A nationwide pilot project concerning community health sendees, the major part and chief link of the reform in the urban medical health system, has basically come to an end. The author expounds against the background of reform in the health system in China the motives and orientation of reform in the medical health system and the current situation of and problems in the development of community health services. It is pointed out that advancing community health services entails all of the following:①genuinely transforming concepts and seeking unity of thinking; ②adopting the mechanism of competition and enhancing the sense of innovation; ③persisting in keeping abreast of the times and laying emphasis on reform and development;④accelerating the readjustment of resources and optimizing resource allocation; ⑤ceating a sound environment and seeking common development; ⑥giving priority to the improvement of quality and avoiding superficial transformation.

0.05)in the mild group compared with at the first day, but an obvious rise(P0.05), while continued to increase in the severe group(P

0.864, P

Community health service in the new century has entered a new stage of development. To ensure the healthy advancement of community health service in the course of system building, the following guiding principles must be adhered to: spurring on system innovation with concept innovation and giving full play to the staying power of community health service; taking the introduction of the competition mechanism as the soul and unremitting impetus of innovation; persisting in the solution of problems accompanying advance and development with methods promoting development; taking the strategic readjustment of health resources as the main line of development; taking the attainment of a favorable external environment as the impetus of development; and sticking to a path of coordinated growth that stresses both quality and speed.

Objective·To investigate the effects of insulin-like growth factor 1 on prion encoding gene (PRNP) expression and amyloid precursor protein (APP) metabolism of PC12 cells. Methods·After PC12 cells were treated with 20, 40, 80 ng/mL IGF-1 for 24 h, real-time PCR was used to detect the mRNA expression levels of PRNP, and Western blotting was used to detect the protein levels of AKT, phosphorylation of AKT (pAKT), ERK and phosphorylation of AKT (pERK). The level of β-amyloid 42 (Aβ42) in supernatant fluid was detected by ELISA. Results·Compared with the blank control group, the expression of PRNP mRNA in Alzheimer's disease (AD) model group was increased significantly (P<0.01). The expression of PRNP mRNA was significantly increased after cells were treated with 40 and 80 ng/mL IGF-1 for 24 h (P<0.01). There was no significant difference in APP protein expression among AD model group and three IGF-1 treatment groups (P>0.05). Compared with the blank control group, the level of Aβ42 in supernatant fluid of model group was decreased significantly with the increasing of IGF-1 concentration. The expression level of Aβ42 was decreased significantly in 40 and 80 ng/ml IGF-1 treatment group (P<0.05). The expression of AKT/pAKT, ERK/pERK in AD model group was significantly increased along with the increasing of IGF-1 concentration (P<0.05). Conclusion·IGF-1 could regulate the expression of PRNP gene and effect the metabolism of APP, which may be associated with PI3K/AKT, MAPK/ERK1/2 signaling pathway.

BACKGROUND: Artesunate can relieve pulmonary fibrosis, but its mechanisms are rarely reported.OBJECTIVE: To explore the effect of artesunate on apoptosis of HFL-I cells and the role of Fas, FasL and Caspase-3 in the artesunate-mediated apoptosis of HFL-I cells. METHODS: Cell counting kit-8 (CCK-8) assay was used to determine the effects of artesunate at 1, 10, 100 mg/L on the growth of HFL-I cells in vitro. Apoptosis ratio was examined by flow cytometry (FCM). The mRNA level of Fas, FasL and Caspase-3, were assessed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS AND CONCLUSION: Artesunate had a significantly inhibitory effect on the proliferation of HFL-I cells in a dose-dependent manner in vitro. The apoptosis rate of HFL-I cells was significantly increased in the artesunate-treated group compared with the control group (P < 0.05 or P < 0.01). The mRNA levels of Fas, FasL and Caspase-3 were significantly higher in the artesunate-treated group than the control group (P < 0.05). The findings of this study demonstrate that artesunate can exert a marked anti-pulmonary fibrosis effect by up-regulating mRNA levels of Fas, FasL and Caspase-3, which can induce the growth inhibition and apoptosis in HFL-I cells.

