The paper summarized the reform practice of the separated ownership/operation of public hospitals in Wuxi's health sector,with analysis and thoughts on the reform outcomes.

0.05). Conclusion The assumable reasons for the dominance of heterozygous ADH2 genotype were a relatively small size of samples or gene mutation etc,which needed further researches to be confirmed.The proportion of individuals carrying about "susceptible genotypes of alcohol_related diseases"in female child_bearing ages was more than one half (0.617),which called on the reinforce of the surveillance on and prevention of alcohol_related birth (ARBD).

To evaluate the efficacy and safety of Azithromycin in the treatment of the bacterial infections. Method s: 94 patients with lower respiratory tract infection were randomly d ivided into 2 groups(47 for each gruop). The treated group were given Azithrom ycin 500mg in 5% glucose injection 500mL, iv drip, bid, for 5-7 days. Another 12 patients (including 4 patients with pelvic inflammatory disease and 8 patients with lower respiratory tract infection) were treated with Azithromycin as the op en group. Results: The treated group yielded a recovery ra te 61.7%, aeffective rate 91.5% and abacterial clearance rate 95.8%, which wer e higher than the controlled group [31.9%, 70.2%, and 76.6% (P＜0.01)]0,res pectively. The total response rate and the cure rate in 59 patients treated with Azithromycin were 93.2% and 62.7%, respectively. The incidence of clinical adve rse drug reactions in the treated group was 12.8%, being lower than 34.0% in the controlled group (P＜0.05). Conclusion: Azithromycin is an effective agent in the treatment of the acquired lower respiratory tract infection, urogenital and urogenital tract infection with slight adverse reaction .

Objectives: To identify any craniofacial morphological changes induced by a mandibular-repositioning oral appliance (MRA) and to explore the possibility of predicting the treatment response to MRA by cephalometric analysis in patients with obstructive sleep apnea (OSA). Methods: Seventy OSA patients [male/female: 63/7; age: (50.5±11.6) years; BMI: (27.6±4.6) kg/m2; AI: (34.9±21.3) episodes/hour; and oxygen saturation nadir: (66.3±16.5) %] were enrolled. MRA was fabricated individually for each patient after the consultation by a dentist. Polysomnographic (PSG) examination was repeated with MRA in place 3 months after the initiation of the MRA therapy. For cephalometric analysis, a pair of cephalograms of each patient was obtained, one with and another without MRA. Results and Conclusions: After 3 months' treatment, AI was (156±19.2) episodes/hour, significantly reduced compared with the pre-treatment average AI (34.9±21.3 episodes/hour,P<0.000 1). Oxygen saturation nadir improved from (66.3±16.5)% (pre-treatment) to (74.1±15.5)% (with MRA) (P<0.001). A reduction of AI≥50% was achieved in 42 patients. Insertion of MRA led to anterior shift of the mandible, increase in upper airway width and area and decrease in upper airway length. Those with evident retrognathia and longer anterior upper facial height were more likely to benefit from the MRA management.

Objective To evaluate the frequency, the change of sleep structure ,pulmonary function and respiratory muscle functions of overlap syndrome: a serious respiratory disease of sleep apnea syndrome (SAS) with chronic obstructive pulmonary diseases (COPD), for the further study of clinical and experimental characteristics.Methods 44 consecutive, unselected SAS patients (39 males and 5 females) were analyzed. All received continuous and overnight polysomonography monitoring with HMS-5500 polysomnography system (Respironics Inc USA) in our sleep laboratory. A thorough and detailed collection of case history, physical examination, blood gas analysis and pulmonary functions, as well as respiratory muscle functions and right ventricular functions were taken before the polysomnographic examination.Results A chronic obstructive spirographic pattern, defined by a FEV1/VC ratio (60%,was observed in 16 of 44 SAS patients (36.3%, the overlap group). The overlap patients were older (62.6±12.5 vs 54.7±11.4 years) than the simple SAS patients. The number of heavy smokers in overlap group was more than that in simple SAS group (600±210 vs 550±127 cigarette-year). There were signi-ficant difference in FEV1.0% (58.70±4.76 vs 86.42±7.50%, P<0.01), maximal expiration pressure (MEP,198.54±21.76 vs 129.3±31.9 cm H2O, P<0.01), maximal inspiration pressure (MIP, 72.75±11.4 vs 111.3±33.6 cm H2O, P<0.01) and minimal nocturnal oxyhemoglobin saturation (63.7±14.7 vs 74.8±11.4%, P<0.01) between two groups. And the total recording time (513±45.8 vs 521±48.6 min, P>0.05), however, showed no significant difference between two groups, while the percentage of total sleep time/total recorded time (73.4±9.6 vs 87.6±8.8%, P<0.01), rapid eye movement sleep time/total sleep time (6.0±4.3 vs 8.9±5.8%, P<0.01) in the overlap group were significantly decreased, and apnea plus hypopnea index (AHI) were significantly higher (54.6±20.3 vs 39.9±16.8, P<0.05) in the overlap group. Also, the incidence rate of right heart failure measured by cardiac ultrasonography was higher in the overlap group than in the simple SAS group. No differences were found in body mass index (BMI) and daytime arterial blood gas analysis between overlap group and simple SAS group.Conlusion Sleep apnea plus hypopnea index, as well as nocturnal hypoxemia, were more obviours in overlap syndrome than in the simple SAS patients. Also pulmonary function and respiratory muscle function were more significantly impaired, indicating a higher risk of developing pulmonary hypertension, cor pulmonale and respiratory failure in overlap syndrome.

