Animals ; Chick Embryo ; physiology ; Electrocardiography ; methods ; Heart ; embryology ; physiology ; Heart Rate ; physiology

Objective:To analyze the effects of essential medicine system on revenue structures at primary med-ical institutions. Methods:Data on revenue status and structures from 58 township health centers in Shanxi Province was collected to analyze changes and trends. Results:Along with growing government investments in primary medical institutions, the essential medicine system has fundamentally realized full coverage. The percentage of essential medi-cine revenue to pharmaceutical revenue rose from 20 . 45% in 2009 to 97 . 03% in 2013 , though the percentage of pharmaceutical revenue to total revenue dropped by 18 . 43%. The percentage of fiscal subsidy revenue in total reve-nue rose from 25 . 77% in 2009 to 54 . 16% in 2013 , though the percentage of business revenue to total revenue dropped in general. Conclusions:The essential medicine system requires the government’s financial support. Essen-tial medicine lists and primary financial aid policies should be further improved;doctor reimbursement and incentive mechanisms should be improved as well and unreasonable doctor service pricing and reimbursement mechanisms should be reformed.

BACKGROUND:Ischemia/reperfusion injury can cause the necrosis of cardiomyocyte,and it can also induce cell apoptosis.However,cell apoptosis may be the main death type of cardiomyocyte at the early stage of infarction,and it may be one of causes for expanding myocardial infarction area.OBJECTIVE:The goal of this study was to observe the anti-apoptotic effect of adenosine (ADO) preconditioning on cardiomyocytes during the ischemia/reperfusion,and to investigate the role of apoptosis-related gene protein Bcl-2 and Bax.DESIGN:A randomized controlled animal experiment.SETTING:First College of Clinical Medical Science,China Three Gorges University&Department of Cardiology,Yichang Central People's Hospital.MATERIALS:Thirty-six healthy male rabbits of clean grade,weighing 2.5 to 3.0 kg,were provided by Laboratory Animal Department,Tongji Medical College,Huazhong University of Science and Technology.The protocol was carried out in accordance with animal ethics guidelines for the use and care of animals.All rabbits were divided into 3 groups according to random number table.There were 12 animals in either control,ADO or ADO+DPCPX (an adenosine A1 receptor antagonist).METHODS:This experiment was carried out in the Central Laboratory,China Three Gorges University between October 2005 and October 2006.Ex vivo rabbit myocardial ischemia/reperfusion models were prepared.After being anesthetized,the rabbits were performed anticoagulation with heparin and carried out Langendorff retroperfusion.In the control group,the hearts of animals subjected to 40 minutes of ischemia and 60 minutes of reperfusion.Six of them were used for determining myocardial infarct size after reperfusion,another six for cardiomyocyte apoptosis,gene expression and ultrastructural analysis of myocardium.In the ADO group:The ADO hearts were continuously infused with 10 μmol/L of adenosine 30 minutes before ischemia,and operated according to the requirement of control group.In the DPCPX roup:the isolated hearts of animals were infused for 15 minutes with 10 mmol/L of DPCPX 45 minutes before ischemia.and operated in accordance with ADO group.MAIN OUTCOME MEASURES:①The heart rate and blood pressure of animals in 3 groups were measured during ischemia/reperfusion process.②The infarct size was determined by triphenyltetrazolium chloride(TTC) staining.③The apoptotic index of cardiomyocytes was detected by histological TUNEL staining and DNA ladder on agarose gel electrophoresis.④Apoptosis-related protein Bcl-2 and Bax expressions were detected by in situ immunohistochemical staining.RESULTS:Thirty-six rabbits were enrolled in the final analysis.①Comparison of heart rate and blood pressure:During the process of ischemia/reperfusion,both heart rate and blood pressure were persistently decreased significantly (P＜0.01).There were no significant differences in two indexes between any two groups (P＞0.05).②Comparison of myocardial infarct size:There were no significant differences in myocardial infarct size among the control group,ADO group and DPCPX group (P＞0.05).The myocardial infarct size of rabbits in the ADO group was significantly smaller than that in the control group.It suggested that ADO preconditioning could contract the myocardial infarct size of rabbits.The myocardial infarct size of rabbits in the ADO+DPCPX group was significantly larger than that in the ADO group,but significantly smaller than that in the control group (P＜0.01).It suggested that DPCPX could partially inhibit the protective effect of ADO.③Comparison of apoptosis of cardiomyocytes: Apoptotic cells were not found in the non-ischemic myocardial tissue,but found in the infarct tissue and infarct edge ischemic tissue.Apoptotic cells in the control group and ADO+DPCPX group were significantly more than those in the ADO group.Apoptotic index in the control group and ADO+DPCPX group was significantly higher than that in the control group,respectively (P＜0.01).④Comparison of apoptosis-related protein expression:The absorbance of Bax in the ADO group was significantly lower than that in the control group(P＜0.01).The absorbance of Bax in the ADO+DPCPX group was significantly lower than that in the control group,but significantly higher than that in the ADO group (P＜0.01).The value of Bcl-2/Bax in the control group was significantly lower than that in the ADO group (P＜0.01).The value of Bcl-2/Bax in the ADO+DPCPX group was significantly higher than that in the control group,but significantly higher than that in the ADO group(P＜0.01).CONCLUSION:Exogenous ADO inhiblts reperfusion-induced apoptosis of cardiomyocytes,which is partially mediated by DPCPX:Down-regulation of apoptosis-related Bax protein plays an important role in the anti-apoptotic effect of exogenous ADO.

