The mode of community home-based care with combination of medical care and elderly care is im-portant for promoting healthy aging. But now the services contents provided by community health service agencies were not clear, related system of policies and regulations were imperfect, human resources were insufficient and net-work of service resource was not perfect. All of these factors caused the service cannot met old people medical de-mands and the use for community health services is inadequate. So we should proposesupply-side reform on communi-ty health service to meet the medical demands for old people and even to stimulate new demand.

Objective To investigate the level of caregivers′burden and the coping style among parents of cancer children. Methods Totally, 229 parents of cancer children participated in the investigation by Chinese version of zarit burden interview (ZBI), Chinese version of coping health inventory for parents (CHIP) and self-designed general information questionnaire. The associations between caregivers′burden and coping styles were tested by Spearman correlation analysis. Results The caregiver′s burden on the parents was in the middle level with a total score of (30.50 ± 12.24). The coping style the parents took most frequently was to unite the family and keep a positive attitude and regard it as most effective. The caregiver′s burden was negatively associated with the positive coping style . Conclusion The parents of cancerous children suffer from middle level of burden . Nurses should assess the caregiver′s burden, provide targeted interventions to relieve it, help the to establish effective coping style and change their psychological and mental state and ultimately improve their quality of life.

Objective To observe the clinical efficacy and safety of second transurethral resection combined with instillation therapy and transfusion therapy of dendritic cells pulsed with tumor cells on non muscle-invasive bladder cancer.MethodsEighty patients with stage T1 non muscle-invasive bladder cancer were included in this protocol in which all patients prospectively received second transurethral resection within 4 to 6 weeks following initial resection.All 80 cases were divided into a DC group and a control group.In the DC group,dendritic cells pulsed with tumor cells were transfused between 6 -8 weeks.Bladder instillation therapy and follow-up was applied on the control group.The recurrence rate,the clinical efficacy and adverse reactions were observed and compared between the two groups.ResultsIn the initial resection,21.3％,67.5％ and 11.2％ had G1,G2 and G3 transitional cell carcinoma,respectively.Twenty-seven (33.7％) had residual tumors at the second TUR,8 patients had Ta(29.6％ ) and 19 had T1 (70.4％).After the initial TUR-Bt,residual tumors were detected in 11.1％,70.4％ and 18.5％ in G1,G2 and G3,respectively.In the 8 Ta cases,2 cases moved to a higher grade,while the grade was unchanged in 6 cases.In the 19 cases with stage T1,12 had a higher grade,5 had a lower grade and 2 remained the same.In the DC group,5 cases suffered chills and fever when dendritic cells were transfused.The fever was releaved when dexamethasone was administered.The white blood cells count,creatinine and alanine aminotransferase had no statistically significance change at pre-therapy,one year after therapy and two years after therapy (P ＞0.05).The index of CD4 、CD8 、CD4/CD8 had statistically significance change at pre-therapy,one year after therapy and two years after therapy ( P ＜ 0.05 ),while the difference between one year after therapy and two years after therapy was not statistically significance ( P ＞ 0.05 ).The first and second year recurrence rate was 2％ and 6％ in the DC group,while in the control group it was 20％ and 30％.The difference was statistically significant ( P ＜ 0.05 ).Conclusion Second transurethral resection combined with instillation therapy and transfusion therapy of dendritic cells pulsed with tumor cells could be an effective therapeutic approach to lower the recurrence rate on non muscle-invasive bladder cancer.

AIM: To explore the expressive role of lipoprotein-associated phospholipase A_2, high sensitive C-reactive protein and matrix metalloproteinase-9 in vulnerable atherosclerotic plaques in a rabbit model. METHODS: Forty eight New Zealand white male rabbits were randomly divided into 4 groups (12 rabbits each): control group, stable plaque group, p53 group, and p53+drug group. Rabbits in control group were fed with a regular diet and underwent sham operation. Rabbits in stable plaque group, p53 group and p53+drug group underwent balloon induced arterial wall injury and then were fed on a diet with 1% cholesterol. The animals were all fed for 3 months, then the rabbits in p53 group and p53+drug group underwent Ad5-CMV p53 transfection at 10th week. Before killed, the animals in p53+drug group underwent pharmacological triggering with Russell's viper venom (RVV) and histamine to induce the rupture of the atherosclerotic plaques. At the 1st day and before sacrifice, the serum was collected for measuring Lp-PLA_2, hs-CRP, MMP-9, HDL, LDL and VLDL. The expressions of Lp-PLA_2, hs-CRP and MMP-9 in tissues were determined by the methods of hybridization and immunohistochemistry. RESULTS: At the end of 12th week, the serum and tissue levels of Lp-PLA_2 and MMP-9 in stable plaque group, p53 group and p53+drug group were significant different from those in control group and in each group at the first day (P<0.05). The serum levels of Lp-PLA_2 and hs-CRP in p53 group and p53+drug group were significantly higher than those in control group and stable group (P<0.05). The serum levels of Lp-PLA_2, hs-CRP and MMP-9 were all significantly different between p53 group and p53+drug group (P<0.05). At the end of 12th week, pathological results showed that 4 groups were normal artery, stable plaque, vulnerable plaque and rupture plaque, respectively. The fabric cap was thicker in plaque groups than that in normal group (P<0.05). The rupture and formation of thrombus were more significant in p53+drug group than those in p53 group. The serum level of Lp-PLA_2 had negative interrelated relationship with fabric cap in plaque groups (r=-0.710, P<0.01), and hs-CRP, MMP-9 had no interrelated relationships with fabric cap in plaque groups. CONCLUSION: Base on the successful establishment of the atherosclerotic plaque animal model, serum Lp-PLA_2 shows better interrelated relationships to plaques stability. Combination with hs-CRP and MMP-9, we can exactly evaluate the nature of plaques.