Mixed-ownership hospitals constitute an experiment of such ownership in the health care sector,attracting high attention as of its birth.This paper introduced the background of such ownership,and analyzed the development of such hospitals in terms of policy,present situation and external effects.The authors,arguing against major challenges,stated their views on such hospitals along with in-depth analysis of key issues in their development.

Based on a field survey of typical hospitals in Zhejiang,this paper drew a conclusion on three models of the mixed-ownership hospitals development in Zhejiang.It summed up the experiences learnt in the practice about how to maintain the public welfare of the public hospitals,how to ensure the essential health services supply as well as the incentive mechanism for social capital.Suggestions were proposed to develop the mixed-ownership hospitals based on the analysis.

Objective To evaluate the short-term and mid-term outcomes in geriatric patients with idiopathic normal pressure hydrocephalus treated with adjustable valve. Methods The 29 patients were selected for the ventriculo-peritoneal shunt by the means of preoperative lumbar tap test and external lumbar drainage test. All patients were assessed by Mini Mental State Examination (MMSE) and timed 10-meter walk test. Results Short-term improvement in gait disturbance and cognitive function could be achieved obviously, and mid-term improvement could not be sustained. The 3 patients had shunt obstruction, 1 had subdural hygroma. 1 case died of pulmonary infection and 2 died of cardiac disease. Conclusions The lumbar tap test and external lumbar drainage test are highly prognostic procedures for identifying patients with idiopathic normal pressure hydrocephalus who mostly likely benefit from shunt surgery. The short-term improvement can be achieved, whereas mid-term improvement can not be sustained. Surgical outcome can be improved by the use of adjustable valve.

Wnt/β-catenin signaling pathway participates in cancer cell proliferation,invasion and metastasis and effectively induces drug resistance.It is also the key signal to mediate cancer carcinogenesis.Recent studies in vitro indicate that disturbance of Wnt/β-catenin signaling pathway can increase the sensitivity of the cancer cells to chemotherapeutic drugs.In-depth researches and analysis of tumor drug resistance induced by Wnt/β-catenin will provide potential targets and possible therapeutic means for the treatment of tumors.

Objective To study the bacteriology, clinical characteristics and treatment of ventriculitis fol-lowing ventricular-peritoneal shunt. Methods The clinical data and bacteriological results of eight patients with ven-triculitis following ventricular-peritoneal shunt from April 1998 to April 2007 were analyzed retrospectively. Shunt de-vice was removed in all patients. Intraventricular and intravenous antibiotics were given until the infection was con-trolled,and a secondary shunt device was placed. Results In eight patients,five were infected by Staph. Epidermi-dis,one by a mixed infection of Staph. Aureus and Pseudomonas acruginosa,one by Staph. Aureus,and one by E. Co-li. All patients were given intraventricular and intravenous antibiotics therapy. 8 cases recovered well after treatment. Conclusion Ventriculitis following ventricular-peritoneal shunt is a dangerous complication and is not easy to cure. After the removal of shunt device, a satisfactory result could be achieved by the administration of intraventricular and intravenous antibiotics.

Objective To study the effect of Qing Yi Tang(QYT) on bacterial and endotoxin translocation from intestine in acute hemorrhagic necrotizing pancreatitis(AHNP) in rats.Methods SD rats were randomly divided into 3 groups: AHNP group,AHNP +QYT treatment group and sham operation(SO) group.AHNP models were set up in the former two group,while the pancreas was only mobilized in SO group.After setting up the model,QYT was gavaged in the QYT group,while normal saline was gavaged in the SO group and AHNP group.The concentration of endotoxin(ET) and the DNA of E.coli expressoin in portal vein blood in three groups of rats were measured 24h later.Results The concentration of ET and amount of E.coli DNA in portal vein of QYT group were lower than those of AHNP group.Conclusions QYT can reduce significantly the concentration of ET and E.coli DNA in portal vein blood and decrease bacterial and endotoxin translocation from intestine in the AHNP rats.

