Based on the organization and implementation of the comprehensive reform of countylevel public hospitals in 15 provinces (municipalities)in southern China,the research discussed the progress and problems of such reforr.The progress made and areas of the reform vary among provinces and municipalities.For example,the reform has completely covered all the counties in four provinces such as Zhejiang and Jiangsu province.Medicine markups have been canceled in all the pilot counties by adjusting the service prices to pave the way for hospital compensation.Contemporary hospital management,remuneration system and personnel system reform are also main targets of the reform,while the collaboration between superiors and subordinates,and hospital regulatory system have recently been included.Problems are also found with the current reform:for example,lack of attention for the system reform,no fundamental changes in place in the business orientation of hospitals,as well as problems in collaboration among departments,and hospital debts.

Objective:To study the mechanism of anti-proliferative effect of lupeol on highly metastatic human hepatocellular car-cinoma HCCLM3 cells. Methods:CCK-8 assay was performed to evaluate the effects of lupeol at different concentration on cell viability in 12-48 h. Caspase inhibitors were used to identify the subtypes of caspases activated during lupeol-induced cell death. The effects of lupeol on the mRNA expression of caspase family and Bcl-2 related genes were detected by real-time PCR. The effects of lupeol on HC-CLM3 cell phase distribution were investigated by flow cytometry. Results:Compared with the control group, lupeol could inhibit HC-CLM3 cell proliferation in a concentration-dependent manner with IC50 of 93 μmol·L-1 in 24h. The number of HCCLM3 cells in the period of G2/M was increased by 1-fold when the lupeol concentration was within 60-100 μmol·L-1 . Lupeol could activate the path-way of caspase, and the mRNA expression of caspase-3 was elevated by 50%-150% when compared with that in the control group. Mo-reover, the mRNA expression of p53 and Bax were increased above 1-fold by lupeol at 100 μmol·L-1 , and the Bcl-2 and PARP ex-pression were significantly suppressed by lupeol at 60-100 μmol·L-1(P<0. 05 or P<0. 01). Conclusion:The results indicate that lupeol has anti-proliferative effect on the liver cancer cells, which is beneficial to the prevention and treatment of liver cancer.

Objective To explore the biphasic effects of simvastatin on vascular smooth muscle cells (VSMCs), which were regulated by sterol regulatory element binding proteins(SREBPs).Methods ① Rat primary VSMCs were cultured,the effects of different concentrations of simvastatin on proliferation and migration of VSMCs were observed, and the expression of SREBP-1 and SREBP-2 mRNA on VSMCs was detected.② Rat models of atherosclerosis were established,and were divided into atherosclerotic injured group (n=6), low concentration simvastatin group (n=6) and high concentration simvastatin group (n=6). Besides, normal control group (sham operation group, n=8) was established. Intragastric group and high concentration simvastation group, respectively, while those in normal control group and atherosclerotic injured group were given same amount of normal saline. Rats were sacrificed 4 weeks later. Plasma lipid levels were examined by enzymic method, ratios of intima/(intima + tunics media) of thoracic aorta and left common carotid artery were determined, and the expression of SREBP-1 and SREBP-2 mRNA on blood vessels was detected by RT-PCR. Results Simvastatin didn't show biphasic effects on the proliferation and migration of VSMCs. Low concentration simvastatin didn't promote the proliferation and migration of VSMCs, while high concentration simvastatin showed inhibition effect on the proliferation and migration of VSMCs, which was dose-dependent and independent of lipid regulation effect by simvastatin. Simvastatin could activate the expression of SREBP-1 and SREBP-2 mRNA of VSMCs. Moreover, high concentration simvastatin could significantly activate the expression of SREBP-1 and SREBP-2 mRNA. Conclusion Simvastatin can inhibit the proliferation and migration of VSMCs by activating SREBPs.

Objective To explore the biphasic effects of simvastatin on vascular smooth muscle cells(VSMCs),which were regulated by sterol regulatory element binding proteins(SREBPs).Methods①Rat primary VSMCs were cultured,the effects of different concentrations of simvastatin on proliferation and migration of VSMCs were observed,and the expression of SREBP-1 and SREBP-2 mRNA on VSMCs was detected.②Rat models of atherosclerosis were established,and were divided into atherosclerotic injured group(n =6),low concentration simvastatin group(n=6) and high concentration simvastatin group(n=6).Besides,normal control group(sham operation group,n=8) was established.Intragastric administration of simvastation of 0.5 mg?kg~(-1)?d~(-1) and 2.5 mg?kg~(-1)?d~(-1) was conducted in low concentration simvastatin group and high concentration simvastation group,respectively,while those in normal control group and atherosclerotic injured group were given same amount of normal saline.Rats were sacrificed 4 weeks later.Plasma lipid levels were examined by enzymic method,ratios of intima/(intima+tunica media) of thoracic aorta and left common carotid artery were determined,and the expression of SREBP-1 and SREBP-2 mRNA on blood vessels was detected by RT-PCR.Results Simvastatin didn't show biphasic effects on the proliferation and migration of VSMCs.Low concentration simvastatin didn't promote the proliferation and migration of VSMCs,while high concentration simvastatin showed inhibition effect on the proliferation and migration of VSMCs,which was dose-dependent and independent of lipid regulation effect by simvastatin. Simvastatin could activate the expression of SREBP-1 and SREBP-2 mRNA of VSMCs.Moreover,high concentration simvastatin could significantly activate the expression of SREBP-1 and SREBP-2 mRNA.Conclusion Simvastatin can inhibit the proliferation and migration of VSMCs by activating SREBPs.

