OBJECTIVE To evaluate the possible effects of Cefuroxime sodium for injection/Sodium chloride injection （referred to as “Cefuroxime powder-liquid dual-chamber bag”） or Cefuroxime sodium for injection （referred to as “Cefuroxime powder injection”） used in perioperative patients on hospital costs under the background of medical insurance payment reform from the perspective of the hospital. METHODS Assuming that the effectiveness and safety of Cefuroxime powder-liquid dual-chamber bag （scenario 1） and Cefuroxime powder injection （scenario 2） were the same for perioperative patients， the cost-effectiveness of both scenarios was compared by calculating the costs of drug， infusion sets， and labor in the pharmacy intravenous admixture service. The robustness of the results was explored through univariate sensitivity analysis and different centralized procurement share scenarios analysis. RESULTS The base-case analysis showed that the average cost per treatment course for patients using cefuroxime in scenario 1 and scenario 2 were 314.54 yuan and 349.41 yuan， respectively， meaning scenario 1 saved 34.87 yuan per capita compared to scenario 2. The univariate sensitivity analysis and scenario analysis indicated that the research results were robust. CONCLUSIONS The application of Cefuroxime powder-liquid dual-chamber bag in perioperative patients can save medical costs while ensuring the quality and efficiency of medical services， compared to Cefuroxime powder injection.

OBJECTIVE To evaluate the cost-effectiveness of vitamin D analogue for postmenopausal osteoporotic women in China. METHODS A Markov microsimulation model was developed to analyze the clinical and economic outcomes of eldecalcitol， alfacalcidol and calcitriol for postmenopausal osteoporosis from the healthcare system perspective in China. The clinical parameters required for the model were derived from network meta-analysis， while cost and utility data were primarily obtained from the literature. The cycle length was 1 year ， the time horizon was life time， and the willingness-to-pay threshold was 0.5 times the gross domestic product per capita in China in 2023（44 679 yuan/QALY）. Model uncertainty was tested with one-way sensitivity analysis， probabilistic sensitivity analysis， and scenario analysis. RESULTS The quality-adjusted life years （QALYs） for eldecalcitol were calculated to be 12.03 QALYs， which were higher than those for alfacalcidol （11.94 QALYs） and calcitriol （11.92 QALYs）. Meanwhile， the direct medical cost associated with eldecalcitol treatment amounted to 38 805 yuan， which was lower than that of alfacalcidol （45 173 yuan） and calcitriol （45 821 yuan）. The results of the one-way sensitivity analysis showed that the risk ratio of hip fracture and vertebral fracture had a significant impact on the result. The probabilistic sensitivity analysis and scenario analysis showed the robustness of the findings from the base-case analysis. CONCLUSIONS Compared with alfacalcidol and calcitriol， eldecalcitol is likely to be a cost-effective treatment for postmenopausal osteoporotic women in China.

