By equality in the healthcare retorm we mean equal access to healthcare protection.Future reiorm should establish a fair value concept and make great efforts to solve the serious lack of fairness in the current healthcare system.Efficiency in the healthcare refers to not only higher revenue income of medical institutes but also to utmostly meet the citizens" needs for medical service.For the sake of the most cost - effective distribution of the insufficient budgets and medical resources,medical services have to be diversified for an improved efficiency. In the framework of the healthcare reform,relations between equality and efficiency is the unity of opposites,and top priority shall be given to equality while maintain efficiency.

Objective To assess the outcomes of chronic hepatitis B (CHB) infection following immunosuppressant and corticosteroid treatment in patients with rheumatic disuses.Methods The medical records of patients with positive HBsAg and rheumatic diseases from 1 Jan 2004 to 31 Dec 2007 were retros pectively reviewed and analyzed for the types of rheumatic diseases,hepatitis B seroiogies,name and dosage of immunosuppressive agents used,anti-viral therapies and outcomes of CHB infection.Results Twenty one patients were included.There were 14 female and 7 male patients.The mean age of all patients was (45±16)years.All patients were positive for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HbcAb),and had alanine aminotransferase (ALT) less than 60 U/L except one patient with dermatomyositis.Twelve(57%) patients treated with immunosuppressant only.Among them,rheumatoid arthritis (75%) was the most commonly diagnosed rheumatic diseases.These patients were treated with methotrexate (no more than 10 mg per week) or leflunomide ( 10 mg/d),combined with suffasalazine or hydroxychloroquine.Three patients received antivirus drugs because of the elevation of HBV-DNA.During the follow-up period (7 to 47 months with a median of 25 months),four (33%) developed ALT elevation,but none had developed HBV reactivation.Nine (43%) patients were treated with prednisolone and /or immunosuppressants.Among them,5 (56%)patients were diagnosed as systemic lupus erythematosus,others were adult onset of Still's disease and dermatomyositis,and 3 patients had elevation of HBV-DNA copies.These patients were treated with predni-soione (0.8～1.2 mg·kg-1·d-1) only or combined with immunosuppressants (methotrexate or cyclophosphamide),and all patients received antivirus drugs.During the follow-up period (3 to 50 months with a median of 13 months),two developed ALT elevation,but none had developed HBV reactivation.Conclusion In patients with rheumatic disease complicated with chronic HBV infection,methotrexate (no more than 10 mg per week) and leflunomide (10 rag/d) may be safe for patients with negative HBV-DNA.Prednisolone and immunosuppressants (methotrexate or cyclophosphamide) may be used safely with prophylactic antivims drugs.

This study was to identify the clinical features of myositis complicated with primary Sj(o)gren's syndrome (pSS). A total of 202 patients with pSS were investigated. Myositis was diagnosed according to the clinical findings, muscle enzyme levels, electromyographic results, and muscle biopsy, and compared with 15 polymyositis (PM) patients. Myositis was identified in 4 of 202 pSS patients (2.0%). They developed myositis 5 to 20 years after the onset of SS. Two patients showed no myalgia and muscular weakness. Creative kinase (CK) was increased from 480 to 2702 IU/L. Anti-Jo-1 antibody was negative. All patients responded well to prednisone and had a median serum CK decrease by 48.9%. No patients had myositis recurrence. Compared with the PM group, the percentage of myalgia, peak of CK, descending rate of CK, and positive rate of anti-Jo-1 antibody were all significantly different. Myositis with Sj(o)gren's syndrome is not common, show relatively moderate symptoms, and respond well to prednisone.

Objective To analyze the clinical features of Weber-Christian disease (WCD) and to make a review of the literature for early diagnosis and treatment.Methods The clinical features of an atypical WCD patient who had been misdiagnosed as polymyositis were analyzed.Results WCD was characterized by subcutaneous nodules and systemic symptoms.Repeating physical examination and biopsy in time were important if the nodules were not obvious.Conclusion WCD is often misdiagnosed because of the complicated clinical manifestations.Carefully physical examination and timely biopsy are help for early diagnosis.

