Firstly,this article introduces the background and detailed content about the New health care reform of the United States.Then it describes the basic principles of these reforms and the problems to be solved,putting forward author's own speculative viewpoints to these health care reforms.Finally,it list the reference to New health care reform of our country.

Objective To describe the CSP genotypic profile in clinical isolates of Aspergillus fumigates from different regions of China,and to investigate if there is a difference in antifungal susceptibility among A.fumigates of different CSP genotypes and from different regions.Methods Totally,112 A.fumigates strains clinically isolated from Fujian,Shanghai,Hebei and Beijing were included in this study,and identified according to macro-and micro-morphological characters,growth temperature and β-tubulin sequence.Classic A.fumigatus strains were typed according to CSP gene sequence.The minimal inhibitory concentrations (MICs) of voriconazole,itraconazole and amphotericin B to A.fumigates were determined in accordance with the National Committee for Clinical Laboratory Standards (NCCLS) M38-A protocol.Results All the strains were identified as classic A.fumigates,and fall into 11 CSP genotypes.The most common genotypes were t04A (n =32),t03 (n =17) and t01 (n =24) in all the strains,tl0,t04A and t01 in Fujian,t04A and t01 in Shanghai,t01,t03 and t04A in Hebei,t02,t04A,t01and t03 in Beijing.One A.fumigatus strain was identified as a new CSP type t25 in Fujian,which showed no obvious difference in morphology,growth rate or appropriate growth temperature from the other CSP genotypes of A.fumigatus strains.No statistical difference was found in the susceptibility to amphotericin B,itraconazole or fluconazole among different genotypes of A.fumigates,whereas the MICs of itraconazole were significantly lower in A.fumigates isolates from Fujian than in those from the other three regions.Conclusions The CSP genotypic profile of A.fumigates varies in clinical isolates from different regions.No significant difference is observed in the susceptibility to amphotericin B,itraconazole or fluconazole among different CSP genotypes of A.fumigates,but the susceptibility to itraconazole is somewhat different between A.fumigates strains from different regions.

Objective Onto investigate the significance of the pleth variability index (PVI) in predicting hypotension after epidural anesthesia for cesarean delivery. Methods Sixity seven pregnant women, with ASAⅠ~Ⅱ, aged 19 ~ 34 years, were enrolled for elective cesarean delivery. SBP, BDP, MAP, HR, PI and PVI were measured at 5 min after the parturients arrived in the operation room. SBP, BDP, MAP and HR were measured every 3 min after epidural anesthesia. According to the change rate of SDP or MAP was higher than 30% or not, the parturients were divided into two groups (the hypotension group and the non-hypotension group). Results No significant differences were found in parturients'age, body height, weight, BMI, gestational weeks, SDP, DBP, MAP and HR before anesthesia between two groups. The PVI in the hypotension group was significantly higher than that in the non-hypotension group (P<0.05). A receiver operator characteristic curve analysis showed the area under curve was 0.888 when PVI was used for boundary value. When PVI over 17.35 was used as the occurrence of hypotension, the sensitivity of PVI was 0.727, and specificity was 0.895. Conclusion PVI can be used to predict the occurrence of hypotension after epidural anesthesia for cesarean delivery.