Objective To discuss the coverage of finger soft tissue defect with dorsal proximal digit fasciocutaneous flap on the middle and distal digit.Methods From May,2013 to December,2014,8 cases with soft tissue defects at 8 fingers were treated with dorsal proximal digit fasciocutaneous flap.The flap sizes ranged from 2.5 cm × 2.0 cm to 3.5 cm × 3.0 cm.The donor site were closed straightly.Results Eight flaps of 8 fingers survived.All the wounds at the donor sites healed well.Eight fingers in 8 cases were followed up for 6-12 months.The color,texture and contour of the flaps were satisfied.The two-point discrimination distances were 8-10 mm.Conclusion The skin defect in the middle and distal digit can be satisfied covered with dorsal proximal digit fasciocutaneous flap.This flap is a simple,reliable and safe management for digit defect and can be performed in the primary hospital.To ensure the surviving of the flap,ensure the surviving of the flap,the awareness of the anatomy of the flap should be known well.The limits of its reconstruction of sensation and coverage size exit in its application.

Objective To evaluate the effect and clinical value of open surgery combined ultrasound-guided Mammotome in the treatment of multiple breast lumps. Methods Four hundred and forty-four patients in our hospital from Jan. 2006 to Jun. 2008 were divided into 3 groups, who underwent classical open surgery, ultrasound-guided Mammotome operation, or combined therapy respectively and followed by post-operation visits reguarly. The operation effects were compared between the 3 groups. Results Compared with the classical open surgery, combined therapy had no difference in time of procedure and procedural bleeding, but had lower incidence of local skin, better incision condition and higher satisfaction of patients. Compared with ultrasound-guided Mammotome operation, combined therapy took less time in procedure, and in the same time had less procedural bleeding, lower post-operation complication and higher patients satisfaction. Conclusions Combined therapy has high complete removal rate, low post-operation complication as well as cosmetic effect. It has special advantages over the other two kinds of surgery, so it has wide clinical application.

Objective The study aimed to explore the relationship between AIF related pathway and the inju-ring of cultured SGNs (spiral ganglion neurons)by glutamate toxicity,and to find AIF expression and distribution changes in SGNs.Methods SGNs of 40 newborn rats within 3 day were obtained and cultured in vitro.Cultured cells were divided into four groups:the normal control group,10 mM,20 mM and 40 mM glutamate injured group, separately.After 48 h hours culturing,optical microscopy,immune fluorescence staining and real-time fluores-cence quantitative PCR were used to observe the morphology,AIF distribution,and AIF,calpain,Caspase3 expres-sion changes in SGNs in vitro.TUNEL was used to verify the cell apoptosis.ResuIts Noticeable morphological chan-ges and cell apoptosis were occurred in 20 mM glutamate group,with AIF nuclear translocation.AIF gene expression was significantly higher than normal after glutamate administration (P<0.05);moreover,calpain gene expression increased(P<0.05);but caspase3 expression was not statistically significantly increased in all glutamate treated groups (P>0.05). ConcIusion In the process of cultured SGNs injured by glutamate,AIF participated in the cell apoptosis.Noticeable cell apoptosis were occurred in 20 mM glutamate group with AIF nuclear translocation.Calpain up-expression also contributed to excitatory neurotransmitter injury on SGNs,but Caspase 3 had no obvious effects.

