The paper reviewed the history of drug price addition system and its impact on hospital management. Based on such facts,authors stated that the significance of abolishing drug price addition helped hospital management not to run their hospitals as a business, helped medical practitioners to make their clinical decisions based on medical needs, and to make the health care service deserve the professionals′value and contributions. Following the abolishment, the hospitals need to reform their internal operating mechanisms before they can achieve better performance.

Objective To evaluate the therapeutic effect of different types of biliary tract reconstruction on the post- resection of congenital choledochal cyst (CCC). Methods 106 cases of CCC undergoing resection of CCC with Roux-en-Y hepaticojejunostomy as biliary tract reconstruction were followed up and analysed. Results In this series, three kinds of biliary tract reconstruction were performed, including single Roux-en-Y hepaticojejunostomy in 48 cases, intussusceptive valve and rectangular valve lying on the jejunal segmental of Roux-en-Y hepaticojejunostomy in 37 and 21 cases, respectively. 61 cases were followed up for 4.82 years in average. None of them occurred anastomasis stricture. There were 4 cases with ascending cholangitis after primary operation: of them 3 after single Roux-en-Y hepaticojejunostomy; symptoms of 2 out of the 3 cases disappeared after reoperation to set up an intussusceptive valve plasty on the jejunal segmental of Roux-en-Y hepaticojejunostomy; another one was in rectangular valve group. Occasional abdominal pain tooke place in 8 patients, of them, 5 in single Roux-en-Y hepaticojejunostomy group, 2 and 1 in intussusceptive valve and rectangular valve groups, respectively. No patients suffered from ascending cholangitis in the intussusceptive valve plasty group. Conclusions The postoperative ascending cholangitis and anastomasis stricture can be prevented effectively, if a prophylactic intussusceptive valve on the jejunal segmental of Roux-en-Y hepaticojejunostomy is carried out after resection of CCC for biliary tract reconstruction. This procedure corresponds to the biliary tract physiology.

Objective:To investigate the clinical effects of stellate ganglion block(SGB) on the stress ulcer in burn patients and explore the underlying mechanisms.Methods:40 patients with burn injury induced stress ulcer were randomized to two groups:SGB group (n=20) and Control group (n=20).SGB group was treated with conventional symptomatic therapy,SGB group underwent SGB every two days for 1 week on the basis of Control group.And the levels of plasma ET-1 and NO were detected using ELISA before and after therapy.And the clinical efficacy of the two groups was observed after the treatment.Results:Compared with the Control group,the levels of plasma ET-1 and NO were markedly lower in the SGB group (P＜0.05),while the clinical efficacy was higher(P＜0.05).Conclusion:SGB could enhance the clinical efficacy stress ulcer in bum patients,which might be related to the decrease of plasma ET-1 and NO levels.

Objective: To investigate the status of hair loss and analyze the influencing factors among university students in Hangzhou City, so as to provide insights into the management of hair loss among university students. Methods: University students were recruited using a convenient sampling method from 4 universities in Hangzhou City in June 2021. The basic characteristics and life styles were collected using online questionnaire surveys. Self-reported hair loss was evaluated using the grading scales for loss of hair (Hamilton-Norwood scale for males and modified Ludwig scale for females), and factors affecting self-reported hair loss were identified among university students using the multivariable logistic regression model. Results: A total of 1 060 questionnaires were allocated, and 1 038 valid questionnaires were recovered, with an effective recovery rate of 97.92%. The respondents included 391 males ( 37.67% ) and 647 females ( 62.33% ), and 463 respondents ( 44.61% ) reported hair loss, including 431 students with mild hair loss ( 93.09% ). Multivariable logistic regression analysis showed that university students in their fourth or fifth years ( OR=1.721, 95%CI: 1.126-2.630 ), art specialty ( OR=0.411, 95%CI: 0.207-0.816 ), overweight or obesity (OR=1.685, 95%CI: 1.050-2.704), diet taste ( sweet: OR=2.131, 95%CI: 1.370-3.316; spicy: OR=1.510, 95%CI: 1.028-2.218; greasy: OR=3.023, 95%CI: 2.015-4.537 ), feeling nervous/anxious (occasionally: OR=1.891, 95%CI: 1.087-3.289; frequently: OR=2.487, 95%CI: 1.337-4.626 ), smoking ( occasionally: OR=1.906, 95%CI: 1.067-3.405; frequently: OR=1.983, 95%CI: 1.050-3.746), family history of hair loss ( OR=1.506, 95%CI: 1.075-2.110 ), perming/dyeing hair ( occasionally: OR=1.795, 95%CI: 1.280-2.517; frequently: OR=3.282, 95%CI: 1.736-6.204), self-perceived oily hair/scalp in the past three months (slightly increased: OR=1.980, 95%CI: 1.477-2.653; significantly increased: OR=5.347, 95%CI: 2.956-9.670) were factors affecting self-reported hair loss among university students. Conclusion The proportion of self-reported hair loss was 44.61% among university students in Hangzhou City, and hair loss was predominantly mild. A family history of hair loss, nervousness/anxiety, diet habits, smoking and frequency of perm/dyeing hair may affect hair loss among university students.

