Objective To investigate the relationship between polymorphisms of candidate genes 〔glucokinase (GCK) gene, NIDDM1(D2S140) gene, fatty acid bindingprotein2(FABP2)gene〕and type 2 diabetes mellitus (DM) in Shandong Chinese Han population. Methods Short tandem repeat (STR) region polymorphisms of GCK gene, NIDDM1 gene and FABP2 gene were analyzed with the polymerase chain reaction and polyacrylamide sequencing gel in 107 patients with type 2 diabetes mellitus and 105 normal subjects. The subjects studied were unrelated and they are Chinese Hans living in Shandong province and no diabetes family history was revealed. Results A5 allele of GCK gene and B2 allele of NIDDM1 gene were positively related with type 2 diabetes (RR=15.70, P0.05). Logistic regression analysis showed that A5 allele and B2 allele were among the risk factors of type 2 diabetes. Conclusion Polymorphic microastellite repeat markers at the glucokinase gene and the NIDDM1 (D2S140) gene locus are associated with type 2 diabetes in Chinese. The polymorphism at the FABP2 locus is not a genetic marker for type 2 DM in Chinese Hans.

Objective To determine the relationship between the polymorphism of D2S140 gene and type 2 diabetes mellitus.Methods D2S140 region polymorphism were analyzed with the polymerase chain reaction and short tandem repeat methods in 103 subjects with type 2 diabetes mellitus and 105 nondiabetic subjects.All subjects were biologically unrelated Chinese without a family history of DM.Results There were 7 alleles ranging from 151bp to 163bp in all subjects.The frequencies were 0.01 to 0.37,2 alleles were more common in diabetic patients than in nondiabetic subjects (RR=16.04, P

The paper presented the payment system theory of the primary health care service in China,the current status of the health service system,and analyzed main challenges for the time being.Based on such studies,the authors made the following policy proposals.The first is adjustment of the fiscal payment method of the government to such institutions in line with the classification guidance principle; the second is to shift the payment method of primary public health services to the post payment of fee-for-service; the third is reform of the performance-based salary system to link payment to medical workers directly with the amount and quality of their services; the fourth is a set of result-oriented performance appraisal indicators,with rising proportion of performance pay; the fifth is to integrate the outpatient clinic fund covered by medical insurance and the primary public health service fund,into a capitation payment.

Based on summarizing the international experiences and reviewing the historical evolution and current situation of the physicians'compensation system of public hospitals in China,this paper clarified the existing problems of the current compensation system.Such problems namely included lack of security on the source of the physicians'compensation,low level of sunshine salary which caused thecompensatory mechanism,lack of scientific design of the salary structure and allocation,as well as other underlying causes.Drawing lessons from reform practices at home and abroad,the basic principles and reform directions were put forward,as well as 4 route selections,namely establishing an security investment system to guarantee a stable and higher level salary under the current compensation system, implementing a high level of flip-type annual compensation with locking the current salary into files, establishing an appropriate compensation system referring to an innovated evaluation system of physicians in public hospitals,and coordinating closely with public institution reforms to promote physicians' compensation system reform.

Objective To investigate the expressions of Pokemon and c-myc in colorectal cancer,colorectal adenomas and normal colorectal mucosa tissues,and demonstrate its relationship with clinicopathological features and prognosis in patients with colorectal cancer.Methods The specimens were taken from colorectal cancer tissue of 86 patients,colorectal adenomas tissue of 60 patients,and 40 normal colorectal mucosa tissue.The expressions of Pokemon and c-myc protein were detected by immunohistochemistry,and the expressions of Pokemon and c-myc gene were detected by reverse transcription polymerase chain reaction (RT-PCR).The correlation between the expressions of Pokemon and c-myc,and clinicopathological features was analyzed.Results The positive expression rates of Pokemon and c-myc protein in colorectal cancer tissue were significantly higher than those in colorectal adenomas tissue and normal colorectal mucosa tissue:69.8％ (60/86) vs.13.3％ (8/60) and 5.0％ (2/40),73.3％ (63/86) vs.15.0％ (9/60) and 2.5％(1/40),and the expression levels of Pokemon and c-myc gene in colorectal cancer tissue were significantly higher than those in colorectal adenomas tissue and normal colorectal mucosa tissue:0.915 ±0.247 vs.0.358 ±0.102 and 0.277 ±0.085,1.272 ±0.360 vs.0.398 ± 0.153 and 0.255 ±0.097,there were statistical differences (P ＜ 0.05).The expression levels of Pokemon and c-myc gene in colorectal cancer tissue had a close correlation with the degree of infiltration,histological differentiation,lymph node metastasis,distant metastasis and Dukes stage,there were statistical differences (P ＜ 0.05),but had no correlation with the sex,age,and tumor diameter (P ＞ 0.05).Conclusions The expression levels of Pokemon and c-myc are higher in colorectal cancer tissue,and the expressions are related to the clinicopathological features of colorectal cancer.The expression levels of Pokemon and c-myc may predict the prognosis in patients with colorectal cancer.

