Multi-locus sequence typing of human Brucella isolated in Sichuan Province from 2014 to 2020 / 中华地方病学杂志

Objective:To learn about the genotyping of human Brucella isolated from Sichuan Province. Methods:BCSP31-PCR and AMOS-PCR were used to identify the genus and biotype of the 66 strains isolated from confirmed human brucellosis cases in Sichuan Province from 2014 to 2020, respectively. The isolated strains were genotyped by multi-locus sequence typing (MLST)-9. The sequence type (ST) was compared trough the online MLST database. A minimum spanning tree (MST) was constructed to cluster the newly discovered and known ST using the BioNumerics software version 7.6.Results:The 66 strains isolated from human cases of brucellosis in Sichuan Province from 2014 to 2020 were Brucella, and 65 of them were Brucella melitensis while one strain was Brucella abortus. The MLST method identified three known STs (ST-8, ST-39 and ST-2) and one newly type (ST-101). Among them, ST-8 was the main ST in Sichuan Province (90.91%, 60/66), another 4 strains of Brucella melitensis were ST-39, and 1 strain of Brucella abortus was ST-2. The newly type ST-101 was isolated from Leshan City in 2019, belonging to the Brucella melitensis and closely related to the evolution of ST-8. Conclusion:Brucella melitensis is the main epidemic Brucella strain in Sichuan Province, ST-8 is predominant genotype, with a small amount of ST-39, ST-101 and ST-2.

Short-term Prognostic Value of ALBI, NLR, FIB-4 and MELD Score in Patients With Acute-on-chronic Liver Failure Undergoing Plasma Exchange / 胃肠病学

Background: Acute-on-chronic liver failure (ACLF) is a rapid-developing critical illness with a high mortality. Accurate prediction of the prognosis of patients with ACLF can guide the individualized therapy, and effectively and rationally utilize the scarce liver source. Aims: To investigate the short-term prognostic value of ALBI, NLR, FIB-4, and MELD score in ACLF patients undergoing plasma exchange (PE). Methods: A retrospective analysis was conducted on clinical data of consecutive patients with ACLF undergoing PE from Jan. 2015 to Jul. 2019 at the Nantong Third People's Hospital. According to the survival status at 3 months after admission, the eligible cases were allocated into improvement group and deterioration group (including clinical deterioration, liver transplantation and death cases). The laboratory parameters before PE were recorded to calculate the score of ALBI, NLR, FIB-4, and MELD. Multivariate logistic regression analysis was performed to identify the influencing factors for prognosis and a combined prognostic model was constructed. ROC curve was used to assess the performance of single and combined score for predicting the short-term prognosis. Results: A total of 147 ACLF patients were enrolled, 71 in improvement group and 76 in deterioration group. ALBI, NLR, FIB-4, and MELD score were all significantly increased in deterioration group than in improvement group (P<0.05). Multivariate logistic regression analysis revealed that all four single score were independent risk factor for poor short-term prognosis of ACLF patients undergoing PE. Area under the ROC curve (AUC) was 0.767, 0.884, 0.750 and 0.860 for ALBI, NLR, FIB-4, and MELD, respectively. When using triple (ALBI+NLR+FIB-4) or quadruple (ALBI+NLR+FIB-4+MELD) combined score established by logistic regression model, AUC could increase to 0.918 and 0.946, respectively. Conclusions: ALBI, NLR, FIB-4, MELD score has a good value for evaluating the short-term prognosis of ACLF patients undergoing PE. Combined model including these four single score has higher predictive value.

