The paper conducts a case study of Yangzhou No.1 People′s Hospital, introduces the practice of outpatient process opti-mization based on informatization support platform, analyzes the operation status of self-service outpatient service platform and existing problems.Based on the M/M/s model in queuing theory, the queuing model of payment for outpatient service in the hospital is construc-ted, the characteristics of queuing payment problems for outpatient service are revealed, the relationship between the sharing rate of self-service terminals and the average length of the queue in service windows, the average waiting time of patients.

OBJECTIVE:To establish a method for the content determination of L-shikonin in Zilian liniment and evaluate the uncertainty by 2 calculation methods. METHODS:HPLC was performed on the column of Waters C18 with mobile phase of metha-nol-0.025 mol/L phosphate(85:15,V/V)at flow rate of 1.0 ml/min,the detection wavelength was 516 nm,column temperature was room temperature,and the injection volume was 10 μl. Quantitative analysis was conducted for the process and procedures calculat-ed by standard curve method and external standard method,and the uncertainty was evaluated. RESULTS:The linear range of L-shi-konin was 4.024-80.48μg/ml;RSDs of precision,stability and reproducibility test were lower than 2.0%;recovery was 88.5%-93.1%(RSD=2.0%,n=6). Standard curve method was used to determine the content,and the expanded uncertainty was 0.70 μg/ml;ex-ternal standard method was used to determine the content,and the expanded uncertainty was 0.30 μg/ml. CONCLUSIONS:Stan-dard curve method is more economical,more convenient and lower uncertainty in the content determination of L-shikonin in Zilian liniment.

Idiopathic pulmonary fibrosis is divided into chronic progression stage and acute exacerbation stage according to progression of disease;early,middle and late stage according to onset time and clinic symptoms.It is considered that the etiological factors of idiopathic pulmonary fibrosis are repeated suffering of exogenous pathogen,environmental pathogen, deficiency of lung and kidney.The basic pathological products are blood stasis and phlegm turbid,the key point of pathopoiesis is that phlegm and stasis hides deeply and stagnated,the pulmonary collaterals are blocked.In addition,the evolutions of pathogenesis during its different stage are discussed.

AlM: To investigate the effect of exogenous peroxisome-proliferator-activated receptor-γcoactivator-1α ( PGC-1α) on vascular endothelial growth factor ( VEGF) expression in human retinal vascular endothelial cells ( HRVEC) .METHODS:Recombinant PGC-1α protein was added to HRVEC, and no recombinant PGC-1α protein was added to HRVEC as control group. After 24h of incubation, two groups of cells were then placed into a normoxic ( 20%O2 ) or hypoxic ( 1% O2 ) environment for another 16h. The expression of VEGF mRNA and protein were detected by real - time PCR, ELlSA and immunofluorescence cytochemistry.RESULTS: VEGF mRNA and protein levels in the cells were significantly increased by recombinant PGC - 1αprotein both under normoxia and hypoxia conditions as compared with control groups (P<0. 01).CONCLUSlON: PGC-1α can upregulate the expression of VEGF in HRVEC under normoxia and hypoxia conditions.

Objective To establish a reasonable method to evaluate nursing quality with both the quantity and quality of nursing taken into account.Methods Quantity indexes of nursing were analyzed with decision tree method (CHAID)in SPSS18.0,which included the number of patients admitted to wards,first grade' s nursing days,critically ill patients,emergencies,operations,intravenous infusions,intramuscular injections,oxygen inhalations,urinary tract catheterizations,gastric tube catheterizations,enemas and the average turnover rate of beds.After the quantity analysis,the nursing units were divided into different groups according to their workload.Then,we made a comprehensive evaluation of nursing quality with 12 indicators on the same group.Results Decision tree analysis can identify hierarchy relationship of various nursing quantity indicators and high-priority work quantity variables.Furthermore,it can establish the hierarchical rule based on the distribution of high-priority variables,and serve the purpose of classifying nursing units based on nursing workload.Conclusion The decision tree method can provide a same-level nursing workload platform for quality examination.This has minimized the influence of nursing workload discrepancies on nursing quality examination,and made nursing quality more comparable with nursing workload units of the same level,thus a scientific method for comprehensive nursing quality evaluation.

Objective:This study was to study effect of keeping ying and weiqi in balance on cardiac muscular collagen Ⅰ,collagen Ⅲ,angiotensinⅡ in spontaneous diabetes rats,and provide new thoughts for prevention and treatment for diabetic cardiomyopathy.Methods:40 spontaneous diabetes rats were divided into four groups at random:spontaneous diabetes control group,diformin group,Guizhi Decoction group and Huanglian Jiedu Decoction group.Except control group,each group was given intragastric administration for 12weeks.Blood glucose,collagenⅠ,collagen Ⅲ,collagenⅠ/collagen Ⅲ,angiotensin Ⅱ were determined.Euzymelinked immunosorbent assay and radio-immuniy method were used.Results:Blood glucose in Huanglian Jiedu Decoction group and diformin group decreased;Compared respectively with diformin group and control group,collagenⅠdecreased obviously and collagen Ⅲ increased signifi cantly in Guizhi Decoction group,and the collagenⅠ/collagen Ⅲ decreased.Compared with diformin group and control group,cardiac muscular homogenate AT-Ⅱ contents decreased in both of Guizhi Decoction group and Huanglian Jiedu Decoction group.Conclusion:Guizhi Decoction can decrease the content of collagen Ⅰ,AT-Ⅱ and collagenⅠ/collagen Ⅲin cardiac muscular,and increase content of collagen Ⅲ,then prevent and treat cardiac muscular collagen reconstruction and myocardial fibrosis.Huanglian Jiedu Decoction can decrease the content of AT-Ⅱ,and decrease collagenⅠ/ collagen Ⅲ,collagenⅠ slightly,and can improve cardiac muscular collagen reconstruction.Keeping ying and weiqi in balance is a new thought for prevention and treatment for diabetic cardiomyopathy.

