Based on a review of literature and the current reform of public hospital corporate governance,such corporate governance is divided intocombined regulation and operation,anddivided regulation and operationmodels.Then the principal-agent theory was called into play to analyze the main problems and causes of the existing models.From the perspectives of government supervision and assessment,professionalization of hospital directors,market competition mechanism,thoughts were made on how to improve such corporate governance.

BACKGROUND: Human embryonic stem cells (hESCs) are pluripotent cells which may differentiate into tissues of all three germ layers. Such research as the feeder-free growth of hESCs is few in China. Fibroblast growth factor (FGF) is a major factor to maintain the undifferentiated state of hESCs.OBJECTIVE: To evaluate the ability of FGF at different concentrations in maintaining the undifferentiated state and pluripotency of hESC lines in the long-term culture.METHODS: Two cell lines of hES-8 and hES-18 were cultured with mouse embryonic fibroblast condition medium for 3 passages and then transferred into mouse embryonic fibroblast condition medium containing different concentrations of FGF: 100, 160, 250 μg/L for 8 passages. The hESCs were removed from the petri dish, cell clusters were digested with collagenase IV and gathered. Cell differentiation and pluripotency were observed. The eighth generation of the hESCs were collected and incubated into severe combined immunodeficiency mice, so as to observe teratoma formation. Morphologies of the cells were evaluated. Alkaline phosphatase staining, surface labeling immunocytochemical analysis and RT-PCR assay method were utilized to determine the OCT-4 expression and tumorigenesis in vivo.RESULTS AND CONCLUSION: Cultured in mouse embryonic fibroblast condition medium containing 160 and 250 μg/L FGF, two cell lines of hESC could maintain undifferentiated state: Clones were round with a high ratio of nucleus to cytoplasm. Large areas in the center of clones were undifferentiated cells, while surrounding the clones were differentiated cells; Strong positive expression for alkaline phosphatase staining was observed; Two cell lines showed high levels of OCT-4 transcription factor protein; The surface markers SSEA-4, TRA-1-60, TRA-1-81 were all positive on both two lines; The hESC clusters could form embryoid body in vivo 10 days later; 3 germ layers of teratomas were also obtained after implanted into severe combined immunodeficiency mice. Mouse embryonic fibroblast condition medium containing 100 μg/L FGF was not sufficient to maintain the long-term proliferation of hESCs, and most of the cells differentiated and died after 4 passages. Alone with concentration 160 μg/LbFGF or more could maintain two hESC lines undifferentiated stably in vitro, has no influence on the differentiation and totipotency of two cell lines.

Objective:To investigate the sleep quality and relative factors of the people aged 18years or over in Tianjin Municipality.Methods:The participants came from the Tianjin Mental Health Survey conducted from Ju-ly to December in 2011.Total of 11618 residents aged 18 years or over were selected randomly among the general population and finished the Pittsburgh Sleep Quality Index (PSQI)for assessment of sleep quality and General Health Questionnaire (GHQ-12)for screening out the individual with possible mental disorders.The PSQI total score >7 was defined as poor sleep quality.Chi-square test and Wilcoxon rank sum test was used to conduct univa-riable analysis,and logistic regression was used to analyze the related factors to poorer sleep quality.Results:In this sample,980 people had poorer sleep quality,with the adjusted prevalence rate in Tianjin was 6.6%.Logistic regres-sion analysis showed risk factors to poorer sleep quality were female (OR =1.47,95%CI:1.19 -1.82),older age (30 -39 years old,40 -49 years old,50 -59 years old,60 -69 years old,70 years or older,OR =1.72(95%CI:1.10 -2.69),2.55(95%CI:1.66 -3.91),4.41 (95%CI:2.85 -6.83),5.34(95%CI:3.32 -8.59),5.40(95%CI:3.21 -9.08),at his/her own expense on medicare (OR =1.52,95%CI:1.15 -2.00),unemployment (OR =1.46,95%CI:1.05 -2.03)or retirement (OR =1.45,95%CI:1.02 -2.06),smoking (OR =1.49,95%CI:1.22-1.83),difficulty to engage in daily work or activities due to physical illness (OR =2.30,95%CI:1.85 -2.85), and GHQ -12 score ≥ 4 (OR =6.51,95%CI:5.46 -7.46).Conclusion:Although the prevalence rate of poorer sleep quality in the people aged 18 years or over in Tianjin is lower,the problem is common and should not to be ignored.

