Health policy research could provide prospecting and effective references and suggestions for top-level design of the new medical reform.Advocacy Coalition Framework was a very important model for the research policy change that synthesizes institutional economics,political science and other theories,which had strong explanatory power in many policy areas of high-income countries.However,China was still in its infancy.It introduced the main ideas of the framework,development,application status of health policy field at home and abroad,and put forward the future research direction in the field of health policy that in order to promote the application of the framework in health policy research in China.improve the theoretical and scientific levels of the policy research.

By taking doctors looking for a job in a certain city of Shandong Province as the research object, this paper to explore the career cognition influence path and degree of career intention among general practitioners.After building a general practitioners' career cognition and intention analysis framework, and conducting random sampling among doctors, this paper uses factor analysis to obtain factor scores and adopts structural equation model to conduct analysis and verification, by taking career cognition as independent variables, career identity and income expectation as intermediary variables, career intention as dependant variables.The empirical results show that the career cognition affects income expectation, which in turn affects career recognition, and the indirect effect on career intention is ultimately also significant.In practice, as these results help to understand the relationship between these variables, the government should consider the impacts of policy on career cognition among general practitioners when formulating policies.

Objective To compare clinical efficacy of clobetasol propionate ointment and vitamin A acid cream in the treatment of skin papule type amyloidosis.Methods 100 cases of skin papule type amyloidosis were randomly divided into the observation group and control group,each had 50 patients.The control group was treated with Vitamin A acid cream while the observation group used clobetasol propionate ointment for treatment.Skin lesion area,infiltration,skin color,skin itching score as well as the cure rate and efficiency were compared after 4 weeks of treatment.Results The two groups' symptoms was improved,symptom scores was decreased gradually after treatment than before,the observation group's symptom scores at 1,2,3,4 weeks were (9.35 ± 1.88),(6.54 ±2.16),(4.08 ±1.32),(2.04 ± 0.95) points which was significant better than (10.86 ± 2.08),(7.98 ± 2.57),(6.25 ± 1.44),(4.56 ± 1.18) points of the control group,the difference of two groups was statistically significant (t =6.22,6.71,7.30,7.41,all P ＜ 0.05) ;4 weeks after treatment,the observation group's efficience and cure rates were 94％ and 34％,significantly higher than 70％ and 22％ of the control group,the difference was statistically significant (x2 =9.040,8.391,all P ＜ 0.05).Conclusion Clobetasol propionate ointment has a exact effect in treatment of skinpapule type amyloidosis than vitamin A acid cream,which is worthy of clinical application.

Objective To evaluate the effects of ultraviolet A (UVA) on autophagy in human skin fibroblasts (HSFs).Methods Cultured HSFs were randomly divided into chronic and acute UVA radiation groups.HSFs in the chronic UVA radiation groups were irradiated with UVA at 5,10 and 20 J/cm2 separately once a day for 4 consecutive days,with HSFs receiving no radiation serving as the chronic radiation control group;HSFs in the acute UVA radiation groups received a single session of radiation with 5,10,30 and 60 J/cm2 UVA separately,with HSFs receiving no radiation serving as the acute radiation control group.After additional culture for different durations,methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferative activity of HSFs,monodansylcadaverin (MDC) staining to determine autophagy levels,and Western blot analysis to track the conversion of the microtubule-associated protein 1 light chain-3 (LC3)-Ⅰ to LC3-Ⅱ.Statistical analysis was carried out by using one-way analysis of variance followed by Students-Newman-Keuls (SNK) test for multiple-group comparisons and by the independent sample t test for two-group comparisons.Results The cellular proliferative activity significantly decreased in the 3 chronic radiation groups at 1 hour after the final UVA radiation compared with the chronic radiation control group (F =155.5,P ＜ 0.05),and in the 4 acute radiation groups at 1,6 and 12 hours after UVA radiation compared with the acute radiation control group (F =1 335,1 649,2 774,all P ＜ 0.05).MDC staining showed that the autophagy levels in HSFs significantly increased in the 3 chronic radiation groups after UVA radiation compared with the chronic radiation control group (F =748.62,P ＞ 0.05),but showed no significant changes in any of the acute radiation groups at 1,6 or 12 hours after UVA radiation compared with the acute radiation control group (F =0.014,0.004,0.002,all P ＞ 0.05).The ratio of LC3-Ⅱ to LC3-Ⅰ was significantly elevated in all the 3 chronic radiation groups at 1 hour after UVA radiation compared with the chronic radiation control group (t =9.002,21.772,18.33,all P ＜ 0.05),but experienced no obvious changes in any of the acute radiation groups at 1,6 or 12 hours after UVA radiation compared with the acute radiation control group (F =0.13,0.27,0.06,all P ＞ 0.05).Conclusion Chronic UVA radiation can upregulate autophagy levels in HSFs,but acute UVA radiation has no evident effects on it.

