The contents of general practice discipline construction comprise of orientation, team development, personnel training, scientific research, teaching base establishment and management of the discipline, etc. At present, the weakness in above aspects of general practice discipline construction is still the major challenges in most of the primary healthcare institutions. Our experiences in last 10 years shows that the application of Leicester Assessment Package can effectively promote the general practice discipline development for primary care institutions.

Objective:To evaluate the safety and efficacy of the technique of minimally invasive separation surgery with small incision and free hand screw placement in patients with spinal metastases.Methods:Retrospectively reviewed the clinical data of 49 consecutive patients from May 2019 to December 2019 who underwent minimally invasive separation surgery with small incision and free hand screw placement for metastatic spinal tumors. Among them, there were 21 males with an average age of 55.62±2.97 years (range: 26-75 years) and 28 females with an average age of 52.50±1.76 years (range: 34-72 years). For patients who have primary tumor history with multiple metastases, routine pre-operative biopsy is not required; but for patients whose primary tumor is unknown and who have no history of tumor, pre-operative biopsy diagnosis is required. Before operation, Karnofsky Performance status (KPS) scoring system was used to evaluate the general condition of patients, Spinal Instability Neoplastic Score (SINS) scoring system was used to evaluate the spine stability, epidural spinal cord compression (ESCC) grading system was performed to access the degree of spinal cord nerve compression, and Frankel grading system was used to evaluate the neurological function. For patients who meet inclusion and exclusion criteria ware performed for decompression and internal fixation by a minimally invasive separation surgery with small incision and free hand screw placement. The demographic, neurological function, complications and perioperative data were collected and analyzed, including pre-operation neurological function, operation time, intraoperative blood loss, postoperative suction drainage, drainage tube extraction time, complications rates, hospital stay, and assessment of neurological recovery at 4 weeks after surgery.Results:Preoperative coil embolization was performed in 1 patient with kidney cancer. The mean intraoperative blood loss was 748.60±79.39 ml. Comparison of intraoperative blood loss of 12 rich blood supply (liver cancer, kidney cancer, thyroid cancer) and 37 poor blood supply spine metastases (970.80 ml vs 676.50 ml) was not statistically significant ( P>0.05). The average operation time was 213.40±9.87 min. The operation involved 1 segment was performed in 41 patients (83.67%) and 8 patients had separation of 2 or more segments. The post-operative drainage before discharge was 494.02±63.30 ml. The average drainage tube retention time was 4.50±0.26 d and the average length of hospital stay was 7.35±0.38 d. The post-operative hospitalization was 5.31±0.29 d. 79.59% of patients had the neurological functions of Frankel grade C and D before surgery and 95.92% of patients exhibited stable and improved function at 4 weeks after surgery which was significantly improved comparing with that before surgery ( P<0.05). The complications occurred were dural rupture (1 case), infection (1 case) and hematoma (1 case). Comparison:The minimally invasive separation surgery with small incision and free hand screw placement could achieve less trauma, low complications rate, rapid postoperative recovery. It is also comparable to the traditional open separation surgery in terms of spinal stability and improvement of neurological functions. It is an excellent alternative for patient with spinal metastases.

Long-term primary culture of mammalian cells has been always difficult due to unavoidable senescence. Conventional methods for generating immortalized cell lines usually require manipulation of genome which leads to change of important biological and genetic characteristics. Recently, conditional reprogramming (CR) emerges as a novel next generation tool for long-term culture of primary epithelium cells derived from almost all origins without alteration of genetic background of primary cells. CR co-cultures primary cells with inactivated mouse 3T3-J2 fibroblasts in the presence of RHO-related protein kinase (ROCK) inhibitor Y-27632, enabling primary cells to acquire stem-like characteristics while retain their ability to fully differentiate. With only a few years' development, CR shows broad prospects in applications in varied areas including disease modeling, regenerative medicine, drug evaluation, drug discovery as well as precision medicine. This review is thus to comprehensively summarize and assess current progress in understanding mechanism of CR and its wide applications, highlighting the value of CR in both basic and translational researches and discussing the challenges faced with CR.

