The article made the analysis of community health care status quo,existing problems,facing challenges and opportunities in the development of community care,and it also studied the work of community care and the development trend of community care and explored the work of the nursing profession to adapt to the needs of the community of teaching reform and promote the development of community care.

Objective To analyze the factors that influence the learning effectiveness of students in higher vocational medical school and to explore the ways to improve the teaching effect of higher medical vocational education.Methods Self-designed questionnaire survey was conducted to investigate the basic condition,study status,teaching satisfaction degree and socre influencing factors of 639 students before internships.Teaching efficacy was assessed by scores (taking full score 100 as the standard,≥ 85 are the first class,≤70 are the second class and the rest are the third class).SPSS 14.0 was employed to do statically analysis and an orderly regression analysis was made by taking the factors affecting student learning outcomes as independent variable and the level of learning outcomes as dependent variable.Results There were statically differences in learning efficacy between nurse group and medical student group (Z=-4.817,P=0.000).Students' interests in discipline,family rearing patterns,secondary education means,whether doing preview and study style satisfaction were factors that influence the learning effectiveness.Conclusions Strengthening ideological education and learning atmosphere improvement as well as encouraging students to adopt appropriate learning methods can help students improve their learn-ing effectiveness.

An electronic medical record(EMR)system is built at urban community health centers to optimize services,achieving information integration of outpatient medical services based on the doctors' workstation.This system has optimized service at the outpatient clinics in the following:1.Digitizing service processes for higher efficiency and service quality; 2.Using EMR templates to save doctors' time in writing medical records for more of their time in patient inquiries and checks; 3.Using LIS,PACs and ECG/EKC systems to check lab results and imaging diagnostics of patients; 4.Using the diagnostic and therapy record sub-system to check electronic records of the patients for consulting their health history;5.Using the Shanghai Medical Alliance's(SMA)shared sub-system to acquire patients' medical records at SMA medical institutions,learning their conditions for their therapies.EMR,when it is built and put into use,can help improve GP's diagnostics and therapeutics,and provide better care to the outpatients as well.

In this case-control study, the relationship between M196R (676 T-->G) variant in exon 6 of tumor necrosis factor receptor type 2 ( TNFR2 ) gene and genetic susceptibility of acne vulgaris in Han Chinese was investigated. A total of 93 acne vulgaris patients and 90 healthy subjects from Han Chinese ethnic group were enrolled in this study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was adopted to analyze the single nucleotide polymorphisms (SNPs) of TNFR2 M196R gene, and to examine the association between acne vulgaris and the polymorphisms in TNFR2 M196R gene. The relationship between different genotypes and the susceptibility of acne vulgaris was analyzed. The results showed that there was significant difference in the frequency of the genotype M/R+R/R in the TNFR2 M196R genetic polymorphisms between acne vulgaris patients and healthy controls (chi(2)=4.343; P=0.037; OR=1.899; 95% CI: 1.036-3.445); and there was significant difference in the allele (R) frequency between acne vulgaris patients and healthy controls (chi(2)=5.588; P=0.018; OR=1.838; 95% CI: 1.105-3.057). It was concluded that the high frequency of 196R allele in the functional M196R polymorphism of TNFR2 is a risk factor for acne vulgaris in Han Chinese.

Objective To observe the changes of β-catenin expression in human skin fibroblasts (HSFs) after induced by oxidative stress, and to explore its possible roles in oxidative stress-induced premature senescence (SIPS) of HSFs. Methods Fibroblasts were isolated from the foreskin of a child and subjected to a primary culture. The fibroblasts of second to fourth passage were treated with various concentrations of H2O2 for 2 hours to establish an optimized model of stress-induced premature senescence, β-galactosidase assay kit was used to detect the activity of β-galactosidase in H2O2rinduced HSFs, RT-PCR and Western blot to measure the mRNA and protein expressions of β-catenin in control and senescent HSFs. Results Premature senescence of HSFs could be induced by the treatment with H2O2 of 150 μmol/L for 2 hours. The proportion of β-galactosidase-positive cells was (2.97 ± 0.25)% in control HSFs and (37.67 ± 1.53)% in senescent HSFs (P< 0.01). A significant increase was observed in the β-catenin/GAPDH protein ratio and β-catenin/GAPDH mRNA ratio in control HSFs compared with the senescent HSFs (0.62 ± 0.03 vs. 0.31 ± 0.01, t = 14.97, P < 0.01; 0.59 ± 0.04 vs. 0.29 ± 0.30, t = 10.06, P < 0.01). Conclusions The two-hour treatment with H2O2 of 150 μmol/L could induce the premature senescence of HSFs, and there is a notable decrease in the expression of β-catenin in prematurely senescent HSFs induced by oxidative stress, implying that β-catenin is an important target gene for the regulation of skin aging.

