Objective To understand the present situation of city-level public hospital reform and to analyze the impacts on different clinical departments by analyzing the changes of hospitalization expenses of a third-level grade-A hospital from Anhui Province.Methods The inpatient data from April to September,2014 and 2015 of the third-level grade-A hospital were collected.Three typical diseases in Department of Internal Medicine,Surgery,Gynecology and Pediatrics respectively,were chosen to compare the changes of expenses and the structure before and after the reform.Results Overall,hospitalization expenses saw a declining trend after city-level public hospital reform.But,it was different in each department.The structure of hospitalization expenses became more reasonable after reform,however,the medical material expense remained a question.Conclusion The city-level public hospital reform reduces drug costs and inspection fees for inpatients effectively,thereby abating the overall cost of hospitalization,and the structure of hospitalization expenses becomes more reasonable.But the changes of hospitalization expenses in different departments reflect some problems.

The cholinergic anti-inflammatory pathway (CAP) is an important neuroimmunomodulatory mechanism that innervates the spleen through vagus nerve efferent and splenic nerve relay, and acts on macrophages by transforming adrenergic stimulation into cholinergic signal by spleen T cells, which plays an anti-inflammatory effect, and maintains the balance of inflammatory response. Due to the critical role of the imbalance of pro-inflammatory and anti-inflammatory responses in the physiological process of sepsis, regulating the activity of the CAP has become an important focus in the treatments of sepsis. Based on the understanding of the CAP, vagus nerve stimulation, drug agonists mimicking cholinergic signals, and acupuncture are currently applied in the research and exploration of sepsis treatment. This article summarizes the recent progress and prospects of the CAP mechanism, biological effects, and application in sepsis treatment.

Objective To screen and identify the recombinants from the cDNA library of the adult Paragonimus west-ermani (PwA) for immunodiagnosis and immunoprophylaxis. Methods PwA cDNA library was screened with the PwA antigen immunized rabbit sera(IRS) pre-absorbed by the extract of E. coli XLl-Blue. The recombinants from positive clones were amplified by PCR, sequenced and cut off by KpnI/BarnHI and, then sub-cloned into pRESETB vector. The fusion protein was expressed,analysed by SDS-PAGE and identified by Western blotting with immune rabbit serum against worm antigen of Paragonimus westerrnani. Results The inserted cDNA fragment from the positive clone Pw-2 was about 800 bp, which contained an open reading frame(ORF) encoding Pw pre-procathepsin L belonging to cysteinase family. Expression product of Pw-2 was a fusion protein of 32 kDa, which can be recognized by immune rabbit serum against worm antigen of Paragonimus 晈esterrnani. Conclusion A recombinant plasmid Pw-2 encodes Pw pre-procathepsin L is constructed.

This paper discussed the interference and noise of medical electronic device and their generation, hazard, depression and application, of which some ones are pointed out for the first time.

Objective To probe into the effect of sitagliptin on blood glucose fluctuation of the patients with type 2 diabetes mellitus(T2DM) and poor control by insulin aspart 30.Methods Ninety cases of T2DM and poor control by insulin aspart 30 in affiliated Zhongshan hospital from January 1,2014 to December 31,2014 were selected and randomly divided into three groups:simply continuous subcutaneous insulin injection(CSII),acarbose combined CSII group(CSII + Aca) and sitagliptincombined CSII group (CSII + Sig),30 cases in each group.Three groups received the intensive treatment for 2 weeks,and72-h continuous glucose monitoring was performed on last 3 d.The 24 h mean blood glucose(24 hMBG),largest amplitude of glycemic fluctuation(LAGE),mean amplitude of glycemic excursion(MAGE) within 1 d,postprandial blood glucose spike(PGS),postprandial glucose peak time(△t),postprandial glucose excursion(PPGE) and total T were observed within 24 h.The difference of insulin dose(△ insulin),hypoglycemia incidence,glucose-target rate,blood glucose profiles were compared at the end of treatment.Results After two-week treatment,intraday blood glucose variation indicators(24 hMBG,LAGE and MAGE) and postprandial blood glucose variation indicators (PGS,△t,PPGE and total T) in the CSII+Sig and CSII+-Aca groups were significantly lower than those in the CSII group(P＜ 0.05),while the differences in blood glucose variation indicators between the CSII+Sig group and CSII+-Aca group were not statistical significant(P＞ 0.05).In the comparison after treatment,△ insulin,hypoglycemia incidence and glucose-target rate in the CSI + Sig group were lower(P＜0.05).Conclusion The combined application of short-term CSII and sitagliptin will achieve a better effect than the combination with acarbose,can smoothly and steadily reduces the blood glucose level,relieves the whole day glucose fluctuations,effectively reduces △ insulin,and has lower hypoglycemia occurrence rate.

Objective: This research is conducted to analyze the background, the main practices and the results of the synergistic service of health institutions in Changzhou city, as well as to provide references for promoting the construction of integrated medical and health service system.Methods: This paper uses qualitative interviews and questionnaires to collect information and analyzes the data based on synergetic management theory.Results:Changzhou city has tentatively achieved the synergy of its health institutions by introducing relevant policies, setting up healthcare unions at the municipal level, integrating internal resources among healthcare unions, establishing health information platform and feedback mechanism, etc.Conclusion: The regional synergistic service of health institutions can be effectively promoted by introducing policies at the municipal level, promoting the mutual sharing and communication on information, and integrating internal resources among healthcare unions.But, as there still exist problems such as the distribution of benefits is not perfect, the degree of synergy is not close, etc., thus, the government is suggested to expand the implementation scope of the close-type medical service synergy and further improve the distribution policy of benefits.

