To discuss background of Medicare hospital payment system reform in the U.S., its legislative and administrative system and the key issues incurred during the design and implementation process, then summarized the experiences and lessons and suggestions were proposed for current provider payment reforms in China.

Objective To optimize the conditions for enhancing the refolding of a novel recombinant human(rh)endostatin and test the biological activities of refolded endostatin.Methods The partial purified inclusion bodies of rh-endostatin were dissolved with 6 mol/L guanidine-HCl followed by combination of dilution and dialysis of the dissolved endostatin.The refolded endostatin was then purified by cation-exchange chromatography.The biological activities of purified rh-endostatin were assessed by endostatin-specific monoclonal antibody and chick embryo chorioallantoic membrane assay.Results A 46% refolding yield was achieved after optimizing the refolding conditions.The purified endostatin reacted with specific anti-endostatin monoclonal antibody and showed significant inhibition of angiogenesis in chick embryo ehorioallantoic membrane assay.Conclusion The method of highest refolding yield of human endostatin was developed.This optimized method significantly promotes the application of this novel human endostatin to preclinical and clinical studies.

CD36 is involved not only in the metabolism of lipids,but also in the inflammatory reaction,in the formation of foam cells and in the pathogenesis of atherosclerosis.Monocyte/macrophage CD36 has been shown to play a critical role in the development of atherosclerotic lesions by its capacity to bind and en-docytose oxidized low density lipoproteins(oxLDL),and it is implicated in the formation of foam cells.CD36 expression and regulation mechanism already provides a new understanding and the relevant drug research has attracted more attention of scholars.This article is to carefully review the importance of CD36 as an essential component in the pathogenesis of atherosclerosis.

Objective To investigate the relationship between the doses of epidural morphine administered for postoperative analgesia and postoperative urinary retention (POUR). Methods Sixty ASA Ⅰ patients aged < 20-56 yr undergoing atthroscopic knee operation under epidural anesthesia were randomly divided into 3 groups ( n = 20 each) : group Ⅰ and Ⅱ received epidural morphine 1 and 3 mg in 5 ml of normal saline (NS) respectively at the end of operation (group M1, M2 ); group Ⅲ received NS 5 ml instead of morphine (group C). Urinary retention was defined as the patient could not void, when bladder volume was ≥ 600 ml measured using ultrasound. Bladder urine volume was measured before anesthesia and at 4, 6, 8, 10 and 12 h after operation. The occurrence of urinary retention, the first postoperative voiding time, VAS scores and the incidences of vomiting and pruritus were recorded. Results The 3 groups were comparable with respect to age, M/F sex ratio, preoperative bladder urine volume, the amount of local anesthetic used during operation and duration. The incidences of urinary retention, vomiting and pruritus were 65%, 60% and 90% respectively in group M2 and significantly higher than those in the other 2 groups. The first postoperative voiding time was significantly longer in group M2 than in the other 2 groups. VAS scores were significantly lower in group M1 and M2 than in group C. There was no significant difference in VAS scores between group M1 and M2. Conclusion Epidural morphine increases the incidence of POUR in a dose-dependent manner, and 1 mg is the recommended dose.

We collected the medical data of conscription physical examination from a certain county,Shandong Province,in August 2013.A cohort of 711 young males aged from 17 to 24 years were included.Among them,231 cases were diagnosed with varicocele (VC) with a prevalence of 32.49％ (231/ 711).Its grades were Ⅰ ° VC(n =5,2.2％),Ⅱ ° VC (n =165,71.4％) and Ⅲ° VC(n =54,23.4％).And 7 cases (3.0％) had surgical intervention.Our reported prevalence was significantly higher than that in the literature.Further researches are waranteed.

Objective To review the recent studies on the multidrug resistance of breast cancer. Methods The literatures of recent years on the studies of multidrug resistance, multidrug resistance protein and breast cancer resistance protein were reviewed. Results Multidrug resistance resulted from multiple factors. How to identify the sensibility of chemotherapy drugs and select individual therapeutic regime early were important to improve the survival rate and life quality of breast cancer patients.Conclusion These studies on multidrug resistance of breast cancer are helpful to predicting the effect and outcome of chemotherapy and overcoming the barrier of drug resistance.

Objective To determine the investigation progression on exemestane in the treatment of breast cancer. Methods The literatures of recent years on the studies of exemestane were reviewed. Results Exemestane is an effective steroidal aromatase inactivator with superior tolerability, safety and efficacy in the adjuvant, neo-adjuvant and metastatic therapy of breast cancer. Conclusion With the progression of clinical trial with exmestane, exemestane will be regarded as an important drug in comprehensive therapy of breast cancer.

Objective To describe the diagnosis and preoperation evaluation of pancreatic carcinoma with spiral CT three-phase contrastenhanced scan and post-processing.Methods Three-phase helical CT enhanced scan and post-processing images of 41 patients with pancreatic carcinoma were retrospectively analyzed,including the location,size,characteristic of tumor and peripancreatic blood vessels,the results were compared with that of surgery.Results Low degree of enhancement of pancreatic carcinoma in pancreatic phase was showed compared with parenchymal phase.There was significant difference in density between focus and normal pancreas,the lesions were showed clearly.In comparison with surgical results,the diagnostic accuracy of CT was 80.7% and the accurate rate in evaluating the metastasis was 75.8%.Conclusion Three-phase helical CT enhanced scan and postprocessing are of great value in diagnosis of pancreatic carcinoma and it is helpful in choosing the treatment program preoperatively and assessing the respectability of tumors.

Nowadays,family detergent has become necessary content in families,a great deal of detergent,specifically,chemical synthesis detergent is used and goes into water and pollutes the water and severely affects aquatic creatures.The active component of family detergent is linear alkylbenzenesulfonate(LAS).Recently,family detergent is emphasized for its toxicity and pollution.This paper summarized the status of toxicity and pollution of family detergent.

OBJECTIVE:To facilitate a high performance operation of drug supply chain so as to provide satisfactory service for patients,the common terminal customers.METHODS:The principle of customer demand driven in drug supply chain and the significance of customer demand driven in drug supply chain management as well as the role hospitals played in the practice of the customer demand driven-based drug supply chain management were analyzed and qualitatively described.RESULTS & CONCLUSIONS:In the environment of buyers' market of drugs,as the terminal customers' envoy plenipotentiary and the best valuable clients in the drug market,hospitals play a key role in back driving drug supply chain's high performance operation.