Objective To investigate the effects of electroacupunctures at Baihui,Fengfu,and Shenshu on the cognitive function and learning memory of mice exposure with ionizing radiation.Methods C57BL/6J (30-day old) mice were randomly divided into l0 groups consisting of the control group,X-ray exposure groups (4,8 and 16 Gy),electroacupuncture-nonacupiont (E-nonA) groups (4,8 and 16 Gy) and electroacupuncture-acupiont (EA) groups (4,8 Gy and 16 Gy),with 10 mice assigned to each group.The mice were irradiated (IR) on the left cerebral hemisphere with doses of 4,8 and 16 Gy.Some mice were electroacupunctured for 3 courses of treatment.Using weight as a measurable parameter,the open-field test and Morris water maze test were used to evaluate the curative effects.Results Compared with the control group,the weights of mice in the exposure groups (8 and 16 Gy) significantly decreased (t =2.917,9.650,3.043,2.882,P ＜ 0.05) at 7 and 14 d,while the weights of the E-nonA (8 and 16 Gy) and EA groups (8 and 16 Gy) were not significantly altered.Compared to the model groups (8 and 16 Gy),the weights of EA groups (8 and 16 Gy) significantly increased (t =6.602,5.409,19.660,2.975,P ＜ 0.05).In the open-field test,the crossing times and the rearing time of exposure model groups (8 and 16 Gy) significantly decreased compared to the control group (t =2.183,2.119,2.369,2.231,P ＜ 0.05).Compared with model groups (8 and 16 Gy) and E-nonA groups (8 and 16 Gy),the crossing times and rearing time of the EA groups were significantly increased (compared with model:t =8.914,2.727,4.325,4.178,P ＜ 0.05;compared with E-nonA:t =4.030,3.014,2.150,4.771,P ＜0.05).In the Morris water maze,compared with the control,the latent period of model group (4 Gy) was significantly increased and the crossing times significantly decreased (t =4.544,3.422,P ＜ 0.05);compared to model and E-nonA groups (4 Gy),the latent period of EA group significantly increased (compared with model:t =2.877,P ＜ 0.05;compared with E-nonA:t =3.001,P ＜ 0.05).At day 2 and 3,the latent period of model groups (8 and 16 Gy) significantly increased (t =2.544,3.706,3.796,7.934,P ＜ 0.05) and the crossing times (t =2.120,2.393,P ＜ 0.05) significantly decreased,resident time in target area of model group (8 Gy) was significantly decreased (t =2.543,P ＜ 0.05) compared to the control group.Compared with model and E-nonA groups (8 and 16 Gy),the latent period of EA gourps significantly decreased (compared with model:t =5.404,7.869,4.104,15.590,P ＜ 0.05;compared with E-nonA:t =2.938,7.955,6.566,10.350,P ＜ 0.05) while the through times and resident time in target area significantly increased in the EA group (8 Gy) (compared with model:t =2.673,2.613,P ＜ 0.05;compared with E-nonA:t =3.345,2.179,P ＜ 0.05).Conclusions Irradiation with a dose higher than 8 Gy could induce mice brain injury.Electroacupuncture can alleviate the radiation damage of cognitive function as well as learning and memory functions in mice.

Objective: To conifrm the omentopexy decreasing the susceptibility of ventricular arrhythmia in experimental rats with chronic myocardial infarction (MI) by nerve remodeling.
Methods: The MI model of SD rats was established by left coronary artery ligation. 3 weeks later, the qualiifed animals were randomized into 3 groups for the 2nd operation. ① Sham operation group, the rats received the 2nd operation without ligation, ② Isolated MI group, the rats received the 2nd operation without omentopexy, ③ Omentopexy group, the rats received the 2nd operation with omentopexy. n=20 in each group. 4 weeks after the 2nd operation, the electrophysiological characteristics were assessed by relevant techniques, the new and sympathetic nerves in MI border zone were examined by immunohistochemistry, the protein expressions of connexin43 and nerve growth factor (NGF) were measured by western blot analysis and the cardiac endothelin-1 (ET-1) level was evaluated by ELISA.
Results: Compared with Isolated MI group, Omentopexy group showed decreased susceptibility of arrhythmia (3.5 ± 1.2) vs (0.9 ± 0.2), improved electrical transduction (1.5 ± 0.2) mV vs (3.4 ± 0.3) mV and decreased capture threshold (5.5 ± 0.3) mV vs (2.2 ± 0.2) mV, all P<0.05. Compared with Isolated MI group, immunihistochemisty indicated that Omentopexy group had decreased new and sympathetic nerves in MI border zone, as for GAP43:(1388.4 ± 244.9)μm2/mm2 vs (768.6 ± 144.1)μm2/mm2, for TH:(1552.4 ± 270.3)μm2/mm2 vs (1018.5 ± 124.7)μm2/mm2, all P<0.05. Western blot analysis showed that Omentopexy group had the lower NGF expression and higher connexin43 expression;ELISA demonstrated that Omentopexy group had the lower ET-1 expression, P<0.05.
Conclusion: Omentopexy may decrease the susceptibility of ventricular arrhythmia after MI in experimental rats, which might be related to the cardiac nerve remodeling.

