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Objective:To study the current process and steps of government procurement in China, analyze the key factors affecting fair competition in the process of government procurement in public hospitals, and put forward feasible operational suggestions to promote fair competition in government procurement.Methods:Delphi method was used to construct the index system of the key factors affecting fair competition during the process of government procurement of public hospitals. The weight of the index system was determined by the analytic hierarchy process, and the key factors were quantitatively analyzed.Results:The index system affecting fair competition in the process of government procurement of public hospitals included 1 first-level index, 8 second-level indexes and 21 third-level indexes. Through calculation and analysis, it was concluded that the key factors affecting fair competition were feasibility study, market research, contract performance acceptance, procurement demand confirmation and project approval, with their comprehensive weights of 0.228 5, 0.144 0, 0.085 9, 0.072 9 and 0.060 4, respectively.Conclusions:We should properly expand the scope of feasibility study, fully carry out market research, reasonably set government procurement demand parameters, and strengthen contract performance acceptance and payment management, so as to promote the fair competition of government procurement in public hospitals.
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The case report aims to raise the concern of clinicians about hiccups as an adverse reaction in olanzapine treatment. A 47-year-old male patient with epileptic mental disorder appeared symptoms of persistent hiccups on the fourth day of treatment with sodium valproate and carbamazepine jointing 10 mg/d olanzapine， and the symptoms disappeared two days after olanzapine withdrawal. The patient began to take olanzapine again， hiccups reappeared seven days after administration and relieved two days after withdrawal. During the whole treatment period， the dosage of sodium valproate and carbamazepine remained unchanged， indicating that the hiccups was induced by olanzapine. This case suggests that the possibility of hiccups should be considered in the clinical application of olanzapine.
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Objective To investigate the clinical effect of radiofrequency ablation (RFA) combined with non-specific sequential immunotherapy (IM) for early hepatocellular carcinoma (HCC),and analyze the factors affecting prognosis of patients after RFA.Methods The prosepctive study was conducted.The clinicopathological data of 72 early HCC patients who were admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from January 2009 to October 2015 were collected.Patients were divided into 3 groups by random number table:patients in group A underwent single RFA therapy;patients in group B underwent RFA + non-specific sequential IM (1-3 times);patients in group C underwent RFA + non-specific sequential IM (≥ 4 times).RFA was performed by the same doctors team,and non-specific sequential IM planning included thymalfasin + interleukin-2 (IL-2).Observation indicators:(1) treatment situations;(2) follow-up and survival;(3) analysis of prognostic factors after RFA.Follow-up using outpatient examination was performed to detect tumor recurrence and overall survival up to December 2015.Measurement data with normal distribution were represented as (x) ± s,and comparison among groups were evaluated with the ANOVA.Comparison of count data were analyzed using the chi-square test.The curve,rate and time of tumor recurrence after treatment,overall survival curve and time were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were respectively done using the COX proportional hazard regression model.Results Seventy-two patients were screened for eligibility,including 31 in group A,22 in group B and 19 in group C.(1) Treatment situations:patients in 3 groups underwent RFA,and contrast enhanced ultrasound showed complete tumors ablation at 5 days postoperatively.Patients in group B and C didn't have significant adverse reactions after RFA during IM therapy.(2) Follow-up and survival:72 patients were followed up for 2-66 months after treatment,with a median time of 34 months.The 1-year tumor recurrence rates after treatment in group A,B and C were respectively 19.4％,13.6％ and 10.5％,with no statistically significant difference (x2=0.714,P＞0.05).The median tumor recurrence times in group A,B and C were respectively 24.0 months,30.0 months and 33.0 months,with no statistically significant difference (x2 =3.283,P＞0.05).The median overall survival times in group A,B and C were respectively 46.0 months,56.0 months and 57.0 months,with a statistically significant difference (x2=7.079,P＜0.05).There were statistically significant differences between group A and group B and C (x2 =4.566,4.243,P＜0.05),and no statistically significant difference between group B and group C (x2 =0.078,P＞0.05).(3) Analysis of prognostic factors after RFA:results of univariate analysis showed that initial tumor,tumor number,Barcelona clinic liver cancer (BCLC)staging and sequential IM after RFA were related factors affecting prognosis of early HCC patients [hazard ratio (HR)=2.636,2.530,0.145,0.582,95％ confidence interval (CI):1.218-5.703,1.110-5.767,0.041-0.517,0.321-0.867,P＜0.05].Results of multivariate analysis showed that tumor number ＞ 1,staging B of BCLC and without sequential IM after RFA were independent risk factors affecting prognosis of early HCC patients (HR=2.376,2.683,0.567,95％CI:1.080-5.229,1.530-21.112,0.335-0.962,P＜0.05).Conclusions The non-specific sequential IM of thymalfasin + IL-2 can prolong survival time of early HCC patients after RFA.Tumor number ＞ 1,staging B of BCLC and without sequential IM after RFA are independent risk factors affecting prognosis of early HCC patients.
