Objectives: To investigate the role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis.Methods: From February 2014 to November 2014,pus specimens of 49 osteoarticular tuberculosis patients and 32 nontuberculosis patients were detected by Xpert MTB/RIF system,and the sensitivity,specificity,positive predictive value,negative predictive value,agreement rate of Xpert MTB/RIF system were calculated,and clinical diagnosis was used as the reference standard.All the pus specimens were detected by acid-fast stain and fast culturing(BACTECT MGIT 960),to find the difference of sensitivity and specificity among Xpert MTB/RIF,acid-fast stain,and fast culturing.The role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis was evaluated through the two factors above.Results: It took 2.3±0.2h to detect each pus specimen by Xpert MTB/RIF.Among the 49 osteoarticular disease patients,46 were positive,3 were negative by Xpert MTB/RIF test.Among the 32 nontuberculosis patients,1 was positive,31 were negative by Xpert MTB/RIF test.The sensitivity,specificity,positive predictive value,negative predictive value,agreement rate was 93.87%,96.87%,97.87%,91.17%,95.06% respectively for Xpert MTB/RIF assay.Among the 46 specimens which were positive by Xpert MTB/RIF test,10 had rifampicin resistance mutation,with the rate of rifampicin resistance mutation as 21.73%.Among the 49 osteoarticular disease patients,8 were positive,41 were negative by acid-fast stain test,the sensitivity was 17.39%,and based on fast culturing test,11 were positive,38 were negative,the sensitivity was 23.91%.All pus specimens of 32 nontuberculosis patients were negative by acid-fast stain test and fast culturing test.As for the sensitivity,Xpert MTB/RIF was superior to acid-fast stain and fast cultureing (P＜0.05).While as for the specificity,there was no statistical difference among Xpert MTB/RIF,acid-fast stain,or fast culturing (P＞0.05).Conclusions: The role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis is perfect.It is of time saving,high sensitivity and high specificity,which is superior to the traditional methods.

It is a well-recognized difficult empirical task to disentangle the moral hazard effect from adverse selection impact by using the health insurance data in the empirical research of health economics. In the research, the unique social experiment in China’s health care reform, which enables cleanly identify moral hazard is applied. Using individual-level hospital patient data, it estimates the impact of the reimbursement rate increase on Chinese patients’ demand for health care service. Difference-in-Difference Propensity Score Matching approach and find strong evidence for moral hazard are approached. For instance: if the reimbursement rate increases by 5% while other factors remain the same, the corresponding health care service expenditure will increase by around 7%. The finding also has important implication for policy making. Chinese government pledges to lower the average individual out-of-pocket cost from the current 37.5% of total health care service cost to 30 % in 5 years. According to the former estimation, if the goal of the policy is successfully achieved, moral hazard problem itself will cost Chinese health care system around 200 billion yuan.

BACKGROUND: The therapeutic effects of acupuncture on weight loss have been verified. How does the central neural system act on weight loss with acupuncture?What relationships are there between the central regulation and peripheral action?OBJECTIVE: To study the effect of acupuncture on feeding center of hypothalamus in obese cases.DESIGN: Randomized and controlled study in which the experimental animals were taken as the subjects.SETTING: Clinical medical college of a university of traditional chinese medicine.MATERIALS: The experiment was performed in Key Laboratory of Acupuncture and Moxibustion in Nanjing University of Traditional Chinese Medicine from June 1998 to January 2000. Fifty SD male rats were employed and randomized into acupuncture group, obese group and normal group.METHODS: The experimental obese model was prepared by feeding SD rats with high-fat forage. Microelectrode record of nerve cell and cerebral stereotaxic technique were applied, by the treatment with acupuncture on experimental obese rats, the electric activity (Hz) of nerve cell was observed at unit time in hunger center of lateral hypothalamus area(LHA) and satiety center of ventral medium nucleus of hypothalamus(VMH).MAIN OUTCOME MEASURES: Mass changes at the same stage before and after acupuncture in rats of every group and discharge frequency in LHA and VMH in rats of every group.RESULTS: Acupuncture reduced remarkably the excitability in LHA, the values of which in acupuncture, obese and normal groups were(9.4 ± 3.7),(21.4 ± 6. 8), (9. 1 ± 5.2) Hz respectively( P < 0. 01 ); improved electric activity frequency in VMH, the values of which in 3 groups were (21.1 ± 4. 3), (5.0 ± 1.3), ( 14. 5 ± 2. 2)Hz, respectively( P < 0.01 ), inhibited excessive appetite of obese rats and reduced calorie intake so as to achieve weight loss.CONCLUSION: The regulation of acupuncture on central neural nuclei in obese animals is one of the important mechanisms on weight loss.

