Objective To analyze the effect of different medical insurance payments on medical expenses so as to provide some suggestions for Guangdong Provincial Department of Offsite Medical Insurance Administration in its future policy-making.Methods An statistic analysis was conducted of medical expenses among patients who chose different medical insurance payments and their average length of stay.Results Medical expenses and average length of stay were statistically different among patients who chose different payments.Conclusion The medicare reimbursement′s inclusion of prevention and diagnosis should be recommended to establish a flexible referral system, reinforce the payments reform and increase the efficiency of social security funds.

The incidence of breast cancer increased rapidly in recent years. Breast cancer has become the most frequent malignant tumor of female especially in the developed regions. Traditional Chinese medicine (TCM) is effective in treating breast cancer, but its theories appear hysteretic, restricting the progress in clinical practice, teaching and research of TCM in the treatment of breast cancer. This article described the significance and urgency to work out the standardization of syndrome differentiation based on stages for breast cancer and put it into practice. It also analyzed the foundations, ideas and approaches of the research of standardization of syndrome differentiation based on stages for breast cancer in light of the changes of spectrum of diseases, the weaknesses of modern medicine in treating breast cancer, and the existed problems in the update clinical practice.

The study on use of traditional Chinese medicine in perioperative management of breast cancer is still in the beginning phase. With the emergence of new understanding about the biological characteristics of breast cancer, the concept of treatment has changed. For instance, the resection extent is tending to be narrower, large doses of radiotherapy may be adopted during the operation, and early use of adjuvant chemotherapy is advocated after the operation. These have bought about changes to the intervention factors in the perioperative period for breast cancer. Some related problems about the participation of traditional Chinese medicine in perioperative management of breast cancer are discussed in this article, so as to make the perioperative management perfect.

Bile collected from 28 cases with various hepatic or biliary diseases during operation was assayed for the ?-glucuronidase level. In Group I consisting of 14 patients with primary intrahepatic stone, the ?-glucuronidase level averaged 2250.67 u/dl, while in Group II consisting of 14 patieats with other hepatic diseases, it averaged only 463.99 u/dl(P = 0.01).The patients of both groups showed a declination of the enzyme level gostoperatively, but in Group I, the enzyme level raised with other hepatic diseases, he T-tube. The AMPS and MP contents of the bile .remarkable inhibitory effect on two substances exert their function in positive remarkable inhibitory effect on at pH4,6. It is believed that. ?-glucuronidase, Group 11 consisting the results of thisles in the reformation of biliary stones reformation biliaryWhen ?-glucuronidase level is lower than 200u/dl.Chinese traditional prescriptions with glycynrhizae liquid extract shows a remarkable inhibitory effect on this enzyme. In Chinese traditonal prescriptions, the drugs which can promote circulation and clear deposit are usually added. According to the results of this study, the authors suggest that the therapeutic effect of glycyrrhizae be emphasized.

Objective To explore the clinical value of two-dimensional speckle tracking imaging (2DE-STI) by measuring global longitudinal strain (GLS) in normal children.Methods Totally 176 normal children underwent cardiac ultrasound examination,the left ventricular GLS were measured,and the difference of GLS between gender was analyzed.And the changes of GLS with body surface area (BSA) and age were discussed.Results GLS had no significant difference between male and female ([-24.90 ± 2.06]％ vs [-24.93 ± 2.01]％,t =0.83,P =0.934).GLS had significant differences among different BSA groups (F=3.84,P =0.003),and the differences of GLS in BSA＞ 1.0 group and the other five groups were statistically significant (all P＜0.05).GLS had statistically significant differences among different age groups (F=4.81,P=0.001),and the differences of GLS in ＞9 years old group and the other four groups were statistically significant (all P＜0.05).Conclusion Left ventricular GLS presents certain regularity with children's growth.

