Introduced in the paper are the connotation and current operations of the medical insurance negotiation mechanism.The authors also discussed obstacles blocking operations of the mechanism, including insufficient coordination capacity of the medical insurance institution over the negotiation, and lack of motivation of the institution for curbing costs and the contradiction against the profit pursuit of drug companies.Corresponding countermeasures and suggestions are put forward in the end, namely system reform for inter-governmental functions, enhancement of the capacity of both medical institutions and doctors against risks, and perfecting the restraint and incentive mechanism for medical institutions, aiming at smooth operation and optimization of the medical insurance negotiation mechanism.

This paperd probed four mistakes about teaching of Operational Research of Hygienic Management from different angles such as nature of courses,content of courses,academic goal and multimedia.By teaching example analysis,it put forward corresponding measures and suggestions on how to avoid these mistakes.

Objective To explore whether combination of Goremor vessel electroacupuncture and transplanted neural stem cells could promote the completely transected spinal cord tissue producting some nerve growth active substances. Methods Fourty-five adult rats were divided into normal group,control group,neural stem cells transplanted group(NSCs group),Goremor vessel electroacupunctural group(EC group) and Goremor vessel electroacupuncture plus NSCs transplanted group(EC+NSCs group).All animals(except for the normal group) were performed complete transection on T10 segment of spinal cord.The electroacupunctural treatment started at the fifth day after operation among EC group and EC+NSCs group.The sacrifice time of rats was the 14d and 28d after operation respectively.The cyclic adenosine-monophosphate(cAMP) radioimmunoassay and Western blotting test for levels of Neuroltrophin-3(NT-3),neurotrophic factor receptor——Trk and growth associated protein-43(GAP-43) were made in the tissue of injured spinal cord. Results 1.Fourteen days after operation,cAMP concentration at cranial segment and caudal segment of injured spinal cord segment was lower in all groups than that of normal group,except for EC group.cAMP concentration at injured segment was increased slightly in EC group and EC+NSCs group than that of normal group,Twenty-eight days after operation,cAMP concentration at cranial segment and caudal segment of injured spinal cord segment maintained a higher level in EC+NSCs group.cAMP concentration at injured segment was increased slightly in NSCs group and EC+NSCs group than normal group.2.The expression of NT-3,Trk and GAP-43 was more prominent in EC group and EC+NSCs group.Meanwhile,the expression of three proteins was lower in control group and NSCs group than that of EC group and EC+NSCs group.Conclusion Goremor vessel electroacupuncture may promote the injured spinal cord tissue producting cAMP.The combination of Goremor vessel electroacupuncture and transplanted neural stem cells may maintain higher cAMP concentration and tend to increase the concentration of NT-3,Trk and GAP-43 in injured spinal cord tissue.

Many stakeholders are involved in the implementation of centralized drug procurement , namely government agencies ,drug bidding or procurement agencies ,pharmaceutical companies ,medical institutions ,doctors ,patients and health care institutions among others.The game falls into three stages.The first is that between government agencies or drug procurement agencies and medical institutions or doctors ;the second is that of price negotiations between the hospital and the winner pharmaceutical enterprise ; the third is that between doctors , patients and medical insurance agencies.Major setbacks found in the implementation of such a policy are as follows :disappearance of classic inexpensive drugs from the market ;rebates and commissions in the second bargainingphenomenon ;slow progress in the implementation of the purchase with quantity indication policy ;rapid rise of medical costs for national health insurance.Recommendations by the authors include optimization of the centralized drug procurement ;improvement of the public hospital performance appraisal system and talent evaluation system ;promotion of the purchase with quantity indication policy ;building of the game pattern of equal‐footing negotiation between hospitals and pharmaceutical companies ; and introduction of the payment management of medical insurance .

Hashimoto thyroiditis (HT) is the most common autoimmune disease of the thyroid. The thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) always increase greatly in the patients. Thyroid cancer is the most common malignant tumor in the endocrine system. And papillary thyroid carcinoma (PTC) is the most common pathological type of it. Recently, the coexistence of HT and PTC has shown an increased incidence. And these two diseases have many similarity in immunology, endocrine, genetics, implying the links between them. However the underlying mechinisms remain unclear. On the ground of the characteristics of epidemiology and histopathology, this article reviews and summarizes possible mechanism in many ways for the coexistence of these two disease, including precancerous lesion, cell proliferation and apoptosis disorder, immunology, endocrinology, genetics, etc.

