Community health service is an effective measure to relieve the difficult medical services and expensive medical cost problem,but community inhabitants in Chongqing make little use of community health service.The actual cause is that people s degree of trust in community health service is low.In view of existing situation,this article analyzes the various factors that influence community residents' degree of trust in community health service and puts forward corresponding policy proposal.

Adult ; Antibodies, Monoclonal, Murine-Derived ; administration & dosage ; therapeutic use ; Female ; Hemophilia A ; drug therapy ; Humans ; Rituximab

BACKGROUND:There is no doubt that animal model of fracture is the basis of fracture healing research.The fracture animal mode is divided into open osteotomy model and closed fracture model.There is no research about the difference between two kinds of fracture rat models.OBJECTIVE:To compare the modeling process between open osteotomy model and closed fracture model in rats,and to compare fracture healing using radiograph.DESIGN,TIME AND SETTING:The randomized,controlled animal experiment was performed at the Laboratory of Department of Orthopaedics,Second Affiliated Hospital,Soochow University from January to May 2007.MATERIALS:A total of 40 SPF male Sprague Dawley rats,weighing(220?30) g,were randomly divided into an open osteotomy model group and a closed fracture model group,with 20 rats for each group.Electric swing saw was a kind of self-made percussion device for closed fracture models.METHODS:All rats in the open osteotomy model group received open osteotomy to create transverse fracture of the middle femur,and fixed using Kirschner wire.Rats in the closed fracture model group received retrograde Kirschner wire fixation,and midshaft femoral closed fracture induced by model establishment stent.MAIN OUTCOME MEASURES:Mean model establishment time;Successful rate of model establishment;Radiography of fracture healing at 2,3,4 and 8 weeks after surgery.RESULTS:Success rate of open osteotomy model establishment was 90%.Average modeling time was 17 minutes.Rate of malunion and nonunion was 40%.Successful rate of each closed fracture models was 85%,with average modeling time was 12 minutes.There was no malunion and nonunion.At 2,3 and 4 weeks after surgery,X-ray score was lower in the open osteotomy model group compared with the closed fracture model group(P 0.05).CONCLUSION:Model establishment of open osteotomy takes a longer time,with a high rate of malunion and nonunion.In near future or medium-term,fracture healing is significantly lagged.Thus,open osteotomy is not suitable for the study of early or medium-term fracture healing.

OBJECTIVE To understand epidemiologic situation of pathogens causing nosocomial infection,their resistance and changing pattern.METHODS A retrospective analysis was made upon the pathogens data from 2002 to 2006.The identification of bacteria was evaluated by VITEK32 and susceptibility test by K-B method.RESULTS The prevalence rate was 6.4%,and main infection sites were lower respiratory tract and urinary tract.Gram-negative bacteria(38.11%) stood first,followed by Gram-positive bacteria(25.25%) and fungi(22.54%).The mean resistance of Gram-negative bacteria was very high,from them Stenotrophomonas maltophilia(72.71%) and Chryseobacterium meningosepticum(68.13%) stood the highest.Besides Enterococcus faecalis,the mean resistance of Gram-positive bacteria exceeded 55.00%.Candida albicans stood first on the list of fungi.CONCLUSIONS The composition of pathogens is changing and showing serious resistances.It is important to strengthen nosocomial infection management and utilize drug rationally.

