Reform on medial service compensation mechanism,as a key point in the heahhcare system reform,runs through the entire reform process.It plays a key role for the establishment and improvement of urban medical care system,medical service system,medical management system and operating system,for its guidance and regulation effects.Such a refonn to build a scientific and perfect compensation model and mechanism will be highly significant for the smooth progress of the new round of healthcare reform and its success in the end.

Taking the modern occupation education concept as the guide,oriented by adapting to the demand of occupation post,we established a new open education mechanism of medical occupation education to promote the reform of personnel training mode,curriculum and teaching content to explore the effective way of the sustainable development of local medical occupation education.

Objective To evaluate the clinical features,diagnostic methods and treatment of venous thromboembolic disease (VTE) during pregnancy.Methods From June 2006 to June 2011,a total of 20 pregnant women were diagnosed VTE at the Department of Obsterics and Gynaecology,Qilu Hospital of Shandong University.Clinical data of these patients were analyzed retrospectively.Results (1) Characteristics of patients:the symptoms of all the 20 patients commenced in pregnancy.Of these,6 (30％) happened in the first trimester,7 (35％) in the second trimester,and 7 (35％) in the third trimester.Twelve (60％) patients went to hospital in one week after they had symptoms,while 8(40％ ) went to hospital after one week.(2)Clinical manifestation:18 patients were diagnosed deep venous thrombosis (DVT),one was diagnosed pulmonary embolism (PE).One patient was diagnosed DVT and PE simultaneously.Among the 19 DVT patients,16 (16/19)were on the left side,3 (3/19)were on the other.They all came with sudden swelling and pain of the affected lower extremity.In 17(17/19) patients,the circumference differences between two legs were beyond (4.0 ±0.5) cm.In all the 20 patients,12 (60％) had elevated plasma level of D-dimmer.The diagnosis of DVT was made mainly by a Doppler ultrasound.Among the 19 DVT events,7 (7/19) were proximal DVT,2 (2/19) were distal,and 10( 10/ 19) were mixed type.(3)Anticoagulant therapy:patients with VTE during pregnancy were treated with low molecular weight heparin (LMWH) (enoxaparin,once 1 mg/kg subcutaneous,twice a day).After delivery,patients were treated with subcutaneous LMWH and warfarin simultaneously for at least 5 days,until the prothrombin time-international normalized ratio ( PT-INR ) was ＞ 2.0 for 24 hours.( 4 ) Thrombolytic therapy:for most patients with VTE,we are against the routine use of thrombolytic therapy,especially before delivery.For patients with acute massive PE,urokinase of 600 000 units intravenously daily was recommended for 3 days.For those patients with DVT whose standard anticoagulation therapy was ＜ 30 days,an inferior vena cava filter(IVCF) placement was recommended before delivery or abortion.If it was ≥30 days,IVCF was not recommended as a routine,and anticoagulant therapy was used 24 hours after delivery.If there was no recurrent DVT or PE,IVCF was retrieved routinely in 12 days.(5)Outcome:among patients treated with LMWH (95％,19/20).Three received IVCF placement,which was retrieved successfully in 12 days,with no interventional complication.All patients recovered well after 2 weeks,and the circumference differences between two legs were within (2.0 ± 0.3 ) cm.Of the 18 patients maintained to the third trimester,17 received anticoagulant therapy,and no abnormal findings were found during antenatal examination.Ten patients received cesarean section (50％,10/20),while 8 had vaginal delivery (40％,8/ 20).Neither neonatal asphyxia nor malformation was observed.The patients were followed-up for 1 - 24 months,no venous thrombus extension was found in 17 cases by Doppler ultrasound,thrombus disappeared in 2 cases of distal DVT after 4 weeks and 8 weeks respectively.By echocardiography,the pulmonary arterial pressure of the 2 patients with PE was found normal 3 months after hospital discharge.There was no maternal death during the study,no recurrent PE or bleeding occured.Conclusions LMWH is safe and effective for VTE during pregnancy.Routine use of thrombolytic therapy is not recommended.VTE in pregnancy is not the absolute indication of termination of pregnancy.The indication of an IVCF placement should be stricter,and a retrievable suprarenal IVCF is recommended under certain circumstances.

Acquired Immunodeficiency Syndrome ; prevention & control ; therapy ; Communicable Disease Control ; Humans

Objective To study the effect of CsA in a therapeutic dose on the hepatic ultrastructure in rats.Methods Twenty-four SD rats were divided into 3 groups.The control group was orally administered olive oil,and the other 2 groups were orally given CsA 25 mg/kg and 50 mg/kg daily respectively.After 2 weeks.the liver samples were taken for ultrathin sections.The stereological method was used to quantify some hepatic ultrastructural parameters including volume density (Vv),surface density(Sv),numerical density(Nv) and specific surface(δ).Results CsA caused an increases of Vv and Sv and a decrease of δ in endoplasmic reticulum;a decreases of Vv and Nv in microbody;decreases of Vv in Golgi complex and glycogen inclusions;an increases of Vv and Nv in lipid inclusions.Conclusion CsA in a therapeutic dose could cause the change of hepatic ultrastructure of rat.

