The authors described the hospital group reform made by Jiangsu Kangfu Medical Group,and its main actions taken and initial success in public hospital organizational structure.Based on such studies, they recommend further clarification of the rights and responsibilities, for sectional integration;appropriate adjustment to update the supervision mechanism;building of the appointment system to speed up personnel system reform.

This paper introduced overseas experiences and theories of health systems in view of the ongoing medical and health system reform in China.It proposed the super health ministry reform,justified its necessity,and clarified key issues of such a reform,in addition to discussing how to improve the system of macro-health.

Combined Modality Therapy ; High-Frequency Ventilation ; methods ; Humans ; Infant, Newborn ; Nitric Oxide ; administration & dosage ; Persistent Fetal Circulation Syndrome ; drug therapy ; Pulmonary Surfactants ; administration & dosage

Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; Occupational Diseases ; therapy ; Osteoarthritis, Knee ; therapy

Acupuncture was frequently used for alternative treatments in Parkinson's disease because of its safety,but there was an argument whether acupuncture improves motor symptoms or not.Besides,few electrophysiological studies were designed for acupuncture combined with Parkinson's disease Using the technique of paired transcranial pulse magnetic stimulation,we measured the excitability of corticocortical inhibitory circuits to investigate effects of scalp acupuncture from 9 patients with Parkinson's disease.Although patients didn't take any short-term benefit in motor symptoms through the treatment of scalp acupuncture,there was no any adverse event,and some electrophysical effects developed in patients.The enhanced corticocortical inhibition on motor cortex possibly developed at longer interstimulus intervals,and there was a relatively increase in later part of motor-related cortical potentials on the central part and right-side near vertex around over sensory cortex,but was not significant in early potentials.So a further long-term study is essential to ascertain the physical mechanism and clinical effects in scalp acupuncture.

Aim To detect the effect of Bio on impro-ving insulin resistance and explore its molecular mech-anism. Methods The HepG2 liver cells were derivat-ed by high concentration insulin to establish the insulin resistance cell model, and the cells were intervened by Bio. The glucose consumption was measured by glu-cose oxidase and peroxidase ( GOD-POD) assay. The expression of PPARγmRNA was detected by RT-PCR. The expression of PPARγ protein was detected by Western blot method. Results The glucose consump-tion was significantly decreased in the insulin resist-ance cells after incubated with 1 . 72 × 10 -5 mol · L-1 insulin ( P<0. 05 ) . 10 -5 ,10 -6 ,10 -7 mol · L-1 Bio increased the glucose consumption 135%,62%,39%separately in the insulin resistance cells. RT-PCR a-nalysis of PPARγ showed that Bio raised the PPARγmRNA. Western blot analysis displayed that the pro-tein of PPARγ with Bio was increased. Conclusion Bio can improve the insulin resistance of the HepG2 cells, and the molecular mechanism may be relevant with raising PPARγ expression.

Objective To evaluate the short-term efficacy of Perigee system in the treatment of anterior pelvic organ prolapse. Methods From October 2012 to September 2014, 59 patients with pelvic organ prolapse, pelvic organ prolapse quantitation system (POP-Q) were diagnosed as anterior pelvic organ prolapse Ⅲ degree and above were performed Perigee anterior pelvic floor reconstruction, while some patients combined with sacrospinous ligament suspension, posterior wall repair or posterior pelvic reconstruction surgery for pelvic prolapses. Pelvic floor distress inventory-short form 20 (PFDI-20), pelvic organ prolapse-urinary incontinence sexual questionnaire-12 (PISQ-12) were evaluated, and postoperative POP-Q were used to analyze the changes of the indexes and postoperative complications. Results In 59 patients, the average operation time was (99±29) minutes, the average intraoperative blood loss was (119± 92) ml. The median postoperative follow-up time of 59 cases was 17.5 months (range:8-30 months), median follow-up time of subjuctive symptoms was 21.2 months (range:11-34 months), the total score of PFDI-20 was compared with the preoperative, and the difference was statistically significant (5.6 versus 27.8, P<0.01). It was statistically significant of PISQ-12 score before and after surgery (34±3 versus 36±4, P<0.05). Short-term anatomical cure rate was 98%(58/59), 1 cases (2%, 1/59) in recurrence, 2 cases (3%, 2/59) of erosion. Conclusion This results show that the Perigee system is effective and reliable in the treatment of anterior pelvic organ prolapse.

