Towards the problems after the medical reform of China,such as dramatic increase of healthcare expenditure and conflict between doctor and patient,this paper analyzes the tripartite relationships between hospital,insurance supplier and patient from the theoretical and practical aspects,concludes that the non-balanced development of the current relationships is an important reason of the problems,and gives the corresponding countermeasures for reference.

Objective To investigate the role of 15 kinds of growth regulatory factors in the pathogenesis of benign prostatic hyperplasia (BPH). Methods 15 kinds of growth regulatory factors involving cell proliferation and apoptosis were studied by immunohistochemistry with computer assisted quantitative image analysis.The mean percent area densities of stroma,epithelium and glandular lumen in BPH were examined by quantitative image analysis. Results Positive relations were found bewteen expressions of basic fibroblast growth factor (bFGF),transforming growth factor ?, fibronectin, type Ⅳ collagen and proportions of stroma (r=0.323?0.278?0.235?0.241,P

Hepatocellular carcinoma is a common malignant tumor, which has a poor prognosis and a high mortality rate. Under the influence of respiratory motion, the position error of liver cancer is relatively high. The image-guided radiotherapy is a combination of radiotherapy and imaging device, which can detect and correct the error caused by the movement of the organs and the position of the pendulum to improve the accuracy of radiotherapy.

The use of tyrosine kinase inhibitor imatinib in treatment of gastrointestinal stromal tumors(GISTs)has achieved a dramatic therapeutic efficacy. However,secondary imatinib resistance emerged as a clinical problem needs to be solved urgently. The underlying mechanisms of GISTs secondary resistance to imatinib may be related with secondary mutations of KIT/ PDGFRA genes,loss of PTEN gene and induction of cellular quiescence. This resulted in the adoption of new therapeutic strategies such as novel tyrosine kinase inhibitors,combined use of imatinib with downstream signaling inhibitors,KIT/ PDGFRA independent targeted inhibitors such as KIT chaperone inhibitors and aurora kinase inhibitors,as well as inducing apoptosis in quiescent GIST cells. In this article,the above-mentioned issues were summarized.

An electrochemical aptasensor for Pb2+ was constructed based on the layer-by-layer assembly of graphene (GR) and anthraquinone -2-sulfonic acid sodium salt (AQMS) on the surface of Pb2+ aptamer. The mercapto-modified Pb2+ aptamer was first anchored on a gold electrode. Then the highly conductive material of GR was adsorbed on apt through the unique π-π stacking interaction, which was further used for the assembly and signal amplification of the electroactive AQMS. Upon interaction with Pb2+ ions, the apt on the aptasensor undergone conformational switch from a single-stranded form to the G-quadruplex structure, causing the GR assembled with AQMS releasing from the electrode surface into solution. As a result, the electrochemical signal of AQMS on the aptasensor was substantially reduced. Base on this concept, a useful platform for detection of Pb2+ ions was constructed. Under the optimal experimental conditions, the attenuation of peak currents (△Ipa ) showed linear relationship with the logarithm of Pb2+ concentrations (lgCPb2+) over the range from 5. 0×10-10 to 5. 0×10-8 mol/ L. The detection limit was estimated to be 6. 0×10-11 mol/ L.

Objective To study the relationship between resting heart rate(RHR)and essential hypertension(EH).Methods 215 patients with EH and 82 healthy subjects underwent RHR detection.The relationship between RHR and the state of EH was analyzed.Results RHR in EH group was significantly higher than that in normal group[(78.9±9.1)bpm vs(69.5±10.9)bpm,P＜0.01)],RHR in different stages of EH was significantly different(F=21.280,P＜0.01,respectively),and increased with grades(P＜0.05 orP＜0.01).RHR in EH patients complicated with left ventricle hypertrophy(LVH)was higher than those with no LVH[(83.9±9.1)bpm vs (75.9±8.9)bpm,P＜0.01].There was positive correlation between RHR and LVH(r=0.8097,P＜0.01).Conclusion RHR is related to the development and progress of EH,and it may be one of the index for estimating the state of EH.

