Full-speed development of the primary health care centering on community health service is key to the ongoing health reform in China. Building a new management mechanism for these grass-root health centers is an innovative approach of such a reform as carried out in Zhejiang province.The authors described the present management mechanism in the province, and focused on the specific measures and main outcomes of the nine Group-scale model as used by a district health bureau in Hanzhou since end of 2007. The paper aims at building an ideal model for group-scale management of community health centers, and improving the new city primary health care system centering on community health service.

Scanning near-field optical microscopy (SNOM) is developing on the base of near-field optical theory and SPM technique, and producing the highest optical resolution to break through the diffraction limit. It is able to study cellular ultrastructure, function and interaction between biomolecules without destructing the living cells. Recent advances in applying SNOM to cellular and molecular biology were introduced in this review.

Mild cognitive impairment is a transitional state between normal aging and dementia, which is the best intervention window to delay cognitive decline.As one of the adjustable risk factors affecting cognitive function, perceived stress significantly increases the risk of cognitive impairment by causing hypothalamic-pituitary-adrenal axis dysfunction and psychological disorders.Therefore, perceived stress management will become a new hot spot in the research and practice of non-drug intervention techniques for cognitive impairment.This paper reviews the current situation of perceived stress in MCI population, the relationship between perceived stress and cognitive function, and the evaluation techniques of MCI individual perceived stress.Further more, this paper summarizes the relevant influencing factors of perceived stress based on stress attribution model, and comments on the action mechanism and practical enlightenment of perceived stress intervention program on cognitive function management, in order to provide theoretical reference for cognitive function management of MCI population.

Liver sinusoidal endothelial cells (LSECs) are the highest proportion of liver non-parenchymal cells with fenestrae structure and high endocytic ability maintaining liver homeostasis and playing an indispensable role in the physiology and patholo-gy of the liver.LSECs are involved in the regulation of patholog-ical process in nonalcoholic fatty liver disease(NAFLD),alco-holic fatty liver(AFL),hepatocellular carcinoma(HCC),liverregeneration and liver fibrosis mainly via antiinflammation,endocytosis,secretion of angiocrine signals and maintaining thequiescence phenotype of HSCs.This review highlights the physiological function of LSECs and the different roles in different pathological conditions,which aims to provide a new perspectivefor the treatment of liver diseases through targeting LSECs.

Objective To evaluate the efficacy ofintravitreal injection (IVI) ofexpansile gas alone to treat idiopathic full-thickness macular hole (FTMH).Methods This is a prospective interventional case series.Twenty FTMH patients (26 eyes) who underwent IVI with expansile gas alone were enrolled in this study.There were 5 males (5 eyes) and 21 females (21 eyes),with the mean age of (59 ± 12) years.All patients received the best corrected visual acuity (BCVA),slit lamp microscope,indirect ophthalmoscopy,fundus color photography and three-dimensional optical coherence tomography (OCT) examinations.The BCVA was measured using the international standard visual acuity chart,and the results were converted to the logarithm of the minimum angle of resolution visual acuity.The diameters of macular holes and the interface between vitreous and macular were observed by OCT (Topcon,OCT-2000).Based on the diameter,the holes were classified as small FTMH (equal or lesser than 250 μm),medium FTMH (more than 250 μm but equal or lesser than 400 μm) and large FTMH (more than 400 μm).The mean BCVA was 0.85 ± 0.29.There were 7,10 and 9 eyes with small,medium and large FTMH.There were 10 eyes with vitreous-macular traction (VMT).All the eyes received IVI of 0.2 ml C3F8 followed facedown positioning for 7-14 days.The follow-up ranged from 1 to 23 months.The BCVA,FTMH closure and complications were observed.If holes failed to close at 1 month after IVI,vitrectomy combined with internal limiting membrane (ILM) peeling and C3F8 tamponade would be performed for these eyes.Results FTMHs was able to close in 17/26 eyes (65.4％) had hole closure,failed to close in 9/26 eyes (34.6％).All 10 eyes with VMT achieved vitreous-macula separation after IVI of gas.The eyes failed in the closure initially with IVI of gas alone,all succeed with hole closure after vitrectomy combined with ILM peeling and C3F8 tamponade.The closure rate of small (6 eyes),medium (8 eyes) and large FTMH (3 eyes) was 85.7％,80.0％ and 33.3％ respectively.The diameter of FTMHs in holes-closure eyes and failed-closure eyes was (307.8 ± 122.8),(431.6± 128.4) μm respectively,the difference was significant (t=-2.407,P=0.024).VMT was found in 6 eyes and 4 eyes in holes-closure group and failed-closure group,respectively,the difference was significant (t=-2.196,P=0.038).The mean preoperative BCVA was 0.51 ±0.36.There was a significant difference between pre-and postoperative BCVA (t=4.758,P＜ 0.05).Two eyes developed local retinal detachment,which achieved hole closure and retinal reattachment after vitrectomy.Conclusion IVI of expansile gas alone is an effective way in treating FTMH with a diameter smaller than 400 μm and with VMT before surgery.

