To point out expensive medical treatment increase hospital cost, which become an important reason of expensive expenditure for seeing a doctor. A large number of advanced medical treatment facilities are either the motivation or the burden of development for hospital. The resource sharing of medical treatment facility was applied to solve questions that how to make full use of function of these facilities, and concentrate technical power for repairing, operation and diagnosis, which can also be helpful for seasonable utilization of medical treatment resource, saving the costs, optimization of technical power, reducing repairing cost.

Objective: To analyze the factors affecting the dropping-out from methadone maintenance treatment (MMT) in Hangzhou City, so as to provide the evidence for improving the compliance to MMT. Methods: One MMT clinic was sampled from each of the eight districts in Hangzhou City using a cluster random sampling method, and patients that received MMT and were at ages of 18 years and older and registered during the period from December 2020 through June 2021 were recruited. Participants' basic characteristics, illegality and crime within 6 months prior to MMT and family and social relationships were collected through questionnaire surveys, and factors affecting the dropping-out from MMT were identified using a multivariable logistic regression model. Results: A total of 315 outpatients were included from MMT clinics. The participants had a mean age of (45.33±7.63) years, and included 245 men (77.78%) and 70 women (22.22%), with a dropping-out rate of 65.71%. Multivariable logistic regression analysis showed a low likelihood of dropping-out from MMT among patients at ages of 60 years and older (OR=0.080, 95%CI: 0.018-0.350), employees (OR=0.415, 95%CI: 0.236-0.727), patients without drug-related infectious diseases (OR=0.411, 95%CI: 0.231-0.731), patients with per dossing of 60 mL and higher (OR=0.431, 95%CI: 0.236-0.787) and patients without contact with drug-using friends (OR=0.328, 95%CI: 0.185-0.582), and a high possibility of dropping-out from MMT among patients with poor relationship with family members (OR=2.905, 95%CI: 1.127-7.488). Conclusion Age, working status, drug-related infectious diseases, dosing, relationship with family members and contact with drug-using friends affected the dropping-out from MTT in Hangzhou City.

Objective To investigate the clinical effect of the proximal femoral nail anti rotation nail combined with anti osteoporosis drugs in the treatment of intertrochanteric fracture in elderly patients.Methods From October 2014 to October 2015 in our hospital department of orthopedics for PFNA surgical treatment of 80 cases of intertrochanteric fractures in osteoporotic patients, according to the time of admission were divided into simple operation group (control group) and combined group (treatment group),with 40 cases in each group.Both the two groups were treated with PFNA surgery,treatment group were treated with ossification in three alcohol,calcium and calcitonin in the treatment of patients with hip.The fracture healing and hip function were compared between the two groups.Results The treatment group callus appear time,healing time were lower than the control group, the difference was statistically significant (P<0.05);One and three months after operation,the callus scoring of treatment group was higher than control groups (P<0.05);Six months after operation, the bone density of treatment group were higher than control group (P<0.05),the satisfactory rate of treatment group 90.00% was higher than the control group72.50% ( P<0.05 ) .Conclusion PFNA combined with anti-osteoporosis drugs in the treatment of elderly patients with intertrochanteric fracture is conducive to promote fracture healing , improve the condition of osteoporosis in patients with osteoporosis.

BACKGROUND:Osteonecrosis of the femoral head (ONFH) results from an interruption of the blood supply to the femoral head or injury-caused death of chondrocytes and bone marrow components. Many osteogenesis-related factors, such as Runt-related transcription factor 2 (Runx2), bone morphogenetic protein (BMP), osteoprotegerin and osteocalcin, are involved in the subsequent repair process. The Runx2 gene has been shown to control osteoblast differentiation and formation by upregulating the transcription of various mineralization-related protein genes, alowing osteoblast precursors differentiation into osteoblasts, and playing a key role in bone repair.
METHODS/DESIGN:This retrospective, single-center, non-randomized, paralel-controled trial was performed at Shengjing Hospital of China Medical University, China. Fifteen patients with ONFH and 15 patients with osteoarthritis undergoing total hip replacement were included. Primary measure was Runx2messenger RNA (mRNA) expression in femoral head and neck tissue, and secondary measures included BMP-2, BMP-7 and osteoprotegerin mRNA expression, as wel as osteocalcin immunoreactivity. This trial was registered at ClinicalTrials.gov (identifier: NCT02735538) and acquired written approval from the Ethics Committee of Shengjing Hospital of China Medical University (approval No. 2016PS222K). Written informed consent was obtained from each included patient.
DISCUSSION:This study involved in the detection of mRNA expression of several bone repair-related genes, including Runx2, in the femoral head and neck of patients with ONFH was performed between 2010 and 2011. This observational study wil help clarify the role and possible clinical significance of Runx2 in femoral head necrosis, bone repair and reconstruction.

