There is a high degree of information asymmetry in medical services.Public hospitals are characteristic of the nature of multi-layer principal-agent relationships.Asymmetric information can lead to inconsistent value goals between the principal and the agent,giving birth to the government regulation capture as a result.Such capture ranks a fundamental cause for diluted public welfare nature of public hospitals.To offset such capture at public hospitals calls for reconstruction of government regulation system within the framework of public hospital corporate governance at an institution level.It is also necessary to eliminate the information asymmetry and its negative results,bringing public hospitals back on track to public welfare.

Objective To evaluate the effectiveness and side effect of MT regimen (mitoxantrone plus teniposide) in inductive chemotherapy and explore the relationship between the effectiveness and karyotype. Methods 33 patients with acute monocytic leukemia were divided into two groups according to the treatment history or risk status according to cytogenetics MRC criteria. Group A (n=23) and B (n=10) were primary treatment and no remission following one course of DA (daunorubicin plus cytarabine) or HDA (Harringtonine,daunorubicin plus cytarabine) regimen,respectively. According to MRC criteria,group C (n=29) and D (n=4) were intermediate and adverse group. All the cases received two courses MT regimen chemotherapies to induce remission. The results and side effects were analysed. Results The complete remission rate and effective rate in group A and B were 83 % (19/23) and 60 % (6/10),91 % (21/23) and 70 % (7/10) respectively. The complete remission rate and effective rate in group C and D was 83 % (24/29) and 25 % (1/4),88 % (26/29) and 50 % (2/4) respectively. In complex cytogenetic group and 11q23 abnormal without complex cytogenetic group,CR rate was 0 (0/3) and 100 % (4/4). The time point,count of WBC nadir and the duration of WBC were less than 1×109/L is (7±3) day after chemotherapy,(0.4±0.2)×l09/L,(8±5) day. Chemotherapy related mortality was 0. Conclusion MT regimen was highly effective and safe in inducing remission in acute monocytic leukemia,including the cases which achieved no remission following one course of DA or HDA regimen. The effectiveness of MT regimen relates to the cytogenetics. MT regimen may be highly effective in cases with 11q23 abnormal and poor effective in cases with complex cytogenetic.

Setting up the 3D finite element (FE) model on the basis of medical images is a necessary method of biomechanical analysis. The pretreatment, including data processing of images and mesh generation, becomes the bottleneck of FE analysis, and this is especially the case of the modeling for thoracic vertebrae, because the shapes and data are complicated. In this paper, on the basis of the data for building a 3D FE model of thoracic vertebrae, we present some structures and types of data which are essential for the reconstruction of CT medical image, analyze some methods for obtaining and processing the data from images, and then advance a theory for data management based on mesh generation by block with the software MSC. Marc. A 3D-FE Model of T10-T12 thoracic vertebrae is set up, which keeps the configuration of the true one, and satisfies the requirements of biomechanical analysis. We focus affention on the data obtainment and management during medical image processing and FE modeling, all of which are very important for the biomechanical analysis. It is helpful and instructive to reconstruct some similar tissues of human body on the basis of the medical images from CT, MRI, etc.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Models, Anatomic ; Thoracic Vertebrae ; diagnostic imaging ; Tomography, X-Ray Computed

A finite element model of human mandible is developed from CT scan images by the technologies of three-dimensional reconstruction, image processing and meshing. The mandible model is connected to one modified head model of Hybrid III dummy with joint according to the anatomic structure and mechanical characteristics of the temporomandibular joint. Then a finite element model of the human head with the true anatomic structure mandible is developed. This model has been validated with the cadaver test results. It can be used in researches on the mechanism of craniofacial blunt-impact injury and on the assessment of injury severity.
Biomechanical Phenomena ; Craniocerebral Trauma ; Finite Element Analysis ; Head ; anatomy & histology ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Mandible ; anatomy & histology ; Models, Anatomic ; Tomography, Spiral Computed

