Objective: To rationally reduce the fees and improve the development of large public hospitals. Methods: Analyze the relationship among the fees, hospital economic activity and medical treatment price mechanism in large public hospitals based on resource dependence theory. Results: Price control can not effectively control the costs. Conclusion: Medical price mechanism reform should in the direction of medical system reform, avoid the “quantity success” in large public hospitals, strive for patients with basic medical health institutions; then it should adequately embodies the value of technical work value of medical project and stimulates the initiative of the doctor.

The present paper reviewed the recent researches on the toxicity and health effect of phthalate in the following four aspects: animal toxicology, population epidemiology, people exposure, and safety standard, moreover, some critical problems which should be studied as soon as possible were proposed.

ObjectiveTo introduce a rapid and stable rat model of middle cerebral artery occlusion (MCAO). Methods32 Wistar male rats were used to induce focal cerebral ischemia according to Longa's method. The main difference from Longa's was to introduce a nylon suture into the cervical internal carotid artery without ligation the pterygopalatine artery (PPA). Regional cerebral blood flow (rCBF), neurological deficit, brain water content, red tetrzolium (TTC) stain and pathology were evaluated in all rats.ResultsThe operation proceeded about 15 min after anaesthesia. Rats after operation presented severe neurological deficits companied with rCBF decreases. There were significant increases of brain water contents in ischemic brain regions. TTC staining showed infarct areas and histological examinations revealed remarkable astrocyte swelling and neuronal necrosis.ConclusionInducing rat MCAO without ligation of PPA could produce reliable ischemic changes,with the advantage of shortening operation time.

Objective To evaluate the significance of the treatment of intra- and extra- hepatic recurrent stones through the subcutaneous jejunal loop. Methods The authors respectively analyzed 24 cases of intra- or extra- hepatic recurrent stones and/or acute cholangitis treated through the subcutaneous jejunal loop from January 1989 to January 2003. Results Of the 24 cases, 10 cases (18 times) of acute cholangitis received drainage through the subcutaneous jejunal loop and their symptoms relieved (18/18); 14 cases (17 times) of recurrent intra- and extra- hepatic stones received selective drainage placement through the subcutaneous jejunal loop. The extra- or intra- hepatic stones were removed under choledochoscope through the subcutaneous jejunal loop, the stone clearance rate being 79.2% (19/24). Conclusions It is a convenient, minimally invasive, and effective method to treat intra- and extra- hepatic recurrent stones through the subcutaneous jejunal loop.

The projections from the nuclei of the brain stem to the cerebellar nuclei were studied with the horse-radish peroxidase (HRP) retrograde transport method. The following nuclei in the brain stem were labelled with HRP;the inferior olivary nucleus, the lateral reticular nucleus, the nucleus reticularis tegmenti pontis, the pontine nuclei, the spinal trigeminal nucleus, the principal sensory trigeminal nucleus, the mesencephalic nucleus of trigeminal nerve, the spinal vestibular nucleus, the medial vestibular nucleus, the nucleus reticularis medullae .oblongatae pars ventralis, the nucleus reticularis gigantocellularis, the nucleus reticularis paramedianus, the raphe nucleus pontis, the raphe nucleus obscurus, the raphe nucleus magnus, the perihypoglossal nucleus, the locus caeruleus, the gracile nucleus, the cuneate nucleus, and the external cuneate nucleus.It was found that there are different patterns for the cerebellar nuclei to receive the afferent fibers from the brain stem. The number of the labelled nuclei of the brain stem projecting to the cerebellar lateral nucleus is similar to that projecting to the interpositate nucleus, while the number of the labelled brain stem nuclei projecting to the cerebellar fastigial nucleus is smaller than the above two. The topographic organization of the projections from the inferior olivary nucleus to the cerebellar nuclei was discussed.

