Firstly,this article introduces the background and detailed content about the New health care reform of the United States.Then it describes the basic principles of these reforms and the problems to be solved,putting forward author's own speculative viewpoints to these health care reforms.Finally,it list the reference to New health care reform of our country.

Acupuncture Therapy ; Bloodletting ; Combined Modality Therapy ; Humans ; Male ; Middle Aged ; Pigmentation Disorders ; therapy

Objective: To investigate the cultural and psychological adaptation of business expatriates in the Chinese mainland. Methods: The questionnaires included sociocultural adaptation questionnaire and psychological adaptation questionnaire. Results: The construct of sociocultural adaptation could be divided into three dimensions: living conditions, interaction and communication, and cognition and value system. The sociocultural adaptation pattern showed a double-U-curve and the psychological adaptation pattern showed a decreasing tendency by time. There was no significant discrepancy in sociocultural adaptation across cultural distance. Conclusion: The cultural and psychological adaptation is difficult for business expatriates in China. The reasons perhaps include insufficient cultural training and improper training time.

Objective: To explore the effects of 17 β-estrogen (E2) and 2-methoxyestradiol (2ME) on hypoxic induced factor-1α (HIF-1α) and alkane hydroxylase (AlkB) in experimental rats with ovariectomy and hypoxic pulmonary hypertension. Methods: A total of 60 healthy female SD rats with castrated surgery were randomly divided into 6 groups:①Routine oxygen group,②Routine oxygen + E2 group, the rats received subcutaneous injection of E2 (20 μg/kg?d),③Routine oxygen + 2ME group, the rats received 2ME (240 μg/kg?d) and④Hypoxia group,⑤Hypoxia + E2 group,⑥Hypoxia + 2ME group.n=10 in each group and all animals were treated for 8 weeks to establish the hypoxic pulmonary hypertension model. The mean pulmonary artery pressure (mPAP) was measured after bloodletting, right ventricle hypertrophy index (RVHI) was calculated and small pulmonary artery remodeling was observed by HE staining. The expression level of HIF-1α and AlkB were examined by RT-PCR and Western blot analysis. Results: Compared with Routine oxygen group, the rats in Hypoxia group had obviously thickened small pulmonary artery wall with narrowed lumen, increased mPAP and RVHI; the above changes in Hypoxia + E2 and Hypoxia + 2ME groups were relatively smaller, their mPAP and RVHI were higher than Routine oxygen group, while mPAP and RVHI were similar between Hypoxia + E2 and Hypoxia + 2ME groups. There were no real morphological changes in small pulmonary vessels in Routine oxygen + E2 and Routine oxygen + 2ME groups. The HIF-1α expression was obviously elevated in Hypoxia group than Routine oxygen group, while the elevation was less in Hypoxia + E2 and Hypoxia + 2ME groups. HIF-1α expression had no real changes in Routine oxygen+E2 and Routine oxygen + 2ME groups. The AlkB expression was obviously reduced in Hypoxia group than Routine oxygen group, while the reduction was less in Hypoxia + E2 and Hypoxia + 2ME groups. AlkB expression had no real changes in Routine oxygen + E2 and Routine oxygen + 2ME groups. Conclusion: Estradiol E2 and 2ME could remit pulmonary hypertension which might be via up-regulating AlkB expression and down-regulating HIF-1α expression in experimental rats with hypoxic pulmonary hypertension.

