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 observe the effect of extract from Branchlets roses on blood glucose and glucose tolerance in diabetes mice induced by alloxan.Methods Diabetes animal model was established by alloxan.Dividing the model mice into eight groups:model group,water extract high,middle,and low dose (3.70,1.85,and 0.93 g/kg) group,and ethanol extract high,middle,and low dose (2.75,1.37,and 0.70 g/kg) group,and metformin (positive drug,200 mg/kg) group,and normal mice were taken as control group.Drug was ig administered to mice 3 d after molding once daily.Blood glucose test paper was used to determine fasting blood glucose 0,10,20,and 28 d after modeling,and the glucose tolerance test was performed 30 d after modeling.Results The extract of Branchlets roses from all the groups could decrease the blood glucose and improve the glucose tolerance,and showed a certain dose-effect relationship.In all the extracts,the alcohol extract had the best effect,but the effect was not as good as the positive control drug metformin hydrochloride group.Conclusion The extract of Branchlets roses can reduce the blood sugar content of diabetic mice,and improve the glucose tolerance.

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 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

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 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 summarize the clinicopathological features of ampullary cancer,and investigate the diagnosis and treatment strategy for ampullary cancer.Methods The clinical data of 187 patients with ampullary cancer who were admitted to the Peking Union Hospital from January 2000 to December 2010 were retrospectively analyzed.According to different surgical procedures applied,patients were divided into pancreaticeduodenectomy (PD) group (162 patients) and local resection group (25 patients).Survival curve was drawn by using Kaplan-Meier method,and the difference in survival rate between the 2 groups was compared by using Log-rank test.All data were analyzed by using t test or chi-square test.Results The positive diagnostic rates of B-ultrasound,computed tomography (CT),magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP) were 9.3％ ( 15/161 ),43.9％ (65/148),21.3％ (19/89) and 83.9％ ( 135/161 ),respectively.There were 87 patients with well differentiated adenocarcinoma,64 with moderate differentiated adenocarcinoma,27 with low differentiated adenocarcinoma and 9 with tubular canceration.There were no significant differences in survival rate between patients with ampullary cancer in T1 or T2 stage who received PD or local resection ( x2 =3.163,P ＞0.05).The prognosis of patients with ampullary cancer in T3 or T4 stage who received PD were superior to those who received local resection ( x2 =6.309,P ＜ 0.05 ).Conclusions Most of the ampullary cancer is well differentiated adenocarcinoma,and ERCP has a higher diagnostic rate than B-ultrasound,CT and MRI.Local resection is an ideal treatment for patients with ampullary cancer in T1 or T2 stage,while for patients with ampullary cancer in T3 or T4 stage,PD is the first choice of treatment.

Objective To screen the optimal dose of Tangtong Formula in vitro. Methods RSC96 Schwann Cells were cultivate by DMEM mediums which contains different concentrations of glucose (5–125 mmol/L). The prevention effects of Tangtong Formula at different concentrations (0.25, 0.5, 0.75, 1.0, 1.5, 2.0, 3.0, 5.0 mg/mL) on the proliferation of RSC96 Schwann Cells induced by high glucose were detected. After the RSC96 Schwann Cells were cultivated in 100 mmol/L and 125 mmol/L high glucose mediums for 72 h, the apoptosis of RSC96 Schwann Cells was detected by flow cytometry Annexin V/PI, and the apoptosis rate was calculate; the proliferation situation of RSC96 Schwann cells in different times was detected by CCK-8 method. Results RSC96 Schwann cells were in apoptosis after being intervened by 100 mmol/L and 125 mmol/L high glucose mediums. The apoptosis rates were respectively(7.46±0.96)％ and(16.53±1.01)％, with statistical significance compared with control group (P<0.01). Different concentrations of Tangtong Formula could alleviate the inhibitory effect of high glucose on the proliferation of RSC96 Schwann cells, and the threshold concentration of Tangtong Formula in 24 h was 0.25 mg/mL. The concentrations of Tangtong Formula in 0.5 mg/mL, 1.0 mg/mL, and 1.5 mg/mL could inhibit the apoptosis of RSC96 Schwann cells induced by high glucos, compared with 125 mmol/L high glucose group, the apoptosis rate of RSC96 Schwann cells decreased significantly (P<0.05, P<0.01). Conclusion Among three different doses, when the dose of Tangtong Formula is in 1.5 mg/mL, the effects on inhibiting apoptosis are the best.

Objective To compare the various surgical procedures commonly used to treat ampullary neoplasms.Methods The clinical data of 238 patients with ampullary tumor who were admitted to the Peking Union Hospital from January 1995 to June 2012 were retrospectively analyzed.There were 51 patients with benign ampullary adenomas (34 patients treated with local tumor resection,17 patients treated with pancreaticoduodenectomy) and 187 patients with ampullary cancer (25 patients treated with ampulla local excision,162 patients treated with pancreaticoduodenectomy).Results For both ampullary cancer and benign tumor,the group of patients who received local excision was superior to the group of patients who received pancreaticoduodenectomy in operative time,blood loss,hospital stay,and incidence of postoperative complications (all P＜0.05).For benign ampullary adenomas,there were no significant differences in postoperative median survival time between local resection and pancreaticoduodenectomy (P=0.071,x2 =2.003).For stage T1 or T2 ampullary cancer,there was also no significant difference in the postoperative median survival time (P=0.054,x2=3.163).However,the postoperative median survival time of the pancreaticoduodenectomy group was significantly longer than that of the local resection group for patients with stage T3 or T4 ampullary cancer (P=0.041,x2 =6.309).Conclusions Ampullary tumors are characterized by relatively good response to treatment.The results suggested that for patients with benign ampullary adenomas and stage T1 or T2 of ampullary cancer,local resection is a good surgical procedure.For patients with ampullary cancer at more advanced stages (T3 or T4),pancreaticoduodenectomy is the first choice of therapy.