ObjectiveTo investigate the clinical efficacy of focused ultrasound for treating non-neoplastic epithelial disorders of vulvar. Methods212 patients with non-neoplastic epithelial disorders of vulvar were treated with focused ultrasound. The patients were followed up after the treatment,and symptom was observed and the efficacy was evaluated. ResultsThe efficacy of non - neoplastic epithelial disorders of vulvar of squamous hyperplasia,lichen sclerosus and mixed dystrophy was 99.2％, 100. 0％, 88.9％ respectively, the difference was not significat (P ＞ 0.05 ). The efficacy in different courses of patients was 100.0％ ( ＜ 2 years), 100.0％ (2 ～10 years) ,91.3％( ＞ 10 years) respectively,the difference was not significat( P ＞ 0.05). ConclusionFocused ultrasound was obviously effective in the treatment of patients with non-neoplastic epithelial disorders of vulvar.

Objective To investigate the effect of ulinastatin on the postoperative immune function of effective T-lymphocytes (Teff cells) and regulatory T-lymphocytes (Treg cells) in the peripheral blood in patients undergoing laparoscopic operation.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 20-40 yr,weighing 45-65 kg,scheduled for elective laparoscopic operation for infertility,were equally and randomly divided into 2 groups using a random number table:control group (group C) and ulinastatin group (group U).At 15 min before induction of anesthesia,ulinastatin 200,000 U (in 100 ml of normal saline) was infused intravenously in group U,while the equal volume of normal saline was infused instead in group C.Anesthesia was induced with iv injection of fentanyl,propofol,and cisatracurium and maintained with iv infusion of propofol and sevoflurane.Before surgery (T0),at the end of surgery (T1) and on 1st and 3rd days after surgery (T2.3),venous blood samples were collected from the peripheral blood for determination of the expression of Teff cells (CD4 + CD25-) and Treg cells (CD4 + CD25+) and serum interferon-γ (IFN-γ) and transforming growth factor-β (TGF-β) concentrations (by ILISA).Teff/Treg and IFN-γ/TGF-β ratios were calculated.Results Compared with the baseline value at T0,the expression of Treg cells was significantly up-regulated,and Teff/Treg ratio was decreased at T2 and T3 in group C,and the expression of Teff cells was up-regulated at T3 (P ＜ 0.05 or 0.01),while no significant difference was found in the expression of Treg cells and Teff/Treg ratio at T3 in group U (P ＞ 0.05).Compared with group C,the expression of Teff cells was significantly up-regulated at T3,the expression of Treg cells was down-regulated and Teff/Treg ratio was increased at T2 and T3,the concentration of serum TGF-β was decreased and IFN-γ/TGF-β ratio was increased at T2 and T3 in group U (P ＜ 0.05 or 0.01).No significant changes were found in the serum IFN-γ and TGF-β concentrations and IFN-γ/TGF-β ratio at each time point in the two groups (P ＞ 0.05).Conclusion Ulinastatin can enhance the immune function of Teff cells in the peripheral blood and decrease the immune function of Treg cells,thus maintaining the balance of the postoperative cellular immune function in patients undergoing laparoscopic operation.

Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.

Objective To discuss the impact of nursing intervention on self- care ability and health behavior of cancer patients with indwelling PICC in order to improve their life. Methods 218 cases of cancer patients with PICC catheter were randomly divided into the intervention group (107 patients)and the control group (111 patients),the control group were treated with conventional care, the intervention group was treated with targeted cognitive intervention by the PICC nurse specialists on the basis of conventional care. Interventions included improving health knowledge, self-concept, self-care responsibility and self-care skills in four areas, the intervention lasted 3 months. A questionnaire survey was conducted before and after intervention. Self-care skills and health behavior levels were compared between the two groups. Results Self-care skills and health behavior levels of the intervention group were significantly higher thanthose of the control group after intervention. Conclusions Targeted interventions can effectively improve the self-care capacity of outpatient oncology patients with PICC catheter and improve their health behaviors.