Based on the describing the effects and restricts of fiscal subsity and medical insurance payment on medical institutions and doctor behavior,the lead of fiscal subsidy and payment was managed as the important key for the supply-side reform in health service field,so as to promote the regression benefits for public hospitals,help to solve the core problems for new medical reform and achieve the main goal of medical service system reform.

ObjectiveTo investigate the dynamic changes of T helper (Th) responses and hepatic granuloma development during Schistosoma japonicum infection and to evaluate the possible correlation between the Th1/Th2 cytokines and pathological liver damage. MethodsSera from both Schistosoma japonicum infected C57BL/6 mice and uninfected controls were measured for interferongamma (IFN-γ), interleukin (IL)-4 and IL-13 at week 4, 6, 8 and 12 post-infection. At the same time, the splenic Th1/Th2 ratio was examined. The development of liver granulomas in infected mice was also observed and the correlation between the cytokines and granulomas were assessed. Wilcoxon test and Spearman rank correlation test were performed for data analysis. ResultsSerum IFN-γ level in infected mice was (2. 835±0. 049) lgpg/mL at week 4 post infection, which was significantly higher than that in controls [(1. 787 ± 0. 174) lgpg/mL, Z= - 2. 646, P = 0. 008]. Thereafter, the level declined after week 6, but remained higher than controls at the end of 12-week experiment (Z= -2.457, P=0. 014). IL-4 and IL-13 levels did not increase until week 6 (Z=-2. 646,P=0. 008;Z=-2. 646,P=0. 008), and peaked at week 8. After soluble egg antigen (SEA) stimulation, splenic Th1/Th2 ratio in infected mice was 0.5 (95％ CI 0. 2-1.2) at week 8 and 0.3 (95％ CI 0. 3-0.6)at week 12 post infection, both of which were significantly lower than those in uninfected controls (week 8: Z=2. 173, P=0.030; week 12:Z=2.551, P=0.011). Compared with unstimulated splenic cells, splenic Th1/Th2 ratio after SEA stimulation significantly decreased at week 8 (Z=2. 236, P=0. 025) and week 12 (Z=3. 130, P=0.002). Granulomas were first observed in livers at week 6 and the size kept on increasing. A negative correlation between serum IL-13 and the diameter of liver granulomas was discovered at week 12 post infection (r=0. 636, P= 0. 048). Conclusions Th1 response is dominant during the early stage of Schistosoma japonicum infection.However,followed by oviposition, Thl response declines and meanwhile a strong Th2 response gradually develops. Therefore, Th2 response probably plays a role in the development of hepatic granulomas.

Objective To establish normal range of components of cord blood cells in healthy fetuses from 19 to 37 weeks' gestation and to provide proof for diagnosis of hematological disorders in prenatal fetuses and premature infants.Methods Twelve hematological parameters were determined in 182 fetuses using Coulter GENS system 2 full automated blood cell counter,and the blood cells were classified by microscope.Results The number of white blood cell(WBC) was increased gradually from 3.58?10~9/L to 5.76?10~9/L with the gestational weeks increasing from 19 to 37 weeks.The differential counts indicated that the lymphocytes represented the main population.The number of lymphocytes and normoblast was decreased gradually and that of neutrophils was increased gradually.The numbers of monocytes,eosinophils and basophils remained stable as the increasing of gestational weeks.The red blood cell(RBC),hemoglobin(HGB) and hematocrit(HCT) were increased gradually but mean corpuscular volume(MCV) was decreased.The differences between mean corpuscular hemoglobin(MCH),platelet volume distribution width(PDW),mean platelet volume(MPV),plateletcrit(PCT) and mean corpuscular hemoglobin concentration(MCHC) were not significant among different fetuses' ages.Conclusion The components of cord blood cells in healthy fetuses are dynamic and the establishment normal range of components of cord blood cells in healthy fetuses is helpful to diagnose the disorders in prenatal fetuses and premature infants.

