The new round of medical and health system reform proposed the need to explore effective ways to gradually reform the mechanism of “using medicine costs to supply medical care”, through the implementation of “medical separation”, solve patients’ problem of “difficult and expensive”. While implementing the mode of the “medical separation”, according to exploring and practicing the actual situation of the region, it describes on the main mode of “medical separation”, analyzes the advantages and disadvantages, and proposes policy recommendations of “medical separeation” according to analysis of different modes.

Objective To investigate the risks and anesthetic management of scar uterus undergoing cesarean section.MethodsOne hundred pregnant women(aged 24-43 years old)with scar uterus underwent cesarean section.Epidural anesthesia was used in 90 cases(group A)and general anesthesia in 10 cases(group B).The monitorings included ECG,BP,HR and SpO_2.CVP was measured in the high risk cases.The time from skin incision tO neonatal delivery(I-D).the time from uterine incision to delivery(U-D),and Apgar scores of neonates were recorded.Results Incomplete blockade was seen in 20 cases(22％).The I-D time was shorter in group B than that in group A[(7.5±2.0)min vs.(12.3±2.6)min](P<0.01).Intraoperative hypotension occurred in 32 cases (32％).Neonatal asphyxia happened in 21 cases(21%).Apgar scores of 11 neonatals werc less than 3,of whom 5 neonates died.Apgar scores were 4 to 7 in 10 cases,8 to 10 in 79 cases.Subtotal uterectomy was performed in 2 cases.Repair of injuried bladder had to be done in one case.Intraoperative huge bleeding took place in 15 cases.Conclusion The scar uterus undergoing cesarean section has a high risk for mothers and neonates.The incidence of incomplete epidural blockade is higher.Effectively preventing and managing the risk factors are the keys for reducing maternal and neonatal complications and mortality.

Objective:To explore the changes of serum cholinesterase(ChE)and its clinical significance in patients with sepsis.Methods:Serum cholinesterase concentration,acute physiology and chronic health evaluation(APACHE)Ⅱ scores were estimated in patients.The patients in this study were divided into the sepsis group and the non-sepsis group.The patients with sepsis were further divided into the death group and the survival group.The influence of altered serum ChE levels on prognosis was compared between the groups.Results:(1)Serum ChE was significantly lower in patients of sepsis group than that of control group(P ＜ 0.01).(2)In patients with sepsis,the serum ChE level was significantly lower in the death group compared with that of survival group(P ＜ 0.05).(3)In patients with sepsis the serum ChE levels were significantly negatively correlated with APACHE Ⅱ scores(r=-0.280,P ＜ 0.05),positively correlated with serum albumin and body mass index(r=0.458 and 0.287,P ＜ 0.05).Conclusion:Serum ChE levels can be used to determine the prognosis and severity of illness in patients with sepsis.

AIM: To study the effectiveness of urapidil and nitroglycerine on controlling the cardiovascular responses to tracheal intubation/extubation in patients with essential hypertension. METHODS: 45 patients with essential hypertension undergoing general anesthesia were divided randomly into control (C, without depressor, n=15), urapidil (U, 0.5 mg?kg -1 , n=15), and nitroglycerine (N, 1 ?g?kg -1 , n=15) groups. The SBP, DBP, MAP, HR and RPP were measured during intubation and extubation and at the induction of anesthesia and the end of operation respectively. RESULTS: The SBP, DBP, MAP, HR and RPP increased markedly (P

