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.

[Objective] To sum up teacher He Lingzhi’s clinical experience and academic ideas on diagnosing and treating IgA nephrosis. [Method] From casa morbi, mechanism and clinical treatment based on differentiation of signs, it expounds teacher He Lingzhi ’s clinical experience and academic points, exampled with a case. [Result] The disease has main mechanism of Qi deficiency, teacher He Lingzhi divides the IgA nephrosis into types of Qi deficiency of lung and spleen, spleen and kidney, both deficiency of lung and kidney, Yang deficiency of spleen and kidney, Yin deficiency of liver and kidney, both deficiency of Qi and Yin, Yin and Yang, thus forms the treating rules of tonifying Qi to reinforce spleen, tonifying lung to nourish kidney, tonifying liver and kidney, Qi and Yin, Yin and Yang. The case here was relieved the nephrosis symptoms with the treatment. [Conclusion] Teacher He Lingzhi has rich clinical experience in treating IgA nephrosis with differentiation of signs, with definite cure effect.

Nicotinic acid could increase high density lipoprotein and reduce serum total cholesterol, low density lipoprotein cholesterol and triglycerides in human bodies, thus is frequently applied in treating low high-density lipoprotein cholesterol and hypertriglyceridemia in clinic. However, according to the findings, nicotinic acid could also cause adverse effects, such as skin flush, beside its curative effects. In this study, bioisosterism, fragment-based search and Lipinski's Rule of Five were used to preliminarily screen out potential TCM ingredients that may have similar pharmacological effects with nicotinic acid from Traditional Chinese medicine database (TCMD). Afterwards, homology modeling and flexible docking were used to further screen out potential nicotinic acid receptor agonists. As a result, eleven candidate compounds were derived from eight commonly used traditional Chinese medicines. Specifically, all of the candidate compounds' interaction with nicotinic acid receptor was similar to nicotinic acid, and their docking scores were all higher than that of nicotinic acid, but their druggability remained to be further studied. Some of the eight source traditional Chinese medicines were used to lower lipid according to literature studies, implying that they may show effect through above means. In summary, this study provides basis and reference for extracting new nicotinic acid receptor agonists from traditional Chinese medicines and improving the medication status of hyperlipidemia.
Drug Evaluation, Preclinical ; Drugs, Chinese Herbal ; chemistry ; Humans ; Models, Molecular ; Molecular Structure ; Nicotinic Acids ; chemistry ; Nicotinic Agonists ; chemistry ; Protein Binding ; Receptors, G-Protein-Coupled ; agonists ; chemistry ; Receptors, Nicotinic ; chemistry

A new dynamic in vitro intestinal absorption model for screening and evaluating lipid formulations was established by means of the characteristics of the intestinal digestion and absorption of the lipid formulations. This model was composed of two systems, including intestinal digestion and the intestinal tissue culture, which drew the evaluation method of intestinal absorption into the in vitro lipolysis model. The influence of several important model parameters such as Ca2+, D-glucose, K+ on the two systems of this model has been investigated. The results showed that increasing of Ca2+ concentration could be significantly conductive to intestinal digestion. The increasing of D-glucose concentration could stepped significantly down the decay of the intestinal activity. K+ was able to maintain intestinal activity, but the influence of different concentration levels on the decay of the intestinal activity was of no significant difference. Thus the model parameters were set up as follows: Ca2+ for 10 mmol x L(-1), D-glucose for 15 mmol x L(-1) and K+ for 5.5 mmol x L(-1). Type I lipid formulation was evaluated with this model, and there was a significant correlation between the absorption curve in vitro and absorption curve in vivo of rats (r = 0.995 6, P < 0.01). These results demonstrated that this model can be an attractive and great potential method for the screening, evaluating and predicting of the lipid formulations.

This paper report the development of a new dosage form - self-microemulsifying mouth dissolving films, which can improve the oral bioavailability of water insoluble drugs and have good compliance. A three factor, three-level Box-Behnken design was used for optimizing formulation, investigated the effect of amounts of microcrystalline cellulose, low-substituted hydroxypropyl cellulose and hypromellose on the weight, disintegration time, cumulative release of indomethacin after 2 min, microemulsified particle size and stretchability. Optimized self-microemulsifying mouth dissolving films could fast disintegrate in (17.09 +/- 0.72) s; obtain microemulsified particle size at (28.81 +/- 3.26) nm; and release in vitro at 2 min to (66.18 +/- 1.94)%. Self-microemulsifying mouth dissolving films with broad application prospects have good compliance, strong tensile and can be released rapidly in the mouth through fast self-microemulsifying.

Solid carriers had important effects on the properties of solid self-microemulsifying drug delivery systems (S-SMEDDS). In order to make the basis for further development of S-SMEDDS, the influences of silica on the absorption of S-SMEDDS were investigated. An in vitro lipolysis model was used to evaluate the influence of silica on self-microemulsifying drug delivery system digestion from intestinal tract. S-SMEDDS containing silica were prepared by extrusion/spheronization. The drug release and absorption were investigated. The results showed that lipolysis rate and drug concentration in aqueous phase after intestinal lipolysis both increased by adding silica, which was benefit to drug absorption. And silica was not benefit to absorption for slowing drug release. Consistently, there was no significant influence of silica on intestinal absorption. This study implied that the influences of silica on lipolysis rate and drug release were both amount dependent and it is suggested that silica could be used as the solid carrier but the proportion needs to be optimized.

