Although private hospitals are generally encountering development difficulties, some private non-profit medical institutions thrived in the medical market. These hospitals have rich experiences in terms of manage-ment system, operation mechanism, and competition methods. In this paper, we summarize the experiences of those well-functioning private non-profit hospitals and analyze the essential conditions for developing private non-profit med-ical institutions. These conditions include meeting local health market needs, ensuring that the hospital management system and operation mechanism result in high-quality health services, ensuring hospital development meets local health plans ( in order to obtain policy support) , ensuring the goal of the hospital is public welfare and that the hospital has strong financial support, obtaining certain social and political capital, and ensuring high-quality managers and staff.

Objective To investigate the effects of long-term low-dose radiation (LDR) of γ-rays on the proliferation and radiosensitivity of human lymphoblast cells HMy2.CIR (HMy) and to elucidate the underlying mechanism.Methods HMy cells were divided into control group and long-term LDR group.For the long-term LDR treatment,HMy cells were fractionally exposed to a low dose of γ-rays,which could enhance cell proliferation,3 times per week for 4 weeks.After the long-term LDR exposure,part of the control and long-term LDR exposed cells were further irradiated with a challenging dose (2 Gy) of γ-rays.Then cell proliferation and radiosensitivity were assayed by CCK-8 kit,cell apoptosis,and γ-H2AX formation was measured by flow cytometry.Gene expressions of cyclinD1,PCNA,bcl-2 and bax were detected by RT-PCR.Results The long-term LDR significantly increased cell proliferation (t =9.607,P ＜ 0.01) accompanied with up-regulation of cell cycle regulation gene cyclinD1 (t =6.869,P ＜ 0.01),proliferation regulation gene PCNA (proliferating cell nuclear antigen) (t =9.229,P ＜ 0.01) and bcl-2 gene (t =2.662,P ＜ 0.05),but decreased the expression of pro-apoptotic gene bax (t =19.908,P ＜0.01) in HMy cells.Compared to untreated cells,the long-term LDR decreased cell radiosensitivity (t =8.896,P ＜ 0.01),including apoptosis induction (t =4.762,P ＜ 0.01) and γ-H2AX formation (t =10.264,P＜0.01).Conclusions The long-term LDR promoted cell proliferation by up-regulating cell cycle related genes,while it reduced the radiosensitivity of HMy cells with acquisition of apoptotic resistance.

Objective To investigate the dose-response of micronuclei (MN) frequency in the lymphocytes irradiated with or without combination of α-particles and γ-rays. Methods Human lymphoblast cells HMy2.CIR were irradiated with 0 - 1 Gy of α-particles,0 - 5 Gy of γ-rays,and 0.025 -0.5 Gy of α-particles followed by different doses of γ-rays,respectively.The micronuclei (MN) in the irradiated cells were measured with the cytokinesis block technique,and the dose-responses of MN were established under different irradiation conditions.Results For γ-ray irradiation,the dose-response of MN was well-fit by the linear-quadratic model with an equation Y =c + αD + βD2.For α-particle irradiation,the MN induction increased linearly with the dose less than 0.250 Gy. But when the dose of α-particles increased continually,the dose-response curve bended and could be well fit with the BaD model Y =c + αD + σ[ 1 - exp( - δD) ] exp( - βD) where radiation-induced bystander effect (RIBE) was indicated.For the combined exposure,the dose-response of MN was similar to that of γ-irradiation when the dose of α-particles was lower than 0.1 Gy,but it was similar to that of α-irradiation when the dose of α-particles was higher.When the dose of α-particles was 0.2 and 0.5 Gy,MN induced by the mixed radiation were significantly higher than the sum of corresponding irradiation alone ( t =5.22 - 11.86,P ＜ 0.05 ).Conclusions The radiation damage of α-particles differs from that of γ-rays,where RIBE may be involved.The combination irradiation of α-particles and γ-rays has a synergistic effect on radiation damage of lymphoblast cells.

