After a description of the background of hierarchical diagnosis and treatment in China, the total frame-work of hierarchical diagnosis and treatment system in the Internet+era was proposed by analyzing its needs in the Internet+ era, and the main functions of its data center, information system, clinical professional collaboration and public health service were elaborated in order to promote medical health actions and construction of hierarchical diagnosis and treatment system in China.

The classification of social capital involved in health information construction was proposed according to the connotation of social capital and health information construction, and the comprehensiveness, broadness, coop-erative variety, innovative technical application and good development situation of social capital involved in health information construction were dealt with.

Objective To observe the therapeutic efficiency of naoxintong capsule on the patients with moderate obstructive sleep apnea hypopnea syndrom ( OSAHS ) of cognitive dysfunction. Methods Sixty pa?tients of moderate OSAHS were randomly divided into treatment group and control group, 30 cases in each group. Patients in the treatment group were given naoxintong capsule,three goals,three times a day,at the same time,with double level positive pressure ventilation therapy for 3 months. Patients in the control group accepted double level positive pressure ventilation therapy for 3 months. The questionnaires of Montreal Cognitive Assess? ment( MoCA) were administered to assess cognitive in all the patients before and after treatment. Results There was no statistically significant difference in term of MoCA score between the two groups before treatment( t=0. 14,P>0. 05). After treatment,the MoCA score of the treatment group was (25. 83+1. 70),of control group was (22. 70+2. 51),the difference was statistically significant(t=5. 62,P<0. 05). The visual space and execu?tive function,naming,attention,language,abstract,delayed recall and directional score in the treatment group af?ter treatment were (5. 03±0. 81) points,(2. 90±0. 31) points,(4. 73±0. 58) points,(2. 63±0. 49) points, (1. 97±0. 18) points,(3. 93±0. 98) points,(5. 03±0. 56) points respectively,compared with before treatment ((4.07±0.79) points,(2.17±0.59) points,(3.40±0.50) points,(2.03±0.49) points,(1.80±0.41) points,(2. 87±0. 73) points,(4. 03±0. 77) points),the differences were statistically significant (t=6. 55, 6. 89,13. 36,5. 29,2. 41,4. 87,6. 60;P<0. 05) . The naming,attention,language,abstract,delayed recall and di?rectional score in the control group after treatment were ( 2. 77 ± 0. 43 ) points, ( 4. 07 ± 0. 75 ) points, ( 2. 20 ±0. 55) points,(1. 87±0. 35) points,(3. 10±0. 66) points,(4. 67±0. 71) points respectively,ompared with be?fore treatment((2. 30±0. 65) points,(3. 43±0. 68) points,(2. 00±0. 70) points,(1. 73±0. 45) points,(2. 93 ±0. 58) points,(3. 93±0. 69) points),the differences were statistically significant(t=5. 04,4. 34,2. 26,2. 11, 2. 41,6. 28;P<0. 05) . MoCA score in treatment group than the control group have improved significantly in visu?al space and executive function,attention,language and delayed recall,directional ( t=4. 51,3. 80,3. 22,3. 86, 2. 23,P<0. 05) . Conclusion Naoxintong capsule can improve cognitive dysfunction in patients with moderate OSAHS.

Objective To evaluate the effectiveness of Chronic Care Model in hypertension management in community health services.Methods Three hundred patients diagnosed with hypertension participated in this study and were divided into intervention and control groups.In the following 9 months,intervention measures based on the Chronic Care Model were delivered to intervention group,while the conventional measures to control group.Data collected before and after the intervention were analyzed uuing descriptive statistics,t-test,x2-test and analysis of covariance by SPSS16.0 for Windows.Results The intervention group had statistically significant positive effectiveness in drinking habit,daily salt intake(decreased 0.78g),diastolic blood pressure (decreased 2mmHg),BMI(decreased 0.4) and SF-36 physical component summary score(decreased 1.7)(P＜0.05).The intervention group had better improvement in BMI and SF-36 physical component summry score than the control group.Conclusion The health outcomes of patients with hypertension could be improved by applying the Chronic Care Model featured diet,exercise habits and other health related factors management.

〔Abstract〕 In order to advance the comprehensive and balanced development of health and family planning informatization in Beijing on the whole, according to the theoretical method of top -level design and in combination with actual situations of health and family plan-ning informatization in Beijing , the paper studies practices on top -level design from the aspect of technical routes and organization and implementation, and elaborates achievements of top -level design.

