Since the China's new healthcare reform has launched , beneficial policies introduced by the central and local governments has promoted the rapid development of private hospitals .This paper taking Sichuan Province as an ex-ample analyzes the development of private hospitals from four points of view:hospital amount, scale, location and services package, using 2002—2014 hospital-level data, which provides decision support for formulating and improving relative pol-icies.As per the analysis of the data at hand , it has been confirmed that private sector has developed quickly during the 13 years, with the number of hospitals increasing by 19.2%annually.Private hospitals were mainly of small-scale.Although the proportion of services provided by privates sector has grown yearly , it was merely 14.5%in 2014.The hospital location that the private sector selected concentrated mainly in developed regions , but the proportion of private hospital in the un-derdeveloped region has risen steadily .In terms of types of service provided , there were certain differences between private and public sector.Compared to the public sector, the private sector provided a higher proportion of specialized medical services, concentrating on otolaryngology , cosmetic plastic surgery , cardiovascular services , etc.

BACKGROUND: Non-invasive vascular ultrasound is used to assess in tima-media thickness (IMT) and atheromatous plaque, of which the result is better correlated to that of pathological examination. OBJECTIVE: Non-invasive vascular ultrasound was used to assess the hemodynamical changes of external and internal carotid in hypertensive elders, so as to investigate the relationship between pulse pressures, left ventricular mass index (LVMI), vascular resistance index (VRI) and shearing ratio. DESIGN: Randomized, controlled, correlative analyzedstudy. SETTING: Ultrasound Department of Affiliated Hospital of Jiangshu University. PARTICIPANTS: Totally 54 hypertensive elders, including 33 males and 21 females, were recruited from the Ultrasound Department of Affiliated Hospital of Jiangshu University, from September 30th 2000 to March 30th 2002. Meanwhile 26 normotensive elders (systolic pressure ＜ 130 mm Hg and/or diastolic pressure ＜ 85 mm Hg), including 16 males and 10 females, were selected as controls, METHODS: Color duplex blood flow imaging technique was used to assess the left ventricular end-diastolic diameter (LVEDD) and the interventricular septum thickness (IVST), so as to calculate the LVMI. The insiddiameter of bilateral common carotid artery (CCA) and internal carotid,IMT, the systolic peak flow velocity and resistance index were measured in order to calculate the vascular shearing ratio and atheromatous plaque index,moreover arterial pressure, LVMI, as well as resistance index and shearing ratio were subjected to linear correlative analysis,of which the results were compared with that of control group. MAIN OUTCOME MEASURES: ① Pulse pressure, LVMI and atheromatous plaque index of CCA. ② The inside diameter of bilateral CCA and internal carotid, IMT and the systolic peak flow velocity and resistance index were measured in order to calculate the atheromatous plaque index and maximum vascular shearing ratio. RESULTS: According to the experimental objective,data of all 80 cases were analyzed without loss. ① The pulse pressure and LVMI, the incidence of atheromatous plaque and plaque index of CCA in hypertensive elder group were obviously higher than that of control group [(64.36±7.44) mm Hg,(45.78±8.72) mm Hg; (131.47±18.73) g/m2, (83.28±12.34) g/m2; 5.62 ±1.78,3.44±1.10; 66.7％, 23.1％, (x2=13.37, t=5.730-13.234, P ＜ 0.01)]. ② The inside diameter of bilateral CCA and internal carotid, IMT and resistance index in hypertensive elders were significantly higher than that of control group [CCA: (8.96±1.20) mm, (8.08±0.96) mm; (1.28±0.88) mm, (0.91±0.17) mm;0.75±0.05, 0.69±0.06; ICA: (6.82±1.12) mm, (5.72±0.92) mm; (1.06±0.17) mm,(0.76±0.15) mm; 0.70±0.07, 0.64±0.06, t=2.872-10.850, P ＜ 0.01], but the systolic peak flow velocity and shearing ratio were markedly lower than that of control group [CCA: (47.44±12.85) cm/s, (60.20±14.32) cm/s;(225.78 ±95.76)/s, (300.26 ±110.42)/s. ICA: (41.22 ±10.18) cm/s,(48.64±11.58) cm/s; (268.54±112.56)/s, (324.52±121.42)/s, t=2.872-10.850, P ＜ 0.01]. ③ The pulse pressure, LVMI, the resistance index of CCA and ICA and shearing ratio were linearly correlated (r=0.30-0.36, P ＜ 0.05). CONCLUSION: Pulse pressure and LVMI were found increased in hypertensive elders, together with carotid vessels dilated, IMT and resistance index increased, as well as shearing ratio decreased, atheromatous plaque formed, vascular stiffness increased, which resulted in consequently decrease of vascular compliance.

