Objective To evaluate the usefulness of ultrasonography in detecting parathyroid lesions in the patients with hyperparathyroidism. Methods The results of ultrasonography were compared with operative and histologic findings, and other imaging techniques such as 99m-Tc-sestamibi scintigraphy and CT in 210 patients with proved hyperparathyroidism.Results The overall sensitivity and specificity of ultrasonography in detecting parathyroid lesions were 68.62%, 93.79%. Lesions at lower pole of thyroid were more likely to be detected than ectopic ones. Ultrasonography was helpful in diagnosis of parathyroid adenoma, hyperplasia or carcinoma when combined with clinical manifestations. Conclusions Ultrasonography is a useful means in preoperative localizing of hyperparathyroidism.

The authors conceive of dispersing and transferring medical risks by means of insurance. They suggest developing two modules of insurance business, including malpractice insurance and medical accident insurance. They also discuss such basic issues as risk financing, financial compensation and choice of insurance undertakers.

Objective To evaluate the effect of immune enhanced enteral nutrition on immune function in postoperative patients with gastric cancer by using meta-analysis. Methods The databases of PubMed, the Cochrane Library, CNKI, CBM, VIP and Wanfang Data were used to search randomized controlled trials (RCT) about the effect of immune enhanced enteral nutrition and conventional enteral nutrition on immune function in postoperative patients with gastric cancer. The retrieval time span was from inception to Sept 1, 2016. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Besides, the meta-analysis was conducted by using RevMan 5.3 software. Results Meta-analysis included 5 RCT, 216 cases in total. The results showed that the immune parameters of immune enhanced enteral nutrition such as IgA (MD=0.18, 95 % CI 0.09-0.27, P< 0.001), IgG (MD= 0.76, 95 % CI 0.43-1.09, P< 0.001), IgM (MD= 0.13, 95%CI 0.07-0.20, P<0.001), CD3 (MD=4.74, 95%CI 2.99-6.48, P<0.001), CD4 (MD=3.6, 95%CI 2.14-5.06, P< 0.001), CD4/CD8 (MD= 0.58, 95 %CI 0.20-0.97, P< 0.003) were significantly higher than those of conventional enteral nutrition after 9 or 10 days of gastric surgery. The CD8 level of conventional enteral nutrition were higher than immune enhanced enteral nutrition after 9 or 10 days of gastric surgery (MD = -1.26, 95 %CI-2.21 - -0.30, P= 0.01). The difference between two groups had no statistical significance in immune parameters such as IgA, IgG, IgM, CD3, CD4, CD8, CD4/CD8 after 1 day of gastric surgery (P>0.05). Regarding to cellular factor, the IL-6 level of immune enhanced enteral nutrition was lower than conventional enteral nutrition after 9 days of gastric surgery (MD=-77.40, 95 %CI-112.25 - -42.55, P< 0.001). The difference between two groups enteral nutrition had no statistical significance about IL-6, TNF-αafter 1 day of gastric surgery, TNF-α, IL-2 after 9 days of gastric surgery (P> 0.05). Conclusion Immune enhanced enteral nutrition for postoperative patients with gastric cancer can improve and enhance the immune function under stress, and reduce the excessive inflammatory reaction, which is more conducive to the safety of patients with gastric cancer.

In the progress of the new healthcare reform, China has carried out a series of reform exploration in the drug distribution system.But fluctuating markups of drugs are still the main cause of high drug price.In order to simplify the distribution procedure, the National Health and Family Planning Commission proposed to encourage the implementation of two-receipt system nationwide.As the important part of the price system of drug circulation, drug distribution system made a great impact on the implementation of two-receipt system policy.Focusing on two provinces namely Fujian and Shaanxi provinces, this paper will discuss the typical drug distribution system in china.This paper has evaluated the main body and operation pattern in the implementation of two-receipt system, and by analyzing the benefits and drawbacks, in the same provinces.It has put forward the optimized distribution mode and provided policy suggestions for strengthening the two-receipt distribution system.

