Objective To assess the use of medical services by patients with chronic hepatitis B, cirrhosis resulting from hepatitis, or hepatic carcinoma and the composition of the expenses incurred. Methods A survey was made on the use of outpatient and inpatient services as well as the details of medical expenses incurred by 1 395 self-funded patients and patients enjoying social medical insurance in Shanghai. And an analysis was made on the composition of the expenses and direct medical expenses per annum. Results There was no significant difference between the self-funded group and the insurance group in the use of outpatient and inpatient services; in terms of medical expenses, those incurred by the insurance group were 30% to 50% higher than those incurred by the self-funded group; an analysis on the composition of outpatient expenses showed that drug expenses accounted for over 80% and examination and test expenses accounted for over 15%; an analysis on the composition of inpatient expenses showed that drug expenses incurred by the two groups both accounted for 45% to 60% of the total expenses and examination and test expenses accounted for 15% to 25%. Conclusion Social medical insurance reduces the economic burden of individual patients but significantly raises treatment expenses. The key to containing the rise of medical expenses lies in controlling the conversion of hepatitis B to cirrhosis and the irrational growth of inpatient drug expenses and examination and test expenses.

Objective To summarize the experience of surgical treatment for thyroid nodules.Methods The clinical data of 352 patients with thyroid nodules who had received surgical treatment were collected and analyzed retrospectively.Results The post-operation pathological diagnosis showed these cases were composed of 182 thyroid adenomas,75 nodular goiters,38 adenomatous goiters,16 Hashimoto's diseases,40 papillary carcinomas and 1 follicular carcinoma.Surgical complications included 4 recurrent laryngeal nerve injuries,1 superior laryngeal nerve injury,1 chyle leak,2 neck hematomas,1 pneumoderma,2 wound infections,1 transient hypocalcemia and 1 death from tracheal collapse.9 cases of recurrence were observed.Conclusion Pre-operation evaluation of patients with thyroid nodules should be well performed in order to identify surgical indications.Appropriate surgical procedures and experienced surgical hands may help to reduce operation complications and recurrence rate.

Adjuvant therapy of breast cancer in the child-bearing period tends to affect ovarian function of patients.Adjuvant chemotherapy has a great damage for ovarian function,and tamoxifen's extent of the damage is not yet clear,but gonadotropin-releasing hormone (GnRH) has a protective effect on ovarian function.In the adjuvant therapy,synthetic weigh the pros and cons,make the best individualized programs,is the future direction of the treatment of breast cancer.

Objective To study the clinical significance of the proinflammatory cytokines and anti-inflammatory cytokines in acute pancreatitis with systemic inflammatory response syndrome. MethodsIn this study, 13 cases of mild acute pancreatitis (MAP), and 19 cases of severe acute pancreatitis(SAP) were recruited to evaluate acute physiology and chronic health evaluation (APACHEⅡ) on post admission day 1,3,5,7 and Balthazar CT criteria on post admission day 1,7. Values of serum IL-6?IL-8?IL-10?IL-12 were measured. ResultsThe scores of APACHEⅡ and Balthazar CT criteria were lower in the MAP patients than those in the SAP patients(5.6?2.1 and 1.5?0.6 vs. 13.6?4.3 and 6.3?1.5, all P

Objective To investigate the clinical features of early postoperative inflammtory small bowel obstruction,and discuss its diagnosis,treatment and preventive measures.Methods The clinical data of 68 cases of early postoperative inflammatory small bowel obstruction were analyzed retrospectively.Results Within the 68 cases,65 cases were cured by non-operative treatment including gastrointestinal decompression,anti-inflammatory drugs,somatostatin,total parenteral nutrition(TPN) and traditional Chinese medicine.The mean time from the onset of symptoms to the recovery of bowel function was 14 days.Three cases were cured by transferring to operation.One case of them was transferred to operation for strangulated intestinal obstruction during the period of conservative treatment.One case underwent oper.ion because the patient didn t recover after 4 weeks expectant treatment.One case underwent operation for the impatience with the conservative treatment of both the doctors and the patient.Conclusion Non-operative therapy should be the first choice for the treatment of early postoperative inflammatory small bowel obstruction,and its therapeutical effect was well-accepted.

