Objective: To analyze the constitution of hospitalization expenses and provide evidence for controlling unreasonable increase of medical costs. Methods: To compare the medical expense constitution of cerebral infarction patients with and without medical insurance; interview the doctors, patients and the medical insurance managers of medical insurance, analyze the influencing factors of the expense through combining the result of interview and quantitative data. Results: The patients with medical insurance spent higher expense than their counterparts, the per capita cost of medical insurance increase by year. Through analyzing the constitution of hospitalization cost, medicine fee and examination cost are the major medical costs. Conclusion: The costs of patients with medical insurance have over-treatment problem, which could be controlled by changing payment method and strengthening management.

BACKGROUND: Rheumatoid arthritis(RA) is an autoallergic disease,but its immunological pathogenesis has not been completely known. T lymphocytes, especially CD4+ TH1/TH2 cells, may have an important effect in the occurrence and development of RA.OBJECTIVE: To investigate the action of CD4+ TH1 and TH2 cells which separately mediate cellular immunity and humoral immunologic response (respectively) function in the occurrence and development of RA.DESIGN: Case-control, comparative observation.SETTING: Department of Immunology, Medical College of Chinese People's Armed Police Forces.PARTICIPANTS: Totally 15 patients with RA hospitalized in the Department of Internal Medicine of General Hospital of Tianjin Medical University between March 1999 and March 2000 were selected for a RA patient group, consisting of 2 males and 13 females. Of them, 12 patients whose serumal rheumatoid factor (RF)was positive and the three others' was negative. At the same time, 30 healthy individuals from persons receiving health examination in the hospital or from our department were selected for a healthy control group, consisting of 4 males and 26 females. Informed consents were obtained from the participants.peripheral blood mononuclear cells(PBMC) from the two groups of subjects were detected by enzyme-linked immunospot assay (ELISPOT). 200-500 lymphocytes were counted under a normal light microscope, and the perwhich secreted cytokines were detected by ELISPOT, and those which had red spots in their plasma after staining were positive cells. Among them,the cells secreting γ-interferon (IFN-γ) were Tm cells while those secreting interleukin-4 (IL-4) were TH2 cells. 200-500 lymphocytes were counted under a normal light microscope and the percentages of TH1 and TH2 cells square test were used for comparing statistical differences of data between the two groups.MAIN OUTCOME MEASURES: Quantitative analysis of T lymphocyte subsets (including CD3+ T cells, CD4+ T cells and CD8+ T cells) and CD4+ TH1/TH2 cells in peripheral blood from the two groups of subjects.RESULTS: Analysis of the results was from the study on all of subjects percentages of total T cells (CD3+ T cells), CD4+T cells and CD8+F cells in peripheral blood were not significantly different between the two significantly higher in RA patient group than that in healthy control group [(24.44±5.25)%, (14.93±3.82)%, P ＜ 0.05],while in RA patient group the percentage of TH2 cells and ratio of TH1 cells to TH2 cells from peripheral blood were not significantly different as compared with those of control group(P ＞ 0.05).CONCLUSION: Cellular immunologic function mediated by TH1 cells may be associated with the occurrence and development of RA.

Clinical medicine professional degree education focuses on cultivating students' ability to engage in clinical practice, but the aim of medical postgraduate education program is to cultivate high-leveled clinical and research personnel. In the light of the problems that professional degree postgraduates majoring in obstetrics and gynecology are faced with such as unreasonable energy distribution in scientific research, the weak foundation of scientific research, the emergence of new trend of obstetrical and gynecological dis-eases, we have explored how to improve obstetrics and gynecology professional students' scientific research ability from several aspects such as the guidance of mentors, transferring learning and thinking and strength-ening the communication between various disciplines, to adapt to the requirements of the scientific develop-ment of modern obstetrics and gynecology.

Objective To investigate the relationship between occurrence of unexplained recurrent spontaneous abortion(URSA) and immune function of T lymphocytes. Methods T lymphocyte subsets and CD + 4 T helper subsets (including T helper 1 and T helper 2 cells) in peripheral blood from 30 cases with URSA and 24 healthy women (controls) were detected by enzyme-linked immunospot assay (ELISPOT). Results The percentage of CD + 4 positive T lymphocytes in URSA group was higher than that in the controls (60% vs 45%, P

