Based on the organization and implementation of the comprehensive reform of countylevel public hospitals in 15 provinces (municipalities)in southern China,the research discussed the progress and problems of such reforr.The progress made and areas of the reform vary among provinces and municipalities.For example,the reform has completely covered all the counties in four provinces such as Zhejiang and Jiangsu province.Medicine markups have been canceled in all the pilot counties by adjusting the service prices to pave the way for hospital compensation.Contemporary hospital management,remuneration system and personnel system reform are also main targets of the reform,while the collaboration between superiors and subordinates,and hospital regulatory system have recently been included.Problems are also found with the current reform:for example,lack of attention for the system reform,no fundamental changes in place in the business orientation of hospitals,as well as problems in collaboration among departments,and hospital debts.

Lactose was shown to no less competent than Isopropyl-?-D-thiogalactoside (IPTG) in inducing the expression of the ENHANCIN coding gene from Helicoverpa armigera granulosis virus in Eswcherichia coli BL21 (DE3) regulated by a T7 promoter, since the lactose induction could lead to an ENHANCIN band no smaller than the one in IPTG induction on the SDS-PAGE gel. This would decrease the cost of the large-scale ENHANCIN production. The lactose concentration was optimized at 2.2% - 2.5% (w/v) . Different treatments on the lactose sterilization showed that lactose steam- sterilized in 116. 5℃ for 15min could lead to the ENHANCIN production. The convenience and the relatively low cost in its" operation could further decrease the cost of the ENHANCIN production.

Objective To investigate the association between arsenic(+3 oxidation state) methyltransferase (AS3MT) genetic polymorphism and susceptibility to endemic arsenism.Methods Polymerase chain reactionrestriction fragment length polymorphism-single strand conformation polymorphism(PCR-RFLP-SSCP) technology was performed to detect mutations of AS3MT gene intron 8 and exon 9 in genome DNA of the 79 cases and 110 controls.PCR products with abnormal band forms were further sequenced to find the types and sites of mutation.Chi-square test and multivariate Logistic analyses were conducted.Results The incidence of the 9149 base mutation(A→C) in AS3MT gene intron 8(AS3MT-9149) in case group(19.0％,15/79) was lower than that in control group (23.6％,26/110).The incidence of the codon 287 mutation(ATG→AT/CG) in AS3MT gene exon 9(AS3MT-287)in case group(10.1％,8/79) was lower than that in control group (11.8％,13/110).However,statistical analysis indicated no significant difference in both mutations between two groups[AS3MT-9149:odds ratio(OR) =0.59,95％ confidence interval(CI):0.26-1.31,P =0.195; AS3MT-287:OR =0.85,95％ CI:0.32-230,P =0.751].Conclusions There are no significant association between the genetic polymorphisms of AS3MT-9149,AS3MT-287 and the susceptibility to endemic arsenism.Similarly,due to small sample amount,we can not exclude the possibility that these gene polymorphisms are related to susceptibility to endemic arsenism.

OBJECTIVETo study the effect of acupuncture on the immune function of sepsis patients.

METHODSNinety sepsis patients were assigned to the control group, the thymosin a1 group, and the acupuncture treatment group according to random digit table, 30 patients in each group. Patients in the control group were treated according to the guideline of Surviving Sepsis Campaign (SSC). Patients in the control group received routine treatment. Those in the thymosin alpha1 group additionally received subdermal injection of thymosin alpha1 (1.6 mg), once per day for 6 successive days. Needling at related points such as Zusanli (ST36), Yanglingquan (GB34), Neiguan (PC6), Guanyuan (RN4), and so on, was performed in patients of the acupuncture treatment group, once per day for 6 successive days. T cell subgroups (CD3+, CD4+, CD8+, CD4+ /CD8+) and immunoglobulin levels (IgG, IgA, IgM) were detected. The length of ICU hospital stay, hospital readmission rate, and 28-day mortality were compared among the three groups.

