Objective To improve the hospital's capability for controlling the quality and expenses of disease categories so as to reduce unnecessary consumption of medical resources while ensuring medical quality. Methods All inpatient cases in the hospital were classified according to disease categories,reference criteria for the quality and expenses of all disease categories were formulated,feedback and analysis systems and assessment systems for the quality of disease categories were improved,and evaluation of the care quality and work performance by departments or physicians was conducted.Results The departments' awareness of the quality and expenses of disease categories was enhanced,the rate of good-quality cases rose from 80.01% to 86.22%,and the proportion of drug expenses dropped to 40.32%.Conclusion Classified management of cases of disease categories plays a key role in improving a hospital's managerial level,enhancing its medical efficiency,reducing its medical costs,and standardizing its medical behavior.

ABSTRACT:Many studies show that helminth‐derived molecules can induce immunoregulatory cells to form immune net‐work‐mediated immune ,thereby inhibiting allergic and autoimmune diseases .Helminth parasites can induce immune cell activa‐tion and produce cytokine .And parasites play an inhibitory effect to affect other immune related diseases .However ,the associ‐ation between helminths infections and immune related diseases does not always have an unequivocal outcome .While some hel‐minths infections protect against allergic diseases ,other helminth can exacerbate this immunopathology .

Objective To examine the change of body weight (BW) and blood pressure (BP) in obese rats, clarify relationships between BP and BW and other factors. Methods Male Spraque-Dawley rats were fed either with normal diet (ND) or high calorie diet (HC) for 20 weeks. BW and BP of tail artery were observed biweekly and tetraweekly respectively; serum leptin and fasting insulin (FINS) were detected by enzyme-linked immunoadsordent assay (ELISA) and radioimmunoassay (RIA) respectively. Fasting plasma glucose (FPG) and free fatty acid(FFA) were measured by conventional means. Results BW, abdominal fat weight (AFW), ratio of abdominal fat weight to body weight (RF/W), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum levels of leptin and FINS, FPG, FFA increased in the HD group after 20 weeks diet intervention (P＜0.05 or P＜0.01). SBP was strongly correlated with BW, leptin, FINS and FFA (P＜0.05), DBP was correlated with FFA (r=0.47, P＜0.05). In addition, leptin was positively correlated with BW, AFW, RF/W, FINS and FFA (P＜0.05 or P＜0.01). Conclusion In this study of high calorie-diet induced rats, the gain of BW is accompanied by increased BP. The obese rats have hyperleptinemia, hyperinsulinemia, hyperglycemia and dyslipidemia which may have important effects on the development of obesity-related hypertension. RF/W is the key factor in which affect serum leptin level.

Objective To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. Methods A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled. They were randomly divided into two groups. The patients in APRV group were given APRV pattern, while those in control group were given lung protection ventilation, synchronized intermittent mandatory ventilation with positive end-expiratory pressure (SIMV+PEEP). All patients were treated with AVEA ventilator. The parameters such as airway peak pressure (Ppeak), mean airway pressure (Pmean), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial blood gas, urine output (UO), the usage of sedation and muscle relaxation drugs were recorded. AVEA ventilator turning point (Pflex) operation was used to describe the quasi-static pressure volume curve (P-V curve). High and low inflection point (UIP, LIP) and triangular Pflex volume (Vdelta) were automatically measured and calculated. The ventilation parameters were set, and the 24-hour P-V curve was recorded again in order to be compared with subsequent results. Venous blood was collected before treatment, 24 hours and 48 hours after ventilation to measure lung surfactant protein D (SP-D) and large molecular mucus in saliva (KL-6) by enzyme linked immunosorbent assay (ELISA), and the correlation between the above two parameters and prognosis on 28 days was analyzed by multinomial logistic regression. Results Twenty-six patients with ALI/ARDS were enrolled, and 22 of them completed the test with 10 in APRV group and 12 in control group. The basic parameters and P-V curves between two groups were similar before the test. After 24 hours and 48 hours, mechanical ventilation was given in both groups. The patients' oxygenation was improved significantly, though there were no significant changes in hemodynamic parameters. The Pmean (cmH2O, 1 cmH2O = 0.098 kPa) in APRV group was significantly higher than that in control group (24 hours: 24.20±4.59 vs. 17.50±3.48, P < 0.01; 48 hours: 18.10±4.30 vs. 15.00±2.59, P < 0.05). After ventilation for 24 hours, the ratio of patients with increased Vdelta in APRV group was higher than that in control group (90% vs. 75%), but without statistical difference (P > 0.05). The SP-D level (μg/L) in serum in APRV group showed a tendency of increase (increased from 19.70±7.34 to 27.61±10.21, P < 0.05), in contrast there was a tendency of decrease in control group (decreased from 21.83±7.31 to 16.58±2.90, P > 0.05), the difference between the two groups was statistically significant (P < 0.05). After 48-hour ventilation, SP-D in APRV group was decreased, but no change was found in control group, and no significant difference was found as compared with that of the control group (16.45±8.17 vs. 17.20±4.59, P > 0.05). There was no significant difference in serum KL-6 between the two groups before and after ventilation. The SP-D and KL-6 levels in serum were unrelated with 28-day survival rate of the patients. The odds ratio (OR) of SP-D were 0.900 [95% confidence interval (95%CI) = 0.719-1.125], 1.054 (95%CI = 0.878-1.266), 1.143 (95%CI = 0.957-1.365), and the OR of KL-6 were 1.356 (95%CI = 0.668-2.754), 0.658 (95%CI = 0.161-2.685), 0.915 (95%CI = 0.350-2.394) before the test, 24 hours and 48 hours after ventilation (all P > 0.05). Conclusions APRV was similar to lung protective ventilation strategy in oxygenation and improvements in the lung mechanics parameters. APRV with a higher Pmean can recruit alveolar more effectively, and it had no impact on hemo-dynamics, but might exacerbate VILI.

