Priority setting of health resource allocation depends on effective and comprehensive government-based stewardship, the national research of which lacks comprehensive considerations. The paper articulates the trend of western research from solo economic analysis to a combined comprehension of political economies, systemic con-straints and health financing, to consider the scope, strategy and enforced framework for government rationing within a larger organizational and political context. In the health decision-making practice, the best formula for interdiscipli-nary tools is a test of stewardship capacity. A multi-disciplinary approach from the perspectives of politics, health e-conomies, philosophy, law and evidence-based medicine must be adopted for the priority setting of health resource al-location. Finally, a clear stewardship phased objective is proposed as well as strategies, with emphasis on health de-cisions from “stewardship as structure” to “stewardship as a process” with challenges that lie ahead.

Solidarity is the foundation of European health care and policy. However, it is constantly discussed by the new concept of personal responsibility, liberalism and privatization. In some European countries, out of pocket money was used more because of the limited resources which indeed weakened the solidarity, an element which con-sistently marks the difference among the European Union countries, and the main source of European political com-mitment and accountability associated with health. In the universal health care reform tide, the European government restrains its power in detailed operation on the health care and pharmaceuticals delivery, medical insurance design, and health resource allocation, but this is done through more specific supervision to ensure solidarity in health care system.

Objective:To evaluate the China’s fairness of health resource distribution in recent years. Methods: Index of priority for health services (IPHS)and index of resources distribution ( IRD) were applied to test the allocation status of health resources with the horizon and vertical comparison analysis. Result: With the development of new health care reform, the public health service gradually improves and the basic health needs are further satisfied. The unfair distribution kept the same among different regions, and the provincial health supply and demand are not matched. Conclusion: Public health resource allocation should keep focus on reducing the divergence from rural-urban dichotomy and narowing inter-provincial gaps.

Healthy China 2030 projected to accelerate the development of health care services, but the healthcare industry in China is still in the early stages of development, and is currently threatened by the lack of the relevant legislation, industry regulations and government supervision.The current plight of supervision on traditional Chinese health care consists of the following factors, lack of legislative guarantee, the overlap between the traditional Chinese medicine(TCM) and traditional Chinese health care services blurred the supervision scope, no unified standards of Chinese health care service industry, low cost of illegal misconduct, regulatory fragmentation without substantive supervision.Based on the domestic and foreign experience, the following recommendations were put forward: Strengthening government supervision of the whole process of the Chinese medicine health care, clearly identifying the monitoring and the main supervision responsibility by legislation, screening the pseudo-information and enhance public Chinese medicine literacy, improving the self-regulation and self-supervision, and a variety of innovated government led supervision methods should be elaborated and put into practice, such as grid monitoring, classification management, establishment of credibility system, joint supervision, and so on.

Objective To discuss the feasibility of endoscopic axillary lymph node dissection by using balloon dilatation.Methods Seven patients with breast cancer from June 2005 to October 2005 were studied.Methylene blue injection around the areola or the tumor in combination with balloon placement in the axilla was performed to create surgical space for further endoscopic axillary lymph node dissection.Results The number of resected lymph nodes was 9~17(mean,12.3).No crushed lymph node was found.Positive lymph nodes were found in 4 patients.The operation time was 95~140 min(mean,114.3 min).The axillary vein and other important anatomic structures were clearly exposed.There was no edema of the upper limbs or other complications in the axillary area.No recurrence was noted during a follow-up survey for 2~6 months(mean,4.6 months).Conclusions Endoscopic axillary lymph node dissection can be performed after the establishment of surgical space by using balloon dilatation.

OBJECTIVE:To study the stability of omeprazole in micro-pump by continuous administration.METHODS:RP-HPLC were used to determine the concentrations of omeprazole at different times in micro-pump after administrcotion24h by simulating the dose mode in clinical.RESULTS:Omeprazole for injection was stable in6h after administration.CON?CLUSIONS:The time of taking omeprazole via micro-pump should be controled in6h.

Objective To evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil.Methods The clinical data of 821 patients (858 eyes) who underwent removal of silicone oil in General Hospital of PLA during 2008-2012 were retrospectively analyzed.The patients included 518 males and 303 females.The age was ranged from 1 to 79 years old,with an average of 44.03 years.All patients underwent removal of silicone oil after vitrectomy combined with silicone oil tamponade (the tamponade period was ranged from 40 days to 13 years,with an average of 6.82 months).The incidence,time and causes of retinal re-detachment were analyzed.Results Retinal re-detachment occurred in43 patients (44 eyes,5.13％).Among these retinal re-detachment in 44 eyes,23 eyes (52.27％) occurred in 1 week,13 eyes (29.55％) in 1-4 weeks,4 eyes (9.08％) in 4-8 weeks,2 eyes (4.55％) in 8-12 weeks,and 2 eyes (4.55％) more than 12 weeks after silicone oil removal.Possible reasons of retinal re-detachment included activated original retinal holes (7 eyes),residual peripheral vitreous (3 eyes),traction of epiretinal proliferative membrane (18 eyes),new retinal hole (9 eyes),non-closure of original retinal holes (5 eyes) and traction of retinal incarceration in the scleral incision (2 eyes).Conclusions The incidence of retinal re-detachment after silicone oil removal is 5.13 ％.The incidence reduced gradually with the extension of time after removal silicone oil.

