A consensus remains unsettled yet for basic medical insurance and common protocols on managing patients seeing doctors out of their hometown.This results in such setbacks as difficulty in seeing doctors elsewhere for those covered and in unaffordable financial burden,as well as medical insurance fraud,lack of information sharing among social insurance authorities,and difficulty of supervision.This study described the status quo of seeding doctors elsewhere under China's basic medical insurance system,and analyzed problems found in the management framework.On such basis,authors proposed such recommendations as unified management system for seeding doctors elsewhere,network information sharing for medical insurance information,and networked settlement for medical expenses for basic medical insurance.These measures should be carried out as per general requirements for health reform stage by stage.

Objective To explore the effects of two lubricants on skin preparation from donor site in patients with skin flap transplantation. Methods According to digit number table, 83 patients undergoing wound repair using modified fascia flap were divided into observation group (n=41) and control group (n=42). The former group were treated with Johnson K-Y Lubricant, while the latter with talcum powder. The two groups were compared in terms of the skin flap quality from donor site, pain degree and number of bacteria before and after transplantation. Results There was no significant difference in bacteria number before and after transplantation in the two groups (P>0.05), but the difference between the groups was significant (P<0.01). The flap preparation quality in the observation group was significantly better than that of control group and the pain degree was significantly lower than that of observation group. Conclusion Johnson K-Y Lubricant can significantly improve flap preparation quality and reduce pain.

OBJECTIVE To report a case of AIDS associated with penicilliosis marneffei and discriminate the morphology in bone marrow examination and cultural characteristic of Histoplasma capsulatum and Leishmania donovani.METHODS The three pathogens in bone marrow morphology and cultural characteristic were studied.RESULTS AIDS patient was often infected with P.marneffei,but we could differentiated easily from other pathogens because of its breeding by splitting up and the characteristis structure in bone marrow examination.CONCLUSIONS Isolation of the P.marneffei is the golden diagnosis standard,and the examination of bone marrow is important to diagnose P.marneffei infection.

Objective To approach a simple identification method for clinical Burkholderia cepacia isolates.Methods Thirty eight clinical isolates and 5 referenc strains were identified by phenotypic and genotypic methods. A simple method presented here included TSI agar, oxidase test, pigmentation test, catalase test and antibiograms.Results All but one B. cepacia isolate identified by phenotypic and genotypic methods were identified correctly by our method. One non B. Cepacia isolate identified by the genotypic method was identified as Burkholderia spp. by phenotyic and our methods.Conculsion The method we presented here was simple, practical for identification of clinical B. cepacia isolates.

Objective To observe the expression of mRNA of podocin,nephrin,CD2AP and α - actin - 4 in Doxorubicin - induced nephrotic(ADN)rats,and explore the possible mechanisms of podocyte molecule during the de-velopment of proteinuria. Methods Forty - eight Sprague - Dawley(SD)rats were divided into ADN model group(in-jected with 6. 5 mg/ kg Doxorubicin in tail vein,n = 24)and control group(injected with saline solution in tail vein,n =24). After the nephropathy model was established,6 rats were killed at the end of 1st ,2nd ,4th ,6th week in each group. The changes of the following indicators were observed:(1)24 - hour urinary protein,serum albumin and cholesterol were detected;(2)mRNA expression of nephrin,podocin,CD2AP and α - actin - 4 in cortex of kidney were examined by real time fluorescence quantification PCR. Results The model group came out massive proteinuria(15. 66 ± 1. 50) mg/ 24 h,(45. 98 ± 1. 45)mg/ 24 h,(65. 58 ± 4. 68)mg/ 24 h,(82. 83 ± 8. 43)mg/ 24 h in 1,2,4,6 weeks respec-tively,hypoalbuminemia(27. 4 ±2. 5)g/ L,(23. 6 ±2. 9)g/ L,(20. 6 ±1. 5)g/ L,(6. 9 ± 2. 3)g/ L in 1,2,4,6 weeks respectively and hypercholesterolaemia(2. 00 ± 0. 25)mmol/ L,(2. 16 ± 0. 44)mmol/ L,(4. 02 ± 0. 81)mmol/ L, (7. 54 ± 1. 12)mmol/ L in 1,2,4,6 weeks respectively,and the differences of proteinuria,plasma albumin and total cholesterol compared with control group at each time point had statistical significance(all P ﹤ 0. 01). Compared with the control group,podocin mRNA expression in the model group decreased at the end of 1st week(10. 56 ± 3. 62),de-creased significantly at the end of 2nd week(20. 44 ± 9. 03),and decreased at the end of 4th week(2. 19 ± 0. 18)com-pared with the control group;nephrin mRNA expression decreased at the end of 1st week(2. 41 ± 1. 10)and reached to the peak value,decreased at the end of 4th week(0. 52 ± 0. 18);CD2AP mRNA expression did not change significantly in the 1st week(4. 17 ± 0. 79),increased at the end of 2nd week(6. 74 ± 1. 53),reached to the peak value at the end of 4th week(6. 91 ± 1. 13),but did not change significantly at the end of 6th week(4. 04 ± 0. 82);α - actin - 4 mRNA ex-pression did not change significantly at the end of 1st week(1. 75 ± 0. 48),decreased at the end of 2nd week(2. 01 ± 0. 55),reached to the peak value at the end of 4th week(2. 24 ± 0. 81),but did not change significantly at the end of 6th week(1. 39 ± 0. 18). Compared with the control group,the difference had statistical significance( all P ﹤ 0. 05). Conclusion The abnormal expression of podocyte molecules mRNA in ADN rats may be an important molecular mechanism in the development of proteinuria.

