OBJECTIVE To explore the construction of selection system for drug directory of the county-level medical community based on multi-criteria decision analysis， and provide decision-making basis for the selection of drug directory of medical community. METHODS Taking county-level medical community in Chongqing as an example，Delphi method and analytic hierarchy process were employed to construct the selection system for drug directory of the county-level medical community. Selected drugs were quantitatively scored based on the constructed index system， and the drug directory was selected according to the drug’s comprehensive score. The implementation effect of the directory was then evaluated through questionnaire surveys one year after the implementation of the directory. RESULTS The expert authority coefficients of the two rounds of consultation were＞ 0.8， with Kendall’s W values of 0.213 and 0.196， respectively （P＜0.001）. Finally， the selection system for drug directory of the medical community was determined to include five evaluation dimensions： safety， effectiveness， economy， accessibility， and innovation， along with eight evaluation indicators. In the drug directory selected according to the above method， the proportions of centrally procured drugs， medical insurance drugs， and essential drugs had all increased compared to before the selection； the comprehensive scores of chemical drugs ranged from 50.25 to 96.31 scores， and the proportion of drugs scoring between 70 and 100 scores had increased from 78.06% before selection to 85.82%. Among them， antiparasitic drugs had the highest comprehensive scores， while drugs for the digestive tract and metabolism were the most numerous. The evaluation scores of each indicator and the comprehensive scores of drugs in the drug directory after the selection process increased significantly than before selection （P＜ 0.05）. CONCLUSIONS The selection system for drug directory of the county-level medical community constructed in this study is scientific， objective and operable. This process facilitates the promotion of standardized and unified management of drugs in the medical community.

Perineural invasion (PNI) by tumor cells is a key phenotype of highly-invasive oral squamous cell carcinoma (OSCC). Since Schwann cells (SCs) and fibroblasts maintain the physiological homeostasis of the peripheral nervous system, and we have focused on cancer-associated fibroblasts (CAFs) for decades, it's imperative to elucidate the impact of CAFs on SCs in PNI⁺ OSCCs. We describe a disease progression-driven shift of PNI^- towards PNI⁺ during the progression of early-stage OSCC (31%, n = 125) to late-stage OSCC (53%, n = 97), characterized by abundant CAFs and nerve demyelination. CAFs inhibited SC proliferation/migration and reduced neurotrophic factors and myelin in vitro, and this involved up-regulated ER stress and decreased MAPK signals. Moreover, CAFs also aggravated the paralysis of the hind limb and PNI in vivo. Unexpectedly, leukemia inhibitory factor (LIF) was exclusively expressed on CAFs and up-regulated in metastatic OSCC. The LIF inhibitor EC330 restored CAF-induced SC inactivation. Thus, OSCC-derived CAFs inactivate SCs to aggravate nerve injury and PNI development.
Schwann Cells/metabolism* ; Mouth Neoplasms/metabolism* ; Humans ; Cancer-Associated Fibroblasts/metabolism* ; Animals ; Carcinoma, Squamous Cell/metabolism* ; Neoplasm Invasiveness/pathology* ; Male ; Female ; Mice ; Cell Movement/physiology* ; Cell Proliferation/physiology* ; Cell Line, Tumor ; Leukemia Inhibitory Factor/metabolism* ; Middle Aged

