Objective:Based on the perspective of Universal Health Coverage(UHC),a mathematical model was developed to conduct quantitative study on the development status of Basic Medical Insurance Schemes(BMIS) in China.Methods:A mixed model was developed to conduct quantitative study on the development of BMIS in the period of 2003-2015 from five dimensions:coverage of population,benefit package,reimbursement rate,risk pooling level and unity of the schemes.Sensitivity analysis was also performed.Results:The UHC scores for BMIS in China from 2003 to 2015 fluctuated obviously.Given the range of 0-100 percent,the UHC score in 2003 was 52.2％,28.5％ in 2006,23.9％ in 2010 and 26.5％ in 2015.The integration and equalization of BMIS and scaling up the risk pooling levels were shown to contribute significantly to UHC.Conclusion:The construction of mixed models was developed to provide a new calculation assessment tool for measuring the UHC,which consisted of completed evaluation tool package with addition model and multiplication model.Considering the future development of UHC,there is a still long way to go for BMIS in China.Emphases should be given to integration and equalization of BMIS as well as scaling up the risk polling to provincial and national level.

Objective To analyse the clinical features of pelvic insufficiency fractures (PIF) in patients with cervical cancer after radiotherapy and explore the risk factors affecting its occurrence .Methods 55 cases of patients with cervical cancer that used radia-tion therapy as a single treatment were chosen in our hospital from February 2007 to May 2010 and the clinical features were ana-lysed;The fractures of spine ,sacrum ,sacroiliac joint ,ilium and pubis and femoral were observed and the density of fifth lumbar (L5 ) vertebrae ,left and right sacrum were detected via the CT or MRI (Hounsfield Unit)after 2-year follow-up ,the different factors on the incidence of PIF were explored .Results 12 cases (19 sites) of patients in 55 patients occured PIF after follow-up 2years ,the cumulative incidence was 21 .82% ;the distribution of PIF parts were followed :lumbar vertebrae had 5 cases ,sacral had 5 cases ,pu-bis had 4 cases ,sacroiliac joint had 2 cases ,iliac had 2 cases and femoral head had 1 case .The incidence rate of PIF that density of fifth lumbar vertebrae was ≤130 HU and >130 HU were 16 .36% and 5 .45% respectively ,the PIF′incidence rate that density of left side of sacrum was≤ -35 HU and > -35 HU were 18 .18% and 3 .64% respectively ,the incidence rate of PIF that density of right side of sacrum was ≤ -35 HU and > -35 HU were 20 .00% and 1 .82% respectively ,the density of the three parts all had statistical difference on the incidence of PIF (P<0 .05) .Univariate analysis showed that menopausal status and the average density of CT had statistical effects on PIF (P<0 .05);Multiple analysis showed that the average density of CT was the independent factors affecting PIF′incidence after radiotherapy .Conclusion The patients with cervical cancer may occur pelvic insufficiency fracture af-ter radiotherapy ,and its incidence is related to menopausal status and bone mineral density .

BACKGROUND: Early enteral nutrition (EEN) following liver transplantation can benefit to recover and guarantee the normal gastrointestinal tract function,which plays an important role on post-operational immunosuppressive therapy.OBJECTIVE: To conduct EEN on the patients undergoing liver transplantation,and observe the post-operation recovery of intestinal function.DESIGN: Case analysis.SETTING: The 81 Hospital of Chinese PLA.PARTICIPANTS: From April 2003 to June 2006,86 patients undergoing liver transplantation in Liver Transplantation Center at the 81 Hospital of Chinese PLA were enrolled,including 57 males and 29 females.They aged 21-68 years,with a mean of 48 years.Among them,there were 37 cases of primary hepatic carcinoma and 49 cases of posthepatitic cirrhosis; 8 cases graded in Child A (all hepatic carcinoma),34 cases in Child B,and 44 cases in Child C.And 5 cases were complicated with serious hepatitis liver function failure and hepatic coma.Informed consents were obtained from all the patients and relatives.Transplantation operation was approved by the hospital ethical committee.METHODS: Surgical approach was orthotopic liver transplantation through caval vein in 80 cases,typical orthotopie liver wansplantation without veno-venous bypass in 4 cases,and piggyback orthotopic liver transplantation in 2 cases.The average warm ischemia time was (4.8±2.4) minutes,and average cold ischemia time was (8.6±3.2) hours.Anhepatic phase was (84±28)minutes.Post-operational trigeminy immunity and anti-rejection therapy consisted of tacrolimus (Fujisawa product) +mycophenolate mofetil (Roche product) + prednisone (Pred).According to the presence of nasogastric feeding tube,the patients were divided into control group (n=49) and EEN group (n =37).There were no significant differences in the sex,age and general data of patients between the two groups.Control group adopted EEN mainly,while EEN group was fed with EEN via a nose-intestine nutritional tube,and they received short-peptide enteral nutrition (Pepti-2000) at 24 hours post-operation at the initial dose of 63-126 g/d,which was gradually increased to 372 g/d.Liquid diet was allowable by 3-5 days.MAIN OUTCOME MEASURES: ①Clinical recovery and complications of patients.②Liver function recovery indices such as total serum protein,albumin and prealbumin,as well as C reactive protein at days 1,3,5 post-operation.③Level of serum immune globulin at day 7 post-operation.RESULTS: Totally 86 patients were involved in the result analysis.①Clinical recovery and complications: In EEN group,abdominal distension occurred in 10 cases,diarrhea in 5 cases,and blocking or slippage of feeding tube in 3 cases; No emesia,back flow or aspirated pneumonia was found; In control group,2 cases appeared bile leakage,which was not detected in the EEN group.②Indices of liver function recovery: Compared with control group,the prealbumin level was significantly rised and C reactive protein was significantly decreased in the EEN group at days 3 and 5 (P ＜ 0.05).③Levels of serum immune globulin: Blood IgA and IgM of EEN group were significantly higher than those of control group at day 7 (P ＜ 0.05).CONCLUSION: EEN in post-operation patients can reduce stress,promote synthesize metabolism,improve the recovery of liver cells,and decrease the infection rate.

