Objective The aim of the study was to analyze the psychological problems and psychological needs of the odinopoeia patients with stillbirth or fetal malformation.Methods From May to August 2012,25 patients with stillbirth or fetal malformation were collected and 40 normal patients were selected as control in the targeted hospital,their psychological conditions were compared.The socio-demographics of patients were survey,the Symptom Check List 90(SCL-90) was applied to assess the two groups' psychological conditions,and Impact of Event Scale Revised (IES-R) was applied to assess the post traumatic stress disorder (PTSD),moreover,the associated factors with PTSD was also analyzed.Results The symptom factor scores of the cases were significantly higher in odinopoeia patients than the controls.The age,education levels,having or no offsprings and the support of spouse were greatly associated with PTSD of patients with stillbirth or fetal malformation.The patients with stillbirth or fetal malformation demanded to understand some prenatal care knowledge and the reasons for stillbirth or fetal malformation.Conclusions The patients with stillbirth or fetal malformation had low levels of psychological health,so the medical workers and family members must pay much attention to the psychological conditions of patients with stillbirth or fetal malformation,and provide them the psychological counseling in order to eliminate the patients' suffering from stillbirth or fetal malformation and improve their mental health.

This article makes a contrastive analysis on the first category and second category of traditional Chinese medicine among Chinese Traditional Medicine and Materia Mediea Subject Headings (third edition), the TCMLS Metathesaurus and Chinese Library Classification (fifth edition), and points out the features and defects in these classifications, hoping to give some useful proposals to the construction of traditional Chinese medicine vocabulary.

The puberty and reproduction are regulated by the hypothalamic-pituitary-gonadal axis. The activation of hypothalamic gonadotropin-releasing hormone (GnRH) neurons and an increase in GnRH is critical for the initiation of puberty. The mechanism of GnRH regulation for neurons activity is complicated, because many different factors can affect the secretion of GnRH. Glutamate is the main excitatory neurotransmitter, which can promote the secretion of GnRH through a variety of pathways. In recent years, relevant studies showed that NELL2 may influence the secretion of GnRH by regulating the secretion of glutamate or through other pathways,thereby affecting the onset of puberty. So NELL2 plays an important role in promoting neuronal growth,differentiation, neuronal plasticity maintenance and synapse transportation etc.

Pneumonia is the primary cause of death in children under five years of age.About 2 million children younger than 5 years die of pneumonia each year worldwide,accounting for 19％ of the total number of deaths.According to the survey in 2008,7％ ～ 13％ of the children with pneumonia are severe pneumonia.Severe pneumonia is a life-threatening disease which needs for intensive care.Cytokine IL-10 is a anti-inflammatory cytokine,and IL-18 is a proinflammatory cytokine,both of them are released by the inflammatory response,and can be involved in severe pneumonia immune-mediated.They are closely related to the occurrence,development and prognosis of severe pneumonia.

Objective To study the clinical features and the clustering of risk factors in gestational diabetes mellitus (GDM),and analyze the risk factors.Methods Two hundred and three gravida were selected.According to the result of 75 g oral glucose tolerance test,they were divided into 2 groups:GDM group(134 cases) and normal glucose tolerance (NGT) group (69 cases).Blood sugar,blood fat and insulin were measured,and the homeostasis model of assessment for insulin resistance index (HOMA-IR),pancreatic islet beta cell function index (HOMA-β) and insulin sensitivity index (ISI) were calculated.The relation was analyzed between the risk factors and GDM.Results The age,progestation body mass index (BMI),fasting blood glucose,fasting insulin,total cholesterol,triglyeride,low density lipoprotein-eholesterol (LDL-C),HOMA-IR and the positive rate of diabetes mellitus family history in GDM group were significantly higher than those in NGT group [(30.8 ±4.1) years vs.(28.7 ±3.9) years,(24.29 ±3.65) kg/m2 vs.(21.35 ±2.39) kg/m2,(5.22 ±1.26) mmol/L vs.(4.33 ±0.53) mmol/L,(9.27 ±3.55) mU/L vs.(4.75 ±2.73) mU/L,(5.54 ± 1.26) mmol/L vs.(3.74 ± 1.07) mmol/L,(2.63 ± 1.43) mmol/L vs.(1.73 ± 0.76) mmol/L,(3.02 ± 0.97) mmol/L vs.(2.10 ± 0.75) mtmol/L,0.67 ± 0.47 vs.0.43 ± 0.34,40.3％ (54/134) vs.26.1％(18/69)],there were statistical differences (P＜ 0.01 or ＜ 0.05).The HOMA-β and ISI in GDM group were significantly lower than those in NGT group (4.62 ± 0.72 vs.5.57 ± 1.30 and-3.79 ± 0.47 vs.-2.91 ± 0.48),there were statistical differences (P ＜ 0.01).Logistic regression analysis result showed that fasting blood glucose (OR =6.016,95％ CI:1.603-22.585,P =0.008),total cholesterol (OR =2.823,95％ CI:1.568-5.083,P=0.001),diabetes mellitus family history (OR =2.780,95％ CI:1.168-6.617,P=0.021),fasting insulin(OR =1.954,95％ CI:1.371-2.785,P=0.001),progestation BMI(OR =1.787,95％ CI:1.124-2.839,P =0.014),age (OR =1.374,95％ CI:1.087-1.737,P =0.008) and diastolic pressure (OR =1.184,95％ CI:1.045-1.342,P =0.008) were the risk factors of GDM.Conclusions GDM has the clinical features of the clustering of risk factors and genetic susceptibility.The disorder of lipid metabolism and glycometabolism,genetic susceptibility and age are the main risk factors in the development of GDM.

