Medical service system integration follows the logic of system innovation and development.Case studies of the UK,the USA and Australia found that medical delivery system integration is the product of a series of mixed factors.Health care financing and payment mechanism reform,physician team building,stair-cased movement to grassroots of healthcare service,shared clinical norms utilization as well as its gradual development constitute the general logic of such an integration.In the evolution process,the check and balance between the government and market,equity and efficiency have been affecting the integration process all the way.In light of these logics,China should speed up its transform of the integration concept,improve the integration elements,and strengthen the guidance of integration principles during its integration of the medical service integration.

Arteriovenous Fistula ; complications ; etiology ; Cardiac Output, High ; Femoral Artery ; Femoral Vein ; Heart Failure ; etiology ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; Male ; Middle Aged

Objective To isolate and purify melanin from yeast cells of Penicillium mameffei (PM) and to analyze its physicochemical features.Methods PM yeast cells were cultured in minimal medium containing levodopa (L-dopa) with continuous shaking at 37 ℃.Melanin was isolated from the yeast cells of PM by cell walllysing enzyme,denaturant,concentrated hot acid,and purified by sodium hydroxide and concentrated hydrochloric acid.The physicochemical properties of isolated melanin were assessed on the basis of combined chemical analysis and spectroscopic methods including ultraviolet-visible (UV-vis),Fourier transform infrared (FT-IR) and electronparamagnetic resonance (EPR).Results Similar to synthetic dopa-melanin,the isolated melanin from PM was alkali soluble,acid-resistant,insoluble in water and most organic solvents,precipitated at or below PH 3,and could be bleached by hydrogen peroxide.UV-vis spectrophotometric analysis showed that the PM-derived melanin had a typical absorption peak at 205 nm and the absorbance decreased with the increase of wavelength.FT-IR spectroscopy displayed two absorption peaks at about 3 μm and 6 μm,which was characteristic of classic melanin.EPR spectroscopy revealed that the isolated melanin contained stable free radicals.Conclusion Yeast cells of PM can use exogenous L-dopa to synthesize dopa-melanin.

Background Penetrating keratoplasty (PKP) has become an effective method of treatment for fungal keratitis in recent years,but the application timing of glucocorticoids after PKP is still unclear.Literature reported that the concentration of tear (1,3)-β-D-glucan in fungal keratitis was significantly higher than that in normal.Objective This study was to investigate the change of tear (1,3)-β-D-glucan before and after PKP in fungal keratitis and to explore the application duration of anti-fungal drugs and application timing of glucocorticoids.Methods This study protocol was approved by ethic committee of Affiliated Hospital of Qingdao University.A serial cases-observational study was performed from August,2011 to December,2012.Twenty eyes of 20 patients with fungal keratitis were collected in Affiliated Hospital of Qingdao University.PKP was performed in affected eyes,and the fellow health eyes served as controls.Tear of 50 μl was obtained in the controls on 1 day before operation and 1 day,7,14,21 and 28 days after operation to detect tear (1,3)-β-D-glucan levels.Results Tear (1,3)-β-D-glucan levels were (14.67±3.84)mg/L,(1 861.66±196.17) mg/L,(927.71±155.82)mg/L,(392.30±71.22)mg/L,(179.60±40.47) mg/L,(40.20± 12.46) mg/L and (15.12± 1.80) mg/L in the control group,preoperative 1 day,postoperative 1 day,7,14,21,28 days,respectively,showing a significant difference among various time points (F=883.45,P=0.00).Tear (1,3)-β3-D-glucan levels were gradually reduced with the lapse of the postoperative time,with significant differences between adjacent timepoints (t' =13.84,t =16.67,t' =11.02,t' =13.97,t' =-8.45,all at P=0.00).Tear (1,3)-β-D-glucan levels in postoperative 28 days came near that of normal control group,without significant difference between them (P =0.64).Fungal keratitis recurred in 2 eyes on the fifth and sixth day after operation,with the tear (1,3)-β-D-glucan levels of 2 350.24 mg/L and 1 992.82 mg/L,respectively.Conclusions The concentration of (1,3)-β-D-glucan in the tears increases in the eyes with fungal keratitis and drops to normal range at 28 days after PKP,indicating that the antifungal eyedrops should be applied until 4 weeks after PKP,and this is an optimal timing of using corticosteroid eyedrops to resist reject reaction.

