Shanghai healthcare system reform is proceeded in the system engineering theory adopting the methods of making the overall plans, the combination of scientific design whole and part, the combination of microcosm and macrocosm, the combination of innovation and standard, the combination of qualitative analysis and quantitative analysis, the combination of structural optimization and improvement so as to promote the development of Shanghai healthcare system and provide successful experiences for our national healthcare system reform.

Objective: To study the effect of zinc deficiency(ZD)on the gene expression of vitamin D receptor(VDR)and CaBP in duodenal mucosa of rats. Methods: Thirty weaning male rats were randomly divided into three groups:ZD,paired-fed(PF),zinc adaquate(ZA). After 15 d feeding, took the duodenal mucosa to extract RNA,and measured the levels of VDR mRNA and CaBP mRNA in duodenal mucosa by real time fluorescent quantity PCR. Results: The VDR gene expression of ZD group was downregulated 88.89% as that of PF group,and 50.00% as that of ZA group. CaBP gene expression of ZD group was downregulated 80.16% as that of the PF group,and 88.50% as that of ZA group. Conclusion: Zinc deficiency, by changing the activity of VDR and the mRNA expression of VDR,affects the transcription of the target gene CaBP,and then the absorption of calcium that causes allo-osteogenesis.

Objective To study the effectiveness of EEG bio-feedback in ameliorating the attention of children with attention deficit/hyperactivity disorder (ADHD) compared to a control group receiving methylphenidate treatment; and to explore the effectiveness of EEG bio-feedback in treating ADHD children refractory to methylphenidate. Methods Forty-four ADHD children were randomly assigned to an EEG bio-feedback group or a methylphenidate group. An additional twenty ADHD children refractory to methylphenidate were referred to as EEG bio-feedback group B. The two EEG bio-feedback groups received training in enhancing their beta activity and suppressing their theta activity. The methylphenidate group were treated with methylphenidate for 3 months. The subjects′ attention stability was measured using a number cancellation test. Their attention allocation and attention shift were tested using a neuropsychological behavioral test instrument, including trail-making test. All groups received re-tests during treatment, post-treatment and during a 6 month follow-up. Results During treatment, the cancellation speed of children in the EEG bio-feedback group A was slower than that of children in the MPH group. At the end of the treatment, there were no significant differences in speed between the two groups. Six months to one year after treatment the cancellation speed of the EEG bio-feedback group A was significantly faster than that of the MPH group. The EEG bio-feedback group B demonstrated significant increases in their cancellation speeds after 20 treatments and during a 1 year follow-up. During treatment and post-treatment, Q scores were significantly lower in EEG bio-feedback group A than in the methylphenidate group. Six months to one year after treatment the Q scores were significantly higher in EEG bio-feedback group A than in the methylphenidate group. There was no significant increase in the Q scores in EEG bio-feedback group B during treatment, but they increased significantly post-treatment. There was no significant difference in the trail-making time between EEG bio-feedback group A and the methylphenidate group during the treatment. Six months to one year after treatment, the trailmaking times in EEG bio-feedback group A were significantly less than in the MPH group. EEG bio-feedback group B showed significant decreases in trailmaking time post-treatment and during follow-up. Conclusions EEG bio-feedback may produce significant and long-term improvements in attention stability, attention allocation and attention shift. EEG bio-feedback may be useful for children with ADHD when methylphenidate is ineffective.

Objective To assess surgical strategies and its therapeutic effect on treating tumors invading of the great vessels. Methods 23 patients underwent tumor resection along with reconstruction of great vessels from Jan. 2001 to Dec. 2005 were retrospectively reviewed. Results 19 cases (82.6%) experienced radical resection along with reconstruction of great vessels, 4 cases (17.4%) underwent palliative resections. 20 cases (86.9%) were followed up by various imaging examination methods. 4 cases (17.4%) died perioperatively and 7 cases (30.4%) had complications in perioperative period. Up to Aug. 2005, the postoperative survival times in patients were from 1.5 to 59.0 months. 3 cases (15.0%,3/20) existed more than 48 months, 4 cases (20.0%,4/20) more than 36 months, 6 cases (30.0%,6/20) more than 24 months, 9 cases (45.0%,9/20) more than 12 months and 12 cases(55.0%,11/20)more than 6 months. No complications related to vascular graft occlusion and tumor recurrence next to grafts occurred in these patients. In 2 cases appeared partial thrombosis in grafts in perioperatively. Conclusion Combination of radical resection of tumor and reconstruction of great vessels could extend survival time and improve quality of life in selected patients with tumor invading thoracic and abdominal great vessels.

Parkinson's disease (PD) is a complicated disease, commonly diagnosed among the elderly, which leads to degeneration of the central nervous system. It presently lacks an effective therapy for its complex pathogenesis. Adverse effects from Western drug-based medical intervention prevent long-term adherence to these therapies in many patients. Traditional Chinese medicine (TCM) has long been used to improve the treatment of PD by alleviating the toxic and adverse effects of Western drug-based intervention. Therefore, the aim of this study is to evaluate the efficacy and safety of Xifeng Dingchan Pill (XFDCP), a compound traditional Chinese herbal medicine, taken in conjunction with Western medicine in the treatment of PD patients at different stages in the progression of the disease.