The incidence and risk factors for hip fractures in elderly patients within two years after stroke onset / 中华老年医学杂志

Objective:To investigate the incidence, clinical characteristics and risk factors for hip fractures in patients within two years after stroke onset.Methods:A total of 332 persons with first-onset stroke from the neurology department of our hospital between 1 June 2013 and 31 December 2014 were recruited and were divided into the hip fracture group and the non-hip fracture group.Clinical characteristics were recorded.Vision was tested as normal or impaired.Patients were accessed by the National Institutes of Health Stroke Scale(NIHSS), Behavioral Inattention Test, Baking Tray Task, Mini-Mental State Examination(MMSE), Birgitta Lindmark(BL)motor assessment scale, Berg Balance Scale(BBS), Timed Up & Go(TUG)Scale, and Stops Walking When Talking(SWWT)Scale.The clinic characteristics and risk factors for hip fractures were compared between the two groups after a 2-year follow-up.The accuracy of risk factors for fracture prediction was assessed by the sensitivity, specificity, and positive and negative predictive values.Results:Of 332 patients with stroke, 16 cases fractured their hips within two years after stroke onset, which corresponded to an incidence of 33‰/year(95% CI: 15‰/year-50‰/year). The 2-year mortality rate was 44%(95% CI: 25%-60%)and 48%(95% CI: 42%-54%)in patients with and without hip fractures respectively( χ2=0.036, P=0.724). The mean survival time for patients with and without hip fracture was 2.72 years(95% CI: 1.45-2.79)and 2.21 years(95% CI: 1.48-2.34)respectively.The proportions of patients with previous fractures history( χ2=16.780, P=0.041)and impaired vision( χ2=11.210, P=0.027), MMSE scale score( U=14.220, P=0.031), TUG ≥ 15 s( χ2=18.560, P=0.000)were higher, and SWWT( χ2=20.340, P=0.000)was lower in the hip fracture group than in the non-hip fracture group.The negative predictive values of previous fractures history, impaired vision, TUG and SWWT were higher than their positive predictive value.The specificities of previous fractures history, impaired vision, and SWWT were higher than their sensitivities.And the sensitivity of TUG was higher than its specificity. Conclusions:Hip fractures after stroke are common in elderly patients.Fractures often occur during daytime at home in daily activities.The previous fractures history, visual and cognitive dysfunction and impaired functional mobility are risk factors for hip fractures.We should take measures to prevent falls according to the relevant factors.Among the test scales, the timed up & go(TUG)scale could much more accurately identify patients at high risk for hip fractures.

Relationship between peripheral blood neutrophil lymphocyte ratio and osteoporosis in Chinese elderly women / 中国基层医药

Objective:To explore the association of peripheral blood neutrophil lymphocyte ratio(NLR) with primary osteoporosis (POP) in Chinese elderly women.Methods:From December 2015 to April 2019, a total of 788 elderly women in Chongqing Three Gorges Central Hospital were included in this study.They were divided into three groups according to bone mineral density: 242 cases of osteopenia, 206 cases of normal bone mineral density and 340 cases of osteoporosis.Their height, weight, statuses of bone of left femoral neck and results of blood tests were recorded, and the values of BMI, NLR and OSTA were calculated.The SPSS statistics software was used to analyze the differences of parameters among the three groups.Logistic regression analysis was used to get significant independent related factors for osteoporosis.The relationship of NLR and OSTA with T-score of left femoral neck was confirmed by Pearson correlation test.ROC curves were used to define the values of NLR and OSTA in diagnosis of osteoporosis.Results:There were statistically significant differences in age(median values: 66, 68 and 70, χ 2=71.596, P<0.001), BMI(median values: 23.46, 24.04 and 25.415, χ 2=64.936, P<0.001) and NLR(median values: 1.97, 2.435 and 2.84, χ 2=106.218, P<0.001) among the three groups(all P<0.01). Logistic regression analysis demonstrated that age, BMI and NLR were all independent significant related factors.There was correlation of NLR, OSTA with T-score of left femoral neck.In diagnosis of osteoporosis, the cut-off value, maximum Youden index, sensitivity and specificity were 2.395, 0.299, 70.3%, 59.6% for NLR, and -1.315, 0.174, 73.6%, 43.5% for OSTA. Conclusion:NLR has intermediate sensitivity and specificity in screening POP in Chinese elderly women, and deserves future researches.

