Objective To explore the effectiveness of the home-community-hospital network management (HCHNM) on the prevention and treatment of stroke.Methods From June to December 2011,HCHNM was implenented in Qingdao of Shandong Province to prevent and treat stroke patients.According to community residents healthcare records,A total of 80 stroke patients were randomly selected from Badahu and Fushanhou communities (study group) and another 80 patients from Zhongshan Road and Liaoning Road communities (control group).A household questionnaire survey was then conducted among these participants.Chi-square test and t test were used for data analysis.Results The overall effective rate of the study group was 86.25％ (69/80),which was significantly higher than that of the control group (67.5％) (x2=221.807,P＜0.05).The study group also showed largely improved quality of life (total score:t=4.593;physical fitness,family activities,movement,mood,self-care ability,social activities,upper limb function and work ability scores:t values were 7.775,2.244,5.329,3.832,5.463,2.979,5.924 and 3.555,respectively; all P＜0.05),although language,character,thinking and vision abilities had no statistically significant difference from the control group (t values were 0.561,1.466,0.831 and 1.000,respectively; all P＞0.05).The scores of daily activities and life satisfaction of the study group were higher than those of the control group,while per capita medical cost was much lower (t values were 12.998,20.760 and-29.777,respectively; all P＜0.05).Conclusions As an effective,safe and economy therapy model,HCHNM could improve rehabilitation,self-care ability,quality of life,and life satisfaction of community stroke patients.In addition,it greatly mitigates medical burden.

Aim To observe whether the activation of aldehyde dehydrogenase 2 ( ALDH2 ) can protect a-gainst diabetes induced liver injury in rat model, and analyze the role of JNK pathway in the liver protection induced by activation of ALDH2 . Methods All male SD rats were randomly divided into three groups: nor-mal control group ( Con ) , diabetes group ( DM ) and ethanol + diabetes group ( EtOH + DM ) . After 8 weeks, the fasting blood glucose ( FBG) level, glyco-sylated hemoglobin ( HbA1c) level, serum AST and ALT levels were measured. The changes of hepatic pa-thology were observed by hematoxylin and eosin ( HE) staining method. The protein expressions of ALDH2, JNK and p-JNK in liver tissue were measured. Result Compared with control group, in DM group, the lev-els of FBG and HbA1c, serum AST and ALT levels were increased significantly. The structure of liver mor-phology was destroyed, disarranged and unclear, the hepatocyte was swollen, and a large number of inflam-matory cells were infiltrated. ALDH2 protein expres-sion was decreased, while the expressions of JNK, p-JNK and the ratio of p-JNK/JNK were increased. Com-pared with DM group, in EtOH+DM group, the levels of FBG and HbA1c, serum AST and ALT levels were decreased. The expression of ALDH2 protein was in-creased, accompanying with the decrease of JNK, p-JNK protein expressions and the ratio of p-JNK/JNK. Conclusion Activation of ALDH2 can protect the liv-er against diabetes induced liver damage in rat model, which may be relevant with inhibiting the JNK path-way.

Based on the urban residents' basic medical insurance system in Qingdao,with hospitals,community aging care institutions and families as the carriers,Qingdao city explored and implemented the long-term medical care insurance system(LTMCI),and established mechanisms for fundraising,payment,handling,service and supervision.The city also designed a scientific application and reimbursement process.Three service modes are designed and put into practice as follows:Long-term care in designated nursing homes or pension institutions; Medical care at designated hospitals; and home health care.These services are charged by quota-lump per bed per day,with the reimbursement ratio of 96％,90％ and 96％ respectively.A practice over a year proved the LTMCI as effectively alleviating disease burden of patients,and guiding long-term care to serve communities.This way a new type of medical care system comes into being,with medicine-care-recovery-endowment for disabled population.

A systematic summary of the concept and operational mechanism of the intensive disciplines management in a hospitals group,and that of the intensive disciplines management for hospitals groups,as well as a comparison of the differences found in department service capacity,service quality,discipline development and patient satisfaction before and after the intensive discipline management is in place.The practice proved that the departments practicing intensive management have witnessed significant rise in outpatient headcount,hospitalization headcount and surgical operation headcount.Their weight in the group is also higher.For example,their curative rate and rescue success rate of dubious and acute diseases higher than before (P＜ 0.05).The Group has 8 provincial key medicine-specialties,including 5 intensive management departments.It has 8 provincial key clinicaldisciplines,including 2 intensive management departments.The overall patient satisfaction for service of such departments is 92.1％,the satisfaction for convenience is 84.4％,that for service quality 90.0％,that for service attitude 92.5％,and that for medical service experience is 89.5％.All of which are significantly higher than that those on their admission to the hospital.The intensive management has enabled unified management of internal medicine and surgery of the same profession in the campus,integrated workforces of both internal medicine and surgery department along with those of medical technicians.In addition,it has enhanced departmental service capacity and quality,discipline competence,as well as outpatients' convenience,patients' satisfaction and medical experience.

OBJECTIVETo compare the efficacy and safety of recombinant human interferon α-2b (INFα-2b) monotherapy and combined therapy with entecavir (ETV) plus adefovir dipivoxil (ADV) in chronic hepatitis B patients with poor response to combined therapy with lamivudine and ADV.

