The development status of regional longitudinal healthcare alliances in China was analyzed in the paper.As found by the authors, such existing problems as the healthcare administrative system and fiscal input system, the crisis of confidence on primary medical institutions, poor information platforms, and limited means of medical insurance payment, constitute roadblocks for healthcare alliances to play their roles.Proposals of the paper cover such grounds as follows: the government to make a top-down design and a longitudinal and integrated healthcare system can be built;to build a corporate structure for the alliances, with greater fiscal support;to reform the medical insurance payment practice for integrating interests of medical associations;to clarify the responsibilities of tertiary hospitals, for building a win-win mechanism among stakeholders, and improving the information sharing platform.These measures, if in place, can propel the healthy development of healthcare alliances in China.

Objective To investigate the relationship between the Schatzker types and postoperative knee function in tibial plateau fractures .Methods Totally 120 patients with tibial plateau fracture from January 2010 to December 2014 were selected and performed the Schatzker classification according to the X‐ray film ,CT and three dimensional reconstruction .They were divided into 6 groups .The postoperative knee function in each group was followed up and the statistical analysis was conducted .Results The excellent grade distribution of knee function by Kruskal‐Wallis test had statistical difference among 6 groups(P<0 .05) ,in the fur‐ther pairwise comparison ,the significant differences were found between the group 1 and 2 with the group 4 ,5 and 6(P<0 .05) . Conclusion The Schatzker types of tibial plateau fractures is closely correlated with the postoperative knee function .The knee function scores of type Ⅳ ,Ⅴ and Ⅵ are obviously poor .

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Joints ; injuries ; Male ; Meridians ; Middle Aged ; Sprains and Strains ; therapy ; Young Adult

Objective To study the apoptosis-inducing effect of Oridonin on PC-3 cells line and the role of Survivin in the process.Methods After PC-3 cells were incubated with different concentrations of Oridonin,cell viability was analyzed with MTT assay.The percentage of earlier apoptosis cell was analyzed by flow cytometry.The protein expression of Survivin in PC-3 cells were detected by Western blot and fluorescent quantitative PCR.Results Oridonin effectively inhibited the proliferation of PC-3 cells in a concentration-time dependent way.After PC-3 cells were treated with Oridonin ( 2.5,5,10,20,40 μmol/L)for 48 hours,the cytotoxicity index were 9.2％,25.3％,39.3％,77.2％,92.5％ and the IC50 of PC-3 cells was 10.29 μmol/L,respectively.Flow cytometry was used to detect the effect of different concentration of Oridonin (0,10,20,40 μmol/L) for 48 hours,the apoptotic rates of PC-3 cells were 4.8％,15.4％,19.5％,27.4％ ( P ＜ 0.05).Oridonin down-regulated Survivin protein in a concentration-dependent way in PC-3 cells.Conclusions Oridonin can induce the apoptosis of PC-3 cells by a concentration-dependent manner.Oridonin can induce the apoptosis of PC-3 cells by down-regulated Survivin protein.

Objective A rabbit model of common carotid artery grafted by external jugular veins was used. Vein grafts were transferred by c-myc antisense oligodeoxynucleotides(ODN) and carried by soluble stent. Try to find a new approach to prevent veins graft failure on molecular basis. Methods New Zealand rabbit were randomly divided into five groups, 10 animals each. Pretreating the soluble stents with synthesized c-myc ODN, following stents: (1) control group; (2) soluble stent; (3) soluble stent with sense-ODN; (4) soluble stent with antisense-ODN; (5) soluble stent with mismatch-ODN were put into the vein graft during end to end anastomosis. After 7, 28 and 90 days of operation, vein grafts were harvested. HE and ET stain were made aim to calculate the extent of intima hyperplasia. The expression of c-myc and PCNA were identified by immunchemistry methods. Situ hybridization and Northern Bloting were made to assess the expression of c-myc mRNA quantitatively and semi-quantitatively in veins. Results In the vein grafts of 7,28,90 days post-operation of soluble stent antisense-ODN group ①Intima hyperplasia were inhibited significantly compare with other four groups. ②The expression of c-myc and PCNA were inhibited significantly compare with other four groups. ③C-myc mRNA expression level was significantly Lower than the other four groups. Conclusion Soluble stent can transfer c-myc ODN effectively. C-myc antisense-ODN transferred by soluble stent can inhibit the expression of c-myc and PCNA, can inhibit intima hyperplasia of vein graft significantly, thus preventing the stenosis of vein graft.

Objective:To assess coronary stenosis using 256-slice spiral CT (CTA).Methods:The data of 126 pa-tients diagnosed as coronary heart disease (CHD)using CTA and coronary angiography (CAG)Were retrospectively analyzed.The CAG results for CHD Were regarded as “gold standard”diagnosing CHD.The CTA diagnostic value for CHD and consistency of CAG and CTA diagnosing coronary stenosis Were analyzed.Results:A total of 393 cor-onary segments Were assessed using CTA.According to CAG results for CHD ,the CTA diagnostic accuracy Was 89.3%,sensitivity Was 91.4%,specificity Was 84.8%,negative predictive value Was 82.2% and positive predictive value Was 92.8%;the consistency of CAG and CTA diagnosing coronary stenosis Was good (Kappa value =0.755, P<0.01).Conclusion:The 256-slice spiral CT can diagnosing coronary stenosis,it possesses high sensitivity in di-agnosing vascular stenosis;as a simple and noninvasive examination it can be used as a reliable method for early screening subhealthy population and reexamine of putients With coronary heart disease.