Epidemiological characteristics of Class A and B infectious diseases in Jiading District of Shanghai, 2014-2019 / 公共卫生与预防医学

Objective To analyze the incidence and epidemic characteristics of Class A and B infectious diseases in Jiading District of Shanghai from 2014 to 2019，understand the prevention and control effects of infectious diseases in recent years，and provide a reference for the formulation of future prevention and control strategies and measures for infectious diseases． Methods According to the " China Disease Prevention and Control Information System"，statistical analysis was conducted on the data of Class A and B infectious diseases in Jiading District of Shanghai from 2014 to 2019． Results A total of 11 862 cases of Class A and B infectious diseases were reported in Jiading District of Shanghai from 2014 to 2019，with an average annual incidence rate of 127.34/100000． The overall reported incidence rate showed a downward trend (χ2=36.354，P =0.0002=818.269，P=0.000<0.05) ．The high incidence age was 5- years old， followed by 20- years old. The top three occupations in terms of morbidity were workers, housework, unemployed，and retired．In terms of onset time，December and May-June were the two peak periods; February was the trough．Conclusion Class A and B infectious diseases in Jiading District of Shanghai showed a downward trend from 2014to 2019． Blood-borne and sexually transmitted infections and respiratory infectious diseases are still infectious diseases that need to be focused on prevention and control，mainly syphilis，gonorrhea and tuberculosis. Targeted prevention measures should be formulated in conjunction with peak onset times and key populations to further reduce the incidence of Class A and B infectious diseases．

Epidemiological analysis of syphilis in Jiading District of Shanghai, 2014-2018 / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of syphilis in Jiading District of Shanghai from 2014 to 2018, and to provide a scientific basis for the development of future syphilis prevention and control work. Methods According to the date of onset, all syphilis cases in the infectious disease report information management system from 2014 to 2018, and their epidemic characteristics were analyzed using descriptive epidemiological methods. Results A total of 2 992 cases of syphilis were reported in Jiading District from 2014 to 2018, with an average annual incidence of 38.89/100 000. The overall incidence showed a downward trend year by year. Recessive syphilis was the main cause, and the incidence increased year by year. Fetal syphilis was relatively small and the incidence decreased year by year. The composition ratios of recessive syphilis, primary syphilis, secondary syphilis, and tertiary syphilis in different years were significantly different, and the differences were statistically significant (χ2=26.955, P2=17.793, P=0.0012=12.701, P=0.0130.05). 20~39 years old had the highest incidence rate of syphilis. The areas with high incidence were mainly concentrated in the old urban area of Jiading Center and areas with high population density. The occupational distribution was mainly concentrated in young and middle-aged household workers and unemployed people, workers and elderly retirees. Conclusion In recent years, the syphilis epidemic in Jiading District of Shanghai has shown a downward trend. However, the situation of prevention and control was still severe. It is necessary to continue to improve the level of syphilis detection, and to detect and treat syphilis early. Meanwhile, it is important to strengthen publicity and education in key areas and key populations, and increase awareness of disease prevention to reduce the incidence of syphilis.

Application of molecular tracing technique in one analysis of AIDS infection source / 中华实验和临床病毒学杂志

Objective@#To determine the HIV infection of a 13-year-old leukemia patient Wei using molecular tracing technique.@*Methods@#Three blood samples were collected from the persons who were associated with HIV positive blood donation member Lang. The viral load was tested and pol gene was sequenced and analyzed. At the same time using HyPhy2.2.4 and Cytoscape 3.6.1 to establish the molecular network with these 3 samples sequences and other HIV subtypes sequences obtained from Luzhou.@*Results@#The HIV-1 viral load test result of the three patients were: Lang 933 CPS /ml (treated, blood donor), Wei (blood recipitent) 89 813 CPS /ml, Deng (blood recipitent) 85 158 CPS /ml. The subtype of HIV-1 of these three samples were all recombinant HIV CRF01_AE, and the pol gene similarity was 98.8% (Lang and Wei), 99.7% (Lang and Deng), and 99.1% (Wei and Deng), respectively. The gene sequences of the three samples were linked into clusters (the gene distance was less than 0.004).@*Conclusions@#The patient Wei with leukemia was infected with HIV-1 due to blood transfusion during the seroconversion period, and the three patients were more likely to be infected with the same HIV-1 strain. It is necessary to popularize the use of high-sensitivity nucleic acid detection method in blood collection and supply institutions, which can effectively improve the safety of blood use.