The construction of art mass organization in medical colleges can consummate quality education system,make up insufficiency of the classroom teaching,promote medical students' comprehensive development and innovative ability and mold fine mind and lofty medical ethics.Therefore,it has important theoretical and practical significance to study existing problems and find out the ways to improve art mass organization construction of medical schools.

Objective To study the success rate of ventilator weaning in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients influenced by bobbed endotracheal intubation. Methods One hundred and sixteen AECOPD patients who were given invasive mechanical ventilation and reached the standards of off-ventilator were divided into control group (general endotracheal intubation group) and experiment group bobbed (tracheal intubation) by random digits table method with 58 cases each. The respiratory rate (RR), heart rate (HR), rapid and shallow breathing index (RSBI), oxygenation index (OI), pulse blood oxygen saturation (SpO2), tidal volume and success rate of ventilator weaning were compared. Both groups were implemented of extubation if they reached the standards of the extubation time by observing their ability in spontaneous breathing test (SBT). Results The RR, HR and RSBI before extubation in experiment group were significantly lower than those in control group:(19.7 ± 2.3) times/min vs. (23.5 ± 2.3) times/min, (91.2 ± 6.3) times/min vs. (93.4 ± 8.1) times/min and 80.2 ± 6.7 vs. 90.5 ± 9.6, P<0.05, and the OI, SpO2, tidal volume and success rate of ventilator weaning were significantly higher than those in control group: (269 ± 9) mmHg (1 mmHg = 0.133 kPa) vs. (245 ± 16) mmHg, 0.929 ± 0.014 vs. 0.870 ± 0.037, (6.1 ± 1.2) ml/kg vs. (5.1 ± 0.8) ml/kg and 91.38%(53/58) vs. 77.59%(45/58), P<0.05. Conclusions The bobbed endotracheal intubations can improve the success rate of ventilator weaning in patients with AECOPD.

OBJECTIVE:To understand the knowledge about rational drug use(RDU) in inpatients.METHODS:An cluster sampling investigation was carried out by questionnaire at separate times and in separate groups in 2 419 inpatients in the hospital where the authors work. RESULTS:The majority of the inpatients were concerned much with the drug use,but lacked the knowledge about RDU and had much misunderstanding about drug use.CONCLUSION:The relevant measures must be taken to guide the RDU in patients and to improve the understanding of RDU.

Objective To investigate the clinical characteristics and laboratory examinations in incident dialysis effect on the prognosis of elderly patients undergoing hemodialysis.Methods Ninety-three patients aged 65 years or older initiating hemodialysis were enrolled from Hemadialysis Center of Beijing Hospital from January lst,2007 to June 30th,2016.The duration time of HD of all patients was more than three months.Patients were divided into death group and non-death group.The clinical characteristics and laboratory examinations were compared between the two groups.Cox proportional hazards regression was used for the multivariate analysis to determine independent prognosis factors.Results The average year of patients was 74.2±6.5 years old with 43 months of median time of follow-up.The first two causes of death were infection (n =25,49.0％) and cardiovascular and cerebrovascular diseases (n =16,31.4％).Cox single factor regression analysis showed that the older ages,diabetic nephropathy being the cause of end-stage renal disease (ESRD),complicating with diabetes mellitus or congestive heart failure,the higher Charlson cardiovascular diseases score,ALB being under 35 g/L were correlated with poor outcome respectively(P＜0.05).Cox multivariate regression analysis indicated that older ages (HR =1.056,P =0.021),diabetic nephropathy being the cause of ESRD (HR =2.661,P =0.001),the higher Charlson cardiovascular diseases score (HR =1.675,P =0.010),central venous catheters being vascular access(HR=1.167,P=0.048) on incident dialysis were the main risk factors for mortality in elderly patients.Conclusion The older ages,diabetic nephropathy being the cause of ESRD,the higher Charlson cardiovascular diseases score,central venous catheters being vascular access on incident dialysis are independent risk factors influencing survival of elderly patients.

Objective To explore the clinical pathological characteristics and prognostic factors of patients with neuroendocrine tumor of the appendix.Methods Data of 42 cases of the appendiceal neuroendocrine tumor from June 2006 to June 2016 at Tianjin Police Hospital were analyzed.Tumors were classified according to 2010 WHO classification.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test.Results There were 27 males and 15 females,with median age of 60 years.Tumors located in the head of the appendix in 37 cases,in the body in 2 cases and at the base in 3 cases.The median of tumor sizes were 1.2 cm.G1 in 17 cases,G2 in 21 cases,G3 in 4 cases.The follow-up rate was 100％.The overall 1-year survival rate was 92％.Conclusions The clinical symptoms of appendiceal neuroendocrine tumors are most often nonspecific.The diagnosis depends on pathological examination and immunohistochemistry,and prognosis varies with pathological grades.