The reform experiences of physician fee system ( PF ) practiced at a hospital in Nanjing were analyzed to come up with key influencing factors to make the reform a success,including income level,income makeup and income equity.Most noteworthy of the authors' points was income equity,proposing such reforms as target physician salary and inter-departmental balance,especially the two key factors of implementing the price target factor and inter-departmental balance.Their efforts aim at exploring a brand new idea and successful experiences in making PF system a success in China's hospitals.

BACKGROUND:So far there is not an ideal animal model for clinical research of osteonecrosis of the femoral head, which hinders its development. OBJECTIVE:To compare the merits and characteristics of different methods and various animal models, and to provide a reference for selection of models of osteonecrosis of the femoral head. METHODS:Literature search was performed in databases of PubMed, EMBASE, Wanfang, and China National Knowledge Infrastructure, published from 2006 to 2014 by computers. The key words were“Osteonecrosis of the Femoral Head, Animal model, Vivo Experiment, Legg Calve Perthes disease, Osteoarthritis, Col apse of the Femoral Head, Trauma, Corticosteroid, Alcohol, Liquid Nitrogen”in English and Chinese, respectively. Final y, 48 articles were included. RESULTS AND CONCLUSION:Traumatic osteonecrosis of the femoral head models simulates the most common clinical type, which is more effective in Legg Calve Perthes disease. Glucocorticoid-induced osteonecrosis of the femoral head models is more suitable for etiology, pathology and comprehensive research. Physical osteonecrosis of the femoral head models could be used for evaluating treatment methods, such as surgery. The ideal animal models should be similar with human in anatomy, histology and biomechanics;pathology, pathophysiology, and radiographic progression of osteonecrosis of the femoral head can simulate the whole process of human osteonecrosis of the femoral head, and it is easy to be obtained, cost-effective and good repeatable.

Objective To investigate the effect of transarterial infusion ( TAI) chemotherapy on estrogen receptor ( ER) and progesterone receptors ( PR) expression in breast carcinoma tissue. Methods Samples of 81 patients with breast carcinoma were selected in this study. ER and PR mRNAs levels in the samples were determined by RT-PCR. Immunohistochemistry was employed to measure ER and PR expressions in different samples before and after TAI chemotherapy. Western blotting was used to assay ER and PR proteins level in the samples before and after the chemotherapy. Results RT-PCR results indicated that ER mRNA level was increased in 43 cases ( 53. 1% ) and PR level in 33 cases ( 40. 7% ) . Meanwhile,both ER and PR mRNAs levels were increased in 25 cases ( 30. 9% ) . Immunohistochemistry results showed that ER level was up-regulated in 35cases ( 43. 2% ) ,and PR level in 21 cases ( 26. 0% ) . Both ER level and PR level were up-regulated in 16 out of 81 cases( 19. 8% ) . Western blotting also suggested that the both proteins levels of ER and PR were up-regulated in some patients after the chemotherapy. Conclusion Transarterial infusion neoadjuvant chemotherapy affects the mRNA and protein level of the hormone receptors,which facilitates the subsequent killing effect of chemotherapy on tumor cells. ER and PR expressions should be determined after the transarterial infusion chemotherapy,which might provide a guide for the subsequent treatment and prognosis.

In recent years , the increasing number of private medical institutions in China has not led to the re-sponding increase in medical services , capital asset scales .The competitive situation between public and private medical institutions has not yet been formed .This paper discusses the difficulties that Chinese private medical institu-tions have encountered in overseas capital inflow , in order to foster local private medical Institutions , as well as the development of private non-profit hospitals .Based on a systematic analysis of the key points in policy , suggestions were proposed in regarding with enhancement of top-level design of the policies , encouragement of the development of off-shore or on-shore small-scale private medical institutions , as well as facilitation of the productive factors flow in medical institutions'operation.The suggestions on the policies are to be referenced in decision making for a healthy development of Chinese private medical institutions .

Life education is the education based on perception and experience of life,the very nature of which is the cultivation of life awareness.It is the urgent requirement to carry out life education for university students,because it helps them to adjust to the developing and changing society and promotes their physical and psychological development coordinated.In order to strengthen college students' rational thinking on the value and significance of life,enhance their humanistic quality,life education should be incorporated into higher education system independently.

