The new healthcare reform project raised the thought that basic medical care service should be available to each individual,and the objective of an entire-people covered medical care assurance,which provide policy guarantee for the improvement of medical care service.To achieve the real advancement of medical care service,many endeavors are involved as follows.It is necessary to strengthen the responsibility share of all-level governments,guarantee the input for medical care adapted to local conditions and meanwhile embody medical care impartiality,strengthen the quality construction within medical care institutions,develop the role of medical care service in directing the patients triage which guides residents to get access to community medical centers,and respect individual's own choice for medical care so as to achieve the competition mechanism among medical care service designated hospitals.

Objective To investigate antimicrobial susceptibility of Klebsiella pneumoniae (K .pneumoniae )to aminoglycosides and detection of 16S rRNA methylase genes in K .pneumoniae .Methods Ninety-six non-repetitive clinical K .pneumoniae isolates were collected from Xiangya hospital of Central South University from January to Ju-ly 2009,minimal inhibitory concentrations (MICs)of gentamycin,amikacin and tobramycin were determined by agar dilution method ;genotype of 16S rRNA methylase genes (armA,rmtA,rmtB ,rmtC,rmtD ,npmA)were detec-ted by polymerase chain reaction(PCR).Results MIC50 of amikacin,gentamycin and tobramycin was 256μg/mL, 512μg/mL and 512μg/mL respectively;and MIC90 were all>512μg/mL;antimicrobial resistance rate was 21 .88%, 63.54%,and 41 ,67% respectively.68 isolates (70.83%)were resistant to at least one kind of antimicrobial agent, 21 isolates(21 .88%)were resistant to three kinds of antimicrobial agents.22 isolates(22.92%)carried armA,but rmtA,rmtB ,rmtC,rmtD and npmA were not detected;of 22 isolates harboring armA 16S rRNA methylase genes, 17(77.27%)were highly resistant to gentamicin,amikacin and tobramycin,the homology of armA positive isolate and armA (FJ410928.1 )was 100%.Conclusion armA 16S rRNA methylase gene harbored in K .pneumoniae plays an important role in aminoglycoside resistance.

BACKGROUND: There are many studies from both domestic and abroad certifying the conclusion that sport exercise can descend state anxiety even though the study outcome is diversified.OBJECTIVE: Analysis of the effects of different exercise intensities on state anxiety and physiologic index of female college students taking different exercise frequencies, in order to take exercise of adequate intensity for descending the state anxiety of female college students.DESIGN: Matched observations, selecting female college students as subjects stochastically. SETTING: Department of Military Sports, China Metrology College. PARTICIPANTS: Totally 60 students from the Management Department and Track and Field Department of Shanghai Physical Culture Institute were selected as the subjects from March 2004 to July 2004. The subjects were categorized into two groups: frequent exercise group and infrequent exercise group according to exercise frequency (3 times per week, above 30 minutes each time), and each group consisted of 30 subjects.METHODS: All subjects were tested on running stage of Swiss-made Monark power bicycle with the time length: 20 minutes, exercise intensity 30%VO2max and 75%VO2max. The exercise intensity of subjects was deter mined by the linear relationship between oxygen uptake and heart rate. The state anxiety of the students was assessed with state-trait anxiety scale which have 40 items in a survey questionnaire of two pages. The state anxiety was mainly evaluated with the state anxiety survey questionnaire of items 1-20 under stress condition, and the human emotional experiences were appraised with the trait anxiety survey questionnaire of items 21-40. Each scale was then rated from 1-4, 1 = almost nothing, 2 = a little, 3 = sometimes, 4= approximately always. The questionnaire were handed out and collected respectively in 3 time intervals (immediate, 5 minutes, 20 minutes), before and after exercise the students' heart rate and blood pres sure were tested with PoLar distance cardiotachometer and HeM-741c oMron electronic blood pressure gauge in the same time intervals before and after exercise. MAIN OUTCOME MEASURES: Comparison of the effects of different exercise intensities on the state anxiety of female college students taking exercise of different frequencies. Evaluation on their heart rate and blood pressure.RESULTS: Totally 60 survey questionnaires were handed out and 60 col lected with the collection percentage of 100%. ①Variation of state anxiety under different exercise intensity. In infrequent exercise group,as compared with those prior to the test, the state anxiety of subjects in infrequent exercise are descended remarkably (P ＜ 0.01) in 30%VO2max exercise of the 3 time intervals immediate, 5 minutes and 20 minutes, with the descent amplitude: 9.286, 24.44%; the state anxiety was descended as well in the 75%VO2max exercise of the 3 time intervals, but without remarkable descent amplitude. In frequent exercise group, the state anxiety was descended remarkably (P ＜ 0.01-0.05) in 75%VO2max exercise of the 3 time intervals with the descent amplitude: 5.575, 19.5%; the state anxiety was descended remarkably in 30%VO2max exercise for 20 minutes. ② Assessment on heart rate and blood pressure indexes. In frequent exercise group, heart rate showed temporal elevation immediately after test, and soon resumed to previous level before test;diastolic blood pressure (DBP) remained stable. Systolic blood pressure (SBP) showed temporal elevation immediately after test and SBP showed remarkable descent with the greatest degree in 75%VO2max exercise for 20 minutes. In infrequent exercise group, heart rate and SBP showed descent after elevation. SBP showed descent remarkably in 75% VO2max exercise and 30%VO2max exercise for 20 minutes, and more remarkably in 30%VO2max exercise particularly. DBP showed descent remarkably in aerobic exercise 5 minutes or 20 minutes.CONCLUSION: 75%VO2max aerobic exercise can descend noticeably the state anxiety of female college students in frequent exercise group , and 30%VO2max can eff

