In the health service field,health resources and health service supple capacity were related with the resource and capacity in economics.Health resources,health service supple capacity and their relationships were important factors for the cooperation and benign interaction of hierarchical medical institutions.However,inversion of health resources and health dislocation of service supply capacity exacerbated the agglomeration degree of patients in the tertiary medical institutions under the impact of residents' freely searching for medical service concept.Vicious interaction and mutual competition among hierarchical medical institutions had become an important obstacle for the implementation of hierarchical medical services.Therefore,its mechanism needed to be clarified while the corresponding policy recommendations should be proposed.

AIM:To explore the cataract suspensory ligament rupture and artificial lens implantation suture fixation into capsular bag without capsular tension ring(CTR).METHODS:We reviewed 20 cases of 20 cataract suspensory ligament rupture without CTR intraocular lens (IOL) implantation fixation in our department from Jan.2012 to Dec.2016.The needle crossed into ocular ciliary sulcus, in the equator of the eye ball which suspensory ligament rupture from, then the needle crossed out 1.5mm away from the angle of sclera.Sutures fixed on the IOL, then the artificial lens implantation in the pouch, carried out in accordance with the Z type suture, or to the beforehand prepared triangle scleral flap.The visual acuity, intraocular pressure, the anterior chamber and the IOL position were measured after operations.RESULTS:All of the postoperative visual acuity improved different level.The postoperative best corrected visual acuity(BCVA) was ≥0.8 in 4 eyes(20%), 0.5-0.6 in 7 eyes(35%), 0.3-0.4 in 8 eyes(40%), 0.1 in 1 eye(5%) because of the glaucoma optic atrophy.There were 12 cases with mild corneal endothelium edema, 4 cases exudation membrane in the pupil area, 2 cases hyphema, all of which recovered after treatment.There were 2 eyes with vitreous prolapse in the pupil, 1 case appeared mild IOL center deviation and no special treatment for the vision did not be involved.Followed up for 6mo, displaced stitches or artificial lens shift did not occur.CONCLUSION:Without CTR, the IOL implantation and suture fixation in capsular bag during cataract surgery is a surgical method for basic-level hospitals.

Objective To establish a method for the determination of alum residual amount in Rhizoma Pinelliae Preparata from different companies,and to provide a scientific evidence for quality evaluation of Rhizoma Pinelliae Preparata.Methods Na2EDTA titration method was applied for the quantitative analysis.Results There were obvious differences in residual quantity of alum in Rhizoma Pinelliae Preparata from different companies.Conclusion The method is simple,reproducible and accurate,it can be used for the determination of alum residual amount in Rhizoma Pinelliae Preparata.

Objective To assess the effect of repetitive transcranial magnetic stimulation (rTMS) at different frequencies on behavioral and psychological symptoms and cognitive function in patients with Alzheimer's disease.Methods Seventy-two patients were randomly divided into a high frequency group,a low frequency group and a control group (n =24 for each),and given 10 Hz,1 Hz or sham rTMS over the left and right dorsolateral prefrontal cortex at an intensity was 80％ of each patient's movement threshold.The stimulation was for 30 min a day,five days a week.During the 4 weeks of treatment,risperidone was used at a fixed dose of 1 mg per day for all patients.Before and after the treatment,all 3 groups were assessed using the behavioral pathology in Alzheimer's disease rating scale (BEHAVE-AD) and the mini-mental state examination (MMSE).Results Two weeks after the treatment,the average BEHAVE-AD score of the high frequency group had decreased significantly from (16.75±6.26) to (13.84± 6.10),significantly lower than the low frequency and the control groups' averages.Two weeks later,the average BEHAVE-AD scores of the 3 groups were significantly lower than before the treatment,but the decrease of the high frequency group was of significantly greater compared to the other 2 groups.Four weeks after the treatment the average MMSE score of the high frequency group was significantly better than before the treatment (P＜0.01),and better than the low frequency and the control group's averages.The effectiveness rates of the high frequency group,the low frequency group and the control group were 88％,58％ and 54％ respectively,all significantly different.Conclusion High frequency (10 Hz) rTMS combined with risperidone can improve the behavioral and psychological symptoms and cognitive function of AD patients,while low frequency (1Hz) rTMS does not have obvious effects.

Translational medicine has been on the rise for 20 years as a new model of biomedical research,which plays a positive role in narrowing the gap between basic research and clinical medicine and in development of medical sciences.This paper traced back the milestones of translational medicine,and analyzed the hurdles for China to develop translational medicine,namely the organization system,management model and benefit sharing.On such basis,the authors recommended on the development and strategy,especially in clinical medical institutions in China.

Objective To analyze the ecological environmental differences of hibernation hole and temporary hole of Himalayan marmot based on global positioning system (GPS),remote sensing (RS) and geographical information system (GIS) in Yushu City,Qinghai Province.Methods Hibernation holes and temporary holes were located based on GPS.Ecological environment factors related with Himalayan marmot,such as land surface temperature (LST),digital elevation model (DEM),normalized different vegetation index (NDVI),were extracted based on RS and GIS.The ecological environment differences between hibernation hole and temporary hole were explored based on epidemiological statistical method.Results Monthly LST (degree Kelvin,K) of hibernation hole was slightly higher than that of temporary hole in the same period.Yearly day LST of hibernation hole was 1.1 K higher than that of temporary hole in the same period.Yearly night LST of hibernation hole was 0.3 K higher than that of temporary hole in the same period.Monthly NDVI of temporary hole was slightly higher than that of hibernation hole in the same period.Yearly NDVI of temporary hole was 0.001 higher than that of hibernation hole in the same period.DEM of temporary hole was about 40 m higher than that of hibernation hole.The top two ratios of soil type factors were both alpine meadow soil and dark felty soil for hibernation hole and temporary hole,which were 62.1％ and 29.3％,64.4％ and 25.6％.The top two ratios of land cover factors were both rainfed cropland and mosaic cropland for hibernation hole and temporary hole,which were 43.3％ and 25.8％,40.0％ and 26.2％.Conclusions Soil type factors and land cover factors for hibernation hole and temporary hole are similar.Lower DEM and higher LST are chose for hibernation hole,and better NDVI is chose for temporary hole,which is good for food intake.

