Covered in the paper are reform efforts made by the hospital on the HIS system amid the pilot programs total prepaid and mcdicine-drug separation trials in Beijing.Findings of the programs revealed defects of the HIS system,for example measures for refusal of payment of non-compliance items,and real-time reimbursement for patients.In view of these setbacks,the hospital made further attempts to the system in such aspects of the fundamental maintenance,rational drug usage and new problems,for the purpose of successful completion of the pilot programs at the hospital.Discussions were also made as to how to adapt the HIS system to total prepaid and the separation reforms,aiming at helping those not yet initiated with the reforms,and the information sharing of patient diagnosis/treatment records and social insurance payment at all hospitals in Beijing.

Objective　To investigate the effects of leptin on steroidogenesis of human luteinized granulosa cell in vitro. Methods　Human luteinized granulosa cells were isolated from follicular fluid obtained during oocyte retrieval of in vitro fertilization-embryo transfer program and were cultured with M199 medium plus various concentration of leptin (0, 10, 30, 100, 300 ng/ml)，human menopausal gonadotropin (hMG, 0, 0.1, 0.2, 0.5, 1, 2, 5, 10 IU/ml) and testosterone 100 μg/ml. For 2 days the media were collected for estradiol and progesterone measurements. Results　Addition of leptin alone did not alter estradiol and progesterone production (P>0.05) by human luteinized granulosa cells. Leptin of 10～30 ng/ml concentrations caused a dose-dependent inhibition of estradiol production (P<0.05) while greater than 0.5 IU/ml of hMG were added. There was no effect of leptin on hMG -stimulated progesterone production (P>0.05). Conclusion　Leptin can directly inhibit hMG-stimulated estradiol production by human luteinized granulosa cells in vitro, but has no effect on progesterone production. Leptin may play an important role in follicle development and luteinization.

Objective To assess the technical efficiency and subsystem technical efficiency of the healthcare institutions in China,including that of management system and medical system.Methods Panel data of 31 provinces' healthcare institutions were selected,and Network DEA was adopted to assess such input indicators as managerial staff and health technical personnel,and such output indicators as medical revenue and number of medical visits.Results The technical efficiency of healthcare institutions is as lower as an efficiency mean of 0.853 in five year.Provinces of Zhejiang,Shandong,Henan,Guangdong and Tibet have maintained a higher level.The healthcare system breaks down into two independent subsystems of the management subsystem and medical subsystem.The mean of the former one is 0.937,higher than 0.783 of the latter.The number of medical revenue and that of patients in the non-effective provinces were relatively inadequate.Conclusions Healthcare resources allocation in China needs to be optimized.It is imperative to adjust the input-output ratio,improve medical service quality via scientific management.

Objective To measure the average value of CT lung density at the phase of end inspiration and end expiration in children under 5 years.Methods Sixty patients with normal lungs who underwent chest CT for reasons caused by trauma etc.in our institute from January 2010 to March 2012 were enrolled to the study.All of the patients were divided into end inspiration group and end expiration group through random number table.CT images of the phase of end inspiration and end expiration were taken.Three levels of CT images were chosen to measure the lung density,which were 2 cm above the arch,1 cm below the carina and 2 cm above diaphragm.Lung density was measured at anterior,posterior,lateral,medial and central of the images at each level in each lung.The average lung density of each and entire lung were respectively calculated.The influence of phase,level,location was quantified using analysis of variance methods and LSD method.Results The average lung density at end inspiration was (-766 ±56)HU for the left,right and both lung.At end expiration,the average lung density of the left,right and both lungs was (-625 ± 86),(-647 ± 85) and (-636 ± 86) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the left lung at end inspiration were (-798±63),(-733±68),(-767±64),(-754 ±65),(-775 ±63)HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-796 ± 70),(-736 ± 65),(-769 ± 64),(-754 ± 62),(-776-± 59) HU respectively.At end expiration phase,the average densities at anterior,posterior,lateral,medial and central of the left lung were (-692±91),(-555±116),(-639±91),(-598±103),(-640±98) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-712 ± 90),(-575±121),(-657±90),(-619±95),(-670±87) HU respectively.The statistical differences of these five measurement areas were significant at both inspiration and expiration phase (F=12.55,11.29,23.31,25.47,P＜0.01).The posterior lung density was the highest and the anterior was the lowest.As for the other measurement areas,in descending order were medial,lateral,and central.Conclusion The lung density at end inspiration and end expiration in children under 5 years old is described to provide reference for the clinical work.

