The policy of“licensed doctors'multi-site clinical practice” aims to provide patients with a better access to quali-ty medical and health resources.Patient's understanding and support indicates the executive condition of the implementation of the pol-icy and it can also promote the implementation of the policy to a certain extant .In this study , the questionnaire survey and statistical tools were used to investigate the differences in their attitudes to the policy .

Analysis of patient satisfaction , as the supplement and improvement of the traditional medical quality assessment , has great significance for improving the quality of medical services , reducing the medical disputes and building a harmonious doctor -patient relationship .Based on the connotation of patient satisfaction , the patient satisfaction theory at home and abroad were introduced , providing a guide meaning for establishing a rational evalua-tion system and scientifically managing hospital service .

BACKGROUND: Due to the source of conspecific heart transplanted organ is limited and it becomes more and more deficient, and porcine cardiovascular system and haemodynamics are very similar to that of human being, therefore, domestic and foreign scholars have paid more attention on the heterogeneic heart transplantation from swine to human, and there are more and more basic studies about it.OBJECTIVE: To compare the zero-stress state of ascending aorta and pulmonary artery trunk between swine of different months and healthy persons, which provides necessary vascular tissue reconstruction basis for anastomosing vessel of heterogeneic heart transplantation from swine to human being.DESIGN: Open experiment.SETTING: Laboratory of Biomechanics, Yunyang Medical College.MATERIALS: This experiment was carried out at the Laboratory of Biomechanics, Yunyang Medical College from October 2001 to September 2002. Human heart specimens were chosen from 6 male adult corpses who had no visible manifestation of cardiovascular diseases, aged 18 to 30 years. Informed consents were obtained from all the relatives. Totally 42 conspecific swine, aged one month, were also chosen and divided into 7 groups, named as 1,2,3,4,5,6 and ＞ 6 months groups respectively, with 6 in each group. Swine were anesthetized at 1,2,3,4,5,6,＞ 6 months respectively and sacrificed in each group.METHODS: The corresponding ascending aorta and pulmonary artery trunk were dissected and isolated. Each arterial anterior wall was labeled in situ with coloring pen, and then artery was shifted into the oxygen-saturated Kreb's solution. Five isometric vascular rings were divided along the axial direction, then each vascular ring was cut open along the radial direction. Opening angle of each vascular ring at zerostress state was measured and recorded by computer 20 minutes later(The included angel formed through connecting the middle point of inner wall of open vascular plane and two end points of inner wall). The experiment was conducted at room temperature 20-30 ℃. All the procedures of vascular samples were performed within 24 hours after subjects died.MAIN OUTCOME MEASURES: Measuring results of opening angle of ascending aorta and pulmonary trunk at zero-stress state of swine at different months and human being.RESULTS: ①Comparison of measuring results of opening angle of ascending aorta and pulmonary trunk between swine at different months and human being: Opening angle of ascending aorta of human being increased from (100.4±12.8)°at proximal end to (152.8±18.6)°at distal end. Opening angle of swine at different months increased from about 68°at proximal end to about 130°at distal end; Opening angel of pulmonary artery trunk of human being did not changed significantly along axial direction, and opening angel of pulmonary artery trunk of swine at different months increased from about 65° at proximal end to about 125°at distal end. There was significant difference of opening angle of ascending aorta and pulmonary trunk at zero-stress state between human being and swine (P=0.028 ＜ 0.05).But the opening angle of ascending aorta of human being was similar at the second segment to at the fourth and fifth segments of swine of different ages; Opening angle of each segment of pulmonary artery trunk of human being was close to that of proximal end (first and second segments) ofpulmonary artery trunk of swine.② Comparison of measuring results of ascending aorta and pulmonary artery trunk at zero-stress state of swine at different months: Opening angle of ascending aorta and pulmonary artery trunk of swine did not changed with the increase of age (P=-0.063 ＞ 0.05).CONCLUSION: Opening angels of ascending aorta and pulmonary artery trunk at zero-stress state are close in some segments between human being and swine, suggesting that corresponding ascending aorta or pulmonary artery trunk can mutually anastomose in some segments in the heterogeneic heart transplantation from swine to human, and the effect of age is not significant in vascular reconstruction.

Objective To investigate the effects of exercise on learning and memory after cerebral ischemia. Methods Ninety Sprague-Dawley rats were randomly divided into a sham-operated group, a model group and a treadmill training group ( n=30 for each) , which were further subdivided into groups to receive 7 days, 14 days or 28 days of training with 10 rats in each. The training was treadmill running at 10 m/min for 30 min a day. Cerebral ische-mia was induced in the model and training groups using permanent, bilateral common carotid artery occlusion. The training began three days after the operation. Morris water maze tests were used to measure the rats′ learning and memory ability, and Nissl staining was employed to detect the survival rates of pyramidal neurons in the CA1 area of the hippocampus. Results The average escape latency in the treadmill trained group had shortened significantly by day 7, then further by days 14 and 28. It was significantly shorter than the model group′s average at each time point. The average platform crossing time increased significantly compared with the model group′s average. Few dead neu-rons were observed in the sham-operated group. On days 14 and 28 the average survival rate of pyramidal neurons in the model group was significantly lower than in the treadmill training group or the sham-operated group, though there was no significant difference on day 7. Conclusion Treadmill training can improve learning and memory after cere-bral ischemia, at least in rats. Better effects can be observed after longer training.

