Against the backdrop of ongoing healthcare system reform and escalating competitions among hospitals in China,more and more specialists and scholars on hospital administration begin to focus their studies on the theories and practice of hospital flows.Methodology frequently called into play in such study include out-patient flow refom,progressive flow improvement,and attention to management and service.Discussed in this paper are the advantages and disadvantages of these three methods as a reference for an appropriate choice by hospitals at large.

Objective To observe the expression changes of microRNA-124(miRNA-124) following traumatic brain injury (TBI) in mice and investigate the correlation of miRNA-124 with neural axon regeneration.Methods Ninety-one C57BL/6 mice were assigned into TBI group (n =63) and control group (n =28) according to the random number table.Mice in TBI group were subjected to controlled cortical impact and euthanized at 12 hours and 1,3,7,14,21,28 days postinjury for the collection of brain tissue in the trauma zone.Mice in control group underwent craniectomy only.Trauma zone observation was done using the HE staining.Expression of miRNA-124 was detected using the real-time PCR.Levels of Nrp-1,Gap-43 and Tau were detected using the Western blot and immunohistochemical staining.Results After injtury,study of mice behavior and HE staining indicated the establishment of experimental model was successful.Expression of miRNA-124 reached the peak at 3 days postinjury (3.80 ± 0.22),expression of Nrp-1 reached the peak at 7 days postinjury (2.006 ±0.179),expression of Tau reached the peak at 14 days postinjury (2.063 ±0.172),and expression of Gap-43 sustained high level since 12 hours after injury(1.355 ± 0.093) (P ＜ 0.05).Count of axon marker positive cells in TBI group was the lowest at 1 day postinjury due to the direct damage and edema,and then slowly recovered.There was no significant difference in the count of axon marker positive cells between the two groups at 14,21 and 28 days postinjury (P ＞ 0.05),but the morphology in TBI group changed obviously.Although the positive cells of axon marker decreased at 1 day postinjury,expressions of miRNA-124,Nrp-1,Tau and Gap-43 in TBI group were significantly increased compared to the detections in control group (P ＜ 0.05).Conclusion Increased expression of miRNA-124 in trauma zone may closely related to axon regeneration after TBI in mice.

Objective To study the features and differences of electromyography of diabetic polyneuropathy (DPN) and alcoholic peripheral neuropathy (APN ), and to provide reference basis for the clinical application of electromyography.Methods 58 patients with DPN and 30 patients with APN were used as subjects. Nerve conduction studies (NCS)and sympathetic skin response (SSR)were performed in the patients, all data were analyzed.Results In the patients with DPN, the abnormalities of NCS and SSR were increased with the prolongation of the time diabetes,and the abnormality of SSR was higher than that of NCS(P<0.05).In the patients with APN, both demyelination and axonal loss in motor and sensory nerves were significantly involved, and the abnomalities of NCS and SSR were higher than those of the DPN patients (P<0.05 or P<0.01);but the proximal nerves were just involoved mildly. Conclusion Both DPN and APN have characteristic electrophysiological features.Early electromyography is useful for the early diagnosis of DPN and APN.According to the electrophysiological features of DPN and APN,the reason of peripheral neuropathy in the patients who have diabetes mellitus and alcoholism could be differentiated.

Objective To grasp the basic situation concerning visits by emergency outpatients to big urban hospitals before the implementation of reform in the medical insurance system in our city. Methods An investigation was made by means of profile survey questionnaires into the form of medical security of emergency outpatients, the sources of patients, referrals of patients, and the evaluation of doctors. Results Current emergency outpatient services in big urban hospitals have the following features: fairly great medical demands and attraction, widespread sources of patients, and pretty strong advantages in comprehensive clinical treatment. At the same time, before the implementation of reform in the basic medical insurance system, existing medical security setups, which are in the stage of transition, are characterized by a variety of types, a pretty narrow coverage in the provision of medical security and a rather high proportion of self-paying patients. Conclusion It is imperative to actively promote reform of the medical insurance system, formulate regional health plans that conform to the situation in our country, and expand the functions of community medical healthcare.

