The medical and health reform at grass-root level was monitored during the NPC and CPPCC from 2015-2017 . The public sentiment on medical and health reform at grass-root level in recent years was thus as-sessed according to the text mining and data analysis using the R language and Python method from the aspects ofnow rural cooperative medical care,comprehensive health reform at grass-root level,health service develop-ment at grass-root level and Internet + medical care in order to provide reference for the effective feedback of achievements and development in policies of medical and health reform at grass-root level.

Objective To study the clinical features and antifungal therapeutic effects in nonacquired immune deficiency syndrome(AIDS)patients with cryptococcal meningitis. Methods One hundred and fifty-four non-AIDS patients with cryptococcal meningitis admitted to Huashan Hospital, Fudan University from 1997 to 2007 were reviewed retrospectively. Clinical characteristics, initial antifungal therapies and outcome of these patients were analyzed. Continuous variables were analyzed using t test and categorical variables were compared by X~2 test or Fisher's exact test. Kaplan-Meier survival curves of different therapies were compared with log-rank test. Results Fifty-one patients (33.12%)had one or more predisposing factors. Headache, fever, meningeal irritation, vomiting and altered mental status were common clinical symptoms and signs during the course of diseases. The positive rates of cerebrospinal fluid(CSF)smear, CSF culture and detection of CSF cryptococcal capsular polysaccharide antigen were 88.44%,78.95%and 100.00%,respectively.Twelve cases were excluded because treatment durations were less than 7 days, including 9 died,2 discharged against medical advice due to illness exacerbation and 1 lost after against medical advice discharge. The remaining 142 patients were evaluated for therapeutic effects. The effective rates in amphotericin B (AmB)group, fluconazole group and AmB plus fluconazole group were 78.3%(36/46),33.3%(8/24)and 76.0%(38/50),respectively. The therapeutic effects in AmB group and AmB plus fluconazole group were superior to fluconazole group(X~2=13.6354,12.5509;P＜0.01).Eleven patients were lost during 1-year follow-up. The attributable and overall mortality in the remaining 143 patients were 19.58% and 28.67%,respectively.The 1-year survival rates in AmB group and AmB plus fluconazole group were significantly higher than that in fluconazole group. Conclusions The mortality of non-AIDS cryptococcal meningitis is still high,which is closely correlated with initial antifungal therapies. AmB alone or combined with flucytosine is related to both higher successful response and higher survival rate, while the efficacy of initial fluconazole alone or combined with flucytosine is poor.

Objective To analyze the clinical characteristics of brucellosis cases with fever of unknown origin (FUO) as initial manifestation,and to further raise awareness of doctors in non-epidemic areas.Methods Clinical data of 19 brucellosis cases with FUO as initial manifestation in Huashan Hospital,Fudan University and Jing'an branch from June 2005 to July 2016 were collected.The epidemiological,clinical,assistant examination,imaging,treatment and prognosis data of these patients were retrospectively analyzed.Results The average age of the 19 cases was 48 years old,of whom 3 were female and 16 were male.Seventeen cases had the history of contact with sick livestock or epidemic areas.The main clinical manifestations were hepatomegaly or splenomegaly or lymphadenectasis (14 cases),bone,joint and spine involvement (9 cases),orchitis (3 cases),encephalopathy and peripheral neuropathy (1 case),infectious myelitis (1 case) and sequelae of infectious transverse myelitis (1 case).Brucella was detected in 7 patients by blood culture.The agglutination test of serum antibody were 100％ positive.All patients got improvement after anti-Brucella therapeutic regimen based on doxycycline.Conclusion Brucellosis should be considered for patients with FUO from non-epidemic areas according to clinical and epidemic features.

significantly save the time of diagnosis and facilitate the clinical application of large samples.

Objective To evaluate the sensitivity and specificity of BP180NC16a-ELISA in the diagnosis of bullous pemphigoid (BP). Methods A multi-center, randomized, double-blind, parallel-controlled study was conducted. Sera were collected from 106 patients with clinically confirmed active BP and 106 control subjects including patients with non-BP bullous diseases, scleroderma, psoriasis or systemic lupus erythematosus,late pregnant women and healthy blood donors. BP180NC16a-ELISA was performed on these sera. The IgG antibody levels measured by ELISA kit were compared with those measured by indirect immunofluorescence (IIF) test. Results Of the 106 BP sera, 81 were positive for BP180NC16a-ELISA with a sensitivity of 76.4%,83 for ⅡF test with a sensitivity of 78.3%. Among the 106 control serum samples, 95 were negative for BP180NC16A-ELISA with a specificity of 89.6%, and 102 for ⅡF test with a specificity of 96.2%. There was no significant difference between the two tests in dignostic sensitivity and specificity for BP (both P ＞ 0.05).Conclusion BP180NC16A-ELISA may serve as an adjuvant tool for the diagnosis of BP.