BACKGROUND:Pain is the main reason for the recovery of knee function after total knee arthroplasty. OBJECTIVE:To explore and analyze the influencing factors of pain after total knee arthroplasty.METHODS:160 patients with knee osteoarthritis underwent total knee arthroplasty. At 12, 24 and 48 hours after total knee arthroplasty, patients were evaluated with visual analogue scale (VAS) and knee function was assessed with KSS score preoperatively and 90 days postoperatively. Factors, including operation time, age, gender, body mass index, anesthesia method, and preoperative score of KSS were analyzed by Pearson correlation and multiple linear regression. These statistics method also was used to analyze the relationship between the postoperative 90 days score of KSS and postoperative VAS score at each time point. RESULTS AND CONCLUSION:(1) Pearson correlation analysis and multiple linear regression analysis showed that operation time, gender, and body mass index had been correlated positively with VAS score at 12, 24 and 48 hours postoperatively. (2) Patient age had been correlated negatively with VAS score at 12, 24 and 48 hours postoperatively. (3) VAS score at 12, 24 and 48 hours postoperatively had been correlated negatively with KSS score at 90 days postoperatively. (4) Gender, operation time, body mass index and age are al the influencing factors of the pain after total knee arthroplasty. Pain after total knee arthroplasty affects the recovery of knee function.

Objective To investigate the pregnancy opportunity and outcome of patients with sysmetic lupus erythematosus (SLE).Methods We carried out a retrospective analysis of the clinical information of patients who suffered from SLE complicated with pregnancy and were hospitalized to People's Hospital of Peking University from December of 1992 to February of 2012.Chi-square test were used for statistical analysis.Results Forty-nine cases of patients with SLE complicated with pregnancy had 52 pregnancies in total.In 27 cases of planned pregnancies,24 cases(89％ )resulted in live births and 5 cases( 18％ ) had flares during pregnancy.Of the 24 live births,3 cases( 12％)were premature deliveries and 4 cases(17％) had low birth weight infants.In 25 cases of unplanned pregnancies,12 cases (48％) resulted in live births and 20 cases (80％) had flares during pregnancy.Of the 12 live births,6 cases(50％ ) were premature deliveries and 6 cases (50％) were low birth weight infants.The patients in the planned pregnancy group tended to have flares during pregnancy more frequently than those in the unplanned group (P＜0.01),the former were more likely to have live births than the latter (P＜0.01) and were less likely to have premature delivery (P＜0.05).Conclusion Patients with SLE should have planned pregnancy and need collaborative supervision of both rheumatology and immunology department and obstetric department to improve live birth rate,decrease premature delivery and the activity of SLE during pregnancy.

Objective Systematic review the effect and side effect of Probucol on contrast-induced acute kidney injury (CIAKI), and to evaluate the characteristics and strength of the protective effect. Methods Electronic search studies from databases published in English and Chinese before March 2014, and hand searches of relevant randomized controlled trials of references. Features, the quality of research and valid data of included studies were extracted, then using RevMan 5.0 software to conduct a Meta-analysis base on Cochrane systematic review methods. Results A total of 11 literatures described eight randomized controlled trials involving 1938 cases of patients evaluated the effect of Probucal on CIAKI. A total of seven studies involving 1,298 patients, compared the incidence of CIAKI, the total incidence rate was 10.9%(141/1298), CIAKI incidence was 5.7%(37/652) in the Probucal group and 16.1%(104/646) in the control group (RR 0.37, 95%CI 0.26~0.53). Lower postoperative creatinine values was observed in Probucol group, compared with the control group on the first day Weighted Mean Difference (WMD-6.76, 95%CI-9.33~-4.20)μmol/L, the second day (WMD-16.90, 95%CI-22.61~-11.19)μmol/L, the third day(WMD-11.05, 95%CI-17.65~-4.45)μmol/L, and lower peak postoperative creatinine than the control group[(WMD- 14.58, 95%CI- 19.00 ~ - 10.16)μmol/L]. Probucol group with lower postoperative urinary KIM-1[(WMD-3.64 , 95%CI-3.72~-3.57) ng/ml], and the serum CysC was also low. Conclusions Preoperative or postoperative oral Probucol has a protective effect on CIAKI, can reduce the rise of postoperative renal injury indicators of coronary angiography or coronary intervention, such as serum creatinine and CysC, and CIAKI can be reduced by about 60%, no significant side effects observed.

