Objective To evaluate the influence of extraocular counterpulsation on ocular fundus blood vessels using high-frequency color Doppler ultrasonography. Methods Twenty-one patients with ischemic optic neuropathy were treated with extraocular counterpulsation. During treatment, the Doppler spectra were detected with high-frequency color Doppler ultrasonography. The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance retinal index (RI) of central retinal artery and posterior ciliary artery were measured instantly before treatment and 1 min,5 min and 15 min after treatment. Results The instant PSV and EDV of central retinal artery and posterior ciliary artery were significantly increased (P＜0.05) after treatment, then decreased gradually. Fifteen min after treatment ,they returned to the level before treatment. Conclusions We can observe the changes of ocular fundus blood vessels noninvasively on high-frequency color Doppler ultrasonography. The method may be regarded as one of the basis for evaluating the effect of extraocular counterpulsation.

Objective To detect the initial results of total hip arthroplasty (THA) after failure of internal fixation of femoral neck fractures and investigate the key points in surgical procedures and prosthesis selection.Methods A retrospective analysis was performed on 36 cases who had THA for femoral neck fractures due to the initially failed internal fixation between January 2007 and December 2012.There were 21 males and 15 females,with age ranging from 46 to 72 years (mean,58.6 years).After internal fixation,13 cases were complicated by femoral head necrosis,eight fracture nonunion,and 15 fracture nonunion combined with femoral head necrosis.All the 36 cases had cementless THA,including proximally fixed stem in 25 cases and distally fixed stem in 11 cases.Harris hip score was assessed before operation and at follow-up.Results All the cases received a follow-up of 26-52 months (mean,32.5 months).Mean Harris hip score improved from 26.3 to 83.6,including excellent results in 12 cases,good in 22,and fair in two,with excellence-good rate of 94％.Conclusion With respect to the failed internal fixation of femoral neck fractures,THA is an effective remedial method to improve hip function and quality of life of the patients.

Patient engagement is considered as one pillar of new stage of health care reform and new vitality of health care quality improvement.In recent years,the rapid development of E-Health technology provides richer opportunities for patients to actively participate in health care.The article concludes the basic connotation of patient electronic engagement and proposes the framework on the basis of foreign actions as well as literature reviews,expounds the type,media and methods of patient electronic engagement as well.From the views of projects support,patient education and information rights,feasible policy measures are proposed for patient electronic engagement advancement under E-Health environment.

[Objective]To explore the surgical management and its results of intercondylar fracture of humerus through approach of osteotomy of olecranon(AOO) with dual anatomical steel plate DASP.[Method]From July 2002 to March 2006,26 patients of intercondylar fracture of humerus were treated surgically through AOO,and the fracture was reduced and fixed with DASP.The patients were 19 males and 7 females with a mean age of 35 years (range 15～46 years),According to Riseborough and Radin classification,type Ⅱ fracture was found in 6 cases,type Ⅲ in 18,type Ⅳ in 2.Early rehabilitation exercises was taken.[Result]Twenty-five fractures were satisfactory reduced but one not too good,none had incision infection,injuries of the ulnar nerve.Twenty-two patients were followed up from 6 months to 19 months(average 13.5 months),of these 22 patients,all the osteotomies healed in 17 weeks averagely(range 14～24 weeks) and the injuried ulnar nerve recovered completely.The function of the elbow(according to Cassbaum scale) showed excellent in 5 cases,good in 13,fair in 3 and poor in 1.the good-excellent rate was 81.8%.[Conclusion]The technique of DASP for the treatment intercondylar fracture of humerus through transolecranon approach offers many advantages,such as sufficient exposure easy to get anatomical reduction,stable fixation and earlier exercise.

Wuhan Pu Ai Hospital implemented the pharmaceutical direct supply mode since October 2006 as an experiment.The pilot proved the mode as successful in reducing drug costs proportion,promoting rational use of drugs,and raising business volume of the hospital.Authors also recommend to further efforts in drug supply price supervision mechanism,government subsidy mechanism,direct supply catalogue and drug supply mode among others.Other recommendations include innovation in directly supply mode,hospital internal reform,packaged performance appraisal and incentive mechanism for medical workers,and building a ceiling mechanism for total medical expense control.

Objective To establish the system of statistic index of health examination information. Methods The items of health examination were screened, the valuable indexes for guiding the health condition were selected and standardized, and then the system of statistic index of health examination information was constructed. Results The 42 items for male clients and 74 items for female clients were selected as the statistic index of health examination information system. Standardized the statistic index with international classification of diseases system, including the criterion of name, diagnosis and data collection.The standard statistical tables were constituted. Conclusions Health examination information system can be statistically added up by standard index system.

