OBJECTIVE:To provide reference for comprehensive intervention and management of chronic disease in China.METHODS:The global chronic disease trends and disease burden were summarized;theoretical framework,practice and experience of international chronic disease management were summarized and analyzed as well as enlightenment on domestic chronic disease management.RESULTS&CONCLUSIONS:Worldwide prepresentative chronic disease theory model mainly involved USA chronic disease nursing model and WHO innovation care for chronic conditions.Main experience of international chronic disease management is that managing based on community,confirming preferential intervened disease types,adopting standardized clinical diagnosis and treatment pathway,designing rational transfer treatment system,providing patient self-management support.At pres ent,chronic disease management have been improved in China,but is still poor in community management.It is necessary to strengthen community medical staff training about chronic disease prevention and treatment and health education for social group.

Objective To investigate the efficacy and safety of amisulpride and clozapine in schizophrenia patients with predominantly negative symptoms.Methods Totally 166 cases of schizophrenia patients with predominantly negative symptoms from May 2013 to May 2016 in The Sixth People's Hospital of Hebei were divided into observation group and control group,83 cases in each group.Patients in the observation group were treated with amisulpride,and control group were treated with clozapine.The clinical effect,SANS scores,and occurring rate of abnormal electrocardiogram were compared.Results The clinical effect,emotional insipid (blunting),and attention dysfunction scores from SANS of observation group were significantly better than those of control group on week 4,8,and 12,respectively (P ＜ 0.05);The occurring rate of abnormal electrocardiogram in observation group was significantly lower than that of control group on week 12 (P ＜ 0.05).Conclusion Compared with clozapine,amisulprid has better efficacy and safety in schizophrenia patients with predominantly negative symptoms,and can effectively improve of symptom of insipid (blunting) and attention dysfunction.

Objective To explore the emotional socialization development between boys and girls aged 1-3 years. Methods A total of 1008 children were randomly selected with 571 boys and 437 girls. Chinese version of Urban Infant-Toddler Social and Emotional Assess-ment (CITSEA) was used to assess the emotional socialization development situation between boys and girls. Results There were statistical-ly significant differences between boys and girls in the overt behavior domain and ability domain of CITSEA (t>2.136, P<0.05), and was not in the covert behavior domain and imbalance domain (t<1.172, P>0.05). Conclusion There are gender differences in emotional socialization development of children.

Objective To investigate the incidence,location and morphological features of Laimer fibers between mucosal layer and inner circular muscularispropria in patients with achalasia.Methods Data of 107 patients with achalasia who underwent POEM between May 2010 and June 2013 were collected.Endoscopic video was reviewed to determine the incidence of Laimer fibers and the corresponding images were analyzed according to gender,age,Ling typing and location of Laimer fibers.Results Laimer fibers were found in lower esophageal sphincter of 44 patients (41.12％).There were no significant differences in the incidences of Laimer fiber among groups with different age or gender (P ＞ 0.05).The incidence in Ling type Ⅱb was 46.15％ (12/26),and 45.83％ (22/48) in Ling type Ⅰ,0 in Ling type Ⅲ.There was no significant difference among the groups of Ling type (x2 =2.042,P =0.564).All Laimer fibers were found in lower esophageal sphincter and the majority of which were in right wall (36.45 ％,39/107),followed by left wall (3.74％,4/107) and none was found in anterior wall (x2 =107.468,P =0.000).Conclusion Laimer fibers generally exists in lower esophageal sphincter and most of which are discovered on right wall of the esophagus.Further study is needed to explore its role in development and treatment of achalasia.

[ ABSTRACT] AIM:To investigate the changes of migration of lung adenocarcinoma cells promoted by IL-8 and the inner and outer mitochondrial membrane dynamic changes during this process.METHODS:Human lung adenocarci-noma cell line A549 was divided into control group and IL-8 group.Cell migration was analyzed by scratch detection and Transwell assay.The secretion of endogenous IL-8 was detected by ELISA.The protein levels of mitochondrial cytochrome C ( Cyt C) and mitochondrial outer membrane protein Tom20 was detected by Western blot.The mRNA expression of mito-chondrial fusion genes Mfn1, Mfn2 and OPA1 and fission genes Fis1, Drp1 and MTP18 was detected by RT-PCR.The morphological changes of mitochondria were observed by MitoTracker Red CMXRos dye staining and confocal microscopy. RESULTS:The migratory rate of A549 cells and endogenous secretion of IL-8 in A549 cells were higher than those in SPC-A-1 cells.The migratory rate of A549 cells was improved by IL-8 in a time-dependent manner.Compared with control group, the Tom20 protein expression was increased ( P<0.05 ) , and the Cyt C protein expression was decreased ( P<0.05).The expression of mitochondrial outer membrane fusion genes Mfn1 and Mfn2 was increased (P<0.05), and the expression of mitochondrial inner membrane fusion gene OPA1 was decreased (P<0.05).The expression of fission genes Drp1 and MTP18 were decreased (P<0.05), while the expression of Fis1 was no change (P>0.05).Under confocal microscope, the punctate aggregates in the mitochondria of the A549 cells treated with IL-8 were observed.CONCLU-SION:The migratory rate of A549 cells is increased by IL-8, which is related to the changes of mitochondrial fusion genes and the fission genes.