Objective:To explore means of process quality assessment for antibacterial drug utilization among a-cute appendicitis patients under the New Rural Cooperative Medical Scheme ( NCMS) through the use of the explicit method in order to provide evidence for the rationality of drug utilization in NRCMS. Methods: Data was collected from the NCMS information system of one county in Shandong Province from 2007 to 2011 and included 1 ,721 cases of acute appendicitis in county and town-level hospitals. The explicit method was employed, which adopted the ad-herence rate to represent drug process quality by comparing the actual antibacterial drug utilized with those recom-mended by quality standards. Descriptive statistics were used to analyze quantitative data with Excell2007, Microsoft SQL 2005 and SPSS 17 . 0 . Results: The average overall adherence rate from 2007 to 2011 was 22 . 4% ( SD =22. 3%) at the individual level. The overall adherence rate of township health centers was very low, between 14. 6%and 19. 6%, with no significant difference among the five years. The utilization of cephalosporin drugs was relatively stable at town-level hospitals, that is, third-generation cephalosporins was used most frequently, while cephalosporin, recommended by quality standards, was the least utilized in all five years. At county-level hospitals, fourth-genera-tion drugs were gradually substituted with second and third-generation drugs. Utilization of the recommended drug metronidazole of the nitromidazoles drug group decreased over time at both the town and county-level hospitals, and the drug was gradually substituted by tinidazole and ornidazole, especially in county-level hospitals. Conclusions:From 2007 to 2011 , the rationality of drug utilization was low in the NCMS designated hospitals at both town and county-level hospitals, particularly in town-level hospitals. The underuse of recommended quality standard drugs was the main issue at hand, and this situation experienced no significant changes during the study period.

The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medi-cal expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation be-tween quality of care and medical expenditure. Based on Donabedian’s structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common;more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, ac-cording to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way.

To explore the allocation and equity of health resource in Changsha between 2007 and 2013 and to provide references for government to carry out regional health planning. Method:General statistical analysis was used to describe changes of health resource allocation in Changsha;from the perspective of the population and geography of the nine counties in Changsha, the equality and change of the configuration among doctors, nurses and hospital beds were analyzed by using the Gini coefficient and Theil index. Results:1) The per capita amount of health resources in Changsha increased gradually, and health resources were mainly concentrated in urban areas. 2 ) The Gini coeffi-cients of doctors, nurses and hospital beds was 0. 24~0. 46 according to population distribution between 2007 and 2013 in Changsha, and the Gini coefficient of all health resources by geography was 0. 59~ 0. 79 and peaked in 2009 to then decrease year after year. Following a comparison of the two kinds of regions, the Gini coefficient of urban are-as was significantly higher than that of rural areas, and the Gini coefficient of nurses was the highest among all health resources. 3) Changes in the Theil index were consistent with the Gini coefficient. The difference in the degree of re-source allocation in urban areas exhibited a rising trend, The Theil index was higher than each regional difference. Conclusion:Overall, the equity of allocation of health resources in Changsha between 2007 and 2013 gradually im-proved year by year. The equity of population configuration was greater than that of geographical configuration, and the equity of rural areas was superior to that of urban areas;the equity of the configuration of nurses was poor. The difference between areas is the main factor affecting the equity of Changsha’s health resource allocation.

A lot of basic and clinical studies have proved that limb remote ischemic preconditioning (RIPre) is a safe and effective means reducing perioperative myocardial reperfusion injury .However ,RIPre possesses specific protec‐tive window .Therefore ,researchers used repeated limb RIPre to prolong the protective window in order to explore a new prevention and rehabilitation measure for cardiovascular diseases .

Objective To compare cardiovascular responses of intubations by Discopo and Macintosh laryngoscope in elderly patients with hypertension. Methods Sixty elderly hypertensive patients with ASAⅡ~Ⅲundergoing elective surgery were equally randomized into two groups. After induction of general anesthesia , orotracheal intubation was performed with Discopo or Macintosh. The Mean arterial pressure (MBP) and heart rate (HR), as while as Electrocardiogram (ECG) and Blood oxygen saturation (SpO2), were recorded before (baseline values) and at 1,3,5 minutes after intubation(post-induction values). The rate of one-time successive intubation,intubation time and complication were also recorded. Results Compared with the macintosh group, the rate of one-time successive intubation was higher and the intubation time was shorter in the Discopo group (P< 0.05, respectively),with no complications. Compared with T0,MBP and HR at T2 in the two groups and T3 in the Macintosh group increased significantly (P < 0.05). Compared with the Macintosh group,MBP and HR at T2,T3 of the Discopo group decreased significantly (P < 0.05). Conclusion Little effect of tracheal intubation with Discopo on cardiovascular response was observed in elderly hypertensive patients.