Objective To evaluate the effect of Beijing' s separation of clinic from pharmacy reform.Methods Use difference-in-difference method based on dataset on patients having Urban Worker Medical Insurance from twelve state-owned hospitals.Results The reform incurs a decrease in the outpatient and inpatient expenditure on medicine per visit (30％ and 21％,respectively),a decline in hospital's pharmaceutical ratio (9 percentages and 4 percentages,respectively); reduces the outpatient and inpatient expenditure per visit (19 ％ and 8 ％,respectively),with a decrease in the out-of-pocket part (23％ and 3％,respectively),and a slight increase in the Medical Insurance's part (2％); raises hospital's turnover (11％),outpatient's visits (22％),and inpatient visits (43％).Conclusion The reform encourages physicians to prescribe more scientifically,and hence reduces patient 's expenditure on medicine and hospital's pharmaceutical ratio; leads to a decrease in patience' s expenditure per visit;raises hospital's turnover; and doesn't cause a significant increase in the expenditure from social medical insurance.

Objective　To explore the efficacy of large dose of magnesium sulfate used to treat patients with brain trauma. 　Methods　According to standards 32 patients were chosen and divided into experimental group and control group at random. Sixteen patients in experimental group received 16 mmol magnesium sulfate intravenously over 15 minutes, followed by 65 mmol over 24 hours; while 16 patients in control group received nothing. Serum NSE, GCS and GOS of all the patients were measured after 3 days, 2 weeks and 6 months, respectively and the data were analyzed statistically. 　Results　The serum NSE, GCS and GOS in experimental group were (24.8±19.2) μg/L, 12.3±3.3 and 3.6±1.4, respectively; while the serum NSE, GCS and GOS in control group were (49.7±23.1) μg/L, 9.8±2.8 and 3.1±1.6, respectively. Between the two groups the serum NSE and GCS were different significantly (P<0.01, P<0.05, respectively) while the GOS was not (P>0.05).　 Conclusions　Large dose of magnesium sulfate is effective to treat patients with brain injury at least within a short term.

Objective To summarize the clinical experiences of diagnosis and treatment of graft versus host disease (GVHD) in patients, who had undergone liver transplantation. Methods The clinical symptoms, diagnosis, treatment and clinical effect of 2 patients with GVHD were analyzed, including the time of occurrence of GVHD after operation, the sequence of clinical symptoms, the methods of administration and the dosage of immunosuppressant, as well as therapeutic measures when the disease was confirmed. Results Both patients developed unidentified high fever, skin rash and gastrointestinal syndromes on the 19th and 20th day, respectively, after orthotopic liver transplantation, and then pancytopenia occurred. There was no obvious signs of liver dysfunction during the period. One of the two patients died of mixed infection and multiple organ failure the 34th day after the transplantation with an increased dosage of glucocorticoid and immunosuppressant. The other patient was highly suspected of having GVHD at the early period and treated with small dose of methylprednisone and immunosuppressant, or completely withheld the immunosuppressant contingent on the condition of the patient. Gamma globulin was used for upholding the immunity, nasal feeding for energy supplementation, and antibiotics, fungicide and antivirotics were administered to the patient. This patient was cured and still alive and healthy. Conclusions Patients with unidentified high fever, skin rash and gastrointestinal symptoms after liver transplantation should be suspected to have GVHD. Decrease the dose or withhold immunosuppressant, symptomatic treatment, supplementation of nutrition, prevention of combined infections, and maintenance of immune function may be the optimal treatment of GVHD.

Objective To summarize the incidence,clinical presentation,diagnosis and treatment strategy of Mycobacterium tuberculosis(TB)infection in liver transplanted recipients.Methods The data of clinical situation,laboratory examination,imaging,diagnosis and management of 3 patients who were infected TB after liver transplantation were retrospectively analyzed.Results The incidence of TB infection after liver transplantation was 1.2 %(3/246).One patient had was pulmonary tuberculosis complicated by pleural tuberculosis,one had pleural tuberculosis complicated with tuberculosis in liver.Both of them had recovered after standard antituberculosis therapy and no relapse up to now.One patient was found to have tuberculous cavity in the lung died of multiple bacterial and fungous infections postoperatively.As clinical presentations of the patients with TB infection were atypical after liver transplantation,it would take about 30d to confirm the final diagnoses after the onset of symptoms.The serologic examination for TB were all negative results in the 3 patients,and the only positive result was of purified protein derivatives(PPD)skin test in one patient.Administration of antituberculous drugs could decrease the plasmic level of immunodepressant,but the level could be kept normal by adjusting the dosage of immunodepressant.In neither of the 3 patients discontinuation of drugs was necessary because of hepatotoxicity of antituberculosis drugs.Anti-TB treatment was effective,safe and feasible.Conclusion The clinical presentation,diagnosis and treatment are specific for patients with TB infection after liver transplantation.Early diagnosis and rational treatment will lead to a better prognosis.

In order to improve the noise ratio and stability of the amplified small-signal in microwave-induced thermoacoustic tomography,an amplifying circuit with wide band and high voltage gain is designed in this paper.The results show that the voltage gain is up to 80dB and the bandwidth is about 7MHz.

