OBJECTIVE:To construct the structure equation model for the burden of chronic disease inpatients in primary hos-pital before and after the implementation of zero price policy,and analyze the changes of burden factor loading. METHODS:6 pri-mary hospitals were randomly selected in Danyang,Jiangsu province. The data of hospitalization expenses for chronic diseases(hy-pertension,diabetes,bronchitis)were collected before and after the implementation of zero price policy. Using drug cost,nursing fees,inspection fees and treatment fees as independent variables,hospitalization burden as latent variable,SPSS and AMOS 24.0 software were adopted to establish the model. RESULTS:The burden factor loading of inpatients changed greatly before and after the implementation of zero price policy. χ2=24.586,χ2/df=1.446, RMSEA=0.019,GFI=0.995,AGFI=0.989,CFI=0.988,NFI=0.963 manifested good model fitting. Factor loading of drug cost increased greatly,indicating the burden of inpatients was reduced after the implementation of zero price policy. Factor loading of inspection fees and treatment fees increased significantly,the charac-terization effects of them to the burden of inpatients were enhanced. Factor loading of nursing fees was the lowest,and it had the weakest effects on the burden of inpatients,of which the government should enhance the regulation. CONCLUSIONS:Established model has good reliability and validity. It can reflect the change of burden factor loading of inpatients before and after the implemen-tation of zero price policy.

Hydrogen evolution from water electrolysis is one of the effective ways to obtain clean hydrogen energy in the future. Pt-based materials are the efficient catalysts in hydrogen evolution reaction, but it is expensive, difficult to recycle, which impedes its application in the development of hydrogen energy and economy. Therefore, it is the key trend to develop efficient non-noble metal electrocatalysts with the aim of providing cost-competitive hydrogen energy. In this review, we highlighted the recent research efforts toward the synthesis of noble metal-free electrocatalysts for the hydrogen evolution reaction ( HER) , mainly focusing on nanomaterial catalysts supported on carbon fiber materials. We reviewed several important kinds of heterogeneous non-noble metal electrocatalysts, including sulfides, selenides, carbides, phosphides, and oxides. In the discussion, emphasis was given to the synthetic methods of these HER electrocatalysts, and the strategies for performance improvement. In addition, this paper also briefly summarized the application of carbon fiber material as substrate in the field of electroanalytical chemistry.

Objective To investigate the effect of Shenfu injectio on insulin resistance in rabbits undergoing cardiopulmonary bypass (CPB) . Methods Thirty New Zealand white rabbits of both sexes weighing 2.2-2.5 kg were randomly divided into 3 groups (n = 10 each): group I sham operation (group S); group Ⅰ CPB and group Ⅰ CPB + Shenfu injectio (group SFI). In group IE (group SFI) Shenfii injectio 10 ml/kg was injected intraperitoneally (IP) once a day for 2 days and at 30 min before anesthesia. In group Ⅱ and Ⅲ the duration between aortic cross-clamping and unclamping was 60 min. MAP was maintained at 50-60 mm Hg during CPB. The plasma glucose and insulin concentrations were measured immediately after induction of anesthesia (T_1), immediately after aortic cross-clamping (T_2) , and at 5, 35 and 75 min after aortic unclamping (T_3, T_4 , T_5) and insulin resistance index (HOMA-IR) was calculated. The expression of insulin receptor substrate-1 (IRS-1), phosphatidyl-inositol 3 kinase (PI3Kp85) and glucose transporters (CLUT4) in skeletal muscle was detected at 150 min of CPB by immuno-histochemistry. Results Compared with the baseline values at T_1 , plasma glucose and insulin concentrations and HOMA-IR were significantly increased at T_(2-5) in all 3 groups ( P < 0.05) . CPB significantly increased the plasma glucose and insulin concentrations and HOMA-IR at T_(2-5) in group Ⅱ and Ⅲ as compared with group S ( P < 0.05). The expression of PI3Kp85 and GLUT4 in muscle was significantly decreased in group Ⅱ and Ⅲ as compared with group S ( P < 0.05). Shenfu injectio significantly decreased plasma glucose concentration and HOMA-IR and increased plasma insulin concentration in group fD as compared with group Ⅱ . Shenfu injectio significantly attenuated the CPB-induced changes in IRS-1, PI3Kp85 and GLUT4 expression in muscle. Conclusion Shenfu injectio can ameliorate CPB-induced insulin resistance and the mechanism may be related to the up-regulation of the expression of insulin signal transduction molecules in skeletal muscle.

