The forepassed socialized medicine system for urban workers has many ethical faults. The institutional reform on the social medical insurance for urban workers will readjust the relationships between government, hospitals, employers and patients. It means much to ethics, and impulses the basic health service towards self-determination, duty and justice. But it has some problems about the responsibility of government,the sanction of hospitals and the burden of patients. At last,the paper offers some suggestions for improvement.

Objective To investigate the diagnostic value and the clinical significance of six tumour markers of pleural effusion and serum in patients with lung cancer by detecting tumour marker and pleural effusion cytological examination. Methods Carcinoembryanic antigen (CEA), cancer antigen 19-9 (CA19-9),squamous cell carcinoma antigen (SCC), neuron specific enolase(NSE), cytokeratin 19 fragments(CYFRA21-l)and progastrin releasing peptide (ProCRP) levels in pleural effusion and serum sample from 50 cases of lung cancer and 30 cases of benign lung disease were detected by chemical and enzyme-linked immunosorbent assay.At the same time, the specimen of patients from pleural effusion was examinated by cytological method.According to the data above, the rational clinical diagnosis value were established by ROC curves. Results Six tumour markers in pleural effusion of lung cancer were higher than those of benign lung diseases, CEA,CA19-9, CYFRA21-1 and ProGRP were the highest group (P<0.05). The ratio of CEA, serum CYFRA21-1and CEA levels in pleural fluid and serum (P/S) in the group was the largest area under the ROC curve.Conclusion Pleural fluid CEA, the ratio of CYFRA21-1 and CEA levels in pleural fluid and serum (P/S) is helpful to differentiating benign and malignant pleural effusion diseases.The diagnostic value of pleural fluid CEA is important.

Objective To detect whether trichostatin(TSA) can induce HL-60 differentiation in vitro. Methods MTT method was used to test the effect of TSA on HL-60 cell growth. Cell cycle was tested by flow cytometry. CD11b expression was tested for detecting cell differentiation, RT-PCR was used to detect the mRNA expression of c-myc in the cells treated by TSA. Results Down-regulation of cell proliferation was observed and cells significantly accumulated at the G0 and G1 phase in HL-60 cells treated with TSA( P <0. 01). Dif-ferentiation rate was 15. 24% after being treated by TSA for 48 h. mRNA of c-myc was down regulated in time-dependent manner. Conclusion TSA can inhibit proliferation and induce differentiation in HL-60 cells.

There is still a certain recurrence rate after extensive lymphadenectomy even to patients with node-negative gastric cancer.It promotes the researchers to use a more sensitive and effective way to track tumor cells which are missed,especially lymph node micrometastases.With the development of detection tech-nology,the diagnostic rate of micrometastasis is significantly increased.There are so many controversies about the impact of lymph node micrometastases that no consensus on the clinical treatment can be reached.In recent years,with the rise of endoscopic therapy,how to balance the relationship between the quality of life and the safety makes the research of micrometastases more urgent.

Objective To investigate the comparability of test seven tumor marks results of two electrochemiluminescence immu-noassay analyzer between Roche Cobas E411 and Cobas E601 .Methods According to United States Clinical and Laboratory Stand-ards Institute (CLSI) EP9-A2 document ,E411 was acted as comparison method (X) and E601 was as the experimental method (Y ) .Alpha fetoprotein (AFP ) ,carcinoembryonic antigen (CEA ) ,carbohydrate antigen125 (CA125 ) ,carbohydrate antigen199 (CA199) ,carbohydrate antigen153(CA153) ,total prostate specific antigen(TPSA) and free prostate specific antigen(FPSA) levels of patient samples were tested and the results were analyzed .Results The correlation between the two systems was good and the bias was acceptable in the medical decision level .Conclusion Two systems have good concordance in detecting the seven tumor markers ,w hich can meet the clinical need .

The curative effect of chemotherapy in malignant tumors has been unsatisfactory because of drug resistance and the toxicity of chemotherapeutic drugs. Extensive studies on the metabolism of tumor cells have been undertaken to determine a novel se-lective antitumor drug. An increasing number of studies have demonstrated the close relation between the malignant behavior of tumor tissues and their specialized energy metabolism. Hyper-lipogenesis is one of the metabolic characteristics of the rapid proliferation of tu-mor cells. Stearoyl-coenzyme A desaturase 1 (SCD1) is a critical enzyme in fatty acid synthesis because it catalyzes the conversion of saturated fatty acids into monounsaturated fatty acids. This enzyme is closely related to obesity, fatty liver disease, insulin resistance, and a series of metabolic syndromes. It is also involved in the occurrence and progression of cancer. Determining the function of SCD1 in malignant tumors would provide a new therapeutic target in chemotherapy.

