Objective To identify the changes of outpatients/emergency visits at Nanjing Children′s Hospital since introduction of the general pricing reform at public hospitals.Methods Fluctuations of outpatients/emergency visits at Nanjing Children′s Hospital before and after the reform in 2015 were compared,and an empirical analysis was made in view of the overall structural changes,demand price elasticity and cross-price elasticity of various outpatients/emergency visits.Results The change of total outpatients/emergency visits was minimal,yet the composition registered significant changes.Monthly average of common outpatients totaled 7 072 visits,a growth of 12.6%;that of senior specialists totaled 3 035 visits,a growth of 48.4%.The price elasticity was<1,while the demand for various outpatients/emergency visits services and cross-price elasticity appeared inelastic.Conclusions The one year reform has witnessed the hospital in smooth operations as yet.Given the sizable rise of examination prices for both outpatients/emergency visits,patient volume remains stable instead of drastic decrease,evidencing the strong demand for children′s medical services.

Background Small incision lenticule extraction (SMILE) was a new procedure which is miniinvasion and flapless,but few attentions were paid to the visual quality after SMILE.To understand the changes of intraocular straylight after SMILE is of important significance for the assession of the visual quality after the procedure.Objective This study was to compare the characteristic of straylight between SMILE and femtosecond laser assisted laser in situ keratomileusis (FS-LAISK) after surgery.Methods A retrospective study was designed.Written informed consent was obtained from each patient prior to accepting the surgery.One hundred and twenty-seven eyes of 68 patients with myopia and myopic astigmatism were included in Tianjin Eye Hospital from January 2011 to July 2013.SMILE was performed on 64 eyes of 35 patients and FS-LASIK was carried out in 63 eyes of 33 patients at the same period.Stray light was detected with C-Quant stray light meter before and 1 week,1 month and 6 months after surgery.The changes of stray light values following the surgery were compared between the two groups,and the correlations between postoperative stray light values with operative parameters were analyzed.Results The mean stray light values were (1.03 ±0.19)D and (0.95±0.16)D at 1 week and 1 month after surgery,which were higher than (0.88 ±0.18)D at preoperation in the FS-LASIK group (P =0.000,0.012).The stray light values were (0.98±0.16),(0.95±0.14) and (0.94±0.16)D at 1 week,1 month or 6 months after surgery,and no statistically significant differences were found in comparison with (0.91 ±0.15)D in preoperation in the SMILE group (all at P＞0.05).No significant intergroup difference was seen in the stray light values (Fgroup =0.077,P=0.781).The stray light differences of various time points after surgery and before surgery were increased in the FS-LASIK group compared with SMILE group (Fgroup =14.798,P＜0.001),with the significant difference in postoperative 1 week between the two groups (P＜0.01).The negative correlations were found between stray light values at 1 week,1 month and 6 months after SMILE with the lenticule thickness/central corneal thickness (CCT) (R2=0.123,0.145,0.098,all at P＜0.05) or between stray light change.Conclusions Intraocular stray light appears less change in operative eyes after SMILE.However,intraocular stray light increases in the eyes received FS-LASIK,especially at early stage after operation.The stray light shifts return to normal with the lapse of postoperative time.

Objective To investigate the statistical methods used in nursing papers for bachelor's degree. Method We collected 160 nursing theses for bachelor's degree in 2016 in our college and analyze the statistical methods. Results A total of 80 papers used statistical methods consisting of statistical table, statistical inference, single factor analysis, variance analysis and statistical description. Among them, the statistical methods in 66 papers (82.5%) were misused. About 139 misuses of statistical tables was found in papers, and about 23 misuses of statistical inference in papers, taking up 45.4%. Conclusions The nursing undergraduates are familiar with the application of statistical methods, but the methods tend to be simple and unitary. Therefore, it is a need to enhance their practice in using statistical methods.