Objective:To evaluate the role of the retinoic acid raceptor α (RARα) , retinoic acid receptor β(RARp) , estrogen receptor(ER) and progesterone receptor(PR) in the clinical pathological stage, histologcal classification and the muscular invasive depth of the endometrial carcinoma through detecting the expression of these receptors.Methods:48 paraffin sections with endometrial carcinoma by pathological conformation ware selected.Immunohistochemistry was used to detect the expression of RARα, RARβ, ER and PR.The relationship between these raceptors and the clinical pathological parameters was evaluated.Results:①The positive expression ratio of the RARα and RARβ were 47.92% (23/48) and 25.00% (12/48) respectively.The level of RARα was higher than that of RARβ (P<0.05).②The expression of RARα in the endometrial carcinoma increased with the increasing of the pathological stage and the decreasing of the histological differentiation (P<0.05).But the expression of these two receptors had no significant relation with the histological classification and the muscular invasive depth (P >0.05).③The level of the RARβ was consistent with that of the ER and PR, and it decreased with the increasing of the malignant extent of the endometrial adenocarcinoma (P < 0.05) ,and had no significant relation with the pathological stage, the histological classification and the muscular invasive depth (P >0.05).④The expression of RARβ was positively correla ted to the expression of ER and PR, but the expression of RARα was negatively correlated to the expression ER and PR.Conclusions :There is expression of RARα、RARβ in endometrial carcinoma, and it has close relationship between the expression of RARα and the development of endometrial carcinoma.The absence of the RARβ expression and the high expression of the RARα are related to the histological classification of endometrial carcinoma.

Objective: To explore and discuss the clinical curative effect on intermittent positive pressure breathing therapy of non - invasive ventilator in the treatment for chronic obstructive pulmonary disease (COPD) of elderly patients with complication of acute respiratory failure. Methods: 112 elderly patients who were COPD (all of patients were acute exacerbation period) with complication of acute respiratory failure were divided into control group (60 cases) and observation group (52 cases) as the random number table. A series of basic therapy including routine anti-inflammatory, relieving asthma and expectorant therapy were implemented for all of patient. And the non-invasive ventilator was used to implement non-invasive mechanical breathing therapy. In this therapy, patients of control group were implemented sustaining positive pressure breathing therapy, while patients of observation group were implement intermittent non-invasive positive pressure breathing therapy (1:1). The curative effect, pH value (at 6,24 and 72h), PaO2 (at 6,24 and 72h), PaCO2 (at 6,24 and 72h) and complications between the two methods were compared. Results: There was no significant difference in the general demographic characteristics between the two groups. For patients at 6, 24 and 72 h, the differences of the pH value, PaO2and PaCO2 between pre and post-treatment were significant in observation group (F=5.669, F=6.985, F=7.628, P<0.05) and control group (F=5.311, F=6.892, F=7.958, P<0.05) , respectively. The differences of the pH value, PaO2 and PaCO2 at 6h, 24h and 72h were significant (at 24h, F=6.776, F=7.098, F=7.673. at 72 h, F=7.883, F=6.983, F=7.335, P<0.05),respectively. For two groups, the differences of pH value, PaO2 and PaCO2 at pre-weaning, post-weaning 6h and post-weaning 12h were not significant. While the mechanical ventilation time and mechanical ventilation rate of observation group were significant lower than that of control group (t=3.591, x2=3.052, P<0.05). Besides, the incidences of complications including flatulence, trachea intubation, respiratory and relative pneumonia of observation group were significant lower than that of control group (x2=4.997, P<0.05). Conclusion: The new method can significantly shorten duration of breathing and duration of hospital stays. And its incidence of complication is lower while safety of treatment is relatively higher than that of traditional method.

Objective:To evaluate the changes of different parts of upper airway after alternating rapid palatal expansion and constriction via three dimensional measurement, compared with the protocol of ra-pid palatal expansion alone.Methods: In the study, 36 patients with retrognathic maxilla were selected and randomized to either group A or group B.The patients in group A were treated with rapid palatal expansion alone.The patients in group B were treated with alternating rapid palatal expansion and constriction.Three dimensional analyses were performed on all pre-and post-treatment cone-beam computed tomography (CBCT) images with the software Dolphin.Results: Two subjects in group B were lost to follow up during the treatment.The gender distributions, ages and all measuring items before treatment had no significant difference between group A and group B (P>0.05).Nasal floor width, nasal lateral width, nasal volume, and nasopharynx volume increased significantly in each group after rapid palatal expansion alone or rapid palatal expansion and constriction (P<0.05).The variations of oropharyngeal volume and hypopharyngeal volume had no significant difference (P>0.05).No significant difference was observed in the nasal floor width and nasal lateral width increment among the anterior, median and posterior parts in each group either (P>0.05).No significant difference in all the measuring items was observed between the two groups (P>0.05).Conclusion:Alternating rapid palatal expansion and constriction could increase the volume of nasal and naopharynx cavities by the similar way of rapid palatal expansion alone, and had no obvious effect on oropharynx and hypopharynx cavities.

