OBJECTIVE To evaluate the impact of the specialized centralized procurement policy for insulin on daily cost and affordability of insulin， and provide data support for the enhancement of relevant policies. METHODS In this research， the insulin purchasing data were obtained from provincial centralized procurement platforms in provinces before and after the specialized centralized procurement of insulin （October-December 2021 and October-December 2022）， and the cost variations of insulin before and after the centralized procurement were analyzed by the defined daily dose cost （DDDc） of various types of insulins. The changes in the affordability of various types of insulins before and after the specialized centralized procurement were evaluated， using the percentage of annual expenditure on various types of insulins relative to annual per capita disposable income （i.e. the proportion of annual expenditure） as an indicator. RESULTS After the specialized centralized procurement， DDDc of various types of insulins decreased by 20.7%-71.8%， with an average reduction of 45.7%. Moreover， the reduction in DDDc for third-generation insulin exceeded that for second-generation insulin. The reduction in the proportion of annual expenditure on insulin ranged from 24.3% to 73.4%， with an average decrease of 48.5%. Premixed insulin analogs experienced the greatest reduction （73.4%）. Following the specialized centralized procurement， DDDc of insulin decreased in all provinces. Except for Guangxi （10.2%）， the average proportion of annual expenditure on insulin in the remaining provinces dropped to below 10%. CONCLUSIONS The specialized centralized procurement policy for insulin has significantly reduced insulin costs and improved affordability， thereby alleviating the economic pressure on patients with diabetes. There are notable cost disparities among provinces and among insulin categories， which require attention.

Over the years of exploration and development, the surgical techniques and prognosis of liver transplantation in China have been significantly improved, resulting in a notable decrease in the prevalence of postoperative complications. However, ischemic-type biliary lesion remain a non-negligible issue. The Third Affiliated Hospital of Sun Yat-sen University formulated and published the "Expert Consensus on the Diagnosis and Treatment of Ischemic-Type Biliary Lesions after Liver Transplantation in Mainland China" in 2015, which has now been updated into a guideline based on current conditions and literature reports. This guideline elaborates in detail on the definition, incidence, pathogenesis, diagnosis, prevention of high-risk factors, and treatment of ischemic-type biliary lesion, aiming to provide standardized and normative guidance for the diagnosis and treatment of ischemic-type biliary lesion after liver transplantation, thereby reducing the rate of re-transplantation and fatality, and to improve the overall quality of life of liver transplant recipients.

Objective    To verify the feasibility of a self-designed magnetic anchoring and traction device (MATD) for assisting two-port video-assisted thoracoscopic esophagectomy. Methods    Three Beagle dogs were selected as animal models with age ranging from 1-6 years and weight ranging from 8-12 kg, and they underwent two-port video-assisted thoracoscopic esophagectomy after general anesthesia. We used the MATD to retract the esophagus to different directions, which assisted mobilizing esophagus, detecting the nerves along esophagus and dissecting paraesophagus lymph nodes. The operation time, blood loss and feasibility of the MATD were recorded. Results    With the aid of the MATD, we successfully retracted and mobilized the esophagus, detected the nerves and dissected the lymph nodes in three Beagle dog models. During the operation, the MATD provided sufficient and steady traction of esophagus to achieve a good exposure of the operative field, effectively decreasing the interference between working instruments. The MATD worked well. The mean operation time was 30 min, and the mean intraoperative blood loss was about 10 mL. Conclusion    It is effective to use the MATD to assist retracting esophagus during video-assisted thoracoscopic esophagectomy. The magnetic anchoring and traction technique can assist to expose the surgical field, decrease the interference between the working instruments and have the potential clinical application.