Objective To investigate the clinicopathologic features of Chinese patients with early gastric cancer (EGC) according to the World Health Organization(WHO) diagnostic criteria,and to explore the risk factors of lymph node metastasis (LNM) in EGC.Methods From 2002 to 2017,at the Second Affiliated Hospital of Nantong University,and from 2014 to 2017,at the People's Hospital of Qidong City,the People's Hospital of Haimen City and the People's Hospital of Rugao City,315 EGC patients with complete clinicopathological data were enrolled.The clinicopathologic features were analyzed including gender,age,tumor location,tumor size,macroscopic type,histological type (WHO),differentiation degree,depth of tumor invasion,Lauren subtype,infiltration pattern,ulceration,lymphoid follicles,lymphovascular invasion and perineural invasion.Chi-square test and Fisher's exact test were performed for univariate analysis and the logistic regression was used for multivariate analysis.Results The ratio of EGC was 10.0％ (315/3 140) of patients with gastric cancer and received surgery during the same period.Among the 315 EGC,the ratio of well-differentiated tubular adenocarcinoma was 11.7％ (37/315),which was lower than 24.8％(2 752/11 104) in Japan and 19.9％(41/206) in South Korea,and the differences were statistically significant (x2 =28.208,P＜0.01;x2 =6.51 0,P =0.011),however there was no statistically significant difference when compared with Western countries (11.9 ％,8/67;x2 =0.002,P=0.964).Among the 276 patients who underwent radical gastrectomy,49 (17.8 ％) patients had with LNM.The results of univariate analysis showed that tumor size,macroscopic type,differentiation degree,depth of invasion,infiltration pattern,ulceration and lymphovascular invasion were related with LNM(x2=9.327,6.038,6.381,34.983,19.309,52.297 and 5.058;all P＜0.05).The results of multivariate analysis revealed that lymphovascular invasion and ulceration were the independent risk factors of LNM (odd ratio (OR)=7.028 and 2.566,both P＜0.05).Conclusions There is obvious difference in pathological diagnostic standard of well-differentiated tubular adenocarcinoma between China,Japan and South Korea,which may influence the therapeutic strategy of EGC.Lymphovascular invasion and ulceration are independent risk factors of LNM in EGC.

Objective:To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants.Methods:This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1 st, 2015 to December 31 st, 2021 of the Seventh Medical Center of the People′s Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children′s Hospital from January 1 st, 2020 to December 31 st, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks′ corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model′s discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. Results:A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all P<0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95% CI 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that P>0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested P>0.05. Conclusions:A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.

【Objective】 To study the effect of intravenous immunoglobulin(IVIG) on the detection of blood transfusion compatibility in patients. 【Methods】 56 patients, submitted to our Hospital from March 1, 2017 to December 31, 2020, were enrolled as the research objects. They had negative unexpected antibody screening, major crossmatch incompatibility with the same blood type donors, and had a history of IVIG infusion. ABO and RhD blood groups typing, unexpected antibodies screening, crossmatch, direct antiglobulin test, indirect antiglobulin test, and acid elution test were all conducted by microcolumn gel method. 【Results】 After IVIG infusion, the initially major crossmatch incompatibility with the same blood type donors turned into compatiblity with O-type donors. Among them, 2 patients had transient discrepancy in ABO forward and reverse blood typing due to the IVIG infusion. IgG anti-A were detected in the red blood cell elution of 37 A-type patients; IgG anti-B in 2 B-type patients; 3 cases of IgG anti-A+ anti-B and 14 cases of solo IgG anti-A in 17 AB-type patients. 3 batches of IVIG preparations were detected randomly, IgG anti-A titer was 32-64, and IgG anti-B titer was 8-16. 【Conclusion】 The discrepancy in ABO forward and reverse blood typing and major crossmatch incompatibility with the same blood type donors may occur after non-O type patients received IVIG, which contains IgG types of anti-A and anti-B. In this situation, it is recommended to prepare major crossmatched O-type washed red blood cells to ensure the safety and effectiveness of clinical blood transfusion.