Objective To evaluate the effects of alpha-lipoic acid (α-LA)on autophagy in human skin fibroblasts (HSFs). Methods HSFs at passage 3 - 5 were divided into several groups to be cultured with α-LA at final concentrations of 0, 0.01, 0.05, 0.10, 0.15, 0.20 and 0.50 mmol/L for 4, 12 and 24 hours, respectively. Methyl thiazolyl tetrazolium(MTT)assay was performed to evaluate cellular proliferative activity, monodansylcadaverin(MDC)staining to determine autophagy levels, and Western blot to measure the expression of the microtubule-associated protein 1 light chain-3B(LC3-B). Results After incubation for 24 hours, there was a significant difference in the proliferative activity of HSFs among all the groups (F = 10.41, P < 0.05), while no significant differences were observed after incubation for either 4 or 12 hours (F = 2.85, 1.34, respectively, both P > 0.05). MDC staining also showed a significant difference in the percentage of autophagosome-positive cells among all the groups after 24-hour incubation (F = 8.03, P < 0.05), but no significant difference after either 4- or 12-hour incubation (F = 0.11, 0.10, respectively, both P > 0.05). Western blot revealed that the degree of conversion from LC3-Ⅰ to LC3-Ⅱ(LC3-Ⅱ/LC3-Ⅰratio)was significantly different among all the groups after 24-hour incubation (F = 37.49, P < 0.05), but similar after 4- and 12-hour incubation (F = 3.38, 2.13, respectively, both P > 0.05). Conclusion α-LA may inhibit basal autophagy in HSFs.

Background and purpose: FGFR2 is a receptor tyrosine kinase and c-Cbl is a new RING finger type of ubiquitin ligase in the ubiquitin-proteasomes path. The purpose of this study was to evaluate the expression and significance of FGFR2 and c-Cbl in gastric carcinoma. Methods: The expression of FGFR2 and c-Cbl were detected by immunohistochemical method of SP. Results: The positive expression rates of FGFR2 and c-Cbl were 77.4%,71.0% in gastric carcinoma, respectively, both were higher than those normal tissue (P<0.05);The expression of FGFR2 and c-Cbl were positively correlated with depth of invasion and TNM staging, and there was a positive relationship between the expressions of FGFR2 and c-Cbl. Conclusion. The expressions of FGFR2 and c-Cbi were associated with some clinicopathologic features in gastric carcinoma, indicating that their expression may be the prognostic factors for gastric carcinoma.

Objective To explore the safety and effectiveness of different reinforcement methods in laparoscopic radical resection of low rectal cancer.Methods The clinical data of 215 patients who underwent laparoscopic radical resection of low rectal cancer in Nan-yang Central Hospital from January 2019 to December 2022 were analyzed retrospectively.According to the different ways of anastomotic reinforcement,the patients were divided into three groups:transanal reinforcement group(n=63),transabdominal reinforcement group(n=69)and non-reinforcement group(control group,n=83).The perioperative related indexes,postoperative complications(anasto-motic leakage,bleeding,stenosis)and postoperative anorectal function were compared among the three groups.Results The incidence of anastomotic leakage and the number of anastomotic bleeding in the reinforcement group were significantly lower than those in the non-reinforcement group,the difference was statistically significant(P＜0.05).There was no significant difference in intraoperative blood loss,postoperative first exhaust time,hospital stay,anastomotic stenosis and anorectal function,the difference was not statistically signifi-cant(P＞0.05).The incidence of anastomotic stenosis in the transabdominal reinforcement group was significantly higher than that in the transanal reinforcement group,the difference was statistically significant(P＜0.05).There was no significant difference in operation time,intraoperative blood loss,postoperative first exhaust time,hospital stay,incidence of anastomotic leakage,number of anastomotic bleeding and anorectal function between the two groups,the difference were not statistically significant(P＞0.05).Conclusion Transanal reinforcement of low colorectal anastomosis can significantly reduce the incidence of postoperative complications,which is a safe and effective reinforcement method in laparoscopic radical resection of low rectal cancer.