Objective To investigate the protective effects of creatine phosphate pretreatment on circulato ry function in prone position in elder patients with general anesthesia.Methods Forty patients in ASA physical status Ⅰ or Ⅱ of male and female,aged 60 to 75 years undergoing percutaneous nephrolithotripsy in prone position,were randomly divided into two groups (n =20 each):the control group (gToup N) and the creatine phosphate group (group P).In the group P,creatine phosphate sodium (30 mg·kg-1 in 50 mL normal saline) was continuous infused at a speed of 100 mL· h-1,while only normal saline 50 mL in the group N at the same time.HR,MAP,CO,SV,CVP,Pulse Pressure Variation (PVV) and Systemic Circulation Resistance (SVR) were monitored and recorded at 1 min before prone position (T0) and 1 min (T1),3 min (T2),5 min (T3),10 min (T4) after prone position.The requirement for vasoactive agents were also recorded.Results Compared with T0,HR began to increase significantly at T1 in the group N(P ＜ 0.05),while MAP,CO and SV began to decrease at T1 to T3,and CVP,PVV and SVR began to increase significantly at the same time in the group N (P ＜ 0.05).Compared with the group N,MAP,CO and SV were decreased,PPV,CVP and SVR were increased significantly at T1 to T2 in the group P (P ＜ 0.05).The requirement for vasoactive agents in the group P was obviously lower than that in the group N (P ＜ 0.05).Conclusion Creatine phosphate pretreatment can stabilize the hemodynamic change effectively,and prevent the adverse cardiovascular events caused by prone position in elder patients with general anesthesia.

Objective To explore the establishment of an new artificial bladder reflex arc for controlled micturition function in the conical spinal cord injury(SCI). Methods One conical SCI patients were included by lateral microanastomosis of the L6 ventral root to S2 ventral root. After several months of axonal regeneration, the function of bladder were examined clinically and urodynamically. Results Stimulation of the new artificial reflex are could inuduce controlled voiding, and could cause detrusor contraction when following 55 months of one patient. Conclusions Establishing of an new artificial reflex arc may effective for controlled micturition in conical SCI.

The evolution of China’s policy on private medical institutions has been ongoing, and a comprehen-sive policy system has been established. In this paper, we review the development history and summarize the main policy points in terms of planning, approval, financial input, supervision and administration, support and incentives. We analyze current policy barriers from three levels:1 ) policy ideas, consensus on the function and role of private medical institutions have not reached, which may influence the corresponding policy making and implementation;(2) policy design, multiple policy bottlenecks still exist, such as lack of flexibility, poor convergence, vague stand-ards and other aspects; 3 ) policy implementation, the health planning polices and equal treatment polices haven’t been carried out, and there are many hidden obstacles. To solve these problems, we recommend that further attention be paid to the importance of private medical institutions;the running mode should be chosen properly; the develop-ment space should be expanded;the classified management policy should be improved; and the supervision and ex-amination of policy implementation on local governments should be intensified.

Objective To investigate the effects of remifentanil postconditioning on apoptosis in hippocampal neruons in a rat model of cerebral ischemia-reperfusion(I/R)and the mechanism involved.Methods Twentyfour male SD rats weighing 250-300 g were randomly divided into 4 groups(n = 6 each): sham operation group (group S);global cerebral I/R group(group I/R);remifentanil 0.6μg·kg- 1·min-1+global cerebral I/R group (group R1)and remifentanil 1.8μg·kg-1·min-1 + global cerebral I/R group(group R2).Global cerebral ischemia was induced by 10 min occlusion of bilateral common carotid combined with hypotension.In group R1 and R2,remifentanil at 0.6 and 1.8μg·kg-1·min-1 were infused for 5 min before ischemia respectively.The cognitive function was tested with Morris water maze and step-down tests from the day 3 to day 8 after reperfusion.When Morris water maze test was finished,rat brains were removed for HE staining and determination of the expression of caspase-3 in hippocampal CA1 region by immuno-histochemistry.Apoptosis in neurons in hippocampal CA1 region was detected by TUNEL assay.Results Compared with group S,the cognitive function was significantly decreased and the number of apopotic neurons in hippocampus CA1 region increased in group I/R,R1 and R2,and the expression of caspase-3 was up-regulated in group I/R(P＜0.05).Compared with group I/R,the cognitive function was significantly increased,the expression of caspase-3 was down-regulated,and the number of apopotic neurons in hippocampus CA1 region was significantly decreased in group R1 and R2(P＜0.05).Conclusion Remifentanil postconditioning can improve the cognitive function through down-regulating caspase-3 expression and inhibiting the apoptosis in hippocampal neruons in a rat model of cerebral I/R.