Objective To investigate the injury of podocyte and its association with proteinuria in IgA nephropathy (IgAN). Method Thirty-five patients of IgA nephropathy with proteinuria more than 1.0 g/24 h were enrolled in the study, and eight cases of renal harmatomaeetomy or renal cancinomaectomy were as controls. Cell cycle regulatory proteins (p21, p27), podocyte-associated molecules (integrin-β1, nephrin, α-actinin 4, nestin), foot process width (FPW) and the amount of podocyte were examined by immunohistochemistry and real-time PCR, respectively. Patients were divided into two groups according to podocyte number per volume (Nv): podocytopenia group (n=15, Nv<52.49×106/μm3) and normal number group (n=20, Nv≥52.49× 106/μm3). Proteinuria was followed up for eighteen months. Results Compared with the controls, podocyte p21 was re-expressed, while the expression of p27 was decreased (0.71±0.12 vs 0.91±0.07, P<0.05) in IgAN. The nestin protein level was markedly decreased in IgAN (13.4%± 0.04% vs 17.6%±0.04%, P<0.05). The mRNA expression of integrin-β1 was significantly increased (12.54±5.20 vs 1.02±0.30, P<0.05), while the amount of nephrin, α-actinin4 remained unchanged. Effacement of foot processes and podocyte detachment from the glomerulax basement membrane were observed in some cases. Nv was significantly less than that of controls (161.27± 225.92 vs 323.22±138.12, P<0.05), which was associated with the Lee's grade of IgA nephropathy. The integrin-β1 mRNA expression and Nv were negatively correlated with baseline proteinuria by univariate analysis (r=-0.840, P=0.034; r =-0.4483, P=0.014, respectively). Proteinuria in podocytopenia group was decreased more slowly than that in normal number group. Conclusions Podocyte injury exsists in IgAN with proteinuria, which manifests alterations in cell cycle regulatory protein and some podocyte-associated molecules, as well as foot process effacement and loss of pedocyte. Podocyte injury may be involved in proteinuria by affecting the progression of proteinuria in IgAN.

Background The operation mode of automobile manufacturing industry (AMI) makes workers have different degrees of occupational stress and burnout, which may lead to negative emotions and depressive symptoms. Objective To study the relationship between occupational stress, job burnout, and depressive symptoms in AMI workers. Methods In this study, 1300 workers from a Guangzhou AMI company were selected as subjects by cluster random sampling method. Occupational stress, job burnout, and depressive symptoms of the workers were assessed by using the Effort-Reward Imbalance (ERI) questionnaire, the Maslach Burnout Inventory general survey questionnaire, and the Patient Health Questionnaire-9, respectively. Hierarchical regression was used to analyze the effects of occupational stress and job burnout on depressive symptoms in AMI workers. Mediating effect model was used to analyze the mediating effect of job burnout on the relationship between occupational stress and depressive symptoms. Results There were 1300 questionnaires distributed, 1228 valid questionnaires collected, with a 94.5% recovery rate. The ERI ratio of 1228 AMI workers was 1.06±0.72, and the positive rate of occupational stress was 37.3% (458/1228). The score of job burnout was 2.18±1.37, and the positive rate of job burnout was 62.6% (769/1228). The score of depressive symptoms was 10.27±6.42, and the positive rate of depressive symptoms was 47.1% (578/1228). The dimensional scores of effort and over-commitment in occupational stress as well as emotional exhaustion and depersonalization in job burnout of AMI workers were positively correlated with the depressive symptom scores (r_s=0.415, 0.571, 0.573, 0.593, P＜0.05). The dimensional scores of reward and personal achievement were negatively correlated (r_s=−0.454, −0.339, P＜0.05). The percentages of variance in depressive symptoms score explained by occupational stress and job burnout were 26.7% and 16.6%, respectively. Job burnout had a partial mediating effect between the three dimensions of occupational stress and depressive symptoms, and the mediating effect values were −0.2832 (95%CI: −0.3250– −0.2434), 0.3553 (95%CI: 0.3071–0.4041), and 0.4193 (95%CI: 0.3681–0.4725), respectively. Conclusion AMI workers' occupational stress affects job burnout, but also indirectly affects depressive symptoms. Job burnout partially mediates the association between occupational stress and depressive symptoms. Reducing occupational stress and burnout levels of AMI workers may alleviate depressive symptoms.

