In this paper, we describe mismatch, chaos, and disorder behavior during healthcare seeking. Such structural imbalances, scarcity and surplus make healthcare services less efficient. We give reasons for such phenomena in terms of long-term effects of health resource allocation policy-making and implementation, inherent de-fects within healthcare insurance, incomplete market development, and cultural issues. We then propose four policy strategies, including rational price mechanism, strict referral healthcare system, confidence in basic healthcare facili-ties, and proper healthcare cultures. These will restore orderly healthcare behavior and help realize expectations for the current healthcare reform in China.

Objective To investigate the associated factors of complete virological response (CVR) in Entecavir treatment among chronic hepatitis B (CHB) patients with positive HBeAg.Methods Data of 166 CHB patients with positive HBeAg receiving Entecavir treatment in Yantai Infectious Diseases Hospital during December 2009 and May 2014 were collected.Clinical data including age,gender,genotype,baseline alanine aminotransferase (ALT),HBV DNA load,HBsAg and HBeAg levels as well as CVR cumulative rates at different time points during Entecavir treatment were retrospectively analyzed.The cumulative rate of CVR was estimated using Kaplan-Meier method,and the difference in cumulative CVR rates was studied with Log-rank test.Cox's proportional hazards regression model was used to analyze the factors associated with CVR during Entecavir treatment.Results The cumulative rates of CVR during Entecavir treatment in HBeAg positive CHB patients were 54.5％ (87/157),74.3％ (106/129),80.2％ (109/119) and 86.8％ (110/112) at 48,96,144 and 192 weeks,respectively.Log-rank test showed that female patients and patients with genotype B,high baseline ALT level or low baseline HBV DNA load had higher CVR rates (x2 =15.601,11.542,17.021 and 10.094,all P ＜ 0.01).Cox's proportional hazards regression model showed that female was the only associated factor for CVR in Entecavir treatment among HBeAg positive CHB patients [hazard ratio (HR) =3.015,95％ confidence interval (CI):1.875-4.968,P ＜ 0.01].Conclusion CVR rate is increasing with the course of Entecavir treatment in HBeAg positive CHB patients,and CVR is more likely to occur in female patients.

Physiology parameters measurement based on volume pulse wave is suitable for the monitoring blood pressure continuously. This paper described that the systolic blood pressure (SBP) and diastolic blood pressure (DBP) can be calibrated by measuring the pulse propagation time, just on one point of finger tip. The volume pulse wave was acquired by lighting the red and infrared LED alternately, and after signal processing, an accelerated pulse wave was obtained. Then by measuring the pulse wave propagation time between the progressive wave and reflected wave, we can find the relationship of the time and the blood pressure, and establish the related systolic blood pressure measurement equation. At the same time, based on the relationship between alternating current and direct current components in the volume pulse waveforms and through regression analysising, the relevant diastolic blood pressure measurement equation can be established. 33 clinical experimentation cases have been worked by dividing them into two groups: training group (18 cases) and control group (15 cases), by comparing with the measuring results of the OMRON electronic sphygmomanometer. The results indicated that the two methods had good coherence. The measurement described is simple and reliable, and may be served as a new method for noninvasively and continuously measurement of blood pressure.
Blood Pressure ; physiology ; Blood Pressure Determination ; instrumentation ; methods ; Humans ; Pulse ; Sphygmomanometers

Objective To investigate the impact of steatosis on liver stiffness (LS) detected by transient elastography (Fibroscan) in patients with chronic hepatitis B (CHB).Methods 303 cases of CHB who underwent liver pathology and Fibroscan from January 2010 to May 2013 were retrospectively analysed.Biochemical parameters were collected.LS values in patients of CHB with and without steatosis were compared.LS values in patients of the same stage of liver fibrosis combined with different degrees of steatosis were compared using ANOVA.Cut-off values were obtained by Receiver Operating Characteristic (ROC curve) analysis.Results 273 cases were included when excluding BMI ＞ 28 kg/m2 and ALT ＞200U/ml.Steatosis was present in 75 (31.6％) cases,steatosis was absent in 162 (68.4％) cases.In every stage of fibrosis,combining with steatosis has no significant impact on LS values.LS(kPa) were 5.3 ±1.4vs5.9±1.9,9.5±4.2 vs8.7 ±3.0,18.4 ±7.5 vs 15.0 ±6.6,21.4 ±7.5 vs27.6±5.9 kPa,respectively.(P ＞ 0.05).While in the degree of F2,LS values in patients combined with the steatosis (S2) were higher than those in patients without steatosis (S0) (P ＜ 0.05) and with mild steatosis (S1) (P ＜0.05).LS values(kPa) were 11.28 ±5.54,8.68 ±2.95,8.12 ±2.44,respectively.Conclusions LS values have no significant difference in patients of CHB with steatosis and without steatosis with different degree of liver fibrosis.In patients with fibrosis stage of F2,LS values in those combined with moderate steatosis (S2) were higher than those without steatosis and with mild steatosis.

