Objective To put forward a reform assumption of physician payment model based on review of physician payment models abroad. Methods Literature review and expert interview. Results Physician payment model and its reform patterns overseas were discussed. Problems of current physician payment model in Chinese public hospitals were analyzed. Conclusions The physician payment reform in public hospitals should focus on raising physician salary. The investment of resources and technology of medical service projects should be measured reasonably. Setting up responsibility center , saving health care costs and improve the quality of health care are the most important three aspects of physician payment model reform in Chinese public hospitals.

In order to overcome the adaptability of electrical stimulation produced by the traditional electro acu-puncture and improve the effects of electro acupuncture, a new type of music electro acupuncture instrument has been designed based on ARM. This article put forward to choose the music as prescription whose spectral density met the 1/f fluctuation law in order to make the patients more comfortable accepting electrical stimulation. What’s more, the music prescription for insomnia had been designed. At last, a total of 23 insomniacs were randomly divid-ed into three groups to verify the therapeutic effects. Clinical tests showed that the scheme in this paper was feasible and the treatment effect was significant.

Objective To design and implement a dynamic simulation system for medical treatments on hospital ship, the application of which can provide evidence for the tactical and technical index of the equipment and the research on medical treatments. Methods Queuing theory and discrete events imitation methods were applied to make research on how to simulate random arrival of the sick and wounded of corresponding various random pattern, organizing of medical resources and medical treatments as well as procedures and rules of medical treatments by means of establishing overall system mathematics model on condition that the amount of the wounded and different distribution of wound type was given. Results The process data and outcome data of medical treatments such as passing ratio were achieved under different running circumstances in the given time. Conclusions The system can imitate the large-scale medical treatment process which can rarely implement many times in reality, meet different needs flexibly, and provide optimization foundation to medical resources configuration on medical ships.

Objective To study improvement of neural function by stereotaxic transplantation of adipose-derived stem cells (ADSC) into lateral cerebral ventricle after intracerebral hemorrhage in rats and its mechanism. Methods ADSC were cultured and proliferated in vitro, which had been marked with Brdu for 48 h before transplantation. The rat caudate nucleus hemorrhage (ICH) models were divided into 2 groups. ADSC were stereotaxically transplanted into the right lateral ventricles in ADSC group, and equal volume of saline was transplanted into control group. The score of neurological behavior were evaluated at modeling and 1, 3, 7, 14, 28 days after transplantation respectively.Double-staining immunofluorescence technique was used to detect Brdu-positive cells and the differentiation of neurons and astrocytes. In accordance with the instructions of TUNEL kit, cell apoptosis, and the expression of VEGF and angiogenesis were assayed. Results In vitro ADSC expressed undergo osteogenic and adipogenic differentiation. Compared with the control group, ADSC group had better motor function at 3, 7, and 14 days (P＜0. 05). Double-staining immunofluorescence showed mostly grafted Brdu-reactive ADSC had migrated to the hematoma zone, and some survivedand expressed Neun of Gfap. TUNEL analysis revealed that, 3 days after transplantation, the number of apoptotic cells in ADSC group was significantly less than in the control group (P＜0. 05). Three days after transplantation, VEGF expression levels in ADSC group were significantly higher than in the control group (P＜0. 05). Conclusion ADSC stereotaxially transplanted into the lateral ventricle can survive and differentiate into neuron-like cells. ADSC transplantation may reduce apoptosis and secret VEGF to promote the angiogenesis, and improve neural functional in intracerebral hemorrhage rats.

