Improving the basic medical and health service system is an important measure to deepen health care reform.Jilin province has explored its unique way of comprehensive reform of the primary organizations in the province by means of reforming grassroots medical operation mechanism and mode of service,and perfecting the compensation mechanism,achieving remarkable results.This article,based on the overall situation of Jilin province,main contradictions and countermeasures research,made detailed analysis of healthcare reform and bottlenecks encountered in the reform.The author pointed out the direction of Jilin province primary medical and health institutions reform,and put forward feasible policy adjustments and suggestions for such a reform.

Objective To explore the therapeutic effect of Xiefu Zhuyu decoction joint brain protein hydrolysate injection in the treatment of patients with traumatic brain injury and its effect on cerebrospinal fluid of endothelin-1 ( ET-1 ) .Methods 102 cases of patients with craniocerebral injury were divided into control group (n=51) and experimental group (n=51),the control group were treated with brain protein hydrolyzate injection, the experimental group based on the control group were treated with Xuefu Zhuyu decoction, the curative effect, ET-1, inflammatory factor, protein, blood rheology, S-100β, neuron specific enolase (NSE), National Institutes of Health Stroke Scale (NIHSS) and complications of two groups were compared.Results The total effective rate of experimental group was higher than the control group (94.11% vs.78.43%), the difference was statistically significant (P<0.05).The ET-1 of experimental group was lower than the control group[(32.45 ±4.05) ng/L vs.(28.11 ±3.50) ng/L] (P<0.05).The inflammatory factor, protein, blood rheology, NSE, S-100βof experimental group were better than those of control group (P<0.05). The NIHSS of experimental group was lower than that of the control group ( P <0.05 ) .The complication rate had no difference between two groups. Conclusion The clinical curative effect of Xiefu Zhuyu decoction joint brain protein hydrolysate injection in the treatment of traumatic brain injury , can reduce cerebrospinal fluid levels of ET-1 and can improve inflammatory factors, proteins and hemorheology.

Objective To explore the status of C57BL/6J mouse brown fat adipogenic differentiation function with aging.Methods C57BL/6J female and male mice at the ages of 0-week (newborn),4-week,8-week,12-week old were selected from the same brood,brown adipose tissue was obstained from their interscapular region,and the brown adipose was identified by using immunohistochemical markers.Then the total RNA was extracted from the brown adipose and quality identification was determined at the same time.The expression levels of the related genes (PPARα,C/EBPα,PGC-1α,PPARγ,FOXC2,BMP7) induced by brown adipose adipogenic differentiation were detected by quantitative real-time PCR in 0-week,4-week,8-week,12-week mice.Results Uncoupling protein -1 (UCP1) immunohistochemical data indicated that positive deep-colour substance was brown adipose tissue.Quantitative Real-time PCR also indicated that the expression volume of adipogenesis gene gradually reduced with aging,and there were significant differences at the different time points [PPARα (F =11.96,P ＜ 0.000 1),C/EBPα (F =9.39,P ＜0.000 1),PGC-1α(F =17.21,P ＜0.000 1),PPARγ(F =13.11,P ＜0.000 1),FOXC2(F =12.23,P ＜0.000 1),BMP7(F =16.44,P ＜0.000 1)].Conclusions The adipogenic differentiation ability and activity of mouse brown adipose gradually reduce with aging.But the regulatory factors for its function needs to be further investigated.