Objective To explore the distribution rule of metastatic lymph node in nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI).Methods 315 histopathologically proved NPC patients were studied retrospectively.All patients had had their nasopharynx scanned by MRI with plain and contrast enhanced sequences.The distribution of lymph node was divided into six cervical levels plus retro- pharyngeal nodes(RN) according to RTOG guidelines proposed in 2003.Results 254 out of 315 patients (80.6%) had lymph node involvement,with 81 in the right neck alone,72 left neck alone,and 101 both necks;73 in RN alone,21 neck node alone,and 160 both necks and RN node.Skip metastasis was found in only 4 patients (1.6%).There was significant difference in BN metastasis between the primary tumor be- ing located merely on the superior/posterior wall and lateral wall (78% vs 49%,P＜0.01).The incidence of lymph node metastasis in T1,T2,T3 and T4 patients was 73.5%,91.2%,71.9%,73.5% (P＞0.05), respectively,without significant difference between early or advanced T stage in node distribution (P＞0.05).Conclusions The incidence of lymph node metastasis is high in nasopharyngeal carcinoma,with retropharyngeal node being the most commonly involved,but the incidence of skip metastasis is very low. There is no significant difference between T stage and the incidence of lymph node metastasis.So is the dis- tribution of metastatic node.

Objective To study the possible relationship between the psychological health of children with hematuria and their mothers.Methods Sixty children with hematuria were tested with podiatric symptom checklist(PSC),and the findings were compared with 60 healthy children.The mothers of the patients were assessed by self-rating anxiety scale(SAS),compared with the mothers of healthy children.Results The scores of PSC in patients were higher than those in healthy children(P

Objective: To summarize the application and efficacy of fresh autologous pericardial tri-leaflet pulmonary artery conduit for right ventricular outflow tract reconstruction in patients with complex congenital heart disease (CHD). Methods: A total of 18 relevant patients received fresh autologous pericardial tri-leaflet pulmonary artery conduit for right ventricular outflow tract reconstruction in our hospital from 2007-08 to 2012-12 were studied. The patients were at the mean age of (2.12±2.02) years with body weight ≥ (9.41±3.62) kg including 10 male. Echocardiography was followed-up at 1 month, 3-6 and ≥12 months post-operation. Results: All 18 patients had successful operation. 2 patients died at early post-operative stage including 1 with severe infection and respiratory failure, 1 with low cardiac output syndrome. 16 survivors had the average ICU stay time (140.2±124.5) h, mechanical ventilation (94.4±87.6) h, transcutaneous O2 saturation at quiet condition without O2 inhalation at (97.1±3.34) %. There were 3 patients lost contact during followed-up period and 13 received periodical examination. No obvious calcification was found in chest X-ray; echocardiography showed infrequent stenosis of right ventricular outflow tract, pulmonary valve ring and main pulmonary artery; left and right pulmonary artery stenosis at the second place. Conclusion: The safety and efficacy of fresh autologous pericardial tri-leaflet pulmonary artery conduit for right ventricular outflow tract reconstruction was fine for treating relevant patients, the mid and long term effect should be further observed.

Objective:To study a new positioning method of elbow external fixation rotation axis,and to evaluate its feasibility.Methods:Four normal adult volunteers and six Sawbone elbow models were brought into this experiment.The kinematic data of five elbow flexion were collected respectively by opti-cal positioning system.The rotation axes of the elbow joints were fitted by the least square method.The kinematic data and fitting results were visually displayed.According to the fitting results,the average moving planes and rotation axes were calculated.Thus,the rotation axes of new kinematic methods were obtained .By using standard clinical methods,the entrance and exit points of rotation axes of six Sawbone elbow models were located under X-ray.And The kirschner wires were placed as the representatives of rotation axes using traditional positioning methods.Then,the entrance point deviation,the exit point de-viation and the angle deviation of two kinds of located rotation axes were compared.Results:As to the four volunteers,the indicators represented circular degree and coplanarity of elbow flexion movement tra-jectory of each volunteer were both about 1 mm.All the distance deviations of the moving axes to the ave-rage moving rotation axes of the five volunteers were less than 3 mm.All the angle deviations of the mo-ving axes to the average moving rotation axes of the five volunteers were less than 5 °.As to the six Saw-bone models,the average entrance point deviations,the average exit point deviations and the average angle deviations of two different rotation axes determined by two kinds of located methods were respective-ly 1.697 2 mm,1.838 3 mm and 1.321 7°.All the deviations were very small.They were all in an ac-cep-table range of clinical practice.Conclusion:The values that represent circular degree and coplanari-ty of volunteer's elbow single curvature movement trajectory are very small.The result shows that the elbow single curvature movement can be regarded as the approximate fixed axis movement.The new method can replace the traditional method in accuracy.It can make up the deficiency of the traditional fixed axis method.