From the aspects of advantages, barriers, opportunities and challenges, this paper analyzed the environmental factors of Shanghai medical resources serving people in the Pan-Yangtze River Delta. As envisaged by the author, such services will provide medical resources information to patients from outside Shanghai, probe into feasible ways to medical insurance based on experiences drawn from serving such patients, help with the resources integration of medical systems in Shanghai, and probe into the potentials of telemedicine and distant medical e-learning, as well as improve hospital management levels and service functionality.

During the period of 11th Five-Year Plan,the Natural Science Foundation of China Peking University First Hospital acquired has improved in the total amount and project types.An analysis was made on the status of grant application and support in Peking University First Hospital as well as on the management method of the grant,offering some suggestions for the general hospitals on the management and development of Natural Science Foundation.

Objective To investigate the relationship between Oxfordshire community stroke project(OCSP) classification and imaging classification in acute cerebral infarction. Methods Two hundred and thirty-six patients with acute cerebral infarction were retrospectively evaluated with OCSP classification and imaging characteristics. Results According to OCSP classification,of all the 236 patients with acute cerebral infarction,28(11.9%) experienced total anterior circulation infarction(TACI),71(30.1%) partial anterior circulation infarction(PACI),94(39.8%) lacunar infarction(LACI),and 43(18.2%) posterior circulation infarction(POCI).The consistency was found in 171 cases(72.5%) between the OCSP classification and imaging classification,with the accuracy of 76%(25/33) for TACI,81%(34/42) for PACI,71%(81/114) for LACI and 66%(31/47) for POCI. Conclusion OCSP classification can predict the location and size of cerebral infarction with a high accuracy,and is well consisted with the imaging findings.

Objective To investigate the feasibility of reducing spine metal artifacts with metal artifacts reduction technique (WARP) at 3.0 T MRI.Methods This study included 15 cervical and 14 lumbar spine cases.The image quality of WARP sequences and conventional sequences were compared (5 score evaluation scale) as well as the signal to noise ratio (SNR) and contrast noise ratio (CNR) of the image artifacts.The scanning time was recorded.Paired-t test and Mann-Whitney test were used respectively to compare the SNR and CNR,and qualitative scoring between the two sequences.P＜0.05 was considered to indicate a significant difference.Results The image distortion and blur of the WARP sequences were obviously reduced as compared to the conventional sequences.The SNR and CNR of artifacts of the WARP sequences were lower than that of the conventional sequences (All P＜0.05).The image quality scores of WARP sequences in cervical and lumbar spines[4(3 to 5) and 4(3 to 5)] were higher than that of conventional sequences[3(2 to 4),3(2 to 4)](P＜0.05).The scanning time of cervical spines in WARP sequence(14 min 9 s) was increased by 64 s (8.2％),and the time of lumbar spines (13 min 41 s) decreased by 9 s (1.1％).Conclusion The WARP sequences at 3.0 T could effectively reduce the artifacts of metallic prosthesis in cervical and lumbar spine without prolonging the scanning time at 3.0 T MRI.

Objective To observe the three-dimensional structure changes of subchondral bone in early stage knee joint instability and the effect of diphosphonate intervention so as to test the role of early three-dimensional structure changes of subchondral bone in pathogenesis of osteoarthritis (OA).Methods Sixty healthy male New Zealand white rabbits were assigned to model group (n =24),diphosphonate group (n=24) and control group (n =12) according to random number table.Rabbit right knee destabilization (anterior cruciate ligament transection) is used to induce OA.Rabbits in diphosphonate group received subcutaneous injection of 0.01 mg/kg diphosphonate (risedronate) per day.Instead,isotonic saline solution of the same volume was subcutaneously given to rabbits in model and control groups.One third of the animals in each group were killed at week 4,8 and 12 respectively.Surgical knee joint with preservation of each 2 cm bone above and below joint surface was dissected to perform Micro-CT.Bone volume fraction (BVF),trabecular thickness (Tb.Th),trabecular spacing (Tb.Sp),trabecular number (Tb.N),volumetric bone mineral density (vBMD) and tissue BMD (tBMD) were measured and analyzed statistically.Results At week 4 following operation,BVF,Tb.N and Tb.Th were lowered significantly in model group as compared to control group (P ＜0.01) ;BVF was lower in model group than in diphosphonate group (P ＜ 0.05) and lower in diphosphonate group than in control group (P ＜ 0.05) ; Tb.Sp was increased in model group as compared to diphosphonate group and control group (P ＜0.01) and had obvious increase in diphosphonate group as compared to control group (P ＜0.01) ; vBMD was significantly lower in model group than in diphosphonate group and control group (P ＜ 0.05),but there was no statistical difference between diphosphonate group and control group.At week 12 following operation,model group presented higher BVF,Tb.Th and Tb.N (P ＜0.05),significantly lower Tb.Sp (P ＜ 0.05) and significantly higher vBMD (P ＜ 0.01) as compared to diphosphonate group and control group.Conclusions In knee joint instability,variations of subchondral bone are mainly characterized by osteoclasia in the early stage,followed by osteogenesis in later stage.Diphosphonate may improve the bone architecture of subcondral bone via inhibition of bone resorption.

