Objective:To provide strategic suggestions for optimizing children′s diagnosis and treatment services in the communities, by means of analyzing the overall efficiency of children′s diagnosis and treatment services in the sample community health service centers, and learning the current input and output of children′s diagnosis and treatment resources.Methods:In April 2020, a total of 27 community health service centers in 14 cities were selected by random sampling. Data such as the number of medical visits by children aged 0 to 18 years and the area of pediatric diagnosis and treatment departments in the sample centers in 2019 were collected by self-filling questionnaires. Excel was used for data sorting. Data envelopment analysis(DEA) was used for data processing. The data processing tool was DEAP 2.1.Results:The average comprehensive efficiency, the average technical efficiency and the average scale efficiency of the 27 sample community health service centers were 0.445, 0.865 and 0.494 respectively. There were five DEA efficient centers, 4 DEA weak inefficiency centers and 18 inefficient centers. Six out of 18 DEA inefficient centers had redundant input of healthcare professionals capable pediatrics; 12 centers were short of children visits, and 15 were short of visits by children aged 0-6 years.The centers where DEA was inefficient were concentrated in the central region, the suburbs and " centers with independent pediatric clinics but without pediatric wards" .Conclusions:The comprehensive efficiency of children′s diagnosis and treatment services in the sample community health service centers is relatively low. Currently, the sample community health service centers are faced with such problems as small and insufficient input of children′s diagnosis and treatment resources in the community, unbalanced development of children′s diagnosis and treatment services in the region among others. It is suggested that on the basis of making full use of the existing resources to create the maximum output value, we should consider appropriately expanding the scale of resource input to improve the efficiency of children′s diagnosis and treatment services at the primary level and further give play to the value of the " gatekeepers" at the primary level in children′s diagnosis and treatment.

Objective: To investigate the effects of reducing blood transfusion in ventricular septal defect surgery on the volume of blood transfusion, safety and complications of children. Methods: A total of 72 children aged 4-10 years who underwent ventricular septal defect repair at Xinxiang Central Hospital between January 2018 and June 2019 were recruited in the study (38 males, 34 females). The patients were randomly divided into reduced transfusion group (36 cases) and control group (36 cases) in accordance with the random number table.Reduced transfusion group: (1) after anesthesia, 5 mL/kg of blood was drained from the central vein based on blood pressure and stored in a special citric acid anticoagulant blood storage bag which was then put into a 4 ℃refrigerator.(2) hemostasis was performed strictly from skin incision, and after sternum was sawed, the whole body was heparinized, wound bleeding was recovered, and autologous blood recovery device was used.(3) the extracorporeal circulation pipeline was shortened as far as possible, and in case of the intraoperative hematokrit (Hct) of above 0.18-0.20, no red blood cells were transfused.After stopping the extracorporeal circulation, the remaining blood from the membrane lung and pipeline was transfused back.(4) antifibrinolytic drugs were adequately used during operation, and autologous blood recovery device was used to salvage blood after protamine neutralization.(5) hemostatic drugs and hemostatic materials were used.(6) after admitted to intensive care unit (ICU) postoperatively, the blood pressure was controlled at an appropriate level, to avoid bleeding caused by high blood pressure.Blind rehydration should be also avoided, and unnecessary blood thinning should be reduced.(7) encouraging children to get out of bed early after surgery, so as to improve the gastrointestinal activity of children, thus enhancing nutrition.Control group: (1) unconventional preoperative preparation of autologous blood; (2) systemic heparinization before aortic intubation; (3) conventional extracorporeal circulation device; (4) routine treatment in ICU.Primary outcomes including general situation, the rate of erythrocytic transfusion, mean consumption of erythrocytes, intraoperative blood loss, the volume of postoperative drainage, operative time, ventilator weaning time, ICU stay time, hospital stay, hospitalization costs, the incidence of pulmonary infection, secondary endotracheal intubation rate, reoperation rate, intra-transportation colloid osmotic pressure (COP), as well as the intra-transportation, preoperative and postoperative concentration of hemoglobin (Hb) and Hct and those at discharge were compared. Results: All 72 patients rehabilitated and discharged from hospital successfully.The rate of erythrocytic transfusion in the reduced transfusion group and control group was 22.22% (8/36 cases) and 83.33% (30/36 cases), respectively, and the difference of which was statistically significant (χ²=93.12, P<0.05). The mean consumption of erythrocytes in the two groups were (1.56±0.68) U and (4.26±1.12) U, respectively, and the difference of which was statistically significant (t=1.18, P<0.05). Postoperative blood loss and drainage, hospital stay, and hospitalization costs in the reduced transfusion group were less than those in the control group (t=1.38, 2.35, 2.22, all P>0.05). There was no statistically significant differences in the operative time, ICU stay time, ventilator weaning time, the concentration of Hb and Hct at discharge between the two groups (t=0.25, 0.85, 0.85, 0.72, all P>0.05). In addition, there were also no differences in the incidence of pulmonary infection, secondary endotracheal intubation rate and reoperation rate between the two groups (χ²=56.36, 55.33, 55.33, all P>0.05). Conclusions Reducing intraoperative blood transfusion is safe and feasible for children with ventricular septal defect.Besides, it also helps reduce the volume of perioperative blood confusion, save hospitalization costs and reduce transfusion complications.

