According to the present deficiency existing in contractual community medical service financing mechanism,it analyzed the financing difficulties and mutual interest game from the angle of game analysis of the various stakeholders in the financing process,explored the reasonable optimizing strategies for improving financing mechanism.The purposes aimed as:(1) determine the responsibility of each contractual community health financing body,reduce the fund shortage phenomenon caused by the lack of responsibility;(2) promote the stability and sustainable development of the financing mechanisms,to provide sufficient power to the development of contract services;(3) it was conducive to vigorously promote the contractual community medical service and lay the foundation for the grading system.

Objective:To analyze the causes and countermeasures for the inefficiency of implementing the contract community health service policy.Methods:Based on the authority and regulation of organization,it innovatively used the French organization theory,build an analysis framework of organizational actors adapting to the general organization.On the above basis combined with the characteristics of contract health service,it constructed a new organizational structure of contract health service and analyzed the low efficiency of policy implementation from the three relations among the actors,the power and the rule.Results and Conclusion:It needed to focus on authority and rule to rationally division the authorities of actors,optimize the organizational structure,adjust the benefit relationship of actors;play the regulation role,implement the incentive and constraint mechanism to improve the execution efficiency of contract health service policy.

Objective To study the thyroid volume(TV) of patients with autoimmune thyroid disease (AITD) and the iodine intake and the factors associated with the goiter of patients with AITD.Methods Questionnaires,physical examination,urinary iodine concentration and thyroid B ultrasound were performed in cases of newly diagnosed patients with AITD.Result The TV of patients with AITD did not associated with the urinary iodine concentration (P ＞ 0.05).The TV associated with patients gender and age and goiter of palpation (P ＜ 0.05).Conclusion The U-shape relation did not show between iodine and goiter in patients with AITD.The goiter of patients with AITD did not associated with the iodine intake.

Objective To investigate the clinical effect of mild hypothermia on neonatal bilirubin encephalopathy, and the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT and amplitude integrated electroencephalogram (aEEG) for diagnosis and evaluation of curative effect. Methods From May, 2013 to December, 2014, 29 newborns with bilirubin encephalopathy were divided into conventional group (n=15) and mild hypothermia group (n=14). The conventional group received conventional therapy, and the other group received mild hypothermia in addition. The aEEG and neuron-specific enolase (NSE) were measured before and after treatment, as well as the glucose metabolism rate with 18F-FDG PET/CT after treatment. Results The NSE was lower after treatment in both groups (t>9.670, P<0.001), and was lower in the mild hypothermia group than in the conventional group (F=46.146, P<0.001). After treatment, sleep-wake cycle (SWC), epileptiform activity and the degree of abnormality were obviously improved (P<0.05), and were better in the mild hypothermia group than in the conventional group (P<0.05). The cerebral glucose metabolism rate was significantly better in the mild hypo-thermia group than in the conventional group (t>2.943, P<0.01). The cerebral glucose metabolism rate was negatively correlated with aEEG and NSE (r>0.640, P<0.05). Conclusion Mild hypothermia therapy could further promote the energy metabolism of brain cells in neonatal bilirubin encephalopathy. 18F-FDG PET/CT and aEEG can be used for early diagnosis and therapeutic evaluation.