Objective:To establish the HPLC fingerprint of Cassia leschenaultiana from different regions. Methods: The column was SinoChrom ODS-BP (250 mm × 4. 6 mm, 5 μm). The mobile phase consisted of acetonitrile-0. 1% phosphoric acid with gradient elution. The flow rate was 1. 0 ml·min-1 , the detection wavelength was 285 nm, the column temperature was 25℃, and the injection volume was 10 μl. Results: The fingerprint consisted of 13 common peaks. The range of similarity for ten batches of Cassia le-schenaultiana was 0. 839-0. 998. And the reference fingerprint of Cassia leschenaultiana was established by HPLC. Conclusion: The fingerprint method is simple and reproducible, which can provide basis for the quality control and the medicinal resources exploration.

Objective:To study the chemical constituents in the seed of Cassia leschenaultiana.Methods: The compounds were separated and purified by column chromatography , thin-layer chromatography and recrystallization .The structures were identified by the physicoche mical identification and spectral analysis .Results:Seven compounds were isolated from the seeds of Cassia leschenaultiana and identified as 1-desmethylchryso-obtusin (Ⅰ) , aurantio-obtusin (Ⅱ) , ale-emodin (Ⅲ) , obtusin (Ⅳ) , chryso-obtusin (Ⅴ) , ob-tusifoline(Ⅵ)and aurantio-obtusin(Ⅶ).Conclusion:All of the compounds are isolated from the seeds of Cassia leschenaultiana for the first time.

Objective To explore the effect and lung function of the budesonide combined with montelukast for treatment of chronic obstructive pulmonary disease(COPD)and the effect on serum IL-6,IL-8 and TNF-α.Methods 120 patients with COPD in our hospital from April 2012 to December 2013 were randomly divided into observation group and control group (n =60 ).Observation group was given budesonide combined with montelukast on the basis of general routine treatment and control group was given budesonide on the basis of general routine treatment.The lung function and the level of IL-6、IL-8 and TNF-αin serum were detected berore and after treatment.Results The efficacy in observation group was significantly better than that in control group(P<0.05).The forced vital capacity(FVC),forced expiratory volume in one second(FEV1),maximal mid expiratory flow(MMEF),and peak expiratory flow(PEF)in the observation group were significantly higher than those in the control group(P<0.05 ).In addition, after treatment the levels of IL-6,IL-8 and TNF-αexpression in serum of the observation group and control group were significantly lower than before treatment,but the levels of the observation group after treatment was significantly lower than the control group,the difference were statistically significant (P<0.05).Conclusion The efficacy of the budesonide combined with montelukast for treatment of COPD is exact by reducing cytokine release, controling airway inflammation to improve the lung function.It is worthy to be popularized.

