Following an analysis of the problems and challenges of hospitals regulation in China and a comparative study of situations at home and abroad,this paper presented six policy proposals for the reform of public hospitals regulatory system in China.The policy suggestions included definite regulatory objectives,defined relationship between public hospitals and government,strengthening both economic regulation and social regulation, establishing multivariate regulatory system, introducing flexible regulatory methods and full utilization of the third-party impact,which met the requirements of public hospital in healthcare reform in China and propelled the reform forward.

Objective:To analyze the characteristics of adults (non-pregnant women) infected with Listeria monocytogenes and to provide evidence for diagnosis and treatment of this disease. Methods:Patients admitted in West China Hospital of Sichuan University between January 2008 and April 2020 with Listeriadisease were enrolled in this study. The clinical data of patients including age, symptoms, underlying diseases and prognosis, as well as the laboratory results of WBC, neutrophil ratio (N%), procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP), were obtained for analyzing the clinical infection and prognosis characteristics of the patients. Results:A total of 57 patients were included, patients were 18-83 (52.8±15.9) years old, percent of over 60 years old patients accounted for 35.09% (20/57). The incidence rate in summer season was the highest (45.61%, 26/57). There were 48 cases with comorbidities, sepsis occurred in 31 cases and meningitis in 18 cases. The time of diagnosis of Listeriosis was (6.1±2.9) days. After diagnosis, the target therapy was applied: such as carbapenem (26.32%, 15/57) and penicillins (22.81%, 13/57). The levels of WBC (6.77 [2.99, 9.54]×10 9/L vs 10.23 [6.71, 16.55]×10 9/L), NLR (3.07 [1.66, 8.16] vs 11.26 [5.66, 20.08]) and CRP (40.7 [16.9, 91.9] g/L vs 92.8 [59.9, 142.7] g/L) were significantly lower after treatment than those before treatment in 47 hospitalized patients (all P<0.05). Thirty-eight patients were treated according to the guidelines, 33 cases improved, 2 cases had poor prognosis and 2 cases died. Conclusion:The main risk factors of Listeria monocytogenes infection in adults (non-pregnant women) are underlying diseases, especially autoimmune diseases and pulmonary infections. Penicillins can be used as the first choice for empirical therapy. Carbapenems and erythromycin serve as the combination medications during the full course of treatment.

Objective To study the effect of ulinastatin (UTI) on blood gas analysis in rabbits with acute lung injury (ALI) after an explosion.Methods A total of 24 healthy New Zealand white rabbits were made to be ALI models by an explosion at a distance of 11 cm.The rabbits met the criteria of ALI,and were randomly (random number) divided into A and B groups.In group B,rabbits received UTI injected at 0.5 h,6 h,12 h,24 h after modeling.In group A,an equal volume of saline was given to rabbits instead at the same intervals after modeling.Arterial blood pH,carbon dioxide partial pressure (PaCO2) and partial pressure of blood oxygen (PaO2) were determined by a portable blood gas analyzer before modeling and at given intervals after modeling.All rabbits were sacrificed after 48 h later.The pathological changes of lung tissue were observed with naked eye and extent of lung injury with HE staining.Results Compared with group A,pulmonary edema and infiltration of inflammatory cells in the lungs of rabbits in group B were less significant.The blood gas analysis showed there were significant difference in pH at 24 h after injury between group A (7.24 ± 0.07) and group B (7.35 ± 0.06),P ＜ 0.05.There was significant difference in PaO2 at 24 h after injury between group A (50.5 ± 9.9) mmHg and group B (78.1 ± 8.4) mmHg,P ＜ 0.05.And there was significant difference in PaCO2 at 24 h after injury between group A (52.4 ± 5.5) mmHg and group B (42.8 ± 4.5) mmHg,P ＜ 0.05.Conclusion UTI can significantly reduce acidosis,PaCO2 and increase PaO2 in rabbits with ALI following a blast,improving oxygenation and mitigating lung histopathological changes.