Objective To evaluate the therapeutic effect and safety of insulin lispro mix 50/50 combined with mefformin in newly diagnosed overweight/obese type 2 diabetic mellitus patients.Methods Sixty-two patients with newly diagnosed overweight/obsess type 2 diabetic mellitus were randomly divided into observation group (32 cases) and control group (30 cases) by systematic sampling method.The observation group received insulin lispro mix 50/50 combined with metformin,and the control group received recombinant human insulin and insulin glargine.The therapeutic effect and safety were compared between the 2 groups.Results There were no statistical differences in the blood glucose before eating,before retiring and at mane primo 3:00 between the 2 groups (P ＞ 0.05).There were no statistical differences in the time of blood glucose standard and rate of hypoglycaemia between the 2 groups (P ＞ 0.05).Daily insulin dosage and costs in the observation group were lower than those in the control group [(0.6 ± 0.1) U/kg vs.(0.8 ± 0.1) U/kg and (15.8 ±2.1) yuan/d vs.(21.3 ±2.6) yuan/d],and there were statistical differences (P ＜0.05).Conclusion Insulin lispro mix 50/50 combined with mefformin provides a convenient,effective and safe therapy for newly diagnosed overweight/obese type 2 diabetic mellitus patients and high cost performance.

Objective To observe the curative effect of acupuncture on insulin receptor substrate 1 ( IRS-1) , IRS-2 and glucose transporter 4 (GLUT4) in skeletal muscle of experimental rats with insulin resistance (IR) . Methods Thirty-two rats were randomly divided into normal group, model group, acupuncture normal group and acupuncture model group. The fasting plasma glucose ( FPG) level was detected with glucose oxidase method, fasting insulin and C-peptide ( C-P) were examined with enzyme linked immunosorbent assay ( ELISA) , insulin sensitivity index ( ISI) was calculated, and IRS-1 mRNA, IRS-2 mRNA and GLUT4 mRNA of skeletal muscle were observed by real-time PCR-based fluorescent assay in each group. Results Compared to the normal group, the FPG, FINS, C-P levels were increased dramatically (P<0.01), ISI, IRS-1 mRNA, IRS-2 mRNA and GLUT4 mRNA of the model group declined remarkably ( P<0.01). Compared to the model group, the FPG, FINS, C-P levels declined evidently ( P<0.05 or P<0.01) , and ISI, IRS-1 mRNA, IRS-2 mRNA and GLUT4 mRNA of the acupuncture model group were increased dramatically ( P<0.01). Conclusion The curative mechanism of acupuncture for insulin resistance is probably related to the increase of IRS-1 mRNA, IRS-2 mRNA and GLUT4 mRNA expression in skeletal muscle which contributes to the improvement of PI3K signal pathway.

[Objective] The aim of this study is to investigate the mechanism and curative effect of cataplasma of Artemisia Argyi by supercritical CO 2 fluid extraction to rat weight, foot swel ing, interleukin-1β, interleukin-17 and tumor necrosis factor-αin the adjuvant arthritis rat models;and afford theoreti-cal evidence for clinical work.[Methods]50 healthy male SD rats were randomly divided into 5 groups:Control group, Model group, Low-dose treatment group, Medium-dose treatment group, High-dose treatment group. Model and al treatment goups took CFA for model ing. After establishing animal models of AA rats, the first group and second group used cataplasm without active drug ingredients. Other groups were given treatment according to dif-ferent drug doses. Assess the joint swel ing degree at different times. Measure the arthritic index and rat weight in two weeks. After 21 days ,detect the cy-tokines level of IL-lβ,IL-17 and TNF-α from the rat's serum and examine the pathological changes of joint observed by HE . [Results]Cataplasma of Artemisia Argyi by supercritical CO2 fluid extraction can significantly reduce rat foot swel ing of the ankle joint pathology ,reduce arthritis score and slow down the weight loss,meanwhile,effectively improve the general daily behavior of rats. The standard of IL-1β,IL-17,TNF-α in serum can be decreased by cataplasma of Artemisia Argyi by supercritical CO2 fluid extraction. The pathological result showed: in the treatment group,the rats synovial hyperplasia the vesselwing reduced, the inflammatory cel infiltration was more decreased than the model group. [Conclusion]The result showed that the cataplasma of Artemisia Argyi by supercritical CO2 fluid extraction had an obvious effect in treating RA. The mechanism was probably that it regulated the immune dis-order of RA.