Effect of intelligentized patient-controlled analgesia management on quality of postoperative analgesia / 中华麻醉学杂志

Objective To evaluate the effect of intelligentized patient-controlled analgesia ( PCA) management on the quality of postoperative analgesia in the patients. Methods A total of 6601 patients who underwent postoperative PCA from January 1, 2015 to December 31, 2017 searched from the intelli-gentized PCA system database were selected as intelligentized PCA management group ( I group) , and then were divided into 3 subgroups according to the year: 2015 subgroup ( n=2221 ) , 2016 subgroup ( n=2152) and 2017 subgroup (n=2228). A total of 1235 patients who underwent PCA which was mainly performed by a department of anesthesiology in the postoperative analgesia-related multi-center questionnaire from April 11, 2016 to April 22, 2016 in 12 grade A tertiary hospitals in Guangdong Province were select-ed as the traditional PCA management group (C group). The development of moderate and severe pain, nausea and vomiting, over-sedation at rest and during activity and patient′s satisfaction were recorded on 1st and 2nd days after operation. Results Compared with C group, the incidence of moderate and severe pain, nausea and vomiting and over-sedation at rest and during activity was significantly decreased, and the rate of patient′s satisfaction was increased at each time point after operation in I group ( P<0. 05 or 0. 01) . Com-pared with 2015 subgroup, the incidence of moderate and severe pain at rest and severe pain during activity was significantly decreased in 2016 and 2017 subgroups ( P<0. 05 or 0. 01) , and the incidence of nausea and vomiting was significantly increased in 2017 subgroup ( P<0. 05) . Compared with 2016 subgroup, the incidence of nausea and vomiting was significantly increased in 2017 subgroup (P<0. 05). Conclusion Intelligentized PCA management can improve the efficacy of PCA, mitigates the occurrence of adverse reac-tions and raise the quality of postoperative analgesia in the patients.

Clinical characteristics and risk factors for falls within two years after stroke in elderly patients / 中华老年医学杂志