Objective To explore the value of MRS and DWI in diagnosis of cervical spinal cord injury.Methods The MRI plain scan images of 95 cases who suffering from cervical spinal cord injury were analyzed.They were divided into two groups according to the T2 signal of cervical cord,63 cases in Group A(incomplete injury group)with no abnormal on T2 ,32 cases in Group B(complete injury group)with high signal on T2 .The other 50 cases with no injury of cervical cord were recruited as control group (Group C). All the cases were performed with MRS and DWI.The N-acetyl aspartic acid(NAA),choline compounds(Cho)and creatine(Cr)as well as the peak area of lactic acid (Lac)on MRS,and apparent diffusion coefficient(ADC)on DTI were measured separately.Mean-while,NAA/Cho,NAA/Cr,Cho/Cr,Lac/Cho and ADC were analyzed.Results On MRS sequence,the values of NAA/Cho and NAA/Cr were lower in Group B (P <0.05)when compared with Group A.The values of NAA/Cho and NAA/Cr were also lower in Group B,when compared Group C.However,the value of Lac/Cho in Group B was higher than it in Group C(P <0.05).When com-pared Group A with Group C,the value of Lac/Cho only increased in the former.However,on DWI,the value of ADC in Group A was(0.79±0.1 7)×10 -3 mm2/s,lower than that of Group C(0.93±0.1 5)×10 -3 mm2/s (P =0.026);the value of ADC in Group B was(1.21±0.20)×10 -3 mm2/s,significantly higher than that of Group C(P =0.01 7).When compared with Group B,the value of ADC in Group A was a lightly lower (P =0.143)with no statistical significance.Conclusion MRS can noninvasively and quantita-tively reflect the changes of metabolism of medium in injured cervical cord and help characterize the severity and degree of cervical cord injury from metabolic and molecular level.DWI has high sensitivity on early diagnosis of cervical cord injury.The combination of MRS and DWI has important value for formulating reasonable treatment plan and prognostic evaluation.

Objective To observe the changes of learning function and neuron-specific enolase (NSE)protein of both brian and serum in rats after intermittent hypoxia,and explore the relation between NSE protein and learning and memory function.Methods Male Wistar adult rats(n=48)were randomly divided into control group (UC group) and 7.5％ chronic intermittent hypoxia group (7.5％CIH group).7.5％ chronic intermittent hypoxia model in rats were simalated by using the self-made cabin of intermittent hypoxia.At the 2nd,4th,6th,and 8th week respectively,learning and memory function in rat was tested by Morris water maze in two groups.The level of NSE protein in hippocampal CA1 region was detected by immunohistochemical method,and was detected in serum of rats by using enzyme-linked immunosorbent adsorption method.Results Compared with the control group,7.5％ CIH group at the 2nd,4th,6th,and 8th week in rats from the second week of the escape latency time was 44.13± 2.84) s,(50.35 ± 1.96) s,(57.47 ± 1.66) s,(62.85 ± 1.80) s,and across the target quadrant time was 48.81 ± 2.09) s,(42.04± 1.84) s,(36.82± 2.07) s,(31.81 ± 1.68) s.From the first two weeks,the longer the hypoxia time prolonged,the longer the rat's escapedlatency (P＜0.05) and the shorter the rats acrossed the target quadrant (P ＜0.05).7.5％ CIH group of hippocampal CA1 neurons NSE protein at the 2nd,4th,6th,and 8th week was (9.69±1.37),17.10± 1.87),(24.79± 3.51),(34.16±5.35),respectively,and serum NSE protein at the 2nd,4th,6th,and 8th week respectively was (6.03±0.91) μg/L,(11.04± 1.89) μg/L,(16.39± 1.00) μg/L,(24.22±3.73) μg/L,both of which were more than the control group.The difference was statistically significant (P＜0.05).7.5％ CIH group of hippocampal CA1 neurons and serum NSE protein expression were significant time differences,and gradually increased over time.The difference was statistically significant (P＜0.05).Positive NSE protein expression in hippocampal CA1 region relative NSE and serum protein expression values were positively correlated (r=0.94,P ＜0.01).But in control group NSE protein expression did not exist time difference (P＞0.05).Conclusion Intermittent hypoxia can cause NSE levels significant increase in serum and brain tissue,and the dynamic changes of them can reflect severity of learning and memory impairement in rat.

