The difficulties were alleviated since the emergence of affiliated hospital indirectly under medical colleges and universities,which provided the opportunities for development of these universities and also for their own development with teaching and research support.But the difficulties appeared in the teaching work of indirectly affiliated hospital.This article proposed some countermeasures for reflection on the win-win strategy of both side.

To explore the risk factors and features in patients with premature coronary artery disease (CAD) and mature CAD. Methods: General and clinical information was collected from 747 patients who received coronary angiography (CAG) in our hospital from 2015-01 to 2016-02 and the patients were divided into 3 groups based on CAG findings: Premature CAD group, n=138, Mature CAD group, n=364 and non-CAD group, n=245. CAD diagnosis was defined by at least one major coronary artery stenosis ≥50%; premature CAD was defined by the onset age in male<55 years, in female<65 years. Risk factors and features were compared between premature CAD and mature CAD patients. Results: Compared with Mature CAD group, Premature CAD group showed the higher incidences of family history of hypertension, abnormal blood glucose and BMI, increased blood levels of TC, TG, LDL-C, elevated apolipoprotein A and B (APOA and APOB); while the lower ratio for combining hypertension, P<0.05. Multinomial Logistic regression analysis presented the following parameters had the increased risk for premature CAD occurrence: combining hypertension and diabetes (OR=2.98, 95% CI 1.04-8.57), family history of hypertension (OR=3.50, 95% CI 1.28-9.57), abnormal blood glucose (OR=1.98, 95% CI 1.04-3.80) and elevated APOB (OR=36.67, 95% CI 3.51-99.83). The following parameters had the increased risk for mature CAD occurrence: advanced age (OR=1.20, 95% CI 1.15-1.24), male gender (OR=6.22, 95% CI 3.31-11.69), combining hypertension (OR=1.75, 95% CI 1.08-2.82), concomitant hypertension and diabetes (OR=3.25, 95% CI 1.42-7.46) and elevated APOB (OR=16.39, 95% CI 1.74-99.44). Compared with Mature CAD group, Premature CAD group presented the higher ratio of double vessel disease (38.4% vs 22.3%) and lower ratio of multi vessel disease (31.2% vs 48.1%), all P<0.05. Conclusion: The incidences as family history of hypertension, abnormal blood glucose and BMI, elevated APOB were higher in premature CAD patients than mature CAD patients. It is important to conduct targeted prevention to control relevant risk factors.

Objective To investigate the efficacy and safety of recombinant human Pro urokinase ( rhPro-uk) in treatment of patients with acute ST segment elevation myocardial infarction.Methods 90 cases from 2014 to 2015 selected in three hospital diagnosed with STEMI were randomly assigned into experimental group and control group, 45 cases in each test group.Experimental group received rhPro-uk thrombolytic therapy, control group received urokinase thrombolytic therapy, thrombolytic efficacy and incidence of adverse events were observed and compared between two goups.Results After thrombolysis 2 h, ST segment decline ≥50% of patients in experimental group was 80.00%, ST segment completely fall rate was 55.56%, coronary recanalization rate was 77.78%, all significantly higher than that in control group(60.00%, 33.33%, 55.56 %,separately.P<0.05).After thrombolysis 2h, the difference of TIMI grade between two group was significant (Z=-3.198, P<0.05).After thrombolytic therapy, CTn-I, CK-MB peak levels between two groups were not significantly different.The peak time and average time of experimental group were significantly lower than that in control group (P<0.05).The incidence of adverse events of experimental group 13.33%, significantly lower than 33.33% in control group(P <0.05).Conclusion Therapeutic effect of rhPro-uk on acute ST-segment elevation myocardial infarction is better than urokinase, and has higher safety.