Objective To evaluate the performance of desmoglein (Dsg)1 enzyme-linked immunosorbent assay (ELISA) in the detection of serum antibodies in patients with pemphigus foliaceus (PF). Methods Sera were obtained from 80 patients with PF and 132 human controls including 33 patients with bullous pemphigoid, 3 patients with linear IgA bullous dermatosis, 2 patients with acquired bullous epidermolysis, 20 patients with systemic lupus erythematosus (SLE), etc, and subjected to a random and blind test by Dsg1 ELISA and indirect immunofluorescence (IIF) on monkey oesophagus. Results The Dsg1 ELISA was positive in 75 (93.8%) patients with PF and 5 (3.8%) human controls (including 1 case of bullous pemphigoid, 1 case of SLE, 1 case of dermatomyositis, 1 case of eczema and 1 normal human control with indeterminate value), and IIF was positive in 71 (88.8%) patients with PF, but in none of the controls. The sensitivity and specificity was 93.8% (95% CI: 0.85 - 0.98) and 96.2% (95% CI: 0.91 - 0.99) respectively for Dsg1 ELISA in the serodiagnosis of PF, 88.8% (95% CI: 0.82 - 0.96) and 100% (95% CI: 0.96 - 1.00) respectively for IIF. There was no statistical difference in the sensitivities (P= 0.289) or specificities (P= 1.000) between the two test methods.Conclusions Dsg1 ELISA is a simple, sensitive and specific serological detection method, and can serve as an adjunct in the diagnosis of PF.

Type 2 diabetes mellitus(T2DM)is a metabolic disorder caused by excessive energy intake and insufficient consumption,which is mainly characterized by the dysfunction of islet β-cell dysfunction and insulin resistance(insulin resistance,IR).In modern medicine,oral administration of T2DM may be accompanied by adverse reactions such as liver and kidney function injury.Studies have proved that traditional Chinese medicine has the significant superiority of multi-target,multi-component and multi-pathway.Mitochondria are the main organelles for cells to provide energy.They supply energy to ATP through oxidative phosphorylation(OXPHOS)reaction to maintain the functional balance of cells.There are closely related to the occurrence of T2DM between mitochondrial dysfunction,abnormal mitochondrial dynamics and impaired mitochondrial autophagy.Mitochondria has been gradually confirmed as the target of traditional Chinese medicine in the treatment of diabetes,but there is a lack of an overview of the effects of traditional Chinese medicine on T2DM by regulating mitochondrial-mediated inflammation.Therefore,this paper reviews the relationship between mitochondrial-mediated inflammation and T2DM,and the mechanism of traditional Chinese medicine to interfere with T2DM by regulating mitochondrial-mediated inflammation.

Objective To report two cases of meningitis caused by Corynebacterium and review relevant literature to enhance clinical awareness of the pathogenicity of Corynebacterium species.Methods The clinical details were reported for 2 cases of meningitis caused by Corynebacterium.Similar case reports were retrieved from PubMed,CNKI,Wanfang,VIP,and CBM databases using search terms"Corynebacterium meningitis"and"cerebrospinal fluid shunt infection".Clinical data of the identified patients were reviewed and analyzed.Results Both patients with meningitis caused by Corynebacterium developed symptoms of fever,abdominal pain,and unconsciousness following lumboperitoneal shunt procedures.The culture of cerebrospinal fluid was positive for Corynebacterium.Both patients improved significantly after vancomycin treatment.Literature search yielded 29 similar cases.Overall,the 31 cases(including the two cases in this report)included 20 males and 11 females,aged between 4 weeks to 87 years.The identified Corynebacterium species included C.jeikeium in 12 cases,C.striatum in 9 cases,C.xerosis in 2 cases,C.bovis in 2 cases,C.aquaticum,C.equine,and C.minutissimum one case each,and unspecified Corynebacterium species in 3 cases.Underlying diseases were reporetd in most patients,including immune disorder in 2 cases,malignant tumor in 8 cases,genetic disease in 2 cases,premature with hydrocephalus in 4 cases,brain trauma in 2 cases,intracranial vascular malformation in 2 cases,and cerebral aneurysm in 2 cases.Risk factors for Corynebacterium meningitis included chemotherapy for malignancy in 5 cases,long term use of steroids and immunosuppressants in 2 cases,invasive procedures in 24 cases,and prior antibiotic use in 11 cases.Vancomycin was the most commonly prescribed treatment.The drainage tube and/or venous catheter were also removed or replaced in 19 cases.Twenty-five patients recovered after treatment and 6 patients died.Conclusions Corynebacterium species are emerging as opportunistic pathogens.Clinicians should be aware of the infections caused by Corynebacterium if patients have undergone invasive procedures or are immunocompromised,especially when associated with fever,altered consciousness,and clinical signs of encephalitis/meningitis.If cerebrospinal fluid test is positive for Corynebacterium,specific treatment should be prescribed promptly for Corynebacterium infection.