Objective To investigate the expression of S-phase kinase associated protein 2 (Skp2) in rats with acute liver failure (ALF) and its significance. Methods There were 256 male SD rats used in this study, among which 240 were injected with D-galactosamine (D-GaIN) to set up ALF model. The rats were divided into 3 groups: ALF model group, free hepatocellular transplantation group, microencapsulated hepatocyte transplantation group, which were intraperitoneally injected with 2 mL of RPMI 1640 culture medium, free hepatocellular suspension and microencapsulated hepatocyte suspension, respectively. The other 6 rats were in control group and the rest 10 rats were used for hepatocyte isolation. Expressions of Skp2 protein in hepatocytes of rats at different time points were detected by immunohistochemical technique. Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) were detected by automatic biochemistry analyzer. The survival rate in each group was observed. Comparisons among groups were done using one-factor analysis of variance. Results Levels of ALT, AST and TBil decreased more significantly by intraperitoneal transplantation of microencapsulated hepatocytes than those by intraperitoneal transplantation of free hepatocytes (P<0. 05). Skp2 labeling indices after 36 h of injection in ALF model group, free hepatocellular transplantation group and microencapsulated hepatocyte transolantation grouo were (28. 2±6.1) %, (41.4± 10. 5) % and (68. 0±10.8) %, respectively (F=29. 08 , P<0. 05). There were 4, 6 and 11 out of 15 rats survived in the 3 groups, respectively. Conclusion The dynamic observation of Skp2 expression could be used to judge the regeneration of hepatocytes.

Objective To investigate the relationship of iPTH levels, calcium and phosphorus metabolism with cardiovascular event status in the chronic renal failure (CRF) patients. Methods This article retrospectivly studied the clinical and laboratory data of 87 CRF patients. 66 patients of A group didnt occur cardiovascular events,and 21 cases of B group occurred cardiovascular and cerebrovascular events. This article analyzed iPTH levels,serum calcium, phosphorus, calcium and phosphorus product and therelationship between cardiovascular and cerebrovascular events between the two groups. Results Decreased iPTH,increased serum C reactive protein and increased lipoprotein(a) had relationship with cardiovascular and cerebrovascular events in patients with chronic renal failure,but calcium,phosphorus,calcium and phosphorus product has nothing to do with the cardiovascular and cerebrovascular events. Cardiovascular and cerebrovascular events increased significantly in dialysis patients than in non - dialysis patients. Conclusiou Chronic renal failure patients on dialysis levels of serum iPTH, CRP level, LP(a) level and dialysis could lead to cardiovascular and cerebrovascular events.

Laryngeal carcinoma related gene 1(LCRG1) is a candidate tumor suppressor gene of Laryngeal carcinoma. To further investigate its transcriptional regulation, the transcriptional start sites for LCRG1 gene have been identified by 5′ RACE (rapid amplification of cDNA ends) based on the bioinformation analysis of LCRG1. Then eleven luciferase expression vectors which contained potential human LCRG1 gene promoter were constructed. Luciferase reporter assay indicated that LCRG1 promoter region was mainly located in -169～+127 region nearby the major transcriptional start site. These results suggested that the region (-169～+127) includes an essential promoter for human LCRG1 gene transcription.

Objective To analyze the clinical characteristics and drug resistance of gram -negative bacillus in Department of Respiratory Medicine.Methods 100 patients in Department of Respiratory Medicine were selected, analyzed the clinical characteristic and drug resistance of 125 strains of gram -negative bacillus that was separated. Results 125 strains of pathogenic gram negative bacilli were isolated out of 100 patients,among which 34 strains were pneumonia klebsiella bacteria,24 strains were acinetobacter baumannii,18 strains were pseudomonas aeruginosa, 10 strains were enterobacter cloacae,18 strains were escherichia coli and 21 strains were other bacteria.Results The drug resistance rates were 79.4%,76.5%,76.5% and 76.5% respectively in klebsiella pneumoniae to amikacin, cefotaxime,ampicillin and imipenem,was more sensitive to meropenem and cefoperazone,the drug resistance rate was 100.0% in acinetobacter baumannii to ampicillin and cefazolin,and was 91.7% to ceftriaxone,and the resistance rate for other drugs are higher generally.The drug resistance rate was 100.0% in pseudomonas aeruginosa to ampicillin and ceftriaxone,and was 94.4% to cefotaxime and levofloxacin,the drug resistance rate was 90.0% in enterobacter cloacae to ampicillin,and was 60.0% to ceftriaxone,cefazolin and cefoxitin,the drug resistance rate on the other drug was relatively low.Conclusion Klebsiella pneumoniae,acinetobacter baumanni and pseudomonas aeruginosa were the main gram negative bacillis the cause hospitalized patients with drug resistance.

OBJECTIVE:To evaluate the efficacy and adverse effects of paroxetine alone or in combination with small dose of doxepin for somatization disorder.METHODS:280 patients with somatization disorder were randomly assigned to receive paroxetine alone or in combination with small dose of doxepin for 8 weeks.Clinical global impression scale(CGI)and symptom check list(SCL-90)were used to assess the efficacy,and treatment emergent symptom scale(TESS)was used to assess the adverse effects.RESULTS:After treatment for 8 weeks,CGI score showed the total effective rate was 87.5% in the patients treated with paroxetine alone versus 93.8% in those treated with paroxetine in combination with small dose of doxepin(P0.05).CONCLUSION:Paroxetine in combination with small dose doxepin showed better efficacy for somatization disorder yet without increasing adverse effects as compared with paroxetine alone.