Objective: By constructing the cash flow model, it proposed the premium adjustment mechanism of critical illness insurance(CII). Methods: Based on the practical data of critical illness insurance in China, it established some actuarial assumptions and cash flow model to simulate and analyze premium adjustment mechanism of CII. Results: ( 1) Because of the deterioration of critical illness incidence rate and the change of market interest rates , CII guaranteed premium usually resents pricing risk, which showed that the cash flow is negative, sometimes accumulated cash is negative; (2) based on the criteria of insurance cost adjustment, it is suggested that when the loss rate reached more than 70%, which could permit the insurance company adjust the premium, if the loss rate reached more than 80%, it needs to compulsory the insurance companies to adjust premium. Conclusion: The study proposes the mechanism of CII premium adjustment, provides guidance for practice.

Objective To investigate the expression and significance of IDO and c-myc in bladder urothelial carcinoma.Methods IDO mRNA expression from fresh tumor and mucosa specimens from 20 cases were detected by fluorescence quantitative PCR,and SP was used to detect the IDO,c-myc protein in paraffin-embeded specimens from 84 cases and mucosa specimens from 22 cases.Results In bladder urothelial carcinoma,IDO,c-myc protein expression level had no relationship with age and sex.Expression of IDO protein in invasive bladder urothelial carcinoma was significantly higher than that of no-invasive (x2 =5.600,P =0.018).With the increase of the histological grade (x2 =20.268,P =0.000) and UICC stage (x2 =12.075,P =0.007),the positive expression rate of IDO protein was increased.There was not positive expression of c-myc protein in normal bladder tissue,but in bladder urothelial carcinoma,44 cases (52.4 ％) were positive expression (x2 =10.733,P =0.001).The expression of c-myc protein had no relationship with the histological classification,histological grade and UICC stage.In bladder urothelial carcinoma tissue,IDO protein expression level was positively correlated with c-myc protein expression (r =0.205,P =0.047),and was positively correlated with the histological classification,histological grade and UICC stage (r =0.258,P =0.018; r =0.491,P =0.000; r =0.365,P =0.001).Expression of IDO mRNA in bladder urothelial carcinoma (7.696 1±1.745 2) was significantly higher than that in normal bladder tissue (6.397 0±1.205 1)(t =2.367,P =0.023).The average expression level of IDO mRNA in bladder urothelial carcinoma of Ta-T1 stage was 6.803 4±1.567 5,which was significantly lower than that in T2-T4 stage (9.183 8±0.690 3) (t =4.955,P =0.000).The average expression levels of IDO mRNA in grade Ⅰ,Ⅱ,Ⅲ bladder urothelial carcinoma were 7.058 7±1.771 5,7.934 2±1.530 5,9.290 7±0.574 5,respectively,which were increased with the grade increasing (t =2.729,P =0.011).Conclusions The high expression of IDO correlates with bladder urothelial carcinoma progression,and expression of c-myc is irrelevant with bladder urothelial carcinoma progression,but maybe associate with bladder urothelial carcinoma occurrence.IDO may be a predictive factor of prognosis.IDO and c-myc may be therapeutic target in the treatment of bladder urothelial cancer.

Objective To investigate the expression and significance of bin 1,C-myc in bladder urothelial carcinoma.Methods SP method was used to detect the expression of bin 1,C-myc protein in paraffin specimens from bladder urothelial carcinoma of 84 cases and mucosa of 11 cases,and its relationship with clinical pathological charac-teristics was analyzed.Results The positive expression rate of bin1 in normal bladder tissues was 81.81%,that in bladder urothelial carcinoma was 46.43%,the difference was not significant (χ2 =4.873,P=0.051).No expression of C-myc was observed in normal bladder tissue ,the positive expression rate of C-myc in bladder urothelial carcinoma was 52.38%,the difference was statistically significant (χ2 =10.733,P=0.001).The expression of bin1 in invasive bladder urothelial carcinoma was significantly lower than the non-infiltrating type(χ2 =7.685,P =0.007),with increased histological grade and UICC stage ,the positive rate of bin1 expression decreased (χ2 =15.817,P=0.000;χ2 =11.104,P=0.010).The expression of C-myc had no relationship with the histological classification ,histological grade and UICC stage .Correlation analysis showed that the expression of bin 1 was negatively correlated with histologi-cal classification,histological grade and UICC stage (r=-0.302,P=0.005;r=-0.411,P=0.000;r=-0.302, P=0.005).With the increased expression of bin1,C-myc expression decreased,but the difference was not statistical-ly significant.Conclusion Low expression of bin1 or loss of bin1expression were associated with the progression of bladder urothelial carcinoma , the expression of C-myc was related with bladder urothelial carcinoma lesions .The results suggest that bin1 may be predictive factor for prognosis of urinary bladder urothelial carcinomas ;bin1,C-myc may be viewed as molecular targets for tumor chemotherapy .

