Objective:To analyze essential health care equity in cities and counties of Hainan in order to provide the basis for its development. Methods:Based on health statistics of Hainan, China and OECD countries, indicators of essential health care equity in cities and counties were analyzed. Results:Equity in distribution of resources, the hospi-tal geographical distance is large difference, physician-to-nurse ratio is 1:1. 2, and the Gini coefficient is more than 0. 3. Equity in financing, health care spending per capita is less than the national level. Cities and counties with high government budgets for health are located in regional centers. The hospitalization costs compensation with new rural co-operative medical scheme is about 50%. Equity in service supply, bed occupancy rate below 90% and drugs accounted for 30% ~40% in most cities and counties. Regional differences in maternal and child health management are small, but below the national level. Conclusions:The situation of essential health care resources is related to the political and economic climate. Financing mechanisms for essential health care are imperfect;and a low supply of basic medical and public health services reduced the quality of essential health care. Suggestions:Rational distribution of essential health care resources should be promoted;essential health care financing should be increased;and the capability of essential health care supply should be improved.

Objective To evaluate Caspofungin for the treatment of fungous infection liver transplant patients. Methods From 2003 to 2008 clinical data of 27 cases of liver transplant patients with fungal infections were reviewed retrospectively. Before 2005 (control group) fungal infections were treated with amphotericin B or Fluconazole in 13 cases. After 2005, the infection was treated with Caspofungin (observation group) in 14 cases. Liver function (AST, ALT, TBIL) and renal function (BUN, Scr) were evaluated at one and two weeks respectively. Result of treatment was evaluated 7 ～ 14 d after the treatment as for the clinical cure rate, with or without acute rejection. Result The liver function of the observation group compared with that of the control group at one week was as AST(t =8. 03 ,P <0. 01), ALT(t =9. 09, P<0.01), TBIL(t =6.01,P<0.01), and at 2 week as AST(t=5.59,P<0.01), ALT(t =6.60,P< 0. 01), TBIL(t = 8.45,P <0. 01). The renal function of the observation group compared with that of the control group after one week as for BUN(t =6. 51 ,P <0. 01), Scr(t =5.66,P <0. 01). At 2 week,as BUN (t =7.61,P <0.01), Scr(t =6.91,P <0.01). The clinical cure rate of the control group was 7/13 (53%), that of the observation group was 12/14(86%) ; Two cases in the observation group and one in the control group had acute rejection which was successfully managed by methylprednisolone pulse therapy. Conclusion Caspofungin is an ideal alternative therapy for fungal infection after fiver transplantation.

Objective To explore the modified of methods and techniques to establish a rat model of or thotopic liver transplantion effectively by a single operator, and improve the stability. Methods On the basis of two-cuff technique of Kamada, we improved the techniques of perfusing, shearing, triming donor liver, the suturation of the superior and inferior eaval veins, and so on. Operation was performed in 80 rats with modified techniques (experiment group) and conventional techniques (control group), respectively, compare the survival rates of 48 h, 1 week, lmonth were compared between the two groups. Results In contrast to conventional teehniques, the modified techniques reduced the average time of donor operation, recipient operation and anhepatie phase (P < 0. 05), elevated 1-week, 1-month survival rates, remarkably (P < 0. 05 ).Between the Iwo groups, the survival rate of 48 hour had no statistical significance (P > 0. 05). Conclusions The modified techniques may reduce the operation time of donor and receptor effectively raise the quality of donor liver, elevated the survival rate of receptor. II is a stable, reliable and effective method to establish the rat urthotopic liver transplantation model.

Postgraduate education is the highest leveled education in the national education hierarchy and bears the historic task of providing top-notch innovative personnel for the country and conducting independent innovation. At present,the medical degree is divided into two types: clinical scientific degree and clinical professional degree. Clinical scientific degree is different from clinical professional degree due to its importance and peculiarities. Therefore,education for postgraduates with clinical scientific degree faces many problems in enrollment,research and clinical capacity develop-ment and evaluation system. Through reforming enrollment plan,strengthening capacity building and establishing sound clinical education evaluation system can further improve training quality for post-graduates with clinical scientific degree.