Objective: To explore the effects of ambient fine particulate matter（PM2.5）exposure on semen quality in healthy adult men . Methods: The semen quality data were collected from the pre-pregnancy check outpatient of Taizhou Central Hospital from August 2014 to December 2017,excluding the patients with any disease of reproductive system. The data of daily pollutant concentration of this area during the same period were also collected to estimate the exposures of PM2.5,PM10,SO2,NO2,O3 and CO during 90 days before each semen examination. Logistic regression model was applied to estimate the association between PM2.5 exposure and semen quality . Results: A total of 3 456 healthy adult men were included in this study. The median （interquartile range）of the total sperm count of the 3 456 subjects was 161.00（122.00）×106,and 94.40% of the subjects could reach the lower reference limit for sperm count. The median（interquartile range）of the sperm concentration was 22.20（18.80）×106/mL,and 69.50% of the subjects were qualified. The median（interquartile range）of the sperm vitality was 55.30%（23.37%）,and 44.10% of the subjects were qualified. The median（interquartile range）of daily average concentration of PM2.5 at 0-90 days before semen examination was 37.82（12.33）μg/m3. The results of multivariate logistic regression model showed that,with each 12.33 μg/m3 increase of PM2.5 exposures at 0-90 days before semen examination,the odds ratios of unqualified sperm concentration,sperm motility and sperm vitality were 1.236（95%CI：1.041-1.466）,1.493（95%CI：1.260-1.770）and 1.462（95%CI：1.246-1.715）,respectively . Conclusion The results suggested that high concentration of ambient PM2.5 exposure during the sperm development period negatively affects sperm concentration,sperm motility and sperm vitality.

AIM: To explore the expressive role of lipoprotein-associated phospholipase A_2, high sensitive C-reactive protein and matrix metalloproteinase-9 in vulnerable atherosclerotic plaques in a rabbit model. METHODS: Forty eight New Zealand white male rabbits were randomly divided into 4 groups (12 rabbits each): control group, stable plaque group, p53 group, and p53+drug group. Rabbits in control group were fed with a regular diet and underwent sham operation. Rabbits in stable plaque group, p53 group and p53+drug group underwent balloon induced arterial wall injury and then were fed on a diet with 1% cholesterol. The animals were all fed for 3 months, then the rabbits in p53 group and p53+drug group underwent Ad5-CMV p53 transfection at 10th week. Before killed, the animals in p53+drug group underwent pharmacological triggering with Russell's viper venom (RVV) and histamine to induce the rupture of the atherosclerotic plaques. At the 1st day and before sacrifice, the serum was collected for measuring Lp-PLA_2, hs-CRP, MMP-9, HDL, LDL and VLDL. The expressions of Lp-PLA_2, hs-CRP and MMP-9 in tissues were determined by the methods of hybridization and immunohistochemistry. RESULTS: At the end of 12th week, the serum and tissue levels of Lp-PLA_2 and MMP-9 in stable plaque group, p53 group and p53+drug group were significant different from those in control group and in each group at the first day (P<0.05). The serum levels of Lp-PLA_2 and hs-CRP in p53 group and p53+drug group were significantly higher than those in control group and stable group (P<0.05). The serum levels of Lp-PLA_2, hs-CRP and MMP-9 were all significantly different between p53 group and p53+drug group (P<0.05). At the end of 12th week, pathological results showed that 4 groups were normal artery, stable plaque, vulnerable plaque and rupture plaque, respectively. The fabric cap was thicker in plaque groups than that in normal group (P<0.05). The rupture and formation of thrombus were more significant in p53+drug group than those in p53 group. The serum level of Lp-PLA_2 had negative interrelated relationship with fabric cap in plaque groups (r=-0.710, P<0.01), and hs-CRP, MMP-9 had no interrelated relationships with fabric cap in plaque groups. CONCLUSION: Base on the successful establishment of the atherosclerotic plaque animal model, serum Lp-PLA_2 shows better interrelated relationships to plaques stability. Combination with hs-CRP and MMP-9, we can exactly evaluate the nature of plaques.

To establish a quantitative estimate model for diagnosing traditional Chinese medicine (TCM) syndromes of patients with osteoporosis.

To establish diagnostic criteria for common traditional Chinese medicine (TCM) syndromes in osteoporosis.