Objective To explore rational and effective treatment strategies by comparing long-term effects of different treatment methods for hepatolithiasis. Methods One hundred and fifty-nine cases of hepatolithiasis treated in this hospital from January 1993 to December 2002 were analyzed retrospectively.Five treatment methods: conservative treatment,choledocholithotomy followed by choledochostomy,hepatolobectomy,hepaticojejunostomy,and hepaticoplasty with the conservation of the Oddi's sphincter,were compared in respect of postoperative complications and long-term outcomes.Results Out of the 159 cases,follow-up was completed in 146 cases(91.8%,146/159) for 2~12 years(median,7 years).Of 16 cases of conservative treatment,15 were followed.Cholangitis occurred in all the 15 cases,with 1 fatal case.Of 47 cases of extrahepatic surgical exploration,the incidence of residual stones was 100%.Follow-up in 43 cases found 32 cases of cholangitis(74.4%) with 7 fatal cases.Of 16 cases of hepatolobectomy,residual stones were noted in 3 cases(12.5%).Follow-up in 15 cases found 4 cases of cholangitis(26.7%) with 1 fatal case.Of 32 cases of hepaticojejunostomy,residual stones were found in 11 cases(34.4%).Follow-up in 29 cases found 14 cases of cholangitis(48.3%) with 3 fatal cases.Of 48 cases of sphincter-sparing operation,residual stones were found in 8 cases(16.7%).Follow-up in 44 cases found 7 cases of cholangitis(15.9%).The incidence of residual stones was significantly higher in cases of extrahepatic surgical exploration than in cases of other treatment(P=0.000).The recurrence rate of cholangitis was significantly higher in cases of conservative treatment and extrahepatic surgical exploration than in cases of other treatment(P

Objective To study kidney transplantation in the aged and its perioperative management. Methods Scrutinized screening of heart,lung and liver were carried out before renal transplantation for 29 patients,aged 65～84.Color Doppler B type ultrasonic inspection was used to determine the status of arteriae iliaca externa and arteriae iliaca interna.Tissue match included HLA and PRA measurement.Warm ischemia time of donor kidney was within 5 minutes and cold ischemia time 10 hours.The dose of MP was under 2.0 g during the period of operation and the immunosuppressive regimen was CsA or FK506+MMF+Pred.The general condition,blood electrolytes,whole blood CsA or FK506 concentration and immune index were monitored. Results There were 4 cases of AR,1 cases of FK506 toxicity and 1 case of lung infection.All these 6 patients were cured.1 kidney graft was removed because of thrombogenesis of renal artery.Up to now,the other 28 have been surviving with the graft functioning well for 1 to 5 years. Conclusions Abide to the indications of kidney transplantation,donor kidney of good quality and well tissue match were important in the elderly patients.With comprehensive monitoring and adequate management,kidney transplant in old patients can achieve sa tisfying outcome.Rational application of immunosuppressants and effective long term follow up are major factors for long term allograft survival.

Objective To explore the preliminary experience of combined liver-kidney transplantation.Methods Twelve patients were subjected to combined liver-kidney transplantation. The orthotopic liver transplantation was preceded with the classic fashion in 8 patients and the piggyback fashion in 4 patients. The pump-driven veuovenoas bypass technique was not used. And then the kidney transplantation was performed under stable homodynamic circumstance. The renal graft was implanted to the right iliac fossa routinely. The renal vein was anastomosed to the external iliac rein end-to-side, and the renal artery to the external iliac artery end-to-side or the hypogastric artery end-to-end. After operation, anti-CD25 monoclonal antibody or antithymocyte globulin (ATG), tacrolimus (FK506), mycophenolate mofetil and prednisone were used to prevent the allograft rejection.Results The survival rate of the 12 cases receiving combined liver-kidney transplantation was 100 %, and the graft function was restored well postoperation. An acute rejection episode of liver occurred in one patient. The FK506 toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pneumonia occurred in one case and the peritoneal infection in one patient. No patient experienced any episode of acute rejection of renal allograft.Conclusions The combined liver-kidney transplantation is the ideal option of patients with end-stage liver disease with chronic renal failure.

[Objective] This study was to investigate the effect of TMP on function of EPCs in normal or hydrogen peroxide(H2O2)inducing injury model cell culture,and to approach a therapy to coronary heart disease(CHD).[Method] Total mononuclear cells were isolated from the cord blood by ficoll density gradient centrifugation,cultured in vitro.After the cells cultured for 7 days,identified them by cellmarkers and the ability of intaking the ac-LDL,and made sure they were EPCs.To divide the cells into three groups,TMP(5,25,100,200mg),H2O2(500??)model and TMP together with H2O2,cultured for 24h and then detected the function and apoptosis of EPCs.[Result] Versus to control group,the TMP(5,25,100mg)groups had no important effect on the proliferation and adhesion of EPCs,but TMP(200mg)group had negative effect on EPCs.Versus to H2O2 model group,TMP(5,25,100mg)preincubated groups had important protective effect on EPCs in proliferation,adhesion and apoptosis.[Conclusion] TMP could protect EPCs from oxidative stress injury,but had little benefit to EPCs in normal incubation.

3)between theventral divison of the middle part and the other parts of the locus coeruleus.Theneurons of the locus coeruleus were mainly medium-sized(59.25%),the smaller andlarger ones were observed in 33.75% and 7% respectively.