Medical service system integration follows the logic of system innovation and development.Case studies of the UK,the USA and Australia found that medical delivery system integration is the product of a series of mixed factors.Health care financing and payment mechanism reform,physician team building,stair-cased movement to grassroots of healthcare service,shared clinical norms utilization as well as its gradual development constitute the general logic of such an integration.In the evolution process,the check and balance between the government and market,equity and efficiency have been affecting the integration process all the way.In light of these logics,China should speed up its transform of the integration concept,improve the integration elements,and strengthen the guidance of integration principles during its integration of the medical service integration.

Objective By means of analyzing the antihypertensive use of hypertension patients of Guiyang in 2013 and impact factors for basic drug use,to evaluate the impacts of the essential medicines list in place in Guiyang to hypertension patients in communities in Guiyang.Methods 969 hypertension patients were surveyed with structured questionnaire of stratified random sampling at 6 community health centers in Guiyang city.Results Hypertension patients in communities averaged 1.4 types of antihypertensive,and the essential medicines used accounted for 39.8％of all the antihypertensive.The distribution differences of the ratio of essential medicines use are significant interms of age,gender,and household annual income.Use ratio of non-essential medicines of the 55～64 age group and 65～74 age group are 3.48 times and 0.47 times over that of the 75 and above age group.For hypertension patients of low income and medium income,their probable use of non-essential medicines is 2.05 and 2.87 times that of high income households.Conclusion As the use ratio of hypertension patients in Guiyang is relatively low,and the factors for it are age and household income,focused intervention is recommended for the 65～74 age group and low-income households,for the purpose of high use ratio of essential medicines of such people.

Objective To establish a fingerprint analysis method for Ganzhixiao Decoction. Methods RP-HPLC was applied with Phenomenex Synergi 4?Hydro-RP 80A as the chromatic column,methanol-0.1 %H3PO4 solution (gradient elution) as the mobile phase,detection wavelength at 280 nm,flow rate being 1.0 mL/min,and column temperature at 30 ℃. Results Twenty common peaks were presented in 10 batches of Ganzhixiao Decoction and the positions of 20 characteristic peaks were identified,including 5-hydroxymethyl furfural,chlorogeni C acid,Salvianolic acid B. Conclusion The method is reliable and accurate,and can provide a reference for the research of Ganzhixiao Decoction.

OBJECTIVE To investigate the association between 592C/A and-819C/T of interleukin-10 gene polymorphism in patients with immediate ?-lactam drug allergy in Chinese Han population.METHODS The genotype and allele frequency of interleukin-10 gene were studied by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)in 44 Chinese Han patients with evidence of immediate ?-lactam drug allergy and 44 controls subjects.They all matched for sex and atopy,the production was investigated by sequence analysis.RESULTS Our analysis did reveal differences in the distribution of the single nucleotide polymorphism(SNP)between female allergic patients and controls.Among allergy subjects,we found two distinct significant associations between immediate drug allergy women and two linked IL-10 promoter genes polymorphism,-592C/A and-819C/T(P

2h.The shape of bacterium was changed by amikacin from sphero-rhabditiform to dolicho-rhabditiform,while by ceftriaxone changed from rhabditiform to long-chain-form or filament-form.Conclusion The capability of ceftriaxone-induced release of endotoxin from Escherichia coli is significantly stronger than that of amikacin,and the morphologic changes of bacteria caused by ceftriaxone were more significant.For clinical treatmentg of infectious diseases the first dosage of medication should increase to reach the effective bactericidal concentration but not the bacteriostasis concentration in order to receive better therapeutic effects.

