Ten-year experience of state-owned public hospitals reform of Shanghai was reviewed and analyzed according to theGuiding Opinion of General Reform of Public Hospitals in Urban areas. The paper focused on administration and operation mechanisms reform,modes transition on service delivery and management with support from information technology were thoroughly introduced,and further working plans were provided based on the analysis of problems and challenges.

Evidence-based medicine (EBM) has rapidly developed in recent years and is currently a hotspot in international medicine. The guiding principle behind EBM is that any medical decision should be determined based on objective clinical and scientific evidence, doctor's professional skills and experience, and patient's needs and desires. This paper introduces the concept and practice of EBM and explains how it can be used to solve the issues in stomatology.
Evidence-Based Medicine ; Humans ; Oral Medicine

Objective To investigate whether polymorphisms of apolipopretein D gene (APOD) have an effect on the risk for sporadic Alzheimer's disease (SAD).Methods Combination of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing technique to screen all exons (1-5),along with flanking exon-intron boundaries of the ApoD gene.We investigated the polymorphisms of ApoD in 256 SAD patients and 294 healthy controls from North China by PCR-RFLP technique.Association of every polymorphism with AD was analyzed in this case-control study.Results Two ApoD (rs5952 and rs1568566) polymorphisms were detected and there were significant differences in the genotype or allele frequencies for the 2 ApoD polymorphisms respectively between cases and controls.Logistic analysis showed that rs5952C or rs1568566T allele carrier increased the risk for SAD (rs5952 adjusted OR=1.817,95% CI 1.237--2.669,χ2=9.282,P=0.002 ; rs1568566 adjusted OR=1.563,95% CI 1.060-2.306,χ2=5.072,P=0.024).The APOD polymorphisms showed gender specific associations.The linkage disequilibrium of the 2 single nucleotide polymorphism loci was found between rs5952 and rs1568566 of ApoD.Conclusion Polymorphisms of rs5952 and rs1568566 in APOD might play an important role in modifying risk for SAD.

OBJECTIVE:To establish a method for the simultaneous determination of paeoniflorin and ferulic acid in Naoxuesh-uan pill. METHODS:HPLC was performed on the column of Waters SunfireTM C18 with mobile phase of acetonitrile-water-glacial acetic acid(17:82:1,V/V/V)at a flow rate of 1.0 ml/min,detection wavelength was 230 nm,column temperature was 35 ℃,and the volume injection was 20 μl. RESULTS:The linear range was 0.024-0.240 mg/ml for paeoniflorin(r=0.999 9)and 0.009 4-0.141 0 mg/ml(r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 2%;recoveries were 95.00-97.90%(RSD=0.59%,n=6) and 95.29-98.24%(RSD=0.54%,n=6),respectively. CONCLUSIONS:The method is simple and repro-ducible,and can be used for the quality control of Naoxueshuan pill.

To discuss the character and application of internal fixation with cervical lateral mass plate fixation in posterior approach of cervical spine operation. Twelve patients with cervical fracture dislocation treated with posterior cervical lateral mass fixation and bony fusion were selected. The patients received spinal decompression or reduction and decompression according to different diseases. A suitable 3.5 mm bi-cortical screw was inserted using Magerl technique. The results showed that solid bony fusion could be obtained at 3-5 months after the surgery, and the intervertebra heights as well as physiological curves were kept well without screw loosening or breaking. Neurological function was recovered to different extent. Cervical lateral mass plate fixation has the advantages of easily operation technique, wide indications, strong stability and short segment fixation.

Objective To investigate the effects of ventilation strategy of permissive hypercapnia on the expression of inflammatory mediators in the patients received laparoscopic radical gastrectomy. Methods Thirty-six patients received laparoscopic radical gastrectomy were randomly divided into two groups: control group and experiment group. The patients in control group received conventional ventilation strategy [partial pressure of carbon dioxide in endexpiratory gas (P<,ErCO2) 34.5-45.0 mm Hg (1 mm Hg =0.133 kPa),pH7.35-7.45], and patients in experiment group received ventilation strategy of permissive hypercapnia(PErCO2 49.5-60.0 mm Hg,pH7.20). Blood samples were collected respectively from the peripheral vein before anesthesia induction (T0), 1 h (T1), 3 h (T2) after operation and when operation finished (T3) for the assessment of interleukin(IL)-8, IL-6,tumor necrosis factor (TNF)- α. Results The levels of IL-8, IL-6, TNF-α at T2, T3 were higher in control group [(96.732±3.173) μg/L and (107.767±3.654) μg/L, (0.273±0.009 ) ng/L and (0.287±0.008) ng/L,(1.443±0.086)μg/L and (1.614±0.107) μg/L] than those in experiment group [(91.771±4.332) μ g/L and (97.682±4.998) μg/L, (0.231±0.008 ) ng/L and (0.241±0.006) ng/L,(1.268±0.066) μg/Land (1.428±0.058) μg/L](P<0.05 or <0.01), mean arterial pressure, partial pressure of oxygen in artery and heart rate were relative stabilization. Conclusions Ventilation strategy of permissive hypercapnia can reduce the released amount of inflammatory mediators and may be advantageous for the patients received laparoscopic radical gastrectomy.