Objective To investigate the optimum concentration and dose of ropivacaine for caudal block in the neonates undergoing laparotomy under general anesthesia.Methods One hundred pediatric patients of both sexes,aged 9-30 days,weighing 2.5-4.5 kg,scheduled for elective pyloromyotomy,were randomly divided into 5 groups (n =20 each) using a random number table:control group (group C),0.10％ ropivacaine 1.0 ml/kg group (group 0.1％ L1),0.15 ％ ropivacaine 1.0 ml/kg group (group 0.15 ％ L1),0.10 ％ ropivacaine 1.2 ml/kg group (group 0.10 ％ L2),and 0.15 ％ ropivacaine 1.2 ml/kg group (group 0.15 ％ L2).Anesthesia was induced with sevoflurane and cisatracurium.The pediatric patients were tracheally intubated and mechanically ventilated.Remifentanil was infused intravenously at 0.2-0.3 μg· kg-1 · min-1 in group C.In 0.10 ％ L1,0.15 ％ L1,0.10 ％ L2 and 0.15％L2 groups,the corresponding concentrations and doses of ropivacaine were injected into the sacral canal under the guidance of ultrasound.The operation was started at 15 min after administration and sevoflurane was inhaled and the end-tidal concentration of sevoflurane was maintained at 0.8-1.0 MAC.Before induction (T1),at pyloric muscle retraction (T2),and at 4,8,12 and 24 h after operation (T3-6),blood samples were collected from the central vein for determination of plasma concentrations of cortisol and interleukin-6 (IL-6).Pain was assessed using CRIES score at T3-6.When CRIES scores ＞ 3,10％ chloral hydrate 0.5 ml/kg was given by retention enema for analgesia,and the requirement for chloral hydrate was recorded.The emergence time,extubation time,duration of stay in post-anesthesia care unit (PACU) and hospital discharge time were recorded.Bradycardia and hypotension during operation,and development of motor block of lower extremities,infection and dehiscence of incision,vomiting,and urinary retention after operation were also recorded.Results Compared with group C,no significant changes were found in the emergence time,extubation time,duration of stay in PACU,hospital discharge time,plasma concentrations of cortisol and IL-6,the requirement for chloral hydrate,and the incidence of bradycardia,hypotension,motor block of lower extremities,and infection and dehiscence of incision in 0.10％ L1 and 0.15 ％ L1 groups,the emergence time,extubation time,duration of stay in PACU,hospital discharge time were significantly shortened,and the plasma concentrations of cortisol and IL-6,requirement for chloral hydrate,and the incidence of hypotension and infection of incision were decreased in 0.10％ L2 and 0.15％ L2 groups,and the incidence of vomiting and urinary retention was increased in 0.15％ L1 and 0.15％ L2 groups.Compared with group 0.10％ L2,the incidence of vomiting and urinary retention was significantly decreased,and no significant changes were found in the other parameters mentioned above in 0.15％ L2 group.Conclusion The optimum concentration and dose of ropivacaine are 0.10％ and 1.2 ml/kg,respectively,for caudal block in the neonates undergoing laparotomy under general anesthesia.

