Based on the theory of value and value ethics,there were 3 aspects problems as following at the present stage of the health care system reform:paying more attention on the quantity of inpatient services rather than the quality of medical services,taking hospital as the center instead of the close cooperation of various sanitary institutions and inappropriate incentive mechanism.It considered that the next step of the health care system reform of China should make efforts to achieve 3 value goals:to improve people's health level,provide high-quality medical services and service experience and affordable health care costs.To achieve these value goals,it proposed suggestions from five aspects:providing integration services,transforming the functional localization of hospitals,changing the incentive mechanism,improving the medical service quality continually and enhancing the participation of the public.

Objective To study the effects of three anesthetic techniques on the neuroendocrine and immune responses to surgical stress Methods Thirty patients undergoing elective upper abdominal surgery, were allocated randomly to epidural anesthesia group(groupⅠ), general anesthesia group (groupⅡ)and combination of epidural and general anesthesia group(group Ⅲ ) The serum concentrations of IL 6 and cortisol, and T cell subsections were measured respectively before induction, before incision, 1 h following the operation, at the operative end , on the first and fifth postoperative day Results Serum IL 6 concentrations increased significantly in groupⅠand Ⅱ(P0 05) during and after the operation, and serum IL 6 concentrations of all patients at the operative end were correlated positively to the operative duration (r=0 61, P

Objectives:To observe the characteristics of rocuronium bromide in cirrhotic patients. Methods:Six healthy patients and six patients with hepatic cirrhosis undergoing intraabdominal operation were studied. Rocuronium 0.6 mg/kg was given to all of the patients,and the twitch high of adductor pollicis muscle was recorded using NMT mechanosensor (Datex Ohmeda). The time of onset, T 1 Maximum depression, the clinical duration of initial dose, the clinical duration of repeated maintenance doses and the spontanous recovery index were observed. Results:The time of onset was markedly prolonged in the cirrhotic compared with the healthy group( P

Myasthenia gravis is an autoimmune disease resulting from the production of antibodies against acetylcholine receptors of the endplate. These antibodies impair postjunctional membrane and reduce the number of functional acetylcholine receptors of endplate. Thymectomy is an effective therapeutic method for adult myasthenic patients. In this paper, the author reviewed the pathophysiological characteristics and problems related to anesthesia, such as preoperative evaluation, the effect of preoperative medical treatment on the anesthesia, patients'response to muscle relaxants and postoperative management.

[Objective]To develop an ideal method for extracting type I collagen from cortical bone and to prepare a collagen-gelatin scaffold.[Method]The cortical bone was disintegrated into bone matrix powder in a high speed mill and was subsequently dehydrated in alcohol,decalcificated in hydrochloric acid and defatted in chloroform:methanol(1:1,v/v).The osscins were extracted using improved pepsin digestion method after the bone matrix powder was dissolved,centrifuged,dialyzed and lyophilized.Type I collagen was then characterized by SDS-PAGE and amino-acid composition analysis.The biomaterial was made of type I collagen and gelatin using freeze-drying method,and the alignment regularities of microscopic channels and their course directions were observed under the scanning electronic microscope.The size of the micropores and the factor of porosity were also measured.[Result] The collagen extracted was confirmed to be type I collagen by SDS-PAGE and amino-acid composition analysis.All the scaffolds looked like circular cylinder,the microscopic channels were arranged in parallel manners,and the pore sizes of the channels were uniform.[Conclusion]Ossein extracted from cortical bone is a real type I collagen that can be applied in the construction of collagen products.

Objective To study the effects of cleavage of Bcl-2 by two DNAzymes on apoptosis of human hepatoma cell line (HepZ1).Methods Two “10-23” DNAzymes(DzT and DzTi) targeting Bcl-2 mRNA and their analogues(DzT' and DzTi') were synthesized and used to cleave Bcl-2 mRNA in vitro and in BEL-7402 cells.The RT-PCR was performed to assess the cleaving efficiency.Expression of Bcl-2 protein was determined by immunofluorescent method.Cell apoptosis was detected by flow cytometry.Results The unmodified Enzymes DzT,and its modified form DzTi,which had an added 3'-inverted thymidine,could effectively cleave Bcl-2 mRNA in vitro.After transfected into BEL-7402 cells,DzTi exhibited more powerful cleaving ability than DzT,significantly down-regulated the level of Bcl-2 protein(P ＜0.01) and inhibited the cell growth(P ＜0.05).The results of flow cytometry suggested that the apoptosis rate of DzT and DzTi significantly increased,appeared apoptotic peak.Cell cycle was delayed in DzT and DzTi group,proportion of cells in G0/G1 increased,S phase cells decreased.Conclusion The synthesized DNAzymes could effectively cleave Bcl-2 mRNA,decrease the level of Bcl-2 protein and induce hepatoma cells apoptosis.

