Cancelling drug price addition is one of public hospital reform content, under the condition of insufficient financial input, public hospitals should enhance the drug cost management, taking measures to reduce drug proportion, to deal with all kinds of hospital operation problems produced by hospital income decline due to the cancellation of drug addition. Through years of exploration and practice, Affiliated Hospital of Jining Medical University has controlled the rising of drug cost effectively and received better effect, which built a good foundation of public hospital reform.

Objective To observe the effect of interferon (IFN) λ1 on the function of peripheral blood mononuclear cell (PBMC) derived dendritic cells (DC) in adolescents with chronic hepatitis B virus (HBV) infection.Methods A total of 34 adolescent patients with chronic HBV infection including 16 cases in immune clearance phase and 18 cases in immune tolerant phase,and 10 healthy youths were enrolled in the study.PBMC from all samples were isolated and then cultured according to the following 3 groups.IFN-λ1 group:cultured with IFN-λ1 only; normal group:cultured with recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) and recombinant human interleukin-4 (rhIL-4); combination group:cultured with IFN-λ1,rhGM-CSF and rhIL-4.The shape of DC was observed and the phenotypic patterns of CD83,CD80,CD86 and human leucocyte antigen (HLA)-DR were characterized by flow cytometry.The levels of interleukin 12 (IL-12) and IFN-γ in the supernatant produced by DC were analyzed with enzyme-linked immunosorbent assay (ELISA).Independent-samples t test was used to compare means between two groups and one-way ANOVA was used to compare means among multiple groups.Results In the IFN-λ1 group,the shape of adherent cells showed no change after 7 days of culture.In the normal group and combination group,typical morphology of mature state DC was observed.The expressions of phenotypic patterns of CD83,CD80,CD86 and HLA-DR in DC from immune tolerant phase patients were lower than those from healthy control youths and immune clearance phase patients (F=14.82-46.32,all P＜0.01).Co-stimuation of IFN-λ1 with rhGM-CSF and rhIL-4 up-regulated the expressions of phenotypic patterns on DC.Among patients both in immune tolerant phase and immune clearance phase,the expressions of CD83,CD80,CD86 and HLA-DR in the combination group were higher than those in normal group (t=3.16-5.69,all P＜0.01).In the normal group,the levels of IL-12 and IFN-γ in culture supernatants from healthy aldolescents were (287.25 ± 19.78) pg/mL and (56.38 ± 15.27)pg/mL,respectively; those from patients in immune tolerant phase were (198.42±22.28) pg/mL and (29.36±8.45) pg/mL,respectively; those from patients in immune clearance phase were (256.12±18.43) pg/mL and (38.38±9.72) pg/mL,respectively (F=69.22 for IL-12,F=20.29 for IFN-γ,both P＜0.01).IFN-λ1 combined with rhGM-CSF and rhIL-4 significantly up-regulated the secretion of IL-12 and IFN-γ by matured DC from patients both in immune tolerant phase and immune clearance phase (t=4.69-8.55,all P＜0.01).Conclusions In adolescent patients with chronic HBV infection,the DC function is markedly impaired in those in immune tolerant phase,compared with patients in immune clearance phase and healthy youths.IFN-λ1 can promote the maturation and phenotypic pattern expression of PBMC derived DC in adolescents with chronic HBV infection both in immune tolerant phase and immune clearance phase.

【Objective】 To investigate the incidence of β-th alassemia (β-thal) heterozygote carrying α-thalassemia (α-thal ) 1 gene in Guangdong area. 【Methods】 β-thal genes were screened by reve rse dot blotting (RDB). In β-thal DNA samples α-thal 1 genes were am plified using gap-PCR method. 【Results】43 α-thal-1 cases were identifi ed among the 500 β-thal traits. The rate is 8.6%. 【Conclusion】 In Guangd ong area the incidence of β-thal heterozygote carrying α-thal-1 gen e is 8.6%, which should be paid much attention in the genetic counselling and pr enatal diagnosis.

Aim To isolate cancer stem cells from human pan-creatic cancer cell line L3. 6pl and to identify their biological characteristics. Methods L3. 6pl cells were cultivated in com-mercial low adhesion plate with serum-free stem cell culture me-dium ( MEM/F12 1:1 ) supplemented with B27. The cancer stem cells reformed into floating spheres were isolated. The method of tumor sphere formation was used to isolate/enrich and characterize the cancer stem cells in pancreatic carcinoma cell line L3. 6pl. Cancer stem cell spheres were collected and sorted using magnetic cell sorting ( magnetic activated cell sorting, MACS) technology, with the cell surface markers of CD24 +CD44 + ESA+. Self-renewal and EMT-related oncogene expres-sion were measured with Western blot. Cancer stem cells differ-entiation potential and the expression of cancer stem cell related signs were checked with Immunofluorescence assay. To deter-mine tumorigenesis in vivo, Xenograft assay in NOD-SCID mice were performed respectively, then immunohistochemistry proto-oncogene c-Met and RON expression were also checked. West-ern blot was used to detect the changes of stemness relative tran-scriptional factors and epithelial markers expressed in spheres before and after differentiation. Drug resistance of pancreatic cancer stem cells to gemcitabine or paclitaxel was measured with MTT assay. Results CD24 + CD44 + ESA+ cells were signifi-cantly tumorigenic, and cultured in serum-free conditions to form spheroids, which had the characteristics of stem cells with self-renewal, EMT and drug-resistant capabilities, and had a posi-tive correlation with the c-Met, RON protein expression. Con-clusion Human pancreatic stem cells are successfully isolated, which provides a useful model for individualized therapy and e-valuation of the therapeutic efficacy for pancreatic cancer pa-tients.