Objective To study the clinical diagnosis and therapy of scar pregnancy after uterine cesarean section.Methods Clinical data of 21 patients with uterine cesarean section in our hospital from June 2006 to December 2008 were retrospectively analyzed.Results The success rate of 16 cases by drug therapy (including three cases of surgical treatment) was 81.3%;3 cases of auto-discharge transferred to other hospitals to do intervention,1 case used expectant treatment,1 case used complete curettage of uterine cavity under B-Ultrasound.Conclusion Drug treatment can terminated scar pregnancy after uterine cesarean section effectively,but there is a potential risk of massive hemorrhage or uterine rupture;color doppler ultrasound,especially Transvaginal color doppler ultrasound was the primary means of cesarean section,and benefit to judge prognostic factors and observed treatment.

Objective To explore the relationship between R time in thrombelastography (TEG) and prognosis of traumatic brain injury (TBI).Methods The data of TBI patients were collected in Fourth Peoples Hospital in Shaanxi Province from January 2015 to June 2016.The patients were divided into two groups according to the prolongation of R time at admission,and the basic data and the outcomes were analyzed.Results In basic data,Glasgow coma scale (GCS) [(9.7 ± 4.4) scores vs (12.1 ± 2.2) scores] was lower,and injury severity score (ISS) [(32.4 ± 8.9) scores vs (21.7 ± 10.4) scores],head abbreviated injury scale (AIS) [(5.0 ±0.0) scores vs (4.1 ± 1.5) scores],hemorrhage volume [(6.2 ± 5.5) ml vs (1.1 ± 1.8) ml] and mean arterial pressure[(127.2 ± 28.1) mmHg vs (103.3 ± 17.0) mmHg] were higher in the prolonged R time group.In outcomes,the in-hospital mortality (42.9％ vs 17.2％) and the rate of neurosurgical intervention (71.4％ vs 37.7％) were higher,and the duration of mechanically ventilated [(9.3 ±3.2) d vs (4.1 ± 1.7) d],ICU stay [(10.2 ± 4.4) d vs (5.6 ± 2.1) d] and hospital stay [(22.4 ± 8.1) d vs (8.3 ± 4.7) d] were longer in prolonged R time group.The Logistic regression analysis results showed that GCS ≤8 scores,ISS ＞ 25 scores and R time ＞ 10 min were the possible risk factors of hospital mortality.Conclusion TBI patients with longer R time have worse prognosis and longer R time is the possible risk factor of hospital mortality,and the prediction efficiency of R time need to be explored and validated by more research.

AIM:To observe the expressions of cathepsin B (CB) and cystatin C (CC) in different stage of diabetic rats and to investigates their potential roles.METHODS:Sixty rats were divided into diabetes mellitus group induced by intravenous injection of streptozotocin (55 mg/kg) and normal group injected with citrate buffer. Ten rats were sacrificed respectively at the end of fourth week,eighth week and sixteenth week in both groups. 24 h urine excretion was collected in rats before sacrifice. The blood and the kidney were also collected. The mRNA and protein expressions of CB and CC in kidney were detected by real time PCR and immunohistochemical staining,respectively.RESULTS:At the end of eighth week,the expression of Ccr,24 h urinary protein excretion,CB,CC in diabetic rats increased significantly,compared to the results at the fourth week (P

Objective To set up the reference range for thyroid hormones and thyrotropin (TSH) of 8-10 years old school children in certain regions of China to provide reference criteria for diagnosis,treatment,and monitoring of thyroid diseases and related research.Methods A cross-sectional survey was conducted in primary school children aged 8-10 years from six iodine sufficient areas.664 normal school children were selected for establishing reference ranges of thyroid hormones and TSH after crucial screening through questionnaire and laboratory investigation.The serum hormone levels were determined by using chemiluminescent immunoassay (Bayer's reagents),and the reference range of each hormone was displayed as its 95％ central interval.Results The reference ranges of TSH,FT4,FT3,TT4,and TT3 were 1.03-8.42 mIU/L,13.44-20.59 pmol/L,4.75-6.96pmol/L,75.29-152.66 nmol/L,and 1.76-3.35 nmol/L,respectively.There was no significant difference in hormone levels between boys and girls.The eight years old group had slightly higher TT4 level compared with the other age groups.The rural children had higher TSH and TT3 levels and lower FT4 level than the urban children.Conclusion The thyroid hormone and TSH levels are substantially different between school children and adults.Therefore,it is necessary to establish the reference range of thyroid function indices for normal school children in order to diagnose,treat,and monitor thyroid diseases.