Objective To study the antitumor activity of steroid saponins,such as Rhizoma Paridis saponins,Rhizoma Paridis saponin Ⅰ,and diosgenin,extracted from Paris polyphylla var.yunnanensis against lung adenocarcinoma cells.Methods Taking mouse lung adenocarcinoma LA795 cell line and its T739-bearing mice as models,the antitumor activity of steroid saponins of P.polyphylla var.yunnanensis against lung adenocarcinoma cells was carried out in vitro and in vivo.The inhibitory activity of Rhizoma Paridis saponins,Rhizoma Paridis saponin Ⅰ,and diosgenin on the LA795 cell line was studied by means of MTT assay and their antitumor effects in vivo were carried on inbred strains of mice(T739) affected by LA795 metastatic lung cancer.Results The MTT assay of in vitro cytotoxicity of Rhizoma Paridis saponins,Rhizoma Paridis saponin Ⅰ,and diosgenin showed strong cytotoxicity against the growth of LA795 cells.IC50 Values were 24.33 ?g/mL,1.85,and 149.75 ?mol/L,respectively.The tumor weight in all treated groups was significantly lower than that in the control group and the inhibition of tumor growth were 41.82%,29.44%,and 33.94% in their high-dose groups.The metastasis of tumor cells was inhibited by different degrees in treated groups.Conclusion Steroid saponins of P.polyphylla var.yunnanensis have tumoricidal activity on lung adenocarcinoma cell line,both in vitro and in vivo.

Objective To establish a novel flow cytometric crossmatch assay allowing detection of complement-fixing donor specific anti-HLA IgG alloantibodies (Flow cytometry complement-dependent crossmatch,Flow-CDC). Methods One hundred pretransplant crossmatchings were performed using Flow-CDC and NIH-CDC between 62 patients awaiting renal transplantation and 33 donor cells.These crossmatchings were divided into two groups according to PRA.Group 1 consisted of 25 sera with negative PRA,and group 2 consisted of 75 sera with positive PRA.All of the sera were pretreated with DTT to inactivate IgM. Lymphocytes were isolated from peripheral blood (or,in a few instances,from the spleen) of the cadaveric donors. The correlation between different techniques for detection of donor specific anti-HLA antibodies was evaluated.The effect of both methods on clinical transplantation outcome was observed. Results In group 1,NIH-CDC and Flow-CDC were negative for all 25 sera.In group 2,24 (32.0%) had a positive NIH-CDC,31 (41.3%) had a positive Flow-CDC.There was a significant difference between two methods (?2=5.14, P= 0.016 ).Overall concordance between both tests was 93% with 69 concordant negatives and 24 concordant positives. The correlation coefficient (r) was 0.80.In group 2,5 patients received transplantation. One of them with negative NIH-CDC and positive Flow-CDC suffered from acute rejection after transplantation and lost the graft,and the other patients with negative NIH-CDC and Flow-CDC had good outcome. Conclusions Flow-CDC can detect specifically complement-fixing IgG alloantibodies against donor HLA and is more sensitive than NIH-CDC.Additionally,the computer printouts represent a permanent record of the crossmatch for retrospective review.Flow-CDC may become the standard crossmatch method as a possible alternative to conventional NIH-CDC testing.

Anti-glutamic acid decarboxylase antibody-associated encephalitis is a kind of autoimmune encephalitis mediated by anti-glutamic acid decarboxylase antibody, which belongs to anti-neuronal intracellular synaptic protein antibody-associated encephalitis. Clinical manifestations include stiff-person syndrome, cerebellar ataxia, limbic encephalitis, seizures, etc., often associated with a variety of autoimmune diseases, rarely associated with tumors. Detection of anti-glutamic acid decarboxylase antibody is crucial for clinical diagnosis. Immunotherapy helps to relieve symptoms and improve prognosis. The incidence of this disease is low, and there are few reports at home and abroad. This paper intends to review the research on this encephalitis, hoping to improve the clinicians′ understanding and the level of diagnosis and treatment of the disease.

