Objective:To analyze the causes and countermeasures for the inefficiency of implementing the contract community health service policy.Methods:Based on the authority and regulation of organization,it innovatively used the French organization theory,build an analysis framework of organizational actors adapting to the general organization.On the above basis combined with the characteristics of contract health service,it constructed a new organizational structure of contract health service and analyzed the low efficiency of policy implementation from the three relations among the actors,the power and the rule.Results and Conclusion:It needed to focus on authority and rule to rationally division the authorities of actors,optimize the organizational structure,adjust the benefit relationship of actors;play the regulation role,implement the incentive and constraint mechanism to improve the execution efficiency of contract health service policy.

Objective To evaluate the role of TVS in assessing endometrial pathology in women with postmenopausal bleeding and in evaluating the depth of myometrial invasion in endometrial carcinoma.Methods A group of 111 women with postmenopausal bleeding were examined by TVS,endometrial thickness,echotexture,blood flow characteristics were evaluated.Results An endometrial thickness less than 5 mm was associated with normal or benign condition.This suggested that endometrial biopsy or curettage might not be necessary in this situation,visualization of abnormal blood flow within the endometrium in the endometrial carcinoma with mean resistance index constituted a statistical difference compared with that of benign endometrium(P<0.05).TVS accurately detected depth of myometrial invasion in endometrial carcinoma,and had significant relation with pathologic assessment(r=0.98,P<0.001).Conclusion TVS could be implemented as a routine first-step procedure in patients with postmenopausal bleeding.

ObjectiveTo search for the effect and safety of urokinase (UK) in different dosage on acute cerebral infarction.Methods80 patients suffering from acute cerebral infarction were randomly divided into two groups. Group A received UK 0.75 MU intravenously within 30 min. Group B received UK 1.0～1.5 MU intravenously within 30～45 min. ResultsThe neurological deficits scores was improved in both groups. There was no significant difference between group A and group B(P>0.05). The total effective rate and significant effective rate was 82.5% and 60.0% in group A respectively, but those were 87.5% and 65.0% in group B respectively(P>0.05). More hemorrhage happened in group B. ConclusionThe UK in small dosage is effective and relatively safe in treatment of acute cerebral infarctions.

Objective To study the relationship between lymph node micrometasis and clinicopathological parameters.Methods Immunohistochemical method was adopted to detect cytokeratin pan(CK)、Epithelial Membrane Antigen(EMA) and Carcinoembryonic Antigen(CEA) in 389 lymph nodes from 36 cases of breast cancer, in which conventional pathological diagnosis showed no lymph node metastasis.Results Micrometastasis was found in 38 lymph nodes (9.2) of 12 cases (33.3) .The incidence of micrometasis was correlated with tumor size. Pathological diagonosis and metastasis lymph nodes. Conclusion Micrometastasis detection in negative lymph nodes of breast cancer is recommended to precisely determine the tumor stage, in order to direct cancer therapy and predict prognosis.

Objective To study the expression and clinical significance of Survivin and PTEN in cervical carcinoma. Methods The expression of Survivin and PTEN in 60 cases of cervical carcinoma, 15 cases of CIN Ⅰ , 15 cases of CIN Ⅱ, 15 cases of CIN Ⅲ and 15 cases of normal cervical tissues were detected by immunohistochemical staining. Results The expression positive rates of Survivin were 86.67 %, 80.00 %,33.33 %, 20.00 % and 0, respectively, and those of PTEN were 21.67 %, 40.00 %, 80.00 %, 86.67 % and 100.00 % in cervical carcinoma, CIN Ⅲ, CIN Ⅱ, CIN Ⅰ and normal cervical tissues, respectively. The expression positive rates of Survivin were increased along with normal cervical epithelium, CIN Ⅰ, CIN Ⅱ,CIN Ⅲ and invasive carcinoma of cervix;while those of PTEN were inverse order.Compared with the expression positive rates of Survivin and PTEN protein in the CIN Ⅱ group, those in the CIN Ⅲ group had significant differences (P <0.01 and P <0.05, respectively). Expressions of Survivin and PTEN were correlated to the size of focus(P <0.05), the depth of tumor and pelvic lymphnode metastasis (P <0.05), but not to clinical staging, pathological types, pathological grading and age(P >0.05). There was a negative correlation between the expression of PTEN and Survivin in cervical carcinoma. Conclusion The expressions of Survivin and PTEN are correlated with invasion and metastasis of cervical carcinoma, and be related to clinical pathotology.Survivin and PTEN may play a important role in the formation, proliferation, differentuation and metastasis of cervical carcinoma. They may be used as markers of early diagnose, efficacy and prognosis evaluation.

