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 study the changes of intestinal epithelial barrier function in rats with aging.Methods SD rats were divided into 3 groups:3-month-old group (group A),12-month-old group (group B) and 24-month-old group (group C,established by D-galactose injection with the dose of 0.125 g· kg-1 · d-1subcultaneously for 6 weeks) (n=10,each).The terminal ileum was obtained to make microtome section,and the morphology of small intestine mucous membrane,trophonema altitude and thickness were observed under light microscope.Occludin and ZO-1 protein expressions in terminal ileum mucous membrane were detected by immunohistochemistry.The expressions of Occludin and ZO 1 mRNA were determined by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR).Results The small intestinal mucosa thickness and villus height were lower in group C and B than in group A [thickness:(87.6± 6.32) μm,(131.8± 5.22) μm vs.(162.9±7.28) μm; villus height:(56.4±5.38) μm,(76.7±5.40) μm vs.(108.1±6.42) μm;both P＜0.05].The small intestinal mucosa thickness and villus height was lower in group C than in group B (both P＜0.05).Occludin and ZO-1 protein expressions in small intestine tissue were reduced in group C and B as compared with group A [Occludin protein:(2.23±0.60)％,(4.21±0.61)％ vs.(12.31±0.94)％; ZO-1 protein:(2.03±0.54)％,(4.02±0.65) ％ vs.(12.21±0.81)％ ; both P＜0.05],and Occludin and ZO-1 protein expressions were less in group C than in group B (both P＜0.05).The levels of Occludin and ZO-1 mRNA in small intestine tissue were reduced in group C and B as compared with group A [Occludin:(0.20±0.03),(0.38±0.02) vs.(0.66±0.03) ; ZO-1:(0.18±0.03),(0.37±0.02) vs.(0.63±0.03); both P＜0.05],and Occludin and ZO-1 mRNA expressions were less in group C than in group B (both P ＜ 0.05).Conclusions The small intestinal mucosa thickness and villus height are reduced,the levels of Occludin and ZO-1 expressions are significantly decreased in small intestinal mucosa,and the intestinal barrier function is impaired with rat aging.

To select appropriate descriptors for response of the patient-reported outcome (PRO) scale for the main symptoms of patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary heart disease.

Objective To observe the clinical effects of a new method:non-optic nerve transecring evisceration combined with first stage hydroxyapatite orbital implantation.Methods One hundred and twenty two eyes (122 cases) were randomly divided into group A and group B,evisceration was first undertaken,the scleral wall was superior-temporally to inferior-nasally dissected and double scleral petals were placed before the implanted hydroxyapatite artificial eyeball.The difference between group A and group B was:in group A,the optic nerve was transected behind the eyeball,but in group B,a 2 mm outside the optic nerve scleral circle cutting was taken.Hemostasis time before implantation,tensile force during conjunctival suture,pain during surgery,palpebral fissure height after eye speculum wearing,operation time consuming,pain after surgery,conjunctival edema and congestion,and ocular prosthesis wearing time were compared between the two groups.Results In groups A and B,the intra-operative hemostasis time were (23.46 ± 6.96)mins and (5.49 ± 1.72)mins,the tensile force score during conjunctiva suture were 3.39±0.74 and 0.45±0.59,the score of pain in the first day were 2.8 ±0.68 and 1.47 ± 0.67,the ocular prosthesis wearing time after surgery were (6.27±2.73) and (3.07 ± 2.11)weeks,respectively.The differences of all the parameters above were with statistical significance between groups A and B (P＜0.01).During 2 years follow-up,no complications such as orbital implant exposure or infection happened.Conclusions Compared to traditional methods,the non-optic nerve transecting evisceration method has merits of less impairment,short time-consuming,less pain,and quicker postoperative recovery.

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.

Objective To investigate neural correlates of the generation,execution and inhibition of motor intention. Methods Behavioral performance and event-related potentials (ERP) of 14 participants were recorded when they performed a two-staged Go-Nogo task. At the stage of intention preparation,three kinds of the "what" cues were presented separately to the participants : (1) to press a response key by the left or the right hand (the instructed) ,(2) to decide freely which hand will be used (the free) ,(3) to wait for the second cue (the control). At the stage of intention execution,the "whether" cue suggested the participants execute (Go) or withdraw (Nogo) the previous intention either voluntarily or forcedly. Results The interaction effect between the "what" and the "whether" was significant(F(2,26) = 8.262, P=0.002). The forced responses were faster than those of voluntary action under both the instructed condition ((468.52 ±105.87)ms vs (546.67 ±146.33)ms) and the control condition ((536.78 ± 83.28) ms vs (589.75 ± 140.80) ms). No significant difference was found for the free condition((538.71 ± 127. 39) ms vs (561. 44 ± 146. 51) ms). At the stage of intention preparation,significant ERP effects between the instructed intention and the freely intention were revealed in bilateral frontal regions (150～200 ms) , frontoparietal area (300～700 ms)and right temporal area. At the stage of intention execution,ERP effects between voluntary inhibition and voluntary action were observed in left prefrontal area (160～220 ms) ,fro-nto-cento-parietal area and right frontoparietal area. (300～550 ms). Conclusion The motor intention may be generated in the prefrontal area and maintained in the frontoparietal network. The left prefrontal and fronto-centro-parietal areas inhibit intention in the early stage and the right frontoparietal area involves response inhibition lately.