Objective To evaluate the effects of low molecular weight heparin(LMWH)and heparin-binding epidermal growth factor(HB-EGF)on the biological function of human trophoblast in first trimester.Methods From Feb.2011 to Nov.2011,the trophoblast isolated from human first trimester chorionic villi was cultured in vitro.Based on variation of LMWH concentration,the trophoblast was classified into 0.025 U/ml group,0.25 U/ml group,2.5 U/ml group,25 U/ml group and 250 U/ml group.In the mean time,based on treatment of heparin,the trophoblast was classified into LMWH group (0.25 U/ml),HB-EGF group(10 μg/L),combination group(LMWH at 0.25 U/ml + HB-EGF at 10 μg/L)and add with DMEM as control group.Cell prolferation was assessed by the methyl thiazolyl tetrazolium(MTY)test,which was showed with the mean absorbance as A value.Cell invasion was measured by transwell,which counted the number of cells migrated to the superficies inferia of filter membrane.Cell differentiation was assessed by the concentration of hCG secretion.Results Compared with control group,the trophoblast proliferation and invasion treated by LMWH at 0.025 U/ml did not show significant difference (P ＞ 0.05).When treated by LWMH at 0.25 U/ml and 2.5 U/ml,trophoblast proliferation and invasion was increased significantly(P ＜ 0.05).When LMWH at 25 U/ml and 250 U/ml,it could inhibit trophoblast proliferation and invasion(P ＜ 0.05).When compared with A value of 0.44 ± 0.04 in control group,the increased A value were 0.51 ± 0.05 in LMWH group,0.56 ± 0.04 in HB-EGF group and 0.69 ± 0.06 in combination group(P ＜ 0.05).In the transwell test,the cell number were 511 ± 78 in LMWH group,669 ± 67 in HB-EGF group and 872±64 in combination group,which were significantly higher than 405 ± 67 in control group(P ＜ 0.05),respectively.And the hCG concentration were(7143 ± 649)U/L in LMWH group,(11 762 ± 1059)U/L in HB-EGF group and(11 015 ± 1084)U/L in combination group,which showed statistical difference with(8182 ± 666)U/L in control group(P ＜ 0.05).Conclusion LMWH could modulate trophoblast proliferation,invasion,and differentiation.HB-EGF is one of important factors involved in effects of LMWH on trophoblast function.

ObjectiveTo understand the quality of life and influencing factors of elderly person in agedcare at home.MethodsThe elderly person in aged-care at home in 3 towns and a street of Shanghai Minhang District were enrolled by stratified cluster sampling.To investigate quality of life for elderly person by adopting SF-36 form.Meanwhile,to find out the principal influencing factors on quality of life by adopting both single-factor and multiple-factor analysis.ResultsThe score of life quality of senior citizen in local was as following:43.63 ± 30.04 (Physical Function),55.57 ± 48.96 (Role Physical),81.75 ± 20.49 (Bodily Pain),42.07 ± 18.84 ( General Health),58.57 ± 18.96 (Vitality),66.94 ± 26.79 ( Social Function),73.33 ± 43.33 ( Role Emotional),70.92 ± 19.02 ( Mental Health),61.60 ± 21.06 ( Weighted average).There were two aspects of the factors that influencing elderly persons'the quality of life:disease-related (coronary heart disease,cerebrovascular accident) and non-disease-related ( whether to go out for a walk every day,loneliness,living space,gender and on the current life satisfaction etc).ConclusionQuality of life of elderly person in aged-care at home is relatively low,special in the general health and physical function dimensions.The controllable factors are diseases,whether to go out for a walk every day,loneliness,on the current life satisfaction etc.

Objective: To design a convenient and safe leg support of lithotomy position surgical bed. Methods:Put the gas spring in the device to lift and drop the leg support, instead of turning screw, And then use the new leg support in 80 lithotomy position surgeries. Results:The new device can be operated by one man, it is easy operating and labor saving. There was no leg slip occurred in 80 surgeries, operators all expressed satisfaction. Conclusion: This innovation patent solved the problem of toilsome operating and potential safety hazard, It worth widely use in the clinical.

Objective To evaluate the value of extended latissimus dorsi flap (ELDF) in immediate breast reconstruction in patients with breast cancer after modified radical mastectomy.Methods Thirty-six patients with breast cancer who accepted modified radical mastectomy and 12 patients with breast cancer who accepted immediate breast reconstruction after modified radical mastectomy from January 2008 to June 2009 were included.The complications,cosmetical results and quality of life of these patients were compared.The shape of breast reconstruction was also evaluated.Results All of 12 patients succeeded in proceeding immediate breast reconstruction with ELDF.The evaluation of shape of breast reconstruction was good in 6 cases,secondary in 4 cases,and bad in 2 cases,which was beyond that in patients of radical operation group (P0.05).The patients in breast reconstruction group had a better quality of life compared with the patients in radical operation group (P