The article reviewed the function of general practitioners in Beijing Jiaotong University Health Service Center, which was transitioned from sole curative service to both curative and preventive services. The article also discussed the role as gatekeeper for health system played by practitioners in university health service centers.

Objective To observe the dynamic changes of the numbers of CD34 positive microvessel and RCA-1 positive cell and neutrophil in perihematoma tissue after intracerebral hemorrhage (ICH) in rats at different time points and the impact of thrombin-specific inhibitor hirudin on the above different indicators and to investigate the protective mechanisms of hirudin for brain injury following ICH. Methods An experimental model was made with autologous whole blood injecting into the rat brain basal ganglia by using the stereotactic method. The rats were randomly assigned to sham operation, ICH, hirudin intervention, and normal saline groups.CD34 and RCA-1 immunobistochemistry stainings and conventional HE staining were used to observe CD34-positive microvessel, RCA-1 positive cell and neutrophil.Results The numbers of CD34-positive microvessel began to decrease at 12 hours after ICH, it decreased to the lowest at 72 hours, and it gradually returned to normal levels at day 7. The RCA-1 positive cells could be observed at 6 hours after ICH. It reached the peak at 48 hours. A small amount could persist for two weeks. Neutrophil could be observed at 12 hours after ICH. It reached the peak at 48 hours and disappeared at week 2. The administration of hirudin significantly reduced the numbers of RCA-1 positive cell and neutrophil in the early stage of ICH (5 min). At the same time, it significantly inhibited the decreased numbers of CD34-positive microvessel (all P ＜0. 01). The administration of hirudin during the edema formation also significantly reduced the numbers of RCA-1 positive cell and neutrophil (all P＜ 0.05), however, it could not significantly increase the numbers of CD34-positive microvessel. Conclusions Thrombinmediated inflammatory response has involved in the process of brain injury after ICH, and early administration of hirudin may significantly relieve perihematoma tissue injury.

OBJECTIVE To evaluate the influence of three high-level chemical disinfectants for sterilization on cauterization of dental instruments.METHODS The measuring methods for disinfectants on cauterization of metal instruments,and usage indications for disinfectants followed Technical Standard for Disinfection published in 2002 by the Ministry of Health.Fourteen kinds of small instruments(grouped by 4 different metal materials) were analyzed on receipt and after sterilization by three high-level disinfectants(2% glutaraldehyde,chlorine dioxide, and symclosene),using cauterization rate.RESULTS Three high-level disinfectants had different cauterization rates,the cauterization rate was affected by concentration of disinfectant,sterilizing time,and morphology of instruments.The cauterization of chlorine dioxide was the strongest,followed by symclosene(trichloroisocyanuric acid),and then 2% glutaraldehyde.CONCLUSIONS In clinical sterilization,different materials of small instruments need proper disinfectants,concentration and sterilizing time for decreasing their cauterization.

