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.

Objective To explore the effective procedures and practices to solve the ethical dilemma of nursing, and to building nursing ethics decision path. Methods Using inductive-deductive method, summarize predecessors′ research on nursing ethics mode and decision-making process, and establish nursing ethical decisions paths, then display the application based on clinical case. Results Six-steps-Nursing ethics decision path was established, and tested. Conclusions Pay attention to strengthen the cultivation of nurses nursing ethics accomplishment and ability of the decision.

Under the situation of national demand for cardiopulmonary resuscitation (CPR) skills, it is very important to develop a scientific and feasible education and training program to popularize CPR skills, and improve first-aid ability. This study illustrated the significance and feasibility of setting up car-diopulmonary resuscitation courses in colleges and universities. On this basis, specific suggestions and countermeasures were put forward to improve teaching organization and leadership, teaching material de-velopment, curriculum design, teaching faculty development, teacher training and laboratory construction. This study proposed to strengthen the legislation, and the implementation of first-aid qualification examina-tion in colleges and universities, making the students become the preferred educational group of CPR skills, which is of great significance to improve public popularity rate of CPR.

Objective To study the application of microelectrode stereotactic functional nucleus lesioning operation in the treatment of Parkinson′s disease(PD) ,and to explore its clinical value .Methods The clinical data in 84 cases of PD treated with‐out using the microelectrode stereotactic functional nucleus lesioning operation(observation group) and 74 cases of PD treated by u‐sing microelectrode guided stereotactic functional nucleus lesioning in our hospital were retrospectively analyzed .At the same time the Unified Parkinson′s Disease Rating Scale (UPDRS) scores before the nucleus lesioning and at postoperative different medication states were obtained in the observation and the control group .Furthermore the difference of the UPDRS motor scores before and af‐ter operation were compared between the two groups .Results The UPDRS motor scores at postoperative 3 ,6 months and 1 year in the observation group were significantly improved compared with before operation(P<0 .05) ,meanwhile the postoperative anti‐PD drug dosage was significantly decreased compared with before operation(P<0 .05) .Among them ,70 cases(83 .3% ) in the control group were obviously effective ,14 cases(16 .7% ) were effective ,and the total effective rate was 100% ;while 62 cases(83 .7% ) in the observation group were obviously effective ,12 cases (16 .3% ) were effective ,and the total effective rate was 100% .The differ‐ence in improving the UPRDS motor scores before and after operation had no statistical difference between the two groups(P>0 .05) .Conclusion Stereotactic nucleus lesioning in treating PD has satisfactory effect and can significantly improve the UPRDS motor scores .Accurate positioning is the key to the operation success ,whether microelectrode recording can significantly improving the operation accuracy needs further discussion .

BACKGROUND:Cholesterol is closely linked to the occurrence and progression of atherosclerosis. Current approaches to study celular cholesterol dynamics have their own limitations.
OBJECTIVE: To measure the cholesterol efflux rate of RAW 264.7 mouse macrophages by BODIPY-Cholesterol labeling and to explore the effects of extracelular cholesterol and lipopolysaccharide on the cholesterol efflux rate.
METHODS:RAW 264.7 cels were cultured in vitro with DMEM containing 10% fetal bovine serum, and labeled with BODIPY-Cholesterol for 1, 2, 4, 8 hours. Then, the cels were rinsed with serum-free DMEM and inoculated for 6, 12, 24, 48, 96 hours to optimize the labeling time and incubation time. We measured and compared the cholesterol efflux rates after cultured cels were treated with cholesterol, lipopolysaccharide, human sera with high cholesterol or human sera with normal cholesterol.
RESULTS AND CONCLUSION: The best labeling time for BODIPY-Cholesterol was 2-8 hours. Cholesterol efflux rates were gradualy decreased after the cels that were labeled for 2 hours were incubated with increasing concentrations of cholesterol (0.1, 0.5, 2.5 mmol/L,P< 0.01). Treating cels with lipopolysaccharide also decreased the cholesterol efflux rate (P < 0.05). Furthermore, the cholesterol efflux rate was decreased after cels were treated with human sera with high cholesterol (P< 0.05). These findings indicate that BODIPY-Cholesterol can be used to measure celular cholesterol efflux rate and to study the effects of extracelular cholesterol and lipopolysaccharide on the cholesterol efflux rate.