Objective To evaluate the clinical curative effect and safety of the stapled transanal rectal resection (STARR) in treatment rectocele. Methods Ninety-two cases suffering from rectocele were treated with rectal inferior extremity half circum mucosectomy by PPH stapler. The operative time, operation effect,complication and recurrence rate were studied. Results All cases were operated successfully. The mean operation time was (25 ±8)min,The totol effective rate was 100% ,postoperative complication included inferior abdomen discomfort and pain (32 cases,34. 7%),urinary retention(9 cases,9. 8%) ,anal anus pain(5 cases, 5. 4%) and bleeding(3 cases,3. 3%). The average length of postoperative stay was 1-5 days (average[2. 2 ±0. 9]days). The follow-up period ranged from 4 to 40 months and no recurrence was observed. Conclusion The stapled transanal rectal resection (STARR) has several advantages,such as safety,rapid recovery,good recent therapeutic effect and lower recurrence in treating rectocele.

OBJECTIVE: To explore the techniques for providing drug consultations to improve the pharmaceutical care level.METHODS: The drug consultation records of 601 ophthalmological outpatients in our hospital from Mar.2007 to Mar.2008 were analyzed retrospectively.RESULTS: 36.8% of the patients consulted from the clinical pharmacists about the administration of drugs versus 15.9% about the adverse drug reactions.CONCLUSION: The drug consultation service provided by pharmacists can promote rational drug use and enhance the therapeutic efficacy.

OBJECTIVE:To evaluate the effect of ambroxol on plasma concentration and pharmacokinetic parameters of roxithromycin when healthy volunteers received roxithromycin and ambroxol. METHODS: In double-period cross-over experiment, 24 healthy male volunteers received roxithromycin tablets or roxithromycin tablets combined with ambroxol tablets. Serial venous blood samples were collected at different time points after drug administration. Plasma concentrations of roxithromycin were measured by LC-MS. The pharmacokinetic parameters of roxithromycin were calculated and analyzed by variance analysis. Drug interaction was detected by 90% confidence interval. RESULTS: Main pharmacokinetic parameters of roxithromycin tablets and drug combination were as follows: tmax(1.67?0.32)h vs. (1.67?0.41)h; Cmax(10.26?2.82) mg?L-1 vs. (10.86?3.19) mg?L-1; AUC0～72(110.19?35.18) mg?h?L-1 vs. (113.42?38.72)mg?h?L-1; AUC0～∞(111.70?36.23) mg?h?L-1 vs. (115.04?39.98) mg?h?L-1. CONCLUSION:? Ambroxol has no effect on the plasma concentration and pharmacokinetics of roxithromycin in healthy volunteers.

Objective To evaluate the effects of different doses of propofol infusion on real-time monitoring of recurrent laryngeal nerve. Method 30 ASA Ⅰ-Ⅱ patients who underwent thyroid gland surgery were given propofol intravenously in different concentrations. BP, HR and real-time monitoring of recurrent laryngeal nerve were recorded with the propofol dosage varying from 3 to 6, 9, 12, 15, 18?g/(kg?min). Results The amplitude of recurrent laryngeal nerve reflex had no change with different doses of propofol infusion. The HR and BP were elevated with low doses of propofol infusion, but there were no changes when propofol concentration was 15 or 18?g/(kg?min). Conclusion Propofol infusion i.v. does not interfere with real-time intraoperative monitoring of recurrent laryngeal nerve, and it does not inhibit the action potential of recurrent laryngeal nerve, but can effectively decrease the cardiovescular reaction.

Objective To present a moified technique of island flap (Duckett+Perovic's method)for repair of severe hypospadias.Methods Between January 1996 and May 2002,26 cases of severe hypospadias were repairs using Perovic's method in a lonely or using Duckett's method plus Perovic's method.In all patients,we employed island flaps in one stage.Suprapubic diversion was used for drainage,and 10F or 12F tube was inserted to the proximal end of new urethra.Ceftriaxone was used after the operation on all of patients for one week.Urethral tubes were removed at 6 or 8 days postoperation and the suprapubic tubes at 10 or 12 days postoperation.Results One stage healing was successfully achieved in 23 patients.Three patients suffered from fistula,of them were healed through re-operation at six months later.After the operation,normal function was recovered and perfect appearance was achieved.Conclusion The result of repair turned out to be satisfactory and we believe that the technique is a good alternative for severe hypospadias.