Objective To explore the correlation between simple thyroid peroxidase antibody (TPOAb) positive (higher than the normal reference value) and the adverse pregnancy outcomes;and to discuss the necessity of clinical intervention on TPOAb positive and the characteristic of gestational thyroid peroxidase antibody changes.To study wether clinical intervention affects its direction.Methods Subjects were selected from TPOAb positive pregnant women during June 2012 to February 2015.They were registered regularly for thyroid function during pregnancy and 6 weeks postpartum,and timely treated for abnormal thyroid function.They were grouped according to the thyroid function:Group 1 (n =122),simple TPOAb positive group;Group 2 (n =67),patients with elevated TSH and positive TPOAb who accept the levothyroxine (L-T4) intervention;Group 3 (n =120),TPOAb negative healthy pregnant women.They were regularly tested for thyroid function during pregnancy,and with follow-up until 6 weeks postpartum.Results When Group 1 compared with Group 3:the risk of premature rupture of membranes,abnormal amniotic fluid,and fetal distress rate increased,the relative risk (RR) were 3.066,4.782,2.605,all P ＜0.01,while the gestational diabetes,gestational hypertension,preterm birth,abnormal gestation and birth showed no statistical differences (P＞0.05).When Group 2 compared with Group 3,the risk of premature rupture of membranes,abnormal amniotic fluid,and fetal distress increased (RR were 3.830,5.537,3.600 respectively,all P ＜ 0.01).While gestational diabetes,gestational hypertension,preterm birth,abnormal gestation and birth did not show any statistical difference (P＞0.05).Compared with Group 2,Group 1 had no statistical difference between the above observational parameters.The levels of TPOAb from stage T1 (the first trimester) to T3(the third trimester) showed a overall downward trend in Group 1 and Group 2,rise again six weeks after child birth.Comparison of the two groups (Group 1 and Group 2),the median value during this period did not reveal any significantly statistical differences (P＞ 0.05).Conclusion In simple TPOAb positive pregnant women,premature rupture of membranes,abnormality in amniotic fluid,and fetal distress were significantly higher than those in healthy pregnant women;even with thyroid function correction the TPOAb positive pregnant women still cannot reduce the adverse pregnancy outcomes.Levels of TPOAb from T1 to T3 presented the overall downward trend and to rise again six weeks after pregnancy.L-T4 intervention for TPOAb positive pregnancy did not show any significant effect.

Objective To analyse the therapeutic effect of methylprednisolone combined with anterior decompression and internal fixation in the treatment of cervical spine hyperextension injury. Methods 42 patients who were diagnosed with cervical hyperextension injury in orthopaedics department of the First Hospital of Jiaxing were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.Patients in control group received anterior cervical decompression and internal fixation only , patients in experimental group received methylprednisolone combined with anterior decompression and internal fixation, after treatment, the serum levels of TNF-α, SOD and American Spinal Injury Association (ASIA) score were detected in all patients.Results After treatment, compared with control group, the serum levels of TNF-αwas lower, SOD was higher and ASIA score was higher in experimental group, and the differences were statistically significant (P<0.05).Conclusion The methylprednisolone combined with anterior decompression and internal fixation could significantly reduce the serum level of TNF-α, and increase the serum level of SOD and ASIA score in patients with cervical spine hyperextension injury, could reduce the inflammatory damage, improve the antioxidant capacity, which has a good clinical effect.

Discussed in the paper are case-based payment practice in China,and outcomes of this practice for the past ten years.The authors pointed out that compared with DRGs,such a practice is exposed to such risks as low coverage of diseases,incompatible policies,defective pricing method,and lack of comprehensive evaluation.It indicates that China is on the initial stage of case-based payment reform which should be promoted with reference to international experiences.

AIM To study the direct effect of amiloride on recombinant human protein kinase CK2 holoenzyme and its kinetics. METHODS Recombinant human protein kinase CK2 ? and ? subunits were cloned,expressed and purified by gene engineering. The two subunits were mixed at the same molar ratio to form CK2 holoenzyme,which displayed the maximum biological activity. CK2 activity was assayed by detecting incorporation of 32 P of [? 32 P]GTP into the substrate in various conditions. RESULTS Amiloride inhibited the holoenzyme activity of recombinant human protein kinase CK2 with an IC 50 of 257 57 ?mol?L -1 . Kinetic studies of amiloride on recombinant human CK2 showed that the inhibition was competitive with GTP with the K i of 236 30 ?mol?L -1 ,and noncompetitive with casein with the K i of 163 63 ?mol?L -1 . CONCLUSION Amiloride inhibits the activity of cAMP or ATP dependent enzymes as well as the kinase with GTP as phosphate donor,and the recombinant human protein kinase CK2 may be used as a molecular target for simple screening and development of effective inhibitors of CK2.