Objective:To reveal the significance of microRNA 155 (miR-155) level or the suppressor of cytokine signaling 6 (SOCS6) level in distinguishing the differentiating tuberculosis (TB) infection.Methods:A case-control study was conducted. A total of 60 patients were enrolled in the study retrospectively, including 20 patients with active pulmonary tuberculosis, 20 patients with latent tuberculosis and 20 patients with other pulmonary infectious diseases (non-TB infection), who visited The Third Affiliated Hospital of Third Military Medical University from January to June of 2017. The expression level of miR-155 and SOCS6 in peripheral blood mononuclear cells (PBMC) of from these patients were examined by using the quantitative real-time polymerase chain reaction (qPCR) methods. The associated statistics and graphs was utilized to obtain the relationship, which were reflected by the Co-index receiver operating characteristic(ROC) curve or calculating the area under ROC curve (AUC), between the miR-155 and SOCS6 in differentiating tuberculosis infection by using the Logistic Regressive analysis methods, MedCalc and GraphPad Prism 8.0 software.Results:Neither of the three index miR-155 (AUC=0.663, P=0.031), SOCS6 (AUC=0.708, P=0.002) and Co-index (AUC=0.718, P=0.001) was outstanding to distinguish the tuberculosis infection and non-TB infection. Moreover, the miR-155 (AUC=0.867, P<0.001) and Co-index (AUC=0.875, P<0.001) were similar sufficient ( Z=0.142, P=0.887) to distinguish the active and latent infections. The Co-index (AUC=0.923, P<0.001) was better ( Z=2.586, P=0.010) than SOCS6 (AUC=0.723, P=0.007), and similar ( Z=1.585, P=0.113) to miR-155 (AUC=0.835, P<0.001) on the distinguishing active and non-TB infection. Conclusions:By performing the qPCR and the correlation-analysis, miR-155 has been considered as a potential biomarker for differentiating latent tuberculosis infection from active tuberculosis infection. Conjoint analysis of miR-155 and SOCS6 benefits the distinguishing active TB infection from other pulmonary infectious diseases.

Objective To investigate the expressions of T cell immunoglobulin and mucin-domain contain-ing moleculesfamily-3(Tim-3)and CD4+ and CD8+ T cells in peripheral blood from patients with coronary heart disease (CHD). Methods 51 CHD patients were divided into two groups:stable angina pectoris group (27 patients)and acute coronary syndromes group(24 patients). Another 25 healthy subjects confirmed by coronary angiography were selected as a control group. Peripheral blood was drawn on admission. Enzyme-linked immunosor-bent assay was used to detect the concentration of Tim-3. Flow cytometry was applied to detect the expressions of CD4+and CD8+. Results As compared with the healthy control group ,the concentration of Tim-3 and the propor-tion of CD8+ in stable angina pectoris group and acute coronary syndrome group were reduced ,and those in acute coronary syndrome group were lower. The differences were statistically significant (P < 0.05). As compared with the healthy control group,the proportion of CD4+ and the ratio of CD4+/CD8+ of stable angina pectoris group and acute coronary syndrome group were increased ,while those in acute coronary syndrome group were higher. The differences were statistically significant(P<0.05). Conclusions At the onset of CHD,the concentration of Tim-3 and the proportion of CD8+ in peripheral blood are reduced ,but the proportion of CD4+ is increased. The more severe the disease,the greater changes the values.

Objective To measure the gap of community health staffing and establish new norms for community health facilities by means of the WHO Workload indicator of staffing need (WISN) method,for reference of the government in evaluation and decision making of community health staffing. Methods With Xicheng District of Beijing as an example,we collected data on community health staffing and calculated the total demand,measuring the total demand and supply,and gap or surplus in the staffing.Results in 2013,the demand of community health staffing was about 1 7.18 million standard equivalents in Xicheng,while the supply was 10.5 12 million.The WISN ratio was 0.67 for community health supply and demand,in which the ratio of physicians was close to 1,while that of nurses and public health workers was far below 1.850 extra community health staff was needed to reach the total of 2 602 persons.Conclusion The demand and supply of community health service in Xicheng District was seriously unbalanced,a huge gap featuring overstaffing of nurses and inadequate public health workers.This results from the enhancement of primary public health services and rising utilization of community healthcare services in recent years,which deserves high attention from government of all levels,by increasing the staffing of community health staffing standards.

