This paper aims at evaluating the effectiveness of the “Medical and Pharmaceutical Separation” re-form in Beijing in three years , and put forward suggestions for the reform of public hospitals .Using data obtained from hospital database, we compared changes in the proportion of drug cost , the average drug expenditures per time, medical workload , quality , income and structure .The key findings of this study show that after the reform , the quali-ty of medical services has improved .Compared to one year before the reform , in the third year of reform the outpa-tient and inpatient medicine accounted for decreased to 16.98%and 13.3%, from 25.57%and 36%, respectively;and the outpatient and inpatient patients per capita medical expenses decreased by 21.39%and 34.8%respectively. The health care revenue increased by 68 .1%compared with before reform .Drug revenue fell 14.29%before the re-form.Medical service fee income reached 243,500,000 yuan.Income from medical examination and laboratory tests in-creased by 52.60%.Based on the findings of the present investigation , the Trial“Medical and Pharmaceutical Separa-tion” to control the cost of drugs achieved good results .Therefore ,it would be advantageous in adopting the reform of public hospitals in the next step toward the medical examination separated , adjust the price of medical services ,etc.

Lung metastasis is one of the most common metastases.Metastasectomy is only indicated for selected patients,and most patients are unsuited to surgery.The main treatment is systemic chemotherapy,however,the long-term survival is limited.With the development of precision radiotherapies such as threedimensional conformal radiation therapy (3D-CRT) and stereotactic body radiotherapy (SBRT),it is proved that radiotherapy is favorable for the patients with lung metastasis,especially for limited lung metastasis.SBRT can be obtained better survival,but still need large prospective studies.

0.05).[Conclusion]Both SF and NH/C have good biocompability with BMMSCs and could be used as an ideal scaffold material in tissue engineering.

BACKGROUND: Documents recorded that the correlation between micro emulsion Ciclosporin peak concentration (C_2) and area under curve was best with maximum individual difference. According to C_2, dose of Ciclosporin can be adjusted indMdually to decrease acute rejection and Ciclosporin toxicity, which has widely used in perioperative stage of renal transplanted recipients. However, some transplantation center still used tough concentration (C_0) to adjust the dose of Ciclosporin in stable stage of renal transplanted recipients. OBJECTIVE: To analyze the efficacy and safety of changing from monitoring C_0 to C_2 in stable stage recipients following renal transplantation. METHODS: Totally 65 patients with renal transplantation were enrolled in this study, including 31 males and 34 females, aged 20-57 (39.4±15.3) years. Within 3 months prior to this study, all patients did not suffered from rejection, and their serum creatinine and urea nitrogen were stable (creatinine ≤180 μmol/L). They were in stable stage after renal transplantation. Their period of transplantation and function of allograft were recorded. Their C_0 and C_2 of Ciclosporin were assayed. According to the target C_2 value 500-600 μg/L, the patients were prospectively and randomly divided into 3 groups. In the high C_2 group (n=17), the dose of Ciclosporin was decreased. In the target C_2 group (n=23), the dose of Ciclosporin was remained. In the low C_2 group (n=25), the dose of Ciclosporin was increased. All of the patients were followed-up for 12 months. The grafts function and the complications of heart, lung and brain were compared. RESULTS AND CONCLUSION: According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in the high C_2 group was decreased by 575.0 mg. The Creatinine and urea nitrogen of 88% patients were stable, while blood pressure, blood fat and blood uric acid decreased in parts of patients. In the target C_2 group, the levels of creatinine, urea nitrogen, Co and C_2 of patients were stable, no complications of heart, lung and brain occurred. According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in low C_2 group was increased by 755.0 mg. The creatinine and urea nitrogen of 84% patients were stable. All of the patients were no complications of heart, lung and brain. It is safe and effective to adjust Ciclospori dose under C_2 monitoring according to the target peak concentration (500-600 μg/L) in most stable stage recipients following renal transplantation.

Objective To investigate the signal transducer and activator of transcription 1(STAT1) and matrix metalloproteinase 3(MMP3)′s genetic expressions and their clinical significance on urothelial carcinoma after renal transplantation. Methods Fifty-one patients with urothelial carcinoma were recruited in this study. Sixteen of them who had renal transplant were in the experimental group and 35 of them without renal transplant were in the control group. All the cases had been proved postoperatively having transitional cell carcinoma by histopathological study. The human genome oligo arrays were used to analyze the gene expression spectrum of urothelial carcinoma after transplantation, aiming the STAT1 and MMP3's expression. Real time RT-PCR and immunohistochemical staining were used to compare the differences in the 2 groups. Results The experimental group showed that there were 35 genes up-regulated compared with the control group. Of them, 23had known gene function or partly known, and 12 had unknown gene function. There were 76 genes down-regulated. Of them, 46 had known gene function or partly known, and 30 had unknown gene function. After pathway analysis of the differentially expressed genes, there were 23 groups of pathways which had significant differences (P＜0.05), referring to the aspects of immunosuppressive and tumor growth. The levels of STAT1 and MMP3 expressions had significant differences between the 2groups(P＜0.05)as well. Conclusions The differential expression of urothelial tumor genes is obvious between patient who has had renal transplant and who has not. There are many aspects that are related to the tumor's growth like signaling pathways regulating proliferation, apoptosis of tumor cells, tumor angiogenesis and the tumor metastasis potential. STAT1 and MMP3 maybe become the targets of chemoprevention for post-transplantation urothelial carcinoma.