Objective To evaluate the graduation clinical skill examination based on objective structured clinical examination(OSCE) for college nursing undergraduates.Methods Classic OSCE was simplified and taken as references for nursing undergraduate graduation clinical skill examination including nursing evaluation,nursing dignosis,nursing intervention and health education for stations.Self-made questionnaire was conducted among students.Examination scores and the questionnaire results were statistically analyzed by SPSS 16.0 software.Measurement data and categorical data were shown as ((x)±s) and ％ respectively.T test was used in comparison between the groups according to the inspection level of α =0.05,P ＜ 0.05 means significant difference.Results Simplified OSCE was composed of 4 stations and the mean score was (80.38 ± 4.22) with mean scoring rate of the 4 stations varied from 72.2％ to 88.0％.More than 93％ students thought that OSCE score can or basically can evaluate comprehensive clinical nursing competence,clinical thinking,communicating and adaptability.Conclusions Simplified OSCE is designed properly for the objective evaluation of nursing students' clinical competence and students are mostly satisfied with its design and organization,quality and efficiency.

Based on a definition of the concept and its connotation,and summary of the evolution and practice of global budget in China,this paper focused on analyzing the existing problems,namely a defective mechanism in the determination and adj ustment of the total budget,unreasonable settlement, absence of a regulatory mechanism and poor linkage of this system with other payment modes reform.Thus the authors proposed such policy recommendations as designated management of those covered by health insurance,and experiments with the global budget mode for regional groups,scientific estimation and adj ustment of the total budget,reasonable setting of settlement standards and rules,and enhanced supervision and appraisal,as well as various payment system reforms based on global budget.

Objective To study the value of serum procalcitonin(PCT) to the early diagnosis of sepsis .Methods From June 2014 to June 2015 ,a total of 686 cases were enrolled in this retrospective study .PCT tests were assayed within 2 days of bacterial culture .Results In this study ,56 cases ,67cases ,and 567cases were classified into the positive blood culture group ,positive body fluid culture group ,and negative all culture group ,respectively .Median PCT values were 4 .26 2 .78 ,0 .46 ng/mL ,respectively .Me-dian PCT values in the gram-positive bacterial culture group and gram-negative bacterial culture group ,respectively ,were 2 .35 and 4 .56 ng/mL .Median PCT values in the positive hydrothorax culture group ,positive ascites culture group ,and positive bile culture group ,respectively ,were 1 .91 ,5 .23 ,3 .64 ng/mL .In all ,Median PCT values of 47 cases of sepsis and 16 cases of severe sepsis were 5 .32 and 10 .25 ng/mL ,respectively .Conclusion PCT level is correlated with the severity of sepsis ,pathogenic bacteria type ,and the site of infection ,and can be used in the early diagnosis of sepsis .

Objective To find out the satisfaction changes among young medical workers and explore the influence of the healthcare reform on such people.Methods A survey was conducted by means of random sampling among 716 medical workers under 45 years old from 6 hospitals,and combined with the survey data in 2009,young medical workers′satisfaction changes and the influencing factors were analyzed.Results Young medical workers′satisfaction is generally low,with declining satisfaction of social respect as well;satisfaction of medical workers in community medical institutions and secondary medical institutions was found declining dramatically.Conclusions Healthcare reform should pay more attention to these young people in terms of their own satisfaction,especially for those working at primary healthcare institutions.

Based on summarizing the international experiences and reviewing the historical evolution and current situation of the physicians'compensation system of public hospitals in China,this paper clarified the existing problems of the current compensation system.Such problems namely included lack of security on the source of the physicians'compensation,low level of sunshine salary which caused thecompensatory mechanism,lack of scientific design of the salary structure and allocation,as well as other underlying causes.Drawing lessons from reform practices at home and abroad,the basic principles and reform directions were put forward,as well as 4 route selections,namely establishing an security investment system to guarantee a stable and higher level salary under the current compensation system, implementing a high level of flip-type annual compensation with locking the current salary into files, establishing an appropriate compensation system referring to an innovated evaluation system of physicians in public hospitals,and coordinating closely with public institution reforms to promote physicians' compensation system reform.

Following an analysis of the problems and challenges of hospitals regulation in China and a comparative study of situations at home and abroad,this paper presented six policy proposals for the reform of public hospitals regulatory system in China.The policy suggestions included definite regulatory objectives,defined relationship between public hospitals and government,strengthening both economic regulation and social regulation, establishing multivariate regulatory system, introducing flexible regulatory methods and full utilization of the third-party impact,which met the requirements of public hospital in healthcare reform in China and propelled the reform forward.