Objective:To explore the efficacy and safety of escharectomy and skin grafting combined with negative pressure wound treatment in the treatment of patients with deep burn.Methods:A total of 208 deep burn patients who were treated in Haining People's Hospital from May 2018 to May 2019 were selected in the research.They were randomly divided into observation group and control group according to the random digital table method, with 104 cases in each group.The observation group was treated with escharectomy and skin grafting combined with negative pressure wound treatment.The control group was treated with escharectomy and skin grafting combined with traditional pressure bandaging.The general treatment, wound healing rate, changes of serum inflammatory factors before treatment and after treatment for 7 days, and complications of the two groups were compared.Results:The total excellent and good healing rate of the observation group (92.31%) was higher than that of the control group (79.81%) (χ 2=6.772, P<0.05). The granulation growth time [(8.23±2.16)d], wound healing time [(17.64±2.58)d], postoperative pain score[(3.16±1.24)points] and hospitalization time [(22.61±2.47)d] in the observation group were lower than those in the control group [(12.15±2.33)d, (20.25±3.16)d, (5.33±1.27)points and (26.13±2.55)d] ( t=12.582, 6.525, 12.468, 10.111, all P<0.05). At 7 days after treatment, the levels of CRP[(21.12±2.48) ng/L], TNF-α [(3.27±0.38)ng/L], IL-6 [(5.32±1.46)ng/L] and C3a [(12.13±1.62)μg/L] in the observation group were lower than those in the control group [(28.06±2.62)ng/L, (5.13±0.43)ng/L, (6.68±1.51)ng/L and (16.43±1.26)μg/L] ( t=19.618, 33.055, 6.603, 21.367, all P<0.05). The total incidence of complications in the observation group (7.69%) was lower than that in the control group (22.12%) (χ 2=8.529, P<0.05). Conclusion:Escharectomy and skin grafting combined with negative pressure can improve the wound healing rate, improve the body's inflammatory response, shorten the recovery time, reduce the occurrence of complications and has good safety.

Objective To explore the advancement and efficiency of informatization exam system and provide practice basis for its application in the nursing assessment through the construction and application of informatization exam operation system platform in the nursing skill assessment of the objective structured clinical examination (OSCE).Methods OSCE for nursing skills was performed on nursing undergraduates from a university school of nursing in 2015 using the informatization exam system. Voice calls was used for calling students in order. The teachers used paperless PAD for evaluation. After the examination, students were required to finish the informatization evaluation questionnaire to assess the satisfaction rate.Results A total of 91 nursing students were included in the study. The highest dimension score was exam environment (4.20±0.86), while the lowest dimension was the exam time (3.89±1.10). The entry score ranked in the top three were reasonable location (4.31±0.89), clear instructions content (4.25±1.01) and clear play sound (4.18±1.06). 72.73% of the examinees thought that the combination of high-tech in the informatization exam system were advanced, and the exam arrangement was clear and time-saving. 27.27% of the examinees thought that the system response and test arrangement required improvement to increase the flow velocity and avoid nervous and anxiety caused by long waiting.Conclusions The application of the informatization exam operation system changes the traditional model of artificial operation examination. The examinees give the affirmation to exam environment. The examination schedule needs to be improved. The paperless scoring system improves the working efficiency of the evaluation and management in teaching management.

Objective To study the direct immunofluorescence method for rapidly detecting influenza A virus antigen and its clinical application .Methods The inpatients with clinically diagnosed acute respiratory tract infection were selected .Two hundred samples were collected and divided into two groups :the winter and spring epidemic seasons children group and the summer and au‐tumn non‐epidemic seasons children group ,100 cases in each group .The US D3 Ultra influenza A virus antigen detection reagent was used .The fluorescence labeled monoclonal antibody was adopted to detect influenza A virus antigen in the patients with cold . Results During the winter and spring seasons of influenza prevalence ,8 cases of 100 detected cases were positive with the positive rate of 8% ;during the summer and autumn seasons of non‐influenza prevalence ,2 cases of 100 cases were positive with positive rate of 2% ,the difference in the positive rate between the two groups had statistical significance(P<0 .05) .Conclusion Applying the direct immunofluorescence method for rapidly detecting influenza A virus antigen is an economical ,efficient ,rapid and specific detec‐tion method ,and can guide clinical rapid diagnosis and rational medication .

OBJECTIVE:To establish the fingerprint of Artemisia apiacea to identify common model and evaluate the quality coherence of the commercially available A. apiacea decoration pieces in Chongqing. METHODS:HPLC method was performed on the column of Waters XTerra C18 with the mobile phase consisted of methanol-0.1% phosphoric acid(gradient elution)at the flow rate of 1.0 ml/min. The detection wavelength was 220 nm,column temperature was 30 ℃ and the sample size was 10 μl. The simi-larity of 12 batches of samples was evaluated by TCM Chromatogram Fingerprint Similarity Evaluation System(2004A edition);a common model of fingerprints was identified by principal component analysis(PCA)and cluster analysis(CA). RESULTS:Total-ly 11 batches of samples were screened to establish common model of fingerprints and 16 common peaks were obtained,among which,3 common components were identified;RSDs of precision,stability and reproducibility tests were lower than 2.53%. The similarity of 11 batches of A. apiacea and reference chromatogram was more than 0.990. CONCLUSIONS:The method is stable and easy,and can provide reference for the scientific quality evaluation and control of A. apiacea;the quality of commercially available A. apiacea decoration pieces is generally good,however,there is still a little number of batches with poor quality. The production procedures and supervision of A. apiacea decoration pieces should be strengthened.

