Objective The expression of TGF-β1 and IL-10 in the grafts of inbred mice with rejection of heart transplantation were studied and the interaction of them in the rejection of heart transplantation in inbred mice investigated.Methods Allografts were divided into 2 groups:control group (n =70),cyclosporin A-treated group (CsA group,n =70).Hearts from inbred BABL/c mice were transplanted into a cervical location in the other recipients and the survival time of the allografts was observed.The local expression of TGF-β1 and IL-10 was detected at day 1,3,7,11,14,21 by reverse transcription polymerase chain reaction(RT-PCT) respectively.Results The survival time of the allografts was (20.3 ± 1.7) days in control group,and(32.2 t 3.4) days in CsA group (P ＜ 0.01).The levels of the two cytokines expression were up-regulated in CsA group.The up-regulation of TGF-β1 was closely correlated with the survival of the grafts.Conclusion The expression and production of the two cytokines is up-regulated probably cause of administ ration of cyclosporin A,and favorite to the heart graft survival,and action of these two cytokines are probably interrelated.

Objective To observe the sensitivity of myocardium to ischemia/reperfusion (I/R) injury in mechanical trauma rats.Methods The mechanical trauma was established by Noble-Collip drum in the rats that were completely randomized into five groups:sham trauma group,trauma group,sham trauma and sham surgery group,sham trauma and I/R group,trauma and I/R group.The rats were subjected to 30 minutes of ischemia and one hour of reperfusion one week after trauma.The left ventricular systolic pressure (LVSP) and the left ventricular maximum rate of pressure rise and fall ( ± dp/dtmax ) were recorded with BL-410 biological signal recording and analysis system.The levels of serum creatine kinase isoenzyme MB (CK-MB) and cardiac troponinⅠ (cTnI) were detected by double antibody sandwich ABC-ELISA technique.At the end of reperfusion,the heart was excised and stained with Evan' s blue dye and triphenyltetrazolium chloride (TTC) to measure the infarct region with Image-Pro Plus 6.0 image analysis software.Results Compared with the sham traumatic I/R group,the cardiac function in vivo was significantly decreased in the traumatic I/R group ( P ＜ 0.01 ).While the serum CK-MB [ (4 960 ± 588 ) ng/ml:(2 925 ± 426) ng/ml,P ＜ 0.01 ],cTnI [ ( 18.10 ± 3.06 ) ng/ml:( 6.67 ±1.57 ) ng/ml,P ＜ 0.01 ] levels and myocardial infarct size [ ( 36.70 ± 7.42 ) ％:( 22.27 ± 4.54 ) ％,P＜0.01] were obviously higher in the traumatic I/R group compared with the sham traumatic I/R group.Conclusion Mechanical trauma increases the sensitivity of myocardium to I/R injury in rats.

Based on the Australian AR-DRGs, this research gathered the diagnosis related information on the first page of medical records and accomplished the computerization of data collection and analysis through the data-base of Shanghai Shenkang Hospital Development Center.According to the clinical practices, the DRGs model has been adjusted to complete the localization and a severity-based-DRGs model and grouping tool have been established for the municipal hospitals in Shanghai.

The severity of disease can be used to evaluate the current situation of patients as well as to predict the diseases outcome.In the meantime, the severity among different diseases has been more and more applied in the evaluation of the patients at hospital level.This study collected and summarized different types of international disea-ses grouping tools'characteristics and applications based on the severity of disease, and their suitability and practical values in hospital performance evaluation were compared and analyzed.

The performance evaluation is an effective method to guide the public hospitals behavior and pro-mote their sustainable development.The introduction of disease severity could make the performance evaluation sys-tem more scientific and reasonable, and encourage the hospitals to improve their technical skills and services ability. Based on the Shanghai diagnosis related groups system, a case-mix index ( CMI) was introduced and a severity score of disease was developed after the relative weight ( RW) adjustment to evaluate different types of disease severity in hospitals.The results have shown that CMI effectively reflects the patients'disease severity and the intensity of treat-ment in those hospitals taken into consideration.Therefore, the scientific indicators should be selected and the evalu-ation system should be improved thereby establishing an effective monitoring and dynamic adjustment mechanism and further developing the diagnosis related group application.