0.05).The positive rate of Uu in biovar 2 show a significant difference(P0.05).(2)The fallopian tubes infected by biovar2 have a high rate(90%)of ciliary adhesion and exuviation.While there is a low rate(10%)for biovarl with ciliary adhesion and exuviation.There was significant difference between the two groups of Uu (P

Objective To detect the influence of fluoride on the expression TM9SF1 mRNA and Ras mRNA of osteoblasts. Methods The third generation of primary cultured osteoblasts were exposed to a series concentrations of 0,2.5,5.0, 10.0,20.0 mg/L fluoride for 10 days. The influence of different doses of fluorine on the expression of TM9SF1 mRNA and Ras mRNA of osteoblasts cultured in vitro was investigated by SYBR Green I methods. Results The osteoblasts of the control group and the 2.5 mg/L group were in the shape of long spindle, triangle or irregular polygon and had processes, and the cytoplasm was translucent, adjacent cells affixed to each other under light microscope. Those of the 20.0 mg/L group shaped as long spindle or irregular polygon, and some vacuolization and granular materials appeared in cytoplasm. The number of the cells decreased and the volume increased significantly. After exposed to fluoride for 10 days, osteoblasts of 2.5 mg/L group morphologically proliferated. There were statistical siguificances between each groups of TM9SF1 mRNA in human osteoblasts(F = 322.82, P < 0.01). The highest in the 2.5 mg/L group(9326.0 ± 115.97), the expression of TM9SF1 mRNA decreased along with the increasing dose of fluorine. There were statistical significances between 5.0, 10.0,20.0 mg/L groups(6495.0 ± 323.9, 4387.5 ± 545.2, 5962.5 ± 536.7) and control group(9221.0 ± 107.5, all P< 0.01). There was a statistical significance between each groups of Ras mRNA in human osteoblasts(F = 703.28, P < 0.01). The highest in the control group, the expression of Ras mRNA decreased along with the increasing of dose of fluorine. There were statistical significance between 2.5, 5.0, 10.0, 20.0 mg/L groups(6144.5 ± 270.82,5603.5 ± 88.39,3181.0 ± 159.81,4067.5 ± 37.4) and control group(6571.0 ± 196.58). Conclusion The influence on TM9SFI mRNA and Ras mRNA expression in osteoblasts correlates with the dose of fluorine.

Five compounds (tenuifoliside C, tenuifoliside D, telephiose A, telephiose C and polygalaxanthone III) from polygala tenuifolia wild were incubated together with CYP probe substrate in human liver microsomes to investigate the inhibitory effect towards CYP450 enzyme. Phenacetin (CYP1A2), coumarin (CYP2A6), paclitaxel (CYP2C8), diclofenac (CYP2C9), S-mepheriytoin (CYP2C19), dextromethorphan (CYP2D6), chlorzoxazone (CYP2E1), midazolam (CYP3A) were selected as the isoforfn specific substrate. And the formation of paracetamol, 7-hydroxycoumarin, 6alpha-hydroxy paclitaxel, 4'-hydroxydiclofenac, dextrorphan, 6-hydroxychlorzoxazone, 1'-hydroxymidazolam, 4'-hydroxymephenytoin were detected respectively to measure the effect towards CYP450 by high-pressure liquid chromatography (HPLC). The result shows that five compounds from polygala tenuifolia willd significantly inhibit chlorzoxazone 6-hydroxylation catalyzed by CYP2E1, while showed no effect towards CYP1A2, CYP2A6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A. And IC50 value was 38.73, 54.14, 61.77, 62.22, 50.56 micromol x L(-1), respectively.
Cytochrome P-450 Enzyme System ; metabolism ; Esters ; pharmacology ; Glycosides ; pharmacology ; Humans ; Microsomes, Liver ; drug effects ; enzymology ; Oligosaccharides ; pharmacology ; Polygala ; chemistry ; Xanthones ; pharmacology

