With reference to the research report of American Medical Association on the healthcare system,the paper analyzed the existing medical service,and probed into the causes of poor quality of care The author staged the six countermeasures highlighting patient-focus,safe,effective,timely,efficient and fair medical service models,in the hope of improving quality of care and ensuring patient safety.

BACKGROUND:5-Fluorouracil is a common chemotherapy drug for gastric cancer, but it is more likely to develop drug resistance in clinical treatment. Studies have shown that tumor stem cels are lowly sensitive to chemotherapeutic drugs, which may be an important cause of chemotherapy resistance. OBJECTIVE:To analyze the sensitivity of gastric cancer stem cels to 5-fluorouracil in vitro, and to understand the mechanism of drug resistance associated with gastric cancer. METHODS:Based on the sorting strategy, human gastric cancer cel clones were isolated from AGS cel lines. CD44 and thymidylate synthetase expression in different clones was detected using immunocytochemistry analysis. Clone formation assay was used to evaluate self-renewal capacity of different clones. Cel counting kit-8 was used to determine the clonal growth inhibition rate of AGS under treatment with different concentrations of 5-fluorouracil. RESULTS AND CONCLUSION:The AGS cels that were inoculated with low density and cultured could differentiate into 32 forms, including the ful clone (16%, 5/32), the second clone (66%, 21/32) and the accessory clone (19%, 6/32). Among them, the ful clones highly expressed CD44 and thymidylate synthetase, and could generate a great amount of passage 2 clones after inoculation; the second clones showed a weak expression of CD44 and thymidylate synthetase, and could generate a smal number of passage 2 clones after inoculation; the accessory clones showed a weak or no expression of CD44 and thymidylate synthetase, and there was no passage 2 clone after inoculation. Under the effect of different concentrations of 5-fluorouracil, the growth inhibition rates of the secondary clones and AGS cels were both higher than that of the ful clones (bothP < 0.05). These findings indicate that gastric cancer stem cels have a relatively lower sensitivity to 5-fluorouracilin vitro, which is speculated to be an important mechanism of drug resistance.

Objective To compare the curative effects between one‐stage anterior debridement bone graft fusion and posteri‐or fixation fusion combined with anterior debridement bone graft fusion in the treatment of multiple lower thoracic spinal tuberculo‐sis .Methods A total of 62 patients with multiple lower thoracic spinal tuberculosis in our hospital from March 2002 to March 2010 were treated by the anterior debridement bone graft fusion ,including 32 cases of anterior internal fixation by one screw‐rod system (group A) and 30 cases of posterior internal fixation by two nail‐stick systems(group B) .The cure rate ,operation time ,bleeding volume ,the Cobb′s angle and recovery situation of spinal cord injury were compared between the two groups .Results All patients were followed up for 24-36 months (average 28 months) and showed successful bone graft fusion .In the Frankel classification e‐valuation at postoperative 12 months ,the improvement rate of spinal cord injury was 76 .92% (10/13) in the group A and 81 .82%(9/11) in the group B ,showing no statistically significant difference (χ2 =0 .087 ,P>0 .05) .The total cure rate was 84 .38% (27/32) in the group A and 85 .48% (26/30) in the group B ,showing no statistically significant difference (χ2 =0 .066 ,P>0 .05) .The Cobb′s angles before operation ,immediately after operation and at the last follow‐up were (28 .16 ± 4 .16)° ,(5 .03 ± 3 .24)° and (8 .81 ± 2 .44)° in the group A and (26 .83 ± 5 .41)° ,(5 .50 ± 3 .03)° and(8 .06 ± 2 .45)° in the group B ,showing no statistically sig‐nificant difference (t=1 .038 ,t=0 .588 ,t=1 .200 ,all P>0 .05) .The operation time was (171 .31 ± 12 .84)min in the group A and (219 .23 ± 21 .44)min in the group B ,showing statistically significant difference (t=10 .754 ,P<0 .05) .The bleeding volume was (341 .25 ± 76 .10)mL in the group A and (440 .67 ± 67 .16)mL in the group B ,showing statistically significant difference (t=5 .439 ,P<0 .05) .Conclusion One‐stage anterior debridement ,and anterior or posterior internal fixation for treating multiple lower thoracic spinal tuberculosis can obtain the better curative effect ,but selecting case is very important .

