Hierarchical medical system is a high priority in China ’s health reform,bearing significant impacts on remolding of its healthcare system,in which tertiary public hospitals must redefine its role.Five strategies have been proposed as follows:the first is internal management;The second is high-tech;Third is paring assistance;Fourth is telemedicine;Fifth is better medical conditions.

Objective To apply E- learning in training of related knowledge about public health emergencies in emergency department in order to improve the treatment level of medical staff in public health emergencies. Methods The medical staff was divided into the observation group and the control group with 50 persons in each group according to the odd and even grouping method. The control group was given conventional training method, while the observation group received E- learning based on conventional training method. The theoretical test results and training effect were compared between two groups. Results The scores of the observation group were obviously higher than that of the control group [ (90.88 ± 4.09) points vs. (84.36± 4.92) points ], Z= -5.895, P<0.01. Conclusions The application of E- learning in the training of public health emergencies is beneficial to help the medical staff to obtain and share information resources more conveniently, to enhance the ability of the clinic medical workers of understanding the condition of emergent public health affairs, to elevate the grades of theoretical learning of the relevant knowledge and to improve the management level of training, training effect and efficiency.

Objective To evaluate efficacy ,stability and safety after implantation of toric implantable collamer lens (TICL) to correct moderate to high myopic astigmatism .Methods This study evaluated 125 eyes of 71 patients with moderate to high myopic astigmatism who accepted TICL implantation .LogMAR uncorrected(UCVA) and best corrected(BCVA) visual acuity ,intraocular pressure ,cycloplegic refraction and manifest refraction examination were assessed preoperatively on 3 ,6 ,12 months postoperatively . The rotation of TICL axis were measured on 3 ,6 ,12 months postoperatively .Results 12 months postoperatively ,the logarithm of the minimum angle of resolution(LogMAR) UCVA were 0 .064 ± 0 .157 which were remarkably better than preoperative BCVA (P<0 .01) .119 eyes(95 .2% ) had postoperative UCVA better than or equal to preoperative BCVA .The manifest spherical refrac‐tion(absolute value) was (0 .36 ± 0 .41)D .105 (84 .0% ) eyes were within ± 0 .5 D .The mean manifest refractive cylinder was (-0 .63 ± 0 .61)D .109(87 .2% ) eyes had ≤ -1 .00 D .The mean rotation on 12 months postoperatively was (4 .76 ± 6 .14)° .The rotation of 101(80 .8% ) eyes were within 5 degrees .No vision threatening complications occurred during the observation period . Conclusion Implantation of TICL is safe and stable in the treatment of moderate to high myopic astigmatism .TICL is an ideal sur‐gical option to treat moderate to high myopic astigmatism .

Skeletal muscle possesses a remarkable ability for its regeneration and injured tissue repair. This ability depends on the activity and contributions of muscle satellite cells. Proliferating satellite cells, termed myogenic precursor cells or myoblasts, are activated and driven out of their quiescent state upon muscle injury. In this summary, we present a review to summarize the molecular regulation in skeletal satellite cells to light on the satellite cells' self-renewal mechanism.
Cell Proliferation ; Humans ; Muscle, Skeletal ; Regeneration ; Satellite Cells, Skeletal Muscle ; cytology ; Soft Tissue Injuries

Objective To study the rhubarb phenol and P38 inhibitor suppression on light aging of human skin HaCaT induced by UVB. Methods The potential of cell proliferation of the different concentrations of rhubarb phenol and P38 inhibitor (SB203580) on human skin HaCaT was detected by MTT method. The cells was divided into the control group, the model group, the rhubarb phenol group, the SB203580 group by random number table method after the 24 h incubation. The 10-6 mol/L rhubarb phenol and 10-7 mol/L SB203580 were added to the rhubarb phenol group and SB203580 group for 24h, The competence of cultured cell proliferation which was irradiated with UVB of intensity of 0.61mW/cm2, mutiply time of 7 min and distance of 10 cm for 24 h except the control group; Western Blot method detected rhubarb phenol and P38 inhibitor of the influence of P38, P-P38, TNF-α, IL-6 protein. Results Compared with control group, the cell proliferation in UVB group significantly reduced (P<0.01); Compared with UVB group, the expression of the P-P38 (0.419 ± 0.029, 0.398 ± 0.015 vs. 0.497 ± 0.051), TNF-α (0.435 ± 0.025, 0.411 ± 0.021 vs. 0.509 ± 0.040) and IL-6 (0.457 ± 0.027, 0.432 ± 0.018 vs. 0.478 ± 0.036) in rhubarb phenol and P38 inhibitor group significantly reduced (P<0.01). Conclusions The rhubarb phenol and P38 inhibitor could significantly suppress HaCaT cells light aging, and its mechanism may be related with inhibiting P38 signaling pathways, and inhibiting the secretion of inflammatory cytokines.