Objective To evaluate the short-term and mid-to-long-term clinical effectiveness of endovascular isolation technique with covered-stent in treating Stanford type B aortic dissection. Methods A total of 183 patients with Stanford type B aortic dissection, who were admitted to authors’ hospital during the period from January 2005 to December 2013 to receive endovascular isolation treatment with covered-stent under general anaethesia, were enrolled in this study. The clinical data, including post-operative symptoms, complications, retention time in ICU, hospitalization days, 30-day mortality, etc. were retrospectively analyzed. After discharged from hospital, the patients were followed up to check the situation, position and shape of the stent, the diameter of dissection false lumen, the internal leakage, etc. The survival rate and the quality of life were determined. Results Endovascular isolation procedure with covered-stent was successfully accomplished in all the 183 cases. The retention time in ICU was (3.08 ± 1.93) days, the mean hospitalization time was (3.08 ± 1.93) days, and the 30-day mortality was 1.09%. After discharged from hospital, the patients were followed up regularly, and no collapse or displacement of stent was observed, and the stent remained in its normal shape. No recurrence of dissection, rupture or reversal tear was observed. No long existing internal leakage could be detected. During the follow-up period 4 patients died, among them three died from cerebral infarction and one died of natural death. The 5-year survival rate was 97.82% and the patient’s quality of life did not become apparently worse. Conclusion For the treatment of Stanford type B aortic dissection, endovascular isolation therapy with covered-stent has excellent short-term effect and stable mid-to-long-term result.

Objective To examine the effect of voice cues on nonfluent aphasia patients'performance in reading idioms.Methods Very familiar idioms were presented to aphasia patients on a computer screen either with or without an accompanying voice cue.The patients were asked to say the last two words of each idiom.The number of errors with the last two words of the idioms wag used to compare the patients'performance under the two conditions.Results The mean correct score was 9.46±13.08 when the idioms were presented without a voice cue,but 13.61±6.06 with the voice cue.The difference was statistically significant.Conclusion Voice cues can improve the speaking of familiar idioms for nonfluent aphasia patients.

The solvent extraction of rare earths with mixtures of di-( 2-ethylhexyl) phosphoric acid (D2EHPA,H2A2) and sec-nonylphenoxy acetic acid (CA100,H_2B_2) has been carried out. The separation abilities among rare earths were determined and compared with those with D_2EHPA alone. The mechanism of synergistic extraction of lanthanum was discussed. The methods of slope analysis and constant mole were used to examine the extraction stoichiometry. Effects of acidities,concentrations of extractants,and temperature on the extractabilities have been investigated. The results showed that the synergistic effects decrease with increasing atomic numbers of rare earths. At proper ratios of the extractants,the separation abilities of some rare earths with D2EHPA +CA100 were higher than those with D2EHPA alone,which may be applied to the separation of these rare earths. The extracted complex of lanthanum with D2EHPA + CA100 was determined as LaH5A6B2. The synergistic extraction is endothermically driven.

Objective To investigate the characteristics of inanune status change in sepsis and severe sepsis patients by quantitative analysing the serum concertrations of pro-and anti-inflammatory cytokines. Method Serum of 38 sepsis patients, 32 severe sepsis patients were collected and 15 health individuals were as controls.ELJSA method was used to quantify the serum levels of inflammatory cytokines. The severity of patient's condition was assessed according to the APACHE Ⅱ system, Retolts The serum concentrations of inflammatory cytokines were different among sepsis and severe sepsis patients. In the serum of sepsis patients the pro-inflammatory eytokine were dominant. But in the serum of severe sepsis patients the anti-inflammatory cytokine were dominant.The serum levels of TNF-α, IL-6, IL-1, IL-10 were obviously different among control, sepsis and severe sepsis groups ( P<0.05). The serum levels of IL-1 and IL-10 were significantly correlated with APACHE II scores. The multiple linear regression eqution was APACHE Ⅱ=- 9.393 + (IL-10 x 0.550) + (IL-1 x 0.305) (F =26.198,P<0.001) Conclusions The serum levels of pro-and anti-inflammatory cytokines were significantly different among patients with different stages of sepsis, and the immune status were different. The activation of inflatrmmtory reaction were constant in sepsis patients, while the expression of anti-inflammatory cytokines increased in severe sepsis patients.