Objective To investigate the serum therapeutic concentration of tramadol during intravenous analgesia for postoperative pain relief. Methods Twenty adult patients ASA Ⅰ-Ⅱ (10 male, 10 female) undergoing elective radical operation for cancer of stomach were treated with intravenous tramadol for postoperative pain relief. Patients addicted to any drug or tolerant to opioid and patients with epilepsy or liver and/or renal dysfunction were excluded. All patients were premedicated with intramuscular phenobarbital 0.1g and atropine 0.5mg. Anesthesia was induced with midazolam 0. 1mg/kg and fentanyl 5 μg/kg and intubation was facilitated with vecuronium 0.16mg/kg. Anesthesia was maintained with continuous intravenous infusion of propofol 4-6 mg@ kg 1 @ h 1, fentanyl 2-3 μg@ kg-1 @ h-1 and vecuronium 0.1mg@ kg-1@ h-1 combined with inhalation of 1% isoflurane. After surgery in ICU when patients felt slight pain (VAS 1-2), intravenous tramadol 1.5mg/kg was given as initial dose. Whenever patients felt slight pain (VAS 1-2) again, a bolus of tramadol 20 mg was given intravenously every 10 min until VAS was 0. The onset time (from the end of iv injection of initial dose of tramadol to VAS 0), the duration of action (from VAS 0 to VAS 1-2) and the time when accumulated dose of tramadol amounted to twice the initial dose were recorded. HR, MAP, respiratory rate (RR) and SpO2 were monitored and recorded before and 10, 20, 30 min after administration of tramadol. Venous blood samples were taken before each additional tramadol administration on demand for determination of serum tramadol concentration by high performance liquid chromatography. Results The mean serum therapeutic level of tramadol during period of analgesia was (370±148)ng/ml(248.6-615.7ng/ml). The mean onset time of the initial dose was (9.2± 2.1 )min. The mean duration of action was (2.3 ± 1.0)h. The time when accumulated dose of tramadol amounted to twice the initial dose was (6.4 ± 2.7)h on average. There were no significant changes in HR,MAP, RR and SpO2 after tramadol. Conclusions It is safe and effective to give intravenous tramadol for postoperative pain relief. Serum therapeutic concentration of tramadol varies greatly from patient to patient,so the dose of tramadol should be individulized.[Key Words] Pain, postoperative; Tramadol; Plasma concentration; Injections, intravenous

Objective To investigate the clinical and characteristic imaging findings of intracranial gliosarcoma. Methods The imaging findings of surgery and pathology proved intracranial gliosarcoma in 15 cases were retrospectively analyzed. There were 10 males and 5 females, ranging in age from 44 to 67 years (mean age 58 years). Results All tumors were located in supratentorium, including 13 cases in the temporal or parietal lobe, 1 cases in the occipital lobe, and 1 cases in the thalamus. Tumors appeared as round or ellipse in shape. The lesions ranged in size from 3 to 9 cm (mean 4.6 cm). CT scan showed mingled hypo and isodensity in 7, hypodense in 4 with CT value from 18 to 22 HU, hyperdense in 4 with the CT value from 48 to 55 HU. Enhancement appeared as an irregular pattern. The margin was clear. Most intracranial gliosarcoma showed perifocal edema. MRI were examined in 6 cases, whichappeared as low signal on T 1WI, and as high signal on T 2WI. There was irregular enhancement of the mass. Conclusion It was difficult to make the correct preoperative diagnosis for gliosarcoma, but it was possible to make a tendency diagnosis using CT or MR combined with the history. Contrast enhanced CT and MRI should be useful in differentiating gliosarcoma from glioblastoma.

Objective To investigate the effect of GABAB receptor in spinal cord by detecting semi-quantitatively the mRNA for isoforms of GABAB receptor in a chronic neuropathic pain model. Methods Twenty-four male SD rats weighing 200-250g were anesthetized with intraperitoneal pentobarbital. Lamina of L5 vertebra and superior articular process of L6 were removed and posterior root of left L5 spinal nerve was exposed and tightly ligated with 7/0 atraumatic suture. The animals were randomly divided into 4 groups of 6 animals in each group: group A in which animals were observed for 7 days after sham operation; group B in which animals were observed for 7 days after ligation of posterior root of L5 spinal nerve; in group C animals were observed for 14 days after sham operation and in group D animals were observed for 14 days after ligation. Pain threshold was measured by heat stimulation of bilateral hindlimbs before and on the 1st , 3rd , 7th , 10th and 14th day after operation. Lumbar spinal cord was removed on the 7th or 14th day after operation and mRNA for isoforms of GABAB receptor in the spinal cord was detected semi-quantitatively by digoxin hybridization in situ.Results Pain threshold of left hindlimb (ligated side) was significantly lower than that of right hindlimb on the 7th, 10th and 14th day after operation as measured by heat stimulation. There were less mRNA for three isoforms of GABAB receptor in group B and D as compared with group A and C respectively. Conclusion The gene expression of three isoforms of GABAB receptor in the spinal cord has plasticity and is reduced during chronic neuropathic pain.

In this article, we observed the serum level of Prolactin and the intensity of renal insufficiency in 40 patients with renal failure and compared their relationship. Our study showed that the serum level of Prolactin in patients with renal failure was much higher than that of normal controls (P