Objective: To understand the level of depressive symptoms and associated factors in alopecia college students in Changchun. Methods: The convenience sampling method was used to select 275 alopecia students from outpatient clinics in the Affiliated Hospital of Changchun University of Traditional Chinese Medicine during November 2019 to June 2021. Center for Epidemiological Survey, Depression Scale(CES-D) and general characteristics were collected. Depressive symptoms and its associated factors were analyzed by binary Logistic regression. Results: A total of 121 students with hair loss reported depressive symptoms, with the detection rate of 44.0%. Female( OR=2.26, 95%CI =1.22-4.20), 26-30 years of age( OR=2.43, 95%CI =1.01-5.85), poor sleep quality( OR=13.63, 95%CI =4.09-45.42), substantially affected interpersonal relationship( OR=3.56, 95%CI =1.57- 8.06 ), perceived severe stress ( OR=3.73, 95%CI =1.35-10.30) were positively correlated with depressive symptoms in alopecia college students, and 1-2 times of exercise per week, 3-5 times of exercise per week, and >5 times of exercise per week ( OR= 0.17 , 0.14, 0.03, 95%CI =0.05-0.61, 0.04-0.52, 0.01-0.14) were negatively correlated with depressive symptoms in alopecia college students( P <0.05). Conclusion Depressive symptoms are reported in 44.0% of alopecia college students in Changchun, which might be related with age, gender, sleep quality, interpersonal distress, stress perception and exercise.

OBJECTIVETo investigate the effects of the mixed endothelin receptor antagonist, bosentan, combined with the long-acting calcium channel blocker, amlodipine, compared to the angiotensin-converting enzyme inhibitor, cilazapril, on the progressive renal injury in spontaneous hypertensive rats (SHR) with diabetes.

METHODSDiabetic hypertensive rats (SHR-DM) were induced by streptozotozin injected in male SHR (7-week-old),and divided into an untreated and three treated groups: 1) cilazapril treated group; 2) bosentan+amlodipine treated group; and 3) amlodipine treated group. Wistar Kyoto rats (WKY) and SHR rats served as normotensive and hypertensive control, respectively. The mean arterial blood pressure, renal function, endothelin and angiotensin II levels as well as the protein expression of renal extracellular matrix components and transforming growth factor (TGF)-beta1 were determined at the end of the 4th week.

RESULTSMean arterial blood pressure significantly increased in SHR and SHR-DM rats compared to WKY rats. All the therapies reduced the blood pressure to normal levels. However, the enhanced urinary protein excretion, the decreased creatinine clearance as well as the increased plasma and intrarenal endothelin and angiotens in II levels were found in the untreated SHR-DM and prevented by treatment with bosentan+amlodipine and cilazapril. Similarly, these two kinds of therapies in SHR-DM abolished the overexpression of renal TGF-beta1 by Western blot analysis and reduced the accumulation of collagen type IV, laminin and fibronectin proteins by an immunochemical approach. Amlodipine monotherapy had no detectable effects on the above parameters.

CONCLUSIONBosentan combined with amlodipine can offer similar renoprotective effects on that of cilazapril and may be a potent therapy to attenuate renal injury by reducing renal protein levels of TGF-beta1 in diabetes with a hypertensive state.

Amlodipine ; administration & dosage ; Angiotensin II ; analysis ; Animals ; Calcium Channel Blockers ; administration & dosage ; Collagen Type IV ; analysis ; Diabetic Nephropathies ; prevention & control ; Drug Therapy, Combination ; Endothelin Receptor Antagonists ; Hypertension ; complications ; drug therapy ; Kidney ; drug effects ; Male ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Sulfonamides ; administration & dosage ; Transforming Growth Factor beta ; analysis ; Transforming Growth Factor beta1

