Based on the describing the effects and restricts of fiscal subsity and medical insurance payment on medical institutions and doctor behavior,the lead of fiscal subsidy and payment was managed as the important key for the supply-side reform in health service field,so as to promote the regression benefits for public hospitals,help to solve the core problems for new medical reform and achieve the main goal of medical service system reform.

Digital usage technology has infiltrated into all kinds of social fields with progress of high technology.We have been in digital informal times.It is absolute to change traditional experimental teaching model.Animal experiments of our west surgical course have been done in simulating operating room with digital modern teaching method.The experiment results have been improved.

Intracranial hypertension easily causes brain herniation,brainstem compression,and leads to death.Western medical treatment mainly chose medicines that can change the permeability of plasma,but with noticeable side effects.Chinese medicines had manifested therapeutic effects to inuacranial hypertension with multiple approaches and no obvious side effects.Besides Chinese medicines can also adjust the overall state of patients,which can not be replaced by western medicine.The treatment of intracranial hypertension with Chinese medicines will become an important research subject and have a broad outlook.

For comprehensive ability's cultivation of clinical graduate students,this article presents new and feasible methods in placing emphasis on cultivating teaching ability,in order to improve clinical graduate student's teaching ability.It also provides feasible experience and lessons for many other medical schools on graduate cultivating and management.

Objective To investigate the influence of double-effect activation of cholinergic antiinflammatory pathway on the liver injury and inflammatory response in obstructive jaundice rats by applying cholinesterase inhibitor and cholinergic M receptor blocker to activate alpha 7 nicotinic acetylcholine receptor.Methods 22 adult male Wistar rats were randomly assigned into three groups:sham operation (SO) group (n=6),bile duct ligation (BDL) induced obstructive jaundice with (BDL treatment group) or without treatment (BDL control group) (n=8 each).The medicine treatment group was given anisodamine (25 mg/kg) and neostigmine (25 μg/kg) daily via intraperitoneal injection after surgery,the control group was given equal amount of normal saline.The body weights of rats in each group were measured every other day.After 12 days,the rats were killed,and the pathological changes of liver injury,liver function and the expression levels of proinflammatory cytokines in the serum and liver tissue were observed.Results The body weight of BDL rats was significantly lower than the SO group rats,and the growth rate of BDL treatment group rats was the same as the rats in BDL control group 3 days after the starting of treatment.The AST,ALT,bilirubin and gamma-GT levels of BDL control and treatment groups were significantly higher than the SO group (P＜0.05),but there was no significant difference between BDL control and treatment groups.The serum albumin level of BDL treatment group was obviously higher than that of BDL control group,but the pathological liver injury was significantly slighter.The gene expression levels of TNF-alpha,IL-1 beta and IL-6 in the liver tissue were significantly higher in BDL groups than SO group (P＜0.05),but BDL treatment group was significantly lower than BDL control group (P＜0.05).In addition the serum TNF-alpha and IL-1 beta concentrations of BDL treatment group and control group were significantly higher than the SO group (P＜0.05),but the BDL treatment group was obviously lower than that BDL control group (P＜0.05).Conclusion The combine application of cholinesterase inhibitor and cholinergic M receptor blocker to activate the cholinergic anti-inflammatory pathway can significantly inhibit the obstructive jaundice induced proinflammatory gene expression and liver injury.

Objective To investigate the effects of methylprednisolone on neurocyte apoptosis in rats with severe acute pancreatitis(SAP).Methods Thirty-six SD rats were divided into sham operation group,SAP group and methylprednisolone group(12 rats in each group).SAP model was constructed by injecting 5%sodium taurodeoxycholate into biliary-pancreatic duct.Serum amylase,interleukin-6(IL-6),tumor necrosis factor α (TNF-α),volume of aseites and histopathological changes of pancreas were determined.The mRNA expressions of Bcl-2 and Bax in brain tissue were analyzed by RT-PCR.and neuroeyte apoptosis was detected by TUNEL method.Results The levels of serum IL-6 and TNF-α were significantly increased:the expression of Bcl-2 mRNA in brain tissue was down-regulated;the expression of Bax mRNA was up-regulated;the Bcl-2/Bax ratio Was decreased:the apoptosis of the neurocytes was increased in SAP group.Compared with SAP group,the levels of serum IL-6 and TNF-α were significantly decreased;the expression of Bcl-2 mRNA was unchanged but the expression of Bax mRNA was down-regulated in brain tissue,so the Bcl-2/Bax ratio was elevated significantly;the rate of the ueurocyte apoptosis in brain tissue were reduced in methylprednisolone group.Conclusions The apoptosis of neurocytes in brain tissue may be one of the factors causing pancreatic encephalopathy.Methylprednisoione can inhibit the release of IL-6 and TNF-α.improve the balance of Bcl-2 and Bax expression and decrease the apoptosis of neurocytes in brain tissue.

