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.

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.

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.

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

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.

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.

ObjectiveTo investigate the surgical procedures of orthotopic small bowel transplantation (SBT) model in mice to study the function and rejection of SBT.MethodsWe established a mouse SBT allograft model as follows: the donor portal vein was anastomosed end by side with the recipient inferior vena cava; the donor superior mesenteric artery with aorta patch was anastomosed end by side with recipient abdominal aorta.After an appropriate length of the recipient's small bowel was removed,the donor's small bowel and the recipient's small bowel were end-to-end anastomosed discontinuously.The mice were fasted for 4 d after the operation,free access to water and subcutaneously injection of 2 mL of 5％ glucose saline twice daily.Operation success was regarded as survival for more than 5 d.There is no antibiotic and immunosuppressor.ResultsA total of 30 transplantations were done,the 5 d survival rate was 60％ ( 18/30),and 12 died within 5 d.Among the dead recipients,5 died of arterial anastomotic stenosis and anastomotic thrombosis,2 of hemorrhagic shock caused by anastomotic bleeding,and the other 5 of intra-abdominal infection caused by postoperative intestinal fistula.The donors' operative time was (40 ± 4.5 ) min,warm ischemia time was about 0.5 min,donor preparation time was about 3 min,and cold preservation time was (30 ±7.5) min.The recipients' operative time was (95 ±8.0) min,among which,the abdominal aorta and inferior vena cava clamping time was ( 38 ± 3.5 ) min,the venous anastomotic time was (10 ±2.0) min and the arterial anastomotic time was (15 ± 3.0) min.The mean intraoperative blood loss of the surviving recipient mice was about 0.2 mL.ConclusionHigh quality vascular anastomosis,and rehydration of donors and recipients are crucial factors for improving the success rate of SBT.

Objective To detect the changes of gastric emptying function by gastroenteric contrastenhanced ultrasonography and to offer the evidence for the diagnosis and treatment of diabetic gastroparesis.Methods The gastric emptying function was measured by gastroenteric contrast-enhanced ultrasonography in 35 cases of diabetic gastroparesis (DGP,DGP group) and 35 volunteers (control group).The gastric emptying rate(GER) and emptying time(ET) after taking orally gastroenteric ultrasound developer in DGP group were observed and compared with control group.Results The GER in DGP group was lower than that in control group [(27.05 ± 11.32)％ vs.(45.38 ± 15.08) ％] (P ＜ 0.05).The ET in DGP group was longer than that in control group[(102.43 ± 15.76) min vs.(75.31 ± 11.52) min] (P ＜ 0.05).Conclusions The method of gastroenteric contrast-enhanced ultrasonography is a simple,and repeatable imaging method,which can be used to make a real-time assessment on the gastric dynamic changes,but don't influence gastroenteric function and can provide a dependent and noninvasive examine means for clinical physician to test the gastric emptying function in DGP.

Objective To investigate the clinical efficacy and safety of intravenous immunoglobulin and interferon in the treatment of hand foot and mouth disease complicated with viral encephalitis .Methods 80 cases of hand foot and mouth disease complicated with viral encephalitis were randomly divided into the three groups according to the random number table .27 cases in the control group were given comprehensive symptomatic treatment ,27 cases in the study group 1 were given gamma globulin ,and 26 cases in the study group 2 were given interferon .The clinical efficacy,improvement of disease ,incidence of adverse reactions of the three groups were compared .Results Defer-vescence time ,seizure control time ,time of skin rash subsided ,time of psychiatric symptoms relieved and the average hospitalization time in the study 1 group were (3.65 ±0.28)d,(4.04 ±0.33)d,(3.86 ±0.27)d,(5.83 ±0.36)d and (7.53 ±0.83)d,which were significantly less than those in the control group (t=8.43,8.58,9.15,9.80,8.96, all P<0.05).Those in the study 2 group were (3.92 ±0.29)d,(4.21 ±0.32)d,(4.27 ±0.30)d,(6.32 ±0.43)d and (8.10 ±0.72)d,which were significantly less than the control group (t=7.99,8.17,8.54,9.18,8.55,all P<0.05);however,there were no significant differences between the study 1 group and the study 2 group(t=1.12, 2.04,1.67,1.38,2.21,all P>0.05).The incidence rate of adverse reaction among the three groups showed no sta-tistically significant difference (χ2 =2.17,P>0.05).Conclusion Intravenous immunoglobulin and interferon have significant effect in the treatment of hand foot mouth disease complicated with viral encephalitis , which can quickly improve symptoms ,shorten treatment time and have high safety and good clinical application value .