BACKGROUND: The investigation of culturing, passaging and establishing human limbal stem cells can strengthen the recognition of the stem cells and provide the enough cellular reserve for the basic and clinical research of limbal stem cell transplantation.OBJECTIVE: To explore a method of pessaging and establishing cell line of human limbal stem cells cultured in vitro.DESIGN: Randomized controlled observation.SETTING: Gannan Medical College.MATERIALS: The experiment was performed at Scientific Center of Gannan Medical College and the National Key Laboratory of Ophthalmology Hospital Affiliated to Sun Yat-Sen University from June 2003 to April 2004. Fresh human limbus corneae were isolated from two healthy donors. Procedures were performed according to the informed consent of the donors. Main reagents contained RPMI-1640 (Sigma R8755, containing L-glutamine) and 200 g/L fetal calf serum (FCS) (Gibco 16140-071). DMEM medium, chondroitin sulfatase and human epidermal growth factor (hEGF) were purchased from Sigma Co. USA; HEPES and DMSO were bought from Gibco, USA; 100% glycerinum was purchased from Yunjia Huangpu Pharmaceutical Product Limited Company, PRC; glutaraldehyde was bought from E.Merk, Germany; Alcohol, chlorhydric acid, acetone and methyl aldehyde were purchased from Beijing Chemical Agent Company, PRC; 0.25% parenzyme was bought from Shanghai Xinhua Pharmaceutical Factory, PRC.Above-mentioned reagents were analytical pure grade.METHODS: After digestion, human limbal tissues in limbal basilar part with an abundant pigment were cultured in the culture flask containing RPMI-1640 and 200 g/L FCS and in culture dish containing amniotic extracellular matrix (AECM) as the cultural supporter. Primary and passage cells were observed under light microscope and scanning electron microscope (SEM). The revival ratio of stem cell refrigeration of every generation was calculated by the trypanblau exclusion experiment.MAIN OUTCOME MEASURES: ① Observational results of limbal stem cells during the primary culture and serial subcultivation in vitro, and ② revival ratio of stem cell refrigeration.RESULTS: ①Findings of primary culture: Most limbal stem cells in the culture flask had the adherence and were arrayed uniformly sparsely to form monolayer and adhered to the bottom of culture flask under the inverted phase contrast microscope after 1-day culture. ② Findings of serial subcultivation: After human epidermal growth factor (hEGF) was added into the second passage, cells were scattered into the monolayer and adhered to grow quickly.Morphological variability of all the cells increased obviously when passage the 30th generation. The cellular volume was obviously increasing, and the round or irregular round cells gathered together. The 33rd generation human limbal stem cells still could vigorously differentiate, proliferate and grow in ACEM. ③ The revival ratio of stem cell refrigeration was 82.2%.CONCLUSION: The human limbal stem cell lines were preliminarily established by culturing and freezing the cells of 33 generations in vitro. The human limbal stem cell lines preferred to grow in the culture dish containing AECM as the cultural supporter.

AIM To investigate the relationship between sinomenine distribution and its organic toxicology in rats so as to give some pharmacological data for clinical application of sinomenine. METHODS Three kinds of administration plans were designed in the experiment, ie sinomenine was ip administered at the dosage of l50 mg?kg -1 per day, repreat dosed for 6 wk and suspended the drug for 1 wk after 6wk repeat doses.At the end of the each administration plan,the animals were sacrificed and their blood and their main internal organs were collected for the purpose of measurement of sinomenine concentration in each sample by HPLC. Meanwhile,the histopathological and serological examinations were also done in the experiments. RESULTS The sinomenine concentration in rats internal organs were in order of liver, heart, lung and brain either in single dosed treated animals or in repeat dosed treated animals for 6 wk. However,the concentration of sinomenine could not be detected by HPLC after l wk drug suspension,the histopathological examination showed that sinomenine at the dosage of l50 mg?kg -l per day for 6wk treatment could slightly damage liver ce11s, dominant1y caused the cell edema,but no any influence on the sero1ogy of liver and kidney. Sinomenine ip could also cause a mild hyperaemia of the rats heart tissues but no any histopathological changes had been observed. In testis tissues no sinomenine had beed detected although the animals were treated by repeat treatment for 6 wk and no any histopathological changes had been found yet. However, Sinomenine could partialy inhibit the sperm vitalities and amount of the dead sperms were a1so augmented. It was similar to in vitro eperiments. These influences of sinomenine on testis could be quickly recovered by drug suspension. CONCLUSION Sinomenine concentration were in order of liver, heart, kidney, lung and brain either in treatment by single dose or by repeat dose administration. The histopathological changes were only abserved in liver cells of the animals which indicates that it should be in consideration of the liver functions during treatment course of the drug.

AIM　To investigate the relationship between sinomenine distribution and its organic toxicology in rats so as to give some pharmacological data for clinical application of sinomenine. METHODS　Three kinds of administration plans were designed in the experiment, ie sinomenine was ip administered at the dosage of l50 mg*kg-1 per day, repreat-dosed for 6 wk and suspended the drug for 1 wk after 6wk repeat-doses．At the end of the each administration plan，the animals were sacrificed and their blood and their main internal organs were collected for the purpose of measurement of sinomenine concentration in each sample by HPLC. Meanwhile，the histopathological and serological examinations were also done in the experiments. RESULTS　The sinomenine concentration in rats internal organs were in order of liver, heart, lung and brain either in single-dosed treated animals or in repeat-dosed treated animals for 6 wk. However，the concentration of sinomenine could not be detected by HPLC after l wk drug-suspension，the histopathological examination showed that sinomenine at the dosage of l50 mg*kg-l per day for 6wk treatment could slightly damage liver ce11s, dominant1y caused the cell edema，but no any influence on the sero1ogy of liver and kidney. Sinomenine ip could also cause a mild hyperaemia of the rats heart tissues but no any histopathological changes had been observed. In testis tissues no sinomenine had beed detected although the animals were treated by repeat treatment for 6 wk and no any histopathological changes had been found yet. However, Sinomenine could partialy inhibit the sperm vitalities and amount of the dead sperms were a1so augmented. It was similar to in vitro eperiments. These influences of sinomenine on testis could be quickly recovered by drug suspension. CONCLUSION　Sinomenine concentration were in order of liver, heart, kidney, lung and brain either in treatment by single dose or by repeat-dose administration. The histopathological changes were only abserved in liver cells of the animals which indicates that it should be in consideration of the liver functions during treatment course of the drug.

