Objectives To provide reference for the improve of health care system and healthcare insurance con-trolling method, through researching on the value-based healthcare paying system in South Korea. Methods The basic characteristics of the Korean health care system was researched, Specifically, its reform experiences of value-based health insurance review and assessment paying system,which government took. Results South Korea’s health care pay-ing system had achieved both good social and policy effects. Conclusions Value-based health care paying system is the main reason for the reducing of health care expenditures and making of scientific health policy.

Objective To explore the clinical significance of a series of cytokines and peripheral blood immunocyte subsets before and after immunosuppressive therapy in patients with immune thrombocytopenia (ITP).Methods The percentages of immunocyte subsets in the peripheral blood of 20 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD4+/CD8+,CD1~.ELISA was applied to detect the level of serum TNFα,IL-2,IL-6,IL-4,IL-10,IL-11,IL-17,IL-27,transforming growth factor β (TGFβ),thrombopoietin (TPO) of 20 patients with ITP and 20 healthy controls.Results The percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+ / CD8+ T lymphocyte in patients with ITP were lower than those in healthy controls [(62.66 ± 6.58) ％ vs (69.93 ± 4.81) ％,(29.46 ± 5.02) ％ vs (39.08 ± 3.50) ％,0.97 ± 0.35 vs 1.56 ± 0.26,all P ＜ 0.05].After immunosuppressive therapy,the percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+/CD8+ T lymphocyte [(71.49 ±5.16)％,(39.25 ±3.21)％ and 1.56 ±0.28] recovered to the same levels in healthy controls.The percentage of CD8+ T lymphocyte and CD19+ B lymphocyte in patients with ITP were higher than those in the healthy controls [(30.28 ±4.63)％ vs (25.90±3.06)％,(18.92 ± 4.27)％ vs (13.17 ± 3.64)％,all P ＜ 0.05].After treatment of immunosuppressive therapy,the percentage of CD8+ T lymphocyte and CD19+ B lymphocyte [(25.16 ± 3.45) ％ and (11.98 ± 3.68) ％] recovered to the similar levels in healthy controls.The serum levels of IL-4,IL-6,IL-11,IL-17 and TPO in patients with ITP were significantly higher than those in healthy controls.While TGFβ level was significantly decreased.There was no significant difference of IL-27 between ITP patients and healthy controls.After the treatment of immunosuppressive therapy,IL-4,IL-6,IL-11,IL-17,TPO and TGFβ were down-regulated while IL-27 was up-regulated.There was no significant difference of IFNγ,TNFα,IL-2 and IL-10 among ITP patients before or after immunosuppressive therapy and healthy controls.Conclusions The present study suggests that the aberrant immunocyte subsets and cytokines are involved in the pathogenesis of ITP.Hyper-function of Th2 and Th17,dysfunction of Treg cells,up-regulation of IL-27,IL-11,TPO and other factors may contribute to the pathogenesis of ITP.

Objective:To investigate the expression of SHIP1 in the patients with acute myeloid leukemia and its effect on the apoptosis of human leukemia cells.Methods:The expression of SHIP1 in the bone marrow of patients with acute myeloid leukemia was detected by Westem blot.U937 cells was transfected with SHIP1 expression vector (pEGFP-SHIP1 group) and empty vector control (pEGFP group) respectively,U937 cells without transfection were used as the control group.Flow cytometry was used to detect the apoptosis of the cells,the expression of SHIP1,Bcl-2,Bax,Akt,p-Akt were detected by western blot.Results:The expression of SHIP1 in the bone marrow of patients with acute myeloid leukemia was significantly lower than that of the normal human bone marrow SHIP 1 (P＜0.01).The SHIP1 and Bax expressions as well as the apoptotic rate ofpEGFP-SHIP1 group were significantly higher than those of the control group(P＜0.01),while the Bcl-2 and p-Akt expressions were significantly lower than those in the control group(P＜0.01).Conclusions:SH-P1 expression was down regulated in the bone marrow of patients with acute myeloid leukemia.SHIP1 could promote the apoptosis of human leukemia cells via Akt signaling pathway.

