To a certain extent, itemized government subsidies to public hospitals, primarily used for hospital infra-structure and large equipment investments, can alleviate the financial pressure of development expenditures and thus re-duce the medical expenditure burden on patients. To test the hypothesis, the panel data method has been adopted based on the data of 23 tertiary hospitals. Empirical results find that:(1) increases in itemized subsidies will reduce the burden of medical expenses on patients;(2) conversely, the impact of itemized subsidies on outpatient medical expenses is more sig-nificant. By sharing a portion of public hospital expenses and impacting hospital service providing behavior, itemized sub-sidies help to reduce the burden of medical expenses on patients.

Directed evolution was conducted to improve the thermostability of lipase from Rhizopus chinensis CCTCC M201021. Mutations were introduced by two rounds of error-prone PCR and mutant lipase was selected by fast-blue RR top agar screening. Two positive variants were selected in the first-round and four in the second-round screening process. Ep2-4 was proved as the most thermostable lipase and its DNA sequencing revealed three amino acid substitutions: A129S, P168L and V329A. Compared with the parent, its half-life at 60 degrees C was 5.4- times longer and T50 was 7.8 degrees higher. Purified lipase of Ep2-4 was characterized and the result shows that its thermostability improved without compromising enzyme activity. According to the mimicked protein structure, mutation A129S formed a hydrogen bond with Gln133 and improved the thermostability by increasing the hydrophilicity and polarity of protein; mutation P168L by forming a hydrophobic bond with the nearby Leu164.
Cloning, Molecular ; Directed Molecular Evolution ; methods ; Enzyme Stability ; genetics ; Hot Temperature ; Industrial Microbiology ; Lipase ; chemistry ; genetics ; Mutation ; Pichia ; genetics ; metabolism ; Polymerase Chain Reaction ; methods ; Protein Engineering ; methods ; Rhizopus ; enzymology

This paper is prepared to discuss the common issues in data management, such as building and training of data management team, standard operation procedure, document management, execution and communication, strategies to correct and prevent mistakes, and measures to improve the quality and efficiency of clinical trials and data management.
Clinical Trials as Topic ; Data Collection ; standards ; Information Storage and Retrieval ; standards

Preeminent Doctors Education and Training Plan has put forward an urgent request to reform the five-year clinical undergraduate medical talent training mode and strengthen the professional spirit cultivation for medical students. As a pilot project, our college continuously explored the professional spirit cultivation mode for medical students in preeminent physician class and has almost established the three-dimensional mode of whole process, joint participation, multi approach and stressing practice.

Mel-18 gene is one of the core members of the PcG (polycomb group) family,which plays an important role in embryogenesis,cell growth and proliferation and self-renewal of stem cells.Mel-18 gene expressing abnormally has been related to human tumorigenesis,development process.Mel-18 serves as a tumor suppressor gene and inhibits tumor growth through transcriptional repression of Bmi-1 and c-myc.Mel-18 expression is decreased at transcriptional and translational levels in most human cancers including breast cancer,prostate cancer,and gastric cancer and other tumors.Mel-18 is expected to become a prognostic marker for human cancers.

Objective To investigate the correlation of interleukin-1 family genotypes,including interleukin-1 (IL-1α,IL-1β) and interleukin-1 receptor antagonist (IL-1Ra),with coronary heart disease (CHD) and serum lipoprotein level in the elderly.Methods Interleukin-1 family genotypes were detected in 318 elderly controls and 329 elderly CHD patients by polymerase chain reaction and restriction fragment length polymorphisms method.Serum levels of lipoproteins were inspected simultaneously.Results The TT and Ⅰ / Ⅰ or Ⅰ/Ⅳ genotype frequency of IL-1Ra was 90.3％ in elderly CHD patients,but 82.4％ in controls.Carriers with TT,Ⅰ / Ⅰ or Ⅰ/Ⅳ genotype of IL-1Ra were at an increased risk with an odds ratio of 1.98 in elderly CHD patients as compared with controls (x2=8.55,95％ CI:1.25-3.16).The TT and Ⅰ/Ⅰ or Ⅰ/Ⅳ genotype frequency of IL-1Ra was 96.2％ in elderly CHD patients with acute coronary syndrome,but 84.8％ in elderly CHD patients with stable angina.Carriers with TT,Ⅰ / Ⅰ or Ⅰ/Ⅳ genotype of IL-1Ra were at an increased risk with an odds ratio of 4.54 in acute coronary syndrome group as compared with stable angina group (x2=12.17,95％CI:1.81-11.36).The CT or TT genotype frequency of IL-1α-889 was 22.8％ in acute coronary syndrome group,but 7.6 ％ in stable angina group.Carriers with CT or TT genotype of IL-1α-889 were at an increased risk with an odds ratio of 3.59 as compared with stable angina group (x2 =14.93,95％CI:1.82-7.03).There were no significant differences in levels of serum lipoproteins among the different genotypes (P＞0.05).Conclusions In elderly patients with coronary heart disease,IL-1α(-889) CT or TT genotype carriers are at high risk for acute coronary syndrome,but IL-1Ra CC,TC,Ⅰ / Ⅱ or Ⅱ / Ⅱ genotype carriers are at a low risk for CHD or severe CHD.

