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ObjectiveTo understand the current drug resistance status and bacterial multilocus sequence typing （MLST） of human and avian Campylobacter jejuni in Jinshan District， Shanghai. MethodsFecal samples were collected from diarrhea patients in the annuity mountainous area from 2021 to 2022， and poultry and related samples were collected from 2 poultry farms in the Jinshan area for detection of C. jejuni. Minimal inhibitory concentration （MIC） drug sensitivity test was performed on the detected C. jejuni， and some strains were selected for whole genome sequencing and MLST analysis. ResultsA total of 823 samples of diarrhea disease were collected， and 32 strains of C. jejuni were detected， with a detection rate of 3.89%. Out of 600 poultry related samples， 62 strains of C. jejuni were detected， with a detection rate of 10.33%. Human multidrug resistance reached 93.75% （30/32）， while avian multidrug resistance reached 100.00%（62/62）. The top four drug resistance rates of human and avian C. jejuni were azithromycin （100.00% from humans and 100.00% from birds）， naphthoic acid （93.75% from humans and 87.10% from birds）， ciprofloxacin （90.63% from humans and 98.39% from birds）， and tetracycline （84.38% from humans and 98.39% from birds）. The relatively low resistance strains of human derived C. were erythromycin， chloramphenicol， and thalithromycin. The relatively low resistance strains of avian C. jejuni were erythromycin， clindamycin， and flufenicol. MLST analysis showed that the selected 16 strains of bacteria were divided into 9 ST types， among which the evolutionary relationship of avian C. jejuni was relatively concentrated， while human C. jejuni was relatively dispersed. It was found that one strain of avian C. jejuni was closely related to two strains of human C. jejuni. ConclusionsC. jejuni infection is severe in patients with diarrhea in this region， with a detection rate second only to salmonella and Vibrio parahaemolyticus. C. jejuni infection in poultry is relatively common， and both are highly resistant. Therefore， monitoring and control should be strengthened. MLST analysis shows new ST types in both avian and human sources of C. jejuni， indicating the emergence of new mutations that require continuous monitoring to avoid the epidemics caused by new strains. The isolated strains with close genetic relationships between avian and human sources reveal the evidence of the spread of C. jejuni from poultry to humans. Therefore it is necessary to strengthen the monitoring of C. jejuni in relevant samples from breeding farms.
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Objective:To investigate the correlation between serum concentration of vasohibin-1 (VASH-1) and urinary albumin creatinine ratio (UACR) in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy.Methods:The clinical data of 196 patients with T2DM from February 2017 to December 2020 were analyzed retrospectively. According to whether diabetic nephropathy (DN) was combined, 33 patients without DN of T2DM were divided into the control group,and 163 patients with DN of T2DM were divided into the case group, and the case group was divided into four groups:normal albuminuria group (groupⅠ, UACR <30 mg/g, 21 cases),microalbuminuria group (groupⅡ, UACR ≥30-≤300 mg/g, 50 cases), clinical albuminuria group (group Ⅲ, UACR>300 mg/g, 43 cases), and clinical albuminuria hypertensive group (groupⅣ, UACR >300 mg/g with hypertension, 49 cases). Serum levels of VASH-1,C-reactive protein(CRP), erythrocyte sedimentation rate (ESR) and transforming growth factor β1 (TGF-β1) with other biochemical indicators were measured. T-test was used for comparison between measurement data groups in accordance with normal distribution, one-way ANOVA was used for comparison between multiple groups, q-test was used for pairwise comparison, and χ2 test was used for comparison between counting data groups. The influencing factors were analyzed by multivariate