative MELD score ＞ 14 requires active preoperative preparation,bringing the score near to or less than 14.

Objective To investigate the protective effect of propotol against hepatic ischemiareperfusion injury in rats on mitochondrial permeability transition pore (MPTP) and the mechanism of GSK-3β.Methods Thirty SD rats were randomly assigned into five groups (n =6):sham operation group (S group),ischemia reperfusion group (I/R group),CsA pretreatment group (C group),propofol pretreatment group (P group),and propofol plus atractyloside pretreatment group (A + P group).Nauta liver ischemia-reperfusion rat model was used.Liver lobes were subjected to warm ischemia for 60min and then reperfusion for 120 min.In P group,propofol [12 mg/(kg · h)] was administered in the femoral vein for 30 min before ischemia until the end of reperfusion.In C group,CsA (2 mg/kg) was administered in the femoral vein for 20min before ischemia.In A + P group,20 μmol/kg of atractyloside was given through the femoral vein 10min before the injection of propofol.Rats were sacrificed at the end of reperfusion,and venous blood and hepatic tissue specimens from the same part of ischemia were obtained from different groups.Results Compared with S group,the AST and ALT levels were increased significantly,mitochondrial swelling were increased and mitochondrial membrane potential were decreased significantly in I/R group and A + P group.Casepase-3 were increased significantly and p-GSK3β Ser9 were decreased significantly in I/R group and A + P group.Compared with I/R group,the content of AST and ALT were decreased significantly,mitochondrial swelling were decreased and mitochondrial membrane potential were increased significantly,casepase-3 release were decreased significantly and p-GSK3β Ser9 were increased significantly in P group and C group.GSK-3β in each group displayed no significant difference.Conclusions Propofol can significantly reduce hepatic ischemia-reperfusion injury.The protective effect of propofol may be achieved via the inhibition of GSK-3β activation,increased p-GSK-3β Ser9 level,suppressing MPTP opening and decreasing hepatocytes apoptosis.

Objective To investigate the change trend of liver function indicators in different types of hyperlipidemia patients. Methods From July 2014 to July 2015 ,a total of 2571 patients with hyperlipidemia and 1063 normal people(control group) were collected in this research.All patients with hyperlipidemia were divided into the hypercholesterolemia group (high TC group ,n=258) ,hypertriglyceridemia group (high TG group ,n=859) and mixed type hyperlipidemia group(n=282) ,low high-density lipo-protein cholesterol group(low HDL-c group ,n=1172).The liver function indicators of total protein (TP) ,albumin (ALB) ,alanine aminotransferase(ALT ) ,aspartate aminotransferase (AST ) ,AST/ALT and globulin (GLB ) were measured in each group. Results The TP and ALB levels in the high TC group ,mixed group and low HDL group were significantly decreased compared with the control group ,the difference was statistically significant (P<0.05).The ALT ,AST ,AST/ALT and GLB levels in the four hyperlipidemia groups had different degrees of increase as compared with the control group ,the difference was statistically signifi-cant(P<0.05).The TP and ALB levels in the mixed group and the low HDL group were significantly lower than those in the high TG group and high TC group ,the difference was statistically significant (P<0.05).The ALT level in the low HDL group was sig-nificantly higher than that in the other three groups ,the difference was statistically significant (P<0.05).The AST/ALT level in the mixed group was significantly higher than the other three groups (P<0.05).The GLB level in the high TC group was signifi-cantly higher than the other 3 groups with statistical difference (P<0.05).Conclusion Blood lipid increase may induce the liver function injury.The detection of liver function indicators in the patients with hyperlipidemia will contribute to the early detection and treatment of fatty liver.

Objective To explore the effect of dexmedetomidine on phosphoinositide 3-kinase/protein kinase B (PI3K/Akt ) pathway in hippocampus of propofol anesthetized neonatal rats. Methods Eighty Sprague-Dawley male rats,aged 7 days,weighing 10-1 5 g,were randomly divided into 8 groups (n= 10 each):normal saline group (group N),DMSO group (group D),intralipid group (group I),propofol group (group P),dexmedetomidine 25 μg/kg,50 μg/kg and 75 μg/kg +propofol 100 mg/kg groups (groups PD25 ,PD50 and PD7 5 ),LY294002 25 μg + dexmedetomidine 75μg/kg + propofol 100 mg/kg group (group LYPD).The hippocampus of rats in all groups were taken 2 h after the animals fully awake.The ultrastructure of hippocampal neurons was observed by transmission electron microscope.The pAkt-(ser473 )protein and Akt protein in the hippocampus were evaluated by Western blot analysis.Results There was no significant difference in the expression of Akt protein among the eight groups.Compared with group N,the expression of pAkt (ser473)protein was significantly down-regulated in groups P,PD25 ,PD50 ,PD7 5 and LYPD (P <0.05).Compared with group P,the expression of pAkt (ser473)protein was increased significantly in groups PD7 5 and LYPD (P <0.05).Compared with group PD7 5 ,the expression of pAkt (ser473) protein was significantly down-regulated in group LYPD (P <0.05 ).The structure of hippocampal neurons was normal in groups N,I and D.Nuclear nuclei swelling,chromatin decreasing and mito-chondrion vacuolar degeneration were observed in group P while improved gradually with dexmedeto-midine in a dose-dependent manner in groups PD25 ,PD50 and PD7 5 .Neurons karyopyknosis,partial dissolution of nuclear membrane,chromatin condensation,mitochondria vacuolar degeneration were observed in group LYPD.Conclusion Dexmedetomidine pretreatment provides neuroprotection against propofol-induced hippocampal destruction by preserving PI3K/Akt pathway activity in the de-veloping brains.