0.05)was found in the 2 groups.The costs of the 2 groups were 3270.84 yuan and 10 873.20 yuan respectively,and the cost-effectiveness rates were 37.38 and 117.55 respectively.Conclusion:Scheme A is an effective,safe and economical scheme in the treatment of CHB.

Objective To investigate the expression and clinicalsignificance of neutrophils heparin binding protein (HBP) and CD64 in the chronic obstructive pulmonary disease to explore the clinical value. Methods From March 2015 to December 2015 , 197 patients with chronic obstructive pulmonary disease (COPD), 223 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and 265 healthy persons were recruited in this study. 223 patients with AECOPD were divided into two groups based on bacteria concentration in lower respiratory. Infection group was defined as patients with bacteria concentration exceeded 107 cfu/mL group. The rest of patients were in the non-bacterial infection group. Flow cytometry was used to analyzeexpression of CD64 and convert to index of CD64. Enzyme-linked immunosorbent assay (ELISA) was used to analyze expression of HBP. PCT, hs-CRP and WBC were measured at the same time. Results CD64 , HBP , CRP , WBC and PCT were highly expressed inthe acute exacerbation of chronic obstructive pulmonary patients than those in the chronic obstructive pulmonary patients and healthy group (P<0.01). CD64, HBP , CRP , WBC and PCT were highly expressed inthe acute exacerbation of chronic obstructive pulmonary bacterial infection group patients before treatment than thenon-bacterial infection group (P<0.01). HBP, CD64, CRP , WBC and PCT decline dramatically inthe AECOPDbacterial infection group patients after treatment , which were close to the levels in non-bacterial infection group.When the intercept value of CD64 index was defined as 4.0, the sensitivity to diagnose AECOPD bacterial infection was 92.2% with specificity of 86.2%. When the intercept value of HBP index was defined as 49 ng/mL , the sensitivity to diagnose AECOPD bacterial infection was 87.3% with specificity of 92.3%. Therefore, 4.0 of CD64 index and 49ng/ml of HBP index could be used as sensitive indicator of AECOPD detectedby bacterial infections. Conclusion HBP,CD64 were highly expressed in the acute exacerbation of chronic obstructive pulmonary patients than the those of chronic obstructive pulmonary patients and healthygroup, and decline dramatically after treatment. HBP and CD64 has high sensitivity and specificity to diagnose AECOPD bacterial infection. HBP and CD64 could be used as the indicators of auxiliary diagnosis of acute exacerbation of chronic obstructive pulmonary disease and to guide the clinical medication.

Objective:To develop lipiodol-containing calcium alginate microspheres (LAMs) for embolization,and study the characterization for emoblization and the radiopacity. Methods:LAMs were prepared by dripping method. The preparation of LAMs was optimized by orthogonal experiment which involved effects of three factors (the volume ratio of lipiodol to the external aqueous solution,airflow rate,and the weight pushing the injector) at three levels on the responses to the size,polydisperse index and entrapment efficiency of LAMs. The morphology of LAMs was observed under microscope. The elasticity of LAMs was investigated by texture analyzer. The capability injected through catheter of LAMs was monitored by video spinning-drop tensionmeter. The radiopacity of LAMs was measured by X-ray imaging system after LAMs were injected into vas of a rat. Results:The optimal condition for preparation of LAMs was:the volume ratio of lipiodol to the external aqueous solution was 3∶ 10,airflow rate was 40 g/mL and the weight pushing the injector was 100 g. According to the optimized condition,LAMs were prepared and characterized. The mean diameter of LAMs was (493.9?42.6) ?m,the polydisperse index was 1.02 and the entrapment efficiency was (88.97?1.09)%. The LAMs were with round shape and smooth surface in view of photograph of microscope. The maximum average load was (1.09?0.18) N when LAMs were compressed to 60%. The LAMs were injected through catheter without much difficulty. The radiopacity of LAMs in rats was demonstrated to be visible under X-ray photography system. Conclusion:The radiopaque LAMs developed are suitable for the arterial embolization,with round shape,proper size,good elasticity,easy handling character and visible property under X-ray imaging. The radiopaque embolic agent is supposed to be useful for emoblization therapy.