Objective To investigate the relationship between perineural invasion and clinicopathological factors of gastric cancer or prognosis of patients.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 801 patients with gastric cancer who were admitted to the Affiliated Tumor Hospital of Fujian Medical University between March 1999 and November 2015 were collected.All the patients received surgery in order to the radical resection of gastric cancer,and total gastrectomy or two-thirds and above of gastrectomy and D2 lymph node dissection were performed.Patients with preoperative stage Ⅲ of clinical staging underwent neoadjuvant chemotherapy.Patients with T3-T4 of histopathologic stage,T1-T2 of positive lymph nodes and T2N0 of high risk factors (low differentiated tumor,lymphovascular invasion,perineural invasion and age ＜ 50 years) underwent postoperative chemotherapy.Observation indicators:(1) treatment situations;(2)pathological characteristics;(3) follow-up results;(4) prognostic factors.Follow-up using outpatient examination and telephone interview was performed once within 1 month postoperatively,once every 3 months within 2 years postoperatively and once every 6 months from 3 to 5 years postoperatively up to February 2016.Follow-up included inquiry,physical examination,routine blood test,biochemical test,carcinoembryonic antigen (CEA),CA19-9,color Doppler ultrasound or computed tomography (CT) and endoscopy.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Ordinal data was analyzed by the nonparametric test.The univariate analysis and multivariate analysis were done using the COX regression model.The hazard ratio (HR)and 95％ confidence interval (CI) were calculated.The survival curve and survival analysis were respectively drawn and done by the Kaplan-Meier method and Log-rank test.Result (1) Treatment situations:all the 1 801patients underwent traditional open surgery,including 1 570 undergoing radical resection and 231 undergoing palliative surgery.Of 1 801 patients,1 029 received total gastrectomy,540 received distal gastrectomy,201 received extended gastrectomy and 31 received resection of residual stomach.Operation time,volume of intraoperative blood loss,number of lymph node dissected and duration of hospital stay were (173±40) minutes,(224-±91) mL,30± 13 and (15±9) days,respectively.Of 1 801 patients,79 underwent preoperative neoadjuvant chemotherapy and 906 underwent postoperative adjuvant chemotherapy.(2) Pathological characteristics:results of pathological examinations of 1 801 patients showed that 509 had positive perineural invasion and 1 292 had negative perineural invasion.Tumors located in the upper region,middle region and lower region of stomach,whole stomach and stump stomach were respectively detected in 173,189,123,12,12 patients with positive perineural invasion and 395,417,428,29,23 patients with negative perineural invasion.Type Ⅰ,Ⅱ,Ⅲ and Ⅳ of Borrmann type were respectively detected in 13,213,244,39 patients with positive perineural invasion and 92,511,629,60 patients with negative perineural invasion.The good and poor tumor differentiations and tumor diameter ＜5 cm and ≥5 cm were respectively detected in 172,337,244,265 patients with positive perineural invasion and 536,756,833,459 patients with negative perineural invasion.Stage Ⅰ,Ⅱ,Ⅲ,Ⅳv of histopathologic stage,T1,T2,T3,T4 of invasive depth,NO,N1,N2,N3 of lymph node metastasis and positive and negative lymphovascular invasion were respectively detected in 27,54,346,82,17,24,26,442,77,84,109,239,383,126 patients with positive perineural invasion and 263,283,623,123,188,169,289,646,409,219,312,352,437,855 patients with negative perineural invasion,with statistically significant differences in above indexes between positive and negative perineural invasion patients (X2 =14.142,Z =-2.098,X2 =9.061,41.536,Z=-10.389,-13.824,-8.638,X2 =252.624,P＜ 0.05).(3) Follow-up results:1 629patients were followed up for 1.0-99.0 months,with a median time of 37.3 months.The 5-year overall survival rate was 58.5％.(4) Prognostic factors:results of univariate analysis showed that tumor location,Borrmann type,degree of tumor differentiation,tumor diameter,histopathologic stage,invasive depth,lymph node metastasis,lymphovascular invasion and perineural invasion were factors affecting prognosis of patients with gastric cancer (HR=1.209,1.303,1.496,2.303,3.368,2.057,1.812,2.013,1.332,95％ CI:1.123-1.301,1.171-1.449,1.290-1.736,2.001-2.649,3.012-3.767,1.856-2.279,1.694-1.939,1.749-2.317,1.126-1.576,P＜0.05).Resuhs of multivariate analysis showed that tumors located in the upper and middle of stomach,whole stomach and stump stomach,tumor diameter ≥ 5 cm,stage Ⅱ-Ⅳ of histopathologic stage,T2-T4 of invasive depth,N1-N3 of lymph node metastasis,positive lymphovascular invasion and positive perineural invasion were independent risk factors affecting prognosis of patients with gastric cancer (HR =1.087,1.234,2.663,1.174,1.136,1.254,1.272,95％ CI:1.008-1.172,1.063-1.432,2.292-3.095,1.035-1.332,1.044-1.236,1.064-1.501,1.066-1.516,P＜0.05).The 5-year survival rate was 49.1％ in 509 patients with positive perineural invasion and 60.7％ in 1 292 patients with negative perineural invasion,respectively,with a statistically significant difference (X2 =11.270,P＜0.05).The 5-year overall survival rate was 41.1％ in 383patients with positive perineural invasion and lymphovascular invasion,77.1％ in 126 patients with positive perineural invasion and negative lymphovascular invasion,49.1％ in 437 patients with negative perineural invasion and positive lymphovascular invasion and 92.1％ in 855 patients with negative perineural invasion and lymphovascular invasion,respectively,with a statistically significant difference (X2=244.368,P＜0.05).Conclusion Perineural invasion is a high risk factor affecting prognosis of patients with gastric cancer,and it may be useful in evaluating prognosis of patients with gastric cancer.

