Objective: Through analyzing the level, construction and operation efficiency of revenue, to analyze the basic status and change trend of current economics operation of county-level hospitals in this area, provide former basic information for making comprehensive reform evaluation on public hospitals. Methods: To collect data of annual health financial report, collect and analysis the data. Results: The overall level of revenue and expenditure of couty-level hospitals in Hainan increased rapidly , but there were rapid fall in 2012, the balance gap increased obviously; the proportion of financial assistance increased in 2011, while the construction of income and expenditure remained relatively stable. Conclusion: The general economic operation efficiency of county-level hospitals improved, but the comprehensive reforms still has not appeared, which needs further implementation of compensation mechanism for ensuring the successful implementation of comprehensive reform.

Objective To observe the preventive effect of epidural injection with low - dose of ketamine on postanesthesia shivering(PAS) undergoing percutaneous nephrolithotomy. Methods Sixty ASA Ⅰ～Ⅱ grade patients aged 35 ～ 72 years undergoing PCNL were randomly divided into kctamine group (n = 30, Epidural injection of 0.5mg/kg of ketamine) ,Control group(n = 30, Epidural injection of 10ml saline). The rate of shivering was observed and recorded during operation,and blood pressure and respiration were measured. Results The rate of shivering in ketamine group(10%) was significantly lower than that in control group(46.7%, P ＜ 0.05) ,There were no significant differences of blood pressure and respiration between two groups (P ＞ 0.05). Conclusion Epidural injection 0.5 mg/kg of ketamine on postanesthesia can prevent shivering in PCNL.

BACKGROUND:Osteoprotegerin and nitrogen monoxidum play a key role in the prevention and treatment of osteoporosis. However, the correlation of the two in inhibiting the proliferation and differentiation of osteoclasts remains unclear.
OBJECTIVE:To observe the effect of different doses of osteoprotegerin on nitric oxide production and endothelial nitric oxide synthase activity in osteoclasts.
METHODS:Tartrate resistant acid phophatase staining was used to test whether the induced cells are osteoclasts. Osteoclasts were divided into six groups:blank control group (no reagent);negative control group (DMEM);four osteoprotegerin groups (10, 25, 50, 75μg/L of osteoprotegerin). Annexinv-FITC kit and flow cytometry were used to test the apoptosis rate of osteoclasts. Real-time PCR was used to detect the expression of osteoclasts marker gene, TRAP mRNA and protein kinase K mRNA. Nitric oxide production and nitric oxide synthase activity were determined using the corresponding kits. Four osteoprotegerin groups were added with L-NAME, a kind of nitric oxide synthase inhibitor, to test the changes of the apoptosis rates of osteoclasts and the changes of the expression of TRAP mRNA and protein kinase K mRNA of osteoclasts.
RESULTS AND CONCLUSION:Osteoprotegerin inhibited the differentiation of osteoclasts and induced the apoptosis. Osteoprotegerin concentration had a positive correlation with the apoptosis rate of osteoclasts, and a negative correlation with the numbers of osteoclasts and expression of marker gene TRAP mRNA and protein kinase K mRNA in osteoclasts. Osteoprotegerin boosted the nitric oxide production and endothelial nitric oxide synthase activity, and osteoprotegerin concentration was positively correlated to the nitric oxide production and endothelial nitric oxide synthase activity. After Raw264.7 cells were in vitro cultured, osteoprotegerin and nitric oxide play a synergic role in inhibiting osteoclasts production and promoting the apoptosis. We speculate that there is osteoprotegerin/endothelial nitric oxide synthase/nitric oxide signal pathway.