Objective To investigate the correlation between the CD40 gene( - 1 C/T)single nucleotide polymorphism(SNP) and acute coronary syndromes(ACS), and the expression of CD40 on platelets. Method A total of 562 patients with ACS canfirmed by coronary angiography were divided into 3 groups according to the clinical characteristics, namely ACS patients( n = 210), stable angina(SA) patients( n = 189) and control group( n = 163).ACS was defined as ischemic chest pain at rest resulting in admission to hospital and > 50% stenosis in a major coronary artery with or without a rise in troponin Ⅰ. SA was defined as stable effort-related angina without change in angina pattern in 3 months. Patients with infection, tumor, or liver or kidney disease were excluded The gene polymorphism was measured by the polymerase chain reaction and restriction fragment length polymorphism(PCR-RFIP) and identiffed by sequencing. The expression of CD40 on platelets was detected by flow cytometry. The frequency, distribution of genotypes was compared using cross-tabulation and standard X~2 test. Result The CC genotype(31% ) and C allele of frequency(57.9%)of CD40 gene in ACS patients were significantly higher than those in SA(15.9%, 43.1% ) and control groups( 16.1%, 42.6% ). No significant difference of the genotypes or allele frequencies was found between SA and control group(X~2 = 0.053, P = 0.974;X~2 = 0.017, P = 0.897). 1he expression of CD40 on platelets in patients with C alleles carries was significandy higher than that of T allele carries in each group( P <0.0001). Conclusions CD40- 1C/T polymorphism was associated with ACS in Chinese Han nationallity.

Objective To evaluated the effect of the regional cooperative rescue model implemented on the length of time from first medical contact (FMC) to balloon dilation (B),economic expense and prognosis in patients with acute coronary syndrome (ACS).Methods Patients with ACS (including ST-segment elevation and non-ST-segment elevation) selected from other hospitals within 24 hours after onset were treated with emergency percutaneous coronary intervention.Patients were divided into two groups, regional cooperative rescue group and control group without the regional cooperative rescue model approved.The lengths of FMC-to-B time and Door-to-B time (from arrival at emergency department or OPD to balloon dilation),time required for patients referred to our hospital,cardiac function,averaged hospital costs,average hospital stay,percentage of medication used and a major adverse cardiac event (MACE) were analyzed.Results Mean FMC-to-B time,Door-to-B time,referral time and time consumed to obtain informed consent were significantly shorter [(106±33) min,(31 ±8) min,(62 ±18,8 ±3) min] vs.[(231 ±35) min,(109 ±26) min,(98 ±31) min,(28 ±11) min,respectively] by implementing the regional cooperative rescue compared with control group,and LVEF was increased,and LVED was deceased inregional cooperative rescue group.The mean costs [(44 123.0 ±3 427.0) yuan vs.(51 587.0 ±5 621.0)] yuan,days of hospital stay [(8.7 ±4.1) vs.(13.2 ±6.4)] and percentage of medication used were significantly decreased in the regional cooperative rescue group.The incidence of MACE inregional cooperative rescue group was 6.2％,whereas the incidence in control group was 16.8％.Conclusions The regional cooperative rescue model can improve the prognosis and decrease the FMC-to-B time,the rate of MACE and financial burden in patients with ACS.

Objective To compare two effective preparation methods for paclitaxel-loaded lipid microbubbles, and to evaluate the physiochemical properties as for acoustic activated drug delivery. Methods Paclitaxel-loaded lipid microbubbles were prepared with two methods: one was mixed with phospholipids directly (Ⅰ); the other was added in triacetin, then mixed with phospholipids (Ⅱ). Concent ration, size, pH, drug entrapment efficiency, drug-loading amounts of these two kinds of paclitaxel-loaded lipid microbubbles were studied, while drug release with ultrasound and tumor imaging enhanced on rabbit breast tumor were observed. Results There was no significant difference in tumor imaging between two kinds of microbubbles which could be ruptured by low energy ultrasound. Compared with Ⅰ, the mean diameter of Ⅱ decreased significantly ([ 1.07±0.38] μm vs [2.79± 0.41] μm, P<0.01), the surface potencial was higher ([19.10±0.32] mV vs [-5.90±0.21] mV, P<0.01), whereas entrapment efficiency and drug-loading amounts increased markedly ([ 95.00±1.22]% vs [36.10±4.74]%, P<0.01; [5.60±0.11]% vs [0.50±0.04]%, P<0.01). Conclusion The Ⅱ paclitaxel-loaded lipid microbubbles added triacetin have an important clinical value.