In order to provide morphological data and theoretical basis for pig-to-human hepatic xenotransplantation, the difference in morphological parameters and vessel wall structural factors between human and porcine hepatic portal vein was studied. From human subjects and pigs of varying ages, hepatic portal veins were collected, paraffin-embedded and cut into sections. The histological structures were stained with HE, and elastin, collagen and smooth muscles were stained with Weigert, Aniline blue and orange G, respectively. Morphological parameters and relative contents of structural components were determined under microscopy and by computer image analysis system, respectively. The results showed that histological structures of human and porcine hepatic portal vein wall were similar. Caliber, wall thickness, lumen and wall area in pigs increased with age, all in linear correlation to months. Morphological parameters of 6- month-old pigs were similar to those of human. In pigs, collagen content increased gradually with months, elastin content remained relatively stable, smooth muscle content reached the peak at the 3rd month, and collagen/elastin (C/E) rose gradually. The contents of collagen and elastin in porcine hepatic portal vein wall were lower, while the content of smooth muscle was higher than in human, and C/E at the 5th and 6th month was similar to that in human. It is concluded that morphological parameters and contents of structural components of porcine hepatic portal vein vary with age. At the 6 month, its caliber, wall thickness, lumen and wall area are similar to those of human. There are differences in contents of structural components between human and pigs. However, in terms of C/E, mechanic properties of pigs at the 5th and 6th month mimic those of human, hence inosculation is viable in xenotrans-plantation between pigs and human.
Collagen/*analysis ; Elastin/*analysis ; Image Processing, Computer-Assisted ; Liver Transplantation ; Muscle, Smooth, Vascular/cytology ; Portal Vein/*anatomy & histology ; Portal Vein/chemistry ; Swine ; Transplantation, Heterologous

Objective To establish a semi-quantitative method for measurement of HCV RNA by use of primers and probe, which was sensitive and designed by ourselves, a new europium fluorescent chelate BHHCT. Methods 44 serum samples of HCV infected patients and 20 samples of the healthy people were collected. HCV RNA in serum sample was extracted by HCV fluorescence PCR diagnostic kit produced by Zhongshan University DAAN Gene Co Ltd, and amplified by RT-PCR in which one PCR primer was pre-labeled with biotin. The amplified products were hybridized with capture probes pre-fixed on the microplate. The biotin in the amplified products was conjugated with europium labeled streptavidin. So europium was linked to the target DNA. Then the fluorescent of europium was measured. Results The linear range of this assay was 10 - 10 copies/ml. Both sensitivity and specificity were 100%. Conclusion Europium labeled RT-PCR assay is a sensitive, specific, fast and non-radioactive contaminant method for the measurement of HCV RNA.

Objective To investigate the phenotype and function of CD8+T cells cultured with SK-OV-3. Methods Transwell coculture experiments were conducted in 24-well plates with inner wells to separate CD8+ T cells and SK-OV-3. After 5 days of culture, CD8+ T cells were washed, and 1 × 106 cells were collected for Foxp3, CD25, CD28, CTLA-4 and GITR mRNA analysis and 2 × 106 cells were collected to detect expression of Foxp3, CD25, CD28, CTLA-4 and GITR in CD8+ T cells by flow cytometry. CD8+T cells that cultured alone or with SK-OV-3 were added at ratios of 1∶0 , 1∶1 , 1∶5 , 1∶10 , and 0∶1 to na?ve CD4+ T cells in 96-well plates. All wells were cultured with the presence of irradiated PBMCs and anti-CD3 antibody. After 72 h, [3H]-thymidine was added for 16 h prior to the determination of proliferation by scintillation counting. Results Compared with CD8+ T cells cultured without SK-OV-3 , the expression of Foxp3 and CTLA-4 was increased and CD28 expression was decreased in CD8+ T cells cultured with SK-OV-3 (both P < 0.001). We found that CD8+T cells cultured with SK-OV-3 significantly suppressed the na?ve CD4+ T cell proliferation induced by the anti-CD3 stimulation in a dose-dependent manner. In contrast, CD8+ T cells cultured without SK-OV-3 did not suppress na?ve CD4+ T cell proliferation. Conclusion Ovarian cancer cell can induce the suppressive CD8+Treg, which is an important link of the immunosuppressive microenvironment in ovarian cancer.

