The current situation of the rise in medical expenses is shown through statistics and the causes of the rise are analyzed. These include: ①inevitability of development, such as changes in the spectrum of diseases, use of new technologies and materials, rise in the overall price index, and generally increased needs for medical care; ②restriction of social factors, such as the imperfect medical insurance system, the reduced proportion of input by the government, the irrational medical pricing and compensation, the fictitiously high pricing of drugs and health materials, and the hospital's excessively high operational costs; ③the boosting effect of the "supporting medicine with drugs" policy. Countermeasures are put forward for the government's price control and financial organs, the departments of health administration, and the hospitals.

Objective To investigate the clinical significance of serum CEA , CA19-9, CA72-4, CA242, CA50, PGⅠand PGR ( PGⅠ/PGⅡ) in the Diagnosis of preoperative and postoperative gastric cancer.Methods Retrospective study.The levels of CEA , CA19-9, CA72-4, CA242, CA50, PGⅠand PGⅡin serum of 41 patients with gastric cancer preoperative and postoperative and 60 healthy people were detected by AutoLumo A2000 chemiluminescence immunoassay and compared.Statistical analysis was performed using Rank-sum test by SPSS 17.0.Results The median of CEA, CA19-9, CA72-4, CA242, CA50, PGI, PGII and PGR in postoperative gastric cancer group were 3.79 ng/ml, 17.85 U/ml, 3.50 U/ml, 14.52 U/ml, 17.62 U/ml, 32.81 ng/ml, 11.48 ng/ml, 3.35.The postoperative gastric cancer group were 1.67 ng/ml, 7.76 U ml, 1.73 U/ml, 6.30 U/ml, 7.57 U/ml, 20.56 ng/ml, 5.71 ng/ml, 2.94.The healthy group were 1.53 ng /ml, 7.59 U/ml, 1.47 U/ml, 6.08 U/ml, 5.68 U/ml, 90.86 ng/ml, 14.85 ng/ml, 6.67.There were statistical differences in the serum levels of CEA , CA19-9, CA72-4, CA242, CA50, PGⅠ, PGⅡand PGR among different groups (chi-squared values were 79.108, 20.678, 20.374, 7.252, 56.73, 131.212, 20.38, 86.37, P<0.05).By the Mann-Whitney rank sum test,the serum levels of CEA , CA19-9, CA72-4, CA242 and CA50 in patients with preoperative gastric cancer were significantly higher than those in healthy controls (Z values were -8.598, -4.425, -4.365, -2.000,-7.420, P<0.05).The level of postoperative group was significantly lower than that of preoperative group (Z value were -4.641, -2.383, -2.459, -2.399, -2.903, P<0.05).The serum PGⅠ, PGⅡand PGR levels in patients with preoperative gastric cancer were significantly lower than those in healthy controls (Z values were -10.309, -2.695, 8.637, P<0.05).The PGⅠlevel in the postoperative group was significantly lower than that in the preoperative group (Z value was -2.109, P<0.05).PGⅡ,PGR levels of postoperative group were lower than those of preoperative group , but the difference were not statistically significant.(Z values were -1.506,-0.838, P values were 0.132,0.402).Conclusion The detection of the seven serum markers can help to preoperative diagnosis and postoperative monitoring of gastric cancer .

ObjectiveTo investigate the relationship between Dicer expression and clinicopathological characteristics and prognosis by detecting the expression of Dicer in hilar cholangiocarcinoma tissues and cells.MethodsThe expression of Dicer in tissues was detected using immunohistochemistry.Western blotting and RT-PCR were used to investigate Dicer expression in QBC939 and HIBEpic cells.The relationship between Dicer expression and clinicopathological characteristics was analyzed.A Kaplan-Maier analysis was performed to analyze the disease-free survival (DFS) and overall survival (OS) after radical surgical resection of hilar cholangiocarcinoma.ResultsWhen compared to control,Dicer was significantly down-regulated in hilar cholangiocarcinoma tissues (P＜0.05) and in QBC939 (P＜0.05).The expression of Dicer was higher in well differentiated adenocarcinoma than poorly and moderately differentiated tumours. Univariate analysis showed low expression of Dicer protein was significantly correlated with short disease-free survival and overall survival of patients with hilar cholangiocarcinoma after radical surgical resection (P＜0.01). Multivariate analysis revealed that the expression of Dicer was the most important factor for predicting prognosis after radical surgical resection of hilar cholangiocarcinoma (P＜0.05).ConclusionsDicer could be used as a prognostic marker for hilar cholangiocarcinoma.