AIM: To observe the effects of hypertriglyceridemia and fenofibrate on CD40L expression in platelets in vitro and in vivo. METHODS: In vivo experiments, according to its own strict standards, 20 patients were respectively selected for hypertriglyceridemia group and control group, before and after treatment of fenofibrate for hypertriglyceridemia patients. The CD40 ligand positive rates of platelets by flow cytometry and plasma soluble CD40 ligand by ELISA were examined under the same conditions as control group. The CD40L and sCD40L in each group were compared. In in vitro experiments, all 6 objects plasma was chosen in the same condition except for triglyceridemia, after the co-incubation of these plasma with the same healthy platelets was performed and the interference with wy14643, the CD40 ligand positive rate of platelets by flow cytometry and total platelets CD40 ligand protein content by Western blotting were examined under the same conditions in all objects. The CD40L positive rate and total CD40L content in each group were compared, respectively. RESULTS: The platelet CD40L positive rate and plasma sCD40L concentration in hypertriglyceridemia group were significant higher than those in control group (P<0.01). Followed the TG concentration decreased, the platelet CD40L positive rate and plasma sCD40L concentration decreased after the treatment of fenofibrate, the same as the total platelets CD40L content which was significant higher in hypertriglyceridemia group than that in control group in vitro (P<0.05). No effect of wy14643 on the total CD40L content expression was observed in vitro. CONCLUSION: Hypertriglyceridemia plasma stimulates immune-activation of platelets both in vitro and in vivo. sCD40L may mainly come from CD40L on platelet membrane. PPARα activator of fenofibrate may inhibit the immune-activation of platelets by reducing the concentration of plasma TG, but PPARα activator WY14643 cant inhibit the expression of CD40L and CD40L in vitro.

Objective To investigate the nasal endoscope Television Co-line self-retaining laryngoscope vo-cal polyps surgery treatment. Methods 121 cases diagnosed of vocal cord polyp (of which 54 cases of bilateral, u-nilateral 67 cases), in the serf-retaining laryngoscope and surveillance camera system of vocal cord polyp removed and opened Lacunar Reinke and will preoperative laryngoscopy and laryngoscopy after surgery and review the results of the video and retain. Results 4 weeks to review 70° nasal endoscope, and 116 cases of vocal sounds close to nor-mal, the cure rate reached 95.9 percent, and the remaining five cases because of vocal hypertrophy or incomplete closure of the vocal cords, sounds worse than normal shoots. Follow-up 3～18 months without recurrence, no serious complications. Conclusion The nasal endoscope and television surveillance camera system of amplification, in par-ticular, Reinke Lacunar throat image more clearly, so that lesions can be completely removed, and the vocal cords can be a very good organization had to protect, and by retaining the video can be pre-operative, during and after vo-cal dynamic comparative situation.

Objective To investigate the effect of flurbiprofen axetil(FA)on the acute lung injury(ALI)induced by LPS in rats.Methods Forty male SD rats weighing 190-220 g were nmdomly divided into 3 groups:group Ⅰ control(C,n=8);groupⅡ LPS(n=16)and group Ⅲ FA+LPS(n=16).In group Ⅱ and Ⅲ LPS 5 mg/kg in 1 ml of normal saline(NS)w88 given iv.In group Ⅲ FA 6 mg/kg in NS 1 ml was given Ⅳ 0.5 hbefore LPS administration.In group Ⅱ and Ⅲ 8 animals were killed at 2 h(T1)and 4 h(T2)after LPS administration respectively.Blood samples were obtained at T1 and T2 for blood gas analysis and determination of serum TXB2,6-keto PGF1α(by radio-immuno assay),TNF-α,IL-1β,IL-6 and IL-10 concentrations(by ELISA).Lungs were removed for determination of W/D lung weight ratio,lung water content(LC)and microscopic examination.ResultsCompared with group C,LPS signitlcanfly decreased PaO2,PaO2/FiO2 and increased PaCO2,W/D lung weight ratio,LC,serum TXB2,6-keto-PGF1α concentrations,TXB2/6-keto-PGF1α ratio and serum IL-1β,TNF-α,and IL-6 concentrations in LPS group.Pulmonary edema and hemorrhage were observed in LPS group.FA pretreatment significantly attenuated LPS-induced blood gas,bio-chemical and pulmonary histological changes in group Ⅲ.Conclusion Flurbiprofen axetil pretreatment can protect the lungs against LPS-induced acute injury by down-regulating TXB2/6-keto-PGF1α ratio and inhibiting inflammatory response.