Objective To explore the value of DWI ADC in the diagnosis of hepatic ischemia reperfusion injury (IRI) at 3.0 T and investigate the mechanism by comparison with liver enzyme and pathological findings. MethodsForty-two New Zealand white rabbits were divided randomly into ( n ＝ 6,each) six IRI groups by rank sum test. The IRI animals underwent left lobar ischemia for 60 min and were reperfused 0. 5 h, 2. 0 h, 6. 0 h, 12. 0 h, 24. 0 h and 48. 0 h later. One Sham operative group underwent laparotomy without liver ischemia. T2 WI, T1 WI, DWI and contrast-enhanced T, WI were performed with 3.0 T magnetic resonance imaging scanner in each group respectively. For DWI, b-values of 20, 50, 100,200,300,400,500 and 600 s/mm2 were used respectively. Blood samples were taken to detect the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at different time points. Liver samples were examined histologically after MRI scanning. One-way analysis of variance (ANOVA) was used to determine differences, followed by LSD-t test for multiple comparisons. ResultsOverall, ADC decreased markedly at the early IRI phase ( 0. 5 h), drastically increased in the 2.0 h group, and then ascended slightly from 6. 0 h to 48.0 h after reperfusion, except for a transient decrease at the time point of 24. 0 h. When b values were 20, 50, 100,200 and 300 s/mm2, the ADC values in the Sham group were (3.47 ±0.53) × 10-3, (3.11 ±0.39) ×10-3, (2.87 ±0.19) ×10-3, (2.56 ±0.37) × 10-3 and (1.95 ±0.33) ×10-3mm2/s, (2.63±0.31)±10-3, (2.47±0.32) ×10-3, (2.12±0.38) ×10-3, (2.01±0.51) ×10-3and (1.61 ±0.17) ×10-3mm2/s in the 0.5 h group, (2.72 ±0.09) ×10-3, (2.51±0. 11) ×10-3, (2.28 ±0.30) ± 10-3, (1.96 ±0. 14) × 10-3 and (1.58 ±0. 17) × 10-3mm2/s in the 24.0 h group, respectively. ADC of 0. 5 h and 24. 0 h groups were significantly lower than that of Sham group (P＜0.05) when b value was under 300 mm2/s.In the Sham, 0.5 h, 2.0 h, 6.0 h, 12.0 h,24.0 h and 48. 0 h IRI groups, they were (80±8), (181 ±34), (413 ±62), (474 ±83), (424 ±41 ),(332 ±41 )and(302 ±39) U/L for the levels of ALT,and (79 ± 10), (454 ±55), (547 ±72), (607±31 ), (649 ±79), (785 ±49) and ( 1526 ± 167) U/L for the AST respectively. The levels of AST and ALT in IRI groups were significantly higher than those in the Sham group ( P ＜ 0. 01 ).Histological findings showed diffuse hepatocytes swelling and erythrocytes depositing in the hepatic sinusoids, portal area, central venous and arterials at the initial phase.With the injury aggravated, inflammatory cell infiltration,hepatocyte nuclear condensation of apoptosis, sinusoidal dissociation and coagulation necrosis developed eventually. Conclusion 3.0 T DWI can monitor the pathological process of rabbit liver ischemia reperfusion injury dynamically, and provides a feasible imaging modality for clinical diagnosis and treatment.

OBJECTIVE: To explore the mechanisms of Runing Recipe II (a recipe composed of traditional Chinese herbs) in inhibiting the growth of breast cancer by observing its effects on the expressions of p53 and ras oncogene proteins and cell cycle of the transplanted Ca761 breast cancer in mice. METHODS: We established the breast cancer model by transplanting Ca761 cells in mice. The mice were randomly divided into 4 groups: normal saline control group, CTX-treated group, Runing Recipe II-treated group, and Runing Recipe II and CTX-treated group, with 12 mice in each group. We detected the cell cycle of the cancer cells in the mice's transplanted tumor with flow cytometry and measured the expressions of p53 and ras oncogene proteins in the transplanted tumor with immunohistochemical methods. RESULTS: The percentages of tumor cells in S-phase of the Runing Recipe II treated group, CTX-treated group and Runing Recipe II and CTX-treated group were significantly lower than that of the normal saline control group respectively (P<0.05). The percentage of tumor cells in G(0)-G(1) phase of the Runing Recipe II treated group was lower than that of the CTX-treated group (P<0.05), while the percentage of tumor cells in G(2)-M phase was higher than that of the CTX-treated group. The immunoreactive scores (IRSs) of p53 in the Runing Recipe II treated group and Runing Recipe II and CTX-treated group were significantly lower than that in the normal saline control group respectively (P<0.05). The effect of CTX on the expression of p53 was not significant. The IRSs of ras oncogene protein in the Recipe II-treated group, CTX-treated group and Runing Recipe II and CTX-treated group were lower than that in the normal saline control group respectively (P<0.05). CONCLUSION: Runing Recipe II can inhibit the growth of Ca761 breast cancer in mice by controlling the cell cycle of the transplanted tumor. This may be related to its effect on the gene expressions of p53 and ras in the tumor tissue.

