This paper explores accountability on medical service quality in China. Based on a literature analy-sis and model building, the paper analyzes different actors involved in the management of medical service quality in China from the‘who is accountable, accountable to whom, accountable for what’ three dimensions. The study found that there is a gap between how managers and patients perceive quality, and we need to start the patients’ accountabil-ity. Appeared quality standard gap and service delivery gap, we need to start the medical institutions internal ac-countability. Appeared marketing communication gap, we need to start the social accountability. Among the entire accountability system, how to improve patient satisfaction and the quality of medical services, patients’ accountability plays a key role, is the core part of the accountability system.

Objective: To study the determinants that affect patient satisfaction to rural doctors. Methods:Based on survey data of Liupanshui City, Guizhou Province, structural equation modeling analysis was adopted, and the study was mainly from the following four aspects:the image of rural doctors, service quality, quality of diagnosis and treatment, and harmonious doctor-patient relationships. Results: The study found that the quality of diagnosis and treatment had the greatest direct impact on rural patient satisfaction, followed by service quality, the image of ru-ral doctors and harmonious doctor-patient relationships;rural patient satisfaction has a significant impact on rural pa-tient loyalty. Conclusion:Rural patient satisfaction and loyalty to rural doctors is mainly based on kinship and geopo-litical relations;given the state of medical technology, the medical environment, medical equipment, service aware-ness and other restrictions, rural doctors cannot fulfill the “gatekeeper” role, and consequently, the primary health-care system has been severely affected.

AIM: To investigate inhibition of K562 cell growth by antisense drug targeted VEGF mRNA. METHODS: X7, 20-mer antisense sequences were selected, synthesized and modified with phosphorothioate. The drug was transfected into K562 cells in the present of lipofection. Cell growth was assayed by trypan blue dye exclusion assay and MTT. The level of VEGF protein in the media was determined by ELISA. The morphology of apoptotic cells were observed by Giemsa staining, and the propotion of apoptotic cells was detected by flow cytometry. RESULTS: The antisense drug inhibited growth of K562 and downregulated expression of VEGF protein significantly, compared with Scrambed control group and showed dose-dependent relation. Signs of apoptosis of K562 cells were not observed. CONCLUSION: Inhibition of K562 cell proliferation, but not cells apoptosis induction is the mechanism of inhibing growth of K562 cells by antisense drug targeted VEGF mRNA. At same time, VEGF has function of promoting K562 cell proliferation, and VEGF mRNA may be a new target attached by drugs. [

Objective To explore the regularity of hematopoietic materials during the clonal evolution of aplastic anemia(AA), paroxysmal nocturnal hemoglobinuria (PNH) , myelodysplastic syndrome (MDS) and acute leukemia(AL). Methods Patients diagnosed as AA, PNH, MDS and AL were recruited as cases and health volunteers were recruited as controls. Serum folic acid, vitamin B12 and ferritin levels were measured by radioimmunoassay and competitive enzyme immunoassay,before and after-treatment. Results Before treatment,the level of serum folic acid in PNH group were significantly lower than that in the control group(P<0. 05). Vitamin B12 and ferritin levels of MDS patients were higher than the control group (P < 0. 05); Serum Folic acid level in AL patients was significantly lower than the control group (P < 0. 05). In contrast, vitamin B12 and ferritin levels were higher than the control group(P <0. 05). Compared to pre-treatments AA patients, vitamin B12 and ferritin levels of MDS patients were significantly higher(P <0. 01) ;Serum folic acid level in AL patients was significantly lower(P < 0.05). However,vitamin B12 and ferritin levels were higher. Compared to pre-treatments MDS patients, serum folic acid level in AL patients was significantly lower(P < 0. 05) , whereas vitamin B12 and ferritin levels were higher(P < 0. 05). The comparison of hematopoietic materials between pre-and post-treatments among the groups showed that there was no significant difference for AA patients between pre- and post-treatments in the levels of serum folic acid and vitamin Bl2 (P > 0. 05), whereas ferritin was significantly higher after treatment caused by transfusion in AA patients(P<0. 05) ;ln PNH patients,serum folic acid was significantly higher after treatment(P<0. 05) ,and there was no significant difference in the levels of vitamin B12 and ferritin between pre-and post-treatments (P >0. 05). In MDS patients, there was no significant difference in the level of ferum folic acid between pre-and post-treatments (P > 0. 05) , whereas vitamin B12 and ferritin levels were significantly lower after treatment (P < 0. 05); In AL patients,serum folic acid was significantly higher after treatment(P <0. 05) .whereas the levels of vitamin B12 and ferritin were significantly lower after treatment (P <0. 05). Conclusions There are significant difference in serum folic acid,vitamin B12 and ferritin among the patitents of AA,PNH,MDS and AL and would be helpful in discovering the interrelationship among the four diseases pertinent to the clonal evolution,prognosis,treatment and prognosis.

