Objective To define basic medical service items in Shanghai community health centers.Methods Two rounds of Delphi expert consultation were carried out with 36 experts specialized in general practice,general practitioner training,internal practice,public health and health management,then the scope of medical service system was set up based on experts' opinions.Results The newly-defined system consisted of three first-grade items:outpatient medical service,hospital medical service and medical service for home beds and temporary home visits.The first-grade items contained 22 second-grade items and the second-grade items consisted of 26 detailed items,including 17 baseline items,8 optional items and 1 restrained item.In two rounds of Delphi consultation the activity coefficient of experts was all 100％,authority coefficients of experts was 0.825,and harmonious coefficient of the importance of the evaluation was 0.361 and 0.488 (all P ＜ 0.01),respectively.Conclusion The preliminarily developed system of basic medical service items in Shanghai community health service can provide a reference frame for government policy-making.

Objective To evaluate the effects of lipoxin A4 (LXA4) administered at different time points on the expression of connexin43 (Cx43) during myocardial ischemia-reperfusion (I/R) in rats.Methods Seventytwo healthy male Sprague-Dawley rats,weighing 200-250 g,wcre equally and randomly divided into 6 groups:groups sham operation Ⅰ (group S1) and Ⅱ (group S2),groups myocardial I/R Ⅰ (group Ⅰ/R1) and Ⅱ (group I/R2),and groups LXA4 administered before chest opening (group LX1) and at 30 min of reperfusion (group LX2).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch (LAD) of coronary artery followed by 120 min reperfusion.LXA4 100μg/kg was injected via femoral veins before chest opening and at 30 min of reperfusion in groups LX1 and group LX2,respectively.While normal saline 2 ml/kg was injected via the femoral vein at the corresponding time points in the other four groups.In groups S1 and S2,LAD was only threaded,but not ligated.Blood samples were taken from the femoral vein before chest opening and at 120 min of reperfusion for measurement of serum IL-8,TNF-α and cardiac troponin Ⅰ (cTnI) concentrations.The rats were then sacrificed after blood samples were taken at 120 min of reperfusion and hearts were removed for determination of Cx43 protein (by immunohistochemical SP method) and Cx43 mRNA expression (by real-time quantitative PCR),SOD activity and MDA content in myocardial tissues.The development of arrhythmia was observed from occlusion of LAD to 120 min of reperfusion.Duration of ventricular tachycardia (VTd) and ventricular fibrillation (VFd) was recorded.Scores of ventricular arrhythmias were calculated.Results The expression of Cx43 protein and mRNA was significantly down-regulated,and scores of ventricular arrhythmias,VTd,serum IL-8,TNF-α and cTnI concentrations,SOD activity and MDA content were increased in groups I/R1 and LX1 as compared with group S1,and in groups I/R2 and LX2 as compared with group S2 (P ＜ 0.05).The expression of Cx43 protein and mRNA was significantly up-regulated,SOD activity was increased,and scores of ventricular arrhythmias,VTd,VFd,serum IL-8,TNF-α and cTnI concentrations,and MDA content were decreased in group LX1 as compared with group I/R1,and in group LX2 as compared with group I/R2(P ＜ 0.05).The expression of Cx43 protein and mRNA was significantly lower,scores of ventricular arrhythmias,VTd and SOD activity were higher,and the serum IL-8,TNF-α and cTnI concentrations and MDA content were lower in group LX2 than in group LX1 (P ＜ 0.05).Conclusion LXA4 administered before myocardial ischemia and at 30 min of reperfusion can up-regulate the expression of Cx43 and reverse remodeling of Cx43,thus reducing myocardial I/R-induced arrhythmia in rats,and LXA4 administered before ischemia can provide better efficacy.

According to the law of circulation of meridians and the locations of acupoints, the opposite acupoints were proposed. It facilitates comprehension of the routes of meridians and the locations of acupoints. Application of opposite needling or penetrative needling, it is easy to practice and the effectiveness is significant. Promoting this concept into acupuncture training, can expand out from acupoint to meridian, from one meridian to other meridians, it will generate good rewards.
Acupuncture ; education ; methods ; Acupuncture Points ; Meridians ; Teaching ; methods

Genes, Viral ; genetics ; Hepacivirus ; genetics ; Hepatitis C ; virology ; Recombination, Genetic

OBJECTIVETo investigate the HCV genotypes distribution in northern and southern cities in China and the difference between patients infected with HCV by transfusion and non-transfusion routes.

