Drawing on recently published foreign literature, this paper comprehensively analyses the research status of medical tourism from the concept of decision-making factors and risks for tourists, as well as the impacts of medical tourism. For future research, it proposes a greater focus on medical tourists, caregiver-companions and medi-cal tourism facilitators. To promote the development of Chinese medical tourism, a development model must be con-structed, international medical services, consummate policies, and regulations must be in place, and medical tourism personnel must be trained and welcomed.

Objective: To observe the effect of ultrasound-guided clavicular brachial plexus block in upper limb surgery.Methods: Eighty patients undergoing upper limb surgery were enrolled and randomly divided into two groups: ultrasound-guided clavicular brachial plexus block group (ultrasound guidance group, n=40) and nerve stimulator-assisted positioning of the supraclavicular brachial plexus block group (nerve stimulator group,n =40).The block effect, anesthesia effect, anesthesia completion time, nerve block onset time, nerve block duration and complication were compared and analyzed statistically between the groups.Results: The completed rate of block was 97.5%in the ultrasound guidance group, which was significantly higher than that in the nerve stimulator group (65.0%) (P<0.05);the uncompleted rate was significantly lower than that in the nerve stimulator group.The fine/excellent rate of anesthesia was 95.0% , which was significantly higher than that of the nerve stimulator group (75.0%, 30/40) (P<0.05);the complete time of anesthesia and nerve block onset time were significantly shorter than those in the nerve stimulator group (P<0.05);the duration of nerve block was significantly longer than that in the nerve stimulator group (P<0.05);the incidence of complications was 7.5%), which was significantly lower than that of the nerve stimulator group (37.5%, 15/40) (P<0.05).Conclusion: In upper limb surgery, ultrasound-guided nerve stimulator assisted positioning of clavicular brachial plexus block is better than nerve stimulator assisted positioning of clavicular brachial plexus block.

Objective Applying color Doppler ultrasonic test on the first dorsal metatarsal arteries,to acquire relevant Doppler bloodstream parameters,and in the end,to explore the clinical value of this approach.Methods Applying GE-LOGIQ-400 color Doppler high-frequency ultrasonic test on the first dorsal metatarsal arteries of 100 diabetes patients,contrasting to those of 60 normal persons,observing the origination,trend,smooth of bloodstream,angioplerosis Status,analyzing bloodstream spectrum(including the interior diameter of blood vessel,spectrum status,bloodstream speed,drag index,erc.),and contrasting the resuits.Results The first dorsal metatarsal arteries of diabetes patients have narrower interior diameter,faster bloodstream speed,higher drag index than those of non-diabetes patients.Conclusion The high-frequency color Doppler ultrasonography can provide objective clinical evidence on the test of the first dorsal metatarsal arteries diseases.

Objective To analyze the features of pelvic arteriography in postpartum hemorrhage.Methods The pelvic arteriographic results of postdelivery hemorrhage caused by differeut cause in 10 patients whom were treated with artery embolization were analysed and compared with the clinical data.Results The arteriographic features included irrgeular nodose or diffuse outflow of contrast medium in bilateral upper branches of uterine artery in 5 cases with atonic uterus streaky or cloudy contrast medium in the site of uterine incision in 2 cases after caesarean.In two cases with incomplete laceration in the lower portion of soft puerperant tract,there was distinct outflow of contrast medium in one side or bilateral down branches of uterine artery but its bilateral upper branches was displayed clearly.On angiography in one case with uterine vascular malformation displayed one of upper uterine branch was enlarged and the constrast medium flowed into utrine cavity directly.Conclusion Pelvic arteriography in postpartum hemorrhage with different causes has its special findings.Arteriography in combination with the clinical data can afford more direct and accurate informations for analysing the causes of postpartum hemorrhage causes.

Objective To observe the expression of forkhead or winged helix transcription 3 (Foxp3) in colon cancer tissue and paracancerous tissue,and detect the level of serum interleukin (IL)-17 in colon cancer patients and healthy human,to explore the changes of regulatory T cell (Treg cell) and Th17 cell in the process of occurrence and development of colon cancer.Methods The expression of Foxp3 in 56 patients with colon cancer and paracancerous tissue and 15 cases with normal colon tissue was measured by immunohistochemical SP method and the level of serum IL-17 was determined by enzyme-linked immunosorbent method.Results The level of serum IL-17 in colon cancer tissue was higher than that in normal colon tissue [(9.1 ± 2.3) ng/L vs.(6.2 ± 1.5) ng/L],and there was significant difference (P =0.007).Foxp3 positive cell number in colon cancer tissue was more than that in normal colon tissue and paracancerous tissue (24.1 ± 6.4 vs.2.7 ± 1.1 and 8.7 ± 2.3),paracancerous tissue was more than normal colon tissue,and there was significant difference (P ＜ 0.01).The level of serum IL-17 in colon cancer tissue with TNM Ⅲ was higher than that in TNM Ⅰ-Ⅱ [(8.5 ± 2.1) ng/L vs.(5.4 ± 0.9) ng/L],Foxp3 was more than that in TNM Ⅰ-Ⅱ (25.8 ± 6.2 vs.18.2 ± 4.4),and there was significant difference (P＜ 0.01).There was no significant difference in the level of serum IL-17 between middle-high differentiated adenocarcinoma and low differentiated adenocarcinoma [(9.4 ± 1.1) ng/L vs.(8.9 ± 1.8) ng/L] (P ＞ 0.05).Foxp3 in middlehigh differentiated adenocarcinoma was more than that in low differentiated adenocarcinoma (26.8 ± 5.5 vs.17.2 ± 3.2),and there was significant difference (P ＜ 0.01).Conclusions Detection of IL-17 and Foxp3 can provide a new way of targeting therapy for colon cancer.IL-17 levels and Foxp3 expression are closely related to the immune status of local tumor tissues,the joint detection is benefitial to the further understanding of the patients with tumor immune state,provide basic information for tumor immunotherapy.

