Objective Analysis of the operational efficiency trends of and problems with the public tertiary hospitals. Methods A retrospective statistics analyzed the indicators of ten public tertiary general hospitals in Shanghai during 1997-2006. Results The outpatients number per capita for the hospital staff maintains an rising trend, averaging 12.2% per year prior to year 2000; The yearly-averaged total assets turnover of the hospitals decreases from 0.89 in 1997 to 0.69 in 2003, then maintaining unchanged; The yearly-averaged receivables turnover began to fall since 1999, falling from 21.4 in 1999 to 9.7 in 2006; hospital income growth fluctuated during the years, yet with a high level of total assets growth; given the fluctuations in asset-liability ratio, such ratio has been growing slowly, maintaining at 20 % since 2004. Conclusion Problems are found with the operational efficiency of these public tertiary general hospitals as follows: the rapid growth of productivity in such hospitals finds no concurrent improvements in assets related indicators. Against a low income ratio, high debt ratio will plague hospital development to some extent.

AIM: To evaluate the therapeutic effect and safety of the rifamycin sodium injection (SV) in treatment of patients with pulmonary tuberculosis. METHODS: 44 cases of pulmonary tuberculosis were randomly allocated to two groups: rifamycin sodium group and routine treatment group. Chemotherapy regimens: in the rifamycin sodium group, 21 cases were treated with the regimen of 2HZE+SV/7HR; and in the routine treatment group, 23 cases were treated with the regimen of 2HRZE/7HR. RESULTS: The sputum negative conversion rate of the rifamycin sodium group was 85.7 %, and the foci vanishing rate was 90.5 %, while the both rates in the routine treatment group were 60.9 % and 60.9 %, respectively. There was significant difference between the two groups (P

Objective Studies show that the ERCC1 gene may be involved in secondary cisplatin resistance.This article aims to investigate the effects of shRNA targeting silencing excision repair cross-complementation group 1 (ERCC1-shRNA) on the proliferation and apoptosis of lung cancer A549/DDP cells treated with different concentrations of cisplatin.Methods Lung cancer A549/DDP cells were divided into a negative control, a blank control, an ERCC1-shRNA1, and an ERCC1-shRNA2 group.Human interfering RNA (RNAi) targeting the human ERCC1 gene was constructed and transfected into the A549/DDP cells using Lipofectamine 2000.The mRNA and protein expressions of ERCC1 in the A549/DDP cells were detected by real-time PCR and Western blot respectively, the proliferation-inhibition rate was assessed by MTT, and their cell cycle and apoptosis were determined by flow cytometry.Results ERCC1-shRNA was successfully constructed and transfected into the A549/DDP cells.Both the mRNA and protein expressions of ERCC1 were significantly lower in the ERCC1-shRNA1 (0.20±0.04 and 0.24±0.10) and ERCC1-shRNA2 (0.47±0.28 and 0.37±0.11) than in the negative control (0.96±0.12 and 1.32±0.13) and blank control groups (0.84±0.07 and 1.45±0.23) (P<0.01).Compared with the negative and blank control groups, the ERCC1-shRNA1 group showed a significantly decreased IC50 value (16.71±2.33 and 16.69±1.69 vs 7.78±0.54, P<0.01) and an increased proportion of G0/G1 phase cells ([72.87±3.23] and [71.75±4.56] vs [82.99±4.23]%, P<0.05), with the cell cycle arrested in the G0/G1 phase.The apoptosis rate of the cells in the ERCC1-shRNA1 group was remarkably lower after treated with cisplatin at the concentrations of 6.25 and 12.5 μg/mL than at 0 μg/mL ([8.17±0.65] and [11.91±1.41] vs [29.97±3.14]%, P<0.05).Conclusion ERCC1-shRNA can inhibit the proliferation and enhance the apoptosis of A549/DDP cells by silencing the expression of the ERCC1 gene.

Objective To study the express of matrix metalloproteinase(MMP)-2 and tissue inhibitor of metalloproteinase(TIMP)-2 protein in human endometrial carcinoma. Methods The Immunohistochemistry was used to measure the MMP-2, TIMP-2 in endometrial carcinoma tissue of 40 patients, the atypical hyperplasia of 12 samples and the normal endometrium of 12 samples. Results The positive express of MMP-2 and TIMP-2 in the normal endometrium , atypical hyperplasia and endometrial carcinoma was increased gradually. In endometrial carcinoma, with progression of clinical stage and decrease of histological grade as well as deepening of cancer invasion, the ratio of MMP-2/TIMP-2 was increased. Conclusions The expression of MMP-2 and TIMP-2 were connected with endometrial carcinoma. The imbalance of MMP-2/TIMP-2 in the endometrial cancer might be one of the pathogenesis and development.