Objective To evaluate the effect of goal-directed fluid therapy on postoperative rehabili-tation in elderly patients undergoing surgery in the prone position.Methods Sixty patients of both sexes,aged 60-75 yr,of American Society of Anesthesiologists physieal status Ⅱ or Ⅲ,scheduled for elective lumbar surgery in the prone position under general anesthesia,were divided into 2 groups (n =30 each) using a random number table:conventional fluid therapy group (group C) and goal-directed fluid therapy group (group G).The CNAP system was used to monitor stroke volume variation and cardiac index continuously in group G.Mean arterial pressure was maintained at 60-110 mmHg,central venous pressure at 6-12 emH2O and urine volume more than 0.5 ml · kg-1 · h 1 using conventional fluid therapy in group C.In group G,goal-directed fluid therapy was performed under the guidance of stroke volume variation,and cardiac index was maintained at 2.5-4.0 L · min-1 · m 2.The requirement for crystalloid and colloid solution,total volume of fluid infu sed,blood loss,urine volume and requirement for vasoaetive agents were recorded during operation.After anesthesia induction,at 1 h after turning to the prone position and at the end of operation,blood samples were collected fromn the left radial artery for blood gas analysis,and the blood lactate concentration was recorded.The volume of drainage within 3 dlays after operation,perioperative blood transfusion,early postoperative cardiovascular and pulmonary complications,development of oliguria and anuria,emergence time and length of hospital stay were recorded.Results Compared with group C,the requirement for crystalloid solution,total volume of fluid infused,urine volume and requirement for vasoactive agents were significantly decreased during operation,the requirement for colloid solution was increased during operation,the blood lactate concentration was decreased at 1 h after turning to the prone position and at the end of operation,the length of hospital stay was shortened,and the incidence of postoperative cardiovascular and pulnonary eomplications was decreased in group G (P＜0.05).Conclusion Goal-directed fluid therapy can promote postoperative rehabilitation and shows a certain clinical value in elderly patients undergoing surgery in the prone position.

A method for simultaneous determination of 20 Perfluorinated alkyl substances ( PFAS) in animal liver using QuEChERs and HPLC_MS/MS technique was developed. The samples were extracted with 0. 1%hydrochloric acetonitrile and cleaned up with C18 , N_Propylethylendiamine ( PSA ) and graphitized carbon blacks ( GCB ) . The analytes were separated by a reversed phase C18 column and gradiently eluted with a mixed solution of 5 mmol/L ammonium acetate methanol and 5 mmol/L ammonium acetate. The samples were quantified using isotope internal standard and external standard with the matrix matched standard calibration curve method. Good linearity was obtained for all the 20 PFAS at the concentration of 0. 1-10 μg/L with the linear correlation coefficients more than 0. 9995. The limits of detection (LOD) and the limits of quantification ( LOQ) for PFAS were 0. 05-0. 2 μg/kg and 0. 4-0. 5 μg/kg, respectively. The recoveries at three different concentration levels ( 0 . 5 , 2 and 5 μg/kg ) were in the range of 70 . 3% -108 . 1%. The repeatability expressed as relative standard deviations (RSD) was ranged from 2. 1% to 11. 9% (n=6).

[ABSTRACT]OBJECTIVETo investigate the phoenix roebelenii pollen as the allergen of allergic rhinitis in Hainan Province and provide guidance for prevention and treatment of allergic rhinitits.METHODSA total of 2054 patients with allergic rhinitis were tested with the allergen of phoenix roebelenii pollen by skin prick test, and then choose 30 positive cases to give the nasal mucosa provocation test. RESULTSThe total positive rate of allergen of phoenix roebelenii pollen by skin prick test was 67.38% (1384/2054). The 30 cases with positive skin prick test were all positive in nasal mucosa provocation test and the cases in control group were all negative.CONCLUSIONPhoenix roebelenii pollen is an important allergen in Hainan Province. There is a correlation between skin prick test and nasal mucosa provocation test. The allergen skin prick test can provide clue for the patients to avoid the pathogenic allergens and for the specific immunotherapy.