Objective To reduce the misdiagnosis rate of spondyloarthritis (SPA) by reviewing the rare cases misdiagnosed as SpA.Methods Cases misdiaguosed as SpA were collected from our hospital from January 2004 to April 2014.Reported cases among Chinese journals from January 1998 to October,2014 were also collected.According to the Assessment of Spondylo Arthritis international Society (ASAS) axial SpA criteria (2009) and peripheral SpA criteria (2011),the diagnostic accordance rate was studied.Results There were 112 cases within the objective scope,out of which,27 cases (24.1％) were infectious diseases,47 cases (42.0％) were heredity and metabolic diseases,25 cases (22.3％) were hematonosis or tumor,13 cases (11.6％) were osteoarthropathies.Also,only 10 cases (8.9％) out of 112 had the symptoms of inflammatory back pain (IBP),23 cases (20.5％) exhibited fever.Human leukocyte antigen (HLA)-B27 was positive in 20.4％ (21/103) of the cases.Eleven cases out of those 29 cases performed X-ray in the sacroiliac joint and showed blurred articular surface,narrowing of joint space or bone destruction.Four cases were diagnosed based on magnetic resonance imaging (MRI).18/91 (19.8％) cases met the criteria of ASAS axial SpA criteria (2009),2/6(33.3％) cases were in accordance to the ASAS peripheral SpA criteria (2011).Conclusion For patients with atypical back pain,if accompanied with fever,other diseases such as tumor,infection,heredity and metabolic diseases should be considered.The diagnosis should not only based on HLA-B27 for SpA diagnosis.Due to the ambiguity of X-ray in sacroiliac joint,CT or MRI may be recommended to assist the diagnosis.Careful clinical history taken is also with great significance.

Objective To research etomidate or propofol in the whole intubation during the induction of elderly coronary heart disease autonomic nervous system function. Methods Ninety patients undergoing abdominal surgery patients with coronary heart disease were randomly divided into etomidate group (E group, 45 cases) and propofol group (P group, 45 cases). In pre-anesthesia, after the induction of anesthesia and after intubatiou with power spectral analysis of heart rate variability (HRPSA) observed in patients with heart rate variability (HRV) changes. Results After the induction of anesthesia, the low frequency(LF)[(316±301) ms2/Hz] end total power(TP)[(756±535) ms2/Hz] decreased significantly in E group(P<0.05) and LF, high frequency (HF), LF/HF ratio(LF/HF)and TP decreased significantly in P group [ (187±168) ms2/Hz, (89±48)ms2/Hz, 2.3±1.6 and (616±462) ms2/Hz] (P<0.05). The duction degree of LF, HF, TP and LF/HF in E group was more significant than that in P group (P<0.05). After intubation, LF, HF, LF/HF and TP increased significantly in both groups and no significant difference of HRV was observed between the two groups (P>0.05). Conclusions Propofol decreases the activity of autonomic nervous system, wherea etomidate produces minimal changes under anesthesia induction in elderly coronary heart disease patients.There is no remarkable difference in cardiovasological changes induced by etomidate and propofol during tracheal intubation.

Objective To investigate the anesthetic management of perventricular closure of ventricular septal defects (VSD) under transesophageal echocardiography. Methods A retrospective review of the clinical data of 52 children who underwent perventricular closure of VSD under transesophageal echocardiography were analyzed. All the children were performed tracheal intubation under general anesthesia, and the electrocardiogram, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, end tidal carbon dioxide partial pressure, temperature and urine output were continuously monitored throughout the procedure. The transesophageal echocardiography was necessary for guiding transcatheter or per-ventricular device placement. Results Perventricular closure of VSD was successfully completed in 51 children under transesophageal echocardiography, the operation time was (76.7 ± 36.4) min, the anesthesia time was (89.5 ± 27.1) min; 1 child was converted to open surgical repair. Conclusions The intraoperative transesophageal echocardiography technology is the key to the success of the surgery. At the same time of analgesia and sedation, the anesthesia doctor needs to pay attention to the changes of hemodynamics in children.