Objective To observe the difference of anoreetal dynamics between Milligan-Morgan hemorrhoidectomy plus internal sphinctemtomy and simple Milligan-Morgan bemorrhoidectomy in the treatment of annulus mixed hemorrhoids.Method Measured the anal resting pressure,maximal anal contractive pressure,rectal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance 1 day before and 3 months after Milligan-Morgan hemorrhoidectomy plus internal sphincterotomy (therapy group,50 cases)and simple Milligan-Morgan bemorrhoidectomy(control group,52 cases)by anorectal manometric device made in Sweden.Results The anal resting pressures of therapy group and eontrol group reduced signifieanfly 3 months after operation compared with that 1 day before operation(P＜ 0.01 or ＜ 0.05),but there was significant difference between the two groups in 3 months after operation(P＜0.05).The maximal anal contractive pressure,reetal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance were no significant difference between the two groups in 3 months after operation (P ＞0.05).Conclusion Anal sphineterotomy can change the high anal pressure significantly in the treatment of annulus hemorrhoids without copracrasia,it is a proper operation method.

Background and objective Invasive mucinous adenocarcinoma(IMA)was a rare and specific type of lung adenocarcinoma,which was often characterized by fewer lymphatic metastases.Therefore,it was difficult to evaluate the prognosis of these tumors based on the existing tumor-node-metastasis(TNM)staging.So,this study aimed to develop Nomo-grams to predict outcomes of patients with pathologic N0 in resected IMA.Methods According to the inclusion criteria and exclusion criteria,IMA patients with pathologic N0 in The Affiliated Lihuili Hospital of Ningbo University(training cohort,n=78)and Ningbo No.2 Hospital(validation cohort,n=66)were reviewed between July 2012 and May 2017.The prognostic value of the clinicopathological features in the training cohort was analyzed and prognostic prediction models were established,and the performances of models were evaluated.Finally,the validation cohort data was put in for external validation.Results Univariate analysis showed that pneumonic type,larger tumor size,mixed mucinous/non-mucinous component,and higher overall stage were significant influence factors of 5-year progression-free survival(PFS)and overall survival(OS).Multivariate analysis further indicated that type of imaging,tumor size,mucinous component were the independent prognostic factors for poor 5-year PFS and OS.Moreover,the 5-year PFS and OS rates were 62.82％and 75.64％,respectively.In subgroups,the sur-vival analysis also showed that the pneumonic type and mixed mucinous/non-mucinous patients had significantly poorer 5-year PFS and OS compared with solitary type and pure mucinous patients,respectively.The C-index of Nomograms with 5-year PFS and OS were 0.815(95％CI:0.741-0.889)and 0.767(95％CI:0.669-0.865).The calibration curve and decision curve analysis(DCA)of both models showed good predictive performances in both cohorts.Conclusion The Nomograms based on clinicopathological characteristics in a certain extent,can be used as an effective prognostic tool for patients with pathologic N0 after IMA resection.

Objective To evaluate the efficacy and safety of microneedling radiofrequency in the treatment of facial acne scars.Methods A retrospective study was conducted.According to the inclusion and exclusion criteria,42 patients with acne scars receiving microneedling radiofrequency treatment (observation group) and 47 patients with acne scars treated with fractional CO2 laser (control group) in Guangzhou Institute of Dermatology were enrolled into this study from June 2016 to June 2017.Single-blind evaluation was conducted according to a four-grade scoring system and ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné) by two clinically experienced dermatologists to evaluate and compare the clinical efficacy between the 2 groups,based on the clinical photos before and after the treatment.Statistical analysis was done by using chi-square test,t test of two independent samples and paired Wilcoxon signed rank test.Results After treatment,no significant difference in the total response rate was observed between the observation group (92.9％,39 cases) and control group (89.4％,42 cases;x2 =0.042,P ＞ 0.05).Before the treatment,there was no significant difference in the ECCA score between the observation group (46.7 ± 16.3) and control group (45.7 ± 15.8,t =0.271,P ＞ 0.05).After the treatment,the ECCA score in the observation group and control group significantly decreased into 29.5 ± 15.1 and 31.3 ± 14.9 respectively (Z =-5.713,-6.086,respectively,both P ＜ 0.05).Conclusion Microneedling radiofrequency is effective for the treatment of facial acne scars,with high safety and less injuries.