Objective To compare the diagnostic value of endoscopic ultrasonography (EUS) versus intraoperative cholangiography (IOC) for suspected common bile duct stones (CBDS).Methods 324 patients with suspected CBDS who were admitted to the Hepatobiliary Pancreatic Surgery Department of Shaoxing People's Hospital between June 2010 and June 2014 were retrospectively studied.Either EUS or IOC was used and the diagnostic value of these two imaging modalities was compared.Results The sensitivity, specificity, positive predictive value and negative predictive value of IOC in diagnosing suspected CBDS were 90.6％, 98.4％, 9.5％ and 97.7％ respectively.Its consistency rate was 96.9％.The sensitivity, specificity, positive predictive value and negative predictive value of EUS in diagnosing suspected CBDS were 97.1％, 100％, 100％ and 99.1％ respectively.Its consistency rate was 99.3％.Conclusions In diagnosing suspected CBDS, the sensitivity, specificity, positive predictive value and negative predictive value of EUS were significantly higher than IOC.When compared with IOC, EUS was more sensitive to detect occult CBDS and avoided unnecessary ERCP or bile duct exploration.Patients with negative EUS were less likely to have retained CBDS.

Objective To investigate the regulatory effects and possible mechanisms of autophagy induction and bactericidal activity in muring bone marrow derived macrophages ( BMDMs) . Methods Murine BMDMs were isolated and cultured in vitro. Then standard strain of E. coli was used to infect BMDMs and cellular autophagy levels and AMPK activation were detected. We next modulated functions of AMPK by pretreating cells with the specific agonist or antagonist of AMPK. Then cellular AMPK activation, autophagy levels and bactericidal activity were observed after E. coli infection. Results In E. coli infected BMDMs,autophagy related molecules like LC3B and Beclin1 were upregu-lated,accompanied with elevated LC3Ⅱ/Ⅰratio. Phosphorylation of AMPK was also upregulated by E. coli treatment. Enhanced AMPK activi-ty by its agonist leads to increased cellular autophagy and bactericidal activity,whereas inhibition of AMPK by its suppressor downregulated autophagy and dampened bactericidal activity. Conclusion AMPK and its related signaling pathway is required for anti-bacterial response in macrophage,which is dependent on its function in upregulating autophagy related molecules and inducing autophagy.

Objective To evaluate magnetic resonance imaging (MRI) in the diagnosis of deep anorectal abscess. Methods Twenty-one patients who were suspected of having deep anorectal abscess were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2006 to December 2007, and their clinical data were retrospectively analyzed. Phased-array coil MRI was applied to all patients before the operation. We compared the efficacy of MRI and rectal digital examination in the classification of deep anorectal abscess and the diagnosis rate of internal opening according to the postoperative results. All data were analyzed using the chi-square test. Results Nineteen patients were diagnosed with deep anorectal abscess, one patient had presacral cyst combined with infection and one patient had perianal mucinous adenocarcinoma. A total of 25 lesions were identified, including 14 ischiorectal abscesses, five pelvirectal abscesses, and six high intersphincteric abscesses. Thirteen patients had single space abscesses and six had multiple space abscesses. There were no significant differences in the diagnosis rate between MRI (12/19) and rectal digital examination for internal opening (13/19) (χ2 =0. 116, P>0.05). The accuracy rate was significantly different between MRI (25/25) and rectal digital examination (16/25) in the classification of deep anorectal abscess (χ2 = 10.970, P <0.05). Operative exploration revealed that there were 13 patients with single space abscesses and six with multiple space abscesses. The accuracy rate was significantly different between MRI (19/19) and the rectal digital examination (13/19) for detecting multiple space abscesses (χ2 =7. 125, P <0. 05). Conclusions MRI with a phased-array coil can accurately detect the extent of deep anorectal abscess and its relationship with anorectal sphincters. MRI examination is helpful in excluding potential lesions in the anorectal region.