Objective To assess the efficiency of central urban and rural hospitals in the 7 cities, counties and districts under the jurisdiction of Hangzhou City and the status of the medical markets so as to provide theoretical basis for the promotion of decentralized medical markets. Methods On the basis of defining the scope of a medical market, the HHI values of the medical markets in places where 37 hospitals in Hangzhou were located was calculated, the average efficiency of the various hospitals was measured by means of DEA, and an analysis was made on the correlation between the average efficiency and the HHI values. Results The central urban and rural medical markets in the various places surveyed, whose HHI values were all greater than 1 800, belonged to markets of monopolistic competition. Of the 37 hospitals, there were 11 whose relative efficiency reached 100% and another 11 whose relative efficiency was less than 60%. The greater the monopoly of a medical market, the lower the average efficiency of its hospitals. Conclusion Establishing competitive markets with low market concentration is an effective way of enhancing overall hospital efficiency.

With high incident of cancer and chronic disease, it is more and more important to develop palliative care; as developing later, there is neither unified palliative care mode and related policy, nor mature assessment collaboration in China. It pointed out that Australia as an advanced country with stable development of palliative care and assessment collaboration, called palliative care outcomes collaboration (PCOC). It expatiated the PCOC on structure,function and operation. China should learn from the mode of Australia palliative care assessment and management collaboration, find references to improve and further develop Chinese palliative care assessment collaboration.

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.ResultsCompared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).ConclusionTriglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.

Objective To observe the effect of electroacupuncture on onset time and effectiveness of Paroxetine for mild or moderate depression patients and on the scores of Hamilton depression rating scale for depression(HAMD) and self-rating depression scale(SDS). Methods Fifty-five patients with mild or moderate depression were randomly divided into A group( Paroxetine group,29 patients) and B group (Electroacupuncture combining with Paroxetine group,26 patients). Therapeutic periods for the two groups were 6 weeks. HAMD and SDS were used to evaluate the efficacy before the research and after treatment on 1 week,2 weeks,4 weeks,6 weeks.Results HAMD scores and SDS scores for A group were significant difference after 2 weeks treatment compared with the beginning of the research (P＜ 0.05 ) ;HAMD scores and SDS scores for B group were significant difference after 1 week treatment compared with the beginning of the research(P＜0. 05 ). Total effective rate of HAMD for A group was 71.4% ,total effective rate of SDS for A group was 75% ,total effective rate of HAMD for B group was 88% ,total effective rate of SDS for B group was 84%. The total effective rate between the two groups ordered by the individual chi-square test was significant difference( X2 = 4. 1790, P= 0. 0408). Conclusion Electroacupuncture can shorten the onset time and increase the effectiveness of paroxetine for mild or moderate depression patients.

Objective To acquire normative values of anorectal manometry and sensation in population of our country with different gender and age.Methods Healthy individuals from four medical centers were collected and divided into three group according to their age,group Ⅰ 18 - 39 years old, group Ⅱ 40-59 years old and group Ⅲ ≥60 years old.The parameters of anal of subjects at resting status was examined by pneumohydraulic capillary perfusion system and high resolution PC Polygraf HR desktop gastrointestinal dynamic monitoring system.Subjects were asked to simulate defecation and then the defecation related indexes were recorded.In the end rectoanal inhibitory reflexes (RAIR)and rectal sensation were assessed by aired balloon.One-way analysis of variance and independent sample test were performed to compare indexes among three groups with different age and between different genders. Results A total of 166 healthy subjects were enrolled,79 in group Ⅰ with 40 male,68 in group Ⅱ with 29 male and 19 in group Ⅲ with 11 male.There was no significant difference in anal sphincter length (ASL),valid anal sphincter length (VASL),resting anal sphincter pressure (RASP),squeeze anal sphincter pressure (SASP)and duration of valid squeeze anal sphincter pressure (VSASP)among three groups with different age (all P > 0.05 ).Compared between male and female,only SASP of male ((180.13±8.10)mmHg,1 mmHg=0.133 kPa)was significantly higher than that of female ((143.93± 6.59)mmHg,t = -3.489,P <0.001 ),no difference in other parameters was found (all P >0.05 ). There was no significant difference in rectal pressure (RP),rectoanal pressure gradient (RAPG),anal sphincter relaxation rate (ASRR),and rectoanal coordination (RAC)among three groups (all P >0.05). During simulated defecation,RP and RAPG of men ((61 .23±3.46)mmHg and (40.04±4.08)mmHg) were significantly higher than those of women ((44.47 ± 2.32)mmHg and (24.00 ± 2.59 )mmHg, t=-4.075 ,-3.367,both P <0.01 ).There was no significant difference in other parameters between men and women (all P >0.05).All participants had RAIR,and there was no significant difference neither among three groups nor between men and women (both P >0.05).There was no significant difference in first rectal sensation (FRS)and constant rectal sensation (CRS)among three groups with different age (all P >0.05).However,the maximum rectal tolerable sensation (MRTS)of group Ⅱ and group Ⅲ was significantly higher than that of group Ⅰ ((194.41 ±6.32)mL and (200.00±12.75)mL vs (167.80 ± 5 .00)mL,F = 6.698,P = 0.002).There was no significant difference in rectal sensation between different gender (all P >0.05 ).Conclusions In our country,SASP,RP and RAPG during simulated defecation of male are higher than those of female.The value of MRTS increases along with the age.

