By analyzing the situation that large general hospitals face at present in their development and the background of reform in the system of overall responsibility by the attending physician in the hospital, the authors offer an account of the guiding ideology for large general hospitals to adopt the system of overall responsibility by the attending physician, the specific steps taken and the initial results attained. They also discuss the impact of the system of overall responsibility by the attending physician on the hospital from the perspectives of human resources, technological innovation, managerial system, and information system. The positive significance of the system of overall responsibility by the attending physician in the management of the hospital reform is also identified.

Collateral circulation may be a potential therapeutic target for ischemic stroke.However,aiming at improving the treatment of collateral circulation,it has not yet got the reliable clinical validation now.Therefore,undergoing the study of collateral circulation first in the animal models of chronic cerebral hypoperfusion has important practical significance.This article reviews the methods of rat chronic cerebral hypoperfusion models,neurobehavioral evaluation,cerebral perfusion assessment,collateral circulation pathways,and the experimental research status of improving collateral circulation.

The painless needle insertion technique, summarized by Professor WU Lian-zhong during his decades of acupuncture clinical practice is introduced in this article, which is characterized as soft, flexible, fast, plucking and activating antipathogenic qi. The Sancai (three layers) lifting and thrusting manipulation technique is adopted by Professor WU for getting the qi sensation. And features of 10 kinds of needling sensation such as soreness, numbness, heaviness, distension, pain, cold, hot, radiation, jumping and contracture are summarized. Finger force, amplitude, speed and time length are also taken as the basis of reinforcing and reducing manipulations. Moreover, examples are also given to explain the needling technique on some specific points which further embodies Professor WU's unique experiences and understandings on acupuncture.
Acupuncture Therapy ; history ; methods ; China ; History, 20th Century ; History, 21st Century ; Humans ; Needles

Objective To study material basis of Zhou's prescription, components of effective parts Ⅰ in Zhou's prescription was gualitative and quantitative analyzed. Methods The components of effective part Ⅰ was identified by test-tube reaction and qualitative TLC method, the content of saponins and flavones was quantitative analyzed. Results Total content of the saponins and flavone are 1.07% and 0.85% in Zhou's Prescription. The purity of saponins and flavones in effective parts Ⅰ are 37.4% and 29.7%. Conclusion The main components of effective part Ⅰ in Zhou's Prescription were flavones and saponins.

Objective To analyze the corneal flap thickness in laser in situ keratomileusis(LASIK) using Moria M2 microkeratome and to identify the related factors. Methods Sixty patients with LASIK were divided into two groups: M2 90 group,using the Moria M2 90 microkeratome,n=30;M2 110 group,using the Moria M2 110 microkeratome,n=30.All were performed on both eyes with the right one treated first.Subtraction pachymetry was used to measure corneal flap thickness which was analyzed statistically with the data including age,preoperative corneal diameter,curvature,corneal thickness and refraction. Results In the 30 patients of M2 90 group,the mean corneal flap thickness of right eye and left eyes were(128.03?12.03)?m(105~156 ?m) and(123.40?12.38) ?m(92~147 ?m),respectively,and the corneal flap thickness were statistically different between the right and left eyes(P

Objective To evaluate and analyse the morphological structure in late pregnancy women of pelvic hiatus by appli-cation of transvaginal three-dimensional ultrasound .Methods The 60 cases pregnant women who were checked pregnant weeks for 31 to 40 weeks from January 2012 to December 2014 came to our hospital were chosen as the observation group ,and other 60 cases women who were nulliparous women because of irregular menstruation at the same period treatment as control group .All patients underwent transvaginal three-dimensional ultrasound examination by observed the morphological structure of pelvic hiatus in each period ,and the research object of pelvic hiatus left and right diameter ,anteroposterior diameter and area were compared and meas-ured between the two groups .Results (1)The normal pelvic hiatus morphology was rhombic column crack-like structure ,but the observation group who had 43 .33% abnormal pelvic hiatus morphology and there was kind oval ;(2)The observation group were pelvic diaphragm hiatus of left and right diameter ,anteroposterior diameter and area were significantly larger than the control group in three conditions of the resting period ,anal contraction period and tension period ,and the difference was statistically significant(P< 0 .05) ;all the research object of the pelvic diaphragm hiatus left and right diameter ,anteroposterior diameter and area were de-crease in the anal contraction and increases in tension period for compared with the resting period ,so the difference was statistically significant (P< 0 .05) .Conclusion The three-dimensional ultrasound can be clearly observed the morphology of the female pelvic diaphragm hiatus ,and can be effectively evaluated .The late pregnancy women who will be significantly increases of pelvic dia-phragm ,occurs the relaxation phenomenon and some abnormal morphology for compared with nulliparous women .