Objective To investigate role of N-(30,40-dimethoxycinnamonyl) anthranilic acid (3,4-DAA) in mediating the negative immune regulation by indoleamine 2,3-dioxygenase in mice skin transplantation.Method The mice skin transplant model was established.T lymphocytes were isolated from mice splenocytes,and serum was collected.ELISA was applied to detect the IL-2 and IFN-γ concentrations in culture supernates of mice spleen lymphocytes and serum.Flow cytometry was applied to examine the phenotypes of T lymphocytes and RT-PCR to analyze the IDO mRNA transcription.Results T lymphocyte proliferation was significantly decreased by 3,4-DAA and the concentrations of IL-2 and IFN-γ were apparently decreased in 3,4-DAA group as compared with those in control group.The percentages of CD3 +,CD4 + and CD8 + T lymphocytes were lower,and the percentage of CD4 + CD25 + T lymphocytes was higher in 3,4-DAA disposal group than in control group,but there was no significant difference.IDO mRNA expression showed obvious increase in 3,4-DAA group as compared with control group.Conclusion 3,4-DAA can up-regulate the IDO expression to induce the increasing metabolism of tryptophan,subsequently inhibiting T cell proliferation and showing specific property of negative immune regulation.

Objective To assess the enhancement feature of intracranial atherosclerotic plaque in the vessel supplying the territory of infarction by using high-resolution MR imaging.To analyze the correlation between the degree of plaque enhancement , time elapsed and the concentration of hypersensitive C-reactive protein ( hs-CRP ).Methods The characteristics of vessel walls and intracranial vascular stenoses were retrospectively analyzed in 81 patients with ischemic strokes.All subjects were imaged with a traditional stroke MR protocol and HR-MRI scanning for plaque on a 3.0 T MRI scanner.According to the elapsed time between infarct and MR examination , all cases were classified into early stage (<4 weeks from acute stroke, n=58), middle stage (4-12 weeks, n=13) and late stage ( >12 weeks, n=10).The characteristics of vessel walls and degrees of enhancement of atherosclerotic plaques were assessed and the concentrations of hs-CRP in all patients were determined.The Kruskal-Wallis H test was used to compare the degree of enhancement and hs-CRP concentration among the early , middle and late stage.The concentration of hs-CRP was presented as median ( interquartile range ).The Spearman correlation was used to analyze the correlation between elapsed time , hs-CRP concentration and degree of enhancement.Results Fifty-five (55/81) plaques were located at the M1 segments, and the other 26 (26/81) plaques were at the basilar artery.The degree and presence of enhancement from strong to none were 29, 25 and 4 in the early stage;4, 6 and 3 in the middle stage and 0, 4, 6 in the late stage, respectively.The degree and presence of enhancement were significantly different among them (H=16.934,P<0.01).There was a remarkable trend of decreasing degree and presence of enhancement of the atherosclerotic plaque relative to increasing time after the ischemic event(r=-0.792,P<0.01).The serum hs-CRP concentration for early, middle and late stage were 7.0(3.0, 13.0), 2.27(1.0, 3.03) and 1.88(0.50, 4.0)mg/L (H=14.345,P<0.01) , respectively.There was a trend of decreasing hs-CRP concentration relative to the time elapsed ( r =-0.357,P<0.01).The degrees of enhancement of the plaques were parallel to the levels of hs -CRP( r=0.526,P<0.01).Conclusions Enhanced HR-MRI scanning may clearly demonstrate the enhancement characteristics of intracranial atherosclerotic plaques as an indicator of inflammation.It might play an important role to detect risk factors for intracranial plaque rupture and subsequent acute ischemic stroke .

Objective To investigate the efficacy of high frequency jet ventilation via the nasopha?ryngeal catheter in assissting ventilation in patients with obstructive sleep apnea hypopnea syndrome ( OS?AHS) undergoing gastroscopy. Methods Eighty patients with OSAHS of both sexes, aged 40-64 yr, weighing 65-99 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with an apnea?hy?popnea index 20-40 events∕h, scheduled for elective painless gastroscopy, were divided into control group and test group using a random number table, with 40 patients in each group. In control group, a nasopha?ryngeal catheter 6.0-7.0 mm in internal diameter was inserted, and oxygen was inhaled at 4 L∕min through the catheter. In test group, a nasopharyngeal catheter 4.0 mm in internal diameter was inserted, and a high frequency jet ventilator was connected ( inspiratory∕expiratory ratio 1. 0 ∶ 1. 5, frequency 150 bpm, peak pressure 0.4 kPa, tidal volume 180 ml) . Anesthesia was maintained with propofol in both groups. The oc?currence of hypoxemia during ventilation, and peak value of partial pressure of end?tidal CO2 before induc?tion of anesthesia and during ventilation, and occurrence of chin lift, mask ventilation, and epistaxis after insertion of the catheter during operation were recorded. Results Compared with control group, the inci?dence of hypoxemia, peak value of partial pressure of end?tidal CO2 during ventilation, and incidence of chin lift, mask ventilation and epistaxis during operation were significantly decreased in test group ( P<0.05) . Conclusion High frequency jet ventilation via the nasopharyngeal catheter can be safely and effec?tively used to assisst ventilation in patients with OSAHS undergoing gastroscopy.