Before 2002, the three existing basic medical security systems of Thailand covered 30% of the population, and the surplus population participated in the universal coverage(UC)policy of medical security system which promulgated in 2002. Since the implement of UC policy, it has improved the equity of medical service application and health financing, reduced Catastrophic Health Payments and low-income groups have obtained more benefits. The incidence rate of Catastrophic Health Payments decreased and the spending burden of catastrophic health expenditure in low-income groups decreased from 6.11%(2000)to 4.65%(2002).

Objective To identify the chief factors influencing health insurance patients' hospitali-zation expenses so as to provide basis for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods All the medical insurance cases involving the three disease entities in two hospitals of a certain city for the past three years, which totaled 647, were collected and a statistical analysis was made of the possible influencing factors using multi-stepwise regression analysis. Results The factors influencing the health insurance patients' hospitalization expenses included choice of hospitals, length of stay, performance of operations, proportion of drug fees, and province- wide readjustment of medical service prices. Reducing length of stay and lowering proportion of drug fees were the key to controlling expenses. Conclusion It is imperative to formulate scientific diagnostic and treatment routines and expense standards for single disease entities, speed up and deepen reform in the medical insurance system, and, on the basis of trying out payment based on certain single disease entities, implement payment based on disease entities.

Exudative erythoma multiforme is a related to the immune function of children with skin and mucosa,damage to its diversity of characteristics of acute non suppurative inflammation,one of the aller-gic diseases.The disease and its pathogenesis is complex,the body can cause multi system and multi organ damage,the cause has not yet entirely clear.In recent years,due to our understanding of the exudative erytho-ma multiforme gradually thorough,both domestic and abroad on the level of diagnosis and treatment of the disease have greatly improved,the prognosis of patients with exudative erythoma multiforme has improved significantly.The progress of the pathology,clinical manifestation,diagnosis and treatment of exudative ery-thoma multiforme were summarized.

Objective To discuss the cleaning effect of biofilm cleaners for the endoscopic equipment,in order to clean the endoscopic equipment in the operation room thoroughly,improve the cleaning quality of surgical instruments in hospital and prevent nosocomial infection.Methods 300 polluted endoscopic equipments were selected in the operation room and were divided into the experimental group and the control group randomly.Then the two groups were dealt with biofilm cleaners and multi-enzyme detergent respectively.At the end of the cleaning step,the cleaning effect were compared between the two groups.Results The passing rate of cleaning in the experimental group was 96.8％,significantly better than that of the control group,which was 78.0％.The difference between two groups had statistical significance.Conclusions Cleaning endoscopic equipment with biofilm cleaners can improve the cleaning effect of the surgical instruments,ensure the cleaning quality of the surgical instruments.

Objective　To analyze the influence of multiple variable factors on the occurance rate of pneumothorax associated with transthoracic needle aspiration biopsy of the lung. Methods　Fluoroscopically guided lung biopsies were performed in 46 patients. Variable factors were analyzed including lesion size, location, number of puncture, presence of emphysema and patients position after needle biopsy of the lung. Results　Pneumothorax occurred at 9 (19.6%) of 46 patients and that occurred at 4 (44.4%) of 9 emphysematous patients. Among them 2 necessitated chest drainage tube placement. The pneumothorax occurance rate was 30% (3/10) for lesions of diameter 3cm or less in size. In the dependent group, pneumothorax occurred in 4 of 20 patients (20%). In the nondependent group, pneumothorax occurred in 5 of 26 patients (19.2%). Conclusion　The correlation showed that increasing frequency of pneumothorax with decreasing size of lesions. An increased rate of pneumothorax was correlated with presence of emphysema. Patients with emphysema are more likely to have a symptomatic pneumothorax. No significant differences were found in the incidence of pneumothorax between patients placed with the puncture site dependent after biopsy and those placed with the puncture site nondependent.

Salteffectinhigh-voltageassistedlaserdesorptionionizationmassspectrometry(HALDI-MS)has been studied under both positive and negative ion modes using L-tyrosine, β-cyclodextrin, α-lipoic acid, as well as the complex formed between α-lipoic acid and β-cyclodextrin as the test analytes. Compared the mass spectra obtained with and without the addition of salt, it is found that HALDI-MS can tolerate a higher amount of salt than electro spray ionization mass spectrometry ( ESI-MS) . Also, the addition of salt can enhance the HALDI-MS signal intensity of the complex ion of α-lipoic acid and β-cyclodextrin, and we suggest that such signal-enhancement effect is due to the formation of the three component complex consisting of α-lipoic acid,β-cyclodextrin and the positive ion of the salt.

Endocardial fibroelastosis(EFE) is a rare heart disease with a thickening of the endocardium by layers of collagenous and elastic fibres.Patients with EFE have diastolic and systolic heart failure.With the improvement of medicine,some progress has been achieved in EFE research.This article gave a comprehensive review to deepen the understanding of EFE.

Objective To investigate the effects of ult rasonic cavitation on cell membrane cultured in vitro. Methods The rat pulmonary artery vascular smooth muscle cells were divided into three groups, control group, simple ultrasound radiation group and contrast plus ultrasound radiation group.The latter two groups were exposed to ultrasound(665 kHz, 0.5- W/cm 2) for 20 s but the last group with contrast agent. Immediately after the experiment or 24 hours after treatments, electron microscopic scanning was used to observe the membrane change. Results Compared with control group, the cell structure and cell surface had no apparent changes in the second group treated with ultrasound alone. In the third group, nearly 20% cells exhibited small holes with diameter mostly about 1-2 ?m in the cell surface and returned to normal appearance after 24 hours later. Conclusions Ultrasonic cavitation can cause small transient holes in cell surface and hence increase permeability of the cell membrane. It might be the main mechanism for gene delivery with ultrasound contrast agents.

0 05). No postoperative pyrexia and severe complications occurred in all the four groups. Conclusions The four procedures are all safe and feasible. The selection of these procedures is based on the patient’s individual conditions.

Adolescent ; Adult ; Child ; Congenital Microtia ; surgery ; Female ; Humans ; Male ; Perioperative Care ; Young Adult