Objective To study the incentives created by both government service purchase mode and direct funding mode on village clinics.Methods Sampling on village clinics in 24 counties in Guizhou province,to learn their public health services and villagers' satisfaction under both modes.Results Except for the infectious disease report,health lectures and health records,values of most public health service indexes of the government purchase services group are better than those of the direct investment one (P＜0.05).Villagers' satisfaction scores for facilities and service attitude showed no significant difference between the two modes,but the purchase services mode was better than direct funding one in other dimensions and comprehensive scores (P＜ 0.05).Conclusion Government purchase of health services has a great potential to improve the service efficiency of village clinics.It is,however,imperative to further break the monopoly,identify reasonable purchasing projects and approaches,and construct scientific supervision mechanisms to achieve incentive-compatible effects.

Objective To compare the quality of emergence from TCI of sufentanil and remifentanil supplementing propofol-sevoflurane anesthesia in patients undergoing radical colo-rectal cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 40-64 yr undergoing elective radical colo-rectal cancer resection were allocated into 2 groups ( n =20 each):sufentanil group (group S) and remifentanil group (group R).Anesthesia was induced with propofol TCI at plasma concentration (Cp) of 4.0 μg/ml in both groups and sufentanil TCI (effect-site concentration Ce =0.4 ng/ml ) or remifentanil TCI ( Cp =4.0 ng/ml).Tracheal intubation was facilitated with vecuronium 0.1 mg/kg.The patients were mechanically ventilated (VT =8-10 ml/kg,RR =12-16 bpm).PErCO2 was maintained at 30-40 mm Hg.Anesthesia was maintained with propofol TCI-sevoflurane supplemented with sufentanil (Ce=0.25 ng/ml) or remifentanil (Cp=2.5 ng/ml).The depth of anesthesia was maintained at Narcotrend index of 37-56 by adjusting Cp of propofol TCI and sevoflurane concentration.The infusion of sufentanil was discontinued at 40 min before the conclusion of the operation while remifentanil was administered until the end of surgery.The incidence of postoperative adverse events,the time from the end of operation to eye openg and the time to extubation were recorded.Reesults The two groups were comparable with respect to demographic data.Neither group developed prolonged emergence and respiratory depression but the time from the end of operation to eye opening and the time to extubation were significantly longer in group S than in group R.The incidence of hypertension and tachycardia,agitation,shivering aad coughing were significantly lower in group S than in group R.Conclusion The quality of emergence from sufentanil supplementing propofol-sevoflurane anesthesia is higher than that from remifentanil.

Objective To investigate the role of phosphatase and tensin homologue deleted on chromosome 10 (PTEN) protein in the spinal cord neurons in diabetic neuropathic pain (DNP) in rats.Methods Male Sprague-Dawley rats,aged 2 months,weighing 180-200 g,were studied.Diabetes mellitus was induced by single intraperitoneal injection of streptozotocin (STZ) 60 mg/kg.Sixteen rats with DNP were randomly divided into 2 groups (n =8 each) using a random number table:DNP group and DNP+PTEN inhibitor bpv (pic) group (DPN-bpv group).Another 16 rats were equally and randomly divided into either control group (group C) or bpv group.In DNP-bpv and bpv groups,bpv (pic) 0.2mg/kg was injected intraperitoneally once a day within 14-28 days after injection of STZ.Before STZ injection (T1),and at 2,7,14,21 and 28 days after STZ injection (T2-6),the mechanical paw withdrawal threshold (MWT) was measured.After measurement of MWT,the rats were sacrificed,and the lumbar segments of the spinal cord (L4.5) were removed for determination of PTEN protein activity (by ELISA) and Akt (s473) phosphorylation (by Western blot).Results Compared with group C,the MWT was significantly decreased at T4-6,and the PTEN protein activity and Akt (s473) phosphorylation were significantly increased in DNP and DNP-bpv groups (P＜0.05 or 0.01).Compared with group DNP,the MWT was significantly increased at T6,and the PTEN protein activity and Akt (s473) phosphorylation were significantly decreased in group DNP-bpv (P＜0.05).Conclusion PTEN protein in the spinal cord neurons is involved in the maintenance of DNP in rats.

Objective To evaluate the role of mTOR in spinal cord in the development of diabetic neuropathic pain in rats.Methods Sixty adult male Sprague-Dawley rats,aged 2 months,weighing 180-220 g,were used in the study.Forty-five rats among them were chosen randomly and diabetes mellitus was induced by intraperitoneal streptozotocin (STZ) 60 mg/kg and confirmed by blood glucose ＞ 16.7 mmol/L on day 3 after STZ injection.The left 15 rats received intraperitoneal injection of the equal volume of citric acid-sodium citrate buffer and served as normal control group (group C).Paw withdrawal threshold to von Frey filament stimulation was measured in the right hind paw before STZ injection and on 3,6,9,12,15,18,and 21 days after STZ injection.The diabetic rats with mechanical pain threshold decreasing by more than 50％ of the baseline were allocated to diabetic neuropathic pain group (group DP),and by less than 25 ％ of the baseline were allocated to diabetic non-neuropathic pain group (group NP).The rats were sacrificed at 21 days after STZ injection,and their lumbar enlargements of the spinal cord were removed for determination of the expression of mTOR and phosphorylated mTOR (p-mTOR) by Western blot.Results The expression of mTOR was significantly up-regulated in DP and NP groups when compared with group C (P ＜ 0.05),the expression of p-mTOR was up-regulated in DP group,and no significant change was found in the expression of p-mTOR in group NP (P ＞ 0.05).Compared with group NP,the expression of p-mTOR was significantly up-regulated (P ＜ 0.05),and no significant change was found in the expression of mTOR in group DP (P ＞ 0.05).Conclusion Activation of mTOR in the spinal cord is involved in the development of diabetic neuropathic pain in rats.