AIM: To investigate whether the circadian mRNA expression of the renin-angiotensin system (RAS) components (ATNG、AT_1R、AT_2R) in myocardium is correlated with left ventricular hypertrophy in both spontaneously hypertensive rats (SHR) and renal hypertensive rats (RHR). METHODS: The model of RHR was established using 2K1C (two-kidney one clip). SHR, RHR, and normotensive control rats (CON) were housed in a separate environment-controlled room for two weeks, in which a strict 12-hour light/12-hour dark cycle regimen was enforced (lights on at 900, zeitgeber time [ZT0]). Rats were killed every 4 hours from 900 am (ZT0) to 500 pm (ZT20) on three separate days. We examined the circadian mRNA expression of ATNG、AT_1R、AT_2R in the hearts of SHR, RHR and CON rats by RT-PCR. RESULTS: Heart weight to body weight ratios and left ventricle weight to heart weight ratios indicated a significant increase in SHR and RHR compared with normotensive rats. The cardiac mRNA expression of the RAS components showed circadian oscillations in SHR, RHR and CON rats. The amplitudes of these circadian fluctuations were greater in the SHR and RHR than in the CON rats. The mRNA levels of the RAS components were increased in the SHR and RHR compared with the CON rats at many time points. CONCLUSION: The data indicate that overexpression and enhanced amplitudes of circadian fluctuations of RAS components in SHR and RHR may play a role in the development of left ventricular hypertrophy.

AIM: To establish a PCR method for investigating the expression of clock genes in cultured rattus cardiac myocytes. METHODS: PCR was carried out using 3 primer pairs based on the published sequences of dbp, bmal1 and per2 genes of rattus. The conditions of PCR were optimized and the specificity of amplication was tested. RESULTS: In a volume of 20 ?l, the optimal PCR mixture of bmal1 gene contains 0.5 U Taq polymerase, 0.006 ?mol dNTP and 0.035 ?mol Mg 2+; the annealing temperature being 57 ℃; and circle times being 30. In a same volume, the optimal PCR mixture of dbp gene contains 0.5 U Taq polymerase, 0.006 ?mol dNTP and 0.03 ?mol Mg 2+; the annealing temperature being 58 ℃; and circle times being 32. The optimal PCR mixture of per2 gene contains 0.5 U Taq polymerase, 0.006 ?mol dNTP and 0.05 ?mol Mg 2+; the annealing temperature being 57 ℃; circle times being 30. The specificity of amplication was very high. CONCLUSION: The PCR method can successfully detect mRNA expression of clock genes in cultured rattus cardiac myocytes.

Objective To detect the expression of osteopontin (OPN) in cervical local tissues of patients with chronic cervicitis, cervical intraepithelial neoplasia (CIN), cervical cancer. To investigate the possibility that OPN is used as tumor marker of cervical cancer. Methods The expression of OPN in 25 cases of chronic cervicitis, 18 cases of CIN and 21 cases of cervical cancer was detected by immuohistochemistry SP method. Results The positive expression rates of OPN in the chronic cervicitis, CIN and the cervical cancer had a rising trend (48 %, 77.78 % and 80.95 %, respectively) and their differences had statistical significant (P <0.05). The OPN expression level in cervical cancer had no statistical correlation with age, tumor size, clinical stage and other clinical pathological features (P >0.05). Although OPN expression level in cervical cancer wasn' t related with tumor clinical stage, positive expression rates of OPN had a gradually increased trend along with the clinical stage. Conclusion High expression of OPN is found in cervical cancer and may be related to the occurrence and development of cervical cancer.

