Objective To survey health management cognition of residents in Shanghai city communities,and to analyze the causes,and to put forward related suggestions.Methods In October of 2013,this study was conducted in communities of Shanghai central district (Xuhui District),urban border area (Minhang District),and suburban area (Jinshan District); 800 residents from each health management cognition outpatient clinic (400 people from each of hospitals and community health service center),totally 2 400 residents were studied and investigated in the communities of Shanghai city,and 2 082 questionnaire were received (the questionnaire recovery rate was 86.75％).We used stratified random cluster sampling method,and self-designed investigation form,and did pre-experiment.The Survey included:Whether family doctors need to carry out the evaluation work about risk factors,to implement health management for school students,to implement health management for people over 60 years old,to implement the elderly health management for pension agencies,to implement special crowd health management for special people;conduct questionnaire of demand level for different population groups (type,age,gender,marital status,retirement,occupation,level of education and medical insurance form).Results The research results found that,when asked about the family doctor whether to carry out risk assessment,family doctor whether to implement special health management,whether family doctors need to teach health management to students, whether family doctor should undertake the health management work for the people over the age of 60,whether family doctors should implement special health management,whether a person thinks that it is indifference (9.3％,7.4％,3.8％,6.2％ and 5.7％) and unnecessary (3.6％,4.4％,2.5％,4.2％ and 3.9％)in the minority,the majority of people believe that they need (51.1％,52.9％,57.2％,55.6％ and 55.3％),then the general (24.5％,18.9％,12.4％,18.0％ and 16.5％) and very necessary (11.5％,16.4％,24.1％,16.0％ and 18.6％).Among them,the occupation,whether retired or not,level of education,medical insurance form and different age groups had different cognition and demand level for health management work.Conclusion To Strengthen the health management training,to take specific health management services according to different groups of people and to improve community health management services are very important.

Background and purpose:Patients with lung cancer often have metastases to the mediastinal and/or hilar lymph node.Three dimensional conformal radiation therapy(3-DCRT) has been used for the treatment of lung cancer.The delineation of the lymph nodes metastasis based on CT transections may be variable from doctor to doctor.It is necessary to standardize the definition of lymph nodes regions on CT scans.Methods:Retrospective studies were performed with the enhanced CT scans and/or PET/CT imaging of patients with NSCLC before treatment from November 2004 to November 2005.A series of thoracic enhanced CT scans from a middle stature female was selected as the model.Positive mediastinal and hilar lymph nodes were marked as red points on the CT model according to its relative position.Based on standardized definition of regional lymph nodes and the actual metastasized regional nodes on the images,the boundaries were delineated by Adobe Photoshop CS software and the metastasized regional lymph nodes were delineated on the Exomio 2.0 system.Results:Forty patients with enhanced CT data were enrolled in this study.Ten cases also underwent PET/CT examination.There were 278 positive lymph nodes that were detected and marked on the CT model.We defined the boundaries of regional lymph nodes of Group 1-2R,1-2L,3A,3P,4R,4L,5,6,7,8,10-11R and 10-11L,and delineated the above regional lymph nodes on template of CT model.Conclusions:Clear definition of mediastinal and hilar lymph region boundaries on CT images provides guidelines for the clinical staging of lung cancer and the contouring nodal drainage for 3-DCRT.It is essential to make target volumes more repeatable with good conformity in contour for conformal irradiation,which would benefit the clinical diagnosis,staging and therapy of lung cancer.

This paper systematically analyzed the concept of patients'trust based on a study of the literatures and compared patients'trust with patients'satisfaction. The conclusion is that patients'trust plays a key role on the quality improvements of medical services.

ObjectiveTo analysis the current conditions of the main chronic disease,satisfaction,reactive and trust,then to make the control policy in community health management base in China.Method Using the questionnaire by oneself,which the contents include prevalence,understand rate,management rate,behavior correct rate,control rate,medicine obey and satisfaction,reactive and trust of 2009 the chronic disease in 2009.ResultsThe total investigate people was 1 189 456.The hypertension prevalence is 8.01％,the diabetes prevalence is 4.41％.To compare with Shanghai and Jilin in 6 aspects,the prevalence,understand rate,management rate,control rate,medicine obey rate is higher in Shanghai.But behavior correct rate is lower in Jilin.Survey of hypertension prevalence rate was decreased,awareness,management,rates,rates of behavior modification,medication compliance rates and control rates of growth from 2009 to 2010.Satisfaction,responsiveness and trust indicators investigated a total of 2268 people,the process of service satisfaction to 93.43％,93.78％ overall satisfaction; to have the privacy of reactivity to 94.41％ of the basic amenities and clean comfortable response of the 90.45％ ; of treatment services for the 92.59％confidence,the confidence of the cost for the 93.98％ of the overall trust in institutions is 92.76％.ConclusionsThe government must take main principle in chronic disease control.We must enhance base construct of community health management and increase management level of chronic disease.We must enhance practitioner's culture ang increase knowledge of chronic disease management.

