Objective To explore the characteristics of diagnosis and treatment for the pyogenic spinal osteomyelitis. Methods From July 1999 to August 2003, 12 patients with pyogenic spinal osteomyelitis were involved, 7 males and 5 females, aging from 13 to 61 years, with an average of 36.6 years. The pain in the thoracolumbar area was early in the beginning, the temperature was above 39 ℃, and there was no redness and swelling, but the pain on deep pressure and percussion. The spinal movement was limited, but without any symptoms from compression of the spinal cord or cauda equina, and the sphincter function remained normal. The white cell count, ESR, X-ray and MR imaging were analyzed. Among 12 patients, the ESR above 60 mm/1 h in 10,28 mm/1 h and 50 mm/1 h in each 1 respectively. The white cell count of 2 patients increased (1.0?109/L). Transpedicular core biopsy was taken in 4 cases with doubtful diagnosis,the positive rates were 75%. The antibiotics was administrated intravenously for at least 6 weeks in hospital, then succeeded orally for about another 6 weeks. The ESR of 11 of patients decreased more than 50% after 1 month treatment. The conservative treatment was effective in 91.7% cases. Results 9 of 12 patients were available at final follow-up, the mean duration was 2 years and 2 months (ranged from 6 months to 4 years). Among these 9 patients, 7 patients were free of symptoms, 1 patient had slight back pain, 1 patient had chronic severe back pain who was operated because of the relapse after the conservative treatment. Among 7 patients who underwent MR imaging,2 still had destruction in their vertebra and disc. The extent of T1-weighted low signal decreased, while T2-weighted high signal was obvious, but they had no back pain. Conclusion ESR is a more sensitive index than the white cell count for the diagnosis of pyogenic spinal osteomyelitis. MR and pathologic examination are of important significance for the diagnosis of the disease. After the sequential intravenous and oral antibiotic treatment for 1 month, the decrease of ESR is hallmark of the success of conservative treatment, while the failed cases should be treated with surgery.

Resident standard training for traditional Chinese medicine(TCM) is an important part of medical training, after-department examination plays the role of its quality control. Through the construction of question database for after-department examination, combining TCM residency standard training requirements and actual situation of the department, it contribute to the formation of standardized examination,improve the system of resident standardization training for TCM, help to training appropriate and qualified TCM residency.

In recent years, polysaccharides have received much attention because of their high safety and good immunological activity. The study of polysaccharide in vivo process is a key scientific problem that needs to be solved for polysaccharide drug development. Some progress has been made in the field of polysaccharide pharmacokinetics and immunomodulation. However, due to the lack of both chromogenic and light-absorbing groups and the complex molecular structure of polysaccharides, the in vivo processes and immunomodulatory mechanisms of polysaccharides have been slow to be investigated. The effective combination of multiple techniques can break the bottleneck of difficult tracing and unknown immunomodulatory mechanism of polysaccharides in vivo, and promote the development and utilization of polysaccharides. In this paper, we systematically summarize the key techniques in the study of polysaccharide in vivo processes and immunomodulatory mechanisms in order to provide technical references and research ideas for the study of polysaccharide in vivo processes and immunomodulatory mechanisms.