Objective To clone and construct the recombinant plasmid containing Jo-1 of HepG2 cells,then purify the protein and identify the immunoreactivity of the recombinant protein.and establish the enzyme linked immunosorbent assay(ELSA)to detect Jo-1 autoantigen correlative antibodies in diagnosis of polymyositis/dermatomyositis.Methods The constructed plasmid was transformed into E.coli.DH5α and BL21(DE3).This fusion protein was purified by Ni-NTA chromatography and its immunnoreactivity was identified by SDS-PAGE and Western blot.ELISA with the fusion protein was established to detect the Jo-1 autoantigen correlative antibodies in sernm samples of 75 patient with PM/DM,30 patients with SLE.30 patients with RA,10 patients with SS and 30 normal controls.Results The sequence of Jo-1 autoantigen gene Was the same as the sequence reported on the literatures.SDS-PAGE gel analysis showed the molecular weisat of fusion protein was approximately 55 000 Da. Western blotting analysis showed that the fusion protein had the same immunoreactivity as human Jo-1 autoantigen.The results of ELISA indicated that the positive rate of anti-Jo-1 antibody was 28%.but the antibody was negative in other controls.There was significant difierence of positivity of the autoantibody between PM/DM and disease controls or normal controls (x2=31.84,P＜0.01).Conclusions The plasmid containing Jo-1 is successfully cloned into E.coli.DH5α and BL21 (DE3).EUSA analysis shows its good antigenicity and specificity.

Objective To explore the relation of stroke and metabolic syndrome (MS), and provide theoretical evidence for prevention of stroke and MS. Methods Five hundred stroke patients accompanied with MS were enrolled, and divided into different types according to the distribution of the components of metabolic syndrome and abnormal metabolic condition. The systolic blood pressure(SBP) ,diastolic blood pressure( DBP),fasting glycemia ( FPG ), triglycerides ( TG ), total cholesterol ( TC ), low density density lipoprotern-cholesterol (LDL-C), high density density lipoprotern-cholesterol (HDL-C)of each patient were detected and recorded. Results Among these stroke patients with MS, most patients were 60 - 69 years old ( 39.60% ), and there was no significant difference between two gender( P = 0. 545 ). Among each component of MS, hypertension was most related to MS;patients complicated with hypertension + hyperlipidemia + hyperglycemia were the most major proportion of stroke patients with MS(48. 00% ). Conclusion MS and its components are all risk factors for stroke,and the more complication the patients had,the more patients suffered from stroke with MS. Targeted interventions of different type of abnormal condition has important prevention effect on MS and stroke.

Objective To observe the effects of high-fat feeding on growth and the expression of insulin-like growth factor 1 (IGF-1),insulin receptor substrate 1 (IRS-1) in adolescent rats'liver with non-alcoholic fatty liver disease,and to elucidate the relationship between growth failure in adolescent rats with non-alcoholic fatty liver disease and IGF-1,IRS-1 turbulence.Methods Thirty-six Sprague-Dawley (SD) young rats of 21 days were randomly divided into normal control group(NC group,n =18) and high-fat feeding group(HF group,n =18).Non-alcoholic fatty liver disease(NAFLD) model was induced by feeding the SD rats with high-fat food.Immunohistochemistry was applied to detect the expression levels of IGF-1 and IRS-1 in liver tissue.The expressions of mRNA of IGF-1 and IRS-1 were measured by RT-PCR.Results Compared with NC group,the serum alanine amino transferase (ALT),total cholesterol (TC),triglyceride (TG) of HF group in the 6th,8 th,12th week were gradually increased.The serum ALT [(194.67 ± 11.15) U/L],TC [(1.81 ± 0.09) mmol/L],TG [(0.34 ± 0.05) mmol/L] contents of HF group at 8th week were higher than those at 6th week [(166.00 ± 22.01) U/L,(1.52 ± 0.22) mmol/L,(0.41 ±0.12) mmol/L,respectively],and the serum ALT[(213.0 ±27.67) U/L],TC[(2.15 ±0.37) mmol/L],TG[(0.38 ±0.15)mmol/L] contents of the 12th week were significantly increased compared with 6th week and 8th week.The constitution and body length of the HF group were lower than those of the normal control group.With time extended,the liver tissue steatosis,inflammation,the balloon like change of the liver tissue pathology of HF group in 6,8,12th week gradually increased.Immunohistochemistry results showed that HF group IRS-1 [(1.46 ± 0.23),(0.74 ± 0.17),(0.85 ± 0.31)],IGF-1 [(0.92 ± 0.02),(0.83 ± 0.02),(0.77 ± 0.03)] expression gradually decreased,the difference was statistically significant(F =36.024,P ＜ 0.05).IGF-1 and IRS-1 mRNA expressions in HF group were consistent.Conclusion The liver tissue IGF-1 and IRS-1 are correlated with the weight and body length.The growth failure of young rats induced by high-fat feeding may be related to the decreased expression of IGF-1 and IRS-1.