Objective:To evaluate arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors in the treatment of tibial eminence fracture.Methods:The 23 patients were retrospectively analyzed who had been treated at Department of Orthopedics, Beiing Shunyi District Hospital for tibial eminence fractures by arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors from October 2015 to December 2019. They were 15 males and 8 females, aged from 12 to 55 years (average, 35.5 years). All the injuries were unilateral (14 right and 9 left sides). According to the modified Meyers-McKeever classification, 2 cases belonged to type Ⅱ, 18 cases to type Ⅲ and 3 cases to type Ⅳ. Range of motion of the knee, Lysholm and International Knee Documentation Committee (IKDC) scores were observed before surgery, 1 month and 12 months after surgery. The anterior tibial slope angle (ATSA) on CT was measured preoperatively and 1 month after surgery for evaluation of fracture reduction.Results:All the 23 patients were followed up for an average of 23 months (from 12 to 52 months). Postoperatively, limited knee movement was observed in 2 patients and non-anatomic reduction in one patient. At 1 month and 12 months after operation, the Lysholm scores (61.4 ± 3.5 and 90.4 ± 4.3) and IKDC scores (69.6 ± 4.2 and 88.5 ± 3.0) were significantly improved compared with the preoperative values (45.4 ± 6.8 and 49.6 ± 3.9, respectively) ( P<0.05). ATSA was significantly restored from preoperative 4.2° ± 5.7° to -11.7° ± 2.9° at 1 month after operation ( P<0.05). Conclusion:In the treatment of tibial eminence fracture, arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors can achieve anatomical reduction and firm fixation, leading to satisfactory surgical outcomes.

Objective To provide reference on the difference in blood glucose metabolism between different mouse strains by comparing blood glucose changes under food and /or water deprivation.Methods C57BL/6J mice, BALB/c mice,and ICR mice used in this study were divided into four groups:control group, food deprivation group, water depriva-tion group and food &water deprivation group .Their blood glucose was measured within 12 hours under various stresses . Results and Conclusion There are different blood glucose regulation patterns in different mice strains .The blood glucose level of C57BL/6J mice is usually higher than that of the BALB/c and ICR mice, while the of blood glucose level BALB/c mice stays relatively stable , and the ICR mice have the widest range of blood glucose levels upon these stresses .Accord-ing to our data, the difference in blood glucose metabolism between different mouse strains should be taken into considera -tion in blood glucose related studies for proper interpretation and design of experiments .

Objective To provide reference for clinical application of combined antoxidants , by evaluating the com-bined and individual antioxidant activities of three commonly used antioxidants :edaravone,glutathion(GSH) and vitamin C ( VC) .Methods The multiple and individual antioxidant activities of the three antioxidants were compared by determining total antioxidant activity assay , reductive activity assay , superoxide anion scavenging assay and hydroxyl radical scavenging assay.Results and Conclusion Results showed that the combined antioxidants acted synergistically in scavenging free radicals and increased remarkably antioxidant activity at the same molar concentration .The rationality of different antioxi-dant combination should be taken into consideration in subsequent clinical application .

