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 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.

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.

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.

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.

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 determine the effect of individualized oral hygiene instruction (OHI) on volatile sulfur compounds (VSCs) level in mouth air of patients with chronic periodontitis.Methods The individualized oral hygiene instruction was provided for 31 patients with chronic periedontitis (Organoleptic score was over two points).The VSCs and plaque index (PLI) were evaluated pre-OHI and post-OHI.Results The score of PLI decreased from 3.09±0.44 to 2.63±0.46 significandy (P<0.05).The organoleptic score (OS) decreased from 2.68±0.70 to 2.35±0.75 significandy (P<0.05).While there was no significant difference on the VSCs level pre-OHI and post-OHI (P<0.05).Conclusions Individualized oral hygiene instruction is helpful to remove plaque and improve oral hygiene.But the effect of OHI on VSCs level in mouth air is limited.

Objective The study aimed to evaluate the application effect of clinical pathways in laparoscopic cholecystectomy patients by using the meta-analysis.Methods Published randomized controlled trials (RCT) about laparoscopic cholecystectomy patients were searched and screened in China National Knowledge Infrastructure (CNKI),China Scientific Journal Database by VIP,Wanfang Database under present standards.The quality of the included studies was evaluated by certain standards.The Review Manager 5.2 software was used for analysis.Results Totally 29 studies including 5 570 cases were eligible to the criteria (2 753 in the experimental group and 2 853 in the control group) altogether.The meta-analysis showed that the hospitalization time and hospitalization costs in the clinical nursing pathway group were significantly less than those of the control group (SMD=-1.69 and-3.75),the satisfaction degree and the mastering of health knowledge in the clinical nursing pathway group were significantly higher than those of the control group (RR=1.16 and 1.26),the differece had statistical significance.Conclusions Application effect of clinical nursing pathways is superior to the traditional nursing method in laparoscopic cholecystectomy patients.

Objective To investigate the neuroprotective effect and mechanism of astragalus injection in cerebral ischemia reperfusion injury in rats .Methods A total of 70 healthy adult male Wistar rats were subjected to establish middle cerebral artery occlusion reperfusion models by inserting a monofilament thread from the external -internal carotid artery and treated by injecting 1g/L intraperitoneally astragalus injection (3ml/kg).The neurobehavioral function of rats was evaluated by Longa ’ s test and the cerebral infarction volume was calculated by tetrazolium chloride staining .The shape and ultrastructure of neurons in parietal cortex were observed by HE stain TEM .The early apoptotic ratio of neurons was detected by flow cytometry .The expressions of c-Jun N-terminal kinase 3 ( JNK3) mRNA and protein were determined by RT-PCR and Western blotting , respectively.Results After treatment with astragalus injection , the expressions of JNK3 mRNA and protein reduced significantly , the number of neuronal apoptosis in parietal cortexminus , the cerebral infarction volume shrink, the neuronal shape and ultrastructure and animal neurobehavioral function were improved significantly than those in model group rats .Conclusion The results suggest that astragalus injection may inhibit neuronal apoptosis , reduce the infarction volume and improve the animal neurobehavioral function by down -regulated the expression of JNK 3 gene following cerebral ischemia in rats .

Red blood cell distribution width is an index reflecting the size heterogeneity of circulating red blood cells, which is usually used for diagnosis and treatment of blood system diseases.In recent years, more and more evidences show that the increase of red blood cell distribution width level is closely related to the occurrence, development and prognosis of cardiovascular diseases.We focused on the relationship between red blood cell distribution width and atrial fibrillation (AF) and its possible mechanism, in order to provide some reference value for the clinical treatment of AF.