Although the Shanghai's basic health insurance always takes the leading position nationwide in the aspects of coverage, funding level, security level, etc, it still cannot avoid the contradictory problems brought by the rapidly rising demand for health care, poor results of funds management, etc. Commercial health insurance has its u-nique advantages in terms of funds and personnel management. Therefore, they can play their complementary role to the basic medical insurance in order to improve the basic health insurance system. Based on the perspective of com-mercial health insurances, this paper explores the basic health insurance system in Shanghai from the aspects of man-agement patterns, governing body, insurance objects, funding modalities and insurance programs.

PurposeTo investigate whole-body magnetic resonance imaging in diagnosis of idiopathic inflammatory myopathy (IIM), and to guide clinical treatment.Materials and Methods Twenty-six patients clinically diagnosed IIM including 19 dermatomyositis and 7 polymyositis were analyzed retrospectively. Whole-body MRI was performed in all patients including whole-body coronal scan and axial scan of both sides of thigh. Short tau inversion recovery (STIR) sequences were used in the coronal scan and T1WI and fat-suppressed T2WI were performed in the axial scan. Ten healthy volunteers were recruited as control group. MRI findings were compared between the two groups.Results Whole body MRI showed that muscles were homogeneously low signal intensity in the control group. Imaging findings of the patients with IIM included muscle inflammation, fascitis, subcutaneous tissue edema, muscle atrophy and fatty infiltration. The most common distribution site of muscle inflammation of dermatomyositis patients was thigh (n=18), followed by gluteus (n=14), great psoas muscle (n=13), shoulder muscles (n=11), leg muscle (n=11), erector spinae (n=10) and neck muscles (n=9). Findings out of muscles included cavities in the both lungs, infarction in femurs and tibias, avascular necrosis of femoral head, adrenal mass and thyroid nodules. The most common distribution site of muscle inflammation of polymyositis was thigh (n=5), followed by gluteus (n=3), great psoas muscle (n=3), shoulder muscles (n=2), leg muscles (n=2), erector spinae (n=1) and neck muscles (n=1). Findings out of muscles included 1 case of infarction in femurs and tibias.Conclusion Whole-body MRI can not only comprehensively evaluate the activity of IIM but also detect complications such as bone infarction. It's a powerful tool for diagnosis, guiding treatment and monitoring of IIM.

Background:Bioinformatics is an effective technology for microarray data mining and gene function prediction. Aims:To analyze the gene CRELD2 that associated with pathogenesis,disease activity and efficacy of biological agents in ulcerative colitis( UC)by bioinformatics to provide a theoretical basis for subsequent studies on its biological function and molecular mechanism in the development and progress of UC. Methods:The microarray data associated with pathogenesis, disease activity and efficacy of biological agents in UC were downloaded from the Gene Expression Omnibus( GEO database);the data mining and analyses were conducted by using bioinformatics tools such as BRB-ArrayTools, ProtParam,ELM,SignalP 4. 1,PBIL-IBCP Lyon Gerland,GO and STRING. Results:Cross-over analyses revealed that expressions of four genes(CDC25B,CRELD2,IL1RN,PITPNC1)were up-regulated in the order from colonic mucosa of healthy subjects,un-inflamed mucosa of active UC patients to inflamed mucosa of active UC patients,meanwhile these four genes were significantly down-regulated in infliximab responders after treatment when compared with that before treatment and infliximab non-responders. The function of CRELD2 gene was unknown. Bioinformatics analyses showed that CRELD2 gene was located on the long arm of chromosome 22(22q13. 33),and encoded a secreted protein composed of 402 amino acids. This protein contained several epidermal growth factor( EGF)-like domains,mainly distributed in Golgi apparatus, endoplasmic reticulum and extracellular site and had calcium- and protein-binding effect. Interactions existed between CRELD2 and CHRNA4,CHRNB2 and RHBDD3 proteins. Conclusions:Gene CRELD2 may have EGF-like biological function and via participating directly or indirectly the regulation of immunocytes to affect the pathogenesis and disease activity of UC. It might be used as a biomarker for diagnosis and assessment of disease activity and therapeutic efficacy of UC. Furthermore,it might be a potential target for treatment of UC.

Objective To investigate the value of serum markers in the early diagnosis of liver cirrhosis with minimal hepatic encephalopathy (MHE). Methods A prospective analysis was performed for 81 patients who were hospitalized and treated in General Hospital of Ningxia Medical University from April 2020 to February 2022, and all these patients were diagnosed with hepatitis B cirrhosis based on clinical manifestation, laboratory examination, and radiological examination or liver biopsy. According to digital connection test A (NCT-A) and digital symbol test (DST), these patients were divided into simple cirrhosis group with 45 patients and MHE group with 36 patients. Related indices were measured, including liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil)], albumin, blood ammonia, cholinesterase, and prothrombin time. The independent samples t -test was used for comparison of normally distributed continuous data between two groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. The logistic regression analysis and the area under the ROC curve (AUC) were used to investigate the predictive factors for MHE. Results Compared with the simple cirrhosis group, the MHE group had a significant increase in NCT-A score ( Z =-7.110, P < 0.001) and a significant reduction in DST score ( t =12.223, P < 0.001). The univariate analysis showed that there were significant changes in AST, albumin, prothrombin time, cholinesterase, and blood ammonia in the patients with MHE ( Z =-2.319, -2.643, -1.982, -6.594, and -5.331, all P < 0.05), while the multivariate analysis showed that only cholinesterase and blood ammonia were significant predictive factors (all P < 0.05) and were correlated with Child-Pugh score (all P < 0.05). Cholinesterase, blood ammonia, and their combination had an AUC of 0.925, 0.845, and 0.941, respectively, in the diagnosis of MHE, with an optimal cut-off value of 2966, 60, and 0.513, respectively. Conclusion Blood ammonia, cholinesterase, and their combined measurement have a potential clinical value in the early diagnosis of liver cirrhosis with MHE.

OBJECTIVE: To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. METHODS: A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. RESULTS: The wound area was 21.0-180.0 cm ² (mean, 57.82 cm ²) before operation, and it was 1.2-27.0 cm ² (mean, 6.57 cm ²) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). CONCLUSION Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cicatrix ; Retrospective Studies ; Treatment Outcome ; Tibial Fractures/surgery* ; Wound Healing ; Fracture Fixation, Internal/methods* ; Fractures, Open/surgery*