It is always an important academic and policy issue to understand the impact of hospital distance on Chinese inpatient service demand in rural areas. It employs household survey data collected from 97 villages in Shandong in 2006 and 2008, and investigates the influences of hospital distance on the demand of famars in rural areas. The discrete choice model is constructed to estimate the inpatient service demand function for patients in rural areas. The empirical analysis finds that the hospital distance is significantly affecting Chinese inpatient service demand in the rural areas. The longer the distance increases, the lower the visiting rate drops. In addition, the impact changes with the changes of hospital level; the lower the primary hospital is, the higher the impact would be. It paper provides new evidence for the understanding of the geographical characteristics of medical health care.

Objective To evaluate the impact of influenza virus hemagglutitin (HA) 306-318 peptide on T cell activation and to investigate the inhibitory effect of the altered HA306-318 peptide on T cell proliferation. Methods HA306-318 peptide and its mutant containing amino acid substitutions were synthesized. They were used in T cell activation assay using HLA-DR1 transfected cells. Responses were determined by MTT proliferation assays. The HA mutant without stimulating effect on T cells was then examined by inhibiting HLA-DR1-restricted T cell activation. Results It was demonstrated in this study that the altered HA306-318 peptide bound to HLA-DR1 molecule on L57.23 cells transfected with HLA-DR1 cDNA, but not on the control cells. The altered HA306-318 peptide had no stimulating effect on T cells compared with the wild type HA306-318 which induced T cell proliferation. It was shown that the altered HA peptide inhibited T cell activation mediated by wild type HA306-318 as well as by CⅡ263-272 which was the specific T cell antigen. Conclusions This study suggests that HA306-318 peptide is antigenic and can induce responses in HLA-DR1 specific T cells. Altered HA306-318 peptide is hyporesponsive in T cell activation with inhibitory effect on antigen-driven T cell responses, and it is potentially a therapeutic agent in rheumatoid arthritis.

Objective To consecutively investigate the quality of auto-antibody testing of the whole country and to improve quality.Methods A nation-wide investigation was carried out and hospitals or departments participating were notified by letter or telephone communication.Autoantibodies tested for quality control survey included anti-nuclear antibody (anti-ANA),anti-double-stranded DNA (anti-dsDNA)antibody,anti-extractable nuclear antigens (anti-ENA) antibody,anti-mitochondria antibody (AMA),anti-smooth muscle antibody (ASMA) and anti-citrulline antibody (anti-CCP).There were 15 samples in total for testing,including 3 control samples for each test.Same sample was used for both AMA and ASMA test.Sample distribution and data analysis were carried out double-blindly.A total of 114 hospitals or departments participated in the survey.Multiple testing methods were adopted including indirect immumo-fluo-rescence (IIF),immuno-blot (IB),dot-blot (DB),double immuno-diffusion (DID),enzyme linked immuno-sorbent assay (ELISA),chemiluminescent assay,dot-immunogold filtration assay.Results The accurate rates for this survey were 98％,96.6％,89.5％,98.1％,92.1％,96.4％ respectively for ANA,anti-dsDNA,anti-ENA,AMA,ASMA and anti-CCP.Anti-ENAs were further divided into anti-RNP,anti-Sm,anti-SSA,anti-SSB and anti-Scl-70 subgroups,and the accurate rates were 88.4％,96.8％,100％,100％ and 95.8％,respectively.Titers of ANA varied greatly among different labs,so did quantitative analysis of anti-CCP,AMA and antidsDNA by ELISA.However,the accuracy of ANA types determined by IIF was greatly improved.Detection rate of AMA and AMSAwas still low.Conclusion Among detected antibodies,ANA,anti-dsDNA and antiCCP are the most prominently improved.Accurate rate of anti-ENA antibody is slightly increased.