Objective To explore the efficacy and prognostic factors of postoperative intensity?modulated radiotherapy ( IMRT) with or without chemotherapy in rectal cancer. Methods A retrospective analysis was performed on the clinical data of 218 patients with rectal cancer, who underwent postoperative IMRT in our hospital from January 2009 to December 2013. The Kaplan?Meier method was used to calculate survival rate;the log?rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The follow?up rate was 97. 7%. The 1?and 3?year overall survival rates were 90. 8% and 75. 2%, respectively, the 1?and 3?year disease?free survival rates were 85. 3% and 70. 5%, respectively, and the 1?and 3?year locoregional recurrence?free survival rates were 96. 7% and 88. 1%, respectively. The incidence of grade 3?4 acute adverse reactions was 28. 4%, mainly manifested as leukopenia ( 13. 8%) and diarrhea ( 11. 0%) . Univariate prognostic analysis showed that preoperative carcinoembryonic antigen ( CEA) and CA199 levels, maximum tumor diameter, tumor location, degree of differentiation, depth of tumor invasion, number of lymph node metastases, TNM stage, perineural invasion, surgical procedure, total mesorectal excision, preoperative bowel obstruction, and preoperative anemia were the predictors of survival ( P=0. 006, 0. 000, 0. 000, 0. 017, 0. 000, 0. 016, 0. 000,0. 011,0. 001,0. 006,0. 037 and 0. 010) . Multivariate prognostic analysis showed that preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction, and preoperative anemia were the predictors of survival ( P=0. 000,0. 000,0. 000,0. 001 and 0. 001) . Conclusions Postoperative IMRT with or without chemotherapy is an effective method for rectal cancer with mild adverse reactions and high compliance. Preoperative CEA level, tumor position, TNM stage, preoperative bowel obstruction, and preoperative anemia are independent prognostic factors for the overall survival.

Objective To compare different susceptibility testing methods of tigecycline against Acinetobacter baumannii and Klebsiella pneumoniae.Methods Fifty carbapenem-resietant A.baumannii (CRAB) strains and 49 K.pneumoniae strains were collected from Tianjin Medical University General Hospital during January and March 2012.Minimum inhibitory concentration (MIC) and inhibitory zone diameters for tigecycline were determined by broth microdilution,Vitek-2,MTS and disk diffusion methods.The results of Vitek-2,MTS and disk diffusion methods were compared with those of broth microdilution method.Results According to FDA standards,the susceptibilities of CRAB and K.pneumoniae to tigecycline determined by broth microdilution,Vitek-2 and MTS were 94.0％/91.8％,68.0％/91.8％ and 90.0％/91.8％,respectively.For CRAB isolates,the essential agreement (EA) and categorical agreement (CA) produced by Vitek-2 and MTS were 94.0％/72.0％ and 92.0％/90.0％.MICs determined by Vitek-2 were 1-2 dilutions higher than the reference method in 33 (66.0％) strains,and those determined by MTS were higher in 16 (32.0％) strains and lower in 11 (22.0％) strains.For K.pneumoniae isolates,the EA/CA produced by Vitek-2 and MTS were 95.9％/98.0％ and 83.7％/91.8％,respectively.MICs determined by Vitek-2 were 1-3 dilutions lower than the reference method in 17 (34.7％) strains,and those determined by MTS were 1-3 dilutions lower than the reference method in 39 (79.6％) strains.None of thetwo methods produced very major error (VME) and major error (ME) against two kinds of isolates.The results were determined by disk diffusion method using different breakpoints according different isolates.For CRAB,using ≥14 mm/≤ 10 mm as breakpoint,CA was 94.0％,which was higher than the breakpoint recommended by Jones et al (≥16 mm/≤12 mm,CA was 82.0％) ; and for K.pneumoniae,using the ≥ 14 mm/≤ 10 mm as breakpoint,CA was 93.9％,higher than the FDA Enterobacteriaceae breakpoint (≥ 19 mm/≤ 14 mm,CA was 67.3％).Conclusion For CRAB strains,MTS produces better consistence with broth microdilution,with several higher or lower MIC results.For K.pneumoniae strains,Vitek-2 has better correlation with reference method,with several lower MIC results.The consistence between disk diffusion method and broth microdilution is comparatively lower,and the breakpoint should be adjusted according to different bacteria.