Objective To study the effect of Yiqi Jiedu compound on autoimmune regulator(Aire)and transcription factor retinoic acid-related orphan receptor(ROR-γt)/Effects of forkhead wing helix transcription factor 3(Foxp3)-related inflammatory factor expression.Methods The EAMG model was replicated by immunization-induced injection of mouse-derived AchR-α subunit 97-116 peptide,including normal group,model group,positive control group(prednisone),and Yiqi Jiedu compound high-dose,medium-dose and low-dose groups.Group of 10,the behaviors and Lennon scores of the rats in each group were observed.ELISA method was used to detect serum transforming growth factor-β1(TGF-β1)and interleukin-6(IL-6)levels.Western blot was used to detect the thymus tissue of EAMG rats.The expression of Aire and Foxp3,and the expression of RORγt in the thymus tissue of rats in each group was detected by RT-PCR.Results Compared with before treatment,the Lennon grading score of each drug group was significantly decreased;compared with the prednisone group,there was no significant difference in the Lennon score of each dose group of Yiqi Jiedu compound(P>0.05).RT-PCR detection results showed that compared with the normal group,the relative expression of RORγt mRNA in the thymus of the model group was significantly increased(P<0.01).Western blot detection results showed that the expressions of Aire and Foxp3 in the model group were significantly lower than those in the normal group(P<0.05);The levels of Aire and Foxp3 proteins in thymus of the rats in each drug group were significantly higher than those of model group(P<0.01).ELISA results showed that serum IL-6 content in model group was significantly higher than that in normal group(P<0.01),while TGF-β1 content was significantly lower than that in normal group(P<0.01).After intragastric administration,the content of IL-6 in all drug groups was significantly decreased,and the content of TGF-β1 was significantly increased(P<0.01).Conclusion Yiqi Jiedu compound can improve the symptoms of muscle weakness in EAMG rats,and its mechanism may be through up-regulating the expression of Aire protein,regulating immune inflammatory response,affecting the differentiation of Th17/Treg,thereby regulating the immune balance of ROR-γt/Foxp3.The role of autoimmune response may be one of the mechanisms of its treatment of MG.

Objective:To investigate the epidermal growth factor receptor (EGFR) mutation rate, mutation characteristics and distribution characteristics of different mutation types in patients with non-small cell lung cancer (NSCLC) in Fuyang of Yunnan province, to provide the clinical individualized targeted therapy of NSCLC in this region.Methods:A total of 328 NSCLC patients whose native place were Fuyuan and who underwent EGFR test in Fuyuan County People's Hospital in Yunnan Province from January 2018 to August 2020 were selected, and their clinical data such as gender, age, ethnicity, pathological type and the results of EGFR test were collected for statistical analysis.Results:The EGFR mutation rate of NSCLC patients was 40.55% (133/328). The EGFR mutation rate of female patients was higher than that of males ( P < 0.01). The EGFR mutation rate showed a downward trend with age, the EGFR mutation rate of patients ≤ 60 years old was higher than that of patients > 60 years old ( P = 0.014). The EGFR mutation rate in ethnic minority was not statistically different from Han nationality ( P = 0.789). The EGFR mutation rate of patients without smoking history was higher than that of patients with smoking history ( P<0.01). Patients with adenocarcinoma had a higher EGFR mutation rate than squamous cell carcinoma ( P = 0.002). The EGFR mutation rate in patients with stage Ⅰ-Ⅱwere higher than that in patents with stage Ⅲ-Ⅳ ( P = 0.013). The EGFR mutation rate in tissue samples were higher than that in peripheral blood samples ( P = 0.009). In 328 patients the EGFR single-point mutation rate was 24.70% (81/328), and the compound mutation rate was 15.85% (52/328); the common mutation rate was 17.07% (56/328), and the rare mutation rate was 23.48% (77/328). The top 5 mutation types were L858R (10.06%), G719X+S768I (7.32%), 19-Del (7.01%), G719X+L861Q (6.40%), and G719X (4.21%). In 133 patients with EGFR mutation, the proportion of patients with rare mutation [57.89% (77/133)] was higher than the proportion of patients with common mutation [42.11% (56/133)]. Conclusion:The EGFR mutation rates of female, adenocarcinoma, non-smoking and young NSCLC patients in Fuyuan area are high, and the rare mutation rate is high.

