Applying the value, cost and delivery of Lean Management, with the point of view of hospital president, health bureau and personnel of the medical record(TMR) and statistics, to analyze the problems existed in present work mode of TMR and statistics, and help the personnel of TMR and statistics to change thinking style, to find a new way to embody oneself value, at the same time solve the orientation of the TMR and statistics in hospital administration.

Shenzhen implemented the health reform on the separation of drug prescribing and dispensing.This policy abolished the drug price addition system,which interrupted the interest chain between hospitals and pharmaceutical enterprises,and curbed the over-medication and use of expensive drugs.Such a reform has lowered the average cost of diagnose and treatment,the out-of-pocket payment by those covered by social insurance,outpatient infusion and the utilization of antibiotics.To further strengthen these outcomes and maintain the momentum of this policy,Shenzhen will further improve the compensation system for public hospitals,encourage the medical staffs' work enthusiasm and implement the reform measures actively.

As requested by both central government and Guangdong provincial government on the reform to separate drug prescribing and dispensing,Shenzhen has introduced its 1 + 6 comprehensive program.Breaking through from the drug price addition system,the program stages such six measures as the health service payment system reform,the compensation system reform among public hospitals,reform of the competition mechanism between pharmaceutical distribution enterprises and hospital pharmacies,reform of drug procurement methods,investigation and punishment of commercial briberies in drug purchase,and enhanced supervision of public hospitals.The paper detailed these measures and explained these innovative practices.

Objective A new method is researched based on ECG for human identification.Methods Three features of wave feature,wavelet feature,fusion feature were selected as the feature vectors for 35 normal subject ECGs,and correlation coefficient discriminate analysis was used for human identification. Results The other 40 sessions from 35 subjects were used for verifying the accuracy of each feature.They were 82.5%、87.5% and 95% respectively for wave feature,wavelet feature and fusion feature. ECG wavelet feature outperformed ECG wave feature. While ECG fusion feature performed better than either feature. Conclusion The verification experiment demonstrates that the technology of human identification based on ECG is feasible. ECG can be combined with other biometric features such as fingerprint for developing the multi-biometric identification system. The method proposed in this paper is simple,real-time and exact for human identification.

To investigate the relationship among serum vascular endothelial cells(VE) -cadherin, advanced glycation end-products( AGE), and atherosclerotic lesion. 20 healthy subjects and 60 patients with diabetes mellitus,including 30 patients with carotid atherosclerosis (CI), were enrolled.Soluble VE-cadherin and AGE were determined using the enzyme-linked immunosorbent method (ELISA). The relationships among the concentration of soluble VE-cadherin, AGE, and the course of the disease, blood glucose, and blood lipid levels were analyzed with multivariant stepwise regression analysis. The levels of serum VE-cadherin and AGE in the patients with diabetes and CI were higher than those in control group( P＜0. 05 ). There was a significant difference in VE-cadherin between the diabetes group and the CI group( P＜0. 05 ). Serum VE-cadherin levels were positively correlated with serum AGE levels(r = 0. 69, P＜0. 01 ). AGE levels were positively correlated with the diabetes duration ( r = 0. 31, P =0. 02 ). The levels of serum VE-cadherin in diabetic patients are positively correlated with their serum AGE levels. The VE-cadherin seems to play an important role in the development of atherosclerosis caused by AGE.

Objective To study the influencing factors of the colorants used in the placebo of herbal medicine.Methods The effect of pH value,temperature,and illumination and sterilization method on the coloring of the pigments like carmine,sunset yellow 60,brilliant blue 60 and caramel were investigated by determining the Lab value with the instrument.Results PH value of solution had effects on the coloring of carmine and sunset yellow 60,but no effects on the brilliant blue 60 and caramel.When pH values of the solutions were adjusted to 10,chromatic aberration values of carmine and sunset yellow 60 were 17.29 and 27.29,respectively; In the conditions of acidification,the color of carmine and sunset yellow 60 solutions were not changed much; short heating and illumination had no effects on all the four pigments,and all the chromatic aberration values were less than 1.5; 60Co-ray irradiation had great effects on the coloring,and the chromatic aberration values of carmine,sunset yellow 60,brilliant blue 60 and caramel solutions after 60Co-ray irradiation were 12.43,22.45,37.53 and 19.22,respectively; While autoclaving (121 ℃,20 min) would not change the color of solution,and all those chromatic aberration values were less than 1.5.Conclusion These colorants are suitable for the placebo preparation of Chinese medicine decoction,which is recommended to be added in the preparation of the final link.60Co-ray irradiation sterilization is forbidden.

