Objective: Through analyzing the level, construction and operation efficiency of revenue, to analyze the basic status and change trend of current economics operation of county-level hospitals in this area, provide former basic information for making comprehensive reform evaluation on public hospitals. Methods: To collect data of annual health financial report, collect and analysis the data. Results: The overall level of revenue and expenditure of couty-level hospitals in Hainan increased rapidly , but there were rapid fall in 2012, the balance gap increased obviously; the proportion of financial assistance increased in 2011, while the construction of income and expenditure remained relatively stable. Conclusion: The general economic operation efficiency of county-level hospitals improved, but the comprehensive reforms still has not appeared, which needs further implementation of compensation mechanism for ensuring the successful implementation of comprehensive reform.

Objective To observe the preventive effect of epidural injection with low - dose of ketamine on postanesthesia shivering(PAS) undergoing percutaneous nephrolithotomy. Methods Sixty ASA Ⅰ～Ⅱ grade patients aged 35 ～ 72 years undergoing PCNL were randomly divided into kctamine group (n = 30, Epidural injection of 0.5mg/kg of ketamine) ,Control group(n = 30, Epidural injection of 10ml saline). The rate of shivering was observed and recorded during operation,and blood pressure and respiration were measured. Results The rate of shivering in ketamine group(10%) was significantly lower than that in control group(46.7%, P ＜ 0.05) ,There were no significant differences of blood pressure and respiration between two groups (P ＞ 0.05). Conclusion Epidural injection 0.5 mg/kg of ketamine on postanesthesia can prevent shivering in PCNL.

Objective To observe the results of melatonin combined with alprostadil in the treatment of patients with acute pancreatitis.Methods Seventy patients with acute pancreatitis were included in the study,14 patients died after conventional treatment were set to group Ⅰ ,28 patients cured after conventional treatment were set to group Ⅱ and 28 cases cured after melatonin combined with alprostadil and conventional treatment were set to group Ⅲ.White blood cell count,blood gas analysis,serum amylase,endotoxin and malondialdehyde (MDA) content was detected at 6 h,48 h and 4 d.Results White blood cell count,serum amylase,endotoxin,MDA content at 6 h,48 h and 4 d in group Ⅰ were higher than those in group Ⅱ ,Ⅲ (P＜0.05).Endotoxin levels reached a maximum in the 4 d [(273.5 ± 20.4) pg/L],and MDA content reached a maximum in the 4 d [(5.12 ± 0.87) μmol/L].White blood cell count,partial pressure of carbon dioxide in artery (PaCO2),serum amylase,endotoxin and MDA content at 48 h,4 d in group Ⅲ were lower than those in group Ⅰ,Ⅱ (P <0.05).Conclusions Melatonin combined with alprostadil not only shows antioxidant,anti-inflammatory,anti-apoptotic effect but also improves the pancreas,lung,small intestine microcirculation,protects the cell membrane and the lysosomal membrane,and prevents effectively the pancreatic digestive enzymes release; also it inhibits intestinal bacterial translocation,reduces the generation of gut-derived endotoxin and pro-inflammatory cytokine release.It can reduce effectively the systemic inflammatory response in acute pancreatitis.

Objective To discuss the intraoperative and postoperative effects of conbercept combined with pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients.Methods From January 2016 to December 2016,123 PDR patients (149 eyes) aged 41-65 years old with nonclearing vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) were enrolled in this study.According to whether preoperative intravitreal injection conbercept,the patients were divided into two groups:Conbercept group (64 cases,78 eyes),Control group (59 cases,71 eyes).Conbercept group was treated with intravitreal injection of Conbercept 0.50 mg (0.05 mL) at 3 days before PPV.Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed if no significant complications after the injection of conbercept.The operation time,intraoperative bleeding,iatrogenic retinal hole,use of endodiathermy and silicone oil,and postoperative complications were recorded and analyzed.The visual acuity and macuiar thickness were compared before and 1 month after the surgery.Results Two groups had no difference on age,sex,HbA1 C,duration,VH ≥ three degree(56/78,45/71),TRD.Conbercept pretreatment could significantly reduce the bleeding during PPV (43/78,49/71),the probability of iatrogeuic retinal holes (11/78,21/71),reduce intraocular electrocoagulation using (57/78,62/71) and silicone oil (43/78,51/71),and then shorten the operation time (58.63 ± 21.66)s and (72.69 ± 22.48)s,and it could significantly improve the postoperative visual acuity (0.23 ± 0.15,0.16 ± 0.11) and macular edema thickness (260.95 ± 27.44) μm and (330.81 ± 36.62)μm,while reduce the incidence of second bleeding (3/78,10/71).Conclusion Conbercept pre-treatment combined with PPV for PDR is a positive and effective treatment,which has good clinical application significance.

