Starting from the experiment of Zhenjiang Rehabilitation Group in establishing a tightly-organized medical association,the authors detailed the practices and outcomes of the group in deepening the system and mechanism reforms,promoting the hierarchical medical system,and other reforms of public hospitals.Key roadblocks and causes were identified,with reform measures proposed as well.

Building a contemporary hospital management system is inevitable in the reform and development of public hospitals in China.With a background introduction to public hospital reform in major countries and China,this article named the goals and analyzed the main problems in the establishment of a contemporary hospital management system.On such basis,the authors proposed the roadmap to establish such a system.

Establishing a corporate governance structure is an important goal in this round of public hospital reform.The “group plus corporate governance” model in Zhenjiang is highly typical and significant for building such a structure.This paper introduced the main measures of the group,analyzed the main problems found and proposed policies correspondingly.

The public hospital non-administration action is a strong power push to deepen the public hospital reform, also as an important goal of the institution reform, which has great significance. It introduces the goal of public hospital administrative, analyzes the key problems to be solved in the process of administration and puts forward the concrete path to the administration.

Human lymphocyte function-associated antigen 3 (hLFA3) has been identified as an important T cell accessory molecule. Rhesus monkeys (Macaca mulatta) have been widely used as animal models for human immune disorders. Due to the species-specificity of immune system, it is necessary to study M. mulatta LFA3 (mmLFA3). In this study, the gene encoding mmLFA3 CD2-binding domain (mmLFA3Sh) was amplified by polymerase chain reaction (PCR) and genetically fused to human IgG1 Fc fragment in pPIC9K to construct the expression plasmid pPIC9K-mmLFA3Sh-Ig. Approximately 3-4 mg mmLFA3Sh-Ig protein was recovered from 1 L of inductive media, and mmLFA3Sh-Ig produced by the P. pastoris can bind to the CD2 positive cells, and suppress the monkey and human lymphocytes proliferation induced by Con A and alloantigen in a dose-dependent manner. These results suggested that mmLFA3Sh-Ig might be used as a novel tool for pathogenesis and experimental immunotherapy of Rhesus monkey immune disorders.
Animals ; CD58 Antigens ; biosynthesis ; Humans ; Immunoglobulin G ; Lymphocyte Activation ; Macaca mulatta ; Pichia ; Plasmids ; Protein Interaction Domains and Motifs ; Recombinant Fusion Proteins ; biosynthesis ; T-Lymphocytes

This paper introduced overseas experiences and theories of health systems in view of the ongoing medical and health system reform in China.It proposed the super health ministry reform,justified its necessity,and clarified key issues of such a reform,in addition to discussing how to improve the system of macro-health.

Objective To observe the effect of transcutanous acupoint electrical stimulation(TAES)and dexmedetomidine on postoperative cogni?tive dysfunction in female patients underwent laparoscopic surgery. Methods Nighty patients scheduled for laparoscopic surgery were recruited in this study and randomly divided into control group(group C,n=30),TAES group(group T,n=30)and dexmedetomidine group(group D,n=30). In group T,patients received TAES treatment 30 min before the anesthesia until the end of the surgery at Neiguan(PC 6)and Zusanli(ST 36). The frequency was 2/100 Hz. In group D,patients were intravenously administrated with dexmedetomidine(0.5μg/kg)before the induction. All the patients were given routine general anesthesia. Drugs induced were sulfentanyl,etomidate and cisatracurium. Sevoflurane was given to main?tain the bispectral index(BIS)between 40 and 55. The time of extubation and in PACU was recorded. The serum S100βlevel was assessed at pre?operation(T0),the end of operation(T1)and 24 h after operation(T2). Mini?mental state examination(MMSE)was adopted to evaluate and re?cord the changes in cognitive function 1 day before operation and 24 h after operation. Results The incidence rate of POCD in group T and group D were lower than that in group C(all P<0.05). The level of S100βin group T and group D was lower than those in group C at T1 and T2 separately (all P<0.05). The time of extubation and time in PACU in group D were longer than those in group C and group T(all P<0.05),and the incidence of bradycadia in group D was higher than that in the other groups(all P<0.05). Conclusion TAES and dexmedetomidine reduce the incidence of cognitive dysfunction,decrease the release of S100βprotein. However,dexmedetomidine increases bradycadia,and prolongs extubation time and stay time in PACU. Hence,TAES deserve to be recommended practically.

