Objective: Analyze the impact of NCMS(new cooperative medical scheme) on rural medical institutions,and give suggestions for the sustainable development of medical institutions and the NCMS.Methods: Collect and analyze the efficiency and the account materials of the county-level healthcare departments and the town-level health centers of Zhen'an County in 2003 and 2006.Results: The implementation of NCMS produced an effect on the increase of the outpatient medical service;the service quality of the county-level medical institutions and the town-level health centers needs to be enhanced in spite of the increase of in-patient medical service;the medical institutions' income increased,and the medical service fees increased rapidly;the expenditure per person and time rose sharply.Conclusions: Management mechanism of NCMS should be further developed,construction and supervision of the county-level medical sectors and the town-level health centers,especially supervision of the quality of medical sectors be enhanced;the payment system be changed to control the growth rate of medical expenses.

Objective To compared the effect of combined teaching method of lecture,case analysis and GasMan@software (LAG) and traditional teaching method (LBL) in inhalation anesthesia practice course.Method 78 anesthesiological undergraduates were randomly assigned to G group (n=39) or Control group (n=39).According to the requirements of clinical anesthesiology in the syllabus,G group used classroom lectures,case analysis and GasMan@software (LAG) teaching method,while Control group used lecture based learning (LBL) teaching method.The students took anonymous quiz and filled teaching effect evaluation form after practice course.Then the exam results were compared between groups to evaluate the teaching effect.SPSS 19.0 was applied to do statistical analysis and t test and x2 test were used.Results Compared to the Control group,G group got better results in objective questions like choosing,judgment,case analysis and average ranks (P=0.000),and there was no significant difference in the identification section (P=0.087),while G group also got better results in subjective questions like learning interests,study efficiency,memorize,logical thoughts,ability of analysis,solving problems and cooperation (P＜0.05).Conclusion Compared to traditional teaching method,the combined use of lecture,case analysis and GasMan@software make students immersive,develop their clinical thinking ability,and improve the teaching effect of inhalation anesthesia practice course significantly.

[Objective]To design a method of in vitro preparation and seperation for metallic wear particles around joint prosthesis and evaluate its feasibility in medical experiments.[Method]Ti-6Al-4V and Co-Gr-Mo alloys were used to make two friction jars respectirely. National inventive patent applied number 03142073.7.Lots of quadrate blocks made of the same materials are put into the jars respectively,which were then.lubri cated by man-made body fluid and vibrated on a bottle shaker.After 21 days the fluid was harvested and centrifuged to get the produced wear particles.The collected particles were studied by using element trace analysis,laser countersizer and scanning electron microscopy.The J774.A1 macrophages cultured together with these particles for 24 hours were observed under inverted phase contrast microscopy and transmission electron microscopy.[Result]A got great amounts of metallic particles with 1?m diameter coned beproduce using this method.The aver age diameter of titanium alloys(Dv90) is 1.011 and that of Co-Gr-Mo is 1.010.Particle size distribution had good consistency in different materials.Under scanning electron microscopy ,the particles had irregular shapes just like those got from revision operations.The particles taken into the J774.A1 macrophages could be seen under inverted p hase contrast microscopy and transmission electron microscopy.[Conclusion]This method is good enough to producl lots of metallic wear particles mosth like those around total joint prosthesis and can be used in further in vivo and in vitro studies about joint prosthesis loosening.

Background:Vitamin D receptor( VDR)is a member of the steroid hormone receptor superfamily,which plays roles in various biological processes including cell proliferation,differentiation,apoptosis and immune responses,and is low expressed in many malignant tumors. Aims:To evaluate the expression and regulation mechanism of VDR in colorectal cancer. Methods:A total of 30 patients with colorectal cancer admitted from February 2010 to December 2012 at Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University were enrolled. Expression of VDR in cancerous tissue and para-cancer noncancerous tissue was determined by immunohistochemistry. Clinical data of 224 patients with colorectal cancer were collected from Gene Expression Omnibus( GEO)for analyzing the correlation between VDR expression in cancerous tissue and clinicopathological characteristics as well as survival time. Expression of VDR in human colon cancer cell lines HCT116 and SW620 transfected with enhancer of zeste homolog 2( EZH2 )-siRNA or treated with 5-azacytidine (5-AZA)was determined by real-time PCR,and methylation level of VDR promoter was determined by methylation-specific PCR( MSP). Results:Positivity rate of VDR was significantly lower in colorectal cancer tissue than that in para-cancer noncancerous tissue( 26. 7% vs. 70. 0%,P < 0. 001 ). Expression of VDR was negatively correlated with histological staging,distant metastasis,vascular metastasis and lymph node metastasis of colorectal cancer(P<0. 05). Survival time was significantly longer in patients with high expression of VDR than patients with low expression of VDR (P=0. 032). Compared with cells transfected with control-siRNA,expression of EZH2 mRNA and methylation level of VDR promoter in HCT116 and SW620 cells transfected with EZH2-siRNA were significantly decreased(P<0. 05),and expression of VDR mRNA was significantly increased(P<0. 05). Compared with negative control group,methylation level of VDR promoter in HCT116 and SW620 cells treated with 5-AZA was significantly decreased(P<0. 05),and expression of VDR mRNA was significantly increased(P<0. 05). Conclusions:Expression of VDR in colorectal cancer is down-regulated and positively correlated with a favourable prognosis. Transcriptional repression of VDR in colorectal cancer is co-regulated by histone methylation and DNA methylation.