Objective To analyze the radiation dose in low-dose chest CT examination of pediatric patients with mycoplasma pneumoniae pneumonia(MPP)by using size-specific dose estimation(SSDE).Methods A total of 95 patients who were scanned with low-dose chest CT were prospectively selected,65 patients with weight ≤50 kg,using 80 kV and DoseRight Z-DOM(30-50 mAs);30 patients with weight＞50 kg,using 100 kV and DoseRight Z-DOM(50-100 mAs).A total of 65 patients who were scanned with conventional chest CT were retrospectively collected,40 patients with weight ≤50 kg,25 patients with weight＞50 kg,using 120 kV,DoseRight Z-DOM(50-100 mAs)and fixed mAs.Image noise,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were used to objectively evaluate image quality.The subjective evaluation of image quality was performed by two radiologists using a 5-score system and a double-blind method.The volume CT dose index(CTDIvol)and dose length product(DLP)were collected,the SSDE and effective dose(ED)were measured,respectively.Results Compared with conventional scan,CTDIvol,DLP,SSDE,and ED values of 80 kV scan was decreased by 81.3％,80.3％,81.5％,and 82.4％,respectively,with a statistical difference(Z=-8.433,-8.137,-8.146,-8.142,P＜0.05).There were statistically significant differences in image noise,SNR,and CNR between 80 kV scan and conventional scan in patients with weight ≤50 kg(Z=-6.762,-5.075,-3.430,P＜0.05).In 100 kV scan,CTDIvol,DLP,SSDE,and ED values was decreased by 75.7％,76.3％,75.3％,and 75.3％,respectively,with a statistical difference(Z=-6.301,-6.173,-6.347,-6.308,P＜0.05).There were statistically significant differences in image noise and SNR between 100 kV scan and conventional scan in patients with weight＞50 kg(Z=-5.367,-4.650,P＜0.05).The subjective evaluation scores of the two groups images were all greater than 3 points,all images could be used for clinical diagnosis.SSDE was 45.3％and 29.9％higher than CTDIvol for 80 kV and 100 kV scans,respectively,SSDE was 45.7％and 28.8％higher than CTDIvol for conventional scans with weight ≤50 kg and weight＞50 kg,respectively.Conclusion Low kV combined with DoseRight Z-DOM effectively reduces radiation dose to pediatric patients with MPP;SSDE more accurately assesses radiation dose than CTDIvol in children.

Objective:To study the effect of samarium trioxide (Sm 2O 3) particles on rat lung tissue and compare it with the same dose of silica (SiO 2) particles, in order to find the reference index for early screening of pneumoconiosis. Methods:In October 2018, 72 SPF healthy male rats were randomly divided into control group, SiO 2 group and Sm 2O 3 group. The lungs of rats in each group were perfused with 2.0 ml/kg normal saline and 280 mg/kg SiO 2 and Sm 2O 3 particle suspension by one-time non exposed tracheal perfusion. The lungs of rats were stained with hematoxylin eosin (HE) staining, and the pathological changes of lung tissues were observed. The concentrations of SNAIL homologue 1 (SNAI1) , SNAIL homologue 2 (SNAI2) , and heat shock protein-27 (HSP-27) in rat serum were detected by enzyme-linked immunosorbent assay. 0.5 g of lung tissue from rats in Sm 2O 3 group and control group exposed to dust for 56 days was screened for long-chain noncoding RNA (lncRNA) and circular RNA (circRNA) . Results:After 7 days of dust exposure, the alveoli in SiO 2 group and Sm 2O 3 group were disordered, and lymphoid tissue aggregation and proliferation were observed around the bronchial wall. At 14 days, a large number of lymphocytes infiltrated in SiO 2 group, and a small number of macrophages containing Sm 2O 3 and fibrotic nodules scattered in Sm 2O 3 group. At 28 days, a small amount of lymphocyte infiltration appeared in SiO 2 group, and fibrotic nodules were seen in some areas of Sm 2O 3 group. At 56 days, there was a small amount of fibroblast proliferation in SiO 2 group, and a large number of fibrotic nodules containing gray black matter were seen in Sm 2O 3 group. There was no significant difference in lung organ coefficient among groups at different dust exposure time ( P>0.05) . After 14 days of dust exposure, the contents of SNAI1 and SNAI2 in serum of rats in SiO 2 group were lower than those in control group, the content of SNAI2 in serum of Sm 2O 3 group was lower than that in control group, and the contents of SNAI1 and SNAI2 in serum of Sm 2O 3 group were higher than those in SiO 2 group ( P<0.05) . The content of HSP-27 in SiO 2 group was lower than that in control group ( P<0.05) . After 56 days of dust exposure, the content of HSP-27 in Sm 2O 3 group was lower than that in control group ( P<0.05) . At 56 days, lncRNA in Sm 2O 3 group was up-regulated by 148 and down regulated by 725, circRNA was up-regulated by 16 and down regulated by 153. Conclusion:Sm 2O 3 can cause lung injury in rats, and the change of SNAI2 content can be detected in the early stage, which can be used as a reference index for early screening of pneumoconiosis. There are differences in the expression of lncRNA and circRNA after 56 days of dust exposure in rats, which may be related to the pathogenesis of pneumoconiosis.