Objective To observe the effects of co-transfection of proto-oncogene c-myc antisense oligodeoxynucleotides(c-myc-AODN) and tissue-type plasminogen activator(tPA) gene on intimal hyperplasia of auto-transplantion artery in rabbit. Methods The left and right external iliac artery(length 1.0 cm) of rabbits were cross transplanted. The artery grafts and sutures were respectively soaked in Lipofection, c-myc-AODN, pBudCE4.1/tPA, c-myc-AODN and pBudCE4.1/tPA solution for 15 minutes. Each group were divided into five subgroups(n=5, in each subgroup) according to the sacrifice times(3, 7, 14, 28 and 56 d after operation). Specimens were harvested for pathology, chromogenic substrate test, 3H-TdR incorporation test and immunochemisty coloration study. Result The intimal area, stenosis ratio, 3H-TdR incorporation, PCNA positive cell in c-myc-AODN adding tPA co-transfection group were significantly lower than that of control group(P0.01), and that were lower than c-myc-AODN transfection group and tPA gene transfection group(P0.05). Conclusion Vascular local co-transfection of tPA gene and c-myc-AODN effectively inhibits the proliferation of vascular smooth muscle cell(VSMC) and hyperplasia of intima of the transplanted artery.

Objective To investigate the relationship between the maturity and function of dendritic cells (DC) and hepatitis B virus covalently closed circular DNA (HBV cccDNA) load in the peripheral blood mononuclear cells (PBMC)/monocyte-derived DC in patients with chronic hepatitis B (CHB). Methods The peripheral blood samples were collected from 29 patients with CHB and 10healthy controls. PBMC were isolated freshly and induced with granulocyte/macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4). A large amount of DC were harvested after seven days of culture. The expressions of CD209, CD80, CD86, human leucocyte antigen (HLA)-DR and CD1a of DC were analyzed by flow cytometry. The HBV cccDNA load in PBMC and DC were measured by real-time polymerase chain reaction (PCR). The interleukin-12 (IL-12) level in the culture supernatant of DC was determined by enzyme linked immunosorbent assay (ELISA). The effects on T lymphocyte proliferation induced by DC were tested by mixed lymphocyte reaction (MLR). The data was compared by t test and analysis of variance. Results HBV cccDNA could be detected in PBMC from 16 patients, but not in DC from all 29 patients. HBV cccDNA load was all negatively correlated with the expressions of CD209 (r= -0. 793, P＜0.01), CD80 (r= -0. 581,P＜0.05), CD86 (r=-0. 698, P＜0.01), HLA-DR (r=-0. 817, P＜0.01), CD1a (r=-0. 734, P＜0.01), IL-12 level (r=-0. 632, P＜0.05) and allogenic T lymphocyte proliferation induced by DC (r=-0. 617, P＜0.05). The expressions of CD209, CD80, CD86, CD1a and HLA-DR on DC,IL-12 level in culture supernatant of DC and the allogenic T lymphocyte proliferation induced by DC in patients with positive PBMC HBV cccDNA were all significantly lower compared to those in healthy controls, and the changes of the parameters mentioned above were greater in PBMC HBV cccDNA positive patients than those in PBMC HBV cccDNA negative patients (P ＜ 0. 05 or P ＜ 0. 01).Conclusions The function and maturity of DC are impaired in CHB patients. HBV cccDNA can be detected in PBMC from CHB patients. Moreover, the higher PBMC HBV cccDNA is, the worse DC function and maturity are, which could be one of the important mechanisms of HBV persistent infection.