Objective To explore the value of clinical application of high intensity focused uitrasound (HIFU)supplementary treatment evaluated and instructed by immediate contrast-enhanced uitrasound for Drimary hepatic carcinoma.Methods Fifty-five cases(68 lesions)of hepatocellular carcinoma(HCC)were randomized into 2 groups,30 cases(38 lesions)in group A and 25 cases(30 lesions)in group B.Patients of group A were examined by contrast-enhanced ultrasound before and after therapy in 10 minutes.The lesions of incomplete deactivation were treated by HIFU in time.The treatment security and the therapeutic effects were observed by the clinical symptom,serum AFP and imaging appearance.The long-term therapeutic effects were judged by follow-up survival rate.Results Nineteen lesions in group A were found incomplete deactivation and run supplementary treatment in time.No serious complication was identified.The AFP descending rate was 86.7%(26/30)in group A,64.0%(16/25)in group B,respectively(P＜0.05),and the lesions complete necrosis rate was 97.3%(37/38),60.0%(1 8/30),respectively(P＜0.05).Half year survival rate was 100%in group A,90.0%ih grouD B(P＜0.05),and 1 year survival rate was 76.0%,68.0%,respectively(P＜0.05).Conclusions HIFU supplementary treatment evaluated and instructed by immediate contrast-enhanced ultrasound for primary hepatic carcinoma can help to destroy the lesions completely,alleviate the symptom,reduce recurrence,improve life quality,lengthen the lifcrime,and has the better clinical practice value.

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans.METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured.RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured.CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.
Asian Continental Ancestry Group ; Head ; Humans ; Knee ; Magnetic Resonance Imaging ; Nerve Compression Syndromes ; Peroneal Nerve ; Peroneal Neuropathies ; Posture ; Retrospective Studies

Objective: To investigate the clinical therapy for Gustilo type Ⅲ B、ⅢC open fractures with skin and soft tissue defects on the upper extremities. Methods: From July 2014 to July 2016, 19 patients with Gustilo type Ⅲ open fractures (type ⅢB 12 cases , type ⅢC 7 cases) and soft-tissue defects in upper extremity were admitted, including 14 males and 5 females , aged 22 to 59 years (average 42 ). All the cases were treated by staged treatment. In the first stage, early debridement, nerves, vessels and tendons repairment, fixation of the fractures, VSD for the wound were performed. One patient underwent amputation 5 days after first operation. All the other 18 patients received flap transplantion, including 10 anterolateral thigh perforator flaps, 3 latissimus dorsal muscular flaps and 5 free lateral arm flaps. Results: 8 patients were followed up for an average duration of 14.5 months(ranged from 7 to 23 months). Partial necrosis happened at the distal end of one anterolateral thigh perforator flap and healed with skin-grafting.1 flap encountered vascular complication which survived with 5cm-in-width skin necrosis at the distal end of the flap after successful surgical exploration. 1 case had superficial infection at wound. The wounds at donor sites were primarily healed except for 1 case with skin graft necrosis and superficial infection. All the other flaps survived completely. The patients received 2-6 operations each. The average hospital stay was 34 days (12-71 days). All Skin flap texture was soft and had varying degrees of pigmentation. The flap sensory recovery was S2 in 4 cases, S3 in 9 cases, S4 in 5 cases. 1 case had obvious scar hyperplasia. Conclusions Staged surgical treatment in Gustilo type Ⅲ open fractures with soft-tissue defects in upper extremity provide a high survival rate of flaps and satisfactory results. The treatment is well tolerate by patients.

T-cell acute lymphoblastic leukemia (T-ALL) is derived from the malignant transformation and clonal proliferation of precursor T cells. T-ALL is usually associated with the genetic mutations and/or chromosomal translocation, thus causing the change of survival, proliferation and progenitor cell differentiation of T cells in T-cell development. Studies have shown that Wnt signaling pathway plays a key role in the regulation of hematopoietic stem cell and normal T-cell development, and it is also abnormally altered in T-ALL. This article reviews the research progress of the mechanism of Wnt signaling pathway in T-ALL development.

