Objective To investigate the clinical correlation of intestinal bacterial translocation(BT) and in-testinal barrier of pediatric intestinal surgery,and to observe the relationship between BT and postoperative infection.Methods The plasma D-lactic acid,LPS level of 61 children with intestinal surgery in our hospital were detected before and after surgery.Polymerase chain reaction (PCR) was used to test blood bacterial DNA,in order to judge whether there is BT.Results The PCR results of preoperative children were negative,the PCR positive for 3 cases.According to the PCR results,postoperative systemic inflammatory response syndrome(SIRS) and complications of infection of PCR positive group were obviously higher than those of PCR negative group(P ＜ 0.01).And plasma D-lactic acid,LPS inspection of PCR positive group were obviously higher than PCR negative group(P ＜ 0.01).Conclusion Intestinal barrier damage has close relationship with BT in children after intestinal surgery,SIRS and infection complications also has a direct relationship with BT.

Radiofrequency ablation therapy not only causes the necrosis of localized tumor cells,but also produces immunogenic tumor associated antigens and a large number of inflammatory cytokines and a variety of immunogenic mediums,which promotes the local infiltration and activation of immune cells and stimulates the immune system to produce certain anti-tumor effect.But the intensity of anti-tumor effect is feeble and is insufficient to inhibit the growth of tumor cells.Radiofrequency ablation therapy combined with special immunotherapies,such as immune stimulants,adoptive immunity cells therapy,dendritic cell vaccines,monoclonal antibodies and so on,can maximize the clinical benefit,which is a good pattern about tumor comprehensive treatment containing immunotherapy.

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals, the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.

Objective To evaluate catheter-directed thrombolysis via the popliteal vein in the treatment of the lower limb acute deep venous thrombosis.Methods From July 2009 to October 2010,32patients of the lower limb acute deep venous thrombosis including 3 patients with concurrent pulmonary embolism underwent uhrasound-guided catheter-directed thrombolysis via the popliteal vein.The thrombolytic catheter was inserted into thrombus,through which urokinase was infused at a dosage of 100 × 104U/d.The venous patency score and the rate of patency improvement were observed by venograms before and after therapy.Results In every patient,the lower limb swell and pulomonary symptoms relieved.The circumferences between affected and normal thigh before and after the thrombolysis were(5.4 ± 1.4)cm and (1.7 ± 1.3)cm(t =9.92,P ＜0.01).The circumferences between affected and normal leg before and after the thrombolysis were(4.1 ± 1.5)cm and(1.5 ±0.7)cm(t =7.65,P ＜0.01).The venous patency score before and after the thrombolysis were(15 ± 4)and(4 ± 3)(t =7.12,P ＜ 0.01).The mean rate of venous patency was 88.21％.In the 3 patients with pulmonary embolism,thrombus was complete dissolved in 1 case and partial dissolved in 2 cases.No major complications occurred in all these patients.29 patients were followed up for 3-12 months.There were no thrombosis relapsed.Conclusions Catheter-directed thrombolysis via the popliteal vein with urokinase for acute lower limb deep venous thrombosis is safe and effective.

In the development of primary care system,Shenzhen has called into play the model of hospital-centering,and made it a link to build a new urban medical service system of clear-cut levels,rational division of responsibilities and mutual benefit.This design provides the primary care with a good credit,a reasonable medical insurance system,and appropriate technical support.Furthermore,it improved the efficiency of unban health resource allocation and utilization and alleviated residents' burden of medical costs.This study aims to introduce the measures and advantages in the implementation of the primary care system in Shenzhen,analyze the problems found in Shenzhen' s community health service system and make recommendations for the improvement.

Shenzhen implemented the health reform on the separation of drug prescribing and dispensing.This policy abolished the drug price addition system,which interrupted the interest chain between hospitals and pharmaceutical enterprises,and curbed the over-medication and use of expensive drugs.Such a reform has lowered the average cost of diagnose and treatment,the out-of-pocket payment by those covered by social insurance,outpatient infusion and the utilization of antibiotics.To further strengthen these outcomes and maintain the momentum of this policy,Shenzhen will further improve the compensation system for public hospitals,encourage the medical staffs' work enthusiasm and implement the reform measures actively.