Objective To investigate the relationship between satisfaction of nursing service and nurses' personality and mental state.Methods 368 nurses ,288 patients and 234 dependents involved the investigation.Minnesota Multiphasic Personality Inventory(MMPI)was used to analyze nurses' personality.Symptom Checklist-90(SCL-90),Self-rating Depression Scale(SDS) and Self-rating Anxiety Scale(SAS)were used to analyze nurses' mental states.A self-made questionnaire on satisfaction was used to investigate the satisfaction degree of patients and dependents with nursing service.The data were analyzed by descriptive statistics and multiple regression analysis.Results The average score on satisfaction with the nurses' service was(8.29±0.98)and the average score on satisfaction with nurses' attitude was(8.19±1.21).The satisfaction with nurses' service was negatively correlated with the MMPI factors of manifest anxiety and dependency and positively with dominance of MMPI(both P<0.05).Satisfaction with nurses' attitude was negatively correlated with total score of SAS,dependency of MMPI,compulsion,anxiety,hostility and paranoid ideation of SCL-90(all P<0.05).Satisfaction with the service attitude was positively correlated with social responsibility of MMPI(P<0.05). Conclusion Satisfaction degree of patients and their dependents is related to nurses' personality and mental states.It's helpful to establish good relationship between nurses and patients and improve the clinical nursing service to perfect nurse's personality and relieve psychological stress on nurses.

Abstract Neonatal disease screening is a major tool for prevention of birth defects, and monitoring and evaluation of neonatal disease screening facilitates the improvements in screening quality and efficiency. A strict quality control of screening, diagnosis, treatment and follow-up of neonatal diseases is performed in Zhejiang Provincial Center for Quality Control of Neonatal Disease Screening. In this study, the data pertaining to screening of neonatal inherited metabolic diseases, hearing loss and congenital heart diseases were collected in Zhejiang Province from 2018 to 2020, and the screening rate, recall rate of suspected screening-positive neonates, and detection rate of diseases were calculated to assess the quality of neonatal disease screening. The screening rate and recall rate of neonatal inherited metabolic diseases, hearing loss and congenital heart diseases were high in Zhejiang Province, and the detection of screened diseases was stable, indicating a high overall quality of neonatal disease screening. Increasing the impact of neonatal disease screening and consolidating the screening achievements should be given a high priority during the future quality control of neonatal disease screening in Zhejiang Province.

Objective: To evaluate the quality of tandem mass spectrometry (MSMS) screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021. Methods: The data pertaining to MSMS screening for neonatal inherited metabolic diseases in Zhejiang Province from 2009 to 2021 were collected from the database created by Zhejiang Provincial Center for Neonatal Disease Screening. The percentage of MSMS screening, percentage of recall of suspected screening-positive infants and incidence of neonatal inherited metabolic diseases were analyzed retrospectively to evaluate the quality of MSMS screening for inherited metabolic diseases. Results: A total of 4 706 916 newborns were screened among 8 297 039 live births by MSMS in Zhejiang Province from 2009 to 2021, and the percentage of MSMS screening increased from 5.48% to 97.54%, with a mean percentage of 56.73%. Of 46 838 suspected screening-positive infants, 45 527 infants were recalled, and the percentage of recall increased from 94.57% to 98.62%, with a mean percentage of 97.20%. A total of 1 038 infants were definitively diagnosed with inherited metabolic diseases in Zhejiang Province from 2009 to 2021, with an overall incidence rate of 1/4 535, and the incidence rates of amino acid metabolic disorder, fatty acid oxidation metabolic disorder and organic acid metabolic disorder were 1/11 767, 1/13 763 and 1\15 902, respectively. Of the 11 cities in Zhejiang Province, the highest percentage of tandem mass spectrometry screening for inherited metabolic diseases was found in Hangzhou City (83.01%), and the highest percentage of recall of suspected screening-positive infants was se en in Zhoushan City (99.08%). Conclusions A high percentage of MSMS screening for neonatal inherited metabolic diseases was observed in Zhejiang Province from 2009 to 2021; however, there was a region-specific percentage of screening, and the recall of suspected screening-positive infants remains to be improved.

Abstract Transport of filter paper-dried blood spot samples is a critical procedure during the screening of neonatal inherited metabolic diseases, which is of great significance for the screening accuracy. In order to ensure the timing and safety of sample transport, the cold chain positioning system was initiated by Zhejiang Provincial Center for Quality Control of Neonatal Disease Screening since March 2015. Based on the framework of neonatal disease screening information management system, the function of the logistics transport management system was included in this positioning system, with aims to achieve the monitoring and tracking of sample transport processes through real-time positioning of the sample transport box via China Unicom 4G logistics card and global positioning system/BeiDou Navigation Satellite System. The samples are maintained in a transport environment at 2 to 8 °C via the temperature-controlled box made of 5 °C phase-changed cold-stored materials and general packet radio service (GPRS) temperature recorders. The mean pretest turnover duration reduced from 8.44 days to 5.03 days following introduction of the cold chain positioning system, and the percentage of timely sample delivery increased from 31.69% to 77.90%, while the withdrawal rate of unqualified samples reduced from 0.12% to 0.08%. The cold chain positioning system meets the requirements of transport of filter paper-dried blood spot samples, which has a high potential in screening of neonatal inherited metabolic diseases.

