"Everyone′s access to healthcare service" is established as the ultimate goal of the healthcare reform,which manifests the principle of impartiality.The practice of impartiality principle is not only the duty-bound responsibility of public hospitals,but also the important orientation of public hospitals′ reform,thus should be performed through out the whole process of healthcare reform,in order to explore a management system of public hospitals consistent with the Chinese current condition.

Objective To investigate the existence and variance of quinolone-resistance genes in a group of pan-drug resistant of Acinetobacter baumannii ( A.baumannii ).Methods Twenty strains of pandrug resistant A.baumannii were isolated from patients registered in Affiliated Hospital of Nantong University from January 2011 to April 2011.Drug target genes to quinolone (gyrA,parC) and quinolone-resistance genes mediated by mobile genetic elements [ qnrA,qnrB,qnrS,aac(6')-Ⅰ b-cr,qepA] were analyzed by PCR and verified by DNA sequencing.Results In all 20 strains of A.baumannii,the sense mutation was found in the quinolone resistance-determining region of the gyrA gene in the form of TCA to TTA at codon 83 (Ser-83-Leu).Moreover,in the quinolone resistance-determining region of the parC gene sense mutation was found in the form of TCG to TTG at codon 80 (Ser-80-Leu) and 3 synonymous mutations were CCC to CCT at codon 40,GTA to GT]T at codon 41 and CGT to CGC at codon 44.And parC gene was a new mutation.However,mutations were not found in quinolone-resistance genes mediated by mobile genetic elements [ qnrA,qnrB,qnrS,aac( 6 ' )-Ⅰ b-cr,qepA ].Conclusion Quinolone-resistance-determining region play a key role in resistance to quinolones in this group of A.baumannii.To our knowledge,this is first report about the emergence of the new mutation of parC gene in China.

Objective To evaluate the value of two-dimensional (2D) and color Doppler ultrasonography and B-blood flow (B-flow) in quick screening for venous diseases of the lower extremities in late pregnant women. Methods Sixty late pregnant women excluding other-cause blood vessel diseases were recruited during September 2007 to January 2008 and underwent 2D and color Doppler ultrasonography and B-blood flow examinations for diameter and blood flow velocity of the veins in their both lower extremities during prenatal and postnatal periods to record intravenous condition, activities of the venous valve and venous valvular regurgitation in detail. Results Diameters of the veins in beth lower extremities of the late pregnant women widened significantly during prenatal period, as compared to that in postnatal period [(11.5±1.5) mm vs. (8.4±1.0) mm, t =7.14, P <0.01] and their blood flow velocity slowed down significantly in prenatal period than that in postnatal period [(11.5±4.0) cm/s vs. (29.7±6.9) cm/s, t =-15.74, P <0.01]. Spontaneous enhancement phenomenon could be shown in their veins in 57 of 60 (95%) pregnant women by 2D and color Doppler ultrasonography, but could not be shown by 2D and color Doppler uhrasonography in the poplitel veins in 21 pregnant women (35%) or in the small and great saphenous veins in 39 pregnant women (65%), which should be activated by B-flow. Venous valvular regurgitation occurred in the great saphenous veins and the superficial femoral veins in 24 percent of pregnant women during prenatal period, and small venous valve bag thrombus formed in 20 percent of the superficial femoral veins and 10 percent of the great saphenous veins, but disappeared two weeks after delivery, without formation of pulmonary embolism. Conclusion Tow-dimentional and color Doppler ultrasonography and B-blood flow examinations can be used in late pregnant women to quickly screen for venous diseases in their lower extremities.

Transient receptor potential A1 (TRPAl) is a cold sensitive cation channel, which could also be activated by various pungent compounds. As a transduction channel in a number of sensory modalities, TRPAl expressing in heterogonous systems serves to provide great convenience in pharmacological analysis and functional investigation. Due to cellular toxicity, establishment of stable TRPAl cell line has always been challenging. Nevertheless, the first stable human embryonic kidney (HEK-293) cell line with un-controlled expression of TRPAl was successfully established. It was also confirmed that this stable cell line retained TRPAl expression for more than 25 passages in culture. The functional analysis of the cell response verified the stability and specificity of this novel recombinant TRPAl cell line. Altogether, the data indicated this TRPAl-HEK cell line would be a useful tool for functional analysis of TRPAl and for the development of high throughput screening (HTS) compatible assay in the effort to identify TRPAl modulators.