METHODSThe HCV genotypes of the patients with chronic hepatitis C from 9 cities belonging to different regions were genotyped by the PCR products of 5 prime untranslated region NTR digested with restriction endonucleases, and the HCV genotypes distribution among different cities or between the patients infected with HCV through transfusion and other routes was analyzed.

RESULTSThe HCV genotypes of 214 in 219 cases were determined; 197 patients were infected with monogenotype HCV. The major epidemic genotypes of HCV isolates in China were 1b (76.64%) and 2a (18.22%), but 5.14% of patients were infected with HCV belonging to genotype 3b and this was the first report that there is genotype 4a in China. The HCV genotype distribution was not different in northern and southern areas, but was significantly different between patients infected with HCV through transfusion and non-transfusion routes (P=0.036). In patients infected trough transfusion, the rates of monogenotype HCV infection and genotype 1b were 93.88% and 76.87%, respectively, which were higher than those (86.57% and 58.21%) in the patients infected with HCV through non-transfusion routes. The rate of patient infected with mixed genotype HCV strains in non-transfusion group was 13.43%, which was higher than that (6.12%) of patients in transfusion group.

CONCLUSIONThe HCV genotype distribution in northern and southern regions were similar, but was significantly different between the patients infected through transfusion and other routes.

5' Untranslated Regions ; Adolescent ; Adult ; Aged ; China ; Female ; Genotype ; Hepacivirus ; classification ; genetics ; isolation & purification ; Hepatitis C, Chronic ; etiology ; genetics ; transmission ; Humans ; Male ; Middle Aged ; Transfusion Reaction

OBJECTIVETo investigate the effect of Chinese medicine (CM) Schisandra chinensis on interleukin (IL), glucose metabolism, and pituitary-adrenal and gonadal axis of rats after strenuous navigation and exercise.

METHODSA total of 45 Sprague-Dawley rats were randomized into the quiet control group, the stress group, and the CM group (15 in each group). The CM group received 2.5 g/kg of Schisandra chinensis twice per day for one week before modeling. Except the quiet controls, rats were trained using the Bedford mode for 10 days. On the 11th day, they performed 3 h of stressful experimental navigation and 3 h of strenuous treadmill exercise. The levels of serum testosterone (T), cortisol (CORT), luteinizing hormone (LH), IL-1, IL-2, and IL-6 were tested by radioimmunoassay and enzyme-linked immunosorbent assay, respectively. The adrenal cortex ultrastructure was observed using electron microscopy.

RESULTSCompared with the quiet control group, after navigation and strenuous exercise, blood glucose was increased, and T level was decreased in the stress group (both P<0.01). The blood glucose, CORT, IL-1 and IL-2 levels were significantly reduced in the CM group (P<0.05 or P<0.01) as compared with the stress group. Electron microscopy revealed that the rats in the CM group had a smaller decrease in adrenal intracellular lipid droplets and higher levels of apoptosis than those in the stress group.

CONCLUSIONSSchisandra chinensis can reduce serum CORT and blood glucose levels in stressed rats. It appears to protect the cell structure of the adrenal cortex, and offset the negative effects of psychological stress and strenuous exercise related to immune dysfunction. Schisandra chinensis plays a regulatory role in immune function, and can decrease the influence of stress in rats.

Adrenal Cortex ; pathology ; ultrastructure ; Animals ; Blood Glucose ; metabolism ; Glucose ; metabolism ; Gonads ; drug effects ; metabolism ; Hydrocortisone ; blood ; Interleukin-1 ; blood ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Interleukins ; blood ; Luteinizing Hormone ; blood ; Male ; Physical Conditioning, Animal ; Pituitary-Adrenal System ; drug effects ; metabolism ; Plant Extracts ; pharmacology ; Rats, Sprague-Dawley ; Schisandra ; chemistry ; Swimming ; physiology ; Testosterone ; blood

OBJECTIVETo investigate the association between transforming growth factor beta-1 (TGF-beta1) gene polymorphism and chronic allograft nephropathy (CAN).