Objective To observe the effects of methionine enkephalin (M-Enk) on migration of macrophages from mice with impaired liver and its immunomodulatory mechanisms. MethodsLiver of mice was impaired by feeding CCl4 and macrophage migration inhibitory factor (MMIF) was produced by Con A-stimulated spleen lympho- cytes. Inhibition of macrophage migration was measured in reaction system by adding M-Enk. Results Migration of macrophages in both liver-impaired and control group were suppressed by MMIF, but the suppression might be re- versed by adding 1 μmol/L M-Enk (P＜0. 05). M-Enk could significantly inhibit in vitro both of the combination of MMIF with macrophages and production of MMIF from lymphocytes (P＜0. 01). Macrophages from liver-imparied group showed a higher sensitivity compared to the control group (P＜0. 05). ConclusionThe study suggests that opi- oid peptieds play an important role in the modulation of the immune response under stress as liver impairment.

With the research progress of pathogenesis of JAK gene in myeloproliferative neoplasms (MPN), more tyrosine kinase inhibitors were developed. MPN quantify scoring system is used to determine the efficacy of tyrosine kinase inhibitors for MPN. The choice of tyrosine kinase inhibitors, tyrosine kinase for the relief of MPN symptom burden, etc, become the topics of the 57th American Society of Hematology (ASH) annual meeting.

Objective To investigate the Adamkiewicz artery visualization using gemstone spectral CT angiography (CTA) with optimal monochromatic technique.Methods The prospective study was approved by the local institutional review board,and written informed consents were obtained for all the examinations.The successive 58 patients with suspected aortic aneurysm or dissection underwent aortic gemstone spectral CTA.They were divided into two groups based on the different reconstruction protocols:A,optimal monochromatic reconstruction;B,polychromatic reconstruction.Visualization rate of Adamkiewicz artery in two groups were recorded.Objective(measure CT value of the descending aorta and calculate signal-to-noise ratio [CNR]) and subjective (score of Adamkiewicz artery visualization) were evaluated.Paired samples t,Chi-square and Mann-Whitney U test were used for statistical analysis.Results CT value of descending aorta and CNR of group A [(568.4 ± 57.5)HU and (52.3 ± 8.1)] were significantly higher than group B[(346.2 ± 48.6)HU and (26.7 ± 3.7)] (t=12.70 and 15.20,P＜0.01).The visualization rate of Adamkiewicz artery in group A (94.8％,55/58) was higher than B (82.8％,48/58;x2=4.20,P=0.04).The score of group A (55 cases,3.9±0.8) was significantly higher than the group B (48 cases,3.4±1.0)(Z=-2.40,P=0.02).Conelusion Gemstone spectral CTA with optimal monochromatic reconstruction can improve the visualization efficiency and quality of the Adamkiewicz artery compared with routine polychromatic reconstruction protocol.

An electrochemical L-lactate biosensor was fabricated by combining Platinum nanoparticles (Pt-nano) with multi-walled carbon nanotubes(MWCNTs).L-lactate oxidase(LOD) was immobilized on the surface of the glassy carbon electrode (GCE) modified with MWCNTs and Pt-nano.The surface of resulting LOD/MWCNTs/Pt-nano electrode was covered by a thin layer of sol-gel to avoid the loss of LOD and to improve the anti-interference ability.The cyclic voltammetric results indicated that MWCNTs/Pt-nano catalyst displayed a higher performance than MWCNTs.Under the optimized conditions, i.e., applied potential of 0.5 V, pH 6.4, 25 ℃, the proposed biosensor's determination range was 0.2-2.0 mmol/L, response time was within 5 s, and the sensitivity was 6.36 (A/(mmol/L).It still kept 90% activity after 4 weeks.The fabricated biosensor had practically good selectivity against interferences.The results for whole blood samples analyzed by the present biosensor showed a good agreement with those analyzed by spectrophotometric method.

