As an important policy, the multiple-site physician practice system is expected to promote the flow of physicians and optimize the distribution of health resources, though it is difficult to enforce in practice. From the perspective of institutional change, the fundamental reason lies in path dependence existing in system, organization and mindset:First, the government regulation system has a strong inertia to restrict the flow of physicians, and the multiple-site physician practice lacks the unity of legitimacy and rationality. Secondly, fierce competition between hospitals and the distribution pattern of rights and responsibilities between hospital and physician cause the hospitals to oppose multiple-site physician practices. Third, the stability tendency in mind and the desires for profit restrain the flow of physicians. Therefore, the institutional change of the multiple-site physician practice requires improvements in three aspects:the innovation of government systems to unlock the multiple-site physician practice must be accelerated to realize the unity of legitimacy and rationality;a change is needed in the operation logic of hospitals to control the profit incentives and management of practices by contract;the thought-pattern of physicians must be changed to con-front the proper demand for interests and build innovative incentive mechanisms.

Specific activation of toll-Like Receptor 9 (TLR9) by ligand CpG DNA/ODN can initiate downstream signaling.The activation of TLR9 signaling is regulated by Granulin,high-mobility group box-1 (HMGB1) and soluble TLR9.Interestingly,TLR9 is no longer only presented in the immune cells,but also expressed in many kinds of tumor cells.TLR9 is involved inmaintaining and promoting the malignant biological behaviors of tumor cells.Elucidation of the function of TLR9 inherent signaling pathways in the tumor cells will provide a novel idea for oncotherapy.

OBJECTIVE:To determine the concentration of dehydroisoandrosterone sulfate (DHEAS) in human plasma by LC-MS.METHODS:With estrogen sulfate (ES) served as an internal standard,the plasma samples were deproteinized with acetonitrile,extracted by solid phase,hydrolyzed and derivatized.Then the concentration of DHEAS was determined by HPLC-MSD on Agilent SB C18 with column temperature kept at 40℃.The mobile phase consisted of acetonitrile-water (in gradient elution).Atmosphere pressure chemical ion source in negative ion detection model was employed.The ions selected for SIM (selected ion monitoring) quantitative analysis included m/z 490.0 (DHEAS ) and m/z 472.1(ES)[M-H]-.RESULTS:The linear range of DHEAS was 250.0～320.0 ng?mL-1(r=0.999 4).The extraction recovery of the simulated human albumin samples ranged from 71.1%～78.9% and its relative recovery ranged from 98.3%～101.4%.Both the intra-day RSD and inter-day RSD were less than 10%.The mean concentration of DHEAS in 15 health aged male volunteers was (981.6?353.4) ng?mL-1.CONCLUSION:The method is simple,practical,accurate and sensitive,and it is applicable for the determination of plasma concentration of DHEAS.

ObjectiveTo investigate the gene expression of Chk1 gene in cerebrum after brain ischemia-reperfusion,trying to provide evidence to elucidatethe molecular mechanism of brain injury. MethodsEighty-five male Wistar rats were divided into 3 groups. Group Ⅰ served as normal control. In group Ⅱ (non-ischemia group) animals underwent the whole experimental procedures except the occlusion of the bilateral vertebro-arteries and common carotid arteries. In group Ⅲ(ischemiareperfusion group) animals were further divided into 3 subgroups according to the duration of ischemia: 10min, 30min and 60min. Each subgroup was again further divided based on the duration of reperfusion: 30min, 2h and 6h. The cerebrum was immediately removed from rats after complete brain ischemiareperfusion. The RNA was isolated and the reverse-transcription-polymerase chain reaction (RT-PCR) was carried out . The cDNA was analyzed by automatic system and the parameters were assessed to define the status of Chk1 mRNA expression in different ischemia and reperfusion groups. ResultsThe quantity of Chk1 mRNA expression in the cerebral cortex of normal adult rat was about half of the glyceraldehyde-3-phosphatedehydrogenase. When reperfused for 30min, 2h or 6h following 10min, 30 min cerebral ischemia and reperfused for 30min or 2h following 60 min cerebral ischemia, the expression of Chk1 mRNA was not significantly different from that in non-ischemia group. Only reperfused for 6h following 60 min cerebral ischemia, Chk1 mRNA expression decreased significantly. ConclusionsThe results indicate that Chk1 gene might be involved in molecular mechanism of cerebrum damage during complete global brain ischemia- reperfusion.

Objective To investigate the effects of low tidal volume ventilation on pulmonary and cardiac function before and after mitral valve replacement. Methods Thirty patients with mitral valve diseases were randomly divided into traditional tidal volume ventilation (groupⅠ), low tidal volume ventilation with conventional respiratory rate (group Ⅱ), and low tidal volume ventilation with high respiratory rate (group Ⅲ). Mean arterial pressure (MAP), cardiac output(CO), cardiac index(CI), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), and pulmonary vascular resistance index (PVRI) were monitored. Arterial oxygen tension (PaO_2), carbon dioxide tension (PaCO_2), oxygen saturation index(PaO_2/FiO_2), alveolar-arterial PO_2 gradient (PA-aO_2), and Q_S/Q_T were measured. Results Before CPB, CO in group Ⅰ was significantly lower than that in group Ⅲ (P