OBJECTIVE:To study the hypoglycemic effects of Insulin self-microemulsion for parenteral administration on mod-el rats with type 1 diabetes in vivo. METHODS:Rats were treated with streptozotocin(50 mg/kg)to reproduce model with type 1 diabetes,ip. The model rats were randomly divided into model group (normal saline),positive control group (Insulin injection 2.25 u/kg) and self-microemulsion low,medium and high dose groups (Insulin self-microemulsion 4.5,9 and 18 u/kg);and 10 normal rats were involved in sham-operation group (normal saline). Anesthesia and operation were conducted for all rats. Positive control group was administrated,ip;other rats were parenterally administrated. The blood glucose levels in groups were detected be-fore and after 15-600 min administration. Glucose tolerance test was conducted for the rats in normal control group,model group without glucose,model group with glucose and microemulsion group (Insulin self-microemulsion 9 u/kg). All group were given glucose except model group without glucose. RESULTS:Compared with sham-operation group,the blood glucose levels in model group within 0-240 min were increased,with significant difference(P<0.05). Compared with model group,there was hypoglyce-mic trend in positive control group after 15 min,the blood glucose levels within 30-480 min were decreased,the hypoglycemic peak was 36%,and the peak time was 30 min;there was also hypoglycemic trend in microemulsion low,medium and high dose groups after 30 min,the blood glucose levels within 45-360 min were decreased,hypoglycemic peak was 18%-21%,and the peak time was 90-120 min,with significant differences (P<0.01 or P<0.05). All rats had glucose absorption peak except for model group without glucose in glucose tolerance test,and glucose of rats in microemulsion group reached its peak and then quickly de-creased. CONCLUSIONS:Insulin self-microemulsion can obviously reduce the blood glucose of model rats with type 1 diabetes.

Objective To evaluate the reliability of lactate clearance rate in evaluating the efficacy of early fluid resuscitation in the patients with severe sepsis.Methods One hundred and forty-two patients with severe sepsis,aged 28-87 yr,were enrolled in the study.Isotonic crystalloid fluid was infused after admission to ICU to maintain central venous pressure ≥ 8 mmHg,mean arterial pressure ≥ 65 mmHg,central venous oxygen saturation (ScvO2) ≥ 70％,and urine output ≥ 0.5 ml·kg 1 ·h-1 within 6 h.The patients were divided into 2 groups according to the treatment outcome:survival group and death group.Immediately before fluid resuscitation and at 6,12 and 24 h after fluid resuscitation,blood samples were collected from the central vein for blood gas analysis and ScvO2 was recorded.Blood samples were collected from the peripheral vein for determination of the concentration of lactate and lactate clearance rate was calculated.Results Compared with survival group,the lactate clearance rate was significantly decreased at 6,12 and 24 h after fluid resuscitation,and no significant change in ScvO2 was found in death group.Conclusion Lactate clearance rate can evaluate the efficacy of early fluid resuscitation in the patients with severe sepsis.

Purpose To examine the regulatory effect of recombinant human fibroblast growth factor-21 on the expression of liver X receptor α and glucose transporter protein 1 in the type 2 diabetes mellitus rats.Methods The rat models of type 2 diabetic mellitus were divided into four groups at random, ic. rhFGF-21 every day, after eight weeks of these treatment, Inspect the fasting blood glucose (FBG), fructosamine(FA), triglyceride(TG), T-cholesterol(TC), high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C) of these rats, then detecting the mRNA expression of LXRα and GLUT1 by RT-PCR.Results (1) rhFGF-21 can reduce blood glucose steadily to near normal levels in diabetic rats. (2) The expression of LXRα and GLUT1 level was significantly higher in the rhFGF-21 treatment group than that in the model group. (3) rhFGF-21 megadoses and middle doses decreased FA, TG, TC,and LDL-C and elevated HDL-C.Conclusion rhFGF-21 could regulate the mRNA expression of LXRα and GLUT1 in diabetes rats, increase basal level glucose transport, then reduce blood glucose, improve lipid metabolize dysfunction.

