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Artemisia annua is the main natural source of artemisinin production. In A. annua, extended drought stress severely reduces its biomass and artemisinin production while short-term water-withholding or abscisic acid (ABA) treatment can increase artemisinin biosynthesis. ABA-responsive transcription factor AabZIP1 and JA signaling AaMYC2 have been shown in separate studies to promote artemisinin production by targeting several artemisinin biosynthesis genes. Here, we found AabZIP1 promote the expression of multiple artemisinin biosynthesis genes including AaDBR2 and AaALDH1, which AabZIP1 does not directly activate. Subsequently, it was found that AabZIP1 up-regulates AaMYC2 expression through direct binding to its promoter, and that AaMYC2 binds to the promoter of AaALDH1 to activate its transcription. In addition, AabZIP1 directly transactivates wax biosynthesis genes AaCER1 and AaCYP86A1. The biosynthesis of artemisinin and cuticular wax and the tolerance of drought stress were significantly increased by AabZIP1 overexpression, whereas they were significantly decreased in RNAi-AabZIP1 plants. Collectively, we have uncovered the AabZIP1-AaMYC2 transcriptional module as a point of cross-talk between ABA and JA signaling in artemisinin biosynthesis, which may have general implications. We have also identified AabZIP1 as a promising candidate gene for the development of A. annua plants with high artemisinin content and drought tolerance in metabolic engineering breeding.
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After recent years′ development, China′s Internet medical service and medical insurance policy system has begun to take shape, but it still needs to be further improved. By combing the connotation and mode of Internet medical services, the evolution of medical insurance payment system and the content of medical insurance payment policy in the United States, the authors put forward that China could further improve the medical insurance payment policy system of Internet medical care, strengthen the multi-point practice management of licensed doctors on the Internet, give full play to the role of commercial insurance in promoting Internet medical care, and rely on information technology means to improve the medical insurance supervision of Internet medical services, then promote the development and management of Internet medical insurance services in China.
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By means of analysis of related national policies on medical alliances, and investigation of their current development in China, the authors summarized the conceptual category of existing medical alliances. Typical cases were selected for comparative analysis in terms of urban medical groups, medical communities, specialized alliances and telemedicine collaboration networks. In view of such setbacks found as lack of health services, ambiguity of power and duties of stakeholders, and low penetration rate of composite medical insurance payment, as well as lack of effective incentives and poor online diagnosis and treatment mechanism, the authors recommended on development of medical alliances in respect of framework improvement and mechanism optimization among others.
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Objective:To provide a reference for establishing the evaluation system of the implementation effect of cross provincial direct settlement policy.Methods:By referring to the public policy evaluation model and using the expert consultation method, the authors built an evaluation index system for the implementation effect of cross provincial direct settlement policy for urban and rural residents. The multi-attribute group decision-making analytic hierarchy process, Matlab software and Yaahp software, combined with Spearman correlation coefficient method, were used to cluster the expert opinions and further determine the weight of each element at different levels.Results:The evaluation index system of the implementation effect of direct settlement policy for urban and rural residents′ cross provincial medical insurance was constructed, including 3 first-class indicators, 9 second-class indicators and 20 third-class indicators, and the weight of each index was calculated.Conclusions:The designed index system is suitable for grasping the implementation level of the cross provincial direct settlement policy from a macro perspective, and find out the problems in the implementation process. Efforts should be made to refine the evaluation criteria of the indicators in the index system.
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OBJECTIVE To discuss the correlation between effectual time and the curative effect in patients with all frequency descending sudden deafness. METHODS According to effectual time,the subjects were divided into first week effectual group and second week effectual group and the curative effect of each group was compared. RESULTS In patients with flat descent sudden deafness, the curative rate of the first week effectual group was higher than that of the second week effectual group, but there was no significant difference between the two groups(χ2=1.599, P =0.206). Meanwhile, the total significant effective rate of the first week effectual group was higher than that of the second week effectual group, without obvious difference between the two groups(χ2=0.124, P =0.725). Furthermore, in patients with total deafness type of sudden deafness, the curative rate of the first week effectual group was higher than that of the second week effectual group, showing no remarkable difference between the two groups(χ2=2.493, P =0.114). Besides, there was no remarkable difference in the comparison of the total significant effective rate (χ2=2.308, P =0.129), which was higher in the first week effectual group than that in the second week effectual group. CONCLUSION The course of treatment should be at least 2 weeks in patients with all frequency descending sudden deafness after onset.
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Based oncompetence-basedphilosophy of education, core competences of Master of Nursing Specialist (MNS) postgraduates serve as a benchmark for the education quality. Furthermore, the evaluation of core competences is a key link. Our research mainly summarizes the evaluation methods of core competences of MNS at home and abroad, thus providing suggestions to the improvement of domestic core competences evaluation methods of MNS.
