The ongoing health reform is bringing reforms of public hospitals under spotlight in China, attracting growing attention onto its progress and roadblocks. Probing into the "three steps" of public hospital system reform in Wuxi, this article analyzed such a reform in the city. It described the measures and initial outcomes gained in such fields as the hospital trusteeship reform, the separation of hospital regulation from its administration, and the hospital board system. Citing the case of Wuxi No. 2 People's hospital as an example, the authors introduced the innovative efforts made in hospital internal mechanism, management innovation, medical service model, hospital connotation construction, and talents cultivation.

Objective:To explore the correlation between serum protein factor level and clinical symptoms and cognitive impairment in patients with schizophrenia and to predict the degree of cognitive impairment, so as to provide an auxiliary method for clinical evaluation of cognitive impairment severity and prognosis of schizophrenia.Methods:From September 2017 to April 2019, 71 schizophrenic patients diagnosed in the First Affiliated Hospital of Kunming Medical University were selected as the patient group, and 65 healthy volunteers from the physical examination center of the same hospital were selected as the control group.The concentrations of tumor necrosis factor α(TNF-α), brain-derived neurotrophic factor(BDNF) and calcium-binding protein β(S100β) in peripheral blood were detected by ELISA method.Cognitive function was evaluated by MATRICS consensus cognitive battery(MCCB) cognitive assessment.The clinical symptoms of patients were evaluated by positive and negative syndrome scale(PANSS) scale.SPSS 20.0 software was used for statistical analysis, independent sample t-test was used for comparison between groups, and Pearson correlation analysis was used for the relationship between serum protein factor level and cognitive function and clinical symptoms.In order to objectively predict, evaluate and verify the severity of cognitive impairment in schizophrenia, Bayes discriminant function was established with serum protein factor concentration and PANSS total score as independent variables and the defect degree of cognitive factors in MCCB as dependent variables. Results:The serum TNF-α((63.2±25.2)pg/L vs (31.4±14.3)pg/L) and S100β((68.0±26.4)pg/L vs (47.3±20.2)pg/L) concentrations in the patient group were higher than those in the control group.The concentration of serum BDNF in the patient group was lower than that in the control group ((2 517.8±1 140.2)pg/L vs (5 202.2±447.2)pg/L), and the difference was statistically significant ( P=0.000). In the retrospective test of cognitive impairment severity in Bayes discriminant function model, the correct discrimination rates of four cognitive factors were speed of processing(SoP) 69.0%, Verbal learning(VeL) 63.4%, reasoning and problem solving(RPS) 76.1% and visual learning(ViL) 73.2%.The correct discrimination rates of cross-examination were SoP 66.2%, VeL 60.6%, RPS 73.2%, ViL 66.2. Conclusion:The levels of serum protein factors TNF-α, BDNF and S100β and clinical symptom scores of schizophrenia have different degrees of correlation with the severity score of cognitive impairment.Bayes discriminant function model has higher correct discrimination rate for the severity of cognitive impairment of schizophrenia.It is found that the levels of schizophrenia-related protein factors and clinical symptom scores may have predictive effect on the severity of cognitive impairment, providing a more objective basis for the clinical efficacy evaluation of schizophrenia patients.

Objective To evaluate the value of immune cell functional assay (ImmuKnow CD4+ T cell ATP assay) in monitoring immune status in renal recipients.Methods A total of 131 adult renal transplant recipients who received transplantation for the first time were under investigation.According to the dynamic monitoring ATP concentration before operation,2 week,1,3,6 months after operation and during infect or rejection,samples were divided into the following groups:health control group (HC),pretransplant (Pre-Tx) group,stable (Tx) group,infect group,acute rejection (AR) group,acute kidney injury (AKI) group.Immune cell functions were detected by ImmuKnow CD4+ T cell ATP assay.Lymphocyte subsets (CD4+/CD8+) were analysed and serum concentrations of FK506 were tested.Mixed lymphocyte reaction(MLR) was analysed.Results The ATP concentration was no significant difference between Pre-Tx and HC group.The ATP concentration of 2 weeks,1 months after operation were significantly higher than Pre-Tx group (P ＜ 0.01).After 3 months,6 months follow-up,the ATP concentration stabilized with time.The ATP concentration of AR group was significantly higher than other three groups (Tx,infect and AKI group,all P ＜ 0.05).The correlation coefficient between the ATP concentration and MLR,CD4+/CD8+,FK506 level were R2=0.0072,R2=10-6,R2=0.004 respectively (all P ＞ 0.05).Conclusions The cell-mediated immunity of recipients is relatively strongger during the first month after transplantation.The ATP concentration is not related to the levels of MLR,CD4+/CD8+,FK506.ImmuKnow ATP assay is a valuable predictor in acute rejection diagnosis.