Objective To investigate the effect of citric acid and ambroxol on clearing insoluble particles of depleted uranium in rat lungs by establishing a tracheal perfusion model.Methods One hundred and fifty male Wistar rats were randomly divided into model exposure group, normal control group(NC group), depleted uranium exposure group(DU), citric acid treatment group( CA) , ambroxol treatment group( AM) and citric acid+ambroxol treatment group( CA+AM) . The rats were sacrificed on 7, 15 and 30 days.Uranium content in the lungs was detected by microwave digestion method, pathological changes in the lungs were observed, and inflammatory factors of lung homogenates were detected.Results Compared to DU control group, the intrapulmonary uranium deposit amount in experimental groups was significantly reduced on 7 and 15 days (P<0.05).HE stained lung tissue showed that the pathological changes in treatment groups were less significant than in DU control group.The level of IL-1α,IL-1β,and IL-2 was significantly lower than in DU control, but the level of MCP-1 and MIP-1 was observably higher.Conclusion Citric acid and ambroxol can evidently improve the clear-ance of lung uranium and reduce damnification of lung tissues.Drug treatment can reduce the level of pulmonary inflamma-tory cytokines alleviate the chronic inflammation in the lungs, and enhance the capacity of macrophage to recruitment.

Objective:To analyze the characteristics of ultrasound in children with myocardial hypertrophy and to understand the etiology.Methods:From December 2016 to December 2019 in our hospital, 44 cases of children with ventricular septum and left ventricular posterior wall thickness Z value >2 were retrospectively analyzed.Results:There were 10 cases of hereditary myocardial hypertrophy (22.7%), 6 cases of hypertrophic cardiomyopathy showed asymmetric myocardial hypertrophy, the hypertrophy mainly concentrated in the apex, anterior septum and posterior septum, and the thickened myocardial fibers were disorderly arranged, the myocardial echo was disorderly and uneven; 2 cases had family history but did not do gene detection; 2 cases of glycogen storage disease type Ⅱ showed symmetrical myocardial hypertrophy, enhanced and dense myocardial echo, and progressive myocardial hypertrophy, 1 case was misdiagnosed as hypertrophic cardiomyopathy; 1 case of primary carnitine deficiency showed symmetric hypertrophy of myocardium with dense and uniform echo, which was misdiagnosed as hypertrophic cardiomyopathy for the first time; 1 case was clinically diagnosed as myocardial amyloidosis, symmetric hypertrophy of myocardium, dense and uniform echo, with unique signs of " ground glass degeneration" and granular strong echo. There were 29 cases (65.9%) with acquired myocardial hypertrophy, including 14 cases caused by aortic disease, 1 case with Williams syndrome, showing myocardial thickening mainly with ventricular septum thickening, but without abnormal myocardial echo; 12 cases were mothers with abnormal glucose metabolism during pregnancy, with thickening of interventricular septum and posterior wall of left ventricle without abnormal myocardial echo; 2 cases of renal hypertension showed concentric myocardial hypertrophy. The remaining 5 cases (11.4%) are unknown.Conclusions:The causes of myocardial hypertrophy are complex and diverse. Comprehensive analysis of imaging characteristics and clinical results should be used to identify the cause of the disease as early as possible and take timely intervention to the cause to save the child's life and improve the quality of life.

Objective:To investigate the characteristics and management of the emergency patients with orthopaedic trauma during COVID-19 epidemic.Methods:A retrospective analysis was performed of the 32 emergency inpatients at Department of Orthopedics, Nanfang Hospital from January 20 to February 26, 2020. They were 23 males and 9 females, aged from 4 to 66 years (mean, 35 years). The causes for their injury included traffic accident in 14 cases, sharp cutting (e.g. by a kitchen knife) in 6 cases, heavy object crushing in one, machine crushing in one, fall in 2, and machine twisting in one. High energy injury occurred in 13 cases and low-energy injury in 9 cases. The injury involved the upper limb in 7 cases and the lower limb in 15 cases. Grade Ⅱ protection was adopted during the diagnosis and treatment for the one emergency patient who had not undergone nucleic acid screening for 2019-nCoV while grade Ⅰ protection for the other 21 patients. 2019-nCoV infection was recorded in the patients and medical staff as well. The measures and experience were reviewed in the management of orthopaedic emergencies during the COVID-19 epidemic.Results:During the diagnosis and treatment of 22 emergency patients with orthopaedic trauma, none of the medical staff or patients was infected with COVID-19. As the one emergency patient was treated as a suspected case and protected by grade Ⅱ measures, COVID-19 infection was ruled out after surgery.Conclusions:During the COVID-19 epidemic, front-line medical staff dealing with traumatic emergencies faced a higher risk of infection. The emergency orthopaedic traumas were mainly caused by a traffic accident or a machine, and those in the elderly patients by a sharp cutting or a fall. The incidence of COVID-19 infection could be reduced by COVID-19 screening before admission, appropriate anesthesia and surgical methods, protection of perioperative medical staff, postoperative wards care and psychological counseling.