Ophthalmology rotation is an integral part of standardized training for general practitioners. The duration of ophthalmology training is only half a month in whole 33-month general practice residency training. The main objective of training for general practice residents is to master the basic clinical skills of ophthalmology, to be able to accurately and timely identify eye diseases, especially those requiring urgent treatment, and to prevent the loss of visual function. This article introduces our teaching experience in ophthalmology training for general practice residents accumulated since 2014. We suggest that the trainees should pre-examine patients independently, play a role of standard patients and receive consultation from teachers. We developed a simple patient assessment form for primary care doctors, the patient who got 10 or more points of the form, should be referred to ophthalmological specialists.

Since the performance appraisal of national tertiary public hospitals was carried out, higher requirements have been put forward for the operation and management of hospitals. Under the premise of ensuring the quality of medical service and medical safety, how to save hospital operating costs and improve the efficiency is an urgent problem for hospital managers. Supported by information upgrading, a tertiary hospital in Guangzhou reformed the treatment process and carried out pre-hospitalization in surgical departments. Data showed that pre-hospitalization can significantly shorten the length of stay, reduce hospitalization costs, and improve the operation efficiency of the hospital.

Objective: To explore the function of cluster needling at scalp points therapy on regulating differential protein's expression at different time points in middle cerebral artery occlusion (MCAO) model rats. Methods: Fifty-four rats were divided into three groups randomly and 18 rats in each group. The groups respectively were the model group (group M, n = 18), cluster needling at scalp points group (group C, n = 18), false operation group (group F, n = 18). Each group was then assigned in three subgroups, including 24-h, 7-day, and 14-day subgroups. Six rats in each subgroup. Acupuncture at Baihui (GV20) and 2 points beside Baihui, which was 3-4 mm away from the midline. Longa score was used to eval-uated neurological effects. Proteomics methods were used to identify differentially expression proteins with a standard of fold change greater than 1.5 and P<.05 at different times. Results: 1. Nerve function scoring: The nerve function scores at 7 and 14 days decreased in group C, which showed better neural function than group M (P<.05). 2. Fold change in proteins:Group M showed 932 differentially expressed proteins compared with group F, and among them, 414 proteins showed significant changes in expression after acupuncture. The expression levels of Cdc42 and GFAP were increased, and Mag, Shank2, and MBP levels were decreased. In the Gene Ontology analysis, the cellular component consisted of the terms cytoplasm, cytoskeleton, lysosome, and plasma membrane. The main related biological processes were cell-cell signaling, protein transport, aging, and cell adhesion. Many synaptic and metabolic pathways were found by KEGG analysis. Conclusion: Cluster needling at scalp acupoints can improve the nerve function score and improve dyskinesia in MCAO model rats. Cluster needling at scalp acupoints can regulate the expression of 414 proteins, including Cdc42, GFAP, Mag, Shank2, and MBP, which are related to cerebral ischemia. The differential proteins are major concentration in cytoplasm, cytoskeleton, lysosomes, and plasma mem-brane, participate in cell-cell signaling, protein transport, aging, and cell adhesion, and act through multiple synaptic and metabolic pathways to exert their biological functions.

Objective To evaluate the status of home medication safety among elderly patients with chronic diseases and analyze its influencing factors in urban and rural areas of Henan Province.Methods Convenient sampling method was adopted.Data was collected through a designed and optimized questionnaire.Pharmacists conducted in-home surveys.Excel and SPSS 26.0 software were used for data analysis.Results A total of 352 valid questionnaires were analyzed.Most respondents were aged 60～70 years,with a female proportion of 56.2%,and 52.0%of them had a junior high school education or lower.The top-ranked chronic diseases were hypertension(62.2%)and hyperlipidemia(33.2%),and 61.1%of patients suffered from multiple chronic diseases.Antipyretic and analgesic drugs were most common in home medicine cabinets(90.1%).The proportion of drugs being stored in accordance with the instructions(46.9%)was slightly low,and 93.8%of the elderly handled expired drugs improperly.Awareness of medication guidance services was low(34.9%).Logistic regression analysis showed that factors such as education level and monthly income had significant effects on the understanding of drug package insert,rational drug storage,proper disposal of expired drugs,and awareness of medication guidance services(P<0.05).Conclusion There are still some potential safety risks in the home medication use of elderly patients with chronic diseases in urban and rural areas of Henan Province.It is necessary to enhance education on drug storage and medication guidance,particularly for low-income and less-educated groups,to improve the safety of home medication use.