Objective To study the association between cytotoxin-associated gene A of Helicobacter pylori (Hp-CagA) and the expressions of mtp53 and c-myc protein in different subtypes of intestinal metaplasia.Methods One hundred and sixty-five patients with gastroscopy included 125 cases with chronic atrophic gastritis with intestinal metaplasia,40 cases with non-atrophic gastritis.Intestinal metaplasia included complete intestinal metaplasia,incompletetype intestinal metaplasia,complete colonic epithelial metaplasia and incomplete colonic epithelial metaplasia.The carbon-14-urea breath test was used to determine Helicobacter pylori (Hp);AB-PAS and HID-AB mucinous staining was used to distinguish intestinal metaplasia subtypes; the immunohistochemical Elivision method was used to determine the expressions ofmtp53 and c-myc protein;indirect ELISA was used to determine Hp-CagA.Results Forty-five cases with incomplete colonic epithelial metaplasia,47 cases with incomplete type intestinal metaplasta,17 cases with complete colonic epithelial metaplasia,16 cases with complete intestinal metaplasia.The positive rate of Hp-CagA in all intestinal metaplasia subtypes was higher than that in non-atrophic gastritis,but there was no significant difference (P ＞ 0.05).The expression of mtp53 protein in incomplete colonic type of intestinal metaplasia with Hp-CagA positive was higher than that in incomplete colonic type of intestinal metaplasia with Hp-CagA negative (x2 =5.494,P ＜ 0.05).The expression of c-myc protein in incomplete colonic type of intestinal metaplasia with Hp-CagA positive was higher than that in incomplete colonic type of intestinal metaplasia with Hp-CagA negative (x2 =13.950,P ＜ 0.01).Conclusion Hp-CagA is a sort of highly virulent strain,and Hp-CagA may do a strong role in the promotion of gastric atrophy and intestinal metaplasia.

Based on the Australian AR-DRGs, this research gathered the diagnosis related information on the first page of medical records and accomplished the computerization of data collection and analysis through the data-base of Shanghai Shenkang Hospital Development Center.According to the clinical practices, the DRGs model has been adjusted to complete the localization and a severity-based-DRGs model and grouping tool have been established for the municipal hospitals in Shanghai.

The performance evaluation is an effective method to guide the public hospitals behavior and pro-mote their sustainable development.The introduction of disease severity could make the performance evaluation sys-tem more scientific and reasonable, and encourage the hospitals to improve their technical skills and services ability. Based on the Shanghai diagnosis related groups system, a case-mix index ( CMI) was introduced and a severity score of disease was developed after the relative weight ( RW) adjustment to evaluate different types of disease severity in hospitals.The results have shown that CMI effectively reflects the patients'disease severity and the intensity of treat-ment in those hospitals taken into consideration.Therefore, the scientific indicators should be selected and the evalu-ation system should be improved thereby establishing an effective monitoring and dynamic adjustment mechanism and further developing the diagnosis related group application.

OBJECTIVETo observe the clinical effect of Guilu Erxian Glue Cataplasm (GEGC) on carcinoma of the large intestine patients with myelosuppression after chemotherapy, and further to confirm its efficiency and safety.

METHODSTotally 60 patients with carcinoma of the large intestine were randomly assigned to two groups. Meanwhile, they all accepted FOLFIRI chemotherapy. Patients in the treatment group were additionally applied at Shenque (RN8), exchanging once per every other day, for 14 successive days. Patients in the control group took placebos with the same dose and dosage as the treatment group. The blood cell counts (WBC, NE, and PLT) were detected before chemotherapy, at day 7, 10, and 14. The TCM symptoms integrals, Karnofsky performance score (KPS), liver and kidney functions were observed before chemotherapy, at day 7 and day 14. Adverse skin reactions were observed each day. And the usage of hematopoietic growth factors was recorded.

RESULTS(1) The KPS score at day 7 was more stable in the treatment group than in the control group; the WBC and NE counts in the peripheral blood at day 14 were higher in the treatment group than in the control group; and TCM symptoms integrals at day 14 was lower in the treatment group than in the control group, all with statistical difference (P < 0.05). (2) Compared with the control group, the PLT count was higher in the treatment group than in the control group, the usage of rhG-CSF and antibiotics was less in the treatment group than in the control group, all with no statistical difference (P > 0.05). (3) No obvious adverse reactions such as liver injury, renal injury, or skin allergy were observed.

CONCLUSIONSAdjuvant treatment of GEGC could improve carcinoma of the large intestine patients with myelosuppression to some extent. No relevant adverse reactions were found.

Adjuvants, Immunologic ; therapeutic use ; Adult ; Aged ; Bone Marrow Diseases ; chemically induced ; drug therapy ; Colorectal Neoplasms ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged

This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.

The public hospital reform is the main content of the new healthcare reform.Studying the diagnosis related group system and establishing a set of scientific and rational performance assessment, which is essential to strengthen the public hospitals'public and social benefits, improve the service capacity and enhance the specialized and delicacy management.The international diagnosis related group system localization and weight settlement have been proved suitable and consistent through the Shanghai Shenkang Hospital Development Centre.Hence, the severity-based DRGs should be introduced to reflect the actual hospitals operation and management outcome, which provides a proper guidance on the hospitals'specialized and delicacy management.

