Occupational Health

This paper reviews outpatient security policy of typical developed countries .It provides reference for outpatient security system in China .Analysts believe that the experience for Chinese reference should be acquired in the following ways:The pooling of outpatient service is an inevitable trend in the development of health insurance , which is in principle an integral part of payment and financing system; the implementation of outpatient community first diagnosis system should be adapted to the local conditions; the community first diagnosis system is a necessary condition for capitation , so it is closely related to compensation methods and the elaborate degree of outpatient treat -ment catalog;Outpatient services should be supervised and payment policies should be developed respectively .There are two supervision models about outpatient service:external supervision and self supervision , but the key is to focus on the management of outpatient doctors .External regulation should be consistent with the current regulatory approach of the situation and patients have to bear some responsibilities for outpatient treatment expenses in some proportions , but the payment cap line should not to be low .The implementation of certain preferential policies for vulnerable groups can be considered under the harmonized system to partially reduce their medical expenses .

OBJECTIVE:To probe into the status quo and requirements of drug utilization in Haiqin Sanatorium Area of Nanjing Military Region Hangzhou Sanatorium.METHODS:The drug utilization in 710 convalescents in Sanatorium Area from May 2007 to April 2008 was analyzed statistically.RESULTS:A total of 10 categories of drugs were used in the 710 convalescents,chiefly including anti-cold drugs,antihypertensive drugs,drugs for external use,antimicrobial agents,ophthalmic drugs,otorhinolaryngological drugs,vitamins and gastrointestinal drugs.The rate of drug use conforming diagnosis was 87.32%.Oral administration occupied 71.13%.CONCLUSION:The drug utilization in convalescents in Haiqin Sanatorium Area is basically rational.However,there are also some unreasonable points in the drug utilization which remain to be tackled further.

Objective:To compare the dissolution of domestic terazosin hydrochloride tablets and capsules to provide reference for clinical use. Methods:The dissolution of the products from different manufacturers was investigated respectively in 4 kinds of media:pH 1. 0 hydrochloric acid solution,pH 4. 5 phosphate buffer solution,pH 6. 8 phosphate buffer solution and water. The dissolution tests were carried out by a paddle method at the stirring speed of 50 r·min-1 and an HPLC method was used to determine the dissolution rate. The dissolution behavior of the samples from different manufacturers was compared by a similar factor method. Results:The do-mestic tablets showed higher similarity with the reference formula, and the dissolution behavior of the capsules had significant differ-ence. Conclusion:The calculation method for the specification in some manufacturers is different from that of the reference prepara-tion, which leads to the difference between the testing preparation and the reference preparation, and should be paid attention in clini-cal use.

Objective To design a new presigmoid translabyrinthine keyhole approach assisted by Stryker neuro-navigation system according to the keyhole idea,and observe microscopic anatomy structures, which could be.regarded as the bases of this approach in clinical application.Methods Navigation data were established on 8 cadaveric heads fixed by formalin and perfused intracranial vessels with colored silicone. A 7-cm postauricular C-shaped skin incision as we reported was performed.After elevating the skin flap and musculofascial flap,a 3.5 cm?3.0 cm bone window was made.On skeletonizing the sigmoid sinus,bony lab- yrinth and the canal for facial nerve,the presigmoid retrolabyrinthine,partial labyrinthectomy with petrous api- cectomy,translabyrinthine keyhole approaches were simulated in turn.The length of important structures ex- posed and the angle of vision were measured step by step, and the anatomic structures were observed.Re- suits The approach-correlated bone could precisely be drilled with the aid of neuro-navigation,which could avoid the bewilder in drilling process.The angles of visual field,the length of clivus andⅦcranial nerve were significantly increased after partial labyrinthectomy with petrous apicectomy or all labyrinth removal,but there were no significant difference between partial and all labyrinth removal.The retrolabyrinthine keyhole approach spares hearing and facial function but provided for limited window of petroclival region exposure.The partial labyrinthectomy with petrous apicectomy keyhole approach provided wider exposure to petroclival region,cere- bellopontine angle,prepontine region and posterior cavernous sinus;an area between theⅢ-XI cranial nerves was easily visible with an excellent chance of hearing and facial nerve preservation.The translabyrin- thine keyhole approach,producing more morbidity,provided for greater versatility in treating lesions,added little exposure of petroclival region.Conclusion The presigmoid translabyrinthine keyhole approach,which could provide excellent exposure of the petroclival region,was feasible to be performed in our study.The ap- proach-correlated bone could be precisely removed assisted by neuro-navigation system.The exposure was oh- viously increased hy partial labyrinthectomy with petrous apicectomy or all labyrinthine removal,the former provided an excellent chancre of hearing and facial nerve preservation.

