Objective To analyze the coordination and continuity of service delivery for hypertension patients in rural health network,so as to provide references for improving integrated service utilization.Methods Self-developed questionnaire of service coordination and continuity delivery according to the research literature at home and abroad was used as the tool,and the data was analyzed by descriptive statistics.Results 49.6％ patients were accompanied by one or more diseases.About 73.0％ had seeking care experience in township health centers.Patients with seeking care to two or more medical institutions accounted for 51.3％.Recommending referral institutions for patients with poor therapeutic effect by grassroots doctors were the biggest proportion with 28.4％ and 68.7％ respectively.The proportion that superior doctors treating patients according to the related information from subordinate institutions was less than 43.0％,the proportion that junior doctors continuing to treat referral patients according to early diagnosis and treatment information was just over 40％.Easier upward referral but harder downward referral also existed among medical settings of different levels.Conclusion The disease characteristics of rural patients increased the possibility of seeking care among vertical medical institutions,but the level of continuity and coordination service delivery was not high in this network.So all-sided service integration to rural tertiary health institutions should be strengthened.

Ankle Injuries ; diagnosis ; surgery ; therapy ; Ankle Joint ; surgery ; Humans ; Joint Instability ; diagnosis ; surgery ; therapy

Background In vitro study showed that chemotaxis consist of chemotaxis factor 4(CXCR4)and stromal cells derived factor-1(SDF-1)and may play a role in the orientation and migration of retinal progenitor cells (RPCs)toward lesion.Overexpression of CXCR4 in RPCs can enhance the chemotaxis activity.Objective This work was to explore the feasibility and underlying mechanism of up-regulation of CXCR4 on RPCs induced by hypoxia.Methods RPCs were retained in an incubator with normal O2volume(16％)or hypoxia condition(10％ O2)for 12 hours and 24 hours respectively.Flow cytometer cell analysis screening(FACS)was conduced to measure the proportion of CXCR4-expressing cells,and CXCR4,HIF-1 mRNA were analyzed by reverse transcription-polymerse chain reaction(RT-PCR).The chemotical effect of 30 mg/L SDF-1 to RPCs cultured under the hypoxia condition was assessed using Boyden chamber.Results The expression level of CXCR4(CXCR4 mRNA/β-actin mRNA)inRPCs cultured by 10％ O2 for 12 and 24 hours were 0.28+0.07and 0.48+0.17 and increased by 1.75 and 3.00 fold more than that of 16％ O2 culture group(0.16+0.02)(P＜0.01).The expression level of HIF-1 mRNA(HIF-1 mRNA/β-actin mRNA)in RPCs cultured by 10％ O2 for 12 and 24 hours were 0.18 ±0.07and 0.38 ±0.13 and increased by 3.00 and 6.30 fold more than that of 16％ O2 culture group(0.06±0.01)(P＜0.01).The chemotical effect of 30 μg/L SDF-1 to RPCs increased from 13.00％ in 16％ O2 culture group to 36.00％ and 46.00％ in the cells cultured by 10％ O2for 12 and 24 hours.FACS revealed that the proportion of CXCR4+ cells in hypoxia-exposure for 12 and 24 hours were 26.90％ and 46.10％,respectively,but that in 16％ O2 culture group was 9.10％,showing a statistically significant difference(P ＜ 0.01).Conclusions RPCs induced by hypoxia can enhance the expression of CXCR4 in RPE cells and the chemotaxia to SDF-1.The overexpression of H1F-1 in RPCs may be involved in the up-regulation of CXCR4 expression.

Objective To investigate whether iceberg phenomenon of celiac disease(gluten-sensitive enterpathy,GSE) exists among the people of China,and study on the levels of anti endomysial antibody(AEA)IgA and IgG,which provide the foundation for studying functional genome of GSE.Methods One hundred and thirty-six cases liability crowd,which showed part symptoms of GSE,were selected as case group and 50 cases of normal were selected as control group.Enzyme-linked immunosorbent assay was used to detect the level of 2 groups and positive rate of AEA was compared between 2 groups.Results The levels of AEA IgA and IgG in case group(17.69?2.97,15.23?2.36)were significantly higher than those of control group(11.65?2.75,12.25?1.86),especially 2 strong positive cases were found in case group.Conclusion Iceberg phenomenon of celiac disease exists in the people of China,which means many celiac disease patients have not been diagnosed and it need us far more research.