Objective To investigate the therapeutic effect of goal-directed fluid therapy on perioperative volume therapy in patients with placenta previa during perioperative period. Methods Eighty patients undergoing cesarean section were randomly divided into 2 groups(n=40 in each group):the conventional therapy group(N group)and the target management of resuscitation group(G group). Patients in G group were connected the Flo-Trac/Vigileo monitoring system to obtain the information of△SV and CI which were used to guide goal-directed flu-id therapy. Hemodynamics,blood coagulation indexes and lactic acid content in different periods of operation were recorded. Results Compared with N group,colloid infusion volume,HR,△SV,the amount of phenylephrine, PT,APTT and TT were decreased,but urine volume,CVP,CI and MBP of each time point and FIB were mark-edly increased(P < 0.05,respectively). Conclusion The application of FloTrac/Vigileo monitoring system for goal-directed fluid therapy,real-time monitor and effectively maintain hemodynamics in patients with dangerous placenta previa during perioperative period,which can improve the postoperative coagulation function and is better than the conventional rehydration capacity.

Objective To investigate the diversity and antimicrobial susceptibility of cultivable commesal bacteria from 18 to 22 year-old healthy people′s nose and skin. Methods From June to August 2017,18 to 22 year-old healthy people (n=210) were swabbed on skin and nose and cultured with blood plates at Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Species determination was performed using matrix assisted laser desorption Lonization-time of flight-mass spectrometry(MALDI-TOF-MS);Susceptibility testing was performed on the major species by the disc diffusion method; Genomic characteristics of methicillin resistant Staphylococcus epidermidis(MRSE) were determined by pulsed field gel electrophoresis (PFGE) method;SCCmec typing was tested by polymerase chain reaction(PCR);Statistical analysis was performed using SPSS software and association statistics were tested using Chi-Square tests. Results In total, 25 genera were identified of cultivable bacteria from 210 healthy people′s nose (1497 isolates) and skin (941 isolates).Staphylococcus isolates from nose and skin accounted for 82.03% and 80.23% respectively.Eleven species were identified of all Staphylococcus isolates and coagulase-negative Staphylococci(CoNS)from nose and skin accounted for 90.72% and 99.21% respectively.Furthermore, a variety of other species and differences between men and women were observed. Susceptibility testing was done on 631 Staphylococcus isolates, which were sensitive to most antibiotics but show high prevalence of resistance towards penicillin (76.55%), erythromycin (41.20%), clindamycin (10.77%) and trimethoprim/sulfamethoxazole(10.14%). Methicillin Resistant Staphylococcus (MRS) (45 isolates) showed higher prevalence of resistance towards penicillin (χ2=12.17,P<0.001), erythromycin (χ2=10.80,P=0.001), levofloxacin (χ2=20.24, P<0.001) and trimethoprim/sulfamethoxazole (χ2=58.57,P<0.001) compared to methicillin sensitive Staphylococcus (MSS)(586 isolates). Moreover, multidrug resistance (MDR) was observed in 42.16% of 631 isolates and MRS showed a significantly higher proportion than MSS(100.00% vs 37.71%,χ2=66.49,P<0.001).PFGE generated 23 groups out of 33 MRSE isolates. SCCmec genotyping of MRSE showed the most prevalent type was SCCmecⅣ (66.67%). Conclusions Obvious genus and species diversity and genetic diversity were observed on cultivable bacteria from 18 to 22 year-old healthy people′s nose and skin,and CoNS was in the majority. Staphylococcus isolates from healthy people′s nose and skin were sensitive to most antibiotics,but show high prevalence of resistance towards penicillin, erythromycin, clindamycin and trimethoprim/sulfamethoxazole. In addition, MDR was serious especially in MRS. Commensal bacteria may act as reservoir for resistance genes facilitating bacteria infection.