Objective To identify the relationship between patients' trust and their health outcomes and verify the mediator role played by patients' behavioral intention in affecting the health outcomes.MethodsThe 24-item patients' trust evaluation scale customized based on QOC improvement was called into play to measure the extent of trust of 727 inpatients at two tertiary hospitals and 20community hospitals in Shanghai.The patients' behavioral intention scale,life quality scale and patients'clinical effect general scale helped reveal the patients' behavior tendency on their health.RestltsIt is found that patients' trust affects their health outcomes.Furthermore,such trust plays partial mediator role on patients' life quality,and a complete mediator role in affecting the clinical effect.Conclusion Improvement of patients' behavior can result in better health outcomes.For doctors,better trust from the patients can affect patients' behavioral intention,encourage doctor-patient communication and therapy plans for better health outcomes in the end.

Humanistic quality of medical workers directly affects the quality of medical service and patient satisfaction.In view of patient′s value demand,this paper identified main setbacks in humanistic service in China in the course of medical service.The authors found out the reasons for the lack of humanities quality,and interpreted medical humanistic spirit,medical professional spirit,medical ethics and morality,and connotation of medical law culture.On such basis,the paper unveiled the importance of medical humanities accomplishment in medical practice and medical students′training,proposing to promote the concept of humanistic spirit of medicine and the doctor-patient communication skills.

Objective To explore the clinical efficacy of minimally invasive implantation figure-ofeight steel plate in treatment of children with lower limb angular deformity caused by a variety of reasons.Methods The clinical data of 35 lower limb angular deformity children who treated with minimally invasive implantation figure-of-eight steel plate half epiphyseal plate block method were retrospectively analyzed.During pre-operation and post-operation,the X-ray of both lower limb was shoot,the mechanical axis of lower limb and femoral tibial angle (FTA) were measured,and the clinical efficacy combining clinical results was assessed.Results All the children were completed the follow-up,the average follow-up was 15 (13-20)months.The 35 children with lower limb angular deformity achieved satisfactory correction and restored normal the mechanical axis of lower limb.All children were normal,and no complications of epiphyseal plate injury were found,except 1 child appeared incision fat liquefied and healed after secondary wound debridement and suture.Conclusions Minimally invasive implantation figure-of-eight steel plate half epiphyseal plate block method in treatment of the children with lower limb angular deformity is simple,cheap,effective,needless osteotomy,well tolerated and with less complications.It is an easily learned technique for osteology surgeons and to be worth generalization at clinical especially those hospitals without establishing special department of children' s osteology.

Background Epithelial-mesenchymaltransition (EMT)isamajorcontributortothe pathogenesis of posterior capsular opacification(PCO).Kruppel-like factor 6 (KLF6) is a zinc finger protein,which can be stimulated by high glucose in proximal tubule cells and involved in transforming growth factor beta (TGF-β)induced EMT of diabetic nephropathy.ObjectiveThis study was designed to investigate the effect of high glucose on the expression of KLF6 and its target genes( TGFB1,TGFBR1,COLIA1,HSP47) in human lens epithelial cells (LECs).MethodsHuman LECs(SRA01/04) were cultured and exposed to different concentration of glucose.The expressions of KLF6 mRNA and protein were analyzed by real time polymerase chain reaction( real time PCR) and western blot after treatment with high glucose.The expressions of KLF6 target genes were analyzed by real time PCR to evaluate the EMT of SRA01/04 cells.ResultsCompared with the control group(5.5 mmol/L),the relative mRNA levels of t-KLF6 and wt-KLF6 in SRA01/04 treated with high glucose(22.2,44.4,66.6 mmol/L) increased obviously (F =72.53,42.02,P＜0.01 ).Then,the concentration of 22.2 mmol/L was used in the next experiments.The relative mRNA levels of t-KLF6 and wt-KLF6 increased to the peaks after treatment with high glucose for 12 h,and began to decrease after 24 h until lower levels after 48 h ( F =100.12,125.52,P ＜ 0.01 ).Western blot showed that the expression of KLF6 protein was also upregulated by high glucose treatment.With the promotion of the expression of KLF6 gene,the relative mRNA levels of TGFB1,TGFBR1,COLlAl and HSP47 of treated cells also respectively increased after treatment for 12 h,and began to decrease after 24 h until nearly at the levels of the control groups after 48 h( F=6.73,162.35,64.39,12.05,P＜0.05 ).ConclusionsIt was concluded that high glucose induced the expression of KLF6 in human LECs,and KLF6 transiently stimulated the expression of target genes TGFB1,TGFBRl,COLlAl and HSP47 which were mainly involved in the mechanism of EMT.

Liver ischemia reperfusion injury is a common pathophysiological process in hepatic surgery,which is the consequence of multiple mechanisms such as oxidative stress,inflammatory reaction,apoptosis,and autophagy and so on.However,the molecular mechanisms behind these processes have not been completely elucidated,the current treatment of liver I/R injury is merely supportive care,and thus new therapeutic strategies are needed.The recent studies indicate that the ischemic precondition and pharmacological precondition may protect the liver against hepatic ischemiareperfusion injury.It will be an important clinical significance of further studying its molecular mechanisms and protective strategies.

From the aspects of advantages, barriers, opportunities and challenges, this paper analyzed the environmental factors of Shanghai medical resources serving people in the Pan-Yangtze River Delta. As envisaged by the author, such services will provide medical resources information to patients from outside Shanghai, probe into feasible ways to medical insurance based on experiences drawn from serving such patients, help with the resources integration of medical systems in Shanghai, and probe into the potentials of telemedicine and distant medical e-learning, as well as improve hospital management levels and service functionality.