Objective:To analyze the success rate and safety of artery blood-collection from related artery and provide reference for clinical work.Methods:A total of 600 patients in need of artery blood-collection ,who visited to our hospital from Jul 2013 to Sep 2013,were selected.They were randomly divided into femoral artery blood-collection group (n=120,femoral group),radial artery blood-collection group (n= 240,radial group)and brachial artery blood-collection group (n=240,brachial group).Success rate of puncture and incidence rate of adverse reactions were compared among three groups.Results:Success rates of puncture in femoral group and brachial group were sig-nificantly higher than that of radial group (95.00%,92.92% vs.86.67%,P <0.01 all),there was no significant difference between femoral group and brachial group,P >0.05;incidence rate of adverse reactions in femoral group was significantly higher than those of radial group and brachial group (11.67% vs.5.83%,5.00%),there was no significant difference between radial group and brachial group,P >0.05. Conclusion:Synthetic judgment:Success rate of puncture is higher and incidence rate of adverse reactions is lower for brachial artery blood-collection,so it may be regarded as preferred.

Objective To investigate the occupational musculoskeletal injury of nurses in a thirdgrade and A-level general hospital in Zhengzhou,and analyze the relationship between occupational musculoskeletal injury and presenteeism.Methods 460 nurses were surveyed with questionnaires by convenience sampling,including nurses' demographic data,Nordic Standardized Questionnaires and Work Limitations Questionnaire.Results The annual incidence rate of OMSI in nursing staff was 82.38％.The parts of body which had high annual incidence rate of nurses' OMSI were lower back,neck and shoulder.The rates of presenteeism for no OMSI,one part OMSI and two or more parts OMSI were 35.14％,52.60％ and 59.68％.The scores of work efficiency decrease were (2.02±1.26),(4.67±2.53),(7.31±3.42).Conclusions Nurses' occupational musculoskeletal injury can result in presenteeism.The more serious occupational musculoskeletal injury is,the higher incidence rate of presenteeism,the more critical the presenteeism is.

OBJECTIVE:To raise the competition power of China's pharmaceutical enterprises,make them adapt to the principle of WTO better,and finally to build a safe,effective,and convenient pharmaceutical circulation channel.METHODS:To interview the pharmacy-related departments and enterprises in22provinces and cities to collect the firsthand materials,and consult a lot of literature.RESULTS&CONCLUSION:The government should enhance the macro-management for the purpose to build a fair,unified and ordered national market;enterprise should promote and enhance themselves to improve the core competition capacity;the trade association should play a role in micro-harmonization.

Objective To investigate the safety and effectiveness of radioactive 125I seed implantation in treating recurrent cervical lymphatic metastases after radiotherapy. Methods During the period from Aug. 2011 to July 2012, 17 patients with recurrent cervical lymphatic metastases who had received radiotherapy before were admitted to authors’ hospital. The clinical data were retrospectively analyzed. A total of 23 metastatic lymph nodes were detected in the 17 patients. Brachytherapy treatment planning system (TPS) was used to formulate the number, activity and distribution of radioactive 125I seeds. The radioactive activity was 0.3 - 0.8 mCi (1.30 × 107- 2.96 × 107 Bq), and the matched peripheral dose (MPD) was 60 - 120 Gy. Guided by ultrasound and CT radioactive 125I seeds were implanted under local anesthesia. CT scanning was performed within 24 hours after the procedure. Postoperative D90 was (81.4 ± 2.1) Gy. CT examination was employed every two months to determine the tumor size and to record the complications. Results All patients were followed up for 6 months. The 6-month local control rate was 65.2%. The control rates (CR+PR) for<4 cm (n=10) and>4 cm (n=13) lymph nodes were 90%and 46%respectively, the difference between the two was statistically significant (P = 0.038). No significant difference existed between the control rate (CR + PR) and the un-control rate (SD + PD) for each lymph node group at cervical Ⅰ, Ⅱ, Ⅲ and Ⅴ grade Ⅱ was seen in 8 cases and grade Ⅰ in 7 cases. No severe complications occurred. Conclusion For the treatment of recurrent cervical lymphatic metastases after radiotherapy, radioactive 125I seed implantation is effective and mini-invasive with fewer complications. This technique is more suitable for < 4 cm solitary metastatic lymph node with clear border.

Objective To study the effective dose and precaution time of the irradiation of the close contact from the radiators who underwent implantation of radioactive 125Ⅰ seeds so as to guide scientifically people how to avoid radiation damage.Methods Twenty patients with different types of cancer underwent implantation of radioactive 125Ⅰ seeds with the median value of implantation depth of 2.16 cm.Within 24hs after the operations the dose rates 30 cm and 100 cm from the skin were measured with pocket-size radiometer so as to imitate the situations of the close contacts.The effective doses and precaution times of different persons were calculated according to relevant formula.Results The dose rate a person received at the same time points (1,54,78,and 109 d,respectively) decreased along with the increase of the distance from the skin (t =5.962,5.961,5.961,5.962,P ＜ 0.05).and the dose rate a person received at the same distance from the skin decreased along with the extension of time (30 cm:t =6.236,6.236,6.235,P＜0.05;100 cm:t=7.310,7.315,7.314,P＜0.05).At different time points,the dose rates at 30 cm distance point were all significant higher than those at the 100 cm point (P ＜0.05).The adult living together,minors and pregnant women sharing the room,colleagues,adults who slept together with the patients began to reach the 50％ dose constraint values 0,54,78 and 109 days after the operation.Conclusions After their precaution time,it's safe to contact with the patients for the groups;otherwise,it's necessary to take some protect works within the precaution time.