Objective This study evaluates the Anti- hypoxic effect of Fo li um Bambusae extract (FBE). Methods The survival time of mice under the conditi on of closed normobaric hypoxia, and those subjected to KCN, NaNO2 and lidoc aine poisoning, and the time of electrocardiograph disappearance after occlusio n of trachea and the duration of continuous gasping in mice after decapitation were used to evaluate the Anti- hypoxic effect of FBE. Results FBE ( 22.5 m g/kg, 45.0 mg/kg, 90.0 mg/kg) prolonged the survival time of mice under the c ondition of closed normobaric hypoxia, prolonged the survival time in mice subj ected to KCN, NaNO2 and lidocaine poisoning and prolonged the time of electro cardiograph disappearance and the duration of gasping in decapitated mice. Conc lusion FBE can increase the anti- hypoxic effect of animals.

Apolipoprotein C3 (APOC3) is a multifunctional protein.Its concentration is positively correlated with triglyceride (TG) levels and is an independent risk factor for coronary heart disease (CAD) prediction and development.Recent studies showed that APOC3 could not only regulate triglyceride-rich lipoproteins (TRL) metabolism,but also regulated endothelial function,that is,it could induce endothelial dysfunction and disorders of lipid metabolism.Gradually,APOC3 induces atherosclerosis (AS),increases the risk of the occurrence of CAD and other related diseases.APOC3 polymorphisms are also closely related to related diseases.

Objective To investigate the expression of B-cell activating factor ( BAFF ) and its specific receptor BAFF-R in patients with B-cell non-Hodgkin′s lymphoma ( B-NHL) and to analyze the cor-relations between BAFF and the development of B-NHL.Methods RTQ-PCR and Western blot assay were used to measure the expression of BAFF and its specific receptor BAFF-R in patients with B-NHL.Fluores-cence immunocytochemical staining was used to determine the localization of BAFF and BAFF-R in Raji cells, a B-NHL cell line.The expression of BAFF in tumor tissues from patients with B-NHL of different his-tologic subtypes was measured by immunohistochemistry.WST proliferation and TUNEL assays were used to evaluate the effects of BAFF and BAFF-R on the proliferation, survival rate and apoptosis of Raji cells.Lin-ear correlations between the concentrations of lactate dehydrogenase ( LDH) and the expression of BAFF and BAFF at mRNA and protein levels in patients with B-NHL were analyzed.Results BAFF and its specific receptor BAFF-R were expressed in Raji cells and played an important role in the survival and proliferation of B-NHL cell line.The expression of BAFF in tumor cells from patients with B-NHL varied with the different histologic subtypes of B-NHL.Patients with small B-cell malignant lymphoma, large B-cell lymphoma ( LBCL) , mucosa-associated lymphoid tissue lymphoma ( MALT lymphoma) and follicular lymphoma showed higher levels of BAFF, while those with mantle cell lymphoma showed lower levels of BAFF.Compared with the healthy subjects, patients with B-NHL showed significantly increased expression of BAFF at mRNA and protein levels.The levels of LDH were closely related to the expression of BAFF at mRNA and protein lev-els.Conclusion BAFF and its specific receptor BAFF-R might play an important role in the growth and survival of malignant B cells.

Objective To explore the application value of pulse induced contour cardiac output (PiCCO) monitoring in diagnosis and treatment of patients with neurogenic pulmonary edema (NPE).Methods With review of literature, the data of 4 patients of severe neurological disease complicated by NPE admitted into Department of Critical Care Medicine of Huangshan People's Hospital Affiliated to Wannan Medical College from 2011 to 2013 were retrospectively analyzed and discussed in their PiCCO hemodynamic characteristics and processes of treatment.Results The PiCCO of 4 patients with NPE showed that the extravascular lung water index (EVLWI) was increased significantly (EVLWI was 12 - 42 mL/kg on admission and 10 - 22 mL/kg after hospitalization for 24 hours), all revealing a high permeability pulmonary edema type. The capacity balance of the first 24 hours in the 4 cases was all of positive balance (+1 130, +1 200, +1 750, +1 120 mL respectively). In the treatment, the supplementary colloid was strengthened, the vasoactive drugs such as, dopamine, dobutamine, milrinone, etc were applied to improve the circulatory oxygenation, then the EVLWI was declined; finally the disease situation in 3 cases was improved and one died.Conclusions The clinical diagnosis and treatment of NPE is complex, and many contradictions appear in the therapeutic course. PiCCO monitoring is valuable in early diagnosis, identification of pulmonary edema type, guidance in fluid supplement and vascular active drug application, and assessment of disease severity and prognosis.

