Objective:To analyze the coordination between the growth of per capita health expenditure and per capita gross domestic product (GDP) in China from 2012 to 2021, and to explore the changes and regional disparities in the health consumption elasticity coefficient.Methods:Descriptive analysis was used to compare the average annual growth rates of per capita health expenditure and per capita GDP between 2012-2019, Pearson correlation analysis was conducted to test the relationship between the two variables. The health consumption elasticity coefficient was calculated as the ratio of the growth rates of health expenditure to GDP, and its temporal changes and regional distribution characteristics were analyzed.Results:After adjusting for price factors, the average annual growth rate of per capita health expenditure in China from 2012 to 2021 was 9.11%, higher than that of per capita GDP (6.11%), with no correlation between the two variables ( r=0.30, P>0.05). The national average health consumption elasticity coefficient was 1.49, lower than that in 2012-2019 (1.60), indicating an improvement in coordination. Compared with developed countries, China′s elasticity coefficient was at a moderate level. Conclusions:Overall, the growth of health expenditure in China remains faster than that of economic growth, with certain regional differences, but the degree of coordination has improved compared with the previous period.

Objective:To analyze the coordination between the growth of per capita health expenditure and per capita gross domestic product (GDP) in China from 2012 to 2021, and to explore the changes and regional disparities in the health consumption elasticity coefficient.Methods:Descriptive analysis was used to compare the average annual growth rates of per capita health expenditure and per capita GDP between 2012-2019, Pearson correlation analysis was conducted to test the relationship between the two variables. The health consumption elasticity coefficient was calculated as the ratio of the growth rates of health expenditure to GDP, and its temporal changes and regional distribution characteristics were analyzed.Results:After adjusting for price factors, the average annual growth rate of per capita health expenditure in China from 2012 to 2021 was 9.11%, higher than that of per capita GDP (6.11%), with no correlation between the two variables ( r=0.30, P>0.05). The national average health consumption elasticity coefficient was 1.49, lower than that in 2012-2019 (1.60), indicating an improvement in coordination. Compared with developed countries, China′s elasticity coefficient was at a moderate level. Conclusions:Overall, the growth of health expenditure in China remains faster than that of economic growth, with certain regional differences, but the degree of coordination has improved compared with the previous period.

In order to improve the professional level and service ability of general practitioners, this study is guided by the needs of community medical institutions in the county medical communities. Two small-class training of 15 modules were carried out for a week, taking "2+5" training mode, including 2 days of theoretical teaching and case discussion, and 5 days of bedside teaching. After the training, the theoretical examination, case report and objective clinical structured examination were carried out. Those who passed the examination were issued a certificate of qualification and given corresponding rewards. The results showed that the post-test scores of trainees after training were significantly improved compared with the pre-test scores, and the qualification rate increased from 18.4% to 85.9%. This training mode can be promoted in a wider range, but it should be adjusted appropriately according to the actual situation in various places, and the relevant departments and hospitals should give full support.

Objective:To explore the risk factors of subsyndromal delirium (SSD) after cardiac surgery in adults and construct a risk model.Methods:The convenience sampling method was used to select 620 adult patients undergoing cardiac surgery admitted to the Surgical Intensive Care Unit (SICU) of Zhejiang Provincial People's Hospital from January 1, 2017 to December 31, 2018 as the research object. Patients with postoperative SSD were included in the SSD group, and patients without postoperative SSD were included in the non-SSD group. The preoperative, intraoperative and postoperative clinical data and various indicators of all patients were recorded in detail. Through univariate analysis and binary Logistic regression analysis, the risk factors of SSD after cardiac surgery in adults were explored, and the risk model function was constructed.Results:A total of 569 cases were included in the study. Among them, 399 cases of postoperative subdelirium did not occur (non-SSD group) , 170 cases of postoperative subdelirium occurred (SSD group) , and the incidence of SSD was 29.9%. Univariate analysis found that the influencing factors of adult SSD after cardiac surgery were age, emergency surgery, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, aortic occlusion time, deep hypothermia circulatory arrest time, intraoperative plasma transfusion, SICU stay time and the use of dexmedetomidine, and the differences between the two groups were statistically significant ( P<0.05) . The binary Logistic regression analysis found that age>76 years [odds ratio ( OR) =4.332, 95% confidence interval ( CI) : (2.103, 8.965) , P<0.001], emergency surgery [ OR=3.453, 95%CI: (1.143, 7.534) , P<0.05], APACHEⅡ score> 15 [ OR=5.453, 95% CI: (1.453, 9.536) , P<0.001], deep hypothermia circulatory arrest time > 34.2 min [ OR=2.132, 95% CI: (1.053, 5.532) , P<0.05] and SICU stay time > 50.0 h [ OR=1.675, 95% CI: (0.832, 5.233) , P<0.05] were independent risks of SSD after cardiac surgery in adults, and the use of dexmedetomidine [ OR=1.536, 95% CI: (0.763, 4.862) , P<0.05] was a protective factor. Conclusions:Age > 76 years, emergency surgery, APACHE Ⅱ score > 15, deep hypothermia circulatory arrest time > 34.2 min, and SICU stay time >50.0 h are independent risk factors for SSD after cardiac surgery in adults, and the use of dexmedetomidine can reduce the occurrence of SSD.