Objective To compare the advantages and disadvantages of SNPscan and Sanger sequence which are both used to detect the common deafness gene mutations in non-syndromic hearing loss (NSHL) in Gansu Province.Methods Peripheral blood samples were obtained from Dongxiang, Yugu and Baoan people with moderately severe to profound sensorineural hearing loss in Gansu province to extract genomic DNA.SNPscan was used to detect the 115 mutations in the common pathogenic GJB2 gene, SLC26A4 gene and mtDNA gene.Results We used the SNPscan to screen the mutation of GJB2 gene,mtDNA A1555G and mtDNA C1494T, SLC26A4 gene of sensorinural deafness patients from Gansu Province.The mutation rate of these three genes was 23.18% (35/151), and the mutation rate of Dongxiang, Yugu, Baoan was 21.31% (26/122), 54.54% (6/11), 16.67% (3/18), respectively.Compared with the Sanger sequence, the results were statistically insignificant(P>0.05).The detection rates in the three genes of SNPscan were 11.26% (17/151), 1.32% (2/151) and 0.66% (1/151),respectively , and the detection rates of Sanger sequence were 9.93% (15/151), 1.32% (2/151) and 0.66% (1/151) ,respectively.The results of the two methods were compared.The results were statistically insignificant (P>0.05).Time, cost and flux, SNPscan method is superior to Sanger sequencing.Conclusion Compared with the Sanger sequence, SNPscan is more lighter in workload, less time-consuming, higher-throughput, lower cost, and can get more meaningful mutations and reduce the false negative rates.

Objective:To investigate the change of expression of miR-7 in activated CD4+ T cells in vitro, and preliminary explore its possible significance. Methods: CD4+CD62L+T cells was purified from splenocytes of FVB mice by magnetic cell sorting system (MACS). After stimulation with anti-CD3/CD28 antibody,the relative expression of miR-7 was examined by Real-time PCR, and the expression level of CD69 molecular was analyzed by FACS. Furthermore,the relative expression of miR-7 in CD4+T cells was detected at different time points during stimulation. With the treatment of ERK inhibitor PD98059,change of miR-7 expression was de-termined by Real-time PCR. Meanwhile, the proliferation of CD4+T cells was examined by CCK-8 assay and the expression level of CD69 and CD62L molecular were analyzed by FACS. Finally,the expression of cytokines IL-6,IL-10,and IFN-γ were determined by Real-time PCR. Results:Compared with control group,the relative expression of miR-7 was increased significantly after stimulation with anti-CD3/CD28 antibody,as well as expression level of CD69 molecular was augmented(P<0. 05). In contrasted with 0 h and 24 h,the expression of miR-7 was significantly increased after 48 h and 72 h during stimulation(P<0. 05). Furthermore,the relative expression of miR-7 was significantly declined in CD4+T cells in ERK inhibitor PD98059 treatment group. Finally, the expression level of CD69 molecular,as well as cytokines IL-6, IL-10 and IFN-γ, were also decreased significantly ( P<0. 05 ) . Conclusion: The relative expression of miR-7 was significantly increased in activated CD4+T cells,closely related to ERK pathway,which provided an important foundation for successive research work on exploring the functional role of miR-7 in the CD4+T cells.

Objective To evaluate the olfactory functions in patients with Parkinson's disease (PD) with a smell identification test developed for the Chinese population and to examine possible factors contributing to PD patients' olfactory performance.Methods Fifty-five patients with idiopathic and nondementia PD and 55 demographically matched healthy controls (HC) were recruited and their olfactory identification tested using the Chinese Smell Identification Test developed by the Institute of Psychology at Chinese Academy of Sciences.Results Olfactory identification score was significantly lower (t =-6.827,P＜0.01) in the PD group (19.3 ±5.4) as compared with the HC group (26.5 ±5.7).Of all PD patients,63.6％ scored over 1 SD below the age norm.In particular,of those with Hoehn-Yahr ratings between 2 to 3,77.8％ scored over 1 SD below the age norm.Receiver operating characteristic (ROC) curve analysis indicated that a cut-off score of 22.5 on the Chinese Smell Identification Test distinguished between PD patients and HC with a sensitivity of 74.6％ and specificity of 70.9％.Within the PD group,age,education,Hoehn-Yahr rating and Mini-Mental State Examination score were not found to correlate with olfactory performance (all P ＞ 0.05).Conclusion PD patients in China show significant impairment of olfactory identification,which is effectively captured by the Chinese Smell Identification Test.