Objective To examine the incidence ,clinical characteristics ,and risk factors for falls within two years after stroke in elderly patients. Methods A total of 365 elderly stroke patients from the Department of Neurology at the 8th Nanning People's Hospital were recruited from June 1 , 2013 to December 31 ,2014. They were divided into a fall group and a non-fall group and were followed up for two years. The incidence and clinic characteristics of falls were analyzed. The risk factors for falls were analyzed by multiple Logistic regression analysis. Results Of the 365 stroke patients included in this study ,falls were observed in 146(40.2％ )patients. The interval between the stroke and the first fall :72(49.3％ )patients had the first fall within 3 months;22(15.1％ )occurred between 4 and 6 months;20 (13.7％ )between 7 and 12 months ;17 (11.6％ )between 13 and 18 months ;and 15 (10.3％ )between 19 and 24 months.A hundred and five(71.9％ )patients fell during daytime and 41 (28.1％ )patients during night.Eighteen(12.3％ )patients had one fall ;65(44.5％ )patients fell 2 to 4 times ;60(41.1％ )patients fell 5 to 10 times ;and 3(2.1％ )patients fell over 10 times.A total of 709 falls were observed.Places of falls :102(69.9％ )falls happened indoors and 44(30.1％ )falls occurred outdoors.Circumstances of falls :27 (18.5％ )patients fell when turning over ;23 (15.8％ )fell when rising from a seating position ;4(2.7％ )patients fell when showering ;15(10.3％ )patients fell while standing ;9(6.8％ )fell when turning around ;56(38.3％ )fell while walking ;and 12(8.2％ )fell while climbing the stairs or running.The severity of falls :52(35.6％ )patients had no injury ;78(53.2％ ) suffered soft tissue injury ;16 (11.0％ )had fractures ;and 78 (53.2％ )had fear of falling.Multiple Logistic regression analysis showed that age(OR=2.41 ;95％ CI :1.69-3.05) ,history of falls(OR =2.85 ;95％ CI :1.46-3.81) ,history of stroke(OR=1.87 ;95％ CI :1.12-2.79) ,right hemiplegia(OR=2.37 ;95％ CI :1.62-4.59) ,left hemiplegia(OR= 2.47 ;95％ CI :1.46-4.78) ,paraplegia(OR= 2.55 ;95％ CI :1.57-4.98) ,visual impairment(OR=2.35 ;95％ CI :1.35-6.62) ,apraxia(OR=2.53 ;95％ CI :1.42-5.63) ,unilateral spatial neglect (OR=3.34 ;95％ CI :2.82-6.34) ,use of psychotropic medications (OR= 1.76 ;95％ CI :1.11-1.98) ,impaired physical mobility (OR = 1.58 ;95％ CI :1.82-2.91) ,low MMSE scale(OR = 3.42 ;95％ CI :1.38-7.41) ,low Barthel Index score(OR = 2.83 ;95％ CI :0.97-4.68) ,BBS scale<45(OR=2.48 ;95％ CI :1.27-4.18) ,TUG>15seconds(OR=3.56 ;95％ CI :1.91-5.23) ,and lack of rehabilitation therapy (OR=3.42 ;95％ CI :1.38-7.41)were independent predictors for falls(all P<0.05). Conclusions Falls are common among elderly patients within two years after stroke.Most falls happen indoors ,during daytime and while moving.Age ,history of falls ,history of stroke ,hemiplegia ,visual impairment ,apraxia ,unilateral spatial neglect ,use of psychotropic medications ,walk with a walker ,low MMSE scale ,low Barthel Index score ,BBS scale<45 ,TUG>15 seconds ,and lack of rehabilitation therapy are independent risk factors for falls after stroke.

Clinical study on foscarnet prophylaxis and pre-emptive therapy for cytomegalovirus infection in hematopoietic stem cell transplantation / 白血病·淋巴瘤

Objective To observe the clinical safety and efficacy of foscarnet prophylaxis and pre-emptive therapy for cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Ninety-six patients undergoing allo-HSCT from October 2014 to December 2016 were retrospectively analyzed. Plasma CMV-DNA was monitored with real-time quantitative polymerase chain reaction (RQ-PCR) from beginning to 180 days after transplantation. Foscarnet was used not only for prophylaxis but also for first-line pre-emptive therapy when plasma CMV-DNA turned to positive. Foscarnet was given 60 mg·kg-1·d-1 and 120 mg·kg-1·d-1 respectively in prevention and pre-emptive therapy. Incidences of CMV infection and CMV disease were observed, influencing factors on CMV in faction and the efficacy and safety of foscarnet prophylaxis were analyzed, and survival of patients treated by all-HSCT was evaluated. Results Of the total 96 patients, 42 cases (43.8%) had CMV infection with the median time of 42 days after allo-HSCT. CMV-DNA became negative in 36 patients (85.7%, 36/42) after pre-emptive therapy. Six patients (14.3 %, 6/42) developed CMV disease, including 5 patients with CMV negative and 1 patient died for CMV pneumonia. Haploidentical donor and grade Ⅱ-Ⅳacute graft versus host disease (GVHD) were the risk factors for CMV reactivation (χ2 = 3.834, P< 0.05; χ2 = 16.807, P< 0.001). The side effects of foscarnet prophylaxis were mild without hematologic toxicities. 12 patients (28.6 %) died in 42 patients with CMV infection, and 6 patients (11.1 %) died in 54 patients without CMV infection. The difference of survival rates between both groups was not statistically significant. Conclusion Foscarnet is an effective agent for prophylaxis and pre-emptive therapy in CMV infection after allo-HSCT with mild adverse reactions, especially for patients following with hematopoietic recovering.