In this work, a fast and efficient microwave-assisted extraction (MAE) method was developed to extract main bioactive alkaloids from lotus plumue. To optimize MAE conditions, three main factors were selected using univariate approach experiments, and then central composite design (CCD). The optimal extraction conditions were as follows: methanol concentration of 65%, microwave power of 200 W, and extraction time of 260 s. A high performance liquid chromatography–diode array detector (HPLC–DAD) method was established to quantitatively analyze these phytochemicals in different lotus plumule samples and in different part of lotus. Chromatographic separation was carried out on an Agilent Zorbax Extend-C18 column (4.6 mm×150 mm, 3.5 μm). Gradient elution was applied with the mobile phase constituted with 0.1%triethylamine in water (A) and acetonitrile (B): 40%?70% B at 0?8 min, 70%?100% B at 8–9 min, 100% B for 2 min, and then equilibrated with 40%B for 2 min.

Objective To compare the results of surgical resection with radiofrequency ablation in the treatment of primary hepatocellular carcinoma with type Ⅰ portal vein tumor thrombus.Methods The clinical data of 30 patients with primary hepatocellular carcinoma with type Ⅰ portal vein tumor thrombus treated between January 2006 and December 2009 were analyzed retrospectively.Patients were divided into two groups according to the treatment.Result The treatments were successfully carried out in the surgical resection group (n=15) and the radiofrequency ablation group (n =15).There was no perioperative death.Both surgical resection and radiofrequency ablation improved the overall survival and recurrence-free survival.The survival outcome of radiofrequency ablation was similar to surgical resection.Conclusion Both surgical resection and radiofrequency ablation were safe and effective for patients with primary hepatocellular carcinoma with type Ⅰ portal vein tumor thrombus and improved the overall survival and recurrence-free survival.

Objective Aprotinin has been suspended in cardiac surgery since risks factors associated with mortality and other adverse events in western Literatures.This study was to investigate the effect of aprotinin on short-term outcomes in cardiac surgery in Chinese patients.Methods Two groups of patients who underwent cardiac surgery during equal period just before and after aprotinin was suspended in China.Aprotinin groupp(n=1699) was defined as operations from june 19,2007 to Dec 18,2007,when aprotinin was used in all the patients.Control group(n=2225)was defined as operations from Dec19,2007 to June 18,2008,when aprotinin was not umed.Postoperative outcomes between the two groups,including blood loes and transfusion requirement,in-hospital mortality and major adveme outcome events were compared,using univariate analysis and mulfivariable logistic regression analysis.Results Aprotinin group had less postoperative blood loes,transfusion requirement and reoperation for bleeching as compared with the control group.Application of aprotinin did not increase the risk of in-hospital mortality (0.5%vs.10%,P=0.08)and other major ad-verse events,including renal dysfunction,renal failure requiring dialysis,low cardiac output syndrome (LCOS),neurological and pulmonary complications.Aprltinin group also had and shorter mechanical ventilation time(P=0.04),a lowwer rate of delayed mechan-ical ventilation time(P=0.04)and a higher PaO2/FiO2 in the bolld gas analysis(P<0.001).which presented a better respiratory function.Multivariable Logistic regression analysis got identical results with univariate analysis.Conclusion The use of aprotinin in cardiac surgery could reduce blood loss and transfusion requirement significantly,and showed a protective effect on the lungs.In the mean time it did not increase the risk of mortality or major complications.We suggest further studies should be performed to make a decision of continuing or stopping the use of aprotinin in cardisc surgery in Chinese or Asian population.

To confirm that Bartonella and Wolbachia were carried by sheep keds (Melophagus ovinus) in southern Xinjiang of China, 17 M. ovinus samples, which were collected in Aksu Prefecture, Xinjiang, were randomly selected. In this study, the Bartonella gltA and Wolbachia 16S rRNA gene were amplified through conventional PCR and the sequence of those amplified products, were analyzed. The results demonstrated that Bartonella was carried by all of the 17 sheep keds and Wolbachia was carried by 15 out of them. Bartonella was identified as B. melophagi. Three strains of Wolbachia were supergroup F and 1 strain has not been confirmed yet. It is the first report about Wolbachia supergroup F was found in sheep keds and provided the molecular evidence that B. melophagi and Wolbachia supergroup F were carried by sheep keds in Aksu Prefecture of southern Xinjiang, China. The 2 pathogens were found in sheep keds around Taklimakan Desert for the first time.
Bartonella ; China ; Genes, rRNA ; Polymerase Chain Reaction ; Sheep ; Wolbachia