The paper first offers a comprehensive analysis of the current situation of and contradictions in community health service in China and then, in view of the major problems, puts forward the view of improving the mechanism of community health service with reform as an impetus. The chief steps to be taken include: strengthening confidence, clarifying orientation and bringing into play the primary, comprehensive and preventive role of community health service; taking advantage of the current “founding activities” to deepen the reform and construction of community health service; focusing on the priorities and speeding up the cultivation of the contingent of talents; and perfecting as soon as possible the policy of setting quotas for subsidies to community health service and promoting in an all-round way community health service development.

A nationwide pilot project concerning community health sendees, the major part and chief link of the reform in the urban medical health system, has basically come to an end. The author expounds against the background of reform in the health system in China the motives and orientation of reform in the medical health system and the current situation of and problems in the development of community health services. It is pointed out that advancing community health services entails all of the following:①genuinely transforming concepts and seeking unity of thinking; ②adopting the mechanism of competition and enhancing the sense of innovation; ③persisting in keeping abreast of the times and laying emphasis on reform and development;④accelerating the readjustment of resources and optimizing resource allocation; ⑤ceating a sound environment and seeking common development; ⑥giving priority to the improvement of quality and avoiding superficial transformation.

Community health service in the new century has entered a new stage of development. To ensure the healthy advancement of community health service in the course of system building, the following guiding principles must be adhered to: spurring on system innovation with concept innovation and giving full play to the staying power of community health service; taking the introduction of the competition mechanism as the soul and unremitting impetus of innovation; persisting in the solution of problems accompanying advance and development with methods promoting development; taking the strategic readjustment of health resources as the main line of development; taking the attainment of a favorable external environment as the impetus of development; and sticking to a path of coordinated growth that stresses both quality and speed.

Objective To observe the clinical effect of small gauge vitrectomy (SGV) treatment for proliferative diabetic tractional (PDR) with retinal detachment (TRD).Methods The data of 42 patients (50 eyes) with PDR combined with TRD who had received SGV treatment were retrospectively analyzed.There were 22 males and 20 females,with an average age of (44.5±11.2) years.There were 16 eyes with TRD involving the macular area,34 eyes without TRD involving the macular area.The eyes with rhegmatogenous retinal detachment or retinal hole were excluded.The best corrected visual acuity (BCVA) was worse than finger counting in 18 eyes,worse than 0.1 in 15 eyes,0.1-0.3 in 16 eyes and better than or equal to 0.3 in 1 eye.Post operative tamponade was delivered for patients with iatrogenic retinal breaks,including 5 eyes with long acting gas and 7 eyes with silicone oil.The mean follow-up time was 9.7 months.The visual outcome,rate of retinal reattachment and complications were analyzed.Results The visual acuity improved in 34 eyes (68.0％),unchanged in 12 eyes (24.0％) and decreased in 4 eyes (8.0％).The difference of visual acuity before and after surgery was statistically significant (t=7.087,P＜0.01).The total rate of retinal reattachment was 96％,and 84％ of eyes achieved anatomic reattachment after single surgery.The rate of retinal reattachment was 89.5％ (34/38) for these eyes without iatrogenic retinal breaks,4/38 eyes without iatrogenic retinal breaks still had retinal detachment in 3 months after surgery and received tamponade of long-acting gas or silicone oil.The rate of retinal reattachment was 66.7 ％ (8/12) for these eyes with iatrogenic retinal breaks and received post-operative tamponade.There were 17 eyes experienced postoperative vitreous hemorrhage,which were treated with anti-vascular endothelial growth factor (VEGF) antibodies or vitreous cavity lavage.There were 9 eyes with transient ocular hypertension,and 4 eyes with neovascular glaucoma (NVG).Among 4 eyes with NVG,2 of which were controlled through anti VEGF treatment or laser treatment,and 2 eyes of 2 patients refused to have further treatment.Conclusion SGV is safe and effective treatment for PDR combined with TRD,and intraocular tamponade is not necessary in the absence of iatrogenic retinal break.

Objective To approach the protective actions of Red Rose Capsule for Releasing the Dysmenorrhea(RRC) on the mice of primary dysmenorrhea.Method Sixty four health rats with the similar menstrual cycle were divided into four groups-NS group,RRC low dose group,RRC high dose group and Yueyueshu group.The indexes of TXB2 and 6-Keto-PGF1? in plasma were observed.Result RRC had significant effect on increasing 6-Keto-PGF1 ? and decreasing TXB2 in plasma of primary dysmenorrhea mice.Conclusion RRC has protective action against primary dysmenorrhea by influencing the content of TXB2 and 6-Keto-PGF1?.

To investigate the etiological and pathological characteristics of adolescent lumbocrural pain, the findings of X ray, CT and MRI and biopsy in 67 cases of adolescent (14～28 years old) and 97 of the adult and the aged were compared. The results showed that the incidence of back epiphysis loop fracture of lumbosacral vertebrae was 40.74% (12/27) and 22.50% (9/40) in the teenage (14～18) and the youth (19～28) respectively, and 3.85% (2/52) and 4.44% (2/47) in the adult(28～60) and the aged (over 60) respectively, showing that the differences were significant between the adolescent and the adult(P 0.05 ). It is indicated that back epiphysis loop fracture of lumbosacral vertebrae is the specific pathological feature of adolescent lumbocrural pain. Therefore, it should be regarded as an important cause of adolescent lumbocrural pain.