Expression of Aquaporin 4 in Astrocytes of Rats in Vitro / 中国康复理论与实践

Objective To explore the expression of aquaporin 4 (AQP4) in primary and secondary cultured rat astrocytes. Methods Rat cortical astrocytes from a newborn (one day) Wistar rat were cultured. Astrocytes were identified with immunofluorescence staining of glial fibrilillary acidic protein (GFAP). The expression of AQP4 was determined with real-time quantitative polymerase chain reaction and immu-nofluorescence staining three, five, seven and nine days of primary culture, and nine days of secondary culture. Results The purity of GFAP-positive cells was more than 95％. The expression of AQP4 mRNA was found three days of primary culture, remained unchanged five days of primary culture (P>0.05), and increased seven and nine days of primary culture (P0.05). AQP4 immunofluorescence staining showed the same trend of AQP4 mRNA. Conclusion AQP4 may express since three days of primary culture in rat astrocytes in vitro, and increase slowly until nine days of primary culture.

Distribution of Astrocytic Syntrophin in Hippocampus from Human Mesial Temporal Lobe Epilepsy / 中国康复理论与实践

Objective To investigate the expression changes of astrocytic syntrophin in hippocampus from human mesial temporal lobe epilepsy (MTLE). Methods From April, 2015 to July, 2016, 17 cases of hippocampus, collected from temporal lobectomy, were divided into MTLE group (n=13) and non-MTLE group (n=4) according to hematoxylin and eosin staining, glial fibrillary acidic protein and neuronal nu-clei immunohistochemical staining. Immunofluorescence double labeling and immunofluorescence histochemistry were used to observe the expression of syntrophin. Results The proliferation of astrocytes increased and neurons reduced in the hippocampus of MTLE group. Syntro-phin was found in the membrane and foot processes of astrocyte, that was enriched along perivascular astrocyte end-feet domain in non-MTLE group, but lost in MTLE group. While the whole expression of syntrophin was more in MTLE group than in non-MTLE group (t=5.421, P<0.001). Conclusion The distribution of syntrophin in hippocampus astrocytes may be related to the development of MTLE.

Comparison of the differences in glutamate-induced astrocyte swelling between Wistar and Sprague-Dawley rats / 中国实验动物学报

Objective To compare the differences between the cell swelling of cultured astrocytes ( AST) from Wistar and Sprague-Dawley ( SD) rats after incubation with glutamate.Methods Primary cultured AST derived from the cerebral cortex of one-day-old Wistar or SD rats were prepared.The cultured AST received 1 or 10 mmol/L glutamate treat-ment for 48 h on the tenth day after subculture.The viability of AST was determined by lactate dehydrogenase ( LDH) kit to assess the cell injury, and the perimeter of AST was measured using Image Pro Plus software after glial fibrillary acidic protein immunofluorescence staining to evaluate the astrocyte swelling.Then, the expression of aquaporin 4 ( AQP4 ) in cultured AST was detected by quantitative reverse transcription polymerase chain reaction.Results No significant differ-ence was found in the LDH release after the glutamate treatment in cultured AST from these two strains (P>0.05).The perimeter of AST from normal Wistar rats was shorter than that from SD rats, but was longer after the treatment of glutamate (P<0.05).Meanwhile, AQP4 expression in the Wistar rats was significantly higher than that from SD rats after incuba-tion with 1 mmol/L glutamate ( P<0.05 ) .Conclusions These results suggeste that cultured AST from Wistar rats are more susceptible to glutamate-induced swelling than that from SD rats, and there are differences between the effects of glu-tamate on AQP4 expression in astrocytes of Wistar and SD rats.