Objective To explore the relationship of human papilloma virus (HPV) genotype and loading dose with development of cervical intraepithelial neoplasia (CIN) or squamous cell carcinoma of the cervix ( SCC),and explore the relationship of HPV genotype and CIN or SCC.Methods One hundred and twenty four patients in Sun Yat-sen Memoral Hospital of Sun Yat-sen University with CIN or SCC from September 2005 to December 2010 were selected in this study.HPV DNA was detected by Hybrid capture Ⅱand flow-through hybridization and gene chip.The relationship between the infection of HPV and CIN or SCC was analyzed.The influencing factors of CIN or SCC were analyzed by logistic regression.Results The total detection rate of HPV was 75.8％,and it was 44.4％,70.0％,95.7％ and 76.2％ in CIN Ⅰ,CIN Ⅱ,CIN Ⅲ and SCC group,respectively.The detection rate of HPV in high-grade lesion group ( 84.5％ ) was higher than low-grade lesion group(44.4％ ).The median of HPV load decreased in order as CIN Ⅲ,SCC,CIN Ⅱ and CIN Ⅰgroup.Infection of multi-genotypes or single genotype of high-risk HPV accounted for 97.9％.In logistic regression,HPV loading dose had significant influence on degree of cervical lesion.Conclusions Infection of HPV is a main etiological factor for SCC.There is some kind of correlation between HPV loading dose and development of SCC.

Objective To understand the quality of care for disabled elderly persons in ethnic areas and its influencing factors.Methods A questionnaire survey was carried out using multi-stage stratified random cluster sampling method for the disabled elderly persons in ethnic minority areas,and the relevant factors affecting the quality of care were analyzed.Results The object with different regions,ethnicity,marital status,residence and social support condition,education degrees,health status,the degree of disabilities affecting their life,occupations,income showed different scores in each dimension of care quality.Multiple linear regression analysis showed that other ethnic people with disabilities,unmarried,unemployed/laidoff people with disabilities,disabilities extremely influenced the quality of life affected the total score of care quality.Conclusions To improve the financial aid for disabled elderly people in ethnic areas,attach great importance to the physical and mental care of unmarried disabled elderly people,perfect and establish effective handicapped rehabilitation mechanism,can improve the care quality of disabled elderly people.

Objective To observe the effects of Sishen Pills on gene and protein expressions of toll-like receptor 2 (TLR-2) and toll-like receptor 4 (TLR-4) of colonic tissue in spleen-kidney yang deficiency rats with ulcerative colitis (UC); To discuss its mechanism of action for spleen-kidney yang deficiency UC. Methods Lavage of senna +intraperitoneal injection of hydrocortisone injection + enema of 2,4,6-trinitrobenzene sulfonic acid/ethanol were used to establish the model of UC of spleen-kidney yang deficiency type. 90 Wister rats were randomly divided into blank group, model group, Salazosulfadimidine group and the Sishen Pills high-, medium- and low-group. Each medication group was intervened by relevant medicine. RT-qPCR was used to detect the expressions of TLR-2 and TLR-4, and Western blot was used to detect the protein expressions of TLR-2 and TLR-4. SOD and MDA in serum were detected. Results Compared with the blank group, SOD activity decreased and MDA content increased in the model group (P<0.01); gene and protein expressions of TLR-2 and TLR-4 increased significantly (P<0.05). Compared with model group, SOD increased and MDA content decreased in all the medication groups (P<0.05, P<0.01); gene and protein expressions of TLR-2 and TLR-4 decreased (P<0.05, P<0.01). Conclusion Sishen Pills can achieve the treatment of UC by improving the metabolism of oxygen radicals in colonic tissue and regulating the immune system of the intestinal epithelium.

Objective To investigate the prevention and management strategies of in-hospital complications in the hip replacement in elderly patients(≥80 years old) Methods The data of 42elderly patients with hip replacement between Oct.2004 and Dec.2006 were collected and analyzed.Their age ranged from 80 to 96 years with an average of 84.6 years.Twenty-four cases were associated with severe osteoporosis(Dorr Ⅲ),13 with coronary heard disease,10 with arrhythmia,7with diabetes,5 with cerebral paralysis.Twenty five cases had a cemented stem bipolar femoral head replacement,2 had uncemented stem bipolar femoral head replacement,7 had cemented total hip replacement,3 had revision of total hip replacement. Results No death occurred during operations,1 died postoperatively due to dislocation at the 5th day postoperation.One case had coma for 1 week after general anaesthesia.5 had temporary cognitive handicap,38(90.5%)were able to walk at the aid of walker with easement of pain before discharging. Conclusions To gain good results in elderly patients with hip arthroplasty,less invasive and quick anaesthetic technique and operative procedures are encouraged.Meticulous preoperative preparation.active preventing and treating the intraoperative and postoperative complications should be emphasized.