Successful pain management of perioperative shoulder arthroscopy may allow patients to go home earlier, improve the quality of life in perioperative period, and facilitate rehabilitation. A comprehensive method to perioperative pain control has three stages including preoperative, intraoperative and postoperative phase. Successful pain reduction should begin preoperatively because of an excellent communication between patient and physician, moreover, preoperative analgesia also should be administered. Intraoperative efforts should include local wound infiltration and the administration of anesthetic medication intra-articularly. Postoperative management should include oral analgesics, constant infusion devices, Patient Controlled Analgesia (PCA), sedative-hypnotic drug, continuous cryotherapy and vicarious treatment.
Acupuncture Analgesia ; Analgesia ; methods ; Analgesia, Patient-Controlled ; Arthroscopy ; Humans ; Pain, Postoperative ; therapy ; Perioperative Period ; Shoulder Joint ; surgery ; Transcutaneous Electric Nerve Stimulation

OBJECTIVE To investigate the distribution and the resistance variance tendency of the pathogenic bacteria isolated from the blood cultureing specimens collected during the period of 2002-2005.METHODS A retrospective analysis was made to the blood cultureing results during the period of 2002-2005 with WHONET 5.1 software.RESULTS Gram-negative rods were the predominant bacteria which caused sepsicemia,the isolated rates of Escherichia coli,Klebsiella pneumoniae and Staphylococcus aureus were the most high during the period of 2002-2004 but the S.epidermidis and S.hominis were also the important pathogenic ones which caused blood stream infection.Vancomycin and the teicoplanin were the most effective to the Gram-positive bacteria,and the imipenem and the cefepime were the most effective to the Gram-negative ones.CONCLUSIONS It′s important to strengthen the blood cultureing for blood stream infection patient.

Objective: To explore the effect of early enteral nutrition on post-operation recovery of patients undergone liver transplantation.Methods:86 patients undergone liver transplantation were enrolled,among which 37 cases undertook early enteral feeding and 49 cases were mainly giren parenteral nutrition.The infection rate,metabolism condition and immunol function of post-operation were compared.Results:Patients in EN group had a high lever of blood globulin and a lower infection rate,and their liver function recovery,rise of pre-albumin and decrease of CRP were much quick than those of PN group.Conclusion:Early enteral nutrition in post-operation patients can reduce stress reaction,promote synthesis metabolism,improve the recovery of liver cell and decrease the chances of infection.

BACKGROUND: It is an important subject that how to relieve liver injury during perfusion preservation, and the pretreatment for donated liver is considered to be an effective method in this process, however, most studies are limited in animal experiment. Atomolan is a kind of reduced glutathione, which possess bidirection regulation of metabolism and detoxication. OBJECTIVE: To study the protective effect of reduced glutathione Atomolan on donor liver injury.METHODS: Totally 80 patients received liver transplantation in the Liver Transplantation Center, 81 Hospital of Chinese PLA, from May 2003 to August 2006, were divided into the control (n = 42), and Atomolan (n = 38) groups. The perfusion preservation conditions were similar, except 2.4 g glutathione was added into solutions in later group. Adenosine triphosphate (ATP) and malonaldehyde levels in liver tissues were measured, meanwhile, the liver tissues were observed under a light microscope and an electron microscope. Recipient plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin concentrations were assessed at 1 day post-operation.RESULTS AND CONCLUSION: Compared with the control group, the liver ATP level of the Atomolan group was markedly increased (P < 0.01), MDA was decreased (P < 0.01), and the concentrations of ALT, AST, as well as total bilirubin were notably decreased (P < 0.01). Under a light microscope, it showed that the degrees of liver swelling histopathologic hepatic alterations were significantly lessened in the Atomolan group. While under an electron microscope, the structure of liver cells of the Atomolan group was clearer and included a higher number of mitochondria (P < 0.01). Results suggested that reduced glutathione has protective effect on donor liver injury during the procedure of hot and cold ischemia and perfusion.