Objective To investigate the liver repair effects of Pim-3 gene in rat with fulminant hepatic failure (FHF). Methods Thirty-two rats were divided into four groups (eight for each group). Three groups of rats were pretreated with Ringer's solution, vector plasmid or Pim-3 gene recombinant plasmid respectively and, one day later, received intraperitoneal injections with lipopolysacchride (LPS) and D-galactosamine (D-GalN). The fourth group served as normal control.Eight hours after the LPS/D-GalN injection, the liver tissues and blood samples were collected. The contents of serum transaminase was tested by automatic blood biochemistry meter. The morphological changes were observed by light microscopy using hematoxylin and eosin (HE) staining. Tumor necrosis factor (TNF)-α and interleukin (IL)-1β gene expression was detected by reverse transcriptionpolymerase chain reaction(RT-PCR). The serum levels of TNF-α and IL-1β were measured by enzyme linked immunosorbent assay (ELISA), and cell apoptosis by TdT-mediated dUTP nick end labeling (TUNEL) assay. Comparisons between groups were done by analysis of variance. ResultsThe over expressions of Pim-3 gene and reporter gene, green fluorescent protein (GFP) were induced by injection with recombinant plasmid solution.In comparison with the rats retreated with Ringer' s solution or vector plasmid, those pretreated with recombinant plasmid had a lower mortality and lower serum transaminase levels. The injection of recombinant plasmid significantly reduced hemorrhage, necrosis and inflammatory infiltration in the liver. Liver apoptotic index (AI) was dramatically lower in rats treated with recombinant vectors compared to the rats treated with Ringer's solution or vector plasmids [(10. 2±6.9)％ vs (83. 1±12.6) ％ and (79.9±13.4) ％ respectively, P＜0. 01]. In addition, the expression of exogenous Pim-3 gene remarkable inhibited the transcriptions and expressions of TNF-α and IL-1β. ConclusionsPim-3 gene can protect rats from LPS/D-GalN-induced FHF possibly by inhibiting expressions and secretions of inflammatory cytokines, such as TNF-α and IL-13, in liver tissues.

Objective To evaluate both the causal relationship between plasma metabolites and the risk of knee osteoarthritis(KOA)and the potential mediating or masking effect of immune cells using Mendelian randomization(MR)systems.Methods The GWAS data on 1400 plasma metabolites,731 immune cell traits and KOA was retrieved from the genome-wide association study(GWAS)database.Two-way MR analysis was used to evaluate the causal relationship between plasma metabolism and KOA.Two-step mediation MR analysis was conducted to evaluate immune cell traits that might have mediating or masking effects.Results After sensitivity analysis and screening,65 plasma metabolites and 35 immune cell traits were found to have causal relationships with KOA(P＜0.05).Mediation analysis found that CD45RA+CD28-CD8br％CD8br had a mediating effect in the causal relationship between three metabolites(2-hydroxyhi-ppurate,X-07765,X-23739)and the risk of KOA.2-hydroxyhippurate(salicylic acid)exerted a masking effect,and the effect ratio was 0.0412.Conclusion A variety of plasma metabolites and immune cell traits are causally related to KOA,which should not be regarded as a simple degenerative joint disease.The protective effect of salicylic acid against KOA may be weakened by its role in inducing the differentiation of Treg cells,which is worthy of more studies.

Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.

OBJECTIVETo compare the difference and correlation between dietary salt intakes assessed by 24 hours urinary Na method, food weighted record method and food frequency questionnaire method.

METHODSAll 2 184 subjects aged 18 to 69 were selected by multi stage stratified cluster random sampling method in Shandong province in June to September, 2011. Dietary salt intakes were measured by 24 hours urinary Na method, food weighted record method and food frequency questionnaire method. The information on gender, age, dining locations and labour intensity of members dining at home for 3 days were recorded. And the dietary habits were surveyed by questionnaire.

RESULTSSalt intakes were 14.0, 12.0 and 10.5 g/d assessed by 24 hours urinary Na method, food weighted record method and food frequency questionnaire, respectively. Comparing with 24 hours urinary Na method, salt intakes assessed by food weighted record method and food frequency questionnaire method were 2.0 g (14.3% undervalued) and 3.4 g (24.3% undervalued) less, respectively. Comparing with 24 hours urinary Na method, the proportion of individuals with salt intake over-reported and under-reported were 42.4% (856/2 020) and 55.3% (1 117/2 020) by food weighted record method, and were 20.7% (418/2 020) and 16.3% (329/2 020) by food frequency questionnaire method, respectively; the proportion of individuals with salt intakes within ± 25% of 24 hours urinary Na method were 36.9% (745/2 020) and 28.4% (574/2 020), respectively. Salt intakes assessed by 24 hours urinary method correlated significantly with both salt intakes assessed by food weighted record method and food frequency questionnaire method; the correlation coefficients were 0.13 and 0.07, respectively. With the increasing of salt intakes by subjects' self-judgment, salt intakes were all rising significantly using three survey methods. Salt intakes of three group population of light, moderate and partial taste salty were 13.6, 13.6 and 14.7 g/d by 24 hours urinary Na method (F = 0.47, P < 0.05); 11.0, 12.0 and 12.7 g/d by food weighted record method (F = 5.83, P < 0.05), and 9.3, 10.2 and 11.9 g/d by food frequency questionnaire method (F = 5.83, P < 0.05), respectively.

CONCLUSIONComparing with 24 hours urinary method, food weighted record method and food frequency questionnaire method would undervalue dietary salt intake. Salt intake status can be more accurately assessed by adjusting the underestimation rate.