Background: Numerous studies have supported that nonalcoholic fatty liver disease (NAFLD) is highly associated with gut microbiota dysbiosis. Lingguizhugan Decoction (LG) has been clinically used to treat NAFLD, but the underlying mechanism remains unknown. Purpose: This study investigated the therapeutic effect and mechanisms of LG in mice with NAFLD induced by high-fat diet (HD).Methods: A HD-induced NAFLD mice model was established to evaluate LG's efficacy followed by biochemical and histopathological analysis. Metagenomics, metabolomics, and transcriptomics were used to explore the structure and metabolism of the gut microbiota.Results: LG significantly improved hepatic dysfunction and lipid droplet accumulation in HD-induced NAFLD mice. LG reversed the structure of the gut microbiota that is damaged by HD and improved intestinal barrier function. Meanwhile, the LG group showed a lower total blood BA concentration, a shifted BA composition and a higher faecal short-chain fatty acid (SCFA) concentration. Furthermore, LG could regulate the hepatic expression of genes associated with the primary BAs biosynthesis pathway and PPAR signalling pathway. Conclusion: Our study suggested that LG could ameliorate NAFLD by altering gut microbiota's structure and metabolism, while BAs and SCFAs are considered possible mediating substances.

目的:探讨虎杖苷(PD)对由过氧化氢(H2O2)诱导的人神经母细胞瘤SH-SY5Y细胞损伤的影响及其作用机制.方法:采用SH-SY5Y细胞进行实验,细胞用不同浓度的H2O2处理24h,通过细胞计数试剂盒-8(CCK-8)法检测细胞活力,以确定H2O2的诱导浓度.PD预处理细胞2 h后,加入H2O2诱导22 h,CCK-8法检测细胞活力,以确定PD的浓度.将细胞分为二甲基亚砜(DMSO)组、H2O2组、H2O2+PD 20μmol/L组和H2O2+PD 40μmol/L组.膜联蛋白V-异硫氰酸荧光素/碘化丙啶(Annexin V-FITC/PI)凋亡试剂盒检测细胞凋亡,流式细胞术测定细胞内总活性氧(ROS),酶联免疫吸附测定(ELISA)检测细胞中谷胱甘肽(GSH)、丙二醛(MDA)、超氧化物歧化酶(SOD)的含量,JC-1线粒体荧光探针检测线粒体膜电位,Western blot检测B细胞淋巴瘤-2(Bcl-2)、Bcl-2相关X蛋白(Bax)、半胱氨酸蛋白酶-3(Caspase-3)、剪切的多腺苷二磷酸核糖聚合酶(Cleaved-PARP)、核因子E2相关因子2(Nrf2)、Kelch样环氧氯丙烷相关蛋白1(Keap1)和血红素氧合酶1(HO-1)蛋白的含量.结果:①CCK-8实验结果显示,400 μmol/L浓度H2O2处理后,SH-SY5Y细胞活力为60％,故选择400 μmol/L H2O2作为后续SH-SY5Y细胞的刺激条件;20、40、50、80 μmol/L PD可显著抑制H2O2诱导的SH-SY5Y细胞活力下降(P＜0.05).②Annexin V-FITC/PI凋亡实验结果显示,20、40 μmol/L PD能够抑制H2O2诱导的SH-SY5Y细胞凋亡(P＜0.05).Western blot结果显示,20、40 μmol/L PD能够抑制H2O2诱导的SH-SY5Y细胞中凋亡相关蛋白Bax、Caspase-3表达(P＜0.05),并促进抗凋亡蛋白Bcl-2的表达(P＜0.05).③20、40 μmol/L PD能减少H202诱导的SH-SY5Y细胞中ROS、MDA的含量(P＜0.05),以及增加GSH、SOD含量(P＜0.05).④JC-1线粒体膜电位检测结果表明,20、40 μmol/L PD能够缓解H2O2诱导的SH-SY5Y细胞线粒体损伤.⑤Western blot结果显示,20、40 μmol/L PD能够显著抑制H202诱导的SH-SY5Y细胞中Keap1、Nrf2和HO-1蛋白水平的下调(P＜0.05).结论:PD能够减少H2O2诱导的SH-SY5Y细胞凋亡、氧化应激以及线粒体损伤,其作用机制可能与激活Keap1/Nrf2/HO-1信号通路有关.