Objective: To investigate knowledge, attitudes, and practice on exercise and dietary behaviors among the primary and middle school pupils in Shandong province, and to provide a theoretical basis for a targeted education on diet and physical health among the primary and middle school students. Methods: A questionnaire survey was conducted among 6 161 students from 3 cities in Shandong province by random cluster sampling. Results: Self-reported rate of having breakfast every day for primary and middle school students were 85.0% and 75.3% ,respectively(χ2=84.0，P<0.01). 41.2% of primary school students were reported to do physical exercises more than 60 minutes every day and the rate was only 29.6% for middle school students(χ2=270.0，P<0.01). 39.2% of boys were reported to do physical exercises more than 60 minutes every day and the rate was 28.7% for the girls(χ2=90.4，P<0.01). The awareness rates of knowledge about dietary and physical exercise among primary and middle school students were 44.4% and 55.8%, respectively(χ2=702.0，P<0.01). The awareness rates among boys and girls were 50.4% and 51.9% respectively (χ2=12.4，P<0.01). Parents’ occupation, knowledge score and education level of mother were influencing factors of breakfast behavior everyday. The physical exercise was influenced by gender, parents' occupation, knowledge score and education level of mother. Conclusion It is necessary to educate students to take healthy diet and have more physia1 activities. Families, schools and government departments need to take feasible measures to ensure the time and intensity of pupils’ physical exercise through many ways.

Objective: To explore age-based clinical and immune parameters in Henoch-Schönlein purpura (HSP) to determine clinically useful markers reflecting disease characteristic. Methods: A cohort of 502 patients with HSP were enrolled into this retrospective study to evaluate their clinical and immune data. Results: Majority HSP cases occurred at age ≤14 years and showed significant immune imbalances of ESR, CD3⁺ cells, CD4⁺ cells, CD3^-CD16⁺CD56⁺ cells, CD4⁺/CD8⁺ cells, IgG, IgA, IgM, IgE, complements C3/C4 and ASO in the acute phase. Compared to patients aged >14 years, symptoms of joint were more frequent at disease onset in patients aged ≤14 years (20.8% vs 7.6%, χ²=13.547, P<0.001) , and involvement of digestive tract and joint were also more frequent (57.4% vs 33.8%, χ²=24.106, P<0.001; 55.9% vs 32.5%, χ²=23.768, P<0.001, respectively) , but not for involvement of kidney (21.4% vs 51.3%, χ²=42.440, P<0.001) . The patients aged ≤14 years had distinct immune state, reductions of CD3⁺ cells, CD4⁺ cells and IgG were more frequent than patients aged >14 years, also increase of ASO (33.1% vs 20.0%, χ²=6.656, P=0.010) , but not increase of IgA (2.6% vs 39.4%, χ²=15.582, P<0.001) . In addition, reduction of IgG and increase of IgE were positively associated with digestive tract involvement (P<0.001, P=0.001, respectively) , reduction of CD3⁺CD4⁺ cells and normal IgM were positively associated with joint involvement (P=0.004, P=0.003, respectively) , increase of CD3⁺CD8⁺ cells and normal CD3⁺ cells were positively associated with kidney involvement (P=0.032, P=0.014, respectively) . Conclusion HSP showed significant immune imbalance in the acute phase, patients between aged ≤14 and >14 years had distinct clinical and immune characteristic, and abnormal immune parameters were significantly associated with organ involvements.

Objective: To investigate the feasibility and efficacy of the establishment of regional cooperative acute ST-segment elevation myocardial infarction (STEMI) rescue network among the prefectural-level city hospitals in China. Methods: Based on real-time remote electrocardiogram transmission and "120" emergency systems, we established a regional collaborative STEMI treatment network with our hospital as the network unclears including 8 second-class affiliated hospitals of Jiangsu University in 2013. STEMI treatment time, therapeutic effects and economic indexes were compared before (from January 2010 to December 2012, 180 cases, pre-network) and after (From January 2013 to December 2015, 374 cases, post-network) the establishment of the regional collaborative STEMI treatment network. Results: Post establishment of the rescue network, mean first medical contact (FMC) to balloon (FMC-to-B) time, referral time and obtaining informed consent time were all significantly decreased from (191±41), (94±18), (25±9) minutes to (93±19), (53±18), (7±5) minutes, respectively, in comparison with the pre-network era(all P<0.05). There was a trend of prolonged FMC-to-B time in proportion to aging of STEMI patients(trend P<0.05). Three months post discharge, LVEF was higher (55.3%±10.7% vs. 48.8%±12.1%, P<0.05) and LVEDd was lower ((49.1±10.8)mm vs.(51.8±9.2)mm, P<0.05) in the post-network group compared to pre-network group.In-hospital mortality was also significantly reduced post the establishment of the rescue network (2.14%(8/374) vs. 3.89%(7/180), P<0.05). The results also showed that the total costs (42 017(25 069, 75 148)yuan vs.51 030(28 137, 105 861)yuan), days of hospitalization ((9.1±4.5) days vs. (15.3±4.8)days) and percentage of medicine and consumables were all significantly decreased in the post-network group compared to pre-network group(all P<0.05). Conclusion Establishment of the regional cooperative rescue network is feasible among the prefectural-level city hospitals in China. Establishment of such network can improve the prognosis and decrease the FMC-to-B time, the rate of in-hospital mortality and financial burden of patients with STEMI, and serves as an effective strategy to improve the rescue ability for STEMI patients.