Objective To study the effectiveness of conventional ultrasonography(US) and color Doppler flow imaging(CDFI) in differentiation of malignant and benign nodules of thyroid gland. Methods One hundred and fifty three consecutive patients with thyroid nodules who were to undergo surgery were examined before thyroidectomy by US and CDFI. The vascular pattern on CDFI was classified as follows: TypeⅠ,absence or little blood flow; Type Ⅱ, rich perinodular blood flow,absence or little inside; Type Ⅲ, marked intranodular and perinodular blood flow. Results On histology, 87 cases(263 nodules) were diagnosed as benign and 66 cases(109 nodules) as malignant. There was no correlation between solitary or multiple thyroid nodules and incidence of thyroid cancer. Differences of the US characteristic between the benign and malignant nodules of thyroid gland showed statistical significance (p

Objective To evaluate the effect of OPRM1A118G genetic polymorphism on postoperative analgesia with fentanyl in the patients undergoing radical resection of lung cancer.Methods One hundred and seventy-four patients(native of He′nan province), aged 40-64 yr, weighing 40-70 kg, with American Society of Anesthesiologists physical status Ⅰor Ⅱ, undergoing elective radical resection of lung cancer under general anesthesia, were enrolled in this study.OPRM1A118G genetic polymorphic sites were analyzed by using polymerase chain reaction technique and ABI 3130 Genetic Analyzer.The patients were divided into wild homozygote group,heterozygote group and mutation homozygote group according to their genotypes.The analgesia pump was connected at the end of operation.Patient-controlled intravenous analgesia solution contained fentanyl 30 μg/kg and ondansetron 8 mg in 200 ml of normal saline.The analgesia pump was programmed to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at a rate of 2 ml/h, maintaining the visual analogue scale score ≤3 points.The amount of fentanyl consumed within 24 and 48 h after operation was recorded, and the occurrence of adverse reactions was recorded within 48 h after operation.Results Compared with wild homozygote group, the amount of fentanyl consumed within 24 and 48 h after operation was significantly increased in mutation homozygote group(P<0.05), and no significant change was found in the amount of fentanyl consumed within 24 and 48 h after operation in heterozygote group(P>0.05).There was no significant difference in the incidence of postoperative adverse reactions between the three groups(P>0.05).Conclusion OPRM1A118G genetic polymorphism is one of the genetic factors contributing to individual variation in fentanyl pharmacodynamics in the patients undergoing radical resection of lung cancer.

Objective To evaluate the effects of OPRM1All8G and CYP3A4*18B genetic polymorphism and the interaction on postoperative analgesia with fentanyl in the patients undergoing radical resection of lung cancer.Methods One hundred and thirty-nine patients (native of Henan province),aged 40-64 yr,weighing 40-70 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of lung cancer under general anesthesia,were enrolled in this study.The polymorphic sites of the OPRM1All8G and CYP3A4*18B allele were analyzed by using polymerase chain reaction technique and ABI 3130 Genetic Analyzer.The patients were divided into wild homozygote group (group AA,group *1/*1),heterozygote group (group AG,group * 1/*18B) and mutation homozygote group (group GG,group *18B/*1SB) according to their genotypes.The patients were divided into 7 groups according to the interaction between the two genes:AA plus *1/*1 group (group Ⅰ),AA plus *1/*18B group (group Ⅱ),AG plus *1/*1 group (group Ⅲ),AG plus *1/*18B group (group Ⅳ),GG plus * 1/*1 group (group Ⅴ),GG plus *1/*18B group (group Ⅵ) and *18B/*18B group (group Ⅶ).Patientcontrolled intravenous analgesia with fentanyl was started at the end of surgery to maintain the visual analogue scale ≤ 3 points.The amount of fentanyl used within 24 and 48 h after surgery was recorded,and the occurrence of adverse reactions within 48 h after surgery was observed.Results The amount of fentanyl used within 24 and 48 h after surgery was significantly higher in group GG than in group AA (P＜0.05).The amount of fentanyl used within 48 h after surgery was significantly lower in group *18B/*18B than in group *1/*1 (P＜0.05).The amount of fentanyl used within 48 h after surgery was significantly higher in Ⅱ and Ⅳ groups than in group Ⅰ,in group Ⅲ than in group Ⅱ,in group Ⅴ than in Ⅰ-Ⅳ groups,and in group Ⅵ than in Ⅱ and Ⅳ groups,and was significantly lower in group Ⅶ than in Ⅰ-Ⅵ groups (P＜ 0.05).There was no significant difference in the incidence of adverse reactions within 48 h after surgery between groups (P＞0.05).Conclusion OPRM1A1l8G and CYP3A4*18B genetic polymorphism and the interaction are the genetic factors contributing to individual variation in fentanyl pharmacodynamics in the patients undergoing radical resection of lung cancer.

