By equality in the healthcare retorm we mean equal access to healthcare protection.Future reiorm should establish a fair value concept and make great efforts to solve the serious lack of fairness in the current healthcare system.Efficiency in the healthcare refers to not only higher revenue income of medical institutes but also to utmostly meet the citizens" needs for medical service.For the sake of the most cost - effective distribution of the insufficient budgets and medical resources,medical services have to be diversified for an improved efficiency. In the framework of the healthcare reform,relations between equality and efficiency is the unity of opposites,and top priority shall be given to equality while maintain efficiency.

Objective To investigate the correlations of serum total bilirubin level with infarct volume,severity and etiological typing in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to hospital from January 2012 to January 2014 were used as subjects of study.Their clinical and imaging data were collected,and serum total bilirubin levels were detected.The correlations of the serum total bilirubin levels with the infarct volume,severity and etiological typing were analyzed.Results A total of 290 patients with acute ischemic stroke were enrolled in the study.The patients were divided into either a large infarction group (≥1.8 cm3,n =145) or a small infarction group (＜ 1.8 cm3;n =145)according to the median cerebral infarction volume.The total bilirubin level of the large infarction group was significantly higher than that of the small infarction group (16.896± 7.761 μmol/L vs.13.039±4.477 μmol/L;t =5.185,P ＜ 0.001).Multivariate logistic regression analysis showed that the bilirubin highest quantile group (＞ 17.893 μmol/L) was an independent risk factor for large infarction (odds ratio [OR] 2.754,95％ confidence interval [CI] 1.028-7.375;P =0.044).According to the National Institutes of Health Stroke Scale (NIHSS) score,the patients were divided into a mild stroke group (NIHSS score ＜8;n =210) and a moderate to severe stroke group (NIHSS score≥ 8,n =80).The total bilirubin level of the moderate to severe stroke group was significantly higher than that of the mild stroke group (16.861 ±7.689)μmol/L vs.14.246 ± 6.019 μmol/L;t =3.052,P =0.002).Multivariate logistic regression analysis showed that the total bilirubin level was not an independent risk factor for moderate to severe stroke.Small artery occlusive stroke,large artery atherosclerotic stroke,and other definite causes of stroke were combined into non-cardioembolic stroke group (n =244).The total bilirubin level in the cardioembolic stroke group (n=46) was significantly higher than that in the non-cardioembolic stroke group (19.639±8.409 μmol/L vs.14.087 ±5.831 μmol/L;t =5.479,P＜0.001).Multivariate logistic regression analysis showed that the bilirubin highest quartile group (＞ 17.893 μmol/L) was an independent risk factor for cardioembolic stroke (OR 8.405,95％ CI 1.719-41.106,P =0.009).Conclusions The increased serum total bilirubin level is an independent risk factor for larger infarction and cardioembolic stroke.As an oxidative stress index,serum total bilirubin in acute stage can provide help for early identification of infarct volume and etiological subtype in patients with ischemic stroke.

Objective To find a more suitable approach to pediatric anesthesia during laparoscopic operation to alleviate stress response.Methods Forty patients,1 to 3 years of age,ASA grade Ⅰ-Ⅱ,underwent general anesthesia(group GA)and combined general epidural anesthesia(group GEA)during their laparoscopic operation.Heart rate(HR),mean arterial pressure(MAP),ECG,SPO2,PETCO2,blood gas,plasma epinephrine,plasma norepinephrine,plasma IL-6 and IL-10 were monitered and recorded five minutes before anesthesia(T0),pre-pneumoperitoneum(T1),5 min after pneumoperitoneum(T2),30 min after pneumoperitoneum(T3),30 min after operation(T4)and 24 h after operation(T5).Results(1)HR,MAP of group GA were increased obviously at T2,T3,T4 compared to T0(P0.05).Significant difference was found at T1,T2,T3 and T4 between group GA and group GEA(t=4.749,10.349,13.632,10.051,P0.05).Plasma IL-10 at T1,T2,T3,T4 were higher than that at T0 in both groups(P

Objective To investigate the expressions of Dapper1 in gastric carcinoma and elucidate its relationship with survivin and its role in tumor cell apoptosis. Methods Dapper1 mRNA was detected with RT-PCR using specimens from 30 cases of gastric carcinoma and the corresponding normal gastric mucosa.The pcDNA3.1-Dpr1 plasmid was transfected into SGC-7901 cells with LipofectamineTM 2000.The effect of upregulation of Dpr1 on SGC7901 cell apoptosis was determined by flow cytometry.The downregulation of survivin、Dvl-2 and β-catenin protein expression were detected by Western blot analysis.Results Downregulation of Dpr1 gene expression was observed in 17(57%)of 30 human gastric cancer and the downregulation was significantly correlated with the depth of invasion and the degree of differentiation (P＜0.05).Also,upregulation of Dpr1 mRNA and downregulation of survivin mRNA were detected after transfecting pcDNA3.1-Dpr1 plasmid in SGC7901 cells,which led to downregulation of survivin、Dvl-2、β-catenin protein and increase of the SGC7901 cell apoptosis rate from 2.89%to 13.96%.Conclusion Downregulation of Dp1l gene expression is common in human gastric carcinoma,and upregulation of Dpr1 results in significant inhibition of survivin expression which can induce apoptosis of SGC7901 cells.

