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 evaluate our noval rod-screw construct in anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.Methods From February 2007 through May 2010,we treated 28 patients with Denis type B burst fracture.They were aged from 18 to 52 years (average,37.4 years).The fractures were located at T1 1 in 3 cases,at T12 in 10,L1 in 12,and L2 in 3.Of them,7 were complicated with unilateral pedicle fracture and 3 with bilateral pedicle fractures.According to the American Spinal Injury Association (ASIA) scale,the neurological deficits were rated as grade B in 11 cases,as grade C in 9,and grade B in 8.All the patients received anterior single-segmental decompression,titanium mesh and autogenous bone graft,and fixation with our noval rod-screw construct.The therapeutic efficacy was evaluated in terms of visual analogue scale (VAS),cobb angle,and spinal canal encroachment.Results The mean follow-up time was 26 months (range,from 17 to 33 months).The average length of surgery was 144 minutes(range,from 90 to 176 min);the mean blood loss was 580 mL (range,from 300 to 1 100 mL).The mean VAS score,cobb angle and spinal canal encroachment were improved from 8.2 ± 1.5,17.4° ± 4.3° and 53％ ± 16％ preoperatively to 2.7 ± 2.4,9.4° ± 5.8° and 4％ ±2％ at the final follow-up,respectively(P ＜ 0.05).None of the patients exhibited neurological deterioration.Conclusion Our noval rod-screw construct is a safe and effective device that can be used in the anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.

A 52-year-old female presented with unexplained thrombocytopenia for 29 years and a prunosus plaque on the right cheek for 9 years.She had ever been treated with glucocorticoids,which resulted in a slight improvement of the condition,but the platelet count remained below the normal range.During glucocorticoid tapering,she had administrated traditional Chinese medicines for a long peroid.Recently,the plaque on the cheek became swollen and painful with a progressive decrease in platelet count.Routine blood test showed that the count of white blood cells and platelets was 3.0 × 109/L and 2 × 109/L respectively,and the concentration of hemoglobin was 85 g/L.Computed tomography (CT) scan revealed multiple liver hemangiomas,one of which in the left liver lobe measured 14 cm × 5.7 cm in size.After medical treatment,the giant hemangioma in the left lobe was resected.Thereafter,the platelet count increased to 120 × 109/L with the subsidence of swelling of the right cheek.Postoperative pathological examination confirmed a diagnosis of giant cavernous hemangioma of the liver with extensive intravascular thrombosis and thrombus organization.Based on these findings,the case was diagnosed as adult Kasabach-Merritt syndrome.

Objective:To investigate the current situation of damage compensation for subjects in drugs clinical trials.Methods: Retrospective analyzes was conducted on 70 drug clinical trail from January 2008 to December 2014 in our hospital , including protocols、informed consent and insurance .Results: It was written in most proto-cols that sponsor undertook damage compensation due to experimental drugs , however , lack of detailed rules .Dam-age compensation for subjects was missed in some informed consents .17 drugs clinical trials provided insurance , the rate of jointing insurance 24 .3%.In international trail , the rate of jointing insurance ( 100%) was higher than that in domestic trail (9.1%).As to domestic trail, the rate of jointing insurance increased gradually .There was no difference between insurance of different periods .In 17 insurance , 13 were clinical trial liability insurance , oth-ers were product and general liability insurance;5 provided insurance instruction , only insurance certificate or poli-cy in others;2 insurance applied foreign language .Conclusion:Through project access system , strengthening the ethical approval , strengthening quality management to prevent the damage occurred , participants damage happened after fully protect the health and rights and interests of the subjects , and actively promote clinical trial insurance to perfect our subjects′damage compensation mechanism , the protection of the rights of the subjects , and reduce the risk of clinical trials .

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease characterized by a triad of progressive motor dysfunction, cognitive decline and psychiatric disturbances. The hallmark of HD is the distinctive choreiform movement disorder that typically has a subtle, insidious onset in the fourth to fifth decade of life and gradually worsens over 10 to 20 years until death. Notably, two-thirds of HD patients present with chorea and one third with mental changes. The prevalence of psychiatric symptoms is significantly higher than in the general population, and is estimated to be around 66–73%. Here, we report a unique case of subsequent onset of HD in a patient previously treated for schizophrenia and complicated by the extrapyramidal side effects to antipsychotics.
Antipsychotic Agents ; Chorea ; Humans ; Huntington Disease* ; Neurodegenerative Diseases ; Prevalence ; Psychotic Disorders* ; Schizophrenia

Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion.Methods Form June 2008 to December 2010,12 patients with hypertrophic nonunion were treated with Ilizarov technique,including 10 males and 2 females with an average age of 46.5 years.The pathology sites of nonunion were kept as closed as possible without any bone graft during operation.As to patients who had ever been treated with plate or intramedullary nail,the hardware should be removed by minimal invasive approach.These procedures aimed to keep the vascularity of nonunion site intact.Ilizarov apparatus were preoperatively constructed.Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins.The two-circle stabilizing one segment was nominated with transosseous modules.Distal module and proximal one was connected with a pair of axial hinges.The pathology sites were gradually distracted from the seventh day postoperatively,0.25 mm/d.Accompanying with deformity correction,limb length discrepancy (LLD) also were restored simultaneously.Then,all the screws and nuts in the apparatus should be tightened,which was favourable to the callus consolidation.Results All 12 cases of nonunion healed without any bone graft.The fixator wearing time lasted 6-12 months,with an average of 8 months.Correction of deformity and LLD were achieved.The average lengthening was 3.0 cm (range,2.0-5.5 cm),the average correction angle was 23° (range,10°-30°).After 6-18 months follow-up,all the patients restored satisfactory function.Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique.The key of successful callus distraction is strictly identifying the indications.