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Objective To understand the level and correlation of biochemical joint indicators in stroke high risk population in Yi-chun City ,and the differences in biochemical joint indicators between community and rural stroke high risk populations .Methods Three hundreds and fifty-four high risk people during stroke screening in 2015 and 2016 included 115 community high risk cases , 239 rural cases ,226 males and 128 females ,aged 40 to 86 years old .Thirty-one cases of non-stroke high risk included 15 cases of male and 16 cases of female ,aged 28 to 85 years old .Seven biochemical joint indicators were detected and statistically analyzed ,in-cluding glucose (GLU) ,glycated hemoglobin(HbA1c) ,total cholesterol(TC) ,triacylglycerin (TG) ,high-density lipoprotein choles-terol(HDL-C) ,low-density lipoprotein cholesterol (LDL-C) and homocysteine (Hcy) .Results In the comparison between stroke high risk population and non-high risk populations ,CH ,TG ,LDL-C and Hcy had statistically significant difference (P0 .05) .In the comparison between community and rural stroke high risk populations ,CH ,TG ,LDL-C and GLU had statistically significant difference (P0 .05) .Conclusion The increase of CH ,TG ,LDL-C and Hcy is the risk factors of stroke , while CH ,TG ,LDL-C and Hcy are the interventional risk factors and play an important role in its early diagnosis ,treatment and prognosis .The key to prevent stroke is the healthy diet ,good living habits ,moderate exercises ,and regular monitoring of CH ,TG , LDL-C ,Hcy and GLU ,forewarning ,prevention and treatment ,which can avoid the occurrence or less occurrence of stroke ,thus re-duces the its incidence rate ,greatly decrease the morbidity ,recurrence rate ,and reduces the familial and social burden of manpower , material resources and financial resources .
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Objective: To explore influence of nursing health education on morning blood pressure surge (MBPS) fluctuations in aged patients with hypertension.Methods: A total of 100 outpatients and inpatients with non-dipper hypertension, who haven't been treated, were selected from Apr 2011 to Sep 2015.According to random number table method, patients were randomly and equally divided into routine treatment group and health education group (received nursing health education based on routine treatment group), both groups were treated for four weeks.MBPS, trough/peak(T/P) ratio and smoothness index (SI) were measured and compared between two groups after treatment.Results: Compared with routine treatment group after four-week treatment, there were significant reductions in systolic blood pressure (SBP) morning surge[(46.95±5.17) mmHg vs.(42.21±5.19) mmHg]and diastolic blood pressure (DBP) morning surge[(16.31±3.23) mmHg vs.(14.21±3.58) mmHg], and significant rise in SBP T/P[(59.22±6.65)% vs.(70.11±6.41)%], DBP T/P[(50.91±5.04)% vs.(56.97±5.12)%], SBP SI[(1.19±0.13) vs.(1.42±0.12)]and DBP SI[(1.11±0.09) vs.(1.29±0.08)]in health education group, P<0.05 all.Conclusion: Health education can effectively improve blood pressure fluctuations and may likely improve prognosis in patients with non-dipper hypertension, which is worth extending.
