Irrational use of medicine has some reasons subjectively and objectively.Under a system of new framework,the key link of achieving rational medical use is that how to strengthen the effeetive regulation.Construeting a scientific surveillance system.innovating monitoring system,intelligent using of modern management techniques,controlling the entire process of the implementation of medicine,to promotion the rational use of medicineprovides a strong institutional guarantee and technical support.

Objective To determine the aberrant methylation status of TFPI-2,FOXE1 and NPTX2 gene promoter region in bile from cholangiocarcinoma patients and the diagnostic value for cholangiocarcinoma. Methods Methylation—specific PCR(MSP)was used to detect the promoter methylation status of TFPI-2, FOXE1 and NPTX2 genes in bile from 29 patients with cholangiocarcinoma and 27 patients with choledocholi-thiasis.The sensitivity and specificity of combined methylation of 3 promotors and brush cytology were analyzed. Results There was significant difference between the methylation rate of NPTX2,FOXE1 in choledocholithiasis group and cholangiocarcinoma group(75. 86% VS 25. 93%,χ2 = 13. 964,P<0. 05;44. 82%VS 14. 81%,χ2 = 4. 622,P<0. 05).There was no significant difference between the methylation rate of TFPI-2 in choledocholithiasis group and cholangiocarcinoma group(17. 24%VS 18. 52%,χ2 = 0. 016,P>0. 05).Positive rate was 34. 48% with endoscopic retrograde brush cytolog,and 86. 20% with promoter methylation of FOXE1 combined with NPTX2 genes,and there was significance difference in the positive rates between the two methods(χ2 = 14. 122,P< 0. 05). Conclusion The methylation rates of NPTX2,FOXE1 were significantly higher in choledocholithiasis group than those in the cholangiocarcinoma group. Detection of comethylation rate of the FOXE1 and NPTX2 genes could improve diagnostic sensitivity of cholangiocarcinoma.

Objective: To analyze the methods of Lishui Central Hospitals performance management, and evaluate the important role of performance management in the modern hospital management. Methods:Evaluate the hospital operation management data in recent 5 years, basing on the performance management measures of Lishui Central Hospital. Results: During 2007 to 2012, outpatients and emergency patients increased to 80.41%, discharges increased to 89.35%, operating table increased to 84.59%, total revenue increased to 121.61%, average length of stay decreased by 5.1 days, times cost of patients had been effectively controlled, and total assets increased by 149.21%. Conclusion: The reform of Central Hospital performance management has great significance in mobilizing the enthusiasm of workers and enhancing the level of hospital management, and will solve the difficulties of expensive medical treatment problems well.

The situation of the ongoing fifth epidemic (beginning October,2016) of human infection with avian influenza A (H7N9) virus are more serious than the first four ones.As of March 8,2017,the fifth epidemic reported 40.00％ of the cumulative cases.Recently,the pathogenic study reported two new human infections in Guangdong with an influenza A(H7N9)virus strain for which gene sequencing analysis revealed mutations in the haemagglutinin (HA) gene that resulted in the insertion of basic amino acids at the cleavage site of this protein,known to confer increased pathogenicity in chickens.However,most strains show no obvious difference in pathogenic characteristics compared with those detected during the first four waves.Although epidemiological studies showed that 3 clusters with limited human-to-human transmission have been investigated during the current wave,there are no indications of sustained person-to-person spread.Based on epidemic analysis and risk assessment results,it's likely that human infections with H7N9 virus will continue to occur in China,but epidemiological and pathogenic analysis suggested that it's unlikely to have a continued transmission of this virus.Profound public health significance would be presented by strengthening etiology and epidemiology studies of avian influenza A(H7N9) virus.

Objective To study the method for determination of nipacide PX and triclosan in disinfectant by high performance liquid chromatography. Methods High performance liquid chromatography, based on the mobile phase (CH3CN:H2O=60:40, pH=3.0) and diode array detector(DAD, ?= 280 nm), was chosed to determine nipacide PX and triclosan in disinfectant. Results The detection limit of nipacide PX was 2.48 ng and triclosan was 2.08 ng. The rate of recovery was 95.4%-103.3%,the relative standard deviations(RSD) was 0.6%-3.4%. Conclusion The method is simple, precise and suitable for the determination of nipacide PX and triclosan in disinfectant.

Objective To explore how the different intervention measures affect the outcome of central venous catheter-related thrombosis (CRT) in children. Methods A retrospective analysis was carried out to collect the clinical data of patients with CRT from the nursing management system of the Children′s Hospital Affiliated to Zhejiang University School of Medicine which reported by each nursing unit from January 1,2015 to December 31,2015. Results Totally 108 cases were included (72 boys and 36 girls), median age of 24.5 months (ranged from 1 month to 14 years old). Nearly 42.59% (46/108) patients suffered from neurological diseases. Nearly 55.56%(60/108) CRT was detected in the first week after catheterization. Once CRT conformed, there were four kinds clinical intervention options applied. Intervention 1: thrombolytic therapy with urokinase combined anticoagulation with nadroparin calcium. Intervention 2: anticoagulant therapy only. Intervention 3: thrombolytic therapy alone. Intervention 4: no medications. The differences of effective between the four kinds of intervention were statistically significant (χ2=13.380, P=0.004). The single-factor regression analysis was done to each relevant factor. Finally the multivariate regression analysis showed four factors had impacts upon the results. The factors were as follows:gender (OR=10.400, 95%CI 1.879-57.563, P=0.007);interval (OR=1.107, 95%CI 1.035-1.184, P = 0.003), size of thrombus(OR = 1.562,95%CI 1.033-2.362,P=0.035; Intervention 2 (OR =11.757, 95% CI 2.254- 61.327, P = 0.003), intervention 4 (OR = 35.397, 95% CI 3.493-358.760, P =0.003). Conclusions The earlier and small size thrombus is more soluble. Thrombolytic therapy or combined anticoagulation is more effective. It is recommended that if no contraindications presents, thrombolytic combined with anticoagulant therapy should start early standardized treatment.