Background Studies demonstrated that human amniotic epithelial cells (AECs) have some characteristics of embryonic stem cells and they were used to re-establish the surface of eyes. Human AECs may serve as new seed cells in tissue engineering for corneal epithelium reconstitution in the future. Objective The present study was to investigate the application value of human amniotic epithelium cells transfected by lentiviral vectormediated enhanced green fluorescent protein (EGFP) gene as new seed cell source for engineering the corneal surfacelayer. Methods Lentiviral vector carrying the objective gene EGFP was transfected into human amniotic epithelial cells (pLenti6/V5-DEST),and the transient expression of the transgene in the human amniotic epithelial cells was observed under the fluorescence microscope. Flow cytometry was used to detect the positive expression rates of EGFP in transfected cells. The transfected human amniotic epithelial cells were seeded onto the fresh corneal stromal surface of New Zealand white rabbit and cultured in vitro. The stem cell deficiency ( SCD ) models were established by cutting off the limbus of cornea in 20 eyes of New Zealand white rabbits, and the model rabbits were then divided into 2 groups randomly. The transplanted grafts carrying the pLenti6/V5-DEST-EGFP gene-transferred human amniotic epithelium cells were regarded as the pLenti6/V5-DEST-EGFP group, and the corneal stroma graft without any epithelial cell served as the control group. The opacity of stroma and corneal conjunctivalization and vascularization were observed daily. The rabbits' eyes were extracted one month after operation. The expression of EGFP in the cornea was detected under the fluorescence microscope, and the expression of CK8, CK18 and CK12 in cornea was detected by immunohistochemical staining. Results The shape of the transferred human amniotic epithelial cells resembled normal human amniotic epithelial cells. 48 hours after the transient transfection of EGFP presented with the highest expression level throughout the observation duration, with a positive expression rate of EGFP of 61.5% ,showing significant differences in comparison with that of 12 ( 5.24% ) , 24 ( 38.27% ) or 96 ( 39. 10% ) hours ( P ＜0. 05) post-transfection; but no obvious difference was found in the positive rate of transiently transfected EGFP between 48 hours and 72 hours ( 58.36% ) ( P＞0. 05 ). Six cornea grafts were clear in 1 month and two corneas were rejected during the observation period in the pLenti6/V5-DEST-EGFP group. A few new blood vessels were seen around the graft. Ten corneas of the control group became opaque and cloudy with new blood vessels growth around the grafts. Imunohistochemistry revealed the positive expressions of CK8, CK1 8 and CK12 in the corneal epithelial layer in the pLenti6/V5-DEST-EGFP group. However,the expression of CK12 was absent in the control group. Conclusion Human amniotic epithelium cells transfected with the pLenti6/V5-DEST-EGFP gene is a new and ideal feed cell type to reconstruct the corneal surface layer. Lentivirus is a relatively safe gene transfection vector.

Objective To compare the therapeutic efficiency of laparoscopic and open radical colorectal surgery in the treatment of colorectal carcinoma. Methods Clinical data of 77 cases undergoing laparoscopic colorectal surgery from September 2004 to October 2007 were compared with 90 patients treated by open surgery. Results Mean operating time was longer in the laparoseopic group than that in the open group [248 minutes vs. 225 minutes (t = -2. 11 ,P =0. 036)], blood loss was less in laparoscopic group [210 ml vs. 315 ml (t = 2. 82, P = 0. 005)]. Laparoscopic surgery was associated with lower rate of analgesia use [48% vs. 80% (x2 = 18. 69 ,P < 0. 01)], earlier recovery of bowel function [2. 9 days vs. 4. 3 days(t =5.59,P <0. 01)]and shorter hospital stay [12. 5 days vs. 15.5 days (t =2. 32,P=0. 039)]compared with open surgery. The number of removed lymph nodes [14. 2 vs. 15.3 (t = 1.04, P = 0. 3)]and length of reseeted bowel [18. 9 cm vs. 20. 0 cm, (t = 0. 88,P = 0. 383)]were not different between the two groups. The mean follow-up time of the two groups were 28 months, local recurrence rate, metachronous metastases rate and 3-year cumulative survival rate were not statistically different between the two groups. Conclusion Laparoscopic surgery is as effective as conventional open surgery in the treatment of colorectal carcinoma.