Objective:To study the effect of samarium trioxide (Sm 2O 3) particles on rat lung tissue and compare it with the same dose of silica (SiO 2) particles, in order to find the reference index for early screening of pneumoconiosis. Methods:In October 2018, 72 SPF healthy male rats were randomly divided into control group, SiO 2 group and Sm 2O 3 group. The lungs of rats in each group were perfused with 2.0 ml/kg normal saline and 280 mg/kg SiO 2 and Sm 2O 3 particle suspension by one-time non exposed tracheal perfusion. The lungs of rats were stained with hematoxylin eosin (HE) staining, and the pathological changes of lung tissues were observed. The concentrations of SNAIL homologue 1 (SNAI1) , SNAIL homologue 2 (SNAI2) , and heat shock protein-27 (HSP-27) in rat serum were detected by enzyme-linked immunosorbent assay. 0.5 g of lung tissue from rats in Sm 2O 3 group and control group exposed to dust for 56 days was screened for long-chain noncoding RNA (lncRNA) and circular RNA (circRNA) . Results:After 7 days of dust exposure, the alveoli in SiO 2 group and Sm 2O 3 group were disordered, and lymphoid tissue aggregation and proliferation were observed around the bronchial wall. At 14 days, a large number of lymphocytes infiltrated in SiO 2 group, and a small number of macrophages containing Sm 2O 3 and fibrotic nodules scattered in Sm 2O 3 group. At 28 days, a small amount of lymphocyte infiltration appeared in SiO 2 group, and fibrotic nodules were seen in some areas of Sm 2O 3 group. At 56 days, there was a small amount of fibroblast proliferation in SiO 2 group, and a large number of fibrotic nodules containing gray black matter were seen in Sm 2O 3 group. There was no significant difference in lung organ coefficient among groups at different dust exposure time ( P>0.05) . After 14 days of dust exposure, the contents of SNAI1 and SNAI2 in serum of rats in SiO 2 group were lower than those in control group, the content of SNAI2 in serum of Sm 2O 3 group was lower than that in control group, and the contents of SNAI1 and SNAI2 in serum of Sm 2O 3 group were higher than those in SiO 2 group ( P<0.05) . The content of HSP-27 in SiO 2 group was lower than that in control group ( P<0.05) . After 56 days of dust exposure, the content of HSP-27 in Sm 2O 3 group was lower than that in control group ( P<0.05) . At 56 days, lncRNA in Sm 2O 3 group was up-regulated by 148 and down regulated by 725, circRNA was up-regulated by 16 and down regulated by 153. Conclusion:Sm 2O 3 can cause lung injury in rats, and the change of SNAI2 content can be detected in the early stage, which can be used as a reference index for early screening of pneumoconiosis. There are differences in the expression of lncRNA and circRNA after 56 days of dust exposure in rats, which may be related to the pathogenesis of pneumoconiosis.

Objective To investigate the effect of covered stent on the treatment of Stanford type B aortic dissection and its effect on cardiopulmonary function. Methods From June 2014 to December 2015, sixty-four AD patients treated in our hospital were selected and were divided into the control group(30 cases) and the observation group ( 32 cases) . The control group was treated with conservative treatment while the observation group was treated with covered stent. After treatment,two groups of patients were followed up for at least 24 months to understand the recovery status after treatment and evaluate the effect. . Results The time of hospitalization of the observation group ((26. 10±8. 14) d) was shorter than that of the control group ((33. 89 ±8. 32) d) (t＝4. 963,P＜0. 05),and there was no statistically significant difference in the mortality and complication rate in 30d after operation between the two groups (χ2＝1. 084,0. 015,P＞0. 05); at 24 months after discharge,the survival rate (93. 75%(30/32)),standard rate of blood pressure 93. 75 (30/32) and treatment compliance rate(90. 63 (29/32)) of the observation group were higher than those of the control group (53.33%(16/30); 60.00(18/32);73.33(22/30)) (χ2 ＝ 13.210、10.088、4.771,P＜0.05) . After treatment,the cardiac output((4. 99±0. 53) L/min) and left ventricular ejection fraction((51. 88±3. 64)%) of the observation group were higher than those of the control group((4. 13±0. 13) L/min,(46. 30 ±9. 63)%). The end systolic diameter of left ventricle (( 55. 75 ± 2. 11) mm) and left ventricular end diastolic diameter ((57. 80± 3. 53) mm) of the observation group were less than those of the control group (( 65. 77 ± 2. 21), (64. 54±2. 67) mm). The differences between the two groups were statistically significant(t＝8. 643、3. 054、8. 436、18. 263,P＜0. 05). Conclusion Covered stent is safe and effective in the treatment of Stanford type B aortic dissection.

