Trials in public hospital reforms bear special significance for rational deployment of health resources and exploring the separation of hospital management from routine operations. The paper identified such setbacks in the present trials as easy technology measures, numerous models of separations, difficulty in setting pharmaceutical service fees, and inadequate governance. Authors also recommended such measures as searching for appropriate reforms for public hospitals locally, greater financial resources for completing the compensation mechanism of public hospitals, streamlining their management system for separation of management from operations, and improving governance. All these efforts are designed to enhance the public benefit nature of public hospitals.

Objective To investigate the expression of CD4 +CD25 +CD127 low regulatory T cells in peripheral blood mononuclear cells( PBMNCs) in order to explore the influence on the immune status and disease progression in the different period of acute ischemic stroke. Methods 60 patients with acute cerebral infarction were selected as the stroke group,and divided them into the 24~48 h group (n=16), 3~7 d group (n=22) and 8~14 d group (n=22);22 healthy human were set as the control group. To analyze the percentage of CD4 +CD25 +CD127low regu-latory T cells in the peripheral blood of acute cerebral infarction patients and healthy human with flow cytometry. Results The percentages of CD4 +CD25 +CD127 low and CD4 +CD25 high regulatory T cells in the peripheral blood of the stroke group were significantly decreased at 24 ~48 h,3 ~7 d ( P <0.01 ) when compared with the control group, and then tended to return toward the control value at 8~14 d (P>0.05);the percentage of CD4 + regula-tory T cells in the peripheral blood of the stroke group was significantly higher than control group ( P <0.05 ) . Conclusion Imbalance of regulatory T cells is very likely to play an important role in the immunological injury of acute ischemic stroke. Regulatory T cells may be involved in the pathogenesis of acute ischemic stroke,and early detection may provide a basis for treatment.

Objective To study changes of?-glutamyltransferase(GGT)and its isoenzyme in urine and renal cortex of rats with subacute cadmium exposure.Methods Sixty healthy SD male rats were chosen and divided randomly into control group,middle dose group and high dose group,which were orally dosed daily with feed containing0,5and10mg cadmium per kg for six weeks.The activities of GGT and its isoenzyme in urine and renal cortex of the rats were determined in the3rd and6th week respectively.Re sults During the whole experimental period,the body weights and kidney to body weight ratios of control group,middle dose group and high dose group showed no significant differences.The GGT activities of middle dose group and high dose group increased significantly with the prolongation of exposure to cadmium and the increase of cumulative exposure compared with those in the control group.Unusual bands of GGT isoenzyme in the urine and renal cortex homogenate were found in the3rd week and the incidence of unusual bands of GGT isoenzyme was100percent in the6th week in the cadmium-treated rats of middle dose group and high dose group.Con clusion The GGT activities and the unusual bands of GGT isoen-zymes in the urine and renal cortex could be used as sensitive indexes to identify the renal toxic effects induced by cadmium.

Before and after treatment as well as before metastasis,the combined detection of progastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) was performed in 150 patients with small cell lung cancer.The follow-up period was 1 year.Enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay were conducted.The result showed a negative correlation between the serum levels of ProGRP and NSE the curative effect.And a positive correlation existed between the serum levels of ProGRP and NSE and disease development.The difference had statistical significance (P ＜ 0.05).The levels of ProGRP and NSE may be used to indicate the disease development and evaluate the curative effect.

Objective To study effect of nasal tolerance with rat-derived 97-116 peptide of AChR α-subunit(Rα97-116(V108A))on the manifestation of muscle weakness and the immunity function of experimental autoimmune myasthenia gravis(EAMG).Methods Twenty-two EAMG model Lewis rats immunized thrice with Rα97-116(V108A)were divided randomly into tolerance group and control group.They were respectively immunized with Rα97-116(V108A)and PBS buffer solution for 10 days via nasal mucous.Then the body weight and Lennon score of two group Lewis rats were measured.Their serum anti-AChR antibodies were tested by ELISA,the expression levels of CD28,CTLA4,B7-1 and B7-2 were determined by flow cytometry.Results Compared with control group at different time points.the body weight of tolerance group rats(tolerance group(228.1±5.8)g,control group(215.0±16.2)g,t=2.395,P＜0.05)increased,the mean clinical score of rats(tolerance group 1.55±0.44.control group 2.10±0.66,t=-2.20,P＜0.05)decreased and the amount of serum anti-AChR antibody(tolerance group 0.97±0.20,control group 1.27±0.26,t=-2.857,P＜0.05)decreased obviously.the amount of CD28,B7-1,B7-2,CTLA4(%)expressed on the surface of peripheral blood cells(tolerance group:27.35±7.05,4.73±0.58,2.71±0.35,1.72±0.44,control group:40.02±8.81,9.52±1.25,5.88±1.09,2.64±0.47)down-regulated markedly(t=3.479,10.861,8.755,4.403,all P＜0.01).Conclusion Nasal mucous tolerance with Rα97-116(V108A)could ameliorate muscular weakness of EAMG rats while activates T cell and inhibits B cellular immunity.