Objective:To explore the basic biological characteristics of lncRNA B230352I09 and its role in the process of myocardial injury.Methods:We analyzed the biological characteristics of lncRNA B230352I09 on the UCSC website and predicted the possible binding protein of lncRNA B230352I09 by the catRAPID. Real-time fluorescence quantitative (RT) PCR method was applied to detect the expression of lncRNA B230352I09 in heart tissues at different time points (0, 1, 3, 7d) within 7 days after birth, the organs distribution and expression of lncRNA B230352I09 in neonatal mouse and the expression pattern of lncRNA B230352I09 in the heart of mice with myocardial injury. In addition, we constructed hypoxia model by culturing primary cardiomyocytes to detect the effect of lncRNA 230352I09 overexpression on hypoxic cardiomyocyte apoptosis by Hoechst staining kit, the effect of lncRNA B230352I09 overexpression on ROS content of hypoxic cardiomyocyte by DCFDA probe and changes in mitochondrial membrane potential of hypoxic cardiomyocytes by JC-1 Fluorescent probes.Results:Full-length of mouse B230352I09 was 663bp, located in the chr7:123031415-123066439 forward strand. RBBP6 gene was adjacent to B230352I09, which may be the target of lncRNA B230352I09 by catrapid prediction analysis. With the development of the heart, the expression level of lncRNA B230352I09 showed a gradual downward trend. The main expression organs of lncRNA B230352I09 in 1-day-old mice were heart, brain, kidney and liver. In heart tissue, lncRNA B230352I09 expression in non-cardiomyocytes was significantly less than in cardiomyocytes [ (1.0± 0.03) vs. (9.2± 3.29), P=0.013]. After myocardial injury, the expression level of lncRNA B230352I09 showed an increasing trend compared with the normal developing mice, but there was no statistical significance. Hoechst staining showed that lncRNA B230352I09 could inhibit the apoptosis of hypoxic cardiomyocytes. Detecting the content of ROS in cardiomyocytes showed that compared with the hypoxia group, the generation of ROS was significantly reduced in the lncRNA B230352I09 overexpression group ([(3.8±0.71) vs. (1.65±0.56), P=0.015]). JC-1 fluorescent probe was used to detect the mitochondrial membrane potential, and the results showed that the mitochondrial membrane potential of cardiomyocytes in the lncRNA B230352I09 overexpression group was significantly higher than that in the hypoxia group. Conclusions:In heart tissue, lncRNA B230352I09 was mainly expressed in cardiomyocytes. LncRNA B230352I09 has a protective effect in the process of myocardial injury in mice, mainly by inhibiting apoptosis of cardiomyocytes, reducing ROS production, and protecting mitochondrial membrane potential of cardiomyocytes.

Medicinal animals are important part of Traditional Chinese medicine resources in China. Cytochrome c oxidase subunit I (COI) was selected as the standard DNA barcoding sequence for animal medical materials. In this study, the 51 animal species from 45 animal medical materials in the Chinese Pharmacopoeia were selected and the intra-specific variation and the inter-specific divergence, the barcoding gap, the identification efficiency of their COI sequences were analyzed. The results showed that the inter-specific divergence is higher than intra-specific distance. The barcoding gap existed between inter-specific sequence divergence and intra-specific dis-tance. The identification efficiencies were 100% both at the genus and species level except the Arthropoda. The cluster dendrogram exhibited that different species distinguished from others. Therefore, COI sequence as a bar-code is suitable to identify the species of animal medical materials in Chinese Pharmacopoeia.

Shennongjia is well known as the national treasure of traditional Chinese medicine resources at home and abroad. In order to provide Shennongjia with better protection of traditional Chinese medicine and promote the sustainable utilization of its resources, based on the specific analysis of She nnongj ia′s conservation status and
available resources, we put forward primary strategies and specific measures for the sustainable utilization framework of Shennongjia traditional Chinese medicine resources, in view of resources conservation, development, utilization, as well as the resources administration.

