This paper analyzed the 15-year exploration and practice in Zhenjiang City on the reforms of the healthcare reform From the perspectives of the role and impact exerted by medical insurance in hospitals,as well as main challenges and countermeasures or recommendatioas of this regard,the paper discussed the development relationship among public hospitals,healthcare system reform and medical insurance.Main points include the following:orchestrated development between hospitals and medical insurance;establishment of an equal negotiation mechanism between hospitals and medical insurance;establishment of a beneficary system adaptable to medical insurance capacity;establishment of a scientific and feasible pattern of fees settlement and payment;hospitals are expected to deepen the reform and better management,playing the role of providing quality medical services and reasonably controlling medical costs.

Objective To evaluate intravesical instillation of epirubicin plus BCG to prevent recurrence of transitional cell cancer of bladder after surgical management. Methods A total of 44 cases of bladder cancer who underwent TURBT or partial cystectomy were divided into 2 groups.①Group 1 received intravesical instillation of epirubicin plus BCG (24 cases).Within 1 week following operation single dose of intravesical epirubicin instillation was given and from the second week regular intravesical BCG was instilled afterwards.②Group 2 received BCG alone (20 cases).Within 1 week after surgical management regular intravesical BCG instillation was given. All the patients were followed up for 24 months. Results In Group 2,3 cases had recurrence at 5,9,12 months individually,the incidence rate being 15% (3/20).No recurrence developed in Group 1.The recurrence rate was significantly different between the 2 groups (?2 test,P

Objective To discuss the efficacy of intravesical instillation of sodium hyaluronate for the treatment of cystitis glandularis after transurethral resection.Methods 85 patients (9 male and 76 female,age range 37-70 years,mean age 51) who were diagnosed as CG in China-Japan Union Hospital of Jilin University underwent transurethral resection.After the operation they were divided into three groups randomly according to different intravescal instillation:sodium hyaluronate for group A,epirubicin for group B and no medicine for group C.The group A started to instill with sodium hyaluronate 40mg once a week for four weeks,and then once a month for four months.The group B did the same way of intravesical instillation of epirubicin.All the patients were followed-up for 12 months.The cystoscopy was done every three months to detect recurrence and the clinical symptom score was evaluated at 1,3,6 and 12 months.Results No patients in group A treated by sodium hyaluronate relapsed but 6 cases and 9 cases in group B and group C respectively.Recurrence rate of group A is significant low compared with group B and C (P ＜ 0.05).The scores of clinical symptom score appendix after 1,3,6 and 12 months for group A were (3.18 ± 1.44),(1.29 ±0.66),(1.25 ±0.65) and (1.21 ±0.63),respectively.It was (3.37 ±1.62),(3.33 ±1.59),(1.37±0.74) and (1.30±0.61) for group B,and (3.47±1.81),(3.40±1.52),(3.27±1.41) and (3.23 ± 1.19) for group C.Compare the score of clinical symptom in the same group,there were significant differences for the score after 3 months compare with the score after 1 month in group A (P ＜ 0.05).But in group B,the significant differences showed after 6 months (P ＜ 0.05).There was no significant difference in group C (P ＞ 0.05) in the whole year.Conclusions Intravesical sodium hyaluronate therapy can effectively decline the recurrence rate of cystitis glandularis after transurethral resection.It could also significantly improve the urinary tract symptoms.

Objective To explore the clinical and radiological features of bilateral thalamus venous infarction.Methods The cases definitely diagnosed as thalamus venous infarction were collected and the corresponding clinical and radiological data were retrospectively analyzed.Results Four cases confirmed as thalamus venous infarction by digital substraction angiography (DSA) were collected.Bilateral thalamus lesions were detected in all cases by brain MRI scans which mainly presented as thalamus edema with high T1 and T2 signals with partial enhancement.Mild hemorrage was also shown in one case.Acute or subacute onset with clinical manifestations of headache,hypomnesia and hypersomnia were reported in all cases.The neurological examination showed conscious disturbance,memory impairment and positive Babinski sign.The venous thrombi were formed mainly in the transverse and the straight sinuses in 3 cases with the deep cerebral venous involved in 2 cases.All patients were improved after the anticoagulation therapy.Dural arteriovenous fistula was found in the other case drained by the Rosenthal's vein,and the symptoms were ameliorated after the embolotherapy.Conclusions As the thalamus is drained by the thalamostriate vein and the lateral thalamic vein towards the internal cerebral vein with the caudate portion drained particularly by the Rosenthal's vein,venous thrombosis or fistula drainage into these veins would probably disturb the normal drainage of the thalamus and result in further edema and infarction.Thus,the venous infarction should be taken into consideration whenever bilateral thalamus lesions are encountered in clinical practice and DSA is necessary to confirm the diagnosis.