Objective: To study the effect of cytochrome P-450 4F2 (CYP4F2, rs2108622) gene polymorphisms in patients with warfarin for initial doses in 7 days.
Methods: A total of 271 patients treated by warfarin were studied. The CYP4F2 gene polymorphisms were assessed by real-time PCR, the average initial warfarin doses in 7 days and the time of international normalized ratio (INR) ifrst arrived to therapeutic range were recorded. The differences of initial warfarin doses and the time of INR ifrst arrived to therapeutic range among CYP4F2 gene polymorphisms of CC, CT and TT genotypes were analyzed by statistical method.
Results: The average initial warfarin doses among CYP4F2 polymorphisms of TT and CT/TT were higher than CC, P<0.05. The times of INR first arrived to therapeutic range in TT genotype was higher than CC genotype, P<0.05. With adjusted gender, age, body height and weight, CYP2C9 and VKORC1 polymorphisms, conditions of disease and medication, the effect of CYP4F2 gene polymorphisms on initial warfarin doses in 7 days were still with the statistic meaning (regression coefifcient=0.21, P=0.003).
Conclusion: CYP4F2 polymorphisms inlfuenced the initial warfarin doses in 7 days in relevant patients.

Objective To investigate the effects of lentivirus-mediated heat shock protein 70 (HSP70) gene on voltage-gated calcium channels on the cell membrane of pheochromocytoma cell 12 (PC 12 cells) induced by ischemic/hypoxia and its mechanisms.Methods PC12 cells at logarithmic phase were collected,which were challenged with hypoxia for 6 hours and reoxygenation for 12 hours to stimulate the nerve cells suffered ischemia/reperfusion pathological process in vitro.PC12 cells were divided into non-infection group,infected by lentivirus containing green fluorescent protein (GFP) without HSP70 gene lentivirus control group (GFP lentivirus control group),and infected by lentivirus containing HSP70 and GFP gene recombined lentiviral infection group (HSP70 recombined lentiviral infection group).Real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot were used to determine mRNA and protein expressions of L-type voltage-gated Ca2+ channel subunits cav1.2 and cav1.3,receptor gated channel subunits NR1 and NR2,and Na+/Ca2+ exchange (NCX) in PC12 cells.Results After being challenged with hypoxia/reoxygenation,the mRNA and protein expressions of cav1.2,NR1 and NR2 in the PC12 cells were significantly lower in HSP70 recombined lentiviral infection group than those of GFP lentivirus control group and non-infection group [cav1.2 mRNA (2-△△Ct):3.13 ± 0.46 vs.5.12 ± 0.52,5.13 ± 0.66;NR1 mRNA (2-△△△Ct):1.61 ± 0.44 vs.3.23 ±0.82,3.31 ±0.78;NR2 mRNA (2-△△Ct):2.09±0.41 vs.3.91 ±0.64,3.88±0.62;cav1.2 protein (gray value):2.82±0.39 vs.3.98±0.23,3.96±0.24;NR1 protein (gray value):1.84±0.35 vs.2.79±0.21,2.86±0.23;NR2 protein (gray value):0.87±0.24 vs.1.57±0.31,1.33±0.44;all P ＜ 0.01].But there were no statistical differences in the mRNA and protein expressions of cav1.2,NR1 and NR2 between GFP lentivirus control group and non-infection group (all P ＞ 0.01).There were no statistical differences in the mRNA and protein expressions of cav1.3 and NCX among non-infection group,GFP lentivirus control group and HSP70 recombined lentiviral infection group [cav1.3 mRNA (2-△△Ct):4.82 ± 0.32,4.72 ± 0.36,4.82 ± 0.29;NCX mRNA (2-△△Ct):3.49 ± 0.78,3.47 ± 0.71,3.56 ± 0.65;cav 1.3 protein (gray value):2.63±0.40,2.64±0.39,2.68±0.39;NCX protein (gray value):3.27±0.48,3.34±0.48,3.31 ±0.42;all P ＞ 0.01].Conclusion Exogenous HSP70 affects the expression of L-type voltage-gated Ca2+ channel subunit cav1.2 and receptor gated channel subunits NR1 and NR2,which may protect PC12 cells from the injury caused by ischemic/hypoxia.