Objective To investigate peoples' awareness degree and attitudes about organ donation in current China.Methods A questionnaire regarding organ donation was designed,including 20 little questions distributed in 10 groups,most of which were choice questions.The major question was people's attitudes on organ donation,and the development of organ donation.The survey was held in the outpatient hall,bustling commercial district and four professional colleges.The interviewees were randomly selected,and their gender,age,education background,profession or major filed were asked to be indicated on the paper.Results 2930 valid questionnaires were acquired in all.The proportion of men to women was nearly 1 ∶ 1.2,with mean age of 38.12 years old; more than 90％ of the interviewees knew organ transplantation,and could choose.some of the transplantable organs;more than 95％ knew organ donation,but the time varied; nearly 90％ of the interviewees approved cadaveric organ donation,and 73％ of them would like to donate their organs post mortem.People who know more about organ failure and organ transplantation can give more supports to organ donation.The young students have much enthusiasm to organ donation,but much professional knowledge is also needed to firm their attitudes.The approval percentage of living organ donation was 65.3％,obviously lower than cadaveric organ donation ( P ＜ 0.05 ).85.7％ of the interviewees approved to compensate the donators family appropriately.62.9％ suggested using media and various kinds of education to increase people's knowledge about organ donation,and only 20％ chose appropriate legislation.Conclusion At present,the public are aware of some general knowledge about organ transplantation and organ donation.Most of the public approve organ donation and would like to donate their organs post mortem.The popularization of organ transplantation can give facilitation to organ donation.Most of the interviewees believe appropriate compensation is necessary for the donator's family.Media and education can promote the development of organ donation.

ObjectiveTo investigate DNA loads and risk factors of BK virus infection in renal transplant recipients.MethodsWe developed a real-time PCR assay to quantitate BK virus loads in 80 patients receiving renal transplantation in our center,and correlation between the BK virus load and clinical course was analyzed.BK virus loads were measured in urine and plasma. Epidemiological features and risk factors of BK virus infection were analyzed.ResultsThe positive rate of BKV viruria and viremia in 80 renal recipients was 37.5％ (30/80) and 8.75％ (7/80),respectively.BKV loads were higher in renal allograft recipients whose age was more than 50 years old.BKV loads were observed in urine and plasma (compared with group whose age was less than 50 years,P=0.017 and 0.05,respectively).BKV DNA copies were higher in group Tac than that in group CSA (P＜0.05),and the peak of BKV load in serum appeared at14th and10th month after transplantation,respectively,but the peak in urine was ahead of that in serum,appeared at 2nd and 8th month,respectively.ConclusionSerial measurement of BKV viral loads by quantitative PCR is a useful tool in monitoring the course of BK virus infection.The ages of recipients (＞50 years) and using Tac + MPA can reactivate BK virus and then result in BKVAN in renal transplant recipients. Intensive BKV monitoring is necessary for these recipients.

Objective To investigate the effect of cyclosporine on matrix metalloproteinase-3 (MMP-3)’ s genetic expression on bladder cancer in rats induced with BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously and 10 samples of SD rats bladder cancer induced with BBN only as control were used to observe the effect of cyclosporine on MMP-3’ s genetic expression.Real time RT-PCR and immunohistochemistry stain were used to analyze MMP-3 mRNA and protein levels of bladder cancer in rats respectively.Results The MMP-3 mRNA median expression were 7.6 (4.2-9.1) in experimental group and 4.7 (2.8-7.7) in control group.The MMP-3 protein expression were 1 case with (-),4 cases (+),5 cases (++) in experimental group and 3 cases (-),4 cases (+),3 cases (++) in control group.The differences of MMP-3 mRNA and protein levels of bladder cancer between experimental group and control group were both significant (P ＜ 0.05).Conclusion Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like MMP-3,and MMP-3 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer.

Objective To investigate the effect of cyclosporine on signal transducer and activator of transcription 1 (STAT1) genetic expression on bladder cancer in rats induced by BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously as experimental group,and 10 samples of SD rats bladder cancer induced with BBN only as control.Real time RT-PCR and immunohistochemistry stain were used to detect STAT1 mRNA and protein level expressions of bladder cancer in rats respectively.Results The STAT1 mRNA median expression fold was 4.5 (2.1-6.6) in experimental group and 5.6 (3.4-8.5) in control group.The STAT1 protein expression were 5 cases with (-),3 cases (+),2 cases (++) in experimental group and 0 case (-),5 cascs (+),5 cases (++) in control group.The expression of STAT1 mRNA and protein level of bladder cancer between experimental group and control group were both significant different (P ＜ 0.05).Conclusions Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like STATI,and STAT1 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer.

Objective To study the clinicopathologic features of post-transplant lymphoproliferative disorders (PTLD) following renal transplantation.Methods Four cases of PTLD following renal transplantation were studied and relevant literatures were reviewed.Results All the 4 cases had received 3-drug-immunosuppression after transplantation.The duration between renal transplantation and diagnosis of PTLD was 5-112 months,averagely 34 months.The patients were suffered from infective monocytic hyperplasialike PTLD,plasmacytic hyperplasialike PTLD,polymorphic PTLD and monomorphic PTLD respectively in morphology and had no specific symptoms.All the patients received therapy with dosage reduction of immunosuppressants and some received rituximab or chemotherapy.The case of monomorphic PTLD died in a short time after diagnosis.Conclusion PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics.The main treatments include the dosage reduction of immunosuppressive agents,biotherapy and chemotherapy.The prognosis of monomorphic PTLD is poor.