OBJECTIVE To investigate thechanges and clinical significance of serum Nesfatin-1 in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and type 2 diabetes mellitus (T2DM).METHODS 25 OSAHS cases who visited the department of otolaryngology, pneumology department, endocrinology department, physical examination center and sleep monitoring room from December 2014 to April 2015 were assigned as OSAHS group, and 25 patients with OSAHS and T2DM as OSAHS combination T2DM group, and 25 other patients as control group. All patient were took polysomnography, and the height, waist, neck circumference and BMI with all subjects were recorded. The serum Nesfatin-1 and fast blood glucose levels of all patients were measured.RESULTS The gender, age, height, waist and neck circumference had no statistical difference among all groups. The height and BMI in OSAHS group and OSAHS combination T2DM group were statistically significant difference compared with the control group (P<0.05); the FBG in OSAHS combination T2DM group and OSAHS group were significantly higher than that of the control group, and the FBG in OSAHS combination T2DM group were significantly higher than that of the OSAHS group, with statistically significant(P<0.05); The AHI in OSAHS combination T2DM group were significantly higher than that of the OSAHS group, with statistically significant(P<0.05); the serum Nesfatin-1 in OSAHS combination T2DM group and OSAHS group were significantly higher than that of the control group, with statistically significant(P<0.05); FBG, AHI and Nesfatin-1 were positively correlated with each other.CONCLUSION The serum Nesfatin-1 in patients with OSAHS combination T2DM are in a high level.

Due to the insufficient education of medical ethics and tending to medical moral educa-tion, the residents lack the ability to make ethical decisions. Therefore, we applied Four Topics method in the clinical ethics training of residents. The clinical ethics training was divided into three stages, and each stage had different training content and objectives. Dongyang People's Hospital adopted the form of lectures and panel discussions. During the group discussion, the group leader was in charge of case preparation, which came from clinical practice, and then all members applied the Four Topics method to analyze and discuss the ethical conflicts, and make the ethical decision. Through this process, residents' ability to solve ethical problems in clinical practice was enhanced.

Objective To quantify the correlations between Elekta XVI cone beam CT dose and various scanning protocols,providing mathematical models to assess the protocol-dependency of imaging dose during imnage guided radiotherapy.Methods Based on standard protocols and various combinations of kVp and mA on an XVI mounted on an Elekta Versa HD accelerator,the air KERMA was measured at various positions in a standard PTW CTDI body phantom using calibrated PTW 30009 kV chamber and UNIDOS webline electrometer.Weighted CT dose index (CTDIw) was computed thereafter.SigmaPlot 10.0 was used to fit the measurements against mA and/or kVp yielding empirical functions.Results Under standard protocols,the CTDIw of Varian OBI was only 11.23％ (chest) and 9.15％ (pelvis) of Elekta XVI.Using the default and other 4 investigated kVp values,the central and peripheral KERMA were both proportional to mA,and vet the slope value a varied dramatically from 0.479 to 6.679.Major affecting factors included kVp settings,measurement locations,and dosimetric mnetrics,etc.None linear regressions were used to fit kVp against KERMA at various locations and CTDIw (R2 ＞ 0.997).The differences between all coefficients were statistically significant (P ＜ 0.05).The impact of changing both mA and kVp on the dose to phantom center can be described as mGy =(5.917-0.197 ×kVp+0.002 × kVp2-5.063 × 10-6 × kVp3) × mA.Conclusions Imaging dose of Elekta XVI is strongly dependent on scanning paraneters.The proposed mathematical models can be used as efficient and robust indicators of such dependency.

Objective To build a clinical key disciplines evaluation index system for county level hospitals in Chengdu city.Methods Literature meta analysis, focus group discussion, expert consultation method, boundary value method, brainstorming and hierarchy analysis method were comprehensively used.Results The clinical key disciplines evaluation index system for county level hospitals in Chengdu city comprises 5 level-1 indexes,1 6 level-2 indexes,47 level-3 indexes.Among the level-1 indexes,service capacity,medical quality,technical personnel,scientific research and education, and foundation of specialty was 0.474 6,0.202 7,0.148 2,0.097 7,0.076 8 respectively.Conclusion The clinical key disciplines evaluation index system for county level hospitals in Chengdu city is scientific, guiding and practical,which can be used to evaluate the status of the clinical key disciplines for county level hospitals in Chengdu city.

Objective: To investigate the mechanism of vascular endothelial growth factor ( VEGF)165 and hepatocyte growth factor (HGF) improving cardiomyocyte proliferation in experimental porcine after myocardial infarction (MI).
Methods: The MI model was established by left anterior descending artery ligation in 15 male pigs and the animals were divided into 3 groups, n=5 in each group. Control group, the pigs received normal saline injection at the infarct and peri-infarct zones. VEGF group, the pigs received (1×1010 ) pfu of viral titers of Ad-VEGF injection. HGF group, the pigs received (1×1010 ) pfu of viral titers of Ad-HGF injection. The myocardial perfusion and cardiac function were examined by SPECT, the protein expressions of VEGF165 and HGF were measured by Western blot analysis, cardiomyocyte proliferation was analyzed by immunolfuorescence and immunoprecipitation method.
Results: ① Compared with Control group, the expressions of VEGF165 and HGF were higher at the infarct and peri-infarct zones in both treatment groups; ② Both treatment groups had better cardiac function and myocardial perfusion; ③ Both treatment groups had improved cardiomyocyte proliferation at the infarct and peri-infarct zones.④VEGF165 promoted cardiomyocyte proliferation via p27 pathway;⑤HGF promoted cardiomyocyte proliferation via p21 and p27 pathways.
Conclusion: VEGF165 and HGF could improve myocardial perfusion and function in experimental porcine after MI, VEGF165 and HGF promote cardiomyocyte proliferation via different pathways.

Education of evidence-based medicine in clinical research is important in enhancing primary hospital clinical research capacity and quality.Dongyang People's Hospital of Zhejiang Province has carried out evidence-based medicine education and training,and greatly improved the performance of clinical research and development of scientific researchers.