Modern medicine makes it possible to turn those former impossible ideas into reality.Meanwhile,more and more social and ethical issues are also drawing public attention arising from the development of modern medicine.This paper explores reasonable and feasible countermeasures to cope with the ethical issues brought by modern medical development from a cultural perspective.

Medical insurance system plays a key role in China's social security system.In the social insurance system,medical insurance features the widest coverage and the most complex in mechanism,while China' s medical insurance system itself is found with many setbacks.This paper probed into such risks found in the county-level medical insurance system as excessive cost growth causing overpayment of the medical insurance fund and poor supervision of the fund.On such basis,the authors recommended such policy changes as payment reform,and enhanced supervision over the fund,the demand side,and the government,in an effort to optimize China' s medical insurance system for theoretical and decision reference of other county-level hospitals in their reforms.

Objective To investigate the relationship of PI3K/Akt signaling pathway with the activation of hepatic stellate cells (HSC) and its role in radiation-induced hepatic fibrosis.Methods HSC was treated with 6 MV X-ray irradiation (IR) together with the inhibitor of PI3K/Akt signaling pathway.The cells were divided into inhibitor group,10 Gy IR group,10 Gy + inhibitor group,20 Gy IR group,an 20 Gy + inhibitor group and blank control group.Then cell apoptosis rate was detected,the expression of transforming growth factor β1 (TGF-β1) in cell supernatant and the mRNA expressions of α-smooth muscle actin (α-SMA) and phosphorylation protein kinase B (p-Akt) were measured.Results Compared with the control group,the apoptosis rate of 10 and 20 Gy IR group increased with irradiation dose (t =8.43,11.63,P ＜0.05) but they were reduced by the inhibitor of PI3K/Akt (t =8.09,4.88,P ＜0.05).The expressions of TGF-β1,α-SMA,and p-Akt also increased with irradiation dose (t =6.91,7.80,9.28,P＜0.05) but they were declined by this inhibitor for both 10 Gy IR (t =6.17,15.11,10.34,P＜0.05) and 20 Gy IR (t =10.04,6.85,23.84,P＜0.05).Conclusions X-ray irradiation could activate HSC through PI3K/Akt signaling pathway,which may further result in hepatic fibrosis.

Objective To explore the basic ingredients of the tree shrew’ s( Tupaia belangeri) milk and compare with the dairy ingredients of other milks.Methods We select ten seed tree shrews after delivery ( 1 ~21 ) d with lactation mother tree shrews, and use artificial passive breastfeeding method let the young tree shrews suck breast milk,we took the milk from the young tree shrews in the stomach, directly using aseptic operation with a syringe immediately, once every two days, for consecutive three to five times, and a total of 18 mL milk was taken from each seed tree shrew.Then the milk was detected according to the national standard method for component testing.Results The total solid content of the tree shrew’ s milk was 43.63%, including 26.01%of fat, 10.41%of protein, 0.45% of lactose and 0.99%of ash content.Compared with cow's milk, the tree shrew’ s milk contained 3.36 times of total solid contents, 1.24 times of ash, 2.74 times of protein, 6.67 times of fat, and 0.09 times of lactose.Compare with baby formula milk, the tree shrew’ s milk contained 1.44 times of total solid contents, 0.20 times of ash, 0.58 times of protein, 1.53 times of fat, and 0.06 times of lactose.The trace mineral composition of the tree shrew’ s milk showed that the calcium, phosphorus, potassium, sodium, magnesium, and iron contents were 1.83 times, 2.73 times, 1.25 times, 1.93 times, 1.28 times, and 1.48 times higher than those in the cow's milk, and were 0.66 times, 0.85 times, 0.34 times, 0.26 times, 0.85 times, 0.24 times lower than those in baby formula milk.Conclusions The main nutrients of tree shrew’ s milk is of high fat, high protein and low sugar, and it can provide a basis for tree shrews artificial brood and breeding work.

Objective:To investigate the effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient-controlled analgesia (PCA) in labor analgesia, and its influence on stress response and pregnancy outcome.Methods:The general data of 97 parturients who underwent intraspinal PCA delivery analgesia in Chengdu Seventh People′s Hospital from April 2019 to March 2021 were retrospectively analyzed. They were divided into the observation group (51 cases) and the control group (46 cases) according to different analgesia methods. The observation group parturients were given ropivacaine hydrochloride combined with sufentanil intraspinal PCA, and the control group parturients were given ropivacaine hydrochloride intraspinal PCA. The numerical scoring system (NRS) was used to evaluate the pain degree of the parturient before, 15 minutes after, 30 minutes after, 45 minutes after analgesia and when the uterine orifice was fully opened. The onset time of analgesia, the time of perfection of analgesia, the amount of ropivacaine hydrochloride, sufentanil and the total amount of analgesic drugs were counted. The levels of serum cortisol (COR), adrenocorticotropic hormone (ACTH) and Norepinephrine (NA) were detected by enzyme-linked immunosorbent assay (ELISA). The time of the first stage of labor, the active stage, the second stage of labor, and the third stage of labor, the amount of vaginal bleeding (during labor and within 2 hours after delivery), the proportion of oxytocin application, normal labor, forceps delivery, lateral perineum resection, and caesarean section, the occurrence of adverse reactions (itching, fever, nausea and vomiting, urinary retention, and fetal bradycardia), and the Apgar score of newborns (1 min and 5 min after birth) were counted.Results:There was no statistically significant difference in the onset time and improvement time of analgesia between the two groups of postpartum women, as well as the NRS scores before and after analgesia at 15, 30, and 45 minutes, as well as when the cervix was fully opened (all P>0.05). The dosage of Ropivacaine hydrochloride and the total amount of analgesics in the observation group were significantly less than those in the control group (all P<0.05). After analgesia, the serum levels of COR, ACTH, and NA in both groups decreased significantly compared to before analgesia (all P<0.05); After analgesia, there was no statistically significant difference in serum COR, ACTH, and NA levels between the two groups (all P>0.05). The second stage of labor in the observation group was shorter than that in the control group, the vaginal bleeding volume and the proportion of caesarean section were lower than those in the control group, the proportion of normal delivery and the Apgar score 1 min after birth of the fetus were higher than those in the control group, and the difference was statistically significant (all P<0.05). There was no statistically significant difference in the analgesic effect and total incidence of adverse reactions between the two groups of postpartum women (all P>0.05). Conclusions:Ropivacaine hydrochloride combined with sufentanil intraspinal PCA can effectively alleviate labor pain, reduce the amount of analgesics, and improve maternal and fetal pregnancy outcomes.