Objective To explore the application effect and nursing methods of pulse indicator continuous cardiac output (PICCO) monitoring technology in large area burn patients. Methods A total of 82 cases of large area burn patients in the hospital from January 2014 to June 2017 were chosen and divided into experimental group (41 cases) and control group (41 cases) by random digits table method. Two groups of patients were treated with the same method, the control group using routine monitoring method to guide liquid resuscitation, the experimental group based on the use of PICCO monitoring technology to guide fluid resuscitation. Hemodynamic indexes, fluid resuscitation time, ICU days, complication rate and mortality rate of the two groups were compared and analyzed. Results After fluid resuscitation, the acute physiology and chronic health system II (APACHE II) score, heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) of the observation group were (18.4 ± 4.2) marks, (98.7±8.5) once/min, (88.5±9.6) mmHg (1 mmHg=0.133 kPa), (10.3±2.5) mmHg.The APACHE II score, HR, MAP and CVP of the control group were (22.7±5.4) marks, (112.5±9.6) once/min, (81.2±10.5) mmHg, (7.9±2.2) mmHg. There were significant differences between the two groups (t=3.285-6.891, all P <0.05). The cardiac index (CI),cardiac output(CO), global end-diastolic volume index (GEDVI), intrathoracic blood volume index(ITBVI), extravascular pulmonary water index(EVLWI) of the observation group after fluid resuscitation were (4.21±0.46) L·min-1·m-2, (4.87±0.52) L/min, (734.51±95.83) ml/m2, (725.91 ± 88.42) ml/m2, (6.26 ± 1.21) ml/kg, respectively. The difference was statistically significant compared to those before fluid resuscitation (t=10.454-21.143, all P <0.05).Resuscitation time and ICU days in the observation group were (3.1±1.2), (31.4±5.8) d. Resuscitation time and ICU days in the control group were (3.9 ± 1.5), (37.8 ± 6.5) d. There were significant differences between the two groups (t=2.667, 4.704, P<0.05). Conclusions PICCO monitoring plays an important role in the early fluid resuscitation in the treatment of large area burn patients, and strengthening the nursing work is beneficial to the targeted treatment and rehabilitation of the patients.

Objective:To probe the exploration and integration of ideological and political teaching resources for College English by medical students' teams, and to build a College English ideological and political teaching resource database in medical colleges, so as to provide feasible experience for the integration of medical students' College English and ideological and political education.Methods:A questionnaire survey was conducted among 1 030 students in a medical college, and SPSSAU statistical software was employed to analyze the results to investigate the attitudes and demands of students towards the integration of English teaching and ideological and political education, the construction methods of College English ideological and political teaching resource database, and the presentation methods and types of resources. Based on the questionnaire results, textbook themes, teaching modules and students' majors, the content analysis and classification method were employed to construct a College English ideological and political teaching resource database that meets the expectations of medical students.Results:① A total of 836 students agreed with the necessity to integrate College English with ideological and political education, hoping to build an ideological and political resource database with videos and audios related to daily life ( n = 731), medical knowledge ( n = 664), social practice ( n = 622), news and current affairs ( n = 604) and guide the students to learn the above resources through the methods "teacher instruction + classroom discussion" ( n = 528). ② The ideological and political integration points in the questionnaire results were matched according to the subjects of the textbook, and further divided into two categories: universal and medically specific ideological and political teaching elements according to the content of the unit modules. Finally, the resource database of College English ideological and political teaching in medical colleges was built. Conclusion:Outstanding courses and resources are jointly explored and built by teachers and students.

Objective:To explore the application effect of quantitative evaluation nursing in Operating Room in patients undergoing radical resection of rectal cancer.Methods:A total of 114 patients who received radical resection of rectal cancer in Xi'an Daxing Hospital from December 2019 to December 2021 were selected by the convenient sampling method. According to the order of admission, they were divided into the observation group and the conventional group, with 57 cases in each group. The observation group received quantitative evaluation nursing in the Operating Room, while the conventional group received routine Operating Room nursing. The differences in physiological indexes and mood state scores were compared between the two groups.Results:The postoperative diastolic blood pressure, systolic blood pressure and heart rate in the observation group were lower than those in the conventional group ( P<0.05). The scores of depression-frustration, tension-anxiety, fatigue-dullness, anger-hostility and confusion-chaos dimensions of postoperative mood state in the observation group were lower than those in the conventional group, and the energy-vitality score was higher than that in the conventional group ( P<0.05) . Conclusions:Quantitative evaluation nursing in the Operating Room can reduce the psychosomatic stress response in patients undergoing radical resection of rectal cancer.