Objective To investigate the prevalence of glomerular microthrombosis in lupus nephritis (LN) and the significance of antibodies to anti-coagulation related factors and anti-phospholipid antibodies in glomerular microthrombosis (GMT).Methods Kidney biopsy specimens and plasma samples were obtained consecutively from 124 patients with LN. Kidney biopsy specimens were examined for the presence of glomerular microthrombi.Plasma samples from 25 LN patients with GMT (LN-GMT group) and 99 LN patients without GMT (LN-non-GMT group) were tested for lupus anticoagnlant (LA) and antibodies to cardiolipin (ACL),β2 glycoprotein I (β2GP I ),plasmin,thrombin,tissue plasminogen activator (t-PA) and Annexin A II.Results The prevalence of GMT in LN patients was about 20.2%.Compared to LN-non-GMT group,LN-GMT group had elevated SLE disease activity indices (SLEDAI),elevated activity and chronicity indices of kidney tissue injury,and elevated serum creatinine,blood urea nitrogen and proteinuria levels,and also had a higher frequency of hypertension (P＜0.01).The positive rates of LA,IgG class anti-β2GP I and anti-thrombin antibodies were higher in LN-GMT group than in LN-non-GMT group (P＜0.05).The positive rates of IgG class antibodies to ACL,plasmin,t-PA and Annexin A II in LN-GMT group were not statistically different from those in LN-non-GMT group (P＞0.05).No difference was found in the positive rate of any IgM class antibody between the two groups (P＞0.05).Conclusion This study has shown that GMT occurs approximately in 20.2% of the LN patients.Patients with GMT have more severe kidney tissue injury and more poor renal outcomes than patients without GMT.LA and antibodies to β2GP I and thrombin play a role in glomerular microthrombosis in lupus nephritis.

Objective To compare the clinical efficacy and safety of pegylated interferon α-2a (Peg IFN α-2a) or adefovir dipivoxil(ADV) monotherapy and their combination therapy in HBeAg positive chronic hepatitis B (CHB) patients. Methods An open randomized controlled multicenter clinical trial was performed. One hundred and twenty cases with CHB were divided into 3 groups: Peg IFN α-2a monotherapy (group A), ADV monotherapy (group B) and Peg IFN α-2a plus ADV combination therapy (group C). The virological response (VR), serological response (HBeAg, HBsAg clearance and seroconversion), biochemical response (BR) and sustained response (SR) were tested at week 24 and 48 of therapy and week 48 of follow-up after end of treatment (EOT) for'evaluation of therapeutic effects, safety and drug resistance. The efficacy was compared using X2 test. Results At week 48 of treatment, the VR (HBV DNA ≤500 copy/mL) rates were 36. 8%(14/38), 37. 5%(15/40) and 62. 9% (22/35), respectively in groups A, B and C; that in group C was higher than those in groups A and B (X2 = 4. 933, 4. 801, respectively; both P < 0. 05); HBeAg seroconversion rates in three groups were 44. 7% (17/38), 17. 5% (7/40) and 51. 4% (18/35), respectively. At week 48 of follow-up,SR rates in three groups were 34. 2%(13/38), 15. 0%(6/40) and 48. 6% (17/35), respectively; those in groups C and A were higher than that in group B (X2 = 9. 894,P<0. 01;X2 =3. 903, P<0. 05, respectively). Conclusions VRs at week 24 and 48 of Peg IFN α-2a plus ADV combination therapy are better than Peg IFN α-2a or ADV monotherapy. SRs at week 48 of follow-up after Peg IFN α-2a monotherapy and combination therapy are both better than ADV monotherapy.

BACKGROUNDRevision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure.

METHODSOne hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed.

RESULTSFifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees).

