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.

Magnetic silica micro-spheres is a kind of novel functional materials, which is expected to be applied to targeted drug delivery, immunomagnetic beads, separation of nucleic acid and protein, immobilization of enzymes and isolation and purification of natural products in biomedicine. This review describes the methods of synthesis, surface modification and applications of magnetic silica micro-spheres, which focus on the various strategies in synthesis with core-shell and mosaic structure, sol-gel method, liquid phase deposition, self-assembly technique and micro-emulsion method. Finally, foregroud and prospect of the research are also discussed.

Objective To analyze and compare the effect of early surgical treatment and nonsurgical treatment for patients with severe acute pancreatitis.Methods Acccording to the including criteria,five randomized controlled trials of this topic were enrolled into the analysis.The detail about the trial design,characters of the subjects,results of the studies were reviewed and analysed by using Revman 4.2 software.Results Compared with nonsurgical treatment,early surgical treatment was associated with a significantly higher(incidence) of mortality(RR 3.42,95% CI 1.81～6.47,P=0.0002) and complications(RR 3.16,95% CI 2.15～4.64,P

Objective To investigate the expression and clinical significance of Bcl-2,NF-κB and C-myc in diffuse large B cell lymphoma (DLBCL) tissue.Methods Sixty-seven cases of DLBCL tissue were selected as the observation group,and contemporaneous 21 cases of lymphoid reactive hyperplasia(RH) tissues as the control group.The levels of Bcl-2,NF-κB,C-myc protein expression in tissues were detected by the S-P method.Then their relationship with the clinicopathological features of DLBCL was analyzed.Results Th epositive expression rates of Bcl-2,NF-κB and C-myc protein in DLBCL tissues were 58.21%,62.69% and 77.61% respectively,which in RH tissue were 0.00%,19.05% and 23.81% respectively,the difference was statistically significant(P<0.05);the Bcl-2 protein expression had no significant correlation with the age,gender,disease location,serum LDH level and extranodal sites in DLBCL patients (P>0.05),was significantly correlated with clinical stage and IPI grade (P<0.05);the NF-κB protein expression had no significant correlation with age and gender in the patients with DLBCL (P>0.05),was significantly correlated with clinical stage,location,IPI grade and serum LDH level (P<0.05);the C-myc protein expression had no significant correlation with age,gender,disease location,serum LDH level and extranodal sites (P>0.05),was significantly correlated with clinical stage and IPI grade (P<0.05).Bcl-2 had stronger positive correlation with NF-κB expression in DLBCL tissues (r=0.671,P<0.05),and had no correlation with C-myc in DLBCL tissue (P>0.05),NF-κB and C-myc expression in DLBCL tissues showed weak positive correlation (r=0.293,P<0.05).Conclusion Bcl-2,NF-κB,C-myc expressions are closely correlated with the clinical stage and IPI grade of DLBCL and can serve as the reference indicators for evaluating DLBCL prognosis.

Objective To investigate the role of microRNA-21(miR-21) on cardiac fibroblast proliferation and dif-ferentiation in the mouse model of myocardial infarction. Methods The mouse model of myocardial infarction (MI) was es-tablished by ligation of the left coronary artery in male C57BL/6 mice(MI group). The echocardiographic assessment and his-tological evaluation were performed after ligation. The expression levels of miR-21 were measured by quantitative real-time PCR in the various myocardial tissues. The cardiac fibroblasts transfected with miR-21 mimic were over-expressed miR-21. The proliferation was assessed by immunostaining for 5-ethynyl-2’-deoxyuridine (EdU). Western blot assay was used to detect the expression ofα-SMA and Smad7 in the cardiac fibroblasts,and compared with control group and blank group. Results The expression of miR-21 was significantly increased in border area in MI group than that of sham group [(6.043 ± 0.231)×10-4 vs(1.620±0.451)×10-4,P<0.01]. There was a higher expression of miR-21 in miR-21 mimic group than that of control group and blank group [(4.839±0.705)×10-4 vs(1.143±0.064)×10-4 vs(1.017±0.201)×10-4,P<0.01]. The EdU positive rate was significantly higher in miR-21 mimic group than that of control group and blank group[(27.892±1.645)%vs(12.553 ± 1.227)% vs(13.946 ± 1.550)%,P<0.01]. The expression of α-SMA was significantly increased in miR-21 mimic group, while the expression of Smad7, a target gene of miR-21, was significantly decreased. Conclusion The over-expression of miR-21 in cardiac fibroblasts disrupts TGF-βsignaling pathway by reducing the expression of Smad7, which promotes the proliferation and differentiation of cardiac fibroblast, and finally regulates cardiac remodeling after myocardial infarction.

Objective To investigate the effect and mechanism of dibenzazepines ( DBZ ) injection on pulmonary hypertension in rat. Methods Rat models of pulmonary hypertension were established, and 30 male rats were randomly divided into 3 groups: normal control group with saline injection, pulmonary hypertension model control group with hypoxia treatment and saline injection, DBZ group with hypoxia treatment and DBZ injection. The right ventricular pressure was determined by ultrasound cardiogram.Pulmonary arterial remodeling was detected by HE staining.Proliferation cell nuclear antigen and CCK-8 in pulmonary arterial smooth muscle cells were detected by Western blotting. Results The right ventricular pressure of pulmonary hypertension group was significantly increased compared with normal control group [(4.60±0.16) kPa vs. (3.37±0.18) kPa(P<0.01)].After hypoxia treatment, pulmonary arterial remodeling and proliferation of pulmonary arterial smooth muscle cells of the rats of pulmonary hypertension group were augmented remarkably. Rats from DBZ group showed reductions in right ventricular pressure, amelioration in pulmonary arterial remodeling and suppression in proliferation of pulmonary arterial smooth muscle cells. The proliferation of rat pulmonary artery smooth muscle cells decreased significantly in DBZ treated group [(2.073±0.064) vs.(4.392±0.013)] compared with model control group (P<0.05). Conclusion Notch pathway takes part in the process of pulmonary hypertension, and DBZ injection can significantly suppress the proliferation of pulmonary artery smooth muscle cells with a protective effect on pulmonary hypertension.