Three-dimensional virtual surgery experiment is the application of virtual reality technology in the medical field.Doctors use the information in the virtual environment to develop surgical planning,surgical drills.surgical teaching,surgical skills training,to lead the surgical technique and postoperative rehabilitation,and the information is available for surgery every sur-gical member to share.Virtual Surgery experiments combined with the real operation together constitute complete experimental teaching system,making telemedicine experimental teaching methods and teaching content rich and varied.

Objective To detect the patients with IgA nephropathy by glycobiology and immunological technique. Methods An helia aspera lectin ELISA immunoassay was developed to discriminate the aberrantly glycosylated IgA in serum from normal IgA molecules by using HAA lectin, which reacts preferentially with the GalNAc of the terminal sugar chain, and AKP conjugated specific IgA antibody. Results The results given by A 405 nm values from 156 controls, 22 patients with IgAN and 19 patients with uncertain IgAN were 0.22?0.10,0.68?0.17 and 0.38?0.15, respectively. The significance between the controls and the patients with IgAN was observed ( P

Objective To study the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1(TIMP-1) proteins in the decidua and villi of the early pregnancy. Methods Immunohistochemical staining was applied to detect the expression of MMP-9 and TIMP-1 proteins in the decidua and villi of 45 the early pregnant women and in the mid-secretory phase endometrium of 30 normal women. Results The OD of MMP-9 and TIMP-1 proteins expression in the decidua and villi was 0 168?0 055 and 0 155?0 046 respectively, in the mid-secretory phase endometrium were 0 133?0 0210 and 0 113?0 0251 respectively, and the expressions of MMP-9 and TIMP-1 in the early pregnancy increased significantly when compared with the mid-secretory phase endometrium(P

Objective: To investigate the characteristics of mortality of injury among residents in Gusu District, Suzhou City, Jiangsu Province from 2013 to 2023, so as to provide the evidence for developing targeted measures of injury prevention and control. Methods: Gender, age and underlying cause of deaths due to injury in Gusu District were collected through Death Reporting Information System of Chinese Disease Prevention and Control Information System and Jiangsu Death Reporting Information System from January 1, 2013 to December 31, 2023. The crude mortality, Chinese-standardized mortality and world-standardized mortality of injury were analyzed, and the trend in mortality was analyzed using annual percent change (APC). Results: Totally 4 217 deaths due to injury were reported in Gusu District from 2013 to 2023. The crude, Chinese-standardized and world-standardized mortality rates were 51.58/105, 23.24/105 and 21.98/105, respectively, all showing a tendency towards a rise (APC=6.802%, 2.688% and 2.823%, all P<0.05). The crude mortality rate of injury was higher in women than in men (54.61/105 vs. 48.41/105, P<0.05). The five most common causes of injury included fall (32.99/105), traffic accidents (6.03/105), suicide (4.23/105), drowning (3.00/105) and asphyxia (2.16/105), accounting for 93.86% of the total number of deaths. The crude mortality rates of fall, suicide and asphyxia appeared a tendency towards a rise (APC=9.724%, 6.333% and 5.638%, all P<0.05). The crude mortality rates of injury among men, women and overall residents appeared a tendency towards a rise with age (all P<0.05). Fall was the primary cause of injury death among residents aged 65 years and above, and suicide was the primary cause of injury death among residents aged 15 to 44 years. Conclusions The crude mortality of injury appeared a tendency towards a rise in Gusu District from 2013 to 2023. The main causes of death were fall, traffic accidents, suicide, drowning and asphyxia, with the crude mortality of fall, suicide and asphyxia showing an upward trend.

? AlM: To examine choroidal thickness and its relationship with axial length and spherical equivalent by spectral domain optical coherence tomography ( SD -OCT ) in patients with myopic choroidal neovascularization ( mCNV) .
?METHODS: We prospectively recruited 30 cases of mCNV in Beijing Anzhen Hospital from October 2010 to December 2014. SD-OCT was used to measure choroidal thickness subfoveally and at 1. 5mm superiorly, inferiorly, nasally and temporally ( SFCT, SCT1. 5mm , lCT1. 5mm , NCT1. 5mm , TCT1. 5mm ) . Paired t- test was conducted to assess the difference of spherical equivalent, axial length and choroidal thickness between mCNV group and controls. Logistic regression analysis was performed to evaluate the correlation between spherical equivalent, axial length, choroidal thickness and mCNV.
?RESULTS: The difference of spherical equivalent and axial length between mCNV group and controls was not significant (P>0. 05). lnferior was decreased in mCNV group compared with controls (140. 85±33. 46μm vs 168. 95±45. 36μm). The difference was significant (P=0. 008). Logistic regression demonstrated that decreased choroidal thickness ( lCT1. 5mm ) at inferior location was associated with mCNV (OR=2. 12;95%CI 1. 35~3. 28;P=0. 02).
?CONCLUSlON: The decrease of lCT1. 5MM may be one of the risk factors of mCNV.

The imaging techniques have been widely used in the diagnosis of chronic osteomyelitis,including plain radiography,magnetic resonance imaging,computed tomography and radionuclide imaging.Plain radiography is useful in the early detection of suspected osteomyelitis,but its sensitivity is low.Due to its high resolution and sensitivity,MRI has been the most widely used but its specificity is relatively poor.CT is mainly recommended for diagnosis of chronic osteomyelitis in complicated anatomic regions.Radionuclide imaging will have prospects of broad application due to its diverse radiotracers and high sensitivity.This paper reviewed the research of imaging modalities in diagnosis of chronic osteomyelitis.