Objective To obtain recombinant human Smith D1 (Sm D1) antigen and establish detecting assay.Methods Human Smith D1 antigen was synthesized by PCR using human Leukemic cDNA. The prokaryotic expression vector pGEX-ST-Sm D1 was constructed and transformed into E.coli.BL21 cell.Protein expressed under the induction of IPTG.We established DIGFA for detecting anti-Sm D1 antibodies with purified Sm D1 antigens.Results Sequence and restriction analysis revealed Sm D1 gene was cloned in frame into pGEX-5T,SDS-PAGE profile showed a clear protein band with a relative molecular weight of 39 000 and western blotting indicated that the expressed product specifically reacted to polyclonal anti-human Sm D1 genes.There was no significant difference between DIGFA and IB.The agreement between DIGFA and IB was 91.7% as calculated by Kappa statistical method.The sensitivity and specificity of DIGFA were 100% and 83.3% repectively.Conclusions Human Sm D1 gene is successfully cloned、 expressed and purification.The DIGFA,using purified Sm D1 antigens,is as good as IB,rather simpler, more rapid and reliable assay.

To clone, express and primarily use human autoantigen Sm D1 in methylotrophic yeast Pichia Pastoris. The gene Sm D1 was cloned by PCR.The PCR product was inserted into the vector pPIC9k. The recombinant plasmid pPIC9k- Sm D1 was transformed into yeast SMD1168 by electroporation. The positive clones were screened in MD plates. The high copy number transformants were rapidly selected by using G418 and were induced by methanol. Supernatants after induction were analyzed by SDS-PAGE and im-munodot. The PCR product was showed about 360 bp in size which was in accordance with predicted. The pPIC9k-Sm D1 showed the same seqencing result with GenBank’s report and restriction enzyme analysis confirmed our prediction. The pPIC9k-Sm D1 positive clone produced an about 16 kD protein which had natural immunogenicity of human autoantigen Sm D1 by SDS-PAGE and immunodot. The sensitivity and specificity of immunodot were 96% and 100%, respectively. The agreement between immunodot and im-munoblot was 98%. Successfully cloning and high-level expression of human autoantigen Sm D1 in methy-lotrophic yeast Pichia pastoris laid a foundation for further research work.

Objective To estimate reliability of magnetic resonance elastography (MRE) in measuring liver stiffness of volunteers and patients with chronic liver disease and to assess inter-rater consistency.Methods MRE was performed on a 3.0 T scanner in all subjects,including 24 volunteers (control group) and 64 patients with liver disease (chronic liver disease group).Liver stiffness was measured blindly by two raters.The pathological fibrosis score was applied as a standard reference for liver fibrosis in 22 patients.The intraclass correlation coefficient (ICC) was used to evaluate inter-rater reliability.The differences of liver stiffness between two groups were evaluated using non-parametric MannWhitney U test.Spearman analysis was used to analyze the correlation between fibrosis stages and liver stiffness.Results The intraclass correlation coefficient of liver stiffness was perfect (ICC =0.99,P ＜ 0.01)between two raters.There was significant difference of mean stiffness between control group and patient group (U =90.5,P ＜0.01) with(2.35 ±0.34) kPa and(4.17 ± 0.47) kPa,respectively.The correlation between fibrosis stage (3,3,5,5 and 6 patients in fibrosis stage S0,S1,S2,S3 and S4) and stiffness (2.13,3.25,3.82,5.45 and 7.35 kPa) was very strong (r =0.96,P ＜0.01).Conclusion MRE is a reliable and promising tool to measure liver stiffness and to assess liver fibrosis.

Objective To evaluate the performance of parallel test in detecting malaria infection for returned person from malaria endemic area.Methods The blood samples of 484 returnees from malaria endemic area were analyzed and detected by thick blood smear,rapid diagnostic test (RDT) and nest PCR in four companies involving the African labor dispatching.Results The sensitivi ty of thick blood smear and RDT was 0.628 and 0.744 respectively,which of the parallel test was 0.930.On the other hand,the area under the curve (AUC) of parallel test was 0.930 (95％CI:0.895-0.986),which was higher than thick blood smear[0.814 (95％CI:0.724-0.904)]and RDT[0.847 (95％CI:0.769-0.926)].Conclusion Thick blood smear and RDT,which consist of parallel test,could improve the detection sensitivity and accuracy for returnees from malaria epidemical area effectively.This approach is worthy of popularization and application.