An in-depth analysis of the problems found in the hierarchical medical system,found that the research hospitals should focus on the conceptions of Big Times and Big Health,initiative the task to undertake Strong grass-roots,and actively build leading model of hierarchical medical system based on the PDCA cycle.At the same time,taking the practice of the 2nd Affiliated Hospital of Harbin Medical University as an example,we propose the research hospitals should strengthen service capabilities in primary health care institutions from talent,technology,management and other aspects, so as to enhance the patient's willingness to visit the grassroots,and to promote the further deepening of our medical reformation.

Micro-ribonucleic acids (miRNAs) are endogenous single-stranded small non-coding RNAs. miRNAs bind to a com-plementary site in the 3' untranslated region of their target mRNAs through canonical base pairing, which can direct the degradation or translational repression of these transcripts. Thus, miRNAs can effectively silence the protein expression of target genes post-transcrip-tionally. miRNAs may also regulate the expression of oncogenes and tumor suppressor genes and could be involved in almost all known hallmarks of cancinogenesis. In this paper, we discuss the following in detail:(1) biogenesis and main functions of cellular miR-NAs, (2) stability and detectability of exosomal miRNAs in biological fluids;and (3) feasibility of miRNAs as a potential new class of biomarkers derived from urinary exosome in the malignancy of urinary system. Finally, we summarize studies on urinary exosomal miRNAs as potential biomarkers of prostate, bladder, and kidney cancers.

Objective: To investigate the molecular changes in bladder urothelial carcinoma via different pathways. Methods:Polymerase-chain reaction (PCR) or coamplification at low denaturation temperature-PCR and Sanger direct sequencing were per-formed to detect the status of fgfr3, p53, and h-ras gene mutations in 88 tissue samples of human bladder cancer and 10 normal control tissues. The relative mRNA expression levels of motility-related protein-1 (MRP-1)/CD9 and the relationship between genes and tumor recurrence were also determined. Logistic regression and relative analyses were conducted to compare the significance and interrelation of genes among tumor recurrences. Results:The mutation rate of p53 increased as pathological grades and stages increased. Recurrence rate was higher in patients with MT-p53 genotype than in patients with WT-p53 genotype. Conversely, the mutation rate of fgfr3 gene decreased as pathological grades and stages increased. Recurrence rate was also higher in patients with WT-fgfr3 genotype than in pa-tients with MT-fgfr3 genotype. In low-grade and early stage tumors, MT-fgfr3/WT-p53 was the most prevalent genotype;in high-grade and late stage tumors, WT-fgfr3/MT-p53 was the most prevalent genotype. The mutations of h-ras were mainly observed in low-grade tumors in early stages. Moreover, the relative mRNA levels of MRP-1/CD9 decreased as pathological grades and stages increased. The mRNA levels of MRP-1/CD9 were negatively correlated with p53 mutations and positively correlated with fgfr3 mutations. Logistic re-gression analysis results showed that patients with WT-fgfr3 genotypes exhibited 3.88 times higher relative risk of tumor recurrence than those with MT-fgfr3 genotypes;by contrast, patients with MT-p53 genotypes exhibited 4.53 times higher relative risk of tumor re-currence than those with WT-p53 genotypes. Conclusion:Fgfr3 and h-ras gene mutations may play important roles in tumorigenesis of low-grade and early stage bladder cancer. p53 gene mutation and mRNA levels of MRP-1/CD9 may be implicated in the tumorigenesis of high-grade tumors in late stage of bladder cancer. In general, the two variants of urothelial carcinoma exhibit distinct genetic defects. fgfr3 gene mutation revealed a pathway of favorable prognosis, and p53 gene mutation demonstrated a pathway associated with poor prognosis.

The lymphatic vessel is one of the earliest routes for systemic neoplastic metastasis. But reports on research of the lymphatic vessel have been few compared to the study for tumor vessels. In the past few years,along with advances in understanding about the construction features of the lymphatic system,work has been done to determine the anatomic fundamentals of lymphatic metastasis. Many new specifi c markers of the lymphatic endothelium had been reported, which is useful to differentiate lymphatic vessels from capillary vessels. The lymphatic vessels are usually found in the animal tumor models, human tumors and peritumoral tissues. Furthermore, the molecular mechanism of lymph-angiogenesis has been discovered, which provide effective targets for anti-lymphatic metastasis of malignant tumors, make optimization of individualized treatment strategy possible to restrain lymph-angiogenesis of malignant tumors and so it could benefi t in improving patients' prognosis and survival.