Objective: To investigate the risk factors of postoperative acute kidney injury (AKI) in patients aged between 40 and 50 years old undergoing cardiac valvular surgery and the impact on outcome. Methods: The clinical data of 286 patients aged between 40 and 50 years old undergoing cardiac valve surgery in Guangdong Provincial People′s Hospital from January 2012 to December 2016 were analyzed retrospectively. Preoperative coronary angiography was performed in all patients. All patients enrolled were divided into AKI group and non-AKI group according to the existence or not of postoperative AKI. Patients with AKI were further divided into AKI stage 1, stage 2, and stage 3 groups according to KDIGO guideline. Demographic characteristics, preoperative clinical data including serum creatinine, estimated glomerular filtration rate, hemoglobin, uric acid, urinary protein, presence or absence of chronic kidney disease, left ventricular ejection fraction, pulmonary artery pressure, New York Heart Association (NYHA) functional classification, preoperative co-morbidity (hypertension, diabetes, anemia, cerebrovascular disease, peripheral artery disease), preoperative medication(vasoactive drugs, diuretic, renin-angiotensin system inhibitor (RASI), surgical data (contrast dosage in coronary angiography, type of cardiac valve surgery) were recorded and analyzed in this retrospective study. The risk factors for postoperative AKI and its impact on clinical outcomes (mortality, hospitalization expenses and Intensive Care Unit stay duration) were evaluated. Logistic regression analysis was used to determine the risk factors for postoperative AKI and the adjusted variables with P<0.2 were selected for the multivariate logistic regression analysis to define the independent determinants for AKI. Results: AKI was defined in 106 out of 286 enrolled patients, including 96 patients with AKI stage 1, 10 patients with AKI stage 2 and no patients with AKI stage 3. The proportion of coexisting cerebrovascular diseases was higher in AKI group than in non-AKI group (9(8.49%) and 5(2.78%), χ²=4.677, P=0.031), while there was no difference among other baseline data between the two groups. Multivariate logistic regression analysis showed that preoperative complications of cerebral vascular disease was an independent risk factor of postoperative AKI (OR=3.578, 95%CI 1.139-11.242, P=0.029). Five out of 106 AKI patients died during hospitalization while there was only 1 patient died among 180 patients without AKI. Patients with AKI after cardiac valve operation experienced higher mortality than patients without AKI (χ²=5.625, P=0.028). Further analysis showed that there was no difference in hospitalization mortality between patients with AKI stage 2 and stage (χ²=0.686, P=0.408) while the hospitalization mortality in patients with AKI stage 2 was higher than those without AKI (χ²=8.113, P=0.004). The hospitalization expenses in patients with AKI were 10.38(8.59,12.54) ×10⁴ RMB, significantly higher than that in patients without AKI (9.72(8.03,11.93) ×10⁴ RMB)(P=0.043). There was no difference in hospitalization expenses between patients with AKI stage 1 and without AKI (P=0.635). The hospitalization expenses in patients with AKI stage 2 was higher than those without AKI (P=0.023). Intensive Care Unit stay duration in patients with AKI was 3(1,4) days, significantly higher than those without AKI (P=0.044). There was no difference in Intensive Care Unit stay duration in patients with AKI stage 1 and without AKI (P=0.978), while Intensive Care Unit stay duration in patients with AKI stage 2 was significantly longer than those without AKI (P=0.006). Conclusions Preoperative complications of cerebral vascular disease is an independent risk factor of postoperative AKI. Non-senile patients with AKI after cardiac valvular surgery is associated with a higher proportion of mortality, hospitalization expenses and Intensive Care Unit stay duration as compared patients without postoperative AKI.

Objective To investigate the incidence of hyperkalaemia and analyze the risk factors in pa-tients with acute kidney injury(AKI)in cardiology department.Methods We conducted a retrospective case-con-trol study,using the electronic medical information of the patients in Guangdong General Hospital. Results A to-tal of 37 837 patients were included in this study and 1 571(4.3%)patients with AKI were detected.Hyperkalae-mia occurred in 517 patients(1.4%).The incidence of hyperkalaemia in AKI patients was higher than that in non-AKI patients(10.1% vs. 1.0%,P < 0.001)and the incidences of hyperkalaemia at AKI stage 1~3 were 2.6 %, 13.9% and 20.6 %,respectively. Multiple logistic regression analysis demonstrated that AKI stages,chronic kid-ney disease and heart failure were risk factors for hyperkalaemia.AKI and hyperkalaemia were related to increased hospitalization expenses,delayed hospital stay,renal replacement therapy and in-hospital mortality. Based on AKI,the combination of hyperkalemia could significantly increase clinical burden and adverse outcomes. Conclu-sion In cardiology department,the monitoring of serum creatinine and potassium level should be emphasized.

Objective To assess the epidemiology and clinical correlates of acute kidney injury(AKI)on patients in department of dermatology. Methods A total of 4710 patients hospitalized in dermatology department with at least two creatinine tests within 7 days were selected as research objects.AKI was defined and staged accord-ing to Kidney Disease Improving Global Outcomes criteria. Results The incidence of AKI was 6.3%. AKI inci-dences of psoriasis with systemic reaction(14.8%),erythroderma(12.8%),drug eruption(12.6%)and systemic lupus erythematosus (12.5%) were significant higher than the total incidence. In multivariate logistic regression model,these 4 skin diseases were independent risk factor of AKI incidence. The OR(95% confidencel interval) was 2.970(2.047~4.310),1.932(1.005~3.717),2.446(1.752~3.415)and 2.254(1.287~3.946). The in-hospital mortality was much higher in patients with AKI than those without(3.1% vs 0.1%,P < 0.001). And the AKI was related to in-hospital death after adjusted by age and comorbidities(Odds ratio 24.630,95%confidencel interval 7.385~82.149 ). Conclusion AKI is common in patients hospitalized in department of dermatology and is associated with patiensts′medical burden ,which shoule be noticed.

