Objective:To study the regulatory effect of Wumen-Yiji powder on 5-hydroxytryptamine (5-HT) signal transduction system in intestine and hypothalamus of diarrhea irritable bowel syndrome (IBS-D) model rats. Methods:Sixty male SD rats were randomly divided into blank group (10 rats) and diarrhea irritable bowel syndrome group (50 rats). The diarrhea irritable bowel syndrome group formed the diarrhea irritable bowel syndrome model after 2 weeks of senna leaf gavage and restraint stress. They were randomly divided into model group, deshute group (1.5 mg/kg), low, medium and high dose group of Wumen-Yiji San (6, 12, 24 g/kg), with 10 rats in each group. After continuous administration for 2 weeks, the contents of 5-HT in serum, colon and hypothalamus were detected by ELISA; HE staining was used to observe the pathological changes of colon in each group. The protein and mRNA levels of tryptophan hydroxylase 1 (TPH-1), serotonin receptor 3 (5-HT3R), serotonin receptor 4 (5-HT4R), serotonin transporter (SERT) in colon and hypothalamus were detected by Western blot and RT-PCR, respectively. Results:Compared with the model group, the pathological morphology of colon in each treatment group was improved. Compared with the model group, the level of 5-HT in serum and colon significantly decreased ( P<0.05), and the level of 5-HT in hypothalamus of rats in the low, medium, high dose group of Wumen-Yiji San significantly increased ( P<0.05). The expression of TPH-1, 5-HT3R and 5-HT4R protein significantly decreased ( P<0.05), and the expression of SERT protein in the medium, high dose group of Wumen-Yiji San significantly increased ( P<0.05). The expression of TPH-1, 5-HT3R and 5-HT4R protein in hypothalamus increased ( P<0.05), and the expression of SERT protein in the high dose group of Wumen-Yiji San significantly decreased ( P<0.05). The mRNA levels of TPH-1 (4.778 ± 0.604, 3.278 ± 0.668, 1.670 ± 0.361 vs. 6.877 ± 0.148), 5-HT3R (3.807 ± 0.463, 2.697 ± 0.455, 1.132 ± 0.136 vs. 6.322 ± 0.778), 5-HT4R (4.521 ± 0.234, 2.801 ± 0.351, 1.331 ± 0.142 vs. 6.741 ± 0.293) in colon tissue of low, medium and high dose groups of Wumen-Yiji San decreased ( P<0.05). The level of 5-HT4R mRNA (0.616 ± 0.208, 0.726 ± 0.226 vs. 0.521 ± 0.062) increased ( P<0.05), and the level of SERT mRNA (1.563 ± 1.023 vs. 2.612 ± 1.035) in medium, high dose group of Wumen-Yiji San decreased ( P<0.05). Conclusion:The result showed that Wumen-Yiji San could regulate the expression of 5-HT signaling system relating proteins and mRNA in the colon and hypothalamus of IBS-D rats within a certain dose range, so as to improve the symptoms of IBS-D.

Objective:To investigate the effects of miRNA-499a-5p targeting CD38 on cardiomyocyte injury induced by hydrogen peroxide (H 2O 2) and the possible mechanism. Methods:H9c2 cardiomyocytes were cultured in vitro and induced with H 2O 2 to establish the cardiomyocyte injury model. Four groups including control, H 2O 2, H 2O 2+ negative control (NC) and H 2O 2+ miRNA-499a-5p groups were set up. Real-time quantitative PCR (RT-qPCR) and Western blot were used to detect the expression of miRNA-499a-5p and CD38 in cardiomyocytes, respectively. MTT assay was used to measure the survival rates of cardiomyocytes. The levels of reactive oxygen species (ROS) and the activity of lactate dehydrogenase (LDH) were analyzed with test kits. Annexin V-FITC/PI double staining method was used to detect the apoptosis rates of cardiomyocytes. Western blot was used to detect the expression of B-cell lymphoma/leukemia-2 (Bcl-2), Bcl-2-related X protein (Bax), phosphoinositide 3-kinase (PI3K), phosphorylated PI3K (p-PI3K), protein kinase B (Akt) and phosphorylated Akt (p-Akt). Dual luciferase reporter assay was used to detect the targeting relationship between miRNA-499a-5p and CD38. Results:Compared with the control group, the expression of miRNA-499a-5p, Bcl-2, p-PI3K and p-Akt and the survival rate of cardiomyocytes were significantly reduced in the H 2O 2 group ( P<0.05), while the expression of CD38 and Bax, ROS level, LDH activity and the apoptosis rate were significantly increased ( P<0.05). Compared with the H 2O 2 group, the expression of miRNA-499a-5p, Bcl-2, p-PI3K and p-Akt and the survival rate of cardiomyocytes were significantly increased in the H 2O 2+ miRNA-499a-5p group ( P<0.05), while the expression of CD38 and Bax, ROS level, LDH activity and the apoptosis rate were significantly decreased ( P<0.05). Dual luciferase reporter assay confirmed that CD38 was a target gene of miRNA-499a-5p. Conclusions:miRNA-499a-5p could alleviate H 2O 2-induced cardiomyocyte injury by inhibiting the expression of CD38 and the PI3K/Akt signaling pathway might be involved.

Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.

The policy model of G. C. Edwards was used to study the policies on building a countywide medical community ( CMC), and identify problems in such aspects as policy communication, resources, disposition and bureaucratic structure. The analysis found that enriching health resources at primary level and powerful government support are creating ideal environment for the construction of CMC. But due to its preliminary development, rooms of improvement of its policy design, and unclear enforcement standards, there appear behavioral polarizations at local health authorities. For example, some are proactive to explore and accumulate rich experiences, while the most take a wait and see stand, or even take administrative means to cope with their authorities by forming medical communities in form only. A small part of county hospitals, thanks to support from the government and inherent conditions, take active measures in this direction as policy frontrunners. On the other hand, most county hospitals prefer to be policy followers in order to avoid cost and risks of the reform. In the worst cases, a few county hospitals have become free riders of the policy, and attempt to take advantages of their primary health institutions. Primary health institutions warmly embrace CMC, but their limited service capability constitutes roadblocks in CMC construction. What is more, poor communication and collaboration mechanisms among systems and authorities hinder the effective policy synergy and health service integration of CMS.

Objective To analyze the motives and tactics of township health centers ( THC) to participate in the countywide medical communities of Shandong province. Methods Such tools as the new institutionalism, rational choice and social network theories, as well as the constituent ratios and Pearson correlation coefficient of data were used in a survey in August 2018 with managers of 264 THCs in Shandong. It aimed to learn from the respondents their motives, tactics, and behaviors to participate in such communities. Results Theoretical analysis of the results found that their participation was bound by both institutional environment and technical environment. For example, compliance tactics, accompanied by efficiency, was adopted to cope with stress from institutional environment. Exploratory tactics, accompanied by legitimacy, was adopted to cope with stress from technical environment. The figures showed 87. 5％ of 264 THCs investigated participated in such communities, and their main motives were in turn to follow government requests (86. 1％ ) and to seek development opportunities (69. 7％ ). The critical criteria of partner selection were in turn technological level (83. 5％ ) and matching of resources (77. 9％ ). Of 231 THCs which participated in the communities, 95. 2％ joined in countywide medical communities, and 28. 6％ participated in other forms of medical alliances. Conclusions THCs showed high organizational convergence in their participation, and adopted diversified strategies of participation in medical alliance.

Objective: To investigate the effects of miR-27b targeting ten-eleven translocation methylcytosine dioxygenase 2 (TET2) on oxidized low-density lipoprotein (ox-LDL) induced inflammatory responses and apoptosis in endothelial cells. Methods: Double luciferase reporter gene analysis verified the targeting effect of miR-27b on TET2. Human umbilical vein endothelial cells (HUVECs) were induced by ox-LDL in vitro. Eight groups were set up including control group, ox-LDL group, ox-LDL+ anti-miR-con group, ox-LDL+ anti-miR-27b group, ox-LDL+ pcDNA group, ox-LDL+ pcDNA-TET2 group, anti-miR-27b+ si-con group and anti-miR-27b+ si-TET2 group. qRT-PCR was used to detect the expression of miR-27b and TET2 at mRNA level. Cell viability was detected by MTT assay. Cell apoptosis rate was detected by flow cytometry. Western blot was used to detect the expression of TET2, Cyclin D1 and caspase-3 at protein level. Results: TET2 was the target gene of miR-27b. TET2 expression could be negatively regulated by miR-27b. ox-LDL increased the expression of miR-27b and reduced the expression of TET2 in HUVECs. The secretion of inflammatory factors and apoptosis rates of HUVECs in the control, ox-LDL+ anti-miR-27b, ox-LDL+ pcDNA-TET2 and anti-miR-27b+ si-con groups were significantly lower than those in the ox-LDL, ox-LDL+ anti-miR-con, ox-LDL+ pcDNA and anti-miR-27b+ si-TET2 groups, respectively (P<0.05). Conclusions miR-27b promoted ox-LDL-induced inflammatory responses and apoptosis in endothelial cells through down-regulating the expression of TET2.