Objective: To explore the effect of low-level laser irradiation (LLLI) preconditioning on milieu of infarcted myocardium in experimental rats.
Methods: The myocardial infarction (MI) model was established by left anterior descending (LAD) artery ligation in female rats. 3 weeks later, the qualified MI rats were randomly divided for 3 groups: ① LLLI preconditioning group, the rats received thoracotomy for LLLI by a 635nm, 5mW diode laser with the energy density of 0.96 J/cm2 for 150 seconds, n=26. ② Control group, the rats received thoracotomy for daylight irradiation, n=27. ③ Sham operation group, the rats received thoracotomy without LAD ligation, n=24. The Expressions of myocardial vascular endothelial growth factor (VEGF), glucose-regulated protein 78 (GRP78), superoxide dismutase (SOD) and malondialdehyde (MDA) were evaluate by real time-PCR, Western blot analysis and other relevant laboratory test at 1 hour, 1 day and 1 week after treatment. The myocardial cell apoptosis was examined by TUNEL staining, and left ventricular function was detected by echocardiography.
Results: LLLI preconditioning obviously increased the myocardial VEGF, GRP78 expression and SOD activity, decreased MDA production; while it could not really improve the myocardial cell apoptosis at peri-infarcted area and left ventricular function in experimental rats.
Conclusion: LLLI preconditioning may improve the milieu of infarcted myocardium via decreasing the oxidative stress in experimental rats.

Objective: To explore the effect of omentopexy combining autologous atrial tissue patch cardiomyoplasty for treating the chronic myocardial infarction (MI) in experimental rats.
Methods:The MI model of SD rats was established by left coronary artery ligation. 3 weeks later, the qualiifed animals were randomized into 4 groups for the 2nd operation. ① Control group, the rats only received re-thoracotomy, ② Atrial appendage group, the autologous atrial tissue patch was harvested from left atrial appendage of rats and transplanted to infarcted zone, ③ Omentum group, the omentum of rats was transplanted to infarcted zone through diaphragm and ④ Combination group, the left atrial appendage tissue and omentum were transplanted to infarcted zone together. 4 weeks after the 2nd operation, the cardiac function was evaluated by echocardiography, the size and scar thickness of the infarction were examined by Masson staining, the survival of transplanted atrial tissue and angiogenesis were measured by immunohistochemistry, the protein expressions of VEGF, MMPs and TIMP-3 were examined by Western blot analysis, and the activities of MMPs were
identiifed by gelatin zymography.
Results:4 week after the 2nd operation, transplanted left atrial appendage tissue only survived in Combination group. The areas of infarction were similar among different groups, P>0.05. Compared with Control group, Combination group had the increased scar thickness (329 ± 33)μm vs (391±31)μm, improved LVEF (47.5 ± 4.5)%vs (57.9 ± 5.8)%, improved LVFS (20.7 ± 2.0)%vs (25.2 ± 3.6)%, all P<0.05. Compared with Control group, both Omentum group and Combination group demonstrated higher density of angiogenesis at infracted area (33/0.2) mm2 vs (49/0.2) mm2 and (33/0.2) mm2 vs (48/0.2) mm2, all P<0.01. Combination group had decreased protein expressions of MMPs, while the expressions of TIMP-3 were similar among different groups, the activities of MMP-2 and MMP-9 were decreased by 68%, P=0.002 and 64%, P=0.016 respectively.
Conclusion:Omentopexy could improve the angiogenesis and support the survival of transplanted autologous atrial tissue patch, therefore improve the cardiac function in experimental rats with chronic MI.

Objective To treat scalp lacerations by using the hair apposition technique (HAT) and to compare the HAT with standard suturing in a controlled prospective trial. Method Fifty patients with scalp lacerations were treated either by HAT or by standard suturing. Two groups were evaluated in consumed times for operation, pain sores, and complications. Results There were 30 HAT patients and 20 patients treated with suturing. The took shorter operation time consumed[(3.33 vs. (6.05 t = 4.85.P < 0.01], and HAT produced significantly lower pain score [(1.73vs. (3.20t = 4.01,P < 0.01]. There was a trend that more and more patients were willing to have HAT performed. Conclusions The advantages of HAT include a shorter time consumed for operation, less pain, satisfactory wound healing, and high acceptance by patients. HAT is acceptable for treating scalp lacerations in emergency room.

Objective To measure the changes of total factor productivity (TFP)of Zhejiang medical facilities for decision makers to promote their service efficiency.Methods Collecting the panel data of 2005-2010(four input indexes and five output indexes)from medical facilities in Zhejiang province and measuring with Malmquist index of DEA programs of DEAP2.1.Results The average annual TFP growth rate in the period is 2.0％.A further decomposition found that the average annual growth rate of technology progress is 1.8 ％,while that of technical efficiency and pure technical efficiency is only 0.2％respectively.In the meantime,no scale efficiency growth was found.Conclusion The average annual growth of total factor productivity of Zhejiang medical institutions is substantially low in the period,with technology recession found as well.To maximize productivity of the medical sector,the allocation and internal management should be strengthened to stimulate technical efficiency and scale efficiency while encouraging technology innovation.