目的 探讨社区老年高血压病患者中医体质类型分布和相关危险因素,为高血压病的防治提供参考.方法 根据《中国高血压防治指南(2010)》,将5582例社区老年志愿者分为高血压病组及非高血压病组.采用中医体质调查问卷,对其进行中医体质及危险因素分析.结果 5582例老年人中,高血压病患者占55.2％,非高血压病者占44.8％;高血压病组平和质562例(18.2％),偏颇体质2521例(81.8％),非高血压病组平和质467例(18.7％),其余共2032例(81.3％).进一步分析发现,高血压病组偏颇体质主要是痰湿质,非高血压病组偏颇体质主要是气虚质,两组之间体质分布差异具有统计学意义(P<0.05).Logistics回归分析结果显示:在高血压病与中医体质类型关系的模型中,痰湿质为独立危险因素;在高血压病与中医体质类型及相关因素关系的模型中,谷氨酸氨基转移酶(alanine transaminase,ALT)、痰湿质、同型半胱氨酸(homocysteine,Hcy)、血脂异常、年龄及血糖为危险因素.结论 本社区老年高血压病患者体质分布以偏颇体质多见,痰湿质、气虚质、阳虚质是较为常见的体质类型;ALT、痰湿质、Hcy、血脂异常、年龄及血糖是高血压病的危险因素.在社区慢性病管理中,根据不同中医体质类型制定相应的防治干预方案,积极调整偏颇体质,倡导健康的生活方式,加强对高血压病高危人群的干预,对社区老年高血压病的防治具有指导意义.

目的 将1000例尿液标本用尿干化学法和镜检法检测红细胞、白细胞,探讨尿液镜检与尿液干化学法在尿液常规检查中的地位和关系.方法 使用优利特1600自动尿液分析仪和显微镜检查标本.结果 尿液分析仪白细胞和红细胞阳性率分别为50.9％、82.2％、74.3％、76.2％.两种方法有显著性差异.结论 尿分析仪干化学法能快速查筛标本,但有较多不足,尿镜检法是尿常规分析中的金标准,两者相互补充才能完善尿液常规分析,提高检测结果的准确性.

全科医疗被世界卫生组织称为"最经济""最适宜"的医疗卫生保健服务模式.与专科医生比之,全科医生更贴近社区,尤其是为社区重点人群(儿童、妇女、老年人、慢性病患者)提供医疗保健服务.作为社区人群的守护者,全科医生是三级预防的践行者,其中最重要的环节是健康教育.全科医生是进行社区健康教育的主要实施者,根据不同对象的特点开展实用性和操作性较强的健康教育工作从而推进社区卫生服务的发展,起到保障居民身心健康的核心作用.本文以案例剖析的方式,介绍了社区健康教育在全科医疗实践中的特点、与循证保健的关系以及创新模式,探索全科医生在开展社区健康教育医疗实践中的有效作用.

类风湿关节炎（rheumatoid arthritis ，RA ）是一种以慢性进行性关节病变为主的自身免疫病，未经及时诊疗的患者可出现不可逆性的关节骨质破坏及功能丧失。据统计未经过规范治疗的 RA 患者2年致残率达50％，3年致残率可达70％［1］。

" 4CH8" health management mode is a new management mode aiming at the key populations needing health management,which organically combines basic public health services with basic medical care and it is appropriate to be carried out in the community of health services. Three forest community health service centers in Shanghai Pudong New Area,ex-plored and implemented the " 4CH8" health management mode according to their status. Now it has initially established the new community health management mode: " 4 health care homes" as the basis," 4 aspects of health management" as the man-agement process," 8 health management module " as the output results and quality control standards and gradually combined it with the " Six in One" function of the community health service centers. Based on the three forest communities of practical experi-ence and evaluation analysis of the effects,the article proposes further thinking of the" 4CH8" health management mode perfec-tion,which will ahve certain significance on the further implementation.

国外华法林抗凝治疗的管理主要通过设立抗凝门诊实现[1-3]。自1968年抗凝门诊在美国出现以来，日趋成熟的抗凝门诊工作模式相继扩展到了英国、法国、加拿大、澳大利亚等发达国家。研究证实抗凝门诊的建立有以下好处：降低了抗凝并发症的发生率[4]；显著降低了医疗费用和去急诊室的次数；药师可以为患者提供更加直接而详细的用药指导。此外，在美国、韩国等国家从事AC工作的药师已取得了有限的处方权，药师有华法林处方权并可以进行必要的剂量调整等。

Fully relying on science and technology advances and has become one of the five policies guiding the health service development in the new era in China. The community health service centers( CHSCs),as the primary providers of health services in China,have been struggling in research and education. Outreach has emerged as an innovative approach to promote health- related research and education in communities. In the past few years,our center has devoted significant efforts to the research and education outreach program and has made encouraging progress. In this paper,we aim to utilize the Michael Porter diamond Model to analyze the past accomplishments from the following six aspects: major components of the research and education outreach program,required conditions,performances of the program- associated enterprises and supporting industries,operation strategies,infrastructure and rivalry,government policies and chances. It is highly anticipated that findings from this analysis would lay some solid foundations for improving the current research and education outreach program in communities.

三林社区卫生服务中心历经了13年的社区卫生服务发展过程,先后完成了7个示范单位与基地的创建.本文通过对示范单位与基地成功创建工作的回顾,分析了创建路径中的逻辑关联,论证了成功创建的必然性,从中总结出4个阶段的建设经验并进行了具体描述.