Objective To explore the effects of physiological ischemia training (PIT) on the function of endothelial progenitor cells.Methods Eighteen male New Zealand rabbits (2.5 ± 0.5) kg were divided into 3 groups:a sham operation (SO) group,a myocardial ischemia (MI) group and a MI ± physiological ischemia training (MI ± PIT) group.The PIT was modeled by ischemic isometric contraction of gastrocnemius muscle induced by electric stimulation (40 Hz,1 ms,40％ maximum current strength),and the MI was modeled by implantation of a water balloon to occlude the left ventrical branch of the heart.The experiment was conducted for 4 weeks.Before and after the experiments,the ability of mobilization and adhesion of endothelial progenitor cells were detected,the number and the capillary density were counted.Results Post-experiment,compared with groups SO and MI,PIT group significantly improved the ability of mobilization (151 ± 16 cells/HPF,P ＜ 0.01) and adhesion (17.8 ± 2.8 cells/ HPF,P ＜ 0.05),increased the circulating amount (P ＜ 0.05) and capillary density (824.0 ± 106.6 /mm2,P ＜ 0.05).Pearson analyze showed that there was positive correlation between circulating EPCs and capillary density.Conclusion Physiological ischemia training could improve EPCs mobilization and function,resulted to neovascularization in the ischemic heart tissues.

Objective: To explore influence of nursing strategies based on evidence based medical theory on negative emotion and daily behavior in aged patients with coronary heart disease (CHD).Methods: A total of 88 CHD patients, who were treated in our department from Oct 2012 to Mar 2015, were selected.According to random number table, they were randomly and equally divided into routine nursing group and evidence based nursing group (received evidence based nursing based on routine nursing group).Unhealthy lifestyles, scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS), satisfaction for nursing and incidence rate of major adverse cardiovascular events (MACE) were measured and compared between two groups before and four months after intervention.Results: Compared with routine nursing group after four-week intervention, there were significant reductions in percentages of smoking (40.9% vs.22.7%), drinking (54.5% vs.38.6%), high-fat diet (43.2% vs.29.5%), physical inactivity (45.5% vs.25.0%) and overweight (52.3% vs.29.5%), scores of SAS [(50.4±3.3) scores vs.(45.8±3.2) scores] and SDS [(53.4±4.7) scores vs.(48.0±4.2) scores], and incidence rate of MACE (25.0% vs.11.4%), and significant rise in satisfaction for nursing (86.4% vs.97.7%) in evidence based nursing group (except for the P of overweight was <0.01, others were P<0.05 all).Conclusion: Evidence based nursing mode can improve unhealthy lifestyle and relieve negative emotional status in aged patients with coronary heart disease, which is worth extending in clinic.

Objective To investigate the significance of heat shock protein 60 (HSP60) and heat shock protein 65 (HSP65) on prognosis acute coronary syndrome (ACS) within one year.Methods Eightynine hospitalized patients were collected from department of Cardiovascular disease,the people's hospital of Wuxi city affiliated of Nanjing Medical University and the Second People's Hospital Wuxi City from November 2009 to February 2011,and divided into ACS group (n =50),stable angina pectoris (SAP) group (n =19) and nonCHD group(n =20).HSP60,HSP65 levels in human serum were measured at the time of admission.The followup records of all patients were established to observe the occurrence of coronary events during one year,and analyzed its relationship between with HSP60,HSP65.Results Eighty-four cases were successful followed-up,and lost cases were 5.Eighteen patients occurred cardiovascular events within one year,and their content of serum HSP60 and HSP65 were significantly higher than that of without cardiovascular events (HSP60:(1026.19 ± 253.47) ng/L vs.(845.75 ± 138.52) ng/L,t =2.49,P ＜ 0.05 ; HSP65:(2573.95 ± 768.75) ng/L vs.(2076.38 ± 385.46) ng/L,t =2.58,P ＜ 0.05).In ACS group,the level of serum HSP60 and HSP65 of the patients occurred cardiovascular events was significant higher than that of without cardiovascular events,and there was significant difference(HSP60:(1162.73 ±249.14) ng/L vs.(892.55 ±204.62) ng/L,t =2.19,P ＜ 0.05 ; HSP65:(2714.39 ± 738.44) ng/L vs.(2136.85 ± 472.62) ng/L,t =2.65,P ＜ 0.05).COX regression analysis showed that HSP65 was an independent risk factor for recent cardiovascular events in patients with ACS (RR =1.002,95％CI 1.000-1.004,P =0.035).Conclusion The detection of HSP60,HSP65 in prognostic coronary artery disease prognosis has important value,and HSP65 was an independent risk predictor of ACS in recent cardiovascular events within one year.