Objective To explore the effects of supraglottic laryngeal carcinoma and hypopharyngeal carcino-ma on swallowing functions .Methods The data of 32 patients with supraglottic laryngeal carcinoma (laryngeal car-cinoma group) ,20 patients with hypopharyngeal carcinoma (hypopharyngeal carcinoma group) and 81 cases of nor-mal persons of the same age (50～79) as a control (normal control group) who were diagnosed and treated in our department from 2015 December to 2017 February were evaluated by repeated saliva swallowing test ,watian drink-ing water test ,and endoscopic examination of swallowing .Results In the laryngeal carcinoma group ,we found swallowing dysfunctions in 17 cases(53 .13％ ,17/32) .In the hypopharyngeal carcinoma group ,we found swallo-wing dysfunctions in 15 cases(75 .00％ ,15/20) .For 81 cases of normal persons (normal control group) ,there were swallowing dysfunctions in 11 cases(13 .58％ ,11/81) .The statistical analysis of the laryngeal carcinoma and hypo-pharyngeal carcinoma groups with abnormal swallowing functions were significantly higher than the normal control group (P<0 .001) .In the laryngeal carcinoma group ,according to the anatomic site ,the tumors were divided into two groups :from 21 cases of epiglottis and fringe group ,we found swallowing dysfunctions in 14 cases (66 .67％ , 14/21);out of 11 cases of ventricular bands + laryngeal ventricle group , swallowing dysfunctions in 3 cases(27 .27％ ,3/11) .The differences between the two groups were significant (P<0 .05) .In the hypopharyngeal carci-noma group ,out of 14 cases of pyriform sinus ,swallowing dysfunctions were in 10 cases(71 .43％ ,10/14);out of 6 cases of posterior hypopharyngeal wall carcinoma ,swallowing dysfunctions in 5 cases(83 .33％ ,5/6) .The differ-ences between the two groups were insignificant (P>0 .05) .Conclusion Supraglottic laryngeal carcinoma and hypo-pharyngeal carcinoma all have effects on swallowing functions and increase the incidence of dysphagia .In the supra-glottic laryngeal carcinoma ,the primary tumor location has influence on the swallowing functions .

Objective: To evaluate whether the self-designed single-channel intracavitary applicator yields equivalent clinical efficacy and safety to the standard Fletcher-type three-channel applicator in the high-dose-rate (HDR) brachytherapy for uterine cervical cancer. Methods: From December 2011 to April 2017, patients initially diagnosed with cervical cancer were randomly assigned into the external beam radiotherapy (EBRT)+ single-channel intracavitary applicator group (the patent single-channel group) and EBRT+ the Fletcher applicator group. Whole pelvis irradiation was delivered with 6-MV photons via a four-field box variant or anterior and posterior parallel fields. Five to six fractions of intracavitary brachytherapy were performed at a dose of 7 Gy at point A once a week after 30 Gy (BED at point A: 80-90 Gy). Chemotherapy was given with intravenous injection of cisplatin at a dose of 40 mg/m² once weekly during EBRT.Clinical efficacy and safety were evaluated after the treatment. Results: In total, 150 eligible cases were assigned into the Fletcher applicator group and 149 cases into the patent single-channel group. The short-term clinical efficacy and acute toxicity did not significantly differ between two groups. The response rate was 94.0% in the Fletcher group, and 94.7% in the patent single-channel group. In the Fletcher applicator group, 76(50.7%) patients developed ≥ grade 3 hematologic toxicity and 61(40.9%) in the patent group (P=0.195). Conclusions: The self-designed patent single-channel intracavitary applicator yields equivalent clinical efficacy and safety (acute toxicity) to the standard Fletcher-type three-channel applicator in the HDR brachytherapy for uterine cervical cancer. Clincal Trial Registration Chinese Clinical Trial Registry (ChiCTR-TRC-12002321).

Objective:To design and synthesize photosensitizers with different substituents and to identify its physicochemical characteritics and photodynamic effect on tumor cells.Methods:Two kinds of BODIPY photosensitizers BPOI and BPCI were synthesized through condensation reaction between aldehyde and reactive hydrogen of pyrrole,followed with electrophilic substitution reaction.Physicochemical properties were characterized by 1H NMR,FT-IR and UV-visible absorption spectra and fluorescence emission spectra.The ability to produce reactive oxygen species was detected by BPDF and DCFH-DA.Photodynamic therapy effect on rat glioma C6 cells in vitro was determined by MTT method.Results:Two kinds of BODIPY photosensitizers BPOI and BPCI were successfully synthesized with different substituents,which were confirmed by 1H NMR,FT-IR.Both materials had low toxicity and could be readily taken up by tumor cells.The ability of synthesized photosensitizers to produce reactive oxygen species was strongly influenced by solvent polarity when the substituent belongs to electron-donating group,while no effect was found when the substituent belongs to electron-withdrawing group.Conclusion:Photosensitizer BPOI with electron-donating substituent produces reactive oxygen species with a slow rate in a highly polar environment,while the ability to produce reactive oxgen is greatly improved in a low polarity environment,which is expected to be used for environmental-selective photodynamic therapy in tumor cells.

