Against the backdrop of ongoing healthcare system reform and escalating competitions among hospitals in China,more and more specialists and scholars on hospital administration begin to focus their studies on the theories and practice of hospital flows.Methodology frequently called into play in such study include out-patient flow refom,progressive flow improvement,and attention to management and service.Discussed in this paper are the advantages and disadvantages of these three methods as a reference for an appropriate choice by hospitals at large.

Objective To grasp the basic situation concerning visits by emergency outpatients to big urban hospitals before the implementation of reform in the medical insurance system in our city. Methods An investigation was made by means of profile survey questionnaires into the form of medical security of emergency outpatients, the sources of patients, referrals of patients, and the evaluation of doctors. Results Current emergency outpatient services in big urban hospitals have the following features: fairly great medical demands and attraction, widespread sources of patients, and pretty strong advantages in comprehensive clinical treatment. At the same time, before the implementation of reform in the basic medical insurance system, existing medical security setups, which are in the stage of transition, are characterized by a variety of types, a pretty narrow coverage in the provision of medical security and a rather high proportion of self-paying patients. Conclusion It is imperative to actively promote reform of the medical insurance system, formulate regional health plans that conform to the situation in our country, and expand the functions of community medical healthcare.

Objective To study the features and differences of electromyography of diabetic polyneuropathy (DPN) and alcoholic peripheral neuropathy (APN ), and to provide reference basis for the clinical application of electromyography.Methods 58 patients with DPN and 30 patients with APN were used as subjects. Nerve conduction studies (NCS)and sympathetic skin response (SSR)were performed in the patients, all data were analyzed.Results In the patients with DPN, the abnormalities of NCS and SSR were increased with the prolongation of the time diabetes,and the abnormality of SSR was higher than that of NCS(P<0.05).In the patients with APN, both demyelination and axonal loss in motor and sensory nerves were significantly involved, and the abnomalities of NCS and SSR were higher than those of the DPN patients (P<0.05 or P<0.01);but the proximal nerves were just involoved mildly. Conclusion Both DPN and APN have characteristic electrophysiological features.Early electromyography is useful for the early diagnosis of DPN and APN.According to the electrophysiological features of DPN and APN,the reason of peripheral neuropathy in the patients who have diabetes mellitus and alcoholism could be differentiated.

Objective To observe the expression changes of microRNA-124(miRNA-124) following traumatic brain injury (TBI) in mice and investigate the correlation of miRNA-124 with neural axon regeneration.Methods Ninety-one C57BL/6 mice were assigned into TBI group (n =63) and control group (n =28) according to the random number table.Mice in TBI group were subjected to controlled cortical impact and euthanized at 12 hours and 1,3,7,14,21,28 days postinjury for the collection of brain tissue in the trauma zone.Mice in control group underwent craniectomy only.Trauma zone observation was done using the HE staining.Expression of miRNA-124 was detected using the real-time PCR.Levels of Nrp-1,Gap-43 and Tau were detected using the Western blot and immunohistochemical staining.Results After injtury,study of mice behavior and HE staining indicated the establishment of experimental model was successful.Expression of miRNA-124 reached the peak at 3 days postinjury (3.80 ± 0.22),expression of Nrp-1 reached the peak at 7 days postinjury (2.006 ±0.179),expression of Tau reached the peak at 14 days postinjury (2.063 ±0.172),and expression of Gap-43 sustained high level since 12 hours after injury(1.355 ± 0.093) (P ＜ 0.05).Count of axon marker positive cells in TBI group was the lowest at 1 day postinjury due to the direct damage and edema,and then slowly recovered.There was no significant difference in the count of axon marker positive cells between the two groups at 14,21 and 28 days postinjury (P ＞ 0.05),but the morphology in TBI group changed obviously.Although the positive cells of axon marker decreased at 1 day postinjury,expressions of miRNA-124,Nrp-1,Tau and Gap-43 in TBI group were significantly increased compared to the detections in control group (P ＜ 0.05).Conclusion Increased expression of miRNA-124 in trauma zone may closely related to axon regeneration after TBI in mice.