Objective To detect serum brucellosis in high risk population,three methods were used and their advantages and disadvantages was compared.Methods In accordance with the surveillance standard for brucello-sis(GB 16885 -1997)and brucellosis diagnostic criteria(WS269 -2007)in the prescribed method,rose -bengal plate agglutination test (RBPT),standard -tube agglutination test (SAT)and enzyme linked immunoassay assay (ELISA)were used to detect brucellosis and analysis of its diagnostic significance in the high risk population of sheep farm of Guoyang county in Anhui province.Results The positive rates of RBPT,SAT and ELISA were 19.1%,12.1% and 16.3% in 257 blood samples,respectively.Compared to SAT,the sensitivity,specificity,accura-cy and the area under the ROC curve of RBPT were 88.5%,91.8%,91.4%,0.81,respectively,which of ELISA were 93.9%,95.1%,94.9%,0.88.Conclusion The sensitivity,specificity,accuracy and the area under the ROC curve of ELISA were higher than those of other methods.Proper method,early surveillance and effective technology can help to control the occurrence and epidemic of brucellosis in the actual test work promotion.

Objective:To evaluate the effect of tropisetron on pyroptosis in cardiomyocytes subjected to hypoxia-reoxygenation (H/R) and the relationship with α7 nicotinic acetylcholine receptor (α7nAChR).Methods:Routinely cultured H9C2 cardiomyocytes were divided into 4 groups ( n=6 each) using a random number table method: control group (C group), H/R group, tropisetron plus H/R group (Tro+ H/R group), and α7nAchR antagonist MLA plus tropisetron plus H/R group (MLA+ Tro+ H/R group). H/R was produced by 12 h exposure of cells to hypoxia followed by 6 h reoxygenation in the other three groups except group C. Tropisetron at the final concentration of 10 nmol/L was added at 1 h before hypoxia in group Tro+ H/R.In group MLA+ Tro+ H/R, MLA was added at 2 h before hypoxia, and then 1 h later tropisetron at the final concentration of 10 nmol/L was given.At 6 h of reoxygenation, the pyroptosis rate of cardiomyocytes was determined by fluorescence immunostaining of caspase-1-AlexaFluor 488/DAPI, the concentrations of interleukin-1beta (IL-1β) and IL-18 in the supernatant were determined by enzyme-linked immunosorbent assay, the activity of LDH in the supernatant was measured by 2, 4 dinitrophenylhydra-zine colorimetric method, and the expression of α7nAchR, NLRP3 and caspase-1 in cardiomyocytes was detected by Western blot. Results:Compared with group C, the pyroptosis rate, activity of LDH and concentrations of IL-1β and IL-18 in the supernatant were significantly increased, the expression of NLRP3 and caspase-1 was up-regulated, and the expression of α7nAchR was down-regulated in group H/R ( P<0.05). Compared with group H/R, the pyroptosis rate, activity of LDH and concentrations of IL-1β and IL-18 in the supernatant were significantly decreased, the expression of NLRP3 and caspase-1 was down-regulated, and the expression of α7nAchR was up-regulated in group Tro+ H/R ( P<0.05). Compared with group Tro+ H/R, the pyroptosis rate, activity of LDH and concentrations of IL-1β and IL-18 in the supernatant were significantly increased, the expression of NLRP3 and caspase-1 was up-regulated, and the expression of α7nAchR was down-regulated in group MLA+ Tro+ H/R ( P<0.05). Conclusion:α7nAchR is involved in the process of tropisetron inhibiting pyroptosis in cardiomyocytes subjected to H/R.