Objective To determine the minimum alveolar concentration(MAC) of sevoflurane without body movement during laryngeal mask airway(LMA)intubation in premature infants less than 37 weeks of corrected gestational age undergoing total inhalation general anesthesia induction.Methods Twenty-one ASA Ⅰ or Ⅱ premature infants less than 37 weeks of corrected gestational age undergoing elective inhalation general anesthesia were enrolled in this study.At first,the general anesthesia induction was started by inhaling 6 ％ sevoflurane.After the premature infant lost consciousness,the end tidal sevoflurane concentration(ET-sev)was adjusted to the predetermined concentration and maintained stable for 15 min.After that,LMA was inserted.The up-anddown sequential allocation was used to determine MAC.The initial ETsev was 2 ％,which was increased or decreased by 1 gradient concentration in the next case according to the LMA insertion body movement response.The adjacent concentration gradient was 0.2％.The midpoint from th body movement response to non-body movement response was set as the balance point and the mean value of the concentrations of sevoflurane at all the balance points were calculated as MAC.Results The end tidal sevoflurane con centration without the body movement responses to LMA insertion was 1.71％.Conclusion The MAC of sevoflurane without the body movement responses to LMA insertion in premature infants less than 37 weeks of corrected gestational age is 1.71％,which is lower than that in the normal children and probably because imperfect central nervous system development in premature infants.

Adenocarcinoma, Mucinous ; pathology ; Adult ; Aged ; Chondrosarcoma ; pathology ; Chordoma ; pathology ; radiotherapy ; surgery ; Combined Modality Therapy ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Neoplasm Recurrence, Local ; Paranasal Sinus Neoplasms ; pathology ; radiotherapy ; surgery ; Retrospective Studies ; Sphenoid Sinus

ObjectiveTo observe and explore the effects ofJiakangning Capsules on the expression of ERK1/2 gene and proliferation of FRTL-5 by studying the effects ofJiakangning Capsules collaborated with siRNA on interfering ERK1/2 gene in FRTL-5.Methods FRTL-5 cells in good conditions were divided into control group, negative control group,Jiakangning Capsules collaborated with siRNA group, siRNA interference group, and Jiakangning Capsules group. RT-PCR was performed to detect the expression of ERK1/2 gene in mRNA levels in FRTL-5; Western blotting was performed to detect the expressions of ERK1/2 and p-ERK1/2; CCK8 method was used to detect cell proliferation.Results RT-PCR results showed that the ERK1/2 mRNA expression of the control group and negative control group were of no significant difference (P>0.05); compared with the control group, siRNA interference group andJiakangning Capsules group could inhibit ERK1/2 gene mRNA expression in FRTL-5 (P<0.01). Compared with the control group and negative control group, the ERK1/2 mRNA expression of Jiakangning Capsules collaborated with siRNA group decreased obviously (P<0.01). Compared with the control group and negative control group, the expression of p-ERK1/2, ERK1/2 ofJiakangning Capsules group, Jiakangning Capsules collaborated with siRNA group, and siRNA interference group decreased obviously (P<0.01). At the time of 24 h and 48 h after transfection, according to the results of CCK8, compared with the control group and negative control group, the cell proliferation ofJiakangning Capsules group, Jiakangning Capsules collaborated with siRNA group, and siRNA interference group was inhibited (P<0.01).Conclusion Jiakangning Capsules have blocking effect on the phosphorylation of ERK1/2. After ERK1/2 gene was silenced, the thyroid cell proliferation was inhibited. Jiakangning Capsules can collaborate with ERK1/2-siRNA to inhibit FRTL-5 cell proliferation.

