According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.

Objective To investigate the effects of surgical method on the falx paraneoplastic parasagittal meningiomas.Methods 30 cases of surgical treatment in sagittal sinus and falx meningioma patients with imaging data,surgical approach,microsurgical resection of the tumor method and efficacy were analyzed.Results 30 patients resected by Simpson standard,Ⅰ grade resection 23 cases,Ⅱ grade resection in 7 cases,no operative mortality.1-5 years of follow-up,2 patients relapsed,all secondary surgical cure.Conclusion To be familiar with microscopic neuroanatomical relationship,using microsurgical resection of the superior sagittal sinus,falx meningioma,tumor removal rate can be increased to reduce the important functional areas of damage,reduce complications and improve quality of life of patients.

Objective To explore a convenient and safety way for surgical treatment of juxtra-papillary duodenal diverticulum.Methods A total of eighteen patients with juxtra-papillary duodenal diverticulum admitted to Hunan Provincial People's Hospital from May 2011 to May 2013 were involved in this study for retrospective analysis.Results Most of patients were old people and the average age was (55.5 ± 11.2) years in this group.All 18 patients accepted diverticulectomy without operation-mortality.No postoperative complications such as bleeding,duodenal fistula,biliary fistula and traumatic pancreatitis were happened.The average operation time was (2.5 ±0.6) hours.The average blood loss was (35.1 ± 14.2)ml.A total of 16 patients had been accepted follow-up survey.Mean length of follow-up was (10.5 ±2.0)months.Good result rate was 100％.Conclusions Do-not-open the duodenum diverticulectomy is the ideal surgical treatment of juxtra-papillary duodenal diverticulum.

Objective To discuss the relativity between serum procalcitonin(PCT) level and renal impairment (RI) in critically ill patients. Methods A perspective study was performed in 60 critically ill patients. They were divided into 2 groups on the serum PCT level within 24 h: abnormal group (PCT ≥ 0.5 μg/L,38 cases) and normal group(PCT < 0.5 μg/L,22 cases). The serum creatinine (SCr) and blood urea nitrogen (BUN) were observed. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) of the patients were recorded. Calculated the sensitivity and specificity for prediction of RI as well as acute renal dysfunction (ARD). Results SCr [(188.91 ± 199.48) μmol/L]and BUN [(13.03 ±9.19)mmol/L]in abnormal group were significantly higher than those in normal group [(67.40 ± 15.35) μ mol/L and (6.91 ± 2.06) mmol/L](P< 0.01). The sensitivity of PCT forecast RI was 71.79%, and specificity was 52.38%. The sensitivity of PCT forecast ARD was 91.67% , and negative predictive value was 95.45%. Conclusion Serum PCT level has an important value for judgement of RI and ARD in critically ill patients.

Objective To analyse the clinical effect and mechanism of hirudin in the treatment of patients with lower limb venous thrombosis after fracture.Methods 56 patients who were diagnosed with lower limb venous thrombosis after fracture in our hospital were collected.All patients were randomly divided into experimental group (n:28) and control group (n:28).12h after fracture operation, patients in control group were treated with subcutaneous injection of low molecular weight heparin calcium, patients in experimental group were treated with Maixuekang capsule ( hirudin) orally on the basis of control group.Before and after the treatment, the plasma levels of thrombin antithrombin complex ( TAT) , thrombin activated fiber soluble inhibitor (TAFI), D-Dimer (D-D), fibrinogen (FIB), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and clinical effect were detected in all patients.Results After treatment, the total effective rate of experimental group ( 92.86%) was significantly higher than that of the control group ( 71.43%) ( P<0.05 );compared with control group, the plasma levels of TAT, TAFI were lower in the experimental group (P<0.05); the plasma levels of D-D, FIB were lower in the experimental group (P<0.05); the plasma levels of TT,PT,APTT were higher in the experimental group ( P<0.05 ) .Conclusion The hirudin could inhibit thrombin activation and coagulation function in fracture patients with lower limb venous thrombosis, decrease the plasma D-D and FIB levels for improving blood hypercoagulable state and preventing thrombosis,thus improve the clinical efficacy.

Bladder pain syndrome or interstitial cystitis (BPS/IC) is a clinical diagnosis based primarily on refractory suprapubic pain,which is lack of effective treatment and a broad consensus of diagnostic criteria,because its etiology and pathophysiology remains unclear.In this review,it was discussed that recent research advancement regarding to definition,etiology,diagnosis and treatment of BPS/IC,through referring to the latest guidelines and literature on this disorder.

Objective To observe the clinical effect of postoperative complications in patients with induced abortion by taking Drospirenone and Ethinylestradiol Tablets.Methods 400 patients with induced abortion from November 2015 to May 2016 were randomly divided into the observation group and the control group,200 cases in each group.The control group was treated with routine antibiotic therapy.The observation group treatment with Drospirenone and Ethinylestradiol Tablets based on the control group, 1 per one night, 21d for a course of treatment, continuous use of 6 courses.Compared the 2 groups of patients with postoperative complications of pelvic infection,intrauterine adhesions,pregnancy,recurrent abdominal pain and two groups of postoperative recovery time of menstruation,vaginal bleeding,endometrial thickness.Results In the observation group after pelvic infection,uterine cavity adhesion,pregnancy,periodic abdominal pain incidence were 1.5%,0.5%,0.0%,1.5%,were significantly lower than that of the control group7.0%,3.5%,4.0%,5.5%(P<0.05);the observation group after menstruation recovery time,vaginal bleeding,endometrial thickness respectively(27.2 ±1.7) d,(6.2 ±1.4)d,(7.2 ±2.3) mm,were lower than the control group(32.5 ±6.0) d,(7.8 ±2.7) d,(5.0 ±2.4) mm,two groups of the difference was statistically significant(P<0.05).Conclusion After artificial abortion,taking Drospirenone and Ethinylestradiol Tablets can effectively reduce the incidence of complications,improve the quality of life of patients,the method is simple,safe,effective and good compliance.

Objective To establish the methods for TLC identification and contents determination of Compound Yantongxiao Spray.Methods Flos Lonicera,Borneolum Syntheticum and Menthol in the spray were identified by TLC,and the content of chlorogenic acid was determined by HPLC.Results The TLC characteristic spots of Flos Lonicera,Borneolum Syntheticum and Menthol can be identified.For content determination,the linear range of chlorogenic acid was in 0.08～0.28 ?g(r=0.999 0),the average recovery of chlorogenic acid was 102.34 %(n=6)and RSD was 2.03 %.Conclusions The methods are simple,accurate,specific and reproducible,can be used for the quality control of Compound Yantongxiao Spray.