Logistic regression.Pearson correlation analysis was used to analyze the correlation between vash-1 and UACR. Results:UACR((1 175.9±120.4) mg/g), CRP((9.80±2.01) mg/L), ESR((20.61±2.20) mm/h),TGF-β1((16.75±2.05) μg/L), VASH-1((645.3±183.5) ng/L) in case group were higher than that in the control group((11.5±2.0) mg/g, (4.77±1.34) mg/L, (8.33±1.56) mm/h, (10.63±1.97) μg/L, (416.3±162.1) ng/L), and there were significant differences between the two groups ( t=123.39,13.76,30.54,15.75,6.66; all P<0.001). Multivariate logistic regression analysis showed that VASH-1 ( OR=1.881,95% CI 1.146-3.089), UACR( OR=1.511,95% CI 1.064-2.146), TGF-β1( OR=1.846,95% CI 1.135-3.001)were all risk factors for DN of T2DM ( P values were 0.009, 0.022 and 0.012). Serum VASH-1 ((693.5±201.4), (709.8±214.7) ng/L] in group Ⅲ and group Ⅳ were higher than those in group Ⅰ and group Ⅱ ((585.3±162.1), (632.9±165.5) ng/L). There was significant difference between the two groups ( F=129.46, P<0.001). The CRP ((7.08±1.36), (8.99±3.72), (10.58±3.48), (11.64±3.50) mg/L), ESR ((17.36±1.76), (19.05±4.12), (21.45±5.74), (22.69±9.13) mm/h) and TGF- β1 ((14.75±1.97), (16.50±1.90), (17.06±1.23), (18.39±1.46) μg/L) of groupⅠ, groupⅡ, groupⅢ and groupⅣ increased gradually, and there were significant differences between the four groups ( F values were 73.48, 156.61, 25.83; all P<0.001). Pearson correlation analysis showed that there was a significant positive correlation between VASH-1 and UACR ( r=0.532, P=0.008). Conclusion:The concentration of VASH-1 in serum of patients with T2DM complicated with DN increased with the increase of UACR. VASH-1 may become a new marker for predicting early DN of T2DM.
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Objective:To analyze the cost difference between bilateral surgery and unilateral surgery in the same diagnosis-related group(DRG), and to explore the necessity of coefficient adjustment in DRG payment for bilateral surgery.Methods:The medical record frontpage information of all discharged patients who were divided into FJ25(complicated operation of venous system, without complications and accompanying diseases)by DRG in a tertiary hospital from 2017 to 2019 was selected, and the cost difference between unilateral operation and bilateral operation was compared.Results:A total of 359 patients were included, including 230 patients(64.07%) in unilateral operation group and 129 patients(35.93%) in bilateral operation group. There was no significant difference in gender, age and length of hospital stay between unilateral operation group and bilateral operation group( P>0.05). The hospitalization expenses of the bilateral operation group were higher than those of the unilateral operation group( P<0.05), and the differences mainly came from the expenses of consumables, operation, anesthesia and drugs. There was no significant difference in the expenses of diagnosis and treatment, and the cost of inspection between the two groups( P>0.05). The individual burden of patients with medical insurance in bilateral operation group was higher than that in unilateral operation group. Conclusions:In the same DRG group, the adjustment coefficient can be used to adjust the medical insurance payment for bilateral surgery, so as to avoid the occurrence of clinical decomposition hospitalization behavior.
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Domestic generic drug registration has a large proportion in chemical drugs with outstanding repeated registration phe-nomenon and low level innovation of enterprises. Under the above background, chemical drug registration reform kicked off. The imple-mentation of new drug registration classification, marketing authorization holder and the changes of listed drug registration documents have a huge impact on China' s pharmaceutical industry, which can promote the reformulation of domestic pharmaceutical market, en-courage R&D and innovation in enterprises and accelerate the pace towards the international market.