Objective Using manganese enhanced MR imaging(ME-MRI)as a standard to validate the accuracy of white matter diffusion tenor tractography(DTT)with different gradients orientations in macaque monkeys.Methods Seven adult male macaque monkeys were scanned for DTY images with different number of gradients orientations.When all data were acquired.3 μl of 0.8 mol aqueous solution of MnCl2 was injected into the primary motor cortex representing forelimb for ME-MRI scanning 48 hours later.On the images of fractional anisotropy(FA),seed region for fiber tracking was chosen according to the subcortical enhanced range on ME-MRI,then the DTT fiber tracts proiecting on axial images of FA were compared with enhancement region on T1WI of ME-MRI.Results Under the calculation method for fiber tracking in the study,different motion-probing gradients orientations led to results consistent with ME-MRI for the brain above the midbrain level.All group's concordance score of fibertracking results were good.Among them,30 and 64 orientation fiber tracking results were optimal.Below the midbrain level,there was significant difference between DTT fiber tracking and ME-MRI fiber tracking. Conclusion Different motion-probing gradients orientations do not influence DTT fiber tracking.But below the midbrain level.the results of DTT fiber tracking were not reliable according to the standard results of ME-MRI fibe tracking.

Objective To discuss the value of digital tomosynthesis for detection of pulmonary nodules. Methods Thirty patients suspected of having pulmonary nodules underwent chest radiography, digital tomosynthesis and CT examination. Above image data were transferred to postprocessing work station and were reviewed by 2 radiologists with 3 years of chest-radiology diagnosis experience in a double-blind method. The number, location and size of nodules were recorded. Then, 2 radiologists reviewed the all images once more, and discuss in consensus. The sensitivities of chest radiography and digital tomosynthesis for detection of pulmonary nodules were respectively calculated according to the CT results. Chi-square test was used for radiography, digital tomosynthesis and CT examination. Results Of 30 patients, 21 were detected having pulmonary nodules by X-ray radiography and 9 were negative, the total number of 40 nodules was detected, while 89 nodules in 26 patients were detected by digital tomosynthesis, and only 4 patients were negative. CT demonstrated 102 nodules in 27 patients, and 3 patients were negative. Taking CT as "gold standard", the sensitivities of X-ray radiography and digital tomosynthesis were 27.4%(28/102)and 87.2%(89/102), X~2=4.35, P<0.05, respectively. Conclusion Digital tomosynthesis has a high sensitivity for detection of pulmonary nodules compared with X-ray radiography, and could be an excellent and necessary supplementary technique of X-ray radiography.

Objective To preliminarily develop a scale to measure the proactive socialization behavior of new nurses and test validity and reliability of the scale, to explore the impact of proactive socialization behavior on turnover intention. Methods Using a questionnaire survey method to investigate 696 new nurses who had worked within three years in nursing organization, structural equation model and hierarchical line regression methods were performed to analyze the data. Results Proactive socialization behavior scale included eight items under one dimension;the consistency coefficient of scale was 0.858;new scale had a good convergent and predictive validity;the proactive socialization behavior of new nurses was significantly negative related to turnover intention (β=-0.236,P<0.01). Conclusions The proactive socialization behavior scale has a good reliability, convergent and predictive validity. Meanwhile, new nurses with higher level of proactive socialization behavior have lower turnover intention. Because they can quickly fit the new environment, role definition and organizational culture, which in turn organization embeddedness is promoted.

The purpose is to establish an emergency medical system that covers a certain region, responds quickly, operates efficiently, functions perfectly and develops sustainably. Such a system leverages the potential social functions of research disciplines, and is guided by the concept of " expanding the emergency system of comprehensive emergency medicine". The authors identified the problems and shortcomings of the existing system and proposed to build a regional emergency medical system led by research disciplines. The path, system layout and functions are stated explicitly, while the system construction strategy is proposed by taking emergency treatment of myocardial infarction patients as an example. The system will be the pivotal support for integrating effectively regional emergency medical resources, improving the ability and level of emergency and first aid in medical institutions at various levels and of different types, promoting the formation of a new pattern of regional emergency medical service and achieving homogenized emergency medical services that everyone enjoy.

Vertigo is one of the most common symptoms in general practice. During the standardized training in theory and practice of vertigo diagnosis and treatment, researchers from group of vertigo subspe-cialty of department of neurology analyzed the epidemiological characteristics of vertigo disease and the present teaching situation of theory and practice teaching. They put forward and adopted the "Three Steps"(laying firm foundation, consolidating and strengthening, and improving skills) which is based on multidis-cipline and conforming to trainees' understanding of the disease. It helped general practitioners tofamiliarize themselves with the etiology, diagnosis, and treatment of vertigo, to perfect their multidisciplinary knowl-edge structure, to establish scientific clinical thinking, and to improve their levels of the diagnosis and treatment of diseases relating to vertigo, which has produced good effects and has been playing an important role in improving the prognosis for vertigo patients.