Objective To evaluate the effect of intrathecal rapamycin on diabetic neuropathic pain in rats.Methods Thirty adult male Sprague-Dawley rats,weighing 180-220 g,in which IT catheters were successfully implanted,were randomly divided into 5 groups (n =6 each) using a random number table:control group (group C),diabetic neuropathic pain group (group DN),rapamycin 1 μg group (group R1),rapamycin 3 μg group (group R3) and rapamycin 10 μg (group R10).Diabetes mellitus was induced by intraperitoneal streptozotocin (STZ) 60 mg/kg on 5 days after IT catheters were implanted in DN,R1,R3 and R10 groups.Citric acid-sodium citrate buffer 6 ml/kg was injected intraperitoneally in group C.In R1,R3 and R10 groups,rapamycin (dissolved in 10 μl 4％ dimethyl sulfoxide) 1,3 and 10 μg were intrathecally injected,respectively,once a day for 7 consecutive days starting from day 21 after STZ injection,while the equal volume of 4％ dimethyl sulfoxide was given instead in C and DN groups.Paw withdrawal threshold (PWT) to yon Frey filament stimulation was measured before IT catheters were implanted,before STZ injection,on 7,14 and 21 days after STZ injection,and on 1,3,5 and 7 days after rapamycin administration.After measurement of PWT,the rats were sacrificed and L2-5 segments of the spinal cord were removed for determination of the expression of mTOR and phosphorylated mTOR (p-mTOR),S6K and phosphorylated S6K (p-S6K) (by Western blot) and expression of mTOR mRNA and S6K mRNA (by RT-PCR).Results Compared with group C,MWT was significantly decreased at 14 and 21 days after STZ injection in DN,R1,R3 and R10 groups,and the expression of mTOR,p-mTOR,S6K,p-S6K,mTOR mRNA and S6K mRNA was up-regulated in group DN (P ＜ 0.01).Compared with group DN,MWT was significantly increased at 5 and 7 days after rapamycin administration in group R1,at 3,5 and 7 days after rapamycin administration in group R3,and at 1,3,5 and 7 days after rapamycin administration in group R10,and the expression of mTOR,p-mTOR,S6K,p-S6K,mTOR mRNA and S6K mRNA was down-regulated in R1,R3 and R10 groups (P ＜ 0.01).Conclusion Intrathecal rapamycin can alleviate diabetic neuropathic pain in rats.

Objective To evaluate the changes in autophagy in spinal neurons of rats with diabetic neuropathic pain (DNP).Methods Forty-eight male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into control group (group C,n =8) and group DNP (n =40) using a random number table.Diabetes mellitus was induced by a single intraperitoneal injection of streptozotocin (STZ) 60 mg/kg.Before STZ injection and at 1,2,4,and 8 weeks after STZ injection,8 rats randomly chosen from each group were used to measure mechanical pain threshold.The animals were sacrificed after measurement of mechanical pain threshold and the spinal cords were removed for determination of the expression of LC3-Ⅰ,LC3-Ⅱ,Beclin-1 and p62 protein.LC3-Ⅱ/LC3-Ⅰ ratio was calculated.Results Compared with group C,mechanical pain threshold was significantly decreased at 2,4,and 8 weeks after STZ injection in group DNP.The expression of LC3-Ⅱ and Beclin-1 in the spinal cord was significantly up-regulated,p62 protein expression was down-regulated,and LC3-Ⅱ/LC3-Ⅰ ratio was increased at 2,4,and 8 weeks after STZ injection as compared with the baseline value before STZ injection in group DNP.Conclusion Enhanced autophagy in spinal neurons may be involved in the development and maintenance of DNP in rats.