As requested by both central government and Guangdong provincial government on the reform to separate drug prescribing and dispensing,Shenzhen has introduced its 1 + 6 comprehensive program.Breaking through from the drug price addition system,the program stages such six measures as the health service payment system reform,the compensation system reform among public hospitals,reform of the competition mechanism between pharmaceutical distribution enterprises and hospital pharmacies,reform of drug procurement methods,investigation and punishment of commercial briberies in drug purchase,and enhanced supervision of public hospitals.The paper detailed these measures and explained these innovative practices.

This articles introduced the development of the four systems and eight mechanisms in Shenzhen's health reform,and described the implementing measures of the public hospitals reform and major mechanisms reform.It also reviewed the major achievements and challenges met in the health reform and made an outlook of the future steps in the reform.

Objective To analyze relationship between elderly patients with acute cerebral infarction hyponatremia and their nutrition status.Methods One hundred and twenty patients were selected who hospitalized from January 2011 to December 2012.All the patiens' fasting venous blood samples were taken in the next day morning after hospitalied.and then performed the routine blood test,blood biochemical testing items,observed the level of serum sodium (Na),hemoglobin (Hb),total protein (TP),serum albumin (ALB),prealbumin (PA),C-reactive protein (CRP) and lymphatic cell counts (LY) were measured.According to the value of serum sodium,all patients were classified to lower sodium group (serum sodium ＜ 135 mmol/L,36cases),normal group (serum sodium range from 136 to 145 mmol/L,76 cases),and higher sodium group (serum sodium ＞ 145 mmol/L,8 cases).The results were statistically analyzed.Results The incidence of hyponatremia was 30％ (36/120).The levels of TP,ALB,PA,Hb and LY in lower sodium group were (50.35 ± 8.61) g/L,(28.35 ± 6.98) g/L,(89.96 ± 12.13) mg/L,(94.13 ± 25.36) g/L and (0.87 ±0.51) × 109 respectively,lower than that of normal group ((65.30 ± 5.48) g/L,(37.50 ± 3.63) g/L,(178.14 ± 18.61) mg/L,(124.87 ± 29.08) g/L,(1.67 ± 0.98) × 109 respectively,t =5.0897,7.1058,4.3216,3.8174,5.4237 respectively,P ＜ 0.01),but the level of CRP ((76.55 ± 49.95) mg/L) in lower sodium group was obviously higher than the normal serum sodium group ((21.33 ±35.04) mg/L,t =0.1287,P ＜ 0.01).The level of the serum sodium in ICU was related to the TP,ALB,PA,Hb and CRP(r =0.3176,0.4369,0.3695,0.2408,0.3612,0.0753 respectively,P ＜0.05).Conclusion The level of the merger of hyponatremia was correlated with malnutrition in the elderly acute cerebral infarction patients in ICU.We must strengthen the nutrition support treatment while correcting hyponatremia,in order to improve the clinical curative effect.

Objective To evaluate the diagnostic value of MSCT longitudinal reconstruction in the ureteral obstruction.Methods 34 patients with ureteral obstruction were scaned transversely and longitudinally by GE Lightspeed 16 CT scanner and the images were reconstructed with three-dimensional software.All cases were proved by operation and pathology except for 2 cases of uretal obstruction compressed by retroperitoneal lymph nodes.Results In 34 cases,there were 22 cases of ureteral calculi,2 cases of ureteritis,3 cases of carcinoma of ureter,3 cases of pelvisureteral conjunction stricture,1 case of ureteral cyst,1 case of retrocaval ureter and 2 cases of ureter compressed by retroperitoneal metastatic lymph nodes.On longitudinal reconstruction images,22 lesions of calculi in the ureter and thickened uretal wall were showed.Contrast-enhanced CT scan was preformed in 5 cases,the CT values of lesions were increased about 20~35 HU,after administration of contrast medium,and light hydronephrosis in 18 cases,medium hydronephrosis in 6,serious hydronephrosis in 2 and no hydronephrosis in one case were showed on delayed contrast-enhanced scan.Conclusion Longitudinal reconstruction image is of significant value in diagnosis of ureteral obstruction.