ObjectiveTo find out about changes in expenses and the orientation of the insured to medical services and analyze the causes of expense growth and the result of containment so as to offer suggestions for policy formulation. MethodsA statistical analysis was made of the actual data on the medical insurance of retired and working personnel in Nantong City from 2000 through 2002 using SPSS and Excel. Results①The mode of payment via "plate" management and total quantity and mean value control resulted in fairly good expense containment, especially outpatient expense containment while the growth of hospitalization expenses was on the rise. ②Third-tier hospitals were most popular to people seeking hospitalized services while for outpatient services people were increasingly turning to clinics and designated drugstores where the average expenses per visit were low. Conclusion①The managing party of medical insurance should step up research on expense containment strategies, steer the patients towards rational splitflow, try to contain expenses in a scientific way, and improve the efficiency of fund utilization. ②Medical institutions confronted with opportunities and crises should enhance quality construction and deliver standard and reliable services. ③It is imperative to strengthen regional health planning and raise the efficiency of health resources utilization.

Objective To improve the quality of teaching, conduct the examination mode reform of the course Fundamental Nursing among undergraduate students, and explore a reasonable and fair appraisal mechanism. Methods Taking a class of 2013 consisting of 160 undergraduates majored in nursing as an experimental group, reform the content, method and evaluation method and implement them in the fundamentals of nursing examination. In addition, compile a self- made questionnaire to investigate the feedback effect of carrying out the assessment model. Meanwhile, take 151 nursing undergraduates in grade 2012 as a historical control group, and conduct the statistical analysis with the overall rating scores of the experimental group. Results After the reform was carried out, 91.82 percent (146/159) of the students holded the view that it was necessary to reform, 86.16 percent (137/159) were satisfied with the evaluation reform, 84.91 percent (135/159) agreed on the spreading of the reformed examination pattern to other courses, and percentage of students′passing the exam reached 98.75 percent (158/160). The difference of the course assessment overall achievement between the experimental group and control group, was statistically significant (Z=-2.62, P < 0.01). Conclusions The reform of the examination mode will achieve the harmonious unification of teaching, learning, exam, improve the quality of teaching and promote the realization of the talent training goal.

OBJECTIVE:To establish the quality standard for Gastrodia elata hency-fired tablet. METHODS:TLC was used to identify the gastrodin and benzyl alcohol and determine the content of moisture,ash and extract;HPLC was used to determine the content of gastrodin and benzyl alcohol. Column was Diamonsil C18 with mobile phase of acetonitrile-0.05% phosphate(3:97,V/V) at flow rate of 1.0 ml/min,detection wavelength was 220 nm,column temperature was 25 ℃ and volume injection was 10 μl. RE-SULTS:The TLC of gastrodin and benzyl alcohol showed clear spots and good separation. The moisture content<35.0%,total ash contents<2.0% and extract content>40.0%. Linear range of gastrodin was 25.2-126.0,12.7-63.5 μg/ml(r=0.999 9),respectively;RSDs of precision,reproducibility and stability tests were lower than 2.0%;recovery was 99.49%-102.40%(RSD=1.09%,n=6), 98.75-102.63%(RSD=1.53,n=6),respectively. CONCLUSIONS:The method is simple and good reproducibility,and can be used for the quality control of Gastrodia elata hency-fired tablet.

Objective To investigate the RADIL mRNA expression in pancreatic carcinoma and to evaluate its clinical significance.Methods Fluoesecent quantitative PCR (FQ-PCR) was used to detect the RADIL mRNA expression in 40 patients with pancreatic carcinoma and adjacent tissue and in 5 healthy adult with normal pancreatic tissue and to observe its relationship with clinicopathologic parameters.Results RADIL mRNA was expressed in pancreatic carcinoma and adjacent tissue, as well as normal pancreatic tissue, and the relative expression was 2.263 ± 3.826, 5.425 ± 8.858 and 8.559 ± 4.214, respectively.There was statistically significant difference among the three groups (P ＜0.05 ).RADIL mRNA expression was closely related with the metastasis and differentiation grade ( r = -0.312 and -0.294, P ＜ 0.05 ), however, it was not significantly related to tumor site, tumor size, CA19-9, TNM staging, sex and age.Conclusions RADIL gene may have an inhibitory effect on the pancreatic cancer.

Objective:This study analyzes COVID-19 prevention and treatment technology patents from 103 countries and regions worldwide, in order to have a good grasp of the most-current trends in COVID-19 prevention and treatment technology research worldwide, discuss the research directions of such technologies, provide theoretical foundations for interdisciplinary and multi-team cooperation.Methods:The retrieval strategies were constructed utilizing the retrieval and analysis system by the Regional Patent Information Service (Nanjing) Center of The State Intellectual Property Office and IncoPat's scientific and technological innovation platform, using third-level branches as the unit and separating the retrieval and proof processes, the queries built using IPC classification numbers and key words; the search was limited to invention patents, with utility models and designs excluded.Results:On February 14, 2020, there had been a total number of 136 087 invention patent applications for COVID-19 prevention and treatment technologies globally. In terms of the country of origin, the U. S. ranked first with 56 095 patents, followed by China (18 096). In terms of technical field, the top three were chemical therapeutic agents (47 634), vaccines (47 248) and diagnostic tests (12 991), with the U. S. possessing absolutely advantageous patent portfolios in all three fields. The applicants were mainly comprised of large enterprises abroad and universities and research institutes in China.Conclusions:China′s COVID-19 related patent applications are relatively scattered. In the field of chemotherapy, there is room for improvement compared with the advanced countries, and cooperation between scientific institutions and enterprises is insufficient. Therefore, China should further increase investment in chemical drug research and development and seize the opportunity to actively promote the research and development of vaccine technology. On the other hand, we need to consolidate the technical advantages and product advantages of epidemic prevention and control which are already accumulated, and strengthen the protection and layout of intellectual property rights. Furthermore, the technological innovation system combining production, education and research is the breakthrough point to encourage enterprises to become the subject of technological innovation.Last but not least, we should build a service platform for the transfer and transformation of scientific and technological achievements to enhance intellectual property rights and promote the transformation of scientific and technological achievements.

