The paper covered key progress of the management system reform for China's public hospitals and analyzed main roadblocks in the reform.It proposed such policy recommendations as clearly separating the regulation and management affairs,concentrating management authorities to build an integrated management system,establishing a clear-cut appraisal criteria for accountability,and completing supportive reforms for effective management.

Objective: To understand the gambling relations between the stakeholders of catastrophic medical insurance policy under New Rural Cooperative Medical System ( NCMS) , and provide theoretical references for the smooth operation of catastrophic medical insurance policy of NCMS. Methods:Analyzing the game relationships among the four sides:the government, business insurance agencies, designated medical institutions and participating farmers suffering from catastrophic diseases through game theory. Results: The government and business insurance agency, and the government and designated medical institution belong to cooperative games. The farmers participated in catastrophic medical insurance tend to choose cooperative strategy. Non-cooperative games exist in business insurance agency, designated medical institution and participating farmers. Conclusion: Strategic relationship of close cooperation should be established between the business insurance agencies and designated medical institutions. The government should strengthen the regulatory constraints between the business insurance agencies and designated medical institutionsi, at the same time, it needs to establish the incentive mechanism soon.

Objective To discuss the indications and complications of primary closure of bile duct incision in laparoscopic bile duct exploration and balloon dilatation catheter dilatation to treat the papillary stenosis and the intrahepatic bile duct stenosis. Methods A pospective study of 42 ptients of bile duct incision closure primary in laparoscopic bile duct exploration and balloon dilatation catheter dilatation, laparoscopic bile duct exploration and extraction of bile duct stones with choledochotomy was first adopted in order to clear the stones, then followed by the balloon dilatation catheter(explosive pressure reached 2020 kPa, used 505kPa) to dilate the papillary stenosis and the intrahepatic bile duct stenosis (CT-7542～ CT-75104) until the stenosis was released. Whether the primary closure of duct incision was selected or not, it was based on the situation of intraoperative choledochoscopic exploration, if it had been selected, the closure of bile duct incision would accepted by using absorbable suture 4-0 or 5-0, without placing bile duct drainage.It was routinely to place the drainage tube in the oriffice of the lesser omentum. Results 41 out of 42 patients had obtained successful duct clearance, the dilatation of the stenosis to reach the expected expansion and without bile leakage. One patient had bile leakage about 30-150 ml daily persisted for 4 days through cured conservatively. Conclusion Eventually it was safe and effective for some patients who had completed successful duct clearance and the dilatation of the stenosis to reach the expected expansion with the balloon dilatation catheter. They were adopted to the primary closure of duct incision using absorbable suture and did not need to place bile duct drainage.

Objective To investigate the serum levels change of vascular endothelial growth factor (VEGF) during operation of non-small-cell lung cancer (NSCLC). Methods 120 cases of NSCLC patient diagnosed by pathology as well as with operation indication were selected as the experimental group. The patients selected were required without any chemotherapy or radiotherapy before operation, besides that, they should have good compliance and free will to be examined. During the process of experiment, 60 cases concluded as healthy in the physical examination were chosen as control group. The correlative information of the experimental group were collected including periphery blood specimen collected in 3 days before the operation, and of the 1st day, 7th day and 30th day after the operation while the periphery blood specimen of control group were collected. The serum levels of VEGF were detected by adopting enzyme linked immunosorbent assay (ELISA) method. Results The serum levels of VEGF in NSCLC patients before operation, of the first postoperative day, of the seventh postoperative day and of the thirtieth postoperative day were significantly higher than that in healthy people (P＜0.01), respectively (279.14±44.89)μg/L, (282.70±42.74) μg/L, (353.79±44.55) μg/L, (178.40±43.43) μg/L and (91.40±16.55) μg/L. The serum levels of VEGF in NSCLC patients showed positive correlation with the stages (P＜0.01). Conclusion The serum levels of VEGF in NSCLC patients scale up. At the same time it shows positive correlation with the stages of the primary tumor. The serum levels of VEGF in NSCLC patients scales up by degrees in one week after the operation, and drop one month later.