A total of 526 team members from 28 community health service (CHS) centers in 5 pilot cities were surveyed by a questionnaire.All CHS centers developed team service.And 275 service teams were established and the coverage rate of area resident committee was 100％.The teaming modes were mainly divided into four kinds:medical-nursing-prevention classic combination,big team professional expansion,small team medical combination and non-health technology extensive participation.The team services showed multiple advantages of professionism,energy and time complementing.We should strengthen team construction,improve perfect team service mode and policy support and create a good environment for CHS development.

Objective To study the effects of platelet activation on the metastasis and prognoies of lung cancer. Methods Radio-immunity and ELISA were employed to detect the TXB_2,DH-TXB_2,TSP, β-TG, GMP-140,CGMP and FN of 168 cases of lung cancer patients (lung cancer group) and 80 cases of healthy persons control group. The lung cancer group included two subgroups: earlier and metaphase group (n=51) and advanced group (n=17), 39 cases in the former group underwent operation (after operation group). Results (1)Compared with control group, the levels of DH-TXB2,TSP,β-TG,GMP-140,CGMP in group of earlier and metaphase lung cancer increased and FN decreased. TXB2,DH-TXB2,TSP,β-TG,GMP-140,CGMP in advanced group increased and FN decreased;DH-TXB2 and GMP-140 increased in group of after operation. (2)Compared with group of earlier and metaphase lung cancer,the levels of DH-TXB2,TSP,β-TG,GMP-140,CGMP in group of after operation increased and FN decreased; In advanced group, levels of TXB2, DH-TXB2,TSP,β-TG,GMP-140,CGMP increased and FN decreased. (3)In the lung cancer group, CGMP was positively correlated with DH-TXB2,TSP,β-TG and GMP-140. (4)Compared with control group,TXB2, DH-TXB2, TSP,β-TG,GMP-140 and CGMP in group glandular cancer and small cell carcinoma cases increased,FN decreased;In squamous cancer, the levels of TXB2, DH-TXB2,GMP-140 and CGMP increased and FN decreased. (5)Compared with small cell carcinoma cases, DH-TXB2 decreased in cases of glandular cancer; GMP-140 decreased in squamous cancer. Conclusions Activations of platelet generally emerged with lung cancer patients, platelet activation was severe in advanced cancer patients. Activations of platelet, after operation, is obviously eased. The level of platelet activation marker is possibly related with histological classification of lung cancer.

Objective To investigate the adhesion molecule expression and functional status of platelets in lung cancer patients, and their relations with disease progression. Methods Using flow cytometry to measure the expression of surface antigens and functional status of platelets in 60 healthy control group, and 164 lung caneer patients. Results Comparing with control group, the expression in early group and mid term group(A group) of CD31, CD36, CD62, CD63 increased, and there is no significant meaning in the differences of surgery group (B group) of CD31, TSP, CD36, CD62, CD63. The expression in advanced group (C group) of CD31, TSP, CD36, CD62, CD63 increased. Comparing with A Group, the expression in B Group of CD36, CD62, CD63 decreased. The expression in C group of CD31, TSP, CD36, CD62, CD63 increased. Comparing with the small cell lung cancer, the expression of adenocareinorna of TSP, CD36,, CD62, CD63, squamous cell carcinoma of CD31, CD62, CD63, and alveolus cancer of CD31, TSP, CD63, all decreased. Conclusion The high level expression of platelet activation exists in patients with lung cancer of different stage, and decreased after operation. Platelet activation expressed significantly in the advanced stage of small cell lung cancer.

Objective To investigate the correlation between the distribution of the charactcristics of TCM syndrome of alcoholic liver fibrosis and alcoholic consumption. Methods Our group studied clinical cases in multi-center prospective method. In virtue of Factor Analysis, we explored the characteristics of TCM syndrome of alcoholic liver fibrosis, and the forming characteristics of alcoholic liver fibrosis in inland. Rerults Among the subjects, the characteristics of TCM syndrome of alcoholic liver fibrosis mainly manifested excess syndrome with the common manifestations of deficiency and excess. The visceral position was mainly in liver and spleen, related to gallbladder and stomach. The result suggested that stagnation of Qi stagnation, blood stasis, damp heat, with deficiency of genuine Qi were the interpretation of the causes of alcoholic liver fibrosis. The total alcoholic consumption was one of the important factors which effected on the distribution of thecharacteristics of TCM syndrome of alcoholic liver fibrosis. Total bilirubin had mostly striking effect on the distribution of the characteristics of TCM syndrome. Conclusions The total alcoholic consumption was one of the important factors which effected on the distribution of the characteristics of TCM syndrome of alcoholic liver fibrosis.