Objective:To investigate the impacts of fatty acid binding protein 4(FABP4)silencing on endoplasmic reticulum stress(ERS)and insulin resistance(IR)in gestational diabetes mellitus(GDM)rats by regulating protein kinase R-like endoplasmic reticulum kinase(PERK)/eukaryotic initiation factor 2α(eIF2α)/transcription factor 4(ATF4)/C/EBP homologous protein(CHOP)signaling pathway.Methods:GDM rat model was established by intraperitoneal injection of streptozotocin(STZ).Rats were injected with FABP4 siRNA plasmid(si-FABP4),negative control plasmid(NC)and PERK activator(CCT020312)via tail vein,and were randomly grouped into Normal group,GDM group,GDM+NC group,GDM+si-FABP4 group and GDM+si-FABP4+CCT020312 group.The levels of FABP4,blood lipids,inflammatory markers and oxidative stress markers in pancreatic tissue were detected,the expres-sions of PERK/eIF2α/ATF4/CHOP signaling pathway-related proteins in pancreatic tissue were detected.HTR-8/SVneo cells were divided into 5 groups:Control group,high glucose(HG)group,HG+NC group,HG+si-FABP4 group,HG+si-FABP4+CCT020312 group.After 24 h,the expressions of FABP4 and PERK/eIF2α/ATF4/CHOP signaling pathway related proteins were detected.Results:Compared with Normal group,the level of FABP4 in the serum and pancreatic tissue of the GDM group were obviously up-regu-lated(P<0.05).FABP4 silencing obviously reduced FBG and IR,decreased the levels of blood lipids,CRP,TNF-α,IL-6 and MDA,and increased the levels of SOD and CAT(P<0.05).Furthermore,FABP4 silencing attenuated pancreatic and placental tissue damages.After CCT020312 up-regulated the phosphorylation levels of PERK and eIF2α and the protein expressions of ATF4 and CHOP,the inhibitory effects of FABP4 silencing on IR,inflammation,oxidative stress,and pancreatic and placental damages in GDM rats were reversed(P<0.05).FABP4 was up-regulated in HTR-8/SVneo cells induced by HG,and silencing FABP4 inhibited the protein ex-pression of the PERK/eIF2α/ATF4/CHOP pathway,while CCT020312 reversed this change(P<0.05).Conclusion:FABP4 silencing improves IR and ERS in GDM rats by inhibiting inflammation and oxidative stress,and the mechanism is related to the inhibition of PERK/eIF2α/ATF4/CHOP signaling pathway.

Objective:To explore the feasibility of low-dose 4DCT scanning in simulation and target delineation for solitary pulmonary tumors (SPTs).Methods:23 patients with SPTs received 4DCT scanning simulation with the conventional scanning (CON), low voltage (LV), low current (LA) and low voltage combined with low current (LVA) in sequence. Based on the 4DCT images derived from the four sets of scanning parameters, the internal gross tumor volume (IGTV CON, IGTV V, IGTV A, IGTV VA) of SPTs were delineated and matched. Taking IGTV CON as reference, the tumor displacement and the centroid position of IGTV V, IGTV A and IGTV VA were compared with IGTV CON. The radiation doses under different scanning parameters were compared. Results:The volumes of IGTV CON, IGTV V and IGTV A were (12.26±12.30) cm 3, (12.21±12.16) cm 3 and (11.87±11.70) cm 3, respectively ( P=0.337). IGTV VA was (11.34±11.07) cm 3, significantly smaller than IGTV CON ( P=0.005). There was no significant difference in the centroid positions of IGTV CON, IGTV V, IGTV A and IGTV VA in three directions ( P=0.491, 0.360, 0.136). The Dice′s similarity coefficient (DSC VA) was significantly lower than DSC V and DSC A ( P=0.004, 0.030). The tumor displacement measured by the four sets of 4DCT images was similar in the LR direction ( P=0.470), and also in the AP direction ( P=0.108). For the displacement in the SI direction, LVA scanning was smaller than CON ( P=0.015). The radiation doses under four different scanning conditions were (397.0±140.3) mGy·cm, (175.0±61.8) mGy·cm, (264.8±95.3) mGy·cm and (116.8±41.2) mGy·cm, respectively ( P<0.001). Conclusions:LV or LA scanning exert no significant effect on the volume, centroid position of IGTV and the tumor displacement in 4DCT simulation for SPTs. The radiation dose that patients receive under LV and LV scanning is lower than that of CON. Consequently, LV or LA scanning is feasible in 4DCT simulation and target delineation for SPTs.

Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.