Objective To explore the effects of basic fibroblast growth factor(bFGF) pre-inducing on marrow stroma cells(MSCs) which were induced into dopaminergic neurons.Methods The rat MSCs were isolated primarily from the femurs and tibias of the Wistar rats.MSCs were cultured,proliferated and purified by passage culture.After being induced by bFGF,cultuered MSCs were divided into experimental groups(GM1 group,GDNF group and GDNF+ GM1 group) and control group.The surface markers of the differentiated neuron,such as neurone specific enolase(NSE),glial fibrillary acidic protein(GFAP) and TH were detected by immunocytochemistry after MSCs were cultured in induction media for 3 days and 7 days.Results In control group,the NSE expression of MSCs was very low.Many NSE-positive cells and TH-positive cells were found in the experimental groups at 3 or 7 days after induction.The percentage of NSE-positive and TH-positive cells of GDNF+GM1 group was significantly more than the other experimental groups(all P

AIM: To analyze the effects of two kinds of anti-vascular endothelial growth factor (VEGF) drugs, conbercept and ranibizumab, on proliferative diabetic retinopathy (PDR) patients as pre-treatment for pars plana vitrectomy (PPV).METHODS: From June 2016 to December 2016, 62 patients (64 eyes) aged 41-59 years old diagnosed with PDR with nonclearing vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) requiring PPV were enrolled in our study.Patients were treated with intravitreal injection of anti-VEGF drugs 0.50mg (0.05mL) 3d before PPV.Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed where there were no significant complications after the injection of anti-VEGF drugs.The operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy and silicone oil, and postoperative complications were recorded and analyzed.We compared and analyzed the visual acuity and macular thickness before and 1mo after the surgery with the preoperative data.RESULTS: Both conbercept and ranibizumab could improve the postoperative visual acuity and reduce the postoperative macular thickness of PPV.There was no significant difference between the impacts of two kinds of anti-VEGF drug pre-treatment on operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy, silicone oil filling and postoperative vitreous secondary hemorrhage.CONCLUSION: The effects of conbercept and ranibizumab pre-treatment were similar.PPV combined with anti-VEGF pre-treatment could improve postoperative visual acuity and macular edema.The choice of conbercept or ranibizumab should be made flexibly according to the actual situation of patients.

BACKGROUND:Osteoprotegerin and nitrogen monoxidum play a key role in the prevention and treatment of osteoporosis. However, the correlation of the two in inhibiting the proliferation and differentiation of osteoclasts remains unclear.
OBJECTIVE:To observe the effect of different doses of osteoprotegerin on nitric oxide production and endothelial nitric oxide synthase activity in osteoclasts.
METHODS:Tartrate resistant acid phophatase staining was used to test whether the induced cells are osteoclasts. Osteoclasts were divided into six groups:blank control group (no reagent);negative control group (DMEM);four osteoprotegerin groups (10, 25, 50, 75μg/L of osteoprotegerin). Annexinv-FITC kit and flow cytometry were used to test the apoptosis rate of osteoclasts. Real-time PCR was used to detect the expression of osteoclasts marker gene, TRAP mRNA and protein kinase K mRNA. Nitric oxide production and nitric oxide synthase activity were determined using the corresponding kits. Four osteoprotegerin groups were added with L-NAME, a kind of nitric oxide synthase inhibitor, to test the changes of the apoptosis rates of osteoclasts and the changes of the expression of TRAP mRNA and protein kinase K mRNA of osteoclasts.
RESULTS AND CONCLUSION:Osteoprotegerin inhibited the differentiation of osteoclasts and induced the apoptosis. Osteoprotegerin concentration had a positive correlation with the apoptosis rate of osteoclasts, and a negative correlation with the numbers of osteoclasts and expression of marker gene TRAP mRNA and protein kinase K mRNA in osteoclasts. Osteoprotegerin boosted the nitric oxide production and endothelial nitric oxide synthase activity, and osteoprotegerin concentration was positively correlated to the nitric oxide production and endothelial nitric oxide synthase activity. After Raw264.7 cells were in vitro cultured, osteoprotegerin and nitric oxide play a synergic role in inhibiting osteoclasts production and promoting the apoptosis. We speculate that there is osteoprotegerin/endothelial nitric oxide synthase/nitric oxide signal pathway.