Objective To analyze pharmacologic action features of single Chinese herbal medicine for the treatment of fatty liver based on literature; To provide references for clinical treatment of fatty liver.Methods Animal research literature about single Chinese herbal medicine for the treatment of fatty liver in CNKI, Wanfang database, and VIP from January 2003 to December 2014 was retrieved by computers. The number of single Chinese herbal medicine and the pharmacologic action features of active ingredients (or extracts) were statistically concluded. Results A total of 279 articles were retrieved, including 67 kinds of single Chinese herbal medicine, among which 8 were used to treat AFLD, 45 were used to treat NAFLD, and 14 were used to treat AFLD and NAFLD simultaneously. Pharmacologic action features of the medicine for AFLD mainly included reducing lipid, protecting liver, antioxidation, and anti-inflammation. Pharmacologic action features of the medicine for NAFLD had the effects of improving insulin resistance additionally.Conclusion Chinese herbal medicine for the treatment of AFLD and NAFLD shows significant efficacy, having the features of multiple pathways and liver damage resistance, which provide references for clinical treatment of fatty liver.

This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.

The public hospital reform is the main content of the new healthcare reform.Studying the diagnosis related group system and establishing a set of scientific and rational performance assessment, which is essential to strengthen the public hospitals'public and social benefits, improve the service capacity and enhance the specialized and delicacy management.The international diagnosis related group system localization and weight settlement have been proved suitable and consistent through the Shanghai Shenkang Hospital Development Centre.Hence, the severity-based DRGs should be introduced to reflect the actual hospitals operation and management outcome, which provides a proper guidance on the hospitals'specialized and delicacy management.

Objective To examine the application of On-Board Imaging (OBI) system-based image-guided radiotherapy (IGRT) in the improvement of the precision of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma.Methods Ten patients with nasopharyngeal carcinoma were treated with IMRT using the OBI system. The IGRT images after positioning, position adjustment, and treatment were observed and recorded to investigate the image difference between CT simulation and IGRT. Results The deviations in the x (lateral), y (cranial-caudal), and z (ventral-dorsal) directions between CT simulation and IGRT images were 0.22±1.00 mm,-0.37±1.28 mm, and 0.04±1.36 mm, respectively, after positioning, 0.29±0.76 mm,-0.04±0.78 mm, and -0.01±0.92 mm, respectively, after position adjustment, and 0.20±0.78 mm, 0.16±0.80 mm, and 0.05±0.92 mm, respectively, after treatment. The probabilities of a ≤1 mm deviation in the x, y, and z directions were 81.0%, 77.6%, and 88.2%, respectively, after positioning, 92.5%, 96.4%, and 96.4%, respectively, after position adjustment, and 91.7%, 94.9%, and 96.8%, respectively, after treatment. Conclusions The application of OBI system-based IGRT is very important in the improvement of the precision of fractionated IMRT for patients with nasopharyngeal carcinoma. The position of the patient should be adjusted based on the IGRT image after positioning in order to correct set-up error and effectively increase the precision of fractionated IMRT.

BACKGROUNDChanging health care providers frequently breaks the continuity of care, which is associated with many health care problems. The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C, D and X drugs.

METHODSA 50% random sample of women who gave a birth in Saskatchewan between January 1, 1997 and December 31, 2000 were chosen for this study. The association between the number of changes in health care providers and with pregnancy exposure to category C, D, and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression, with adjusted odds ratios (ORs) and its 95% confidence intervals (CIs) as the association measures.

RESULTSA total of 18 568 women were included in this study. Rates of FDA C, D, and X drug uses were 14.35%, 17.07%, 21.72%, and 31.14%, in women with no change of provider, 1-2 changes, 3-5 changes, and more than 5 changes of health care providers. An association between the number of changes of health care providers and pregnancy exposure to FDA C, D, and X drugs existed in women without chronic diseases but not in women with chronic disease.

CONCLUSIONChange of health care providers is associated with pregnancy exposure to FDA category C, D and X drugs in women without chronic diseases.

Adult ; Continuity of Patient Care ; Databases, Factual ; Drug Prescriptions ; statistics & numerical data ; Drug Utilization ; statistics & numerical data ; Female ; Health Personnel ; Humans ; Logistic Models ; Pharmaceutical Preparations ; Pregnancy ; drug effects ; Saskatchewan ; United States ; United States Food and Drug Administration