In vivo tumor imaging technique method based on bioluminescence principle was established to evaluate the anti-tumor effect of paclitaxel mixed micelle (PMM). MDA-MB-231 tumor cells with luciferase reporter vectors were firstly implanted into nude mice, and subsequently the luciferase substrate was regularly injected during intraperitoneal administration of PMM. Then the tumor size, growth and the intensity of light signals were monitored with in vivo imaging technique. The method of luciferase tumor in vivo imaging could be real-time, reliable and exact in labeling and reflecting the growth of tumors, and the observed results were consistent with that by conventional method, so it would be a feasible approach to study anti-tumor effect of drugs. The anti-tumor effect of paclitaxel mixed micelle was observed by this method, and the results showed that this formulation could inhibit growth of tumor, and the anti-tumor rate of it was about 85%.

Objective To investigate the relationship between serum levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) and Suzuki' s grading system in adult moyamoya disease (MMD).Methods Fifty-two adult patients with MMD,who were diagnosed in Jinling hospital between April 2009 and January 2010,were retrieved from the Nanjing Stroke Registry Program (NSRP).Sixteen sex- and age-matched healthy individuals with MMD patients consisted of the control group.Using enzyme-linked immunosorbent assay,serum concentrations of VEGF and MMP-9 were compared between adult MMD patients and healthy individuals.By Suzuki' s six-grading system,patients were divided into different subgroups,and the correlation of serum levels of VEGF and MMP-9 corresponding to different subgroup and Suzuki's grading was respectively analyzed.In addition,the correlation of serum levels of VEGF and MMP-9 was also evaluated.Results Serum VEGF concentrations in ischemic and hemorrhagic MMD patients was respectively ( 289.4 + 69.2 ) pg/ml and ( 324.3 ± 95.6 ) pg/ml and were significantly higher compared to those in healthy controls ( ( 63.5 ± 7.6 ) pg/ml; F =69.43,P ＜ 0.01 ).Similar findings were observed for MMP-9 ( ( 499.4 ± 76.2 ) ng/ml and ( 531.2 + 100.2 ) ng/ml versus (257.1 ±30.7) ng/ml; F =66.023,P ＜0.01 ).With the increase of Suzuki' s grading,serum levels of VEGF and MMP-9 respectively showed a high trend ( r =0.879,P ＜ 0.01:r =0.838,P ＜ 0.01 ).In addition,a positive correlation between serum levels of VEGF and MMP-9 was found in the MMD group( r =0.590,P ＜0.01 ).Conclusion The results show that serum levels of VEGF and MMP-9 in adult MMD are higher than those in healthy controls,which may play a role in neovascularization in MMD,and moreover,serum levels of VEGF and MMP-9 show a high trend with the progression of MMD,which suggest that serum levels of VEGF and MMP-9 can reflect the severity of MMD.

Objective To investigate the value of hyperintense vessel signs (HVS) on fluidattenuated inversion recovery (FLAIR) sequence for assessing the patterns of collateral blood flow in adult moyamoya disease (MMD).Methods Forty-one adult patients with non-hemorrhagic MMD retrieved from Nanjing Stroke Registry Program between August 2008 and January 2011 were identified by digital cerebral angiography and performed the examination of FLAIR sequence in Jinling hospital.According to the different sites of HVS located in the territory of the middle cerebral artery,the patterns of HVS were classified into grades 0-3: Grade 0,absence of HVS ; Grade 1,HVS limited in the cerebral sulci of temporal lobe and Sylvian fissure ; Grade 2,HVS in the cerebral sulci of frontal and parietal lobe regions and Sylvian fissure;and Grade 3,HVS in the combined territories of Grade 1 and Grade 2.According to the intracerebral collateral blood flow,steno-occlusions of the arteries were classified into three types: Type 1,residual antegrade flow across steno-occlusive lesions; Type 2,retrograde flow via leptomeningeal vessels; Type 3,the combined collateral blood flow of Type 1 and Type 2.The relationship between the patterns of intracerebral collateral blood flow and the location of HVS was analyzed.Results Of 41 adult patients with non-hemorrhagic MMD,there were 3 patients presented with unilateral vascular lesions and 38 with bilateral vascular lesions,so the total number of vascular lesions of the cerebral hemispheres was 79.Because three patients showed the absence of HVS in bilateral hemispheres,the total number of the presence of HVS of the cerebral hemispheres was 73.Therefore,the percentage of the presence of HVS was 92.4％ (73/79) in vascular lesions of the cerebral hemispheres.Importantly,the patterns of slow collateral blood flow corresponding to Grade 1 HVS were all antegrade (7/7) ; the collateral patterns corresponding to Grade 2 HVS were mainly retrograde leptomeningeal flow (95.0％,19/20) ; and the patterns corresponding to Grade 3 HVS were mainly slow combined collateral blood flow(84.8％,39/46).Furthermore,with the changing sites of HVS from the cerebral sulci of temporal lobe to the cerebral sulci of frontal and parietal lobe regions,the directions of collateral flow changed with a shift from antegrade to retrograde,which was statistically significant.Conclusion The different locations of HVS can reflect the different patterns of collateral blood flow,and the locations of HVS may predict the directions of intracerebral collateral blood flow in adult MMD patients.