METHODSA total of 161 patients with chronic hepatitis B refractory to to combined therapy with lamivudine (LAM) and ADV were randomized to receive INFα-2b monotherapy (5×10(6), three times a week) (group A) or combined therapy with entecavir (0.5 mg/day) plus adefovir (10 mg/day) (group B). Serum levels of HBsAg, HBeAg and HBV viral load were analyzed at 48 weeks using chemiluminescence assay and by real-time PCR as appropriate. The drug resistance genes in HBV was tested by direct DNA sequencing.

RESULTSAt 48 weeks of treatment, HBV DNA decreased significantly in groups A and B to 2.06∓1.15log10 copies/ml and 1.77∓1.28log10 copies/ml, respectively. The rates of viral response, serological response, and biochemical response in groups A and B were 48.15% (39/81) vs 53.75% (43/80), 61.70% (50/81) vs 53.75% (43/80), and 49.38% (40/81) vs 60.00% (48/80), showing no significant differences between the two groups (P>0.05). The drug resistance gene mutation rate was significanty higher in group B (64.86%, 24/37) than in group A (30.95%, 13/42, P<0.05).

CONCLUSIONChronic hepatitis B patients refractory to lamivudine combined with ADV have a good response to INFα-2b monotherapy and combined therapy with entecavir and ADV , and interferon treatment is preferred to reduce potential drug resistance gene mutations.

Adenine ; analogs & derivatives ; therapeutic use ; Antiviral Agents ; therapeutic use ; Drug Resistance, Viral ; Drug Therapy, Combination ; Guanine ; analogs & derivatives ; therapeutic use ; Hepatitis B virus ; drug effects ; Hepatitis B, Chronic ; drug therapy ; Humans ; Interferon-alpha ; therapeutic use ; Lamivudine ; Mutation ; Organophosphonates ; therapeutic use ; Real-Time Polymerase Chain Reaction ; Recombinant Proteins ; therapeutic use

Objective:To explore the effect of combining repetitive transcranial magnetic stimulation (rTMS) with constraint-induced movement therapy (CIMT) in rehabilitating the upper limb functioning of children with hemiplegic cerebral palsy.Methods:Sixty children with hemiplegic cerebral palsy were recruited and randomly divided into a control group ( n=30) and an experimental group ( n=30). Both groups were given conventional rehabilitation therapy and intensive one-to-one CIMT of the affected hand for 30 minutes 5 times a week for 4 successive weeks. The healthy hand was immobilized in a hand cushion for 3 hours. The experimental group was additionally provided with 20 minutes of rTMS at 1.0Hz, 5 times a week for the same 4 weeks. Before and after the treatment, both groups were evaluated using the Peabody Developmental Motor Scales (PDMS-2 FM) and an upper extremities function test (UEFT). Results:After 4 weeks of treatment there was significant improvement in both groups with regard to the average PDMS-2 FM and UEFT scores. The improvement in the experimental group was significantly better.Conclusions:rTMS combined with CIMT can effectively improve upper limb motor function and promote the fine motor development of children with hemiplegic cerebral palsy.

Objective:To compare the differences of short and long-term outcomes between laparoscopic surgery and open surgery treatment of intrahepatic cholangiocarcinoma patients.Methods:A retrospective cohort study was conducted to collect the clinical data of 118 patients with intrahepatic cholangiocarcinoma who underwent surgery in Qilu Hospital of Shandong University from January 2015 to June 2020. They were divided into laparoscopy group and open group according to the operation methods. The perioperative data, such as intraoperative surgical conditions, hospital costs, postoperative complications, postoperative blood biochemical tests, and the follow-up data of the two groups were compared.Results:In the laparoscopic group, there were 40 patients, 18 males and 22 females, aged (61.5±9.1) years. There were 78 patients in the open group, 48 males and 30 females, aged (61.2±8.3) years. The tumor size of the laparoscopic group was (4.4±1.8) cm, which was smaller than that of the open group (6.0±3.3) cm, and the differences were statistically significant ( P<0.05). In the laparoscopic group, 4 cases (10%) were converted to open surgery. The intraoperative blood loss, intraoperative blood transfusion proportion, 3 or more liver segments resection proportion and hospital costs of laparoscopic group were lower than those of open group [200.0(100.0, 261.8) ml vs. 300.0(100.0, 400.0) ml, 5.0%(2/40) vs. 26.9%(21/78), 37.5%(15/40) vs. 66.7%(52/78), (6.2±2.0) wan yuan vs. (7.2±2.3) wan yuan], the differences were statistically significant (all P<0.05). There were no significant differences in the incidence of postoperative complications between the two groups ( P>0.05). On the first post-operative day, ALT serum level and the third post-operative day TBil serum level in the laparoscopic group were lower than those in the open group [188.5(130.5, 274.0) U/L vs. 320.0(144.0, 427.0) U/L, 26.4(18.3, 26.4) μmol/L vs. 31.6(18.8, 37.5) μmol/l], the differences were statistically significant ( P<0.05). There were no significant differences in 1-year and 2-year overall survival rate and disease-free survival rate between the two groups ( P>0.05). Conclusion:Compared with open surgery, laparoscopic surgery in the treatment of intrahepatic cholangiocarcinoma has better short-term outcomes, and can achieve similar results in medium- or long-term outcomes.