Objective To discuss the liver function recovery affected by the portal vein flow in patients who underwent adult-to-adult living donor liver transplantation using the right lobe. Methods Seventy-four donors and recipients were included in this study. Intraoperative Doppler ultrasound (IOUS)were performed before splitting the donor liver and 1 hour after the graft reperfusion. The diameter and velocity of portal vein were measured and recorded for calculation of portal vein flow(PVF). Liver function tests were undertaken at the day 2nd,7th, 15th and 30th postoperative,respectively. Results One hour after reperfusion of 74 grafts,the PVF were significantly increased (2. 84 ± 0. 93) fold. Seventy-four grafts were divided into 4 groups according to the different degrees of the increase of PVF. The levels of blood bilirubin total(TBIL) among 4 groups were differently at the day 2nd,7th, 15th and 30th postoperative. High PVF contributed to recipient's prolonged hyperbilirubinemia ( P ＜0. 001 ). The levels of ALT, AST among 4 groups were differently at the day 7th, 15th and 30th postoperative( P ＜0. 001). Conclusions Detection of portal vein hemodynamics in living donor liver transplantation by IOUS may assist surgeon to anticipate the graft's function and take surgical therapies to secure the graft and the recipient.

Objective To observe the proliferation inhibition and apoptosis promotion effect of oridonin on PC-3 cells.Methods PC-3 cells were treated with different concentrations of oridonin.MTT assay and drug concentration-time survival curve were used to test the effect of oridonin on the PC-3 cells.The percentage of earlier apoptosis cells was analyzed by flow cytometry.The protein expression of caspase-3,Bcl-2,and Bax in the PC-3 cells was detected by Western blot.Results Oridonin effectively inhibited the proliferation of PC-3 cells in both concentration- and time-dependent manner,and the IC50 of PC-3 cells was 10.29 μmol/L.Hochest33258 staining and flow eytometry deteced that oridonin induced the apoptosis of PC-3 cells in a concentration-dependent manner (P ＜ 0.05 ).Oridonin down-regulated Bcl-2,up-regulated Bax protein,and activated caspase-3 in a concentration-dependent manner in the PC-3 cells.Conclusion The apoptosis of PC-3 cells induced by oridonin might be associated with the mitochondrial pathway.

Objective To investigate the application effect of stone basket in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi. Methods The clinical data of 96 patients with upper ureteral calculi were retrospectively analyzed, all patients underwent ureteroscopic holmium laser lithotripsy. Forty-eight cases used the stone basket in the operation process (observation group), and 48 cases did not use the stone basket in the operation process (control group). The operation time, length of stay, success rate of lithotripsy, stone residual rate and incidence of postoperative complication were compared between 2 groups. Results The patients of 2 groups successfully completed surgery. There were no statistical differences in operation time, length of stay and incidence of postoperative complication between 2 groups (P>0.05). The success rate of lithotripsy in observation group was significantly higher than that in control group: 97.92% (47/48) vs. 75.00% (36/48), and the stone residual rate was significantly lower than that in control group:4.17%(2/48) vs. 18.75%(9/48), and there were statistical differences (P<0.05). Conclusions The stone basket in ureteroscopic holmium laser lithotripsy for treatment of upper ureteral calculi can thoroughly remove stones. It reduces the incidence of residual stones, does not affect the safety of the operation, and has good clinical value.

Objective To investigate serum NK cell levels in HBeAg positive early pregnancy women with immune activation.Methods Fifty four HBeAg positive pregnant women admitted in Taizhou People's Hospital from September 2010 to April 2013 were enrolled in the study.Among them,the serum HBV DNA load decreased ≥2 log at 12 weeks after pregnancy in 24 cases (immune activation group) and HBV DNA did not decrease in 30 cases (immune tolerance group).The serum level of alanine aminotransferase (ALT),total bilirubin,HBeAg,HBV DNA load and NK cells were measured.Results At week 12 of gestation,the mean ALT levels and ALT abnormality rate in immune active group were higher than those in immune tolerance group [(146.7 ±93.1) vs.(44.1 ± 14.7) U/L,t =2.95,P＜0.05,50.0％ vs.6.7％,x2 =4.97,P ＜0.05].There was no significant difference of HBeAg level between two groups before pregnancy,while HBeAg level in immune activation group was lower than that in immune tolerance group at week 12 week of gestation [(291.8 ± 170.5) vs.(443.7 ± 289.9) S/CO,t =2.81,P ＜0.05].The percentage and absolute number of NK cells in immune activation group were higher than those in immune tolerance group [(26.7 ±9.1)％ vs.(17.1 ±7.8)％,t =2.52,P ＜0.05 and (370.9 ±136.4)/μl vs.(213.2 ±97.8)/μl,t =2.38,P ＜0.05,respectively].Conclusions In HBeAg positive early pregnant women with immune activation,the inhibition of HBV DNA might be associated with the activation of NK cells.