[Objective]To investigate the protective effect of Zhuangtongyin on the Middle Cerebral Artery Occlusion(MCAO)model by modulating ferroptosis through the Nrf2-SCL7A11/xCT-Gpx4 pathway and its underlying mechanism.[Methods]C57BL/6J mice were randomly divided into Sham operation group(Sham),model group(MCAO),low-dose Zhuangtongyin group(ZTY-L),high-dose Zhuangtongyin group(ZTY-H),with 5 mice in each group.The MCAO group was modelled by silica gel embolization,the middle cerebral artery of mice was embolized for 1h,then the silica gel was pulled out and reperfusion was performed after 72 h;and the other operations in the Sham group were the same as those in the MCAO group except that the thread plug was not inserted.The neural function of mice was evaluated by Zea-Longa method.TTC staining was used to evaluate the volume of cerebral infarction.The level of brain injury was evaluated by HE staining and Nissl staining.Prussian blue staining and the expression of iron transport-related carrier receptors TfR1 and DMT1 on mRNA level was detected by qPCR to evaluate the iron ion deposition level in mice brain.The expression of lipid peroxidation-related gene ACSL4 on mRNA level was detected by qPCR,and the content of 4-HNE was detected by ELISA kit to evaluate the lipid peroxidation level of mice brain.The expressions of ferroptosis marker PTGS2 mRNA level was detected by qPCR.The expressions of Nrf2,SCL7A11/xCT,Gpx4 in mice brain tissue were detected by Western-blot and immunofluorescence.[Results]Zhuangtongyin improved the nerve function of mice after MCAO(P＜0.05)and the cerebral infarction volume of mice(P＜0.05)and alleviate the pathological injury of cerebral cortex cells after MCAO operation.Zhuangtongyin attenuated the accumulation of trivalent iron ions in the brain tissue of mice following MCAO.Additionally,Zhuangtongyin downregulated the expression of TfR1 and DMT1 mRNA(P＜0.001),a transporter associated with cellular iron ion uptake,in the brains of post-MCAO mice.Furthermore,Zhuangtongyin reduced levels of lipid peroxidation product 4-HNE(P＜0.001)and suppressed ACSL4 mRNA expression in brain tissue post-MCAO(P＜0.001).Besides,Zhuangtongyin downregulated the expression of PTGS2 mRNA(P＜0.001),in the brains of post-MCAO mice.Zhuangtongyin increased the expression of nrf2 into the nucleus(P＜0.001),and increased the expression of xCT and Gpx4 in neurons after MCAO(P＜0.001).[Conclusion]Zhuangtongyin can enhance the nerve function and reduce cerebral infarction volume in MCAO/R mice,alleviate the pathological damage of cerebral cortex cells,and modulate the expression of key signaling molecules in the Nrf2-SCL7A11/xCT-Gpx4 pathway.Therefore,it is suggested that the mechanism by which Zhuangtongyin improves MCAO/R injury in mice may involve regulating ferroptosis through the Nrf2-SCL7A11/xCT-GPX4 pathway.

Objective:To explore the effects of WeChat-based health education on management of hypertensive outpatients under medical consortium.Methods:Totally 180 hypertensive patients who attended the Multidisciplinary Clinics of Beijing Anzhen Hospital, Capital Medical University, and Datun Community Health Service Center from communities under our medical consortium from November 2018 to April 2019 were selected and divided into the observation group ( n=91) and the control group ( n=89) according to the visit time. Patients in the control group received routine health education, while patients in the observation group received WeChat-based health education under medical consortium for 6 months. The self-management ability (using Hypertension Patients Behavior Rating Scale, HPSMBRS) , treatment compliance (using Therapeutic Adherence Scale for Hypertensive Patients, TASHP) , the 24 h average systolic and diastolic blood pressure, the average systolic and diastolic blood pressure at daytime, and the average systolic blood pressure and diastolic blood pressure at night were compared between the two groups. Results:After the intervention, the diet management, medication management, disease monitoring, exercise management, work and rest and emotional management scores of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . After the intervention, the medication-taking behavior, bad medication-taking behavior, daily activity management behavior and tobacco and alcohol addiction scores were higher than those of the control group, and the differences were statistically significant ( P<0.05) . After the intervention, the 24 h average systolic and diastolic blood pressure, average systolic and diastolic blood pressure at daytime and average systolic and diastolic blood pressure at night decreased in the observation group, and the differences were statistically significant compared with the control group ( P<0.05) . Conclusions:The WeChat platform under medical consortium provides standardized, consistent, continuous and effective health education, which can improve the self-management ability and treatment compliance of hypertensive outpatients, and can effectively control blood pressure levels. It shows sound effects in clinical use.

Objective:To investigate the association patterns of chronic disease-relevant risk factors for the adults in Haidian District.Methods:Data for chronic disease-relevant risk factors for 3 219 adults in Haidian District in 2014 were collected and analyzed.SPSS 18.0 was used for statistical description and logistic regression.SPSS Modeler 14.1 was used to explore the association among the chronic disease-relevant risk factors.Results:Among men,5 patterns of chronic disease-relevant risk factors were identified,which suggested that heavy drinking,inadequate intake of fruit and vegetables,and physical inactivity were associated with smoking while inadequate intake of fruit and vegetables and smoking were associated with physical inactivity.Among women,one pattern of chronic disease-relevant risk factor was identified,which suggested that inadequate intake of fruit and vegetables was associated with physical inactivity.Conclusion:Chronic disease-relevant risk factors are intercorrelated among the adults in Haidian District.Information on patterns of chronic disease-relevant risk factors could assist interventions targeting multiple behaviors simultaneously.