Objective To observe the biomechanical changes of subchondral bone in the early stage of knee joint instability and effect of diphosphonate therapy so as to investigate the role of the early biomechanical changes of subchondral bone in the onset and development of osteoarthritis (OA).Methods Sixty healthy male New Zealand white rabbits were assigned to model group (n =24),diphosphonate group (n =24) and control group (n =12) according to random number table.Joint destabilization by anterior cruciate ligament transection of the right knee of the rabbits was performed to induce OA models.Rabbits in diphosphonate group received subcutaneous injection of 0.01 mg/kg diphosphonate (risedronate) per day,and isotonic saline solution of the same volume was subcutaneously given to rabbits in model and control groups.Half the animals in each group were killed by aeroembolism at postoperative 4 weeks and 12 weeks respectively.Surgical knee joint with preservation of each 2 cm bone above and below joint surface was dissected to perform gross scoring.Thereafter,two-dimensional image profile was achieved by Micro-CT examination and converted into Ansys for limit element analysis after fitting in Mimics software.Results At four weeks,bone volume fraction (BVF),elastic modulus (EM),reaction force (RF),and mean Von Mises stress were all declined in three groups,the lowest level in the model group (P ＜ 0.01).The diphosphonate group also had lower levels than the control group,with insignificant difference.Bone mineral density (BMD) in the model group was obviously declined in contrast with the diphosphonate and control groups (P ＜ 0.01),but there were no significant difference between the diphosphonate group and the control group.At 12 weeks,the model group showed higher level of BVF and BMD,but lower level of EM,RF and Von Mises stress in comparison with the control and diphosphonate groups (P ＜ 0.01).EM,RF,and Von Mises stress were lower in the diphosphonate group than those in the control group as well,but the difference was statistically insignificant.The model group showed that BVF,BMD,EM,RF,and Von Mises stress at 12 weeks were improved from those at 4 weeks (P ＜ 0.01).Conclusions Biomechanical properties of subchondral bone are affected in the early stage of knee joint instability and a notable decrease of EM is observed in the early stage,followed by an enhancement in late stage.It means that the biomechanical changes of subchondra,l bone in the early stage of knee joint instability may be connected with the bone resorption resulting from abnormal stress.On the contrary,diphosphonate may markedly improve EM of subchondral bone through inhibiting bone resorption.

Objective To study the protective effects of ischemic postconditioning and preconditioning against ischemic reperfusion injury of skeletal muscle.Methods According to different treatment methods on ischemia-reperfusion injury,forty Wistar rats were divided into I/R group,IPost group,IPC group,IPC + IPost group,control group.Using a rat amputation-like model,Wistar rats underwent temporary amputation at the level of the femur,excluding the femoral vessels.By measuring MDA,MPO,the extent of skeletal muscle infarction,protective effects of postconditioning and preconditioning,postconditioning combined with preconditioning were observed.Results In the Ipost group,IPC group,IPC + Ipost group,MDA and MPO at one hour of reperfusion and extent of muscle infarction at 6 hour of reperfusion was lower than group IR (P ＜ 0.05).In the Ipost group,MDA,MPO and extent of muscle infarction was similar to group IPC + Ipost; In the Ipost group,MDA and MPO was lower than group IPC,extent of muscle infarction was similar to group IPC.Conclusion Ischemic postconditioning at the beginning of reperfusion can protect skeletal muscle against ischemic reperfusion injury.Preconditioning also protect skeletal muscle against ischemic reperfusion injury,but preconditioning combined with postconditioning don't offer additional benefit over preconditioning or postconditioning alone.

