ObjectiveFrom the view of the frequence of codes applying,investigate the situation of the Tenth Revision of the International Classification of Disease Clinical Modification of Beijing and to support the further development and application.MethodsFigure out the difference of the frequence of codes between before and post application of coding on clinical modification,to compare and make analysis for them.Results Got lists of percentage periods frequence of codes on classification of disease calculated from all secondary and above level hospitals in Beijing in the year of 2006,2007 and 2008.Conclusionthe Tenth Revision of the International Classification of Disease Clinical Modification of Beijing is well compatible with WHO ICD-10 on the level of applicable codes set; the refine work is effective and balance for codes applying; the localization should be done first before applying ICD-10.

Objective To investigate the effects of intensive insulin therapy on the functions of vascullar endothelial cells in septic patients. Methods One hundred and twenty septic patients were randomly assigned to intensive insulin therapy 1 ,intensive insulin therapy 2 and conventional insulin therapy, serum von Willebrand factor (vWF),thrombomodulin protein(TM),endothelin-1 (ET-1) and nitric oxide(NO) of the three groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle (ELISA) before treatment and the next 3 d,7 d after treatment. At the same time we observed the three groups of patients with 28-d mortality, the days of hospitalized in ICU, number of days for using mechanical ventilation, △ APACHE Ⅱ score and △MODS score. Results After treatment of 3 days,vWF was (142.57 ± 10.07)%, (137.32 ±9.66)% and (138. 32 ± 8. 80) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, vWF was (126.27 ±10.49) %, (116. 55 ± 9. 36) % and (120.72 ± 9. 53) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, TM was (6. 87 ± 1.62) μg/L, (5.95 ± 1.60) μg/L and (6. 17 ± 1.33) μg/L in the CIT, IIT1and IIT2 group, respectively. After treatment of 7 days, TM was (4. 55 ± 1.48) μg/L, (3.35 ± 0.94) μg/L and(3. 87 ± 1.20) μg/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, ET-1 was (61.27 ±9. 20) ng/L, (55.97 ± 9.03) ng/L and (57. 37 ± 7. 70) ng/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, TM was (43. 12 ± 6. 17) ng/L, (33.77 ± 6. 20) ng/L and (35.95 ± 5.73) ng/L in the CIT, IIT1and IIT2 group, respectively. Compared with conventional insulin therapy, vWF, TM and ET-1 were significantly decreased (P ＜ 0.05), NO were significantly higher (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups had no significant difference (P ＞ 0.05). In the CIT, IIT1 and IIT2 groups respectively, the mortality at 28 days were 20.0%, 12. 5 % and 45.0%, the days of hospitalized in ICU were (9.50 ± 3. 70) d, (7. 72 ± 3.29) d and (8.02 ±2. 90) d, number of day for using mechanical ventilation were (8. 92 ± 3.79) d, (7.23 ± 3. 32) d and (7. 37 ±3. 29) d, △ APACHE Ⅱ score were 8. 87 ± 3.46,7. 20 ± 2. 81 and 7.42 ± 3. 18, △ MODS score were 4. 15 ± 2. 15,3.20 ± 1.48 and 3.32 ± 1.74, with significant differences (P ＜ 0.05). These indices were significantly decreased (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups also had no significant differences (P ＞ 0.05). Conclusions Intensive insulin therapy on patients with sepsis has a protective effect of vascular endothelial cells, and the blood glucose controlled in the 6. 6 - 8. 3 mmol/L can significantly decrease the incidence of hypoglycemia, and intensive insulin therapy can also significantly improve the prognosis of patients with sepsis.

