OBJECTIVE:To provide reference for the clinical rational application and preventing the adverse reactions of hy-droxyethyl starch(HES). METHODS:The HES application of inpatients in a hospital in Jul. 2014 were retrospectively analyzed, the usage and dosage,indications,and the changes of renal functions and blood coagulation function before and after HES treat-ment were detected,and the application rationality was evaluated. RESULTS:The usage of HES in the hospital was hydroxyethyl starch 200/0.5 and Sodium chloride injection,which was the second generation of HES. In the 347 patients,295 patients had moni-tored the renal functions before the HES treatment,the result was normal;and 21 patients had monitored the renal functions after HES treatment,the result was normal. Meanwhile,326 patients had monitored the blood coagulation functions before and after HES treatment,the results were normal. HES was not used for the patient of severe sepsis,renal dysfunctions and coagulopathy in this hospital. CONCLUSIONS:The application of HES can induce renal damage and coagulation disorder,so relevant indicators should be closely monitored before and after treatment to prevent the incidence of adverse reactions;further more,clinicians should strictly handle indications,usage and dosage and precautions during the clinical application;in addition,it is suggested to replace the second generation of HES by the third generation,which is more safer.

Currently,medical ethics education is well popularized,yet not popular among medical students,interns or clinical doctors,for which its formalistic teaching content and mode are to blame.To realize its real educative effects,infiltrating medical ethics into the ideological perception among medical students,interns and clinical doctors,besides horizontal expansion in education popularity,more emphasis should be put to grasping and instructing the essence of medical ethics on a vertical level in order to make the recognition of medical ethics education as common sense among medical professionals.

OBJECTIVE:To investigate the clinical characteristics and regularity of adverse drug reaction (ADR),and to pro-vide reference for rational and safe drug use in the clinic. METHODS:ADR reports collected from our hospital by Guangdong ADR Monitoring Center during Jan. 2014 to June. 2015 were summarized and analyzed statistically. RESULTS:Of 433 ADR cases,there were 185 male cases (42.73%) and 248 female cases (57.27%),with ratio of 1∶1.34. The incidence of ADR was in high level (71.59%) in young and middle-aged patients (20-59 year-old);that of male was significantly lower than that of female (1∶1.37). ADR cases caused by intravenous drip(48.04%)and oral administration(41.57%)were most common. The most ADR cases were re-lated with anti-infective drugs(167 cases,38.57%),mainly were related with cephalosporins(64.07%). Organs/systems involved in ADR were main the damages of gastrointestinal system (262 cases,36.19%) and the lesion of skin and appendants (237 cases, 32.73%). The serious ADR was mainly induced by anti-infective and anti-tumor drugs. CONCLUSIONS:Clinical medical personnel should strengthen the ADR monitoring of cephalosporin antibiotics and anti-tumor drug,and select route of administration carefully.

OBJECTIVE:To prepare Tacrolimus niosomes (Tac-NS) and evaluate their characteristics in vitro. METHODS:Tac-NS were prepared by a film hydration-ultrasonic method. Using the comprehensive score of encapsulation efficiency (EE%), drug-loading amount,mean particle size and PDI as the evaluation index,orthogonal design was used to optimize the concentration of sorbitan monostearate(Span-60),mole ratio of Span-60 to cholesterol,mole ratio of Span-60 to SDC. The morphology,mean particle size,PDI,Zeta-potential and EE%of Tac-NS were investigated. Accumulative percutaneous penetration(Q)and accumula-tive retention amount(Qs)of Tac-NS and physical mixture of Tac and NS were compared by percutaneous penetration test in vitro. RESULTS:The optimal formulation was as follows as Span-60 0.025 mol/L,mole ratio of Span-60 to cholesterol 10∶1,mole ratio of Span-60 to SDC 15∶1,drug-loading amount of 5%. Tac-NS was spherical and distributed evenly,but hardly congregated.The mean particle size,PDI,Zeta-potential and EE% were (233.0 ± 6.48) nm,0.266 ± 0.021,(-41.7 ± 0.32) mV and (76.83 ± 4.61)%,respectively. The results of in vitro permeability study showed that Qs of Tac-NS was 2.4 times of physical mixture;in ad-dition,Q of the two were similar. CONCLUSIONS:Tac-NS,owning high EE%,small particle size,uniform distribution and ide-al permeation effect,is prepared successfully.

Objective To explore the economic performance after the performance‐based reform at primary medical institutions in Zhejiang Province and put forward measures for improving primary medical services .Methods Questionnaire investigation was conducted among 84 primary medical institutions with staff over 20 .The financial statements of these institutions during 2009‐2014 were collected and studied as well .Results The average outpatients and emergency patients in 2014 increased 113.3% than that in 2009 .The total usage times of laboratory tests and other auxiliary examinations also increased(55.7% and 103.1% ,respectively ) ,yet with a decrease of inpatients.Moreover ,the proportion of income from traditional Chinese medicine (TCM )in gross income increased from 9.39% in 2009 to 17.14% in 2014 .The cost‐profit ratio of TCM drugs at half of such institutions exceeded 120% . Conclusions The performance‐based reform has motivated medical staffs of primary medical institutions and effectively vitalized such institutions.Rules and regulations of these institutions require further improvement .

