According to the present deficiency existing in contractual community medical service financing mechanism,it analyzed the financing difficulties and mutual interest game from the angle of game analysis of the various stakeholders in the financing process,explored the reasonable optimizing strategies for improving financing mechanism.The purposes aimed as:(1) determine the responsibility of each contractual community health financing body,reduce the fund shortage phenomenon caused by the lack of responsibility;(2) promote the stability and sustainable development of the financing mechanisms,to provide sufficient power to the development of contract services;(3) it was conducive to vigorously promote the contractual community medical service and lay the foundation for the grading system.

Objective To observe the effects of Lizhong Wan and Sijunzi Tang on spleen deficiency induced by reserpine in rats. Methods Active movement of rats was measured with Active-movement equipment (invented by Shan Zengyu, Institute of Basic Theory, CACMS) and analysis & collection system of physiological signal. Results Active movement of rats in normal, Lizhong Wan and Sijunzi Tang group was more than that of rats in model group significantly. Conclusion Lizhong Wan and Sijunzi Tang can increase the active movement of rats with spleen deficiency induced by reserpine.

OBJECTIVETo determine the recognition of healthy medical students on deqi after acupuncture, reveal the qualitative and quantitative rules of deqi and understand whether these rules are the factors of the clinical application of acupuncture therapy.

METHODSThe class questionnaires were used for the investigation study on the understanding of deqi after acupuncture at Hegu (LI 4) or Zusanli (ST 36) in 86 healthy students in the clinical medicine class.

RESULTS(1) Deqi was a kind of complicated compound feelings, with many sensation qualities such as distending pain, distension and pain. (2) Deqi was a kind of mild and moderate sensations. In 10-score credit sys tem of Massachusetts General Hospital acupuncture sensation scale (MASS), the scores of distending pain (4.69 +/- 2.83), distension (4.39 +/- 2.91) and soreness and distension (3.93 +/- 2.93) were around 5 (moderate degree), the scores of stabbing pain (1.89 +/- 2.02) were around 2 (mild degree). (3) The differences in the quantitative scores were significant for stabbing pain, distending pain, distention, soreness and distention and the others before and after treatment (all P<0.05).

CONCLUSIONDeqi of acupuncture is the mild and moderate complicated sensations manifested as distension, soreness, pain and numbness. As the invasive therapy, the filiform needle puncture will bring a certain psychological impacts on the receptors. The subjective sensation is possibly the factor for the patients' selection of acupuncture treatment.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Adult ; China ; Female ; Humans ; Male ; Needles ; Qi ; Schools, Medical ; Sensation ; Young Adult

Objective To compare the clinical outcome of external fixation device with Kirschner wire or fragment fixation pin with mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture dislocation. Methods From October 2002 to March 2008, 106 patients with metacarpal and phalangeal articular fracture dislocation were randomly divided into A and B group. The 53 patients in A group were treated with external fixation device with Kirschner wire or fragment fixation pin. There were thumb injury in 24 cases, fracture-dislocation of proximal interphalangeal joint(PIP) in 36 cases, fracture-dislocation of metacarpophalangeal joint (MP) in 17 cases. The 53 patients in B group were treated with mini plate and screw fixation. There were thumb injury in 22 cases, fracture-dislocation of PIP in 30 cases, fracture-dislocation of MP in 23 cases. Duncan rating criteria were used to compare finger range of motion. Results The mean follow-up of 16.8 and 17.5 months in A group and B group. According to Duncan rating criteria, there were excellent in 33 cases, good in 16, fair in 3, and poor in 1 case. The excellent and good rate was 92.5% in A group. There were excellent in 30 cases, good in 17, fair in 5, and poor in 1 case. The excellent and good rate was 88.7% in B group. In A group, 1 case of wound infection was found. The average arc of motion of thumb joint was 134°±21° while the average arc of motion of other fingers was 248°±19°. In B group, no wound infection occurred. The average arc of motion of thumb joint was 122°±18° while the average arc of motion of other fingers was 225°±17°. Conclusion External fixation device with Kirschner wire or fragment fixation pin was better than the application of mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture-dislocation.