OBJECTIVETo introduce a simple, fast and universal measuring method used in measurement of the surface area of scalp flap over the cranial defect after decompressive craniectomy.

METHODSThe first step: CT images of the patient with craniocerebral trauma after decompressive craniectomy were obtained and imported into Mimics. The second step: based on the defined threshold, the 3D geometric models of brain and skull were reconstructed after the original Dicom format pictures three-dimensional processed by Mimics. The third step: based on the two builded 3D models, utilizing the segmentation and measurement tools of Mimics to conduct cutting, splitting and measuring operations for the 3D model of brain. The forth step: estimating the surface area of scalp flap over the removed bone flap by using mathematical computation methods.

RESULTSThe application of the introduced method estimated the surface area of scalp flap over the cranial defect of different people with different position of craniocerebral trauma.

CONCLUSIONSThis paper introduces a simple, fast and universal new measuring method. We can conveniently estimate the surface area of scalp flap by using the introduced method.

Objective To investigate the effect of Intedeukin-18 (IL-18) on Th1/Th2 balance and its antitumor mechanism in C57BL/6 mice Lewis lung cancer model. Methods 24 C57BL/6 mice were randomly divided into three equal groups: group A(IL-18 injec-tion group, n = 8), group B (Lewis lung cancer model, n = 8) and group C (normal control group, n = 8). The Lewis lung cancer cells were cultured and implanted subcutaneously into the group A and group B. IL-18 and NS were given to group A and B respectively by intrap-eritoneal injection on the 7th day (once every day, 7 times altogether), but group C was not given any treatment. Enzyme-linked immunosor-bent assay (ELISA) was used to detect the Th1/Th2 cytokines. Health status in all the animals was evaluated; the volume and weight ofsubcutaneous tumors were measured. Results The concentration of IFN-γ in group A and C were significantly higher than those in group B (P <0.05), and the concentration of IL-4 in group A and C were significantly lower than those in group B (P<0.05), but there was no significant difference between group A and C (P>0.05). The tumor growth inhibitory rate was 75%. Conclusion IL-18 can effectively induced IFN-γ and inhibit IL-4 production, regulate Th1/Th2 balance in the C57BL/6 mice Lewis lung cancer model, and elicit the antitu-mor immunity of the host, which could obviously inhibit the growth of tumor cells and decelerate the proliferation of tumor cells.

Objective To investigate the diagnostic value of the ratio of % Micro to % Hypo in the diagnosis of three kinds of common thalassemia and iron‐deficiency anemia (IDA ) .Methods Forty‐nine cases of IDA ,24 cases of mildα‐thalassemia ,24 cases of mildβ‐thalassemia ,24 cases of silent α‐thalassemia and 120 individuals undergoing healthy physical examination were selected as the research subjects and divided into 6 groups:normal group ,IDA group ,mildα‐thalassemia group ,mildβ‐thalassemia group ,silentα‐thalassemia and mild thalassemia group(in duding mild α‐thalassemia group and mild β‐thalassemia group) .The % Micro and %Hypo were deteced in each group and their ratio was calculated .The results were performed the analysis and comparison .Results The % Micro/% Hypo ratio had statistical difference between the mild thalassemia group and IDA group ,between the mild thalasse‐mia and IDA group with the normal group(P<0 .01) .The% Micro/% Hypo ratio had no statistical difference between the silent α‐thalassemia group and normal group ,and between the mild α‐thalassemia group and mildβ‐thalassemia group (P>0 .05) .With the% Micro/% Hypo ratio of 0 .9 as the discriminant value to diagnose mild thalassemia and IDA ,its sensitivity ,specificity and accuracy for diagnosing mild thalassemia were 91 .67% ,91 .89% and 91 .72% respectively ,the sensitivity ,specificity and accuracy in diagno‐sing IDA were 91 .94% ,91 .25% and 91 .18% respectively .Conclusion The ratio of % Micro/% Hypo has good differential diagno‐sis and assisted diagnosis screening value ,but has little value for diagnosing silent α‐thalassemia .