Objective:To anslysis the hemodynamic states of vertebrobasilar dolichoectasia based on computational fluid dynamics technique.Methods:The original DICOM format image data from a patient with vertebrobasilar dolichoectasia (VBD), were imported by the Mimics software directly,and the 3D Objects were constructed.The simulation of model was made with Ansys software, the hemodynamic pa-rameters such as streamlines, wall shear stress( WSS) and wall pressure were described.Results:There was stable laminar flow in proximal basilar artery and was no blood flow mixed by bilateral vertebral arter-y.However, Spiral flows were appeared in distal tortuous basilar artery.The low WSS regions in the ver-tebra-basilar junction section and inferior segment of basilar artery were coincide with the high wall pres-sure regions.It could be speculated the initial growth regions might be located in the vertebra-basilar junction section and inferior segment of basilar artery.Local regions with low WSS and high wall pressure might be associated with the occurrence and development of VBD.Conclusion: CFD numerical simula-tion maybe can provide a theoretical basis for the role of hemodynamic factors in occurrence and develop-ment of VBD.

Abstract: Objective　To investigate the molecular characteristic and evolutionary trends of full-genome sequences of coxsackievirus A2 (CV-A2) and A5 (CV-A5) in Changsha City. Methods　The CV-A2 and CV-A5 strains were isolated and detected from patients with hand, foot and mouth disease (HFMD) cases. The full-genome sequences of CV-A2 and CV-A5 strains were obtained using NGS sequencing. Homology and phylogenetic tree analysis were performed, and the recombination regions of the strains were examined by SimPlot software. Results　The full-genome sequences of CV-A2 and CV-A5 strains were obtained from routine surveillance cases of HFMD in Changsha in 2019. The CV-A2 strain was named S281/Changsha/CHN/2019 with the full-genome sequence of 7 422 bp long; the CV-A5 strain was named S272/Changsha/CHN/2019 with the full-genome sequence of 7 425 bp long. Homology analysis of the isolates by comparison with the nucleic acid sequences of CV-A2 and other CV-A2 strains in China showed that the non-structural protein region shared lower similarity than that of structural protein region. The CV-A2 showed 79.20% similarity with Fleetwood strain (NC038306), showed the highest similarity 95.60% with MN419014 strain from Hubei Province. The non-structural protein 3C and 3D region shared the lowest similarity with MN419014, 90.51 and 92.06%, respectively. Phylogenetic tree analysis showed that 3C and 3D regions were located in the CV-A4 branch. Amino acid mutation sites were found in non-structural protein region, and the amino acid sequence in structural protein region was conserved. SimPlot analysis showed that genetic recombination was found in the 3C and 3D region of CV-A2 strains. The full-genome sequence of CV-A5 showed 80.7% similarity with the Swartz (AY421763) and 97.43% similarity with the strain (MH111030) from Australian. Homology analysis showed that the non-structural protein region shared lower similarity than that of structural protein region, based on full-genome of CV-A5. Phylogenetic tree analysis showed that CV-A5 and MH111030 were in the same branch, indicating that CV-A5 strain not from local. The amino acid sequence of CV-A5 strain was conserved. Conclusions　The CV-A2 strain in Changsha City shared genome sequence information with CV-A4, and the CV-A5 strain was imported from abroad. Our findings are expected to understand the molecular and recombination characteristics of CV-A2 and CV-A5, provided the data of evolution and genetic features of the coxsackievirus, and interrupt disease transmission in a timely and effective manner.

AIMTo observe the differences of hemodynamics and nitric oxide synthase(NOS) activity of ventricular cardiac muscle in two septic shock models and explore the possible mechanism.

METHODSTwo rat models of septic shock[lipopolysaccharide(LPS)-induced and cecal ligation and puncture (CLP)-induced septic shock] were used. The hemodynamic parameters and nitric oxide synthase activity of ventricular cardiac muscle were measured.

RESULTSThe hemodynamic parameters in CLP-induced model were increased in the early stage and decreased in the late stage while in LPS-induced model the parameters showed the same change of the CLP late stage. Both LPS model and CLP model (late stage) showed significant increase in NOS activity, but there was no difference between the two models. After treatment of the NOS inhibitor N-nitro-L-arginine methyl ester (L-NAME), the parameters of CLP-late stage and LPS model increased significantly. The NOS activity reached the highest level in the CLP-middle stage. The production of nitrite/nitrate decreased significantly in LPS model and CLP model(late stage) after treatment of L-NAME, but the nitrite/nitrate produced by constitutive NOS in LPS model was higher than CLP model(late stage).

CONCLUSIONThe increase of the NOS activity may be the main reason to lead to the depression of the hemodynamic parameters. Inducible NOS may play the leading role in the LPS model while cNOS and iNOS have the same effect in the CLP model.

Animals ; Hemodynamics ; Lipopolysaccharides ; Male ; Myocytes, Cardiac ; metabolism ; Nitric Oxide Synthase ; metabolism ; Rats ; Rats, Sprague-Dawley ; Shock, Septic ; classification ; metabolism