Objective To observe the effect of Triclosan( TCS) exposure on Caenorhabditis elegans( c. ele-gans) F1 generation of locomotory behavior, brood size, and generation time. Methods The trial included a control group and 4 TCS treatment groups with different doses (100 nmol/L,1 μmol/L,10μmol/L,20μmol/L),the exposure time being 24 hours,the effect of c. elegans′head thrashes,body bending frequency,the brood size and generation time was observed. Results (1) The control group exposed to 100 nmol/L,1 μmol/L,10 μmol/L,20 μmol/L TCS,their head thrash frequency of c. elegans F1 was(109. 40±8. 61) times/min,(84. 70±7. 82) times/min,(76. 35±7. 44) times/min,(74. 74±5. 93)times/min,(71. 95±4. 19)times/min,respectively,the head thrash ability of c. elegans was significantly inhibited(F=62. 245,P<0. 01). (2) When the control group was exposed to 100 nmol/L,1 μmol/L,10μmol/L,20 μmol/LTCS,the frequency of c.elegans F1 body bent was (19.94±2.46)times/20 s,(15.13±1.99) times/20 s,(14.63±2.31)times/20 s,(14.69±1.96)times/20 s,(12.00±1.86)times/20 s,respectively,and the comparative differences between groups were statistically significant(F=25. 636,P<0. 01). (3) When the control group was exposed to 0,100 nmol/L,1 μmol/L,10 μmol/L,20 μmol/L TCS,the body sizes of the c. elegans F1 generation was (286.83±6.01)articles,(273.33±6.41)articles,(214.17±7.25)articles,(173.67±9.20)articles, (118. 50 ± 6. 98 ) articles, respectively, the brood size of the C. elegans F1 generation exposed to 100 nmol/L, 1μmol/L,10 μmol/L,20 μmol/L TCS levels,were reduced by 4. 71%,25. 60%,39. 45%,58. 67%,the ge-neration time of the c. elegans′F1 generation was shortened by 2. 14%-5. 38% in the TCS treatment groups compared with the control group(F=27. 520,P<0. 01). Conclusions After c. elegans exposure to TCS,locomotory behavior can be severe-ly affected,reproductive damage causes a decline in the number of brood size,and the speeding-up of the breeding rate is related to the concentration of TCS concentration-response.

Objective To identify biomarkers associated with the differentiated phenotype based on gene expression profiling of gastric cancer. Methods Two bioinformatic methods, BAGEL and k-TSP, were used to identify featured genes associated with differentiation in gastric cancer samples based on the Oligo gene chip data, and ROC curves were used to verify the classification sensitivity and specificity of the identified genes. Finally, a total of 30 gastric cancer samples with different differentiation levels were collected for laboratory validation using real-time PCR analyses. Results A total of 121 differentially expressed genes were identified using the BAGEL algorithm, the criterion were FC ＞ 2. 0 and P ＜ 0. 001.Then, the k-TSP algorithm for feature selection based on this differential expression data were used, and 3 groups of featured genes which had potential to classify poor and well differentiation gastric cancer samples were identified, including MYLIP and TMPRSS3, ZNF266 and TM4SF1, SNAI2 and CNFN. To define the featured gene groups that had the highest classification capability, ROC curves to calculate the classification sensitivity and specificity of each gene group were used. The results showed that the combination of SNAI2and CNFN as a classifier had the highest classification sensitivity and specificity. Real-time PCR results showed that 18 of 22 poor differentiation samples were found with high expression of SNAI2 and low expression of CNFN (82%); 6 of 8 well differentiation samples were of low expression of SNAI2 and high expression of CNFN (75%). Conclusion The results indicate that SNAI2 and CNFN are constantly expressed in poor or well differentiation gastric cancer samples, and the expression pattern of these two genes is opposite. These results indicate that SNAI2 and CNFN have the potential for the identification of the differentiation level of gastric cancer.

In order to construct a novel multifunctional targeting nano-carrier based on pH-redox characteristics of tumor microenvironment,ketone bonds and disulfide bonds were bonded to the oligomeric hyaluronic acid (oHA) being sensitive to pH and the reduction environment.The chemical structure of oligomeric hyaluronic acid-8-mercaptomenthone 1,2-glycerolketal (oHMST) was characterized by 1H NMR,IR and ESI-MS.Curcuminloaded micelles were prepared by dialysis.The single factor investigation was carried out on the dosage form.Some properties,including particle size zeta potential,the morphology of micelles,and pH-sensitivity were studied.The materials were synthesized successfully.The micelles were spheric with a diameter of about 100 nm.The Zeta potential of the micelles was-(21.97 ± 1.08) mV.The in vitro test showed that oHMST carriers have good pH-sensitivity and redox-sensitivity.

Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.