Objective To compare the clinical effects of four kinds of gingival retraction technique in treat-ment of anterior teeth restoration.Methods 169 patients for 352 teeth with tooth body and tooth dentition defect by anterior crown bridge repair were chosen and divided into 4 group by patients'order,including A group(88cases)with single track method,B group(91cases)with single line for two times method,C group(89cases)with double line method and D group(94cases)with double line for two times method.And the fixed restoration satisfaction rate of anterior teeth of both groups was compared.Results The satisfaction rates of gums,shoulder,impression,model and restoration of A group were 73.9%,70.1%,69.3%,65.9%,61.4% respectively,which of B group were 83.5%, 80.2%,80.2%,80.2%,76.9%;which of C group were 84.3%,80.9%,78.7%,77.5%,76.4%;which of D group were 94.6%,93.6%,92.6%,92.6%,90.4%.There were no significant differences in the fixed restoration satisfaction rate of anterior teeth between B group and C group(χ2 =2.43,1.17,2.85,3.04,2.30,all P >0.05). The fixed restoration satisfaction rate of anterior teeth of D group were significantly better than A,B and C groups (χ2 =14.90,16.39,15.83,19.87,21.38,all P <0.05 ).Conclusion Double line for two times method in the treatment of anterior teeth restoration can efficiently avoid ree gingival damage in the situation with abutment shoulder preparation,improve the quality of preparation,impression and model,and are helpful to higher the fitness of the neck of anterior teeth fixed restorations.

Objective: To detect tumor cells in the peripheral blood of patients with breast cancer by usingthe MAGE-A1 and MAGE-A3 genes as specific tumor markers. Methods: Peripheral blood was obtained from 40 patients with breast cancer and 20 patients with benign diseases. The mRNA of the MAGE-A1 and MAGE-A3 genes in the peripheral blood mononuclear cells (PBMC) was detected by nested RT-PCR. The MAGE-A1 and MAGE-A3 transcripts in breast cancer were detected by RT-PCR. Results: Of the 40 breast cancer patients, MAGE-A1 and MAGE-A3 mRNA were positive in 12.5% (5/40)and 17.5%(7/40)of PBMC, respectively, and in 15.0 %(6/40)and 22.5 %(9/40)of breast cancer tissues, respectively. In the PBMC of the 40 breast cancer patients, 10(25.0%)samples were detected to express at least one type of MAGE mRNA. MAGE mRNA were not detected in the PBMC from the patients whose tumors did not express the MAGE genes, nor in the PBMC from the 20 patients with benign diseases. The positive rate of MAGE mRNA in the PBMC was closely correlated with the TNM stages. Conclusion: MAGE-A1 and MAGE-A3 mRNA could be specifically detected in the PBMCof breast cancer patients by our methods. They may be used as specific tumor markers for the detection of the circulating breast cancer cells.

Objective To compare the effects of three different plasma substitutes, 6% hydroxyethyl starch (HES 200/0.5), 4% Gelofusine and 5% Polygeline, on blood coagulation and arterial blood gases and electrolytes during acute hypervolemic hemodilution (AHHD) . Methods Seventy ASA Ⅰ - Ⅱ adult patients undergoing elective orthopedic surgery with the intraoperative blood loss predicted to exceed 500 ml were entered in this study. Radial artery was cannulated for BP monitoring and blood sampling before induction of anesthesia. Anesthesia was induced with fentanyl 3 ?g?kg-1, propofol 2 mg?kg-1 and atracurium 0.5 mg? kg-1 and maintained with enflurane (1-2 MAC) . The patients were mechanically ventilated ( VT= 10 ml? kg-1 , RR = 12 bpm) after tracheal intubation. Internal jugular vein was cannulated after induction of anesthesia for CVP monitoring. After induction of anesthesia the patients were randomized to receive 20 ml?kg-1 of either 6% HES (group H, n = 20), 4% Gelofusine (group G, n = 20), 5% Polygeline (group P, n = 20) or lactated Ringer's solution (group R, n = 10) within 20-40 min. Arterial blood samples were taken before AHHD, at the end of and 30 min after the infusion of substitute for determination of activated coagulation time (ACT), thromboelastography (TEG) , blood gas analysis and plasma electrolytes. Blood volume expansion rate was calculated [ blood volume expansion rate = (Hct before AHHD - Hct after AHHD) / Hct before AHHD] .Results The four groups were comparable with respect to sex, age and body weight. Lactated Ringer' s solution was significantly less efficient in expanding intravascular blood volume than the 3 plasma substitutes, but there was no significant difference in blood volume expansion rate among group H, G and P. CVP increased significantly after AHHD compared with the baseline value before AHHD in group H, G and P (P