Objective Through an analysis of three cases of ocular flutter-opsoclonus in adults and a review of the relevant literature,we summarized its characteritics to improve the clinical awareness of this sign.Methods Three cases of adult-onset ocular flutter-opsoclonus from July 2014 to July 2017 were retrospectively analyzed in terms of clinical features,cerebrospinal fluid (CSF) analysis,brain imaging,etiologies and treatment,and followed up through telephone calls.Results Case 1:A 68-year-old man presented with ocular flutter,vertigo,myoclonus,ataxia and conscious disturbance.CSF analysis demonstrated pleocytosis and mildly elevated protein level.Brain MR imaging revealed ischemia,and SPECT showed hypoperfusion involving left frontal and occipital lobes.Paraneoplastic syndrome was considered as the etiology.The symptoms subsided without any specific treatment.He died from lung cancer within one year.Case 2:A 66-year-old man presented with ocular flutter,vertigo,ataxia,conscious disturbance and fever.CSF protein level was severely elevated.Brain MR imaging revealed ischemia.Epstein-Barr virus infection was considered as the etiology.The symptoms improved with the administration of antiviral drugs and steroid.Relapse was not observed in the two-year follow-up.Case 3:A 34-year-old woman presented with opsoclonus,oscillopsia,vertigo,ataxia,conscious disturbance and fever.MR imaging showed midbrain lesions.Viral brainstem encephalitis was considered as the etiology.The symptoms improved with the administration of antiviral drugs,steroid,intravenous immunoglobulin and clonazepam.Relapse was not observed in the two-year follow-up.Conclusions Infection and tumors are common etiologies of ocular flutter-opsoclonus.Treatment includes etiological management for infection or tumors and immunosuppressive therapy.The clinical outcomes vary with the underlying etiologies.

ObjectiveTo investigate the effect and mechanism of cinobufotalin in inhibiting hepatocellular carcinoma （HCC） metastasis by regulating epithelial-mesenchymal transition （EMT）. MethodsA total of 36 male BALB/c nude mice， aged 6 weeks， were given injection of MHCC97H cells via the caudal vein to establish a model of HCC lung metastasis， and then the mice were randomly divided into high-and low-dose cinobufotalin groups and control group. Since the day of modeling， the mice in the high-and low-dose cinobufotalin groups were given intraperitoneal injection of cinobufotalin at a dose of 120 μL/kg and 60 μL/kg， respectively， and those in the control group were given intraperitoneal injection of normal saline， twice a week. After 8 weeks， HE staining was performed for lung tissue to measure the lung metastasis rate of HCC. MHCC97H cells were treated with high-dose （2.5 μL/mL） or low-dose （5 μL/mL） cinobufotalin for 24 hours， and wound healing assay， RT-PCR， and Western blot were used to measure cell migration ability and the expression of EMT-related molecules. MHCC97H cells were induced in a simulated hypoxic environment with CoCl₂ incubation， with high- and low-dose cinobufotalin added for intervention， and wound healing assay and Western blot were used to investigate the effect of cinobufotalin on cell migration ability and EMT induced by hypoxia. Transcriptome analysis was used to investigate the effect mechanism of cinobufotalin on MHCC97H cells， and Western blot was used to observe the effect of cinobufotalin on the expression levels of protein kinase B （AKT） and phosphorylated AKT （P-AKT） in MHCC97H cells. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the independent-samples t test was used for comparison of categorical data between two groups. ResultsCompared with the control group， the cinobufotalin group had a significant reduction in the lung metastasis rate of HCC. Compared with the control group， cinobufotalin intervention reduced the wound healing rate of MHCC97H cells， upregulated the expression of epithelial-type molecules （t=2.860， P<0.05）， and downregulated the expression of EMT transcription factors （EMT-TFs） and mesenchymal molecules （t=3.545， 2.022， 2.852， and 2.341， all P<0.05）. Hypoxia induction upregulated the wound healing rate of MHCC97H cells and the expression levels of mesenchymal molecules and EMT-TFs （P<0.05）， and cinobufotalin intervention reversed EMT change and inhibited wound healing （P<0.05）. The transcriptome analysis of MHCC97H cells showed significant gene differences between the cinobufotalin group and the control group， and cinobufotalin mainly affected the expression of genes associated with tumor， metabolism， immunity， and signal transduction， with the largest number of differentially expressed genes in the AKT signal transduction pathway. Further measurement showed that cinobufotalin intervention downregulated the expression levels of AKT， P-AKT， and P-AKT/AKT in MHCC97H cells （t=2.434， 3.401， and 2.258， all P<0.05）. ConclusionCinobufotalin can inhibit the metastasis of HCC， especially hypoxia-induced HCC metastasis， and regulation of EMT mediated by the AKT signal transduction pathway in HCC cells might be one of its mechanisms of action.