Objective To investigate current situation of otoscope use by practitioners at community health-care service facilities in Hainan and Shenzhen and explore its importance and feasibility of spread of its use in community health-care service facilities in China.Methods Group discussion, telephone personal interview, otoscope market survey and literature research all were used among 112 practitioners at 67 community health-care service facilities in Hainan, 47 practitioners at 23 community health-care service facilities in Shenzhen, Guangdong, and 11 representatives involved in general practice training from 11 districts.Results In Hainan, only one community health-care service facility ( 1.5% ) was equipped with otoscopes and only one practitioner (0.9% ) could use it.In Shenzhen, two community health-care service facilities (8.7%) were equipped with it, but which had never be used.All the practitioners at community health-care service facilities surveyed have not been trained for its use, so most practitioners there did not have basic skills to use otoscope.Conclusions Otoscope is not equipped at most community health-care service facilities in Hainan and Shenzhen, and it is little used there even equipped with it.Otoscopy should be used as an adequate and feasible technique at community health-care service and be spread among general practitioners in China.

Objective To study the effective method of improving the diagnosis and treatment of blunt liver injury.Methods The clinical data of 135 cases with blunt liver injury hospitalized in Daxing District People' s Hospital from January 2000 to October 2010 were reviewed retrospectively.Results By standard grading of American Society of Trauma Surgery (AAST) in 1994,36 cases were grade Ⅰ,42 cases gradeⅡ,33 cases gradeⅢ,14 cases grade Ⅳ,10 cases gradeⅤ.Fifty-one cases were treated by non-operative therapy,among which 42 cases were crued,9 cases underwent operative surgery.Ninety-three cases were treated by operative therapy,seven cases died.The morbidity related to blunt liver injury was 5.19％.Conclusions Non-operative therapy may be used firstly in patients with stable hemodynamics,but close monitoring should be done for changes of the life signs.Timely and reasonable choice of time and the way of surgery is important to avoid complications and reduce the mortality rate.

Objective To describe well-child care guidelines in the United States and compare it to China's guidelines so as to inform child health policymakers and providers in developing improvements for China well-child care practices.Methods We used a multistage approach to identify features of well-child care guidelines.The following methods are used:literature review,key informant interviews,site visits to both China and the United States and summarization of experiences.The differences and similarities of the contents were compared.Results Both China and the United States emphasize the importance of well-child care and the basic contents such as immunization,growth monitoring,lab screening and health education are similar for well-child care from 0 to 6 years old.Differences exist in that China's well-child guidelines are a set of general principles,without specific instructions,and only cover children from 0 to 6 years old.There are no guidelines in China for children older than 6 years old.Conclusions China needs a more detailed well-child care guidelines with specific instructions for all-aged children; despite some similarities,there are applicable learnings from that of the United States' for improvement in China's.

Background:Esophageal cancer is a common gastrointestinal cancer with poor prognosis,and effective chemotherapy is lacking currently. Studies have shown that cardiac glycosides can inhibit tumor cells growth,but its mechanism has not been fully clarified. Aims:To investigate the effect and mechanism of ouabain in regulating proliferation of human esophageal carcinoma cells. Methods:OE19 human esophageal carcinoma cells were treated with ouabain,and cells in control group were treated with DMSO. Cell proliferation was assessed by cell counting method. mRNA expressions of Sox2,Sox4,Sox7,Sox9 and Sox10 were determined by real-time PCR. Protein expression of Sox4 was determined by Western blotting. Gene expressions of phospho-histone3( ph3),a cell proliferation marker and Sox4 were detected by immunofluorescence staining. Results:Ouabain( ≥ 40 nmol/ L)could significantly inhibit OE19 cells proliferation. mRNA and protein expressions of Sox4 were significantly decreased in OE19 cells in ouabain(40 nmol/ L)group than those in control group(P < 0. 05). No significant differences in mRNA expressions of Sox2,Sox7,Sox9 and Sox10 were found between the two groups(P > 0. 05). Gene expressions of ph3 and Sox4 in nucleus of OE19 cells were decreased in ouabain (40 nmol/ L)group than those in control group. Conclusions:Ouabain is effective in inhibiting human esophageal carcinoma cells proliferation,the underlying mechanism might be related with down-regulation of Sox4 expression and the subsequent cell cycle modulation.