Objective: To explore the effect of cognitive-behavioral therapy combined with family rehabilitation therapy on improving depression patients. Methods: Totally 82 depressive patients admitted to our hospital from February 2016 to January 2017 were randomly divided into the control group and the observation group according to the random number table method, with 41 cases in each group. Patients in the control group were treated with family rehabilitation therapy, while the patients in the observation group were treated with cognitive behavioral therapy on the basis of family rehabilitation therapy. After 12 months of intervention, the patients in the observation group were treated with cognitive behavioral therapy. The treatment efficiency, psychological status, coping style and medication compliance of the two groups were compared. Results: After intervention the scores of Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD) in the observation group were (31.08±4.83), (14.14±3.52) points respectively, which were significantly lower than (36.97±2.73), (16.68 ±2.14) points of the control group (t=-6.789,-3.948, P < 0.01). The effective rate of the observation group was 97.56% (40/41), which was significantly higher than 70.05% (32/41) of the control group, and the difference was statistically significant (χ²=5.581, P<0.05). The scores of "problem solving" and "help seeking" items in the observation group were (1.66±0.18) and (1.81±0.21) respectively, significantly higher than (1.39±0.11), (1.48±0.13) of the control group; "avoidance" and "self-blame" items were (1.33±0.12) and (1.47±0.14) respectively, significantly lower than (1.58±0.19), (1.48±0.13) in the control group, and the difference was statistically significant (t=-8.349-8.555, P < 0.05). After treatment, the compliance of the observation group was significantly better than that of the control group (χ²= 8.902, P < 0.05). Conclusion Cognitive behavioral therapy combined with family rehabilitation therapy for depression patients can effectively improve the bad mood of patients, improve their medication compliance, and achieve better clinical treatment results.

ObjectiveTo summarize the experience on laparoscopic common bile duct exploration(LCDE). MethodsFrom Mar. 1992 to Mar. 2003, there were 693 cases undergoing LCDE. ResultsThe procedure was successful in 373 out of 391 cases with primary closure of duct incision and 272 out of 302 cases of T tube placement. Membrane stenosis dilation was successful in 68 out of 74 cases. Eleven out of 15 cases of malignant stenosis was successfully treated by biliary endoprosthesis and stent without bile leakage. Seven cases were shifted to open CBD exploration. Bile leakage was cured conservatively in 24 cases. Endoscopy failed to totally remove residual stones in 11 cases. Four cases died postoperatively. Conclusion LCDE was safe and effective in the hands of skilled endoscopists.

OBJECTIVE:To observe the effect of rosuvastatin on prognostic of patients with paroxysmal atrial fibrillation (AF) after circumferential pulmonary vein ablation. METHODS:75 patients with paroxysmal AF were divided into observa-tion group(n=39)and control group(n=36)according to the admission single. All patients underwent circumferential pulmo-nary vein ablation antiarrhythmic treatment. Control group orally received warfarin sodium,amiodarone,metoprolol,and sub-cutaneous injected low molecular weight heparin. Observation group additionally received 10 mg Rosuvastatin tablet,qd on the basic of contol group. Changes of cardiac function,inflammatory factors,lipid levels in 2 groups before and after treat-ment were observed,and follow-up results were compared. RESULTS:There was no significant difference in left atrial diame-ter and left ventricular ejection fraction in 2 groups before and after treatment (P>0.05);atrial effective refractory periods (AERP)in 2 groups significantly prolorged,and observation group prolorged more significantly than control group,the differ-ence was statistically significant(P<0.05). Serum high sensitivity C-reactive protein,interleukin-6 48 h and 1 month after op-eration in 2 groups significantly increased,and control group was significantly higher than observation group,the difference was statistically significant (P<0.05);before operation and after 3 months of operation,there was no significant difference in inflammatory cytokine levels(P>0.05). Triglyceride and low density lipoprotein cholesterol in observation group 1 month after operation significantly decreased, HDL-C significantly increased, there were significant differences (P<0.05). Fol-low-up time was (23.91 ± 5.28) months,AF recurrence was 7.8%,which was significantly lower than control group (13.9%),the difference was statistically significant (P<0.05);and there were no significant differences in ablation-related atrial tachycardia (ATa) and the incidence of adverse reactions between 2 groups (P>0.05). CONCLUSIONS:Rosuvastatin can effectively inhibit the inflammatory reaction and prolong the AERP,thereby reducing the recurrence rate of AF,with good efficacy and safety.

