This paper aims at evaluating the effectiveness of the “Medical and Pharmaceutical Separation” re-form in Beijing in three years , and put forward suggestions for the reform of public hospitals .Using data obtained from hospital database, we compared changes in the proportion of drug cost , the average drug expenditures per time, medical workload , quality , income and structure .The key findings of this study show that after the reform , the quali-ty of medical services has improved .Compared to one year before the reform , in the third year of reform the outpa-tient and inpatient medicine accounted for decreased to 16.98%and 13.3%, from 25.57%and 36%, respectively;and the outpatient and inpatient patients per capita medical expenses decreased by 21.39%and 34.8%respectively. The health care revenue increased by 68 .1%compared with before reform .Drug revenue fell 14.29%before the re-form.Medical service fee income reached 243,500,000 yuan.Income from medical examination and laboratory tests in-creased by 52.60%.Based on the findings of the present investigation , the Trial“Medical and Pharmaceutical Separa-tion” to control the cost of drugs achieved good results .Therefore ,it would be advantageous in adopting the reform of public hospitals in the next step toward the medical examination separated , adjust the price of medical services ,etc.

Objective:To master with structure and function of ForceTriad energy platform, improve the effect of daily maintenance, use the energy platform safety and accurately.Methods:Specific methods involved in connection to the host and device, circuit plate electrode placed, unipolar and bipolar operation points and attention patient position, the common failures and troubleshooting methods.Results: To prevent electric shock and prevent burn patients are fundamental, the key is to connect closely and good contact, maintenance and troubleshooting is the guarantee. Conclusion:Safely use of energy platform correctly, cleaning maintenance equipment in a timely manner, accurate troubleshooting, to give full play to the advantages of energy platform, improve the operation efficiency and effectiveness.

BACKGROUND: Documents recorded that the correlation between micro emulsion Ciclosporin peak concentration (C_2) and area under curve was best with maximum individual difference. According to C_2, dose of Ciclosporin can be adjusted indMdually to decrease acute rejection and Ciclosporin toxicity, which has widely used in perioperative stage of renal transplanted recipients. However, some transplantation center still used tough concentration (C_0) to adjust the dose of Ciclosporin in stable stage of renal transplanted recipients. OBJECTIVE: To analyze the efficacy and safety of changing from monitoring C_0 to C_2 in stable stage recipients following renal transplantation. METHODS: Totally 65 patients with renal transplantation were enrolled in this study, including 31 males and 34 females, aged 20-57 (39.4±15.3) years. Within 3 months prior to this study, all patients did not suffered from rejection, and their serum creatinine and urea nitrogen were stable (creatinine ≤180 μmol/L). They were in stable stage after renal transplantation. Their period of transplantation and function of allograft were recorded. Their C_0 and C_2 of Ciclosporin were assayed. According to the target C_2 value 500-600 μg/L, the patients were prospectively and randomly divided into 3 groups. In the high C_2 group (n=17), the dose of Ciclosporin was decreased. In the target C_2 group (n=23), the dose of Ciclosporin was remained. In the low C_2 group (n=25), the dose of Ciclosporin was increased. All of the patients were followed-up for 12 months. The grafts function and the complications of heart, lung and brain were compared. RESULTS AND CONCLUSION: According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in the high C_2 group was decreased by 575.0 mg. The Creatinine and urea nitrogen of 88% patients were stable, while blood pressure, blood fat and blood uric acid decreased in parts of patients. In the target C_2 group, the levels of creatinine, urea nitrogen, Co and C_2 of patients were stable, no complications of heart, lung and brain occurred. According to the target concentration of Ciclosporin C_2, the dose of Ciclosporin in low C_2 group was increased by 755.0 mg. The creatinine and urea nitrogen of 84% patients were stable. All of the patients were no complications of heart, lung and brain. It is safe and effective to adjust Ciclospori dose under C_2 monitoring according to the target peak concentration (500-600 μg/L) in most stable stage recipients following renal transplantation.