CONCLUSIONTechnical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction ; adverse effects ; Female ; Humans ; Joint Instability ; etiology ; Male ; Middle Aged ; Retrospective Studies

Objective Based on ergonomics and biomechanics simulation technology, the biological evaluations of human muscles and the rehabilitation strategies of foot rehabilitation robot with adjustable swing were carried out and studied. Methods The human-robot coupling model of human body and foot rehabilitation robot with adjustable swing were established by using AnyBody software. Through kinematics simulation of the coupling model, the comparison between the simulation result and the theoretical calculation result confirmed reliability of the coupling model. The parameter study of AnyBody software was used to perform the biomechanical simulation of the verified coupling model. By regarding velocity and swing of the foot rehabilitation robot as variables, the muscle activity and muscle force under different combinations of variables were analyzed. ResultsDuring rehabilitation exercise, stretching performance of the foot related-muscles was effectively trained. The influence of different velocity and swing amplitude on muscles was different, and safety range of the velocity and swing adjustment was obtained. Conclusions The combined analysis of muscle activity and muscle force under different velocity and swing was achieved. The results have certain guiding significance on clinical application of foot rehabilitation robot and formulation of rehabilitation strategies in passive rehabilitation mode.

OBJECTIVETo investigate the influence of activated complement on the secretory function of peritoneal macrophage (PMphi) in the production of nitric oxide (NO) and tumor necrosis factor-alpha (TNF-alpha), especially in the role of different G-protein subtypes in this process after burns.

METHODSThe mice inflicted by 18% TBSA full-thickness scald was established and employed as the model. And the mice were divided into A (the complements were preserved and activated) and B (with intraperitoneal injection of CVF to deplete complement before scald) groups. The plasma of the mice in the two groups was collected at 6 postburn hour (PBH) and cultured with PMphi from normal mice. The PMphi were pretreated with pertussis toxin (PT) and with cholera toxin (CT). The NO and TNF-alpha levels in the supernatant of normal PMphi culture with different pretreatment were measured by Greiss assay.

RESULTSThe NO and TNF-alpha contents in group A [(80 +/- 12) micromol/L, (46 +/- 6)%] were obviously higher than those in group B [(34 +/- 5) micromol/L, (26 +/- 5)%, P < 0.01]. The NO content produced by PMphi (45 +/- 10 micromol/L) in A group decreased (P < 0.01), while the TNF-alpha activity (58 +/- 10)% increased by PT pretreatment (P < 0.05). On the contrary, the NO content produced by PMphi (105 +/- 18 micromol/L) in group A increased (P < 0.01), while the TNF-alpha activity (27 +/- 6)% decreased by CT pretreatment (P < 0.01).

CONCLUSIONThese results indicates that the secretory function of normal PMphi can be enhanced by complement activation after thermal injury, which might partly be due to the effect of activated complement components through complement receptor coupled G-protein. In the secretory function of complement stimulated Mphi, Gi protein has a major role in the production of NO, Gs protein is mainly involved in the secretion of TNF-alpha.

Animals ; Burns ; immunology ; metabolism ; Complement Activation ; Complement System Proteins ; metabolism ; Female ; GTP-Binding Proteins ; metabolism ; Macrophage Activation ; immunology ; Macrophages, Peritoneal ; secretion ; Male ; Mice ; Mice, Inbred Strains ; Nitric Oxide ; biosynthesis ; Signal Transduction ; Tumor Necrosis Factor-alpha ; biosynthesis