Objective To compare the applicability of the Beijing Version of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in screening for cognitive impairment in patients with acute ischemic stroke for 2-3 weeks.Methods MoCA and MMSE were conducted in 201 patients with acute ischemic stroke within 2 to 3 weeks after the onset of stroke.With MoCA＜23 and MMSE ＜26 as the cut off value,we assessed the clinic effect of the MoCA and MMSE and explored the correlation between two instruments.Results The average scores of MoCA and MMSE scale were (20.5±4.3) and (25.4±3.5) points.The prevalence of cognitive impairment evaluated with MoCA and MMSE were 57.2％and 43.3％,respectively.MoCA showed significant correlation with MMSE score (Pearson's correlation coefficient=0.833,P＜0.001),and an agreement with Kappa values of 0.532 (P＜0.01) in screening for cognitive impairment.Conclusions The prevalence of cognitive impairment assessed with MoCA is higher than that of with MMSE when using MoCA＜23 and MMSE＜26 as the cut off values.Both instruments show a good agreement for screening cognitive impairment in acute ischemic stroke within 2 to 3 weeks following the disease onset.

Objective: To observe the influence of sot alol on the QT dispersion in patients with atrioventricular accessory pathways u nderwent radiofrequency catheter ablation (RFCA). Methods: Thirt y-six patients were divided into 2 groups by random. One was the drug group(18 cases) treated by RFCA， and sotalol 160 mg was orally administered and intracar diac electrophysiological study was performed every 30 min for 5 times. Th e other group(control group, 18 cases) only treated by RFCA.QTd,QTcd and QTLcd w ere measured before and after RFCA. Results: There was no signif icant difference with QT dispersion before and after RFCA in control group. When compared with before RFCA, QTd in patients administered sotalol was (30.9 ±14.3) ms vs (24.7±9.6) ms; QTcd(33.7±17.1) ms vs (25.2±10.1) ms; QT Lcd(30.8±14.1)ms vs (25.6±19.4) ms (P<0.05). Conclusion: Sotalol can slightly lower QT dispersion, which is beneficial for preventing malignant ventricular arrthythmia. It is safe in RFCA in pateints with accessory pathway.

Objective:To observe the influence of radiofrequency catheter ablation of the fat pad at the right pulmonary vein- atria junction(RPV fat pad)on Bezold-Jarisch reflex(BJR)induced by veratridine in canine.Methods:Ten mongrel dogs were anesthetized and their chest were opened through a right thoracotomy to expose the RPV fat pad.Veratridine was injected into the left ventricle at bolus doses of 10?g/kg through a catheter to induce BJR.The sinus cycle length(SCL),systolic arterial pressure(SAP),diastolic arterial pressure(DAP),mean arterial pressure(MAP),left ventricle systolic pressure(LVSP), left ventricle diastolic pressure(LVDP)and mean left ventricle pressure(MLVP)were measured under the baseline and after ablation of the RPV fat pad;the changes of the above parameters(?SCL,?SAP,?DAP,?MAP,?LVSP,?LVDP,and?MLVP)were calculated.Then the same dose of veratridine was injected under the pad after ablation and the changes of the a- bove parameters were observed.Results:BJR was successfully induced in the 8 animals;the animals has prolonged sinus cycle length(SCL)and decreased MAP and MLVP.After ablation,the prolongation of SCL after injection of veratridine was markedly reduced([229.2?92.3]ms vs[39.3?14.1]ms,P

OBJECTIVETo study the correlation between arachidonic acid (AA) and acute red blood cells damage in rats, and to build a model with hidden blood loss in vivo, and to explore the pathological mechenism of hidden blood loss.

METHODSA total of 50 male adult Sprague-Dawley rats weighing (200 ± 20) g were randomly divided into five groups (n = 10): control group and four experimental groups. The rats in the experimental groups were given 0.5 ml different concentrations of AA dilu- ents, 5, 10, 20, 40 mmol/L respectively. The blood samples were collected from orbital venous at the beginning and 24, 48, 72 hours after administration. Then the changes of hemoglobin (Hb) ,red blood cell count (RBC), glutathione peroxidase (GSH- PX) activity, total superoxide dismutase (T-SOD) activity and hydrogen peroxide (H202) in the blood samples were tested.

RESULTSSignificant hidden blood loss occurred when the concentration was 10 mmol/L in the experimental group, with the RBC and Hb sharply reduced in blood samples. The Hb and RBC were reduced in all the experimental groups and control group at 24 hours after administration, while in the experimental groups they changed more obviously. The GSH-PX activity, T-SOD activity and H₂O₂were also significantly reduced in all groups, and the changes showed significant differences. The Hb and RBC were relatively stable in the control group and the experimental groups at 48 hours after administration; while GSH-PX activity, T-SOD activity and H₂O₂were all significantly decreased, and the changes in the experimental groups were more notable.