Objective It aims to construct an evaluation index system for the development level of intelligent health insurance,which can serve as a reference for health insurance management departments in assessing the develop-ment level of intelligent health insurance and the implementation of health insurance informatization.Methods Key events in intelligent health insurance were identified based on event system theory and text analysis.The evaluation index system was determined through a combination of expert interviews and Delphi expert consultations.The entro-py method was used to calculate the weights of each index,followed by the assessment of the current and ideal de-velopment levels.Results A total of 16 experts were consulted.After two rounds of Delphi expert consultation,two first-level indicators and 18 second-level indicators were finally included in the system.The current development level of intelligent health insurance in China is at the intelligent development stage(2.524 points),while the ideal de-velopment level is at the intelligent improvement stage(4.073 points).The positivity coefficient of both rounds of Del-phi expert consultation was 100%,with an authority coefficient of 0.842,and the degree of expert coordination im-proved with each round.Conclusion The constructed evaluation index system exhibits high scientificity,stability,and generalizability.It can provide an effective evaluation tool for the development of intelligent health insurance in various pooled areas.

It dified framework of health system resilience analysis.The research integrates practical elements from the case of the online pandemic material procurement and allocation hall in Nanjing,categorizing the resilience-building of local health systems via informatization into two distinct dimensions:static foundation and dynamic endowment.It conducts an in-depth examination of the logical pathways that leverage informatization to bolster resilience,and further investigates the inherent advantages and potential areas for optimization within informatization.The findings suggest that the synergistic empowerment of both static foundation and dynamic endowment effectively amplifies the risk defense capability and resilience of local health systems.

Information collaboration is an important realisation path to deepen the reform of the medical and health system and to promote the collaborative development and governance of the"Three Medicine"during the"14th Five-Year Plan"period.It employs the SFIC model and makes appropriate modifications to it.The analytical framework comprises six elements:"initial conditions-external environment-catalytic leadership-institutional de-sign-collaborative process-results feedback".This framework is used to dissect the current collaborative dilemma in the"Three Medicine"information collaboration and governance.Based on this analysis,an optimized path for infor-mation collaborative governance is proposed:consolidating the foundation of"Three Medicine"information collabora-tion,enhancing the catalytic leadership capability of meta-governance,optimizing the institutional design of informa-tion life-cycle governance,reshaping the information collaboration process,and focusing on the evaluation feedback mechanism.

OBJECTIVE：To provide reference for scientific decision-making of evaluation and application of clinical comprehensive value of drugs from the perspective of the public decision-making in China. METHODS ：Based on relevant documents and literatures ，drug clinical comprehensive value in other countries and areas ，the core indicators of drug clinical comprehensive value evaluation in China were confirmed. The concept and evaluation methods of each indicator were evaluated ， and relevant suggestions were put forward. RESULTS & CONCLUSIONS ：It’s suggested that the core indicators of China ’s drug clinical comprehensive value evaluation are safety and efficacy ，economy and affordability ，accessibility and fairness adherence ， suitability. The concepts of safety ，efficacy，economy，affordability and adherence indexes are clearly defined ，evaluation methods are systematic ，data sources are sufficient ，and international consensus exists in research design. There is no uniform definition of accessibility which composed of availability ，deliverability，availability，affordability and timeliness. The concept of equity is clearly defined and the evaluation method is systematic ，but the data source is insufficient. Appropriateness is evaluated by drug suitability index but there is no clear definition. Taking efficacy as an example ，efficacy includes intermediate indicators ，outcome indicators and quality of life indicators ，which are often confirmed by epidemiological research ，systematic evaluation and expert consensus. It ’s suggested that the Real World Study data should be used as much as possible when selecting or formulating the clinical comprehensive value indicators of drugs. With the help of multi-criteria decision-making analysis ，technical support should be provided by professional evaluation institutions ，and with the support of experts and researchers ，the above indicators should be empowered to form the clinical comprehensive value judgment of a drug by different public decision-making departments ，so as to decide whether to purchase ，use clinically ，or incorporate medical insurance reimbursement.

OBJECTIVES: To compare the differences in clinical characteristics between Type 1 diabetes mellitus (T1DM) and fulminant Type 1 diabetes mellitus (FT1DM), and to reduce the missed diagnosis, misdiagnosis, and mistreatment of FT1DM by medical staff. METHODS: A total of 101 hospitalized patients with T1DM (including 8 cases of FT1DM) were enrolled in this study from Changsha Central Hospital between June 2012 and December 2018. Clinical characteristics of the 8 FT1DM patients were collected and compared with all T1DM patients. RESULTS: All FT1DM patients were adult with the average age of (30.25±5.28) years old, accompanied by severe diabetic ketoacidosis (DKA) occurred within 1 week after onset. Moreover, pancreatic beta cells in these patients were destroyed and the islet-related antibodies were negative, while the serum pancreatic enzyme levels were increased. Compared with classic T1DM patients, the plasma glucose levels in FT1DM patients were much higher [(41.89±12.54) mmol/L vs (22.57±9.74) mmol/L], but glycosylated hemoglobin (HbA1c) and fasting C peptide levels were significantly lower [(6.08±0.41)% vs (10.87±2.46%)%, CONCLUSIONS The onset time of FT1DM patients is very urgent via driving DKA. These patients have higher blood glucose concentration than classic T1DM patients, accompanied by electrolyte disturbances, impaired renal function, partially impaired liver function, as well as gastrointestinal symptoms and elevated trypsin. Most FTDM patients are adolescents and adults with no gender difference, especially pregnant women who are at high risk. Lifelong insulin dependence in FT1DM patients should be paid more attention in clinical treatment.
Adolescent ; Adult ; Diabetes Mellitus, Type 1/complications* ; Diabetic Ketoacidosis ; Female ; Glycated Hemoglobin A/analysis* ; Humans ; Insulin ; Pregnancy ; Sex Factors ; Young Adult