Medical model is the product of medical practice and crystallization of the essence of medicine and insights of life based on human being's fights against diseases for ages.Medical practice and medical model change fundamentally with the changing needs of human.being for health,having undergone for example from biomedical model to biopsychosocial(BPS)model.Thanks to perspectives of Epistemology and practice theory,the medical model is nourishing itself with BPS theories and methodologies for sustainable development,helping human being to better understand health and life multi-dimensionally.In such a model,individual hospitals will shift from focusing on disease care to provision of wholesome and sustained health services,while hospital systems will shift from coordination to resources reallocation and vertical integration.Thus the hospitals will gain new perspectives and broader horizon for development in the future.

Objective To investigate the influence of aerobic exercise on the vulnerability of atherosclerotic plaques and to observe the concentration of matrix metalloproteinase-9 ( MMP-9 ) and matrix metalloproteinase-14(MMP-14) in carotid atherosclerotic plaques in apolipoprotein E (APoE) gene deficient mice.Methods Eighty male, APoE gene deficient mice were divided into two equal groups: an aerobic exercise group and a limited action control group. Carotid atherosclerotic lesions were induced by perivascular constrictive collars placed on the right common carotid artery. Blood lipid levels in the exercise group were measured after 8 weeks of treadmill running and also in the control group. The morphological characteristics of carotid atherosclerotic plaques were observed in the two groups. Plaque area and fibrous cap thickness were measured. Lipid and collagen positive areas were quantified and the ratios correlated with the entimal areas were calculated. Plaque rupture rate and vulnerable index were calculated.Immunostaining was used to detect MMP-9 and MMP-14 expression in the atherosclerotic plaques. The mRNA levels of MMP-9 and MMP-14 mRNA in the fresh carotid plaques were quantified using a real-time reverse-transcriptase polymerase chain reaction (RT-PCR). Western blotting was performed for examining MMP-9 and MMP-14 protein expression in the fresh carotid plaques.Results No significant difference in serum lipid profiles or plaque area was found between the exercise and control groups. Compared with the control group, mean fibrous cap thickness, cap/core ratio and collagen content were all significantly higher in the exercise group, and lipid content was significantly lower. Plaque rupture rate and the vulnerable index were both significantly lower in the exercise group. Immunostaining showed that MMP-9 and MMP-14 expression were lower in the exercise group compared with the control group.The mRNA expression of MMP-9 and MMP-14 was also significantly lower.Conclusions Aerobic exercise can decrease the expression of MMP-9 and MMP-14 in carotid atherosclerotic plaques in ApoE gene deficient mice. Aerobic exercise may play a role in forestalling atherosclerosis by increasing the stability of plaque and decreasing plaque vulnerability.

Objective To investigate the highly-recognized job evaluation factors among the doctors from tertiary general hospitals and to establish a doctor-oriented job evaluation factor system for general hospitals followed with the reliability and validity analyses.Methods A questionnaire about the highly-recognized 23 job evaluation factors was launched among 791 doctors by the stratified sampling from six tertiary general hospitals in Beijing,and the factors were from a job evaluation model of tertiary general hospitals.Initial factor solutions were obtained by the principal components analysis of all evaluation factors and the main factors whose eigenvalues were over one were extracted as evaluation dimensions. Factor loadings were attained through Varimax and the factor whose factor loading was lower than 0.5 was eliminated.A reliability analysis by calculating Cronbachαcoefficient and a validity analysis with structural equation modeling were sequentially conducted on the job evaluation factor system.Results A doctor-oriented job evaluation factor system for general hospitals including 22 factors subject to 3 dimensions was established while the factor of job relevance was removed. The internal consistency coefficients of the dimensions were greater than 0.8 according to the calculation of Cronbachα, which showed a nice reliability. Several main indexes for evaluating the model fitting were all close to 0.9,which indicated a fair structural validity. Conclusion A doctor-oriented job evaluation factor system for general hospitals is established with fair reliability and validity,which could provide more references to the job evaluation of the doctors in tertiary general hospitals.