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Objective To discuss the clinical values of two-dimensional and three-dimensional diagnoses of nontraumatic esophageal hiatal hernia (HH) in middle-aged and elderly people. Methods Thirty-two cases underwent two-dimensional and three-dimensional ultrasonic examination with fasting and water iflling methods in half-sitting, standing, supine and supine right anterior oblique positions. The ifndings were compared with X-ray barium meal examination, endoscopy and operation. Results There were 27 cases sliding HH, 3 cases paraesophageal HH and 2 cases short HH. Traditional two-dimensional manifestations were as follows:widening of hiatal diaphragmatic muscles (1.6±0.4 cm) and echoes of gastric mucosa in superior hernial sac and inside hernial sac. Real-time three-dimensional surface image formations were as follows: along the long axis of diaphragmatic hiatus, superior phrenic sac was showed as mushroom-shaped or pond-shaped and the neck of hernial sac was showed as irregular tunnel-shaped or ditch-shaped;looking upward from the fundus of stomach, superior phrenic hiatus was showed as caved-shaped or louver-shaped;looking downward from mediastinal surface of lung, uperior phrenic hiatus was showed as piercer-shaped. Conclusions Two-dimensional abdominal ultrasound can diagnose nontraumatic HH in middle-aged and elderly people conveniently and accurately. Real-time three-dimensional abdominal ultrasound can display the range, size, and shape clearly. Compared with the former, the latter can provide more information for diagnosis and help ultrsound doctors and clinical doctors to understand and master the anatomical and morphopathological features of this disease.
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This paper reports one case of schistosomiasis haematobia that was misdiagnosed as urinary tract infection. It sug-gests that epidemiological data should be considered in the diagnosis and treatment of the patients with urinary tract infection symp-toms coming back from Africa to avoid misdiagnosis.
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Objective To compare the molluscicidal effects between“Luo-wei”(TDS),a plant molluscicide in 4 percent, and metaldehyde and niclosamide(MNSC)in the field. Methods A natural ecological environment with Oncomelania hupensis was selected as the test area,the test concentrations of TDS and MNSC were 2.5 g/m3 and 2 ml/m3 respectively by the immersion method;the test doses of TDS and MNSC were 3 g/m2 and 2 ml/m2 respectively by the spray method;the doses of WPN in a control group were 2 g/m3 and 2 g/m2 respectively by the two methods above-mentioned. The molluscicidal effects between TDS and MNSC were compared by using the synchronous design method and parallel comparative method. Results In the TDS group,the death rate of snails was 90.70%by immersion for 24 hours,reached to 81.40%after spraying for 7 days,and there were no significant differences among the observation time points in molluscicidal effects(P>0.05). One day after the spraying,the death rate of snails was less in the TDS group compared with that in the MSCN group(P0.05). In the MSCN group,the death rate of snails was 99.17%by immersion for 24 hours,reached to 66.07% by spraying for 1 day. In the WPS group,the death rate of snails was 97.15% by immersion for 24 hours,reached to 71.43%after spraying for 1 day,and there were no significant differences(both P>0.05). Conclusion TDS has a good molluscicidal activity and stable efficacy,and the molluscicidal effect of TDS is similar to that of MSCN in the filed, but the molluscicidal sensitivity of TDS is lower than that of MSCN.
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Objective To discuss the therapy for acute gastric mucosal lesion(AGML)after pericardial devascularization of advanced schistosomiasis. Methods Fifteen advanced schistosomiasis patients with AGML after pericardial devascularization re-ceived supporting therapy,reducing stomach acid and protecting gastric mucosa therapy,reducing gastric blood flow therapy,en-doscopic spraying topical hemostatic agents or electric coagulation therapy,etc. Results After pericardial devascularization of ad-vanced schistosomiasis,15 patients occurred AGML,and among which,10 cases occurred from 8 to 14 days,and the shortest pe-riod was 5 days and the longest was 23 days. Among the 15 patients,13 patients were cured(86.7%),and 2 died. Conclusion The comprehensive therapy including supporting therapy,reducing gastric acid and protecting gastric mucosa,and endoscopic he-mostasis is effective in the treatment of AGML.
