Objective: To assess whether the level of γ-glutamyltransferase(GGT) correlates with severity and stability of coronary atherosclerosis and other established cardiovascular risk factors. Methods: According to the results of coronary angiography, 132 patients with coronary heart disease(CHD) were selected to the CHD group. These patients were further divided into subgroups according to the clinical types, the number of diseased coronary branches. They were devided into one-vessel, two-vessel or three-vessel disease on the basis of the number of diseased coronary branches; were devided into stable angina pectoris and acute coronary syndrome according to the clinical types. 30 patients without CHD were selected to the control group. The level of GGT, white blood cell (WBC) count, total bilirubin(TBiL), fasting plasma glucose(FPG), total cholesterol (TC), triglyceride(TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL),glutamic-pyruvic transaminase(ALT), high sensitive C reactive protein(hs-CRP),systolic blood pressure(SBP), diastolic blood pressure(DBP), body mass index(BMI)were measured, and age, prior medical histories including hypertension? diabetes mellitus and smoking status were obtained. The level of GGT was compared statistically between the subgroups, and correlation coefficients of GGT level with other conventional risk factors for CHD were calculated. Results: The level of GGT in CHD patient was significantly higher than that in controls. The level of GGT increased with the increasing number of diseased coronary branches. No significant difference was found in the level of GGT between patients with acute coronary syndrome and stable angina pectoris. The level of GGT was positively correlated with TC, TG and LDL, weakly correlated with WBC count and FPG, not correlated with hs-CRP, negatively correlated with TBiL. HDL. Conclusion: The level of GGT is associated with pathological severity of coronary atherosclerosis and other established cardiovascular risk factors, though it is not associated with stability of pathological changes of the coronary artery. The plasma level of GGT may be an independent risk factor for CHD.

Objective To explore methods of quickly identifying loopholes in medical quality management and to improve medical quality by means of analyzing low-risk death cases.Methods Two rounds of analysis of 1 14 low-risk death cases of hospitals in Beijing in 2012 in terms of data quality and medical procedures,in an effort to identify problems and to verify the feasibility and accuracy of the method through interaction with other data.Results Totally 585 760 inpatients were discharged in 2012 from 21 hospitals,of whom 1 5 1 1 93 being low-risk cases.Such cases included 1 14 low-risk death cases, accounting for 0.01 9% of the total discharged,and 0.075% of low-risk discharged cases.Analysis of these medical records found 50 cases of problematic diagnosis (43.86%),45 cases of possible defects in diagnosis and treatment (39.47%),39 cases of missing items of secondary diagnosis (34.21%),and 28 cases of missing items of surgery/operation (24.56%). Some of the abovementioned cases had overlapping mistakes.Conclusion Analysis of low-risk death cases can help focus among massive data of medical records,problems of diagnostic and therapeutic insufficiency,pinpointing common problems in medical service and improving medical quality and fine management of hospitals.

Objective To explore the problems and solving countermeasures in application of nursing vertical management,and provide references for nursing post management reform.Methods Through purposive sampling method,nursing administers,clinical nurses,heads of clinical departments and performance directors from five hospitals were interviewed by semi-structured interview method.Data were analyzed using 7-step Colaizzi's phenomenological analysis method.Results Four themes were formed about the problems in application of nursing vertical management,including:affecting department management and doctor-nurse collaboration,insufficient scientificity and fairness of performance evaluation,significant issues regarding post setting of senior nurses,competence and sense of belonging of temporarily deployed nurses.Four themes were formed about the solving countermeasures in application of nursing vertical management,including:improving participation of clinical departments in nursing management,making performance system to public and asking advices of nurses,providing career development for senior nurses,and conducting standardized training and establishing reserve nurses tank.Conclusion The main problems in application of nursing vertical management consisted of affecting department management and doctor-nurse collaboration,insufficient scientificity and fairness of performance evaluation,post setting of senior nurses,and competence and sense of belonging of temporarily deployed nurses.We suggested to better apply nursing vertical management by improving participation of clinical department in nursing management,making performance system to public and asking advices of nurses,providing career development for senior nurses,and conducting standardized training and establishing reserve nurses tank.