Objective:To measure the displacement of the solitary pulmonary lesion (SPL) located in different pulmonary segments based on 4D-CT technology (4DCT) and to establish and verify a relevant mathematical model of tumor displacement.Methods:The modeling samples of 290 SPLs were subject to both 4DCT and active breath control (ABC) spiral CT scans. The tumor displacement in different pulmonary segments was measured based on 4DCT images. The tumor volume was obtained by contouring the gross tumor volume (GTV) on ABC spiral CT images. The diaphragm movement was measured by X-ray simulator. The vital capacity and tidal volume were gained by pneumatometer. The baseline data, such as gender, age, height, weight, respiratory rate, and tumor lobe and segment where tumors were located, were collected. Multivariate linear regression was used to analyze the correlation between the 3D-tumor displacement and gender, age, height, weight, respiratory rate, tumor location, volume and diaphragm movement. The displacement model was established based on the modeling sample of 290 cases. Then, it was verified by comparing the tumor displacement derived from the model with that of 4DCT technology based on the randomly selected 17 SPLs.Results:The displacement model for tumors located in the upper lobe was established as Xup=-0.267+0.002TV+0.446DM, Yup=-1.704+0.004TV+0.725DM+2.250SII+1.349SIII and Zup=0.043+0.626DM+0.599SII+0.519SIII. The displacement model of the middle lobe tumors was Xmid=0.539+0.758DM, Ymid=-2.316+2.707DM+0.009TV and Zmid=0.717+1.112DM. The displacement model for tumors located in the lower lobe was Xlow=-0.425+0.004TV+0.857DM, Ylow=4.691+4.817DM+0.005TV-0.307RR+3.148SIX+2.655SX and Zlow=0.177+0.003TV+0.908DM.(DM: diaphragm movement, TV: tidal volume, RR: respiratory rate, SII: posterior segment, SIII: anterior segment, SIX: lateral basal segment, SX: posterior basal segment). There was no significant difference between two results derived from the displacement model and 4DCT technology.( P>0.05). Conclusions:The diaphragm movement and tidal volume are the main influencing factors of 3D lung tumor displacement. The tumor displacement in the superior-inferior direction is correlated with different pulmonary segments of the upper and lower lobes. The displacement of tumors located in different segments of middle lobes is similar. The displacement model can predict the displacement of SPLs located in different lobes, providing reference for individualized delineation of PTV.

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.

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.

Objective To explore the mechanisms of ligament of Marshall (LOM) initiat and sustain atrial fibrillation (AF).Methods The electrophysiologic properties of canine LOM were investigated using multipolar catheter mapping(normal canines,n =4,group A;AF canines,n =5,group B).The programmed stimulation were performed in the LOM,PV-left atrium(LA)junction and LA,respectively.Activations maps of LOM were analyzed from episodes of spontaneous onset of AF and initiation of induced AF by a single extrastimulus.The effectives refractory period of each part was compared and statistically analyzed among three parts in each group and between the two groups.LOM were cutted with surgical incision technology.The inducing rate of AF and the mapping rate of double potential and fragmented electrocardiogram were compared and statistically analyzed pro and post isolation of LOM.Results The incidence of abnormal potential of LOM in the two groups was significantly different(P ＜0.01),re-entry cycle(group A 25％ vs.B group 80％),tachycardia(group A 25％ vs.B 100％),double potential(group A 25％ vs.group B 80％),fragmentation potential(group A 25％ vs.group 80％).There was a significant difference in the rate of LOM tachycardia induction before and after LOM intervention in group B (P ＜ 0.05,before 100％ vs.after 20％).Conclusion There are two possible mechanisms of LOM involved in the occurrence and maintenance of AF:one is that LOM induces AF through spontaneous excitation,the other is that LOM participates in the reentry of left atrium and pulmonary vein in the form of bypass to induce and maintain AF.

Objective To analyze the resources allocation and service provision of hospital rehabilitation departments in China from 2009 to 2016, for finding problems and providing references for improvement of hospital rehabilitation system in China. Methods Using the statistical yearbook of health and family planning in China from 2010 to 2017,descriptive analysis was made to describe the rehabilitation service and resources allocation of hospital rehabilitation departments in China in recent years. Results From the perspective of service volume, the quantity of rehabilitative services was increasing year by year, and the number of patients discharged from the hospital has increased rapidly among the total number of hospital discharged inpatients countrywide. By the end of 2016, this proportion was 1.26%. From the perspective of resources allocation, by the end of 2016, the proportion of the rehabilitation beds was just 2.62% of all hospital beds. Personnel staffing was poor by the end of 2016, as there were only 0.02 practicing rehabilitation doctors (assistants) per every 1 000 population. Conclusions It is imperative to strengthen the resources of hospital rehabilitation departments, increase the number of hospital beds and personnel,and improve the pay for these staff, to ensure their service capability. It is also an important guarantee to provide the people with healthcare that is all-dimensional and full lifecycle.

Objective To analyze problems in the development of medical service at private hospitals, and provide references for promoting the development of these hospitals and implementing policies for encouraging this sector′s growth. Methods The data were collected from the statistical yearbook published by the National Health Commission of the People′s Republic of China, and descriptive analysis method was used to analyze the medical service workload and medical service efficiency of private hospitals in China since the new healthcare reform. Results Private hospitals accounted for 56. 39％ of the total number of hospitals in China, accounting for 21. 69％ of beds by the end of 2016. From the perspective of medical service workload, the service volume of these hospitals had increased yet at a small pace. The number of patients and inpatients received accounted for 12. 90％ and 15. 84％ respectively of all the hospitals in China. From the point of service efficiency, by the end of 2016, the bed utilization ratio was 62. 8％, the daily medical visits to their doctors were 5. 5 persons-times, and the daily number of hospitalized beds per doctor was 2. 2 beds. These numbers lag far behind public hospitals. The development of private hospitals varied with regions in imbalance. Conclusions Improving the social image, attracting talents and improving service quality are key to improving the medical service capacity of private hospitals.