Setting up a system wherein general practitioners play the role of the “goalkeeper” in the delivery of community health services may guide the rational flow of health resources from the upper to the basic levels, match the allocation of health resources to the demands, improve the effectiveness of health resources allocation, reinforce preventive strategies, and construct a highly efficient and economic health services system. By introducing the role of general practitioners in Britain, Australia and the United States, the paper aims to draw some enlightenment which will contribute to the establishment of such a system in China in the following aspects: ①perfecting the system of national supporting policies; ② making a good analysis of the parties interested; ③improving the makeup of the medical insurance system; ④accepting useful suggestions from relevant learned societies; ⑤ training general practitioners;⑥ establishing standards for the cooperation between general practitioners and specialists.

Patients who have received coronary artery interventional therapy exhibit visible anxiety and depression, which is closely related to prognosis and life quality. Therefore, for coronary artery stent patients,exception of anticoagulation and antihyperlipedemic drugs, psychological support, cognition therapy and distorted behavior rectification should be applied. The medication of anti-anxiety or depression is of great importance in ameliorate mental state, relieve mental load, as well as enhance prognosis of patients.

From August 1989 to March 1994, 240 patients with esophageal carcinoma were studied. They were randomly divided into combined group (BFP chemotherapy plus radiotherapy, 120 cases), and radiotherapy alone group (120 cases). Both groups were treated by the same radiotherapy with dose of D T 50～70 Gy/5～7wk. The 1-,2-,3- and 4-year survival rates were 68.3%(82/120), 49.5%(47/95), 27.1%(19/70) and 15.6%(5/32) in BFP chemotherapy plus radiotherapy group and 44.1%(53/120), 28.4%(27/95), 22.9%(16/70), 15.6%(5/32) in radiotherapy alone group. The 1- and 2-year survival rates were obviously different in the two groups(P

Objective To know the quality of drinking water produced by deep treatment systems in Guangdong Province.Methods The unified investigation form was used,the water supply systems were selected from 4 cities,Guangzhou,Shenzhen,Zhuhai,Dongguan.pH value,conductivity,ozone,COD,TOC,heavy metals,bacteria were determined in 2004.Results Having investigated 169 systems,reverse osmosis,nanofiltration and ultrafiltration equipment used to treat water accounted for 74.40%,19.05% and 6.55 % respectively.The use of ozone disinfection was 70.7%.45.8% of the systems,the water cycled twice per day,and 29%,no water quality test was conducted according to the regulation.The quality of water with deep treatment was satisfactory compared with the common tap water.Conclusion The quality of water produced by deep treatment systems is considered better than the common tap water and the applicable water treatment units should be selected,the routine water quality test and management should be conducted.

Objective To explore the application effect of sufentanil or dexmedetomidine on blind intubation in 88 patients with difficult airway .Methods Eighty eight cases of patients with difficult airways in our hospital were divided into treatment group and control group depending on different preoperative sedation .There were 44 cases in each group .Patients in the treatment group were treated with dexmedetomidine anesthesia treatment ,and patients in the control group were treated in clinical routine application of sufentanil anesthesia ,both groups were taken blind intubation after anesthesia treatment .The heart rate ,systolic arterial pressure , diastolic arterial pressure and respiratory rate of patients before anesthesia ,after anesthesia ,when the intubation tube reached uvu‐la ,epiglottis ,when the intubation finished and 5 minutes after the intubation were recorded .Cases of nausea ,dysphoria ,bucking and respiratory depression during the intubation were also recorded .Results From the induction of anesthesia to 5 min after intubation , the respiratory rate of the treatment group was higher than the control group (P<0 .05);the systolic blood pressure ,diastolic blood pressure and heart rate of treatment group were significantly lower than the control group since intubation tube arrive uvula until the completion of systolic (P<0 .05);The arterial oxygen pressure was (98 .52 ± 9 .18) mm Hg in the treatment group 5 min after intubation ,which was significantly higher than the control group which was (93 .46 ± 10 .81) mm Hg (P<0 .05);cases of nausea , dysphoria ,bucking and respiratory depression in the treatment group were significantly lower than that of control group(P<0 .05) , and the average intubation time of the treatment group were significantly shorter than that of control group (P<0 .05) .Conclusion Dexmedetomidine could effectively improve the condition of the patients with difficult airways ,achieve effective anesthesia ,reduce cardiovascular reactivity in patients ,and ensure the smooth progress of intubation for the difficult airway patients .

Objective To observe the effects of adenosine and adenosine receptor agonist on the expression of inter?leukin-18 (IL-18) in patients with unstable angina (UAP), and the mechanism of adenosine receptor agonists thereof. Meth?ods Fifteen UAP and 15 healthy volunteers were included in this study. The effects of adenosine and the selective adenos?ine receptor agonists on the expression of IL-18 were measured by enzyme-linked immunosorbent assay (ELISA). Results The lower concentration of adenosine (1-100μmol/L) increased the expression of IL-18 in UAP group;whereas the higher concentration of adenosine (1 mmol/L) inhibited the expression of IL-18. The adenosine A1 receptor agonist and A3 receptor agonist increased the expression of IL-18, while the adenosine A2a receptor agonist inhibited the expression of IL-18. There was no significant effect for A2b receptor agonist on the expression of IL-18. Conclusion The lower concentrations of ade?nosine can enhance the expression of IL-18 through adenosine A1 and A3 receptors in UAP. The higher concentrations of ade?nosine can inhibit the expression of IL-18 through adenosine A2a receptors. Adenosine can promote IL-18 expression in lower concentrations.