Effect of Methylene Blue on Blood-brain Barrier after Focal Cerebral Ischemia-reperfusion in Rats / 中国康复理论与实践

Objective To investigate the protective effect of methylene blue (MB) on blood-brain barrier (BBB) injury after focal cere-bral ischemia-reperfusion in rats. Methods 18 male Sprague-Dawley rats were randomly divided into sham-operated group (n=6), model group (n=6) and MB treatment group (n=6). The left middle cerebral arteries were occluded for 1 hour and reperfused. MB was infused intra-venously immediately after reperfusion (3 mg/kg) and again 2 hours post-reperfusion (1.5 mg/kg), while normal saline was administered in the model group. The sham-operated group was treated as same as the model group without occlusion and infusion. HE staining was used to observe the histological injury in the cortex around the infarcted region 47 hours after reperfusion, while albumin immunohistochemistry was used to evaluate the permeability of the BBB, and immunohistochemistry and double immunofluorescence staining were used to exam-ine the expressions of glial fibrillary acidic protein (GFAP) and aquaporin-4 (AQP-4). Results HE staining showed that cells and blood ves-sels were not intact in the cortex around the infarcted region in the model group and they were better in the MB treatment group. The expres-sions of the albumin, GFAP and AQP-4 were higher in the model group than in the sham-operated group (P<0.01), and were lower in MB treatment group than in the model group (P<0.05). The double immunofluorescence staining showed the colocalization of GFAP and AQP-4 in the astrocytes. Conclusion MB may ameliorate the BBB disruption induced by focal cerebral ischemia-reperfusion through reducing glio-cyte proliferation and down-regulation of AQP-4 expression in rats.

THE EXPLORATION OF STANDARDIZED PROCESSES AND METHODS OF HOSPITAL COST ACCOUNTING / 现代医院

Based on the study of cost accounting of several large public hospitals in Guangdong Province according to the New Hospital Financial Regulations, the paper presents a detailed operational and standardized cost accounting rules, including the specific processes and methods of cost accounting.It has laid a solid foundation for cost accounting, financial management and medical service pricing in hospitals.

Effect of remote limb ischemic postconditioning on level of adiponectin during myocardial ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of remote limb ischemic postconditioning on the level of adiponectin during myocardial ischemia-reperfusion (I/R) in rats.Methods Fifty-seven male Sprague-Dawley rats,aged 8 weeks,weighing 250-350 g,were randomly divided into 3 groups (n =19 each):sham operation group (group S); group I/R; remote limb ischemic postconditioning group (group RLIP).Myocardial ischemia was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 180 min reperfusion in urethane-anesthetized rats.In group S,the anterior descending branch was only exposed but not ligated.The animals underwent 10 min ischemia of bilateral hind limbs starting from 20 min of occlusion of the anterior descending branch,followed by reperfusion in RLIP group.The changes in S-T segment were recorded at 30,60,120 and 180 min of reperfusion.At 180 min of reperfusion,the blood samples were taken from the jugular vein for determination of serum levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnⅠ).The animals were then sacrificed and hearts were removed for measurement of myocardial infarct size (IS) and adiponectin contents in myocardial tissues (by ELISA).Results Compared with group S,S-T segment was significantly elevated at each time point,myocardial IS,and serum cTnⅠ and CK-MB levels were increased,and adiponectin contents were decreased in I/R and RLIP groups.Compared with group I/R,elevation of S-T segment was significantly decreased at each time point,myocardial IS,and serum cTnⅠ and CK-MB levels were decreased,and adiponectin contents were increased in RLIP group.Conclusion The mechanism by which remote limb ischemic postconditioning reduces myocardial I/R injury is related to increased level of adiponectin in the myocardium of rats.