Objectives To investigate the etiological factors,clinical features and treatment of pediatric primary spontaneous pneumothorax (PSP). Methods The clinical data of 84 PSP patients under the age of 18 from Departments of Emergency,Respiratory Diseases and Thoracic Surgery of our hospital from June 1999 to June 2009 were collected. There were 72 males (85.7%) and 12 females (15.3%) with a ratio of 6 to 1. Their age ranged from 14 to 18 (mean 17.06). Patients with pneumothorax following trauma,pneumonia,iatrogenic and other underlying causes were excluded. Therapeutic methods included oxygen therapy for 4.8% patients,closed drainage of pleural cavity for 57.1% patients,and surgery for 38.1% patients,But there were 31 patients receiving surgical treatment after closed drainage was failed. The period of follow-up ranged from 1 to 123 months (mean 25.73 months) through telephone or outpatient. Results Eighty-four patients were included,of whom 96.4% had chest pain,7.1% had chest tightness,66.7% had dyspnea,8.3% had shortness of breath and 14.3% had cough. There were 96.4% patients having decreased breathing sound and 3.6% having absent breathing sound. Bullae or blebs occurred mostly in apex and upper lobe. Twenty-one patients suffered from recurrent pneumothorax. Smokers (66.7%,n=9) had higher recurrent rate than non-smokers (22.0%,n=75). Conclusion PSP should be considered when symptoms such as chest pain and dyspnea appear in teenagers. Closed drainage of pleural cavity combined with surgical procedure is recommended for treatment. PSP patient with a history of smoking has higher recurrent rate of PSP.

As to a nitrite-oxidizing bacterium screened in our laborator y, the effect of pH, nitrogen sources, carbon sources and sodium chloride on its g rowth was studied in order to obtain high cell density. It showed that the cult ure conditions of nitrite- oxidizing bacterium were 4500mg/L sodium nitrite, 1 .5g/L sodium carbonate, 0~0.5% sodium chloride and 0~0.1% glucose at 28℃~30 ℃, 110 r/min and pH 8.0~8.5. After cultivation for 9 days, the bacteria conc entration reached 4.6?109 MPN/mL and all NO-_2-N in the medium w as converted to NO-_3-N. But the transformation of nitrogen sources was inhibited while the sodium chloride concentration exceeded 0.5% or glucose con centration exceeded 0.1%. According to the test of NO-_2-N conversion with nitrite-oxidizing bacteria in a freshwater aquaculture pond, NO-_2 -N began to decrease on the third day of the moculation of this bacterium and t he concentration dropped from 1.47mol/L to 0.49mol/L after 18 days at 25℃ and pH 8.6.

Objective To analyze the change of disease spectrum and the direct cause of death in Xi'an Children's Hospital emergency patients in the past 2 years.Methods The cases of death in 130 emergency cases from 2009 to 2010 were retrospectively analyzed.Results The main causes of death in 2009 were pneumonia,congenital heart disease,asphyxia,neonatal pulmonary hemorrhage and intracranial hemorrhage.Meanwhile,The main cause of death in 2010 were pneumonia,asphyxia,viral encephalitis,congenital heart disease and neonatal pulmonary hemorrhage,which significantly changed compared with 2009.Major direct causes of death were found:respiratory failure in 25 cases (27.5％),heart failure in 17 patients ( 18.7％ ),shock in 17patients ( 18.7％ ),asphyxia in 16 cases ( 17.5％ ),and hernia in 16 cases ( 17.5％ ),Conclusion In order to reduce the mortality rate of emergency patients,we should strengthen health care,actively manage pulmonary infection,systemic infection,and shock,control heart failure,and prevent aspiration.