The article reviewed the current status, reform measures and progress of the tiered medical services in Zhejiang province, and analyzed main roadblocks in such a system.Proposals made in the paper include such reform measures as further expanding quality medical resources of better talents and equipments to enhance primary medical institutions;forming the gatekeeper practice featuring firstvisit at community health centers with enhanced primary capabilities;insisting on joint reform of medical treatment, medical insurance and drugs, promoting the development of tiered medical services and utilization efficiency of medical resources in the province.

Covered in the paper are the policies and progress of the county-level public hospital reform in the province,and a summarized analysis of the self-appraisal reports and hospital reform statements submitted by the health authorities and up to 300 hospitals in 79 counties of the province.As found in the papers,the ongoing reform in Zhejiang is focused on reforming the business models in place,seeking breakthroughs from the zero mark-up policy on drug sales,in addition to such policies as reducing drug costs,adjusting medical service pricing,financial subsidies,and medical insurance payment reforms.Despite the initial success,further policy studies are needed in terms of internal management,upper and lower linkage,and personnel incentives.

The paper covered the initial success of Zhejiang province in furthering its development of a basic healthcare system in alignment of social and economic growth. Such progress has been achieved by adhering to the principles of coordinated arrangement,highlighting key points and step-by-step progress. Also presented are the methods and experiences of the province in its reform and perspectives for furthering the ongoing reform.

PURPOSE: Estrogen receptor (ER) and progesterone receptor (PR) have been used as indicators of endocrine system status since the mid-1970s in the clinical management of breast cancer. The predictive role of ER in endocrine therapy is undisputed, but the prognostic value of PR is still debated. The aim of this study was to investigate the clinical characteristics and prognosis of ER positive breast cancer with different PR expression levels. METHODS: A population cohort of 3,030 primary invasive ER positive breast cancer patients from a single cancer center underwent surgery and received adjuvant endocrine therapy from 2004 to 2010. The clinical and biological features of these patients with high PR-expressing tumors were compared with those of patients with low PR-expressing tumors. The follow-up data for disease-free survival (DFS), overall survival (OS), and breast cancer specific survival (BCSS) was obtained from 2,778 patients. Cox regression analysis was used to correlate biomarkers and tumor characteristics with DFS, OS, and BCSS. RESULTS: Tumors with low PR expression had more invasive pathological features and biological indexes than those with high PR expression. Low PR expression was an independent poor prognostic factor for DFS (p=0.014; hazard ratio [HR], 0.781; 95% confidence interval [CI], 0.641–0.950), OS (p=0.002; HR, 0.699; 95% CI, 0.560–0.873), and BCSS (p=0.005; HR, 0.714; 95% CI, 0.566–0.902). Furthermore, in low PR expressing tumors, patients who received chemotherapy had better DFS (p=0.002; HR, 0.449; 95% CI, 0.268–0.751), OS (p<0.001; HR, 0.341; 95% CI, 0.192–0.606), and BCSS (p<0.001; HR, 0.292; 95% CI, 0.156–0.549) than patients who did not received chemotherapy. CONCLUSION: Patients with ER positive invasive breast cancer with low PR expressing tumors have a worse prognosis than those with high PR expressing tumors, and these patients can benefit from chemotherapy.
Asian Continental Ancestry Group* ; Biomarkers ; Breast Neoplasms* ; Breast* ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Endocrine System ; Estrogens* ; Follow-Up Studies ; Humans ; Progesterone* ; Prognosis ; Receptors, Progesterone* ; Tamoxifen

Portal vein thrombosis (PVT) is one of the most common complications of liver cirrhosis. Due to coagulation disorder and the risk of bleeding in liver cirrhosis, there are many controversies over the treatment of liver cirrhosis with PVT in clinical practice. Common therapies for PVT include anticoagulant therapy, intervention, and thrombolysis. This article elaborates on the current status of the treatment of liver cirrhosis with PVT, in order to provide help for the development of standard and reasonable clinical treatment strategies.

Spinal cord injury (SCI) often causes different degrees of sensory and motor dysfunction, resulting in permanent disability, with many complications and difficult to cure. Metabolomics, as a new developing technique, identifies specific biomarkers for diagnosis, treatment or prognosis judgement by analyzing the changes in the metabolites after individual stress, and can make the best treatment and rehabilitation program for the patients in the early stage of the disease. At present, some achievements have been made in the diagnosis, treatment and prognosis monitoring of spinal cord injury, and some potential biomarkers have been identified. However, the pathophysiology of spinal cord injury is not fully understood, and relevant biomarkers are also lacking in clinical trials.

Objective To investigate the effect of olfactory mucosal neural stem cells (OM-NSCs) on neuronal apoptosis in rats. Methods OM-NSCs were isolated from adult male Sprague-Dawley rats, and neurons were isolated from fetal Sprague-Dawley rats. The neurons were divided into blank group, control group and experiment group after culture in vitro, which were further cultured in nomal, cultured in nomal 24 hours after stimulation of interleukin-1β (IL-1β), and cultured with OM-NSCs 24 hours after stimulation of IL-1β, respectively, for 24 hours. The apoptosis of neurons was observed with double staining of TUNEL and microtubule-associated protein 2 antibodies. Results There were few apoptotic cells in the blank group, and very many in the control group; the apoptotic cells were fewer in the experiment group than in the control group (F=39.764, P<0.01).Conclusion OM-NSCs can significantly inhibit neuronal apoptosis, which may play a role in neuroprotection.

Objective To investigate the effect of Ski on the secretion of inflammatory cytokines from activated astrocytes. Methods Astrocytes were obtained from cerebral cortex of a three-day old Sprague-Dawley rat and cultured in vitro. They were divided into blank group, control group and siRNA group. The Ski gene was silenced in siRNA group. The expression of Ski was tested with Western blotting and immunofluorescence 48 hours later. Then the astrocytes were stimulated with lipopolysaccharide for 24 hours. The secretion of tumor necrosis factor α (TNF-α) and interleukin-1β (IL-1β) in activated astrocytes was detected with ELISA. Results The expression of Ski protein reduced in the siRNA group (P<0.001), as well as the secretion of TNF-α and IL-1β (P<0.001). Conclusion Ski may play a role in inflammatory response of astrocyte.