Objective:To observe the bone marrow mesenchymal stem cell isolation,identification methods and protection mechanisms in the kidney of diabetic rats.Methods: Thirty-one rats were used to isolate bone marrow mesenchymal stem cells (BMSCs) by adherent culture method.Cell morphology was observed by phase contrast microscope.The surface molecular weight of cultured cells was detected by Real-time PCR.30 rats were induced by intraperitoneal injection of streptozotocin to establish diabetic rat model (n=15).And stem cell treatment group (n=15) according to the different treatment methods.Rats in the control group were treated with insulin combined with probucol.Stem cell treatment group was implanted with stem cells.Before and after treatment,fasting blood glucose,24 h urinary protein excretion,creatinine clearance rate and kidney weight were measured.PAS staining.And the renal tissue was detected by Western blot.Results: The primary bone marrow mesenchymal stem cells (MSCs) were cultured for 24 hours,and the cells were irregularly distributed in the culture flask.After 7 days of culture,the cells were regular,elongated,elliptical,and strong refraction,and the cells were fused with each other.The morphology of BMSCs was uniform and showed a long fusiform shape,CD44,CD31 and CD34 were observed by RT-PCR.The levels of fasting blood glucose,24 h urine protein excretion and creatinine clearance rate in the observation group were significantly higher than those in the control group (P<0.05).The results of PAS staining showed that the glomerular structure was clear,the morphology was regular,the arrangement rules of glomerular cells,the basement membrane and the encapsulation of the glomerular membrane were significantly higher than those of the control group Man′s capsule clear (P<0.05).In the control group,the glomerular volume increased,the mesangial area widened and the stroma increased significantly.The Bcl-2 protein level and the Bax and Caspase-3 protein levels were significantly decreased in the stem cell treatment group.The levels of Bcl-2 and Bax and Caspase-3 protein in the control group were significantly decreased (P<0.05).The ROS,MDA and SOD levels in oxidative stress group were lower than those in control group (P<0.05).The difference of ROS,MDA and SOD between the two groups was not statistically(P>0.05).Conclusion: It is suggested that BMSCs can be isolated from rat bone marrow mesenchymal stem cells by using adherent culture method and labeled with green fluorescent protein in vitro.Bone marrow mesenchymal stem cells can protect the kidney and inhibit the oxidative stress of diabetic kidney.

Objectives Construct a subtractive library of Caski cell line induced by exposing to the space environment by suppression subtractive hybridization and pave the way to explain the molecular mechanisms of the changes at the gene level. Methods Super SMART cDNA synthesis and suppression subtractive hybridization (SSH) were performed to isolate differentially expressed cDNA fragments from strains subclonal 48A9 cell line. cDNA from the 48A9 cell line were used as " tester" , and the other from the control Caski cell line as "driver". Subtractive products were directly inserted into T/A cloning vector, and then transformed into host bacteria to set up a subtractive cDNA library of specially or highly expressed genes in strains subclonal 48A9 cell line. Results mRNA were directly extracted and purified with good quality. Double strand cDNA were reverse transcripted integratedly, and then cut by Rsa I into even length short segments. Liga-tion was identified as high effective. After two hybridizations, a subtractive library of differentially expressed genes in strains subclonal 48A9 cell line was successfully constructed by SSH. Conclusion SSH is an effective approach to isolate differentially expressed genes.

Objective To investigate the value of critical scoring system in the treatment of multiple organ dysfunction after exposure to poisoning by analyzing 3 cases of industrial organic fluorine gas poisoning.Methods Clinical data of symptoms,signs,treatments,outcome and the changes in the scores as APACHE Ⅱ,SOFA,MODS were collected,the differences among the patients were compared and the relevance was analyzed.Results The first APACHE Ⅱ was 19-26.Scores of case 1 in the three scoring systems constantly increased and different components were found,with the suggestion of sequential organ dysfunction.Other two patients' scores decreased and survived without complications.Conclusiorn Multiple critical scoring systems can be used to evaluate the outcome of multiple organ dysfunction due to organic fluorine gas poisoning.System evaluation and individualized treatment are both important.More studies can help to set up a special critical scoring system.

Objective To study the effects of puerarin on proliferation and apoptosis of human gastric cancer MGC-803 and AGS cells.Methods Human gastric cancer cells were treated with puerarin at different concentrations.MTT assay was used to test cell proliferation and FCM was used to detect cell apoptosis.Results The inhibition rates had upwarded trend with increasing concentrations (MGC-803:1.24 ％,2.80 ％,15.10 ％,18.55 ％,59.65 ％; AGS:15.59 ％,25.31％,30.25 ％,36.91％,64.47 ％),when treated with puerarin at different concentrations (1.5,3.0,6.0 12.0,24.0 mmol/L) for 48 hours.Apoptosis rates gradually increased with increasing concentrations (MGC-803:5.49 ％,9.53 ％,13.81％; AGS:6.23 ％,16.38 ％,25.99 ％),when treated with puerarin at different concentrations (0,12.0,24.0 mmol/L) for 24 hours.Conclusion Puerarin inhibits proliferation and induces apoptosis of human gastric cancer cells MGC-803 and AGS.

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