Objective:To study the efficacy of different systemic chemotherapy regimens as first-line and second-line therapy and to determine the prognostic factors for patients with advanced biliary tract cancer.Methods:The clinical data of patients with advanced biliary tract cancer who underwent systemic chemotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2018 were studied. The efficacy of chemotherapy on objective response rate (ORR) and disease control rate (DCR) were evaluated. Potential prognostic factors for survival were studied using the Cox proportional hazards models.Results:Of 151 patients enrolled into this study, there were 75 males and 76 females, with ages ranging from 31 to 77 years (median 58 years). Two treatment protocols were used: (1) 104 patients received a gemcitabine-based regimen (combined with platinums or fluorouracils) or a combination of platinums and fluorouracils, while (2) 47 patients received a combination of albumin-bound paclitaxel and S-1. The corresponding ORR for each group were 15.4%(16/104) and 27.6%(13/47), respectively, and the DCR were 65.4%(68/104) and 72.3%(34/47), respectively. Of 58 evaluable patients who received chemotherapy as a second-line therapy, 31 patients received the regimen containing gemcitabine, platinums or fluorouracils with an ORR of 3.2% (1/31) and a DCR of 35.5%(11/31); a total of 18 patients received the taxanes-based regimen with an ORR of 11.1%(2/18) and a DCR of 38.9%(7/18); 9 patients received the irinotecan-based regimen with an ORR of 22.2%(2/9) and a DCR of 44.4%(4/9). Univariate analysis showed positive liver metastasis and elevated carbohydrate antigen (CA)19-9 level to be significantly correlated with worse survival outcomes ( HR=1.540, 95% CI: 1.019-2.328, P=0.040 and HR=1.892, 95% CI: 1.123-3.188, P=0.017). Conclusion:For patients with advanced biliary tract cancer, in addition to the conventional regimens containing gemcitabine, platinums and fluorouracils, the combination of albumin-bound paclitaxel and S-1 was shown to be an effective chemotherapeutic regimen for these patients. Second-line chemotherapy was insufficient and ineffective, and an irinotecan-based regimen deserves to be further investigated. Liver metastasis and elevated CA19-9 level were worse prognosis after chemotherapy for patients with advanced biliary tract cancer.

Objective To investigate the predictors of early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke and its impact on short-term outcomes. Methods From January 2017 to April 2019, patients with acute ischemic stroke treated with intravenous thrombolysis in the Second Affiliated Hospital of Xuzhou Medical University were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after admission increased by ≥2 compared with the baseline. The short-term outcomes were evaluated by the modified Rankin Scale at discharge. 0-2 was defined as good outcomes and 3-6 was defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent predictors of END and their correlation with short-term outcomes. Results A total of 199 patients with acute ischemic stroke received intravenous thrombolysis were enrolled. The median age was 68 years (interquartile range: 62- 76 years), 69 were women (34. 7％), and the baseline median NIHSS score was 6 (interquartile range: 3- 12). END occurred in 35 patients (17. 6％). Symptom progression occurred mainly 2 days after admission (31 patients, 88. 6％). Most of the causes of END were ischemic progression or recurrence (28 patients, 80. 0％). The univariate analysis showed that fasting blood glucose and symptomatic intracranial hemorrhage were associated with END (all P < 0. 05). However, multivariate logistic regression analysis did not find independent predictors of END. Excluding 12 patients with missing short-term outcome data, a total of 187 patients were included in the short-term outcome analysis. Among them, 110 patients had good outcomes and 77 had poor outcomes. Univariate analysis showed that ischemic heart disease, atrial fibrillation, mild stroke, etiological classification, baseline NIHSS score, absolute lymphocyte count, fasting blood sugar, neutrophil/lymphocyte ratio, whether to receive interventional therapy, and END were correlated with short-term outcomes (all P < 0. 05 ). Multivariate logistic regression analysis indicated that high baseline NIHSS score (odds ratio 1. 350, 95％ confidence interval 1. 182-1. 541; P < 0. 001) and END (odds ratio 32. 540, 95％ confidence interval 6. 149- 172. 21; P < 0. 001 ) were the independent risk factors for short-term poor outcomes. Conclusions END still occurs in some patients after intravenous thrombolysis for acute ischemic stroke, and END is an independent risk factor for short-term poor outcomes.