Objective To investigate the pile protein (paxillin) and carbonic anhydrases Ⅸ (CA Ⅸ)expression and its significance in duodenal papilla carcinoma patients.Methods Eighty-seven cases of duodenal papilla carcinoma were enrolled as our subject.Immunohistochemical staining was used to detect the expressions of paxillin and CAⅨ in site of tumor,adjacent tissue and duodenal papillitis tissue.Results Sixtyfive cases (74.7％ (65/87)) were showed a higher expression of paxillin in cancer site than that of adjacent tissue (41％ (16/39),P ＜ 0.05) and duodenal papillitis tissue (41.3％ (19/46),P ＜ 0.05),and the difference was statisically significant (x2 =19.869,P ＜0.05).While a higher expression of CA Ⅸ in 62 cases (71.3％) in cancer site was seen,higher than that of adjacent tissue (33.3％ (13/39),P ＜ 0.05) and duodenal papillitis tissue (30.4％ (14/46),P ＜ 0.05),and the difference was statisically significant (x2 =26.936,P ＜ 0.05).As the increase of the cancer tissue malignant degree and the surrounding tissue invasion or distant metastasis degree,paxillin and CA Ⅸ expression increased.Conclusion The paxillin and CAⅨ might served as the early indicators for diagnosis and judgment of prognosis of duodenal papilla cancer.

Objective To investigate the drug resistance and its distribution induced by β-lactamases and class Ⅰ integrons with the deficiency of Omp genes in Enterobacter cloacaes.Methods Totally 112 strains of Enterobacter cloacaes were isolated during January 2008 and May 2011.The identification of strains was performed by using Vitek-2 Compact automatic system; and antibiotic susceptibility was determined by K-B method.Isolates of E.cloacae were screened for carbapenemases by modified Hodge test,improved three dimensional test and EDTA-meropenem synergy test.Genes encoding AmpC β-lactamase,metallo-β-1actamases (MBLs) and OXA-like β-1actamases were screened by multiple PCR.Single PCR was used to detect ISEcpl,OmpK35/36,NDM-1 and OXA-48.The variable regions of class Ⅰ integrons were amplified and sequenced.Results Among 112 isolates,6 (5.4％) demonstrated positive in the modified Hodge test and 14 ( 12.5％ ) were positive in the improved three-dimensional test.No carbapenemases gene was found.There were 29(25.9％ ) strains positive for ESBLs genes,ISEcpl was found in the upstream of all the CTX-M-type ESBLs; OXA-1 ESBLs were detected in 2 isolates.AmpC β-lactamase genes were positive in 45 (40.2％) strains,and 82.2％ (37/45) were MIR-3 type.Twenty two isolates carried class Ⅰ integrons,and four different cassettes arrangements were identified within 16 strains:9 isolates harbored aadB-aadA2 ( 1 000 bp),5 isolates with dfrAl5 (700 bp),2 isolates with aadAl ( 1 000 bp).One isolate harbored all the above gene cassettes.The deficiency of OmpK35/36 was found in all strains.Conclusion ESBL,AmpC β-lactamase and the deficiency of OmpK35/36 are correlated with the resistance to carbapenems in Enteobacter clocace,and class Ⅰ integrons may also partly account for the multidrug-resistance.

BACKGROUND:Vascular endothelial growth factor is a potent angiogenesis and permeability inducible factor. Vascular endothelial growth factor 165 and vascular endothelial growth factor 121 are mainly expressed in vivo, with a strong role of angiogenesis.
OBJECTIVE:To observe the feasibility of vascular endothelial growth factor 165 gene transfected bone marrow mesenchymal stem cel s to differentiate into vascular endothelial cel s.
METHODS:Bone marrow derived mesenchymal stem cel s were isolated and col ected from 50 g Sprague-Dawley rats,and identified by flow cytometry. The plasmid pGLV-EF1a carrying a vascular endothelial growth factor 165 gene was transfected to the mesenchymal stem cel s using lentiviral. Expression of green fluorescent protein was observed under a fluorescence microscope.
RESULTS AND CONCLUSION:After 12 hours of transfection, expression of green fluorescent protein was observed, increased at 48 hours, peaked at 72 hours and gradual y declined thereafter. Results prove that vascular endothelial growth factor 165 gene transfected bone marrow mesenchymal stem cel s have the expression of green fluorescent protein, indicating successful transfection. It is feasible to induce bone marrow mesenchymal stem cel s to differentiate into vascular endothelial cel s.

Objective To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration. Methods Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct (CBD) stones. After extraction of stones, an 8F J-stent (pigtailed) was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed. Results The stent dislodged and was discharged with stool at the 13th (10-18) postoperative day . Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD. Conclusions Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of choledochoscpe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.