The authors described the hospital group reform made by Jiangsu Kangfu Medical Group,and its main actions taken and initial success in public hospital organizational structure.Based on such studies, they recommend further clarification of the rights and responsibilities, for sectional integration;appropriate adjustment to update the supervision mechanism;building of the appointment system to speed up personnel system reform.

Objective To observe the clinical efficacy of dexmedetomidine combined with sufentanil in the treatment of self?control intravenous an?algesia after laparoscopic surgery. Methods Sixty patients,who underwent laparoscopic sugery and general anaesthesia,American Society of Anes?thesiologistsⅠtoⅡ,were randomly divided into dexmedetomidine(DS)group and sufentanil(S)group,with thirty cases in each group. Group S received sufentanil 2μg·kg-1 and ramosetron hydrochloride 0.3 mg;group DS received sufentanil 2μg·kg-1,dexmedetomidine 200μg and ramose?tron hydrochloride 0.3 mg. Drugs of both groups were dissolved in saline 100 mL,with a loading dose of 4 mL,background infusion of 2 mL·h-1,con?trolled dose of 0.5 mL·h-1,and the lockout time was 15 min. Visual analog scale(VAS)score,Ramsay sedation scale(RSS)score,sufentanil cu?mulative consumption after surgery at 2 h,4 h,6 h,12 h,24 h were recorded,as well as the adverse reactions such as nausea,the occurrence of vomiting and chills within 24 h after surgery,and the satisfaction of patients with postoperative analgesia. Results Six hours post operation,VAS score of group DS was significantly lower than the group S(P<0.05);2 hours post operation,RSS score of group DS was significantly higher than the group S(P<0.05);the cumulative consumption within 6 hours after sufentanil was significantly lower in group DS than group S(P<0.05). The incidence of nausea,vomiting,chills and other adverse reactions were significantly higher in group S than group DS(P<0.05). Conclusion Compared with the simple application of sufentanil,dexmedetomidine combined with sufentanil for postoperative analgesia achieve better analgesic effect,reducing the amount of sufentanil,while reducing the associated sufentanil adverse reactions,improve patient comfort and satisfaction of post?operative analgesia.

Objective To investigate the diagnosis and treatment of cervical intraepithelial neoplasia and their clinical effect Methods The cases who were diagnosed as CIN through cytology, colposcopy biopsy and histopathological diagnosis were collected from January 2004 to June 2009 in Songjiang Hospital Affiliated to Shanghai Jiaotong University School. Drug therapy, physical therapy, cervical conization and hysterectomy were performed according to the lesion degree of CIN and patients' willingness. Some cases were further treated with surgery, radiotherapy or chemotherapy according to the pathological findings of the initial excision specimens. With long-term follow-up at 6,24 months after the treatment,we performed a comparative analysis on pathological diagnosis and therapeutic effects. Results Seven hundred and fifty cases of CIN were diagnosed after cervical cancer screening,among which,460 cases of CIN Ⅰ ,180 cases of CINⅢⅡ and 110 cases of CIN Ⅲ. Five hundred and Senventy-eight cases received treatment, among which, 46 cases received drug treatment After 6 months, focus disappeared in 32 cases, sustained in 10 cases, upgraded in 2 cases and canceration occurred in 2 cases. 13 cases received physical therapy,no recurrence occured. Four hundred and thirty-five cases received conization treatment, 34 cases with focus upgraded and 4 case recurred after the operation. 84 cases received hysterectomy, of which, 11 cases focus upgraded after the operation and no recurrence. The cases with focus upgraded or recurred all received additional treatment. The effective rate of physical therapy,conization treatment and hysterectomy on all grades of CIN was more than 98% at 2 years, and 69. 7% of drug treatment. The omission diagnostic rate of colposcopy guided biopsy on invasive carcinoma was 2. 2% , and the residual rate of focus of hysterectomy specimens after conization was 16. 2% . Conclusion Colposcopy including multi-point biopsy has high accuracy and specificity in early diagnosis of CIN . Cervical conization is the main method of the treatment of CIN. Patients with CIN Ⅲ and without desire of fertility should consider the removal of the uterus after cervical conization. Drug conservative therapy of CIN should be chosen carefully.