Objective To observe the analgesic effects of dexmedetomidine combined with dif-ferent-doses of sufentanil in patients undergoing spine surgery.Methods Sixty patients(ASA grade Ⅰor Ⅱ degree,age 18-70 years)undergoing spine surgery were randomly assigned into three groups ac-cording to PCA formulation(n =20):3 μg/kg sufentanil group (group S1),1.5 μg/kg dexmedetomi-dine+ 2 μg/kg sufentanil group (group S2 )and 1.5 μg/kg dexmedetomidine + 1 μg/kg sufentanil group (group S3).The same anesthesia method was applied among three groups.Patient-controlled intravenous analgesia pump was applied before 30 minutes prior to the end of surgery.The drugs in each group were diluted to 1 50 ml and infused by a pump at a rate of 3 ml/h with a patient-controlled analgesia (PCA)bolus of 0.5 ml and lock time of 30 minutes.VAS and Ramsay scores at 2 h(T0 ),4 h (T1 ),8 h(T2 ),12 h(T3 ),24 h(T4 )and 48 h(T5 )after surgery were estimated.Postoperative nausea and vomiting,bradyrhythmia and hypersomnia were also recorded.Results Compared with group S1, VAS of groups S2 and S3 was significantly decreased at T1-T5 (P <0.05).There were also no signifi-cant difference in the incidence of postoperative nausea and vomiting,bradyrhythmia and hypersomnia among three groups.Conclusion Dexmedetomidine of 1.5 μg/kg can significantly reduce the dosage of sufentanil on postoperative analgesia in patients undergoing spine surgery,and decrease the rate of postoperative nausea and vomiting without any bradyrhythmia and hypersomnia.

Objective To investigate the protective effects and mechanisms of granulocyte-colony-stimulating factor (G-CSF)on a rabbit model of chronic myocardial ischemia.Methods Myocardial ischemia models were created by partial ligation of the left anterior descending coronary artery in Japanese white male rabbits.Rabbits were subcutaneously injected with G-CSF (G-CSF group)or saline (control group)for 6 days after myocardial ischemia.The percentage of CD34-positive cells in the peripheral blood was evaluated by flow cytometry,and CD34-positive cells homing and vWF expression in the ischemic myocardium were determined by immunohistochemistry.Results Rabbits in G-CSF group had a higher survival rate than those in control group (P <0.05).Immunohistochemistry of the ischemic myocardium showed that compared with control group,G-CSF group had increased homing of CD34-positive cells on day 7 post-surgery,and more vessels on day 28 post-surgery by anti-von Willebrand factor staining.In addition,we observed an increase in the percentage of CD34-positive cells in the peripheral blood in G-CSF group.Conclusion G-CSF produces an obvious protective effect against chronic myocardial ischemia in rabbits by increasing stem cell mobilization,homing to ischemic myocardium and accelerating neovascularization.

Objective_To evaluate the proangiogenesis of extracelluar matrix proteins SRPX2 on HUVECs.Meth-ods_pcDNA3.1-SRPX2 vector ( transfection group) and pcDNA3.1 vector ( negative group) were transfected into HEK293T cells, then divided into 3 groups including blank group.The proliferation of HUVECs ( absorbance, A450 ) was detected by CCK-8 kit.The transmembrane cell number was counted by Transwell migration and wound healing assay to evaluate the migration ability of HUVECs.A three dimensional culture system of cells was construc-ted on the Matrigel, and tube formation number of HUVECs was assessed.Results_The proliferation of HUVECs ( absorbance,A450 ) among transfection group,negative group and blank group failed to show significant difference (P>0.05).A signifiant difference was noted in the total branch point of capillary tubes among transfection group, negative group and blank group[(97 ±4)/field versus (57 ±3) and (54 ±3)/field] (P<0.05).In wound healing
assay, the distance of transfection group compared to 0, 6 and 12 h were both significantly larger than that of nega-tive group and blank group [(90 ±6), (37 ±7),(36 ±4)μm and (135 ±5),(65 ±8),(63 ±4)μm respective-ly, both( P<0.05) ] .In Tranwell assay, the number of migrating cells in the transfection group was significantly more than negative group and blank group [(549 ±10)/field vs (334 ±11) and (329 ±12)/field(P<0.05)] af-ter co-culture 16 h.Conclusions_SRPX2 may promote angiogenesis by stimulating the migration and tubing on the Matrigel of HUVECs.

To study the cost-effectiveness of temozolomide combined with radiotherapy in the treatment of glioblasto-ma. Methods:According to the clinical trial data, cost-effectiveness and sensitivity of the results was analyzed based on the domestic cost and consumption level. Results:Temozolomide combined with radiotherapy could prolong one month of overall survival with the additional cost of RMB 58 959. 7 yuan in each case when compared with radiotherapy alone. Conclusion:Temozolomide combined with radiotherapy has no advantage on cost-effectiveness when compared with radiotherapy alone.