A description of the intervention measures of the reform program for integrated care and payment in pilot areas,covering such diseases as chronic obstructive pulmonary disease and cerbral stroke.The reform aims at exploring impacts on both medical behaviors and medical costs.Authors of the paper hold that the practice of packaged ceiling payment for a single disease is a two-edged sword for clinical pathway management,and joint efforts by the government,medical insurers,medical workers and patients at large are required to regulate medical behaviors over time.They also see the total growth of medical costs as an objective rule,and the correct way out for optimal use of medical insurance funds is to focus on makeup of such costs.

Aim To further study the molecular mecha-nism of the herbs with hot nature on the regulational action on TRPV1 channel based on the 7900 Real-time PCR instrument. Methods 7900 PCR instrument was applied to detect the intracellular flurescence of TRPV1 channel in the dorsal root ganglions ( DRG ) neurons and the effect on the TRPV1 ’ s thermo-sensational functions of the selected 11 ingredients from hot herbs was explored. Results TRPV1 channels could be ac-tivated by gradually elevated temperature; the activa-tion process could be blocked by the TRPV1 specific blocking agent capsaizepine. Most of the ingredients from hot-nature herbs had the potential to up-regualate TRPV1 channel function. Conclusions The estab-lished TRPV1 channel detection system based on PCR instrument is suitable for the analysis of regulational functions of drugs on the heat-activated TRPV1 chan-nel;the functions of hot herbs may be related to the up-regualtional effects of its active ingredients on the TRPV1 channel which will further up-regulate energy metabolism.

Objective To measure osteoporosis knowledge,belief and self-efficacy of elderly patients with vertebral fracture,and to provide the basis for reducing the incidence of refracture.Methods Totally 72 patients were recruited from an upper first-class hospital in suzhou by using the convenience sampling method.They were measured with the self-designed general information questionnaire,Osteoporosis Knowledge Tests (OKT),Osteopomsis Health Belief scale (OHBS) and Osteoporosis Self-Efficacy Scale (OSES).Results The total score of knowledge was (1 1.06±6.71),the factor scores of risk factors,exercise and calcium intake were(4.13±2.82),(2.90±2.54),(4.04±2.54).The average score of OHBS was (141.82± 13.00).The total score of self-efficacy was (79.49±35.15).Conclusions Health education for elderly patients with vertebral fractures needs to be improved,and to reduce the occurrence of refracture according to different groups of targeted education.

Aim The TRPV1 plasmid was transiently transfected into human embryonic kidney HEK 293T cells to establish the heterologous expression system of TRPV1-channel. Methods The transfection efficiency was confirmed under fluorescence mi-croscope and the TRPV1 protein expression was identified by u-sing Western blot, and the functional characteristics of the chan-nel were studied by using the method of confocal microscopy. Results The transfection rate could reach 40% ~50%; the transfected cells were found to have a clear band at the corre-sponding position that TRPV1 should be, which indicated that TRPV1 channel protein was expressed in the transfected cells. The confocal microscopy imaging result showed that the trans-fected HEK 293T cells were activated by TRPV1 channel ago-nist. Conclusion Transient transfection of HEK 293T cells with TRPV1 channel is successfully constructed and the heterol-ogous TRPV1 channel is verified to have normal calcium-media-ting function.

Objective:To observe the long-term effect of repairing soft tissue defect of the digital palmar with medial plantar artery perforators flap.Methods:From January, 2012 to February, 2015, 15 cases of digital palmar soft tissue defect were selected clinically, including 8 cases with phalangeal fracture, 5 cases with flexor tendon injury, and 9 cases with digital artery and nerve injury. The soft tissue defect area was 7.0 cm×2.5 cm-2.4 cm×3.0 cm. The medial pedis perforators flap with deep branch of medial plantar artery as pedicle and terminal cutaneous branch of saphenous nerve was cut out. The artery of the flap was anastomosed with the digital artery or common digital artery, 1 accompanying vein or superficial vein was selected to anastomose with the dorsal digital vein, and the cutaneous nerve was anastomosed with the digital nerve or common digital nerve. The perforating point, number, source of perforating vessels and the length of vessel pedicle were observed during the operation, and the color, shape, stability and TPD of the flap were observed through long-term followed-up. The good and excellent rate of the affected finger was evaluated and whether there was obvious scar, abnormal sensation and abnormal walking gait in the donor area.Results:All flaps survived and the wounds healed in one stage. All 15 patients were followed-up for 36-72 months, with an average of 48.5 months. The color and thickness of the flap were similar to that of the normal digital palmar, and the flap was wear-resistant, stable and strong in holding. The TPD was 9-12 mm. Twelve patients had transverse finger striations at the interphalangeal joint. According to the Trial Standard of the Function Evaluation of the Upper Limb of the Hand Surgery Society of Chinese Medical Association, 10 cases were excellent, 4 cases were good, 1 case was acceptable, and the good and excellent rate was 93.3%. There was no painful scar or abnormal sensation in the donor area. The ankle and foot function was good, and the gait was normal.Conclusion:The thickness, color and texture of the medial pedis perforator flap are similar to that of the palmar skin, and it is an ideal choice for repairing the palmar skin defect.