Objective: : We aimed to analyze the effectiveness of external neurolysis on the common peroneal nerve (CPN) in patients with posture-induced compressive peroneal neuropathy (PICPNe). Further, we aimed to examine the utility of magnetic resonance imaging (MRI) in assessing the severity of denervation status and predicting the postoperative prognosis. Methods: : We included 13 patients (eight males and five females) with foot drop who underwent CPN decompression between 2018 and 2020. We designed a grading system for assessing the postoperative functional outcome. Additionally, we performed MRI to evaluate the denervation status of the affected musculature and its effect on postoperative recovery. Results: : The median time to surgery was 3 months. The median preoperative ankle dorsiflexion and eversion grades were both 3, while the average functional grade was 1. Posterior crural intermuscular septum was the most common cause of nerve compression, followed by deep tendinous fascia and anterior crural intermuscular septum. There was a significant postoperative improvement in the median postoperative ankle dorsiflexion and eversion grades and average postoperative functional (4, 5, and 2.38, respectively). Preoperative ankle eversion was significantly correlated with denervation status. Additionally, the devernation status on MRI was positively correlated with the outcome favorability. However, denervation atrophy led to a less favorable outcome. Conclusion : Among patients with intractable PICPNe despite conservative management, surgical intervention could clinically improve motor function and functional ability. Additionally, MRI examination of the affected muscle could help diagnose CPNe and assess the postoperative prognosis.

Objective:To introduce the clinical experience and treatment effect of congenital radial longitudinal deficiency in children with one-stage bilobed flap combined with centralization by circular external fixation.Methods:Analysis and statistics from 14 children with radial longitudinal deficiency were summarized in our hospital from January 2006 to December 2018, 8 males and 6 females; aged 3 to 17 years, average 9.7 years. 3 patients on the left side, 10 patients on the right side, 1 case bilateral.1 case was type Ⅱ, 7 cases were type Ⅲ, 6 cases were type Ⅳ.2 cases were with scoliosis. The radial angulation of 30°- 90°(average 67.3°) before operation. In the first phase, bilobed flaps were used to completely release soft tissue and restore dynamic balance. After the centralization, it was fixed with a circular external fixation. Three cases underwent ulnar osteotomy and forearm extension at the same time. Follow-up indicators: Observe the flap survival in the short term, and follow up on the radial deviation of the wrist and the degree of wrist mobility for a long time.Results:In one patient, the distal part of the dorsal wrist flap was necrotic, the necrotic part was removed and directly sutured 12 days later, and the rest all survived. During a follow-up period of 2 to 8 years (average 3.6 years), the average radial angulation was 9.3° (2°to 17°), the average flexion of the wrist was 46.7°(25°to 70°), and the average extension was 14.7° (5°to 20°). One case which forearm extension had a fractured nonunion and bone graft with internal fixation was performed in 9th after surgery, and ulna healed in 3 months after bone grafting. The forearm radial deflection was significantly improved in all patients, and functional recovery was satisfactory.Conclusions:Treatment of radial longitudinal deficiency in children in one-stage bilobed flap combined with centralization by circular external fixation is an effective clinical treatment method. It can reduce the number of operations, obtain satisfactory appearance and receive good functional recovery.

Objective:To introduce the clinical experience and treatment effect of congenital radial longitudinal deficiency in children with one-stage bilobed flap combined with centralization by circular external fixation.Methods:Analysis and statistics from 14 children with radial longitudinal deficiency were summarized in our hospital from January 2006 to December 2018, 8 males and 6 females; aged 3 to 17 years, average 9.7 years. 3 patients on the left side, 10 patients on the right side, 1 case bilateral.1 case was type Ⅱ, 7 cases were type Ⅲ, 6 cases were type Ⅳ.2 cases were with scoliosis. The radial angulation of 30°- 90°(average 67.3°) before operation. In the first phase, bilobed flaps were used to completely release soft tissue and restore dynamic balance. After the centralization, it was fixed with a circular external fixation. Three cases underwent ulnar osteotomy and forearm extension at the same time. Follow-up indicators: Observe the flap survival in the short term, and follow up on the radial deviation of the wrist and the degree of wrist mobility for a long time.Results:In one patient, the distal part of the dorsal wrist flap was necrotic, the necrotic part was removed and directly sutured 12 days later, and the rest all survived. During a follow-up period of 2 to 8 years (average 3.6 years), the average radial angulation was 9.3° (2°to 17°), the average flexion of the wrist was 46.7°(25°to 70°), and the average extension was 14.7° (5°to 20°). One case which forearm extension had a fractured nonunion and bone graft with internal fixation was performed in 9th after surgery, and ulna healed in 3 months after bone grafting. The forearm radial deflection was significantly improved in all patients, and functional recovery was satisfactory.Conclusions:Treatment of radial longitudinal deficiency in children in one-stage bilobed flap combined with centralization by circular external fixation is an effective clinical treatment method. It can reduce the number of operations, obtain satisfactory appearance and receive good functional recovery.