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OBJECTIVE To investigate the protective effect of total saponins from stems and leaves of Panax ginseng (GSLS) on cisplatin (CDDP)-induced kidney damage in mice and its possible mechanism. METHODS Thirty-two male ICR mice were randomly divided into normal control group, CDDP group, and GSLS(150 and 300)+CDDP groups. GSLS was administered to mice by oral gavage once a day for 7 d. On the 7th day, a single injection of CDDP 20 mg·kg-1 was given 1 h after GSLS 150 and 300 mg·kg-1 before GSLS 150 and 300 mg·kg-1 continued to be given for 3 d. Blood urea nitrogen (BUN) and creatinine (CRE) , catalase (CAT) in renal tissue, reduced glutathione (GSH), tumor necrosis factorα(TNF-α) and interleukin 1β(IL-1β) of cisplatin induced mice were detected after 72 h. HE and PAS staining were used to observe the renal histopathological changes;While TUNEL and Hoechst33258 staining were employed to observe apoptosis in kidney tissues. RESULTS Compared with normal control group, CDDP group had a significant reduction in relative body mass (P<0.05), and the level of GSH and CAT in kidney tissues (P<0.05). The level of CRE, BUN, TNF-α, and IL-1βin serum and renal indexes significantly increased (P<0.05, P<0.01), especially BUN and CRE that respectively doubled and quadrupled. CDDP group developed glomerulus swelling, renal tubular expansion and epithelial cell necrosis. Trans?parent tube type of tube cavity appeared, the nucleus pycnosis disappeared, but renal interstitial edema and inflammatory cell infiltration appeared. There was a large amount of glycogen deposition and high expressions of TUNEL positive cells and Hoechst33258 positive cells. Compared with CDDP group, the levels of BUN and CRE in GSLS treatment group significantly decreased (P<0.05, P<0.01) in serum, glycogen deposition was reducted and apoptosis of renal tubular epithelial cells decreased in kidney tissues (P<0.05). The level of TNF-α, IL-1β(P<0.05) and the degree of renal tissue necrosis were significantly reduced (P<0.05) in CDDP+GSLS 300 group, but there was a significant increase in the level of CAT and GSH (P<0.05). CONCLUSION GSLS can protect against mouse kidney injury induced by cisplatin. The mechanism may be related to oxidation, reduced inflammation reaction and resistance to apoptosis.
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Objective To investigate the impacts on inpatient costs of a hospital in Beijing as incurred by the reform of clinic-pharmacy-separation by means of DRGs. Methods As required by BJ-DRGs, we selected DRGs grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Beijing from January to March in 2017 ( pre-reform group ) and that from May to July in 2017 ( the post-reform group ) . Then we compared the differences of inpatient costs before and after the reform, and the inpatient cost changes of the DRGs groups. Results The median of inpatient costs before the reform was 8751. 21 yuan, and that after the reform was 8522. 07 yuan, a difference without statistical significance (P>0. 05). Of the 104 DRGs studied, cost changes were found in 28 DRGs (P<0. 05), with increases in 19 DRGs and drops in 9 DRGs groups. Conclusions The reform, though without impact on the inpatient costs, changed the makeup of costs on the other hand, especially on HJ13 and BB25 DRGs groups, worthy of attention. A dynamic tuning mechanism is thus suggested for pricing of medical services, and a fine management suggested for the hospitals to curb unreasonable growth of costs.
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Objective To investigate the impacts on inpatient costs of a hospital in Beijing as incurred by the reform of clinic-pharmacy-separation by means of DRGs. Methods As required by BJ-DRGs, we selected DRGs grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Beijing from January to March in 2017 ( pre-reform group ) and that from May to July in 2017 ( the post-reform group ) . Then we compared the differences of inpatient costs before and after the reform, and the inpatient cost changes of the DRGs groups. Results The median of inpatient costs before the reform was 8751. 21 yuan, and that after the reform was 8522. 07 yuan, a difference without statistical significance (P>0. 05). Of the 104 DRGs studied, cost changes were found in 28 DRGs (P<0. 05), with increases in 19 DRGs and drops in 9 DRGs groups. Conclusions The reform, though without impact on the inpatient costs, changed the makeup of costs on the other hand, especially on HJ13 and BB25 DRGs groups, worthy of attention. A dynamic tuning mechanism is thus suggested for pricing of medical services, and a fine management suggested for the hospitals to curb unreasonable growth of costs.
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OBJECTIVE:To provide reference for cultivating high-level comprehensive medical talents with high quality. METHODS:Based on the market and social needs,the teaching reform was conducted from the concepts of educational ideas, modes,curriculum system,contents,management and other aspects. RESULTS:In order to adapt to the needs of society and era, it should establish large education educational ideas to cultivate student's independent ability to obtain knowledge and self-develop-ment to make people change into community basic services and service and dedicate society with modes of cultivating inter-disci-plinary talents,including combination of prduction and study,foundation strengthening,professional expanding,penetration of sci-ence and technology and combination of arts and science;generally optimize curriculum system with theprinciple of precise defini-tion,clear classification,and optimized combination based on market and social needs;and update contents timely and teaching materials;the teaching management should be changed from closed off management of the past to the external management which dominated by the market assessment. CONCLUSIONS:Reform of medical higher education based on the market and social needs can cultivate the talents with high quality and comprehensive medical knowledge for the social needs,which is conductive to the de-velopment of medical industry.