Objective To investigate the prevalence of thyroid nodules in the adults in high water iodine area and to reveal the risk factors of thyroid nodules.Methods Questionnaire investigation,determination of urinary iodine and thyroid ultrasound were carried out for residents aged 18 to 65 years old in Gaoche Village of Wenshui County in Shanxi Province,with the exception of pregnant and lactating women.Possible risk factors for thyroid nodules were analyzed.Results Of the 286 residents,89 cases of thyroid nodule were detected and the prevalence rate was 31.1％.The prevalence rate was 25.7％ (35/136) in male and 36.0％ (54/150) in female,there was no significant difference between sex (x2 =2.49,P ＞ 0.05).The average age of the cases with thyroid nodules was (49.6 ± 11.3) years old and was (43.5 ± 11.6) years old in cases without thyroid nodules,there was significant difference between age groups (t =4.11,P ＜ 0.05).The median of urinary iodine of the cases with thyroid nodules was 453.0 μg/L and was 408.4 μg/L in cases without thyroid nodules,there was no significant difference in the median of urinary iodine (Z =-0.616,P ＞ 0.05).The prevalence rate of solitary nodule was 57.3％ (51/89) and multiple nodules 42.7％ (38/89).As to the property nodule,the cyst nodule,the cyst-solid nodule and the solid nodule was 49.4％ (44/89),29.2％ (26/89) and 21.3％ (19/89),respectively.The results of Logistic regression showed that the prevalence of thyroid nodule increased with age (OR =1.048,95％CI:1.024-1.073,P ＜ 0.05) and the multiple nodule increased with age (OR =1.086,95％CI:1.044-1.129,P ＜ 0.05).The cyst nodule was a more common form in women (OR =2.559,95％CI:1.245-5.262,P ＜ 0.05).The prevalence of cyst-solid nodule increased with age (OR =1.125,95％CI:1.065-1.189,P ＜ 0.05).Conclusions The prevalence of the thyroid nodule in adults is high and the thyroid nodules are mainly the cyst nodules.The prevalence of the thyroid nodule is increased with age,especially the multiple nodules and the cyst-solid nodule in high water iodine area.The cyst nodule is a more common form in women.

Objective To evaluate the effect of bone marrow-derived mesenchymal stem cells (BMSCs) on mammalian target of rapamycin (mTOR) signaling pathways in lung tissues of rats with acute lung injury (ALI).Methods Healthy pathogen-free adult male Sprague-Dawley rats were selected,and the BMSCs were obtained and cultured in vitro.One hundred and five healthy clean adult male SpragueDawley rats,weighing 170-190 g,were divided into 5 groups (n=21 each) using a random number table:control group (group C),PBS group,group ALI,ALI plus BMSC group (group ALI+BMSCs),and ALI plus phosphate buffer solution (PBS) group (group ALI+PBS).Group C received no treatment.PBS 0.5 ml was injected via the tail vein in group PBS.Lipopolysaccharide (LPS,0.5 ml) 5 mg/kg was intraperitoneally injected to establish the model of ALI in group ALI.BMSCs (0.5 ml) 1×104 cells/ml were injected via the tail vein after intraperitoneal injection of LPS in group ALI+ BMSCs.PBS 0.5 ml was injected via the tail vein after intraperitoneal injection of LPS in group ALI+PBS.Arterial blood samples were collected for blood gas analysis at 6,24 and 48 h after injection of BMSCs.Lungs were then removed for determination of wet/dry weight ratio (W/D ratio) and expression of mTOR,nuclear factor kappa B (NF-κB) and tumor necrosis factor-alpha (TNF-o) in lung tissues (by Western blot) and for examination of the pathologic changes of lungs tissues (using haematoxylin and eosin staining).Results Compared with group C,pH value and PaO2 were significantly decreased,PaCO2 and W/D ratio were increased,and the expression of mTOR,NF-κB and TNF-α was up-regulated at each time point in ALI,ALI+BMSCs and ALI+PBS groups (P＜0.05).Compared with group ALI,pH value and PaO2 were significantly increased,PaCO2 and W/D ratio were decreased,the expression of mTOR,NF-κB and TNF-α was down-regulated at each time point (P＜0.05),and the pathologic changes of lungs tissues were significantly attenuated in group ALI+BMSCs.Conclusion The mechanism by which BMSCs reduce ALI may be associated with inhibiting mTOR signaling pathways in lung tissues of rats.