Objective To systematically describe and analyze the patient safety culture assessment outcomes of medical workers in China,so as to provide scientific evidence for developing corresponding intervention measures.Methods Such databases as Web of Science,PubMed,Ovid,EBSCO,Google Scholar,CBM,VIP,CNKi and WanFang Data were used to collect studies published before December 2014,on patient safety culture assessment of medical workers in mainland China.Two reviewers independently screened,extracted and cross-checked the data,and the disagreements were resolved by discussion or by consulting a third reviewer.The qualitative synthesis method was used to analyze the study results.Results Of the total 1 721 records,65 studies were included,and most of them were cross-sectional studies.The patient safety culture assessment instruments were foreign scales by the translation and revision for the Chinese version for 52 studies,and self-made questionnaire for the other 13 studies.The main factors influencing the patient safety culture of Chinese medical workers included seniority,department,educational background,experience of patient safety training and so on.Conclusions Many studies have been carried out for patient safety culture,but the research obj ects mostly are nursing staffs,without extensive research on other professional medical workers.Hospitals should strengthen the teams,the patient safety training,and build patient safety culture that is fair and open to safeguard patient safety.

Objective The renin-angiotensin system ( RAS) is involved in myocardial anoxic injury .This study aimed to in-vestigate the expressions of AT 1-R, AT2-R, and angiotensin-converting enzyme ( ACE ) in bone marrow mesenchymal stem cells (MSCs) under hypoxia. Methods Rat MSCs were isolated, cultured, and identified with CD29 and CD11b/c antibodies.The is-chemic injury model was established by exposing the MSCs to hypoxia and serum deprivation ( Hypoxia/SD) for 24 hours, while the control cells were cultured in L-DMEM with 10%FBS.The vitality and apoptosis of the cells were detected by trypan blue staining , CCK8 assay, and Annexin V-FITC staining.The mRNA and protein expressions of AT 1-R, AT2-R, and ACE were determined by real-time quantitative PCR and Western blot , respectively. Results The positive rate of CD29 was >97%and that of CD11b/c was <1% in the MSCs.Compared with the control group, Hypoxia/SD significantly increased the rate of cell apoptosis ([6.73 ±0.78]%vs [19.93 ±4.92]%, P<0.01), decreased the rate of cell viability ([78.49 ±4.94]%vs [37.33 ±2.91]%, P<0.01), and up-regulated the mRNA and protein expressions of AT 1-R, AT2-R, and ACE. Conclusion Hypoxia/SD activates the RAS in MSCs and improves the protective function of the cells against myocardial anoxic injury .

Objective To explore the value of practicing PBL which was guided by MDT in teaching diagnoses and treatments of war wound and trauma caused by compound agents.Methods An emulational war wound case caused by compound factors was designed and a multi-disciplinary team been organized,then totally 45 interns who would graduate in 2017 were divide into two groups randomly,experimental group which had 23 cases received PBL model combined with MDT followed six step procedure which included case preparation by teachers,independent analysis and group discussion by interns,problem extraction by teachers and division of solution by interns before class,then answering and debating problems by interns in class,conclusion and reporting after class in the end,while the control group which had 22 cases received traditional teaching model in accordance with common case discussion in class including characteristics of patient,diagnosis and diagnostic basis,examinations needed to carry out,first aid measures and professional treatments.The effect of new teaching model was evaluated by assessment in class and questionnaire after class.The data was analyzed through Chi-square test by SPSS 22.0.Results Class assessment showed 18 (78.3％) interns in experimental group displayed good abilities of proposing,analyzing and resolving medical problem,as well as good presentation and speech skills.Questionnaire survey showed that not only clinical teaching of war wound and trauma could meet the demands of talent training in battle-field rescue,but also displayed new model,which could help interns to enhance abilities of first-aid and treatment of war wound on future war field,reinforce the consciousness of military medical support and service.In addition,it could clear confusion more professionally and strengthen teamwork and overall importance.Conclusion Applying PBL combined with MDT in teaching diagnoses and treatments of war wound and trauma can not only help interns to review and retain important knowledge of related subjects,but also improve the abilities of interns in clinical diagnoses and treatments,and moreover,it merges the medical knowledge and war wound cure together organically.In short,the new model is well worth applying in clinical teaching and military medical education because of its excellent effects.

Magnetic chitosan (CS) nano-spheres were prepared by the modified suspension cross-linking technique. The results demonstrated that the magnetic drug nano-spheres are mainly spherical in form with a size of 200 to 800 nm, and show good magnetic responsivity. Here, Doxorubicin was used as exam drug. Glutaraldehyde connects Doxorubicin to CS by the chemical bond (-N = C-), and the drug content is in range of 1% to 15% (w/w). The chemical bond is broken depending on pH, so pH is the important factor for the release of doxorubicin. The doxorubicin release was 22.0%, 13.4%, and 4.1% in the space of 7d, when pH was 1, 2, 4. So the nano-spheres are pH-sensitive magnetic targeting drug micro-spheres.
Chitosan ; chemistry ; Doxorubicin ; administration & dosage ; Drug Carriers ; chemical synthesis ; Drug Delivery Systems ; methods ; Magnetics ; Nanospheres ; chemistry