目的探讨三林社区气阴两虚证慢性肾脏病(CKD)患者的危险因素。方法根据CKD的诊断,通过实验室检查筛选出50～70岁的CKD患者325例,进行中医体质辨析,选择以气阴两虚证患者82例为病例组,非气阴两虚证患者为对照组,采用统一问卷调查表采集CKD的相关危险因素资料,然后进行多因素Logistic回归分析。结果回归提示:糖尿病、高尿酸血症、高胆固醇血症、饮食偏油或甜、糖尿病家族史是气阴两虚证CKD患者的危险因(P<0.05或0.01)。结论糖尿病、高尿酸血症、高胆固醇血症、饮食偏油或甜、糖尿病家族史是三林社区气阴两虚证CKD患者的危险因素。

随着经济的高速发展,很多女性都患上了各种疾病,其中乳腺癌是女性常见的恶性肿瘤.目前,我国乳腺癌的发病率虽较西方为低,但近年来增长迅速,并以每年3%-5%的速度递增.在我国的大中型城市,乳腺癌发病率已高达万分之四以上.而在上海、北京等大城市,每8-9名妇女中就有1名乳腺癌患者[1].因此,研究乳腺癌的危险因素,对乳腺癌的有效防治具有重要意义.

<正>随着人们生活水平的提高,筛查诊断技术的进步,慢性肾脏病(Chornic kidney disease,CKD)的发病率呈逐年上升的趋势。美国健康和营养调查(NHANES)研究显示,1988～1994年,20岁以上成人CKD的患病率为11.0%,而1999～2006年的患病率为16.0%。2005年我国北京市石景山地区对40岁以上常住居民CKD的流行病学调查显示,其患病率为9.4%。可见CKD已成为21世纪人类面临的公共健康问题。CKD患者在出现明显的临床症状前,大多经历了较长的无症状阶段。据估计,早期CKD的发病率要比肾衰竭的发病率高约100倍。因此,研究CKD的危险因素对有效防治该病具有重要的意义。多年来,国内外学者经过资料收集及对大量人群进行多种流行病学方法检验,对CKD危险因素的认识不断深化,对其防治也有了进一步研究,主要归结为以下几方面:

上海市三林社区有70岁以上老年人9760例,三林社区卫生服务中心从2000年7月开始为老年人建立健康档案,以便了解老年人的健康需求和健康状况及老年人对社区医疗收费的看法.笔者于2008年10月对社区内3164名老年人的需求意愿进行了调查,旨在人口老龄化不断加剧,社会保障还未完善的情况下,阐明构建一个社区老人服务体系的必要性,为拓展社区卫生服务的内容提出依据,并根据社区老年人的需求开展各项服务及延伸服务.

Objective To make tracking study and analyze the effect of on-the-job training for general practitioners in Pudong New District of Shanghai.Methods The questionnaire survey was conducted on leaders and colleagues of trainees who attended the on-the-job training for general practitioners from 2004 to 2007.Results The leaders and colleagues held the general practitioners taken part in the training had greatly improved in clinical experiences,medical knowledge,health education and guidance foe family panning techniques(P<0.05);and had a little improvement in the patients' satisfaction(P<0.05).The evaluation on trainees' working quality and working amount and scientific research capabilities from the leaders of urban community health service centers was significantly different from that from the leaders of rural areas(P<0.05).Conclusion The current mode of general practitioners' training is scientific and feasible.After the training,the trainees can obtain the basic professional knowledge and general practice skills.However the training on scientific research means should also be included,internship period and service contents in community health service should also be increased;man-oriented and active development of general practice needs to be performed so as to meet the demand of community residents.

Objective To survey the knowledge about breast cancer,attitude and behavior of women in Sanlin community,and provide scientific basis for the prevention and treatment of breast cancer.Methods The questionnaire survey was used to investigate the KAP of screening gynecopathy population in Sanlin community.Results More than nine of the susceptible population factors showed normal distribution.The knowledge of breast cancer prevention and treatment and attitude in the rural group and residents group was better(accounted for 24.75% and 36.79% respectively).The susceptibility factor analysis showed that the rural group with working pressure was only 13.89%,while the resident group was 54.69%.Conclusion The female population aged 40 to 50 with relatively centralized risk factors are the most high-risk breast cancer population.The intervention should be done for those crowds.Raising the awareness of prevention and treatment,restricting the inducing of the multidimensional susceptible factors,and controlling effectively of high-risk behavior was the key to decrease the incidence of breast cancer.

目的以上海市浦东新区三林社区妇女常见病为依据,为社区妇女病防治提供基础数据.方法按妇科病普查卡,对普查对象作病史询问、常规和辅助妇科检查.对所得资料进行比较、分析.结果11 180名检查对象平均年龄(48.3±7)岁,3 643名已婚妇女(32.58%)有妇科疾病:宫颈糜烂(24.53%)、乳腺小叶增生(8.12%)和阴道炎(4.40%).结论在大群体(11 180)社区妇女病普查中,宫颈糜烂、乳腺小叶增生和阴道炎的发病率分别为24.53%、8.12%和4.40%,应列为常见病.如何降低其发病率,普查普治是有效的手段.