The general clinical abilities of attending doctors are closely linked with the overall quality of patient care in a hospital. A set of quality standards for ward rounds by attending doctors were formulated in the author's hospital and an intensive evaluation was conducted by the experts team of the results of inspection and assessment. It is suggested that the hospital should tighten the quality control of ward rounds by attending doctors and pay serious attention to various problems that may occur. In particular, the hospital should set strict assessment standards for post qualification for attending doctors and strive to cultivate their clinical abilities after their post assumption. In addition, it should bring their talent into full play on the basis of vigorous management and assessment and discover and correct their shortcomings in ward rounds in a timely manner.

Objective To sum up our preliminary experience on radical surgery for the treatment of Budd Chiari syndrome under genuine direct vision. Method A total of 13 cases were enrolled in this study with age ranging from 17 to 48 years, and history from 3 months to 5 years. There was inferior vena cava (IVC) membranous obstruction in 3 cases, right hepatic venous membrane (HV) in 1 case, IVC membrane with distal thrombosis in 6 cases, long segment of thrombosis of IVC in 2 cases, IVC tumor thrombus extending to right atrium in 1 case of retroperitoneal tumor. Result All lesions were successfully resected. Extracorporeal circulation was used in one case, cell saver was used in 2 cases. No blood transfusion was needed except for one case receiving bank blood transfusion of 2000 ml, and the other one of 400 ml. One patient died of renal failure during perioperative period. Disappearance of the symptoms and sigh after operation was found in all the other cases. Conclusion This new radical surgery gives access to the lesions under clear direct vision facilitating the correction.

Objective To explore the clinical effect of inlay labial mucosa graft urethroplasty (LMGU) forⅠperiod in the complexity hypospadias.Methods According to the digital table,30 patients with complexity hypospadias were randomly divided into control group and observation group,15 cases in each group.The control group took Ⅰ period operation.The observation group received surgery by stages to complete.Routine urinary diversion during operation was performed after bladder puncture and ostomy,and in the control group,the urethra was placed with self-made 10-14F lateral hole silica gel stent,which was extracted out in the middle of the perineum,left or right.After 12-14d removal postoperative,the urination was observed.The catheter in the observation group was removed after 10 d,the urethroplasty is performed 6 months later.The clinical effects of the two groups were compared.Results In the control group,postoperative urinary fistula in 2 cases(13.3%),urethral orifice in 1 case(6.7%).In the observation group,postoperative urinary fistula in 2 cases(13.3%),6 months postoperatively in patients with urinary fistula to repair fistula was successful,urethral mouth narrow pure line incision.The incidence rate of complication of the control group was 20.0%,which of the observation group was 13.3%,the difference was not significant between the two groups(P>0.05).All cases were followed up for 1 to 2 years,did not occur urinary tract stones,hair growth,oral ulcers,such as the limited mouth complications.The penis was straight,beautiful shape.Conclusion Inlay LMGU Ⅰperiod is suitable for multiple surgery led to the lack of local incidence,urethral plate dysplasia and with severe penis abnormalities such as complexity in patients with hypospadias.The postoperative complications,micturition,penile appearance have no obvious differences compared with the stage,it is worthy of clinical popularization and application.

Objective To evaluate the effect of FTY720 on pancreas islet xenograft rejection by setting up the rat-to-mouse islet xenotransplantation model. Methods Rat islets were harvesed by means of pancreatic duct irregution with collagenase and purified by discontinuous density gradient method. Then the islets were transplanted under the kidney capsule of the mouse. The recipients were divided into 3 groups randomly: control group,the mouth was administrated with saline without any immunosuppressant; experiment group 1,the mouth was administrated with FTY720 (1.0 mg/kg) orally from the operation day to day 14 after operation; experiment group 2,the mouth was administrated with combination of FTY720(1.0 mg/kg) with CsA(15 mg/kg) from the operation day to day14 after operation. The xenograft were removed with the kidney at day 3, 5, 7 and 14 after transplantation, and the rejection was analyzed. Results In the control group and experiment group 1, the xenografts were completely destroyed within one week; on day 7, no intact islets could be seen, but numerous lymphocytes infiltration were found. In experiment group 2, many intact islets were still seen under the kidney capsule in day7 and 14 after operation; and infiltrated lymphocytes could hardly or just occasionally be found. Conclusions FTY720 alone can not inhibit the rejection of islet xenotransplantation; FTY720 combination with CsA can inhibited islet xenograft rejection effectively in the rat-to-mouse model.

Objective To observe dynamically the location and time of attachment and invasion of Toxoplasma gondii tachyzoites to murine intestinal mucosa by chromogenic in situ hybridization targeting SAG2 mRNA. Methods Thirty 7- to 8-week-old BALB/c mice were randomly divided into experiment group(24 mice)and control group(6 mice). Each animal in the experiment group was given 2?104 tachyzoites of RH stain in 0.2 ml PBS by intragastric administration and that in the control group was given 0.2 ml PBS. Four mice in the experiment group and one in the control group were sacrificed at 15 min,30 min,1 h,2 h,4 h and 8 h after infection,respectively,and paraffin sections of duodenum,jejunum and ileum were prepared to perform the in situ hybridization with Dig-labeled oligonucleotide probe complementary to SAG2 mRNA of T. gondii. Results Tachyzoites were found on the striated border of small intestine epithelial cells (absorptive cells,goblet cells and endocrine cells),in or between two absorptive cells or in the lamina propria. At 15 min-2 h after infection,there was significant difference in the number of attachment on jejunum and ileum (P