Based on SWOT analysis and relevant information about the premarital healthcare services through on-site survey and literature research , this paper systematically analyzed the Strengths , Weaknesses , Opportunities and Threats of “one-stop” premarital healthcare services .It also puts forward some strategic suggestions on premarital healthcare services in China including enhancing communication and cooperation between the related national minis -tries and commissions , building a government-led multi-sectoral coordination mechanism , increasing the resource in-vestment , promoting the premarital health care service and pre-pregnancy physical examination integration , and strengthening publicity and mobilization of “one stop” service for premarital healthcare service policy recommenda-tions to provide a basis for decision-making in the promotion of the policy-related works .

BACKGROUND: To apply mouse anti-human cTnI monoclonal antibody as the drug vector in the treatment and diagnosis of myocardial injury, it is important to degrade the immunity of murine antibody and overcome human anti-mouse reaction. Humanization has been applied as an attempt to resolve this problem.OBJECTIVE: To clone murine anti-cTnI Fab fragment and analyse the nucleotide and deduced amino acid sequences.DESIGN: Single sample study.SETTING: An institute of cardiovascular disease under a medical university-affiliated hospitalMATERIALS: The study was conducted in the Institute of Cardiovascular Diseases, First Affiliated Hospital of Nanjing Medical University from January 2003 to May 2004. The hybridoma cell line JS200202 which secrets the anti-cTnI monoclonal antibody was provided by Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University.METHODS: IgG heavy chain primers and κ light chain primers of amplified mouse were designed. Total RNA was extracted from hybridoma cells which secrete cTnI. Reverse transcription polymerase chain reaction(RT-PCR) was amplified. Cloning and subsequent sequence analysis of the Fab fragment was performed. The deduced amino acid sequence was compared and analysed with previously published sequences.MAIN OUTCOME MEASURES: Heavy chain Fd segment and κ light chain gene sequence and its subgroups.RESULTS: A band of approximate 700 and 800 base pairs were amplified using IgG heavy chain primers and κ light chain primers respectively. Sequence analysis indicated that the deduced amino acid sequences were in consistent with the characterization of the amino acid in the murine IgGl Fab fragment(GenBank accession NO AY484430, AY484431; Protein Bank accession NO AAR83243, AAR83244).CONCLUSION: A complete murine anti-cTnI Fab fragment was obtained in this study, which may provide basis for the production of the chimeric anti-cTnI antibody.

Objective To study the diagnosis and treatment of primary adenosquamous carcinoma (ASC) of liver.Methods The clinical and histopathological data of 2 patients with ASC were analyzed retrospectively.The cases were confirmed by surgery and histopathological examination.Results The tumors were located in the left liver in these 2 patients.Both patients presented with abdominal pain and they underwent surgical resection.On gross pathological examination,the tumors were irregular in shape with unclear boundaries.Microscopically,the tumor cells were arranged in a nesting pattern with a tubular structure,which was an adenosquamous carcinoma structure.One patient survived 4 months after surgery and the other patient died of intrahepatic tumour recurrence 7 months after surgery.Conclusions The diagnosis of primary hepatic ASC relied on histopathological examination.Surgical resection was safe and feasible.

Objective To retrospectively analyze the cardiovascular outcomes of the elderly patients with obstructive sleep apnea syndrome (OSAS) and the influence factors. Methods According to polysomnography examination, 79 OSAS patients and 60 patients without OSAS were selected and divided into 3 groups: elder OSAS group [39 patients older than 65 years, respiratory apnea index (AHI)≥5], non-elder OSAS group (40 patients less than 65 years old, AHI≥5) and elder control group (60 patients older than 65 years, AHK5). All patients were followed up by telephone and clinic consulting. The median follow-up duration was 25 months. All patients received the following studies: (1)Flow-mediated vasodilation (FMD), which was assessed by high-resolution ultrasound technique. (2)The sleep-related breathing events and serum biochemical indexes. (3)The death due to cardiovascular disease (CVD), angina, myocardial infarction and stroke. Results (1) FMD was significantly lower in elder OSAS group than in elder control group (P<0. 01). (2)In elder OSAS group versus elder control group, BMI was significantly higher (P<0. 01), while both lowest pulse oxygen saturation (LSpO_2 ) and mean series pulse oximeter ( MeanSpO_2 ) were significantly lower (P< 0.01 and P<0. 05, respectively). Multiple logistic regression analysis showed that impaired fasting plasma glucose was the primary injury factor for FMD (OR=1. 83, 95% CI:1. 11～3.03), and LSpO_2 was the secondary injury factor (OR = 0.92, 95% CI: 0. 85～1. 00). (3) The incidence of cardiovascular events in the 3 groups: the incidence of cardiovascular events was significantly higher in elder OSAS group than in the other 2 groups (χ~2= 7. 339, P<0. 05). Multiple logistic regression analysis showed that FMD (OR=1. 33, 95% CI:1. 06～1. 66)and hs-CRP (OR = 0.51, 95% CI: 0. 34～0.76) were closely related with prognosis. Conclusions Compared with non-elder OSAS group and elder control group, vascular endothelial function impairment is more serious and the incidence of cardiovascular events is higher in elder OSAS group. So OSAS may influence the prognosis of the patients by injuring the vascular endothelial function.