0. 05 ) , but the control group had(P

The elderly in the community who is the focus of the family doctor services , because of his special physical and mental condition , their demands for health care services showing the features of dependence , Recur-rence and urgency .Therefore, as the provided entity of community health service , the family doctor should care for the elderly in the community .In order to promote the realization of Healthy aging , we can build the system of the humane care for the elderly in the community , through the education and guidance of health、conducting psychologi-cal counseling , providing emotional support、building family sickbeds , providing regular visits、emphasizing clinical narrative, establishing mutual participation model and other measures .

Objective To study and analyze the efficacy and adverse reactions of beraprost sodium combined with aspirin in the treatment of diabetic foot.Methods 90 cases with diabetic foot were selected and they were randomly divided into the observation group and control group,35 cases in each group.Two groups were both treated with basic treatment.On the basis of the basic treatment,the control group was given aspirin,while the observation group was treated with beraprost sodium combined with aspirin.The clinical efficacy,ulcer healing rate,ankle back index,transcutaneous oxygen pressure,average healing time and the occurrence of adverse reactions were compared between the two groups.Results The clinical effective rate of the observation group was 93.3％ (42/45),which was significantly higher than 84.4％ (38/45) of the control group,the difference between the two groups was statistically significant (x2 =8.030,P ＜ 0.05).The wound healing rate,ankle dorsal index,average healing time,the degree of improvement of transcutaneous and oxygen pressuer of the observation group were (81.4 ± 2.7) ％,(11.2 ± 2.1),(39.1 ± 2.1) d and (26.3 ± 1.8) mmHg,which were significantly better than (69.3 ± 1.9) ％,(8.4 ± 2.9) ％,(52.3 ± 8.2) d and (16.3 ± 2.6)mmHg of the control group.The differences of these indicators between the two groups were statistically significant(t =12.72,7.92,12.06,9.97,P ＜ 0.05).The difference of adverse reactions between the two groups was not statistically significant (P ＞ 0.05).Conclusion Beraprost sodium combined with aspirin has better clinical efficacy in the treatment of diabetic foot.It can improve the patients'ulcer healing rate,the ankle back index,transcutaneous oxygen pressure,shorter the average healing time,and it has few adverse reactions.

Objective To observe the histopathological and ultrastructural changes of the supraspinal ligaments in ankylosing spondylitis (AS).Methods The supraspinal ligaments were stained with HE,Sirius Red/saturated carbazotic acid and then observed nuder microscope,electyonic scanning microscope and transmission electron microscope respectively.The density of blood vessel and collagen fibril were analy-zed.Statistical analysis was carried out by using t test.Results In the AS group,under the microscope,the arrangement of in collagen fibers was in chaos,and hyalinosis,fatty infiltration could be seen.Vascular proliferation was predominant.Collagen-Ⅲ expression could be detected in this group.Under electron microscope,the distribution of collagen fibril was sparse,and the periodic strita was indistinct,the matrix was degraded,and some matrix vesicle could be seen.While in the control group,orderly arrangd collagen fibrils could be seen,and no change of blood vessels could be seen.The density of vascular structures in the AS group was (6.8±0.7)/HP,and (1.0±0.4)/HP of the control group.The density of collagen fibrils in the AS group was (122±22)/μm2,and that of the control group was (218±10)/μm2,the difference between the two groups was statistically significant (P＜0.05).Conclusion A series of histopathological changes have occurred in the supraspinal ligaments in AS patients.

Establishing and perfecting the family doctor system should adhere to the following ethical princi-ples:the principle of public welfare, fairness and efficiency principle, the combination of comprehensive care prin-ciple, attaches great importance to the precautionary principle, the principle of family support, social participation principle. In the horizon, life ethics, puts forward suggestions for the development of family doctor system:impro-ving humanism quality of family physicians,calling the humanistic concern in the process of family doctor service increasing the government's policy support,increase the health resources into, adjust the health insurance policies, guide the community residents in the family doctor first.

Objective To evaluate the feasibility of interstitial implantation of ~(125)I seeds for malignant tumor at the Head and Neck. Methods From Oct 2006 to Oct 2008,26 patients received interstitial implantation of ~(125)I seeds in our hospital because of recurrent or metastatic malignant tumors at the head or neck after surgery or chemotherapy. ~(125)I seeds were implanted into the tumor tissues under guidance of CT. Results The operation was completed in all the patients. A median of 23 seeds (12～54) were implanted in each case. No complications, such as hemorrhage, infection, or seed migration, occurred in the patients. The patients were followed up for 3～24 months. During the period,the rate of local control was 54% (15/28) at 3 months,72% (18/25)at 6 months,47% (11/23)at 12 months,and 37% (6/16)at 2 years. Conclusion Interstitial implantation of '2!I seeds is feasible for ecurrent or metastatic tumor at the head or neck with a good short - term outcome.

Through the brief introduction of the concept of the mobile medical , this paper pointed out that the ethical issues that exist:health data reliability problems , the patient′s privacy protection , the protection of intellec-tual property rights issues , is involved in the problem of illegal practice medicine , online consulting the legal re-sponsibility of the doctor -patient relationship to define problems , make the reductionism , highlighted the defect of mind-body dualism and instrumental rationality overflow problem .And from the technical level , the law , the poli-cy level and consciousness discusses the related countermeasures .

