On the basis of principal-agent theory,this paper analyzed the reasons of doctor-patient problems from the perspective of patients and hospitals,hospitals and physicians,and patients and physicians.It included asymmetric medical information,ethical risks of physicians,incomplete contracts between physicians and patients,and uncertainty of medical results.Aimed at these problems,this paper put forward relevant suggestions.In the view of recognition,patients are supposed to get a rational idea in the process of selecting hospitals and try making a contract with general practitioners.In the view of improvement,the pattern of performance assessment to physicians should be developed.In the view of system,the corresponding management measures of health service should be improved so as to better serve patients.

Objective To explore the mechanism of nanometer calcium combined with tonifying kidney herbs on osteoporosis by studying the expression of CaBP-D9K mRNA and protein in the intestinal mucosa of osteoporosis rats due to kidney deficiency. Method The rat model of osteoporosis due to kidney deficiency was established by ovariectomy. Applying the nanometer calcium and nanometer calcium combined with tonifying kidney herbs (big, middle and small dosage) to the rats for 12 weeks, choosing Gushukang, E2 and Gai’erqiD600 as the control drugs. The expression of the CaBP-D9K mRNA and protein in the intestinal mucosa of the osteoporosis rats due to kidney deficiency was determined by the method of RT-PCR and western blotting. Result There was CaBP-D9K and protein expression in the normal rats intestinal mucosa tissue, which plays an important role in the process of the intestinal calcium absorption. The episode of the rat osteoporosis due to kidney deficiency is related to the change of the CaBP-D9K and protein expression and has influence on the intestinal calcium absorption. Conclusion The nanometer calcium combined with tonifying kidney Chinese herbs can stimulate the calcium absorption of intestine, prevent and treat the osteoporosis due to kidney deficiency through regulating the expression of CaBP-D9K mRNA and protein in the intestinal mucosa.

Objective To establish an experimental model for exploring the role of RhoC gene in the invasiveness and metastasis of hepatocellular carcinoma.Method The RhoC gene was digested with restricted enzyme Hind III and XbaI,and direct cloned to pcDNA3.1.The recombinant vector (pcDNA3.1 RhoC) and the vector alone (pcDNA3.1) were transfected into HEPG2 cells with LIPFECTAMINETMReagent.After selected with hygromycin,resistant cloneies was obtained.The transcription and translation of RhoC gene were analysed with the reverse transcription PCR and immunohistochemical stain.Results The recombinant vectort (pc DNA3.1 Rhoc) express steadily in HerpG2 cells.Conclusions The modified tumor cells(HEPG2 RhoC) could be used to study the effect of RhoC protein on the invasiveness and metastasis of hepatocellular carcinoma.

OBJECTIVE: To strengthen the monitoring on narcotics and the first class psychotropic substances and to enhance the monitoring efficiency. METHODS: The computer network management of the narcotics and the first class psychotropic substances was achieved by using the special drug monitoring system. RESULTS: A real-time dynamic monitoring on the purchasing, marketing, inventory and distribution of narcotics and the first class psychotropic substances was realized, and the legal, safe and rational use of the above-mentioned drugs was guaranteed. CONCLUSIONS: The special drug monitoring system improved the standard computer network management of narcotic and the first class psychotropic substances, meeting the requirements of both our hospital and the related administration institutions to conduct real-time and dynamic monitoring for narcotic and the first class psychotropic substances

