OBJECTIVE:To establish a RP-HPLC method for the determination of seratrodast concentration in human plasma.METHODS:The sample was determined on Lichrospher C18 column with the mobile phase consisted of 0.02 mol?L-1 potassium dihydrogen phosphate(containing 0.1% triethylamine,pH=5.0)-acetonitrile(70∶30)at a flow rate of 1.0 mL?min-1.The column temperature was 30℃ and the detective wavelength was set at 268 nm.RESULTS:The linear range of seratrodast was 28～5 600 ng?mL-1(r=0.999 5)with the lowest detection concentration at 28 ng?mL-1.The recovery rates of seratrodast at low,middle and high concentrations were 102.9%,100.4% and 99.7%,respectively;and both intra-day RSD and inter-day RSD were all less than 6%.CONCLUSION:The method developed in this study is applicable for the determination of plasma concentration and pharmacokinetic study of seratrodast.

Medical insurance payment reform is an important part of healthcare reform in China. Based on the practice and research of China Rural Health Project ( hereinafter referred asHealth XI Project) financed by World Bank (WB) and UK Department for International Development (DFID) implemented in 40 counties of 8 Chinese provinces between 2009 and 2014 , this thesis analyses the principle and feasible policy route of medical payment re-form for the country, by ways of reviewing the policy evolution, and summarizing the process of project pilot from sin-gle mode of payment-a simple mixed payment-to the comprehensive payment system reform and analyzing the advanta-ges and disadvantages of medical insurance payment methods.

With the support of World Bank ( WB ) and UK Department for International Development ( DFID) , China Rural Health Project ( hereinafter referred as Health XI Project) began to introduce the idea of performance management to 40 counties in 8 provinces in 2008 . The project implemented cyclic performance manage-ment strategies, including performance planning, performance communication, performance evaluation and perform-ance improvement. With the continuous improvement of performance as the goal, the project attempted to establish incentive mechanisms based on the performance of health care services. After five years of pilots in 40 counties, it has achieved good results in the aspects of improving the quality and efficiency of health care services, motivating the enthusiasm of health care managers and workers, etc. Moreover, it has successfully built several advanced counties with exemplary performance management and accumulated some experience, which provides reference and demonstra-tion for implementing performance management in other areas. The key experiences of implementing performance management of rural primary health care include taking health care quality as the core of performance, appropriately combining economic and non-economic incentives, encouraging personnel participation in performance management in order to ensure the sustainability of performance improvement, and effectively applying the ideology of systematic per-formance management in order to effectively enhance the management level of hospitals. The paper also puts forward some policy suggestions based on emerging issues during implementation of performance management.

Objective:To explore the effect of modified multifunctional dressing bag with glauber's salt for relieving swelling and pain in early patients with limb fracture.Methods:A total of 111 patients with limb fracture in Tongde Hospital of Zhejiang Province were divided into two groups according to the admission time. The control group consisted of 53 patients with limbs fracture using common mirabilite bag with glauber′s salt and ice bag for external application admitted from January to August 2018, and the observation group consisted of 58 patients with limbs fracture using modified multifunctional dressing bag with glauber′s salt admitted from September 2018 to January 2020. The degree of pain, the time of appearance of dermatoglyphia, the cases of severe swelling, waiting time for operation, compliance and comfort of the patients were observed within 72 hours after injury.Results:The degree of pain, the time of appearance of dermatoglyphia, the waiting time, the cases of severe swelling for surgery in the observation group were (1.8±0.7) points, (4.5±1.2) days, (5.7±1.2) days,1 case, respectively, which were all lower than those in the control group (2.2±0.8) points, (6.0±1.5) days, (6.5±1.4) days, 19 cases, the differences between the two groups were statistically significant ( t values were -2.6,-5.6,-3.3, &chi;2 value was 21.8, all P<0.05). The total compliance rate in the observation group was 82.76% (48/58), higher than that in the control group 56.60% (30/53), the differences were statistically significant ( &chi;2 value was 9.34, P<0.05). The comfort of the observation group was 82.76% (48/58), significantly higher than that of the control group 3.77% (2/53), the difference was statistically significant ( &chi;2 value was 69.8, P<0.05). Conclusions:The modified multifunctional dressing bag with glauber′s salt can reduce the swelling of limbs, reduce the appearance of skin blisters, stop bleeding and pain, and shorten the waiting time for operation, at the same time, it improves the compliance and comfort of the patients.

