Objective To evaluate the traditional Chinese medicine(TCM) output efficiency of the coUnty-level TCM hospitals in Jiangsu Province before and after the reimbursement mechanism reform,and to analyze the factors which affect the efficiency of county-level TCM hospitals.Methods Using DEA to analyze the efficiency of county TCM hospitals,and using the Tobit regression to analyze the influence factors.Results The output efficiency of county-level TCM hospitals in Jiangsu Province is low,and the reimbursement mechanism reform in county-level hospitals of TCM efficiency further decreases;payment model,cost model and revenue model of regression analysis indicate that different factors has different influence on output efficiency of county hospitals of TCM.Conclusion The reimbursement strategy of county-level TCM hospitals should be optimized,the balance of revenue and expenditure structure be adjusted,and the intensity of TCM services reimbursement be increased.

Objective To explore the operation al skills of laparoscopic appendectomy(LA) and to improve its proficiency.Methods The clinical data of 121 patients under went LA during February 2013 to May 2014 were summarized retrospectively.Results All the 121 cases were completed successfully with no complication.Conclusion With the development of laparoscope and accumulation of experiences LA can be safe and complications can be minimized if the this operation skill being obtained.

OBJECTIVE:To provide reference for the standardization of the instruction of levonorgestrel emergency contraception. METHODS:Instruction of levonorgestrel emergency contraception in the market was compared with the national regulations and foreign instruction of the same kind of productions in order to discover the problems in domestic specification. RESULTS:The major problems of domestic instruction of levonorgestrel emergency contraception included instructions without population limits, unclear frequency and interval of drug use,without attention to ADR of levonorgestrel emergency contraception,lack of pharmacy research data. CONCLUSIONS:The problems existing in domestic instruction of levonorgestrel emergency contraception are shortage of items and warnings of drug safety. Related administration departments and enterprises are suggested to modify and perfect the instruction of levonorgestrel emergency contraception.

The development and progress of gastric mucosal diseases is a complex process associated with multiple factors and underlying mechanisms,and individuals may present different genetic susceptibilities to gastric mucosal diseases. Various studies have demonstrated a strong link between Toll-like receptors( TLRs),as pattern recognition receptors,and the development and progress of gastric mucosal diseases. The gene polymorphisms of TLRs may change its encoded proteins or related signaling pathways,which results in different susceptibilities to gastric mucosal diseases;this might affect the development,progress and clinical outcome of the disease. In this review article,the advances in study on TLRs and its gene polymorphisms in gastric mucosal diseases were summarized.

Objective To investigate the clinical features of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and the significance of anti-NMDAR antibody assay in clinical diagnosis.Methods Sixty-two patients were divided into 3 groups of encephalitis,encephalopathy and other central nervous system diseases based on their affliction. Anti-NMDAR antibody was detected by transfected cell-based indirect immunofluorescence assay in the serum and cerebrospinal fluid. The clinical features,laboratory tests,treatment and prognosis of NMDAR encephalitis were analyzed.ResultsAnti-NMDAR antibody was positive in serum and (or) cerebrospinal fluid of 9 patients (9/32,28％ ) from encephalitis group.The positive rate of anti-NMDAR antibody in cerebrospinal fluid was higher than that in serum of these patients.Among them,5 patients with higher antibody titer had impaired blood-brain barrier.No tumor was detected in these 9 patients.The most predominant symptoms of anti-NMDAR encephalitis include fever,psychiatric disturbances,seizures,dystonia and autonomic dysfunction.Brain MRI and electroencephalography were also abnormal. Patients were responsive to early immunotherapy. Conclusion Detection of the anti-NMDAR antibody may be important for early diagnosis and treatment of autoimmune encephalitis.

Objective:To analyze different age group elderly’s financial burden and risk due to non-communicable chronic diseases (NCDs). Methods:Based on CHARLS baseline investigation data, disease economic burden, disease economic risk for family and disease relative risk are used to analyze the economic risk and economic burden of the different age groups of urban and rural NCDs elderly. Results: The diseases financial burdens of urban NCDs elderly are greater than rural; for diseases family risk and relative risk, NCDs elderly are greater than non-NCDs elderly, urban NCDs elderly are greater than rural, high-age group NCDs elderly are greater than low-age group NCDs elderly. Conclusion: It is needed to improve the NCDs elderly’s medical security ability with basic health insurance, especially to improve medical security ability of the high-age group for rural elderly.