ObjectiveTo observe the treatment effect of seveve acute pancreatitis (SAP) with gabexate combined with Xuebijing after local infusion. MethodsForty-four patients with SAP were randomly divided into receiving intravenous gabexate or Xuebijing alone (control group) group and receiving local infusion with gabexate combined with Xuebijing( experimental group) group. At 1,7,14 days of testing in diamine oxidase (DAO), lipopolysaccharide, IL-18, TNF-α, APACHE- Ⅱ score, T lymphocyte subpopulation and monocyte HLA-DR expression and single change in the number of nuclear cells were tested. ResultsBetween two patients groups at 1,7,14 days diamine oxidase, lipopolysaccharide, IL-18, TNF-α, APACHE-Ⅱ score showed a downward trend; T suppressor cells (Ts) reduced in their percentage; total T lymphocytes, T helper cell (Th), monocyte HLA-DR expression (percentage) and mononuclear cells showed an upward trend in the experimental group than control group, the differences being statistically significant (P ＜ 0.05). In the experimental group and control group, the pain relief time, intestinal function recovery time, the withdrawal of ventilator time, the incidence of sepsis, the rate of conversion to open surgery were statistically significant different (P ＜ 0.05 ). Conclusions Compared with intravenous drug use alone the implementation of gabexate combined with Xuebijing local infusion can reduce the early course of SAP patients intestinal permeability and reduce endotoxin translocation, protect intestinal barrier function of patients with SAP, improve the patients' immune function, symptoms, signs and reduce the rate of sepsis and transit operations.

Objective To investigate the regulation of parathyroid hormone(1-34) on mRNA expression of osteoclast inhibitory lectin (OCIL) gene in UMR106 osteoblastic-like cells and involved signaling pathway.Methods Rat UMR106 osteoblastic-like cells were cultured and treated with various concentration of PTH(1-34) and specific agonists or inhibitors of PKA,PKC,Ca2+/calmodulin-dependent protein kinase (CaMK) and mitogen-activated protein kinase (MAPK) signal pathways for indicated time intervals.Then the cells were gathered at indicated time points and total RNA were extracted.OCIL mRNA expression was analyzed using real-time PCR technique.Results PTH(1-34) stimulated OCIL mRNA expression in a time-and dose-dependentmanner.A dose of 10 nmol/L PTH(1-34) started to induce OCIL mRNA from 6 h,with a highest increase of about 2.8-fold vs.control group (without PTH treatment) at 24 h.The up-regulation of OCIL mRNA began and reached maximum later than RANKL induction and OPG suppression effected by PTH(1-34).Protein Kinase A (PKA) signaling activators forskolin(FSK) and dibutyryl cAMP (db-cAMP),as well as calcium ionophore A23187 all up-regulated OCIL mRNA with the maximal induction of about 4.2-fold,4.5-fold and 5.1-fold.Protein Kinase C (PKC) activator phorbol-12-myristate-13-acetate(PMA) reduced OCIL mRNA expression at the early stage(2-6 h),with the highest down-regulation of 50％ at 6 h.However,the inhibitory effect on OCIL mRNA turned into slightly stimulatory effect later (24 h).PKA inhibitor KT5720,calmodulin antagonist W-7,CaMK Ⅱ inhibitor KN-62 and mitogen-activated protein kinase (MAPK) inhibitor PD98059 all blocked PTH(1-34)-induced OCIL mRNA expression by the maximal reduction of 56％,61％,63％ and 50％ respectively.There also exist cross-talks between different signal pathways.MAPK inhibitor PD98059 blocked the expression of OCIL mRNA which was stimulated by PKA activators FSK or db-cAMP,with the reduction of 98％ and 63％ respectively,while the OCIL mRNA expression stimulated by A23187 remained unaffected.Conclusion PTH(1-34) increased OCIL mRNA expression in vitro through cAMP/PKA,Ca2+/CaMK and MAPK signaling pathways.

Humans ; Nasal Cavity ; pathology ; Nasal Obstruction ; diagnosis ; Nasal Polyps ; diagnosis ; Turbinates