ObjectiveTo investigate the clinical efficiency of oral warfarin after cardiac valve replacement and the influence of vitamin K epoxide reductase complex subunit 1(VKORC1) gene polymorphisms on warfarin maintenance dose.MethodsOne hundred and fifty-nine patients who got cardiac valve replacement surgery were chosen and received anticoagulation therapy by oral warfarin.The prothrombin time (PT),international normalized ratio (INR) of patients were recorded and the safety ranges of PT and INR were calculated statistically.VKORC1 gene polymorphism of patients weredetected by PCR-PFLP technology by adjusting the dose of warfarin,and the results were compared.ResultsThe safety monitoring range of PT of oral warfarin after cardiac valve replacement surgery was 15.36 -24.82 s,safety monitoring range of INR was 1.33 - 2.62.The occurrence rate of bleeding during anticoagulation was 13.21％(21/159).The weekly dose of warfarin of VKORC1 gene type AA [(24.28 ± 10.79) mg] was significantly higher than that of VKORC1 gene type GA[ ( 16.64 ± 7.43 ) mg] and type GG[ ( 12.12 ± 7.17 ) mg](P＜ 0.05or ＜0.01 ).ConclusionsThe polymorphism of VKORC1 gene is the dominant factor of the differences of warfarin maintenance dose.The warfarin dose in patients with different gene type is different.The clinical safety monitoring ranges of PT and INR in patients with oral warfarin after cardiac valve replacement are lower than the recommended ranges of European and American countries.Therefore,the index of patients after surgery should be detected regularly.

Objective To understand the occupational prevention status of clinical nurses in Guangdong province.Methods We investigated 500 nurses in 15 class-three-grade-one hospitals in Guangdong province on occupational prevention status by questionnaires.Results The incidence of pricking wound and incised wound by ampule was frequent.The percent of everyday incidence reached 44.2% and 49.0%.There were 68.2% of nurses wore gloves when contacting the body fluid and blood of patients,55.3% of nurses wore gloves when contacting chemotherapeutic drugs,53.1% of nurses wore gloves during hemospasia,57.2% of them wore gloves when handling urine.There were 52.1% of nurses did not use gauze for protection when handling ampule.There were 61.3% nurses knew related protection law,18.2% of nurses knew the coping process after the incidence of occupational injury.58.2% of nurses established related preventive measure and instructions,43.1% of nurses thought it was necessry for hospitals to produce more comprehensive and systemic occupational prevention instructions.Conclusions The cognition of occupational prevention of nurses was weak and they lacked occupational prevention knowledge.It is necessary to strengthen the occupational prevention education and training.

Objective To investigate the inhibitory effect of baicalein on mycoplasma pneumonia and its the protective mecha -nism in body , and to provide scientific experimental basis for prevention and treatment of mycoplasma pneumoniae infection .Methods The mycoplasma pneumoniae and baicalein treated BALB /c mice lung tissues were stained with hematoxylin eosin (HE), and his-topathological grading .Minimum inhibitory concentration ( MIC) of baicalein on mycoplasma pneumonia was determined by real-time quantitative polymerase chain reaction ( PCR) .The expression of P 1 adhesion molecules mRNA and protein in lung tissue of BALB /c mice was determined with reverse transcription-PCR and Western blot .The expression of epidermal growth factor ( EGF) mRNA and protein in lung tissue was detected by quantitative RT-PCR and immunofluorescence .Results Baicalein significantly reduced the my-coplasma treated mice's lung tissue pathological score .The minimal inhibitory concentration of baicalein was 32 μg/ml.Baicalein sig-nificantly downregulated P 1 gene transcription and protein translation , and upregulated EGF gene transcription and protein expression . Conclusions Baicalein shows significant resistance to mycoplasma pneumoniae , and can protect the body against mycoplasma damage by inhibiting the expression of P 1 protein and promoting the expression of EGF protein .

Objective To explore the influence of body position intervention combined with lying position logo on the compliance of patients after vitrectomy needing to keep lying position. Methods A total of 100 patients, who were hospitalized in ophthalmology ward from January to June 2013,received vitrectomy combined with gas or silicone oil filled were involved. All the patients were divided into intervention group (60 cases) and control group (40 cases) according to the order of admission. Patients in control group received routine nursing after retinal vitreous operation, guiding the proper way to keep lying position, putting a sponge pillow, shaping凹, under patients′heads. And some pertinence measures were applied in intervention group on this basis. Results The percentage of the patients who could keep the special position complying with doctor's orders at 72 h and 1 week after the operation were 95.0%(57/60),91.7%(55/60) in intervention group, which were greater than those in control group 80.0%(32/40),75.0%(30/40), and there were significant differences,χ2=4.090,4.003,P<0.05.The mastery of the body position, and the satisfaction of the nursing care were 96.7%(58/60), 98.3%(59/60) in intervention group, which were better than those in control group 77.5%(31/40), 85.0%(34/40),and there were significant differences, χ2=7.154, 4.666,P <0.05. Conclusions Developing a reasonable nursing plan depending on the body position intervention and relevant nursing measures can help the patients comply with doctor's orders effectively, improve comfort,and extend the time to keep the special position,so as to improve postoperative recovery and ensure the success of the operation.