Objective To study the causes of emergency department (ED) overcrowding and access block in Beijing.Methods This was a multi-center cross sectional study.The studied cohort of patients included all ED visiting patients from 18 municipal teaching hospital EDs in Beijing from 2012 to 2013.Patient' s characteristics and medical care settings were analyzed.Results The urgent care cases accounted for only 4.6 ％ (71 224/1 554 387) of the emergency annual visits in 2012 and 5.5 ％ (88 190/1 615 571) in 2013.The total number of observation patients in EDs was 185 277 and 211 900 in 2012 and 2013 respectively,with an increase of 14.4 ％ (P ＜ 0.01).The total ED-admission inpatients only accounted for 2.97％ and 2.89 ％ of total annual visits in 2012 and 2013 respectively.The average time of ED-admission took 37.1 hours and 36.2 hours in 2012 and 2013 respectively.The average time of ED stay for observation was 4.9 days and 5.4 days in 2012 and 2013 respectively.Upper respiratory tract infection was the leading illness in annual visits.The leading cause of ED stay for observation was bedridden with pneumonia.Conclusions The ED settings in Beijing are different from other countries.The EDs actually assume the task of the clinic and ED service for 24 hours thereby made EDs terribly overcrowded.The main causes are large number of non-emergency patients visiting the ED and patients in the ED are difficulty to be hospitalized.Patients with end-stage disease and multiple organ failure stayed in the ED due to nursing home shortage.

This study was intended to establish a method of purification of HPV16 L1 protein expressed in a prokaryotic system and to obtain the purified protein. The prokaryotic expression vector pGEX-4T-1-HPV16 L1 was constructed and transformed into E. coli BL21 cell, and induced by 1 mM IPTG to express HPV16L1 protein. The inclusion bodies were isolated and solubilized with 8 M urea. After the urea was removed by gradual dialysis, the denatured L1 protein were renatured and then were purified by affinity chromatography. The results showed that HPV16L1 protein formed inclusion bodies in bacterial expression system, suggesting that this assay can be used to purify HPV16L1 protein and hence provide a basis for studying the applications of HPV16 L1 protein.
Capsid Proteins ; biosynthesis ; Escherichia coli ; metabolism ; Genetic Vectors ; Human papillomavirus 16 ; Oncogene Proteins, Viral ; biosynthesis

Objective To report the surgical method and treatment outecome of transfer of free upper limb lateral bone-skin flap for repair of bone defects and nonunion in hand and forearm.Methods 17 cases of hand composite trauma,5 cases of forearm composite trauma and 2 cases of nonunion in forearm were treated with free bone-skin flaps in distal humerus,whose pedicle was the posterior branch of radical collateral artery. Area of the flap was 2cm?3cm to 8cm?10cm,length of exseeted bone was 3～6 cm.Results All the bone-skin flaps completely survived,the donor area all achieved primary healing,On postoperative 1～4 years follow-up,the texture of the flap was excellent,and bone union was obtained in all transplants,the donor area of distal lateral humerus became thicker and thicker with new cortical bones formed.According to the upper arm function assessment criterion issued by hand surgery association of Chinese medical association.The hand function had excellent results in 17 cases and good results in 2 cases.Conclusion The bone-skin flap has following advantages:easy dissection,reliable blood supply,and no major vessel needed to be sacrificed,so it is an effective method for repair of skin and soft tissue with bone defects in hand and forearm,It.also can be used to repair refractory nonunion in ulna and radius.

Objective To use diagnosis related group (DRGs ) for the first time in overall evaluation of inpatient service performance evaluation of major diagnostic category (MDC)for all the Beijing municipal hospitals,and recommend how to strengthen Beijing municipal hospitals system in diagnosis and treatment ability of main diseases and improve inpateint service performance.Methods BJ-DRGs burster software was used to analyze the first page information of the medical records of cases discharged from all the Beijing municipal hospitals between 2012 and 2014 to determine the weight of each DRG,and based on such weight the related indicators of such hospitals and central hospitals in 2012, 2013,2014 were compared and analyzed.Results Improvements were found in such indices as diagnosis and treatment difficulty of 50% MDC,time efficiency of 81.8% MDC,cost efficiency of 77.3% MDC, and general capacity of 54.5% MDC for all Beijing municipal hospitals.In addition,the municipal hospitals were found superior to the central hospitals in such indices as cost efficiency of 68.2% MDC, and time efficiency of 59.1% MDC.On the other hand however,they were found inferior to the central hospitals in such indices as diagnosis and treatment difficulty of 72.7% MDC,and the comprehensive ability index of the two systems were found equivalent.Another finding was that there was no obvious improvement of the coverage of disease types at major tertiary hospitals in Beijing for the past three years.Municipal hospitals of greater contribution of MDC weight were highly consistent with the hospitals assigned with national key projects of disciplinary developments. Conclusion The comprehensive evaluation results of inpatient service performance of main diseases at Beijing’s municipal hospitals based on DRGs system,showed that the Beijing’s hospital authority had played an important role in improving inpatient service performance especially in reducing the burden of patients,improving the service efficiency through increasing government investment,optimizing service organization and implementation of performance management.But it also suggested that measures such as collectivize construction and management should be taken to improve municipal hospitals’linical specialty ability, improve the MDC diagnosis and treatment difficulty,and resume their functions of tertiary hospitals.