BACKGROUND: Tissue-engineered spinal cord has brought new treatment ideas for spinal cord repair.OBJECTIVE: To construct the tissue-engineered spinal cord by chitosan alginate scaffold and adipose-derived mesenchymal stem cells (ADMSCs), and to investigate its repairing effects on acute spinal cord injury in rats.METHODS: The spinal cord hemisection model was established in 48 Sprague-Dawley rats and then, rat models were randomly divided into four groups: model group, scaffold group, ADMSCs group and tissue-engineered spinal cord group,followed by direct suturing of the dura mater, implantation of chitosan alginate scaffold, implantation of ADMSCs, and implantation of tissue-engineered spinal cord, respectively. The limb motor function of rats was evaluated based on the Basso-Beattie-Bresnahan score at 1, 3, 7 weeks after transplantation. Immunofluorescence staining and hematoxylin-eosin staining of the spinal cord specimens were performed at 7 weeks after transplantation.RESULTS AND CONCLUSION: (1) Motor function of the hind limb: At 3 and 7 weeks after transplantation, the Basso-Beattie-Bresnahan score was highest in the tissue-engineered spinal cord followed, followed by the ADMSCs and scaffold groups, and lowest in the model group (P < 0.05). (2) Immunofluorescence and hematoxylin-eosin staining: in the model group, the spinal cord injury area was infiltrated with a large number of fibroblasts and inflammatory cells. In the scaffold group, there was no scar formation; neuron-specific enolase-positive cells, glial fibrillary acidic protein-positive cells and a few neurofilament protein 200-positive cells were found in the junctional area. In the ADMSCs group, the spinal cord injury area was filled with scar tissue, and a large number of glial fibrillary acidic protein-positive cells were found. In the tissue-engineered spinal cord group, there was no scar tissue, and there were a large number of neuron-specific enolase-positive cells, a small amount of CM-Dil-labeled ADMSCs and more glial fibrillary acidic protein-positive cells. Neurofilament protein 200 positive cells were connected to each other at the junction. These findings indicate that the tissue-engineered spinal cord constructed by chitosan alginate scaffold and ADMSCs can promote spinal cord repair after acute spinal cord injury.

Objective To investigate the influence of ?-interferon (?-IFN) on liver cancer cell line (Hep-G2). Methods Observing the expression of Fas and Bcl-2 by ?-IFN-pretreated Hep-G2 cells via immunohistochemical stain; subsequently treating these cells with adrimysin, and observing the cell death rate and apoptosis of these cell by MTT and electroscopy. Results (1) ?-IFN up-regulating the expression of Fas protein and down-regulating Bcl-2 protein (P

Objective To study the expression of RhoC mRNA in human primary hepatocellular carcinoma(PHCC) and paracarcinoma liver(PCL) tissues .Method Reverse transcription polymerase chain reaction(RT-PCR) was used to detect the expression of RhoC mRNA in the PHCC and PCL tissue of 30 patients with PHCC. Results The opacity density (OD)of RhoC mRNA expression in PHCC tissues was significantly higher than that in PCL tissures(P

Objective　To investigate the influence of γ-interferon (γ-IFN) on liver cancer cell line (Hep-G2). Methods　Observing the expression of Fas and Bcl-2 by γ-IFN-pretreated Hep-G2 cells via immunohistochemical stain; subsequently treating these cells with adrimysin, and observing the cell death rate and apoptosis of these cell by MTT and electroscopy. Results　(1) γ-IFN up-regulating the expression of Fas protein and down-regulating Bcl-2 protein (P<0.05), and the sensitivity of pretreated hep-G2 cell to adrimysin was increased. Conclusions　γ-IFN can rise the sensitivity of Hep-G2 to adrimysin via regulating the expression of Fas and Bcl-2.

Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap.Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection,major observations were the origin,perforators and anastomoses regulations of the direct popliteal artery.Based on the anatomical study,direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa.Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery,and about 7-11 cm above knee joint.Then it goes up along the middle line of posterior region of thigh,and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia.Finally,these branches anastomoses with many perforating branches which were gave off form deep femoral artery (the 1st to 3rd perforator artery),obturator artery and lateral circumflex femoral artery.Clinically,all flaps were survived eventually,and 6 of them were healed quickly,only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply.After 2-12 months of following-up,the colors and appearances of these flaps were excellent,and the function of knees were nearly normal.Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application,it is safe and easy to use for recovering soft tissue defects in popliteal fossa.

Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.