ObjectiveTo investigate the effects and mechanism of Zuogui Jiangtang Tongmai prescription （ZJTP） on human umbilical vein endothelial cells （HUVECs） damaged by high glucose combined with lipopolysaccharide （LPS）. MethodThe survival rate of cells was determined by cell counting kit-8 （CCK-8）， and the level of tumor necrosis factor-α （TNF-α） was determined by enzyme-linked immunosorbent assay （ELISA） to determine the optimal injury concentration and action time of LPS， as well as the optimal action concentration of ZJTP drug-containing serum. HUVECs were divided into a blank control group， a model group， a ZJTP drug-containing serum group， and an SCFA mixed liquid group. ELISA was used to detect the level of endothelin-1 （ET-1）， nitric oxide （NO）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and TNF-α. Western blot was performed to detect the protein expression of G protein-coupled receptor43 （GPR43）， β-suppressor protein-2 （β-arrestin-2）， nuclear factor-κB suppressor α （IκBα）， and nuclear factor κB p65 （NF-κB p65）. The nucleation of NF-κB p65 was observed by immunofluorescence staining （IF）. The role of GPR43 in the regulation of inflammatory injury was observed by means of small interfering ribonucleic acid （siRNA）. The cells after intervention were divided into an empty carrier group， a ZJTP drug-containing serum group， a Si-GPR43 group， and a Si-GPR43 + ZJTP drug-containing serum group. The content of IL-1β， IL-6， and TNF-α was detected by ELISA. The protein expression of pathways was detected by Western blot. IF was used to observe the nucleation of NF-κB p65. ResultThe optimal molding condition was 1 mg·L^-1 LPS for 24 h. The optimal drug intervention condition was 5% ZJTP drug-containing serum for 24 h. Compared with the blank control group， the content of ET-1 in the model group was significantly increased， and the content of NO was significantly decreased （P<0.01）. The levels of inflammatory factors were significantly increased （P<0.01）. The expressions of GPR43 and IκBα were significantly decreased， while the protein expressions of β-arrestin-2 and NF-κB p65 were significantly increased （P<0.01）. NF-κB p65 protein was transferred from the extranuclear to the intranuclear （P<0.01）. Compared with the model group， the content of ET-1 in the ZJTP drug-containing serum group was decreased， and the content of NO was increased （P<0.05）. The levels of inflammatory factors decreased （P<0.05）. The protein expressions of GPR43 and IκBα were increased， while the expressions of β-arrestin-2 and NF-κB p65 were decreased （P<0.05）. The amount of NF-κB p65 transferred from the intranuclear to the extranuclear decreased （P<0.01）. The mechanism study showed that compared with the Si-GPR43 group， the content of IL-1β， IL-6， and TNF-α were significantly decreased after treatment with ZJTP drug-containing serum （P<0.01）. The protein expressions of GPR43 and IκBα were significantly increased （P<0.01）， while the protein expressions of β-arrestin-2 and NF-κB p65 were significantly decreased （P<0.01）. The amount of NF-κB p65 transferred from the extranuclear to the intranuclear decreased （P<0.01）. ConclusionZJTP has a protective effect on HUVECs with high glucose and LPS-induced inflammatory injury， which may be related to the regulation of GPR43/β-arrestin-2/IκBα/NF-κB pathway.