Hepatitis C virus (HCV)is an important human pathogen that causes chronic viral hepatitis worldwide.HCV infection,often persistent and asymptomatic,could lead to liver fibrosis/cirrhosis and hepatocellular carcinoma.The interferon/ribavirin therapy has been widely used for treating chronic hepatitis C,but it is not always effective and has strong side effects.The development of small-molecule di-rect antiviral agents (DAA)has greatly improved the curing efficiency of chronic hepatitis C therapeutics and will likely replace the interfer-on-based therapy in the future.However,these developments do not necessarily suggest that the problems of chronic hepatitis C have been completely solved.The HCV research is still facing many challenges in this new DAA era.

40 pairs of lower limbs of adult cadavers were dissected, vasa circumflexa femoris lateralis were measured and observation was made on their anatomical relation to musculus rectus femoris and musculus tensor fasciae latae. The important points of the surgical anatomy were described.In most cases the arteria circumflexa femoris lateralis were found to arise from arteria femoris profunda (89.7%). The average length of the arterial trunks was 16 mm and the diameter at their bases was 5.5 mm. The branching of this artery may be divided into three types: ascending-descending type (77.5%), ascending-transversedescending type and transverse-descending type.The average length of the ascending branches was 87 mm and the diameter at their bases was 3.5 mm. This branch was accompanied by one or two veins. The ascending branch may be utilized together with M. tensor fascia latae flap for grafting. The distal end of the vessel could be freely brought to the head and neck of the femur, thus rendering a possibility of utilizing it for the treatment of ischemic necrosis and non-union due to fracture of the neck of the femur.The average length of the descending branches was 200 mm and with a diameter of 3.5 mm, the veins that accompanied them were slightly larger in diametes. At the area in front of the femur, the descending branch could be used both as receptor as well as donor for transplantation. As a donor, the distal end of the descending branch could be transferred to the shaft or lower portion of the femur for the treatment of non-union fracture.There were two neuro-vascular bundles in M. rectus femoris. One of which was not suitable for vascular anastomosis due to its shortness and small caliber, the other one was the main neuro-vascular bundle of M. rectus femoris.The artery pedicle that supplied the M. tensor fascia latae averaged 50 mm in length and 3.0 mm in diameter and was accompanied with one or two larger veins. M. tensor fascia latae may provide a relatively large dermo-vascular flap, its distal part and ilio-tibial tract could also be sutured to the superior margin of the patella to re-enforce the tracting strength and to correct the pulling direction of the patella, and the extension function of the knee joint would be reasonably restored.

For the purpose of offering data for reference to surgical replacement of the esophagus, the vessels of the small intestine, the internal thoracic and the superiot thyroid arteries of 50 adult cadavers were dissected and their lengths and diameters were measured.1. There were an average of 5.4 arteries supplying the small intestine, their diameters ranged from 1.5 to 10.0mm and more than 50％ of them exceeded 3.0mm. The average length from the 1st to 6 th intestinal arteries ranged between 23.5 to 45.5mm and more than 50％ of them exceeded 30.0mm. The 3rd intestinal artery was the longest (averaged 45.5mm) with larger lumen, an ideal one for anastomosis.22％ of the arteries appeared as short trunks, at least one or two of their branches was suitable in length and size for utilization during operation.The average grading of tile arterial arches of the small intestine was 2.7 grades. The lumens of the arterial arches of the 1st and 2 nd grades were larger than those of the 3 rd grade and the rest, the jority of the latter were smaller than 0.9 mm in diameter. Therefor, the preservation of the 2 nd grade arterial arch will be important during the dissection of the small intestine.2. The average total length of the jejunum and ileum was 530.6 cm (ranged from 328.0 to 765.0cm). The segments of the small intestine supplied by individual intestinal arteries increased its length gradually from the 1st to the 8 th. The preservation of the arterial arches of a calibre 1.0 mm in diameter with their collateral circulation intact is of great importance at the upper part of the jejunum. The proportion of the lengths of straightened mesentery to that of the straightened,, intestinal loop was 1:2.6.3. The number of the intestinal veins averaged 2.9 branches which was less than that of the arteries. The approximate ratio o7 the numbers of veins to arteries was 1 to 2, and usually the 1st branch of the vein accompanied the artery.4. The average diameter of the superior thyroid arteries before branching measured 3.1 mm on e left and 2.8 mm on the right, and was an ideal one for anastomosis with the artery of the small intestinal loop.5. The average diameter of the internal thoracic vessels at the 2nd and 3rd intercostal space ranged from 2.6 to 2.8 mm in areteries and 2.4 to 3.1 mm in veins. The diameter of the arteries were approximately the same as that of the small intestine, but the veins appeared much smaller. Therefore the internal thoracic arteries are of choice for anastomosis with the small intestinal arteries during operation when an isolated small intestinal loop replaces the esophagus; but as to veins, external jugular or anterior jugular are more suitable.