Objective To examine the occupational stability,training needs and capacity building requirements of the general practitioners purposely trained to work in rural communities,for improvement of policies regarding their training and issues related. Methods There counties were selected by stratified random sampling, where general practitioners graduated from such training completed an anonymous questionnaire. Focus group interviews were made to officials of the local Health and Family Planning Commission,those of primary healthcare institutions,and general practitioners themselves. Results The of the 190 valid questionnaires recovered, male accounted for 34. 2% and female 65. 8%. These general practitioners were mostly satisfied with their working environment, social status, work stress and job achievement,yet with lower satisfaction with their salary and availability of medical devices. Consideration of resignation was reported by only 5. 3% of them,with more males than females. As high as 63. 2% of them prefer to work in hospitals of county level. 91. 1% of them held it as necessary to participate in standard resident training,and 98. 4% held it as necessary to have on-job training. 94. 7% of them have participated in further education to gain a bachelor degree in medicine. Conclusions These doctors were found with high stability to work in rural communities and low turnover intention. Further studies are required to encourage these general practitioners to serve rural communities in a long term, and to improve the standard resident training mechanism,and their career development.

OBJECTIVETo explore the effects of aspirin and inflammation on the maturation and function of dendritic cells (DC) on the supernatant of VX-2 squamous cell carcinoma.

METHODSThe rabbit buccal VX-2 squamous cell carcinoma models with inflammation were established by tumor particle implantation, mechanical trauma, and high sugar diet. The rabbits were divided into three groups. For the experimental group (rabbit buccal VX-2 squamous cell carcinoma with local inflammation), aspirin were given by gavage for three consecutive days. For the control group (rabbit buccal VX-2 squamous cell carcinoma with local inflammation), normal saline was given by gavage for three consecutive days. For the blank group (tumor without inflammation), normal saline was given by gavage for three consecutive days. Each tumor specimens were collected in three days and made into tissue homogenate. The supernatant was collected after centrifugation. Normal rabbit peripheral blood mononuclear cells were separated and co-cultured with different states of supernatant. The expression of DC surface markers CD83, CD86, and human leukocyte antigen-DR (HLA-DR) were detected by flow cytometry. The state of function of DC was tested by mixed lymphocyte reaction.

RESULTSThe positive rate of CD83, CD86, and HLA-DR of the experimental and control groups were both lower than that of the blank group (P<0.05). In addition, the ability to stimulate T cell proliferation of the experimental and control groups were weaker than that of the blank group (P<0.05). No significant difference was observed between the experi- and HLADR of DC. The short-term administration of aspirin is not conducive to the phenoty and function of DC in a rabbit mental and control groups (P>0.05).

CONCLUSIONInflammation may inhibit the function and expression of CD83, CD86, buccal VX-2 squamous cell carcinoma inflammatory environment

Animals ; Aspirin ; pharmacology ; Carcinoma, Squamous Cell ; Coculture Techniques ; Dendritic Cells ; drug effects ; Flow Cytometry ; Humans ; Inflammation ; Leukocytes, Mononuclear ; Organothiophosphorus Compounds ; Rabbits

Objective To explore the functional orientation of township hospitals in developed areas to achieve goals of the ongoing health reform.Methods Two rounds of Delphi consultation was made among 18 experts from around the country to learn the degree of importance of every function.Results The experts' average seniority of service in their fields was 23.28±10.41 years.The positivity coefficients of the two-round consultation were 100％.Kendall' S coefficients of the two-round consultation were 0.226 and 0.265 (p＜0.01).These data are of statistical importance,suggesting consensus among these experts and the consultation meeting the needs of forecast.In these consultation,seven class-1 functions and and 27 class-2 functions were determined.Medical services and public health services account for similar proportion of work of township hospitals.Conclusion The functional orientation was feasible and forward looking,for reference of township hospitals in developed areas.

The real-time and wireless mobile has become the trend of electrocardiogram (ECG) monitoring system for atrial fibrillation (AF). At present, the ECG with multi-leads (12 leads) is needed by most of AF signal extraction algorithms in order to extract effective AF waves. However, it is not very convenient for patients' movements in a multi-lead ECG monitoring system. Although the traditional template matching method is for single-lead ECG extraction, it is less robust than blind source extraction algorithm, and is affected severely by noise. In view of this,we put forth a new real-time algorithm for extracting AF from the singlelead ECG, using non-stationary heartbeat series during AF to extend dimension (segmentation), and then applying a blind source extraction algorithm to extract the effective AF signal. Experiment results showed that this method could be used to extract AF signal effectively from a single-lead ECG data. Therefore, it is suitable to apply this method to Wireless Monitoring System using single-lead ECG.
Algorithms ; Atrial Fibrillation ; physiopathology ; Electrocardiography ; methods ; Humans ; Signal Processing, Computer-Assisted

This study aims to analyze the current construction of massive open online course (MOOC) of medical humanities in China, promote the sharing of high-quality curriculum resources, and provide information reference for curriculum design and planning. Mathematical statistics and mind map analysis were used to analyze 42 medical humanities MOOCs on 17 online course platforms during the epidemic, and the results showed that: ①the scale and quantity of medical humanities MOOCs need to be expanded; ②there is regional imbalance in MOOCs construction, with the largest number in East China; ③most of the courses are taught by teachers in a team, teachers with senior professional titles are the main force of the team, and some teams have multidisciplinary backgrounds; ④there are rich teaching contents related to humanistic knowledge and ability, but the content related to medical humanistic spirit cognition needs to be added appropriately. According to the above analysis, it's suggested that the construction of MOOC should focus on systematism and standardization, equip a team of teachers with multidisciplinary backgrounds, value curriculum design and planning, and pay full attention to the feedback and evaluation of learners to find out deficiencies.