OBJECTIVE: To investigate the incidence rate of the ampC gene and AmpC enzyme of gram-negative(G-) bacterium in children,to analyze drug resistance of produced AmpC enzyme and un-produced AmpC enzyme strain.METHO_DS: 4 022 clinical G-isolates collected from 2002 to 2004 were identified and tested using K-B method.Selection 108 ESBLs bacterium,the ampC genes were amplified by PCR using common primers to AmpC and the AmpC enzymes were tested using the enzymatic rough extraction cefoxitin three-dimensional test.The drug resistance of bacterium produced AmpC enzymes were compared with the ones without AmpC enzymes.RESULTS: In 108 G-bacterium,the ampC genes positive bacterium were 70 strain(accounting for 64.8%),and 7 bacterium produced AmpC enzymes(accounting for 6.5%) were detected.The drug resistance of bacterium produced AmpC enzymes to ceftazidime(CAZ),ceftriaxone(CRO),piperacillin(PIP),ampicillin(AMP),aztreonam(ATM) were 85.7%,85.7%,71.4%,79.4%,79.4% respectively.The drug resistance of bacterium non-produced AmpC enzymes to CRO,PIP,gentamicin,AMP,ATM were 50.8%,55.6%,55.6%,70.3%,54.0% respectively,the drug resistance of bacterium to imipenem were the lowest,lower to ciprofloxacin.CONCLUSIONS: Detection rate of ampC gene were higher than AmpC-producing enzymes strains obviously,whereas the drug resistance to antibiotic of AmpC-producing enzymes strains were higher than non-producing enzymes strains.

Objective To investigate the risk factors of gallbladder carcinoma,so as to provide theoretical base for the prevention of gallbladder carcinoma.Methods The clinical data of 153 patients with gallbladder carcinoma (gallbladder carcinoma group) who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed. A total of 300 patients with cholecystolithiasis (cholecystolithiasis group) and 300 patients without gallbladder carcinoma or cholecystolithiasis (control group)were collected and matched at the ratio of 1∶2 to conduct the controlled study.Data were statistically analyzed by the Chi-square test and conditional Logistric regression.Results Univariate analysis showed significant difference in age,history of cholecystolithiasis,postmenopausal age,accumulated menstrual period,giving birth or not and number of birth between gallbladder carcinoma group and control group ( x2 =58.22,180.14,9.59,24.30,18.66,15.17,P ＜0.05).Age,history of cholecystolithiasis,accumulated menstrual period and number of birth were the independent risk factors of gallbladder carcinoma (x2 =55.76,180.95,24.30,8.54,P ＜ 0.05).The risk of having gallbladder carcinoma in patients who had a history of cholecystolithiasis was 34 times higher than those who did not have the history of cholecystolithiasis (OR =34.22).Late postmenopausal age (51 -55 years old),longer accumulated menstrual period ( ≥30 years),and the number of birth ( 3 times) were associated with higher risk of gallbladder carcinoma (OR =3.96,9.68,3.51 ). Age,course of cholecystolithiasis and accumulated menstrual period and number of birth were the risk factors of gallbladder carcinoma when comparing patients who have history of cholecystolithiasis in the gallbladder carcinoma group with those in the cholecystolithiasis group (x2 =70.66,16.66,11.59,4.69,P ＜ 0.05 ).Age,course of cholecystolithiasis and accumulated menstrual period were the independent risk factors of gallbladder carcinoma ( x2 =64.29,8.82,5.58,P ＜ 0.05).The risk of gallbladder carcinoma increased as the increase of age and course of cholecystolithiasis. The accumulated menstrual period ≥ 30 years was also a risk factor of gallbladder carcinoma. Conclusions Age,history of cholecystolithiasis,course of cholecystolithiasis,accumulated menstrual period and number of birth may be the risk factors of gallbladder carcinoma.For patients with age above 60 years and course of cholecystolithiasis above 3 years,cholecystectomy should be conducted to reduce the incidence of gallbladder carcinoma,and great importance should be attached to female patients with indications mentioned above.