Objective To investigate the effect of dexmedetomidine on excitatory aminoacid (EAA)and inhibition of amino acid(IAA)in cerebro-spinal fluid(CSF)of patients undergoing in-tracranial tumor surgery,and to explore the cerebral protective mechanism of dexmedetomidine in neurosurgery.Methods Sixty patients aged 18-64 years old,ASA Ⅰ or Ⅱ,weighing 50-90 kg un-dergoing elective intracranial tumor surgery were randomly divided into dexmedetomidine group (group D)and control group(group C).Dexmedetomidine 1 μg/kg was infused before anesthesia in-duction for more than 10 minutes and pumped continously with 0.2-0.7 μg·kg-1·h-1 in group D, while in group C midazolam 0.03-0.05 mg/kg was injected followed by intermittent administration of 0.03-0.05 mg/kg.BIS value was maintained between 40-50.MAP and HR was recorded at the time points before induction(T0 ),dura mater incision(T1 ),tumor resection(T2 ),at the end of the surgery (T3 ).And we collected CSF at T0 ,T3 ,6 hours after the surgery(T4 ),12 hours after the surgery (T5 ),24 hours after the surgery(T6 ),then the concentrations of EAA and IAA were determined with high-performance liquid chromatography (HPLC)at T0 ,T3 ,T4 ,T5 and T6 .Results The MAP and HR in group D at T1-T3 were much lower than that in T0 and in group C(P <0.05).Compared with T0 ,the Glu and Asp in CSF significantly increased in group C at T3-T6 and were much higher than those in group D (P < 0.05 ),GABA was significantly decreased and much lower than group D(P <0.05).Compared with T0 ,the Glu and Asp in group D at T3-T5 were increased and GABA was decreased, but without statistic significance. At T6 , the values recovered to the level at T0 . Conclusion Dexmedetomidine can be used to maintain hemodynamic stability in intracranial tumor surgery,and may play a role in cerebral protection through inhibiting expression of Glu and Asp (EAA).

Objective To investigate the early clinical outcome of peripheral cutting balloon(PCB) in the management of peripheral vessel stenosis.Methods Thirteen patients with peripheral limb vessel stenosis, in which 4 stenoses in hemodialysis access and 9 at lower limb arteries,underwent angioplasty by PCB.For multiple stenosis in the same vessel,the distal one should be expanded firstly.The balloon pressure was controlled in the range of 8 atm to 10 atm(1 atm=10.108 kPa).All the patient were given continuous anticoagulant therapy after the procedure.Results All the procedure were carried out successfully on the 13 patients,and no serious complications occured.The symptoms did not recur in all patients after the procedure.The 5 months' follow-up angiography proved that no restenosis occurred in one patient with previous stenosis at the hemodialysis access.Conclusion The angioplasty with PCB was a safe and reliable procedure in management of the peripheral limb vessel stenosis.The early outcome is satisfying.

Objective:To analyze the implementation and effectiveness of primary health care reform in Feixi county, Anhui province. Methods: This paper uses data analysis of interviews with key insiders, policy documents and archives, as well as institutional questionnaire survey and other methods to collect information, and then it com-bines qualitative and quantitative research to arrive at research findings through cross-analysis and interpretation. Re-sults:From 2010 to 2014, the reform enhanced the capacity of primary health care in four main aspects, including capacity building of primary health care personnel, network construction of primary health care system, improvement of working conditions, and system construction of institutional management. Accordingly, the human capacity of pri-mary health care personnel was improved, their enthusiasm for work increased, their income was raised, the working conditions were improved, the cooperation mechanism for vertical and horizontal health care services was established, and the consultation rate and primary health care utilization in Feixi county increased. Conclusion:Both the“bottom-up” exploration approach and “from point to area” implementation strategy adopted by Feixi county have not only been the core content of primary health care system’s comprehensive reform, but also effectively leveraged the other aspects of the reform. They have played an important role in deepening medical reform and establishing institutional mechanism of health care system.

Objective:To analyze reverse effects induced in the implementation process of“primary health care strengthening” policies, and the innovative initiatives and countermeasures raised in primary health care system’s comprehensive reform of Feixi county. Method:Based on the principles of Critical Discourse Analysis ( CDA) , this paper designs its analytical framework for policy analysis. Results:Many reverse effects appeared in the implementa-tion process of “primary health care strengthening” policies. However, through improvements in terms of manpower upgrading, network building, working conditions and management mechanisms, Feixi county has successfully strengthened the capacity building for primary health care institutions. Conclusions:The expected and unexpected re-sults should be evaluated systematically when the policies are being implemented, and local governments need to pro-ceed according to local conditions in order to prevent unintended reverse effects from happening.

The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.