Objective To analyze implementation outcomes and obstacles of “treatment before payment” reform seen by medical institutions' managers,along with an optimal strategy proposed.Methods Quantitative survey and qualitative interviews were called into play,and the data so acquired are subject to evaluation of the radar chart and fishbone diagram analysis to learn the implementation outcomes and obstacles.Results The reform proves workable at hospitals of county and lower levels,achieving win-win for the people,hospitals and government.Obstacles found include poor allocation of designated funds for risk coverage,insufficient circulating funds in advance,poor risk aversion mechanism,and poor preparation for tertiary hospitals.Conclusion It is recommended to promote awareness of the reform,enhance inter-department cooperation,improve hospital information systems,clarify the screening standards of “purposely evasion offenders”,standardize the issuance and use of the NRCMS certificates,and better build the credit system of the society.

Objective To assess the efficacy,side effects and perinatal outcome of nifedipine compared with other antihypertensives for treating severe preeclampsia in pregnant women. Methods Randomized controlled trials (RCTs) that comparing nifedipine with other antihypertensives for severe preeclampsia were searched in PubMed,EMBase,Cochrane library,CNKI and VIP database etc( till January 2012).The quality of the included RCTs was evaluated,and Meta-analvsis was performed with Rev Man 5.1software.Results Nine trials were included,involving 386 women in the nifedipine group,and 378 women in other antihypertensives group.Compared with other antihypertensives,nifidepine was associated with greater effective control of blood pressure ( OR =2.65,95％ CI:1.65 -4.25,P ＜0.01 ).There was no clear difference in the time needed to control blood pressure ( W.M D =- 3.64,95％ CI:- 10.90 - 3.61,P =0.32 ).Nifedipine could prolong gestation better than other antihypertensives ( WMD =5.14,95％ CI:3.29-6.99,P ＜0.01 ).There were no clear differences in maternal side effects headache (P =0.28),palpitation ( P =0.06 ),and nausea vomiting ( P =0.28 ).No noticeable difference was found between the two groups in the Apgar score at five minutes ( WMD =- 0.21,95％ CI:- 0.32 - 0.91,P =0.72),neonatal respiratory distress syndrome ( OR =1.24,95％ CI:0.57 - 2.67,P =0.59 ),or perinatal deaths ( OR =0.49,95％ CI:0.22 - 1.11,P =0.09 ).Conclusion Nifedipine is associated with greater effective control of blood pressure and prolongation of gestation,with no additional neonatal respiratory distress syndrome or perinatal deaths,compared with other antihypertensives for women with severe preeclampsia.

Objective To study the effects of a miRNA family member,let-7e,on the LPS-induced expression of TNF-α in primary monocytes and the possible mechanism.Methods Peripheral blood mononuclear cells (PBMCs) were isolated form human blood sample by using density gradient centrifugation for further isolation of primary monocytes.Flow cytometry analysis was used to measure the purity of isolated primary monocytes.The efficiencies of transfection were evaluated by qRT-PCR and immunofluorescence assay after transfecting the primary monocytes with let-7e mimic or miRNA mimic negative control (NC) for 24 h,36 h and 48 h.To screen out the optimal stimulation time,ELISA was performed to detect the concentrations of TNF-α in the supernatants of cell culture after stimulating the primary monocytes with 1 mg/L of LPS for 0 h,1 h,3 h,6 h and 12 h,respectively.ELISA and qRT-PCR were used to measure the expression of TNF-α in the transfected cells with the interference of LPS.Western blot assay was used to detect the level of enhancer of zeste homolog 2 (EZH2) in let-7e mimic-transfected primary monocytes and the levels of NF-κB p65,ADP-ribosylation factor GTPase-activating protein 1 (ARFGAP1) and Arfaptin2 in the siEZH2-transfected monocytes.Results More than 70％ of the isolated cells were CD14+ cells.The miRNA mimics could transfect the primary monocytes effectively and the transfection rate was about 70％.High levels of let7e were detected in let-7e mimic-transfected primary monocytes 24 hours after the transfection.High levels of TNF-α were observed in the primary monocytes after stimulated with LPS for 12 h,which was considered as the optimal LPS stimulation time.Results of the ELISA indicated that let-7e mimic significantly inhibited the LPS-induced expression of TNF-α in primary monocytes at both mRNA and protein levels.Western blot assay showed that the levels of EZH2 in the let-7e mimic transfected primary monocytes were significantly lower than that in mimic NC transfected primary monocytes.Silenced expression of EZH2 significantly inhibited the expression of NF-κB p65 in nucleus as well as the expression of ARFGAP1 and Arfaptin2.Conclusion let-7e mimic significantly inhibited the LPS-induced expression of TNF-α in primary monocytes.It is possible that Let-7e regulates the expression of NF-κB p65,ARFGAP1 and Arfaptin2 by targeting EZH2 directly to inhibit the expression of TNF-α.