Objective To discuss decision of the safety margin of esophagus in the radical gastrectomy of adenocarcionma of esophagogastric junction.Methods The length of esophageal resection margin of intraoperative,postoperative and pathological large slice under the microscope of 50 cases adenocarcionma of esophagogastric junction underwent radical gastrectomy were measured,and the proximal invasive length of esophagus in large pathological slice were also measured,and the relationship between it and pathological factors was analyzed.Determined the minimum safety cut edge distance.Results In 46 of 50 patients,proximal intramural spread of the tumor was observed.The invasive length of tumor from 0.1 cm to 3.5 cm.The invasive length of tumor was <1.0 cm with 11 patients,1.0-1.5 cm with 19 patients,1.5-3.0 cm with 15 patients,in only 1 patient was the distance of spread 3.5 cm.Invasive length of adenocarcionma of esophagogastric junction had a significant difference between the groups in different pathological factors(P<0.001).Conclusion The length of 3.5 cm is the safety margin of esophagus in the radical gastrectomy of adenocarcionma of esophagogastric junction(SiewertⅡ,Ⅲ type) by abdominal incision.

BACKGROUND:Valgus knee deformity is rare in the clinic. The therapeutic effects of artificial knee arthroplasty are worse than varus knee deformity. There is no unified opinion for replacement approach, soft tissue release method and procedure and prosthetic choice at present.
OBJECTIVE:To summarize case data and to observe clinical effects of total knee arthroplasty for valgus knee deformity.
METHODS:Clinical data of 37 cases of valgus knee deformity (42 knees) undergoing total knee arthroplasty, who were treated by the same group of physicians in the First Department of Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine from January 2010 to December 2012 were retrospectively analyzed. There were 11 males (13 knees) and 26 females (29 knees), at the age from 56 to 78 years, with an average age of 63.7 years. The differences in range of motion, femorotibial angle and Hospital for Special Surgery knee score were compared before and after replacement. Clinical effects of total knee arthroplasty for valgus knee deformity were evaluated.
RESULTS AND CONCLUSION:The postoperative fol ow-up lasted from 6 to 36 months. Knee joint range of motion increased from preoperative 68.5° to an average of postoperative 108.5°. Femorotibial angle reduced from preoperative 16.82° to postoperative 5.62° on average. The average Hospital for Special Surgery knee score increased from preoperative 39 points to postoperative 88 points (P<0.05). These results suggested that the curative effect of total knee arthroplasty for valgus knee deformity is proved. Total knee arthroplasty is an effective way to improve deformity.

Objective: To investigate the effect of interferencing receptor tyrosine kinase-like orphan receptor 1 (ROR1) gene expression on epithelialmesenchymal transition (EMT) of osteosarcoma MG-63 cells. Methods: The specific siRNA targeting ROR1 gene (ROR1-siRNA) was transfected into osteosarcoma MG-63 cells with the relative high expression of ROR1 protein, then the down-regulation of ROR1 expression was confirmed by Western blotting. The migration and invasion abilities of MG-63 cells were examined by scratch wound healing assay and Transwell chamber assay. The morphological changes of MG-63 cells were observed under an inverted optical microscope. Finally, the expressions of EMT-associated E-cadherin and vimentin, and tumor metastasis-related zinc finger E-box binding homeobox protein 1 (ZEB1), matrix metalloproteinase 2 (MMP-2) and MMP-9 proteins in MG-63 cells were detected by Western blotting and immunofluoresence staining, respectively. Results: ROR1-siRNA transfection significantly inhibited the expression of ROR1 in MG-63 cells (P < 0.05). After down-regulating ROR1 gene expression by ROR1-siRNA transfection, the migration and invasion abilities of MG-63 cells were significantly reduced (both P < 0.05), the morphology of MG-63 cells conversed from mesenchymal phenotype to epithelial phenotype, and the expression level of E-cadherin was significantly up-regulated (P < 0.05), while the expression level of vimentin was significantly down-regulated (P < 0.05). Furthermore, the expressions of ZEB1, MMP-2 and MMP-9 in MG-63 cells transfected with ROR1-siRNA were decreased as compared with those in the untransfected group (all P < 0.05). Conclusion: RNA interference of ROR1 gene expression can reduce the migration and invasion abilities of osteosarcoma MG-63 cells through inhibiting the occurrence of EMT.