Shanghai healthcare system reform is proceeded in the system engineering theory adopting the methods of making the overall plans, the combination of scientific design whole and part, the combination of microcosm and macrocosm, the combination of innovation and standard, the combination of qualitative analysis and quantitative analysis, the combination of structural optimization and improvement so as to promote the development of Shanghai healthcare system and provide successful experiences for our national healthcare system reform.

Parkinson's disease (PD) is a complicated disease, commonly diagnosed among the elderly, which leads to degeneration of the central nervous system. It presently lacks an effective therapy for its complex pathogenesis. Adverse effects from Western drug-based medical intervention prevent long-term adherence to these therapies in many patients. Traditional Chinese medicine (TCM) has long been used to improve the treatment of PD by alleviating the toxic and adverse effects of Western drug-based intervention. Therefore, the aim of this study is to evaluate the efficacy and safety of Xifeng Dingchan Pill (XFDCP), a compound traditional Chinese herbal medicine, taken in conjunction with Western medicine in the treatment of PD patients at different stages in the progression of the disease.

Objective: To study the effect of zinc deficiency(ZD)on the gene expression of vitamin D receptor(VDR)and CaBP in duodenal mucosa of rats. Methods: Thirty weaning male rats were randomly divided into three groups:ZD,paired-fed(PF),zinc adaquate(ZA). After 15 d feeding, took the duodenal mucosa to extract RNA,and measured the levels of VDR mRNA and CaBP mRNA in duodenal mucosa by real time fluorescent quantity PCR. Results: The VDR gene expression of ZD group was downregulated 88.89% as that of PF group,and 50.00% as that of ZA group. CaBP gene expression of ZD group was downregulated 80.16% as that of the PF group,and 88.50% as that of ZA group. Conclusion: Zinc deficiency, by changing the activity of VDR and the mRNA expression of VDR,affects the transcription of the target gene CaBP,and then the absorption of calcium that causes allo-osteogenesis.

Objective To study the effectiveness of EEG bio-feedback in ameliorating the attention of children with attention deficit/hyperactivity disorder (ADHD) compared to a control group receiving methylphenidate treatment; and to explore the effectiveness of EEG bio-feedback in treating ADHD children refractory to methylphenidate. Methods Forty-four ADHD children were randomly assigned to an EEG bio-feedback group or a methylphenidate group. An additional twenty ADHD children refractory to methylphenidate were referred to as EEG bio-feedback group B. The two EEG bio-feedback groups received training in enhancing their beta activity and suppressing their theta activity. The methylphenidate group were treated with methylphenidate for 3 months. The subjects′ attention stability was measured using a number cancellation test. Their attention allocation and attention shift were tested using a neuropsychological behavioral test instrument, including trail-making test. All groups received re-tests during treatment, post-treatment and during a 6 month follow-up. Results During treatment, the cancellation speed of children in the EEG bio-feedback group A was slower than that of children in the MPH group. At the end of the treatment, there were no significant differences in speed between the two groups. Six months to one year after treatment the cancellation speed of the EEG bio-feedback group A was significantly faster than that of the MPH group. The EEG bio-feedback group B demonstrated significant increases in their cancellation speeds after 20 treatments and during a 1 year follow-up. During treatment and post-treatment, Q scores were significantly lower in EEG bio-feedback group A than in the methylphenidate group. Six months to one year after treatment the Q scores were significantly higher in EEG bio-feedback group A than in the methylphenidate group. There was no significant increase in the Q scores in EEG bio-feedback group B during treatment, but they increased significantly post-treatment. There was no significant difference in the trail-making time between EEG bio-feedback group A and the methylphenidate group during the treatment. Six months to one year after treatment, the trailmaking times in EEG bio-feedback group A were significantly less than in the MPH group. EEG bio-feedback group B showed significant decreases in trailmaking time post-treatment and during follow-up. Conclusions EEG bio-feedback may produce significant and long-term improvements in attention stability, attention allocation and attention shift. EEG bio-feedback may be useful for children with ADHD when methylphenidate is ineffective.