Objective:To investigate the correlation of isokinetic thigh muscle asymmetry with gait asymmetry at one year after anterior cruciate ligament (ACL) reconstruction.Methods:A retrospective case series analysis was made on 25 patients treated by ACL reconstruction in Third Hospital of Peking University from January 2014 to January 2019. All the subjects were male, aged 17-47 years [(29.4±5.2)years]. Standard rehabilitation treatment procedures were conducted after surgery. The isokinetic muscle strength of the thigh was collected at one year after operation to evaluate knee extensor and flexor concentric strength at 60°/s, 180°/s and 300°/s, and knee extensor and flexor eccentric strength at 60°/s. The maximum concentric and eccentric strength of the knee extensor and flexor were analysed between the injured and intact side. The three-dimensional motion information and ground reaction force was collected during the stance phase of gait, and knee kinematic and kinetic parameters were calculated by inverse dynamics analysis, including the peak flexion moment, peak extension moment, first and second peak adduction moment, peak external and internal rotation moment, peak flexion angle, peak extension angle during the terminal stance phase, flexion angle at heel strike, peak abduction angle, and peak external rotation angle during terminal stance phase. Spearman correlation analysis was used to study the correlation between limb symmetry index (LSI) of isokinetic muscle strength and LSI of gait parameters.Results:One year after ACL reconstruction, the maximum concentric strength of the knee extensor and flexor at 60°/s, 180°/s and 300°/s and maximum eccentric strength of the knee flexor and extensor at 60°/s on the injured side were significantly lower than those on the normal side (all P<0.01). Compared with the intact side, the peak knee extension moment on the injured side was significantly lower during the stance phase of gait ( P<0.01), and the extension angle was insufficient during the terminal stance phase ( P<0.01). There were no significant differences between the injured and intact side in terms of peak flexion moment, first and second peak adduction moment, peak external and internal rotation moment, peak flexion angle, flexion angle at heel strike, peak abduction angle, and peak external rotation angle during terminal stance phase (all P>0.05). One year after ACL reconstruction, Spearman correlation analysis during gait stance phase showed that the LSI of 60°/s concentric strength of the isokinetic knee extensor was significantly related to LSI of peak internal rotation moment ( R=0.42, P<0.05), the LSI of 180°/s concentric strength of the isokinetic knee extensor was significantly related to LSI of peak flexion moment ( R=0.45, P<0.05), the LSI of 180°/s concentric strength of the isokinetic knee flexor was significantly correlated with LSI of peak flexion angle ( R=0.46, P<0.05), the LSI of 300°/s concentric strength of the isokinetic knee extensor was significantly correlated with LSI of peak knee flexion angle ( R=0.42, P<0.05), and the LSI of 60°/s eccentric strength of the isokinetic flexor was significantly correlated with LSI of peak knee flexion angle ( R=0.54, P<0.01). Conclusions:For patients following ACL reconstruction at one year postoperatively, a significant correlation of isokinetic thigh extensor strength asymmetry with peak knee flexion and rotation moment and peak knee flexion angle, and that of isokinetic thigh flexor strength asymmetry with peak knee flexion angle are observed during the stance phase of gait, which suggests that patients with ACL reconstruction still need systematic rehabilitation training one year postoperatively to improve muscle strength and motor function so as to reduce the risk of ACL reinjury and secondary injury.

OBJECTIVES: This study aimed to investigate the common types and directions of root fractures of the maxillary first molar and the influence of root canal treatment on the prevalent sites of root fractures. METHODS: A total of 274 maxillary first molars with root fractures diagnosed via cone beam computed tomography were included. The root fractures of nonendodontically and endodontically treated teeth were identified to be spontaneous and secondary root fractures, respectively. The sites, types, and directions of spontaneous and secondary root fractures were determined. RESULTS: Among the spontaneous root fractures, the proportion of palatal root fractures (56.1%) was higher than those of mesial buccal root fractures (36.1%) and distal buccal root fractures (7.8%). Among the secondary root fractures, the proportion of mesial buccal root fractures (52.7%) was higher than those of palatal root fractures (36.5%) and distal buccal root fractures (10.8%). The distribution of predominant fracture sites was statistically significant ( CONCLUSIONS This study provided an epidemiological basis for the clinical features of root fractures of the maxillary first molar. During the dia-gnosis and treatment of the maxillary first molar, the possibility of palatal root fractures should be considered. The occurrence of mesial buccal root fractures may be related to root canal treatment. Therefore, the risk of mesial buccal root fractures caused by iatrogenic factors should be minimized.
Cone-Beam Computed Tomography ; Humans ; Molar ; Root Canal Therapy ; Tooth Root ; Tooth, Nonvital