Objective:To analyze the epidemiological characteristics of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infected patients in Beijing and investigate the associated factors.Methods:The clinical data of patients with HIV infection who were treated in HIV/AIDS designated hospitals (Peking Union Medical College Hospital, Beijing Ditan Hospital and Beijing Youan Hospital) were retrospectively analyzed.Results:A total of 11 572 patients were finally included in the study, among whom 532 patients (4.6%) were co-infected with HIV and HBV. Most of the co-infected patients were young male adults (28~48 years old), accounting for 85.9%. The main transmission route was homosexual behavior (74.8%). There were 87.4% co-infected patients treated with two anti-HBV drugs, including lamivudine (3TC) and tenofovir (TDF). From 2013 to 2018, the annual prevalence of HIV and HBV co-infection decreased gradually, with the rate of 6.37%, 4.55%, 3.92%, 4.68%, 4.24% and 2.74%, respectively. In our study, The main influencing factors of HIV and HBV co-infection were age older than 28 years old versus<28 years old ( OR=2.807, 95% CI 1.241-6.345) and marriage status (married versus unmarried, OR=1.259, 95% CI 1.004-1.579). Conclusions:The proportion of HBV infection in HIV-infected patients is 4.60% (532) in our cohort. From 2013 to 2018, the prevalence of HIV and HBV co-infection in Beijing shows a decreasing trend. The risk of co-infection is higher in married young adults (28~48 years old).

Objective:To construct the Helicobacter pylori infected C57BL/6 mice model to observe the activation of NOD1/NF-κB signaling pathways in the gastric tissues,and study its roles in inflammatory response during Hp infection.Methods:6-8 week-old C57BL/6 mice were randomly divided into two groups,the Hp infection group and the control group,and mice were given by gavage every 48 h for five times with Hp or PBS,respectively.All the animals were sacrificed at different time point and the gastric tissue were stained with hematoxylin-eosin( HE);The mRNA expression of NOD1 and RIP2 in gastric tissues were examined by RT-PCR;Levels of IFN-βand IP-10 in mice serum were assessed by ELISA;Nuclear translocation of p65 in gastric tissue was detected by Western blot.Results:Hp infection elicits an inflammatory cell response,glands in gastric tissue were reduced or atrophic,as compared with that in the control group.The levels of IP-10 and IFN-βincreased in the model group, and peaked at 16 weeks after Hp infection.Hp infection increased the mRNA expression of NOD1 and the p65 content in nuclear between 24-120 h(P<0.05),and the highest level at 48 h,subsequently the expression levels were began to decrease.The mRNA expression level of RIP2 was up-regulated after Hp was administrated, peaked at 48 h and declined after 72 h.However, the expression levels would rise again at 120 h.Conclusion: Hp infection can activate the NOD1/NF-κB signaling pathways and induce the production of IFN-βand IP-10 in gastrics of mice.

BACKGROUND:Bone marrow is the main source of mesenchymal stem cells(MSCs)at present,but its application has been limited,because of some reasons such as inconvenience of isolation,and the quantity of cells decreases with human increased age.Umbilical cord as a new source of MSCs has been widespread concerned recently.OBJECTIVE:To explore the approach of isolating and culturing MSCs from Wharton's jelly of human umbilical cord,and the methods of identifying the surface antigens and the differentiation potential.METHODS:MSCs were isolated and amplified via tissue-cultivation,and cultured by FasGrow medium.Morphology of MSCs from Wharton's jelly of human umbilical cord was observed under the optical microscope.Its immunophenotypes were detected using immunohistochemistry.The differentiation of MSCs into the osteoblasts was determined utilizing Gomori calcium-cobalt alkaline phosphatase staining,von Kossa calcium node staining,and tetracyclinefluorescence labeling.The differentiation of MSCs into the adipocytes was detected using oil red O staining.RESULTS AND CONCLUSION:MSCs were easily obtained from Wharton's jelly of human umbilical cord via the proposed approach.The primary cells grew up to 70%-80% confluence after 12-16 days of culture,and meanwhile the undifferentiated state was maintained and proliferation was stabilized after passage.The cell cycle of double increase was about 2 days,and proliferation in vitro reached twenty generation above.Surface antigen analysis showed that CD44,CD105,CD133,MHC-I were positively expressed,while CD34,CD45 were negatively expressed.Experiments of differentiation in vitro indicated that the obtained cells were capable of differentiating into fat,osteoblast and nerve-like cells.

Objective To evaluate the effect of dexmedetomidine on acute kidney injury after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods One hundred patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 46-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =50 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation in group D,while the equal volume of normal saline was given in group C.The urine output per hour during the postoperative 48 h period was recorded.At 6,12,24,36 and 48 h after operation,blood samples were collected from the median cubital vein for determination of serum creatinine levels.The development and severity of acute kidney injury were determined according to the urine output and serum creatinine level.Results Compared with group C,the incidence and severity of acute kidney injury were significantly decreased in the postoperative 48 h period in group D (P＜0.05).Conclusion Dexmedetomidine infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation can reduce the development and severity of acute kidney injury after cardiac valve replacement with CPB in patients.