Objective To evaluate the clinical effect of clopidogrel combined with low molecular weight heparin (LMWH) on chronic pulmonary heart disease in patients with acute exacerbation.Methods Eighty cases of patients with chronic pulmonary heart disease with exacerbation were randomly divided into treatment group (40 cases) and control group (40 cases).Patients in control group were administrated with conventional treatment including infection control,cough,phlegm,relieving spasm and asthma,persistent low flow oxygen,maintain airway patency,strong heart,diuresis,anti arrhythmia.Patients in treatment group were treated with subcutaneous injection of low molecular weight heparin and oral clopidogrel therapy beside routine treatment.Plasma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time (TT),fibrinogen(Fb) and pulmonary function(FEVI) were measured.Results (1) After treatment,Fb in treatment group and control group were (3.92 ± 1.11) g/L,(4.54 ± 1.41) g/L respectively.While PT,APTT,TT and FEVI in treatment group were (13.02 ± 1.52) s,(33.21 ± 4.03) s,(14.03 ± 2.52) s,(45.73 ± 7.38) ％ respectively,significantly higher than the control group ((11.31 ± 2.01) s,(30.13 ± 3.59) s,(12.88 ± 2.11) s and (40.12 ± 6.99) ％,P ＜0.05).(2) In control group,FEVI after treatment significantly improved than that of before treatment (t =4.821 ; P ＜ 0.05),while PT,APTT,TT were no significant changes (P ＞ 0.05).PT,APTT,TT,FEVI in treatment group were significantly improved after treatment than that of before treatment(P ＜ 0.05).(3) The clinical effective rate in treatment group was 80.0％ (32/40),higher than that in control group (65.0％(26/40) x2 =4.815; P ＜0.05).Conclusion The therapy scheme of clopidogrel combined with low molecular heparin calcium is proved to be an efficacy method for reducing sputum viscosity,antiinflammatory,anti allergic effect,platelet aggregation,increasing pulmonary blood flow,improving the condition of patients with pulmonary heart diseasethe.And its clinical effect is significant,worthy to promote and apply.

BACKGROUND: Thermotherapy has achieved remarkable therapeutic effect on patients with esophageal cancer. However, there are still some problems which cannot be answered today, such as the damage of esophageal mucosa during deep thermotherapy when metal stent is placed in esophagus. OBJECTIVE: To study the metal stent-caused damages to esophageal mucosa of pigs in radiofrequency hyperthermia. DESIGN, TIME AND SETTING: Observational study which was performed in the Department of Tumor, Affiliated Hospital of Luzhou Medical College from October 2004 to January 2005. MATERIALS: 13 pigs weighing 35-40 kg were used in this study. Esophagus stent of memory alloy with membrane was provided by Zhiye Medical Apparatus Institute of Changzhou, China METHODS: Five points were located for measurement, i.e. the middle of the stent, the exit of the stent, 2 cm and 4 cm a distance from the exit and 4 cm from the entrance. Esophagus of 13 pigs was heated for 30 minutes by SR-1000 radiofrequency hyperthermia machine in frequency of 40.82 MHz, pole plate of 25 cm Ⅱ 25 cm and power of 500-700 W. MAIN OUTCOME MEASURES: The esophageal mucosa was observed with naked eyes. And optical microscopy was used to observe the changes of the esophageal mucosa. RESULTS: Because one pig died of anesthesia and there were troubles of thermal detector lines in 4 pigs, only 8 pigs were included in the final analysis. Level of damage of esophageal mucosa on five temperature checkpoints was observed from grade 0 to 1 in naked eyes, and the difference of damaged level between five checkpoints was not obvious in statistics (H=2.0, P=0.157). Level of the damage was observed from grade 0 to 2 in microscope, and the difference was not obvious in statistics too (H=2.734, P=0.255). CONCLUSION: Influence of the metal stent on esophageal mucosa can be neglected in radiofrequency hyperthermia, and metal stent does not cause obvious mechanical damage or thermal damage to esophageal mucosa of pigs. It is safe and feasible to carry out radiofrequency hyperthermia on placed metal stent esophagus.

OBJECTIVE To study the radiose-nsitization by Topotecan on human nasopharyngeal carcinoma in nude mice. METHODS ①To study the maximum tolerance dose of TPT and detect the effective rate of TPT and RT on nude mice. ② Plan of radiosensitization practice:53 nude mice xenografts were distributed to 5 groups:RT 20 Gy group,RT 40 Gy group,TPT 12.5 mg/kg group,TPT 12.5 mg/kg+RT 20 Gy group and the controlgroup. After treatment,the volume of tumors were measured every 3 days in order to value the effective rate [complete remission(CR) + partial remission(PR) ]and regrowth delay time(TGD) and to fit the growth curve. RESULTS This study showed that the effective rates had significant difference among RT20 Gy+TPT 12.5 mg/kg group,RT20 Gy group and TPT12.5 mg/kg group,while that of RT20 Gy +TPT 12.5 mg/kg group and RT40 Gy group had no statistical difference. SER reached to 1.34. CONCLUSION Topotecan has been shown a radiosensitizing effect on human nasopharyngeal carcinoma in vivo.

OBJECTIVE: To observe the effect of lidocaine on respiratory failure and the airway peak pressure in patients with severe asthma. METHODS: The severe bronchial asthma patients treated with mechanical ventilation were randomly divided into treatment group and control group. The change in airway peak pressure, man-machine counteraction, and the correcting time of respiratory failure of the two groups were recorded. RESULTS: The average airway peak pressure was(41.18?10.66) cmH2O in the control group vs.(29.23?9.07) cmH2O in the treatment group; the incidence of man-machine counteraction was 100% for the control group vs. only 40% for the treatment group; the correcting time of respiratory failure was(6.42?1.73) h for the control group vs.(3.31?1.08) h for the treatment group. There were significant differences between the two groups in the above mentioned indexes(P