Teaching in the course of anesthesiology for college students not majoring in anesthesiology was reformed and optimized by inducing various approaches such as development of interest,heuristic teaching,multimedia teaching,clinical simulation teaching and anesthesia experience in the First Affiliated Hospital,Sun Yat-sen University.Students' fundamental knowledge of clinical anesthesiology and abilities of clinical thinking and active learning were improved.Based on the summary of teaching practice,teachers should cultivate students' interest in anesthesiology,emphasize interactive teaching and learning and take fundamental knowledge of clinical anesthesiology as main teaching objectives in the clinical practice course of anesthesiology.

Objective To investigate the effects of total glucosides of paeony (TGP) on mice with experimental ulcerative colitis and the underlying mechanisms. Methods Forty-eight mice were equally randomized into 6 groups ( n = 8): normal control group, model group, salicylazosulfapyridine (SASP) group, low-dose TGP group one day after enama, the mice were treated with corresponding agent by oral gavage for3 days. The disease activity index (DAI) score was evaluated every day. After all the mice were scarified, the macroscopic and histological scores were evaluated. The tumor necrosis factor-α (TNF-α) level of the colon mucosa was measured by ELISA and the colonic expression of nuclear factor-κB (NF-κB) p65 was detected by immunohistochemistry. Results Compared with the normal control group, the DAI score was significantly higher in the model group (P ＜0. 01 ),but was similar to that in low-dose TGP group ( P ＞ 0.05 ). Compared with the model group, the DAI score was significantly decreased in SASP group, medium-dose TGP group, and high-dose TGP group (all P ＜ 0. 05). The macroscopic score, histological score, TNF-α level, and expression of NF-κB p65 were significantly higher in model group than in normal control group, SASP group, medium-dose TGP group, and high-dose TGP group ( all P ＜0. 01 ), but was similar to that in low-dose TGP group (P ＞ 0. 05). The efficacy of TGP was higher in high-dose TGP group than in SASP group. Conclusions TGP has certain therapeutic effects on experimental ulcerative colitis,which may be achieved by its inhibitory effect on the activation of NF-κB and the production of TNF-α.

ObjectiveTo investigate the clinical characteristics and epidemic analysis in children with hand foot and mouth disease(HFMD) following acute flaccid paralysis(AFP).Methods30 children with HFMD following AFP in Hunan Province Children's Hospital were surveyed retrospectively.ResultsAll the patients were below 5 years old, 83.34％ were 1～3 years old, 90% from countryside. Besides AFP of limbs, 86.67% complicated with encephalitis. The major clinical characteristics as followed: fever(100.00%), skin rash(100.00%), startle and skip(80.00%), emesis(63.33%), neurogenic pulmonary edema(13.33%) and urinary retention(16.67%). The most palsy occurred in 3～5 days after onset, and the palsy in lower limbs was major, only a few had palsy in upper extremities or tetraplegia. 26 cases were infected with enterovirus type 71(EV 71), 1 case infected other EV, 3 cases were negatively. The EMG showed that the amplitude of active potential lowered in the femoral nervus, tibial nerve, peroneal nerve, axillay nerve and musculocutaneous nerve, or/and the motor conduction velocity slowed down, the damage of proximate nerve was the most common.ConclusionThe most children with HFMD following AFP were infected with EV 71. Encephalitis was the common complication. The symptom of EV 71 was more severious than distribute EV.