METHODSFifty patients with failed renal allografts and clinically and histopathologically confirmed CAN were enrolled in this study along with another 50 renal transplant recipients with normal graft function. The DNA extracted from whole blood of the patients was amplified with PCR with sequence-specific primers for determining TGF-beta1 genotypes (position +869, codon 10 and position +915, codon 25). According to documented descriptions, the patients were classified into high and moderate-to-low cytokine production genotypes. The distribution frequencies of high production genotypes was then compared between CAN and non-CAN groups. To eliminate interference in the analysis of the association between TGF-beta1 polymorphism and CAN, other possible risk factors for CAN were screened, including the patients' gender, age, HLA match, delayed graft function, acute rejection, immunosuppressive regimen, cytomegalovirus infection, hypertension, and high cholesterol.

RESULTSCAN patients showed significantly greater proportion of high cytokine production genotype than the non-CAN group [70% (35/50) vs 38% (19/50), Chi(2)=10.306, P=0.001). Of the screened risk factors for CAN, only acute rejection showed some difference between the two groups, but analysis after subgrouping according to acute rejection did not suggest its influence on CAN, which supports the result that the rate of high production genotype was significantly higher in CAN group than in the non-CAN group.

CONCLUSIONMost CAN patients have high TGF-beta1 production genotype, which might be a risk factor for CAN after renal transplantation. TGF-beta1 genotyping can be of value in predicting the risk of CAN after renal transplantation.

Adult ; Female ; Genetic Predisposition to Disease ; Graft Rejection ; genetics ; Humans ; Kidney Diseases ; genetics ; Kidney Transplantation ; adverse effects ; Male ; Middle Aged ; Polymorphism, Genetic ; Risk Factors ; Sequence Analysis, DNA ; Transforming Growth Factor beta1 ; genetics ; Transplantation, Homologous

Objective To summarize the experience of long-term survival in patients after simulta- neous kidney-pancreas transplantation(SKPT)with modified enteric drainage(ED).Methods From October 2001 to July 2004,6 patients with end-stage renal disease due to Type 1 diabetes underwent SKPT with modified ED,ie,side-to-side anastomosis between the duodenum of donors and jejunum of recipients. The medication regimen included:mycophenolic acid 500 mg and tacrolimus 2 mg before operation;methyl- prednisolone(MP)1.0 during operation;and 2-dose anti-IL-2 receptor monoclonal antibody(2 cases)or antihuman thymocyte globulin(ATG)(4 cases)for immune induction therapy;MP was used on the first 3 d after transplantation,triple immunosuppressive therapy(tacrotimus,mycophenolic acid and prednisone)was used on the second d after transplantation.Anticoagulants such as low molecular heparin or alprostadil were used for 7-10 d to prevent thrombosis in pancreas graft.Somatostatin was used as prophylaxis for graft pan- creatitis.Ganciclovir was used to prevent cytomegalovirus infection when renal graft gradually recovered 3 to 5 d after transplantation.The follow-up was from 1 year and 3 months to 4 years and 1 month.Results Transplantation was successful in all 6 cases.The blood sugar levels were 6-16 mmol/L.Low-dose insulin was used for 5-10 d,then the blood sugar levels returned to normal range.One of 6 patients experienced nephrotoxicity because of high tacrolimus blood concentration at 7 d after operation;after 3 dialyses and re- duction of tacrolimus dose,the renal allograft regained normal function.Three cases experienced alimentary tract hemorrhage at 14,20 and 22 d,respectively,after operation;the bleeding was stopped after treatment. There were no complications such as pancreatic fistula,intestinal fistula and thrombosis early after operation. All the patients are now alive,specifically,1 survived over 4 years,3 over 3 years,1 over 2 years,and 1 over 1 year.All had normal blood sugar free of insulin use.Five cases had normal renal graft function,with normal sCr,and 1 had sCr＞400?mol/L. Two cases were admitted to hospital due to upper respiratory infection and furuncles in the skin of head 6 months and 2 years,respectively,after operation.They were both cured.No complications such as urinary infection,metabolic acidosis and dehydration occurred.Conclusions SKPT is effective for the treatment of end-stage renal disease due to Type 1 diabetes.SKPT with modified ED are relatively simple with physiological compatibility and fewer complications.High quality of donated organs, HLA matching,pancreatic drainage pattern,rational periopcrative medications and infection late after trans- plantation are important factors affecting the long-term survival of the patients.