Objective To improve the diagnosis of the lung cancer by fiber bronchoscopy and imaging of chest CT or X-ray.Methods 120 cases of lung cancer were diagnosed by fiber bronchoscopy and pathology,and checked by chest CT or X-ray within a week by fiber bronchoscopy,and then it made a comparison between them.Results 114 cases were the central lung carcinoma,6 cases peripheral lung cancer.The fiber bronchoscopic findings showed that,66 cases were outwardly-oriented growth,35 cases were infiltrative growth,4 cases only showed indirect symptom,8 cases were normal.The pathological finding showed that 79 cases were squamous cell carcinoma,19 cases were adenocarcinoma,16 cases were the small cell lung cancer,6 cases were other type lung cancer.The imaging symptom showed that 78 cases were mass shadow of lung,18 cases only showed obstructive pneumonitis,12 cases only showed obstructive atelectasis,9 cases were vaguely lamellar shadow,3 cases were multiple nodes shadow of bilateral lungs.Conclusion The two examines of fiber-bronchoscopy and imaging have their good quality.The diagnostic level of lung carcinoma is raised by combining with two methods.

Objective To determine the sites of action of propofol and isoflurane on somatosensory pathway using median nerve somatosensory evoked potential(MnSSEP) .Methods Twenty-six ASA I - II patients aged 20-50 yrs were randomly divided into two groups: I propofol group( n = 13) and H isoflurane group( n = 13) .In propofol group patients received propofol infusion at a rate of 10 mg?kg-1?h-1 .Oxygen was administered via mask and respiration was assisted or controlled to maintain SpO2 at 96%-100% and PETCO2 at 35-45 mm Hg. The propofol infusion was continued until the patient failed to respond to verbal command. Six minutes later if the patient was still breathing spontaneously, the rate of propofol infusion was increased to 20-40 mg?kg-1?h-1 . In isoflurane group anesthesia was induced with propofol 2 mg ? kg-1 and intubation was facilitated by succinylcholine and anesthesia was maintained with isoflurane inhalation and intermittent iv boluses of vecuronium. The end-tidal isoflurane concentration was maintained at 0.5,1.0 and 1.5 MAC. Each concentration was maintained for 15 minutes. MAP, HR, SpO2,PCTCO2, T0(naso-pharyngeal) and BIS were continuously monitored. MnSSEP( Viking IV D type) was measured and recorded before induction of anesthesia(baseline) and in propofol group when patients became unconscious and apneic; in isoflurane group when end-tidal isoflurane reached 0.5,1.0 and 1.5 MAC.Results In group I there was no change in both latencies and amplitudes of N9 and N13'.With increasing infusion rate, propofol gradually prolonged the latencies and decreased the amplitudes of N60, P45, N35, N20 and P25 waves. In isoflurane group there was no change in the latencies and amplitudes of N9. There was no change in the latencies of N13', but the amplitudes decreased at 1.0 and 1.5 MAC. With increasing concentration, isoflurane gradually prolonged the latencies and decreased the amplitudes of P45, N60, N35, N20 and P25 waves. At 1.5 MAC the inter-peak latencies between N13'-N20 and N13'-P25 were prolonged. Conclusions The sites of action of different infusion rates of propofol and different concentrations of isoflurane are different on somatosensory pathway. The higher the doses, more widespread are the sites of action.