Objective To explore the pathological changes of lung, expression of the relevant inflammatory factors and oxidative stress markers of Sprague-Dawley (SD) rats undergoing autologous orthotopic liver transplantation (AOLT). Methods Thirty SD rats were randomized into sham group and AOLT group. The pathological changes of lung, expression of the relevant inflammatory mediators and oxidative stress markers were detected . Results ( 1 ) Compared with the sham group , the pathological scores of lung tissue in AOLT group increased significantly and reached its peak at 8 h after surgery. Then the pathological scores decreased to the level of sham within 24 h to 48 h after surgery; (2)The relative expression of inflammatory mediators including TNF-α, IL-1β, IL-6 and IL-8 increased significantly and reached its peak at 8 h after surgery in AOLT group. Then decreased to the level of sham group within 24 h to 48 h after surgery; (3)The change trends of MDA and H2O2 were similar to inflammatory mediators.The relative SOD expression decreased significantly and touched the nadir at 8h after surgery and then increased. Conclusion The pathological changes of lung expression, the relevant inflammatory mediators and oxidative stress markers of rats underwent AOLT were consistent.

Objective To study the effect of Chinese medicine combined with large dose interferon in the postoperative adjuvant therapy of malignant melanoma of the skin.Methods A high dose of interferon alpha-2b (GanLeneng) (1200 IU/per day) was used in 20 cases of malignant melanoma of skin for 7 days.One course of treatment was 3 months,8 consecutive courses of treatment and traditional Chinese medicine (0.25 g) were administered 1 hour before meals,2 times a day,taking three weeks per month.Results One patient in 20 cases of patients did not receive timely treatment and resulted in death.The remaining patients were were still live from 2012 to the present.Local and distant metastasis lesions disappeared during the course of treatment.Conclusions Traditional Chinese medicine combined with high-dose interferon in cutaneous malignant melanoma as adjuvant treatment plays an important role.

Objective To analyze influencing factors of physicians' turnover intention at public county hospitals from career stage perspective.Methods Physicians career life was divided into three stages according to professional ranks and titles.The sample was drawn using stratified multistage random methods from public county hospitals in Shandong province and 677 questionnaires were completed,giving a 90.3％ valid response rate.Data were analyzed using multi-group stepwise linear regression.Results The percentage of responders with middle and high-level turnover intention was 23.0％and 6.5％ respectively,and there was no statistically significant difference in turnover intention across three stage subgroups.In physicians at stage 1,the most important factors to predict turnover intention were superiors ' appreciation (r =-0.22,P ＜ 0.05) and payment rationality (r =-0.21,P＜0.05),while in physicians at stage 2,the most important predicting factors were autonomy (r=-0.39,P＜0.05)and learning demand(r=-0.22,P＜0.05),and in physicians at stage 3 were career development(r=-0.31,P＜0.05)and autonomy(r=-0.21,P＜0.05).Conclusion Autonomy and workload are common factors of turnover intention with different predicting power across three career stages.Physicians adjust their career needs to self-actualization with development of career stage,so welltargeted incentives should be taken to stabilize the medical staff of public county hospitals.

Marburg virus (MARV) is a lethal virus that causes fatal hemorrhagic fever.It belongs to the Filoviridae family which also includes Ebola virus.MARV is similar to Ebola virus in structure and infection mechanism.Moreover,the diseases caused by them have similar clinical symptoms.However,researches on MARV are less than those on Ebola virus.In this review,we focus on the viral structure,especially the structure of MARV glycoprotein (GP) which determines its infectivity,functions of MARV GP as well as protective antibodies and vaccines against this protein.