Objective To investigate the effect of nuclear factor-kappa B (NF-?B) signal transcription pathway inhibitor-pyrrolidine dithiocarbamate (PDTC) on mRNA expression of high mobility group box-1 protein (HMGB1) in organs of rats with endotoxic shock and its potential mechanism. Methods Forty-seven male Wistar rats were randomly divided into normal control group (n=8), endotoxic shock group (n=24), and PDTC treatment group (n=15). At serial time points, the animals in each group were sacrificed, and tissue samples from the liver, lungs and kidneys were harvested to determine HMGB1 mRNA expression and pulmonary MPO activity. Also, blood samples were collected to determine the major organ functional indices. Results Compared to normal controls, HMGB1 mRNA levels were significantly increased in samples from the liver, lungs and kidneys at 2-6h after endotoxin challenge (P

512?g/mL; MIC of 16 VIE to vancomycin were 16?g/mL; MIC of 8 VIE to vancomycin were 8?g/mL. It is a risk factor for hospital infection that VRE carriage of inpatients in intestinal tract is high. There is 100% agreement be-tween phenotypes and genotypes in 46 vancomycin resistance enterococci. VRE are multiresistant. Part iso-lates have high homology.

The dysfunction of T cells, especially the interaction of antigen presenting cells and CD4 + T cells, leads to abnormal activation of CD4 + T cells and the initiation of adaptive immune response.Dysfunction of the immune system plays an important role in the pathogenesis of rheumatoid arthritis.It is always considered as the central link of synovial continuous inflammation, articular cartilage and bone destruction in rheumatoid arthritis patients.Exploring CD4 + T cell differentiation and cell subsets provides a new perspective for understanding of arthritis and helps to identify new drug targets.

Objective To observe the changes of HMGB-1 of burned patient with sepsis and to investigate the effect of carbaehol on production of HMGB-1 from human monocytes stimulated by lipopolysaccharide(LPS) and its mechanism. Methods The peripheral blood samples of burned patients with sepsis and healthy donors were taken for isolation of monoeyte. The subjects were divided into six groups: the menocytes group were added only with 1640 culture medium,LPS group were added only with LPS;nicotine group and carbachol group were with carbachol first or nicotine for 5 rain and then with LPS. The levels of HMGB-1 were tested by EIJSA. α-bungarotoxin + carba-chol group were added with atropine or α-bungarotoxin for 5 min and then were given carbachol and 5 min later were stimulated with LPS. 48 h-incubation later supemate were collected for the detection of HMGB-1 by ELISA. Results HMGB-1 levels of burned patients with sepsis were ( 12.94±6.54)μ/L,which were much higher than that of healthy donors( [ (2.01±0.03 )μ/L), P <0.01 ]. When monoeytes were stimulated by LPS alone, concentrations of HMGB-1 were (9.39±1.37 ) μ/L, which were obviously higher than that of controls [( 1.48±0.69 ) μ/L), P < 0.01]. Mter pretreated by carbaehol or nicotine,concentrations of HMGB-1 were (3.52±1.64)μ/L and (4.01± 1.56) μ/L respectively, which were obviously decreased compared with that of LPS stimulation alone group ( P < 0.01). When pretreatedby atropine before addition of carbachol, there was no significant changes in concentrations of HMGB-1 [ (3.87±2.01 )μ/L]. When pretreated with α-Bungaretoxin before carbachol adminitration, inhibitive effect of carbachol on production of HMGB-1 were blocked [(8.97±1.97 )μ/L ]. Conclusion The release of HMGB-1 in burned patients with sepsis is increased. Carbachol could obviously reduce the production of HMGB-1, which may affect through activating α 7 subunit of cholinergic N receptor.