OBJECTIVE:To analyze and determine the compositions of monosaccharide in polysaccharide from leaves and twigs of Morus nigra from Xinjiang.METHODS:The polysaccharides in leaves and twigs of M.nigra were extracted by water and precipitated by ethanol then hydrolyzed into monosaccharide by using 2 mol?L-1 H2SO4.The monosaccharide was derivatized with 1-phenyl-3-methyl-5-pyrazolone(PMP) and determined by RP-HPLC. RESULTS:The polysaccharide in leaves and twigs of M.nigra were composed of mannose,rhamnose,glucuronic acid,galacturonic acid,glucose,galactose and arabinose etc. All the 7 monosaccharides were well-separated within 25 min. CONCLUSION:The method is simple and sensitive with accurate results,and it can be used for the quality control of leaves and twigs of M.nigra from Xinjiang.

Objective:To explore the effect of continuous quality improvement theory on patients' satisfaction and nurses'perception of working environment.Methods:Quality nursing service satisfaction survey was conducted in 450 patients,at the same time,100 nurses were investigated for the situation of working environment.Patients' satisfaction and the status of nurses' perception of their own work environment were compared before and after the implementation of continuous quality improvement theory.Results:After the implementation of continuous quality improvement theory,both patients' satisfaction and nurses' perception of working environment were significantly improved (P ＜ 0.05).Gonclusions:Continuous quality improvement theory can improve the satisfaction of patients with high quality nursing service,and enhance the nurses' perception of their working environment.

Objective To observe the effect of severe heatstroke on intestinal mucosal barrier function,and explore its correlation with systemic inflammatory reaction.Methods The SPF male BALB/c mice were randomly divided into normal control group,40 ℃ heat stress group and 42 ℃ heat stress group,with 6 mice in each group.The mice in normal control group were observed at normal temperature with (25.0 ± 0.5)℃,and the mice in heat stress groups were challenged with a temperature of (35.5 ± 0.5) ℃ and a humidity of (60 ± 5)％ until body temperature increase up to 40 ℃ or 42 ℃ followed by recovering the surroundings temperature to normal temperature for 12 hours.The blood of medial angle of eye of mice in each group was collected for determination of plasma lipopolysaccharide (LPS),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) levels,and diamine oxidase (DAO) activity with enzyme linked immunosorbent assay (ELISA).The level of D-lactic acid was determined with ultraviolet spectrophotometer.Then the mice in each group were sacrificed,and mesenteric lymph node (MLN),liver,spleen,lung,kidney tissues,and the blood from portal vein and caval vein were collected for colony count to observe the intestinal bacterial translocation.The ileum tissue was collected for observation of changes in histomorphology and ultrastructure of small intestine mucous membrane with microscope.Pearson linear regression analysis was used to explore the correlation between intestinal mucosal barrier dysfunction and systemic inflammatory response.Results Compared with normal control group,plasma LPS,inflammatory parameters such as TNF-α and IL-6,and gut barrier function parameters such as DAO and D-lactic acid levels as well as the rate of bacterial translocation after heat stress were significantly increased,and the differences were more obvious in 42 ℃ heat stress group [LPS (EU/L):740±50 vs.340±40,TNF-α (ng/L):148.06±36.61 vs.12.89 ± 1.67,IL-6 (ng/L):110.91 ± 9.97 vs.18.02 ± 2.20,DAO (U/L):1 760 ± 400 vs.670± 50,D-lactic acid (mg/L):9.60 ± 1.48 vs.5.08 ± 0.28,rate of bacterial translocation:78.6％ (33/42) vs.9.5％ (4/42),all P ＜ 0.01].It was shown by Pearson linear regression analysis that plasma LPS,TNF-α,IL-6 were positively correlated with DAO activity (r values were 0.834,0.808,0.836,respectively) and D-lactic acid (r values were 0.811,0.811,0.800,respectively) in 42 ℃ heat stress group (all P =0.000).It was showed by microscope that the changes in histomorphology and ultrastructure changes in intestinal mucosa were found after heat stress,and was obvious in 42 ℃ heat stress group as following:villus atrophy and falling off,infiltration of neutrophils and lymphocytes,the microvillus on the surface of mucosa cells were short and small,arranged in disorder,the tight junction between epithelial cells became widen,the mitochondrion and endoplasmic reticulum swelled obviously.Conclusion During the early stage of severe heatstroke,the damage of intestinal mucosal was obvious,and it has close correlation with systemic inflammatory response.