As an efficient health care system ,the hierarchical medical system is characteristic of its continuation of the division of work at different levels of medical services in the diagnosis and treatment functions .Two major roadblocks hinder the building of such a system ,namely a serious shortage of primary service capabilities ,and lack of incentives in the referral from superior institutions .Success of such a system lies in enhancement of the service capabilities of primary medical institutions by all means , and smooth functioning of a dual referral system .

Objective To explore whether living in rural areas may reduce the risk of atopic sensitization. Methods The standardized questionnaires were answered by the parents of 2 986 school children during 2004 to 2005. Radioallergosorbent technique-fluorescence enzyme immunoassay (RAST-FEIA) was used to determine the level of specific IgE in the serum of the children. The risk factors were analyzed by Logistic regression. Results Compared with the subjects living in the towns from birth, the risk of atopic sensitization was lowest in the subjects living in the villages from birth (OR=0.32, 95%CI: 0.11-0.62) and it was moderate in the subjects who had relocated from village to town (OR=0.51, 95%CI: 0.28-0.92), there was a significant trend among them (P for trend

According to two kinds of acupoint combination methods for Huahe and Huhe in five-door and ten-change theory proposed by the deceased Taiwanese famous acupuncturist Mr. ZHOU Zuo-yu, the origin of the change theory proposed by the deceased Taiwanese famous acupuncturist Mr. ZHOU Zuo-yu, the origin of the acupoint combination method of five-door and ten-change is introduced. This method combines traditional philosophy of Yi with medicine, which is featured with casual timing, casual pattern, capacity to be combined with TCM syndrome differentiation, specific application scope and pertinence. Some clinical cases are additionally presented to verify this method. Huhe method is mostly used for Bi-syndrome while Huahe method has better effects on internal medicine diseases. They open the new thinking methods for clinical acupoint selection.
Acupuncture Points ; Acupuncture Therapy ; Aged ; Female ; Humans ; Meridians ; Middle Aged ; Osteoarthritis, Knee ; therapy ; Shoulder Pain ; therapy

Objective To investigate the effect of liraglutide on the expression of NF-kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in renal tissue of insulin resistance rats. Method The rats were divided into 4 groups, control group ,high fat group ,liraglutide low dose group [100 μg/(kg· d)], liraglutide high dose group[100 μg/(kg·d)]. Detection of serum creatinine and urea nitrogen by automatic biochemical analyzer, and 24 h urine micro albumin was determined by immunoassay. The protein concentration of serum NF-κB,TNF-α and IL-6 was measured by ELISA. The expression of NF-κB,TNF-α and IL-6 mRNA in renal tissues was determined by RT-PCR. Results Compared with the control group, the serum creatinine, blood urea nitrogen,urinary protein, and the expression of NF-κB, TNF-α and IL-6 were significantly higher in high fat group, respectively (P < 0.05). The glomerular basement membrance thickening and foot process fusion were seen under electron microscope. Liraglutide high dose intervention can significantly reduce these changes. Conclusions Liraglutide can inhibit the expression of NF-κB,TNF-α and IL-6 in renal tissues of high fat induced insulin resistance rats,in a concentration dependent manner, which possibly improve renal function.

The cytolytic effect of perforin is a mechanism of anti-virus,killing microbial-infected cells and tumor cells.Perforin is a very important non-specific immune factors in fish.In order to understand the function of perforin,the cDNA of grass carp perforin C-terminal peptide was amplified from grass carp liver and kidney cDNA library.It contains a protein kinase C conserved region 2(C2).The cDNA was connected with pET32a,and transformed to expression bacteria DE3.PFP-C was expressed by a prokaryotic expression system and then purified by affinity chromatography.It showed a significant haemolytic activity when tested with rabbit red cells,the optimal pH for haemolytic activity was 7.5,and its haemolytic function dependents on Ca2+ apparently.

