A review of the system background for the multi-institution physician practice in China,and an analysis for the specific constraints for physicians of public hospitals to embrace such a practice On this basis, the paper probed into the measures to encourage the physicians for doing so. The measures recommended include advanced design, improvement of the quality of care and safety mechanism,incentives mechanism, mandatory enforcement of medical liability insurance to minimize risk exposure of such a practice, aiming at advancement of this practice.

Humans ; Platelet-Derived Growth Factor ; Pulmonary Fibrosis

OBJECTIVE: To observe the clinical efficacy of Jianpi shoushen decoction in the treatment of cases of impaired glucose tolerance with Qi deficiency and phlegm-dampness constitution. METHODS:62 Patients with impaired glucose tolerance with Qi deficiency and phlegm-dampness constitution were randomized into 2 groups, i.e. trial group were treated with Jianpi shoushen decoction q.d for 3months (p.o.,n=31); control group were treated with 50 mg Acarbose tablet t.i.d for 3 months (p.o.,n=31). Patients in two groups were all received healthy education such as diet guide and sport instruction. The effective rate, glycemic index and weight index of two groups were observed. RESULTS: The rate of hypoglycemic efficacy and weight lose efficacy in trial group were better than in control group(P

AlM: To analyze, summarize and describe ophthalmic imaging features of posterior scleritis.
METHODS: Clinical data of 16 patients ( 21 eyes ) with posterior scleritis diagnosed in our hospital from October 2008 to June 2013 were retrospectively analyzed. The results of type-B ultrasonic, fundus chromophotograph, fundus fluorescein angiography, CT were recorded for comprehensive evaluation and analysis of ophthalmic imaging features of posterior scleritis.
RESULTS: All patients underwent type-B ultrasonic examination and manifested as diffuse and nodular types. The diffuse type showed diffusely thickened sclera and a dark hypoechoic area that connected with the optic nerve to form a typical “T”-shaped sign. The nodular type showed scleral echogenic nodules and relatively regular internal structure. FFA showed that relatively weak mottled fluorescences were visible in the arterial early phase and strong multiple needle-like fluorescences were visible in the arteriovenous phase, which were then progressively larger and fused; fluorescein was leaked to the subretinal tissue in the late phase;varying degrees of strong fluorescences with less clear or unclear boundaries were visible in the optic disk. CT results showed thickened eyeball wall.
CONCLUSlON: Posterior scleritis is common in young female patients, whose ophthalmic imaging features are varied and more specific in type-B ultrasonic. Selection of rational ophthalmic imaging examination method, combined with clinical manifestations, can accurately diagnose posterior scleritis and avoid the incidence of missed and delayed diagnosis.

Objective To investigate the expression of occludin in the intestinal epithelial cells of neonatal rats with necrotizing enterocolitis ( NEC) . The influence of vitamin D on NEC and the expression of occludin was also explored. Methods Sixty neonatal Wistar rats from different litters were divided into four groups 48 hours after birth:10 in the breast-fed+ control group,10 in the breast-fed +vitamin D group,20 in the NEC+ control group and 20 in the NEC+ vitamin D group. In groups with NEC,neonatal rats were sep-arated from their mothers and treated with rat milk substitute+hypoxia+hypothermia. In groups with vitamin D treatment,paricalcitol was given through intraperitoneal injection 30 minutes before,one day and two days after the induction of NEC. The tissue was harvested from the ileum of the rats 72 hours after induction of NEC. Microscopically,the tissue was assessed according to the Nadler scoring system. The expression and location of occludin was observed after immunofluorescence staining. Western blotting was performed and quantified to compare the expression of occludin among groups. Results In NEC rats,the intestinal structure was destructed. Separation of the submucosal or muscular layer,discharge or disappearance of the villa was accompanied by necrosis of the intestinal cells. Vitamin D treatment could significantly alleviate those chan-ges,with the Nadler score 1. 70 ± 0. 21 compared to 2. 90 ± 0. 23 without vitamin D treatment ( P<0. 01 ) . The expression of occludin was decreased in NEC rats and vitamin D could partly rescue this decrease (P<0. 01). The distribution of occludin was sparse and discontinuous in NEC rats while after vitamin D treatment,the distribution was maintained even and continuous. Conclusion The expression of occludin in intestinal epithelial cells is significantly reduced in NEC rat. Vitamin D treatment may inhibit the development of NEC by maintaining the expression of occludin.

Objective To investigate the dynamic expression of mRNA and protein of surfactant protein C (SPC),E-cadherin (E-cad),N-cadherin (N-cad) and α-smooth muscle actin (α-SMA) and elucidate the significance of epithelial-mesenchymal transition (EMT) in a newborn rat model of Bronchopulmonary dysplasia (BPD).Methods A newborn rat model of BPD in hyperoxia was established,and a control group exposed to air was established.Lung tissue was collected on days 3,7,14,and 21,respectively.Alveolar development was evaluated by radical alveolar counts(RAC),including thickness of alveolar septum,ratio of alveolar and septa.Real-time PCR and Western-blot were used to detect levels of markers of epithelial cells (SPC,E-cad) and interstitial cells (N-cad,α-SMA) in AT2 and protein expression.Results On day 7,14,and 21,compared with the control group,RAC (7.38 ± 0.92,9.25 ± 0.70,9.88 ± 0.99) and alveolar area/pulmonary septal area ratios (A/S) (2.53 ± 0.02,3.34 ± 0.09,3.96 ± 0.13) were all higher in BPD group [RAC (5.88 ± 0.83,5.14 ± 0.83,4.38 ± 0.52) and A/S (1.88 ± 0.03,1.95 ± 0.03,1.89 ± 0.02)] (all P ＜ 0.05) ; the alveolar septum (8.53 ± 0.04,10.75 ± 0.46,13.55 ± 0.84) in BPD group were thicker than those (5.77 ± 0.09,4.40 ± 0.12,3.67 ± 0.18) in the control group (all P ＜ 0.01).The expressions of SPC and α-SMA in BPD group were significantly higher than those in the control group on day 14 and 21 (all P ＜ 0.05).The level of E-cad mRNA (2.43 ± 0.60,2.59 ± 0.48,3.37 ± 0.53) and protein (18.39 ± 1.77,18.29 ± 1.52,11.48 ± 1.72) for E-cad were higher in the control group than those (mRNA:1.48 ± 0.55,1.57 ± 0.48,1.12 ± 0.45 ;protein:9.50 ± 1.38,8.57 ± 1.06,8.22 ± 1.31) in BPD group was lower(P ＜ 0.05),while the level of N-cad was significantly higher(P ＜ 0.05) on day 7,14,and 21.Conclusions In the development of BPD,the markers of lung epithelial cells were down regulation,while the markers of interstitial cells were up-regulation,and these findings suggest that EMT from lung epithelial cells contributes to the occurrence of BPD.