Adolescent ; Adult ; Child ; Child, Preschool ; Combined Modality Therapy ; Ear Auricle ; injuries ; Female ; Humans ; Male ; Nose ; injuries ; Soft Tissue Injuries ; therapy ; Treatment Outcome ; Young Adult

BACKGROUND: Orphanin (OFQ) is associated with ischemia/hypoxia,which may play an important role in the production and development of fetal distress and neonatal asphyxia.OBJECTIVE: To observe the change of OFQ content in hypothalamus and peripheral blood of intrauterine ischemia/hypoxia fetal rats and analyze the role of OFQ in the perinatal ischemia/hypoxia.DESIGN: Randomized controlled animal trial.SETTING: Department of Obstetrics and Gynecology, Changhai Hospital of the Second Military Medical University of Chinese PLA.MATERIALS: The experiment was performed at the Department of Obstetrics and Gynecology, Changhai Hospital of the Secon d Military Medical University of Chinese PLA from May 2002 to September 2003. A total of 12 Wistar female rats, with the mean body mass of 260 g were selected and fed routinely [provided by the experiment animal center of this university, number of certificate scxk(Hu)2002/0006].METHODS: The 12 female rats were randomized into three groups: control group, ischemia/hypoxia for 10 minutes group, ischemia/hypoxia for 20 minutes group with 4 rats in each group. Female rats in each group were pregnant. On day 21 of pregnancy, female rats in each group were cut the belly open, and the uterine vessels were incarcerated for 10 minutes in the ischemia/hypoxia for 10 minutes group with 21 fetal rats and 20 minutes in the ischemia/hypoxia for 20 minutes group with 17 fetal rats, respectively. Fetal rats were directly obtained from control group with 19 ones. None of fetal rats died. All the fetal rats received Apgar score and decapitation. The blood of trunk was collected and the whole brain was obtained. OFQ content in hypothalamus and peripheral blood was measured with radioimmunoassay.MAIN OUTCOME MEASURES: OFQ content in hypothalamus and peripheral blood of fetal rats in each group.RESULTS: Totally 57 rats were involved in the result analysis. ①The levels ofOFQ in hypothalamus and peripheral blood were (71±14) pg/g and (31±7) ng/L in ischemia/hypoxia for 10 minutes group, (114±21) pg/g and (58±11) ng/L in ischemia/hypoxia for 20 minutes group, (48±9) pg/g and (19±4) ng/L in the control group. Compared with the control group, the levels of OFQ in hypothalamus and peripheralblood increased in the ischemia/hypoxia for 10 minutes group and ischemia/hypoxia for 20 minutes group (P＜ 0.05, P ＜ 0.01), and it in ischemia/hypoxia for 10 minutes group was significantly higher than that in ischemia/hypoxia for 20 minutes group (P ＜ 0.05). ②The score of Apgar was lower in the two groups than in the control group (P ＜ 0.01 ), of which it was lower in the ischemia/hypoxia for 20minutes group than in the ischemia/hypoxia for 10 minutes group (P ＜ 0.05).CONCLUSION: The perinatal ischemia and hypoxia can induce the increase of OFQ content in hypothalamus and peripheral blood.

OBJECTIVE: To evaluate the relationship between serum vancomycin level and efficacy in peritoneal dialysis-related peritonitis(PDRP) patients by analyzing our hospital′s data. METHODS: Forty-six PDRP patients admitted in our hospital from August 2015 to April 2018 were collected, then divided into three groups by different regimens(1 g q3d, 1 g q4d, 1 g q5d), the probability of target attainment of the first trough concentration and those after several administrations, the characteristics of distribution of vancomycin serum level and the relation with efficacy were analyzed. RESULTS: The first trough concentrations of 1 g q3d, 1 g q4d and 1 g q5d were (10.51±2.79), (6.78±1.58) and (6.68±1.68) mg·L-1 respectively, with statistical difference between 1 g q3d regimen and 1 g q4d, 1 g q5d (P0.01). The trough concentration after the 3rd administration of 1 g q3d regimen was (16.15±4.79) mg·L-1, the trough concentration after the 2nd administration of 1 g q4d regimen was (10.20±2.0) mg·L-1, and the trough concentration after the 2nd administration of 1 g q5d regimen was (9.49±3.24) mg·L-1. The serum vancomycin level was increasing after repeated administration with obvious statistical difference among the three regimens(P0.01). There was no significant difference in the efficacy between concentration10 mg·L-1 and that ≥10 mg·L-1 or concentration <15 mg·L-1 and that ≥15 mg·L-1(P0.05). CONCLUSION: There is significant inter-individual differences of serum vancomycin level in PDRP patients after IP administration, and vancomycin is accumulated in body after repeated administration. It is suggested to monitor the serum vancomycin concentration and the trough concentration kept above 10 mg·L-1.