Objective To investigate the early diagnostic value of bronchoalveolar lavage for pulmonary aspergillosis in non-immunocompromised patients. The GM absorbances of recycled bronchoalveolar lavage fluid in different orders were compared, in order to estabilsh a uniform of broncholaveolar lavage in GM test. Methods We mainly focused on the patients (84 cases) confirmed as pulmonary infection by HRCT chest imageological examination from January 2016 to February 2017. They underwent the bronchoalveolar lavage before empirical or pathogenic antifungal therapy. Meanwhile, the lavage was collected in order of the first and the second tube. Then, BALF-GM test was performed. The GM absorbance (A) and I value of bronchoalveolar lavage fluid were detected by ELISA method. The GM test result of the first tube of bronchoalveolar lavage fluid was included into GM1 group and the GM test result of the second tube of bronchoalveolar lavage fluid was included into GM2 group. According to the standards, the patients were divided into case group (proven 2 cases, probable 7 cases, possible 13 cases) and non-IPA group (62 cases). The GM test diagnostic efficiency of bronchoalveolar lavage fluid collected in different orders were statistically analyzed between the case group and control group. Results The GM-I values showed significant difference between GM1 and GM2 groups (Z = -3.98, P = 0.000). the average rank I value of BALF-GM1 (1.78 ± 1.71) was significantly higher than the BALF-GM2. According to the ROC curve, the optimal cut-off of BALF-GM1 was 0.6, the sensitivity was 86.36％, the specificity was 93.55％, the positive predictive value was 82.61％ and the negative predictive value was 95.08％. The area under the curve of BALF- GM1 (0.941) was significantly higher than that of BALF-GM2 (0.798), indicating that the diagnostic efficiency of BALF-GM1 was higher. Conclusion The operation sequence of collecting bronchoalveolar lavage could affect the I value of BALF-GM test. The diagnostic efficiency of BALF-GM test result of the first tube of bronchoalveolar lavage fluid was higher and had the higher application value in the diagnosis of pulmonary aspergillosis.

OBJECTIVETo discuss the correlation of tongue manifestation with the site of cerebral infarction in patients with acute cerebral infarction.

METHODSFrom March 2008 to February 2009, 200 cases of hospitalized patients with first unilateral cerebral infarction were chosen in the Department of Neurology, Xuanwu Hospital. The correlation of different tongue color, fur texture, fur color with the site of cerebral infarction was analyzed.

RESULTSThe site of cerebral infarction in patients were compared between different tongue color by Chisquare test (P=0.314), and further correspondence analysis demonstrated that there was correlation between red tongue and cortical-subcortical infarction group. The site of cerebral infarction in patients were compared between thick fur group and thin fur group, cortical-subcortical infarction occurred more frequently in the former (P=0.0008). The site of cerebral infarction in patients were compared between dry fur group, moist fur group and smooth fur group, correspondence analysis demonstrated there was correlation between dry fur and cortical-subcortical group. The site of cerebral infarction in the patients were compared between white fur group, white-yellow fur group and yellow fur group (P=0.010), and correspondence analysis demonstrated there was correlation between white fur and brainstem infarction; white-yellow fur has relationship with cortical infarction; subcortical infarction was weakly related with white-yellow fur; there was closer relationship between yellow fur and cortical-subcortical infarction.

CONCLUSIONThe change of tongue manifestation was associated with the site of cerebral infarction in patients, providing a new combining site for diagnosing cerebrovascular diseases by integrative medicine.

Aged ; Brain ; pathology ; Color ; Humans ; Middle Aged ; Pilot Projects ; Stroke ; pathology ; Tongue ; pathology

OBJECTIVETo investigate the correlation of tongue manifestation with the fibrinogen level and the neutrophil count in blood of acute cerebral infarction patients.

METHODSA total of 200 patients with first unilateral cerebral infarction in Neurology Department of Xuanwu Hospital from March, 2008 to February, 2009 were recruited in this study. The correlation of the tongue fur color and texture with the blood fibrinogen level and the neutrophil count was analyzed in these patients.

RESULTSThe level of fibrinogen and neutrophil count in thick fur group were significantly higher than that in thin fur group (P<0.05). There was no statistical difference in the level of fibrinogen and neutrophil count found between moist fur and dry fur. Statistical significance existed in the level of fibrinogen between the greasy tongue fur group and non-greasy tongue fur group (P<0.05). The level of fibrinogen and the neutrophil count were compared among different fur color groups, revealing that the level of fibrinogen in yellowish fur group was higher than that of white fur group and normal value with statistical significance (P<0.05) with neutrophil count in yellowish fur group being significantly higher than that in white fur group.

CONCLUSIONOur results suggested that the change of tongue manifestation was associated with the level of fibrinogen and the neutrophil count in the blood of cerebral infarction patients.

Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; metabolism ; physiopathology ; Fibrinogen ; metabolism ; Humans ; Lymphocyte Count ; Neutrophils ; Tongue ; metabolism ; physiopathology

Asphyxia Neonatorum ; blood ; Calcium ; blood ; Humans ; Infant, Newborn ; Parathyroid Hormone ; blood