Objective To observe the results of melatonin combined with alprostadil in the treatment of patients with acute pancreatitis.Methods Seventy patients with acute pancreatitis were included in the study,14 patients died after conventional treatment were set to group Ⅰ ,28 patients cured after conventional treatment were set to group Ⅱ and 28 cases cured after melatonin combined with alprostadil and conventional treatment were set to group Ⅲ.White blood cell count,blood gas analysis,serum amylase,endotoxin and malondialdehyde (MDA) content was detected at 6 h,48 h and 4 d.Results White blood cell count,serum amylase,endotoxin,MDA content at 6 h,48 h and 4 d in group Ⅰ were higher than those in group Ⅱ ,Ⅲ (P＜0.05).Endotoxin levels reached a maximum in the 4 d [(273.5 ± 20.4) pg/L],and MDA content reached a maximum in the 4 d [(5.12 ± 0.87) μmol/L].White blood cell count,partial pressure of carbon dioxide in artery (PaCO2),serum amylase,endotoxin and MDA content at 48 h,4 d in group Ⅲ were lower than those in group Ⅰ,Ⅱ (P <0.05).Conclusions Melatonin combined with alprostadil not only shows antioxidant,anti-inflammatory,anti-apoptotic effect but also improves the pancreas,lung,small intestine microcirculation,protects the cell membrane and the lysosomal membrane,and prevents effectively the pancreatic digestive enzymes release; also it inhibits intestinal bacterial translocation,reduces the generation of gut-derived endotoxin and pro-inflammatory cytokine release.It can reduce effectively the systemic inflammatory response in acute pancreatitis.

Objective To discuss the intraoperative and postoperative effects of conbercept combined with pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients.Methods From January 2016 to December 2016,123 PDR patients (149 eyes) aged 41-65 years old with nonclearing vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) were enrolled in this study.According to whether preoperative intravitreal injection conbercept,the patients were divided into two groups:Conbercept group (64 cases,78 eyes),Control group (59 cases,71 eyes).Conbercept group was treated with intravitreal injection of Conbercept 0.50 mg (0.05 mL) at 3 days before PPV.Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed if no significant complications after the injection of conbercept.The operation time,intraoperative bleeding,iatrogenic retinal hole,use of endodiathermy and silicone oil,and postoperative complications were recorded and analyzed.The visual acuity and macuiar thickness were compared before and 1 month after the surgery.Results Two groups had no difference on age,sex,HbA1 C,duration,VH ≥ three degree(56/78,45/71),TRD.Conbercept pretreatment could significantly reduce the bleeding during PPV (43/78,49/71),the probability of iatrogeuic retinal holes (11/78,21/71),reduce intraocular electrocoagulation using (57/78,62/71) and silicone oil (43/78,51/71),and then shorten the operation time (58.63 ± 21.66)s and (72.69 ± 22.48)s,and it could significantly improve the postoperative visual acuity (0.23 ± 0.15,0.16 ± 0.11) and macular edema thickness (260.95 ± 27.44) μm and (330.81 ± 36.62)μm,while reduce the incidence of second bleeding (3/78,10/71).Conclusion Conbercept pre-treatment combined with PPV for PDR is a positive and effective treatment,which has good clinical application significance.

Objective To explore the effects of basic fibroblast growth factor(bFGF) pre-inducing on marrow stroma cells(MSCs) which were induced into dopaminergic neurons.Methods The rat MSCs were isolated primarily from the femurs and tibias of the Wistar rats.MSCs were cultured,proliferated and purified by passage culture.After being induced by bFGF,cultuered MSCs were divided into experimental groups(GM1 group,GDNF group and GDNF+ GM1 group) and control group.The surface markers of the differentiated neuron,such as neurone specific enolase(NSE),glial fibrillary acidic protein(GFAP) and TH were detected by immunocytochemistry after MSCs were cultured in induction media for 3 days and 7 days.Results In control group,the NSE expression of MSCs was very low.Many NSE-positive cells and TH-positive cells were found in the experimental groups at 3 or 7 days after induction.The percentage of NSE-positive and TH-positive cells of GDNF+GM1 group was significantly more than the other experimental groups(all P