OBJECTIVE:To explore the difference of genotypes in patients with coronary artery disease(CAD)and different responses to clopidogrel. METHODS:Totally 159 CAD patients were selected from cardiology department of our hospital during Mar. 2013-Nov. 2015. They were given clopidogrel+aspirin for dual antiplatelet therapy for at least 1 year. Turbidimetry method was used to detect the percentage of platelet aggregation induced by adenosine diphosphate (ADP) and arachidonic acid (AA) before and after treatment. The polymorphism of cytochrome P450(CYP)2C19,CYP3A5,wild type leucine 33 allele(PLA1)/proline 33 al-lele(PLA2)were detected by PCR-RFLP. RESULTS:There were 3 kinds of CYP2C19 genotypes(2/2,2/1,1/1),3 kinds of CYP3A5 genotypes (3/3,3/1,1/1) and 3 kinds of PLA1/PLA2 genotypes (A1/A2,A2/A2,A1/A1);the frequency of each genotype was in line with Hardy-Weinberg balance(P>0.05). Among 159 cases,there were 81 cases of clopidogrelsemi-re-sponse,accounting for 50.9%;78 cases of clopidogrelresponse,accounting for 49.1%. The frequencies of CYP2C19 gene dele-tion(2/2 or 2/1 genotype)and 2 allele in clopidogrelsemi-responsepatients were significantly higher than clopidogrelre-sponsepatients,with statistical significance(P<0.05). The frequencies of PLA1/PLA2 gene deletion(A2/A2 or A1/A2 genotype) and A2 allele in clopidogrelsemi-responsepatients were significantly higher than clopidogrelresponsepatients,with statistical significance(P<0.05). The frequencies of CYP3A5 gene deletion(3/3 or 3/1 genotype)and 3 allele in clopidogrelsemi-re-sponsepatients were slightly higher than clopidogrelresponsepatients,without statistical significance (P>0.05). After treat-ment,the percentage of ADP or AA-induced platelet aggregation in different genotypes patients were significantly lowered,com-pared to before treatment;but the percentage of platelet aggregation in CYP2C19 gene deletion and CYP3A5 gene deletion patients were significantly higher than gene expression patients(1/1 genotype),with statistical significance(P<0.05). There was no sta-tistical significance in the percentage of platelet aggregation between PLA1/PLA2 gene deletion patients and gene expression patients (P>0.05). CONCLUSIONS:The incidence of clopidogrelsemi-responsein CAD patients is high. CYP2C19 and PLA1/PLA2 gene polymorphism may be related to clopidogrelsemi-re-sponse,while CYP3A5 gene polymorphism has no relation-ship with it. CYP2C19 and CYP3A5 gene deletion may weaken inhibitory effects of clopidogrel on platelet aggregation of CAD patients.

Objective:To explore the feasibility and stability of using oleic acid to establish acute respiratory distress syndrome(ARDS) model in Beagle dogs.Methods:A total of 25 Beagle dogs were injected oleic acid with a speed of 0.25?0.03ml/Kg through jugular vein after being anesthetized.The gas ventilation index,oxygen metabolism,histopathological changes,chest-ray scan and stability of each index after establishing the ARDS situation were continuously monitored and evaluated.Results:All 25 dogs were reached the diagnosis criteria of ARDS in 4.16?0.92 hours after injection of oleic acid,The arterial PaCO2 of the animals was 27.98?8.25mmHg,PaO2 was 65.40?11.48mmHg,and PaO2/FiO2 was 182.3?29.6.After mechanical ventilation treatment,PaO2/FiO2≤200.Pulmonary mesenchyme,and alveolus edema,bleeding,shrinkage and transparent formation were seen under microscope.There was darkness or coarse shadow in the lung by the X-ray scan.Conclusions:Through injection of oleic acid via jugular vein,a Beagle dog ARDS model may be quickly established with stable changes of hemodynamics,pulmonary mechanics and histology.

Objective:Observed activity of adjuvant arthritis ( AA) rats Hedgehog signaling pathway and explore the effect of Cyclopamine on rat arthritis and kidney injury.Methods:40 rats were randomly divided into control group,Cyclopamine group,AA+Cyclopamine group and AA model group.We used Freund′s complete adjuvant rat model with Cyclopamine intraperitoneal injection.By measuring paw swelling, systemic inflammation and arthritis semi-quantitative assessment methods of rats to evaluate the model.HE staining was used to detect the renal pathological changes of rats.Western blot was used to detect kidney Gli1 protein expression levels of the rats.Immunohistochemical staining was used to detect the rat kidney TNF-α,IFN-γ,IL-6 expression.Results:After using Cyclo-pamine,the AA rat paw swelling reduced and arthritis refers relieved significantly.Compared with the control group,Cr,BUN and organ coefficient increased significantly in AA model group, and the difference was statistically significant.Meanwhile renal TEM detection appeared obvious pathological changes in rats of AA model group.After using cyclopamine,the content of Cr,BUN and organ coefficient change reduced significantly, so did the pathological.Western blot detected kidney tissue Gli1 protein in each group.Compared to control group,there was no significant difference in Cyclopamine group.AA model group and AA+Cyclopamine group Gli1 protein expression was significantly higher compared with Cyclopamine Gli1 protein group,the difference was statistically significant.AA model group and AA Cyclopamine group Gli1 protein expression was significantly higher,the difference was statistically significant.Compared to the AA model group,AA+Cyclopamine group Gli1 protein levels have decreased significantly,the difference was statistically signifi-cant.Immunohistochemical assay detection found that kidney tissue proinflammatory cytokines TNF-α,IFN-γ,IL-6 expression and semi-quantitative score changed.Compared with the control group, TNF-α, IFN-γexpression of AA model group were significantly increased.After using Cyclopamine,the expression of TNF-α,IFN-γin kidney of AA model reduced significantly.IL-6 expression in AA model group was significantly higher than the control group.Conclusion:Cyclopamine AA can relieve arthritis and kidney injury in rats with arthritis AA,the Hh pathway was on activity state in the process,may altered expression of inflammatory factors.