The violence behavior is a kind of aggressive behaviors or attempt to hurt another person psychologically,physically or in other forms.Recently,violent incidents occur more and more frequently,and especially among teenagers.A number of concerns on violence continue to rise,and interpersonal violence is the most concerned type.Perpetrators are violence implementers who determine the occurrence and outcome of violence.Many studies provided the risk factors of interpersonal violence,that expounds the influence of personal level,interpersonal relationship,community background and social factors of interpersonal violence.The establishment of the socioecological risk-factor structural model which focuses on the perpetrators' indi vidual,is of great significance for the effective intervention for interpersonal violence.

OBJECTIVE: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
 METHODS: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
 RESULTS: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
 CONCLUSION OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.
Health Care Costs ; Health Expenditures ; Hospitalization ; economics ; Humans ; Inpatients ; Neoplasms ; economics

OBJECTIVE: To analyze the satisfaction degree in outpatients and influential factors at national essential medicine system in primary health care institution of Yiyang and to provide useful information for the sustainable development of the national essential medicine system in China.
 METHODS: A multi-stage random sampling method was conducted. A total of 525 outpatients were randomly selected in 21 primary health care institution. Their satisfaction degree on national essential medicine system were investigated through anonymous survey.
 RESULTS: Categories of medical institutions, age, education, medicare categories and occupation were influential factors, with statistical significance (P<0.05). 
 CONCLUSION There's no difference among different class of outpatients' attitude on national essential medicine system. Categories of medical institutions, age, education, medicare categories and occupation are influential factors for outpatients' attitude.
Attitude ; China ; Humans ; Outpatients ; Patient Satisfaction ; Primary Health Care ; Surveys and Questionnaires

Our primary health care institution began to implement national essential medicine system in 2009. In past fi ve years, the goal of national essential medicine system has been initially achieved. For examples, medicine price is steadily reducing, the quality of medical services is improving and residents' satisfaction is substantial increasing every year. However, at the same time, we also found some urgent problems needed to be solved. For examples, the range of national essential medicine is limited, which is difficult to guarantee the quality of essential medication. In addition, how to compensate the primary health care institution is still a question.
China ; Health Services Needs and Demand ; Primary Health Care ; organization & administration

Objective To promote the standardization of medical practice in China by comparing the discrepancies of diagnosis and medication strategies for benign prostatic hyperplasia (BPH) between urologists and geriatricians.Methods Departments of urology and geriatrics in general hospitals in China were selected through stratified sampling and 145 315 patients who went for the outpatient service in certain days during December 2011 to December 2012 were recruited by cluster.Questionnaires were completed by corresponding doctors and data of patient clinical characteristics as well as diagnostic and therapeutic pattern were collected.Results A total of 142 511 valid questionnaires were collected with 119 426 from urology and 23 085 from geriatrics.The average age of BPH patients was (68.34±8.61) years and the average IPSS was 17.93±4.73.The rates of diagnostic method were IPSS (99.2％),ultrasonic inspection (86.0％),digital rectal examination (DRE) (66.0％) and urine flow rate test (55.2％).The rate of ultrasonic application was lower while the rates of other methods were higher among urologists (P＜0.01) ; the rate of DRE among urologists was 2.2 times to that among geriatricians.For patients with moderate or severe symptoms,most urologists (72.1％ in moderate patients and 79.9％ in severe patients) applied drug-combination strategy and the rate was 2 times to that among geriatricians (P＜0.01).In contrast,most geriatricians (59.7％ in moderate patients and 56.1％ in severe patients) applied single drug to BPH patients.Urologists utilized α-receptor blockers,plant preparations and traditional Chinese medicine more frequently than geriatricians (P＜0.01).Conclusions Urologists performed more integrated diagnosis strategy compared with geriatricians.The urologists tended to use 5α-reductase inhibitor combined with α-receptor blocker to treat BPH patients with moderate or severe symptoms,while geriatricians preferred 5α-reductase inhibitor alone.

Comprehensive evaluation methods are generally used to assess the population data. When we need to estimate the sample data in special situations, the impacts brought by the sampling error should be considered. Due to lack of the accurate measurement for the sensitivity and stability in the comprehensive evaluation methods, sampling errors usually cannot be estimated in the sampling research. Monte Carlo simulation was used in this article to solve the probability of the ordering results, and the matlab programs were presented. Based on the simulated results, we change the conventional “absolute conclusion” of comprehensive evaluation methods to “probability results” for the sample data, and put forward a new sorting and ranking method for the results of comprehensive evaluation.

Objective To evaluate the patient's health care demands in communication,diagnosis,treatment and medical counseling of geriatric BPH outpatients in China.Methods A survey study was carried out in 33 medical centers from 11 different cities in China (North:Lanzhou,Beijing,Shenyang; South:Chengdu,Changsha,Wuhan,Jinan,Nanjing,Hangzhou,Shanghai,Guangzhou).2027 BPH outpatients aged (60 years participated in the survey to measure their health care demands using a questionnaire.Results There were 955 cases (47.1％) thinking communication is necessary before inspection items by a doctor,807 (39.8 ％)thinking communication is necessary before determining the treatment program,389 cases(19.2％) thinking respection items by a doctor is necessary,730 cases(36.0％)the treatment program by a doctor is necessary,849 cases (41.9 ％)thinking health guidance on BPH dignosis is necessary,934 cases (46.1 ％)thinking health guidance on BPH treatment is necessary,The multilevel model showed the demands scores data is similarity among the north and the south.And the patients with more severe lower urinary tract symptoms have more demands on communication and medical counseling.Conclusions It is to get better therapy,considering the patient's health care demands.