Objective: To study the influence of contractual medical association on inpatient service performance. Methods:The data came from“Database of Inpatient Record” administered by Department of Medical Insurance. Using diagnosis related groups ( DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference ( DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index ( CMI) , the total weight, cost efficiency index and time efficiency index. Results:After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had de-clined, and the cost efficiency index had increased. Conclusion:Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.

The expression of C-myc, K-ras and H-ras oncoproteins in lymphocytesand monocytes, and NK subsets were studied in 21 patients with Behcet's syndrome (BS)and 40 healthy individuals. CD16~+,57~- cells of NK from BS patients were much decreasedwhen compared to the control. The positive percentages of three kinds of oncoprotein in BS lymphocytes and C-myc and K-ras oncoproteins in BS monocytes were significantly higher thanthat of the control. Positive correlations were found not only between C-myc expression oflymphocytes and serum ?-globulin%, IgM and IgG levels in BS, but also between C-mycexpression of monocytes and ESR. Expression of K-and H-ras oncoproteins in lympho-cytes and monocytes from BS patients were found to be negatively correlated with serumIgA level. Negative correlation was also found between C-myc expression in monocytesand CD16~+,57~- subset of NK. The significance of these results and the possible correlationsbetween BS and autoimmunity were discussed. It was suggeted that autoimmunity mightbe an important mechanism underlying BS.

Objective To analyze the prevalence and risk factors related to the diabetic patients with hypertension in the Kailuan group workers.Methods A total of 9 498 type 2 diabetic patients were followed up for 5 years,regarding myocardial infarction,stroke,and death incident.The cumulative incidence of hypertension in diabetic patients and the evaluated risk factors of hypertension were analyzed.Results The prevalence of hypertension in 9 489 subjects with diabetes was 63.3％,higher than that in subjects without diabetes(42.0％,P＜0.01).Aging,smoking,obesity,high blood levels of triglycerides,total cholesterol,and low-density lipoprotein-cholesterol were the risk factors of diabetic patients with hypertension,in whom the morbidity of myocardial infarction,cerebral infarction,cerebral hemorrhage,and renal dysfunction was 3.3％,6.0％,0.9％,and 18.8％,respectively,all higher than those (2.1％,2.6％,0.3％,and 10.9％) in diabetic patients without hypertension (P＜0.01).By the end of follow-up for 5 years,incidences of cerebral infarction,cerebral hemorrhage,and death in diabetic patients with hypertension were higher than those with normal blood pressure (P＜0.05),but no difference in incidences of myocardial infarction between the 2 groups (P＞0.05).The 5-years cumulative incidence of hypertension in the diabetic population was 40.1％.Male sex,smoking,snoring,obesity,and hypertriglyceridemia were the risk factors of hypertension in diabetic patients (P ＜ 0.05).Conclusion The prevalence and the 5-years cumulative incidence of hypertension in diabetic patients increased significantly.Diabetic patients with hypertension may have higher risk of cerebrovascular events and kidney dysfunction.

OBJECTIVE:To observe clinical efficacy and safety of rhBNP combined with levosimendan in the treatment of acute heart failure,and to investigated the effects of drug combination on serum UA and BNP levels. METHODS:68 patients with acute heart failure were randomly divided into observation group and control group,with 34 cases in each group. Both groups re-ceived routine treatment;control group was additionally given Levosimendan injection 5 ml added into 0.9% Sodium chloride in-jection 45 ml with persistent micropump injection:at pump rate of 12 μg/(kg·min)within first 1 h,and then at pump rate of 0.5μg/(kg·min)for consecutive 23 h;observation group was additionally given rhBNP 1.5 μg/kg for intravenous shock,and then giv-en consecutive intravenous injection of rhBNP at rate of 7.5 ng/(kg·min)continuous 3-7 days on the basis of control group. Clini-cal efficacy of 2 groups were observed,and serum levels of UA and BNP,heart function index,the safety of drug use were ob-served before and after treatment. RESULTS:After treatment,total effective rate of observation group(94.11%)was significantly higher than that of control group (70.59%),with statistical significance (P<0.05). The improvement of serum levels of UA and BNP in observation group was more significant than in control group,with statistical significance (P<0.05). The stroke volume and left ventricular ejection fraction of observation group were significantly better than those of control group,with statistical signif-icance (P<0.05). There was no statistical significance in the incidence of ADR between observation group (2.94%) and control group(5.88%)(P>0.05). CONCLUSIONS:rhBNP combined with levosimendan have significant clinical efficacy and high safety in the treatment of acute heart failure.

AIM: To provide scientific references for leeches by means of the antithrombin,antitrypsin and antichymotrypsin activities of the four kinds of leeches. METHODS: Using antithrombin,antitrypsin and antichymotrypsin activity analysis methods,the four kinds of leeches,they were,Whitmania pigra Whitman,Hirudo nipponia Whitman,Hirudo medicinalis Linnaeus,Hirudinaria manillensis Lesson,were detected. RESULTS: The blood-sucking leeches except whitnania pigra whitman had high antithrombin activity,and these four kinds of leeches were the same antitrypsin and antichymotrypsin activities. CONCLUSION: These three biological activity methods could be considered as reliable indexes in assessing the qualitity of leeches.