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46 cases of recurrent oral ulcer were treated by acupuncture,after treatment CD +3 ,CD +4 ,and CD +4 /CD +8 ratio of T lymphocytes in peripheral blood of the patients were increased(P ＜0.05),CD +8 lymphocyte decreased(P ＜0.05).Acupuncture may improve cellular immune function of the patients with recurrent oral ulcer.
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Objective To study the value of the diameters of fetal umbilical artery and umbilical vein in early prenatal screening program for thalassemia by ultrasound.Methods A total of 120 cases of singleton pregnant with thalassemia at 12- 28 gestational weeks were detected by ultrasound,328 cases of normal singleton pregnant at 12 - 28 gestational weeks were selected as controls.The diameters of fetal umbilical artery and umbilical vein were tested and compared between the two groups.The diagnostic values were evaluated by ROC curve.Results At 12 - 15+6 gestational weeks,the diameters of umbilical artery and umbilical vein of thalassemia group were larger than those of control group(P ＜0.05).At 16 - 19+6 gestational weeks, the diameter of umbilical vein of thalassemia group was larger than that of control group,the differences were significant (P ＜0.05).The cutoff threshold of the diameter of fetal umbilical artery was 1.80 mm,the diameter of fetal umbilical vein was 2.95 mm at 12 - 15+6 gestational weeks,the diameter of fetal umbilical vein was 3.80 mm at 16- 19+6 gestational weeks,which were obtained by ROC analysis.The sensitivity of this cutoff threshold to identify thalassemia were 83.3％, 83.3％, 47.8％,respectively, while the specificity were 90.5 ％, 95.2 ％, 85.4％, respectively.Conclusions The diameters of fetal umbilical artery and umbilical vein detected by ultrasound have great value on early prenatal screening of thalassemia, these indexes can be used as an important factors in early prenatal screening of thalassemia.
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Objective To discuss the clinical values of transabdominal ultrasonic diagnosis of nontraumatic hiatal gastric hernia of esophagus in middle-aged and elderly people.Methods Thirty-two cases were examined with fasting and filing methods in half-sitting,standing,supine and supine right anterior oblique positions.The findings were contrasted with X-ray barium meal examination,endoscopy and operation.Results Twenty-nine cases were of sliding hiatal gastric hernia of esophagus,3 of impacted hernia.The ultrasonic diagnosis coincidence rate was 100%.The signs and symtoms of acoustic images were widening of esophageal hiatus diaphragmatic muscle(≥1.37 cm),echoes of gastric mucosa were found in superior phrenic hernail sac and inside hernial sac.The display rates were 100%,100%,15.6%respectively.Conclusions The transabdominal ultrasonic diagnosis of nontraumatic hiatal gastric hernia of esophagus in middle-aged and elderly people is brief and accurate.
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Objective To evaluate the application of pure brilliance imaging(PB1) in diagnosis of benign and malignant breast neoplasms. Methods Ninty-seven breast neoplasms were respectively examined by high frequency ultrasound and PBI before operation,then correlated with pathological results. Results The accuracy of high frequency ultrasound for breast neoplasms was 73.2% with the sensitivity 77.8% ,specificity 69.2%. The detectable rate of spiculate margin, halo,calcification were much higher in PBI than those in high frequency ultrasound(P<0.05). And the accuracy,sensitivity and specificity of PBI were 86.6%, 91.1%, 82.6%. Conclusions PBI can significantly increase the detectable rate of ultrasonographie marginal features of breast neoplasms which were also helpful to the differential diagnosis.