Objective: To analyze the capability to overcome the major outbreak of epidemics in different regions of China, it supports the future public health emergency management stratigies in theory and technology. Methods: Based on the data of 31 regions of China, it evaluates the social vulnerability of two major epidemics (SARS in 2003 and H1N1 influence in 2009) by using factor analysis method. Results: In the middle and eastern regions of China, social vulnerability is relatively low, and comparing to SARS in 2003, it decreases in 2009; while the western and southwesternregions are the opposite. Conclusion: Infrastructure construction of health institution, the cultivation of medical and health personnel and the development of commercial health insurance are the key factors to reduce social vulnerability and enhance the ability of emergency.

OBJECTIVE:To analyze the risk factors,pathogens and drug sensitivity test of ventilator-associated pneumonia (VAP) in ICU. METHODS:A case-control study was conducted to analyze the clinical data of 190 patients receiving mechanical ventilatory support in ICU. RESULTS:The incidence of VAP in our hospital was 48.4%;elderly patients(>65 years),duration of mechanical ventilation(>5 d),use of corticosteroids,antacid drugs,indwelling stomach tube,and combined use of antibiotics were the risk factors of VAP;among the 162 pathogens,39 were Gram-positive bacteria(24.07%),102 were Gram-negative bacte-ria (62.96%),21 were fungi (12.96%);multi-drug resistance existed in most pathogens. CONCLUSIONS:A variety of factors are closely associated with the incidence of VAP;the main pathogens of VAP are Gram-negative bacteria;the phenomenon of multi-drug resistance is common. Some measures are adopted to decrease the incidence of VAP,such as strengthen monitoring of el-derly patients,to improve their immunity;use hormonal drugs reasonably;shorten the course of mechanical ventilation as much as possible,and plan ventilator removal;elevate the head of the bed and clean the oral for patients receiving gastric canal implantation and enteral nutrition;clean hands in accordance with asepsis principle strictly,and use antibacterials reasonalbly.

Objective:To investigate the effect of Matrine on inhibiting lipopolysaccharide( lipopolysaccharide ,LPS) -induced macrophages to secrete inflammatory cytokines,including tumor necrosis factor-α( TNF-α) ,leukocyte mediated element 1β( IL-1β) on Toll like receptor 4 ( TLR4 ) , c-jun expression. Methods: Cultured macrophage RAW264. 7 of mouse and divided into four groups, including blank control group,matrine group,LPS group,matrine intervention group. Incubated by the concentration was 100 μg/L LPS DMEM for 1 h,then the LPS was discard. Added free serum DMEM or 125. 25 mg/L matrine DMEM to culture. The cells and culture solution of 5,30,60,120 min after the treatment of the above four groups were collected respectively. Detected of mouse RAW264. 7 macrophage TLR4 and c-jun mRNA expression by PCR. Detected of mouse macrophage RAW264. 7 cells c-jun protein expression by immunocytochemical. Measured secretion in cultured solution of TNF-α and IL-1β by ELISA. Results:Expression TLR4 mRNA,c-jun mRNA and c-jun protein and TNF -α and IL-1β secretion quantity indexes of matrine induced and blank group had no statistical significant differences ( P>0. 05 ) . TLR4 mRNA, c-jun mRNA and c-jun protein expression secretion of and TNF-α and IL-1β LPS group at each time point were significantly higher than that of blank group,and the high level to maintain more than 2 h (P<0. 05);matrine intervention group could effectively inhibit LPS induced macrophage TLR4 mRNA,c-jun mRNA and c-jun protein expression and reduce the secretion of inflammatory cytokines TNF-α and IL-1β. Conclusion: Matrine may inhibit LPS induced macrophage mitogen activated protein kinase signal pathway of TLR4 and c-jun expression so that it can effectively reduce the end inflammatory cytokines TNF-α and IL-1β release,effectively inhibit the inflammatory reaction and reduce the degree of endotoxin inflammatory re-sponse.

OBJECTIVE:To put forward some suggestion to improve drug bidding system in China.METHODS:The process of drug bidding system reform and its common problems were analyzed.Game theory and information asymmetry theory were adopted to analyze the root of the problems and to put forward suggestions.RESULTS:Governments indiscriminately expanded the goals of bidding policy and strengthen price factor.They neglected important steps such as logistics distribution.Current single evaluation system can not count the medication order exactly.Delayed received payment of medical institution resulted in many problems of drug purchase.CONCLUSION:Centralized drug bidding system should be improved and enhanced.It also should be connected with relevant medical system reform to standardize drug circulation channels,reduce drug price and reduce the burden of patient.

With the development of medical sciences, the concept of prevention and treatment of ischemic stroke is being updated continuously. However, there are still some gaps between the available evidence and clinical practice in its strategies of prevention and treatment. The article performs evidence-based analysis for the available evidence in the prevention and treatment of ischemic stroke in accordance with the scientific levels of evidence classification so as to narrow the gaps between the evidence in this field and clinical practice.