Objective To identify the role of autopahgy in the protective mechanism of heme oxygenase 1(HO-1) against hepatic ischemia/reperfusion (I/R) injury.Methods Forty healthy male Sprague-Dawley (SD) rats were randomly (random number table) divided into five groups (n =8 in each group),namely sham group,model group,cobalt protoporphyrin (CoPP) group,zinc protoporphyrin (ZnPP) group and 6-amino-3-methylpurine (3-MA) group.Partial hepatic I/R model was established by clamping the pedicles of left and median lobes for 1 hour and reopening for 6 hours in rats,and the rats in sham group were only received celiotomp without hepatic I/R.In the CoPP group,CoPP (a HO-1 inducer,5 mg/kg) was administered i.p 24 hours before I/R.In the ZnPP or 3-MA group,besides pretreatment with CoPP,the rats were given ZnPP (a HO-1 inhibitor,25 mg/kg) or 3-MA (an autophagy inhibitor,30 mg/kg) i.p 1 hour before I/R.Serum alanine aminotransferase (ALT) was determined with automatic biochemistry analyzer.The hepatic pathological scores (PS) were determined under light microscope using hematoxylin-eosin (HE) staining.The hepatocyte apoptosis index (AI) was assessed with terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining.Autophagosomes in liver tissue were counted under electron microscope.The mRNA expressions of HO-1,caspase-3,Beclin-1 and Atg-5 in the liver were determined by reverse transcription-polymerase chain reaction (RT-PCR).The HO-1 activity was also measured by the generation of bilirubin with the method of double-wave spectrophotometry.Results Compared with the sham group,the level of serum ALT significantly increased in the I/R group (U/L:560.3±73.6 vs.49.1 ± 13.8,P ＜ 0.01),HE staining showed a severe hepatic injury (PS:12.0±2.0 vs.1.3±0.9,P ＜ 0.01),TUNEL staining showed a higher hepatocytes apoptosis and the expression of caspase-3 significantly increased [AI:(19.38±3.07)％ vs.(3.25±1.28)％,caspase-3 mRNA (2-△△CT):4.62±0.40 vs.1.05±0.15,both P ＜ 0.01].However,there was no significant difference in the expression of HO-1 and the genes associated with autophagy between the two groups.In the CoPP group,the hepatic injury was blunted compared with that in the I/R group [ALT (U/L):223.3 ± 34.4 vs.560.3 ± 73.6,PS:5.6 ± 2.3 vs.12.0 ± 2.0,AI:(11.38± 2.39)％ vs.(19.38 ± 3.07)％,caspase-3mRNA (2-△△CT):2.42±0.33 vs.4.62±0.40,all P ＜ 0.01].HO-1 was induced in the CoPP group and autophagy was also increased significantly after I/R when compared with those in the I/R group [HO-1 mRNA (2-△△CT):3.01 ±0.71vs.1.14 ± 0.20,HO-1 activity (pmol ·mg-1 · h-1):259 ± 37 vs.113 ± 26,the number of autophagosomes:8.75 ± 0.87 vs.1.25±0.71,Beclin-1 mRNA (2-△△CT):2.85±0.28 vs.1.15±0.11,Atg-5 mRNA (2-△△CT):2.44±0.25 vs.1.14±0.12,all P ＜ 0.01].In the ZnPP group,the activity of HO-1 was much lower than that in the CoPP group,and as a result autophagy was decreased and liver injury was increased.In the 3-MA group,although there was no difference in the activity of HO-1 compared with that in the CoPP group,autophagy was inhibited,and the protective effect of CoPP was eliminated.Conclusion HO-1 could regulate the level of autophagy during liver I/R,and in turn autophagy might mediate the protective effects of HO-1 against liver I/R injury.

Objective To determine the changes of blood cytokines values and inductions of cytokines expressions after CPB and cardiac valve replacement. Methods Thirty patients undergoing cardiac valve replacement were randomly selected, The plasma cytokines levels or activities and inductions of cytokine expressions were measured before CPB, 1st, 3rd, 7th, 14th d after operation.Results Compared with the baselines, IL 1 activity and souluble interleukin 2 receptor(SIL 2R) level increased on the 1st, 3rd d , then decreased significantly on the 7th d, plasma IL 8 level increased in 14 d after CPB, but IL 2 activity decreased during 7 d postoperatively(P0.05); induction of IL 1 expression increased significantly on the 1st d and decreased on the 3rd d (P