Objective: To investigate the role of indoleamine 2, 3-dioxygenase in the development of uterine cervical squamous carcinoma. Methods: From January 2008 to December 2008, 116 uterine cervical carcinoma specimens and 18 metastatic lymph node specimens from patients with CIN Ⅰ-Ⅲ and uterine cervical squamous carcinoma were evaluated for iDO expression by immunohistochemistry. Twenty normal cervical specimens and 20 normal lymph node specimens were used as the controls. Results: The expression of IDO was not found in normal cervix and CIN Ⅰ. In CIN Ⅱ, IDO expres-sion was weakly positive in 2 cases (2/10, 20%) and negative in 8 cases (8/10, 80%). In CIN Ⅲ, IDO expression was weak-ly positive in 8 cases (8/13, 61.5%), positive in 1 case (1/13, 7.7%) and negative in 4 cases (4/13, 30.8%). The positive ex-pression rate of IDO in cervical cancer stage Ⅰ -Ⅳ was 100% (83/83). In cervical cancer stage Ⅰ A and Ⅰ B, the positive ex-pression rate of IDO was significantly higher than that in CIN Ⅱ and CIN Ⅲ (P<0.01). The positive expression rate of IDO in cervical cancer stage Ⅱ A-Ⅳ B was significantly higher than that in Ⅰ A and Ⅰ B. IDO expression was associated with cervi-cal cancer progression (OR=0.807, P<0.01). IDO expression in primary lesions with lymph node metastasis was significant-ly higher than that in those without lymph node metastasis. IDO expression rate was 100% in metastatic lymph nodes. The IDO expression was not associated with cervical squamous carcinoma differentiation degree (OR=-0.139,P>0.05). Conclu-sion: In CIN Ⅱ, escape mechanisms that stimulate cervical squamous carcinoma progression is gradually developed. IDO expression in metastatic lymph nodes is possibly associated with immune tolerance. IDO expression is not associated with differentiation degree of cervical squamous carcinoma. IDO may be a prognostic factor for uterine cervical squamous carci-noma and a therapeutic target for treatment.

Objective To study postoperative delirium in elderly patients.Methods We investigate the morbidity of postoperative delirium in 142 elderly patients (≥ 60 years)after gastrointestinal surgery by using Confusion Assessment Method (CAM) and Delirium Rating Scale Revised-98 (DRS-R98) scores.Data were analyzed using Student's t test and Chi-squaretest respectively with SPSS 19.0.Results Of 142 patients,delirium was diagnosed in 36 patients(25.4％),delirium developed in 4,7,17,7,1 patients in posto perative 1,2,3,4-7,7 + days respectively.There were significant difference in hospital stay:17.7 ± 2.6 days (postoperative delirium) and 13.4 ± 2.3 days (no postoperative delirium),t =4.608,P =0.000 1.The postoperative complications (52.8％ / 23.6％,x2 =10.710,P =0.001) and ICU admission (22.2％/6.6％,x2 =6.939,P =0.008) significantly increased.Conclusions Postoperative delirium is recognized as one of the most common surgical complications in elderly patients with gastrointestinal surgery leading to other major postoperative complications,and prolonged hospitalization.

Objective To evaluate the results of acromioclavicukr crook plate in treatment of acromioclavicular joint dislocation and distal clavicular fracture and discuss causes for complications and preventive measures.Methods From September 2003 to April 2007,open reduction and acromiocla vicular crook plate fixation was done on 38 patients with acromioclavicular joint dislocation and distal clavicular fracture including 17 with acromioclavicular dislocation and 12 with distal clavicle fractures.Postoperative rehabilitation began early.Results Of all,27 patients were followed up for mean 21 months (3-37 months) and obtained bone healing.The internal fixation was removed at 6-8 months postoperatively and the outcome was evaluated with Karlsson rating system,which showed 22 patients at grade A,four at grade B and one at grade C.There was no dislocation or fracture after the internal fixation was removed ranging.Three patients with limited abduct motion <90° during certain movements got better after plate removal.One patient had acromio clavicular erosion.Conclusions The application of acromioclavicular crook plate provides accurate anatomical reduction and early rehabilitation and enables fast functional recovery.Technically,the implant needs to be used precisely.It is better to get appropriate early exercise and remove plate as early as possible.

OBJECTIVE： To compare the quality of ceftazidime for injection among the domestic and imported products METHODS： The ceftazidime was observed and determined with respect to the property， color and clarity of the solution， insoluble particle， content of pyridine， polymer of ceftazidime and marked content of ceftazidime RESULTS： There were some differences in above－ mentioned parameters among products of different factories， however， the parameters were within the range of standard CONCLUSION： The quality of domestic products is reliable and comparable to that of imported ones