Objective To evaluate the medical efficiency of sample hospitals in Sanming city before and after Sanming health care reform.Methods One tertiary hospital,two general county hospitals and two TCM county hospitals in Sanming were sampled for the study.Two dimensions(the intensity index of medical work and work efficiency index)were selected.In addition,six indexes were identified,namely the number of discharged patients,number of outpatients and emergency diagnostics,doctor′s daily workload per capita for inpatients,bed turnover times,bed utilization rate and average days of stay.Descriptive trend analysis and comprehensive index method were applied in turn to evaluate the longitudinal changes in medical efficiency at the sample hospitals before and after the medical reform.Results The five sample hospitals in Sanming were found with less days of stay in average,and three were found with year-by-year rise of medical efficiency index,with one of them rising from 1.57 to 2.42.Conclusions Sanming′s health care reform has effectively improved internal operational efficiency at the sample hospitals,and has well addressed the relationship of medical service efficiency and scale expansion.On the other hand,the relationship between work intensity and medical efficiency needs to be further balanced,resource allocation to be further optimized,and more priority to be put in the development of TCM hospitals.

[Objective]To simulate the biomechanics mechanism and environment of humeral fracture caused by indirect impact force for the purpose of biomechanics understanding and treatment of such fracture.[Method]Based on the data source, which was high-resolution anatomic slice images from approximal clavicle to distal humerus, 1 mm thickness and totally 380 layers, the geometric model of total shoulder joint was established according to the order:point, line,area, and further meshed to set up the three dimension finite element model of shoulder, fracture sites and instantaneous stress and strain of humerus were simulated and analyzed under the condition which longitudinal impact force was loaded on the humerus based on the 12 functional positions of shoulder(abduction 30?、 45?、 60?、 90?, and simultaneous neutrality, internal rotation 45?,external rotation 45?).[Result]According to the humeral shaft load-strain curve in different functional positions of shoulder, linear relation was found when load changed from 0 N to 250 N, after which non-linear come out, and even load was removed , bone was deformed eternally. With the rise in load amount, the increase in stress was detected. When abduction degree changed from 90? to 30?, the strain of humerus, both the lateral and the medial increased gradually,and increase in internal rotation 45?and external rotation 45? was more significant than that in neutrality. Meanwhile, stress difference could be seen between the lateral and the medial , and medial was larger than the lateral. Increase in stress in rotation positions was quicker and more than that in other functional positions.[Conclusion]Based on 4 abduction degrees (30?, 45?, 60?, 90?) and 3 rotation degrees(neutrality, internal rotation 45?,external rotation 45?) ,the three dimensional finite element shoulder could simulate precisely stress, strain, general trend of fracture line, three dimension images of bone failure. Three dimension finite element simulation and analysis of shoulder is a valuable mechanical method for research on biomechanics theory related to humerus fracture.

Purpose:To compare the survival rates of hyperf ractionated radiotherapy plus concurrent chemotherapy with hyperfractionated rad iotherapy alone in the treatment of stage Ⅲ/Ⅳ nasopharyngeal carcinoma (NPC) a nd analyze the prognostic factors. Methods:Between December 1992 and December 1995, 144 NPC patien ts were randomized into hyperfractionated radiotherapy plus concurrent chemother apy (R +C) and hyperfractionated radiotherapy alone (R alone).Radiotherapy were similar in the two groups: 1.2 Gy/f, twice a day. Chemotherapy was given to R + C patients before and during the course of radiotherapy. Results:The 5-year overall survival rates of the R + C and R alone groups were 63.3% and 50.7%,repectively . The factors influencing the resu lts were N stage,chemotherapy and the peripheral blood hemoglobin concentration . Conclusions:Hyperfractionated radiotherapy plus concurrent chem otherapy can improve the survival rate, especially for the patients with N2-N3 stage.The negative prognostic factors for Ⅲ/Ⅳ NPC are N2-N3 stage, radiothera py alone and the reduction of hemoglobin during treatment.