BACKGROUND: Vertebral reconstruction is stil a chal enge for spinal surgeons. Ideal reconstruction materials should have good osteogenesis ability, reliable support performance, low price and simple operating steps.
OBJECTIVE:To investigate the effect and feasibility of al ogenic cortical ring packed with autogenous cancellous bone in the reconstruction of rabbit cervical vertebra defect.
METHODS:Cervical vertebra defect models were established by resection of the fourth cervical vertebra in rabbits. Frozen-dried humeral cortical ring of rabbits was made to prepare the al ogenic cortical ring which was packed with autogenous cancellous bone. Then, al ogenic cortical ring packed with autogenous cancellous bone, single al ogenic cortical ring and autogenous iliac bone were used to repair rabbit cervical vertebra defects.
RESULTS AND CONCLUSION:The X-ray, histopathological examination, and scanning electron microscope examinations al showed that the bone union was most significant in group reconstructed with al ogenic cortical ring packed with autogenous cancellous bone. The alkaline phosphates activity in serum was higher in groups reconstructed with al ogenic cortical ring packed with autogenous cancellous bone and with autogenous iliac bone than in group reconstructed with only al ogenic cortical ring at 2 and 4 weeks after operation (P<0.01), but there was no difference between the former two groups. The biomechanical examination showed that the stability of al ogenic cortical ring packed with autogenous cancellous bone was higher than that of autogenous iliac bone at 1 month after operation (P<0.01). These findings indicate that the effect of al ogenic cortical ring packed with autogenous cancellous bone in the reconstruction of rabbit cervical vertebra defects is satisfactory, with a good biocompatibility, which is a promising method for the reconstruction of vertebral defects.

Forty five patients with acute cerebral infarction were randomized to two groups: in treatment group patients received local subhypothermia and conventional therapy, in control group patients received conventional therapy only. Clinical outcome was assessed by the National Institutes of Health Stroke Scale (NIHSS) on admission and at 7, 14 and 30 d after treatment. Serum neuron specific enolase (NSE), nitrogen monoxide ( NO ) , superoxide dismutase (SOD), interleukin-6 (IL-6 ) and intercellular adhesion molecule-1 (ICAM-1) were detected on admission and at 7,14 d after treatment The study showed that NIHSS scores of treatment group on 14, 30 d were lower than those of control group ( P ＜ 0. 05 ). Serum NSE, NO, IL-6 and ICAM-1 levels significantly decrease; while serum SOD levels increased (P ＜ 0. 05). In conclusion, local subhypothermia therapy can inhibit inflammatory reaction, reduce oxygen free radical formation and improve neurological function in patients with acute cerebral infarction.

Collection and quality control of inpatient medical record home page information are key to the study and use of DRGs.The paper covered the sampling methods, inspection items, inspection methods, data assembly methods, and data reporting quality scoring methods of Beijing authorities on the hospitals in the city.Also introduced were the inspection results of the city in 2014, which prove a satisfactory outcome in the end.

Objective: To evaluate the effect of echocardiography for occluding the multiple seconded atria1 septal defects ( MASD) in relevant patients.
Methods: A total of 42 MASD patients were selected by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The transcatheter closure was monitored by TTE and X-ray, the effect of treatment was evaluated by TTE, ECG and chest X-ray at 24 hours and 1, 3, 6 months after the procedure. There were 38 patients with 2 defects, 3 with many central small defects and 1 with 3 defects. The patients included 17 male and 25 female with the mean age of (32.6 ± 13.4) years.
Results: The size and distance of the defects were measured with 4 cardiac chambers cross sectional study. The mean diameter of bigger defect from up to down was (9-27) mm, with the mean of (20.7 ± 6.1) mm, from front to back was (8-23) mm, with the mean of (16.9 ± 5.7) mm;the mean diameter of small defect from up to down was (3-12) mm, with the mean of (6.8 ± 3.6) mm. The length of the defect interva1 was (4-18) mm, with the mean of (7.9 ± 2.6) mm. There were 4 patients with 2 defect interval at 8.7 mm who received 2 occluders without post-operative lfow shunt. The rest 38 patients received 1 Amplatzer occluder which was (14-36) mm with the mean of (25.1 ± 6.4) mm which was (6.9 ± 1.7) mm larger than echocardiographic prediction. The success rate of implantation was 100%. There were 17 (40.5%) patients with post-operative lfow shunt. The patients were followed-up for (6-36) months, with the mean of 18.7 months, there were 11 (26.2%) patients with small amount of lfow shunt at 3 months after the operation.
Conclusion: Echocardiography is important for choosing the type and size of occluder devices, in-operative monitoring and post-operative effect evaluation for treating the ASD patients.