Objective To evaluate the application of prevention technique for mother‐to‐child transmission of human immunode‐ficiency virus(HIV) in Laibin City .Methods Prevention techniques for mother‐to‐child transmission of HIV were applicated in the city .Women in pregnancy test received acquired immunodeficiency syndrome(AIDS) counseling and test at the same time .Measures were taken to prevent the mother‐to‐child transmission of HIV for women who confirmed HIV positive ,including the use of antiret‐roviral drugs ,safety midwifery and feeding guidance ,and so on .Results The average HIV counseling and testing rate was 99 .1%(176 001/177 738) for the past 5 years .269 cases were HIV positive ,and the positive rate was 0 .15% (269/176 001) .Via health advisory guidance ,pregnant women diagnosed with AIDS understood the dangers of AIDS and the mode of its transmission ,and then free to chose weather to have the pregnancy terminated .Finally ,there were 67 pregnant women chose to terminate the preg‐nancy ,and 202 women decided to have children who were included in the prevention management system of mother‐to‐child trans‐mission .202 infants were born alive ,192 of which took full amount of antiretroviral drugs .The medication rate was 95 .05% (192/202) .42 d and 3 months after birth ,early diagnosis of HIV/AIDS was performed for the infants ,the positive rate of HIV was 0 .50% (1/202) .There were 118 infants at least 18‐months‐old who had underwent HIV test and no positive case was detected . Conclusion AIDS counseling tests in pregnancy test women is necessary ,which could detect HIV positive women .Comprehensive measures are effective methods for the prevention of mother‐to‐child transmission .

Objective To study the impact of the thymosin alpha 1 on the toxicity and celluar immune function during neoadjuvant chemotherapy of breast cancer.Methods 83 patients of Ⅱ b-Ⅲ a stage breast cancer were randomly divided into two groups:study group(40 patients,neoadjuvant chemotherapy of CEF combined with thymosin α 11.6mg HQD) and control group(43 cases,neoadjuvant chemotherapy of CEF alone).Results Rates of gastrointestinal reaction and bone marrow depression in study group were significantly lower than those in control group.The levels of CD3,CD4,CD4/CD8 and NK in study group were significantly higher than those in control group after chemotherapy.Conclusion The combination of thymosin alpha 1 and neoadjuvant chemotherapy for breast cancer can reduce the toxicity,improve the tolerance,enhance cellular immune function and improve the quality of breast cancer patient's life.

Objective To evaluate the effect of neoadjuvant chemotherapy (NAC) by investigating the expression of cyclin D1 in human breast cancer before and after NAC.Methods Eighty-four cases of breast cancer were diagnosed by core biopsies.The expression level of cyclin D1 in cancer tissues was measured by immunohistochemical envision two-step method before and after NAC (pirarubicin and docetaxel regimen for 3-4 cycles).Results Complete remission (CR) occurred in 4 cases of 84 patients (4.76 ％) with 2 pathological complete response cases,partial response (PR) in 54 cases (64.29 ％),stability (SD) in 26 cases (30.95 ％) and no disease progression (PD) patients.The positive rate of cyclin D1 in cancer tissues [65.48 ％ (55/84)] was significantly decreased after NAC [39.29 ％ (33/84)] (x2 =11.55,P =0.001).In clinical level,the ease rate was significantly improved in patients whose cyclin D1 expression switched from positive [86.36 ％ (19/22)] to negative [45.45 ％ (15/33)] after NAC treatment (x2 =9.359,P =0.002).Conclusion NAC significantly decreases the expression of cyclin D1 in breast cancer tissues.Meanwhile,the ease rate is improved when cyclin D1 expression switched from positive to negative after NAC.Therefore,cyclin D1 expression can be used as an evaluation index for the efficiency of NAC.

In order to investigate whether polymorphism in gene for heat shock protein 70 (HSP70) has any bearing on individual susceptibility to the development of chronic obstructive pulmonary disease (COPD), the geotypes of 88 patients with COPD and 87 healthy smoking control subjects were tested by polymerase chain reaction followed by restriction fragment polymorphism analysis for HSP70 gene. In COPD group, HSP70-1 genotype A/A, A/B and B/B was 59.1%, 35.2% and 5.7%, HSP70-2 genotype A/A, A/B and B/B was 26.1%, 54.6% and 19.3%, and HSP70-hom genotype A/A, A/B and B/B was 70.4%, 27.3% and 2.3% respectively. In the control group, it was 60.9%, 27.5% and 3.5%, 20.7%, 56.3% and 23.0%, and 54.0%, 42.5% and 3.5%, respectively. The frequency of polymorphic genetypes showed no difference between the COPD group and the control group (P>0.05). It was suggested that geneic polymorphism in HSP70 is not associated with development of COPD in Han nationality of China.
China ; ethnology ; Ethnic Groups ; Genetic Predisposition to Disease ; genetics ; HSP70 Heat-Shock Proteins ; genetics ; Humans ; Polymorphism, Restriction Fragment Length ; Pulmonary Disease, Chronic Obstructive ; genetics ; Smoking

Based on the statistical materials of SARS epidemic process in a general hospital in 2003 and with least square method, the epidemic laws are fitted through MATLABL, and the infection characteristics and relative conclusions of SARS are analyzed.