Objective To investigate the effects of propofol on intracellular free Ca2+ concentration and nitric oxide synthase (NOS) activity in PC12 cells exposed to bupivacaine. Methods The PC12 cells were provided by Shanghai Cell Biology Research Institute, Chinese Academy of Sciences and cultured in DMEM liquid culture medium. The cultured PC12 cells were seeded in 36 well plates and randomly assigned to one of 4 groups (n=9 wells each): group Ⅰ control (C);group Ⅱ propofol (P);group Ⅲ bupivacaine (B) and group Ⅳ propofol + bupivacaine (PB). In control group D-Hank solution was added. The cells were exposed to propofol 2 mmol/L and bupivacaine 0.09 mmol/L in group P and B respectively. In group PB the cells were incubated with propofol 2 mmol/L and bupivacaine 0.09 mmol/L simultaneously. After being incubated for 6 and 24 h the apoptosis in BC12 cells was assessed by flow cytometry. Apoptotic rate was calculated. NOS activity and intracellular free Ca2+ coneentration in PC12 cells were determined. Results Bupivacaine significantly increased the apoptotic rate of PC12 cells, the intracellular free Ca2+ concentration and NOS activity in PC12 cells in group B as compared with control group. Propofol significantly decreased the toxic effects of bupivacaine on PC12 cells in group PB compared with group B. Conclusion Bupivacaine is toxic to PC12 cells by increasing apoptosis, intracellular Ca+ concentration and NOS activity in the cells. The toxic effects can be prevented to some extent by concomitant administration of propofol.

Objective To evaluate the significance of TF-PCA to the diagosis of DIC by observing changes of tissue factor(TF) and procoagulant activity (PCA) in patients with disseminated inravaascular coagulation(DIC)according to the enhancenment degree of whole blood leukocyte-derived TF expression and TF-PCA stimulated by Lipopolysaccharide (LPS). Method Patients with acute leukemia (AL) were included during hospitalization from Jan. 2005 to Jan. 2007 in Union Hospital of Huazhong University of Science and Technology. Recalcification time of LPS-stimulated whole blood was applied to evaluate tissue factor clotting time (TiFaCT) : anticoagulated whole blood was incubated at 37°C for a certain time with or without LlS-stimulation, and then the recalcitication time was measured. TF-PCA were evaluated based on the decreased degree of whole blood mcalcification time(△s).LSI)- t test and bivariate correlation analysis were analyzed by using the SPSS software package (version 13.0 for Windows). A P-value less than 0.05 was considered statistically significant. Results A retrospective and contrast analysis indicated that △s in patients with DIC and patients suspected with DIC were (95.2±68.6) and (85.8±16.9), respectively. When compared with normal controls(30.4±25.1 ), the difference both had extremely statistical significe(P<0.01). The results of TF mRNA detection and TF-PCA inhibitory experiments showed that the method of TiFaCT had a high sersitivity and specificity for determination of TF-PCA. Condusiots The levels of TF-PCA were obviously elevated after stimulated by LPS in patients with DIC or suspected with DIC.TiFaCT has an important clinical reference value for the diagnostic and prognostic evaluation of DIC.

Objective To investigate the effects of genistein on the mRNA expressions of collagen (Col), matrix metalloproteinase (MMP ) and tissue inhibitor of matrix metalloproteinase (TIMP) in human embryonic skin fibroblasts (CCC-ESF-1).MethodsThe cultured CCC-ESF-1cells were divided into a black control group, an estradiol group and genistein groups of different doses. The mRNA expressions of ColⅠ, ColⅢ , MMP-1, TIMP-1 and TIMP-2 were detected by RT-PCR.Results Compared with the black group, estradiol and medium dose of genistein (0.451 ± 0.037, 0.446 ± 0.047vs.0.385 ± 0.061, allP<0.05) could promote the proliferation of the CCC-ESF-1 cells, estradiol and medium dose of genistein could up-regulate the mRNA expressions of ColⅠ (0.960 ± 0.012, 0.929 ± 0.015vs.0.812 ± 0.014, allP<0.01), ColⅢ (0.892 ± 0.009, 0.824 ± 0.022vs.0.768 ± 0.025, allP<0.01), TIMP-1 (0.841 ± 0.023, 0.838 ± 0.053vs.0.751 ± 0.027, allP<0.01) and TIMP-2 (0.456 ± 0.017, 0.448 ± 0.036vs.0.381 ± 0.029, allP<0.01), and down-regulate MMP-1 mRNAexpression (0.398 ± 0.043, 0.402 ± 0.044vs.0.525 ± 0.006, allP<0.01).Conclusions Genistein could promote the proliferation of the CCC-ESF-1 cells, and that may be related with up-regulating the mRNA expressions of ColⅠ, ColⅢ , MMP-1, TIMP-1and down-regulating MMP-1 mRNA expression.