BACKGROUND:Mechanical property test is an important method to evaluate the effect of drug treatment on the animal model of osteoporosis. But there are rare reports on the tensile mechanical test for evaluating the therapeutic effects of a variety of drugs on a female rat model of senile osteoporosis. OBJECTIVE: To evaluate the effects ofGusukang capsule, alendronate, vitamin K and calcium on tensile properties of the humerus in the rat model of osteoporosis. METHODS: Totaly 180 female Wistar rats, 4-5 months old, were randomized into six groups, 30 in each group. Except the rats in the normal control group, al the rats were subjected to make ovariectomized osteoporosis models. Then, rats were givenGusukang capsule (0.9 g/kg/d), alendronate (1 mg/kg/d), vitamin K (0.1 mg/kg/d) and calcium (2 mg/kg/d) in theGusukang capsule, alendronate, vitamin K and calcium groups, respectively. After 15 weeks, the bilateral humeri were taken from al the rats, and the tensile test was carried out on an electronic universal testing machine at a speed of 5 mm/min. The fracture morphology of the specimen was observed. RESULTS AND CONCLUSION: The maximum load and maximum strain of the rat fumerus were significantly lower in the model group than in the normal control,Gusukangcapsule, alendronate and vitamin K groups (P < 0.05). There were no differences in the maximum load, maximum stress and maximum strain between the calcium group and model group (P > 0.05). These findings indicate that the tensile properties of the humerus can be improved by Chinese medicine, western medicine and vitamin K, especialy by the Chinese medicine.

ObjectiveTo investigate thc clinical and radiological characteristics of cortical vein thrombosis for early diagnosis and treatment.Methods Retrospective analysis was carried out with the clinical cases of cortical vein thrombosis in 2010.The symptoms,sign,neuroimaging were analyzed and related literatures were reviewed.ResultsFour patients were collected,average age was forty years old.The main symptoms were headache and focal neurological signs in varying degrees,intarction or hemorrhage in one or two sides of parietal lobe could be found in CT or MRI.Hemorrhage was found in two patients,infarction was found in one patient,hemorthage and infarction were both found in another patient.ConclusionsHeadachc and focal neurological signs are the common sings and symptoms of patients with cortical vein thrombosis.CT and MRI are effective methods for the diagnosis of cortical vein thrombosis.

Objective To explore the pathogenesis of Hirayama disease from juvenile cervical curvature and growth rate.Methods Totally 60 patients diagnosed with Hirayama disease (HD) from 2009 to 2011 in our hospital were included in the present study.Patient's height and growth rate 1-2 years prior to the onset of disease were recalled by patients and family members.Lateral cervical X-ray was examined,and cervical curvature was measured by Borden's method.Results All the patients were adolescents with onset age at 12-25 (17.0 ± 2.4) years old and peak age of onset at 15-18 [45 cases (75.0％)].Fifty-seven cases were male and 3 cases were female.Cervical MRI examination of the 60 cases showed that the spinal cord atrophy involving C4-C8 vertebral level.The C line values for cervical curvature by Borden's method of the patients was 2.6 (1.2,4.2) mm.Among 60 patients,57 of them were with abnormal cervical curvature.The average height growth rate 1 year prior to the onset was (7.1 ± 1.8) cm.Conclusions The clinical manifestations that featured in overgrowth in the first two years and abnormal cervical vertebra curvature are possible related with pathogenesis of HD.HD is possibly a cervical spinal cord compression disease,which is associated with cervical spinal dysplasia during juvenile growth.