Objective To investigate the effects of Kangpa bolus on behaviors, dopamine and its metabolites of striatum in animals with Parkinson' s disease (PD). Methods The mice models of muscle tremor and rigor were established to observe the antagonism of Kangpa bolus. Step-down and step-through tests were used to evaluate the effects of Kangpa bolus on learning and memory function in mice. The rat model of PD was established to observe the effects of Kangpa bolus on rotation behaviors. The contents of DA and homovanillic acid( HVA) in the injured side of striatum were detected by ELISA. Results Compared with model group(723. 1 ±79.3) s,the duration of tremor in mice shortened significantly (P < 0. 01) in Kangpa bolus high dose and middle dose group ((548.0±27.0)s,(590.9 ±28.7)s). Compared with model group(3194.5 ±251.7)s,the duration of rigor in mice shortened significantly(P<0.01) in Kangpa bolus all dose group((2300.1 ±352.5)s,(2478.2 ±276.6)s, (2559.3 ±207.6) s). In step-down test, compared with model group (3. 10 ±0.74), the number of errors decreased significantly(P<0.01) in Kangpa bolus high dose and middle dose group (1.60 ±0. 97,1. 80 ±0.63). In step-through test, compared with model group( 2.30 ± 0. 68), the number of errors decreased significantly (P < 0.01) in Kangpa bolus high dose and middle dose group(0.80 ±0.79,1.10 ±0.74). Compared with model group (340.6 ±18.8) , the number of rotations of PD rats in thirty minutes reduced significantly (P< 0.01) in Kangpa bolus high dose and middle dose group(286.5 ± 12.1,296.6 ± 12.7) after three weeks treatment. Compared with model group(9.43 ±1.79,0. 87 ±0.12) nmol/L,the contents of DA and HVA in the injured side of striatum increased significantly(P<0. 01 ) in Kangpa bolus high dose( 18. 9 ±4. 01,1. 50 ± 1. 39) nmol/L and middle dose group (17.3±3.01,1.39±0.53)nmol/L Conclusion Kangpa bolus has some therapeutic effects on the animals of PD.

Objective To investigate the effect of acute hypervolemic hemodilufion (AHHD) on EC50 of propofol by target-controlled infusion (TCI) for loss of consciousness (LOC). Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr scheduled for vertebral eolunm or total hip replacement surgery were randomly divided into 4 groups (n = 15 each) : group Ⅰ target plasma concentration of propofol (Tp) ;group Ⅱ target effect-site concentration of propofol (Te) ;group Ⅲ AHHD + Tp and group Ⅳ AHHD + Te. All the patients recoived iv infusion of lactated Ringer's solution 0.7 ml·kg-1 ·h-1 via peripheral vein for 30 min. At the same time 4% gelofusion 15 ml/kg was infused over 30 min via internal jugular vein in group Ⅲ and Ⅳ. At the end of gelofusine infusion TCI of propofol was started. The initial target concentration was set at 1.2 μg/ml. After the target concentration was steadily maintained for 30 s, the consciousness of the patients was evaluated by an anesthesiologist not involved in the study using OAA/S scale. The target concentration was increased in 0.3 μg/ml increment until the patients lost consciousness (OAA/S = 0). The target plasma concentration and effect-site concentration were then recorded. EC50 and 95% confidence interval (CI) of propofol for LOC were calculated by probit analysis. Results The ECho (95 % CI) of propofol for patients in group Tp, Te, AHHD + Tp and AHHD + Te (group Ⅰ-Ⅳ) were 3.74 (3.46-4.16), 2.32 (2.17-2.42), 4.12 (3.81-4.32) and 2.38 (2.14-2.56) μg/ml respectively. EC50 was significantly higher for loss of consciousness in AHHD + Tp group (group Ⅲ)than in Tpgroup (group Ⅰ), but there was no significant difference in EC50 between group Te and group AHHD + Te. Conclusion AHHD can increase the EC50 of target plasma concentration of propofol by TCI for LOC but has no effect on EC50 of target effect-site concentration.

Objective To evaluate the correlation between CYP3A4 enzyme and analgesia with fentanyl after gynecological operation. Methods One hundred and fifty-nine ASA Ⅰ or Ⅱ patients, aged 30-50 yr, scheduled for elective myomectomy or abdominal total hysterectomy, were enrolled in this study. Anesthesia was induced with midazolam, remifentanil, propofol and succinylcholine and maintained with iv infusion of propofol and remifentanil and intermitent iv injection of atracurium. Venous blood samples were obtained for determination of the plasma 1'-hydroxymidazolam and midazolam concentrations at 1 h after iv injection of midazolam. The ratio of the 1'-hydroxymidazolam concentration to the midazolam concentration was used to reflect the effect of CYP3A4 enzyme. Pain was assessed with visual analog scale (VAS) after consciousness was regained. When VAS score ＞ 4,the patients were given fentanyl 10 μg every 5 min until VAS score ≤ 4 and then PCIA with fentanyl was performed. VAS score was maintained ≤4. The times of successful delivery within 24 h after operation and during the period of 24-28 h after operation and fentanyl consumption within 48 h after operation were recorded. Pearson correlation was used to analyze the data. Results There was no correlation between the effect of CYP3 A4 enzyme and the times of successful delivery or fentanyl consumption, and the correlation coefficients were 0.16, 0.13 and 0.11 respectively ( P ＞ 0.05). Conclusion CYP3A4 enzyme is not the major enzyme metabolizing fentanyl.