Objectives:To evaluate forearm intramuscular autograft Tx vs. forearm subcutaneous ultrasound-guided homogenate injection transplantation. Methods:One hundred-ten end-stage chronic renal failure patients who after total parathyroidectomy and autologous forearm Tx from Mar 2011 to Mar 2020 were enrolled for retrospective analysis.The control group received autologous parathyroid forearm intramuscular autograft Tx, and the observation group had the anterior fascia of the flexor carpus ultrasound-guided homogenate injection Tx. We evaluated the effects of transplantation between the two groups.Results:There were no significant differences in the levels of iPTH, blood calcium, blood phosphorus, and calcium-phosphorus product between the two groups of patients 30 minutes , 1 month , and 3 months after surgery.The two-dimensional ultrasound simulated ellipse dispersion volume in the observation group is much smaller than that in the control group [(2.51±0.41) cm 3vs. (1.91±0.55) cm 3, t=6.519, <0.001] The linear regression equation of the actual volume of the three-dimensional ultrasound in the observation group and the iPTH value in the observation group after 3 months is Y1=47.728+ 122.337X, r1=0.892, P<0.05. The linear regression equation of the two-dimensional ultrasound simulated ellipse diffusion volume in the observation group and the iPTH value in the observation group at 3 months after operation was Y2=121.408+ 81.736X, r2=0.883, P<0.05. Conclusion:Compared with intramuscular Tx, the recovery levels of iPTH, calcium, phosphorus and calcium-phosphorus product after the anterior fascia of the flexor carpus ultrasound-guided homogenate parathyroid glands injection Tx are similar, but its operation is more simple and diffusion volume is smaller.

Objective:To establish a model of mice breast cancer of 4T1 cells in BALB/c mice and choose the best model making method.Methods:Ninety mice were divided into three groups randomly ,with 30 in each group injected by 4T1 cells suspension of 1×106 ml-1 ,1×107 ml-1 ,1×108 ml-1 respectively.Each group of mice were randomly divided into two groups which were inoculated on the chest wall and lateral abdominal wall respectively.Tumor formation time ,tumor growth rate and the 8 week survival rate in each group were compared ,and pathological character was observed by C-erbB-2 immunohistochemistry staining.Results:Tumor growth rate in cells suspension of 1×107 ml-1 was high and grow steadily.Tumor growth rate wasn′t correlative with 4T1 cells injection in different parts.The result of C-erbB-2 immunohistochemistry staining was positive.Conclusion: Injection of 4T1 cells suspension with 1 ×107 ml-1 is the best way to male tumor model in three suspension.

Atherosclerosis ; diagnosis ; metabolism ; Biomarkers ; Humans ; Proteomics

BACKGROUND: Studies have confirmed that Atorvastatin drugs can increase the number of endothelial progenitor cells significantly in vitro, as well as the content of vascular endothelial growth factor(VEGF). OBJECTIVE: To investigate the effect of Atorvastatin on VEGF expression in necrotic femoral heads of rabbits. DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed at the Department of Orthopedic Surgery, Renmin Hospital of Wuhan University, from September 2007 to November 2008. MATERIALS: Forty-five male and female healthy New Zealand white rabbits weighing 2.5-3.5 kg were randomly divided into normal control group, model control group and AtorvastaUn group, 15 rabbits in each group. METHODS: Nitrogen refrigeration was used to develop femoral head necrosis models of rabbits in the model control and Atorvastatin groups. Two weeks after modeling, the animals in the Atorvastatin group were administered intragastically with Atorvastatin, normal control and model control group were treated with the same volume of normal saline. MAIN OUTCOME MEASURES: Each five rabbits were sacrificed at the 4th, 8th, and 12th weeks respectively for general observation, X-ray and histological observation. VEGF protein expression was assessed by immunohistochemistry method and VEGF mRNA level was assessed by reverse transcription - polymerase chain reaction method. RESULTS: The VEGF protein and mRNA levels in the model control and Atorvastatin groups were obviously lower than those in the normal control group, while the VEGF protein and mRNA levels in the Atorvastatin group were much higher than those in the model control group at the 8th and 12th weeks alter the treatment with Atorvastatin (P < 0.05). CONCLUSION: Atorvastatin can significantly upregulate the expression of VEGF, which is probably an effective clinical treatment to avascular necrosis of the femoral head.

