The overuse of drugs and the irrational increase in medical expenses are currently hot social issues. Standards need to be set in a strict way so as to reasonably contain the cost of medical and health care and die prices of drugs and to lower the expenses of medical services. Analyses conducted in our hospital indicate that the component ratio of the drug income fell from 48.1% in January through June, 2001 to 38.7% one year later; the hospital's overall income in January through June, 2002 dropped 5.3% as compared with the same period of 2001, with the drug income dropping 23.7% and the medical treatment income rising 11.8%; the average expenses bom by emergency outpatients and discharged patients in January through June, 2002 both lowered as compared with the same period of 2001. The authors hold that the component ratio of the drug income ought to be a key index in assessing the integrated management Wei of a hospital; the proportion of the drug income in the overall income of a hospital ought to be restricted to 40% or so; and when general plans are being made for a hospital as a whole with regard to the proportion of the drug income, different standards ought to be set for various specialties.

[Objective]To introduce a new technique of ankle arthrodesis with trephine by lateral approach and evaluate its clinical effects.[Method]Ankle arthrodesis with trephine was performed in 20 patients with serious lesions.Lateral incision was adopted and osteotomy of fibula facilitated the exposure of the fusion site.A trephine of appropriate diameter was used for bi-osteotomy,thus inside the trephine gaining two bone blocks were then rotated 90? and replanted in situ.The pruned fibula was fixed with screws as on-lay!grafting.Proper cast was utilized postoperatively to maintain a functional position.[Result]The average follow-up period was 26 months(ranged from 6 months to 4 years).All the wounds healed well at 2 weeks and the callus appeared 4 weeks postoperatively.Sufficient pain relief was obtained in all patients at 12 weeks and appearance improved greatly.A solid union was achieved in all cases through the radiograph.[Conclusion]The use of trephine in ankle fusion by lateral approach is proved to be a simple technique with high union rate.The main advantages of the technique over other methods of arthrodesis include: excellent exposure by regular incision;less disturbance of the original joint,thereby preserving normal height of the joint and length of the extremity;no need for extra graft through in-situ grafting of the bone blocks and rigid on-lay grafting of lateral malleolus for high primary stability.

Objective To evaluate the adjunctive therapeutic effect of intravenous immunoglobulin (IVIG) therapy in the pulmonary infection after kidney transplantation.Methods In 14 cases of pulmonary infection after kidney transplantation, 8 and 6 cases were subjected to high dose (7 to 10 days, group A) or low dose (3 to 7 days, group B) of IVIG therapy besides the standard specific anti-pathogen therapy. In 12 cases of pulmonary infection after kidney transplantation, only standard specific anti-pathogen therapy was given (group C). The incidence and mortality of severe pulmonary infection, levels of serum IgG, IgA, IgM and T lymphocyte subsets among the three groups were observed.Results The incidence of severe pulmonary infection was 0, 66.7 % and 66.7 % respectively in groups A, B and C with the mortality being 0, 16.7 % and 25.0 % respectively. The level of serum IgG was significantly increased in group A after treatment as compared with that before treatment and in group B ( P 0.05 ).Conclusion As an adjunctive therapy, high dose of IVIG at early stage of pulmonary infection can reduce the incidence of severe pulmonary infection and mortality after kidney transplantation.

Objective To explore the resistance to antibacterial drugs in Mycoplasma pneumoniae (Mp) isolated from the chil-dren with community acquired pneumonia (CAP) in Shiyan area .Methods A total of 426 throat swabs and serum samples were collected from children patients with suspected CAP in Shiyan area from Feb .2013 to Apr .2015 .The throat swabs were used to culture Mp .The serum Mp-IgM was detected by ELISA ,the positive samples were confirmed by plate culture method ,meanwhile , the drug sensitivity test was taken .Results Among 426 children cases ,69 cases were confirmed as Mp infection ;the drug suscepti-bility test results showed that the resistance rate of Mp was 76 .8(53/69) to erythromycin ,65 .2% (45/69) to azithromycin ,18 .8%(13/69) to levofloxacin ,4 .3% (3/69) to tetracycline ,4 .3% (3/69) to minocycline and 24 .6% (17/69) to gentamicin .Conclusion Mp is one of the key pathogens of CAP in Shiyan area ,which is severely resistant to macrolide .The treatment should choose sensi-tive drugs as the treatment drug ,but it is important to consider the toxicity and adverse reactions of these several kinds of drugs to children .The blind medication should be avoided .

Objective: Our aim was to investigate the alteration of p16 gene in human pancreatic carcinoma. Methods: A total of 66 human pancreatic tissue specimens, comprising 51 with pancreatic carcinomas and 15 normal pancreatic tissue specimens, were examined for homozygous deletion and mutation of p16 gene by using PCR-SSCP method. Results: No mutation and deletion was detected in 15 normal pancreatic tissue samples. Of 51 pancreatic carcinoma specimens, only one was found mutation for p16 gene in PCR-SSCP assay, and the deletion of the p16 gene in 23 samples were confirmed by using PCR, with a 45% p16 gene deletion rate. Conclusion: These data suggest that p16 gene alterations may play a role in the progression of human pancreatic carcinoma.

Objective To evaluate the using and results of computer-aided detection for full-field digital mammography in Chinese women. Methods 934 individuals more than 40 years old from a specific unit in Shenyang city were screened by full-field digital mammography ( Senographe 2000D, GE) . The examination images were diagnosed firstly by the experienced radiologists and then were analyzed by the computer-aided detection system ( R2' Image Checker ) , respectively. The results from these two assays were compared. Results The prompts were generated in 799 out of 1734 normal images, false-positive rate of computer-aided detection ( CAD) was 46. 1 % in the cases with normal breast image. The correct prompts rate was 70. 5 % in the cases with breast mass, 75. 0 % in the cases with breast microcalcification and 100. 0 % in the cases with breast cancer. Conclusion Although the CAD system has showed clinical values in practice, there are still some false-positive and false-negative results.