Objective To investigate the prevalence of hypertension in adults in different water iodine areas and to explore the epidemiological association between high iodine intake in drinking water and hypertension.Methods In 2016,Xiwenzhuang Village of Taiyuan City as an appropriate-indine area,Gaoche Village and Maxi Village of Wenshui County were selected in Shanxi Province as a high-iodine area and a low-iodine area,respectively,and conducted questionnaire surveys,clinical hypertension examinations,and determination of urinary iodine levels of residents aged 18 to 65 years.Results A total of 853 people were investigated,including 283 in high-iodine area,258 in appropriate-indine area and 312 in low-iodine area.The medians urinary iodine in high,appropriate and low iodine areas were 423.0,218.5 and 126.6 μg/L,respectively,and the difference was statistically significant (H =289.7,P ＜ 0.05).The detection rates of hypertension in adults with high,appropriate and low iodine levels were 38.9％ (110/283),41.9％ (108/258) and 34.0％ (106/312),respectively,the difference was not significant statistically between the three groups (x2 =3.87,P ＞ 0.05).There was no significant difference in the detection rate of hypertension among males [45.9％(62/135),50.0％ (53/106),40.8％ (53/130)] in different areas (x2 =2.04,P ＞0.05),and no significant difference in the detection rate of hypertension among females [32.4％ (48/148),36.2％ (55/152),29.1％ (53/182),x2 =1.89,P ＞ 0.05];The difference between the three groups was not significant statistically in the detection rate of hypertension both among the 18-＜ 45 years group and 45-65 years group (x2 =1.22,5.66,P ＞ 0.05).Conclusion Drinking water with excess iodine might not increase the risk of hypertension in adults in Shanxi Province.

Objective:To investigate the prevalence of thyroid disease in adults in different water iodine areas and to explore the association between iodine and thyroid disease.Methods:In May of 2016, using cross-sectional survey, Gaoche Village and Maxi Village of Wenshui County were selected in Shanxi Province as a high-iodine area and a low-iodine area, respectively, Xiwenzhuang Village of Taiyuan City as an appropriate-iodine area. Questionnaire surveys, urinary iodine levels, thyroid ultrasound, determination of thyroid function and autoantibody were conducted for permanent residents aged 18 - 65.Results:A total of 898 people were investigated, including 288 in high-iodine area, 324 in low-iodine area and 286 in appropriate-iodine area. The medians urinary iodine were 417.8, 126.6 and 216.5 μg/L in high, low and appropriate-iodine areas, respectively, and the difference was statistically significant ( H = 288.61, P < 0.05). After age and sex standardization, the detection rates of hyperthyroidism in low, appropriate and high-iodine areas were 0.27%, 1.06% and 1.43%, respectively. The detection rates of sub-clinical hyperthyroidism were 0.57%, 0.31% and 0.30%, respectively. The detection rates of hypothyroidism were 1.45%, 1.15% and 1.85%, respectively. The detection rates of sub-clinical hypothyroidism were 19.34%, 28.50% and 32.76%, respectively. The detection rates of thyroid nodule were 20.51%, 20.17% and 33.78%, respectively. The positive rates of anti-thyroglobulin antibodies (TgAb) were 18.13%, 19.41% and 11.99%, respectively. The positive rates of thyroid peroxidase antibody (TPOAb) were 9.25%, 12.04% and 8.97%, respectively. The appropriate-iodine area was used as control, logistic regression analysis showed that only the detection rate of thyroid nodule in high-iodine area was significantly higher than that in appropriate-iodine area [odds ratio ( OR) = 0.488 5, 95% confidence interval ( CI) = 0.327 2 - 0.729 2 , P < 0.05]. Conclusion:In Shanxi Province, the detection rate of thyroid nodules is different in different areas of water iodine, and the detection rate of thyroid nodule in adults in high-iodine area is higher than that in other areas.