AIM:To observe the expressions of cathepsin B (CB) and cystatin C (CC) in different stage of diabetic rats and to investigates their potential roles.METHODS:Sixty rats were divided into diabetes mellitus group induced by intravenous injection of streptozotocin (55 mg/kg) and normal group injected with citrate buffer. Ten rats were sacrificed respectively at the end of fourth week,eighth week and sixteenth week in both groups. 24 h urine excretion was collected in rats before sacrifice. The blood and the kidney were also collected. The mRNA and protein expressions of CB and CC in kidney were detected by real time PCR and immunohistochemical staining,respectively.RESULTS:At the end of eighth week,the expression of Ccr,24 h urinary protein excretion,CB,CC in diabetic rats increased significantly,compared to the results at the fourth week (P

Objective To study the clinical diagnosis and therapy of scar pregnancy after uterine cesarean section.Methods Clinical data of 21 patients with uterine cesarean section in our hospital from June 2006 to December 2008 were retrospectively analyzed.Results The success rate of 16 cases by drug therapy (including three cases of surgical treatment) was 81.3%;3 cases of auto-discharge transferred to other hospitals to do intervention,1 case used expectant treatment,1 case used complete curettage of uterine cavity under B-Ultrasound.Conclusion Drug treatment can terminated scar pregnancy after uterine cesarean section effectively,but there is a potential risk of massive hemorrhage or uterine rupture;color doppler ultrasound,especially Transvaginal color doppler ultrasound was the primary means of cesarean section,and benefit to judge prognostic factors and observed treatment.

Objective To explore the relationship between R time in thrombelastography (TEG) and prognosis of traumatic brain injury (TBI).Methods The data of TBI patients were collected in Fourth Peoples Hospital in Shaanxi Province from January 2015 to June 2016.The patients were divided into two groups according to the prolongation of R time at admission,and the basic data and the outcomes were analyzed.Results In basic data,Glasgow coma scale (GCS) [(9.7 ± 4.4) scores vs (12.1 ± 2.2) scores] was lower,and injury severity score (ISS) [(32.4 ± 8.9) scores vs (21.7 ± 10.4) scores],head abbreviated injury scale (AIS) [(5.0 ±0.0) scores vs (4.1 ± 1.5) scores],hemorrhage volume [(6.2 ± 5.5) ml vs (1.1 ± 1.8) ml] and mean arterial pressure[(127.2 ± 28.1) mmHg vs (103.3 ± 17.0) mmHg] were higher in the prolonged R time group.In outcomes,the in-hospital mortality (42.9％ vs 17.2％) and the rate of neurosurgical intervention (71.4％ vs 37.7％) were higher,and the duration of mechanically ventilated [(9.3 ±3.2) d vs (4.1 ± 1.7) d],ICU stay [(10.2 ± 4.4) d vs (5.6 ± 2.1) d] and hospital stay [(22.4 ± 8.1) d vs (8.3 ± 4.7) d] were longer in prolonged R time group.The Logistic regression analysis results showed that GCS ≤8 scores,ISS ＞ 25 scores and R time ＞ 10 min were the possible risk factors of hospital mortality.Conclusion TBI patients with longer R time have worse prognosis and longer R time is the possible risk factor of hospital mortality,and the prediction efficiency of R time need to be explored and validated by more research.

Objective To set up the reference range for thyroid hormones and thyrotropin (TSH) of 8-10 years old school children in certain regions of China to provide reference criteria for diagnosis,treatment,and monitoring of thyroid diseases and related research.Methods A cross-sectional survey was conducted in primary school children aged 8-10 years from six iodine sufficient areas.664 normal school children were selected for establishing reference ranges of thyroid hormones and TSH after crucial screening through questionnaire and laboratory investigation.The serum hormone levels were determined by using chemiluminescent immunoassay (Bayer's reagents),and the reference range of each hormone was displayed as its 95％ central interval.Results The reference ranges of TSH,FT4,FT3,TT4,and TT3 were 1.03-8.42 mIU/L,13.44-20.59 pmol/L,4.75-6.96pmol/L,75.29-152.66 nmol/L,and 1.76-3.35 nmol/L,respectively.There was no significant difference in hormone levels between boys and girls.The eight years old group had slightly higher TT4 level compared with the other age groups.The rural children had higher TSH and TT3 levels and lower FT4 level than the urban children.Conclusion The thyroid hormone and TSH levels are substantially different between school children and adults.Therefore,it is necessary to establish the reference range of thyroid function indices for normal school children in order to diagnose,treat,and monitor thyroid diseases.