ObjectiveTo explore the risk factors of the occurrence of acute kidney injury (AKI) in critically ill patients, and to investigate the effect of hydroxyethyl starch (HES) on renal function in these patients.Methods A prospective investigation was conducted. Critically ill patients admitted to Department of Critical Care Medicine of People's Hospital of Huangshan, Wannan Medical College from March 2012 to October 2013 were enrolled. For all the patients under observation, the following data were collected: demography, comorbidities, clinical presentation, severity of illness, and the use of blood product and drugs. All patients were divided into AKI group and non-AKI group by means of Acute Kidney Injury Network (AKIN) criteria, then the risk factors of AKI were investigated by means of univariate and multivariate logistic regression analysis. The effect of HES 130/0.4 administration on renal function in critically ill patients was evaluated.Results 314 patients were enrolled for study out of 1 152 patients admitted. Among these patients enrolled, 89 of them were found to suffer from AKI. AKI was classified as stage 1 in 59 patients, stage 2 in 19 patients, and stage 3 in 11 patients. It was shown by the univariate analysis that 12 variables were the risk factors of AKI, including age, hypertension, diabetes mellitus, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, coagulation SOFA score, neurological SOFA score, cardiovascular SOFA score, blood pH on intensive care unit (ICU) admission, blood glucose on ICU admission, accumulating dose of HES, and presence of shock (P< 0.05 orP< 0.01). However, HES administration and daily maximum dose of HES were not the risk factors of AKI in critically ill patients (bothP> 0.05). Using the multivariate logistic regression analysis, it was shown that total SOFA score [odds ratio (OR) = 1.20, 95% confidence interval (95%CI) = 1.09-1.32,P< 0.001], hypertension (OR = 2.44, 95%CI = 1.22-4.89,P= 0.012), blood glucose level on ICU admission (OR= 1.85, 95%CI = 1.32-2.59,P< 0.001), and presence of shock (OR = 3.81, 95%CI = 1.93-7.53,P< 0.001) were independent predictors of AKI in critically ill patients, however, the cumulative dose of HES was not independent risk factor for AKI (OR = 0.77, 95%CI = 0.68-0.87,P< 0.001).Conclusions Total SOFA score, hypertension, blood glucose level on ICU admission, and presence of shock were independent risk factors for AKI in critically ill patients. HES administration may not be a causative factor of an increased risk of AKI in the ICU.

Objective To explore the significance of warning score of potential critical disease in predicting changes in patients with traumatic brain injury. Methods The clinic information of 75 patients with traumatic brain injury who were treated in the People's Hospital of Huangshan Affiliated to Wannan Medical College from Jan. to Dec. 2013 were analyzed retrospectively. The warning score of potential critical disease, modified early warning score( MEWS)and glasgow coma score( GCS)of all patients and the rates of changes in patients were calculated. Results Of 75 patients enrolled,60 were survived and 15 were died. Seventy-five patients were performed 448 times of warning score of potential critical disease,MEWS and GCS. The maximum, minimum of warning score of potential critical disease were 24 and 0,and the median score(P25,P75)was 4(2, 7). The maximum,minimum of MEWS were 24 and 0,and the median score( P25,P75 )was 4( 3,7 ). The maximum,minimum of GCS were 8 and 3,and the median score(P25,P75)was 5(4,7). The area under ROC of warning score of potential critical disease was 0. 76(95%CI =0. 66 -0. 86,P ﹤0. 01),Youden index was 0. 42 when score was taken 5. 5. The area under the ROC of MEWS was 0. 71( 95%CI =0. 61 -0. 81,P﹤0. 01),Youden index was 0. 4 when taken 3. 5 score. The area under the ROC of GCS was 0. 51(95%CI=0. 37-0. 63,P=0. 99),Youden index was 0. 27 when score was taken 4. 5. Conclusion The warning score of potential critical disease is effective to predict changes in conditions of patients with multiple injuries and better than MEWS and GCS.