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Systemic lupus erythematosus(SLE)is an autoimmune disease with unknown etiology and pathogenesis, and is characterized by multiple organ involvement and the production of autoantibodies.Late-onset SLE means that clinical symptoms first occur after 50 years of age, often without typical skin lesions and implicating fewer target organs.It exhibits low disease activity, a high degree of cumulative damage, high rates of comorbidity and mortality, and abnormal immunological profiles, which make its diagnosis difficult.Due to the physiological state and disease characteristics in the elderly, the treatment is slightly different from that for SLE.This article reviews the clinical features, diagnosis and treatment of late-onset SLE to provide a basis for accurate diagnosis and treatment.
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Objective@#To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas.@*Methods@#Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis.@*Results@#This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.@*Conclusions@#The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.
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Objective:To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas.Methods:Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis.Results:This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.Conclusions:The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.
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Objective To study the expression difference and the meaning of interleukin (IL)-1β and Claudin-5 in the kidney and kidney's membrane between lupus mice and the control mice. Methods Gene expression difference of IL-1βand claudin-5 between lupus mice and control mice in their kidney and kidney's membrane was detected with quantitative polymerase chain reaction (Q-PCR). The location of the expression was identified by immunohistochemistry. One-way analysis of variance (ANOVA) was used to compare the means of each group, pair-wise comparison was used to compare the difference between multiple sample means. LSD method was used when the variance was equal, and Tamhane's T2 method was used when the variance was different. Results Q-PCR test results showed that IL-1β expression in lupus mice's kidney membrane (0.0095±0.0052) was statistically higher than lupus mice's kidney parenchyma (0.0057±0.0013) (t=2.137, P=0.0458) and control mice's kidney membrane (0.0045±0.0033) (t=2.709, P=0.0131), however, there's no statistical significant difference between control mice's kidney membrane and parenchyma (0.0065± 0.0011) (P>0.05), and there's no statistical difference between control and lupus mice's kidney parenchyma (P>0.05). Claudin-5 expression was statistically higher in control mice kidney membrane (0.0192 ±0.0048) than its kidney parenchyma (0.01156 ±0.002190) (t=4.009, P=0.0015) but statistically lower in lupus mice kidney membrane (0.0069±0.0004) than its kidney parenchyma (0.0098±0.0027) (t=2.727, P=0.0173);there's no statistical significant difference between control mice's kidney parenchyma and lupus mice's kidney parenchyma (P>0.05), and lupus mice's kidney membrane expression was statistically lower than control mice's kidney membrane (t=6.018, P=0.0001). Immun-ohistochemistry showed that IL-1β expression was mainly around glomerulus and membrane, but not renal tu-bule. Claudin-5 expression was mainly around glomerulus and membrane. Conclusion Immune inflammation induced by IL-1β has mainly shown in blood vessels, while claudin-5 has protective effect on lupus immune inflammation.
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In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.
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Adrenal medullary hyperplasia (AMH) is a rare cause of secondary hypertension. Herein we analysed clinical manifestation of 4 cases. The clinical and biochemical features of AMH were similar to those of pheochromocytoma. 131 I MIBG scintigram and CT scanning were helpful to make differential diagnosis. Etiology, diagnosis and treatment of AMH were discussed.
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Objective To investigate the mechanism of orotic acid-induced fatty liver in rats. Method Rats were randomly divided into 2 groups,and fed AIN93 diet with or without 1% orotic acid (OA) for 10d. Serum total cholesterol (TC),triglyceride (TG),high density lipoprotein-cholesterol (HDL-C),hepatic lipids concentrations (TG,TC and phospholipids),hepatic enzymes activities and mRNA levels of key enzymes related to lipids metabolism,as well as hepatic genes expression of transcription factors were determined. Results OA administration significantly increased serum and hepatic TG concentration. The activity and mRNA level of fatty acid synthase (FAS) were obviously up-regulated by OA treatment,whereas the activities and mRNA concentrations of carnitin palmitoyl transferase (CPT) and microsomal triglyceride transfer protein (MTP) were depressed significantly. Furthermore,OA also stimulated the mRNA expression of sterol regulatory element binding protein-1c (SREBP-1c),but did not alter the mRNA concentrations of peroxisome proliferator-activated receptor alpha (PPAR?) in liver. Conclusion:The stimulation of TG synthesis caused by enhancement of SREBP-1c and its target genes-FAS,which could be responsible for development of fatty liver. On the other hand,the inhibition of fatty acid beta-oxidation and VLDL secretion were related to the observed lipids accumulation.