Objective To summarize the lung HRCT findings of lung Langerhans cell histiocytosis (LCH) in children. Methods A total of 54 children with lung LCH pathologically proved in our institute from September 2006 to December 2014 were retrospectively reviewed. Patients were subdivided into two subgroups, diffuse type (n=29) and localized type (n=25). In addition, 32 children with LCH but without pulmonary infiltration were selected as control group. HRCT findings of 54 LCH with lung involvement were reviewed and analyzed for distribution pattern. The age of onset, illness duration and pulmonary function were compared between the lung LCH group and the control group. The differences of HRCT findings in LCH patients between diffuse type and localized type were compared with χ2 test. The differences on the onset age, illness duration and pulmonary function between the LCH group with lung involvement and control group were compared with non-parametric test(Mann-Whitney U Test). The differences of pulmonary function between the LCH group with lung involvement and control group were compared with Fisher exact probability test. Results The signs of pulmonary LCH on HRCT included lobular hyperinflation (n=26), interlobular septa thickening (n=11), cystic lesions (n=11), ground?glass opacity (n=10), nodules (n=9), and centrilobular nodules (n=6). The signs presented in 21, 8, 7, 9, 4 and 6 cases in diffuse type group respectively and 5, 3, 4, 1, 5, 0 in localized type group. Among them, lobular hyperinflation, ground?glass opacity and centrilobular nodules were more prevalent in the diffuse group. The difference was statistically significant (χ2=14.77,2.01,0.55,4.84,0.06 and 3.91, P<0.05). The onset age of LCH group with lung involvement was younger than the other (Z=-2.40, P<0.05). However, there was no statistically significant difference in the illness duration (Z=-1.46, P>0.05) and pulmonary function between two groups (P>0.05). Conclusions Lobular hyperinflation, ground glass opacity and centrilobular nodules are the most common manifestations in LCH patients with lung involvement and the distribution is mostly diffuse. Nodules, cystic lesions and interlobular septa thickening may exist. Several signs may coexist simultaneously. Younger children with LCH are more vulnerable to lung involvement.

Objective To study dIe ESBLs and plasmid-mediated AmpC enzymes in E.Coli and Klebsiella spp. with CLSI ESBL-screening test positive,confirmation test negative but cefepime susceptible.Methods Antimierobial susceptibility testing were performed by Kirby-Bauer(K-B)method.The genes encoding ESBLs and plasmid-mediated AmpC enzymes were detected by PCR Transfer of ESBLs or plagmid-mediated AmpC resistance was studied by conjugation experiments.The homology of donor (E.coli),recipient(E.coli J53)and their transconjugants were analyzed by ERIC-PCR DNA fingerprints of E.coli and Klebsiella pneumoniae were analyzed by PFGE as recommended bv PulseNet protocoL Results Of 18 isolates from Huashan Hospital,11 were E.coli.6 were Klebsiella pneumoniae and 1 was Klebsiella oxytoca.Antimicrobial susceptibility testing indicated all of 18 isolates were positive on the CLSI ESBL screening test but negative on the confirmation test.and all of isolates were susceptible to cefepime(a zoneof-inhibition diameter of≥18 mm wag considered to indicate susceptible).PCR results indicated that 9 of the 11 E.coli isolates predued CMY-2 AmpC enzyme.TEM,SHV,CTX-M,PER,VEB or SFO type β-lactamages were not identified.Of 6 Klebsiella pneumoniae isolates.5 were DHA-1 AmpC-producing strains.4 of the 5 DHA-1 AmpC-producing strains were coexistence of broad-speetrumβ-lactamaae or extended-spectrumβ-lactamase.including two producing SHV-11 and two producing CTX-M-14 and SHV-62 type ESBL respectively.One Klebsiella oxytoca wag also DHA-1 AmpC producing strain.Conjugation experiments indicated that both ESBLs and AmpC enzymes could be transfefred from donor to recipient.PFGE indicated that the DNA fingerprints of K.pneumoniae were difierent but seven CMY-2 AmpC-producing E.coli isolates from general surgieal ward were similar.Concluslons The main mechanism of antibiotic resistance in CLSI ESBLs-screening test-positive but eefepime.susceptible E.coli and KIebsiellaspp.is production of plagmid-mediated AmpC enzymes.Some strains produce both AmpC enzyme and ESBLs.Such strains should be reported as resistant to cefepime.The results suggest that laboratories should routinely conduct research on the ESBLs and plnsmid.mediated AmpC enzymes in Enterobacteriaceae in order to report antimicrobial susceptibility testing results more correcdy.

