Objective:To investigate the microsurgical anatomy of the far lateral suboccipital approach and to evaluate its application to surgical approach. Methods:Fourteen cadaveric heads(28 sides) were dissected through far lateral suboccipital approach to obtain the anatomical data of this approach.A retrospective analysis of microsurgical treatment in 12 cases of tumors situated at lower clivus and foramen magnum was performed. Results:Transverse process of C_1 and inferior occipital trangle were important anatomical marks in the far lateral occipital approach.Drilling the condyle and jugular tubercle was benefit to expand the surgical space.Total removal of the turmors was achieved in 9 patients,subtotal removal in 3 patients,and without any surgical morbidity. Conclusion:Study on the microsurgical anatomy of the far lateral suboccipital approach was helpful in resecting tumors situated at lower clivus and foramen magnum.

Objective To investigate the role and mechanism of simvastatin on colonic fibrosis in rats with 2,4,6-trinitrobenzene sulphonic acid (TNBS) induced colitis.Methods Forty-eight healthy male Sprague-Dawley rats were evenly divided into six groups:control group,TNBS group,simvastatin treated group Ⅰ,group Ⅱ (from zero to 21 days after modeling,simvastatin 5 mg/kg or simvastatin 20 mg/kg treated),group Ⅲ and group Ⅳ (from seven to 21 days after modeling,simvastatin 5 mg/kg or 20 mg/kg treated).Body weight and disease activity index (DAI) of the rats were inspected,and general colon,histological injury and fibrosis were scored.The expressions of collagen types Ⅰ and connective tissue growth factor (CTGF) at mRNA level were detected by reverse transcription-polymerase chain reaction (RT-PCR).The expressions of collagen types Ⅰ,CTGF and phosphorylation of myosin phosphatase target subunit-1 (p-MYPT-1) at protein level were determined by Western blotting.The data were analyzed by one-way ANOVA.Results Compared with control group,the colon length shortened,while colon weight,DAI score,general colon score,histological injury and fibrosis score significantly increased in TNBS group.And the expressions of collagen types Ⅰ also obviously increased.After intervention of simvastatin,both the colon length and weight of rats were improved.The DAI score,general score,histological injury and fibrosis score were lower than those of TNBS group.The expressions of collagen types Ⅰ,CTGF and p-MYPT-1 (group Ⅰ:0.68±0.22 ; group Ⅱ:0.59 ± 0.27 ; group Ⅲ:0.71 ± 0.20 ; group Ⅳ:0.59± 0.25) in colonic tissue were all lower than those of TNBS group (F=5.169,P＜0.05).There were no statistical significance among four groups (al1 P＞0.05).Conclusion Simvastatin can effectively prevent TNBS-induced rat colitis from colonic fibrosis,the mechanism may be related with Rho-kinase inhibition and down-regulation of CTGF over-expression.

Objective To explore the curative effect of the operation of double wedge osteotomy of the first metatarsal for correction of severe hallux valgus.Methods The data of 62 patients (87 feet) with severe hallux valgus caused by enlarged distal metatarsal articular angle (DMAA) who were followed up after receiving the treatment of double wedge osteotomy of the first metatarsal from January 2008 to December 2011 were analyzed retrospectively.There are 9 males (14 feet),and 53 females (73 feet),with an average age of 56 years (range,28-70 years).Preoperative radiographs showed hallux valgus angle (HVA) was 48.6° in average,intermetatarsal angle (IMA) was 19.8° in average,and DMAA was 22.1° in avcragc.Thc opcration plan was made based on the preoperative deformity,and the osteotomy site,the angle,the capacity of osteotomy was all based on preoperative measurement.Compare the changes of HVA,IMA,DMAA before and after operation.The changes were also compared before and after the internal fixation extraction.The curative effect was observation based on American Orthopaedic Foot and Ankle Society (AOFAS) propodium score standard.Results Sixty-two patients (87 feet) were followed up for 10 to 57 months,with an average of 21 months.HVA (14.6°±1.2°),IMA (7.9°±0.7°),DMAA (7.7°±0.9°) were all satisfied 6 months after the operation.Stiff occurred in 2 patients after the operation.Cutaneous nerve injury occurred in 2 patients,and metastatic metatarsalgia occurred in 1 patient.No sever recurrence of deformity,bone nonunion and bone necrosis was found in all the patients.AOFAS score reached 91.8±1.8 one year after the operation,which was 28.4±9.1 preoperatively.Among them,49 feet were rated as excellent,31 as good,and 7 as fair.The excellent and good rate was 92％ (80/87).Conclusion The first metatarsal double osteotomy can effectively correct the severe hallux valgus deformity with enlarged DMAA with few complications.It achieves good effect.Patients can bear part of the loading in the early stage of recovery after operation.

Objective To analyze allocation of health resources and utilization of health services,and evaluate the equity of health resources allocation and health services utilization.Methods Concentration curve and concentration index(CI)were used to evaluate the equity of health resources allocation in terms of health professionals,hospital beds,medical institutions,outpatient visits and hospitalizations in China.Results The CI for health professionals,hospital beds,and medical institutions is 0.038,-0.012,and-0.116 respectively.That for outpatient visits and hospitalizations is 0.111 and -0.023 respectively.Conclusion Health resources allocation in hospital beds and health professionals is fair,while the equity of medical institutions and outpatient service utilization needs to be improved.