Adenoma ; genetics ; metabolism ; pathology ; surgery ; Adult ; Carcinoma, Papillary ; genetics ; metabolism ; pathology ; Diagnosis, Differential ; Exons ; Female ; Follow-Up Studies ; Humans ; Ki-67 Antigen ; metabolism ; Male ; Mutation ; Nuclear Proteins ; metabolism ; Proto-Oncogene Proteins B-raf ; genetics ; Thyroglobulin ; metabolism ; Thyroid Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Thyroid Nuclear Factor 1 ; Transcription Factors ; metabolism

OBJECTIVETo biomechanical analysis of the correlation between sacral tilt displacement and L₅-S₁ disc degeneration.

METHODSFrom July 2011 to July 2013, 81 patients with lumbar disc herniation and sacroiliac joint disorder including 45 males and 36 females with an average age of (45.39±1.30) years ranging from 18 to 65 years old were selected. The course of the disease ranged from 1 to 144 months with an average of (12.64±2.19) months. All patients were taken lumbar spine lateral X-ray films, the lumbar curvature angle, L₄-L₅ or L₅-S₁ intervertebral gap distance between points, and the lumbosacral angle was measured and correlated analyzed.

RESULTSThe lumbar curvature of female patients with L₅S₁DH were significantly larger than male patients [(22.18±8.62)° vs (16.17±4.97)°,<0.05]. Lumbar curvature and lumbosacral angle showed a positive correlation in LDH (=0.48,<0.01,y=7.25+0.38x,<0.01); Male patients with L₄-₅DH were more obvious (=0.55,<0.05, y=5.80+0.43x,<0.01); Female patients with L₅S₁DH were particularly evident(=0.74,<0.01,y=0.91x-5.30,<0.01). The lumbosacral angle and L₄-₅ intervertebral gap was a positive correlation in L₄-₅DH(=0.27,<0.05); While L₅-S₁ intervertebral gap and lumbosacral angle were not correlated(>0.05) in L₅S₁DH.

CONCLUSIONSThe sacral tilt displacement and L₅-S₁ disc degeneration were closely related to provide a new understanding philosophy and therapeutic approach for clinical treatment of intractable lumbar L₅S₁DH.

OBJECTIVETo investigate the role of liver X receptors (LXRs) on endothelin-1 (ET-1) induced murine HL-1 cardiomyocytes hypertrophy.

METHODSCultured murine HL-1 cardiomyocytes were divided into four experiment groups: (1) CONTROL GROUP:treated with DMSO; (2) T0901317 group:treated with LXRs agonist T0901317 (1 µmol/L); (3) ET-1 group:treated with ET-1 (1 nmol/L); (4) T0901317 + ET-1 group:treated with T0901317 (1 µmol/L) for 8 hours, then treated with ET-1 (1 nmol/L). Twenty-four hours later, immunofluorescent staining was performed on HL-1 cells, the surface area of HL-1 cells was analyzed with NIH Image J software, and the synthetic rate of protein in HL-1 cells was detected by (3)H-leucine incorporation. The mRNA level of atrial natriuretic peptide (ANP) and β-myosin heavy chain (β-MyHC) was measured by quantitative realtime PCR. The effect of T0901317 on mRNA expression of ANP was also detected after LXRs gene silencing.

RESULTSThe surface area of HL-1 cells, mRNA expression of ANP and β-MyHC, and (3)H-leucine incorporation in ET-1 group were 2.00 ± 0.29, 1.98 ± 0.47, 2.13 ± 0.39 and 1.79 ± 0.17, respectively, which were significantly higher than those of control group (1.00 ± 0.26, 1.00 ± 0.21, 1.00 ± 0.31 and 1.00 ± 0.03, respectively, all P < 0.05). Compared with ET-1 group, the surface area of HL-1 cells, mRNA expression of ANP and β-MyHC, and (3)H-leucine incorporation were significantly decreased in T0901317 + ET-1 group (1.24 ± 0.25, 1.19 ± 0.21, 1.48 ± 0.27 and 1.15 ± 0.11, respectively, all P < 0.05). After inhibition of LXRα/β expression in HL-1 cardiomyocytes using the specific siRNAs, the mRNA expression of ANP in T0901317 + ET-1 group was 1.78 ± 0.05, which was similar as that in ET-1 group (1.94 ± 0.17, P > 0.05).

CONCLUSIONT0901317, an agonist of LXRs, could inhibit ET-1 induced cardiac hypertrophy in vitro, and LXR ligand-mediated inhibition on ANP mRNA expression by T0901317 is receptor dependent.

Animals ; Cardiomegaly ; metabolism ; Cell Line ; Endothelin-1 ; metabolism ; Hydrocarbons, Fluorinated ; pharmacology ; Liver X Receptors ; Mice ; Myocytes, Cardiac ; drug effects ; metabolism ; Orphan Nuclear Receptors ; agonists ; metabolism ; Signal Transduction ; drug effects ; Sulfonamides ; pharmacology