CMV related matrix protein pp65 antigenemia was screened in 100 Allo HSCT patients after transplantation. As control groups, samples from fourteen autologous HSCT patients, seventeen patients with various hematological malignant disorders, as well as twenty seven normal donors also were detected. CMV antigenemia was found in 91/100 Allo HSCT patients (91%) after transplantation. 56 % patients with antigenemia developed CMV disease. 54% patients developed acute GVHD. In 87 patients survived more than three months, 52 9% patients developed chronic GVHD. After follow up 18(4～36) months post transplantation, 21 patients died of CMV related diseases. Compared with autologous and non transplantation patients, CMV antigenemia and CMV diseases were particularly associated with Allo HSCT patients. It was obviously correlated with acute and chronic GVHD. CMV infection is a major factor affecting the clinical outcome of Allo HSCT patients.

Analyzed in the paper is the current subsidy mechanism for public hospitals in Zhejiang province, with analysis of problems found. The authors recommended to build a mass fraction subsidy mechanism to cover up the insufficiency of government financial subsidy; to fully leverage the price compensation of medical services; to subsidize in view of the functional positioning of various medical institutions;and explore more channels for public hospitals′subsidies.

Objective: To compare the clinical efficacy of minimally invasive closed reduction and open reduction and internal fixation in the treatment of ankle fractures. Methods: 133 cases with ankle fractures were selected.They were divided into closed group (65 cases) and incision group (68 cases) according to random table method.The closed group was treated with minimally invasive closed reduction, and the incision group was treated with open reduction and internal fixation.The therapeutic effect, amount of bleeding, time of fracture healing, time of operation and postoperative complications were compared between the two groups. Results: The good rate of the closed group (98.46%) was higher than that of the control group(85.29%, χ²=7.594, P<0.05). The amount of bleeding in the closed group[(19.40±3.56) mL] was less than that in the incision group[(39.84±4.15)mL], the fracture healing time in the closed group[(10.24±2.15)weeks] was shorter than that in the incision group[(15.46±3.67)weeks], the operation time in the closed group[(38.94±8.71)min] was shorter than that the incision group[(59.38±13.25)min](t=30.424, 9.950, 10.462, all P<0.05). The incidence rate of postoperative complication in the closed group (1.54%) was lower than that in the incision group (16.18%, χ²=8.675, P<0.05). Conclusion Minimally invasive closed reduction in the treatment of ankle fractures is better than open reduction and internal fixation, and has important research value.

Objective To find a selection method system appropriate for China's essential drug list.Methods Collection and analysis of technical paper literature on essential drug list developement,adjustment technical papers,and literature on evidence-based medicine,pharmacoeconomics evaluation,and medical insurance budget analysis from WHO and other countries.On such basis,a method system for selecting China's essential medicine list can be proposed,with its feasibility analyzed and demonstrated.Results The GRADE assessment proposed by WHO was used to evaluate the efficacy and safety of the drug;the pharmacy economics evaluation is added to assess the economic efficiency;these were aided by the pharmacoeconomics evaluation for a comprehensive evaluation of the pharmacoeconomics of the drug in question,supplementing analysis of the medical insurance,and ensuring its affordability of essential medicine so selected.The theory of this system is well developed,and supporting software ready for application.Examples in Zhejiang Province regarding essential medicine for diabetes have proved this method feasible.Data acquisition constitutes a major roadblock for scientific selection due to barriers against medical insurance data sharing.Conclusions Theoretic basis and method tools are fully available for essential medicine selection,and the selection method system as proposed in this study prove feasible to some extent.Decision makers are recommended to scientifically select the essential drugs,and to encourage data sharing,in order to make the list more scientific and pragmatic.

Objective:To explore the subjective well-being and its influencing factors of female elderly in ur-ban community in Shandong province. Methods: Used the multi-stage stratified sampling method to extract 449 elderly women in 6 communities of 18 cities in Shandong Province. The basic situation and Subjective well-being of their were investigated by using the self-designed questionnaire and Memorial University of Newfoundland Scale of Happiness ( MUNSH) . Results:The economic situation, the number of children, living conditions, self-care ability, chronic disease severity, and other variables have a significant effect on the subjective well-being of fe-male elderly. Conclusions:To improve the economic situation of the urban community elderly women, pay atten-tion to their physical and mental health level, improve the pension and health insurance system, intensify the con-struction of old-age care institutions, playing the roles of family, children, society in the network to support the community elderly women society, can significantly improve the community elderly women′s subjective well-be-ing.

The experience of various countries proves that the hierarchical diagnosis and treatment model can lead to reasonable resources allocation and utilization, however, the waste of China''s disordered treatment model has not been estimated.Nowadays, it is very important to establish a hierarchical diagnosis and treatment system during China''s healthcare system reform.Therefore, it is necessary to estimate the benefit the reform may bring.We take Zhejiang Province as an example, and adopted the system dynamics model to build the health delivery system, to emulate the hierarchical diagnosis and treatment model and the disordered model, and to evaluate the benefit.Results showed that if first option at the primary health institutions increased 10%, it could save 0.251 billion yuan, and if increased 15%, it could save 0.39 billion yuan.If the first option at the primary health institution reached 72.35% and the treatment in county reached 90%, the outpatient in tertiary hospital could reduce by 13 million, and those in primary healthcare institutions could increase by 74 million yuan.The direct healthcare cost could reduce 3.016 billion Yuan.