Objective To express the VP8 * protein of the rotavirus vaccine strain LLR in the E.coli with the pGEX4T-1 vector,which is important for the further research of the VP8 * protein functions.Methods The LLR VP8 * gene was obtained by virus RNA extraction and RT-PCR.Then it was cloned in the expression vectors pGEX4T-1.The recombinant plasmid pGEX4T-1-VP8 * was transformed to the E.coli BL21.Then the VP8 *-GST fusion protein was expressed and purified by the affinity chromatograph.The protein of interest was validated by SDS-PAGE and Western Blot.Results The molecular weight of the VP8 *-GST fusion protein was about 52 000 according to the SDS-PAGE.The bands of both 52 000 and 26 000 were shown in the Western Blot with the antibody against GST.Conclusions The LLR VP8 * gene was obtained and cloned to the pGEX4T-1 vector.Moreover,the solvable VP8 *-GST fusion protein was successfully expressed and purified.

Objective To observe the effects of Yiqi Jiedu Compound on TCM syndrome score and immune regulation of Th17/Treg cells in peripheral blood of patients with myasthenia gravis.Methods 63 patients with myasthenia gravis were randomly divided into the control group(n=31)and the treatment group(n=32).The control group was given the basic treatment of pyridostigmine bromide and glucocorticoid and so on,and the treatment group was given Yiqi Jiedu Compound based on the control group.The two groups were treated for 12 weeks.Clinical efficacy was observed,TCM syndrome scores were statistically analyzed,and the expression levels were detected,which Th17/Treg cells,Foxp3/RORγ t gene and IL-6 and IL-17 cytokines in peripheral blood of patients in both groups before and after treatment.Results After 12 weeks of treatment,compared with the control group,the TCM syndrome score of patients in the treatment group was significantly decreased(P<0.05),and the expression of Foxp3 and Treg genes in peripheral blood was promoted(P<0.05),and the expression of Th17 and Treg cells and IL-6 and IL-17 cytokines in peripheral blood was decreased(P<0.05).Conclusion Yiqi Jiedu Compound may regulate the immune balance of Th17/Treg cells by affecting the differentiation of Th17 and Treg cells in peripheral blood and the expression levels of transcription factors RORγ t and Foxp3 genes and related cytokines,thus achieving the effect of myasthenia gravis treatment.

OBJECTIVE：To study the effects of chrysophanol on the activa tion of microglia and the expression of inflammatory factors in cerebral ischemia model rats. METHODS ：SD rats were randomly divided into sham operation group ， model group and chrysophanol high ，medium，low dose groups [7.88，3.94，1.97 mg/（kg·d）]，with 20 rats in each group （the number was complemented in cases of death or unsuccessful modeling during modeling process ）. Except for sham operation group ， middle cerebral artery occlusion model was established in other groups by improved thread method. After 2 hours of ischemia ， sham operation group and model group were intraperitoneally injected with 1 mL normal saline ，and each administration group was intraperitoneally injected with 1 mL corresponding drug ，once a day ，for 7 consecutive days. After last medication ，the score of neurological impairment was recorded ；cerebral infarction of rats was observed by TTC staining ，and the percentage of cerebral infarction area was calculated. The expression of Iba- 1 positive cells in ischemic penumbra of rats was observed by immunofluorescence staining. The expression of Notch- 1，TNF-α and ICAM-1 in the ischemic penumbra of rats were detected by Western blotting assay. RESULTS ：In sham operation group ，there was no infarction area in the brain tissue ，and the Iba- 1 positive cells in the ischemic penumbra were few and branched. Compared with sham operation group ，the infarction area of cerebral tissue in rats was obvious in model group ； the 052）number of Iba- 1 positive cells in ischemic penumbra were 〔ZQ2017003〕） increased significantly ，and they were in amoeba or round shape；the neurological impairment score ，the percentage of cerebral infarction area ， relative expression of Notch- 1， TNF-α and ICAM-1 protein in ischemic penumbra were increased significantly （P＜0.05）. Compared with m odel rats ，the infarction area of cerebral tissue in each dose group of chrysophanol was reduced to different extent ；the number of Iba- 1 positive cells in ischemic penumbra was decreased ；neurological impairment score ，the percentage of cerebral infarction area ，relative expression of Notch- 1，TNF-α and ICAM-1 protein were significantly decreased （P＜0.05 or P＜0.01）. CONCLUSIONS ：Chrysophanol has a certain protective effect on the brain tissue of cerebral ischemia model rats ，and can relieve the nerve injury. Its mechanism may be associated with inhibiting the activation of microglia and expression of inflammatory factors mediated by Notch pathway.