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.

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.

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.

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.

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.

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.

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 evaluate the treatment outcome of endoscopic esophageal mucosal resection (EMR) and alleviate or prevent the complication of EMR. Methods We explore a strategy of endoscopic esophageal mucosal resection to treat early esophageal cancer and severe dysplasia . Endoscopic esophageal mucosal resection was performed with transparent-cap technique, resdiual lesions were treated by Argon Plasma Cocagulation( APC). All patients have been followed up by endoscopic examinations at one month, 4 months, and 12 months after therapy. Results Seventy one cases (88 lesions) were treated by endoscopic esophageal mucosal resection with transparent-cap method. Average doses of saline-epinephrine 18 ml is injected submucosally to each lesion. The resected specimens were on average(21.8 ?1.0)mm ? (18.2?1. 0)mm in size. Five cases have bleeding after mucosectomy, bleeding were managed and controlled by compression , local injection of saline-epinephrin, and APC. Perforation never occurred. Four cases have stenosis after mucosal resection, in three of them the resected area was more than 3/4 esophageal circumference, then it was dilated with water ballon dilater at one month, two months and three months after mucosal resection, all cases were cured. Conclusions Endoscopic esophageal mucosal resection is a safe, simple, minimally invasive and effective procedure with few complication in treating early esophageal cancer and precan-cerous lesion.

Objective To evaluate the application and effect of endoscopic screening directly with i-odine stain in high risked area of esophageal cancer and compare the detecting rate of cancer and dysplasia before and after iodine stains. Methods In the high risked area of esophageal cancer, endoscopic exam were directly performed in 3 022 people, aged 40 - 69 years with iodine staining and biopsy, then observing and recording the alternation of color and morphology of mucbsa and texture of submucosal blood vessels before and after iodine staining. Results One hundred and thirty one cases of esophageal carcinoma and 659 cases of moderate and severe dysplasia were diagnosed by biopsy; the discovery of esophageal cancer before and after iodine stain were 57 ( 1. 9% ) and 111(3.7%) cases, while of moderate and severe dysplasia were 154(5. 0% ) and 659(21. 8% ) cases respectively with significant statistical differences. Conclusion The mucosal iodine staining under endoscopy markedly increased the detecting rates of early superficial esophageal cancer and dysplasia ( moderate and severe) .