Objective: To observe the integration frequency of aadA2 resistance cassette at attI site of the integron under different concentration of streptomycin. Methods: Class 1 integron with known gene sequence was cloned into plasmid pACYC184 to produce recombinant plasmid pACIDA, meanwhile the integrase gene was cloned into plasmid pET28a to construct recombinant plasmid pETINT. These two recombinant plasmids were consecutively transformed into E. coli BL(DE3). These transformed bacteria was cultured in the LB medium at 37 ℃ overnight with addition of different concentration of streptomycin. The copy number of total integrons and the copy number of integrated aadA2 at attI site of integrons were determined by using real-time PCR. and the integration frequency is the result of the former divided by the latter. Results: The resulting frequencies were (1.97±0.24)×10^-3, (3.23±1.77)×10^-3, (3.27±0.67)×10^-3, 0.45±0.13 and 1.32±0.11, with respective streptomycin concentrations of 0, 20, 30, 40 and 50 μg/ml. The background frequency of integration without integrase overexpression was less than (1.75±0.33)×10^-7. Conclusion These findings indicate that antibiotic concentration significantly increase recombination frequency of aadA2 resistance cassette at attI site of the integron, catalyzed by integron integrase.(Chin J Lab Med, 2018, 41: 531-535)

Objective:To construct a reliability management model of medical equipment in the department of respiratory and critical care medicine,and to explore its application effect in the management of medical equipment in the department of respiratory and critical care medicine.Methods:Taking the reliability of equipment management content and management methods as evaluation indexes,standardized procedures of equipment use,cleaning and emergency management were formed,and a reliability management model for medical equipment in the department of respiratory and critical care medicine was constructed.A total of 63 medical devices in clinical use in the Department of Respiratory and Critical Care Medicine of Beijing Anzhen Hospital,Capital Medical University from January 2022 to January 2023 were selected.According to different management modes,conventional management mode(32 devices)and reliability management mode(31 devices)were adopted respectively.The equipment management index score,equipment goal achievement degree and equipment management defect rate,and the equipment management recognition scores of the engineers,equipment operation technicians and doctors of equipment use management were compared between the two management modes.Results:The average recognition scores of the engineers,operating technicians and doctors for the use of equipment of the reliability management model were(90.66±5.25)points,(91.54±4.14)points and(92.17±5.17)points,respectively,which were higher than those of the conventional management model,the difference was statistically significant(t=14.249,13.773,12.267,P<0.05).The average scores of equipment resource allocation,information technology,technical support and management performance indicators of the reliability management mode were(90.25±4.12)points,(92.45±3.26)points,(91.47±2.78)points and(90.25±3.11)points,respectively,which were higher than those of conventional management mode,the difference was statistically significant(t=12.122,18.379,15.581,14.141,P<0.05).The average scores of equipment use standardization,cleaning completion and emergency management timeliness of reliability management mode were(92.36±3.25)points,(90.69±3.69)points and(91.87±3.01)points,respectively,which were higher than those of the conventional management mode,the difference was statistically significant(t=14.953,15.030,14.401,P<0.05).The number of equipment damaged,repaired and factory repair of the reliability management mode was 1,1 and 2,respectively,and the defect rates were 3.22%,3.22%and 6.45%,respectively,which were lower than those of the conventional management mode,the difference was statistically significant(x2=8.581,9.908,8.782,P<0.05).Conclusion:The application of reliability-based medical equipment management model to the medical equipment management of respiratory and critical care medicine can improve the quality of equipment management and operation,reduce the failure rate of equipment,and improve the service level of equipment.

Mosaic variants resulting from postzygotic mutations are prevalent in the human genome and play important roles in human diseases. However, except for cancer-related variants, there is no collection of postzygotic mosaic variants in noncancer disease-related and healthy individuals. Here, we present MosaicBase, a comprehensive database that includes 6698 mosaic variants related to 266 noncancer diseases and 27,991 mosaic variants identified in 422 healthy individuals. Genomic and phenotypic information of each variant was manually extracted and curated from 383 publications. MosaicBase supports the query of variants with Online Mendelian Inheritance in Man (OMIM) entries, genomic coordinates, gene symbols, or Entrez IDs. We also provide an integrated genome browser for users to easily access mosaic variants and their related annotations for any genomic region. By analyzing the variants collected in MosaicBase, we find that mosaic variants that directlycontribute to disease phenotype show features distinct from those of variants in individuals with mild or no phenotypes, in terms of their genomic distribution, mutation signatures, and fraction of mutant cells. MosaicBase will not only assist clinicians in genetic counseling and diagnosis but also provide a useful resource to understand the genomic baseline of postzygotic mutations in the general human population. MosaicBase is publicly available at http://mosaicbase.com/ or http://49.4.21.8:8000.