Objective To summarize the clinicopathological characteristics and analyze the prognostic factors of young gastric cancer patients.Methods Data of 1 801 gastric cancer patients (divided into ≤45 years of age group,n =230 cases,and ＞ 45 years old group,n =1 571 cases) undergoing gastrectomy in Department of Gastrointestinal Surgery,Fujian Provincial Cancer Hospital,from June 1999 to November 2015 were retrospectively analyzed.Results Compared with the elderly patients,those ≤45 years old were more female with higher percentage of signet ring cell carcinoma,M1 and non radical resection while less in the upper stomach area (P ＜ 0.05),but there was no statistical difference in tumor size,depth of invasion,lymph node metastasis,Borrmann type,TNM stage,peripheral nerve involvement,cancer embolus,positive margin.Prognostic analysis showed the difference of 5-years survival rate was not statistically significant between young and elderly patients.But the 5-year survival rate in young patients with signet ring cell carcinoma undergoingt radical gastrectomy was better than that of elderly patients (P =0.047,0.038).Multivariate regression analysis showed that M staging and surgical modality were independent prognostic factors for these ≤ 45 years old patients.Conclusion Although there are special clinicopathological features of gastric cancer in young patients,but the postoperative prognosis is relatively the same as those elderly patients.

Embryonic and induced pluripotent stem cells (ESCs and iPSCs) hold great promise for regenerative medicine. The therapeutic application of these cells requires an understanding of the molecular networks that regulate pluripotency, differentiation, and de-differentiation. Along with signaling pathways, transcription factors, and epigenetic regulators, microRNAs (miRNAs) are emerging as important regulators in the establishment and maintenance of pluripotency. These tiny RNAs control proliferation, survival, the cell cycle, and the pluripotency program of ESCs. In addition, they serve as barriers or factors to overcome barriers during the reprogramming process. Systematic screening for novel miRNAs that regulate the establishment and maintenance of pluripotent stem cells and further mechanistic investigations will not only shed new light on the biology of ESCs and iPSCs, but also help develop safe and efficient technologies to manipulate cell fate for regenerative medicine.
Animals ; Cell Cycle ; Cellular Reprogramming ; Epigenesis, Genetic ; Epithelial-Mesenchymal Transition ; Humans ; MicroRNAs ; metabolism ; Pluripotent Stem Cells ; cytology ; metabolism ; Tumor Suppressor Protein p53 ; metabolism

