Objective To understand the changes of the coverage of medical insurance and the utilization of medical services from 2000 to 2009.Methods The data on medical insurance and utilization of medical services were obtained from China Nutrition Panel Survey conducted by University of North Carolina,Chapel Hill.The trend of medical insurance and use of preventative medical services were examined.And a Logistic regression model was used to estimate the relationship between some social economic status and the enrollment of medical insurance and use of medical services.Results The coverage of medical insurance expanded dramatically from 20％ in 2000 to 89％ in 2009.The rural population experienced higher expansion.The gap between rural and urban populations in terms of insurance coverage was closed.The use of preventive services remained low in both rural and urban populations,with 3.72％ and 4.62％ respectively.Conclusions Both coverage of medical insurance and use of prevention medical services imoroved from 2000 to 2009,which has provided solid foundation for further reforms.

Objective Effects of methylprednisolone on observation of intramedullary spinal cord tumor treatment.Methods Through the 9 cases of intramedullary spinal cord tumors in patients after adjuvant therapy of methylprednisolone clinical observation and analysis.Results 9 cases of ostoperative patients after treatment with methylprednisolone,his condition to resume soon,but the response to 5 cases of side effects,as symptomatic treatment can be back to normal.Conclusions Application of adjuvant therapy of methylprednisolone after spinal marrow tumor effects although good,it should be noted that the occurrence of side effects,and do:the right of dispensing,close observation and timely manner.

Objective: To observe the clinical efficacy of electroacupuncture in treating spastic paralysis following cerebral infarction. Methods: Sixty patients with spastic paralysis after cerebral infarction were randomly allocated into control group and treatment group, 30 cases each. The control group was treated with conventional acupuncture and the treatment group was treated with conventional acupuncture plus electroacupuncture according to the principle of antagonistic acupuncture. Both groups were given routine drugs and scalp acupuncture treatment. Results: Statistical analysis showed significant differences in NFI score and clinical curative effect score between pretreatment and posttreatment in the treatment and control groups and between the treatment and control groups. Conclusion: Both electroacupuncture and conventional acupuncture have clinical curative effect on spastic paralysis following cerebral infarction, but the curative effect of electroacupuncture is significantly superior to that of conventional acupuncture.

Objective:To analyze essential health care equity in cities and counties of Hainan in order to provide the basis for its development. Methods:Based on health statistics of Hainan, China and OECD countries, indicators of essential health care equity in cities and counties were analyzed. Results:Equity in distribution of resources, the hospi-tal geographical distance is large difference, physician-to-nurse ratio is 1:1. 2, and the Gini coefficient is more than 0. 3. Equity in financing, health care spending per capita is less than the national level. Cities and counties with high government budgets for health are located in regional centers. The hospitalization costs compensation with new rural co-operative medical scheme is about 50%. Equity in service supply, bed occupancy rate below 90% and drugs accounted for 30% ~40% in most cities and counties. Regional differences in maternal and child health management are small, but below the national level. Conclusions:The situation of essential health care resources is related to the political and economic climate. Financing mechanisms for essential health care are imperfect;and a low supply of basic medical and public health services reduced the quality of essential health care. Suggestions:Rational distribution of essential health care resources should be promoted;essential health care financing should be increased;and the capability of essential health care supply should be improved.

Objective:To evaluate the value of serum anti citrullinated antibody ( anti CCP-Ab) ,anti keratin antibody ( AKA) and rheumatoid factor ( RF) diagnostic significance of these 3 kinds of index in RA.Methods:256 patients with RA ,92 patients with other autoimmune diseases,50 cases of healthy people were anti CCP-Ab,AKA,RF detection,and the results were analyzed.Results:single target detection ,diagnostic sensitivity of RA from high to low was RF ,anti CCP-Ab,AKA,specific from high to low was AKA ,anti CCP-Ab, RF,anti CCP-Ab and AKA combined detection in clinical diagnostic efficiency.Conclusion: RF,AKA,anti CCP-Ab three index have advantages and disadvantages in diagnosis of RA ,the diagnosis of AKA ,anti CCP-Ab serum of RF negative RA is a powerful complement to,in accordance with the selection of project portfolio appropriate experimental conditions ,the early diagnosis of RA and early treatment ,improve the prognosis had higher value.