Objective To compare the efficacy and safety of twice-daily tacrolimus (Tacrolimus BID; Prograf) vs once-daily prolonged release tacrolimus (Tacrolimus QD; Advagraf), combined with steroids and mycophenolate mofetil in preventing acute rejection in De Novo renal transplantation patients. Methods 241 patients from 11 centers were randomized into two groups with 3 months observation period post-transplantation. Advagraf was administered as a single oral dose in the morning (initially 0. 1-0. 15 mg/kg every day) and Prograf was administered in two equal oral doses 12h apart (initially 0. 1-0. 15 mg/kg). Study visits were scheduled for days 1, 3, 7, 14, 28, 56, 84post-transplantion. The efficacy, safety, compliance and adverse effects were compared between two groups. Results Totally 223 patients completed the study. The two groups were comparable in age,gender and primary disease. There were 12 episodes of acute rejection in each group. There was no graft loss or patient death in both groups. The incidence of drug related adverse events was 32. 1 %and 33. 3% respectively in the control and experimental groups. Dosage was decreased in both groups and there was significant difference in each group. The trough level was similar at the initiate period.Twenty-eight days post-transplantation the trough level in the Advagraf group was lower than in the Prograf group. Conclusion Advagraf has the same efficacy, safety and drug related adverse effects as Prograf. It is practical and feasible for Advagraf substitute for Prograf in clinical practice.

In this case-control study,the relationship between M196R(676 T→G)variant in exon6 of tumor necrosis factor receptor type 2(TNFR2)gene and genetic susceptibility of ache vulgaris in Han Chinese was investigated.A total of 93 acne vulgaris patients and 90 healthy subjects from Han Chinese ethnic group were enrolled in this study.Polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)technique was adopted to analyze the single nucleotide polymorphisms(SNPs)of TNFR2 M 196R gene,and to examine the association between ache vulgaris and the polymorphisms in TNFR2 M196R gene.The relationship between different genotypcs and the susceptibility of acne vulgaris was analyzed.The results showed that there was significant differencein the frequency of the genotype M/R+R/R in the TNFR2 M196R genetic polymorphisms between acne vulgaris patients and healthy controls(X2=4.343; P=0.037; OR=1.899; 95% CI: 1.036-3.445);and there was significant difference in the allele(R)frequency between acne vulgaris patients and healthy controls(X2=5.588; P=0.018; OR=1.838; 95% CI: 1.105-3.057).It was concluded that the high frequency of 196R allele in the functional M196R polymorphism of TNFR2 is a risk factor for acne vulgaris in Han Chinese.

Reasonable intra-hospital hierarchical diagnosis and treatment system will effectively guide the patients to see a doctor on demand and improve the efficiency of medical services. Beijing Tongren Hospital, Capital Medical University, has explored the intra-hospital hierarchical diagnosis and treatment system depending on different situatioins such as for new patients, subsequent visit patient, and the same patients with different clinical stage. Through establishing a series of intra-hospital hierarchical diagnosis and treatment modes, such as the well-known expert team, the outpatient service for specialized diseases, the multidisciplinary outpatient service for complex diseases, the nursing service, and the pharmaceutical care service, the outpatients could be oriented by specialties and disciplines and graded by the complexity in diagnosis and treatment of diseases. Relying on the appointment methods such as referral and revisit to open up the information channel, it can optimize the time cost and economic cost of patients, reflect the functional positioning of the tertiary hospitals, and improve patients′ sense of medical access and happiness.