RESULTSAfter six days of treatment, CD3+, CD4+, CD8+, IgG, IgA, IgM, and CD4+ /CD8+ ratio of three groups were all significantly increased (P < 0.01). Of them, CD3+, CD4+, CD8+, IgG, IgA, and IgM increased more significantly in the thymosin alpha1 group and the acupuncture treatment group (P < 0.01). Compared with the control group, the ICU hospitalization length was significantly shortened, the hospital readmission rate and the 28-day mortality were lower in the thymosin alpha1 group and the acupuncture treatment group (P < 0.05, P < 0.01). There was no statistical difference in each index between the thymosin alpha1 group and the acupuncture treatment group (P > 0.05).

CONCLUSIONAcupuncture could adjust the immune function of sepsis patients, improve their immunological indicators and prognoses.

Acupuncture Therapy ; CD4-CD8 Ratio ; Humans ; Length of Stay ; Prognosis ; Sepsis ; diagnosis ; immunology ; therapy ; T-Lymphocyte Subsets ; Thymosin ; analogs & derivatives

Objective To investigate the correlation factors for hot flashes in climacteric women so as to improve their quality of life. Methods A questionnaire was distributed among 792 climacteric women. The questionnaire items included general information, characteristics of menstruation, reproduction history, information of hot flashes, lifestyle and sexual life. Weight, height, blood pressure, waist and hip circumferences were measured. Logistic regression analysis was made to find out the correlation factors for hot flashes. Results Univariate logistic regression analysis showed that age, education, income, present characteristics of menstruation, dietary habit, soy products intake, physical exercise, satisfaction of sexual life, body mass index (BMI) and systolic blood pressure were significantly associated with hot flashes. Multivariate logistic regression analysis revealed that irregular menstruation or menopause, frequent exercise and higher systolic blood pressure were risk factors for hot flashes in climacteric women. However, higher education, soy products intake and satisfaction of sexual life were protection factors. Conclusion Guiding climacteric women to take moderate physical exercise, knowing more about climacterium, consuming more soy products and controlling diastolic blood pressure are likely to decrease the incidence of hot flashes.

Objective To investigate the three-dimensional structure of normal male canine prostat- ic duct and acinus system,and to study the mechanism of intraprostatic urinary reflux(IPUR)resulting from high pressure of the posterior urethra by experiment.Methods Using scanning electron microscopy (SEM)and corrosion casting methods,high pressure of the prostatic urethra was produced based upon IPUR in normal male canines.Acrylonitrile-butadiene-styrene(ABS)casting solution was injected into 8 Beagle canines'normal prostates to induce intraprostatie resin solution reflux.Results Six casting molds of nor- real canine prostate specimens were obtained,and the casting failed in 2.By corrosion and casting treatment, the prostate appeared to consist of several glandular lobes.The columnar apophyses of glandular surface were observed.The most glandular ducts pointed outward from urethral peristome.Each glandular duct system was made up of many bifurcated branches from the bough as a duct tree.More than 90% of the bifurcations were Y-shaped,and 6 bifurcated branches were rarely seen.The tip of the duct was vesicular.The diameter and length of the bough were(0.37?0.14)mm and(1.14?0.04)mm,respectively.The intersectional angle of urethra and peripheral glandular duct was the biggest.Peripheral glandular duct was perpendicular or con- verse to urinary flow.Peripheral glandular aeinus appeared elliptic and velvet.The mesh-like and crater-like depressions were shown on the surface of central glandular aeinus.Ejaculatory ducts independently and branchlessly entered the urethra.Conclusions The resin corrosion casting methods combined with SEM can clearly show the three-dimensional structure of normal male canine prostatic duct and acinus system. IPUR may easily occur in the peripheral glands from the morphological view.It is suggested that prostatitis occurs more commonly in peripheral glands,confirming a fact that high pressure of the posterior urethra can induce IPUR.