BACKGROUND:The knee joint acts as the body’s largest and most complex joint, which is a commonly seen perplex in patients because of synovium and cartilage diseases. Moreover, clinical physicians are often confused on the ultrasonic diagnosis of synovium and cartilage diseases.
OBJECTIVE: To review the ultrasound misdiagnosed cases of knee cartilage and synovial lesions and to summarize the common misconceptions and discrimination methods.
METHODS: A retrospective analysis was performed in the ultrasound misdiagnosed cases of knee cartilage and synovial lesions reported from 2002 to 2014, and then the common misconceptions and corresponding identification methods were summarized.
RESULTS AND CONCLUSION: High-frequency ultrasound is most likely to have six “mistaken ideas” addressing knee cartilage and synovial lesions: (1) cartilage degeneration; (2) synovial calcification; (3) echo intensity from synovial lesions; (4) blood flow in the synovium; (5) synovial effusion; (6) lesions involving intraarticular structures. High-frequency ultrasound runs through dynamical observation and contrast observation of bilateral knee joint lesions, which is a valuable imaging method for diagnosis of cartilage and synovial diseases based on vigilance at the “mistaken ideas” and mastery of the distinguishing ideas and methods.

Objective: To investigate the clinical value of transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause. Methods: From April 2015 to April 2017, the imaging data of transvaginal three-dimensional ultrasonography of 184 patients with benign and malignant breast tumors in the Second People's Hospital of Yuhang District were retrospectively analyzed.The peak systolic flow velocity, resistance index, peak systolic velocity, intimal arterial resistance index and blood flow display rate of uterine artery of benign and malignant endometrial diseases were compared. Results: The accuracy, sensitivity and specificity of transvaginal three-dimensional ultrasonography in the diagnosis of endometrial diseases were 91.30%(168/184), 92.00%(46/50), 91.04%(122/134), respectively.There were no statistically significant differences in the peak systolic flow velocity, resistance index, peak systolic velocity of patients with benign and malignant endometrial diseases by transvaginal three-dimensional ultrasonography(t=1.17, 0.88, 0.51, all P>0.05). The intimal arterial resistance index of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography was significantly lower than patients with benign endometrial diseases(t=2.59, P<0.05). The blood flow display rates of uterine artery of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography were 19.40%(26/134), 92.00%(46/50). The blood flow display rate of uterine artery of patients with malignant endometrial diseases by transvaginal three-dimensional ultrasonography was significantly higher than patients with benign endometrial diseases(χ²=7.26, P<0.05). Conclusion Transvaginal three-dimensional ultrasonography in the differential diagnosis of benign and malignant endometrial diseases after menopause has higher accuracy, sensitivity and specificity.

Objective To observe the correlation of intrapulmonary TREM-1 with endoplasmic reticulum stress in mice with acute lung injury (ALI).Methods Balb/c mice were tracheally injected with lipopolysaccharide(LPS,5 mg/kg) to induce ALI.Real-time PCR and Western blot were used to detect the expressions of TREM-1,CHOP and GRP78.The correlation of TREM-1 with endoplasmic reticulum-related proteins was analyzed.LPS (100 ng/mL) was used to induce inflammation in mouse primary peritoneal macrophages,and expressions of TREM -1,CHOP and GRP78 mRNA were detected by real-time PCR.The effect of TREM-1 activation on the expressions of CHOP and GRP78 was observed in macrophages.Results The expressions of TREM-1,CHOP and GRP78 mRNA were increased in ALI mice.TREM-1 mRNA expression was positively correlated with CHOP and GRP78 mRNA expression.In vitro,LPS up-regulated the expressions of TREM-1,CHOP and GRP78,and TREM-1 was positively correlated with CHOP and GRP78.Activation of TREM-1 increased CHOP and GRP78 mRNA expressions.Conclusions TREM-1 is positively related to the endoplasmic reticulum stress.The activation of TREM-1 enhances endoplasmic reticulum in mouse macrophages.

Objective:To explore the abundance, diversity, and structural changes of early postoperative pulmonary bacterial microbiota in lung transplant recipients.Methods:Recruiting 40 recipients who underwent lung transplantation surgery at the First Affiliated Hospital of Guangzhou Medical University from October 2020 to May 2022 for the study.All recipients did not receive antibiotic treatment within 4 weeks prior to surgery, and all recipients received a unified immunosuppressive and anti infection regimen after surgery.The bronchoalveolar lavage fluid(BALF) was collected from the amputated lung in vitro before the transplantation for 16S ribosomal RNA sequencing and flora analysis.BALF was also collected at the scheduled time from the transplanted lung on the 7th, 14th and 30th days post transplantaion for analysis.Results:The study included a total of 40 recipients who did not receive antibiotic treatment within 4 weeks before surgery, including 35 males.Among the study participants, there were 14 cases of primary obstructive pulmonary disease, 19 cases of interstitial lung disease, 3 cases of occupational lung disease, and 4 others.Microbiome in BALF of transplanted and detached autologous lungs at the first week after surgery α( P<0.05) and β diversity is statistically significant( R2=0.08, P=0.001), and the bacterial community in the transplanted lungs α Diversity is lower than that of explant lungs.Starting from the second week after surgery, the richness and species diversity of the transplanted lung microbiota gradually increase.The bacterial structure was also changed with postoperative time, and the relative abundance of the same bacterial species were varied at different time points.The bacterial community in BALF was mainly dominated by Proteobacteria both explant lungs and transplant lungs.The relative abundance of Staphylococcus and Acinetobacter genera at the BALF in transplanted lungs was higher than that in explant lung samples, but their relative abundance decreased over time after surgery. Conclusions:The α diversity of the early postoperative pulmonary microbiota after lung transplantation was lower than that of the amputated autologous lung, and the bacterial richness and species diversity in the microbiota of the transplanted lung gradually increased at the second week after the transplantation.The bacterial microbiota of the transplanted lung is changed complicatedly with time.