Objective To test the level of follicular helper T cells (Tfh) and interleukin (IL)-21,CXCL13 in the peripheral blood of patients with ankylosing spondylitis (AS),and to analyze the relationship between Tfh and clinic features and explore the possible immunological pathogenesis of AS.Methods The Tfh cells were obtained from patients and normal controls and detected by flow cytometry.While the levels of IL-21,CXCL13 in patients and normal controls were measured by enzyme-linked immunosorbent assay (ELISA) tests.Data analysis were performed by Student's t-test,Rank-sum test,Spearman's correlation test.Results The expression of CD4+CXCR5 qCOS + cells (Tfh) (mean rank 33.71) and IL-21 [(299±27) ng/L],CXCL13 [(5.8±1.0) μg/L] in the peripheral blood of AS was significantly higher than normal controls [mean rank 23.54,(176±26) ng/L,(4.2±0.8) μg/L] (Z=-2.258,t=17.221,t=6.464,all P＜0.05).It was similar in AS with peripheral joint involvement compared with AS of non-peripheral joint involvement,and there was no difference between AS patients with positive HLA-B27 and those without HLA-B27.Mean -while,no correlation was found between the expression of Tfh,IL-21,CXCL13 and level of ESR,CRP,BASDAI.And there was no significant correlation between the expression of Tfh and IL-21,CXCL13 (P＞0.05).Conclusion The expression of Tfh and the levels of IL-21,CXCL13 are increased significantly,but are not closely relatedto disease activity.These results indicate that the abnormality of Tfh may play an important role in the pathogenesis of AS.

Objective To study the effects of prokaryotic ubiquitin-like protein ( Pup)-proteasome system on the growth of Mycobacterium strains.Methods The genes encoding Pup ( pup gene) and protea-someβsubunit ( prcB gene) were respectively knocked out from Mycobacterium smegmatis ( M.sm) strains by homologous recombination.The growth and viability of the wild-type and mutant strains of M.sm were an-alyzed under normal culture condition and under hypoxia as well as anaerobic conditions.Results The pup and prcB genes were completely and precisely knocked out from M.sm strains and the mutant strains were named △SM-Pup and△SM-prcB, respectively.The△SM-Pup strains grew faster than the wild type ( WT) and△SM-prcB strains.No significantly differences in the growth of M.sm were found between the WT and△SM-prcB strains.Conclusion The Pup-proteasome system was involved in the growth of M.sm, espe-cially the pup gene.There was difference between pup and prcB genes in regulating the growth of M.sm.The functions and influences of Pup-proteasome system still need further investigation.

Objective To observe the clinical efficacy ofXing Nao Kai Qiao (brain-awakening and orifice-opening) needling plus thunder-fire moxibustion in treating vertebrobasilar ischemia.Method Fifty-five patients with vertebrobasilar ischemia were randomized into a treatment group of 26 cases and a control group of 29 cases. The treatment group was intervened byXing Nao Kai Qiao needling plus thunder-fire moxibustion, while the control group was by oral administration ofYangxue Qingnao granules. The blood flow of vertebrobasilar arteries were observed by using ultrasonic Doppler blood-flow detector before and after intervention, and the clinical efficacies were compared between the two groups.Result The recovery and markedly-effective rate and total effective rate were respectively 61.5% and 96.2% in the treatment group, versus 34.5% and 89.7% in the control group, and the differences were statistically significant (P<0.01,P<0.05). The VS and VD of vertebral arteries and VS of basilar arteries were significantly changed after intervention in the treatment group (P<0.05). The VS of basilar arteries was significantly changed after intervention in the control group (P<0.05). After treatment, The VS of vertebral and basilar arteries in the treatment group was significantly different from that in the control group (P<0.05).ConclusionXing Nao Kai Qiao needling plus thunder-fire moxibustion is an effective approach in treating vertebrobasilar ischemia.

Objective Choose an easy method to screen the “leaky" phenotype SCID mice before experimental use. Methods IgG in SCID mice serum was assayed by three kinds of ELISA(sandwich ELISA, sandwich indirect ELISA and Avidin\|biotin sandwich ELISA). Results Avidin\|biotin sandwich ELISA is the most sensitive method of the three, and 41 SCID mice of 6～8 weeks old were assayed with this method. The average IgG of 40 SCID mice was 0 24?0 16mg/L, only one was 2\^3mg/L. The “Leaky" probability was 2\^4%.Conclusion\ The Avidin\|Biotin sandwich ELISA is an easy, sensitive and reliable method to screen“leaky" SCID mice.\;[