Objective To characterize differences within facial profile esthetic evaluations among three groups of evaluators and the influences of sagittal or vertical skeletal patterns on facial profile esthetics. Methods A total of 114 silhouettes,from the pre?or post?treatment facial profiles of 57 patients,were scored by three groups of evaluators(professionals,patients'parents,and laypersons)to characterize differences within facial es?thetics evaluation among evaluators. The highest?scoring 30 silhouettes and the lowest?scoring 30 silhouettes were selected as the high score group and the low score group,respectively. Sixteen indices of the relative lateral cephalometric films were measured. Data were analyzed by SPSS 21.0. Results Facial profiles following orthodontic treatment scored higher than pre?treatment(P<0.05). There were significant differences between professionals and laypersons in facial profile scoring. Different sagittal skeletal patterns had no effect on esthetic evaluation ,but lower facial height significantly influenced whether a patient received a high or low esthetic score(P<0.05). Conclusion Orthodontic treatment can improve the fa?cial profile significantly,and lower facial height is the most sensitive index for facial profile evaluation in our study. However,all three evaluator groups have different esthetic standards that don't overlap. Notably,the expectations of laymen are higher than those of orthodontists.

ObjectiveTo assess the association of rs1344706 and rs4667001 polymorphism of ZNF804A gene with schizophrenia,and the relationship between rs1344706 polymorphism and antipsychotic drug efficacy.MethodsThe studies concerning association of ZNF804A gene polymorphism with schizophrenia and its drug efficacy were retrieved in databases such as Medline and CNKI,and then screened according to the inclusion and exclusion criteria.Meta-analysis was performed by RevMan 5.1 following quality assessment and data extraction.ResultsEleven high-quality studies under the criteria were included.For rs1344706,T allele frequency was significant higher in the schizophrenia group than control group ( OR=1.13,95％ CI (1.06-1.21 ),P=0.0003).Moreover,for rs4667001,G allele frequency was significant higher in the schizophrenia group ( OR =1.14,95％ CI( 1.04-1.26),P =0.005 ).In addition,the difference of PANSS scores reduction between T allele and GG genotype carriers was not significant in both positive and negative symptoms after four-week treatment,and the same trend of difference was in the comparison between TT genotype and G allele carriers.ConclusionThe data supports that T allele of rs1344706 and G allele of rs4667001 in ZNF804A gene are associated with the susceptibility of schizophrenia,but rs1344706 polymorphism is not related to antipsychotic drug efficacy.

Objective To evaluate the clinical value of spectral CT mode in imaging liver by comparing the radiation dose and image quality between spectral CT and conventional multi-slice spiral CT (MSCT).Methods Thirty patients (group A) underwent three-phasic enhanced CT scans spectral CT mode in the portal phase (PP) and conventional helical mode in other phases (Discovery CT 750 HD,GE Healthcare).Another 30 patients in group B underwent conventional three-phasic enhanced CT on a 64-slice MSCT (VCT,GE Healthcare) with 120 kVp and automatic tube current modulation (ATCM) and noise index of 15.The images in PP from the two imaging modes were retrospectively compared.The contrast-noiseratio (CNR) for the veins was calculated using liver parenchyma as background.For the spectral CT mode,101 sets of monochromatic images were reconstructed from 40 to 140 keV,and the optimal energy level for obtaining the highest CNR was determined using the Gemstone Spectral Imaging (GSI)-viewer software.Image noise (at 70 keV),CNR (at the optimal keV level) for the vein and radiation dose to the patient were obtained for spectral images and statistically compared with those in group B with the conventional MSCT using t test.Results The CTDIw value in PP for spectral CT was 15.64 mGy,30％lower than the (22.44 ± 5.09) mGy for the conventional MSCT (t =29.56,P ＜ 0.01).Image noises on the liver parenchyma were 22.81 ±2.85 and 23.80 ±3.31 for the conventional MDCT and spectral CT images at 70 keV,respectively,with no significant difference (t =0.76,P ＞ 0.05).On the other hand,CNR for the vein at the optimal energy level in spectral CT was 7.17 ± 2.09,which was significantly higher than the 2.76 ± 1.34 for the conventional MSCT (t =7.21,P ＜ 0.01).Conclusion Compared with conventional standard-dose liver MSCT,spectral CT imaging provides improved CNR for vessels,comparable image noise for liver parenchyma with 30％ dose reduction.