Objective To study the probability of transferring the regulatory T cells induced by TGF-β1 to prolong the allograft survival and the mechanisms involved.Methods According to the different culture conditions.three experimental groups were established:control group(T cells from C57 BL/6 mice cultured with II-2),MLR group(T cells from C57BL/6 mice activated by alloantigen)and TGF-βgroup(T cells from C57BL/6 mice activated by alloantigen and cultured with 5.0 ng/ml TGF-β1).After the culture,the ratio of CI4+CD25+T and the Foxq3 expression were measured by FACS and RT-PCR,respectively.On 9th day,the pathologic analysis was performed and the ratios of TH1,TH2 and Treg and the proliferation of lymphocytes were measured.Results The ratio of CD4+CD25+T in TGF-β group was higher than that in control group and MLR group(P<0.05),and Foxp3 was expressed in CD4+CD25+T cell from TGF-βgroup.After transferring ofthe cells,the allografi survival time in TGF-β group was prolonged and its mean survival time(MST)was(22.8±1.9)d,which was longer than that in MLR group and control group (P0.05),lower than that of control group(P<0.05). And the ratio of CD4+CD25+T in TGF-β group was higher than that in control and MLR group obviously(P

This study reviewed the reasons for encounter (RFE),diagnoses and the diagnostic categories of patients aged 0-14 y in general practice clinic affiliated to a tertiary hospital from June 2011 to May 2012.The results showed that the most frequent RFE was cough,at a rate of 29.6 per 100 encounters;the second one was fever (21.4％) and the third was nasal problems (9.5％).Medical examinations,skin rashes and follow-up encounters occurred at equal rates (5.2％).The most frequent diagnosis was acute upper respiratory tract infection (41％).Medical examination (6.3％),other viral diseases (5.1％),pneumonia (3.6％) and no detected disease (3.6％) were also common diagnoses.The diagnostic categories included all systems,and the problems of the respiratory system (56.4％) were most common.The results suggest that pediatric care comprises a very important part of primary care.

Objective To construct the recombinant plasmid of protein CFP10-MPT48-TB8.4 of Mycobacterium tuberculosis and to investigate the diagnosis potential of this fusion protein in tuberculosis serodiagnosis.Methods The recombinant fusion protein CFP10-MPT48-TB8.4 was expressed, and identified by Western blot.The ELSIA based on the purified fusion protein was done,and used for screening in 230 cases of clinical serum samples including pulmonary tuberculosis patients ( n =150 ),pulmonary disease patients other than tuberculosis (n =70) and health controls (n =103 ).The test result was analyzed by Medcale11.5 software.Results The fusion protein CFP10-MPT48-TB8.4 was successfully expressed with a purity over 95％.Specific immunogenicity of the recombinant protein was confirmed by Western blot.The overall sensitivity and specificity obtained of ELISA were 56.7％ (85/150) and 90.8％ ( 157/173 ),respectively.The specificity was 85.7 ％ (60/70) in non-tuberculosis group and 94.2％ (97/103 ) in healthy group,respectively.Conclusion The recombinant protein of CFP10-MPT48-TB8.4 has a high sensitivity and specificity and may be a potential candidate antigen in tuberculosis serodiagnosis.

Objective To summarize the clinical experience of ESWL under B ultrasound guidance in treatment of urinary stones.Methods The clinical data of 20 625 patients who underwent B ultrasound-guided ESWL between August 1995 and July 2011 were retrospectively analyzed.Of the stones,8659cases were in the kidney,11 712 cases were in the ureter,and 254 cases were in the bladder.And 1965stones were radioparent.Results The stone fragmentation rates of the kidney,ureter and bladder stones were 96.27％ ( 8336/8659),97.56％ ( 1 1 426/1 1 712) and 99.21％ ( 252/254),respectively.The total stone fragmentation rate was 97.04％ (20 014/20 625 ).The 3-month stone-free rates of the kidney,ureter and bladder stones were 86.63％ (7501/8659),95.32％ ( 11 164/11 712) and 97.24％ (247/254),respectively.The total 3-month stone-free rate was 91.69％ (18 912/20 625).The stone fragmentation rate of radioparent stones was 97.91％ ( 1924/1965 ),and the 3-month stone-free rate was 94.40％ ( 1855/1965).Conclusion B ultrasound-guided ESWL is safe and effective in the treatment of urinary stones.