Objective To observe the effects of mesenchymal stem cells (BMSCs) on the expression of Bcl2 and Bax in atrophied muscles.Methods Immature rats (80～ 100 g) were anesthetized to collect marrow from their femurs and tibias.BMSCs were isolated from the marrow,cultured and purified using the whole bone marrow adherence method.Their right hindlimbs were immobilized fiom the thigh to the paw with the knee in extension and the ankle in plantar flexion.After the modeling,24 of the male rats were divided into a sham-operation group,a BMSC group and a phosphate buffer solution (PBS) group,each of 8.The BMSC and PBS groups were injected with either approximately 106 BMSCs or an equal volume of PBS into the belly of the soleus muscle after they had been immobilized for 48 hours,while the control group did not undergo any treatment except for the injection of PBS.All of the rats were sacrificed for analysis after 14 days.Results The BMSCs were mainly spindle cells,showing radial colony arrangement.They grew vigorously and could passage in a continuous and stable manner over 10 passages.At the 4th passage the BMSCs were positive for CD44 (95.84％) and CD90 (96.00％),but negative for CD34 and CD45.Western blotting assay demonstrated that the expression of Bax protein as measured in grey-scale value (0.41±0.08)in the BMSC group was significantly lower than in the PBS group (0.63±0.10),but significantly higher than in the control group (0.14±0.11) on average.The expression of Bcl-2 (0.47±0.14) was also significantly higher in the BMSC group than in the PBS group (0.22-± 0.13),but significantly lower than in the control group (0.81 ± 0.06).Conclusion Bone marrow mesenchymal stem cells can upregulate the expression of anti-apoptotic Bcl-2 protein and downregulate that of the apoptotic Bax protein when injected early into the belly of a muscle in an immobilized limb.

Objective To compare the efficacy of three kinds of neurolytic celiac plexus block (NCPB) in the patients with upper abdominal cancer pain.Methods Sixty-seven patients of both sexes,with upper abdominal cancer,aged 45-64 yr,weighing 52-69 kg,were randomly divided into 3 groups using a random number table:single-needle NCPB using crura of diaphragm space approach group (group S,n =23),double-needle NCPB via an anterior and posterior crura of diaphragm space approach group (group D,n =22),and continuous NCPB via crura of diaphragm space approach group (group C,n =22).In S and D groups,NCPB was performed with single injection of anhydrous alcohol 25-30 ml after CT-guided successful single and double punctures,respectively.In group C,a catheter was inserted into the crura of diaphragm space and then anhydrous alcohol 25-30 ml was injected via the catheter once a day for 3 consecutive days to perform NCPB.Before treatment,at 1 week after treatment,1,2,4 and 6 months after treatment,the daily consumption of morphine and VAS score were recorded.The therapeutic efficacy was evaluated using VAS weighted value calculation.The development of adverse effects such as diarrhea,hypotension,dysuria and damage to nerves was recorded.Results Compared with S or D groups,the daily consumption of morphine was significantly decreased at 4-6 months after treatment,the rate of effective treatment was increased at 4-6 months after treatment,and the incidence of hypotension was decreased in group C.The incidence of diarrhea was significantly higher in D and C groups than in group S.Conclusion For the patients with upper abdominal cancer pain,continuous NCPB via crura ofdiaphragm space approach provides perfect efficacy with fewer adverse reactions,and the efficacy is better than that of single-needle NCPB using crura of diaphragm space approach or double-needle NCPB via an anterior and posterior crura of diaphragm space approach.

By means of literature review,expert interviews and experts sorting,the authors identified three approaches of medical humanities care,and applied them to three clinical departments of top ten incidence of medical disputes of the hospital in 2012.These departments have similar number of beds,and covered both internal medicine and surgery departments.The purposes of the study are to evaluate the effects of medical humanities care measures in clinical departments,and to make relevant thoughts and suggestions.

Using the method of semi -structure interviews to pre-interview 6 experts and officially interview10 experts , then the record of the interview was compiled into the paper .Using the grounded theory method to encode material of the interview , a summary was made for each case base on data collation and analysis .This paper ana-lyzed the humanities concern the connotation of the application in the construction of a harmonious doctor -patient relationship and the specific measures .On the basis of the application of humanistic care in the construction of a harmonious doctor -patient relationship , significance and limitation is discussed .

Objective To observe the effects of treadmill training at different intensities on the expression of p-AKT in rats' gastrocnemius muscles after focal cerebral ischemia,and to investigate whether intensive training is beneficial for the recovery of motor function.Methods Left middle cerebral artery occlusion (MCAO) was induced in 120 male Wistar rats using the intraluminal thread method,and they were divided into an MCAO group (no training),a normal training group (treadmill training once a day for 30 min) and an intensive training group (treadmill training twice a day for 60 min),each of 30 rats.There was also a sham control group with 30 members not given MCAO or training.The four groups were further divided into 3 day,7 day and 14 day subgroups.Five rats randomly selected from each subgroup were sacrificed for hematoxylin-eosin staining after 4％ paraformaldehyde treatment.Neurological function was evaluated using Zausinger scores,and the expression of p-Akt was detected by western blotting.Results No significant differences in Zausinger scores were observed between the intensive training group and the normal training group after 1,3 or 7 days of training.However the average Zausinger score in the intensive training group was significantly higher than in the normal training group after 14 d of treadmill training.After 7 d and 14 d of treadmill training the average cross-sectional area of the gastrocnemius muscles in the sham group was significantly higher than in the other three groups.The average area of the intensive training group was significantly larger than that of the normal training group.The expression of p-Akt in the gastrocnemius was significantly increased in the intensive training group compared with the normal training group in the 7 day and 14 day subgroups.Conclusion Treadmill training can improve the expression of p-Akt in atrophied gastrocnemius muscles caused by MCAO.Intensive training is more effective for the recovery of muscle function.