Objective To analyze the clinical characteristics of children tsutsugamushi infection in order to strengthen understanding,reduce the misdiagnosis rate,reduce the complications and improve the level of diagnosis and treatment.Methods To analyze retrospectively the clinical data and treatment outcome of 22 cases of children tsutsugamushi disease,including symptoms,physical signs and laboratory examination.Results All the cases with fever onset,high fever (＞ 39 ℃) was 72.7％ (16/22),all cases were typical eschars and ulcers,while 8 cases (36.4％,8/22)had lymphadenectasis.Merger multiple organ damage in 14 cases (63.6％,14/22),anemia in 11 cases (50.0％,11/22)and liver function abnormal in 4 cases (18.2％,4/22).All of 22 cases were treated with azithromycin.All cases after treatment with azithromycin heal,no recurrence.Conclusions The manifestation of tsutsugamushi disease is diversity,much complications,among which hematology and liver are the most common cases.Physical examination roundly might reduce missed diagnosis and misdiagnosis as greatly as possible.Azithromycin has good therapeutic effects on children tsutsgamushi disease.

Objective To observe the effect of recombinant human granulocyte/macrophage colonystimulating factor (rhGM-CSF) combined with nano-silver for deep burn degreen Ⅱ. Methods The burn model were done with Wistar rats. They were randomly divided into four groups , group A (n = 30): petrolatum treatment, group B(n = 30): nano-silver treatment, group C(n = 30): rhGM-CSF treatment, and group D(n =30): rhGM-CSF combined with nano-silver treatment. The healing rates of the four groups were observed on postburn day 1, 4, 7, 10, 14, 21. Meanwhile the levels of VEGF and EGF in serums were measured with ELISA. Results All groups started to heal on postburn day 10. Group A had inflammation obviously , and group D moderately. There were significant difference in the healing retes on postburn day 10 , 14, 21 between four groups (P < 0.05). The level of VEGF in group A peaked on postburn day 21 (25.76 ± 1.46)pg/mL, but the levels of VEGF in group B, group C and group D peaked on postburn day 14[(29.73 ± 1.58)pg/mL, (38.91 ± 2.38)pg/mL, (43.54 ± 1.28)pg/mL]. On postburn day 4, 7, 10, 14, 21, there were significant difference(P <0.05). The level of EGF peaked on postburn day 21 in all groups [(0.72 ± 0.14)ng/mL, (0.93 ± 0.13)ng/mL, (1.18 ± 0.16)ng/mL, (1.50 ± 0.15)ng/mL]. There were significant difference on postburn day 7, 10, 14, 21 between four groups (P < 0.05). Conclusions rhGM-CSF combined with nano-silver treatment could promote wound healing, and be better than rhGM-CSF and nano-silver singly.

Objective To observe the effect of recombinant human granulocyte/macrophage colonystimulating factor (rhGM-CSF) combined with nano-silver as a treatment on deep burn degreen Ⅱ about inflammation .Methods The burn model was built with Wistar rats .They were randomly divided into four groups ,petrolatum treatment (group A ,n= 30) ,nano-silver treatment (group B ,n=30) ,rhGM-CSF treatment(group C ,n=30) ,and rhGM-CSF combined with nano-silver treatment(group D ,n=30) . observation the inflammatory reaction ,and culture bacteria on wound of the four groups at 1st ,4th ,7th ,10th ,14th ,21th day after treatment were made .The level of IL-2 and IL-8 were measured in serums with ELISA .Results The inflammatory reaction:group A>group B>group C>group D ;Bacterias were observed in group A ,group B/C and group D at 4th ,10th ,14th day respectively af-ter treatment .The number of bacterial growed in group D was less than in group A ,group B and group C .The numbers of bacterial growed in group B and group C were less than in group A .And after 10 ,14 ,21 days treatment ,there was significantly statistical difference(P<0 .05) .There was difference among groups in the levele of IL-2 and IL-8 ,which were the lowest in group D and the highest in group A .The level of IL-2 has no significantly statistical difference between every groupat 1st day and between B and C group at 4th day(P>0 .05) .After other days treatment ,there was significantly statistical difference(P<0 .05) .There was signifi-cantly statistical difference in every group at each day of the IL-8 levele except A and B group ,B and C group ,C and D group at 1st day (P<0 .05) .Conclusion rhGM-CSF combined with nano-silver treatment could alleviate inflammatory reaction ,and be better than rhGM-CSF or nano-silver alone .