Objective To study the distribution and clinicopathological characteristics between VEGF-C and pefitumoral lymph vessels density(PLVD) in breast cancer tissue, and to investigate the development and the mechanism of breast cancer-related lymphoedema (BCRL). Methods VEGF-C and VEGFR-3 were detected by using immunohistochemical technique for the detection of VEGF-C and its receptor VEGFR-3 in forty-seven breast cancer specimens. We measured the patients' circumferences of bilateral upper limbs to determine whether there was lymphoedema and made classification in the follow-ups. Results VEGF-C was positive in 33 out of 47 cases. PLVD significantly increased in VEGF-C positive groups (30.39±10. 46) than in negative groups (23.16±11.67) (P<0.05). VEGF-C semi-quantitative score was in a positive correlation with PLVD (r=0.334). The positive expression rate (42.55%) and semi-quantitative score (3.68±1.59) of VEGF-C increased in the lymph node positive group than in the negative group, PLVD increased in the lymph node positive group compared with that in negative group (32.12±10.29 vs. 24.82±11.06), P<0.05. The risk of lymphoedema increased in the VEGF-C negative group (5/14) compared with that in the positive group (3/33) (P<0.05). Conclusion VEGF-C has a high rate of positive expression in breast cancer, and is positively correlated with PLVD. High expression of VEGF-C can reduce the risk of BCRL in breast cancer.

The application of TCM“Preventive Treatment for Disease”in community health care is a major approach to implementing the prevention-first health policy and realizing access to basic health services for all.Covered first in the paper is the significance of TCM“Preventive Treatment for Disease”in community health care.It is followed by a systematic description of the innovative community health care model in Hangzhou in 2008.This innovation started in 2009 to apply the TCM“Preventive Treatment for Disease”in community health care.The authors described the preliminary practice,specific measures and the main results of TCM“Preventive Treatment for Disease”in community health care.They went on to recommend the service model of TCM“Preventive Treatment for Disease”in community health care and provide references for application of TCm in community health care.

ObjectiveTo retrospectively investigate the clinical results of video-assisted thoracoscopic surgery for pulmonary pure ground-glass opacity.MethodsThe clinical data of 45 patients with pGGO underwent video-assisted thoracoscopic surgery were collected.The gender constitution,age,smoking status,surgical procedures,lesion size,histological types of tumor,lymph node metastasis and prognosis were retrospectively analyzed.ResultsThe numbers of females and non-smokers were significantly larger than those of males and smokers.All 45 patients underwent video-assisted thoracoscopic surgery.37 patients of solitary pGGO were all operated with cure intention.27 of the 37 patients received local resection ( wedge resection in 18 or segment resection in 9),and the other 10 patients underwent lobectomy.There are 8 patients of multiple nodes.Amongthese,6 were operated with cure intention,while 2 received VATS biopsy.Pathological examinations after operation revealed that there were 31 cases of bronchioloalveolar carcinoma and 14 cases of atypical adenomatous hyperplasia.And there was no lymph node metastasis.The diameters of bronchioloalveolar carcinoma lesions were significantly longer than those of atypical adenomatous hyperplasia lesions( P ＜ 0.05 ).Patients were followed up for 4 months to 6 years,and all survived without local recurrence and distant metastasis.ConclusionThe diameters of bronchioloalveolar carcinoma lesions are longer than those of atypical adenomatous hyperplasia lesions.Video-assisted thoracoscopic sublobectomy for pulmonary pure ground-glass opacity may achive excellent clinical results.Computed tomography-guided localization is a useful,safe procedure.