Objective To investigate the effects of a miRNA family member, let-7e, and a combi-nation of miR-106b and miR-20a on the expression of cytokines by THP-1 cells with Luminex xMAP technol-ogy.Methods The efficiency of transfection was evaluated by immunofluorescence assay after transfecting THP-1 cells with micrONTM mimic negative control (Cy3) for 24 h, 36 h and 48 h.The three miRNA mim-ics (let-7e, miR-106b and miR-20a) were respectively used to transfect the THP-1 cells for 24 h, 36 h and 48 h and the expression of each miRNA was analyzed by qRT-PCR analysis for screening out the optimal transfection time.The transfected THP-1 cells were stimulated with1 mg/L of LPS for 1 h.The Luminex xMAP technology was used to detect the expression of IL-8, interferon-inducible protein-10 (IP-10), mono-cyte chemotactic protein 1 (MCP-1), IL-1α, IL-6, IL-10, TNF-α, IFN-αand IFN-βin the supernatants of cell culture.A statistical analysis was performed to analyze the data obtained by using SPSS16.0 software. Results More than 90% of the transfected THP-1 cells were labeled with red fluorescence.The optimal transfection times for let-7e mimic and miR-106b/miR-20a mimics were 48 h and 24 h, respectively.Com-pared with the corresponding negative control (NC), the expression of IL-8, IP-10 and MCP-1 by THP-1 cells were enhanced after the transfection with let-7e mimic, but were inhibited after the co-transfection with miR-106b and miR-20a mimics.Conclusion The expression of IL-8, IP-10 and MCP-1 were enhanced in let-7e transfected THP-1 cells, but were inhibited in miR-106b and miR-20a co-transfected THP-1 cells.

Objective To explore the clinical characteristics and rehabilitation of apraxia with unilateral neglect after corpus callosum in-farction. Methods A case of apraxia with unilateral neglect after corpus callosum infarction was discussed. Results After rehabilitation, the apraxia and unilateral neglect were improved. Conclusion For similar cases, rehabilitation can significantly improve the symptoms and ac-tivities of daily living.

Objective To study the protective role of pre-resolving mediator lipoxin A4(LXA4) in the NA+ -K+-ATPase in alveolar type Ⅱ (AT Ⅱ ) epithelial cells of rats exposed to lipopolysaccharide (LPS). Method The AT Ⅱ cells were isolated and purified, and divided randomly into control group (PBS), vehiculum (alcohol 0.7 μL/mL) group, LPS (1 μg/mL) group, LXA4(1/10 mol/mL) group and LPS (1 μg/mL LPS) + LXA4(1/10 mol/mL) group. After exposure to LPS and/or LXA4 for4 hours, NA+-K+ -ATPase and β1-subunits mRNA in AT Ⅱ epithelial cells were detected by using RT-PCR, and ATP, ADP, AMP, total adenine nucleotides (TAN) and energy charge (EC) were measured by using high performance liquid chromatography (HPLC), and then the activities of Na+-K+-ATPase were calculated accordingly. Results The NA+-K+-ATPase α-subunit and β-subunit mRNA were significantly decreased in LPS group ( P ＜ 0.05 vs. control group). However, the expressions of NA+ -K+-ATPase mRNA were significantly enhanced by application of LXA4 to AT Ⅱ epithelial cells exposed to LPS (P ＜0.05 vs. LPS group). The activities of NA+ -K+ -ATPase were enhanced in LPS group (P ＜0.05 vs. control group). Compared with control group and LPS group, the activities of NA+-K+-ATpase in LPS + LXA4 group were significantly increased (P ＜0.01 vs. control group; P ＜0.05 vs. LPS group). The EC of AT Ⅱ epithelial cells were higher in LPS group ( P ＜ 0.01 vs. control group). There were no significant differences in EC between control group and LPS + LXA4group(P ＞0.05). Conclusions The pro-resolving mediator LXA4 can enhance the expressions of NA + -K + -ATPase α-subunit and β-subunit mRNA, and the activities of NA + -K + -ATPase in AT Ⅱ epithelial cells or rats exposed to LPS, and ca also balance the metabolism of AT Ⅱ epithelial cells. These findings suggest that LXA4 plays an important role in lung edema clearance in lung injury induced by endotoxin, and the role is likely associated with the enhancement of the expressions of Na+ -K+ -AT-Pase α-subunit and β-subunit, and the activities of Na+ -K* -ATPase, maintaining the balance of metabolism of AT Ⅱ epithelial cells.