The new current versions of Hospital Finance System and Hospital Accounting System promote the reform of medicine accounting. It requires the method of the drugs cost accounting to change the retailing price accounting to the purchasing price accounting. It clearly defines individual valuation method, “first-in, first-out” method or weighted average method should be used to determine the actual cost of the materials based on the actual situation. It analyzes the problems of medical management and cost accounting, and proposes the practical solutions to strengthen the standard management of medicine and the medical cost accounting.

Objective To investigate the effects of rosuvastatin calcium on bone mineral density and carotid atherosclerotic plaque in patients with type 2 diabetes mellitus complicated with osteoporosis.Methods Eighty-two T2DM patients with osteoporosis were randomly divided into two groups,41 cases in the treatment group and 41 cases in the control group.The control group received routine treatment,including insulin and Caltrate D treatment.The observation group was treated with rosuvastatin calcium 10 mg 1 time/d orally,on the basis of the routine treatmentv.The two groups were treated for 12 weeks.After treatment,the blood glucose level,bone mineral density and carotid atherosclerotic plaques were compared.Results After treatment,the levels of blood sugar,FBG ((7.2±0.4) mmol/L),2 hBG ((9.2±0.6) mmol/L),HbAlc ((7.2±0.4) mmol/L) in the observation groups were lower than those before treatment ((9.6±0.5) mmol/L,(12.3±0.6) mmol/L,(9.8±0.7) mmol/L,t=24.0,23.39,20.65,P<0.05),the levels of blood sugar,FBG,2 hBG,HbAlc in the control group were (8.4±0.3) mmol/L,(10.5±0.6) mmol/L and (8.3±0.6) mmol/L,lower than those before treatment ((9.3±0.3) mmol/L,(12.0±0.8) mmol/L,(9.9±0.5) mmol/L,t=13.58,9.60,13.12,P<0.05).The three indexes in the observation group were lower than those in the control group (t=-15.37,-9.8,-9.77,P<0.05).After 1 course of treatment,the femoral neck BMD value in the observation group was higher than that before treatment ((0.699±0.111) g/cm2 vs.(0.665±0.106) g/cm2,t=0.790,P<0.05),there was no significant increase in the BMD value in the control group after treatment ((0.669±0.130) g/cm2 vs.(0.662±0.119) g/cm2,t=-0.25,P>0.05),the BMD of femoral neck in the observation group after treatment was higher than that in the control group (t=0.842,P<0.05).After 1 course of treatment,IMT value and plaque score in the observation group were lower than those before treatment ((1.202±0.18) mm vs.(1.582±0.369) mm,(3.62±0.33) points vs.(4.39±0.37) points,t=0.778,9.945,P<0.05),in the control group,the intima-media thickness of the carotid artery and plaque score after treatment were not significantly increased compared with those before treatment ((1.487±0.345) mm vs.(1.499±0.356) mm,(4.16±0.26) points vs.(4.28±0.28) mm,t=0.155,2.011,P>0.05).The differences between the observation group and the control group after treatment were statistically significant (t=0.534,0.645,P<0.05).Conclusion Rosuvastatin calcium can effectively improve the curative effect of type 2 diabetes mellitus in patients with osteoporosis and improve bone mineral density and carotid atherosclerotic plaques.

Based on the "Grayscales average distribution" method which equally distributes the input gray levels to output gray levels, three improved methods named: "Reduce the gray range expressed by the less significant subfields", "Low levels preset" and "Modify the exponent of inverse-gamma function" are proposed in this paper. Using these methods, the inverse-gamma relation subfields code can be obtained easily which can improve the low level expressions of AC-PDP. And a program, "gray scales distribution validate program", which can enhance the expressions of the demanded gray levels range, is also proposed in this paper.

