Objective:To explore the diagnostic efficiency of CT enterography (CTE) comprehensive score combined with spectral imaging for Crohn's disease (CD) in active phase.Methods:A retrospective analysis was performed on the case data of 87 CD patients who were admitted to the First People's Hospital of Chenzhou from October 2018 to October 2020. According to CD activity index (CDAI), they were divided into active phase group ( n=58) and remission phase group ( n=29). The results of CTE and spectral imaging in both groups were collected. The diagnostic value of CTE comprehensive score combined with spectral imaging for CD in active phase was analyzed. Multiple linear stepwise regression analysis was used to analyze the independent related factors affecting the active phase of CD. Receiver operating characteristic (ROC) curve was used to predict the area under curve (AUC), sensitivity, specificity and cutoff value of CTE comprehensive score combined with energy spectrum imaging (intestinal wall thickness, intestinal wall uniform enhancement and iodine concentration in portal phase) in active phase of CD. Results:The probability of comb sign, intestinal stenosis or expansion and target sign in CTE of patients with active CD was significantly higher than that in patients with remission CD, the probability of fat sign was significantly lower than that in patients with remission CD, and the CTE comprehensive score was significantly higher than that in patients with remission CD ( P<0.05). Multiple linear stepwise regression analysis showed that the thickness of intestinal wall, uniform enhancement of intestinal wall and iodine concentration in portal phase were independent related factors affecting the active phase of CD ( P<0.05). ROC curve analysis showed that AUC of CTE comprehensive score combined with intestinal wall thickness, intestinal wall uniform enhancement and iodine concentration in portal phase for predicting CD in active phase was 0.953, higher than 0.869, 0.907, 0.914 and 0.913 of single index. The cut-off values of CTE comprehensive score, intestinal wall thickness and iodine concentration in portal phase were 6.0 points, 0.89 cm and 2.68 mg/ml, respectively. There was no homogeneous enhancement of intestinal wall in spectral imaging. Conclusions:CTE comprehensive score combined with intestinal wall thickness, intestinal wall enhancement and iodine concentration in portal phase can more accurately determine CD in active phase, which provide a new quantitative diagnostic reference.

OBJECTIVE： To study the effects of ADRB2 （rs1042713） gene polymorphism on therapeutic efficacy of anticholinergic drug in the treatment for refractory asthma pediatric patients. METHODS： 171 children with refractory asthma were selected from outpatient department of Kunming Children’s Hospital during Nov. 2016 to Jul. 2019. The distribution of ADRB2 （rs1042713） genotype， the clinical efficacy [asthma control test （C-ACT） score， FEV1， FVC， PEF， maximal mid-expiratory flow （MMEF）] of anticholinergic drug were analyzed statistically； the response of different genotypes to the use of anticholinergic drug were also analyzed statistically. RESULTS： 148 of 171 refractory asthmatics pediatric patients were administered anticholinergic drug， among them 50 of the 71 AA genotype and 36 of the 77 GA genotype responded to anticholinergic drug treatment. Statistical analysis showed that 71 children with AA refractory asthma had improved C-ACT score， FEV1， FVC， PEF and MMEF， there was statistical significance， compared with GA genotype （P＜0.05）； the response rate of the AA genotype to anticholinergic drugs was 2.71 times that of the GA genotype [OR＝2.71， 95％CI （1.38， 5.34）， P＝0.005]. CONCLUSIONS： The detection of ADRB2 （rs1042713） gene polymorphism has some guiding significance in the treatment of refractory asthma with anticholinergic drugs， and the response of AA genotype is better.

Objective: To carry out the 4^th round of third-party evaluation on the implementation and effect of the 1^st year of the 2^nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015. Methods: The 4^th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations. Results: The 4^th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.

Following an analysis of the problems and challenges of hospitals regulation in China and a comparative study of situations at home and abroad,this paper presented six policy proposals for the reform of public hospitals regulatory system in China.The policy suggestions included definite regulatory objectives,defined relationship between public hospitals and government,strengthening both economic regulation and social regulation, establishing multivariate regulatory system, introducing flexible regulatory methods and full utilization of the third-party impact,which met the requirements of public hospital in healthcare reform in China and propelled the reform forward.

Objective To investigate the expression and significance of super oxide dismutase activity and malondialdehyde concentration in the serum and adrenal grands of patients with adrenocortica diseases. Methods 12 patients with adrenal hyperplasia and 10 patients with adrenal adenoma which were carried out hospital surgery and confirmed by pathology, and 11 cases of normal as controls were selected.The serum level of Cu/Zn-SOD, Mn-SOD and MDA before operation, and Cu/Zn-SOD and Mn-SOD positive cells percentage of adrenal tissue were compared between three groups. Results Before adrenalectomy SOD activity was lower(P <0.05)and MDA concentration was higher in serum(P<0.05)than the control group.Cu/Zn-SOD positive cell was lower in adrenocortical adenoma tissue than that of adrenocorticohyperplasia and normal cortex(P <0.05).Mn-SOD positive cell had a significant difference among adrenocortical hyperplasia, adrenocortical adenoma and normal adrenal cortex tissue(P <0.05).Both SOD positive cell in adrenocortical adenoma tissue were the lowest of all.In addition,the expression of SOD in tissue had a significant positive correlation with serological expression in study group. Conclusion The superoxide dismutase activities and malondialdehyde concentration seemed to change with adrenocortica diseases.The detection of superoxide dismutase activities and malondialdehyde concentration in the serum and adrenal grands could be the potential methods for the diagnosis and differential diagnosis of adrenocortica diseases.

Objective To isolate and identify the causative agent in an incident with crowd fever of adults in Henan province.Methods The cells was inoculated by the throat swabs of the patients and followed by neutralization assay and other molecular methods.Then indirect immunofluorescence assay was performed to detect the specific IgM/IgG antibodies against virus in the serum of the patients.Results We have isolated 2 strain adenoviruses from 10 swab samples,which were both identified as Ad11 by sequence analysis and neutralization test.6 of 10 samples were positive fer IgM specific for adenovirus and 3 positive for IgG.The remaining sample was negative for both.Conclusion The causative agent in this incident with crowd fever of adults was Ad11 in group B.