Objective To investigate the clinical features of neurobrucellosis and improve the diagnosis and treatment of the disease.Methods The epidemiological information,clinical manifestation,laboratory examination,and imaging characteristics of 30 cases with neurobrucellosis were summarized retrospectively.Results There were 23 men,seven women in this group of cases.The mean age was 43 years.There were six cases with definite history of brucellosis,24 with exposure history of cattle and sheep or their diary products.Brucella blood serum agglutination tests were all positive in 30 cases.Meningitis or meningoencephalitis (29 cases),spinal cord lesion (20 cases) and auditory nerve's damage (18 cases) were the most common forms of neurobrucellosis in these patients.In the cerebral spinal fluid inspection tests,there were 29 cases with increasing leukocyte ((10-599) × 106/L),30 cases with elevated protein (0.5-4.0 g/L),29 cases with decreased glucose (0.8-2.6 mmol/L) in this group of patients.There were 17 cases with white matter lesion on cranial magnetic imaging.The combinations of doxycycline,rifampin and ceftriaxone sodium were given to most cases.The prognosis was good in most cases.Conclusions Neurobrucellosis is not unusual clinically,clinical presentation of which varies greatly.The most common form is meningitis or meningoencephalitis,whereas spinal cord damage and hearing damage are also common.Patients who come from epidemic area and develop unexplained neurological symptoms should be screened and distinguished with neurobrucellosis.

BACKGROUND:The effects and molecular mechanism of simvastatin on the proliferation and differentiation of osteoblasts remain unclear. Especial y, we do not know much about the effects of connexin 43.
OBJECTIVE:To evaluate the effects of simvastatin on the proliferation and differentiation of osteoblasts and the regulatory effect of simvastatin on the expression of osteogenic genes and connexin 43.
METHODS:Newborn Sprague-Dawley rats were chosen and the cranium digestion method was used to culture osteoblasts. The different concentrations of simvastatin (0.062 5, 0.125, 0.25, 0.5 and 1.0μmol/L) were used to deal with osteoblasts. The proliferative effect of simvastatin on osteoblasts was measured with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. The effect of simvastatin on osteoblast differentiation was measured with alkaline phosphatase activities. The mRNA and protein expression of osteogenic genes and connexin 43 were measured by real time quantitative RT-PCR and western blot assay.
RESULTS AND CONCLUSION:There were no significant differences in absorbance values of simvastatin groups at 3 days (P>0.05). However, at 4 and 5 days, absorbance values were lower in the simvastatin groups than those in the control group (P<0.05). Compared with the control group, alkaline phosphatase activities of osteoblasts were greater in the simvastatin groups (P<0.05). Moreover, the effects of 0.25μmol/L simvastatin on alkaline phosphatase activities of osteoblasts were most significant. Osteocalcin, alkaline phosphatase activities, type I col agen and connexin 43 mRNA and protein expressions were increased after treatment with 0.25μmol/L simvastatin (P<0.05). These results indicated that simvastatin may inhibit the proliferation and improve the differentiation of osteoblasts by upregulating the mRNA and protein expression of osteogenic genes and connexin 43. These data may provide the new intervention target for osteoporosis treated with statins.

Objective To investigate the inhibitory effects of trichostatin A(TSA)on bladder cancer cell lines and its synergetic effect with anticancer drugs in treating bladder cancer in vitro and in vivo.Methods The inhibitory effects of TSA on human bladder cancer cell lines in vitro were detected by MTT assay.Hoechst staining was used to observe morphology for apoptotic cells after TSA treatment.Western blot was used to detect expression of acetyl-histone H3 and survivin.In vivo synergetic effects of TSA with anticancer drugs were detected in bladder cancer model rats.Results TSA significantly inhibited growth of bladder cancer cell lines in concentration and time dependent manner.Better results of tumor inhibition have been achieved when it was combined with DDP,MMC and ADM than used alone.After TSA treatment,the survivin expression in bladder cancer cells decreased and acetyl-histone H3 expression increased.Intravesical application of TSA combined with MMC can significantly inhibited tumor growth and progression.Conclusion TSA has direct anti-cancer effect and can enhance the action of several chemotherapy agents markedly.TSA may be an excellent candidate agent for intravesical application to treat bladder cancer.