ObjectiveTo investigate the effects of maternal thyroid dysfunction during pregnancy caused by iodine deficiency of different degrees on doublecortin ( DCX ) and synaptophysin ( p38 ) expressions in fetal brain.Methods Wistar female rats were randomly divided into four groups:adequate iodine ( AI),mild iodine deficiency ( MiID ),moderate iodine deficiency ( MoID ),and severe iodine deficiency ( SID ),according to the total daily iodine supply( fed on an iodine deficient diet with different dosages of KI added in drinking water).Three months later the rats were mated.Serum TSH and thyroid hormones were determined in maternal rats on gestational day 20 using chemiluminescent immunoassay.The iodine contents in urine and histological changes of thyroid gland were observed in pregnant rats.The mRNA and protein levels of DCX and synaptophysin ( p38 ) were analyzed in fetal brain by using real time quantitative RT-PCR and western blotting respectively.Results( 1 ) Iodine contents in urine of pregnant rats were reduced with the decrease of their iodine supply.Compared with group AI,serum TSH was significantly increased [ ( 2.95 ± 1.70 vs 1.31 ± 0.55 ) mU/L,P ＜ 0.05 ],and both TT4 and FT4 were significantly decreased [ ( 14.3±4.1 vs 28.4±19.3 ) nmol/L,P＜0.05 ] and [ ( 10.8±3.6 vs 20.2±8.0) pmol/L,P＜0.01 ] in pregnant rats of SID group.Whereas,a slight rise in TSH,and a mild decline in both TT4and FT4 were found in MoID and MiID groups.However,there were no significant changes in TT3 and FT3 levels among these four groups.( 2 )Histological characteristics of thyroid gland in pregnant rats showed a typical goiter with small follicular hyperplasia and lack of colloid in SID group,moderate follicular hyperplasia with decreased colloid in MoID group; but mild cellular hyperplasia without decrease in follicular size and colloid in MiID group.( 3 ) The mRNA levels of DCX were increased in fetal brains of three iodine deficiency groups compared with AI group,but a statistical significance was found in MoID group.The protein levels of DCX in all experiment groups were significantly increased.Both mRNA and protein expressions of synaptophysin ( p38 )were significantly down-regulated in three iodine deficiency groups.Conclusions Maternal thyroid dysfunction caused by iodine deficiency,even by mild or moderate iodine deficiency,may lead to retardation of fetal neuronal and synaptic growth.

AIM:To investigate the effect of hydrogen sulfide ( H2 S) on high glucose ( HG)-induced injury of the mouse podocyte cell line MPC5.METHODS: The cultured MPC5 cells were randomly divided into 4 groups: HG group, normal glucose (NG) group, NG+DL-propargylglycine (PPG) group, and HG+NaHS group.After treated for a certain time, the cells were collected for further detection .The expression of zonula occludens-2 (ZO-2), nephrin,β-cate-nin and cystathionine γ-lyase ( CSE) was determined by Western blotting .RESULTS:High glucose significantly reduced the expression of nephrin, ZO-2 and CSE (P<0.05), while the level of β-catenin was elevated obviously (P<0.05), all in a time-dependent manner.NG+PPG inhibited the levels of ZO-2 and nephrin significantly (P<0.05), and increased the level of β-catenin (P<0.05), all in a PPG concentration-dependent manner.HG+NaHS induced a more significant increase in the levels of ZO-2 and nephrin as compared with HG group (P<0.01), whereas a severe reduction of β-cate-nin in HG+NaHS group was observed as compared with HG group .Compared with NG group , the expression of ZO-2 and nephrin was decreased obviously , and the level of β-catenin was increased in HG +NaHS group.CONCLUSION:Down-regulation of CSE contributes to hyperglycemia-induced podocyte injury .Exogenous H 2 S protects against hyperglycemia-in-duced podocyte injury , possibly through up-regulation of ZO-2 and subsequent suppression of Wnt/β-catenin pathway .