Air ; analysis ; Alkenes ; analysis ; Butadienes ; analysis ; Chromatography, Gas ; methods ; Environmental Monitoring ; methods ; Workplace

Objective To investigate the cognition and treatment rate of hormone replacement therapy (HRT)in perimenopause women.Methods A survey was conducted in 262 perimenopause women first coming to outpatients care.A predesigned structured questionnaire was used to collect information:the symptoms of perimenopa-use women,the cognition and acceptance to the treatment.Results Finally,248 women with the mean age of (50.30 ±2.10)years finished the questionnaire,the natural menopause age was (48.90 ±1.90)years.48.79% of these women understood the role of HRT in clinical application,and only 12.50% knew the side effect of HRT. Among them,35.48% thought that HRT was necessary for the duration of perimenopause.40.73% of them had the attitude to treatment with HRT.After the education of perimenopausal acknowledgement,117 patients (47.18%) accepted the treatment with HRT.Conclusion It showed that the awareness and treatment rate of HRT in perimeno-pause women was low.The health education should be strengthened to improve the level of perimenopause health care.

Objective To summarize the principle and structure of objective structured clinical examination(OSCE)in the graduation practice examination of undergraduate nursing students.Methods A OSCE model was designed with a case running through the whole process of it by referring to the classic model of OSCE and applied it to the graduation practice examination of undergraduate nursing students of grade 2004.Results 75.0%students believed that the setup of OSCE location was reasonable and 78.1%of them thought that they were used to this kind of examination.100.0%of them considered that this examination model could objectively evaluate the general clinical capacity and at the same time make clear the future purpose of next internship stage. Conclusion The OSCE model could objectively evaluate the general clinical ability of students and truly reflect the existing problems,thus provide benefitable reforrences for the next internship stage.

Objective To study the influence of high dose atorvastatin (80 mg/d) in early heart rate variability and malignant ventricular arrhythmia in patients underwent emergency coronary intervention (PCI). Methods A total of 350 pa-tients underwent emergency PCI were randomly divided into two groups:high dose atorvastatin group and regular dose atorv-astatin group. And 85 cases of control were enrolled randomly. The patients using high dose atorvastatin group received atorv-astatin 80 mg orally STAT upon hospitalization and 40 mg once a day from the second day. The patients using regular dose atorvastatin group received atorvastatin 40 mg orally STAT after hospitalization and 20 mg once a day from the second day. Patients were monitored by continuous dynamic electrocardiogram for 24 hours after PCI. According to the results of dynamic electrocardiogram, the early heart rate variability (HRV) and rate of malignant ventricular arrhythmia (MVA) were measured and compared between three groups. Results The values of standard deviation of all normal sinus RR intervals over 24 h (SDNN) were(108.3 ± 21.5)ms and(70.6 ± 17.6)ms for high dose atorvastatin group and regular dose atorvastatin group re-spectively. The values of SDNN measured every 5 minutes during 24 hours (SDANN) were (111.7 ± 19.2)ms and (65.9 ± 18.5)ms respectively, and values of root-mean-square of successive normal sinus RR interval difference (RMSSD) were (25.6±8.3)ms and(18.7±10.2)ms respectively, and the percentage of adjacent RR intervals that differed by more than 50 ms (PNN50) were(14.7±5.9)%and(6.9±3.4)%for high dose atorvastatin group and regular dose atorvastatin group respec-tively. The above data were significantly lower than those in control group [ (122.5±23.8) ms and (119.6±15.2) ms, (29.2±9.3) ms and (17.7±6.5)%, P＜0.05]. There were significantly higher values in high dose atorvastatin group than those in regular dose atorvastatin group (P＜0.05). The incidence rate of MVA was much higher in high dose atorvastatin group and regular dose atorvastatin group than that in normal control group (12.00%vs 21.14%vs 2.35%). The incidence rate of MVA was sig-nificantly lower in high dose atorvastatin group than that in regular dose atorvastatin group (χ2=5.29, P＜0.05). Conclu-sion The HRV was significantly reduced and the incidence rate of MVA was much higher in patients with early AMI. High-dose atorvastatin can increase the HRV and decrease the incidence rate of MVA in patients underwent emergency PCI.

Objective To observe the effects of salmeterol/fluticasone on the bone metabolism and bone density of the patients with moderate COPD and whether the effects is relate with inhaled corticosteroid course. Methods Sixty pa-tients with COPD were divided into 2 groups by random digit table. Patients in experimental group (n=30) were given conven-tional therapy with salmeterol/fluticasone one inhale(bid) for continuously 12 months while patients in control group (N=30) were given conventional therapy without any glucocorticoid.The bone mineral density (BMD) of the femoral triangle in all patients were measured by DXA before therapy, 3 months and 12 months after therapy. At the same time, biochemical indi-cators that are correlated with bone metabolism include bone gla protein (BGP) and alkaline phosphatase (ALP) were mea-sured by radioimmunoassay. Results The BMD, BGP and ALP of patients in experimental group and in control group be-fore therapy, 3 month and 12 month after therapy were compared. There is no significant difference (P>0.05) between these two groups before therapy and after 3 month but significant difference was shown after 9 months (P<0.05). Conclusion Short period inhaling salmeterol/fluticasone in patients with COPD is safe. But long-term inhaling salmeterol/fluticason may lead to decline of the bone density in patients with COPD.