Objective:To investigate the understanding of cancer pain by medical doctors and its therapeutic status in Shanghai. Methods:We recruited 1 982 medical physicians from 106 secondary and tertiary hospitals in Shanghai city from January to March in 2007. The understanding and the therapeutic status of cancer pain were investigated by conducting a questionnaire survey and the results were statistically analyzed.Rusults:There were 52.3% physicians who believed that they understand the treatment protocol of the Three-step Analgesic Ladder regimen. The rate increased by 21.6 percentage point compared with the results in 1999. The understanding degree of oncologists was significantly better than non-oncologists. There were 16.8% physicians giving the correct answers on the three main principles of the dosage titration in analgesic management. The correct rate of oncologists was significantly higher than that of non-oncologists. Opium with strong analgesic effect had become the first choice for severe cancer pain, and the use of pethidine (Dolantin) for severe cancer pain decreased significantly.The pain was significantly relieved in 74.8% patients. The pain-relieving rate increased by 25.4 percentage point compared with the results in 1999. There were 81.1% medical doctors confirming the effect of pain treatment and among them oncologists were more optimistic to therapeutic outcome than others. There were 93.3% physicians who agreed that it was necessary to carry out the standardized training of cancer pain treatment and the requirement of non-oncologists were much emergent. The over-strict controls by the hospitals and the regulations were the main obstacles for using analgesic drugs.Conclusion:The understanding of medical doctors and the diagnostic and therapeutic levels of cancer pain were improved significantly compared with those in 1999. But more training of cancer pain treatment are still required to publicize the standardized therapy and overcome the obstacles of using analgesic drug.

Objective To investigate the clinical outcomes of percutaneous kyphoplasty (PKP) for treatment of vertebral compression fractures in perimenpausal women.Methods A total of 53 perimenopausal patients (70 vertebrae) undergone PKP for vertebral compression fractures from January 2007 to May 2014 were analyzed retrospectively by case-control study.Thirty-six patients had single vertebral fractures and 17 two-level vertebral fractures.The fracture segments included 5 T11 vertebrae,14 T12 vertebrae,30 L1 vertebrae,12 L2 vertebrae and 9 L3 vertebrae.Ratio of vertebral compression was 10％-30％.According to treatment difference,the patients were divided into PKP group and non-operation group.In PKP group,there were 30 patients with age range of 44-54 years (mean,51.0 years),and the fracture segments included 13 T11 vertebrae,11 T12 vertebrae,17 L1 vertebrae,7 L2 vertebrae,3 L3 vertebrae.In non-operation group,there were 23 patients with age range of 44-54 years (mean,50.5 years),and the fracture segments included 2 T11 vertebrae,3 T12 vertebrae,13 L1 vertebrae,5 L2 vertebrae,6 L3 vertebrae.Visual analogue scale (VAS),Oswesty disability index (ODI),vertebral compression rate,Cobb angle and bone mineral density change were compared preoperatively,2 weeks,6 months and 3 years after operation.Results All patients were followed up for 6-36 months.VAS and ODI were improved compared with preoperative status in two groups at 2 weeks,6 months and 3 years (P ＜ 0.01).VAS and ODI in PKP group were significantly decreased at 2 weeks and 6 months compared with non-operation group (P ＜ 0.01).The Cobb angle and vertebral compression rate in non-operation group were improved at 6 months compared with those in preoperative status (P ＜ 0.05),and a consistent increase was noted at 3 years,but the difference was not statistically significant (P ＞ 0.05).The Cobb angle and vertebral compression rate in PKP group were reduced at 6 months compared with preoperative status (P ＜ 0.05),and an increase was noted at 3 years,but the difference was not statistically significant (P ＞ 0.05).The Cobb angle and vertebral compression rate in PKP group did not increase at 6 months and 3 years,but they had significant increase in non-operation group (P ＜ 0.05).The body mass index in non-operation group decreased at different degrees at 6 months and 3 years,compared with preoperative status (P ＜ 0.05),while the body mass index reduction in PKP group had no statistically significant difference (P ＞ 0.05).The body mass index reduction in PKP group was less than that in non-operation group at 3 years (P ＜0.01).The body mass index reduction in PKP group was slow and had no statistically significant difference compared with preoperative status (P ＞ 0.05).The body mass index reduction in non-operation group was fast and had significant decrease compared with preoperative status (P ＜ 0.05).Conclusion PKP can relieve pain for vertebral compression fractures in perimenopausal women in short term and long term,and PKP can also improve spinal kyphosis and prohibit the decline of bone mineral density.