Objective:To study the relationship between thyroid volume (TV) and thyroid autoantibodies in patients with autoimmune thyroid disease (AITD), and to explore the factors affecting goiter in patients with AITD.Methods:The newly diagnosed AITD adult patients in the Affiliated Hospital of Shanxi Institute for Endemic Disease Prevention and Control from November 2019 to October 2020 were selected for questionnaire survey, physical examination, thyroid function and thyroid autoantibody test, determination of serum iodine content and thyroid ultrasound, and the correlation between thyroid volume and thyroid autoantibody was analyzed.Results:A total of 147 newly diagnosed adult AITD patients were included, including 63 cases of Graves' disease (GD, 30 males and 33 females) and 84 cases of chronic lymphocytic thyroiditis (HT, 29 males and 55 females). The TV of male and female patients with GD was positively correlated with the levels of thyrotropin receptor antibody (TRAb) ( rmen = 0.515, rwomen = 0.412, P < 0.05). The TV of male and female patients with HT was not correlated with the levels of thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb, rmen = - 0.137, 0.168, rwomen = 0.184, - 0.088, P > 0.05). There were no correlation between TPOAb levels and TGAb levels in male and female HT patients ( rmen = 0.153, rwomen = 0.102, P > 0.05). The TV of male and female patients with GD or HT was not correlated with the serum levels of iodine ( rmen = 0.230, 0.013, rwomen = 0.096, 0.069, P > 0.05). Conclusion:TRAb level is positively correlated with the TV in GD patients.

Objective:To investigate the influencing factors of breakthrough cancer pain (BTcP) in patients with advanced pancreatic cancer.Methods:According to the inclusion and exclusion criteria, patients with advanced pancreatic cancer who were diagnosed and followed up by outpatient service in the 909th Hospital of the Joint Logistic Support Force from January 2019 to December 2020 were prospectively selected as the study subjects. According to whether breakthrough cancer pain occurred, all patients were divided into observation group (breakthrough cancer pain) and control group (no breakthrough cancer pain). The relevant clinical data of the included patients including age, gender, presence or absence of vomit, constipation, sleep disruption, frequency of basic pain every week, with or without regular medication, heavy physical labor, with or without vascular invasion, bone metastasis, abdominal metastasis and lung metastasis, as well as whether surgery, radiotherapy or chemotherapy were collected and the data of evaluation indicators during follow-up were recorded. Digital pain score (NRS) and visual analog score (VAS) were used as pain evaluation score. Univariate and logistic regression were used to analyze the related influencing factors of breakthrough cancer pain. Receiver operating characteristic curve (ROC) was drawn, and area under curve (AUC), sensitivity and specificity were calculated to analyze the predictive value for breakthrough cancer pain.Results:A total of 173 patients were included in the study, with 49 cases in the observation group and 124 cases in the control group. Univariate analysis showed that aged ≥50 years old, constipation, sleep disruption, frequency of basic pain ≥3 times, irregular medication, heavy physical labor, bone metastasis, lung metastasis, radiochemotherapy, high NRS score and high VAS score were the influencing factors for breakthrough cancer pain (all P value <0.05). Multivariate analysis showed that irregular medication ( OR=1.879, 95% CI 2.473-4.757, P=0.002), basal pain ≥3 times ( OR=2.067, 95% CI 1.364-6.825, P=0.004), bone metastasis ( OR=2.756, 95% CI 1.153-5.846, P<0.001), NRS score ( OR=3.787, 95% CI 2.647-5.958, P<0.001), VAS score ( OR=2.684, 95% CI 1.545-7.878, P<0.001), were the risk factors for breakthrough cancer pain. The AUC of NRS score for predicting the occurrence of breakthrough cancer pain was 0.665 (95% CI0.573-0.757, P=0.001), and the cut-off value was 2.5 score with a sensitivity of 61.2% and a specificity of 77.1%. The AUC for predicting breakthrough cancer pain by VAS score was 0.608 (95% CI0.515-0.701, P=0.028), and the cut-off value was 2.5 score with a sensitivity of 67.9% and a specificity of 63.7%. The AUC of NRS+ VAS score for predicting breakthrough cancer pain was 0.692 (95% CI0.604-0.780), and the cut-off value was 4.5 score with a sensitivity of 81.6% and a specificity of 79.8%. Conclusions:Patients with advanced pancreatic cancer have a high incidence of breakthrough cancer pain, which was related to a variety of factors. NRS combined with VAS score can effectively predict the occurrence of breakthrough cancer pain.