Objective To summarize the clinical experience of "One-stop" hybrid procedure that performs minimally in-vasive direct coronary artery bypass ( MII)CAB ) and percutaneous coronary intervention ( PC! ) concurrently on 35 patients with multivessel coronary artery disease (CAD). Methods Between June 2007 and May 2008, 35 patients [33 men and 2women, mean age (63.5±9.2) years] with multivessel CAD ( two-vessel CAD, n = 19; three-vessel CAD, n = 16, left main coronary artery disease, n = 7 ; coronary artery lesions, 2.5 lesions per patient) underwent "one-stop" hybrid procedure. The hybrid strategy was performed as a primary MIDCAB procedure for bypassing the left internal mammary artery ( LIMA ) to the left anterior descending artery ( LAD ), simultaneously followed by PCI ( pereutaneous transluminal coronary angioplasty (PTCA) and/or stenting) on the remaining non-LAD vessels. Concomitant diseases included hypertention in 20 patients, hy-perlipemia in 12 patients, previous myocardial infarction (MI) in 10 patients, diabetes mellitus (type 2) in 9 patients, previ-ous cerebrovascular disease in 2 patients, chronic obstructive pulmonary disease (COPD) in 1 patient, renal dysfunction in 1 patient, and ostium secundum atrial septal defect in 1 patient. The left ventricular ejection fraction (LVEF) averaged 0. 62±0.07. Results There were no reexploration for bleeding, strokes, myocardial infarctions, acute renal dysfunctions, or deaths in hospetal. Of the total 35 patients, 34 patients (97.1%) were successfully treated with "one-stop" hybrid procedure, and 1 patient (2.9%) was converted to conventional coronary artery bypass grafting ( CABG ) because of dissection of one obtuse marginal branch during PCI. One of the LIMA-LAD grafts was confirmed to be anastomotic stenosis by followed coronary angiog-raphy and was corrected immediately. The patient with ostium secundum defer underwent tranesophageal echocardiography guiding transcatheter closure after LIMA-LAD anastomosis. Catheter-based interventions were carried out in 61 coronary le-sions, including PTCA in 6 lesions and implantation of 62 drug-elating stents (DES) in the rest appropriate lesions. The mean number of DES implantation was 1.8 per patient, and the average diameter and length of implanted DES were respectively ( 3.2±0.5 )mm and 37.3 mm per patient. Of the 34 patients receiving hybrid procedure, the average mechanical ventrilation time was ( 10.8±7.9) hours, and 4 ( 11. 8% ) pateints were extubated in the operating room; length of stay in the intencive care unit averaged (33.6±33.0) hours and hospital stay (9±3) days; 24 patients (70.6%) avoided transfusion require-ment. Conclusion Our findings indicate that in high-risk patients with multivessel CAD, the "one-stop" hybrid procedure by performing MIDCAB and PCI simultaneously is a feasible and safe alternative.

Objective To study the pinoresinol diglucoside (PDG) on gene regulation role of ESF-1 cells in collagen secretion, to reveal PDG repair mechanisms on scalded skin.Methods The cells cultured in vitro were divided into the control group, the estradiol group and the three different PDG doses groups. The concentration of the high, medium and low dose groups were 100, 10, 1μmol/L, and that of estradiol group were 10-3μmol/L. The activity of proliferation was detected by MTT. Then collagen type I (Col I), collagen typeⅢ (ColⅢ), tissue inhibitors of metalloproteinase 1 (TIMP-1), tissue inhibitors of metalloproteinase 2 (TIMP-2) and matrix metalloproteinase 1 (MMP-1) expression levels of mRNA after administration of cells were detected by RT-PCR.Results Compared with the control group, the proliferation of ESF-1 cells (0.559 ± 0.027, 0.552 ± 0.034vs. 0.489 ± 0.027,P<0.05) in the estradiol and medium-dose PDG was significantly higher. The expression level of mRNA of ColⅠ(0.958 ± 0.021, 0.929 ± 0.031, 0.916 ± 0.015vs. 0.844 ± 0.022), ColⅢ (0.783 ± 0.038, 0.918 ± 0.021, 0.855 ± 0.017vs. 0.678 ± 0.024), TIMP-1 (0.939 ± 0.025, 0.889 ± 0.036, 0.853 ±  0.015 vs. 0.780 ± 0.023), TIMP-2 (0.507 ± 0.024, 0.655 ± 0.037, 0.572 ± 0.025vs. 0.405 ± 0.062) in the estradiol, low-, medium-dose PDG groups were significantly higher than those in the control group (P<0.05 or P<0.01). Besides, the MMP-1 (0.343 ± 0.038, 0.407 ± 0.046, 0.435 ± 0.037vs.0.519 ± 0.041) mRNA expression level in the middle and low dose PDG groups significantly decrease (P<0.05 orP<0.01). Conclusions The PDG could enhance the activity of ESF-1 cell proliferation, increase the expression of related collagen and tissue inhibitor of metalloproteinases and inhibit that of matrix metalloproteinases to repair scalded skin.