Objective To summary the clinical data of pediatric renal transplantation from multiple renal transplant centers in China,and analyze the factors influencing the therapeutic outcomes of pediatric renal transplantation.Methods From March 1986 to May 2010,the clinical data of 138 children who underwent renal transplantation in eight centers of renal transplantation in China were retrospectively analyzed.Results The one-year patient and graft survival rate was 99.3％ and 95.7％respectively.Acute rejection episodes occurred in 38 cases (27.5％),15 cases suffered delayed graft function (DGF),and graft functions were returned to normal in all recipients within one month.Moreover,other complications included transplant renal artery stenosis in 8 cases (5.8％),ureteral necrosis in 2 cases (1.4％),urinary fistula in 5 cases (3.6％),hypertension in 57 cases (41.3 ％),hyperlipidemia in 38 cases (27.5％),hirsutism in 32 cases (23.2％),drug-induced liver damage in 26 cases (18.8％),urinary tract infection in 25 cases (18.1％ ),gingival hyperplasia in 22 cases (15.9％),pulmonary infection in 21 cases (15.2％),bone marrow suppression in 12 patients (8.7％),herpes simplex in 10 cases (7.2％),and diabetes in 8 cases (5.8％).The body weight was increased by 4 to 13 kg and the body height was increased by 2 to 7 cm during the first year posttransplantation. Conclusion The careful perioperative management, rational use of immunosuppressive agents,strengthening the follow-up management of children and social support,and improving compliance were the key points to obtain good outcomes in pediatric renal transplantation.

Objective To explore the effects of minimally invasive removal of intracranial hematoma on blood-brain barrier (BBB) index, serum myelin basic protein (MBP) and activity of daily living (ADL) in hypertensive patients with cerebral hemorrhage.Methods Through observing 30cases operated within 3.0 hours, 32 case operated between 3. 1-8. 0 hours, 28 cases operated between 8. 1 to 24.0 hours and 22 cases operated over 24 hours, the changes of BBB index, serum MBP and ADL were analyzed. Results The BBB index and serum MBP were significantly lower in patients operated within 8. 0 hours than in patients operated over 8. 1 hours [≤3.0 hours group:(6.57±0.69)×10-3 and (3. 12±0.40)μg/L;3. 1-8.0 hours group: (7. 37±1.29)×10-3 and (3.25±0.60)μg/L;8. 1-2.0 hours group: ( 12. 02± 1.51 ) × 10 3 and (4. 60±0. 48)μg/L;over 24.0 hours group: ( 14. 68±2.07)×10-3 and (5.88±0.64)μg/L,Q＞13.8,P＜0. 05]. And the ADL was lower in patients operated within 8. 0 hours than in patients operated over 8. 1 hours [≤3.0 hours group: (2. 60± 1.07)scores; 3.1-8.0 hours group: (3. 06±0. 91 )scores;8. 1-24.0 hours group: (4.00±0.67) scores;over 24.0 hours group:(3.68±1.32)scores,Q＞3. 1,P＜0.05].Conclusions The minimally invasive surgery of intracranial hematoma within 8.0 hours can mitigate the cytotoxicity-damaged BBB so as to lighten brain edema and improve the patients quality of life.

Objective To evaluate the application of “expert-guided network tracking system” in training community general practitioner for hypertension management.Methods Total 855 general practitioners (GPs) from 20 community health service centers in Hangzhou,Jiaxing and Shaoxing of Zhejiang province were divided into two groups: 430 GPs from 10 community health centers received training for hypertension management using “ expert-guided networking tracking system” (intervention group) in December 2008 and 425 GPs from another 10 health centers received conventional training (control group).Questionnaire surveys about the knowledge and skill of hypertension management were conducted before and 3 y after training.Results The awareness rates of knowledge about hypertension prevention and control,non-drug therapy and drug therapy increased from 37.0％ (159/430),45.6％ (196/430),42.8％ (184/430) to 66.8％ (284/425),81.4％ (346/425),77.6％ (330/425),respectively and the accuracy of case analysis increased from 38.4％ (490/1290) to 73.3％ (946/1290) (P ＜0.01) after training in intervention group.Meanwhile the knowledge and case management abilities in control group were also improved after conventional training,but the degree was significantly lower than that in the intervention group.Conclusions “Expert-guided networking tracking system” can significantly improve the knowledge and skills for hypertension management in community general practitioners.

Objective To study the efficacy and safety of endobiliary radiofrequency ablation (RFA) with stent placement in treatment of unresectable extrahepatic cholangiocarcinoma (EHCC).Methods The patients with unresectable EHCC in Hangzhou First People's Hospital between October 2013 and January 2015 were enrolled in a prospective, randomized, single-blind cohort study, and were assigned randomly into two groups: RFA+stent group and stent-only group.The jaundice fade time, stent patency period, overall survival rate, and postoperative adverse events were analyzed between two groups.Results Among 59 patients with non-resectable EHCC, 28 were divided into RFA+stent group, and 31 were in stent-only group.There was no statistical difference in preoperative serum total bilirubin between the two groups.Mean serum bilirubin decrease time was significantly lower in the RFA+stent group than that in the stent-only group[17.9 d(7-22 d) VS 29.9 d(10-55 d),P=0.03].The biliary patency period in RFA+stent group was significantly longer than that of stent-only group (8.9 months VS 4.5 months, P=0.02).The mean survival time in RFA+stent group was significantly longer than that of stent-only group[13.3 months(6.2-16.5 months) VS 8.6 months(4.5-11.7 months), P=0.000).Incidence of postoperative adverse events showed no statistical difference between the two groups(P=0.727).Conclusion RFA with stent placement is effective and safe as a palliative measure in the treatment of non-resectable EHCC, and it can significantly shorten the jaundice fade time, prolong the biliary patency period and overall survival, while without increase of the incidence of adverse events.