Objective To verify the anti-inflammatory effects of intra-articular injection of botulinum toxin type A (BoNT/A) on adjuvant-induced arthritis using a rat model.Methods A murine model of chronic ankle arthritis was established in 90 Wistar rats by injection of 0.1 ml of complete Freund adjuvant (CFA) into the pads of their left paws.They were then randomly divided into a BoNT group (n =30) which received an intra-articular injection of 0.1 ml (20 IU) of BoNT/A,an NS group (n=30) which received intra-articular injection of0.1 ml of normal saline solution and a sham group (n =30) which were punctured without any injection.In addition,30 normal rats formed a control group.Infrared thermal imaging was performed and an index of arthritis was evaluated every three days.The infrared thermal imaging revealed the expression of interleukin-1β (IL-1β) through hematoxy-eosin (HE) staining.Results The arthritis index began to increase 3 days after the injection of CFA and it had increased significantly after 10 days,reaching a peak value of 18,24 days after the injection.The infrared thermal imaging showed that the temperature in the right paw increased greatly after the injection.Following the development of arthritis,the temperature declined gradually,arriving at a steady temperature of between 37.5 and 38.0 ℃ in both ankles 20 days after the injection.The average temperature in both paws of the BoNT group had decreased significantly more by 7 and 14 days after the injection than in the NS and sham groups.The expression of IL-1β in the synovium of the ankle joint also had decreased significantly more in the BoNT group after 7 and 14 days.HE scoring showed an obvious histopathologic change in the hypertrophic synovium,inflamnatory cell infiltration,cartilage destruction and exposure of subchondral bone after 7 and 14 days compared with right after the injection in all groups except the control group.Moreover,the average HE scores of the BoNT group rats after 7 and 14 days were significantly lower than those seen in the NS and sham groups at the same time points.Conclusion Intra-articular injection of botulinum toxin type A has an anti-inflammatory effect on arthritis induced by complete Freund adjuvant,at least in rats.

Objective To investigate the value of one-stage lymphatics-venous anastomosis in radical mastectomy of breast cancer to prevent post-mastectomy upper limb lymphedema.Methods Ninety patients requiring radical mastectomy of breast cancer in Tangshan Tumor Hospital Affiliated to North China University of Science and Technology from March 2010 to May 2013 were collected as the objects.They were divided into the control group (45 cases) and the treatment group (45 cases) using block randomized grouping (concealment of allocation).Both groups underwent radical mastectomy of breast cancer, and the treatment group was treated with one-stage lymphatics-venous anastomosis on the basis of radical mastectomy.The operation times, amount of bleeding, hospitalization times, postoperative complications and the numbers of axillary lymph node dissection of the patients in the two groups were compared, and the postoperative upper limb lymphedema incidence rates of the patients in the two groups were compared.Results The operative times of the patients in the treatment group and the control group were (152.82 ± 18.76) min and (78.92 ± 10.33) min respectively, and amount of bleeding were (416.64 ± 94.65) ml and (250.84 ± 63.17) ml, with statistical significances (t =-20.39, P =0.00;t =-4.48, P =0.00).The average hospitalization times of the patients in the treatment group and the control group were (14.91 ± 5.44) d and (13.45 ± 2.36) d respectively, the numbers of axillary lymph node dissection were 14.63 ± 3.37 and 14.37 ± 3.18, the numbers of postoperative complications occurred were 9 cases (20.00％) and 5 cases (11.11％), with no statistical significances (t =-0.47, P =0.64;t =0.75, P =0.46;x2 =1.35, P =0.38).Compared with the control group, the treatment group has lower incidence of upper extremity lymphedema (13.95％ vs.40.91％) and lower swelling degree, with statistical significance (x2 =8.48, P =0.03).Conclusion One-stage lymphatics-venous anastomosis in radical masteetomy of breast cancer can effectively transfer lymph diversion to the venous circulation and reduce the incidence of limb lymphedema, which has significant preventive effect.