Cerebral hyperperfusion syndrome (CHS) is a rare but serious complication after cerebral revascularization, which may lead to catastrophic consequences. The mechanism of CHS is not fully understood, and it may be related to cerebral autoregulation dysfunction and the increase of blood pressure after operation. Timely detection and treatment of cerebral hyperperfusion can avoid CHS. This article reviews the pathogenesis, diagnosis, clinical manifestations, prevention and treatment of CHS.

To optimize program of bovine somatic nuclear transfer, we used two different enucleation procedures (by Spindle-view system & Hoechst 33342 staining), two different procedures to introduce donor nuclei (by ooplasm microinjection & electrofusion), and three different group electrofusion parameters (group 1: 1.9 kV/cm, 10 micros, two; group 2: 1.5 kV/cm, 25 micros, two; group 3: 0.6 kV/cm, 100 micros, one) to reconstruct bovine cloned embryos. The cleavation rates and blastocyst development rates of cloned embryos were used to assess the efficiency of different operational procedure. Finally, the best combination of operational procedure, that the spindle-viewer system was used for oocytes enucleating, and donor cell was electrofused into ooplasm by electrical pulse (1.9 kV/cm, 10 micros, two) to reconstruct bovine cloned embryos. Then the excellent blastocysts were transferred to fosters for producing cloned cattle 80 high-quality cloned blastocysts were transferred into 33 fosters, two cloned calves were produced. According to the results, the optimized program could be used to produce cloned cattle.
Animals ; Cattle ; Cell Nucleus ; physiology ; Cloning, Organism ; veterinary ; Embryo Transfer ; methods ; Embryo, Mammalian ; cytology ; physiology ; Female ; Microinjections ; Nuclear Transfer Techniques ; veterinary ; Oocytes ; cytology ; physiology

OBJECTIVE To investigate the surgical methods for the lesions involved the common carotid artery.METHODS The clinical data of 11 cases with lesions involved the common carotid artery who underwent operations were retrospectively studied.The lesions were 1 case with recurrence tumor after 3/4 partial laryngectomy,1 case with bleeding of the carotid aneurysm caused by tuberculosis,1 case with iatrogenic carotid aneurysm,3 cases with carotid body tumor,1 case with thyroid gland cancer,2 cases with neck tumor,1 case with injury of the carotid artery and 1 case with gas gangrene.RESULTS Common carotid artery was reconstructed in 2 cases after removal of the tumors.The tumors were resected using the carotid shunt in 2 cases.Common carotid artery was sutured in 1 case with neck injury.The common carotid artery was repaired in 1 case with iatrogenic carotid aneurysm after removal of the tumor.The carotid artery was dissected out from the thyroid gland cancer in 1 case.The common carotid artery was reserved in 2 cases after resection of the neck tumors. Neck drainage was performed in the case with gas gangrene.CONCLUSION The surgical methods for lesions involved the carotid artery after removal of the tumors include the reconstruction of the carotid artery, resection and suture the carotid artery,and free of the carotid artery from the tumors.