CD8+ T cells play an essential role in defending against viruses,intracellular bacteria,protozoal infections and clearance of tumors since almost all the nucleated cells express MHCⅠ molecule.Following antigen recognition,CD8+ T cells are activated and differentiated to different subsets of effector or memory cells,which could clear the pathogen and form long-term protection.Phenotypic markers,functional properties and anatomical locations are different among these CD8+ T cell subsets.They also show variation in surviving time,proliferation and effector functions when re-challenged with the pathogen or tumor.Multiple signaling pathways and transcriptional factors are involved in CD8+ T cells activation and differentiation,and will be discussed in this review.We will also briefly summary the clinical applications of T cells against tumor or pathogens.

We studied the protective effects of redix salviae miltiorrhizae (RSM) on the ischemic and post-ischemic reperfusion injury which was made by ligating and reopening of the left ventricular branch of the coronary artery of the open-chest anaethetised rabbits under the supervision of ECG. There were 14 rabbits in each group, 7 of them for the measurement of myocardial lipid peroxide level (MLPL) by the thiobarbituric acid method (Hiroshi Ohkawa, 1979), and the other 7 for measuring distribution of regional myocardial blood flow (RMBF) by the biological radionuclidelabeled particle method (Wang Jingxian, 1985). With increasing duration of ischemia, MLPL increased significantly in the ischemic and post-ischemic reperfusion injured heart. In the case of 60 mins ischemia followed by 30 mins reperfusion, MLPL was much higher than that without reperfusion. However, which compared with that of 90 mins ischemia, no significant difference was found. The recovery of RMBF was only 53.2% after 30 mins of reperfusion following 60 mins of ischemia. The occurance of post-ischemic reperfusion injury was dependent on the duration and severity of ischemia. The injury of reperfusion after long period (60 mins) of ischemia is similar to that of increasing duration of ischemia. No-reflow phenomenon was observed in ischemic zones during reperfusion after 60 mins of ischemia. In the RSM (2g/kg body wt) protected reperfusion group. MLPL was reduced by 56.0% and the recovery of RMBF was increased by 32.0%.

AIM: To study the association of the human paraoxonase 2 (PON2) 311Cys/Ser polymorphism genotypes and coronary heart disease (CHD) in type 2 diabetes mellitus (type 2 DM) in Chinese subjects of north area. METHODS: PON2-311 cysteine (C type) / serine (S type) polymorphism was determined using PCR and restriction mapping with DdeⅠ, in 75 elder patients with type 2 DM, 39 with CHD,36 without CHD, and 38 normal elder controls. RESULTS: There was significant difference in frequencies of genotypes between CHD in type 2 DM group and normal control group( P

Objective To investigate the clinical effect of Itopride and esomeprazole combining with deanxit in treating functional dyspepsia ( FD) .Methods Sixty-two patients meeting Rome Ⅲcriterion were randomly divided into the therapy groups which were treated with Itopride and esomeprazole combining with deanxit and the control groups which were treated with Itopride and esomeprazole for 4 weeks respectively .Symptom scoring was done before and after the treatment .Results The symptoms were remarkably improved , there was significant difference in the therapeutic effect between the two groups (P<0.05).The total efficiency was more obvious in the therapy group . Conclusion Itopride and esomeprazole combining with deanxit can produce an effect on the treatment of FD .Itopride and esomeprazole combining with deanxit has better clinical effect than Itopride and esomeprazole on the treatment of FD.

10.3969/j.issn.1007-3969.2013.04.012

Tumor markers for early diagnosis of cancer is an important auxiliary mean,which for early tumor detection,monitoring and for judging curative effect of treatment regimens play important role.Clinical method for early diagnosis on ovarian cancer is the detection of serum CA125,however,its precision and specificity for early diagnosis are not enough.It has been found that in the development period of the patients with ovarian cancer,SMRP and CA125 is co-expression.This article reviews the value of serum mesothelin on diagnosis of epithelial ovarian cancer to provide reference on early diagnosis and treatment.