Objective To investigate the effect of sevoflurane pretreatment on the expression of tight junction protein Occludin and ZO-1 in the lung following ischemia-reperfusion (I/R) injury in rats. Methods Ninty-six adult male Wistar rats weighing 250-350 g were randomly divided into 4 groups ( n = 24 each): group Ⅰ sham operation (group S);group Ⅱ I/R; group Ⅲ sevoflurane (group Sevo) and group Ⅳ Sevo + I/R. The animals were anesthetized, tracheostomized and mechanically ventilated. Right femoral vein and left carotid artery were cannulated for BP monitoring, blood sampling and drug and fluid administration. Lung I/R was induced by clamping left pulmonary hilum for 45 min followed by 120 min reperfusion in group Ⅱ and Ⅳ. In group Ⅲ the animals inhaled 2.2 % sevoflurane for 30 min. In group Ⅳ the animals inhaled 2.2 % sevoflurane for 30 min before lung ischemia. Six animals were killed at the end of 45 min ischemia (T1), and 60 and 120 min of reperfusion (T2, T3 ). The lungs were immediately removed for determination of W/D lung weight ratio and the expression of Occludin and ZO-1 protein (by Western blot). Tissues of lung were obtained for observation of histopathology with light microscope. Lung permeability index (LPI) was calculated. Another 6 animals were killed at 120 min of reperfusion for lung lavage. Results I/R significantly increased W/D ratio and LPI and significantly reduced Occludin and ZO-1 protein expression in the lung tissue as compared with group C and Sev. Sevoflurane pretreatment significantly attenuated the I/R-induced changes. The pathological damage to the lung tissue was significantly less in group SP than in I/R. Conclusion Sevoflurane pretreatment may protect the lungs from I/R injury by up-regulating the expression of Occludin and ZO-1.

Objective To investigate the changes in severe burn patients with acute renal failure by using continuous blood purification(CBP). Methods Twelve severe bum patients underwent early CBP were included in this study. The levels of creatinine、blood urea nitrogen and interleukin-6(IL-6) in plasma were determined. The termperature and heart were also observed. Results After the treatment of CBP,the clinical symptoms were improved obviously ( P ＜ 0. 05 ). The levels of creatinine[( 376. 2 ± 24. 5 ) μ mol/L vs ( 145.2 ± 57. 1 ) μmol/L] 、sodium concentration [( 5.3 ± 1.6 ) mmol/L vs ( 4. 0 ± 0. 7 ) mmol/L] and potassium concentration [( 153. 4 ± 13.0 ) mmol/L vs( 140. 1 ±8.6)mmol/L]in plasma were all decreased evidently after the treatment of CBP. There were significant differences ( t = 2. 79,3.06,3. 01, P ＜ 0. 05 ). The levels of IL-6 and APACHE Ⅱ score were ( 264. 31 ± 122.42 ) ng/Land( 15.2 ±5.8) scores before treatment. While after treatment,their levels were(94. 18 ±63. 82) ng/L and(5.4 ±3. 6) scores. The difference was also significant ( t = 4. 17,3. 67, P ＜ 0. 05 ). In this study, 8 patients cured and 4 patients died. Conclusion CBP could eliminate inflammation factors effectively in severe burn patients with acute renal failure. It could afford a useful assist treatment to these patients.

BACKGROUND:Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE:To investigate the outcome of autologous lilac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN,TIME AND SETTING:The own control study was performed at the Department of Orthopaedics,Sixth People's Hospital,Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS:Of 21 cases of the ununited distal ulnar fracture with osseous defects,13 cases were induced by ulnar and radial fracture,and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fracture of first onset. Bone defects were 1.5 cm-5.0 cm,averagely 3.1 cm. METHODS:Bone defects were filled with intercalary lilac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate,reconstruction plate or locking compression plate. At least two screws were used at the distal end,and 3 or 4 screws were fixed in the proximal end,FoUow-up was conducted once per month to observe clinical appearances and radiograph in each patient. MAIN OUTCOME MEASURES:Fracture nonunion,dorsal extension and palmer flexion of wrist joint,pronation and supination of the forearm were measured. RESULTS:All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union,and a mean time of 4.6 months (ranged 3 to 7 months). The distal ulnar healed with < 10° of angular deformity in a coronal plane in one patient and with 15° of angulation in a sagittal plane in another one,while others (19 patients) obtained satisfactory alignment. The excellent and good rate was 90.5％. CONCLUSION:Intercalary bone-grafting with autologous lilac and secure fixation for treating the ununited distal ulnar fracture with osseous defects can reconstruct ulnar length,correct deformities,and obtain good bone healing and functional recovery.