Objective:To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis.Methods:In the study,42 cases of renal artery stenosis were treated with 52 renal artery stent implantation.Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney,ipsilateral kidney (renal) glomerular filtration rate (GFR),renal effective renal plasma flow effective renal plasma flow (ERPF),kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed.Results:The 52 cases of renal artery stent implantation were all successful.Preoperative ipsilateral GFR was significantly lower than that of normal side (t =-3.989,P =0.000);preoperative ipsilateral ERPF was significantly lower than the contralateral side (t =-4.926,P =0.000).On both sides,the overall FF values were equal (t =1.273,P =O.207).Postoperative ipsilateral renal GFR was increased,but there was no statistical difference (t =-1.411,P =0.164).Postoperative ipsilateral renal ERPF was increased significantly (t =-4.954,P =0.000),and FF lower (closer to the normal value (t =3.274,P =0.002).Postoperative side GFR was significantly reduced (t =2.569,P =0.000),the contralateral ERPF was significantly reduced (t =3.889,P =0.001),and FF had no significant change (t =-0.758,P =0.454).Postoperative side GFR was lower than that of the contralateral (t =-3.283,P =0.002) and postoperative side ERPF was still lower than that of the contralateral (t =-3.351,P =0.001),but on both sides,the FF values were equal (t =-0.361,P =0.719).Preoperative FF was relatively normal in the patients with kidney,and the postoperative FF value change was small (t =O.799,P =O.430);preoperative FF was significantly higher in the patients with kidney,and the postoperative FF value was lower than the preoperative (normal value,t =5.299,P =0.000).Postoperative overall serum creatinine was significantly decreased (t =2.505,P =0.016);but for the patients with unilateral renal artery stenosis,the changes in serum creatinine had no statistical difference (t =1.228,P =0.299);and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative,the changes were decreased significantly (t =2.518,P =0.030);postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t =8.945,P =0.000);antihypertensive drugs taken were decreased significantly compared with the preoperative (t =5.280,P =0.000).Conclusion:For the patients with renal artery stenosis,FF is a useful index to understand the pathophysiological process of renal ischemia.Whether preoperative FF is significantly increased or FF is relatively normal,should be regarded as the indications of renal artery stent implantation.

Objective To investigate the relationship between the concentration of plasma (1→3)-?-D-glucan (?-D-glucan) and deep fungal infection. Methods Thirteen patients were recruited in this study, who were suspected with deep fungal infection. G-test TE reagent for ?-D-glucan measurement was used to detect the plasma (1→3) ?-D-glucan in the patients by using UV-2450 spectrophotometer at 545 nm wavelength. The final concentrations were calculated according to concentration conversion formula. Results Nine of thirteen patients were confirmed as deep fungal infection by positive tissue culture, in whom high concentrations of ?-D-glucan were detected, the highest concentration was 352.94 pg/mL (mixed infection), with a mean value of 203.47 pg/mL. In the other four patients with negative culture, the ?-D-glucan concentration was over 54.40 pg/mL in three patients and 16.16 pg/mL in the another. Our results showed that the sensiti-vity, specificity, positive predictive value and negative predictive value of this test were 92.31%, 100%, 100% and 98.36%, respectively. Conclusion G-test TE method is a simple and rapid test and may be used for the diagnosis of patients with deep fungal infection.

This study is to investigate the effect of artesunate on transforming growth factor-beta1 (TGF-beta1) induced epithelial-mesenchymal transition (EMT) and its possible mechanism. After the in vitro cultured RLE-6TN cells were treated with TGF-beta1 then artesunate intervened on it, after 24 h, expression of the markers of mesenchymal cell was assayed using Western blotting and real-time PCR analysis. Western blotting was also used to detect the effect of TGF-beta1 on the Smad3 and Smad7 expressions of RLE-6TN cells. Morphological alterations were examined by phase-contrast microscope, and ultrastructure changes by electron microscope. Incubation of RLE-6TN cells with TGF-beta1 resulted in the up-regulation of the expression of the mesenchymal cell markers, after artesunate intervened on it, resulted in the down-regulation of the expression. Meanwhile, incubation with artesunate intervened on RLE-6TN cells could lead to the apparent down-regulation of the expression of Smad3 and up-regulation of Samd7 and the transition of RLE-6TN cells to mesenchymal-like by TGF-beta1 induction, after artesunate intervened on it, RLE-6TN cells to epithelial-like. TGF-beta1 induced epithelial-mesenchymal transition process; artesunate can inhibit TGF-beta1-induced epithelial-mesenchymal transition process, the possible mechanism is up-regulation of the expression of Smad7 and down-regulation of the expression of Smad3, meanwhile inhibits phosphorylation of Smad3.

Objective To summarize experience in treating patients with native value endocarditis ( NVE) , and discuss the effect of timing of surgery on the infection control , cardiac function recovery and long-term mortality among patients . Methods Eighty NVE cases with antibiotic treatment were recruited between January 2006 and May 2013 .According to the timing of surgery, the subjects were divided into the early surgery group (38 cases) and the late surgery group (42 ca-ses) .The infection-related markers and cardiac function indexes before and after surgery , and 1-year, 3-year and 5-year mortality after surgery were analyzed .Results The infection control and recovery of cardiac function in the early surgery group were better than in the late surgery group (P<0.05).The difference in 3-year and 5-year mortalities between the two groups was significant .Conclusions For NVE patients with routine antibiotics treatment , the surgical effect and long-term survival rate are much better in the early surgery group than in the late surgery group .