Objective To investigate the clinical characteristics of chronic invasive fungal rhinosinusitis.Methods Clinical features and outcomes of 46 proven cases of chronic invasive fungal rhinosinusitis admitted in Huashan Hospital,Fudan University from January 2009 to December 2016 were retrospectively reviewed.Results Of the 46 patients enrolled,left sphenoid sinus,ethmoid sinus and maxillary sinus were affected in 24,23 and 20 cases,respectively,while right maxillary sinus,ethmoid sinus and sphenoid sinus were affected in 18,16 and 15 eases,respectively.Left and right frontal sinus were affected in 9 and 6 cases,respectively.The central nervous system and orbit were the most commonly affected sites in external nasal involvements,noted in 22 cases respectively.Left sphenoid (17 cases) and ethmoid sinus (15 cases) involvements were most common in central nervous system affected patients.Left sphenoid (14 cases) and ethmoid sinus (13 cases) involvements were most common in orbit affected patients.Aspergillus species were the primary pathogens observed in 42 eases.Zygomycete,candida and dark filamentous fungus were observed in two,one and one case,respectively.Pathologically,37 of the cases were chronic nongranulomatous type and the left 9 were chronic granulomatous type who were all immunocompetent hosts.The initial symptoms usually included headache,dizziness and nasal discomforts including nasal obstruction and purulent secretion.The chief complaints usually included headache,dizziness,and visual disturbances including blurred vision,vision loss or even blindness.Antifungal treatment combined with surgical interventions for removal or drainage focus lesions achieved significant effect,and 42 patients were cured.Conclusions Chronic invasive fungal rhinosinusitis should be taken into consideration in the presence of nasal discomforts or nonspecific symptoms such as headache and dizziness.The possibility of chronic invasive fungal rhinosinusitis should be cautious after the emergence of vision abnormalities.

OBJECTIVE： To investigate current status and quality of domestic pharmacoeconomic literatures， and to provide reference for the standardization of pharmacoeconomic research. METHODS： Retrieved from CNKI， Wanfang， VIP and other database， the pharmacoeconomic literatures published from Jan. 2017 to May 2018 were collected. The qualities of literatures were evaluated with Guidelines for Quality Evaluation of Pharmacoeconomics Evaluation Reports （“PEERs” for short）. RESULTS： Totally 160 domestic pharmacoeconomic research literatures were included. The results of PEERs evaluation showed of which the coincidence rate was 32.5％ （52/160）. The literatureswhich were in full compliance （the report had a certain reference value） accounted for 1.3％ （2/160）， which were in basic compliance （the report had certain reference value after being revised） accounted for 31.3％（50/160），which were in non-conformity （the report did not had reference value） accounted for 67.5％（108/160）. Domestic pharmacoeconomic researches were of high quality in terms of research object， evaluation method and content，research purpose，  research design and design type， etc.； but the researches were of low quality in terms of research angle， incremental cost/incremental output analysis， sensitivity analysis and other aspects， and there was no explanation or unclear elaboration. CONCLUSIONS： The quality of domestic pharmacoeconomic research literatures are uneven， and their research quality needs to be further improved. It is recommended to standardize the evaluation of pharmacoeconomics， making the evaluation of pharmacoeconomics more scientific and objective.