ObjectiveTo compare the CT features of retroperitoneal ganglioneuroblastoma (GNB) and neuroblastoma (NB) in children,and summarize the differentiations between them.Methods From November 2007 to November 2011,19 patients with GNB and 21 patients with NB proven pathologically were enrolled in the study.The CT data of GNB and NB were analyzed retrospectively.These tumor parameters in CT included lesion location,size,shape,margin,calcification,across central line,style of contrast enhancement,degree of contrast enhancement,presence of small vessels in or around the tumor arranged in clumps or in line,tumor embolus,adjacent organs invasion or metastasis,lymph node metastasis,and relationship between tumor and surrounding great vessels.These parameters of both groups were compared by x2 and t test.ResultsIn GNB group,11 patients were located in adrenal gland and 8 patients in the retroperitoneal sympathetic chain; however,in NB group,18 patients were located in adrenal gland and 3 patients in the retroperitoneal sympathetic chain. The difference were statistical significances in the incidence rate of regular morphology,clear border,vessel encased by tumor,vessels displaced,presence of small vessels in /around the tumor arranged in clumps or in line,adjacent organs invasion or viscera metastasis,lymph node metastasis between NB (6/21,7/21,14/21,7/21,11/21,10/21,and 11/21,respectively) and GNB ( 12/19,13/19,6/19,13/19,4/19,3/19 and 4/19,respectively) ( P ＜ 0.05 ).However,there was no statistical significance in size,calcification,across central line,contrast enhancement type,contrast enhancement degree between them ( P ＞ 0.05 ).ConclusionsNB are more likely located at adrenal gland and presented a higher incidence rate of presence of small vessels in or around the tumor which arranged in clumps or in line,vessel encased by tumor,adjacent organs invasion or metastasis and lymph node metastasis.Regular morphology,clear border and vessels displaced are more frequently observed in GNB.