Objective To study mother and infant's iodine metabolism and thyroid function during lactation with different iodine intakes. Methods Wistar rats were randomly assigned to four groups with severe iodine deficiency (SID), mild iodine deficiency (MiID), normal iodine (NI), and excessive iodine (ExI) intake respectively. All rats were fed on an iodine deficient food and drinking water with different quantities of potassium iodide for 3 months until mating. The urinary iodine, milk iodine, blood iodine, and thyroid hormones (TH) were detected in lactating mother and the offspring rats 14 days after birth. Thyroid weight of mother rats was determined. Thyroid morphology of mother and their offsprings was observed. Results ( 1) Iodine contents in urine, milk, and blood of lactating rats and the offsprings were increased with the increase of iodine supplied in diet. But the change in amplitude between groups was decreased in the other; urine iodine > milk iodine > blood iodine. (2) Serum TT4[ (16. 7±12. 0 vs 36.4±15. 0) nmol/L, P<0.05] was significantly decreased, but TSH [(5.73±2.90vs 1. 38±0.30)mIU/L, P<0.01]and TT3/TT4(6.6±2.7 vs 2. l±0.3,P<0.01) were increased in lactating rats of SID group compared with NI, so as TT4( 10.6±2. 3 vs 16.4±4. 7) nmol/L, P<0.05 ] of offspring rats in SID, but were not in MiID and ExI groups. (3 ) Histological studies showed that small follicular thyroid nodules with follicular hyperplasia occurred in both lactating rats and their offsprings in the SID group, mild swelling in MiID group and polymorphism changes appeared in mother rats of ExI group, but no significant difference appeared in offsprings compared with NI group. Conclusions Severe iodine deficiency will lead to hypothyroidism in mother and infant, but normal iodine nutrition and thyroid function in mother and offspring were maintained through the compensatory action of mother and child in mild iodine deficiency and iodine excess.

Objective To observe and compare the different orthotopic models of papillary thyroid cancer ( PTC) cell lines of RET/PTC1 rearrangement and BRAFV600E mutation in nude mice. Methods Human PTC cell lines TPC-1, BHP5-16 and BHP2-7 were used. The genotypes of RET/PTC1 rearrangement and BRAFV600E mutation were determined by realtime-PCR and DNA sequencing analysis. The cells(2×105) were injected into the thyroid gland of nude mice. The nude mice were executed at 4th, 12th week, and then their thyroid tumors were removed and weighed. The levels of thyroid hormone were detected using chemiluminescent immunoassay. Results Both TPC-1 and BHP2-7 cells were identified as RET/PTC1 rearrangement by real time-PCR, and the expression of RET/PTC1 rearrangement in BHP2-7 cell was higher than that of TPC-1 cell. BRAFV600E mutation was found in BHP5-16 cell by DNA sequencing analysis, but was not found in TPC-1 and BHP2-7 cells. There were different characteristics in three orthotopic nude model groups. Tumorigenic rates of TPC-1 and BHP5-16 groups were 100%, but the growth of tumor was more rapid in BHP5-16 group than that in TPC-1 group, with more weight tumor. The changes of thyroid hormone levels in BHP5-16 group and TPC-1 group were the same, which were normal at 4th week and sharply decreased at 12 th week(P<0. 05). However, the tumorigenic rate of BHP2-7 group was only 6. 25%. Compared with normal control group, there was no statistical difference in the levels of thyroid hormone in BHP2-7group(P>0. 05). Conclusions It showed difference in the orthotopic models of PTC cell lines of RET/PTC1 rearrangement and BRAFV600E mutation in nude mice. BRAFV600E mutation has obvious impacts on increasing tumorigenic rate and promotion of tumor growth in the orthotopic model. It should not be ignored that advanced thyroid tumor will lead to the destruction of thyroid function.