10%～20% of acute clinical sporatic hepatitis is hepatitis E (HE). HE has a severe diaease low mortality in general population of about 0.5～1.5%. It has been reported as severe disease and the mortality increased to 20% in pregnant women and old people. China is high-epidemic for hepatitis E virus (HEV). HEV is mainly transmitted through faecaloral route,data also showed that HEV could be transferred through blood donation. The epidemiology,diagnostics and vaccine development of HE is reviewed in this paper.

Objective:To explore grouping methods of subdividing adjacent diagnosis related groups(DRGs) by introducing patient clinical complexity level(PCCL) principle and provide references for exploring DRG grouping method in line with context in China.Methods:Clinical complexity level of each complication was assigned by clinicians.PCCL model was selected to calculate the scores of clinical complexity cases.Each adjacent DRG was subdivided into DRG groups by classification and regression trees(CART) model.The rank-sum test was applied to test the statistical significances of the grouping results.Results:9 surgical adjacent DRGs were subdivided into 18 DRG groups.There were statistical significances in the differences of hospitalization expenses and length of stay among different DRG groups in each adjacent group.Conclusion:PCCL model showed high performance in DRG subdivision.The unification of the quality of medical records and coding were the key factors to ensure the reasonable grouping results.

Objective The purpose of this study was to evaluate the effect of prostaglandin E 1 (PGE 1) on blocking the development of acute respiratory distress syndrome (ARDS) induced by acid aspiration. Methods Twenty new Zealand rabbits were used. Dilute HCl was instilled into right bronchus of the rabbits. The rabbits were then divided randomly into two groups: injury group and treatment group. In injury group (n=10) rabbits received no treatment except mechanical ventilation. In treatment group (n=10) immediately after acid instillation the rabbits received an intravenous bolus of PGE 1 followed by a continuous infusion. Blood gas, airway pressure and dynamic and static compliance were measured before and after acid instillation. Blood samples were taken from artery for determination of 6-k-PGF 1?, TXB 2,NO 2 -/NO 3 - and ET-1. The animals were killed and the wet/dry lung weight (W/D) ratio and total protein of bronchoalveolar lavage fluid(BALF) of right lung were measured. Microscopic examination of the lung was done. Results In treatment group PaO 2 was significantly higher than that in injury group after acid instillation. Plasma 6-k-PGF 1? and NO - 2/NO - 3 levels were significantly higher in treatment group while plasma TXB 2 and ET-1 levels were significantly lower. W/D ratio and TP of BALF of right lung were significantly lower in treatment group. The inflammatory changes were diffuse in injury group while in treatment group they were localized and less severe. Conclusions PGE1 can lessen severity of ARDS induced by acid aspiration. It may protect pulmonary vascular endothelial cells through maintaining the balance between PGI 2 and TXA 2 and that between NO and ET-1 .

ObjectiveThe purpose of this study was to evaluate the effect of prostaglandin E1 (PGE1) on blocking the development of acute respiratory distress syndrome (ARDS) induced by acid aspiration. MethodsTwenty new Zealand rabbits were used. Dilute HCl was instilled into right bronchus of the rabbits. The rabbits were then divided randomly into two groups: injury group and treatment group. In injury group ( n = 10) rabbits received no treatment except mechanical ventilation. In treatment group ( n = 10) immediately after acid instillation the rabbits received an intravenous bolus of PGE1 followed by a continuous infusion. Blood gas, airway pressure and dynamic and static compliance were measured before and after acid instillation. Blood samples were taken from artery for determination of 6-k-PGF1α, TXB2, NO2-/NO3- and ET-1. The animals were killed and the wet/dry lung weight (W/D) ratio and total protein of bronchoalveolar lavage fluid(BALF) of right lung were measured. Microscopic examination of the lung was done. ResultsIn treatment group PaO2 was significantly higher than that in injury group after acid instillation. Plasma 6-k-PGF1α and NO2-/NO3- levels were significantly higher in treatment group while plasma TXB2 and ET-1 levels were significantly lower. W/D ratio and TP of BALF of right lung were significantly lower in treatment group. The inflammatory changes were diffuse in injury group while in treatment group they were localized and less severe. Conclusions PGE1 can lessen severity of ARDS induced by acid aspiration. It may protect pulmonary vascular endothelial cells through maintaining the balance between PGI2 and TXA2 and that between NO and ET-1 .

Objective To discuss the effect of three-dimensional conformal hypofractionated high-dose radiotherapy on non-small cell lung cancer in the elderly. Methods All patients were treated by the same way of fraction radiotherapy,with a prescription dose of 4-5?Gy,every other day,to a total dose of 48-55?Gy. Results Complete response was observed in 23(51.1%) patients,partial response in 15(33.3%) patients, with the overall response rate of 84.4%. The overall 1-,2-,3-year survival rates were 66.7%,48.9% and 39.1%.Conclusions Three-dimensional conformal hypofractionated high-dose radiotherapy is safe and effective, giving mild untoward side-effects.