Objective To explore the prognostic value of Acute Kidney Injury Network (AKIN)criteria combined with Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)and Sequential Organ Failure Assessment(SOFA)scoring system in acute kidney injury(AKI)after cardiac surgery. Methods Clinical data of patients who underwent open-heart surgery in Zhongshan Hospital,Fudan University from April 2009 to August 2009 were prospectively collected.AKI after cardiac surgery was classified by AKIN staging system.APACHE Ⅱ and SOFA scores were evaluated according to the worst value of physiologic variables in the 1st 24 h after surgery.Discrimination and calibration of these three models were assessed by receiver operating characteristic(ROC) curve and Hosmer-Lemeshow goodness-of-fit test.Besides,their effects on inhospital mortality were evaluated by multivariate Logistic regression analysis. Results Of the 993 admissions,309 patients developed AKI and the incidence was 31.1%.The median time that developed postoperative AKI and reached the Scr peak were 1 d and 2 d respectively.Either APACHE Ⅱ or SOFA scores,which was positively correlted with the severity of AKI(APACHEⅡr=0.37,P<0.01;SOFA r=0.42,P<0.01)was higher in AKI patients compared with that in nonAKI patients(P<0.01).The mortality rose corresponding to the severity of kidney injury.However,the predicted death rate-adjusted(PDR-A)calculated by APACHE Ⅱ scoreS Was higher than the actual value in non-AKI patients and AKIN stage 1(P<0.01),while it was lower in AKIN stage 3 (P<0.01).The areas under the ROC curve of APACHEⅡ,SOFA and AKIN criteria were all above 0.8 and the results of Hosmer-Lemeshow goodness-of-fit test indicated good calibration of three models.Multivariate analysis showed that APACHE Ⅱ≥19(OR=4.26)and AKIN stage 3(OR=76.151 were independent predictors of in-hospital mortality. Conclusions AKI can be classified by AKIN criteria in the early stage after cardiac surgery and the AKIN staging system may serve the prediction of prognosis.The APACHE Ⅱ and SOFA scores just evaluated in the 1st 24 h after operation can discern the severity of patients'illness.Three models all present good discrimination and calibration in predicting patients'outcome.APACHE Ⅱ≥19 along with AKIN stage 3 are found to be the independent predictors of in-hospital mortality.It should be noticed that the deviation between PDR-A and the actual mortality in subgroups,dynamic evaluation may raise the accuracy of scoring system.

Objective To prepare recombinant adenovirus pAd-gal-9 containing murine galectin-9 and explore galectin-9's pro-apoptotic effect on T lymphocytes. Methods The recombinant adenovirus plas-mid pAd/CMV/V5-DEST-gal-9 was prepared by conventional molecular cloning and LR reaction. The pAd/ CMV/V5-DEST-gal-9 linearlized by Pac I was transfected into 293A cells with Lipofectin 2000. Eight days after transfection, the 293A cells were subjected to freeze/thraw circle for three times and the supernatant was collected after centrifugation. Higer titer pAd-gal-9 was produced by large-scale infection of 293A cells with the supernatant containing pAd-gal-9. The supernatant was condensed to get purified pAd-gal-9 by CsCl density gradient centrifugation. After titer determination with gradient dilution of harvested pAd-gal-9 infec-tion in 293A-seeded 96-wells, pAd-gal-9 was used to infect the CHO cell line. Immunohistological assay, Western blot and flow cytometry were employed to ascertain the subcellular location expression of galectin-9. We added solid-phase transgenic CHO cells or freshly-cultured supernatant to medium containing activated T cells to detect the pro-apoptotic effect of galectin-9. Results The pAd-gal-9 was prepared successful. Im-munohistochemical staining of CHO infected with pAd-gal-9 confirmed that galectin-9 was expressed in the cytosol. Intercellular staining indicated that mean fluorescence intensity of galectin-9 was significantly higher in pAd-gal-9-infected CHO group than control group. Supernatant from pAd-gal-9-infected CHO promoted the apoptosis of T cells. The percent of apoptotic T cells was higher than the Tim-3 positive T cells. Conclu-sion CHO infected with pAd-gal-9 can secret galectin-9 to promote the apoptosis of activated T cells via Tim-3-independent mechanisms.