Objective To evaluate Western blot analysis in diagnosing limb-girdle muscular dystrophy type 2A (LGMD2A). Methods The clinical records including their pathological and biochemical results of 4 patients with LGMD type 2 were reviewed. Histochemical and immunohistochemical staining were performed on muscle biopsy specimens from the four patients. The expressions of dysferlin and calpain-3 in muscles were analyzed by Western biol. Results All 4 LGMD patients shared some common clinical features, such as dorsal muscular atrophy of lower limbs and remarkably elevated CK. The immunohistochemical results showed partial or complete deficiency of dysferlin staining in all 4 LGMD patients. However, Western blot revealed that the calpain-3 protein in the muscle of patient 1 was completely absent, who was later diagnosed with LGMD2A. The other 3 patients had complete dysferlin deficiency with reduced calpain-3 expression and they were confirmed to be LGMD2B. Conclusions Western blot analysis of calpain-3 and dysfcrlin can be used to differentiate LGMD2A which shows absence of calpain-3 from other LGMD types which show dysferlin deficiency. Western blot is an invaluable method in clinical diagnosis of LGMD2A.

Objective To compare the accuracy of real-time myocardial contrast echocardiography (RT-MCE) with DISA-SPECT in detecting hibernating myocardium. Methods Fourteen hospitalized patients with regional wall motion abnormalities (RWMA) underwent RT-MCE, DISA-SPECT, coronary angiography and percutaneous coronary intervention(PCI). Every left ventricular myocardial segment image was acquired and evaluated according 16-segment model of American Society of Echocardiography. The Motion of every segment was observed by echocardiography after 1,3,6 months. The gold standard is that the motion of ventricular segment get better after PCI. The images of RT-MCE and DISA-SPECT were analyzed semi-quantitatively. Results The sensitivity,specificity,accuracy of RT-MCE and DISA-SPECT in detecting hibernating myocardium were 74.60%, 91.7%, 81.3% and 93.3%, 75.0%, 86.2%, respectively. RT-MCE had more value in specificity while DISA-SPECT had more value in sensitivity. The correlation between two methods was good in detecting hibernating myocardium. Conclusions RT-MCE and DISA-SPECT can be used as valuable methods to detect hibernating myocardium, the correlation between two methods is good and they have more value in specificity and sensitivity respectively.

Objective To determine the minimal local analgesic dose (MLAD) of hypobaric levobupivacaine in elderly patients undergoing spinal anesthesia during lower limb surgery. Methods A total of 25 patients underwent spinal anesthesia with hypobaric levobupivacaine during lower limb surgery. The initial dose of levobupivaeaine was 7.50 mg for the first patient. The dose for next patient was added by 0.25 mg if the level of sensory block was lower than that of T10, conversely the dose was subtracted by 0.25 mg. The MLAD of hypobaric levobupivacaine was calculated with up-and-down sequential experiment according to Dixon-Messay method. Results The MLAD of hypobaric levobupivacaine were 6.67 mg (95% confidence interval: 6.34-7.25). The anesthesia effects of all patients were good. The degree of motor blockade of the healthy leg was less than another leg.The intraoperative and postoperative complications rates associated with spinal anesthesia were low.Conclusions The MLAD of hypobaric levobupivacaine is 6.67 mg in elderly patients undergoing spinal anesthesia during unilateral lower limb surgery.

Objective: To observe the automatic ventricular capture management (VCM) conifrmed by paced depolarization integral (PDI) evoked response detection via the follow-up study in patients with Zephyr5826 pacemaker implantation. Methods: A total of 102 relevant patients were enrolled. In order to conduct PDI calculation, pacemakers were set by bipolar sensing and bipolar pacing at immediately after implantation. VCM functions were observed at 1 day, 7 days and 1 month, 3, 6, 12 months after implantation, the ventricular threshold by VCM test and manual test were compared. The symptoms of pectoralis major stimulus, diaphragm stimulus and palpitation were observed in all follow-up patients. Results: There was 1 patient died by MI at 1 month after Zephyr5826 pacemaker implantation, the rest 101 patients were followed-up for 12 months. VCM function was successfully turned-on at immediately after implantation in all patients, no pectoralis major stimulus and diaphragm stimulus occurred. VCM function was turned-off in 6/101 (5.9%) patients at 7 days after implantation due to intolerable palpitation caused by daily automatic VCM, instead they received manual test at follow-up visit. The coincidence rate of ventricular thresholds between VCM test and manual test were 100%. Ventricular pacing output voltage by VCM was (0.99 ± 0.48) V,n=608. Compared with regular pacing output voltage (2.5V, 0.4ms), VCM function may save 84% of energy consumption; compared to high pacing output voltage (3.5V, 0.4ms), VCM may save 92%. Loss of ventricular capture and poor sensation were not found by ECG and 24 h dynamic monitoring. Conclusion: Zephyr5826 pacemaker may conduct bipolar pacing and scanning with VCM function, it can be effectively and safely operated by low energy output. A few patients may not use VCM function due to intolerable palpitation.

OBJECTIVE:To study the effect of comprehensive psychotherapy on psychology of cancer patients received chemotherapy or radiotherapy. METHODS:77 cancer patients received chemotherapy or radiotherapy were divided into two groups. Both groups received routine chemotherapy or radiotherapy. Intervention group(n=40)were additionally given comprehensive psychotherapy,i.e. cognitive therapy,psychological persuasion and relaxation training. Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were applied to evaluate all patients one week before intervention and one month after comprehensive psychotherapy. RESULTS:SAS and SDS scores of intervention group were significantly lower than that of control group after treatment(P0.05). CONCLUSION:Comprehensive psychotherapy can improve the mental state of patients with can-cer.