OBJECTIVE To investigate the distribution and the drug resistance of pathogens in infective cases and to provide a foundation for reasonable application of antibacterials.METHODS The information of all bacterial cultures and susceptibility tests from the inpatients in the year of 2006 was analyzed.RESULTS A total of 336 strains of pathogens were isolated,and the pathogens causing lower respiratory tract infection rated the top(60.7%).The resistance rate of Acinetobacter baumannii was the highest in Gram-negative bacilli.It was 33.3% to imipenem,and more than 66.6% towards the other antibacterials.All Gram-positive cocci were sensitive to vancomycin.The resistance rate of Enterococcus and Staphylococcus aureus was more than 75% to the most antibacterials.CONCLUSIONS Inspecting pathogens and strengthening susceptibility tests are very important in reducing drug abuse,decreasing the resistance rate and raising the cure rate in hospital.

The cultivation of college students' innovative ability should be strengthened in order to keep up with the development of our society and improve the students' quality to adapt themselves to their future career.In order to cultivate college students' innovative ability,on the one hand,we should advance quality education,enhance teaching staff training and improve teaching methods to provide helpful external factors;on the other hand,we also should equip students with solid basic knowledge,enhance their awareness of innovation,change their study concept and improve their practicing ability to provide beneficial internal causes.

Objective To explore the optimum time of removal of preoperative double J stent before adjuvant radiotherapy in cervical cancer. Meth?ods A total of 90 patients with cervical cancer who underwent radical surgery between January 2014 and March 2015 were retrospectively analyzed. In addition,these recruited patients also underwent preoperative placement of double J stent and had them removed before the adjuvant radiotherapy. The patients were then divided into three groups based on the time of removal of double J stent. Group A(n=21)had the stent removed 2 to 4 weeks after the surgery;group B(n=46)had the stent removed 4 to 5 weeks after the surgery;group C(n=23)had the stent removed greater than or equal to 5 weeks after the surgery. The complications caused by stent placement and their improvement after stent removal were compared among the three groups. Finally,the optimum time of stent removal was determined. Results The overall incidence of complications caused by stent placement in group B(23.91%)was significantly lower(P<0.05)than that in group A(47.62%)and group C(56.52%). The most frequent among these complications were bladder irritation(8.70%)and fever(8.70%). The incidence of hydronephrosis exacerbation after stent removal in group A (28.57%)was significantly higher(P<0.05)than that in group B(6.52%)and group C(4.35%). All the other complications were alleviated or disappeared after the removal in all the three groups. There were no significant difference(P>0.05)among the three groups concerning glomerular filtration rate,serum urea nitrogen,and serum creatinine. Conclusion The incidence of complications caused by preoperative double J stent place?ment increased along with the duration of placement,but the exacerbation of hydronephrosis should be concerned if the stent is removed too early. Therefore,the optimal time of stent removal is 4 to 5 weeks after the surgery.

Objective To identify and analyze the expression of microRNA miR-181a in HepG2.2.15 cell line transfected by full-length hepatitis B virus genome,and explore the potential role of miR-181a engaged in the development of HBV-related liver disease.Methods Based on the previous data from microRNA microarray,miR-181a specific probe was designed and synthesized.The expressive levels of miR-181a in HepG2.2.15 and its parent cell line HepG2 were analyzed using Northern blot analysis.Some putative targets of miR-181a were predicted by computational software RNAhybrid and confirmed by mRNA microarray.One of the targets was selected and flow cytometry analysis was used to further determine the difference of intracellular HLA-A2 level between the two cell lines.Results Northern blot analysis showed that the expressive level of miR-181a in HepG2.2.15 cell was significantly up-regulated compared with that in HepG2 cell.Some putative targets of miR-181a including C8A,IDH1 and HLA-A were predicted and miR-181a might down-regulate the expression of HLA-A gene via partial complement to the 3'-UTR of HLA-A gene.Consistency with the result of mRNA profile microarray,FCM analysis also showed a significantly lower expression of HLA-A2(43.9%)in HepG2.2.15 cell than that in HepG2 cell(96.6%).Conclusion The expressive level of miR-181a in HepG2.2.15 cell is significantly up-regulated and miR-181a might down-regulate its target gene HLA-A,which might be one of the molecular mechanisms that HBV may escape from the immune response and continue replication in hepatocytes.The knowledge is also helpful for understanding the mechanism of HBV-host microRNA interaction.