Humans ; Hydrocarbons, Brominated ; analysis ; metabolism

Flow cytometry analysis of DNA ploidy level and S-phase fraction (SPF) was carried out in 24 snap-forzen tissue specimens of ovarian carcinoma. The relationship of DNA ploidy level and SP-F with age,clinical stage, ascites, histologic type,pathological grade,lymphocyte infiltration and psammoma bodies was analyzed.Results showed that the relationship of DNA ploidy level and SPF with ascites and pathological grade was significant. Aneuploid portion and SPF in patients with ascites or pathological grade Ⅲ or Ⅱ were higher than those in patients with no ascites or pathological grade I. The author considers that DNA ploidy level and SPF of ovarian carcinoma can serve as a relatively independent objective index which reflects tumor's biological behaviours,and will be of great auxiliary value to early diagnosis and therapy of ovarian carcinoma.

OBJECTIVE:To establish a method for the analysis of chemical compositions in Jinqiancao granule. METHODS:HPLC-ESI-Q-TOF-MS was adopted. The chromatographic conditions:the column was Inertsil ODS-4 with mobile phase of 0.1%formic acid- methanol (gradient elution) at a flow rate of 0.8 ml/min,column temperature was 30 ℃,and the injection volume was 15 μl. MS conditions:ion source was ESI(negative ion mode),endplate offset voltage was -500 V,capillary electrophore-sis was 3500 V,carrier gas was helium gas,atomization and drying gas was high purity nitrogen gas at a flow rate of 6 L/min and a pressure of 1.0 bar,drying air temperature was 180℃. Scanning range was 50-1500 m/z. ChemBioDraw Ultra13.0 and Bruk-er data analysis software 4.0 were used to analyze the chemical composition molecular formula. RESULTS:A total of 27 kinds of chemical components were identified in Jinqiancao granule,involving sucrose,uridine,gallic acid,new chlorogenic acid,(-)-epi-gallocatechin,protocatechuic acid,chlorogenic acid,schaftoside,caffeic acid,schaftoside,vanillc acid,ferulic acid,hyperin,ros-marinic acid,rutin,isoquercitrin,astragalin,quercetin-3-rhamnoside,myricetin,4-hydroxybenzoic acid,quercetin,naringenin, luteolin,kaempferol,isorhmnetin,apigenin and emodin. CONCLUSIONS:Caffeic acid,rosmarinic acid,vanillic acid,(-)-epigal-locatechin,uridine and emodin are firstly found and reported in the chemical compositions in Jinqiancao granule.

Objective To establish a quality standard forZishen Tongguan Capsules.Methods Anemarrhneae Rhizoma and Phellodendri Chinensis Cortex were qualitatively identified by TLC method. The contents of neomangferin, phellodendrine hydrochloride, mangiferin and berberine hydrochloride inZishen Tongguan Capsules were quantitatively determined by HPLC method.Results The spots of qualitative identification method were clear without interference. Neomangferin in Anemarrhneae Rhizoma and phellodendrinehy drochloride in Phellodendri Chinensis Cortex were identified. Neomangferin, phellodendrinehy drochloride, mangiferin and berberine hydrochloride showed good linearity in the range of 0.025 25–2.02 μg (r=0.999 7), 0.025 5–2.04 μg (r=0.999 7), 0.026–2.08 μg (r=0.999 7), and 0.025 5–2.04 μg (r=0.999 6) respectively. The average recoveries of neomangferin, phellodendrinehy drochloride, mangiferin and berberine hydrochloride were 99.99%, 101.06%, 103.05%, and 100.55%, respectively. The RSD were 2.69%, 5.62%, 2.49%, and 2.06%, respectively.Conclusion The method is accurate and rapid, with good stability, reliability and reproducibility, which can be used for the quality control and evaluation of the preparation of Zishen Tongguan Capsules.

Objective To evaluate the risk factors associated with operative death after pancreatoduodenectomy(PD) and thus be able to decrease mortality. Methods The data of 123 consecutive patients undergoing PD during 9 years were reviewed. The variables analyzed were clinical data, laboratory data, operative factors , pathological diagnosis, and complications. Results The 30-day postoperative mortality rate was 7.3 percent. Postoperative intra-abdominal hemorrhage(OR=17.954), diabetes(OR=7.097), gastrointestinal hemorrhage (OR=7.789), preoperative serum albumin concentration(OR=10.689) and amount of operative blood loss(OR=5.473) were independent risk factors. Conclusions The chief risk factors associated with operative death after PD are low concentration of preoperative serum albumin, diabetes, large amount of operative blood loss, and postoperative intra-abdominal and gastrointestinal hemorrhage. These risk factors should be specifically considered in the perioperative management of the patients.