Objective To investigate the sedative effect of propofol combined with different doses of midazolam in patients undergoing long-time microsurgeries.Methods Forty ASA(American Society of Anesthesiologists)Ⅰ～Ⅱ patients were randomly divided into 4 groups.Normal saline(NS) 2 mL was administered in groupⅠ,while midazolam 0.01,0.02 and 0.04 mg/kg was administered in groupⅡ,Ⅲ,Ⅳ respectively.one min later,propofol was infused at a rate of 5～10 mg/kg?h combined with midazolam based on the abovementioned dosage per hour for groupⅡ,Ⅲ,Ⅳ respectively.Taking auditory evoked potential index(AAI) as a parameter,after it decreased to 40,the infusion rate of propofol was adjusted to keep AAI at the level of 30～45,and maintained the level by infusing propofol and midazolam for 5 hours.The dosage of propofol required for induction and maintenance was recorded.The emergence time and whether patients had awareness during the operation were recorded after the infusion stopped.Results At the target sedative level of AAI 30～45,the Observer's Assessment of alertness/sedation(OAA/S) score of all patients in the four groups reached 0～1.The induction period was obviously shortened and the propofol dosage was dramatically reduced in group Ⅱ～Ⅳ as compared with groupⅠ.At the stage of maintenance of sedation,the dosages of propofol in both groupⅠandⅡ were larger than those in group Ⅲ and Ⅳ.The emergence time in group Ⅳ was dramatically longer than the other groups(P

Objective To study the inhibitory effect of hammerhead ribozyme targeting connective tissue growth factor(CTGF) on collagen I synthesis and cell cycle progression of human hepatic stellate cell line(LX-2) cells.Methods Hammerhead ribozyme cDNA targeting CTGF mRNA plus two self-cleaving sequences were inserted into pTriEx2 vector to construct a recombinant vector pTriCTGF-Rz.LX-2 cells were transfected with either pTriEx2 or pTriCTGF-Rz and further stimulated with or without TGF-1.There were five groups in the experiment:control group,pTriEx2 group,pTriCTGF-Rz group,pTriEx2 plus TGF-?1 group,and pTrCTGF-Rz plus TGF?1 group.Semi-quantitative RT-PCR was used to detect the levels of CTGF mRNA and collagen Ⅰ mRNA.ELISA and flow cytometry were used to detect the levels of collagen Ⅰ secretion and cell cycle.Results Transfection of pTriCTGF-Rz into LX-2 cells reduced the CTGF mRNA and collagen Ⅰ mRNA levels as well as collagen Ⅰ protein level compared with pTriEx2 group(P

Studies on NaCl concentration, pH tolerance and selectivity to different concent rations of Na +, K +, Mg 2+ and Ca 2+ of 43 isolates from th e saline soils in XinJiang, HeBei and QingHai Provinces of China and 4 type stra ins were performed in this paper Results showed that halotolerant actinomycete s have extensiv e adaptability to Na +, K + and Mg 2+ and only a few of them can grow in low CaCl 2 concentration Halophilic actinomycetes have extensive adaptability to Na +, and for most halophilic actinomycetes, Na + can be substituted by K + , Mg 2+ , but not for Ca 2+ For some halophilic actinomycetes , it is necessary to have Na + for their growth It also showed that the growth of al l halophilic actinomycetes had se lectivity with different concentration of Na +, K +, Mg 2+ So it is pre sumed that only Kaliumphilic or Magnesiumphilic Actinomycetes maybe exist in hig h salt environments In addition, the growth pH range were 6 0～9 0 and the o ptimum pH were 7 0～8 0 not only for halophilic but also for halotolerant acti nomycetes The dis tribution of halophilic actinomycetes also have some relativity to isolation sit es

Objective To observe the clinical effects of Zaobo decoction combined bisoprolol treating premature ventricular contractions.Methods 108 patients of ventricular premature beat were recruited intoa control group and an observation group (n=54) according to the random number table method.The control group was treated with bisoprolol, while the observation group was treated with Zaobo decoction on the basis of the control group, and both groups were treated for 8 weeks.24 h dynamic electrocardiogram (ECG), renin activity plasma (PRA), angiotensin Ⅱ (angiotensionⅡ) and ALD (Ang) were observed before and after treatment.The clinical effects were evaluated.Results The total effective rate showed significant difference between the observation group and the control group (75.9％ vs.57.4％;x2=4.167, P=0.041) after the treatment.After treatment, Ang-Ⅱ (56.22 ± 12.7 pg/ml vs.68.45 ± 12.7 pg/ml, t=5.004) in the observation group was significantly lower than the control group (P＜0.01);24 h sinus RR interval standard deviation (129.16 ± 28.56 ms vs.116.13 ± 17.38 ms, t=2.864), every 5 min sinus RR interval mean standard deviation within 24 h (123.57 ± 25.24 ms vs.112.46 ± 18.23 ms, t=2.622), and within 24 h of sinus RR interval difference rms (31.76 ± 11.42 ms vs.22.64 ± 10.32 ms, t=4.354) in the observation group were significantly higher than the control group (P＜0.01).Conclusion Zaobo decoction combined with bisoprolol can effectively improve heart rate variability, regulate rernin vascular angiotensin system, and improve the clinical efficacy of the patients with ventricular premature beat.