Objective To investigate the predictive value of peripheral blood eosinophil percentage (EOS％) and exhaled nitric oxide (FeNO) on the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) at stable stage.Methods A total of 78 patients with stable COPD during the outpatient clinic from January 2017 to December 2018 were enrolled.EOS％,FeNO,and pulmonary function indicators [forced vital capacity (FVC),forced expiratory volume in 1 sec (FEV1),peak expiratory flow (PEF)] were measured after ICS-free elution.The questionnaire was used to assess the severity of the symptoms.The above indicators were reviewed after 4 weeks of ICS treatment.According to the improvement of pulmonary function and chronic obstructive pulmonary disease assessment (CAT) improvement,the patients were divided into effective and ineffective groups.Pearson correlation analysis and receiver operating characteristic (ROC) curve were used to analyze the predictive value of EOS％ and FeNO for ICS.Results After ICS treatment,EOS％ and FeNO were lower,FVC,FEV1,and PEF were higher than before,and CAT score was lower than before (P ＜ 0.05).There was a positive correlation between EOS％ and FeNO levels before treatment and the FEV1 improvement (r =0.412,0.397,P ＜ 0.05),and no correlation with the improvement of FVC,PEF and CAT scores (P ＞ 0.05).The FeNO level in the effective group was higher than that in the ineffective group before and after ICS treatment,with statistically significant difference (P ＜ 0.05).The pre-treatment EOS％ level and post-treatment EOS％were not significantly different between the two groups (P ＞ 0.05);the area under the ROC curve for EOS％ prediction of ICS efficacy before treatment was 0.531 (P ＞0.05),with critical value 3.13％,the sensitivity 57.1％ and specificity 52.4％,respectively.The area under the ROC curve of FeNO for ICS treatment before treatment was 0.628 (P ＜ 0.05),with critical value 30.00％,sensitivity and specificity (64.6％ and 91.0％) respectively.Conclusions For patients with stable COPD,EOS％ and FeNO levels are positively correlated with the improvement of FEV1 after ICS treatment.Both of them can predict the efficacy of ICS to a certain extent,and FeNO has higher predictive value than EOS％,which can be applied to clinical practice.

Objective: To evaluate the quality of neonatal screening work for inherited metabolic diseases，to learn the incidence of inherited metabolic diseases in newborns in Zhejiang Province from 1999 to 2018，and to provide scientific basis for formulating policies for control of birth defects. Methods: The neonatal screening data for inherited metabolic diseases in Zhejiang Province from 1999 to 2018 were collected from the neonatal disease screening database of Zhejiang Neonatal Disease Screening Center，including congenital hypothyroidism（CH），phenylketonuria/tetrahydrobiopterin deficiency（PKU/BH4D），congenital adrenal hyperplasia（CAH），glucose-6-phosphate dehydrogenase deficiency（G6PD）and other metabolic disorders. The related indicators，such as the screening rate，prevalence rate，recall rate for suspected positive cases，resample rate of unqualified blood slides and rate of delayed blood slides delivery，were calculated to assess the quality of neonatal screening and understand the epidemic situation of inherited metabolic diseases in Zhejiang Province. Results: A total of 10 016 839 newborns were screened and the rate rised from 6.46% in 1999 to 100.62% in 2018. The recall rate for suspected positive cases had exceeded 95% since 2007. The rate of unqualified blood tablets was under 1%（0.06% in 2018）；the resample rate of unqualified blood slides had exceeded 99% since 2004；the rate of delayed blood slides delivery dropped to 0.19% in 2018. The proportion of newborns screened by tandem mass spectrometry reached 92.75% in 2018. There were 13 664 cases of inherited metabolic diseases confirmed，with 6 723 cases of CH（6.71/10 000），472 cases of PKU/BH4D（0.47/10 000），125 cases of CAH（0.38/10 000），5 644 cases of G6PD（22.19/10 000）and 700 cases of other metabolic disorders（2.13/10 000）. The highest prevalence rate of CH，PKU/BH4D，G6PD and other metabolic disorders lay in Lishui，Hangzhou，Ningbo and Quzhou，respectively，which was significantly different in cities（P<0.05）. Conclusion The neonatal screening rate for inherited metabolic diseases，recall rate for suspected positive cases and resample rate of unqualified blood slides are high，while the rate of unqualified blood slides and delayed blood slides delivery have been kept low in Zhejiang Province. The prevalence of CH is above and PKU/BH4D is below the national average.