Twenty-six eyes which appeared rejection after allograft penetrating keratoplasty between April 2003 and April 2004 in Shandong Shi'erming Eye Hospital were collected, including 16 males and 10 females, 9 cases were repeated relapsing viral keratitis, 8 cases were traumatic posterior corneal leucoma, 5 cases were corneal decompensation caused by various intraocular surgery, 2 cases were congenital leucoma, and 2 cases had other symptom. The rejection occurred at 2 month to 2.5 years after operation. Among them 19 cases were transferred to our hospital and asked adding traditional Chinese therapy because western medicine was ineffective in other hospital. All cases were received local treatment with hormone and non-steroidal anti-inflammatory eyedrop, some cases applied systemic administration with glucocorticoid, mainly based on eye black immunosuppression decoction, potion daily, twice per day, the average time of medication was 11-42 days. Clinical symptoms were served as observation indexes, results showed that the total effective rate of the 26 cases were 100%. The bulbar conjunctiva hyperemia and edema was reduced, corneal opacity became light, and rejection was complete response in 9 cases, 5 of 19 cases which were transferred to our hospital were exempted from operation, and the average vision was improved three lines. It was found that purging liver and eliminating dampness compound Chinese medicine can rapidly reduce anterior chamber's inflammatory response and backoff corneal neovascularization in clinical practice.

The incidence of hypokalemia and periodic paralysis was retrospectively analyzed in 1225patients with hyperthyroidism. The results showed that 104 patients with hyperthyroidism (8.5%)had hypokalemia, and 82. 7% cases were women, with the potassium levels of 3.10 - 3.42 mmol/L. Periodic paralysis occurred in 60 patients (4. 9% ) and 96. 7% cases were men; 93.3% patients had the potassium levels less than 3. 0 mmol/L. Hypokalemia and periodic paralysis were alleviated after the control of hyperthyroidism.

Objective To evaluate the efficacy of mid-axillary approach to transversus abdominis plane (TAP) block in each abdoninal and back region.Methods Twenty patients of both sexes,aged 18-64 yr,with body mass index of 20-27 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy,who had expected operation time ＜1 h,were enrolled in the study.Ultrasound-guided TAP block was performed on the left side via the mid-axillary line with 0.25％ levobupivacaine 0.5 ml/kg.TAP block was assessed by cold stimulation (75％ alcohol) and acupuncture in each abdominal and back region (the left side of the body was divided into 19 regions using the anatomical landmarks on the body surface).The positive condition in each region at 20 min after administration was recorded.Results The regions in which the positive rate ≤5％ were 11,14,17 and 18 regions.The regions in which the positive rate ＞5％-20％ were 8,15 and 19 regions.The regions in which the positive rate ＞20％-50％ were 12,13 and 16 regions.The regions in which the positive rate ＞50％-70％ were 1 and 4 regions.The regions in which 70％ ＜ the positive rate ＜ 95％ were 7,9 and 10 regions.The regions in which the positive rate ≥ 95％ were 2,3,5 and 6 regions.Conclusion Mid-axillary approach to TAP block is effective in the left middle-lower regions of the anterior abdominal wall,however,it is ineffective in the left upper region between mid-axillary and posterior axillary lines and in the low back region.

Objective To explore the effects of different extraction methods on yield of Smilax glabra polysaccharides and antioxidant activities. Methods Crude polysaccharides were extracted by using cold water, hot water, NaOH aqueous solution, and EDTA?2Na aqueous solution . Antioxidant activities of Smilax glabra polysaccharides were compared by the methods of scavenging superoxide anion radical , scavenging hydroxyl radical or reducing power. Results Yield of crude cold water-soluble polysaccharides, crude boiling water-soluble polysaccharides, crude alkali-soluble polysaccharides and crude acid-soluble polysaccharides were 0.31%, 1.1%, 10.8 %, 2.0%, respectively. Polysaccharides by using four kinds of different extraction methods had strong scavenging superoxide anion radical power; crude cold water-soluble polysaccharides, crude boiling water-soluble polysaccharides , crude acid-soluble polysaccharides had strong scavenging hydroxyl radical and reducing power , the capacity increased with the increasing concentration of Smilax glabra polysaccharides; the scavenging hydroxyl radical and reducing power capacity of crude alkali-soluble polysaccharides is very poor. Conclusion Polysaccharides by using four kinds of different extraction methods have certain antioxidant activity, the antioxidant capacity to scavenge free radical in vitro showed positive correlation with the concentration of Smilax glabra polysaccharides, considering the yield of polysaccharides, EDTA?2Na aqueous solution extraction method is the best.