Objective To observe visual field outcome and refractive status of patients with retinopathy of prematurity (ROP) treated by laser photocoagulation.Method The data of 39 ROP patients (73 eyes) who received laser photocoagulation were retrospectively analyzed and compared with 13 normal control subjects (25 eyes) whose age and sex were matched with ROP group.There were 24 males (45 eyes) and 15 females (28 eyes) in ROP group,with an average age of (7.0± 1.28) years.The first laser treatment was carried out at postnatal age (PA) of (38.74±3.82) weeks,the birth weight (BW) of (1402.33 ±369.61) g and the number of laser burns was (517.86 ± 277.40).The control group included 7 females (13 eyes) and 6 males (12 eyes),with an average age of (7.17 ± 0.96) years.The age (t=0.691) and gender (x2=1.425) were comparable between the two groups (P=0.491,0.233).The data of patients and controls were retrospectively analyzed including best corrected visual acuity,refractive examination,automated perimetry test.The differences of the mean deviation (MD) of visual field and the spherical equivalent (SE) between these two groups were comparatively observed.ROP patients were divided into no VF loss group (MD≤2 dB) and VF loss group (MD＞2 dB),mild VF loss group (MD ≤ 6 dB) and moderate VF loss group (MD ＞6 dB) according to the results of automated perimetry test,the differences of gestational age (GA),PA,BW,number of laser burns and SE between these groups were comparatively observed.Results The MD in ROP group and control group were 4.87±5.12 dB and 1.27 ± 3.34 dB,respectively;the difference between the two groups was statistically significant (t=-4.01,P＜ 0.001).The subgroup analysis showed that BW,number of laser burns,and SE were significantly different between no VF loss group and VF loss group (t=2.074,-1.996,-2.162;P=0.042,0.026,0.034);while the GA was not significantly different between these two groups (t=1.973,P=0.052).The difference of PA was not statistical significant different between mild VF loss group and moderate VF loss group (t=2.03,P=0.051) and SE was significantly different between the above two groups (t=3.283,P=0.002).For refractive outcomes,the BW and ROP stage correlated with SE significantly (r=-0.304,-0.387;P=0.015,0.002).The mean BCVA in ROP group was 0.84±0.23,and 59 eyes (91.2％) with BCVA better than 0.5.Conclusion Laser treatment for ROP tends to have less effect on long term refractive status and VF loss,with good visual outcome.

Objective:To explore the inflammatory responses of macrophages treated with Helicobacter pylori. Methods:Cytokines IL-23,IL-10,TNF-α and IL-8 in cell culture supernatant of macrophages stimulated with Helicobacter pylori were determined by ELISA kits,and the expression of intracellular proteins NOS2 and COX2 in Helicobacter pylori treated macrophages was analyzed by Western blot. Then,the apoptosis of Helicobacter pylori stimulated macrophages was detected by flow cytometry. Results:The secretion of cytokines IL-23,IL-10,TNF-α and IL-8 in the culture supernatant of Helicobacter pylori treated macrophages increased significantly (P<0. 05),and the expression of NOS2 and COX2 was enhanced evidently(P<0. 05). Meanwhile,helicobacter pylori could induce the apoptosis of macrophages obviously ( P<0. 03 ) . Conclusion: The inflammatory responses of macrophages treated with Helicobacter pylori would be promoted to inhibit or kill Helicobacter pylori,furthermore,Helicobacter pylori could induce the apotosis of macropha-ges.

Objectives To investigate the effect and mechanism of terbutaline sulfate on pulmonary fluid transport in pre-mature rats. Methods Pregnant rats were randomly divided into 5 groups (control group, premature group, low-dose terbutaline group, high-dose terbutaline group and dexamethasone group). Drugs were administered by gavage after rats were fertilized for 16 days and continued for 3 days. Premature rats were taken out from the 19 days pregnant rats, and mature rats were delivered on the due day. Lungs were collected, and the ratio of pulmonary wet weight to dry weight (W/D), Na+, K+-ATP ase activity and concentration of cyclic adenosine monophosphate (cAMP) were measured in lungs. Results The W/D rate, Na+,K+-ATPase acti-vity and cAMP concentration in lungs had significant difference among different groups (P<0.01). The W/D rate was highest in premature group and lowest in the control group. It was lower in the high-dose terbutaline group than in the low-dose terbutaline group and the dexamethasone group (P<0.05). The Na+,K+-ATPase activity was lowest in premature group and highest in high-dose terbutaline group. It was higher in dexamethasone group, low-dose terbutaline group, and high-dose terbutaline group than in premature group, and it was higher in high-dsoe terbutaline group than in low-dose terbutaline group and dexamethasone group (P<0.05). The cAMP levle was lowest in premature group and highest in high-dose terbutaline group. It was higher in dexamethasone group, low-dose terbutaline group, high-dose terbutaline group than in premature group, and it was higher in high-dose terbutaline group than in low-dose terbutaline group and dexamethasone group (P<0.05). Conclusions Terbutaline sulfate facilitates lung fluid transport in premature rats, leading to reduce the W/D rate in terbutaline-treated group. We speculate that this effect is related to the increased cAMP level and Na+, K+-ATPase activity in lung tissue.