Objective To explore the differences between patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied with or without community-acquired pneumonia (CAP).Methods We collected 141 patients with COPD who met the admission criteria and had multiple acute exacerbation hospitalization history.Among them,40 patients with AECOPD accompanied with or without acute exacerbation of hospitalization of CAP (group A),38 patients with AECOPD accompanied with acute exacerbation of hospitalization of CAP (group B) and 63 patients with AECOPD but without acute exacerbation of hospitalization of CAP (group C).The demographic differences of age,sex and smoking status were analyzed and compared.The clinical symptoms and blood-related inflammatory indicators of pa tients in group A were analyzed and compared under the acute aggravation of CAP.The number of acute hospitalizations in 12 months before onset and 12 months after discharge were tracked.Results The age,smoking rate,COPD-GOLD classification,dyspnea index,anxiety and depression score in group A were higher than those in group B and C,while the percentage of forced expiratory volume in the first second (FEV1) in predicted value was lower than that in group B and C.The proportion of patients who cooperated or needed long-term home oxygen therapy and drug therapy was higher than that in group B and C,with statistical significance (P ＜ 0.05),but there was no statistical difference in each index between group B and C (P ＞ 0.05).The clinical symptoms of cough,expectoration,fever and other blood-related inflammatory indicators were aggravated in group A when accompanied with CAP.The number of acute hospitalizations in 12 months after discharge of AECOPD without CAP was significantly higher than that of COPD with CAP (P ＜ 0.05),while there was no significant difference in blood gas analysis indicators between the two cases (P ＞ 0.05).The number of hospitalizations in 12 months after discharge,percentage of neutrophils (N)and the level of interleukin (IL)-17 were independent clinical predictors of COPD with CAP.Conclusions Patients with AECOPD accompanied with or without CAP (group A) had poor lung function,worse illness conditions,greater support of home oxygen therapy and drug therapy and poor quality of life.Patients with AECOPD accompanied with CAP had more symptoms and higher levels of inflammatory indicators,but less risk of re-hospitalization in 12 months after cure than AECOPD patients without CAP.The number of hospitalization in 12 month after discharge,the percentage of neutrophils (N),and IL-17 level were helpful in screening the patients with CAP from the AECOPD patients.

Objective To investigate the current status and characteristics of the use of essential medicines in Chinese Medicare patients aged 65 and over.Methods Using the database from China Medical Insurance Research Association's research group to statistically analyze the total amount and the average cost of chemical and biological essential medicines for outpatients and emergency cases according to age groups in 2013 2015,and ranking and analysis were focused on the expenditure and the number of prescriptions of essential medicines for patients aged 65 and over.Additional analyses were made based on four regions (Eastern,Central,West and Northeast) and medical institutions of different levels.Results The data included nearly 20 million items of medications (4.43 million for patients ≥65 years,) and 307 essential medicines.In Western China,the portion of consumption of national essential medicines by patients aged 65 and over was 46.68％,which was higher than in any other regions.The portion of consumption by tertiary hospitals was the highest among all levels of medical institutions (＞ 40.00％).In all regions and medical institutions,cardiovascular drugs,hormones and endocrine drugs,and antimicrobials were the top categories for patients aged above 65,in terms of both expenditure and prescription numbers.There were some differences in the rankings of prescription numbers for essential medicines between patients aged 65 and over and those aged below 65.The numbers of prescriptions of the top 20 drugs varied little in different regions and medical institutions,and only a few drugs' rankings were different.Conclusions There are some differences in categories and rankings of commonly used essential medicines between younger and elder patients with medical insurance,and cardiovascular drugs are the most commonly used in patients aged 60 and over.These are in line with the spectrum and pathophysiological characteristics of diseases in the elderly.The types of basic drugs most commonly used by outpatients aged 65 and over have stayed stable across regions,and can provide clinical data for the selection of essential medicines with full cost reimbursement for elderly patients.

Objective To evaluate the effect of TanshinonneⅡA preconditioning on nuclear factor kappa B ( NF-κB ) signaling pathway in N9 cells subjected to oxygen-glucose deprivation and restoration ( OGD∕R) . Methods N9 cells cultured in vitro were divided into 4 groups ( n=16 each) by using a ran-dom number table method: control group ( C group) , OGD∕R group, vehicle group ( V group) and Tanshi-none ⅡA preconditioning group ( TP group) . N9 cells were subjected to O2-glucose deprivation for 4 h fol-lowed by restoration of O2-glucose supply for 24 h to establish the OGD∕R model. Group C receive no treat-ment. In group TP, N9 cells were cultured in medium containing Tanshinone ⅡA ( final concentration 5 mg∕L) for 24 h before the model was established. Dimethyl sulfoxide was added to the culture medium in group V. At the 24 h of reoxygenation, the level of lactate dehydrogenase ( LDH) and nitric oxide ( NO) in culture medium was detected by spectrophotometry, cell apoptosis was assessed by using TUNEL, and the expression of NF-κB in nucleus was detected by Western blot. The apoptosis rate was calculated. Results Compared with group C, the levels of LDH, IL-β, TNF-α and NO in culture medium and apoptosis rate were significantly increased, and the expression of NF-κB in nucleus was up-regulated in OGD∕R, V and TP groups ( P<0. 05) . Compared with group OGD∕R, the levels of LDH, IL-β, TNF-αand NO in culture me-dium and apoptosis rate were significantly decreased, and the expression of NF-κB in nucleus was down-reg-ulated in group TP ( P<0. 05) , and no significant change was found in the parameters mentioned above in group V ( P>0. 05 ) . Conclusion The mechanism by which Tanshinonne ⅡA preconditioning reduces OGD∕R injury to N9 cells is related to inhibiting NF-κB signaling pathway.