Objective To assess surgical strategies and its therapeutic effect on treating tumors invading of the great vessels. Methods 23 patients underwent tumor resection along with reconstruction of great vessels from Jan. 2001 to Dec. 2005 were retrospectively reviewed. Results 19 cases (82.6%) experienced radical resection along with reconstruction of great vessels, 4 cases (17.4%) underwent palliative resections. 20 cases (86.9%) were followed up by various imaging examination methods. 4 cases (17.4%) died perioperatively and 7 cases (30.4%) had complications in perioperative period. Up to Aug. 2005, the postoperative survival times in patients were from 1.5 to 59.0 months. 3 cases (15.0%,3/20) existed more than 48 months, 4 cases (20.0%,4/20) more than 36 months, 6 cases (30.0%,6/20) more than 24 months, 9 cases (45.0%,9/20) more than 12 months and 12 cases(55.0%,11/20)more than 6 months. No complications related to vascular graft occlusion and tumor recurrence next to grafts occurred in these patients. In 2 cases appeared partial thrombosis in grafts in perioperatively. Conclusion Combination of radical resection of tumor and reconstruction of great vessels could extend survival time and improve quality of life in selected patients with tumor invading thoracic and abdominal great vessels.

Sequences analysis revealed Grass carp reovirus (GCRV) s10 was 909 nucleotides coding a 34 kDa protein denoted as VP7, which was determined to be a viral outer capsid protein (OCP). To obtain expressed OCP in vitro, a full length VP7 gene was produced by RT-PCR amplification, and the amplified fragment was cloned into T7 promoted prokaryotic expression vector pRSET. The recombinant plasmid,which was named as pR/GCRV-VP7,was then transformed into E.coli BL21 host cells. The data indicated that the expressed recombinant was in frame with the N-terminal fusion peptide. The over-expressed fusion protein was produced by inducing with IPTG, and its molecular weight was about 37kDa, which was consistent with its predicted size. In addition, the fusion protein was produced in the form of the inclusion body with their yield remaining steady at more than 60% of total bacterial protein. Moreover,the expressed protein was able to bind immunologically to anti-his-tag monoclonal antibody (mouse) and anti-GCRV serum (rabbit). This work provides a research basis for further structure and function studies of GCRV during entry into cells.

Objective To probe the etiology and management of restenosis after artificially grafting bypass for chronic ischemia of the lower extremities. Methods In this study 52 cases suffering from postoperative restenosis and obliteration were compared with 32 cases whose artificial grafts remain patent during the same postoperative follow-up period of 3～62 months.Possible risk factors that lead to restenosis were evaluated.Resuits FIB(4.48±1.68)g/L,CRP(9.5±2.6)mg/L and LDL(4.5±1.7)mmol/L were significantly higher in the restenosis group than FIB(3.50±0.72)g/L,CRP(4.0±3.2)mg/L and LDL(2.8±0.9)mmol/L in the patent group(P＜0.01).There were no significant difference between HDL(1.02±0.32)mmol/L in the restenosis group and HDL(1.12±0.28)mmol/L in the patent group (P＞0.05).Reoperation in these 52 cases found severe intima hyperplasia and secondary thrombosis within anastomosis in 42 cases and the remaining 10 cases were found with artificial vessel primary thrombosis.After reoperation,artificial graft remain patent in 28 cases,limb amputation was performed in 10 cases,the grafted bypass were removed due to infection in 3 cases. Five patients died postoperatively.Conclusion The main reason for restenosis after artificially grafting bypass is intima hyperplasia in vascular anastomosis.Higher levels of FIB,CRP and LDL maybe the major high risk factors that lead to intima hyperplasia and artificial graft obliteration.