Objectiv e:To investigate the effect of different culture conditions on the differentiation of Treg and Th17 to lay a foundation for exploring the methods to reverse the immune tolerance induced by tumor microenvironment.Methods:The IL-6 gene was cloned and stablely transferred into the tumor cell line expressing TGF-β.The conditioned mediums ( CM) were prepared by collecting the culture supernatants of tumor cell lines with or without IL-6 expression and used in the in vitro culture of peripheral blood mononuclear cells ( PBMC ) .The changes of Treg and Th17 in PBMC treated with different CM were detected with flow cytometry ( FCM) .Results:The expression of TGF-βin BEL-7402 was higher than that in HepG2.Thus the BEL-7402 was selected for preparation of cell line stablely transfected with IL -6 gene.ELISA detection confirmed the effective expression of IL -6 by the identified cell lines.It was showed that the Treg increased in PBMC treated with culture supernatants of tumor cells .However,the presence of IL-6 reversed the increase of Treg and promoted the differentiation of Th 17.Conclusion: The culture supernatants of tumor cells increases the proportion of Treg.However,the presence of IL-6 in this CM can reverse the increase of Treg and raise the proportion of Th 17.

Objective:To study the relationship between dietary vitamin A intake and plasma vitamin A concentration , and establish the theoretical basis for dietary intake predicting vitamin A nutritional status . Methods:By using cluster sampling , 492 children aged 2-7 years in kindergartens in Banan district of Chongqing were selected .A cross-sectional nutrition and health survey was conducted , including the clinical examination , anthropometry , laboratory test and dietary survey .Results: Among the children surveyed, 229 were boys, and 263 girls, the mean age was (4.54 ±0.87) years, height (107.50 ± 7.20) cm, and weight (18.42 ±3.41) kg, the mean value of plasma vitamin A was (1.04 ±0.30)μmol/L.The prevalence of marginal vitamin A deficiency ( MVAD) was 43.5%.No cases of severe clinical vitamin A deficiency were found (plasma vitamin A≤0.35μmol/L).Clinical examination found no conjunctiva, corneaor skin abnormalities, and no Bitot’s spots.Prevalence of the last two weeks colds were 27.4% (135/492), no diarrhea and other gastrointestinal or digestive diseases were found .The proportion of insufficient dietary vitamin A intake ( <600 μg RE/d) was as high as 50.0%.By using correlation analysis, plasma retinol concentrations were related to dietary vitamin A intake (r=0.162, P<0.001), and to dietary energy intake (r=0.107, P=0.017).After adjustment for the effects of other non-dietary factors on vitamin A deficiency , the multivariate logistic regression showed that vitamin A-rich foods of liver intake=0 g/d (OR=1.95, 95% CI:1.05-3.61, P=0.034), vitamin A-rich fruits intake=0 g/d (OR =1.55, 95% CI: 1.03 -2.33, P =0.034), vitamin A-rich vegetables intake<200 g/d (OR=3.47, 95%CI:1.37-8.75, P=0.009) were important risk factors of vitamin A deficiency .But we had not found the correlation between the intake of meat , eggs and milk and vita-min A deficiency .Conclusion:Dietary factors may be the major risk factor of vitamin A deficiency in the three kindergartens .The dietary vitamin A intakes are significantly related to plasma retinol concentra-tions, and the vitamin A-rich foods intakes can predict the body ’ s vitamin A nutritional status .

Objective To investigate the effect of sperm preparation in male infertility on sperm morphology and DNA fragmentation index(DFI). Methods Four hundred men were divided into the groups of fertile , teratozoospermics and unexplained subfertility. Sperm morphology and DFI were analyzed before and after the sperm preparation. Results Sperm abnormal morphology and DFI in the infertility group were higher than those in the fertile group ,but significantly decreased after sperm preparation. The method of density gradient separation results in obtaining better sperm(P<0.01). Conclusions Compared to the method of swimming up ,the method of density gradient separation could result in obtaining sperm with improved normal morphology and DNA integrity.