BACKGROUND:Increasing studies have found that, percutaneous vertebroplasty and bone cement are characterized by few traumas, few bleeding, simple operation, rapid recovery, rapid pain relief, and effective efficacy. However, tumor recurrence, symptom improvement, bone cement leakage and other complications make people controversial. OBJECTIVE: To explore and summarize clinical outcomes and safety of percutaneous vertebroplasty and bone cement for treating symptomatic vertebral hemangioma. METHODS:Fifty-two cases patients of symptomatic vertebral hemangioma (including 21 male and 31 female, aged 16-63 years) were treated with percutaneous vertebroplasty and bone cement. The lesions were found at T5-T12 in 36 cases and at L1-L3 RESULTS AND CONCLUSION: Al 52 patients were folowed up for at least 6 months after the operation. The Visual Analogue Scale and Oswestry Disability Index were significantly increased at 1 day, 3 weeks and 6 months post-surgery, when compared to before surgery (P< 0.05); the modified Macnab evaluation was excelent in 40 cases, good in 7 cases, fair in 3 cases, and poor in 2 cases, and the excelent and good rate was 90%. Only one patient had recurrence at 6 months after surgery and one patient had the leakage of bone cement. No other complications were found. Percutaneous vertebroplasty and bone cement could effectively cure vertebral hemangioma and relieve the pain, which is a safe treatment. in 16 cases. Clinical outcomes such as Visual Analogue Scale, Oswestry Disability Index and modified Macnab criteria, as wel as complication before and after surgery were evaluated.

Objective To compare the clinical effect and safety of percutaneous vertebroplasty between unipedicular and bipedicular approach for patients with osteoporosis vertebral compressive fractures. Methods A retrospective study was carried out on 147 patients with single osteoporotic vertebral compressive fractures from 2008 to 2014. Ninety-five cases were treated by PVP via a unipedicular approach (unipedicular group) and 52 cases were treated by the bipedicular approach (bipedicular group). The operation time, Cobb, frequency of X-ray exposure,complications like bone cement and postoperative VAS score were compared. Results No significant differences on the VAS score, cobb and complications were found (P > 0.05). However, there were significant differences on the operation time and X-ray exposure frequency (P<0.05). Conclusions No significant differences on clinical effects were found between the unipedicular and the bipedicular approach to percutaneous vertebroplasty for osteoporosis vertebral compressive fractures. However, the unipedicular approach can shorten the operation time and reduce X-ray exposure.

Objective To evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic in laparoscopic cholecystectomy guided by Bispectral Index ( BIS). Methods Forty patients subjected to laparoscopic cholecystectomy randomly allocated into two groups: the control group with opened-loop titratioin of propofol TCI induced at a target of 4 μg?mL-1 and aintained from 2 to 5 μg?mL-1 and the treatment group with closed-loop titration was performed using a proportional differential algorithm.For both groups,the BIS was set at 45-55.Remifentanil TCI was infused at a target of 4 ng?mL-1 and was maintained according to the situation.The change in medial arterial pressure(MAP),heart rate (HR) and BIS were recorded before anesthesia(t0 ),target BIS of 50(t1 ),at tracheal intubation(t2 ),during incision of skin (t3 ),5 min after the operation(t4 ),at t5 of gallbladder removing and at t6 of skin suturing.The dose of propofol was calculated. Results Haemodynamic data were similar between groups during the induction.But MAP was decreased significantly at t1 ,t3 ,t4 , t5 in the control compared with the treatment group (P<0.05).HR changes a lot at t5 in the control compared with the treatment (P<0.05).Total dose of propofol in the treatment group was statistically lower than that in the controls [(110.10± 8.34) vs (120.55±6.26) mg; (603.20±116.55) vs (759.50±116.37) mg,P<0.05)]. Conclusion Automated titration guided by BIS for propofol infusion is feasible without increase in haemodynamic adverse effects and is of less propofol consumption in the laparoscopic cholecystectomy.

Objective:To clarify the differences of host immune responses at different stages of HBV infection. Methods:We constructed three HLA-A*0201/HBV tetramers with immunodominant epitopes of core18-27,polymerase 575-583 and envelope 335-343,and analyzed antigen specific CD8+ T cells and the expression of CD127 in peripheral blood mononuclear cells ( PBMCs) from patients infected with HBV using these HLA-A*0201/HBV tetramers. Results: The frequencies and expansion ability of antigen specific CD8+ T cells in most self-limited HBV infected individuals were higher than that in chronically HBV infected patients. In low copy period the frequencies of antigen specific CD8+ T cells were similar to those in immune clearance phase at a high viral load and liver damage and in immune clearance phase, which had no significant correlation with virus quantitation and ALT level. In chronic infection the ability of antigen specific CD8+ T cells proliferation was inversely proportional to the viral titer. In most self-limited HBV infected individuals the IFN-γsecretion functions of antigen specific CD8+ T cells were higher than in chronic infection,but in immune tolerance phase these cells lost the ability. HBsAg level was different at different stages after HBV infection:it was highest in immune tolerance phase,but in immune clearance phase,activity period and low copy period the correlation with HBV DNA replication gradually declined. The frequency of CD8+ CD127+ T cells in chronic HBV infection was lower than the control group and self-limited infection group,especially in immune tolerance with HBeAg+ and immune clearance phase. Conclusion: The frequencies of antigen specific CD8+ T cells are not the main determinant of immune-mediated protection in chronic HBV infection,memory antigen specific CD8+ T cells are not clear or missing,which provides the possibility for therapeutic vaccines and immunization therapy.