Serum cortisol and plasma ACTH were determined in 10 patients with severe sepsis and 12 with septic shock on day 1,3,5 after diagnosis were made,and the data were compared with 12 control patients. To evaluate the hypothalamic-pituitary-adrenal(HPA)axis function in patients with severe sepsis and septic shock,1?g ACTH stimulation test was applied after hormone concentrations were obtained on day 1.Compared with the control patients,ACTH level was significantly higher in patients with severe sepsis and lower in septic shock(P

Dendrimers are hyperbranched, monodisperse and three dimensional macromolecules, which consist of an apolar core and polar shell have been referred to as "unimolecular micelles". This paper briefly describes the development and structural characteristics of dendrimers and also explains the feature of dendrimers as drug carrier and the dendrimer-drug interactions in details. Recently, dendrimers, which have attracted increasing attention for their applications in many fields such as drug targeted delivery systems and gene transfection, are becoming potential novel carriers.
Dendrimers ; chemistry ; Drug Delivery Systems ; Drug Design ; Polyamines ; chemistry

This paper analyzes the main performance problems of public hospitals in China,s health service field,including the deep institutional mechanism contradictions and the inefficient use of resources relying on debt to expand.Based on the policy paper of public hospital reform,this paper puts forward the path of public hospitals,par-ticipation in supply-side structural reform of medical services with objectives including:to resolve the historical debts of public hospitals,to control the financial and fiscal risks;to strictly control the cost of public hospitals, to cutrail the unreasonable increase of expenses in public hospitals and provide affordable services;to innovate the management system and operation mechanism,to make compensation and supervision in place, and improve the governance sys-tem of public hospitals;to strengthen the links between public hospitals and primary,social capital so as to integrate the medical industry chain,and expand the supply of high-quality medical resources.

Objective:To investigate and evaluate the status of financial information disclosure in public hospitals.Methods:Taking the method of policy analysis,descriptive statistics,consult the relevant policy and the hospital website of 200 countries for public hospital reform pilot cities,sum up the change trend and implementation status of public hospital financial information disclosure regulation policy from 2006 to 2017.Results:There were obvious differences in public financial information in public hospitals from various regions,only 130 hospitals(65％) disclosed financial information in the website,the goal of "hospitals in comprehensive reform of all urban public hospitals should disclose financial information to the public by the end of 2016" was not fully achieved,the standardization and comparison of financial information was not high.Conclusion:In order to achieve the goal of "opening the financial information disclosure system to all public hospitals and all regions in China by the end of 2018",it suggested to integrate the existing documents,combined with the beneficial practices in pilot cities,unified public hospital financial disclosure guidelines and perfect supporting measures for policy implementation.

Based on combing the value-added tax policy for public hospitals,it analyzed the tax burden influence of substituting the value-added tax for business tax to public hospitals.It pointed out that,in the case of the tax rate,the phenomenon of the tax burden did not decrease but increases to some degree occurs in public hospitals because the deductible input tax was less.In addition,it introduced the value-added tax related public hospital accountant course setting and the main accounting treatment under Government Accounting System,suggested that public hospitals should attach importance to the tax planning of value-added tax taxable items,detail cost,the corresponding expenditure of the taxable items and the corresponding expenses of tax-free income shall be separately accounted,to realize the matching of taxable income and cost,obtain the deductible value-added tax invoices of taxable behavior.

On the basis of combing applicable corporate income tax rules for public hospitals in the tax law,regulations and the Government Accounting System,it analyzed the implementation difficulties of corporate income tax policy in public hospitals,such as the level limited average salary brought difficulties for non-profit organization of enterprise income tax exemption qualification in public hospitals.Public hospitals had not fully conducted the accounting for obtaining taxable income,tax-exempt income and its cost accounting respectively.It suggested to combining the characteristics of the industry,emboding the spirt of public hospital reform remmeration in the supplemtary provisins of the financial acounting system;detail the accounting taxable income and related cost under G overnment Accounting Standard and Government Accounting System.

The paper reviews the standard and requirement of hospital cost accounting in hospital financial and accounting system,and policy documents of public hospital reform,introduces the implementation development of hospitals cost accounting,and through combining with the reform of government accounting,analyzes the limitations of hospitals cost accounting,including department cost accounting results are difficult to satisfy both hospital internal management and government pricing compensation needs;project cost and disease cost accounting a.re lack of operational guidelines and report format.Proposals are offered for linking up hospital cost accounting with governmental accounting.

Consultation fees are included in the service homogenization,standardization,patient awareness,relatively high frequency of clinical use,and the general project catalog commonly carried out by public hospitals.On the basis of sorting out the elements of consultation fee price items in some provinces,this paper summarizes the setting of trigger conditions and rules for dynamic adjustment of consultation fee prices in typical regions,and the progress of substantive start-up of dynamic adjustment for consultation fee prices.It compares the level of consultation fees in some provinces,and analyzes the problems faced by consultation fee fees.Some provinces have not dynamically adjusted the examination fee for a long time,and the price comparison relationship with neighboring regions is not coordinated.The policy direction and operational suggestions for improving the dynamic adjustment mechanism of consultation fee price include:Integrating the elements of consultation price items and improving the price standardization level;Popularize the experience of typical areas,after evaluation,start the dynamic price adjustment of consultation items.

Consultation fees are included in the service homogenization,standardization,patient awareness,relatively high frequency of clinical use,and the general project catalog commonly carried out by public hospitals.On the basis of sorting out the elements of consultation fee price items in some provinces,this paper summarizes the setting of trigger conditions and rules for dynamic adjustment of consultation fee prices in typical regions,and the progress of substantive start-up of dynamic adjustment for consultation fee prices.It compares the level of consultation fees in some provinces,and analyzes the problems faced by consultation fee fees.Some provinces have not dynamically adjusted the examination fee for a long time,and the price comparison relationship with neighboring regions is not coordinated.The policy direction and operational suggestions for improving the dynamic adjustment mechanism of consultation fee price include:Integrating the elements of consultation price items and improving the price standardization level;Popularize the experience of typical areas,after evaluation,start the dynamic price adjustment of consultation items.

Consultation fees are included in the service homogenization,standardization,patient awareness,relatively high frequency of clinical use,and the general project catalog commonly carried out by public hospitals.On the basis of sorting out the elements of consultation fee price items in some provinces,this paper summarizes the setting of trigger conditions and rules for dynamic adjustment of consultation fee prices in typical regions,and the progress of substantive start-up of dynamic adjustment for consultation fee prices.It compares the level of consultation fees in some provinces,and analyzes the problems faced by consultation fee fees.Some provinces have not dynamically adjusted the examination fee for a long time,and the price comparison relationship with neighboring regions is not coordinated.The policy direction and operational suggestions for improving the dynamic adjustment mechanism of consultation fee price include:Integrating the elements of consultation price items and improving the price standardization level;Popularize the experience of typical areas,after evaluation,start the dynamic price adjustment of consultation items.