Towards the problems after the medical reform of China,such as dramatic increase of healthcare expenditure and conflict between doctor and patient,this paper analyzes the tripartite relationships between hospital,insurance supplier and patient from the theoretical and practical aspects,concludes that the non-balanced development of the current relationships is an important reason of the problems,and gives the corresponding countermeasures for reference.

Objective To investigate the role of 15 kinds of growth regulatory factors in the pathogenesis of benign prostatic hyperplasia (BPH). Methods 15 kinds of growth regulatory factors involving cell proliferation and apoptosis were studied by immunohistochemistry with computer assisted quantitative image analysis.The mean percent area densities of stroma,epithelium and glandular lumen in BPH were examined by quantitative image analysis. Results Positive relations were found bewteen expressions of basic fibroblast growth factor (bFGF),transforming growth factor ?, fibronectin, type Ⅳ collagen and proportions of stroma (r=0.323?0.278?0.235?0.241,P

Hepatocellular carcinoma is a common malignant tumor, which has a poor prognosis and a high mortality rate. Under the influence of respiratory motion, the position error of liver cancer is relatively high. The image-guided radiotherapy is a combination of radiotherapy and imaging device, which can detect and correct the error caused by the movement of the organs and the position of the pendulum to improve the accuracy of radiotherapy.

The use of tyrosine kinase inhibitor imatinib in treatment of gastrointestinal stromal tumors(GISTs)has achieved a dramatic therapeutic efficacy. However,secondary imatinib resistance emerged as a clinical problem needs to be solved urgently. The underlying mechanisms of GISTs secondary resistance to imatinib may be related with secondary mutations of KIT/ PDGFRA genes,loss of PTEN gene and induction of cellular quiescence. This resulted in the adoption of new therapeutic strategies such as novel tyrosine kinase inhibitors,combined use of imatinib with downstream signaling inhibitors,KIT/ PDGFRA independent targeted inhibitors such as KIT chaperone inhibitors and aurora kinase inhibitors,as well as inducing apoptosis in quiescent GIST cells. In this article,the above-mentioned issues were summarized.

ObjectiveTo investigate the clinical efficacy of focused ultrasound for treating non-neoplastic epithelial disorders of vulvar. Methods212 patients with non-neoplastic epithelial disorders of vulvar were treated with focused ultrasound. The patients were followed up after the treatment,and symptom was observed and the efficacy was evaluated. ResultsThe efficacy of non - neoplastic epithelial disorders of vulvar of squamous hyperplasia,lichen sclerosus and mixed dystrophy was 99.2％, 100. 0％, 88.9％ respectively, the difference was not significat (P ＞ 0.05 ). The efficacy in different courses of patients was 100.0％ ( ＜ 2 years), 100.0％ (2 ～10 years) ,91.3％( ＞ 10 years) respectively,the difference was not significat( P ＞ 0.05). ConclusionFocused ultrasound was obviously effective in the treatment of patients with non-neoplastic epithelial disorders of vulvar.

Objective To study the organizational commitment and influencing factors of clinical nurses at tertiary hospital in Shenzhen. Methods 347 clinical nurses from a tertiary hospital were select-ed by stratified random sampling and investigated and analyzed for organizational commitment with ques-tionnaires. Results Total score for organizational commitment of clinical nurses was (60.45±9.99),in which, from the highest to the lowest, the scores for five aspects were normative commitment (14.49±2.97), affective commitment (13.50±3.57), ideal commitment (11.69±3.20), economic commitment (11.27±3.23), opportunity commitment (9.50±3.30),respectively, their influencing factors included age, nursing age, mari-tal status, professional tide. Conclusions The organizational commitment of clinical nurses is at higher-middle level, their influencing factors are multi-dimensional, demographic characteristics have different im-pact on five aspects of organizational commitment.

Objective To study the relationship between resting heart rate(RHR)and essential hypertension(EH).Methods 215 patients with EH and 82 healthy subjects underwent RHR detection.The relationship between RHR and the state of EH was analyzed.Results RHR in EH group was significantly higher than that in normal group[(78.9±9.1)bpm vs(69.5±10.9)bpm,P＜0.01)],RHR in different stages of EH was significantly different(F=21.280,P＜0.01,respectively),and increased with grades(P＜0.05 orP＜0.01).RHR in EH patients complicated with left ventricle hypertrophy(LVH)was higher than those with no LVH[(83.9±9.1)bpm vs (75.9±8.9)bpm,P＜0.01].There was positive correlation between RHR and LVH(r=0.8097,P＜0.01).Conclusion RHR is related to the development and progress of EH,and it may be one of the index for estimating the state of EH.

Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.

Objective To investigate the effect of pregnancy on the potency of bupivacaine for spinal anesthesia in rats. Methods Female non-pregnant SD rats weighing 180-220 g and 17 day pregnant SD rats weighing 350-400 g were used in this study. The rats ( 18 non-pregnant, 18 pregnant) in which PE-10 catheter were successfully placed without complications were selected. The 18 non-pregnant rats were randomly divided into 3 groups (n =6 each): control group (group C), 2% bupivacaine group (group B2 ) and 4% bupivacaine group (group B4). The 18 pregnant rats were also randomly divided into 3 groups (n = 6 each): control group (group PC),2% bupivacaine group (group PB2 ) and 4% bupivacaine group (group PB4 ). Group C and PC received intrathecal (IT) normal saline 30 μl, and the other 4 groups received 2% or 4% bupivacaine 30 μl intrathecally. Analgesia was determined using the taifllick latency (TFL) before IT administration (baseline), and at 10 min, 20 min,30 min, 1 h, 2 h, 4 h, 1 d, 2 d, 3 d and 4 d after IT administtation. The percentage of the maximal possible effect (MPE) was calculated. Hind-limb motor function (MF) was also assessed. Results Compared with the baseline value, MPE at 10 min-2 h after administration and MF scores at 10 min-1 h after administration were significantly increased in group B2, MPE at 10 min-4 h after administration and MF scores at 10 min-1 h after administration were significantly increased in group B4;MPE at 10 min-1 d after administration and MF scores at 10 min2 h were significantly increased in group PB2 and MPE at 10 min-1 d after administration and MF scores at 10 min4 h were significantly increased in group PB4 ( P ＜ 0.05 ). Conclusion Pregnancy can enhance the potency of bupivacaine for spinal anesthesia in rats.

Objective To discuss the impact of nursing intervention on self- care ability and health behavior of cancer patients with indwelling PICC in order to improve their life. Methods 218 cases of cancer patients with PICC catheter were randomly divided into the intervention group (107 patients)and the control group (111 patients),the control group were treated with conventional care, the intervention group was treated with targeted cognitive intervention by the PICC nurse specialists on the basis of conventional care. Interventions included improving health knowledge, self-concept, self-care responsibility and self-care skills in four areas, the intervention lasted 3 months. A questionnaire survey was conducted before and after intervention. Self-care skills and health behavior levels were compared between the two groups. Results Self-care skills and health behavior levels of the intervention group were significantly higher thanthose of the control group after intervention. Conclusions Targeted interventions can effectively improve the self-care capacity of outpatient oncology patients with PICC catheter and improve their health behaviors.