Objective To measure the expressions of zinc finger protein A20 and nuclear factor (NF)-κB in cutaneous squamous cell carcinoma (CSCC) tissue and their correlation with human papillomavirus (HPV) infection.Methods Tissue specimens were obtained from the lesions of 43 patients with CSCC and normal skin of 21 healthy human controls.Gene chips were used to detect the DNA of 21 HPV subtypes in these specimens.The expression levels of zinc finger protein A20 and NF-κB were determined by immunohistochemistry.The correlation between clinicopathological features of CSCC and HPV infection was estimated by Spearman rank correlation analysis.Results No significant difference was found in the expression level of either zinc finger protein A20 or NF-κB among patients of different age groups,gender,and with CSCC of different primary sites or histological grade (all P ＞ 0.05).However,there was a significant difference in the expression levels of zinc finger protein A20 and NF-κB between 39 patients with histological grade Ⅰ or Ⅱ and 4 patients with grade Ⅲ (25.85 ± 3.84 vs.48.34± 7.69 for zinc finger protein A20,46.64 ± 8.93 vs.57.34 ± 10.02 for NF-κB,both P ＜ 0.05),and between 3 patients with nodular metastasis and 40 patients without (35.34 ± 6.02 vs.26.51 ± 4.09 for zinc finger protein A20,57.53 ± 13.32 vs.45.45 ± 9.64 for NF-κB,P ＜ 0.05 or 0.01).The expression rate was 2/8,5/13 and 1/3 for zinc finger protein A20 (P ＞ 0.05),3/8,10/13 and 2/3 for NF-κB (P ＞ 0.05),in CSCC tissue specimens infected with low-risk HPV subtypes,high-risk subtypes,concurrent low-and high-risk HPV subtypes respectively.In HPV-infected CSCC tissue,a significantly positive correlation was found between the staining scores for zinc finger protein A20 and for NF-κB p65(r =3.14,P ＜ 0.05).Conclusion The high expressions of NF-κB and zinc finger protein A20 may play an important role in the oncogenesis of CSCC induced by HPV infection.

A fast non-local means image denoising algorithm is presented based on the single motif of existing computed tomography images in medical archiving systems. The algorithm is carried out in two steps of prepossessing and actual possessing. The sample neighborhood database is created via the data structure of locality sensitive hashing in the prepossessing stage. The CT image noise is removed by non-local means algorithm based on the sample neighborhoods accessed fast by locality sensitive hashing. The experimental results showed that the proposed algorithm could greatly reduce the execution time, as compared to NLM, and effectively preserved the image edges and details.
Algorithms ; Tomography, X-Ray Computed ; methods

OBJECTIVETo establish the method for quantitative determination of sibricose A5 and sibricose A6 in Polygalae Radix by HPLC.

METHODThe ultrasonic extracting method was applied in sample pre-treatment. The HPLC procedure was performed on the chromatographic column of Agela Promosil C18 (4.6 mm x 250 mm, 5 microm), the mobile phase was acetonitrile-0.1% phosphoric acid water solution (10:90). The detection wavelength was 330 nm and flow velocity was 1 mL x min(-1). The column temperature was 30 degrees C.

RESULTThe method has good linearity in the ranges of 0.0087-0.0694 g x L(-1) (r = 0.9993) for sibricose A5, 0.0090-0.0723 g x L(-1) (r=0.9991) for sibricose A6. The average recoveries of sibricose A5 and sibricose A6 were 101.7%, 97.87%, with the RSD of 1.7%, 1.6%, respectively.

CONCLUSIONThe method was simple, quick accurate and reliable. It is appropriate for the quantitative determination of sibricose A5 and sibricose A6 in Polygalae Radix.

Objective:To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning (bone 3-phase image).Methods:A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics, The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females, aged from 19 to 64 years (average, 39.7 years).The nonunions occurred mainly at the tibia (113 cases) and the femur (72 cases).The preoperative results of their white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards, the sensitivity, specificity, area under curve (AUC) of receiver operator characteristic (ROC) and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results:Compared with the pathological observations, the radioisotope scanning showed a sensitivity of 80.7%, a specificity of 73.3%, an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test, that of radioisotope scanning and CRP produced the largest AUC of 0.683, a sensitivity of 98.0%, a specificity of 70.3%, and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests, that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895, a sensitivity of 94.3%, a specificity of 67.3%, and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%, a specificity of 79.7%, an AUC of 0.925 and a Youden index of 0.762.Conclusion:Combination of haematological testing and radioisotope scanning can be a reliable preoperative diagnosis of low-grade infection nonunion.