OBJECTIVE:To systematically review the efficacy and safety of reinforcing kidney and invigorating spleen princi-ple in the treatment of primary osteoporosis (POP) in middle and elderly aged patients,and provide evidence-based reference for clinic. METHODS:Retrieved from VIP,Wanfang Database,CJFD,Medline,PubMed,Elsevier,Springer,Web of Science and Ovid,randomized control trials (RCT) about reinforcing kidney and invigorating spleen principle (test group) versus other meth-ods(no reinforcing kidney and invigorating spleen principle,control group)in the treatment of POP were collected. Meta-analysis was performed by using Rev Man 5.3 software provided by Cochrane after data extraction and quality evaluation modified by Jadad scale. RESULTS:Totally 28 RCTs were enrolled,involving 2849 patients. Results of Meta-analysis showed,the total effective rate [OR=3.80,95%CI(2.76,5.23),P<0.001],BGP level [MD=2.23,95%CI(1.80,2.66),P<0.001],BMD level of femoral neck [MD=0.04,95%CI(0.00,0.08),P=0.05] and BMD level of lumbar spine [MD=0.07,95%CI(0.03,0.11),P=0.001] in test group were significantly higher than control group,ALP level [MD=-5.59,95%CI(-10.51,-0.66),P=0.03] and VAS score [MD=-1.38,95%CI(-1.87,-0.89),P<0.001] were significantly lower than control group,with statistical significance. There were no significant differences in U-Ca/Cr [MD=-0.07,95%CI(-0.17,0.02),P=0.12] and serum Ca2+ level [MD=0.16,95%CI (-0.07,0.39),P=0.17] in 2 groups. CONCLUSIONS:Reinforcing kidney and invigorating spleen principle can improve patients' osteogenesis during bone metabolism,reduce the activity of the osteoclastic process and relief patients'pain in the treatment of POP.

Objective To verify the dynamic changes of ANP during the diastolic heart failure and the protective effect of amlodipine. Methods Male SD rats underwent the abdominal aorta ligation. Four weeks after Surgery, 40 rats were divided into 4 groups: hypertension model group (group B), low-dose group (group C), mid-dose group (group D), high-dose group (group E). Another 10 healthy male SD rats were used as sham group (group A). During the experiment, different drugs were gavaged to different groups and the normal saline was used for control group. Results After 12 weeks, ANP levels increased in group B much more than in group A, while lower in group C(P < 0.05); LVSP and dp/dt max decreased in group B significantly than in group A, while higher in group C than in group B (P < 0.05); LVEDP and -dp/dt max had no statistically significant (P >0.05); HW/BW and LW/BW decreased in group B than in group A, while higher in group C than in group B (P < 0.05); The extent of myocardial necrosis and fibrosis in group C were much lower than in group B. But there was no Significant differences (P > 0.05). Conclusion ANP level gradually increased accompanying with the aggravation of heart failure, which is related with the dose of the drug within limits. Amlodipine can inhibit cardiomyocyte remodeling by interfering ANP secretion.

Objective To reveal the role of PDK1 in vascular endothelial cells. Methods PDK1 was knocked out in endothelial cells by recombinase-mediated Cre to observe it′s effects on vascular endothelial cells. Results Abnormality of vascular development in rats could be found as a result of endothelial PDK1 deletion. Meanwhile, vascular leakage and bleeding phenotype were observed, and tissue analysis showed vascular endothelial cells abnormalities. Conclusions PDK1 plays an important role in the functioning and integrity of vascular endothelial cells, which made tentative explanation for PDK1-Akt signal path and laid basis for further research.