Objective To understand the gene distribution and drug resistance rate of integron gene of extended spectrumβ‐lac‐tamases(ESBLs) producing Klebsiella pneumonia infection in ICU elderly patients in order to provide the basis for rational use of antimicrobial agents .Methods The BioMerieux VITEK‐2 Automated Microbes Identification System was adopted to conduct the bacteria identification and drug susceptibility test on various clinical specimens of ICU elderly patients in our hospital from January 2013 to December 2015 .The integron gene in 167 strains of ESBLs‐producing Klebsiella pneumoniae was analyzed by PCR ,and the gene was identified by sequencing .Results Among 386 strains of Klebsiella pneumoniae ,the detection rate of ESBLs‐producing strains was 43 .26% ;the positive rate of integron was 50 .89% ,the detected integron was class Ⅰ integron;aadA2 ,aadA1 ,aada16 , dfra27 and arr‐3 genes were amplified from integron variable region;the drug resistance rate of ESBLs‐producing integron gene pos‐itive strains was significantly higher than that of integron gene negative strains .Conclusion the ICU elderly patients with ESBLs‐producing Klebsiella pneumoniae infection is closely related to the integron gene and integron plays an important role in bacterial drug resistance .

Deep vein thrombosis (DVT) is a serious complication of fractures. The incidence of ankle fracture which occurs most frequently intra-articular is 200/100 000, about 3.9%of all fractures. Domestic and foreign reports of ankle fractures and DVT were allocated and analyzed to review their correlation. Furthermore, different methods of rou-tined thromboprophylaxis was discussed. DVT incident after ankle fractures and the necessity of routined thromboprophy-laxis were reviewed. DVT incidence after ankle fractures was low and routine thromboprophylaxis was not necessary to all ankle fracture patients except the ones who had risk factors of thrombosis which could induce DVT.

Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and individualized surgical plans for patients.

ObjectiveTo observe the intraoperative techniques of artificial nasolacrimal duct and evaluate the effectiveness.MethodForty-nine cases(56 eyes) ofchronic dacryocystitis underwent artificial nasolacrimal duct placement.The artificial nasolacrimal duct was dilated and the stent was retrogradely placed.Dacryocystography was performed before operation.ResultsArtificial nasolacrimal duct placement was technically successful in 53 eyes(94.64％),improvement rate was 3.57 ％ (2/56).The total effective rate was 98.21％(55/56) after operation.ConclusionInterventional artificial nasolacrimal duct placement is a safe,simple and effective method for the treatment of chronic dacryocystitis.

The establishment animal model of Graves’ disease contributes to the study of etiology, pathogenesis and therapeutic modalities. After decades of studies and making improvements, the method of building mice model of Graves’disease has achieved a great development. Although there were many reports of animal model building in Graves’disease, as a mature technology A-subunit of thyrotropin receptor( TSHR)-expressing adenovirus was used to establish Graves’disease mice model, which has been accepted widely because of its high efficacy.

Gene therapy of spinal cord injury (SCI) is the most promising method compared with the others, because it doesn't involve the problems of resource and higher exclusion which respectively exists in fetal nerve transplantation and peripheral nerve transplantation. There are two ways of gene therapy to be chosen: one is to transfer objective genes to the target-cells in vivo directly; the other is to transfer objective genes to one proper kind of transplantable cells firstly, then graft the highest expressing cells to the target-cells in vivo. To realize the transfer of genes to cells, two measures are used in common: physical or chemical measure such as micro infection et al and biochemical measure i. e. gene modified defective virus. Although there are some questions unresolved in this field, the clinical value of gene therapy of SCI in the future is depended.

Family physicians may be called upon to respond to trauma patients in their clinics or at scene of injury. Managing trauma can be daunting to any physician who encounters it infrequently. The physician first responder needs to shut out the chaos and distractions at scene and focus on a systematic primary survey to assess for injuries with the potential to cause rapid deterioration, institute crucial life-saving interventions and effect rapid evacuation to hospital. This article details a simple approach to guide the family physician to assess and prioritise management of the trauma patient, and augment the work of the paramedics in the pre-hospital phase.