The Cooperative medical system,like the insurance,has the adverse selection,this article points out the concept of adverse selection,and raises some efficient way to control the adverse selection.

AIM:To report a case of a chronic glaucoma patient whose reduced eyesight is related to ocular ischemia.METHODS:A case report.RESULTS:A 71 year-old man presented with a decreased left eye vision for over 3 years.During the last two months,he had deteriorated blurred vision when he woke up in the morning.The loss of his lower-half peripheral vision was especially serious.The patient suffered from an episode of transient amaurosis fugax three months ago.According to transcranial Doppler ultrasound scan and cerebral computerized tomographic angiography,the patient was found that he had severe stenosis of the bilateral intracranial internal carotid artery and decreased blood flow velocity within the left ophthalmic artery.His symptoms alleviated after an internal carotid artery endarterectomy.CONCLUSION:When vision loss glaucoma cases are presented,more attention should be paid to the presence of ischemia within the ophthalmic artery except glaucoma.

As the development of rehabilitation becomes faster and faster, a lack of rehabilitation professionals appears more and more. This article gave an overview on the condition of the rehabilitation development and rehabilitation professionals, outlined the problems in re-habilitation personnel training, and referred the strategy of rehabilitation personnel training in future.

AIM: To assess the prophylactic effect of lumbrokinase plus aspirin on recurrence of ischemic stroke in the patients recovering from cerebral infarction. METHODS: 87 patients of cerebral infarction were assigned to two groups:control and treatment group,treated respectively with aspirin in control group and lumbrokinase plus aspirin in the treatment group.The recurrence rate and clinical efficacy were analysed. RESULTS: There were remarkable differences in recurrence rate and clinical efficacy between the two groups(P

Objective To explore the effect of video-based teaching of Lamaze method on delivery among primiparae.Methods One hundred and twenty pregnant women were randomly assigned to the intervention group and the control group with 60 in each.The intervention group received additional train-ing by using the video-based teaching of Lamaze method besides routine antepartum education,while the control group received only routine antepartum education.The cesarean section rate,labor course and neonatal asphyxia were compared between the two groups.Results The rate of natural delivery in the in-tervention group was significantly lower,and the rate of cesarean section caused by social factors decreased,which were all better than those in the control group.Neonatal asphyxia showed no difference between the two groups. Conclusions The video-based teaching of Lamaze method can promote natural delivery,shorten Labor course and worthy of wide application in pregnancy school.

OBJECTIVE:To evaluate the economics of alendronate sodium preventing osteoporotic fractures in postmenopausal women,and to provide reference for osteoporotic and osteopenia patients to select economical and effective therapy plan. METH-ODS:Using Markov economic model,TreeAge Pro 2011 software was used for cost-utility analysis using RCTs literature data of basic medication(calcium and vitamin D3)and basic medication combined with alendronate sodium as baseline data. Using quality adjusted life years(QALYs)and incremental cost utility ratio(ICUR)as economics evaluation indexes,the stability of established model was investigate by single factor sensitivity analysis. RESULTS:QALYs of the basic treatment group was 0.704 years,and QALYs of drug combination group was only 0.708 years. However,ICUR of two groups reached 714252.44. For the late period of hip fracture and other fractures,drug combination group was in high cost and low benefit,obviously had no economic advan-tage. For vertebral fractures,the cumulative probability of fracture in drug combination group was significantly lower than basic treatment group,and ICUR of the two groups was only 13902.17,with economic advantage. For hip fracture,the cumulative prob-ability of fracture in basic treatment group was the same as drug combination group,and ICUR was 19109.00,with economic ad-vantage. For wrist fractures,curative effect and economy needed further study. CONCLUSIONS:For the low-risk population with osteoporotic fractures,calcium and vitamin D3 are more economical in preventing osteoporosis fractures. For the high-risk popula-tion with vertebral and hip fractures,alendronate sodium combined with basic treatment is effective and economical.