OBJECTIVESince glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common hereditary hemolytic erythrocyte enzyme deficiency, most cases have single nucleotide mutations in the coding region, and current test methods for gene mutation have some missed detections, this study aimed to investigate the feasibility of RT-PCR sequencing in the detection of gene mutation in G6PD deficiency.

METHODSAccording to the G6PD/6GPD ratio, 195 children with anemia of unknown cause or who underwent physical examination between August 2013 and July 2014 were classified into G6PD-deficiency group with 130 children (G6PD/6GPD ratio <1.00) and control group with 65 children (G6PD/6GPD ratio≥1.00). The primer design and PCR amplification conditions were optimized, and RT-PCR sequencing was used to analyze the complete coding sequence and verify the genomic DNA sequence in the two groups.

RESULTSIn the G6PD-deficiency group, the detection rate of gene mutation was 100% and 13 missense mutations were detected, including one new mutation. In the control group, no missense mutation was detected in 28 boys; 13 heterozygous missense mutations, 1 homozygous same-sense mutation (C1191T) which had not been reported in China and abroad, and 14 single nucleotide polymorphisms of C1311T were detected in 37 girls. The control group showed a high rate of missed detection of G6PD deficiency (carriers) in the specimens from girls (35%, 13/37).

CONCLUSIONSRT-PCR sequencing has a high detection rate of G6PD gene mutation and a certain value in clinical diagnosis of G6PD deficiency.

Adolescent ; Child ; Child, Preschool ; Female ; Glucosephosphate Dehydrogenase ; genetics ; Glucosephosphate Dehydrogenase Deficiency ; diagnosis ; genetics ; Humans ; Infant ; Male ; Mutation ; Reverse Transcriptase Polymerase Chain Reaction ; methods ; Sequence Analysis, DNA

Objective To explore the value of brain CT scanning for distinguishing tumor-like inflammatory demyelinating diseases (TIDD) from glioma or primary central nervous system lymphoma.Methods The brain CT features in 20 patients with TIDD(10 female,10 male;mean age (35.6±14.0)years;range,6-51 years)and 32 gliomas(16 female,16 male;mean age(42.0±19.8)years;range,12-75 years)and 6 lymphomas(3 female,3 male;mean age(53.8±11.8)years;range,32-68 years)were retrospectively reviewed and compared between brain tumors and TIDD.Results (1)Among the 38 primary brain tumors,there were 19 cases(50%,14 gliomas,5 lymphomas)with hyperdense lesions,10 cases(26.3%,9 gliomas,1 lymphomas)with isodense lesions,and 9 glionms (23.7%)with hypodense lesions.In contrast,the brain unenhanced CT manifestation of 20 TIDD all showed with hypodense lesions.(2)On unenhanced CT the lesions of 6 lymphomas all were hyperdense or isodense,like 90% of 20 high grade gliomas(WHO grade Ⅲ and Ⅳ),but this rate for grade Ⅱ was only 41.7%.(3)According to the shape of hyperdense lesions of the 19 primary brain tumors with,7 cages(6 gliomas,1 lymphomas)manifested with asymmetric hyperdense small-patches,4 cases(1 gliomas,3 lymphomas)with symmetric hyperdense large-patches,4 cases(3 gliomas,1 lymphomas)with diffused hyperdensed lesions,and 4 cases(4 gliomas)with ring-shaped hyperdensed lesions.Furthermore,4 primary brain tumors(4 lymphomas)underwent CT enhanced scanning and all the cases showed strong enhancement(3 cases with hyperdense lesions and 1 with isodense lesions on unenhanced CT),but only 3 cases of 7 TIDD showed mild enhancement in contrast.(4)By Spearman's relevant analysis,hyperdense and isodense on unenhanced CT was proved to have significant positive correlation between the grade of gliomas(r=0.435,P=0.013).Therefore,the frequency of hyperdense and isodense lesions in lymphomas and WHO grade Ⅲ and Ⅳ astrocytoma was higher in contrast with low grade astrocytoma.Conclusions Brain CT as a simple,economical and practical examination method has significant meaning for differentiating TIDD from glioma or PCNSL and could be used as an adjuvant method for MRI and magnetic resonance spectroscopy.Patients with hyperdense or isodense on unenhanced CT or strong enhancement could be excluded from TIDD.