Objective:To explore the effect of high fat and low sugar enteral nutrition support on ventilatory function and immune function in patients with chronic obstructive pulmonary disease(COPD) undergoing mechanical ventilation.Methods:From January 2018 to December 2019, 96 COPD patients treated in Zhuji People's Hospital were divided into observation group and control group by simple random sampling method, with 48 cases in each group.The control group was treated with traditional nutrient solution, and the observation group was given high fat and low sugar enteral nutrition.The blood gas analysis, respiratory function, immune function, weaning time and weaning success rate were observed before and after treatment.Results:After treatment, the arterial oxygen partial pressure(PaO 2)[(10.08±0.49)kPa], the blood oxygen saturation (SpO 2)[(96.46±2.15)%] in the observation group were higher than those in the control group[(9.53±0.46)kPa, (95.04±2.08)%]( t=5.670, 3.289, all P<0.05), and the carbon dioxide partial pressure (PaCO 2) [(6.42±0.27)kPa] was lower than that in the control group [(7.33±0.25)kPa]( t=17.134, P<0.05). After treatment, the forced vital capacity(FVC) [(3.03±0.52)L], forced expiratory volume in one second(FEV 1)[(1.61±0.33)L], peak expiratory flow(PEF)(0.54±0.08) in the observation group were higher than those in the control group [(2.78±0.45)L, (1.42±0.31)L, (0.49±0.07)]( t=2.519, 2.907, 3.259, all P<0.05). The immunoglobulin G [(12.45±1.32)g/L], immunoglobulin M [(1.88±0.34)g/L] and immunoglobulin A [(2.68±0.47)g/L] in the observation group were higher than those in the control group [(11.66±1.28)g/L, (1.65±0.37)g/L, (2.38±0.45)g/L] ( t=2.977, 3.171, 3.194, all P<0.05). The weaning time of the observation group was (6.94±1.55)d, which was lower than that of the control group [(8.73±1.41)d] ( t=5.919, P<0.05). The success rate of weaning of the observation group (91.67%) was higher than that of the control group (72.92%) (χ 2=5.790, P<0.05). Conclusion:High fat and low sugar enteral nutrition support can improve the ventilation indicators and immune function indicators of COPD patients with mechanical ventilation, shorten the time of mechanical ventilation, and improve the success rate of weaning.

Objective:To evaluate the value of serum pepsinogen Ⅰ and Ⅱ combined with gastrin-17 in screening precancerous lesions of gastric cancer in physical examination population.Methods:Serum pepsinogen, gastrin-17 and Helicobacter pylori (Hp) antibody were detected in 18 354 physical examination people from July to December 2017 in Wenrong Hospital, Hengdian, Dongyang. The patients were divided into youth group (18 to 39 years old), middle-aged group (40 to 59 years old) and elderly group (≥60 years old) according to their ages. The correlation between the serological level of the above indexes and age was analyzed; according to the new ABC method, the test results were divided into groups A, B, C and D. The patients in group C and D were examined by gastroscopy. The differences of gastric mucosal atrophy or intestinal metaplasia and other precancerous lesions detected by gastroscopy in different age groups were compared.Results:Finally, 18 354 cases were enrolled, including 9 614 males and 8 740 females. With the increase of age, the proportion of group C and D increased gradually. In group C, 181 cases underwent gastroscopy, including 39 cases of atrophic gastritis, 29 cases of intestinal metaplasia and 3 cases of dysplasia/intraepithelial neoplasia, the detection rate of precancerous lesions was 39.23%; in group D, 94 cases underwent gastroscopy, including 22 cases of atrophic gastritis and 13 cases of intestinal metaplasia, the detection rate of precancerous lesions was 37.23%. The proportion of gastric precancerous lesions in group C and D was 29.63% in the young group, 69.70% in the middle-aged group and 71.58% in the old group, respectively. There was significant difference compared with the young group ( P<0.01); atypical hyperplasia occurred in 2.02% and 9.47% of the middle-aged group and the elderly group. Conclusions:The combined detection of serum pepsinogen Ⅰ and Ⅱ and gastrin-17 levels is of great value in the screening of precancerous lesions of gastric cancer; when this method used for early gastric cancer screening in healthy population, it is necessary to consider the influence of age for the risk stratification of gastric cancer.