Objective: To investigate whether platelet-derived growth factor-BB (PDGF-BB) can regulate phenotypic transformation of pulmonary artery smooth muscle cells (PASMCs) via SIRT3 affecting glycolytic pathway. Methods: The PASMCs were isolated from Sprague Dawley rats. PASMCs were divided into 3 groups by using 2-deoxyglucose (2-DG), an inhibitor of the glycolytic pathway: normal control group, PDGF-BB group(30 ng/ml) and PDGF-BB (30 ng/ml)+2-DG (10 mmol/L) group. In lentivirus-mediated overexpression assay, cells were divided into control group, PDGF-BB group(30 ng/ml), PDGF-BB+deacetylase sirtuin-3 (SIRT3) overexpression group and PDGF-BB+empty vector group. The expression levels of phenotype related index such as α-smooth muscle actin (α-SMA), smooth muscle myosin heavy chain (SM-MHC), calponin, vimentin were detected by qRT-PCR and Western blot. Meanwhile, the expression of α-SMA was detected by cellular immunofluorescence staining. EDU staining was used to detect the proliferation of PASMCs. The expression of SIRT3 was detected by Western blot. The expressions of glucose transporter 1 and aerobic glycolytic enzymes were detected by qRT-PCR and Western blot in lentivirus-mediated overexpression assay. Results: (1) PDGF-BB affects PASMCs phenotypic transformation through glycolytic pathway: compared with normal control group, PDGF-BB significantly decreased the expressions of contractile phenotype markers such as α-SMA, SM-MHC, calponin mRNA and protein (all P<0.05), but it increased the expressions of the synthetic phenotype marker vimentin mRNA and protein (both P<0.05). Cellular immunofluorescence assay showed that PDGF-BB significantly decreased the number of α-SMA positive cells, while 2-DG reversed the process. (2) PDGF-BB promoted cell proliferation through glycolytic pathway: the proliferation of PASMCs was significantly higher in PDGF-BB group than in control group (P<0.05), and which could be significantly reduced by 2-DG (P<0.05). (3) PDGF-BB inhibited the expression of SIRT3 protein in PASMCs: the expression of SIRT3 protein in PDGF-BB group was lower than that in control group (P<0.05). (4) PDGF-BB affected glycolytic pathway through SIRT3:compared with the control group, PDGF-BB significantly increased the expression levels of glucose transporter 1 (Glut1), hexokinase 2 (HK2) and 6-phosphfructo-2-kinase 3 (PFKFB3) mRNA (all P<0.05), which was reserved by over-expression of SIRT3. There were no significant difference in mRNA expression levels between PDGF-BB group and PDGF-BB+empty vector group (P>0.05).Compared with the control group, PDGF-BB significantly increased the expression levels of Glut1, HK2 and PFKFB3 protein(all P<0.05), which was reserved by over-expression of SIRT3. There were no significant differences in protein expression levels between PDGF-BB group and PDGF-BB+empty vector group (all P>0.05). Conclusion PDGF-BB regulates phenotypic transformation of PASMCs via SIRT3 affecting glycolytic pathway.

Objective To study the smoking status and influence of the families on pupils regarding smoking-related knowledge,attitudes and behavior,in Shandong province.Methods A multi-stage stratified-cluster random sampling method was used to investigate 6 050 students and their families in 3 different cities.A self-administered anonymous questionnaire survey was conducted by trained investigators.Results The overall passive smoking rate at households of the pupils was 49.7％ in Shandong province and appeared the highest in separate families,followed by in re-organized families and multiple-generation families under the same roofs.Major smokers in the families were fathers and grandfathers,with 43.4％ of the fathers and 74.0％ of the grandfathers had smoking histories for more than 10 years.The main smoking places at home were "elsewhere" or in the "living room".Attempting and current smoking rates of the families were 7.7％ and 1.7％ respectively,significantly higher than those families with no smokers.There was significant difference in smoking associated behavior and attitude between pupils whose family members with smoking habits or without.Conclusion The status of smoking in the families of the pupil' s family was not optimistic in Shandong province,especially in the families of the male students.Since smoking status of the families played an important role on their children,it is necessary to explore suitable health education model to improve the smoking associated behaviors in the families.