Objective:To assess the feasibility and safety of 2-staged hybrid technique for treating coronary artery disease (CAD) patients with multi-vessel lesions.
Methods: Our research included 2 groups:Hybrid group, CAD patients with left anterior descending artery (LAD) lesion or with other major epicardial vessel stenosis>70%who received 2-staged hybrid treatment in our hospital from 2012-03 to 2015-03 and Control group, CAD patients received elective conventional off-pump coronary artery bypass (OPCAB) by the same surgeon at meanwhile. n=91 in each group. The peri-operative conditions and complications were compared between two groups.
Results: Compared with Control group, Hybrid group had the shorter post-operative mechanical ventilation time (7.9 ± 4.8) h vs (21.6 ± 35.9) h, shorter ICU-stay time (29.6 ± 20.8) h vs (47.5 ± 38.3) h, all P<0.01 and less peri-operative blood transfusion (0.59 ± 1.48) U vs (2.82 ± 3.81) U, P<0.01. The post-operative complications of mortality, MI occurrence and delayed wound healing were similar between 2 groups, P>0.05.
Conclusion:2-staged hybrid technique is a safe, feasible and minimally invasive technique for treating CAD patients with LAD and multi-vessel lesions.

Objective Increasing evidence suggest that aberrant activation of PI3K/Akt is involved in many human cancers, and that inhibition of the PI3K/Akt pathway might be a promising strategy for cancer therapy. The study is to evaluate the effects of combined therapy of PI3K inhibitor (LY294002) and Ad-PTEN in athymic mice xenogeneic transplant model of human glioma and to reveal the possible mechanisms involved.Methods Twenty-four athymic mice were randomly divided into 4 groups (DMSO、Ad-vector plus DMSO、LY294002 alone and Ad-PTEN plus LY294002), and were treated, respectively. Athymic mice xenogeneic transplant model was established by inoculation (sc) with LN229 glioma cells. Body mass (BM) and diameter of tumor mass were measured. Furthermore, The protein expressions of PTEN、p-Akt、CyclinD1、Caspase-3、MMP-2、p-FAK in tumor tissues were analyzed with immunohistochemistry.Results The tumor-inhibiting rate of was significantly higher in Ad-PTEN plus LY294002 than in the LY294002 alone (92.46 vs 65.59%)( P <0.05).The protein expressions of PTEN and Caspase-3 were significantly higher, while PCNA、CyclinD1、bcl-2 and MMP-2、p-FAK was significantly lower in Ad-PTEN plus LY294002 group than in the other three groups ( P <0.05).Conclusions LY294002 plus Ad-PTEN achieve better outcome than either alone in treating glioma possibly through enhancement of the inhibitory action of PI3K/Akt pathway and Ad-PTEN pathway.

Objective To evaluate the safety and efficacy of overlapping sirolimus-eluting stent (SES) for long lesions during primary percutanous coronary intervention(PCl) in elderly patients with ST-segment elevation myocardial infarction (STEMI).Methods Seven hundred and seventy-five elderly patients with STEMI who underwent primary PCI were enrolled and followed up. Patients with two or more SES implanted for long lesions during PCI were taken as long lesion group and patients with single stents implanted were regarded as control group. The safety endpoints were in-hospital and follow-up death and stem thrombosis, and the clinical endpoints were the incidence of restenosis and target vessel revascularization rate during in-hospital follow-up and 6 months" follow-up.Results Among 775 patients, 62 patients had 64 long lesions. The average number of stents was 2. 2, and the average lesion length and stent length implanted were (45.3±10. 4)mm and (52.2±11.0)mm, respectively. During the 6 months' follow-up, the incidence of angiographically documented stent thrombosis were 1.6% in long lesion group and 1.1% in control group, respectively. No death or myocardial infarction occurred in two groups. There was no significant difference in the incidence of restenosis and target vessel revascularization rate between long-lesion group and control group (8. 1 vs. 4.8%, 6.9% vs. 3. 7%, both P>0.05). Conclusions Overlapping implantation of homemade SES is safe and effective for STEMI patients with long lesions in short-term period.