Objective To evaluate the efficacy of oxycodone for patient-controlled intravenous analgesia (PCIA) after hip arthroplasty in elderly patients.Methods Sixty patients of both sexes,aged 65-85yr,weighing 42-89 kg,of American Society of Anesthesiologists physical status Ⅰ or]Ⅱ,scheduled for elective unilateral hip arthroplasty under general anesthesia,were divided into 2 groups (n =30 each) using a random number table:morphine group (group M) and oxycodone group (group O).Parecoxib sodium 40 mg was injected intravenously at 30 min before induction of anesthesia,followed by induction and maintenance of anesthesia.PCIA pump was connected at the beginning of skin closure.PCIA solution contained morphine 0.6 mg/kg and tropisetron 10 mg diluted to 100 ml in normal saline in group M and oxycodone 0.6 mg/kg and tropisetron 10 mg diluted to 100 ml in normal saline in group O.The PCA pump was set up with a background infusion at 2 ml/h,a 0.5 ml bolus dose and a 15 min lockout interval in both groups.Visual analogue scale score was maintained ≤ 3,and postoperative analgesia lasted until 48 h after operation.When analogue scale score ≥ 4,pethidine 50 mg/kg was injected muscularly as rescue analgesic.The requirement for rescue analgesic and occurrence of adverse effects were recorded.Results Ten percent patients required rescue analgesics in group M,and no patients required rescue analgesics in group O.Compared with group M,the requirement for rescue analgesics and incidence of nausea,vomiting and pruritus were significantly decreased in group O (P＜0.05).Conclusion Oxycodone provides reliable efficacy for PCIA after hip arthroplasty in elderly patients with fewer adverse effects,indicating that oxycodone produces good analgesic efficacy for severe somatalgia.

Objective To investigate the relationship between various stages of chronic hepatitis B virus (HBV) infection and lipid metabolism and its influencing factors.Methods Seventy-two cases of chronic hepatitis B (CHB),40 cases of liver cirrhosis and 17 cases of hepatocellular carcinoma (HCC) were enrolled.One-way ANOVA analyses were used to compare age,gender,liver function,lipid metabolism,and HBV DNA levels of each group.Pearson correlation analysis was used to study the correlation between HBV DNA and lipid metabolism.Binary Logistic regression analyses were performed to explore the risk factors of cirrhosis and HCC in patients with CHB.Results Differences of age,alanine aminotransferase (ALT),albumin (Alb),triglyceride (TG),and cholesterol(CHO) among the three groups (CHB group,cirrhosis group and HCC group) were statistically significant (all P＜0.05).TG levels in cirrhosis and HCC groups were (-0.061± 0.234)lg mmol/L and (-0.061±0.253) lg mmol/L,respectively,which were both significantly lower than that of the CHB group (0.116±0.182) lg mmol/L (F=11.466,P=0.000).CHO level in cirrhosis group was (0.460±0.333) lg mmol/L,which was lower than that in CHB group (0.586±0.101) lg mmol/L (F=4.892,P=0.009).The HBV DNA levels inversely correlated with TG and CHO levels in CHB group (r=-0.266,P=0.024; r=-0.309,P=0.008,respectively).The HBV DNA levels of cirrhosis and HCC patients positively correlated with ALT levels (r=0.355,P =0.007).Old age (OR=1.096,95％CI:1.025-1.172),low Alb (OR=0.000,95％CI:0.000-0.000),and low levels of ALT (OR=0.128,95％CI:0.026-0.641) were risk factors for development of cirrhosis and HCC in CHB patients (all P＜0.05).Conclusions With the progression of liver injuries,TG and CHO levels are reduced.Further studies of correlation between risk factors for the development of cirrhosis and HCC and lipid metabolism in CHB patients are needed.

Objective To observe the functional changes of T lymphocytes in the spleen of rats with bone cancer pain.Methods forty-one healthy female Sprague-Dawley rats were used in this study, and were divided into blank control, PBS and Walker-256 tumor groups.Bone cancer pain model was established by inoculation of Walker 256 cancer cells into the tibial cavity.The paw withdrawal threshold (PWT), paw withdrawal thermal latency (PWL), and spontaneous pain (SP) were all measured before modelling (as base) and at 4, 6, 8, 10, 12, 14, 16, 18, and 20 days after modelling. The function of T lymphocyte proliferation, and the content of T lymphocytes and their subgroups in the spleen were detected by cell counting kit-8 method and flow cytometry, respectively, on day 20 after modelling.Results Before modellng, there were no differences of PWT, PWL, and SP between the PBS and model groups.After modelling, the PWT and SP of model group were significantly decreased on day 4, and were always lower than that of PBS group during the experiment.Statistical analysis revealed that Walker-256 cancer cell inoculation in the tibia induced a significant decrease in PWL on day 8, 10 and 12 after modellng.Compared with the control group, T lymphocyte proliferation, content of T lymphocyte (CD3) and subgroups ( CD4 and CD8) in the PBS group were not significantly decreased.However, T lymphocyte proliferation and the content of CD3 lymphocytes in the model group were significantly lower than those in the blank control group and/or PBS group.Conclusions The bone cancer pain rat model may appear obvious mechanical allodynia and spontaneous pain.Its thermal pain hyperalgesiaonly occurred in the intermediate stage of bone cancer pain. The content of T lymphocytes and its subgroups, and the function of T lymphocyte proliferation are weakened to some extent in the bone cancer pain rat model.