Objective To investigate the treatment measures of having trigeminocardiac reflex (TCR) for the primary trigeminal neuralgia via microvascular decompression.Methods From January 2016 to December 2016,the clinical data and anesthesia records of 79 consecutive patients with primary trigeminal neuralgia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and treated the first craniotomy microvascular decompression were analyzed retrospectively.They were divided into a no TCR group (n=63) and a TCR group (n=16) according to the intraoperative anesthesia monitoring.The differences of baseline conditions,preoperative complications and pain involved the trigeminal nerve branches were compared between the two groups.The treatment measures and short-term prognosis of the patients with TCR during operation were summarized.Results (1) The proportion of hypertension in the TCR group was 31.2％ (n=5),it was higher than 7.9％ in the no TCR group (n=5).There was significant difference (χ2=6.273,P<0.05).(2) During the operation of microvascular decompression,16 patients in the TCR group had 19-time TCR.The baseline heart rate was 74±10/min before operation,and the heart rate decreased to 51±6/min at onset of TCR.The mean baseline arterial blood pressure was 102±13 mmHg,and the mean arterial blood pressure decreased to 74±8 mmHg at the onset of TCR.There was significant difference (P<0.05).(3) After the onset of TCR,the operation of was stopped,heart rate and the blood pressure recovered spontaneously (n=4).Fifteen patients were treated with medications,including using atropine (12 times,dose 0.2-0.5 mg) and ephedrine hydrochloride (3 times,dose 5-10 mg).Heart rate and blood pressure returned to the baseline level within 20 seconds or 20 seconds after administration of medications.There was no TCR-related cardiac complication or neurological deficit from after procedure to before discharge.Conclusions In microvascular decompression of primary trigeminal neuralgia,if TCR occurs,the selective use of anticholinergic agents or vasoactive agents is needed as early as possible.The risk factors for the occurrence of TCR need to be further verified.

Objective:To study the effect of Xiaoyao Powder on Alzheimer's disease in hippocampal CA 3βregion of rats PP-2A,GSK-3βexpression.Methods:Rats were randomly divided into four groups , including model group, western medicine group,Chi-nese medicine group were treated with intraperitoneal injection of D-gal and A-β1-42 peptide bilateral hippocampal injection mold-ing, physiological group only with equal volume of sterile saline intraperitoneal and hippocampal injection molding .The model was completed, normal group, model group were perfused with saline , western medicine group and Chinese medicine group were treated with oxiracetam solution and Xiaoyao decoction , four groups of intragastric volume was 0.5 ml/100 g, 1 time a day, continuous 28 d. After intragastric administration of isolated rat brain immediately , packet marking in 4℃4%glutaraldehyde solution of glass container , stored at 4℃.Repair piece, cut from the hippocampus, embedded in paraffin, sliced.Dilution of PP-2A for 1∶200, GSK-3βdilution of 1∶150.Images were analyzed by using Image-pro Plus 5 image analysis system, data were conducted by SPSS11.5 statistical analysis software, the comparison between 4 groups by single factor analysis of variance , between the two two groups was compared by LSD-t test, the test level of α=0.05.Results:The expression of PP-2A positive cell number and the positive area , average optical density, integral optical density index , in Xiaoyao Powder orally intervention compared with the model group increased significantly (P<0.01);GSK-3βabove indices were significantly decreased than that in model group after Xiaoyao Powder after intragastric ad -ministration (P<0.01).Conclusion:Xiaoyao Powder can up regulate the expression of PP-2A and down regulate expression of GSK-3β, may be condensed A-β1-42 peptide induced hyperphosphorylation of Tau has certain inhibition .

Objective To explore the association between underweight and mortality from all cause Method We examined the relationship of underweight and mortality among subjects who participated in the survey of cardiovascular risk factors (in 1984-1986 and in 1992). Relative Risks (RRs) were estimate from the COX propor tional hazard model by using a BMI between 18.5-24.9kg/m2 as reference c ategory Results During an average 12.40 years followup, we documented 307 deaths of which 158 were from cancer, 93 from cardiovascular diseases, and 56 from other causes W e observed a Lshaped relation between BMI and overall mortality.(P for trend< 0.01); In multivariated analyses, we found that the RR of mortality for a BMI o f <18.5kg/m2 was 1.58 (95% CI 1.16-2.14) as compared with the risk a mong subjects with BMI of 18.5-24.9kg/m2 The RR of overall mortality among s ubjects with BMI of <18.5kg/m2 was still significant after the exclusion of subjects who died from cancers during the first five years follow-up Conclusion Total mortality was increased among underweight people, and this association can not been completely explained by smoking and early deaths from caner.