Gastric bypass surgery for type 2 diabetes in the world,especially Europe,the United States,and other western countries have been widely carried out.The data of type 2 diabetes mellitus treated by weight loss surgery at home and abroad in recent years were collected and analyzed.It was found that gastric bypass Roux.en-Y gastric bypass (RYGB) after type 2 diabetes remission rate of 80％ to 85％,and the treatment effect can be maintained for long time.Therefore,the RYGB in the treatment of type 2 diabetes has been more and more recognized by the authors.This present article summarizes the gastric bypass (Roux.en-Y gastric bypass) in the treatment of type 2 diabetes mellitus (DM).

Objective To observe the effects of different gastrointestinal reconstruction methods after dis -tal subtotal gastrectomy on nutritional condition and blood glucose in patients with type 2 diabetes ( T2DM) and gastric cancer.Methods 88 patients with T2DM and gastric cancer undergoing radial distal gastrectomy were studied and among them 43 patients had Billroth I gastrointestinal reconstruction , 22 patients had Billroth II gas-trointestinal reconstruction and 23 patients had Roux-en-Y gastrointestinal reconstruction .Body mass index ( BMI) , serum albumin and prealbumin of the 3 groups were measured preoperatively and 1 year after surgery . The patients were followed up .Results There was no significant difference among the 3 groups in preoperative values(P>0.05).One year after surgery, BMI, serum albumin and peralbumin in the 3 groups had different de-grees of reduction , but showed no statistical difference ( P>0.05 ) .The effective rate of diabetes control was 18.60%in Billroth I group , 72.73%in Billroth II group , and 73.91% in Roux-en-Y group and the difference had statistical significance(χ2 =17.390 3,P<0.05).The effective rates of diabetes control in Billroth II group and Roux-en-Y group were higher than that in Billroth I group (χ2 =18.340 9,P<0.05;χ2 =19.480 4,P<0.05), and there was no evident difference between Billroth II group and Roux-en-Y group(χ2 =0.008 1,P=0.928 4).Conclusion Billroth II and Roux-en-Y gastrointestinal reconstruction can improve glycemic metabo-lism of patients with T2DM and gastric cancer without significantly reducing the nutrition status .

Objective: To explore the association between polymorphisms of NF-κBl and NF-κBIα and the risk of hepatitis B virus-associated heptocellular carcinoma (HCC). Methods: The genetic polymorphisms of NF-κBl and NF-κBIα were detected using restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) in patients with the hepatitis B virus-associated HCC, patients with chronic hepatitis B and healthy controls. Multivariate Logistic regression model was used to assess the association of the age, sex, smoking history, alcohol drinking, and site of genetic polymorphisms with the susceptibility to HCC. Results: The frequency of NF-κBl (ATTG2/ATTG2) genotype was significantly higher in HCC group than in healthy controls (odd ratio [OR] = 2.21, 95% CI 1.25-3.88). Compared to the people who carried NF-κBl (ATTG1/ATTG1) and NF-κBIα (AA) genotype spontaneously, healthy controls who carried NF-κBl (ATTG2/ATTG2) and NF-κBIα (GG) genotype had an increased risk for HCC (OR=2.94, 95%, CI 1.03-8.44). Chronic hepatitis B patients who carried NF-κBl (ATTG2/ATTG2) genotype had an increased risk for HCC (OR = 2.31, 95% CI 1.22-4.38). Multivariate analysis showed increased risk in male HCC patients with chronic hepatitis B (OR = 2.01, 95% CI 1.19-3.41), in those who carried NF-κBl (ATTG2/ATTG2) genotype (OR = 2.17, 95% CI 1.23-3.85), in those who had a smoking history (OR = 1.79, 95% CI 1.04-3.07), and in those who had a drinking history (OR = 2.58, 95% CI 1.50-4.43). Conclusion: Genotype NF-κBl (ATTG2/ATTG2) is a risk factor of HCC, and it has a synergistic effect with NF-κBI(GG) genotype in contributing to hepatocarcinogenesis. Smoking and alcohol drinking are also risk factors for HCC.

OBJECTIVE: To optimize the prescription of the novel temperature-sensitive liposomes(NTSL). METHODS: Calcein-loaded temperature-sensitive liposomes with different phospholipid composition (DPPC-MSPC-DSPE-PEG200=86:10:4 and N (20% HSPC + 80% DPPC) -MSPC-DSPE-PEG200=92:4:4) were prepared by the thin film -hydration method. Based on the fluorescence self-quenching off characteristics of calcein, the release behavior of the above liposomes was compared when exposed to 37°C (normal temperature) as well as their respective phase transition temperature (Tm). RESULTS: Compared with the traditional temperature-sensitive liposomes (TTSL), the NTSL showed more favorable temperature-sensitive release performance and more stable encapsulation ability to calcein, even with the amount of lysophospholipids was reduced by 60 percent. CONCLUSION: The application of NTSL helps to enhance the effect of temperature-sensitive release.

