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

BACKGROUND:Cerebral vascular malformations are the leading cause of hemorrhagic apoplexy in young adults, and the rupture and bleeding of malformed vessels may cause severe neurological dysfunction. The mechanism of cerebral vascular malformations remains unclear. Modern molecular biology studies have shown that, angiogenic growth factors are abnormal y expressed in cerebral vascular malformations.
OBJECTIVE:To evaluate differences in the expression of angiogenic growth factors in cerebral vascular malformations, and discuss the possible relationship between cerebral vascular malformations and angiogenic growth factors.
METHODS:Fifty patients with cerebral vascular malformations and fifty patients with intracerebral hemorrhage were included in this study. The expressions of angiogenic growth factor (vascular endothelial growth factor and transforming growth factor-α) in the cerebral vascular malformation specimens and the normal superficial temporal artery specimens were detected with immunohistochemical staining.
RESULTS AND CONCLUSION:In the normal superficial temporal artery of intracerebral hemorrhage patients, no expression of vascular endothelial growth factor and transforming growth factor-αwas found;in the vascular malformations, they were highly expressed (P<0.05). Compared with normal blood vessels, vascular endothelial growth factor and transforming growth factor-αexpression was significantly increased in patients with cerebral vascular malformations.

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.

Objective To evaluate changes in cerebral blood flow before and after cranioplasty by 256-slice Spiral CT perfusion imaging,and evaluate the effect of cranioplasty on the cerebral blood flow in patients with skull defect.Methods 256-slice spiral CT scan was performed in 20 cases with early cranioplasty surgery,CTP check time points were 1 to 2 days before and 10 to 14 days after cranioplasty surgery.We recorded the the CBF and CBV of the cortex,basal ganglia,and thalamus and other parts,MTT on rCBV,parameter values rCBF,MTT and 1TrP etc.and analyzed and compared.(RCBF,rCBV,MTT and TTP) Results The CBF of cortex after cranioplasty at injured side had statistically significant increase (P＜0.05).The CBF of cortex,basic nuclei,thalamus on contrateral had no statistically significant difference.The cerebral blood flow on both sides of the basal ganglia and the thalamus was increased after surgery,but there was no significant difference between before and after surgery (P＞0.05) Conclusion Cranioplasty can significantly improve the ipsilateral cortex cerebral blood flow,and CT brain perfusion can accurately assess changes in brain tissue blood flow before and after cranioplasty.

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 investigate the effect and recurrence of the esomeprazole combined with trimebutine on treatment for non-erosive reflux disease(NERD).Methods One hundred and twenty-five cases of patients with NERD were randomly divided into the treatment group (n =62) and the control group (n =63).Patients in treatment group were received the esomeprazole 20 mg,twice a day and trimebutine 0.2 g,3 times a day,in control group were received the esomeprazole 20 mg,twice a day and mosapride 5 mg,3 times a day.After 8 weeks treatment,6 months follow-up was conducted and the effects and recurrence were evaluated.Results The clinical curative rates at 4th and 8th weeks treatment in treatment group were 75.8％ (47/62) and 95.2％ (59/62),higher than that of control group (57.1％ (36/63),x2 =4.879,P =0.027 ; 84.1％ (53/63),x2 =4.083,P =0.043).The GERDQ curative rates at 4th and 8th weeks treatment in treatment group were 72.6％ (45/62),93.5％ (58/62) respectively,significantly higher than that of the control group (52.4％ (33/ 63),x2 =5.434,P =0.020 ; 79.4％ (50/63),x2 =5.350,P =0.021).The recurrence rates of 6 months followup were 77.4％ (48/62) in the treatment group and 81.0％ (51/63) in the control group,there was no significant difference between the two groups (P =0.627).Conclusion Esomeprazole combined with trimebutine is safe and effective treatment on non-erosive reflux disease,and the recurrence rates was lower than that in the control group.

Objective To observe the ultrasonographic features of local chest wall tumor recurrence after mastectomy for breast cancer and its clinical and histopathological characteristics. Methods The ultrasonographic features, clinical and histopathological characteristics of 27 patients with local chest wall tumor recurrence after mastectomy confirmed histopathologically were retrospectively reviewed. Results The disease-free intervals of twenty-seven patients ranged from 3 to 129 months [mean (31.9±31.4) months]. Most of the recurrence(18/27, 66.7%) occurred within 3 years after mastectomy. The clinical manifestations were:7 cases (7/27, 25.9%) with regional skin redness and swelling, red rash or ulceration on chest wall associated with or without palpable mass, 20 cases(20/27, 74.1%) with chest wall palpable masses without obvious skin change. On ultrasonography, 2 cases showed diffuse inifltrative type with ill-deifned inhomogeneous hypoechoic lesion and skin thickening. And twenty-ifve cases(43 lesions) showed mass type with a lesion size range of 5.4-114.7 mm [mean (24.4±21.6) mm]. Among them, 32 lesions were located near to the operation incision scar, 36 involved muscle layer, 38 were hypoechoic, 31 had irregular shape, 24 had indistinct margin, and 31 had blood lfow signal. In addition, calciifcation, halo, and taller-than-wide shape were absent in all 43 lesions. Conclusions The tumor recurrence often occurred within 3 years after mastectomy in high-risk patients. Ultrasonographic feature of chest wall recurrent lesion is of great value in the diagnosis.