OBJECTIVE: To provide basis for rational use of biapenem in elderly patients through Monte Carlo simulation. METHODS: A total of 294 strains from five species of Enterobacteriaceae were collected. The MICs of biapenem against the bacteria were measured by double broth dilution method. Six therapeutic regimens (300 mg q24h; 300 mg q12h; 300 mg q8h; 300 mg q6h; 600 mg q24h; 600 mg q12h) were simulated by using Monte Carlo simulation, then the probability of target attainment (PTA) and cumulative fraction of response (CFR) were calculated. RESULTS: In patients at 65-74 years old, only the CFR of 300 mg q24h regimen was <90% (73.69%) for E. coli; only the CFRs of 300 mg and 600 mg q24h treatment regimens were <90% (64.98%,82.51%;63.83%,79.82%;63.11%,78.7%, respectively) for K. pneumonia, E. aerogenes and E. cloacae; in patients ≥75 years old, all of the regimens had PTAs >90% for E. coli and E. aerogenes; only the 300 mg q24h regimen had CFRs<90% (89.39% and 88.98%) for K. pneumonia and E. cloacae; for E. aerogenes, all the regimens had CFRs <90%. CONCLUSION: It is suggested that different regimens can be used for target therapy of biapenem on the basis of MICs, while frequency of q12h or higher can be used for experiential therapy of enterobacteriaceae infection in old people in our hospital. Other antimicrobial agents should be chosen for treatment of E. aerogenes.

Objective To explore the efficacy and safety of sodium nilroprusside(SNP) with remifentanil or fentanyl used for controlled hypotension during the pediatric patent ductus arteriosus (PDA) operations. Methods Sixty children undergoing operation were randomly divided into SNP with fentanyl (A group) or remifentanil (B group). Hemodynamic changes in different times and adverse reactions were observed. Results In B group, heart rate was stable and blood pressure declined quickly. The dose of SNP was fewer and hemodynamic changes and recovery from anesthesia were better in B group than in A group. Conclusion Remifentanil could potentiate the hypotensive effect of SNP and decrease adverse reaction.

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.

Background: Hepatocyte nuclear factor 4α (HNF4α) plays an important role in the development of liver,and studies demonstrate that it is correlated with the pathogenesis of hepatocellular carcinoma (HCC).However,the regulatory effect of HNF4α on expression of vascular endothelial growth factor (VEGF) in human HCC cell lines and tube formation of human umbilical vein endothelial cell (HUVEC) is not yet clear.Aims: To investigate the effect of HNF4α on expression of VEGF in human HCC cell lines and tube formation of HUVEC.Methods: Lentiviral vector overexpressed HNF4α was constructed,and then transfected into HepG2 and SMMC-7721 cells (experimental group),cells transfected with lentiviral blank vector and cells without transfection were served as negative control group and blank control group,respectively.The mRNA and protein expressions of HNF4α,VEGF were detected by qRT-PCR and Western blotting,respectively.The conditioned media of HepG2 and SMMC-7721 cells were co-cultured with HUVEC,and number of HUVEC tube formation was measured.Results: HepG2 and SMMC-7721 cells with stable overexpression of HNF4α were successfully established.Compared with negative control group and blank control group,mRNA and protein expressions of VEGF in experimental group were significantly decreased (P＜0.05),and number of HUVEC tube formation was significantly decreased (P＜0.05).Conclusions: HNF4α can significantly inhibit the expression of VEGF in HepG2 and SMMC-7721 cells and tube formation of HUVEC.