Improving the basic medical and health service system is an important measure to deepen health care reform.Jilin province has explored its unique way of comprehensive reform of the primary organizations in the province by means of reforming grassroots medical operation mechanism and mode of service,and perfecting the compensation mechanism,achieving remarkable results.This article,based on the overall situation of Jilin province,main contradictions and countermeasures research,made detailed analysis of healthcare reform and bottlenecks encountered in the reform.The author pointed out the direction of Jilin province primary medical and health institutions reform,and put forward feasible policy adjustments and suggestions for such a reform.

Objective To analyse effect of adefovir dipivoxil combined with pegylated interferon on serum Th1/Th2 type cytokines and IgM and IgG antibodies in patients with hepatitis B.Methods 52 patients who were diagnosed with chronic hepatitis B in Qian’an Infectious Disease Hospital were collected.All patients were randomly divided into experimental group and control group,26 cases in each group.Patients in control group received treatment with adefovir dipivoxil , patients in experimental group were given pegylated interferon treatment on the basis of control group treatment , after treatment, the serum levels of IFN-γ,IL-4,IgM and IgG were detected in all patients .Results After treatment, compared with control group , the serum level of IFN-γwas higher in experimental group(P<0.05); the serum level of IL-4 was lower in experimental group(P<0.05); the serum level of IgM and IgG were lower in experimental group (P<0.05).Conclusion Adefovir dipivoxil combined with pegylated interferon can significantly reduce the serum levels of IL-4,IgM and IgG, and improve the serum level of IFN-γin patients with hepatitis B , reverse Th1/Th2 imbalance .

Objective To explore the effect of telbivudine on serum interleukin-18(IL-18),IL-12, IL-37 and tumor necrosis factor α(TNF-α) levels in patients with HBV-related hepatocirrhosis.Methods 66 cases of patients with HBV-related hepatocirrhosis were collected and divided into treatment group and control group according to the different treatment method , 34 cases in control group were treated with routine treatment , 32 cases in treatment group were treated by telbivudine on the basis of routine treatment.The serum IL-18, IL-12, IL-37, TNF-αlevels and adverse reactions were compared post-treatment.Results Compared with control group, the levels of IL-18, IL-12, IL-37 and TNF-αdecreased significantly post-treatment (P<0.05).The above levels were significantly lower in treatment group post-treatment than that in control group(P<0.05).Conclusion Telbivudine adjuvant therapy could suppress viral replication, and improve liver function and immune response in patients with HBV-related hepatocirrhosis.

Objective To analyze the clinical effect of probucol in prevention of contrast induced nephropathy(CIN) after percutaneous coronary intervention(PCI).Methods 96 patients with coronary heart disease requiring PCI surgery in our hospital were selected as the research subjects, and they were randomly divided into control group(48 cases) and observation group(48 cases).Both two groups were given traditional treatment, besides this, the observation group was given additional probucol (3 d treatment before and after operation,0.5 g/time,2 times/d).The renal function indicators such as serum creatinine (Scr), cystatin C(CysC), blood urea nitrogen(Bun), estimated glomerular filtration rate(eGFR), and the expression levels of C-reactive protein(CRP),interleukin-6(IL-6) and malondialdehyde(MAD) in the two groups 24 h,48 h, 72 h before and after PCI were observed and compared.And the adverse reactions during operation in the two groups were also recorded and compared.Results There were no significant differences in Scr,CysC,Bun and eGFR between the two groups before opertion(t=0.149,P=0.882;t=1.75,P=0.243;t=0.019,P=0.985).12 h after operation, the Scr,CysC,Bun and eGFR levels in the two groups were gradually increased,48 h post-treatment, the levels reached to the peak and showed a downward trend 72 h after operation;compared with the control group, the rise and decline in the observation group were more greater, and the differences were statistically significant (t=3.242,P=0.002;t=9.532,P<0.001;t=9.073,P<0.001;t=2.896,P<0.001).There were no significant differences in CRP,IL-6 and MAD between the two groups before operation (t=0.321,P=0.749;t=0.014,P=0.989;t=0.188,P=0.850).24 h after operation, the CRP,IL-6 and MAD levels in the two groups were gradually increased,48 h post treatment, the levels reached to the peak and showed a downward trend 72 h after operation;compared with the control group, the rise and decline in the observation group were more greater, and the differences were statistically significant (t=8.495,P=0.002;t=7.532,P<0.00;t=16.216,P<0.001).There were no obvious adverse reactions during operation in the two groups.Conclusion Probucol not only has lipid-regulating and atherosclerotic effects on patients with coronary heart disease, but also has certain preventive and clinical effects to CIN after PCI.Thus, it can be considered as a preferred drug for clinical prevention and treatment of CIN.