Objective To evaluate the outcomes of the payment reform at public hospitals in Sanming city.Methods Interrupted time series analysis was used to compare changes of the average days of stay,per capita hospitalization expense,outpatient expense per visit,proportion of medical expense and that of drugs during hospitalization at 21 public hospitals at or above county level before and after the DRGs reform.Results Comparisons before and after the reform found the average days of stay at the original momentum,poor control in curbing the proportion of medical expense and that of drugs during hospitalization,adropping followed by rising trend in the outpatient expense per visit,and minimal drop of the abovementioned proportions.Conclusions The rapid growth of outpatient and hospitalization costs at tertiary hospitals may be incurred by unreasonable cost transfer,structural trend of hospitalization expense makeup,and rationality pending scrutiny.

Tripartite-sector reform (a synergistic reform in public health services,medical insurance and medicine production-circulation) in Sanming city was described in the paper which centers on medical insurance.Tapping full potentials of the medical insurance,the city achieved efficient synergy among healthcare,medical insurance and medication systems.This reform has trimmed out inflated drug pricing to some extent for rooms of maneuver of medical service pricing changes,thus curbing excessive growth of medical costs successfully.The authors proposed areas of further improvements including the relationship between achieving such objective as curbing medical expenditure,and advancement of technical/medical service capacity;that between integrative control of medical insurance expenditure and protection of people's health;the equilibrium of interests between medical insurance,healthcare and medication.All these will contribute to the goal of healthy patients flow and a hierarchical medical system.

Objective To investigate the distribution characteristics of serum pepsinogen (PG) in healthy people and its reference interval establishment .Methods 3 753 healthy people were enrolled and divided into <45-year old ,45- <60-year old and ≥60-year old group according to their ages .Double antibody sandwich enzyme-linked immunosorbent assay was used to detect PG Ⅰ ,Ⅱ . Results Detection results of serum PG Ⅰ ,PGⅡ and PGⅠ /PGⅡ of male and female healthy people in different age group showed a skewed distribution(P<0 .05) .Serum PGⅠ and PGⅠ /PGⅡlevels of females were significantly higher than males(P<0 .01) .In the same age group ,difference of serum PGⅡ levels between males and females was not statistically significant (P>0 .05) .In the same gender ,pairwise comparison of PGⅠlevels was conducted in different age groups ,and the difference showed no statistical sig-nificance(P>0 .05) .PGⅡlevel increased with age increasing (P<0 .01) while PGⅠ /PGⅡlevel increased with age reducing (P<0 .05) .Percentile method was adopted to determine the 95% reference interval ,the bilateral reference intervals (P2 .5 - P97 .5 ) was taken for PGⅠ ,unilateral upper limit(≤ P95 ) for PGⅡ and unilateral limit (≥ P5 ) for PGⅠ /PGⅡ .Conclusion The establishment of serum PG Ⅰ ,PG Ⅱ ,PG Ⅰ /PG Ⅱ reference intervals of healthy people provides a basis for the prevention and treatment for stomach disease .

The countywide healthcare reform in Anhui province since 2015 was analyzed in the paper.The reform is based on the integration of healthcare management system and health service system of the new rural cooperative medical system (NCMS).The core of reform is regional global per capita budget of NCMS.The reform promotes the county′s healthcare institutions to shift from profit oriented to costs control, improves their quality of care, emphasizes disease prevention and control, and maintains residents health.Next, we should pay attention to the rationality of funds balance and benefits distribution, and the training of county healthcare personnel.

This paper analyzed and concluded successful experience and mechanisms of regional global per capita budget implemented since 2015 in Anhui province,including the formation of mutual incentive and restraint mechanism, the mechanism of controlling expenses spontaneously and resource allocation efficiently.After the reform, flow of hospitalized patients was more rational, and the financial burden of patients was alleviated, while the capacity of medical institutions was improved notably in pilot counties.The successful experience of Anhui province can put forward corresponding suggestions to guide the future work in other areas.

BACKGROUNDHypocretin (HCRT) signaling plays an important role in the pathogenesis of narcolepsy and can be significantly influenced by Chinese herbal therapy. Our previous study showed that xingshentongqiao decoction (XSTQ) is clinically effective for the treatment of narcolepsy. To determine whether XSTQ improves narcolepsy by modulating HCRT signaling, we investigated its effects on SH-SY5Y cell proliferation, apoptosis, and HCRT receptor 1/2 (orexin receptor 1 [OX1R] and orexin receptor 2 [OX2R]) expression. The signaling pathways involved in these processes were also assessed.

METHODSThe effects of XSTQ on proliferation and apoptosis in SH-SY5Y cells were assessed using cell counting kit-8 and annexin V-fluorescein isothiocyanate assays. OX1R and OX2R expression was assessed by quantitative real-time polymerase chain reaction analysis. Western blotting for mitogen-activated protein kinase (MAPK) pathway activation was performed to further assess the signaling mechanism of XSTQ.

RESULTSXSTQ reduced the proliferation and induced apoptosis of SH-SY5Y cells. This effect was accompanied by the upregulation of OX1R and OX2R expression and the reduced phosphorylation of extracellular signal-regulated kinase (Erk) 1/2, p38 MAPK and c-Jun N-terminal kinase (JNK).

CONCLUSIONSXSTQ inhibits proliferation and induces apoptosis in SH-SY5Y cells. XSTQ also promotes OX1R and OX2R expression. These effects are associated with the repression of the Erk1/2, p38 MAPK, and JNK signaling pathways. These results define a molecular mechanism for XSTQ in regulating HCRT and MAPK activation, which may explain its ability to treat narcolepsy.

Apoptosis ; drug effects ; Blotting, Western ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Mitogen-Activated Protein Kinases ; metabolism ; Orexin Receptors ; metabolism ; Real-Time Polymerase Chain Reaction