Objective To analyze the clinicopathological features of gallbladder adenosquamous carcinoma.Methods The clinical data of 8 patients with gallbladder adenosquamous carcinoma who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed.The clinicopathological features,diagnosis and treatment strategies were summarized.The survival curve was drawn by Kaplan-Meier method,and the survival of the patients was analyzed by Log-rank test. Results The clinical manifestation of the 8 patients was non-specific,and all the patients were misdiagnosed as with primary gallbladder cancer complicated with cholecystolithiasis or chronic cholecystitis.The levels of carcinoembryonic antigen and γ-glutamyl transferase of 3 patients were higher than the normal,the level of alkaline phosphatase of 2 patients was higher than the normal,the level of aspartate transaminase of 1 patient was higher than the normal,the level of CA242 of 3 patients was higher than the normal and the level of CA19-9 of 4 patients was higher than the normal.The levels of aspartate transaminase,total bilirubin and direct bilirubin were in the normal range. Different surgical approaches were selected according to different tumor positions.The mean diameter of the tumor was (5 ±3)cm. Lymph node metastasis was detected at the hepatic hilar,hepatoduodenal ligament and area behind pancreatic head. Postoperative pathological examination confirmed that all the patients were with gallbladder adenosquamous carcinoma. All patients were followed up till April 2011. Two patients survived with no discomfort,and the survival time was 2-3 months.Six patients died of tumor recurrence or metastasis,and their median survival time was 8 months (range,4-13 months). Conclusions The clinical manifestation of gallbladder adenosquamous carcinoma is non-specific, and definite diagnosis depends on the results of postoperative pathological examination.Surgical treatment is the only effective method in improving the prognosis of patients with gallbladder adenosquamous carcinoma,and the prognosis of patients is poor.

Objective The objective of this article was to compare patients' dose with electrocardiographic gated mA modulation (ECG) and ECG＆CAREDose 4D mode during coronary MSCT angiography.Methods The research was based on phantom experiment and computer simulation to get the mean value of peak skin dose data and effective dose data respectively and to analyze deterministic and stochastic radiation risk.Results The peak skin dose using ECG mode alone and using ECG＆CAREDose 4D mode with the same image noise level was (87.4±0.9) and (45.9 ± 1.2) mGy respectively.Effective dose was 17 and 10 mSy for ECG mode and ECG＆CAREDose 4D mode respectively.Comparing with ECG mode alone, ECG＆CAREDose 4D mode reduced organ dose of gonad, red marrow, lung, stomach, breast and thyroid by 40.0%, 36.7%, 39.3%, 37.7%, 38.8% and 38.9%, respectively. Conclusion Results showed that ECG ＆ CAREDose 4D mode can reduce radiation dose effectively comparing using ECG mode alone, and that ECG ＆ CAREDose 4D mode should be widely applied ehnically with appropriate initial settings.

Objective To summarize the clinical and pathological characteristics of incidental gallbladder carcinoma,analyze the factors such as surgical procedures,tumor stages that associated with prognosis,and standardize the diagnosis and treatment strategy of incidental gallbladder carcinoma. Methods Between January 1991 and October 2009,27 incidental gallbladder carcinoma patients were treated in Peking Union Medical College Hospital (PUMCH).A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis,curative treatment and prognosis. Results Twenty-seven patients were collected (8 male and 19 female) with the mean age of (68.3 ± 1.9)years.Abdominal pain,obstructive jaundice and fever were the main symptoms of incidental gallbladder carcinoma.All the 27 cases underwent open cholecystectomy based on preoperative tentative diagnosis of benign disease,and carcinoma of gallbladder was confirmed by postoperative pathology.In this group(9 lowdifferentiation,9 moderate-differentiation,4 high-differentiation and 5-carcinogenesis from adenoma).Two cases were on the stage of Nevin Ⅰ,5 on Nevin Ⅱ,8 on Nevin Ⅲ,5 on Nevin Ⅳ and 7 on Nevin Ⅴ.The survival terms were of statistic significance between the radical cholecystectomy groups and simple cholecystectomy groups(x2 =4.450,P=0.035); The prognosis of patients on stages Ⅰ、Ⅱ are better than those who are on stages Ⅲ、Ⅳ、Ⅴ (x2 = 6.825,P = 0.014). Conclusion The clinical manifestations of incidental gallbladder carcinoma are diverse,which usually lead to misdiagnosis.Frozen section examination during operation is key to diagnose incidental gallbladder carcinoma.Surgical operation is the first choice of therapy,offering much better prognosis than those received simple cholecystectomy.