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.

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 .

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.

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 analyze postoperative complications of surgical therapy for deep vein thrombosis (DVT) of the lower extremity. Method From January 2001 to January 2008 vena cava filters were placed in 171 DVT cases before surgery. Fogarty catheter (73 cases), Amplatz thrombectomy device (ATD) (55 cases), Acolysis ultrasound ablation(43 cases) were used to extract the thrombi in iliac and proximal femoral vein. The full extraction of thrombi in distal end was facilitated by compressing and massaging the legs in all cases. Iliac venous stenosis or occlusion was managed by interventional therapy, and temporary femoral arteriovenous fistula were carried out routinly. Result Operations were successful in 157 cases(70 cases in Fogarty group, 52 in ATD group,35 in Acolysis ultrasound ablation group), and failed in 14 cases (3 cases in Fogarty group, 3 in ATD group, 8 in Acolysis ultrasound ablation group). Permanent,retrievable and temporary vena cava filters were placed in 51,32 and 88 cases respectively. Stenosis or occulsions of the iliac vein was found in 143 cases and stents were placed after balloon dilatation in 41 cases. During the operation, residual thrombi was found in 80 cases. Vessel perforation and rupture were complicated in 14 cases, thrombosis adhering in eava vein filters in 18 cases. There was no mortality and no pulmonary thromboembolism. During the follow-up, we found iliae vein restenosis in 21 cases, thrombosis recurrence in 36 cases, stents displacement in 6 cases, and stents fracture in 2 cases. Conclusion Surgical therapy is effective for DVT of the lower extremities.

Objective To observe the clinical efficacy of Wenjing Shexue Recipe ( WSR) in treating polycystic ovarian syndrome ( PCOS) with liver-kidney deficiency, and to explore the possible therapeutic mechanism. Methods Seventy-four PCOS patients were randomized into observation group ( N=38) and control group ( N=36). The observation group was given oral use of WSR and the control group was treated with Ethinylestradiol and Cyproterone Acetate Tablets orally. Both groups received treatment for 6 months, and were followed up for 3 moths after drug withdrawal. After treatment, the therapeulic effect was evaluated , and the changes of body mass index ( BMI) , hairiness. acne, and sexual hormone levels were monitored before and after treatment. Results ( 1) The total effective rate of the observation gorup was 92.11% and that of the control group was 75.00%, the difference being significant ( P<0.05). ( 2) After treatment for 6 months, body mass index (BMI), the scores of hairiness and acne, and serum levels of testosterone (T) and luteotrophic hormone (LH) were decreased in the observation group (P<0.05 compared with those before treatment). The control group had lower scores of hairiness and acne and serum levels of T and LH than those before treatment ( P<0.05) , but BMI showed no obvious decrease (P>0.05) . The results of follow-up showed that BMI, the scores of hairiness and acne, and serum levels of T and LH were still lower in the observation group than those before treatment (P<0.05), but the above indexes except acne scores were increased in the control group (P>0.05 compared with those before treatment) and were higher than those of the observation group (P<0.05). Conclusion WSR exerts better effect for the treatment of PCOS with liver-kidney deficiency than Ethinylestradiol and Cyproterone Acetate Tablets, and the possible mechanism is probably related with the regulation of endocrine disturbance by decreasing serum T and LH levels.