ObjectiveTo study the relationship between the plasma level of asymmetric dimethylarginine (ADMA) and the damage degree of white matter and the changes of cognitive function in patients with cerebral small vessel disease.Methods120 patients with white matter lesions,induced by cerebral small vessel disease,were randomly selected.All patients were divided into group with or without cognitive dysfunction according to the results of MoCA scale.The plasma level of ADMA was detected with high-perfomance liquid chromatography method.Scheltens semi-quantitative evaluation was used to detect the damage degree of white matter.Correlation analysis was used to evaluate the relationship between the plasma level of ADMA and white matter lesions and cognitive dysfunction.ResultsThere were 42 patients with cognitive dysfunction and 78 patients without cognitive dysfunction.The plasma level of ADMA in patients with cognitive dysfunction ( ( 1.57 ±0.56) μg/ml) was significantly higher than patients without cognitive dysfunction ( (0.89 ±0.23 ) μg/ml) (P ＜ 0.01 ).Scheltens semi-quantitative evaluationfor patients with cognitive dysfunction and patients without cognitive dysfunction was 8.01 ± 2.50and 2.49 ± 0.59,respectively.There was significant difference between this two groups (P ＜ 0.01 ).The plasma level of ADMA positively correlated with the damage degree of white matter lesions and the changes of cognitive function.The correlation coefficients were 0.913 and 0.837,respectively ( All P ＜ 0.01 ).ConclusionADMA may be involved in the process of white matter damage caused by cerebral small vessel disease.The detection for plasma levels of ADMA may contribute to the prevention and early diagnosis of patients with cognitive dysfunction caused by cerebral small vessel disease.

Objective To study the influence of progesterone (PROG) on infarct volume and functional outcome and to evaluate the therapeutic value of PROG on cerebral infarction in rats.Methods Health adult male Sprague-Dawley rats were randomly divided into sham-operated (control) group,ischemic group,vehicle-treated group and PROG-treated group.Permanent cerebral ischemia was induced by occlusion of the left middle cerebral artery (MCA) using an intraluminal filament technique.Sham-operated rats were subjected to the same surgical procedure,except that the filament was not advanced to occlude the MCA.Progesterone or 2-hydroxypropyl-β-cyclodextrin was injected intraperitoneally following permanent middle cerebral artery occlusion (PMCAO) of rats.Zea Longa test was used to evaluate their functional outcome at 1d,2d,3d after stroke.TTC staining was used to detect the infarct volume at 3d after stroke.Results The results of Zea Longa test showed that there were no functional deficits in all animals prior to ischemia.There were no significant changes in motor function in sham-operated animals across the 3 days assessment period.Both PROG and vehicle-treated rats experienced significant decline in scores following occlusion.However,PROG-treated rats (3.00 ± 0.63,2.83 ± 0.75,2.00 ± 0.89 )demonstrated a gradual improvement in scores compared with ischemic (4.00 ± 0.89,3.83 ± 0.75,3.16 ± 0.75 )and vehicle-treated rats ( 3.67 ± 1.21,3.50 ± 1.05,2.83 ± 0.76) at different times (P ＜ 0.05 ).TTC staining revealed that PROG administration significantly reduced the total infarct volume in the PROG-treated rats ( ( 15.03± 3.75) ％ ) compared with ischemic ( (23.74 ± 4.48 ) ％ ) and vehicle-treated rats ( ( 24.42 ± 7.07 ) ％,P ＜0.05).Conclusions PROG significantly reduces infarct volume and promotes the recovery of neurological functions after pMCAO,which has good therapeutic value for the rat model of cerebral infarction.

Objective To analyze the reasons and therapeutic effects for revision of spinal fractures.Method Ninteen patients with revised internal fixation on spinal fractures were reviewed in average of 3.5 years follow-up. Neurological function, pain and daily life quality of patients with revision surgery were evaluated by questionnaire.ResultIncomplete spinal canal decompression as well as improper application of instrumentation were the main reasons of failed internal fixation for spinal fractures.All patients with incomplete spinal cord injury had improvement on neurological function to some extent after re-operation, and 17 of 19 patients (89%) indicated improved daily life quality. However, revision surgery failed to have motor recovery in patients with complete spinal cord injury.ConclusionCorrect surgical technique and selection of internal fixation are very important in the treatment of spinal cord injury.