BACKGROUND: Intestinal tract factors, especially intestinal ischemiareperfusion, can induce the injury of remote organ. Chinese herb, rhubarb,can clear oxygen free radical to promote the proliferation of beaker cell in intestinal mucous membrane, inhibit excessive multiplication of bacterium and endotoxin absorption in the intestinal tract, activate blood circulation and remove blood stasis, improve microcirculation and other ways to protect intestinal mucous membrane barrier, so as to prevent and treat pulmonary injury.OBJECTIVE: To observe the preventing and treating effect of rhubarb on intestinal ischemia/reperfusion-induced pulmonary injury and the effect of rhubarb on tumor necrosis factor and phospholipase A2 (PLA2).DESIGN: A randomized controlled observation.SETTING: Department of Emergency, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.MATERIALS: This experiment was carried out in the Second Military Medical University of Chinese PLA from February to July 2003. Totally 80SD rats were selected and randomly divided into intestinal ischemia/reperfusion group (n=24), sham operation group (n=46), treatment group (n=24) and normal saline group (n=16).METHODS: In the intestinal ischemia-reperfusion group, rats were fasted before operation. They were anesthetized and given a median abdominal incision. Superior mesenteric artery was isolated and occluded by vascular clamp without wound, and then the incision was sutured; 45 minutes later,vascular clamp was taken out to recover blood supply. For the treatment group, modeling was the same as that in the intestinal ischemia/reperfusion group, 600 mg/kg suspension of rhubarb extract was gastrointestinally perfused into the rats 30 minutes before recovering blood supply. For the normal saline group, modeling was the same as that in the intestinal ischemia/reperfusion group; same dosage of normal saline was gastrointestinally perfused into the rats 30 minutes before recovering blood supply. For the sham operation group, occlusion of superior mesenteric artery was omitted. Taking pathological change and 125I-labeled bovine serum albumin pulmonary uptake index as the index to evaluate pulmonary injury, TNF content and serum of pulmonary tissue and PLA2 activity of lung and intestinal tissue of animals in each group were measured respectively at different time points.MAIN OUTCOME MEASURES: 125I labeled bovine bovine serum albumin uptake index, tumor necrosis factor content of blood and pulmonary tissue, and PLA2 activity of serum, lung and intestinal tissue RESULTS: ① Pathological and morphological change of pulmonary tissue: There was no obvious abnormality in the sham operation group; In the intestinal ischemia-reperfusion group, 6 hours later, pulmonary interstitial edema, neutrophile infiltration appeared and alveolar edema was also found, and there were a little haemorrhage and exudation of fibrin. Only mild pulmonary interstitial edema and a small quantity of neutrophiles were found in the treatment group. ② Ultramicro-pathological change of pulmonary tissue: There was no obvious change in the sham operation group. In the intestinal ishcemia/reperfusion group, 6 hours later, pulmonary capillary endothelial cells were swelled and neutrophilic granulocyte leaked into pulmonary stroma and alveolar space. There were no above changes in the treatment group. ③ Change of tumor necrosis factor of pulmonary tissue in the sham operation group or treatment group (reperfusion for 30 minutes) was significantly lower than that in the intestinal ischemiareperfusion group (reperfusion for 30 minutes) (0.235±0.114,1.374±0.550,16.315±4.587,P ＜ 0.01). ④125I-BSA pulmonary uptake index in the treatment group was significantly lower than that in the intestinal ischemiareperfusion group and normal saline group (P ＜ 0.01), without significant difference in comparison with sham operation group (P ＞ 0.05).CONCLUSION: Early application of rhubarb is helpful to prevent and treat lung injury following small intestine ischemic reperfusion, so as to inhibit tissue disease course to deve1op multiple organ dysfunction syndrome,which might be implemented through inhibiting the release of TNF and PLA2 and other media.

Objective To observe the efficacy and side effects of Jianpi Qutan Decoction combined with Quetiapine in the treatment negative symptoms of schizophrenia.Methods 60 inpatients with schizophrenia were randomly divided into two groups,with one group treated with Jianpi Qutan Decoction combined Quetiapine and the other group treated with Quetiapine.Effects and side effects were assessed with the Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptoms Scale (TESS) respectively 1,4 and 8 weeks before and after the treatment.Results There was no significant difference in the overall efficacy between the two groups,but the improvement of the negative symptoms and illness provocation was significantly better in the treatment group than that in the control group respectively (P＜0.05).Moreover,the adverse reaction was milder in the treatment group.Conclusion It is suggested Jianpi Qutan Decoction in combination with typical antipsychotics is effective and safe in treating negative symptoms in schizophrenia patients.

Objective To identify the susceptibile genes in a rat model for rheumatoid arthritis (RA),to determine whether sex affects disease onset and to define the mechanisms that impacts congenic genes on arthritis. Methods Arthritis-susceptible DA rats were compared with sex/age-matched congenic rats in which alleles were substituted with alleles from arthritis resistant PVG rats. Incomplete Freund's adjuvant (IFA) was injected from the base of the tail. Arthritis was visually scored, the messenger RNA (mRNA) levels of congenic genes and cytokine were determined by reverse transcription-polymerase chain reaction. The differences between two groups were analyzed using Mann-Whitney U test. Results In oil-induced arthritis (OIA), male congenic R16 rats deviated profoundly from DA rats by decreased arthritis severity (5.9±3.8 vs 9.3±2.3, P＜0.05 ), and markedly reduced lymph node mRNA levels for calsyntenin-3 (Clstn3) gene (0.7±0.4 vs 2.2±1.6, P＜0.01 ) and interleukin (IL)-17 (1.4±2.2 vs 2.7±2.9, P＜0.05) and IL-1β (1.5±2.1 vs 2.3±2.5,P＜0.05) levels. Conclusion Rat Clstn3 gene regulates the production of pro-inflammatory cytokines of OIA in male rats. The effect of arthritis-susceptible gene Clstn3 is gender-specific.