OBJECTIVE:To establish a method for simultaneous determination of the effective constituents rhein,emodin and chrysophanol in jiangzhiyin by HPLC.METHODS:SHIMADU VP-ODS column was used as analytical column,methanol-0.2%phosphoric acid(80∶20)as mobile phase,the flow rate was set at1ml/min,the detection wavelength at225nm,column temperature at room temperature.RESULTS:The linear ranges of detected rhein,emodin and chrysophanol in jiangzhiyin were0.015～0.15?g(r=0.9996),0.014～0.14?g(r=0.9998)and0.0085～0.085?g(r=0.9993)respectively;The average recoveries were99.26%(RSD=2.00%),98.72%(RSD=1.80%)and99.76%(RSD=2.3%)respectively.CONCLUSION:The determination results are stable and accurate,and the method is feasible and reliable,which can be used for the quality control of jiangzhiyin.

Endoscopy ; instrumentation ; methods ; trends ; General Surgery ; methods ; Humans

Objective To investigate the current policy of medical insurance expenditure control in Shanghai and put forward feasible advice. Methods Survey in 5 tertiary first-class hospitals in Shanghai involving 400 doctors and patients was conducted.The result of the questionnaire was tracked with Microsoft Excel 2000.The expense reports during 2001 to 2006 from the Office of Medical Insurance of Shanghai Renji Hospital was collected.All the data were statistically analysed. Results The global budget system was accepted by both the doctors and patients.Charging based on disease categories was proved a relatively satisfying method.Drug expenditure control was concerned by both the doctors and patients. Conclusion Ever since the global budget system of medical insurance is implemented in Shanghai,the medical insurance expenditure has been effectively controlled.The key point is the restraint of irrational consumption during the medical treatment.

? AlM: To study the application value of phacoemulsification in clinical treatment of angle-closure glaucoma.?METHODS:A total of 60 cases ( 82 eyes ) , the best corrected visual acuity, anterior chamber depth, intraocular pressure, width of chamber angle and adverse reaction of patients were researched and analysed before and after treatment.?RESULTS:ln this group, 60 cases (82 eyes) compared with that before treatment, the best corrected visual acuity in patients after treatment significantly improved, with significant difference between the two groups ( P<0. 05 ); anterior chamber depth of patients before treatment were 2. 0±0. 3mm, anterior chamber depth after treatment was 4. 4 ± 1. 0mm, treatment of patients with anterior chamber depth comparison significantly improved after treatment, with statistically significant difference between the two groups ( P<0. 05 ); lOP in patients with postoperative effective control over an extended period, the difference before treatment was statistically significant ( P<0. 05 ); the width of chamber angle after treatment compared with before treatment significantly increased, with statistically significant difference between the two groups ( P < 0. 05 ); after treatment by the emergence of 5 corneal edema, 3 mydriasis, an iris atrophy, no one cases of retinal detachment.?CONCLUSlON: Phacoemulsificationin the treatment of angle - closure glaucoma has a high value, can be effectively corrected visual acuity, improve patient anterior chamber angle width and depth, a small incidence of adverse reactions.

?AIM:To improve the efficiency and quality of teaching, and to cultivate students’ ability to analyze and solve clinical problems, the case - based learning ( CBL ) combined with problem-based learning ( PBL ) teaching mode is introduced into the clinical teaching of ophthalmology.?METHODS:Two classes ( total 131 students ) of 2013 grade major in clinical medicine, Kunming Medical University, were randomly selected as experimental group using CBL combined with PBL teaching mode, and control group using traditional teaching mode. The part of acute angle-closure glaucoma was taught. The scores of the experimental group were compared with that of control group at the end of term.?RESULTS:The mean scores of CBL combined with PBL teaching group were significantly higher than that of traditional teaching group.?CONCLUSION: The application of CBL combined with PBL in the clinical teaching of ophthalmology has obvious advantages in improving the learning interests and promoting students’ self-learning ability. It is helpful in improving the students’ ability of independent-thinking, analyzing and solving problem.