While generative artificial intelligence(AI), exemplified by ChatGPT, demonstrated impressive capabilities in understanding the semantics and context of natural language, and generating coherent and meaningful responses, its performance in the medical field, which required high-level expertise and complex reasoning, remained uncertain. This article aimed to explore the potential applications and challenges of generative AI technology, with ChatGPT as a representative example, in enhancing the capabilities of primary healthcare services. Generative AI, represented by ChatGPT, had potential applications in enhancing primary healthcare services, including clinical assistance in diagnosis, electronic medical record documentation, remote management of chronic patients, and patient education. However, limitations such as the inability to guarantee accuracy, lack of doctor-patient interaction, language barriers, and concerns related to data security, patient privacy, and ethical considerations constrained its practical implementation. Therefore, the application of ChatGPT in improving the capabilities of primary healthcare services required extensive discussion and analysis throughout society. A comprehensive evaluation of potential risks and the establishment of corresponding policies and regulations were necessary to ensure the prudent and responsible introduction and application of ChatGPT, ultimately achieving the goal of empowering primary healthcare services.

Objective:To estimate the scale,expenditure and financing structure of potentially preventable hospitalization(PPH)for diabetes in Shenzhen,and provide data support for improving the utilization efficiency of medical and health resources.Methods:The System of Health Account 2011 was used to calculate the status of PPH for diabetes in Shenzhen and its cost scale and structure.Results:In 2019-2022,there will be a total of 441 426 avoidable hospital admissions for diabetes,hypertension,angina,influenza and pneumonia and dehydration and gastroenteritis,which cumulatively account for approximately 70.00%of admissions.The cost of hospitalization could be avoided by 525 028.06 million yuan,accounting for 6.18%of the total costs.The out-of-pocket costs were 1 762.724 4 million yuan,accounting for 33.57%of the total avoidable hospitalization costs.The out-of-pocket payment of angina pectoris,gangrene and rheumatic heart disease were higher and the proportion of out-of-pocket costs was larger.Conclusion:The large scale of hospital can be avoided in Shenzhen,and the waste of medical resources caused by unreasonable hospitalization is serious.The level of primary health care should be improved,the behavior of doctors should be regulated,the role of intervention in diseases of key populations should be increased,and the system of reimbursement of health insurance should be optimized.

Objective:To estimate the scale,expenditure and financing structure of potentially preventable hospitalization(PPH)for diabetes in Shenzhen,and provide data support for improving the utilization efficiency of medical and health resources.Methods:The System of Health Account 2011 was used to calculate the status of PPH for diabetes in Shenzhen and its cost scale and structure.Results:In 2019-2022,there will be a total of 441 426 avoidable hospital admissions for diabetes,hypertension,angina,influenza and pneumonia and dehydration and gastroenteritis,which cumulatively account for approximately 70.00%of admissions.The cost of hospitalization could be avoided by 525 028.06 million yuan,accounting for 6.18%of the total costs.The out-of-pocket costs were 1 762.724 4 million yuan,accounting for 33.57%of the total avoidable hospitalization costs.The out-of-pocket payment of angina pectoris,gangrene and rheumatic heart disease were higher and the proportion of out-of-pocket costs was larger.Conclusion:The large scale of hospital can be avoided in Shenzhen,and the waste of medical resources caused by unreasonable hospitalization is serious.The level of primary health care should be improved,the behavior of doctors should be regulated,the role of intervention in diseases of key populations should be increased,and the system of reimbursement of health insurance should be optimized.

Objective:To estimate the scale,expenditure and financing structure of potentially preventable hospitalization(PPH)for diabetes in Shenzhen,and provide data support for improving the utilization efficiency of medical and health resources.Methods:The System of Health Account 2011 was used to calculate the status of PPH for diabetes in Shenzhen and its cost scale and structure.Results:In 2019-2022,there will be a total of 441 426 avoidable hospital admissions for diabetes,hypertension,angina,influenza and pneumonia and dehydration and gastroenteritis,which cumulatively account for approximately 70.00%of admissions.The cost of hospitalization could be avoided by 525 028.06 million yuan,accounting for 6.18%of the total costs.The out-of-pocket costs were 1 762.724 4 million yuan,accounting for 33.57%of the total avoidable hospitalization costs.The out-of-pocket payment of angina pectoris,gangrene and rheumatic heart disease were higher and the proportion of out-of-pocket costs was larger.Conclusion:The large scale of hospital can be avoided in Shenzhen,and the waste of medical resources caused by unreasonable hospitalization is serious.The level of primary health care should be improved,the behavior of doctors should be regulated,the role of intervention in diseases of key populations should be increased,and the system of reimbursement of health insurance should be optimized.