Objective To observe the effect of cinobufotalin freeze-dry powder on heart rate ( HR ) and electrocardiogram ( ECG) of SD rats and to provide experimental basis for monitoring its adverse effect on heart in clinical application. Methods The drug was administered into external jugular vein at constant speed throughout the whole experiment;standard-Ⅱ limb lead monitored the HR and ECG, and then the changes in HR and ECG before and after administration of cinobufotalin were compared. Results Thirty minutes after administration of cinobufotalin injection and cinobufotalin freeze-dry powder at middle dose and high dose, HR of the rats was significantly increased as compared with blank control group[(469±40) bpm, (466±29) bpm and (484±40) bpm vs. (411±17) bpm] (P<0. 05), but soon afterwards, it returned to normal. A small number of rats also developed arrhythmia. In addition, administration of cinobufotalin significantly shortened the P-R interval[blank control group: (46. 90±3. 90) ms, cinobufotalin injection administration group: (39. 70± 2. 54) ms;middle dose of cnobufotalin freeze-dry powder administration group: (37. 70±3. 77) ms; high dose of cinobufotalin freeze-dry powder administration group:(39. 30±7. 12) ms] and Q-T interval[blank control group:(61. 29±9. 46) ms;middle dose of cinobufotalin freeze-dry powder administration group: (55. 13±4. 67) ms; high dose of cinobufotalin freeze-dry powder administration group:(51.75±11. 53) ms] (P<0. 05), but QRS and S-T were unchanged (P>0. 05). Conclusion Cinobufotalin freeze-dry powder has some side effects on rat heart and can increase HR, even lead to arrhythmia.

Objective To explore the effect of hepatitis B virus(HBV) on the expression of high sensitive C-reaction protein(hs-CRP) and its clinical implication.Methods mRNA expression of hs-CRP in HepG2 and HepG2.2.15 cells was measured by RT-PCR,serum hs-CRP levels in patients with HBV infection and in healthy individuals were measured by biochemical analyzer Olympus5400,the expression of hs-CRP difference among patients with chronic hepatitis B,liver cirrhosis and hepatocellular carcinoma were analyzed.Results Expression of hs-CRP mRNA was higher in HepG2.2.15 cells than in HepG2 cells,serum hs-CRP levels was much higher in HBV patients as compared to healthy individuals ( P＜0.05 ),hs-CRP was detected at higher levels in patients with liver cirrhosis or hepatocellular carcinoma than those with chronic hepatitis B.Conclusion HBV can upregulated the expression of hs-CRP,which is associated with the disease progression.

Objective:To investigate the risk factors and prognostic effects of intolerance of early enteral nutrition after surgery for gastric cancer.Methods:The clinical data of 75 patients with gastric cancer who were admitted in the Shoukang hospital and received early enteral nutrition after surgery were retrospectively retrived and analyzed.Patients were divided into the tolerance group and the non-tolerance group according to whether the patients developed the symtoms of nausea,vomiting,abdominal pain,distention and diarrhea after early enteral nutrition.Results:51 patients (68％) showed enteral nutrition intolerance after early enteral nutrition postoperatively,whereas 24 (32％) were in the tolerance group.The activity time out of bed on the first postoperative day,the time of initiation of enteral nutrition,and nutrition pump were significantly different between two groups.Logistic analysis revealed that the activitity time and nutrition pump were independent favourable factors.Besides,patients with intolerance had longer time to exhaust and defecation,and postoperative hospital stay.Conclusion:Insufficient postoperative activity time and nonuse of nutrition pump are risk factors of intolerance of early enteral nutrition,which may slow the recovery of patients.

Objective To investigate the efficacy of peritoneal dialysis(PD) in the children with complex congenital heart disease after surgery.Methods 65 children with complex congenital heart disease were divided into group A(33 cases) and group B(32 cases).Group A was given PD when diuretics or urine output was less than 0.5ml per hour,while group B was given PD when urine output was less than 0.5ml per hour after 6h.The survival effect and indicators of PD before and after treatment were observed.Results The effective rate of group A (84.85％ ) was significantly better than group B ( 53.12％ ) ( x2 =5.18,P ＜ 0.05 ).The fatality rate of group A (9.09％ ) was significantly lower than group B ( 18.75％ ) ( x2 =5.32,P ＜ 0.05 ).The renal function was significantly improved.Urine output increased to the normal level,serum potassium,blood urea nitrogen,serum creatinine concentration were effectively controlled,the changes of indicators had significant differences before and after PD (t =5.22,3.46,46,4.89,4.77,all P ＜ 0.05).Conclusion PD was an effective support method for heart,renal insufficiency after the surgery of complex congenital heart disease,and it had good clinical effect for early application.

Objective To explore the effect of hepatitis B virus(HBV) on the expression of apolipoprotein A1 (ApoA1) and its regulatory mechanism.Methods RT-PCR and Western blot were used to measure the expression of ApoA1 in HepG2 and HepG2.2.15 cells,serum ApoA1 and high density lipoprotein cholesterol(HDL-C) levels in patients with HBV infection and in healthy individuals were measured by biochemical analyzer,statistical difference was analyzed by SPSS13.0,HepG2 cells was co-transfected with ApoA1 promoter containing the luciferase gene and HBV infectious clone pHBV1.3,luciferase activity was measured,expression of ApoA1 in HepG2 cells was measured by RT-PCR and Western blot after transfected with pHBV1.3.Results Expression of ApoA1 mRNA and protein was lower in HepG2.2.15 cells than in HepG2 cells,serum ApoA1 and HDL-C levels were much lower in HBV patients as compared to healthy individuals( P＜0.05 ),HBV represses ApoA1 gene promoter activity,ApoA1 mRNA and protein expression in HepG2 cells.Conclusion HBV can inhibit the expression of ApoA1 bothin vivo and in vitro.