Objective To investigate the prevalence of the genotypes of extended spectrum ? lactamses (ESBLs) in klebsiella pneumoniae and eschrichia coli, which were isolated in Hangzhou City from 2000 to 2001. Methods Total of 198 isolates of E. coil and K. pneumoniae were isolated from five hospitals in Hangzhou. ESBLs-producing isolates were detected by inhibitor-potentiated disc diffusion test, Agar dilution method was used to determine the minimum inhibitory concentrations (MIC) of cefotaxime and ceftazidime.ESBLs genes were analysed by isoelectric focusing (IEF) assay and PCR initially,genotypes were determined by sequencing. Results 51 isolates (25.76%) from 198 E. coil and K. pneumoniae strains were obtained. In ESBLs producers, the ESBLs types of SHV, TEM, CTX-M were 17.65%,84.31% and 80.39% respectively. genotypes were: SHV 11,12;TEM 1;CTX M 3and CTX M 3 like, CTX M 13,14. respectively. Conclusions CTX M type were the major genotypes of ESBLs in klebsiella pneumoniae and eschrichia coli isolated in Hangzhou city.

Objective To compare the internal fixation methods for treatment of intertrochanteric fractures in elderly patients.Methods One hundred and sixty four elderly patients with intertrochanteric fractures were treated from June 2006 to September 2011.The fractures were fixed with dynamic hip screws (DHS,n =42),locking proximal femur plate (LPFP,n =40),Gamma nails (n =36) or proximal femoral nail anti-rotation (PFNA,n =46),respectively.The clinical data were collected and the operative time,blood loss,time of clinical healing,postoperative complications and Harris hip scores of 6 months after surgery were compared among groups.Results All patients were followed-up for 6 to 36 months.The operative times of DHS,LPFP,Gamma nails and PFNA groups were (103 ± 15),(90 ± 13),(79 ± 11)and (65 ±9)min,respectively(F =2.87,P ＜0.05).The blood loss of 4 groups was (202 ±23),(181 ±23),(98 ± 13) and (87 ± 11) ml,respectively (F =3.21,P ＜ 0.05).The times of clinical fracture healing were (16.1±1.9),(14.6±1.8),(12.9±1.7) and (11.5±1.4) weeks,respectively(F=2.66,P＜0.05).The postoperative complications of 4 groups were 4/42,3/40,2/36 and 1/46,respectively (x2 =5.67,P ＜0.05).The Harris hip scores of 6 months after surgery of 4 groups were 81％ (34/42),85％ (34/40),89％ (32/36)and 93％ (43/46),respectively(H =20.03,P ＜0.05).Conclusions In treatment for intertrochanteric fractures in elderly patients,the efficacy of intramedullary fixation (Gamma nails and PFNA) is better than extramedullary fixation DHS and LPFP).PFNA is more effective than other 3 methods and should be preferentially chosen.

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 evaluate the application of mobile ultrasonoscope in earthquake rescue. Methods According to the characteristic of environment and traumatic conditions in earthquake area, the mobile ultrasonoscope was used to diagnose for clinicians, and the advantages and disadvantages were evaluated. Results The mobile ultrasonoscope played an important role in routine diagnosis, such as organic injury and calculus, superficial organellae injury, soft tissue injury, injury of limbs and blood vessels, gynaecology and obstetrics and so on. As far as certain conditions were conferred in which the mobile ultrasonoscope was seldom used to diagnose in common practice, it played a dramatic role too in bone fracture, joint damage, craniocerebral injury and foreign objects. Conclusion In routine diagnosis or certain conditions, the mobile ultrasonoscope is very practical, especially in earthquake rescue.

Shuyu Pill is the representative prescription for treating deficiency-essence. This article discussed the consistency of diabetes and deficiency-essence from TCM syndromes and etiology and pathogenesis, and probed into the correlation between Shuyu Pill and diabetic Western medicine of pathomechanism diabetes from the modern pharmacological research on Shuyu Pill. Therefore, it proposed that diabetes has the essence of deficiency-essence;the pathogenesis of diabetes should meet the efficacy of Shuyu Pill; pharmacological effects of Shuyu Pill can affect various pathological mechanism of diabetes, with a purpose to provide new ideas for the clinical treatment of diabetes.