Objective To explore the status quo of job stress and happiness in nurses of three grade A hospitals and mediation effects of hope between above two elements. Methods A cross-sectional survey was conducted. The Hope Status Scale, The Nurse's Job Stressor Scale, General Well-Being Schedule and self-designed demographic questionnaire were delivered to 1200 nurses from nine hospitals. Results The path analysis results showed that the direct effect of job stress on the subjective well-being was-0.193, the indirect effect was (-0.486) × 0.456=-0.222, the total effect of working pressure on the subjective well-being was-0.415, the indirect effect of total effect was 53.49％. want direct effect on subjective well-being of 0.456, job stress on the direct effect of hope for-0.486. Conclusion Hope to play an intermediary role between nurses' job stress and subjective happiness. In the process of trying to reduce nurses' job stress, we should make full use of the intermediary significance of hope to help nurses with low level of hope to build hope and improve their happiness level.

Objective To investigate the value of flexi-rigid thoracoscopy in pleural effusion of unknown causes and the correlation with CEA, TK1 and ADA. Methods The clinical data and results of CEA, TK1 and ADA of 25 patients were retrospective analyzed in our department from 2015 January to November 2015. These patients accepted the examination of flexi-rigid thoracoscopy with pleural effusion of unknown causes. Results In the 25 patients with pleural effusion of unknown causes, definite diagnosis was made in 22 cases (88.00 %), of which 9 cases were malignant pleural effusion (36.00 %), 11 cases were tuberculous pleural effusion (44.00 %), 2 cases were inflammatory pleural effusion (8.00 %), 3 cases were undetermined (12.00 %). The positive rate of TK1 and CEA in malignant group was significantly higher than that in the tuberculosis group and inflammatory group, the positive rate of ADA in the tuberculosis group was significantly higher than that in the malignant group and inflammatory group. Conclusion Flexi-rigid medical thoracoscopy examination is an effective and safe method for diagnosis of unexplained pleural effusion with high exact diagnosis rate, less trauma and less complication. Combination with CEA, TK1 and ADA are helpful to improve diagnostic rate of pleural effusion of unknown causes.

ObjectiveTo establish normative values of esophageal manometry in different age groups and standard test method.Methods The values of esophageal manometry were tested in healthy subjects of 3 different age groups (Group Ⅰ: 18-39 years,Group Ⅱ: 40-59 years,Group Ⅲ:≥60 years) with pneumohydraulic capillary perfusion system.The repeatability and stability of this method in lower esophageal sphincter (LES) testing were observed. Results There were no significant differences of LES length (LESL),LES pressure (LESP) at the end of expiration,average LESP,residual pressure of LES and LES relaxation rate (LESRR) in three groups (P＞0.05).The LESP at the end of inspiration in Group Ⅰ (28.98± 1.11 ) mm Hg was significantly lower than that of Group Ⅲ (34.35±1.96) mm Hg (P＜0.05).Trandiaphragmatic pressure (Pdi) in Group Ⅰ (9.55±0.62) mm Hg was significantly lower than that of Group Ⅱ (13.05±0.76) mm Hg (P＜0.05).There were no significant differences in contraction amplitude and duration of proximal and distant esophagus in 3 groups (P＞0.05).UES pressure (UESP) of Group Ⅲ was significantly lower than that of Group Ⅰ and Ⅱ (P＜0.05).As for repeatability,the second recording of LESP in Group Ⅰ and Ⅱ were significantly higher than first recording (P＜0.05).Amplitude of distant esophageal peristaltic contraction (DEPC) of female was significantly higher than of male (P＜0.05).However,there was no significant difference in amplitude of proximal esophageal peristaltic contraction (PEPC)between femal and male (P＞0.05).ConclusionsThe normative values of esophageal manometry in different age groups have been obtained.The dynamic parameters of LES do not change with age.Between age 40 to 59 years old,the contraction of esophageal body is strongest.UESP decreases significantly in old people.If the subjects have enough time to adapt before test,it will help to get accurate and reliable dynamic parameters of LES.

OBJECTIVETo carry out mutation analysis for a Chinese family affected with Escobar syndrome.

METHODSWhole exome sequencing (WES) was employed to detect potential mutation in the proband. Suspected mutations were validated by combining clinical data and result of Sanger sequencing.

RESULTSA homozygous missense mutation c.715C>T (p.R239C) was detected in the proband and his brother who was also affected. The parents and the daughters of the proband carried the heterozygous mutation c.715C>T, while other family members did not carry the mutation.

CONCLUSIONEscobar syndrome is a rare genetic disorder. WES is able to discover genetic mutation underlying this disorder and facilitate genetic counseling and prenatal diagnosis for the affected family.

Abnormalities, Multiple ; genetics ; Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; DNA Mutational Analysis ; Exome ; Female ; Heterozygote ; Homozygote ; Humans ; Male ; Malignant Hyperthermia ; genetics ; Molecular Sequence Data ; Pedigree ; Skin Abnormalities ; genetics ; Young Adult

Objective:To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO 2/FiO 2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO 2/FiO 2, SOFA score, APACHEⅡ score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. Results:Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO 2/FiO 2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHEⅡ score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO 2/FiO 2 ( r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHEⅡ score ( r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ 2 = 3.979, P = 0.046). Conclusions:The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.