Objective To observe the relationship between serum lipid concentration profiles and thyroid function after thyroid hormone withdrawal( THW) in patients with differentiated thyroid carcinoma( DTC) .Methods Sixty-five post-operative DTC patients who prepared to receive radioiodine ablation were included in this study.Serum thyroid hormones ( TSH, FT4 , FT3 ) and lipid profile [ total cholesterol ( TC ) , triglycerides ( TG ) , low-density lipoprotein-cholesterol(LDL-C), and high-density lipoprotein-cholesterol(HDL-C)] levels were measured before and 3 weeks after THW.The relationship between serum lipid profile concentrations and thyroid hormone levels were measured.Results Before surgery, HDL-C level showed a significant positive correlation with TSH level(r=0.273, P=0.041), whereas other lipid profile did not show any significant correlation with thyroid hormones levels.Before THW, no correlation was observed between thyroid hormones and lipid profile.After 3 weeks′THW, the TC level was correlated with FT4 and FT3 levels(r were-0.321 and-0.415, respectively, both P<0.01).The LDL-C level was correlated with FT4 level(r=-0.347, P=0.005).The HDL-C level was significantly correlated with TSH, FT3, and FT4 levels (r were 0.342,-0.452, and-0.478, all P<0.01).The serum LDL-C level in patients with TSH above 50 mU/L(n=50) was higher than that in patients with TSH below 50 mU/L(n=15, P=0.001), while serum TC, TG and HDL-C levels were not significantly different between those two groups(P>0.05).Conclusion The serum lipid profile varies with the change of serum thyroid hormones after THW in postoperative DTC patients.

AIM: To investigate the expression of SCL (stem cell leukemia) gene in bone marrow stromal cells (BMSCs) and bone marrow hematopoietic cells from patients with aplastic anemia (AA) and normal individuals. METHODS: Bone marrow stromal cells from AA (9 cases) and normal individuals (33 cases) were amplified by long-term in vitro culture. The adherent and nonadherent cells were collected respectively. RT-PCR-ELISA assay was then performed to detect the expression of SCL gene and the housekeeping gene ?_2 microglobulin (?_2M). The expression ratio of SCL gene were analyzed and its expression level was normalized by ?_2M gene acting as an internal calibration for the purpose of semi-quantitative analysis. RESULTS: The expression ratio of SCL gene was lower in BMSCs from AA (22.2%) than that in normal controls (69.7%, P

AIM: To investigate the expression of transcription factor GATA-3 gene in the bone marrow stromal cells (BMSCs) from patients with aplastic anemia (AA) and normal controls. METHODS: The expression of GATA-3 gene was analyzed by using RT-PCR-ELISA in BMSCs from 34 normal cases and 9 cases with AA. The standardized semi-quantitative expression level of GATA-3 gene in BMSCs from patients with AA was compared with normal controls. RESULTS: The expression of GATA-3 gene was detected in BMSCs from both normal controls and the cases with AA. The expression level of GATA-3 gene in BMSCs from AA was significant higher than that from the normal controls (P

Objective To investigate the effect of the histological changes on rat dorsal root ganglia (DRG) after 125I seed brachytherapy.Methods Twelve adult male Sprague-Dawley rats ( 150-180g each) were randomly divided into 6 groups,125I seeds with different activities of 0 (Titanium shell),14.8,18.5,22.2,25.9 and 29.6 MBq were implanted to 6 groups of rats respectively and the behavioral changes of rats were observed.The rats were killed in different periods after implantation,the morphological changes in DRG and surrounding muscle tissue were observed with an Olympus BX51 optical microscope and then the irradiation doses were estimated.Results After 125I seed implantation,the movement function of rats was not affected and the weight of rats gained after 7 days.After the titanium shell implantation,very few mild swelling was induced in neuroganglion cells that still had clear nucleolus and normal cytoplasm.At 14 days after 18.5 MBq seed implantation,cell swelling was more serious and cell dehydrating,nuclear condensation and nuclear fragmentation appeared after 30 days.At 60 days after 29.6 MBq of seed implantation,nuclear dissolution and cytoplasmic shrinkage were induced in a large number of cells.In general,the severity of fibrosis was aggravated with the time post-irradiation and the dose in the muscles around the ganglion.Conclusions After 125I seed implantation,the injury degree of DRG tissue is dose-dependent,and the 125I seed irradiation would have analgesic effect on releasing intractable pain.