Objective To compare the clinical curative effect of pedicle screw reduction and fix-ation via or not the injured vertebra in treatment of thoracolumbar fractures. Methods A retrospective study was performed on 27 patients with single thoracolumbar fractures admitted from March 2006 to Feb-ruary 2008. There were 12 patients treated with pedicle screw fixation (Group A) and 15 with traditional two-level fixation (Group B). Group A involved 11 males and 5 females, aged average 43 years (25-56 years); Group B included 10 males and 5 females, aged from 23 to 61 years (mean 42 years). All pa-tients had fresh fractures with intact pedicles on either unilateral or bilateral sides. With body position re-duction under anesthesia, the patients in Group B were treated with posterior routine distraction and lordo-sis restoration, while those in Group A were treated with the methods used in Group B as well as pedicle screw reduction and fixation. The kyphosis (Cobb angle) and recovery of injured vertebral height were observed. Results The mean follow-up period was 9 months (6-22 months). After operation, the op-timal Cobb angle and anterior column restoration were achieved through the ventral reduction from the in-jured vertebral body. The degree in anterior movement of injured vertebrae pre- and post-operatively was (0.089±0.036)° in Group A and (0.023±0.048)° in Group B, with statistical difference (P < 0.01). Cobb angle was (9.88±7.69)° in Group A and (5.19±3.24)° in Group B (P < 0.05). Changes of distance between the anterior- upper edge of the cephalad vertebrae to the anterior - lower edge of the caudal vertebral body was (39.3±5.2) % in Group A and (20.6±6.5)% in Group B (P < 0.05). Over distraction of the contiguous discs was also avoided efficiently. Conclusions Selective pedicle screw fixation into the injured vertebrae can help correct the kyphosis and maintain the reduction and en-hance the stiffness of the posterior short-segment instrumentation in single thoracolumbar fractures.

Objective To construct a Luciferace reporter vector containing the 3'untranslated region (3'UTR) of NFAT5 and measure the correlation between NFAT5 and miR-155.Methods The miR-155 targeting NFAT5 3'UTR was predicted by Target Scan,Mir Base and Pic Tar.NFAT5 and mutant NFAT5 sequence(NFAT5-mu) were then designed and synthesized,and they were cloned into pMIR-REPORTTM Luciferace reporter vector.Human embryonic kidney-293AD (HEK-293AD) cells of the 4th passage were divided into 4 groups according to the random number table.cells in plasimd +miR-155 mimics groups were transfected with pMIR-NFAT5 recombinant plasimid,pRL-Tk plasmid and miR-155 mimics;cells in plasimd + miR-155 mutated groups were transfected with pMIR-NFAT5-mu recombinant plasimid,pRL-Tk plasmid and miR-155 mimics;cells in plasimd + miR-155 control groups were transfected with pMIR-NFAT5 recombinant plasimid,pRL-Tk plasmid and miR-155 Negative control;cells in plasimd +miR-155 inhibitor were transfected with pMIR-NFAT5 recombinant plasimid,pRL-Tk plasmid and miR-155 inhibitor;and were respectively transfected into together by liposome.After culture for 24 h,the luciferase activity was detected by dual luciferase reporter assay system.Results TargetScan,Miranda and PicTar shared the results that NFAT5 has the complementary binding sites with 3'UTR of miR-155.And luciferase reporter vectorwas constructed.Therefore the result of sequencing and double digesting of recombined plasmid were completely correct.Dual-luciferase reporter assay showed that miR-155 possesses a target effect on 3'UTR of NFAT5.Compared to the pMIR-NFAT5 + miR-control group,the luciferase activity of the pMIR-NFAT5 + miR-1 5 5 mimics group was decreased,with statistically significant difference(P＜0.01),while there was no significant difference at other time points(P＞0.05).Conclusion The pMIR-NFAT5 recombinant plasmid and pMIR-NFAT5 recombinant mutated plasmid were confirmed with successful construction.and it was found that miR-155 can target NFAT5 mRNA 3'-UTR.The results provide the experiment data for further disclosing the mechanism of inhalation injury on the level of gene expression.

Objective To explore feasibility and therapeutic effect of posterior decompression by vertebral body resection, interbody bone fusion and transpedicular screw internal fixation in treatment of severe rotational throracolumar fracture and dislocation. Methods From October 2007 to July 2008, nine patients with severe rotational throracolumar fracture and dislocation classified as AO C types under-went decompression by vertebral boby resection, intervertebral bone fusion and transpedicular screw inter-nal fixation via a posterior midline small incision. There were eight males and one female, at age range from 23 to 54 years. All patients involved levels at T_(11)-L_2. According to AO classification, there were three patients with type C1 bursting fractures with rotational dislocation, five with distraction fracture com-bined with rotational dislocation and one with rotational distraction shear fracture/dislocation. The preop-erative Frankel Grading was Grade A in three patients, Grade B in one, Grade C in four and Grade D in one. Postoperative neurological status, the correction and loss of dislocation and the location and union of bone graft were reviewed. Results All patients received successful operation, with operation time of 3.5-5.8 hours (mean 4.4 hours), blood loss of 1 200-3 500 ml (mean 1 800 ml). The follow- up period in nine patients was 3-12 months (mean seven months). Postoperative X-ray photographs showed that the dislocation in all patients was reduced, the spine curvature was recovered to normal and the intervertebral bone graft was well fixed. Three patients at Frankel Grade A had no improvement, one at Grade B was improved to Grade C. Of four patients at Grade C, three patients were improved to Grade D. The follow-up showed bony fusion in all patients, with no loosening, dislocation or breakage of the internal fixation or implants. Conclusions For severe rotational throracolumar fracture and dislocation, decompression, reduction, fusion and fixation are rather difficult, while sufficient posterior decompression by vertebral body resection, rigid interbody bone fusion and transpadicular screw internal fixation can be an effective alternative measure.