Objective To investigate the effect of long-term high-fat diet on insulin resistance and the morphology and function of islets in rats and the relationship between them.Methods Thirty normal male Wistar rats (8 weeks old) were divided into two groups and fed either with normal chow (NC,n=15),or high-caloric and high-fat diet (HF,n=15).Insulin resistance was assessed by euglycemic hyperinsulinemic clamp technique. The insulin secretory function of islets was evaluated by intravenous insulin releasing test.Morphological and quantitative analysis of pancreatic tissues was performed by double-label insulin and glucagon immunohistochemistry.Proinsulin mRNA was detected by RT-PCR.Results The glucose infusion rate (GIR) in HF rats was significandy lower than that in NC rats [(5.83?0.79)mg?kg~(-1)?min~(-1) vs (7.60?1.29)mg?kg~(-1)?min~(-1),P＜0.05].Immunohistochemistry showed that HF rats had larger islet size [(15168?1327)?m~2 vs (6264?1840)?m~2,P＜0.01] and significantly reduced insulin relative concentration of?cells[(-5.15?0.03) vs (-4.81?0.17),P＜0.01],as compared with NC rats.The islet relative?cell volume was decreased signifieandy (P＜0.01),whereas the relative?cell volume was increased (P＜0.01).So the ratio of?to?were lower in HF [(4.68?1.01) vs (11.84?3.82),P＜0.05].The peak of insulin secretion in intravenous insulin releasing test in HF was at 10 min,whereas that in NC rats was at 5 min.AUC (area under curve) 10-60 rain of insulin in HF was higher than that in NC rats [(152.51?34.53)mIU?L~(-1)?min~(-1) vs (86.40?21.21) mIU?L~(-1)?min~(-1),P＜0.01].There was no difference in proinsulin mRNA levels between two groups. Conclusion Long-term high-caloric and high-fat diet results in early impairment of islet morphology and function, as well as significant insulin resistance,suggesting that the compensation ability of islets has already been impaired in the early course of type 2 diabetes mellitus.

Objective To compare the differences and consistency of three criteria of metabolic syndrome(MS)including the third Report of the Adult Treatment Panel Ⅲ of National Cholesterol Education Program(NCEP-ATPⅢ),Chinese Diabetes Society(CDS)and International Diabetes Federation(IDF)used for evaluating in children and adolescents.Methods Four hundred and thirty-two overweight or obesity children and adolescents from Chuansha district of Pudong New Area of Shanghai were selected.Data of investigation of the risk factors of cardiovascular disease were reviewed.Anthropometric measurements and fast plasma glucose(FPG),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and dynamic blood pressure monitoring were performed.MS were identified according to NCEP-ATPⅢ criteria modified by Cook,CDS criteria modified by Liang,and IDF criteria,respectively.The consistency of the 3 criteria were studied.Results The number of subjects who met the criteria of MS were 31.0%,9.5% and 25.7% using Cook,Liang and IDF criteria,respectively.The conformity rate between Cook and Liang,Cook and IDF,Liang and IDF were 78.5%,89.1% and 83.8%,and the Kappa value were 0.378 20,0.719 18 and 0.465 37,respectively.Conclusions There are differences in consistency among the 3 criteria of MS.The agreement in the diagnosis of MS using Cook and IDF definition is higher than using Liang and other 2 definitions.The number of subjects who met the Cook criteria of MS is the most.The Cook definition may be more suitable for MS diagnosis in children and adolescents.A high conformity rate between Cook and and IDF criterion is proved.It is necessary to work out a universally accepted criterion adapted to children and adolescents.