Objective To investigate the sonographic characteristic of hepatic lymphoma. Methods Fifteen patients with pathological proven hepatic lymphomas (4 primary and 11 secondary hepatic lymphomas) were included in this retrospective study. All the 15 patients underwent conventional B-mode ultrasound examinations. Two patients (one with primary lymphoma and another with secondary lymphoma) underwent contrast enhanced ultrasonography (CEUS). Results In the conventional ultrasonography, hepatic masses were detected in 9 patients (4 primary and 5 secondary lymphomas). No hepatic mass was detected in the remaining 6 patients with pathological proven secondary lymphomas. For the 4 patients with detectable primary masses, 2 had a single mass and 2 had multiple masses. All primary hepatic lymphomas were hypoechoic. For the 5 patients with detectable secondary masses, 2 had a single mass and 3 had multiple masses. The hypoechoic lymphomas were found in 3 patients, while hyperechoic and isoechoic lymphomas were found in the other 2 patients. In the 4 patients with primary hepatic lymphomas, 3 had hepatomegaly, while none of the 4 patients had splenomegaly. In the 5 patients with detectable secondary masses, hepatomegaly was found in 3 patients in whom 2 had splenomegaly and 1 had a plate-shaped hypoechoic region within spleen. For the 6 patients without detectable secondary masses, splenomegaly was found in all 6 patients and hepatomegaly was found in 4 patients. In the spleen of one patient, a plate-shaped hypoechoic region was detected in the B-mode ultrasonography. In the CEUS, the primary lymphoma presented a thick ring region with slight enhancement peripheral to the mass during the hepatic artery phase;while the secondary lymphoma presented the uneven enhancement pattern with a small plate-shaped region unenhanced in its center during the hepatic artery phase. Conclusions In ultrasonography, the patients with hepatic lymphomas commonly present a single or multiple hypoechoic well-deifned hepatic masses, poor blood lfow and uneven enhancement peripheral to the mass during the hepatic artery phase of CEUS. Other sonographic characteristic include hepatomegaly and splenomegaly. No mass is detected in ultrasonography can not exclude the diagnosis of hepatic lymphoma.

Background Small incision lenticule extraction (SMILE) is lack of eye-tracking system and there is controversy in the treatment of astigmatism.It is very important to understand its correction effctiveness for myopic astigmatism.Objective This study was to evaluate the clinical outcomes in the correction of myopic astigmatism between SMILE and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK).Methods In this retrospective study,95 eyes of 51 patients and 69 eyes of 40 patients with myopic astigmatism underwent the SMILE surgery and FS-LASIK surgery respectively in Tianjin Eye Hospital from December 2013 to July 2014 under the informed consent.No significant differences were found in spherical power,astigmatic power and spherical equivalent (SE) between the SMILE group and FS-LASIK group before surgery (all at P＞0.05).The uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest refraction,slit-lamp microscopy,intraocular pressure and corneal topography were measured before surgery and 1 day,1 week,1 month,3 months after surgery.Vector analysis was used to calculate the components of astigmatism before and after surgery.Correction index (CI),index of success (IOS),angle of error (AofE) and flattening index (FI) were used to evaluate the correction effectiveness of astigmatism.Safety index and efficacy index were used to evaluate the recovery status of visual acuity.The corrected effectiveness was compared between the two groups,and the correlations of kappa angle with measured parameter were assessed by Spearman rank correlation analysis.Results The mean spherical power,astigmatic power and SE were (0.003±0.106),(-0.063 ± 0.126) and (-0.029 ± 0.101) D in the SMILE group,which were significantly lower than (0.112 ± 0.212),(-0.091 ± 0.142) and (0.067 ± 0.198)D in the FS-LASIK group (Z =-4.328,-3.197,both at P＜0.05).Vector analysis showed the postoperative with-the-rule astigmatism in the SMILE group and oblique astigmatism in the FS-LASIK group respectively,and the CI and F1 in the SMILE group were significantly lower than those in the FS-LASIK group (Z =-3.051,-3.126,both at P ＜ 0.05).The insignificant reduce in IOS and AofE were seen in the SMILE group compared with the FS-LASIK group (Z=-1.557,P=0.119;Z =-1.923,P =0.054).In addition,the safety index and efficacy index were not significantly different between the two groups (both at P ＞ 0.05).Negative correlations were found between safety index or efficacy index and preoperative kappa angle in the SMILE group (r =-0.258,-0.257,both at P＜0.05).Conclusions Both SMILE and FS-LASIK surgeries are effective and safe in correcting myopic astigmatism with good postoperative visual acuity.SMILE surgery shows less axis rotation and higher accuracy than FS-LASIK because of small incision and flapless procedure.The correction of cylinder can adjust based on experience of surgeon.