Objective To evaluate the accuracy of target-controlled infusion (TCI) of sufentanil from termination of cardiopulmonary bypass (CPB) until the end of surgery in the patients undergoing cardiac surgery.Methods Twenty adult patients,aged 25-64 yr,of ASA physical status Ⅱ or Ⅲ,scheduled for elective coronary artery bypass graft under CPB,were enrolled in the study.Immediately after termination of CPB,sufentanil was given by TCI using Gepts pharmacokinetic parameters.The initial target effect-site concentration (Ce) of sufentanil was 0.4 ng/ml.The Ce increased by 0.2 ng/ml every 10 min until it finally decreased to 0.8 ng/ml,and then the Ce decreased by 0.2 ng/ml every 10 min until it finally decreased to 0.4 ng/ml which was maintained until the end of surgery.At 10 min of infusion at each preset target Ce 0.4,0.6,0.8 and 0.6 ng/ml (T1-4) and 1,3,5,10,20,40 and 60 min of infusion at the last concentration of 0.4 ng/ml (T5-11),arterial blood samples were collected for measurement of sufentanil concentrations by using ELISA.For each sample,the bias,accuracy and wobble were calculated.Results Compared with the predicted plasma concentrations of sufentanil,the measured plasma concentrations of sufentanil were significantly decreased at T1-11.The bias,accuracy and wobble were-37.63 ％,37.63％ and 5.09％,respectively.Conclusion The accuracy of sufentanil TCI using Gepts pharmacokinetic parameters is not high from termination of CPB until the end of surgery in the patients undergoing cardiac surgery.

Objective To investigate the effects of sevoflurane and propofol on postoperative cognitive function after abdominal surgery for elderly patients with diabetes. Methods Seventy diabetic patients (aged 60~75 yr, ASAⅠorⅡ) underwent abdominal surgery and are included in the research. Diabetic patients were randomly divided into two groups (n=35): sevoflurane group(group DS) and propofol group (group DP). MMSE score, the attachment test, words memory test and Stroop color word test were carried and the results were recorded before operation (T1), postoperative 24 h (T2), 48 h (T3) and 1 w (T4). Results Compared with T1, patients′ MMSE score reduced at T2 and T3. Time spent in attachment test is longer at T2 and T3. Mistaken incidences in Stroop color words test 1, 2 and 3 are higher and time longer at T2. Time spent on Stroop color words test 2 and 3 is longer in T3. Words memory test reveals decline at T2 and T3, whose difference is statistically significant (P < 0.05). Cognitive dysfunction incidence in the two groups shows no statistical significance (P > 0.05). Conclusion Sevoflurane and propofol can result in postoperative cognitive dysfunction for elderly patients with diabetes within 48 h after abdominal surgery, there were no difference between the effects of them.

Objective To evaluate the role of nitric oxide (NO) in the spinal cord in the maintenance of diabetic neuropathic pain in rats.Methods Male Sprague-Dawley rats,aged 2 months,weighing 180-200 g,were used in the study.Diabetes mellitus was induced by intraperitoneal streptozotocin (STZ) 60 mg/kg and confirmed by blood glucose ＞ 16.7 mmol/L on day 2 after STZ injection.Twenty diabetic rats were randomly allocated into diabetes mellitus group (DM group,n =10) and L-NAME (non-selective NOS inhibitor) group (LN group,n =10).Another 10 age-matched normal rats served as control group (C group).On 21 days after STZ injection,L-NAME 10 mg/kg was injected intraperitoneally once a day for 7 consecutive days in LN group,whereas the equal volume of normal saline 5 ml/kg was given instead of L-NAME in DM group.Paw withdrawal threshold to yon Frey filament stimulation (PWT) was measured before STZ infection and on 7,14,21 and28 days after STZ injection.The rats were sacrificed after the last measurement of PWT and the lumbar segments of spinal cord were removed for determination of NO content and neuronal nitric oxide synthase (nNOS) expression (by Western blot analysis) in spinal cord tissues.Results Compared with C group,PWT was significantly decreased on 14,21 and 28 days after STZ injection,and the NO content and nNOS expression in spinal cord tissues were increased in DM and LN groups (P ＜ 0.05).Compared with DM group,PWT was significantly increased on 28 days after STZ injection,and the NO content and nNOS expression in spinal cord tissues were decreased in LN group (P ＜ 0.05).Conclusion NO in the spinal cord is involved in the maintenance of diabetic neuropathic pain in rats and the mechanism is related to the enhanced function of nNOS.

Objective To evaluate the effects of curcumin preconditioning on the activity of xanthine oxidase (XOD) during intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty female Sprague-Dawley rats,aged 180-220 g,were randomly divided into 3 groups (n =10 each) using a random number table:sham operation group (S group),intestinal I/R group (I/R group),and curcumin preconditioning group (Cur group).Intestinal I/R was induced by clamping the superior mesenteric artery for 75 min followed by reperfusion.Curcumin 200 mg/kg was given everyday for 5 days before intestinal I/R in Cur group and the equal volume of normal saline was given instead of curcumin in S and I/R groups.The rats were sacrificed at 4 h of reperfusion and the intestinal specimens were obtained for microscopic examination of pathologic changes which were graded using Chiu scoring system and for determination of XOD activity,content of malondialdehyde (MDA),and superoxide dismutase (SOD) activity.Results Compared with S group,the Chiu score,activity of XOD and content of MDA were significantly increased,while the activity of SOD was decreased in I/R and Cur groups (P ＜ 0.05).Compared with I/R group,the Chiu score,activity of XOD and content of MDA were significantly decreased,and the activity of SOD was increased in Cur group (P ＜ 0.05).Conclusion Curcumin preconditioning can attenuate intestinal I/R injury in rats,which may be due to inhibition of XOD activity and decreased oxidative stress in intestinal tissues.