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Objective To verify the short and medium term effect of dutasteride in the treatment of lower urinary tract symptoms ( LUTS) secondary to benign prostatic hyperplasia( BPH) with prostate volume≥40 ml.Methods One hundred and seven patients diagnosed as BPH accompanying moderate-to-severe LUTS who met the inclusion/exclusion criteria were enrolled from July 2013 to September 2014.After 12 weeks of treatment with dutasteride 0.5 mg/d, the primary outcome was international prostate symptom score (IPSS) change from baseline at Week 12, and the secondary outcome was Quality of Life (QOL) score before and after the treatment, maximun flow rate ( Qmax ) , and the change in residual urine volume. Comparing with baseline, patients with the rate of IPSS decline ≥30% ( effective group) continued taking dutasteride for another 4 weeks then undergoing the prostate volume and PSA measurement.In addition, patients with the rate of IPSS decline <30% were administered combination therapy with dutasteride and tamsulosin (0.2mg/d), their IPSS at Week 16 were compared with that at Week 12, and their prostate volume and PSA level were followed up until Week 20.The prostate volume and PSA changing were followed up.Results Compared with baseline, after 12 weeks of treatment with dutasteride, patients'IPSS decreased 5.54 points ( P <0.01 ) , including 59 patients ( 55.14%) with IPSS decline rate ≥30%, QOL score decreased 1.56 points (P<0.01), Qmax increased 1.07 ml /s (P=0.049), and residual urine decreased 6.46 ml (P=0.107).IPSS declined ≥30% in 42 patients at Week 12, whose prostate volume reduced 14.15%at Week 16 follow-up, with PSA declining of 0.68 ng /ml in 32 tested cases ( P=0.008).IPSS declining <30%in 36 patients at Week 12 was followed up to Week 20, and their prostate volume reduced 11.89%, with PSA declining of 0.18 ng/ml ( P=0.589) in 33 tested patients.Conclusions Dutasteride can improve the lower urinary tract symptom in patients who are diagnosed as BPH accompanying moderate-to-severe LUTS with prostate volume ≥ 40 ml significantly.Tamsulosin add-on treatment benefited most patients.
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Objective:To investigate the clinical security and feasibility of neoadjuvant chemotherapy with imatinib following lap-aroscopy-guided intersphincteric resection for patients with gastrointestinal stromal tumor of the low rectum (GSTLR). Methods:Clini-cal data of nine patients with GSTLR who were admitted to the Shengjing Hospital between January 2007 and January 2011 were re-viewed. These patients were treated with neoadjuvant imatinib chemotherapy after laparoscopic intersphincteric resection. Results:Pri-or to neoadjuvant chemotherapy, the tumor diameter ranged between from 5 cm to 9 cm (median=7.0 cm). After imatinib chemothera-py, the tumor diameter decreased to 2-4.5 cm (median=3.5 cm, P<0.001). Laparoscopic surgery through intersphincteric resection was performed after imatinib treatment for 3-24 months (median=7 months). All patients received a protective stoma, which was closed 3 months after the surgery. The Wexner scale scores ranged from 1 and 4 (median=2) prior to neoadjuvant imatinib chemotherapy and changed to 1-5 (median=2) after the chemotherapy (P=0.397). After stomal closure operation, the scores significantly increased to 4-9 (median=7, P<0.001) but were not statistically significantly different from those before the therapy. One year after laparoscopic surgery, the Wexner scale scores ranged from 1 to 5 (median=2, P=0.842). Six patients were treated with imatinib for 24 and 30 months after lap-aroscopic surgery. Recurrence in pelvis occurred in only one patient, who ceased imatinib administration at the 30th month after the sur-gery. Conclusions: Laparoscopic surgery through intersphincteric resection was secure and feasible and thus could be used for treat-ment of GSTLR.
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Objective To investigate the effect of endoscopic management of upper tract urothelial carcinoma (UTUC),and evaluate the indication and clinical value of postoperative prophylactic pelviureteric instillation chemotherapy.Methods Patients who met the inclusion criteria included elderly patients,patients who could not tolerate radical surgery,patients with renal insufficiency or needed dialysis after removal of the kidney,patients with bilateral UTUC,patients with tumor≥3 cm in diameter but could be completely resectted under ureteroscopy who required to preserve renal function.Surgical procedure was successful.The ureteral stents were placed,and prophylactic ureteral infusion chemotherapy via the retrograde transvesical ureteric catheterisation was conducted 1-2 times one week at 2 days after surgery.40 milligram of pirarubicin hydrochloride or epirubicin hydrochloride was dissolved in 40 milliliter sterile water for the prophylactic infusion chemotherapy.These instillations were completed within 40 minutes.Results Totally,9 patients (3 males and 6 females) aged 60-86 years,mean age of (69.7±6.4) years,were enrolled in this study.The carcinoma of the renal pelvis was found in 2 cases and ureteral tumors in 7 cases.In pathological results,ureteral polyps was found in 1 case,papillary ureteral neoplasm with low malignant potential in 2 cases,urinary tract epithelial carcinoma in 4 cases (1 case with poorlydifferentiation,1 case with well-differentiation,2 cases with urinary tract epithelial cancer),and 2 cases were lack of pathological reports because of too few pathologic specimens.4 patients received adjuvant chemotherapy by instillation successfully,and lumbago,fever or other complications were not found.Patients were followed up for a mean period of 15 moths (4-31 months).Only 1 patient had recurrence of bilateral ureteral tumor 15 months after surgery,and no tumor recurrence was found in other patients.Conclusions Endoscopic management is a safe and effective in treating UTUC,which can preserve renal function by avoiding nephrorectomy in some patients.The instillation chemotherapy after endoscopic management is safe,which has a satisfactory effect,but further validation in a large clinical sample is needed.Patients with tumor resection under ureteroscopy who cannot obtain the pathology results need to be closely followed up.