Objective To investigate the current national situation of autoantibody test in order to improve the quality of autoantibodies test.Methods Hospitals or departments in the whole country participated voluntarily or on invitation.Fifteen samples in total were distributed double-blindly,and autoantibodies including anti-nuclear antibody (ANA),anti-double-stranded DNA (anti-dsDNA) antibody,anti-extractable nuclear antigens (anti-ENA),anti-citrulline antibody (anti-CCP),anti-mitochondria antibody (AMA) and anti-smooth muscle antibody (ASMA) were tested in 6 samples.The samples were used for AMA and ASMA tests.Results A total of 148 hospitals or departments participated and multiple testing methods were adopted.The accurate rate of ANA(97.3％),AMA (96.1％),ASMA (92.1％) and anti-CCP (97.4％) were higher than that of anti-dsDNA (81.9％) and anti-ENA (77.2％).Anti-RNP and anti-Scl70 in anti-ENAs had the lower accurate rate,90.9％ and 80.3％ respectively.Taking data of the past 10 years together,the accuracy of antiSSA,anti-SSB,anti-Sm had been stable since 2009,while that of anti-RNP and anti-Scl70 decreased slightly.For methodology,indirect immunofluorescence was mainly adopted in the testing of ANA,anti-dsDNA,AMA and ASMA,immunoblotting was mainly adopted in anti-ENA detection and enzyme linked immunosorbent serologic assay was used for anti-CCP test.Conclusion No major variation of primary testing method is found in recent 10 years.Although diverged greatly among different methods,the accuracy of antibody detection has improved year by year.

Objective To investigate and analyze the behavior and therapeutic status of rheumatoid arthritis (RA) patients. Methods Out patients diagnosed with rheumatoid arthritis in our hospital from May to August 2007 were enrolled. The data including sex, age of onset, site of first hospitalization and medication status were collected and analyzed. Results In this 181 RA patients, the mean age of onset was (53±11) year-old, mean history duration was (10±8) years, the ratio of male to female was 1:4.2. The orthopedics department was the most common site of first hospital visit (32.0%, 58/181) and rheumatology department was the most common site to clarify the diagnosis (62.4% ,113/181). The diagnosis delay caused by patients themselves was (5.9±17.2) months and the delay caused by doctors was (9.0±22.0) months. More than half of the patients were not treated appropriately before they came to our hospital. Methotrexate was the most commonly used DMARDs (67.3%), followed by leflunomide (46.4%), sulfasalazine (37.5%) and hydroxyehloroquine (19.6%). Conclusion In this cohort, the proportion of patients who come to rheumatology department immediately after disease onset is low. There is delay between symptoms and final diagnosis. More than half of the patients are not treated appropriately.

Objective To evaluate the relationship between damages of visual field and retinal nerve fibre layer(RNFL)thickness in primary open angle glaucoma(POAG)with high myopia.Design Retrospective,case-controlled study.Participants POAG group with high myopia(21 eyes of 17 cases),POAG group with non-high myopia(17 eyes of 16 cases),high myopia group without POAG(25 eyes of 20 cases)and normal control group(19 eyes of 17 cases).Methods The static central visual fields were tested with Humphrey 750 automated perimetry and thickness of RNFL was measured with optical coherent tomography(OCT).Main Outcome Measures Mean deviation(MD),pattern standard deviation(PSD)and mean sensitivity at upper,lower,nasal and temporal quadrants in total deviation probability plots.Thickness of RNFL at upper,lower,nasal and temporal quadrants.Results There were more obvious general depression of sensitivity in total deviation probability plots of the early POAG with high myopia than those of POAG without high myopia,and the early visual field defects of glaucoma in pattern deviation probability plots of this group.MD of POAG with high myopia was more than those of others(P＜0.05).The differences of MD,PSD and mean sensitivity between POAG with high myopia and others were significant(P＜0.05).Mean sensitivities in each quadrant of POAG without high myopia were similar to those of high myopia(P＞0.05).The thickness of RNFL of POAG with high myopia was thinner than those of others and the thickness of RNFL of normality was thicker than that of others.The correlationship between mean sensitivity and the thickness of RNFL in each quadrant was significant(P＜0.05).Conclusion Pattern deviation probability plots is an important favor for judgement of the visual field changes in POAG with high myopia.The relationship between RNFL thickness with OCT and visual field damage may provide clinically relevant information in diagnosis of POAG with high myopia