Objective To investigate the expression of chemokine-like factor 1(CKLF1) in the balloon injured aorta of Sprague-Dawley rats.Methods Balloon expansion induced aorta injury model was established in 80 male Sprague-Dawley rats.Model rats were randomly divided into 8 groups.Rats were sacrificed at the postoperative periods of 12 hours,1 day,3 days,1 week,2 weeks,4 weeks,6 weeks,and 8 weeks respectively.Sham injury operation was applied to 5 rats as control.The ratio of intimal area (IA) and medial area (MA) was calculated to determine the extent of neointimal hyperplasia.Expression of CKLF1 was examined at protein level with immunohistochemistry and at mRNA level with RT-PCR.Software IPP6.0 was used to examine the mean optical density of positive staining.With β-actin expression as an internal control,semi-quantity of CKLF1 expression was calculated by CKLF1/β-actin.Results Visible neointima was noticed at 1 week postoperation.Extend of intimal hyperplasia(IA/MA)was most remarkable at 4 weeks and receded afterwards. Immnohistochemistry study showed that expression of CKLF1 was stronger in the neointima than in the media(P=0.016).The expression was most obvious in the neotima at 1 week postoperation.RT-PCR showed peak expression at 3 days postoperation and declined gradually but still at a higher level than control(P<0.05).The extent of intimal hyperplasia(IA/MA)was positively correlated to the expression of CKLF1(R=0.70,P=0.188).Conclusion The expression of CKLF1 was up regulated in balloon injured rat aorta.The expression was more obvious in the neointima than in the media.CKLF1 may play a role in the development of intimal hyperplasia.

Objective To sum up our preliminary experience on radical surgery for the treatment of Budd Chiari syndrome under genuine direct vision. Method A total of 13 cases were enrolled in this study with age ranging from 17 to 48 years, and history from 3 months to 5 years. There was inferior vena cava (IVC) membranous obstruction in 3 cases, right hepatic venous membrane (HV) in 1 case, IVC membrane with distal thrombosis in 6 cases, long segment of thrombosis of IVC in 2 cases, IVC tumor thrombus extending to right atrium in 1 case of retroperitoneal tumor. Result All lesions were successfully resected. Extracorporeal circulation was used in one case, cell saver was used in 2 cases. No blood transfusion was needed except for one case receiving bank blood transfusion of 2000 ml, and the other one of 400 ml. One patient died of renal failure during perioperative period. Disappearance of the symptoms and sigh after operation was found in all the other cases. Conclusion This new radical surgery gives access to the lesions under clear direct vision facilitating the correction.

Objective To explore the clinical effect of inlay labial mucosa graft urethroplasty (LMGU) forⅠperiod in the complexity hypospadias.Methods According to the digital table,30 patients with complexity hypospadias were randomly divided into control group and observation group,15 cases in each group.The control group took Ⅰ period operation.The observation group received surgery by stages to complete.Routine urinary diversion during operation was performed after bladder puncture and ostomy,and in the control group,the urethra was placed with self-made 10-14F lateral hole silica gel stent,which was extracted out in the middle of the perineum,left or right.After 12-14d removal postoperative,the urination was observed.The catheter in the observation group was removed after 10 d,the urethroplasty is performed 6 months later.The clinical effects of the two groups were compared.Results In the control group,postoperative urinary fistula in 2 cases(13.3%),urethral orifice in 1 case(6.7%).In the observation group,postoperative urinary fistula in 2 cases(13.3%),6 months postoperatively in patients with urinary fistula to repair fistula was successful,urethral mouth narrow pure line incision.The incidence rate of complication of the control group was 20.0%,which of the observation group was 13.3%,the difference was not significant between the two groups(P>0.05).All cases were followed up for 1 to 2 years,did not occur urinary tract stones,hair growth,oral ulcers,such as the limited mouth complications.The penis was straight,beautiful shape.Conclusion Inlay LMGU Ⅰperiod is suitable for multiple surgery led to the lack of local incidence,urethral plate dysplasia and with severe penis abnormalities such as complexity in patients with hypospadias.The postoperative complications,micturition,penile appearance have no obvious differences compared with the stage,it is worthy of clinical popularization and application.