BACKGROUND:There are abundant cel populations in the placenta that attracts more and more attentions because of high content of CD34+cel s. It is expected to become a new source of hematopoietic stem cel s for the treatment of hematologic diseases and other malignant diseases.
OBJECTIVE:To investigate the amount of cel s derived from placenta, their colony forming ability, and their chimerism analysis.
METHODS:Five placentas obtained from five healthy ful-term cesarean women were treated with perfusion method and tissue digestion for the cel col ection. Flow cytometry was used to detect the proportion of CD34+cel s in the placenta and cord blood, fol owed by the culture of cel colonies as wel as regular observation of cel morphology and counting. PCR amplification with sequence-specific primers and sequence-specific oligonucleotide probes were used to examine HLA type of placenta, umbilical cord blood, and maternal peripheral blood;Short tandem repeat PCR was used for chimerism analysis.
RESULTS AND CONCLUSION:There were more CD34+cel s in the placenta than in the umbilical cord blood. The placenta had good ability to form multiple colonies in vitro, and there were maternal source components in the placenta. It is concluded that the amount of cel s in the placenta and their biological functions exhibit the potential use of placenta as a new source of hematopoietic stem cel s.

Objective To investigate and evaluate the correlation between brain natriuretic peptide (BNP) and gestational hypertension and preeclampsia of hypertensive disorder complicating pregnancy (HDCP).Methods Fifty cases with HDCP and 46 cases with mild and 83 cases with sever stage preeclampsia were selected as our subjects.And 33 cases with regular pregnancy and 31 with irregular pregnancy were served as control group.Plasma brain natriuretic peptide,urinary protein quantity(UBQ),24-hour urinary protein assay (UPA) were measured.The correlations of brain natriuretic peptide and UBQ,UPA,systolic pressure (SP),diastolic pressure (DP) were analyzed.Results The levels of brain natriuretic peptide in the group with gestational hypertension and mild,severe preeclampsia groups were (48.54± 18.27),(79.46± 32.18) and (292.24±213.08) ng/L,higher than that in normal pregnancy and non pregnant group ((27.84± 14.58) and (20.63± 8.28) n/L;F =49.583,P＜0.05).While no significant difference exists between normal pregnancy group and non pregnant group.Grouped on the median values (199) of brain natriuretic peptide of the severe preeclampsia group,the levels of 24-hour UPA,systolic pressure and diastolic pressure were (5.46±2.68) g,(174.55± 13.58) mmHg,(113.74±9.91) mmHg in patients with brain natriuretic peptide ≥ 199 ng/L(n=42),significant higher than those in patients with brain natriuretic peptide ＜ 199 ng/L(n =41;(4.34± 1.95)g,(165.31±11.12) mmHg,(106.05±8.02) mmHg;t=2.603,3.396,2.308;P=＞0.010,0.001,0.024).The levels of 24-hour UPA,systolic pressure and diastolic pressure of patients with brain natriuretic peptide ≥ 86ng/L(n=20) in mild preeclampsia were (1.68±0.27) g,(163.69±8.29) mmHg,(105.45±6.71) mmHg,significant higher than those in patients with brain natriuretic peptide ＜ 86 ng/L (n =26;(1.16 ± 0.31) g,(152.90±7.32) mmHg,(99.19 ± 5.25) mmHg;t =3.180,2.508,2.32;P =0.010,0.016,0.025).Brain natriuretic peptide was closely correlated with UPA,systolic pressure and diastolic pressure in hypertensive disorder complicating pregnancy (HDCP) (r =0.29,0.30;P ＜ 0.01).Brain natriuretic peptide was closely correlated with UPA systolic pressure and diastolic pressure in mild preeclampsia (r =0.39,0.37,0.40;P ＜0.01).And correlation efficacy of brain natriuretic peptide with UPA,systolic pressure and diastolic pressure were 0.44,0.42 and 0.53 (P＜0.01).Conclusion The level of brain natriuretic peptide is closely associated with the severity of gestational hypertension and preeclampsia of hypertensive disorder complicating pregnancy.Correlation of brain natriuretic peptide to the severity of gestational hypertension and preeclampsia is independent of urinary protein and hypertension.Brain natriuretic peptide is an important indicator for the severity of gestational hypertension and preeclampsia of hypertensive disorder complicating pregnancy.