Objective: To investigate the clinical efficacy and safety of lenalidomide (Revlimid, R) -based chemotherapy in the treatment of relapsed/refractory multiple myeloma (MM) patients. Methods: 57 consecutively relapsed/refractory MM patients were retrospectively analyzed from June 2013 to February 2016. All the patients received lenalidomide-based chemotherapy. Results: ① 60.4% patients had international staging system (ISS) stage Ⅲ, 37.9% patients had revised international staging system (R-ISS) stage Ⅲ, and 53.3% patients harbored at least one of the high-risk cytogenetic abnormalities[del (17p) and/or t (4;14) and/or t (14;16) ]. ②The patients received median 6 cycles of R (range: 1-32). The overall response rate (ORR) was 58.9% (33/56) , among which 8.9% was complete response (CR) , 19.8% was very good partial response (VGPR) , and 30.4% was partial response (PR). In addition, 10.7% patients attained minor response (MR). Total clinical benefit was 69.6%. Patients with more than 1 line of prior therapy, or previously thalidomide-resistance, or R-ISS stage Ⅲ disease showed significantly lower ORR. ③With a median follow-up of 27 months, the median progression free survival (PFS) , the median interval to PR, the median duration of response (DOR) , and the median overall survival (OS) was 8 months, 2 months, 8 months, and 19 months, respectively. Univariate prognostic analysis showed that abnormal karyotype, R-ISS stage Ⅲ and response inferior to PR were negative prognostic factors for PFS and OS. While the multivariate prognostic analysis showed that abnormal karyotype and R-ISS stage Ⅲ were independent prognostic factors. ④In the safety aspect, the most common grade 3-4 non-hematology adverse events (AEs) were infection (17.5%) , rash (1.8%) and thromboembolism (1.8%) , and the most common grade 3-4 hematology AEs were neutropenia (7.0%) and thrombocytopenia (3.5%). Totally 3 patients (5.3%) discontinued R because of AEs, and 2 cases (3.5%) of secondary primary malignancies were observed. Conclusion The R-based treatment is effective and safe in the treatment of relapsed/refractory MM patients in China. Abnormal karyotype and R-ISS stage Ⅲ were independent negative prognosis factors in this cohort.

Objective: To investigate the clinical status of lymphoid tissue neoplasms patients with bacteria bloodstream infections, bacteriology and drug susceptibility results, and provide the basis for rational clinical anti-infection option. Methods: A retrospectively analysis of clinical data and bacterial susceptibility test results of patients with bacteria bloodstream infections from September 2010 to December 2014 was conducted. Results: A total of 134 cases including 107 patients with bloodstream infections were enrolled. 84 cases were male, 50 cases were female, the median age was 31 (12-71) years old. 112 cases were agranulocytosis, and 106 cases were severe agranulocytosis (ANC<0.1×10⁹/L) . 27 cases underwent hematopoietic stem cell transplantation, 100 cases received chemotherapy[33 cases with VD (I) CP±L (vincristine+daunorubicin/idarubicin + cyclophosphamide + prednison±asparaginasum) induction chemotherapy, 41 cases with intensive chemotherapy of Hyper-CVAD/MA or MA (mitoxantrone+cytarabine) , 26 cases with other chemotherapy regimens], and 7 cases were infected without chemotherapy. 10 patients discharged from hospital owing to treatment abandoning, 120 cases were cured through anti-infective therapy, 2 patients died of bacteria bloodstream infections, 1 patient died of sudden cardiac, and 1 patient died of GVHD after allogenic hematopoietic stem cell transplantation. A total of 144 strains were isolated, including 108 strains (75.0%) of Gram-negative bacteria and 36 strains (25.0%) of Gram-positive cocci. The susceptibility of Gram-negative bacteria to the carbapenems was 98.00%, and the adjustment treatment rate of carbapenems was 3.0%. The susceptibility of Gram-negative bacteria to the other antibiotics was 60.30%, and the adjustment treatment rate was 90.5%. The susceptibility of Grampositive cocci to the carbapenems was 49.3%, and to glycopeptides and linezolid was 100.0%. Comparing all patients’empirical use of antimicrobial agents with the drugs susceptibility results of blood cultures, 80.1% of the patients’initial drug selection was sensitive. Conclusion The lymphoid neoplasms patients experienced bacteria bloodstream infections most often after receiving the chemotherapy regimens of treating acute lymphoblastic leukemia. The majority type of bacteria was Gram-negative bacteria. Drug susceptibility test showed that susceptibility of Gram-negative bacteria to the carbapenems was the highest, and the treatment adjustment rate was obviously lower. The susceptibility of Gram-positive cocci to glycopeptides and linezolid was high, and which could be applied to the patients with Gram-positive cocci sepsis on basis of susceptibility results in general.