Animals ; Drugs, Chinese Herbal ; pharmacology ; Female ; Gardenia ; chemistry ; Memory ; drug effects ; Mice ; Mice, Inbred ICR ; Motor Activity ; drug effects ; Plant Oils ; pharmacology ; Seeds ; chemistry ; Ziziphus ; chemistry

OBJECTIVE: To systematically analyze the local recurrence of CO₂ laser surgery for early glottic cancer and without anterior commissure involvement. METHOD: By searching CBM, CNKI, wanfang, weipu, PubMed, Embase, OVID, and Springer database, the retrospective clinical studies were included according to inclusion and exclusion criteria. Meta analysis of extracted data was carried out by RevMan 5.0 software. RESULT: By analyzing the 1900 cases from 14 retrospective studies using Meta analysis, it was indicated that local recurrence rate of AC+ group was significantly higher than that of AC- group [OR = 3.00, 95% CI (2.31, 3.89), P < 0.01] for early glottic cancer. Local recurrence rates between AC+ group and AC- group for glottic cancer of Tis and T₁b stage showed no statistically significant difference, while those for glottic cancer of T₁a and T₂ stage showed statistically significant difference. CONCUSION Local recurrence rate of CO₂laser surgery for early glottic cancer was related with anterior commissure involvement.
Carbon Dioxide ; Databases, Factual ; Glottis ; pathology ; Humans ; Laryngeal Neoplasms ; surgery ; Laser Therapy ; Neoplasm Recurrence, Local ; Retrospective Studies

AIM: To investigate the dynamic variety of frequency and function of FoxP3~+ regulatory T cells in patients with acute hepatitis B (AHB). METHODS: Peripheral blood mononuclear cells (PBMCs) from 15 AHB patients at acute phase (week 1 of illness), convalescent phase (primary occurrence of both ALT level normalization and HBsAg negative conversion), resolved phase (at least 8 weeks after both ALT normalization and HBsAg seroconversion, and 15 health subjects were analyzed for FoxP3 (Forkhead/winged helix transcription factor) mRNA expression in MACS magnetic beads-purified CD4~+ T cells by real-time RT-PCR assay. The effects of Treg cells on the proliferation of CD4~+CD25~- T cells were examined by a ~3[H]-thymidine incorporation assay. RESULTS: AHB patients presented a significantly higher FoxP3 mRNA expression at convalescent phase than acute phase (t=-6.04, P<0.01) and resolved phase (t=4.45, P<0.01), and healthy controls (t=3.44, P<0.01). We also observed that the suppression efficiency of Treg cells on proliferation of CD4~+CD25~- T cells was lower at acute phase than convalescent phase (t=-5.30, P<0.01) and resolved phase (t=-3.20, P<0.05), but there was no significant difference between healthy controls and any phase of AHB. CONCLUSION: AHB patients presented lower circulating Treg frequency and suppression function at acute phase, and both of them are increased at convalescent phase, and then return to normal level along with disease resolved. This follow-up study furthers our understanding of Treg' s role in immunopathogenesis of hepatitis B.

Objective To measure the longitudinal elastic modulus in patients with acute ischemic stroke by shear wave elasotography(SWE),and to study its feasibility and related factors.Methods There were 1 79 cases with acute ischemic stroke (AIS)including 103 cases with large artery atherosclerosis and 76 cases with lacunar infarction classified according to the TOAST classification.There were 168 age and sex-matched cases as control group.Pulse wave velocity (PWV ) of bilateral carotid was measured by radiofrequency ultrasound.The 20 areas of superficial walls of bilateral carotid artery were analyzed by SWE,and the average values of longitudinal average elastic modulus (MEmean ),the maximum elastic modulus (MEmax )and minimum elastic modulus (MEmin )were calculated.The independent factors of MEmean were analyzed using multiple linear regression analysis.Results ①Compared with control group, PWV in patients with AIS was increased (P <0.05).②The MEmax and MEmean of carotid artery in patients with AIS were more than those in the control group (P <0.05).③Age,systolic blood pressure,PWV and low-density lipoprotein cholesterol(LDL-C)were positively related to MEmean (r =0.221 ,0.1 74,0.776 and 0.1 73,respectively,P <0.05 ),and were independent factors for MEmean .Conclusions SWE can evaluated the arterial stiffness using longitudinal elastic modulus of carotid.Age,systolic blood pressure,PWV and LDL were independent factors for longitudinal elastic modulus.