Objective To study the effects of marrow mesenchymal stem cells on heart functions and ventricular remodeling after myocardial infarction in rats. Methods Myocardial infarction model was established by ligation of the left anterior descending coronary artery (LAD) in adult SD rats. 4 and 8 weeks after MMSCs implantation,hemodynamic evaluations,left ventricular weight/body weight ratio and heart weight/body weight ratio were determined. HE staining was performed for counting microvasculars and Van Gieson staining was used for measurements and calculation of the myocardial fibrillar collagen. Then we investigated the migration and evolution of MSCs in vivo by fluorescent microscope. Results HR was significantly decreased in transplantation MMSCs group. Eight weeks after transplantation,body weight in transplantation MMSCs group reached that of control group. At the same time,SBP,DBP and MBP were significantly increased in transplantation MMSCs group. HR was significantly decreased in transplantation MMSCs group. Secondly,left ventricular weight/body weight ratio and heart weight/bodyweight ratio were significantly decreased 4 weeks after transplantation MMSCs. Then the ratio was significantly decreased 8 weeks after transplantation MMSCs. Thirdly density of microvasculars was increased at the boundary of infarction site in the animals transplanted MMSCs. Finally,total volume of the myocardial fibrillar collagen was reduced in the MMSCs treated groups after MI. Conclusion Transplanting MMSCs can improve the ventricular remodeling and heart functions in acute MI rat models.

Objective To study the surgical technique of construction of orthopic liver transplantation model in mice by a single operator.Methods On the basis of two-cuff technique,running suture was used to reestablish the suprahepatic vena cava(SHVC),"two-cuff"technology to reestablish the portal vein(PV)and infrahepatic vena cava(IHVC),and"stent"to reestablish the bile duct.Operation was performed in 70 mice,the 24 h,1 week,1M postoperative survival rate were noted,and hepatic function and pathological change were observed.Results The 24 h,1 week and 1M survival rate was 95.7%,90.9%,85.1%,respectively.The ALT increased gradually in the first postoperative week,and dropped to normal level in the first month.Pathology showed the structure of liver tissue was fine.Conclusions The method is an ideal mothod to establish the orthotopic liver transplantation model in mice,because it has high survival rate,good stability and is easily replicated.

Objective To study the effects of marrow mesenchymal stem cells on heart functions and ventricular remodeling after myocardial infarction in rats. Methods Myocardial infarction model was established by ligation of the left anterior descending coronary artery (LAD) in adult SD rats. 4 and 8 weeks after MMSCs implantation, he-modynamic evaluations, left ventricular weight/body weight ratio and heart weight/body weight ratio were determined. HE staining was performed for counting microvasculars and Van Gieson staining was used for measurements and calculation of the myocardial fibrillar collagen. Then we investigated the migration and evolution of MSCs in vivo by fluorescent microscope. Results HR was significantly decreased in transplantation MMSCs group. Eight weeks after transplantation, body weight in transplantation MMSCs group reached that of control group. At the same time, SBP, DBP and MBP were significantly increased in transplantation MMSCs group. HR was significantly decreased in transplantation MMSCs group. Secondly, left ventricular weight/body weight ratio and heart weight/body weight ratio were significantly decreased 4 weeks after transplantation MMSCs. Then the ratio was significantly decreased 8 weeks after transplantation MMSCs. Thirdly density of microvasculars was increased at the boundary of infarction site in the animals transplanted MMSCs. Finally, total volume of the myocardial fibrillar collagen was reduced in the MMSCs treated groups after MI. Conclusion Transplanting MMSCs can improve the ventricular remodeling and heart functions in acute MI rat models.

Objective To observe the co-expression plasmid of tissue plasminogen activator (tPA) and vascular endothelia growth factor165 (VEGF165) in vascular endothelial cell (VEC) and to study the effect of the product on the proliferation of VEC and fibrinolysis activity. Methods pBudCE4.1/tPA-VEGF165 was transfected into VECs by using lipofection. The expression of tPA and VEGF165 at mRNA level was detected by RT-PCR and expression at protein level was detected by Western blot. The fibrinolysis activity of VEC culture solution of transfecting tPA and VEGF165 genes were detected by fibrin plate technique. The VEC and VSMC were cultured with VEC culture solution of transforming tPA and VEGF165 genes, the proliferation of VEC and VSMC were evaluated with 3?H-TdR incorporation and flow cytometry (FCM). Results The expression of tPA and VEGF165 in the transfected VECs was detected. The fibrinolysis activity of transfected VEC culture solution was also detected. tPA and VEGF165 products in VECs elevated proliferation of VEC, while there was no effect on the proliferation of VSMC. Conclusion The tPA and VEGF165 eukaryotic co-expression plasmid could express in transfected VECs, and the expression products have biology activity.