Objective: To investigate the genotypes and prognosis of infants with definitive diagnosis of inherited metabolic diseases during neonatal screening in Zhejiang Province from 2009 to 2021, so as to provide insights into the management of birth defects. Methods: The medical records of infants with definitive diagnosis of inherited metabolic diseases by tandem mass spectrometry during neonatal screening in Zhejiang Province from 2009 to 2021 were collected from the database created by Zhejiang Provincial Center for Neonatal Disease Screening. The prevalence, genotypes and prognosis of inherited metabolic diseases were analyzed. Results: A total of 1 038 infants were definitively diagnosed with inherited metabolic diseases in Zhejiang Province from 2009 to 2021, with an overall incidence rate of 1/4 535. There were 400 infants with amino acid metabolic disorders (AAD), 342 infants with fatty acid oxidation metabolic disorders and 296 infants with organic acid metabolic disorders (OAD), with incidence of 1/11 767, 1/13 763 and 1\15 902, respectively. There were 32 types of diseases, including 13 types of AAD, 8 types of FAOD and 11 types of OAD identified, and phenylketonuria and tetrahydrobiopterin deficiency (PKU/BH4D), primary carnitine deficiency (PCD) and methylmalonic academia (MMA) were detected as the most common forms of AAD, FAOD and OAD, with incidence of 1/20 827, 1/24 262 and 1\49 030, respectively. A total of 789 infants received genetic testing (76.01%), and genetic testing was performed among 70.00% of infants with AAD, 83.04% of infants with FAOD and 76.01% of infants with OAD. The c.728G >A (p.R243Q) variant was the most common mutation in infants with PKU (29.17%), c.1400C>G (p.S467C) variant was the most common mutation in infants with PCD (33.46%), c.609G>A (p.W203X) variant was the most common mutation in infants with combined MMA (40.00%), and c.1663G>A (p.A555T) variant was the most common mutation in infants with MMA (17.86%). Among the 997 infants (96.05%) with successful follow-up, 973 infants (93.74%) had normal intelligence and physical developments, and 41 infants died (3.95%), including 9 deaths due to AAD, 15 deaths due to FAOD and 17 deaths due to OAD. Conclusions The incidence of PKU, PCD and MMA was high among infants with inherited metabolic diseases in Zhejiang Province from 2009 to 2021, with c.728G>A (p.R243Q), c.1400C>G (p.S467C) and c.609G>A (p.W203X) variants as common gene mutations, respectively. Most infants with inherited metabolic diseases had a favorable prognosis; however, the mortality of OAD was relatively high.

Objective: To evaluate the quality of tandem mass spectrometry (MSMS) screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021. Methods: The data pertaining to MSMS screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021 were collected from the database created by Zhejiang Provincial Center for Neonatal Disease Screening. The percentage of MSMS screening, percentage of recall of suspected screening-positive infants and incidence of neonatal inherited metabolic diseases were analyzed retrospectively to evaluate the quality of MSMS screening for inherited metabolic diseases. Results: A total of 4 706 916 newborns were screened among 8 297 039 live births by MSMS in Zhejiang Province from 2009 to 2021, and the percentage of MSMS screening increased from 5.48% to 97.54%, with a mean percentage of 56.73%. Of 46 838 suspected screening-positive infants, 45 527 infants were recalled, and the percentage of recall increased from 94.57% to 98.62%, with a mean percentage of 97.20%. A total of 1 038 infants were definitively diagnosed with inherited metabolic diseases in Zhejiang Province from 2009 to 2021, with an overall incidence rate of 1/4 535, and the incidence rates of amino acid metabolic disorder, fatty acid oxidation metabolic disorder and organic acid metabolic disorder were 1/11 767, 1/13 763 and 1\15 902, respectively. Of the 11 cities in Zhejiang Province, the highest percentage of tandem mass spectrometry screening for inherited metabolic diseases was found in Hangzhou City (83.01%), and the highest percentage of recall of suspected screening-positive infants was se en in Zhoushan City (99.08%). Conclusions A high percentage of MSMS screening for neonatal inherited metabolic diseases was observed in Zhejiang Province from 2009 to 2021; however, there was a region-specific percentage of screening, and the recall of suspected screening-positive infants remains to be improved.