Carbon monoxide(CO)has a significant anti-inflammatory action.Carbon monoxide releasing molecule(CORM),as a new donor of CO,is used widely in biological study.The article reviewed the antiinflammatory action of CO and the progress of CORM.

Objective　To study radiotherapy in the treatment of uterine sarcomas and response to radiation in primary or recurrent uterine sarcomas. Methods　A total of 102 uterine sarcomas treated in the Cancer Hospital from May 1960 to June 1999. A retrospective review of 45 patients receiving surgery alone, 29 patients for postoperative radiotherapy, 4 radiotherapy alone, 24 recurrent sarcomas receiving radiotherapy. Results　The 5-year overall survival for 45 patients treated with surgery alone and 29 patients managed by postoperative radiotherapy were 56.7% and 58.6% respectively (P>0.05). The addition of radiotherapy significantly reduced the local recurrence rate from 42.2% to 20.7% （P<0.05）. The tumor was disappeared completely by treatment of radiotherapy alone in 3 patients of primary uterine cervix sarcomas. 1 patient was free of disease at 36 months. Other 2 patients died 9 and 11 months later because of distant metastases. The complete and partial response rate of radiotherapy was 50.0% for recurrent tumors. The radiotherapetic sensibility of endometrial stromal sarcomas, mixed mesodermal sarcomas and leiomyosarcomas was downward tendency in turn.Couclusions　The postoperation adjuvant radiotherapy reduced the pelvic recurrent significantly. Radiotherapy should be used in the treatment of uterine sarcomas as an important part of combination therapy.

Objective To evaluate the effect of embelin combined with paclitaxel on the inhibition of A 549 lung cancer cell proliferation and tumor growing in tumor bearing nude mice. Methods The anti-proliferation efficiency of embelin combined with paclitaxel were evaluated by MTT assay, and A 549 cell apoptosis were evaluated by lfow cytometry. A 549 cells were xenografted in mice to establish the animal model, which were used to evaluate the effect of anti-tumor. Results compared to saline group、embelin group and paclitaxel group, the (paclitaxel+embelin) group could inhibit the growth of A 549 cells effectively(P<0.05). The embelin combined with paclitaxel induced the apoptosis of A 549 cells more effective than paclitaxel alone. The (paclitaxel+embelin) group significantly inhibited the growth of tumor tissue. Conclusion the paclitaxel can inhibit the growth of A 549 cells, the embelin can induce the apoptosis of A 549 cells, and the combination of paclitaxel and embelin may be a potentially effective treatment for lung cancer.

Objective To evaluate t he efficacy of fluoxetine in treating tinnitus patients with depress. Methods A randomized,open-labeled,controlled clinical tri al was conducted.There were 31 patients in control group and 26 p a tents in fluoxetine group.The efficacy was assessed by tinnitus patients with Ra ting Scale and Hamilton Depression Rating Scale (HAMD). Results The total effective rate of fluoxetine group was 71.11%, and there was significant improvement rate in depression after 1 month f luoxetine treatm ent. Conclusion Fluoxetine is an effective drug for tinnitus p atients with depression.

Objective To investigate the changes of the level of oxidative stress and cell apoptosis of secondary brain injury after traumatic brain injury,and the influence of brain-derived neutrophic factor on these parameters in rats,as well as its potential mechanisms.Methods A total 84 adult and healthy male rats was divided randomly into 2 groups:control (n =42) and traumatic brain injury (TBI) groups (n =42).The brain-derived neurotrophic factor (BDNF) group was induced using improved Feeney method and was received abdominal injections of BDNF (0.5 μg/μl) immediately after injury,the control group were received abdominal injections with the same dose sodium chloride injection immediately after injury and repeat one time everyday until the rats was killed.Each group was divided into seven subgroups by sacrificed time after injury,those are 1 h,3 h,6 h,12 h,24 h,3 d,and7 d,each subgroup got6 rats.Each subgroup was randomly selected three rats after being killed.The water content,superoxide dismutase (SOD),malonic aldehyde (MDA),and glutathione (GSH) of rats were measured contusion peri tissues brain tissue.Specimens were taken from left three rats of subgroup,which was part of the brain tissue.The expression of NF-κB p65,around the brain tissue with immunohistochemical methods were detected.TdT-mediated dUTP nick-end labeling (TUNEL) method was used to observe the peri cell apoptosis after brain contusion.Results NF-κB p65 was expressed obviously around the lesion in 1h group,and strongly expressed in TBI-3 h-12 h,and reached a peak in 24 h after the injury,while NF-κB p65 expression reduced in TBI-3 d-7 d,and still in high expression.NF-κB p65 expression strongly correlated with the degree of cerebral edema (r =0.651,P ＜0.05).For two groups,NF-κB p65 expression strongly correlated with the level of MDA (r1 =0.947,P ＜0.01;r2 =0.961,P ＜0.01).Conclusions Changes of NF-κB protein expression after brain injury were involved in a series of pathological processes of secondary brain injury,such as oxidative stress,and apoptosis,brain-derived neutrophic factor is probably through inhibit oxidative stress levels,control apoptosis,prevent the development of vasogenic cerebral edema,and reduce or mitigate secondary brain injury.