CONCLUSIONElevated levels of AA in the blood causes oxidative stress in the red blood cells, leading to the damage of red blood cells and hemoglobin, which is responsible for hidden blood loss.

Animals ; Arachidonic Acid ; toxicity ; Erythrocytes ; drug effects ; metabolism ; Glutathione Peroxidase ; blood ; Hemoglobins ; analysis ; Male ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; blood

Background Retinal development continues during the early postnatal period in mammals.Correct arrangement of layers and precise location of various cells in the retina are vital for forming normal visual function during critical period plasticity.Spectral-domain optical coherence tomography(SD-OCT)provides highquality in vivo retinal imaging and the possibility to measure retinal thickness longitudinally. Objective The present study was to investigate the changes of retinal thickness during critical period plasticity in rats. Methods In vivo consecutive scanning of retinal image was performed in 10 SPF Sprague-Dawley rats at postnatal day 14(P14),P18,P21,P24 and P42 with SD-OCT,and retinal histopathological examination was used to detect retinal morphologic changes at the same postnatal ages in 20 matched rats.The whole retinal thickness,the thickness from inner limiting membrane(ILM)to inner plexiform layer(IPL),the thickness of inner nuclear layer(INL)and the thickness from outer nuclear layer(ONL)to retinal pigment epithelium(RPE)were measured using Cirrus HD-OCT system and HMIAS-2000 Imaging System in retinal sections.The measurement parameters by Cirrus HD-OCT and those by hematoxylin-eosin staining were compared.The use of animals followed the Statement of National Institute of Health (USA). Results In vivo high-resolution images of rat retinas with SD-OCT compared well with histology,which enabled quantitative comparison of the SD-OCT and histological data during critical period plasticity in rats.From P14 to P42,the retinal thickness gradually decreased with the increase of rat ages(F=15.425,P=0.000),and so were the thickness from ILM to IPL,the thickness of INL and the thickness from ONL to RPE(F=3.973,P=0.007;F=17.529,P=0.000;F=7.038,P=0.000).The retinal thickness,thickness of INL.thickness from ONL to RPE measured by Cirrus HD-OCT were significantly correlated with those measured by retinal sections among P14,P18,P21,P24 and P42 rats(r=0.794,P=0.000;r=0.784,P=0.000;r=0.681,P=0.000). Conclusion SD-OCT is a demonstratably valuable technology to study the structure of retinas in rats.The retinal thickness is shown to reduce in thickness throughout the development of the retina during critical period plasticity due to the decrease in thickness of INL and the distance from the ONL to RPE,as illustrated by OCT scanning.

ObjectiveTo investigate the occurrence of new cretinism cases and the prevalence of endemic goiter in iodine deficiency disorders(IDD) high-risk areas of Fujian province,so as to put forward target prevention and control measures for these areas.Methods Twelve counties from Xiuyu,Xiangan,Pingtan,and Dongshan were chosen into the survey by simple random sampling,searching for new cretinism cases were carried out in children under 10 years old.Two schools were chosen in every county and the thyroid volume of forty children aged 8 - 10 were determined by B-ultrasonography methods and their urinary iodine(UI) was determined by As3--Ce4+catalytic spectrophotometry in each school.Twenty women of child-bearing age aged 18 - 40 were chosen for collecting edible salt and urine samples,and the salt iodine content was determined using self-quantitative kit and their UI was also determined by As3--Ce4+ catalytic spectrophotometry.Results In the 4 high-risk counties,no cretinism cases were found.The goiter rate of children aged 8 - 10 was 3.6％(37/1027),and that in Dongshan county was 5.4％(13/240),which was higher than the national standards for eliminating IDD( ＜ 5％).The median urinary iodine(MUI) of children aged 8 - 10 was 175.3 μg/L,and the MUI of women aged 18 -40 was 152.7 μg/L.The coverage rate of iodized salt was 82.7％(382/462).ConclusionsNew case or suspected new case of cretinism is not discovered in the high-risk areas of IDD of Fujian province,and median urinary iodine level of people is in the adequate range.