Objective:To discuss the application effect of quality management of quality control circle (QCC) for reducing re-washing rate of suction aspirator tip in the quality management of medical instrument of hospital.Methods: Through established QCC group to designate one topic, to investigate its current situation and to protocol project plan of quality management. The qualified rate of first washing of 904 suction aspirator tips was analyzed before control management of QCC was implemented, and then series of QCC methods including fishbone diagram were applied to analyze and confirm main factors. The protocol countermeasure, depend on above information, achieved improvement for washing quality of 856 suction aspirator tips after the quality management of QCC was implemented in practice. The re-washing rates of washing quality of suction aspirator tip between before and after QCC was applied were compared.Results: The qualified rate of first washing of 904 suction aspirator tips before the quality management of QCC was implemented was 65.7%, while it was 97.6% for 856 suction aspirator tips after quality management of QCC was implemented. The washing qualified rate of suction aspirator tip after quality management of QCC was applied was significantly higher than that before it was applied (x2=8.429,P<0.05), and the result has achieved the aim that continuous improved quality.Conclusion: The application of quality management of QCC can decrease re-washing rate of suction aspirator tip, and contribute to decrease cost, to increase work efficiency, to strengthen the attention and degree of involvement of staff for work quality. Therefore, the management can fully exert potential of member of quality management of QCC, and enhance washing quality of suction aspirator tips.

Objective: To demonstrate the influence of HMGB34367,a subfamily member of the high-mobility group protein B1(HMGB1),as a transcriptional factor of the ?-SMA gene expression.Methods: We cloned HMGB34367 cDNA from the fibrotic lung tissue of the Balb/C mouse treated with BLM by RT-PCR,sub-cloned it into a eukaryotic expression vector pcDNA 3.0 or pEGF-N2,and constructed a report plasmid,pDsRed-SMA,encoding red fluorescence(RFP) driven by ?-SMA promoter.Following the co-transfection of pDsRed-SMA and HMGB34367-pcDNA3.0/ pEGF-N2-HMGB34367 in the cultured 16HBE cells,we tested the expression of the RFP in the absence and presence of TGF?1 by fluorescence microscopy.After the transfection of HMGB34367-pcDNA3.0,the nucleus extracts from the transfected cells were subjected to electrophoretic mobility shift assay(EMSA) for the detection of the binding activity of HMGB34367 with ?-SMA promoter CarGB motif.RT-PCR was performed for the evaluation of the ?-SMA gene expression in the cells.Results: The over expression of HMGB34367 activated the ?-SMA promoter and enhances the expression of the ?-SMA gene.An increased binding activity of HMGB34367 with CarGB motif was detected by EMSA in the transfected cells.Conclusion:HMGB34367,a member of HMGB1 family,could act as a transcription factor for the transcriptional activation of the ?-SMA gene,which may play an important role in the development of lung fibrosis.

Objective:To investigate if injury-related myofibroblast induction could occur in bronchial epithelial cells and the role of TGF-?_1(rhTGF-?_1) in epithelial-myofibroblast transdifferentiation. Methods:Cultured bronchial epithelial cells, 16HBE-14o, were exposed to poly-L-arginine(PLA). Using a immunohistochemical method, ?-smooth muscle actin (?-SMA) expression was detected in those cells after being treated with PLA . Relative activity of chloramphenicol acetyltransferase(CAT) was assessed in 16HBE-14o cells, which were transiently transfected with VSMP8 plasmid containing ?-SMA promoter linked to CAT gene, at different time points after rhTGF-?_1(10 ?g/L) treatment. Results:①?-SMA positive, spindle-shaped cells emerged among the regenerated 16HBE-14o epithelial cells following damage. The number of ?-SMA positive 16HBE-14o cells increased and cell repair was delayed under rhTGF-?_1 stimulation.② CAT activity increased significantly in VSMP8 plasmid transfected 16HBE-14o cells 24 h after TGF-?_1 stimulation. (P

Objective To investigate the use of sodium hyaluronate and the preservation of epidural fat in the prevention of epidural scar adhesion after microendoscopic discectomy (MED). Methods A total of 300 patients receiving MED from July 2000 to October 2001 were randomly divided into 2 groups: patients in group A were given sodium hyaluronate with the preservation of epidural fat, while those in group B were on the contrary. Results The mean follow-up duration was 42 months in the group A and 44 months in the group B, respectively. The rate of excellent or good results was 98.6% in the group A (144/146), while 93.8% in the group B (135/144) ( ? 2=4.731, P =0.030). Postoperatively, the pain reappeared in 4 cases in the group A and in 6 cases in the group B, respectively, in which a re-operation was required. Re-operations found the epidural scar adhesion was grade 0 (3 cases) and grade 1 (1 case) in the group A, and grade 2 (2 cases) and grade 3 (4 cases) in the group B ( P =0.005). Conclusions Use of sodium hyaluronate with the preservation of epidural fat can improve the efficacy of MED and effectively prevent epidural scar adhesion.

AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.