BACKGROUND:Procolagen type 1 N-terminal propeptide (P1NP) and β-colagen special sequence(β-CrossLaps) are two bone metabolic markers that are closely related to osteoporosis. Combined detection of bone metabolic markers and bone mineral density is of clinical significance for the diagnosis of osteoporosis. Bone metabolic markers are ideal indicators to predict fractures, which can compensate for the lack of bone density test. OBJECTIVE:To introduce the application of bone metabolic markers in the monitoring of drug efficacy on the treatment of osteoporosis as wel as in the prediction of fracture risks in recent 20 years and to explore the clinical values of P1NP and β-CrossLaps to assess the therapeutic efficacy on osteoporosis and risks for osteoporotic fractures. METHODS:A computer-based search of CNKI and SCI databases were performed for relevant articles published from 2000 to 2014 using the keywords of “serum bone metabolic markers; osteoporosis; bone mineral density” in Chinese and English, respectively. Finaly, 44 articles meeting the inclusive criteria were reviewed. RESULTS AND CONCLUSION:This paper analyzes the source and detection mechanisms of P1NPand β-CrossLaps and then compares their advantages in the therapeutic effect assessment of osteoporosis. Serum bone metabolic markers cannot only reflect the dynamic changes of bone metabolism, but also have earlier changes than the bone mineral density. Both P1NPand β-CrossLaps are very important for assessing the early diagnosis of osteoporosis as wel as anti-osteoporosis drug efficacy.

Objective To investigate the changes of esophageal intraluminal baseline impedance in patients with refluxesophagitis.Methods From December 2013 to August 2014,47 patients with reflux esophagitis and 17 healthy controls were enrolled.The patients with reflux esophagitis were graded according to Los Angeles classification (LA) grading standards.All subjects accepted 24 h multichannel intraluminal impedance (MII) pH examination,and the baseline value of impedance were measured.Independent sample t test was used to compare the difference in impedance between the two groups.Spearman rank correlation coefficient was performed to analyze the correlation between acid exposure time (AET) and the baseline impedance of patients with reflux esophagitis.Kruskal-Wallis test was used to compare the differences in baseline impedance of patients with different grades of reflux esophagitis.Results The impedance baseline value of reflux esophagitis group was (1 676.72±644.41) Ω,which was lower than that of healthy control group ((2 151.27± 322.05) Ω),and the difference was statistically significant (t =-3.883,P＜0.01).The AET of esophagus was negatively correlated with the baseline impedance of the patients with reflux esophagitis (r=-0.530,P＜0.01).The baseline impedance of patients with grade LA-A and grade LA-B reflux esophagitis were 1 823.62 Ω (1 515.38 52 Ω,2 208.38 Ω) and 1 771.81 Ω(1 304.75 52 Ω,2 080.50 Ω),respectively,and the difference was not statistically significant (Z=-0.630,P=0.529).The baseline impedance of patients with grade LA C/D reflux esophagitis was 300 Ω (300 Ω,500 Ω),which was obviously lower than those of patients with grade LA-A or grade LA-B (Z=-2.647 and-2.818,both P＜0.017).Conclusion The baseline impedance of patients with reflux esophagitis is low and correlated with AET.