Urid acid is one of the terminal metabolites of human body.More and more attention was paid to its metabolic mechanisms in intestinal tract;however, few studies were seen so far.This study aims to illuminate the metabolic mechanism of uric acid in intestinal tract by two ways:one is the transporters associated with intestinal epithelium, including ABCG2 and SLC2A9, the other is decomposition of uric acid by intestinal flora.We hope this review can provide new insights to decrease blood uric acid and treat urate-related diseases, and also provide a new way to alleviate drug-induced kidney damage.

Metallothionein is a sulfhydryl-rich,and chelating a large number of metal ions,which is widely found in biological world.It is very highlighted that MT had the same physical and chemical features from different origins.Plenty of research data indicated that MTs contain 20 free sulfhydryl genes,as well as their sulfhydryl clusters,It is a multifunctional protein in health.Many experiments demonstrate that MTs may be a novel target of original new drugs because they play a role in regulating and controlling the organ fibrosis and tumor.

Objective To quantify the concentration of peripheral blood plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with acute pancreatitis (AP) and to explore its value in assessment of the severity of AP.Methods From June 2011 to March 2012,83 patients with AP were selected,among those 43 cases were mild acute pancreatitis (MAP) and 40 were severe acute pancreatitis (SAP).The control group included 30 healthy individuals.The peripheral blood of patients with AP and healthy controls was collected,and plasma was isolated after centrifuged.The concentration of NGAL in plasma was detected by enzyme-linked immunosorbent assay (ELISA).The t-test was performed for comparison between groups.The correlation between the concentration of NGAL in plasma and clinical parameters of AP was analyzed by Spearman rank order correlation analysis.The diagnosis value of the concentration of NGAL in SAP was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).Results The concentration of plasma NGAL in AP group ((10.30± 5.97)nmol/L) was higher than that in healthy control group ((1.94±1.35) nmol/L) and the difference was statistically significant (t=11.924,P＜0.01).The concentration of plasma NGAL in SAP group ((14.61 ±5.28) nmol/L) was higher than that in MAP group ((6.27±-3.09) nmol/L) and healthy control group,the differences was statistically significant (t=8.677 and 14.539,both P＜0.01).The concentration of plasma NGAL of AP patients was positively correlated with acute physiology and chronic health evaluation-Ⅱ score,Ranson score,bedside index for severity in acute pancreatitis score,computed tomography (CT) severity index,C-reactive protein,white blood cells and the days of hospitalization (r=0.651,0.556,0.514,0.620,0.320,0.458 and 0.346,all P＜0.05).The area under the ROC curve of plasma NGAL concentration in diagnosis of SAP was 0.926 (95％CI:0,870-0.983).The cutoff value of plasma NGAL level in diagnosis of SAP was 8.44 nmol/L.The sensitivity and specificity was 87.5 ％ and 88.9％,respectively.Conclusions Plasma NGAL level is correlated with the severity of patients with AP.NGAL may be one of the markers for the early diagnosis of SAP.

Objective To explore the ideal living states and expectations of the elderly residing in Chengdu city,Sichuan Province and the most favorite pension system they want.To provide a theoretical basis for our country to build a suitable pension system and improve the quality of life and happiness of the elderly.Methods Qualitative-quantitative combined methods and convenient sampling were used in this study.The qualitative data with semi-structured in-depth interviews had been obtained from the selected 40 elderly who live in Chengdu,while the quantitative data with the questionnaires were obtained from other 130 elderly.Results Family location,gender,educational background,age had impact on the expected pension system of the elderly(P＜0.05).Conclusion Different elderly have different expectation on the pension system,the current pension system should be reformed according to their expectations.

Objective To summarize the experience of intraoperative rapid parathyroid hormone (PTH) detection by immunochromatography in thyroid surgery.Methods Patients undergoing thyroid surgery in Shanghai Tenth People's Hospital from Nov.2016 to Jul.2017 were collected and the clinical data including level of blood calcium,serum phosphorus and PTH,and pathological findings were analyzed.Results In this study,im munochromatographic assay was used in 45 cases (experimental group) and nano carbon method was used in 47 cases (control group).In benign cases,levels of blood calcium and PTH in experimental group were higher than those in the control group ((2.07±0.09) vs (2.04±0.06) and (3.41±1.82) vs (3.34±1.84),P＞0.05).In malignant cases,blood calcium level in experimental group was higher than that in the control group ((2.02±0.13) vs (1.99±0.38),P＞0.05) and PTH level was significantly higher than that in the control group ((2.22±1.27) vs (1.44±1.44),P＜0.05).Serum phosphorus level in experimental group group was much lower than that in the control group ((1.02±0.17) vs (1.14±0.23),P＜0.05).Conclusions Using intraoperative rapid PTH detection by immunochromatography can identify parathyroid and avoid accidental injury of parathyroid gland,which can reduce the postoperative incidence of hypocalcemia.

Objective:To investigate the biological characteristics, wild resources distribution, chemical constituents, pharmacologi-cal effects and clinical application of She medicine fresh herb tea. Methods: The related literatures on fresh herb tea in CNKI, CBM, Wanfang and Vip database from 1989 to 2014 were sunmmrized and analyzed. Results:Fresh herb tea showed narrow distribution, and mainly contained volatile oils, alkaloids and flavonoids etc with the effects of antioxidant, immune regulation, antibiosis and so on. Con-clusion:The researches on the chemical composition of fresh herb tea provide reliable basis for the separation and extraction of specific chemical components, which also provide reliable support for the development of health products and other products containing fresh herb tea.