Objective To investigate the frequency of autoimmune encephalitis (AE) in limbic encephalitis (LE) syndrome and compare its clinical features with viral encephalitis.Methods Patients diagnosed with LE syndrome who admitted to Huashan Hospital between December 2015 and June 2016 were enrolled and screened for autoantibodies associated with AE (anti-N-methyl-D-aspartate receptor, anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, anti-gamma-amino-butyric acid B-receptor, anti-leucine-rich glioma inactivated 1 and anti-contactin-associated protein-like 2 antibodies) in cerebrospinal fluid (CSF) and serum. Their clinical features and auxiliary examinations were also collected and analyzed retrospectively. Results Fifty-four patients were diagnosed with LE syndrome, including 35 males and 19 females. The age of these patients was (38.98±17.29) (15-75) years. Twenty patients (37.0%) were identified as AE, 17 patients (31.5%) as viral encephalitis. Other cases included three (5.5%) with neurosyphilis, one (1.9%) with glioma and 13 (24.1%) of unknown cause. Young patients(15-29 years old)and patients older than 45 years accounted for 46.0% (17/37) and 37.8% (14/37) of all AE and viral encephalitis cases respectively. Patients with AE had longer disease progression time than patients with viral encephalitis ((22.45±11.62) d vs (6.24±2.95) d, t=6.015, P<0.01).Emergency hospitalization of patients with AE was less frequent than that of patients with viral encephalitis (3/20 vs 12/17, P=0.001). Patients with AE were less common to present with fever at disease onset than patients with viral encephalitis (8/20 vs 15/17, P=0.006). Seizures as the first neurological symptom were less common in AE than in viral encephalitis (2/20 vs 8/17, P=0.023). White blood cell counts in CSF were less frequently elevated in AE than in viral encephalitis (7/17 vs 12/15, P=0.036). The differences of age, gender, disease severity as well as abnormal rates of brain MRI, electroencephalogram and CSF protein were not statistically significant between the two groups. Tumors were discovered in 6 (6/19) patients with AE. Conclusions The frequency of AE in LE syndrome is not low. It is worthwhile to screen for autoantibodies associated with AE in patients diagnosed with LE syndrome. AE and viral encephalitis have their own characteristics, which could offer help in differential diagnosis between them and application of effective treatment.

OBJECTIVE:To provide the reference for verifying and improving the usage criteria and guidelines of compound oral contraceptives(COCs)in China. METHODS:The usage criteria and guidelines of COCs were introduced and compared issued by WHO,US and European Union(EU). RESULTS&CONCLUSIONS:WHO has established 4 standards and guidelines for COCs, i.e. Medical Eligibilitu Criteria for Contraceptive Use(MEC),Selected Practice Recommendations for Contraceptive Use(SPR), Decision-making Tool for Family Planning Clients and Providers,Family Planning:A Global Handbook for Providers. According to the specific circumstances of the user,MEC has been divided into 4 levels according to the situation of users,i.e. suitable for use,use cautiously,relative contraindication,absolute contraindication. SPR mainly describes the specific issues of how to use vari-ous contraception methods safely and effectively. The reading card mode for Decision-making Tool for Family Planning Clients and Providers can query specific methods and steps of contraceptive informed choice fast. Family Planning:A Global Handbook for Providers can provide practical guide for the family planning service providers in the first line. On the basis of WHO MEC and SPR,some projects are modified and added in the US MEC and SPR,including the classification of breast feeding,the risk grade of DVT/PE recurrence,etc. EU have formulated COCs criteria and guidelines earlier than WHO and US;the key points and specif-ic varieties of COCs are prompted and updated based on the latest evidence- based medicine,including a new assessment of the risk of thrombosis after using the COCs,the special safety tips for the use of Diane 35? and its generics. Concerning the optimal ev-idences of current COCs usage of WHO,US and EU,combined with domestic situation,our country may provide the clear and up-to-date usage criteria and guidelines of COCs for its users and medical staff.

Objective To investigate the effects of dexamethasone on the expression of glucocorticoid receptor (GR ?, GR ?) in human monocyte cell line THP-1.Methods Cultured THP-1 cells were stimulated by dexamethasone with different concentrations and for different durations. The GR ? and GR ? protein expressions were examined by Western blotting. Results The expressions of GR ? and GR ? were observed in stimulated and unstimulated THP-1. The quantity of GR ? expression was reduced by dexamethasone treatment in a time-dependent manner. The quantity of GR ? expression was increased by dexamethasone treatment in time- and dose-dependent manner. Conclusion Dexamethas one stimulation time-dependent reduce GR ? expression in THP-1 cell. Dexamethasone stimulation time- dependent and dose-dependent increase GR ? expression in THP-I. The expressions of GR a and GR ? were regulated by glucocorticoid.

Objective To investigate the effect of selenium(Se) and vitamin E(VE) on collagen Ⅰ synthesis in cultured cardiac fibroblasts(CFbs) treated with norepinephrine(NE).Methods CFbs were obtained by the method of enzymatic digestion culture.Cells and culture medium were collected after 48 h,then the hydroxyproline(HYP) and collagen Ⅰ content as well as the expression of ?_1 col1agen mRNA were examined.Results The contents of HYP in Se,VE and Se+VE groups were(64.88?1.25),(47.60?1.59) and(41.34?(1.73) mg?L~(-1)) prot,respectively,all of them were lower than that in NE group(P