Objective To clone VEGF gene and construct its eukaryotic expression vector for the evaluation of the possability of VEGF gene therapy in orthopedic disease. Methods Human vascular endothelial growth factor(hVEGF) cDNA was amplified by nested PCR method from the HL60 cells and cloned to expression vector pcDNA 3. The cDNA was identified by enzyme digestion and DNA sequencing. Rabbit osteoblasts were transfered with pCD-hVEGF165 plasmid by lipofectin mediated gene transfer method. The transient expression of VEGF were detected by Streptavidin-Biotin-enzyme Complex(SABC). Results The cloned cDNA was confirmed to be VEGF165 cDNA. It was observed that the expression of human VEGF gene was detected distinctly 72 h after transfering. Conclusion We successfully cloned hVEGF 165 gene and construced its eukaryotic expression vector, which provided the further foundation of VEGF gene therapy for ostenecrosis,bone defeat and fracture.

Objective To investigate the therapeutic efficacy of surgical treatment of myocardial bridge. Methods Fifteen patients with myocardial bridge had been treated in our hospital from January 1999 to October 2006. Thirteen patients who had typical angina had been treated regularly by medication, but their symptom remission was not satisfactory. One patient suffered from acute myocardial infarction, and another 1 patient complained of palpitation and syncope. All the patients were given surgical treatment. Surgical strategies included minimally invasive off-pump surgery in 9 patients (supraarterial myotomy in 3 patients, coronary artery bypass grafting in 2, and coronary artery bypass grafting with supraarterial myotomy in 4) and on-pump surgery in 6 patients (coronary artery bypass grafting with supraarterial myotomy in 5 patients and supraarterial myotomy in 1). Results All the operations were successfully completed. The operative duration of off-pump and on-pump surgery was 2.8?1.9 h and 3.5?1.7 h, respectively. The extracorporeal circulation time was 59?37 min. No surgery related death or complications occurred. At 3 months after operation, all the patients were free from symptoms, and electrocardiogram returned to normal in 11 patients. During a follow-up for 0.5~7 years (1.9?1.2 years), recurrent palpitation was seen in 1 patient and others reported no angina. Conclusions Surgical treatment of myocardial bridge has good immediate and long-term results.

Objective To discuss the management of bile duct injuries during laparoscopic cholecystectomy(LC).Methods From March 1992 to October 2006,totally 8876 cases of LC were performed in our hospital.Bile duct injury occurred in 16 of them,among which,the common bile duct was mistakenly cut in 4 cases,partly torn in 5,and wrongly clipped in 5,and electrical burn injury happened in 3.The patients received bile duct repair and T-tube drainage(6),bile duct anastomosis plus T-tube drainage(3),or Roux-en-Y bowel biliary anastomosis(5) after the accidents.In 2 patients,the titanium clips were removed.Results In one of the patients with the bile duct been cut,bile duct anastomosis was performed,and T-tube drainage was continued for 3 months;however,3 to 5 months after the T tube being removed,the patient had to underwent Roux-en-Y bowel biliary anastomosis because of biliary stenosis.No obstructive jaundice occurred in this patient after the Roux-en-Y.Two patients received a second t Roux-en-Y bowel biliary anastomosis owing to anastomotic stenosis.The second operation was carried out 9 or 10 month after the first surgery,and the patients were then followed up for 2 to 4 years.None of them developed cholangitis or calculi during the follow-up.One patient,who suffered a clipped bile duct,underwent Roux-en-Y bowel biliary anastomosis after the LC,but developed recurrent infection of the bile duct after the second operation.Among the 16 patients,12 were cured,10 of them were followed up for 3 to 4 years,during which no one showed biliary symptoms.Conclusions Bile duct injury is one of the major complications after LC.Early prevention and intervention are very important to avoid repeated operations.

Objective To evaluate the safety of laparoscopic complete mesocolic excision (CME) in radical resection for right colon cancer. Methods From January 2012 to June 2013, laparoscopic CME was performed in 40 patients with right colon cancer. Another group of 38 patients underwent traditional radical resection from January 2011 to December 2011.Surgical outcomes were compared between the two groups . Results The number of lymph nodes retrieved in the laparoscopic group ( 22.1 ±7.8 ) was significantly more than that in the traditional group (18.6 ±4.3, t =2.436, P =0.017).In patients with stage Ⅲ cancer, the laparoscopic group was associated with higher lymph node counts (23.0 ±6.0 vs.18.2 ±5.1, t=2.699, P=0.000), however, there were no significant differences in those with stage Ⅱ cancer between the two groups (t=0.758, P=0.454).There were no differences in operation time and intraoperative blood loss between the two groups (t=0.716, P=0.476;t=-1.547, P=0.126), but in the laparoscopic group the time to pelvic drainage tube removal , time to first flatus, time to liquid diet intake , duration of hospital stay, and postoperative complications were significantly better than those in the traditional group (t=-2.950, P=0.004;t=-5.767, P=0.000; t =-7.817, P =0.000; t =-6.065, P =0.000; χ2 =4.504, P =0.034). Conclusions CME technique in laparoscopic radical right hemicolectomy is feasible , safe, and effective.CME improves the surgical quality with keeping the integrity of mesocolon , more harvested lymph nodes , and not increasing surgical risks and postoperative complications .