Objective:To study the inhibitory effect of γδT cells on the proliferation of ovarian cancer SKOV3 cells,and to clarify its possible mechanism of inducing apoptosis. Methods:The human ovarian cancer SKOV3 cells cultured in vitro were used as control group,and theγδT and SKOV3 cells were co-cultured for 72 h as γδT cells treatment group.Laser scanning confocal microscope was used to obeserve the morphological changes of nucleus SKOV3 cells,and the inhibitory rate of proliferation of SKOV3 cells in two groups were detected by MTT method;Transwell Chambers was used to detect the cell migration ability,then the apoptotic rates of SKOV3 cells were tested by flow cytometry (FCM).Results:The apoptotic morphology of nucleus of SKOV3 cells in γδT cells treatment group were found under microscope,such as nuclear shrinkage.The MTT resultes displayed that the inhibitory rate of proliferation of SKOV3 cells in γδT cells treatment group was higher than that in control group (P <0.05).The Transwell Chambers results showed that the number of transmembrane cells in γδT cells treatment group was lower than that in control group,and the migration rate was decreased compared with control group (P <0.05).The FCM results showed that the apoptotic rate of SKOV3 cells in γδT cells treatment group was higher than that in control group (P < 0.05 ).Conclusion:γδT cells can inhibit the proliferation and the migration abilities of ovarian cancer SKOV3 cells,and promote the apoptosis.

Objective To analyze the profile of dermcidin (DCD) changes in different stages of acute coronary syndrome (ACS) by quantifying the serum 4 183Da DCD peptide fragment deriving from different ACS patients treated with early antithrombotic therapy.Methods A total of 118 patients with confirmed diagnosis of ACS were enrolled. Immediately after visiting a doctor, the venous blood was collected and afterwards instantly the patient was given orally 300 mg of aspirin and 300 mg clopidogrel, and according to the patient's condition and the consent of his/her or acknowledgement of family members achieved, emergency percutaneous coronary interference (PCI) or thrombolysis or conservative treatment was adopted separately. After anti-thrombotic treatment, at 2, 4, 6, 8, 10, 12, 16, 20, 24, 32, 40, 48, 60 and 72 hours, venous blood was collected and serum isolated respectively. The concentration of 4 183Da DCD fragment in serum was determined by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). Simultaneously, the myoglobin (Myo), cardiac troponin I (cTnI) and MB isoenzyme of creatine kinase (CK-MB) were also detected.Results The mean relative strength of nature logarithmic transformations of 4 183Da DCD fragment of 118 patients with ACS was 2.75±1.02 before treatment on admission, and after intervention therapy (mainly antithrombotic therapy) it was decreased to 1.84±1.19 (P = 0.005) and 1.74±1.12 (P = 0.000) at 2 hours and 4 hours, respectively, and then after 4 hours it was slightly elevated. 4 183Da polypeptide increased earlier than myocardial injury markers.Conclusion Aspirin and clopidogrel can significantly decrease the concentration of 4 183Da DCD peptide fragment in serum in patients with ACS, which indicates that the DCD fragment could be used as one of the indexes for observation on early efficacy of antithrombotic therapy.

Problem-based learning(PBL)plays an improtant role in fostering the ability of problem-solving,creative thinking and active learning of medical undergraduates.Based on the present clinical education resources,how to implement PBL at the largest advantages is the main issue we should concern.