In order to study the antitumor effect of human tumor necrosis factor alpha (TNF-?)gene modified fibroblasts, we have transfered TNF-? cDNA to fibroblasts NIH3T3 by a bicistronic retroviral vector pGCEN/TNF-?, which expressed TNF-? from the long terminal repeat and the selectable Neo~R from the encephalomyocarditis virus (EMCV) internal ribo-some entry site(IRES) . The results indicated that TNF-? modified NTH3T3, NIH3T3/TNF-? ,were able to express TNF-? at a high level for a long term culture. Furthermore, these modified fibroblasts could inhibit tumor progression signifi-cantly(P

Objective To explore the role of apoptosis and Fas, bax and bcl-2 proteins in the pathogenesis of testicular carcinoma. Methods Cell apoptosis was determined with TUNEL and flow cytometry, and the expression of Fas, bax and bcl-2 proteins were detected by cellular immunofluoresence technique in 56 cases of testicular carcinomas. Results Apoptotic index was closely correlated with the pathological type and lymph node metastasis of testicular carcinomas(P0.05). The apoptotic index was positively correlated with Fas and bax expression, and negatively correlated with bcl-2 expression (P

Objective To evaluate the indications, effectiveness and complications of vitreoretinal surgery using the 25G transconjunctival sutureless vitrectomy system (TSV25G) under the topical anesthesia. Methods The clinical and follow-up data of 22 eyes of 22 patients undergone vitreo-retinal surgery using TSV25G under the topical anesthesia were retrospectively analyzed. All of the patients were monocular sickened, including idiopathic macular hole in 10 eyes, idiopathic macular pucker in 6, vitreoretinal traction syndrome in 4, and vitreous hemorrhage associated with branch retinal vein occlusion in 2. Peeling of epiretinal membrane and/or internal limiting membrane, intraocular laser coagulation, air-fluid exchange and tamponiding of C 3F 8 were performed according to the condition of diseases. The postoperative follow-up was 1-11 months, with the mean duration of 6.4 months. The effect of analgesia, cooperation with the patients, operative effect and complications in and after the surgery were observed. Results The operations finished successfully in all of the eyes under the topical anesthesia. The operation duration ranged from 20 to 25 minutes with average of 22 minutes. The patients cooperated with the doctor well without any discomfort. Two days after the surgery, edema of the wounded conjunctiva was found, and recovered 7 days later. A light pigment dot on the surface of the sclera could be seen at the first month. The complications included transient increasing of intraocular pressure in 2 eyes, feather-like opacity of lens in 5 eyes, vitreous hemorrhage in 1 eye, and air-bleb under conjunctiva in 2 eyes. No other complications related with the cut were found. The macular hole closed in 9 eyes with idiopathic macular hole, and the other 1 had the smaller but not closed hole. Idiopathic macular pucker, vitreoretinal traction syndrome, and vitreous hemorrhage associated with branch retinal vein occlusion were cured successfully. Conclusions Vitreoretinal surgery using the TSV25G under the topical anesthesia has many advantages such as simple procedure, short operation time, micro-invasion, less complications and rapid revovery, and mainly serves simple manipulation in some simple diseases such as idiopathic macular hole, vitreo-retinal traction syndrome, and simple hemorrhage.

The relationships between serum endothelin-1,calcitonin gene-related peptide and hypoxic-ischemic brain injury(HIBD) has been widely importance.Their respective functions,mutual relations and their relationships with HIBD has become a hot research.Understanding of their biological characteristics,mechanism and regulation of gene expression characteristics,is conducive to more in depth study on its pathogenic characteristics,provide a theoretical basis for clinical diagnosis and treatment.

AIM: To further investigate the immunologic mechanism of myasthenia gravis(MG). METHODS: Acetylcholine receptor antibodies(AchRab) and presynaptic membrane antibodies (PsMab) was determined by ELISA in 285 cases of MG patients. Tumor necrosis factor- alpha(TNF-?) and RBC-C3b receptor rosette rate(RBC-C3bRR)and RBC-IC rosette rate (RBC-ICR)was determined in 202 patients with MG. Furthermore, the peripheral blood lymphocyte subsets was examined in 104 cases MG patients. RESULTS: The positive rates of the AchRab and PsMab in MG were very significantly higher than that of control.The positive rate of PsMab in patients with negative AchRab was very significantly higher than that of patients with the positive AchRab.In 202 MG patients, the TNF-? was significantly higher, but the RBC-C3bRR was significantly lower than those of control, while the RBC-ICR has no significant change. CONCLUSION: MG is an autoimmune disease with damaged postsynaptic membrane by the AchRab, and some patients with both the AchRab and PsMab could manifest disfunction in the postsynaptic and presynaptic membrane. While the patients who just has the PsMab maybe damaged only in the presynaptic membrane. Other body fluid immune or/and cell immune mechanism may be involved in MG patients without AchRab and PsMab. [