OBJECTIVE:To prepare medicinal water-based magnetic fluid and to study its cyto-compatibility.METHODS:Medicinal water-based magnetic fluids were prepared with microemulsion preparative technique by an one-step surface acting agent management method,the appearances and size distributions of which were detected by transmission elec-tron microscope and photon-related spectrograph.The influences of different concentrations of magnetic fluids on the in vitro cyto-compatibility of normal human liver cell strain(L-02)were detected by methyl thiazolyl tetrazolium(MTT)colorimetric assay and lactate dehydrogenase(LDH)delivery test,respectively.The characterization of the prepared solid magnetic fluid samples coated with monolayer and bilayer capric acid were conducted by infrared spectrometry,thermogravimetry,differential thermogravimetry and differential scanning calorimetry.RESULTS:The results showed that the grain size of the medicinal water-based magnetic fluids ranged from10nm to20nm.Phase separation or marked change in mean particle sizes were failed to be noted after storage for1year.The MTT and LDH tests results showed that medicinal water-based magnetic fluids were of no cytotoxicity to L-02but have good cyto-compatibility.CONCLUSION:Medicinal water-based magnetic fluids can be used in magnetic targeting drugs delivery system.

Objective To investigate the gene expression of Chk1 gene in cerebrum after brain ischemia-reperfusion, trying to provide evidence to elucidate the molecular mechanism of brain injury.Methods Eighty-five male Wistar rats were divided into 3 groups.Group Ⅰ served as normal control.In group Ⅱ (non-ischemia group) animals underwent the whole experimental procedures except the occlusion of the bilateral vertebro-arteries and common carotid arteries.In group Ⅲ (ischemia-reperfusion group) animals were further divided into 3 subgroups according to the duration of ischemia: 10min, 30min and 60min.Each subgroup was again further divided based on the duration of reperfusion: 30min,2h and 6h.The cerebrum was immediately removed from rats after complete brain ischemia-reperfusion. The RNA was isolated and the reverse-transcription-polymerase chain reaction (RT-PCR) was carried out .The cDNA was analyzed by automatic system and the parameters were assessed to define the status of Chk1 mRNA expression in different ischemia and reperfusion groups.Results The quantity of Chk1 mRNA expression in the cerebral cortex of normal adult rat was about half of the glyceraldehyde-3-phosphate-dehydrogenase. When reperfused for 30min, 2h or 6h following 10min, 30 min cerebral ischemia and reperfused for 30min or 2h following 60 min cerebral ischemia, the expression of Chk1 mRNA was not significantly different from that in non-ischemia group.Only reperfused for 6h following 60 min cerebral ischemia, Chk1 mRNA expression decreased significantly.Conclusions The results indicate that Chk1 gene might be involved in molecular mechanism of cerebrum damage during complete global brain ischemia-reperfusion.

Objective To observe the effect of physical factors and promotion canalization on closed injury of brain.Method 68 cases of closed injury of brain were given the comprehensive rehabilitation therapy with many physical factors and promoting canalization technique.Result The patients' consciousnesses were significantly improved after treatment.The motorial function of hemiplegic limbs was distinctly improved(P< 0.05).The balance functions were distinctly improved(P< 0.001).The activities of daily living abilities were significantly improved(P< 0.05).Conclusion The physical factors and promoting canalization treatment on the closed injury of brain are functionally effective.

Objective: To investigate the effects of cadmium (Cd) stress on the growth and physiological characteristics of Panax ginseng (ginseng). Methods: Two-year old ginseng was cultivated in barrels in phytotrone with different concentration of Cd (0, 0.3, 1.0, 2.0, and 4.0 mg/kg) soil for a whole growth period. In red fruit stage, the contents of biomass and SPAD, the activities of anti-oxidant enzymes, and contents of malondialdehyde (MDA) were determined and analyzed. Results: With Cd concentration increasing, the relative growth rate of ginseng expressed a slowly decreasing trend, and showed negative linear correlations with Cd stress level (P<0.05); The SPAD value of ginseng showed a decline; But the activities of anti-oxidant enzymes of different parts of ginseng and the contents of MDA decreased on different levels. The contents of MDA from leaves and roots showed linear correlations with Cd stress level (P<0.05). Contents of MDA in different positions of ginseng showed as: leaf > stem > root. Conclusion: Ginseng has an adaptability to the contaminated soil with Cd (≤1.0 mg/kg), and at this time ginseng can enhance the activity of anti-oxidant enzyme and other physiological and biochemical responses to eliminate reactive oxygen species, maintain stability of the cell membrane, alleviate the harm from the stress of Cd; Though with Cd (>1 mg/kg), the contents of MDA could increase significantly, and the oxidative damage of ginseng is very serious. The growth of plants is affected, resulting in a decline in ginseng biomass.

Objective:To localize the impacted maxillary canine and to observe the root resorption of adjacent incisor in 3 dimen-sions using cone beam computed tomography(CBCT).Methods:92 impacted maxillary canines in 63 patients were scanned by CBCT.The three-dimensional images were obtained by multiplanar reconstructions(MPR).The cusp tip of each impacted canine was localized and set to the X,Y and Z planes after the observation of sagittal,coronal and axial views.The root resorption of adjacent in-cisors was observed.Results:In the X-axis,92% of impactions were mesial by 1 0.4 to 1 5.1 mm,8% distal by 2 to 5 mm;in the Z-axis,60% of impactions were palatal by 1 to 4 mm,40% buccal by 0 to 4 mm.41 .3% of the impacted canines were without root resorption of adjacent incisor,36.5% with slight,1 4.3% with moderate and 7.9% with severe root resorption of the adjacent inci-sor.Conclusion:The most frequent location of impacted maxillary canine is palatal and mesial with high incidence of root resorption of adjacent incisor.