Comparison of general anesthesia of laryngeal mask and mask ventilation during bronchoscopy in elder patients / 实用医学杂志

Objective To evaluate the different effects of laryngeal mask and mask ventilation during bronchoscopy in elder patients. Methods 120 old patients (ASA I-III) were divided into three group according to the table of random number as following:surface anesthesia with autonomous respiration (group I);endoscope mask ventilation (group II);laryngeal mask airway ventilation (group III). Oxygen inhalation through nasal tube in groupⅠ,group II and group III was ventilated with endoscope mask and LMA respectively ,thenwe observed whether there were adverse effects or not during the procedure. Results The adverse reactions of group I were more than other groups. Compared with the group I, variance of MAP,HR, RR, SpO2 in the groupⅡand groupⅢ had less changes, the cases with severe bucking decreased significantly, and satisfaction degree increased markedly, (P <0.01or P<0.05 ) . The incidence rate of resp iratory depression and airway obstruction in groupⅡwas higher than that in groupⅢ (P<0.05). Conclusion Endoscope mask ventilation and LMA can both be adopted in analgesia bronchoscopy for old patient. LMA under general anesthesia to transbronchial lung biopsy would control respiration according to the demand at any time.LMA has more advantage in the operation for the stable respiration and hemodynamics and less complications.

Role of microglial activation in dorsal root ganglia in a rat model of persistent postoperative pain evoked by skin/muscle incision and retraction / 中华麻醉学杂志

Objective To evaluate the role of microglial activation in dorsal root ganglia in a rat model of persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR).Methods Seventy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 2 groups (n =35 each):group sham operation (group S) and group SMIR.The rat model of persistent postoperative pain evoked by SMIR was established according to the method described by Flatters.Pain behavior was assessed by mechanical paw withdrawal threshold to yon Frey filament stimulation at 1 day before and 1,3,7,12,22 and 32 days after operation.Five animals were sacrificed at each time point in each group for microglia count in dorsal root ganglia.Results Compared with group S,mechanical paw withdrawal threshold was significantly decreased at 3-22 days after operation,and microglia count was significantly increased at 3-12 days after operation in group SMIR (P ＜ 0.05).Conclusion Microglial activation in dorsal root ganglia may be involved in the development of SMIR-evoked persistent postoperative pain in rats.

Effects of edaravone postconditioning and remote ischemic postconditioning on myocardial ischemia/reperfusion injury in rats / 中华麻醉学杂志

Objective To evaluate the effects of edaravone postconditioning and remote ischemic postconditioning on myocardial ischemia/reperfusion (I/R) injury in rats.Methods Forty male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were randomly divided into 5 groups (n =8 each):sham operation group (group S); group I/R; edaravone postconditioning group (group E); remote ischemic postconditioning group (group P); edaravone postconditioning and remote ischemic postconditioning group (group EP).Myocardial I/R was induced by occlusion of anterior desending branch of left coronary artery for 30 min followed by 180 min reperfusion.Edaravone 3 mg/kg was injected intravenously at 1 min before reperfusion in groups E and EP.The animals underwent 10 min ischemia of bilateral hind limbs starting from 20 min of myocardial ischemia in groups P and EP.Left ventricular systolic pressure (LVSP),left ventricular end-diastolic pressure (LVEDP) and ± dp/dtmax were measured and recorded during reperfusion.Results Compared with group S,LVSP and ± dp/dtmax were significantly decreased and LVEDP was increased in the other groups (P ＜ 0.05).LVSP and ± dp/dtmax were significantly higher and LVEDP was lower during reperfusion in groups E,P and EP than in group I/R,and in group EP than in groups E and P (P ＜ 0.05).Conclusion Edaravone postconditioning and remote ischemic postconditioning can alleviate myocardial I/R injury and offers better efficacy than either alone.

Discuss on the Medical Price Mechanism after the Cancelling of Drug Price Addition in Public Hospitals / 中国卫生经济

Objective: To rationally reduce the fees and improve the development of large public hospitals. Methods: Analyze the relationship among the fees, hospital economic activity and medical treatment price mechanism in large public hospitals based on resource dependence theory. Results: Price control can not effectively control the costs. Conclusion: Medical price mechanism reform should in the direction of medical system reform, avoid the “quantity success” in large public hospitals, strive for patients with basic medical health institutions; then it should adequately embodies the value of technical work value of medical project and stimulates the initiative of the doctor.