AIM: To analyze the effects of two kinds of anti-vascular endothelial growth factor (VEGF) drugs, conbercept and ranibizumab, on proliferative diabetic retinopathy (PDR) patients as pre-treatment for pars plana vitrectomy (PPV).METHODS: From June 2016 to December 2016, 62 patients (64 eyes) aged 41-59 years old diagnosed with PDR with nonclearing vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) requiring PPV were enrolled in our study.Patients were treated with intravitreal injection of anti-VEGF drugs 0.50mg (0.05mL) 3d before PPV.Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed where there were no significant complications after the injection of anti-VEGF drugs.The operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy and silicone oil, and postoperative complications were recorded and analyzed.We compared and analyzed the visual acuity and macular thickness before and 1mo after the surgery with the preoperative data.RESULTS: Both conbercept and ranibizumab could improve the postoperative visual acuity and reduce the postoperative macular thickness of PPV.There was no significant difference between the impacts of two kinds of anti-VEGF drug pre-treatment on operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy, silicone oil filling and postoperative vitreous secondary hemorrhage.CONCLUSION: The effects of conbercept and ranibizumab pre-treatment were similar.PPV combined with anti-VEGF pre-treatment could improve postoperative visual acuity and macular edema.The choice of conbercept or ranibizumab should be made flexibly according to the actual situation of patients.

Objective To characterize differences within facial profile esthetic evaluations among three groups of evaluators and the influences of sagittal or vertical skeletal patterns on facial profile esthetics. Methods A total of 114 silhouettes,from the pre?or post?treatment facial profiles of 57 patients,were scored by three groups of evaluators(professionals,patients'parents,and laypersons)to characterize differences within facial es?thetics evaluation among evaluators. The highest?scoring 30 silhouettes and the lowest?scoring 30 silhouettes were selected as the high score group and the low score group,respectively. Sixteen indices of the relative lateral cephalometric films were measured. Data were analyzed by SPSS 21.0. Results Facial profiles following orthodontic treatment scored higher than pre?treatment(P<0.05). There were significant differences between professionals and laypersons in facial profile scoring. Different sagittal skeletal patterns had no effect on esthetic evaluation ,but lower facial height significantly influenced whether a patient received a high or low esthetic score(P<0.05). Conclusion Orthodontic treatment can improve the fa?cial profile significantly,and lower facial height is the most sensitive index for facial profile evaluation in our study. However,all three evaluator groups have different esthetic standards that don't overlap. Notably,the expectations of laymen are higher than those of orthodontists.

Objective To observe effects of forced expression of miRNA -101 on glioma U251 cells proliferation and invasion. Meth ods MiRNA-101 oligoneucleotide was transfected into U 251 cells with liposome .MTT assay measured cell proliferation and Tr-answell assay detected cell invasion .Results Compared with control groups ,the growth and invasion of U251 cells transfected with miRNA-101 were decreased markably .Conclusions MiRNA-101 may play important role in inhibiting glioma cell growth and inva-sion.

Objective To study the anatomy of the innervation of hallucis longus muscle,and discuss the clinical value of the innervation.Methods Nineteen limbs of 10 cadavers were studied.There were 4 female cadavers and 6 male cadavers.Nine were left legs and 10 were right legs.The specimens were anatomied to confirm the tibialis anterior,extensor digitorum longus and hallucis longus muscle.The innervation of hallucis longus muscle was been observed along the deep peroneal nerve.Measuring the muscular branches length (nerve length,NL),the distance from the tip of the fibular head to the muscular brance (nerve-fibula head length,NFL),and fibular length (fibula length,FL).The hematoxylin and eosin stain was used to observe the numbers of nerve fascicle for each branch of EHL.Results Twenty-three muscle branches of hallucis longus muscle were found in 19 limbs,15 limbs had a single branch,4 limbs had the double branches.All branches were originated in the deep peroneal nerve.Fourteen branches were into hallucis longus muscle from the fibular side,3 from anterior side,6 from the tibial side.The fibula length was 37.0±1.9 cm (range,34.5-40.6 cm); the nerve-fibula head length was 89.0±5.2 mm (range,75.4-97.2 mm);nerve length was 48.5±5.0 mm (range,33.6-57.4 mm); the nerve-fibula head length/fibula length was 0.245±0.020 (range,0.211-0.280).Among 15 specimens with single branch,3 branches had a unique nerve fascicle and 12 had two fascicles.Among 4 specimens with doulbe branches,only 1 branch had two fascicles,7 branches had a unique fascicle.Conclusion Special anatomical features of muscular branches might be the reason of isolated extensor hallucis longus dysfunction.