Objective To evaluate the impacts of comprehensive diabetes intervention to provide evidence for effective diabetic control in rural communities.Methods Diabetic patients from four communities at Wujin District of Changzhou City were selected.One hundred and seventy-three patients from two communities received comprehensive intervention,including medication therapy,diabetes education,and diet.exercise,and behavior instruction(intervention group);142 patients from the other two communities got medication therapy only (control group).All the participants were interviewed with structured questionnaire and phyrsical examination.The second epidemic investigation was conducted at 4 years to evaluate the effects of the intervention.Results At the end of the intervention,the awareness rates of normal fasting plasma glucose,major diabetes risk factors,healthy diet,and therapeutic strategies in the intervention group were 90.8%.74.6%,89.6%,and 59.5%,respectively,which were significantly higher than those in the control group (all P<0.05).For the intervention group,the rates of diet behavior or physical exercise change were 68.8% and 58.4%.respectively.which were much higher than those of the control group(all P<0.05).The average levels of systolic pressure,diastolic pressure,fasting plasma glucose,and total cholesterol were (130.6±10.4)mm Hg(1 mm Hg=0.133 kPa),(78.4±7.5)mm Hg,(6.2±3.1)mmol/L,and (4.5±0.9)mmol/L,respectively,in the intervention group,which were lower than those in the control group(all P<0.05).Conclusion Comprehensive intervention shows significant effects on rural community patients with diabetes.

Objective To investigate the prevalence and influencing factor of metabolic syndrome(MS)in rural elderly population. Methods With randomized cluster sampling,investigations including questionnaires,physical examination,fasting plasma glucose,blood lipids were performed in rural population aged over 60 years in Changzhou city in 2004-2005. Results A total of 4976 elderly people were enrolled in the study.The prevalence of MS was 24.1%,and 10.3%in men,34.3%in women by international diabetes federation(IDF)2005 definition.86.2%individuals had one or more of the metabolic disorders.Logistic regression analysis showed that sex,smoking,sweetmeat,family history of essential hypertension(EH)and tea drinking were influencing factors of MS. Conclusions The prevalence of MS is high in rural elderly population,especially in females.

Objective To investigate the effects and possible mechanism of Fructus lycii on renal calcium oxalate stone formation in rats. Methods Wistar rats were divided into several groups according to different stone inducer (cigarette smoking, ethylene glycol solution drinking or combination of both), either Fructus lycii infusion interference or not and different interfering concentrations (10% and 25%). Besides, a blank control group was set. After treatment for 40 d, 24 h urine was collected, and renal tissue samples were obtained. The concentrations of calcium, oxalate and citric acid in urine were measured. The deposit condition of calcium oxalate crystals in nephric tubules was observed and scored. The levels of malondialdehyde (MDA) and activity of total-superoxide dismutase (T-SOD) in renal tissues were detected. Apoptosis cells in kidney were observed with TUNEL staining, and index of apoptosis was calculated. Results Compared with blank control group, the urine calcium concentration in group of combination of cigarette smoking and ethylene glycol solution drinking were significantly higher (P<0.01), the scores of calcium oxalate crystals in renal tubules, the levels of MDA in renal tissues and the index of apoptosis of renal tubule epithelial cells in groups of ethylene glycol solution drinking and combination with smoking were higher, while the concentrations of citric acid in urine and activity of T-SOD in renal tissues were lower. Ten percent and 25% Fructus lycii infusion significantly decreased the urine concentrations of calcium in group of combination of cigarette smoking and ethylene glycol solution drinking (P<0.01), decreased the scores of calcium oxalate crystals in renal tubules, the levels of MDA in renal tissues and the index of apoptosis of renal tubule epithelial cells in groups of ethylene glycol solution drinking and combination with smoking, and increased the concentrations of citric acid in urine and activity of T-SOD in renal tissues. There was no significant dose-effect relationship between two concentrations of Fructus lycii infusion. Conclusion Fructus lycii infusion can effectively inhibit the formation of renal calcium oxalate stone in rats with smoking and/or ethylene glycol drinking by reducing the free radicals and apoptosis of renal tissue, decreasing the concentration of elements for stone formation and increasing the concentration of elements for inhibition of stone formation in urine.