Objective To explore the changes of frequency, BAFF expression and sensitivity to apoptosis of CD19 + CD5 + B cells in endometriosis patients and investigate the relationship between CD19 +CD5 + B cells and endometriosis. Methods Flow cytometry and quantitative PCR were used to assess the frequency, BAFF expression and sensitivity to apoptosis of CD19+ CD5 + B cells in the peripheral blood,peritoneal fluids and endometrium biopsies of 39 patients with endometriosis and 31 patients with myoma of uterus ( control subjects). Results: All 39 endometriosis patients had higher frequencies ( all P ＜ 0. 01 ) of CD19 + CD5 + B cells in the peripheral blood, peritoneal fluids and endometrium biopsies than that in 31 control subjects. CD19 + CD5 + B cells from endometriosis patients expressed higher BAFF, and were more resistant to CD95L-induced apoptosis than the cells from control subjects ( P ＜ 0. 01 ). Conclusion CD19 + CD5 + B cells might play an important role in the pathogenesis of endometriosis through higher BAFF expression and more resistance to CD95L-induced apoptosis.

In this article,the connotation of the knowledge management and services as well as the relationship between them were introduced.The specific measures about how to carry out these management and services were described.

Objective To investigate the clinical features, the video electroencephalography ( V-EEG) and synchronous electrocardiography ( ECG) changes in non-epileptic seizures and the significance of ECG monitoring in the diagnosis of epilepsy.Methods We collected 3 patients who came in a chief complaint of“episodes of unconsciousness with limbs twitch”, whose clinical features and EEG, ECG in longterm VEEG monitoring were analyzed.The 3 patients were followed up for at least 6 months.Results The 3 patients were all diagnosed as epilepsy in other hospital,and during the 24-hour VEEG monitoring in our hospital,2 patients showed abnormal cardiac rate and arrest during the attack and corresponding EEG changes after cerebral ischemia and hypoxia.After consultation with the department of cardiology, they were diagnosed as cardiac syncope episode and no attack showed up after the placement of pacemaker.The Q-T interval was prolonged in the other patient during the longterm ECG monitoring, after the coherence check who was diagonsed as severe hypocalcemia combined with myocardial damage due to a lower parathyroid function and had no attack after symptomatic treatment.Conclusions The synchronous ECG monitoring during the attack is of great significance in the differential diagnosis of epileptic and non-epileptic seizures. The ECG changes in patients with longterm VEEG monitoring should be focused on.It is necessary to add the early warning function to prevent the occurrence of accidents.

Objective To analyze risk factors for the perioperative heart failure following hip fracture surgery in the aged patients.Methods The present study included 186 elderly patients(≥ 65 years)who had received hip fracture surgery from August 2009 to Janurary 2014 in our department.Their clinical data were analyzed to define risk factors for perioperative heart failure.Results Factors significantly affecting the perioperative heart failure included age,gender,hypertension,time from injury to operation,general health before injury,pain score,perioperative blood transfusion,perioperative human serum albumin transfusion,fluid infusion during operation,perioperative balance between daily fluid intake and output,perioperative temperature changing and heart diseases.A multivariate Logistic regression analysis revealed that the independent risk factors for perioperative heart failure included general health before injury (OR =21.967,P=0.000),perioperative balance between daily fluid intake and output (OR =19.349,P =0.005),heart diseases (OR =6.009,P =0.006).Conclusions In aged patients undergoing hip fracture repair operations the independent risk factors for perioperative heart failure include general health before injury,perioperative balance between daily fluid intake and output,heart diseases.Perioperative risk assessment and prevention are the keys of better prognosis.

Objective To investigate the therapeutic efficiency of intravenous implanted endothelial progeni-tor cells (EPCs) pretreated with stromal cell derived factor-1 (SDF-1) in rat model of acute myocardial infarction (AMI). Method The bone-marrow derived EPCs were cultured. The effects of SDF-1 on the migration and sur-rival of EPCs were evaluated in vitro. The rat models of AMI were produced and randomly divided into SDF-1 +EPCs group (n=12), EPCs group (n=12) and control group (n=12). EPCs pretreated with or without SDF-1 were infused via tail vein 24 hours after AMI modelled. The EBM-2 culture medium without cell was infuaed in control group. Vessel density, cardiac function and infarct area were measured on 14 days and 28 days after cell implantation. Results Fourteen days after cell implantation, the vessel density of SDF-1+EPCs group was higher than that of EPCs group and control group. Twenty-eight days after cell implantation, the cardiac function of SDF-1+EPCs group was better than that of EPCs group and control group. Conclusions EPCs pretreatment with SDF-1 can improve the survival and migratory capacity of EPCs, and increase the therapeutic efficiency for myocardial infarction.