OBJECTIVETo investigate the relationship between the genotypes of hepatitis B virus and the clinical and liver pathological features of patients with chronic hepatitis in the Zhoushan Islands.

METHODSOne hundred eighty HBV DNA positive chronic hepatitis patients with HBV markers were enrolled in this study. They were at least second generation Zhoushan Island residents. One hundred forty-seven of them were males and 33 were females with an average age of 39.0+/-11.3. Among the 180 patients, 17 had ASC, 57 had mild CHB, 48 moderate CHB, 9 severe CHB, 6 SHB, 39 LC, and 4 had HCC. The genotypes of their serum HBV were detected by using PCR integrated with Tagman MGB probe technology, and their serum HBV markers, HBV DNA and liver functions were also examined. Out of 180 patients, 129 accepted a liver biopsy. A pathological evaluation was then performed.

RESULTSHBVs of genotype C, 135 cases (75.0%), of B, 40 cases (22.2%), and of B+C, 5 cases (2.8%) were found among these 180 patients. No genotype A or D HBV were found. The proportions of genotype C virus were 7/17, 86/114, 34/39, 6/6 in ASC, CHB, LC and SHB patients. In the hepatocellular carcinoma patients, there were 2 each of genotype B and C. Among the 99 patients with genotype C HBV, 84 cases (84.8%) showed moderate and severe inflammation histologically in their livers and among the 30 patients with B, 7 cases (23.3%) showed moderate to severe inflammation in their livers (z = 6.47, P less than 0.01). The proportion of genotype C HBV was significantly different from that of genotype B HBV in those that showed moderate and severe (S3-4) liver fibrosis. In patients infected with genotype C HBV who had moderate and severe liver pathological changes, their clinical manifestations reflected better the histological alterations of their livers.

CONCLUSIONGenotypes C, B and B+C HBV were found in CHB patients in the Zhoushan Islands of China, and type C was the predominant one. The liver pathological damage level of genotype C HBV infected patients is more serious than that of genotype B.

Adult ; China ; epidemiology ; DNA, Viral ; genetics ; Female ; Genome, Viral ; Genotype ; Hepatitis B virus ; classification ; genetics ; Hepatitis B, Chronic ; epidemiology ; pathology ; Humans ; Liver ; pathology ; Male ; Middle Aged

OBJECTIVETo summarize the features of pulmonary infection (PI) in kidney transplant (Ktx) and liver transplant (Ltx) recipients for effective control measures.

METHODSA retrospective analysis was conducted among Ktx recipients and Ltx recipients with PI during the period from Jan 2004 to Dec 2008. The clinical data concerning the infection was compared.

RESULTSForty-five Ktx recipients and 23 Ltx recipients developed PI after the transplantation. The incidence of PI was 7.4% and 56.1% in (P<0.001), respectively, with severe PI occurring in 2.6% and 46.3% of the recipients (P<0.001). The median time from PI diagnosis to transplant was 230 days (29-1080 days) and 4 days (2-104 days) (P<0.001), the case-fatality rate for PI was 6.7% and 17.4% (P=NS), and the mortality rate was 0.5% and 9.8% (P<0.001) in Ktx and Ltx recipients, respectively; Gram-negative organisms were the most common in both Ktx and Ltx recipients, but Ltx recipients had significantly higher incidence of multidrug-resistant bacteria (12.9% vs 37.0%, P=0.005).

CONCLUSIONThe knowledge of PI after the transplantation will benefit appropriate prophylactic and empirical treatment to improve the survival of Ktx and Ltx recipients.

Adult ; Female ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Pneumonia ; epidemiology ; microbiology ; virology ; Retrospective Studies