Objective To research the effect of ulinastatin on T-cytoimmunity in patients with infertility undergoing laparoscopic surgery. Methods Forty patients scheduled for receiving laparoscopic surgery were equally randomized into two groups, ulinastatin group (Group U) and control group (Group C). Ulinastatin was given to patients in the Group U at a dose of 20 × 104 U before anesthetic. No ulinastatin was given to patients in the Group C. Patients′venous blood samples for T-lymphocyte subset (CD3+,CD3+CD4+,CD3+CD8+) and CD3+CD4+/ CD3+CD8+ ratio calculation were collected before the surgery (T0) and at 0 h (T1),1st day (T2),3rd day (T3) after the surgery. Results CD3+ had less difference at T1~3 compared with T0 in the Group C but raised obviously at T2~3 in the Group U. CD3+CD4+ were only raised at T3 compared with T0 but raised obviously at T2~3 in the Group U. CD3+CD8+ were raised obviously at T2~3 compared with T0 in the Group C but had less difference in the Group U. CD3+CD4+/CD3+CD8+ had less difference at T1~3 compared with T0 in the Group C but raised obviously at T3 in the Group U. Conclusion The application of ulinastatin in laparoscopic surgery could significantly produce protective effect on T-cytoimmunity.

Serum triglyceride ( TG ) , total cholesterol ( TC ) , low density lipoprotein cholesterol ( LDL-C) , high density lipoprotein cholesterol ( HDL-C) , uric acid ( UA) levels and fasting blood glucose ( FBG) were measured in 67 patients with chronic spontaneous urticaria ( CSU ) and 66 healthy subjects ( controls).Results showed that the rates of increased serum TG and FBG levels in CSU patients were higher than those in controls ( 19% vs.6%,χ2 =5.309, P <0.05; 12% vs.1%,χ2 =4.194, P <0.05, respectively);however, there were no significant differences in abnormal rate of TC(7%vs.3%) , LDL-C (4%vs.1%), HDL-C(6%vs.3%)and UA(6%vs.1%) between CSU patients and healthy controls(all P>0.05).The rate of rising FBG in CSU patients accompanied by angioedema(4/9)was higher than that in CSU patients without angioedema(7%,χ2 =7.181,P<0.05).

Objective To investigate the effect of pigment epithelium- derived factor (PEDF) on p38MAPK-CREB pathway and the expression of fibronectin (FN) in human mesangial cells (HMCs) cultured with high glucose. Methods HMCs were treated with different concentrations of glucose and the osmotic control respectively in the presence or absence of PEDF for 24 h:normal glucose (5.6 mmol/L),24.4 mmol/L mannitol,high glucose (30 mmol/L),high glucose+PEDF(30 mmol/L glucose with 10 nmol/L PEDF,40 nmol/L PEDF or 100 nmol/L PEDF).After samples were collected,the expression of phospho-p38MAPK (p-p38) and p-CREB was assessed by Western blotting,while FN mRNA and protein expression was assessed with RT-PCR and ELISA respectively. Results In contrast to normal glucose and mannitol treatments,the expression of p-p38MAPK,p-CREB and FN increased significantly in high glucose group (all P＜ 0.01).However,PEDF abolished the up-regulation of p-p38MAPK,p-CREB and FN induced by high glucose (all P＜0.05). Conclusion PEDF may inhibit fibrosis through P38MAPK-CREB pathway in diabetic nephropathy.

Insulin resistance model of 3T3-L1 adipocytes were prepared with plamotic acid.Adipocytes with generated insulin resistance were cultured with different concentrations of globular domain of adiponectin(gAd:250,500,1 000 ng/ml).The cell culture medium glucose content was detected with the glucose oxidase method,the mRNA expressions of insulin receptor substrate-1 (IRS-1),phosphatidylinositol-3 kinase(PI3K),and protein kinase B(PKB) were detected with real-time quantitative PCR method.The phosphorylation of IRS-1 was detected by Western blot.Compared with the control group,the experimental group showed significantly increased glucose consumption (P ＜ 0.01),and with the increasing gAd concentration,glucose consumption was gradually increasing.IRS-1 phosphorylation was increased gradually with the increasing concentration of gAd.These results suggest that gAd can promote glucose uptake by 3T3-L1 adipocyte model with generated insulin resistance.This may be correlated with promoting insulin signal transduction and improving insulin resistance in adipocytes.