Objective To explore the clinical value of laparoscopic hepatectomy for the treatment of hepatic hemangioma.Methods Clinical data of forty-six patients treated with hepatic hemangioma hepatectomy in Dongfeng Hospital Affiliated to Hubei University of Medicine from February 2014 to February 2017 were collected.The patients were divided into the laparoscopic hepatectomy group (LH group 26 cases) and the open hepatectomy (OH group 20 cases) by retrospective descriptive study.The operation time,hepatectomy time,intraoperative blood loss,postoperative complications,postoperative liver function recovery time,hospitalization time,total hospitalization cost,number of residual tumor tissues and follow-up recurrence rate of the two groups were compared.Results The length of incision in the laparoscopic hepatectomy group was significantly lower than that in the open hepatectomy group ((5.41±0.53) cm vs.(19.72±1.26) cm,t=52.335,P=0.000),the intraoperative blood loss,operation time,exhaust time,indwelling drainage time,first postoperative feeding time and postoperative hospitalization time in the LH group were significantly lower than those in the OH group ((572.23±16.92) ml vs.(911.75±19.41) ml,(149.52±18.14) min vs.(171.47±21.35) min,(2.84±0.63) d vs.(3.46±0.57) d,(5.74±3.380) d vs.(10.62±3.59) d,(2.08±0.52) d vs.(3.10±0.61) d,(8.91±2.16) d vs.(14.84±2.09) d,t=63.287,3.767,3.447,4.725,6.117,9.360,P<0.05);in the LH group,liver function recovery index alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower than those in the OH group ((45.73±2.16) U / L) vs.(149.29±3.44) U/L,(47.32±1.89) U/L vs.(50.60±3.53) U / L,t=124.985,4.051,P<0.05).Conclusion Laparoscopic hepatectomy for patients with hepatic hemangioma is characterized by less trauma,quicker recovery and higher safety.

Objective To investigate the effects of diammonium glycyrrhizinate (DG) on the expression of Toll-like receptor 4 in rat' s kidney poisoned by paraquat (PQ).Methods The PQ (100 mg/kg) were administered via a gastric tube to make an animal model of acute kidney injury in rats.Then DG (50 mg/kg per 24 h) were administered immediately by intraperitoneal injection in the DG group.The ELISA assay was applied to measuring the IL-6 and IL-10 in kidneys and in blood.And the protein expressions of TLR-4, Myd88 and NF-κB P65 were examined by Immunohistochemistry.The gene expressions of TLR-4, Myd88 and NF-κB on kidneys were detected by RT-PCR.Results The levels of serum Cr, BUN , IL-6 and renal IL-6 in PQ group were significantly higher than those in NS group (F =266.014, 168.160, 63.279, 192.997, respectively, P ＜0.01).While, the levels of serum Cr, BUN , IL-6 and renal IL-6 in DG group were significantly lower than those in PQ group (F =266.014, 168.160, 63.279, 192.997, respectively, P ＜ 0.01).And the levels of serum and renal IL-10 in PQ group were higher than those in NS group (F =87.511, 79.473, respectively, P ＜ 0.01).But the levels of serum and renal IL-10 in DG group were lower than those in PQ group (F =87.511, 79.473, respectively, P ＜0.01).The results of PCR confirmed that the expressions of TLR-4 mRNA , myd88 mRNA and NF-κB mRNA in PQ group were higher than those in NS group (F =84.408, 60.683, 86.272, respectively, P ＜0.01), while, the expressions of TLR-4 mRNA , myd88 mRNA and NF-κB mRNA in DG group were lower than those in PQ group (F =84.408, 60.683, 86.272, respectively, P ＜ 0.01).The protein levels of TLR-4 , Myd88 and NF-κB P65 in PQ group were higher than those in NS group (F =79.139, 61.799,112.740, respectively, P ＜0.01).While the protein levels of TLR-4, Myd88 and NF-κB P65 in DG group were lower than those in PQ group (F =79.139, 61.799, 112.740, respectively, P ＜ 0.01).Conclusions Diammonium Glycyrrhizinate can attenuate rat's acute kidney injury caused by paraquat poisoning and decrease the expressions of TLR-4, Myd88 and NF-κB.