Objective To explore the application of case-based discussion combined with translational medicine teaching method in clinical teaching of gastrointestinal surgery.Methods Totally 100 undergraduates of clinical medicine in grade 2007 and 100 undergraduates in grade 2008 from the second military medical university were divided into experimental class (50 students,25 in discussion class and 25 in comprehensive class) and control class (50 students).Method of case-based discussion was applied in discussion class; method of case-based discussion combined with translational medicine was employed in comprehensive class and traditional method was used in control class.Results Scores in experimental class were superior to those in control class ; questionnaire survey showed that 90％ students thought the new model was better than the traditional model; the interests of students in exploring clinical problem in experimental class were increased (90％ vs.50％ ) ;the sense of mission and responsibility was Strengthened (86％ vs.64％ ) ;the scientific research thinking was more active (80％ vs.48％ ) ; the individual ability and quality were enhanced (76％ vs.50％ ),the depth and width of study were markedly increased (80％ vs.52％ ),the consciousness of independent study and thinking was strengthened (88％ vs.54％ ).Comprehensive class had more obvious improvements in scientific research thinking,individual ability and quality,depth and width of study,independent study and thinking.Conclusions The new teaching model which combined translational medicine with case discussion breaks through the traditional model and adapts to the requirements of modem medicine,it can enhance the teaching effect and worth promoting in educational reform.

Objective To investigate the change of the neutrophil apoptosis and neutrophil respiratory burst in the patients and the effect of ulinastatin on the apoptosis of neutrophil and respiratory burst of neutrophil during cardiopulmonary bypass (CPB). Methods Sixty-two patients undergoing valve replacement with CPB were randomly divided into two groups: ulinastatin group (U group, 31 cases) and control group (C group, 31 cases). In U group patients received ulinastatin after induction of anesthesia. In C group patients received equal volume of normal saline, instead of ulinastatin. Arterial blood was obtained before operation (T1), 30 min after the start of CPB (T2), 30 min after the termination of CPB (T3). The apoptosis of neutrophil and respiratory burst of neutrophil were measured by flow cytometer. The level of superoxide dismutase (SOD) and malondialdehyde (MDA) were measured by kit. Results In C group, compared with T1 [(66.57±5.93)%], the rate of the apoptosis of neutrophil was significantly decreased at T2[(55.37±3.51)%] and T3 [(48.92±4.21)%] (P<0.05). And in U group, compared with T1 [(73.57±7.94)%], the rate of the apoptosis of neutrophil was significantly decreased at T2 [(68.34±4.92)% ] and T3 [(62.13±4.76)%] (P<0.05), And it reached to the minimum at T3. The rate of the neutrephil apeptosis was significantly lower in C group than that in U group (P<0.05). The respiratory burst of neutrophil increased significantly after the start of CPB and reached to the peak at T3[C group (1422.50±89.75) MCF,U group (1156.52±93.20) MCF]. The respiratory burst of neutrophil in U group was significandy lower than that in C group at T2 and T3 (P<0.05). The vitality of SOD decreased significantly after the start of operation in the two groups (P<0.05). The level of MDA increased significantly after the start of operation in the two groups, and reached to the peak at T3. The vitality of SOD in C group was significantly lower than that in U group at T3 (P<0.05). The level of MDA in C group was significantly higher than that in U group at T3 (P<0.05). Conclusions The rate of neutrophil apoptosis decreased and the respiratory burst of neutrophil increased during CPB. By improving the apoptosis of neutrophil and reducing the respiratory burst of neutrophil, ulinastatin can inhibit inflammatory reaction during CPB. Meanwhile, ulinastatin can improve the vitality of SOD and reduce the level of MDA. In conclusion, ulinastatin has a significant protective effect during CPB.