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.

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.

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

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.

Objective The aim of this study is to examine the effect of myoophenolate mofetil (MMF) on epithelial-myofibroblast transiation(EMT) in adenine-induced chronic renal failure (CRF) rat model and the role of vascular endothelial growth factor(VEGF) and inhibitor of differentiation (Id2 and Id3) in EMT in the rat kidney. Methods Sixty-four male Wistar rats were randomly assigned to the following groups: normal control (n=16), CRF (n=24) and MMF(n=24). CRF was induced by gastric gavage of adenine (125 mg·kg-1·d-1) to rats for eight weeks. CRF rats were treated with MMF (15 mg·kg-1·d-1) as "MMF" group. The rats were sacrificed at week 2, 4, 6 and 8, respectively.Urinary protein and serum ereatinine levels were measured, and the histopathologic degrees of interstitial fibrosis were evaluated in Massen-stained sections. Expressions of a-smooth muscle actin (α-SMA),transforming growth factor β1 (TGFβ1), VEGF and Id (Id2 and Id3) in the kidney tissue were assessed by immunohistochemistry, RT-PCR and/or Western blot methods. Results The urinary protein level in MMF group was evidently lower than that in CRF group (P<0.01), whereas no statistically significant difference was observed in serum creatinine level between the two groups. Renal interstitial fibrosis was reduced significantly with MMF treatment (P<0.01). Expression of α-SMA in MMF group was lower than that in CRF rats at week 6, 8 (P<0.01), while expression of TGFβ1 was decreased markedly at week 2, 4,6 (P<0.01). The expressions of VEGF in MMF rats were increased significantly at week 6,8 (P<0.01),and Id2,Id3 in MMF rats were increased significantly at week 4,6 (P<0.05). Conclusions MMF may ameliorate chronic renal fibrosis and EMT in adenine-induced CRF rats. This effect of MMF on EMT is probably related to upregulation of VEGF, Id2 and Id3 expressions and suppressing overexpression of TGFβ1 in renal tissue. The exact mechanism needs to be studied further.

Objective To ecaluatc the diagnostic value of digital subtraction angiography (DSA) and carotid artery ultrasound for transient ischemia attack (TIA). Methods Among the 74 patients with TIA, 45 had internal carotid artery (ICA)-TIA and 29 had vertebrobasilar artery (VBA)-TIA. DSA examination was performed in order to detect intracranial and extracranial arterial stenosis in the above two systems. Cervical artery ultrasound examination was used to understand the distribution of arterial plaques. Results DSA shoved that the detection rate of vascular stenosis in patients with ICA-TIA was 84. 4% (n = 38),and the patients with serious, moderate and slight stenoses were 31.1% (n = 14), 26. 7% (n = 12) and 11.1% (n =5), respectively. Of those, intracranial arterial stenosis was 44.4% (n =20), and it was significantly higher than 22.2%(n = 10) in extracranial arterial stenosis (P ＜0. 001 ); the detection rate of vascular stenosis in patients with VBA-TIA was 65.5% (n = 19), and the patients with serious, moderate and slight stcnoscs were 17. 2% (n = 5), 27. 5% (n = 8), and 20. 7% (n = 6), respcctivegly. Of those, cxtracranial arterial stenosis was 44.8% (n = 13), and it was significantly higher than 13.8% (n = 4) in intracranial stenosis (P ＜ 0. 001 ). Carotid artery ultrasound shoved that the detection rate of ICA plaque was 44.4% (n = 20), and it was higher than 24, 1% (n =7) in patients with VBA-TIA; the detection rate of the plaques in the initial segment of subclavian artery in patients with VBA-TIA was 44. 8% (n = 13), and it was significantly higher than 13.3% (n = 6) in patients with ICA-TIA (P ＜ 0.001 ). Conclusions There were differences between the intracranial and extracranial vascular lesions and the distribution of atherosclerotic plaques in patients with ICA-TIA and VBA-TIA. 1he former was more common in intracranial lesions, and the latter was more common in extracranial lesions.

Objective To explore the effect of valium and barbitone in the treatment of convulsion in neonate. Methods 156 children with convul sion were randomly divided into two groups, 77 cases in control group and 78 cases in treatment group. Results The instant and total effective rates of treatment group and control group were companed, respectively. There were significant difference between these two groups.Conclusion Valium and Barbitone is effective in treating neonate with convusion.

Objective To compare difference of nt and aa of H gene between the measles virus strains(MVW) recently circulating and used vacci ne strain (Chang-47) in Liaoning province of China, and to study biological an d immunological characteristic and genotype of MVW and Chang-47. Method s The analysis of 1～1 800 nt and 1～600 aa abou t H gene of MVW and Chang- 47 vaccine strain was performed. Neutralization test was performed against MVW and Chang-47 vaccine strain in the sera of measles cases and children vaccinated after 30 days. Results The genoty pe of the MVW was different from genotypes previously described in other c ountries and vaccine strain (Chang-47) used in Liaoning province. It also showe d that 18～28 aa were distinct from aa of other genotype, but most of the importa nt biological and immunological sites were not changing except the site at aa 24 0 .Neutralization antibody titer GMT against MVW and Chang-47 strains were no sig n ificantly different in the sera of measles cases and the children vaccinated af te r 30 days, but antibody titers GMT of the measles cases sera against MVW or Cha ng-47 strain were much higher than children vaccinated. Conclusions There was nt variation in the MVW. Most of biological and immunological a a sites of the MVW and Chang -47 strains were the same and were not changing. C hang -47 vaccine may also protect from infection of the MVW.

ObjectiveTo understand the clinical and microbiological characteristics of AIDS-associated bloodstream infection (BSI).MethodsThe clinical and laboratory ifndings of 143 cases of BSI in AIDS patients who were hospitalized during the period from 2013 to 2014 were retrospectively analyzed.ResultsThe prevalence of BSI in AIDS patients was 22.1%. The 143 patients were divided into two groups in terms of fungal or bacterial infection. The incidence of speciifc skin rashes, anemia, hepatosplenomegaly and lymph node enlargement in fungal infection group was higher than those in bacterial infection group (allP<0.05). CD4+ cell count, WBC, neutrophils, RBC, hemoglobin, and platelet count in fungal infection group were lower than those in bacterial infection group, while AST and Cr were the opposite (allP<0.05).Penicillium marneffei(84/143, 58.7%) was the most common pathogen isolated from AIDS-associated BSI, followed byEscherichia coli (10/143, 7.0%),Cryptococcus neoformans (9/143, 6.3%),Klebsiella pneumoniae (7/143, 4.9%),Salmonella (6/143, 4.2%),Candida albicans(3/143, 2.1%), andAeromonas (3/143, 2.1%). Most strains were still susceptible to the commonly used antibiotics.ConclusionsThe prevalence of BSI is high in AIDS patients. Fungal BSI is more likely to have skin rash, anemia, hepatosplenomegaly and lymphadenopathy, hematologic abnormalities, liver and renal function impairment. Fungi, especiallyPenicillium marneffei, are the main pathogen of AIDS-associated BSI. Most strains are susceptible to the commonly used antibiotics.