Objective To investigate CT,clinical and pathological features of primary pulmonary lymphoepithelioma-like carcinoma (LELC). Methods The clinical,CT and pathological data of 22 patients with pulmonary LELC confirmed by pathology were analyzed retrospectively, including 8 males and 1 4 females whose ages were from 1 8 to 88 years old.Results Among 22 cases,1 2 patients were found by physical examination,2 patients had cough and sputum,7 patients had cough hemoptysis and 1 patient was found by re-examination after breast cancer surgery.On CT,all cases manifested single mass in the lung,and the longer diameters ranged from 1.5 cm to 1 1 cm,in which there were central type tumors in 8 cases and peripheral type tumors in 14 cases.Nineteen masses showed homogeneous density in non-enhanced scan,and the cavity,irregular calcification and small patchy necrosis were seen in each 1 case.After contrast-media injected,masses were mild-moderately or evidently enhanced in 7 cases and 1 5 cases respectively.Eighteen cases had well defined border and unclear border in 4 cases.Vascular encasement were found in 6 central type tumors,8 tumors squeezed peripheral vascular and 8 cases had clear demarcation between tumors and vascular.Nineteen tumors were surgically removed,in which 7 cases appeared metastasis of lymph node.Histopathology showed that the tumor cells had large volumes,unclear boundaries,large nuclei,growing in syncytial nest-like patches.There were abundant lymphocyte and plasma cell infiltration in tumor’s mesenchyma.EBER were done in 1 6 cases and the results were all positive.Conclusion CT feature of pulmonary LELC manifestes that the masses are mostly single,large size, homogeneous density,clearly boundary,shallow lobulated and significantly enhancement.Vascular encasement is the feature of central pulmonary LELC,and peripheral LELC is more likely to occur in the sub-pleural region.Final diagnosis should be combined with clinical and pathological diagnosis.

One hundred and fourty-nine normal persons were tested to gain the normal scale of Comprehensive Function Evaluation(CFE).It includes seven items eighteen categories.The result demonstrated that fifteen categories of normal persons in age of twenty to sixty-nine incuding understanding and expressing,feeding,grooming,dressing clothes,dressing trousers and skirts,bathing,bowel and bladder management,control of sphincter of bowel and bladder,bed wheelchair mobility,bathtub-wheelchair mobility,ambulation,up and down the stairs,which gained one hundred degrees each,memory ninty eight to one hundred degrees,problem solving ability eighty-four to one hundred degrees,social communication ninty-nine to one hundred degrees.We conclude preliminarily:CFE is an individual ability evaluation of preson,demonstrating the comprehensive function of presons which were in aga of twenty to sixty nine,educated in and above primary school.It can be used as a main scale to evaluate the guality and effect of rehabilitation sequence,and has practical value to improve rehabilitation medical level.

Presented in this paper is a preliminary report on reliability study of comprehensive function evaluation.One hundred and five normal persons were evaluated twice in the interval of one month.The result revealed significant statistical difference,Kappa=0.79,u=7.938>2.56,P<0.01,demonstrating the substantial agreement of these two evaluations.The result suggests that the scale has substantial intra observer agreement and high reliability.The personal comprehensive function could be evaluated completely in the scale.It would be significant not only in practice but also in theory to improve the rehabilitation evaluation and rehabilitation medical level.

Objective:To explore the safety and efficacy of immune checkpoint inhibitors(ICI)for patients with tumor recurrence after liver transplantation(LT).Methods:A single-center retrospective study was conducted for 6 recipients of tumor recurrence after LT on a therapy of ICI admitted into Shulan(Hang Zhou)Hospital from September 2015 to June 2018.The authors examined the occurrences of graft rejection and clinical outcomes of overall response rate, progression-free survival and overall survival after dosing of PD-1/PD-L1 inhibitors.Results:Six patients enrolled with tumor recurrence on a therapy of ICI undergoing LT due to hepatocellular carcinoma (HCC). Nivolumab (n=4) and duvalizumab (n=2) were administrated.The median session of treatment was 8.3(2-31) cycles.The disease outcomes were stable (3/6, 50%) and progressive (3/6, 50%), The progression-free survival time of 3 disease-controlled patients was 1.5, 16.2 and 18 months and the median survival time after recurrence was 19.75(10.8-37.8) months.Rejection occurred in 1 patients (1/6, 16.7%) and the occurring time of rejection was 28 days after PD-1 inhibitor dosing.After acute rejection, high-dose corticosteroids and immunoglobulin were ineffective and the patient died from acute rejection related liver failure.Conclusions:ICI may be employed as a salvage treatment for tumor recurrence after LT for HCC.Due to a possibility of severe acute rejection, usage should be cautious under close monitoring of liver function.