Strengthening the capacity of medical students' clinical thinking is an important aspect of medical education,the writers believe that medical students' clinical thinking ability can be improved through three aspects which include basic teaching practice,thinking knowledge based learning and clinical teaching.

Objective:To study the neuropsychological features and explore possible mechanisms in pure word deafness.Methods:A case of a 55 year-old right-handed woman was analysed,who presented with a long lasting pure word deafness following subcortical and cortical hemorrhage in right temporal and parietal lobe.Results:There was no sign of aphasia. The auditory deficit was sepecific for language, while recognition of music and environmental sounds was normal. CT examinations showed that the lesion was due to right cerebral hemisphere hemorrhage, mainly the white matter of temporal and parietal lobe. Conclusion:It is proposed that pure word deafness was consequent to the isolation of Wernicke's area from incoming auditory information due to the interruption both of the association fibers from the right auditory area traveling across the corpus callosum and of the left auditory radiations.

ObjectiveTo evaluate the long-term survival rate of precancerous lesions and early esophageal cancer after endoscopic mucosal resection (EMR).MethodsThe follow-up endoscopy was performed in 154 patients with early esophageal cancer and precancerous lesions who underwent EMR.The examinations were carried out at 1 month,6 months and every 1 year after the procedure,respectively,and argon plasma coagulation (APC) was applied if a recurrent lesion was suspected.The follow-up rate was 100%.ResultsAfter EMR,reecurence occurred in 6 cases (3.9%) in 5 years,of which 4 received esophagectmy,1 underwent APC,and the other one died from matastasis.The 5-year survival rate was 97.4% (150/154),with 1 died from matastasis and 3 from noncancerous diseases.The 5-year survival rate of 125 patients with high grade dysplasia,carcinoma in situ and intramucosal carcinoma was 97.6%( 122/ 125),with 1 died from noncancerous disease and 1 from metastasis.The 5-year survival rate of 29 patients with low grade dysplasia was 96.6% ( 28/29 ) with 1 patient died from noncancerous disease.ConclusionEMR,as a minimally invasive procedure,is suitable for precancerous lesions and early esophageal cancer,especially for high grade dysplasia,carcinoma in situ and intramueosal carcinoma,with little sequela and long-term survival.

Objective To explore the reversal effect on MDR1 gene-mediated multidrug resistance in human colon carcinoma LOVO/5-Fu cells by tetrandrine ( Tet) and to clarify its molecular mechanism.Methods LOVO/5-Fu cells were treated for 48 h with Tet.Drug sensitivity was measured by MTT.The cell cycle, apoptosis of cells and expression of P-glycoprotein (P-gp) were determined by flow cytometry assay.Expression of MDR1 mRNA was detected by real-time quantitative PCR (real-time PCR).P-gp expression was detected by Western blot.Results After LOVO/5-Fu cells were treated for 48 h with Tet, the IC50 of 5-Fu decreased to ( 4.15 ± 0.31 ) μg/ml ( P ＜ 0.05 ) ; and the apoptotic rate increased to (3.44% ± 0.28% ) ( P ＜ 0.05) ; the expression of MDR1 mRNA reduced to (570 ± 85) (P ＜ 0.05 ).Conclusions Tetrandrine reverses MDR1 gene-mediated multidrug resistance in human colon carcinoma LOVO/5-Fu cells possibly by inhibiting the expression of MDR1, decreasing the expression of P-gp, thus enhancing the sensitivity of LOVO/5-Fu cells to 5-fluorouracil.

Objective To observe the effects of recombinant plasmid of rat's interstitial collagenase on experimental liver fibrosis. Methods We constructed the recombinant plasmid of rat's interstitial collagenase fused Flag peptide which can be expressed in eucaryotic cells. After bound to galactose terminal glyco poly L lysine(G PLL), we transferred the recombinant plasmid to the rat's fibrotic liver in vivo by intravenous injection, then observed the effects of the plasmid on the fibrotic liver by RT PCR, immunohistochemistry and the observation of pathology. Results The recombinant plasmid of interstitial collagenase could be expressed in rat liver, the expression of the plasmid could increase the degradation of type Ⅰ and type Ⅲ collagen in the rat's fibrotic liver compared with fibrotic modal group ( P 0.05). Conclusion The recombinant plasmid of interstitial collagenase have some effects on liver fibrosis, but this effects is limited.