Objective To establish the normal reference range for serum folate of healthy children in Guangzhou region.Methods Levels of serum folate of 1 860 healthy children (1 061 males and 799 females) and 129 adults (52 males and 77 females) living in Guangzhou region were examined by LK3000V Vitamin Analyzer.Then the data were analyzed with statistical methods.Results ①There was no statistical difference between boys and girls for levels of serum folate in every group defined by age (P＞0.05).②The levels of serum folate [median(P2.5,P97.5)] defined by age were as follows:9.39 (6.12,14.85) nmol/L for 0～1 year-old group,10.65 (6.05,16.52) nmol/L for 1.01～17 year-old group and 11.12 (6.3,17.51) nmol/L for the adult group.Statistical difference was found between any two groups of the three (P＜0.05).③No statistical correlation was found between age and the level of serum folate (r=0.039,P=0.09).Conclusion Reference range for serum folate for healthy children in Guangzhou region include two parts:6.12～ 14.85 nmol/L for 0～ 1 year-old group and 6.05～～16.52 nmol/L for 1.01～17 year-old group.

Objective:To explore the clinical value of combined detection of procalcitonin (PCT), C-reactive protein (CRP), neutrophils (CD64), interferon-induced protein 10(IP-10) in the diagnosis of upper respiratory infectious diseases in children.Methods:A total of 122 children with upper respiratory tract infectious diseases treated in the Affiliated Hospital of Shaoxing University of Arts and Sciences from January 2017 to December 2018 were selected as the research subjects.According to the clinical symptoms and diagnosis results of the children, the children were all infected by bacteria (infected group), and healthy children in the same period were selected as normal control group ( n=61). The PCT, CRP, CD64 and IP-10 levels of the two groups were detected.The correlation between the indicators and the diagnostic value of combined detection was analyzed. Results:The PCT levels of the normal control group and infected group were (0.55±0.13)μg/L, (10.81±1.25)μg/L, respectively, and the CRP levels of the normal control group and infected group were (1.85±1.07)mg/L, (15.18±5.05)mg/L, respectively, and the CD64 index of the normal control group and infected group were (4.37±0.51), (9.91±1.62), respectively, and the IP-10 levels of the normal control group and infected group were (0.08±0.01)μg/L, (0.70±0.20)μg/L, respectively, the differences were statistically significant between the two groups( t=63.847, 20.362, 26.040, 24.163, all P<0.001). The levels of PCT, CRP, CD64 and IP-10 in the infection group were higher than those in the normal control group.After treatment, the levels of PCT, CRP, CD64 and IP-10 in the infection group were decreased (all P<0.05). Pearson correlation analysis found that PCT and CRP, PCT and CD64, PCT and IP-10, CRP and CD64, CRP and IP-10, CD64 and IP-10 were positively correlated (all P<0.05). The sensitivity, specificity and Yoden index of combined diagnosis were higher than those of single index by ROC. Conclusion:The combined detection of PCT, CRP, CD64 and IP-10 has high sensitivity and specificity.It can be used as an index for the diagnosis of early bacterial infection in children with upper respiratory infectious diseases.

Objective To study the clinical value of electronic bronchoscope in diagnosis and treatment of recurrent dyspnea in neonates.Method From October 2014 to October 2017,the clinical data of recurrent dyspnea receiving electronic bronchoscopy examination and treatment in the neonatal intensive care unit of our hospital were retrospectively selected.Their clinical characteristics and treatment effects were summarized and analyzed.Result A total of 171 infants of neonatal recurrent respiratory infections were examined using electronic bronchoscope.The top four causes included endo－tracheo－bronchitis in 78 cases (45.6%), laryngomalacia, and tracheobronchomalacia in 22 cases (12.9%), airway stenosis in 14 cases (8.2%) and esophagotracheal fistula in 12 cases ( 7.0%).The complications of intraoperative and postoperative included decline of percutaneous oxygen saturation and /or heart rate (20.5%, 35/171), mucosal bleeding (12.3%, 21/171 ), and fever after bronchoalveolar lavage.Electronic bronchoscopy examination confirmed all the 171 neonates′diagnosis and some of them recovered after corresponding treatment.78 cases of infants with endo－tracheobronchitis were all cured.22 cases of laryngomalacia and tracheobronchomalacia and nine patients with airway stenosis improved and were discharged after treatment . One patient with subglottic stenosis received bronchoscopic holmium laser ablation therapy and the airway significantly expanded.No re－stenosis was found during follow－up.Conclusion Electronic bronchoscopy is an important method to determine the cause of recurrent dyspnea in newborns , and it′safe,reliable and can play a therapeutic role in some neonates.