Objective To investigate the influence factors of tumor diameter and related prognostic factors on the prognosis of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 240 patients who underwent resection of hilar cholangiocarcinoma in the West China Hospital of Sichuan University between January 1995 and January 2013 were collected,including 104 patients with tumor diameter ≤ 2 cm (8 with tumor diameter ≤ 1 cm and 96 with 1 cm ＜ tumor diameter ≤ 2 cm),85 with 2 cm ＜ tumor diameter ≤ 3 cm and 51 with tumor diameter ＞ 3 cm (40 with 3 cm ＜ tumor diameter ≤ 4 cm and 11 with tumor diameter ＞ 4 cm).Observation indicators:(1) surgical situations;(2) follow-up situations;(3) risk factors analysis affecting the prognosis of patients;(4) correlation analysis between related prognostic indicators and tumor diameter.The follow-up using outpatient examination and telephone interview was performed to detect the survival up to August 2016.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The prognostic factors and correlation between related prognostic indicators and tumor diameter were respectively analyzed using the COX proportional hazard model and logistic regression model.Results (1) Surgical situations:240 patients underwent successful resection of hilar cholangiocarcinoma and lymph node dissection.Of 73 patients with postoperative complications,1 died of intraperitoneal infection induced to systemic infection and multiple organ failure,1 diel of renal failure,and other patients were cured by symptomatic treatment.(2) Follow-up situations:240 patients were followed up for 12.0-98.0 months,with a median time of 47.4 months.The overall median survival time,1-,3-and 5-year overall survival rates were respectively 30.6 months,81％,47％ and 29％.The median survival time and 5-year survival rate were 46.5 months,34％ in patients with tumor diameter ≤ 2 cm and 30.5 months,30％ in patients with 2 cm ＜ tumor diameter ≤ 3 cm and 13.8 months,20％ in patients with tumor diameter ＞ 3 cm,respectively,with a statistically significant difference (x2 =17.83,P＜0.05).Results of further analysis showed the median survival time and 5-year survival rate were 31.3 months,38％ in patients with tumor diameter ≤ 1 cm and 46.5 months,34％ in patients with 1 cm ＜ tumor diameter ≤ 2 cm,respectively,with no statistically significant difference (x2=1.16,P＞O.05).The median survival time and 1-year survival rate were 14.7 months,62％ in patients with 3 cm ＜ tumor diameter ≤ 4 cm and 13.0 months,55％ in patients with tumor diameter ＞ 4 cm,respectively,with no statistically significant difference (x2 =2.34,P＞O.05).(3) Risk factors analysis affecting the prognosis of patients:univariate analysis showed that tumor diameter,surgical margin,lymph node metastasis,vascular invasion and histological differentiation were the related factors affecting patients' prognosis [hazard ratio (HR)=1.456,8.714,1.737,2.246,1.665;95％ confidence interval (C I):1.212-1.748,5.558-13.663,1.311-2.301,1.494-3.378,1.375-2.016,P ＜ 0.05].The multivariate analysis showed that 2 cm ＜ tumor diameter ≤ 3 cm,tumor diameter ＞ 3 cm,R1 resection,lymph node metastasis and low-differentiated tumor were the independent risk factors affecting poor prognosis of patients (HR =1.559,1.868,7.410,1.521,2.274,95％ CI:1.125-2.160,1.265-2.759,4.497-12.212,1.136-2.037,1.525-3.390,P＜0.05).(4) Correlation analysis between related prognostic indicators and tumor diameter:the results of univariate analysis showed that there was a correlation between lymph node metastasis,vascular invasion,histological differentiation and T staging of American Joint Committee on Cancer (AJCC) and tumor diameter of 2 cm as a cut-off point (x2 =6.063,4.950,8.770,9.069,P＜0.05).There was a correlation between surgical margin,lymph node metastasis,vascular invasion and histological differentiation and tumor diameter of 3 cm as a cut-off point (x2=10.251,9.919,5.485,15.632,P＜0.05).The results of multivariate analysis showed that lymph node metastasis and T staging of AJCC were independent related factors affecting tumor diameter of 2 cm as a cut-off point[odds ratio (OR) =1.882,2.104,95 ％CI:1.075-3.293,1.220-3.631,P＜0.05];surgical margin and lymph node metastasis were independent related factors affecting tumor diameter of 3 cm as a cut-off point (OR=3.187,2.211,95 ％CI:1.377-7.379,1.133-4.314,P＜0.05).Conclusions The 2 cm ＜ tumor diameter ≤ 3 cm,tumor diameter ＞ 3 cm,R1 resection,lymph node metastasis and low-differentiated tumor are the independent risk factors affecting the prognosis of patients with hilar cholangiocarcinoma.Three cm (T staging in De Oliveira staging system) as the second cut-off point is feasible,meanwhile,2 cm cut-off point may be become another potential tumor dividing point described in De Oliveira staging system.