Objective To investigate the effect of Early Intervention Denver Model ( Early Start Denver Model,ESDM) on children with autism spectrum disorder( ASD). Methods From May 2017 to April 2018,forty four children aged 2-5 years with ASD were enrolled in the study and were randomly divided into the experimental group(n=20) and the control group (n=20). The experimental group received ESDM rehabilitation intervention and the control group received conventional rehabilitation intervention. Before and 6 months after intervention,all children were assessed by the Psycho-educational Profile-3rd Edition ( PEP-3). Results After 6 months of intervention,the developmental age of cognition (30 (26,34),33(30,44);Z=-3. 728,P<0. 001),imitation (33(29,40),38( 32,43); Z=-2. 010,P=0. 044),expression language (29(23,39),41( 33,50); Z=-3. 923, P<0. 01), receptive language ( 25 ( 20,32),34 ( 28,38); Z=-3. 727,P<0. 01) and fine motor (29(23,41),39(33,47) ;Z=-2. 704,P=0. 007) of the control group were significantly higher than those before intervention. In the experimental group,the developmental age of cognition (25 ( 21,32),37 ( 32,40); Z=-3. 922, P<0. 01),imitation ( 22 ( 17,35),39 ( 38,42); Z= -3. 826,P<0. 01),expression language (30(24,35),47( 37,53); Z=-3. 824,P<0. 01),receptive lan-guage (22(15,32),37(30,43); Z=-3. 924,P<0. 01),fine motor (25(22,33),43(30,52); Z=-3. 924, P<0. 01) and gross motor ( 24(17,38),40(27,43); Z=-3. 523,P<0. 01) were significantly higher than those before intervention. Compared with the control group,the experimental group had significantly greater changes in the five regions:cognition(6(3,10),11(10,20); Z=-2. 821,P=0. 005),expression language (6(4,9),12(7,18); Z=-3. 278,P=0. 001),receptive language(5(3,10),12(7,18); Z=-3. 299,P=0. 001),fine motor (7(1,10),13(10,22); Z=-3. 038,P=0. 002)and gross motor(1(0,10),11(5,16);Z=-2. 568,P=0. 01) of PEP-3 after intervention. Conclusion Both conventional intervention and ESDM intervention can improve the cognitive,expression language,receptive language,imitation and fine motor abili-ty of children with ASD aged from 2 to 5 years,but ESDM intervention is more effective on improving the cog-nitive,language,imitation and fine motor ability of children with ASD.

An accident of mixed acute gas poisoning accident happened in a place in GuangDong in March 2018. To investigates three poisoning workers and related clinical data were summarized., we tested the field air and analyzed the accident reasons. This event due to the staff lack of occupational protection awareness and illegal operation. The working environment must be ventilated before limited space operation, and must be sure that the limited space is safe by toxic gas monitoring. In case of occupational acute gas poisoning, rescuers should help the persons who are poisoned reasonably and meanwhile their own safety.

Objective: To explore the correlation between sleep and laryngopharyngeal reflux disease by epidemiological approaches. Methods: From May 1, 2017 to April 30, 2018, data of age, gender, height, weight, smoking, alcohol consumption, constipation and high fat diet in patients in Otorhinolaryngology specialist clinic, the Eighth Medical Center, General Hospital of the Chinese PLA were retrospectively analyzed. Reflux Symptom Index (RSI), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS)were filled. According to RSI scores, patients were divided into case group and control group. The differences of the above indicators between the two groups were compared by Stata 12.0 software, and the risk factors of LPRD were analyzed by multivariate Logistic regression. Results: A total of 908 patients were enrolled, including 166 in the case group and 742 in the control group. There was no significant difference in BMI, smoking, drinking, constipation and high fat diet between the two groups (all P>0.05). The PSQI, anxiety and depression score of the case group were higher than those of the control group. The anxiety and depression scores of the patients with sleep disorders in the case group were significantly higher than those of the normal sleepers (all P<0.05). RSI of the patients with sleep disorders was higher than that of the patients with normal sleep(9.5[4.0,16.0]vs. 5.0[1.0,10.0], Z=-6.07, P<0.001). Multivariate analysis showed that sleep disorder was the risk factors of LPRD (OR=2.59, 95%CI 1.75-3.84). Conclusions Sleep disorder is related to the occurrence of LPRD. The association between LPRD and sleep disturbances is bidirectional. Sleep disorder may also be related to the anxiety and depression in LPRD patients. Handling sleep disorder timely may benefit LPRD patients.

The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.