Objective To observe the efficacy and safety of endoscopic ultrasonography submucosal resection for treatment of gastric muscularis propria mesenchymal tumor.Methods Endoscopic ultrasonography preliminary diagnosis of 19 cases were diagnosed stromal tumors originating from gastric muscularis propria layer,the endoscopic ultrasonography diagnosis the source,echo,size,blood supply,etc.than treated by endoscopic submucosal excavation.To observe the therapeutic effect and complications.Results Eighteen patients were the full excavation,1 patient was failed.Intraoperative perforation was seen in 2 cases,the wound was healed by the titanium clamp.A small amount of bleeding happened in operation and bleeding was stopped by hot biopsy forceps or argon coagulation.No delayed bleeding happened.Conclusion Submucosal resection for gastric muscularis propria mesenchymal tumors is safe and effective,endoscopic ultrasonography has important value in the strict assessment.

AIM:To investigate the effects and mechanisms of microRNA-25 (miRNA-25) on the proliferation of human esophageal squamous-cell carcinoma cell line TE1.METHODS: The abundance of miRNA-25 in different tis-sues was measured by RT-PCR.After silencing or over-expression of miRNA-25 with mimics or inhibitor in TE1 cells, the cell proliferation, cell cycle distribution and the expression of cyclin E1 and cyclin-dependent kinase 2 (CDK2) at mRNA and protein levels were measured by CCK-8 assay, BrdU detection, flow cytometry, RT-PCR and Western blot, respective-ly.RESULTS:miRNA-25 was prominent in esophageal mucosal tissue and highly expressed in TE1 cells (P<0.05).O-ver-expression of miRNA-25 increased TE1 cell proliferation, promoted the cell cycle progression and enhanced the en-trance of the cells into S phase (P<0.05).Inverse results were obtained after down-regulation of miRNA-25 (P<0.05). Furthermore, the expression of cyclin E1 and CDK2 at mRNA and protein levels was significantly increased after over-ex-pression of miRNA-25, but decreased after down-regulation of miRNA-25 (P<0.05).CONCLUSION: miRNA-25 en-hances cell cycle transition by increasing the expression of cyclin E1 and CDK2, thus accelerating TE1 cell proliferation. This study provides a novel mechanism by which miRNA-25 increases the proliferation of human esophageal squamous-cell carcinoma cell line TE1, suggesting that down-regulation of miRNA-25 may be a potential new therapeutic strategy for trea-ting esophageal squamous-cell carcinoma.

Objective To evaluate the clinical value of transnasal gastroscopy in diagnosis and treatment of upper gastrointestinal diseases and the endurance of patients to the operation,as well as to measure the distance between the external naris and pectinate line. Methods Between January 2007 and April 2008,totally 3481 patients underwent transnasal gastroscopy in our hospital,meanwhile 3705 patients received routine gastroscopy; 109 patients who received transnasal gastroscopy and 106 patients that underwent routine gastroscopy were surveyed by questionnaires on their tolerance to the procedures. In the transnasal gastroscopy group,210 patients were selected for measuring the distance between the external naris and pectinate line,while 210 patients from the routine gastroscopy group were examined to determine the length from the front teeth to the pectinate line. Results Among the patients underwent transnasal gastroscopy,89.9% (98/109)of them had no or mild nausea and 97.2% (106/109)had no or mild vomiting; 85.5%(53/62) of the patients who had suffered routine gastroscopy reported less pain after transnasal gastroscopy,and 93.6%(102/109)of the patients would like to underwent transnasal gastroscopy again if necessary. The average length from the external naris to pectinate line was (43.1?2.6) cm,which was statistically significantly different from that measured from the incisor teeth to pectinate line by routine gastroscopy [(39.7?1.9)cm,t=15.290,P=0.000]. The diagnostic and differential diagnostic value of transnasal gastroscopy is same to that of routine gastroscopy. Therapies under transnasal gastroscopy were conducted in 38 cases without complications occurred. Conclusions The feasibility,tolerance,and safety of transnasal gastroscopy are superior to routine transoral gastroscopy. It can provide a more comfortable process for examination. The ability of diagnosis and differential diagnosis of transnasal gastroscopy resembles those of routine transoral gastroscopy.

Objective To optimize the extraction process of Yangwei Jinshi Granules. Methods An orthogonal test was adopted in the study. With the paste-forming rate, the content of extract and the content of hesperidin of Yangwei Jinshi Granules as indices, data processing was carried out with grading method of synthesizing multiple indexes for optimizing the extraction condition. Results The best extraction technology was as follows:boiled 2 times, first with 10 times amount of water for 1.5 h, and then boiled with 8 times amount of water for 1 h. Conclusion The optimized process is reasonable, stable and economic for Yangwei Jinshi Granules.