Objective To investigate the oxalate-degrading abilities of 10 strains of lactic acid bacteria for yoghourt fermentation. Methods Ten different strains of lactic acid bacteria (L.acidophilus, L.paracasei, Enterococcaceae faecium, B. lactis, B. adolescentis, B. infantis, B.longum, Lactococcus lactis subsp. Cremori, L.bulgaricus and S. thermophilus) were cultured separately in culture fluid containing 5 mmol/L oxalate. Seventy-two hours after culture, the concentrations of oxalate and lactic acid bacteria were detected. Besides, blank control cultured without lactic acid bacteria was established. Results Seventy-two hours after culture, the concentrations of all the 10 strains of lactic acid bacteria were significantly higher than those before culture (P<0.01). Compared with blank control, the concentrations of oxalate in the culture fluid with 10 strains of lactic acid bacteria decreased 72 h after culture, and were significantly different from those before culture for L.acidophilus, Lactococcus lactis subsp. Cremori, B.longum, B. adolescentis and B. lactis (P<0.05 or P<0.01). The oxalate-degrading rate of B. lactis was the highest (29.03%), and that of Enterococcaceae faecium was the lowest (0.23%). The correlation analysis revealed that there was no significant correlation between times of proliferation and oxalate-degrading rates (r=0.435 7, P=0.208 2). Conclusion All of the 10 strains of lactic acid bacteria for yoghourt fermentation have the ability of oxalate degrading, and there is no correlation between lactic acid bacteria proliferation and oxalate degradation.

Objective To compare the effects of kidney calcium oxalate calculus resistant acidophilus milk (KCOCRAM) versus commercially available acidophilus milk (CAAM) on urinary oxalate excretion in rats. Methods Fifty SD rats were randomly divided into 5 groups (n=10), and were bred with KCOCRAM (KCOCRAM group), CAAM (CAAM group), sterilized KCOCRAM (sterilized KCOCRAM group), sterilized CAAM (sterilized CAAM group) and water (blank control group), respectively for a consecutive 20 d, with 4 mL/d for each rat. The data of body weight and 24 h urinary oxalate excretion volume were obtained 1 d before breeding and every 4 d during breeding. Results During breeding, body weight and 24 h urinary oxalate excretion volume of each group increased with time. There was no significant difference in urinary oxalate excretion volume among sterilized KCOCRAM group, sterilized CAAM group and blank control group (P>0.05). The increase tendency of KCOCRAM group and CAAM group was weaker than that of the other three groups. The urinary oxalate excretion volume was significantly lower in KCOCRAM group than that in sterilized KCOCRAM group from 8 d after breeding, and that was significantly lower in CAAM group than that in sterilized CAAM group from 12 d after breeding (P<0.05). The urinary oxalate excretion volume was significantly lower in KCOCRAM group than that in CAAM group from 16 d after breeding (P<0.05). There was a positive correlationship between body weight and 24 h urinary oxalate excretion volume in each group (r＝0.97-0.99, P<0.01). Conclusion Both KCOCRAM and CAAM can reduce urinary oxalate excretion in rats, and the former has a more favourable effect.

Objective To analyze the influencing factors of deep vein thrombosis (DVT ) in the patients with abdominal trau‐ma .Methods A total of 200 cases of patients with abdominal trauma in our hospital from June 2014 to June 2015 were selected and performed the color Doppler ultrasonography for determining whether DVT occurring .The clinical data were retrospectively ana‐lyzed .The influencing factors of DVT occurrence in the patients with abdominal trauma were analyzed .Results Among 200 cases of abdominal trauma ,56 cases appeared the symptoms and signs of muscular pressing pain ,swelling pain ,positive Homans sign ,su‐perficial varicose and skin temperature decrease within 7 d after abdominal trauma ,60 cases were diagnosed as DVT by color Doppler ultrasonography .The multivariate Logistic regression analysis results showed that advanced age ,high cholesterol level ,high D‐dimer level ,high blood urea nitrogen level ,complicating hypertension ,complicating diabetes ,complicating hyperlipidemia ,surgical history at preoperative 1 month ,lower abdominal trauma ,high score of trauma ,bedridden time more than 3 d and infection were the independent risk factors of DVT occurrence in abdominal trauma patients (P<0 .05) .Conclusion Clinic should perform the color Doppler ultrasound screening in the abdominal trauma patients with risk factors of DVT ,which is conducive to early discovery and early treatment of DVT .