Objective To evaluate the efficiency of health resources allocation of 31 provinces,autonomous regions and cities in China in 2011,identify the causes for low allocation efficiency and provide suggestions accordingly.Methods By ways of literature research and data envelopment analysis.Results The average efficiency value of these provinces and cities was 0.973.The health resources allocation of 18 provinces and cities were found efficient in general,and that of the other provinces and cities were found non-efficient.They respectively account for 58.1 ％and 41.9％.Conclusion To improve the efficiency of health resources allocation of the 13 provinces and cities,their policymakers should increase government funding support,attract private capital into medical institutions,optimize health investment scale,improve medical management and foster medical and health personnel development.

Multidrug resistance (MDR) remains the major obstacle to the success of clinical cancer chemotherapy. P-glycoprotein (P-gp), encoded by the MDR1, is an important part with complex mechanisms associated with the MDR. In order to overcome the MDR of tumors, we in the present experimental design incorporated small interfering RNA (siRNA) targeting MDR1 gene and anticancer drug paclitaxel (PTX) into the solid lipid nanoparticles (SLNs) to achieve the combinational therapeutic effects of genetherapy and chemotherapy. In this study, siRNA-PTX-SLNs were successfully prepared. The cytotoxicity of blank SLNs and siRNA-PTX-SLNs in MCF-7 cells and MCF-7/ADR cells were detected by MTT; and the uptake efficiency of PTX in MCF-7/ADR cells were detected via HPLC method; quantitative real-time PCR and flow cytometry were performed to investigate the silencing effect of siRNA-PTX- SLNs on MDR1 gene in MCF-7/ADR cells. The results showed that PTX loaded SLNs could significantly inhibit the growth of tumor cells, and more importantly, the MDR tumor cells treated with siRNA-PTX-SLNs showed the lowest viability. HPLC study showed that SLNs could enhance the cellular uptake for PTX. Meanwhile, siRNA delivered by SLNs significantly decreased the P-gp expression in MDR tumor cells, thus increased the cellular accumulation of rhodamine123 as a P-gp substrate. In conclusion, the MDR1 gene could be silenced by siRNA-PTX-SLNs, which could promote the growth inhibition efficiency of PTX on tumor cells, leading to synergetic effect on MDR tumor therapy.
ATP Binding Cassette Transporter, Sub-Family B ; genetics ; Antineoplastic Agents ; pharmacology ; Breast Neoplasms ; pathology ; Drug Delivery Systems ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Humans ; Lipids ; chemistry ; MCF-7 Cells ; drug effects ; Nanoparticles ; chemistry ; Paclitaxel ; pharmacology ; RNA, Small Interfering ; pharmacology ; Real-Time Polymerase Chain Reaction

The voltage-gated potassium channels Kvl.5 is widely expressed in the plasma membranes of numerous tumor cells and it can contribute to a variety of cellular functions such as proliferation,ap optosis,and cell cycle.Several types of antineoplastic drugs can change the expression of Kv1.5 and then affect the biological processes.Kv1.5 is identified as a novel target for therapy in human cancer.The researches of Kv1.5 will contribute to gain a further understanding of the molecular mechanism of tumor and provide therapeutic opportunity for the prevention and treatment of cancer.

Objective For an analysis and evaluation of the technical efficiency of tertiary hospitals in Tianjin.Methods Data Envelopment Analysis of different combinations of indicators and Spearman Rank Correlation Analysis were used for a study of the relative efficiency between 28 tertiary hospitals and the correlation between the indictors.Results The study showed that 12 hospitals reached DEA efficient,effective rate of 42.86%,and there is a correlation between the five sets of indicators. Conclusion Regulators of Tianjin hospitals should pay attention to efficiency calculations,make full use of medical resources,strengthen scientific management,and enhance the competitiveness of the hospital.

Objective To probe into the varying efficiency of public hospitals and recommend on efficiency improvement.Methods By means of DEA method including CCR model,BCC model and Malmquist index,to study the static and dynamic changes of operating efficiency of hospitals in Tianjin from 2008 to 2012.Results The overall efficiency of these 24 hospitals is not high,and the efficiency of the tertiary hospitals (0.900)is higher than the second-level hospitals(0.828).There exist problems that the size of the second-level hospitals is either too big or too small,a lot of health resources can be saved by managing the non-DEA efficient hospitals.The trends of the total factor productivity of 24 hospitals in Tianjin from 2008 to 2012 are increased.Thanks to the advanced technology and innovation, the overall efficiency of tertiary hospitals is improved.Through improving organizational management level,the overall efficiency of second-level hospitals is improved.Conclusion Hospital managers should introduce the high-level medical workers,enhance technological innovation,improve and standardize the hospital management and service system,optimize the allocation of medical resources and select the appropriate size of the hospital with the hospital's own situation to improve the operating efficiency of the public hospitals.

Objective To assess the technical efficiency and subsystem technical efficiency of the healthcare institutions in China,including that of management system and medical system.Methods Panel data of 31 provinces' healthcare institutions were selected,and Network DEA was adopted to assess such input indicators as managerial staff and health technical personnel,and such output indicators as medical revenue and number of medical visits.Results The technical efficiency of healthcare institutions is as lower as an efficiency mean of 0.853 in five year.Provinces of Zhejiang,Shandong,Henan,Guangdong and Tibet have maintained a higher level.The healthcare system breaks down into two independent subsystems of the management subsystem and medical subsystem.The mean of the former one is 0.937,higher than 0.783 of the latter.The number of medical revenue and that of patients in the non-effective provinces were relatively inadequate.Conclusions Healthcare resources allocation in China needs to be optimized.It is imperative to adjust the input-output ratio,improve medical service quality via scientific management.