Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

Leptospirosis is an important zoonosis with worldwide distribution. As the first procedure in immunity system, the role and significance of innate immunity in controlling infection at the early stage of the disease have gradually been emphasized. Macrophages can phagocytize and kill leptospira, while the pathogenic leptospira can evade the killing by macrophages. In addition, neutrophils, complement system and cytokines also contribute to the defence of leptospira infection.

Objective To analyse the economies of scale in public hospitals in Zhejiang Province. Methods One hundred and twenty-five public hospitals in Zhejiang Province with qualification no less than class two level two were selected as sample hospitals. Douglas production function was employed to analyse the relationship between investment and output in sample hospitals between 2004 to 2006, with two types of production models established by medical service and incomes in hospitals as dependent variables. Results From 2004 to 2006, the medical service and incomes of sample hospitals were in line with economies of scale. The production increase rate was higher than investment increase rate. The medical service, incomes, total assets and number of staff in class three hospitals were higher than those in class two hospitals (P =0.000). Conclusion Economies of scale is the ultimate incentive to continuous outstretch for hospitals. Hospitals should rationally control the scale so as to avoid problems in medical service caused by overstretch.

Objective To investigate the methods of diagnosis and treatment of pediatric and hebetic adrenocorticotropic hormone ( ACTH) secreting pituitary microadenoma. Methods The data of 10 patients with ACTH secreting pituitary microadenoma were retrospectively analysed. ACTH secreting pituitary microadenoma was diagnosed by clinical manifestations, biochemical and imaging findings, and 5 patients underwent bilateral inferior petrosal sinus sampling ( BIPSS). Transsphenoidal surgery was performed on all the patients under microscope, and the tumor specimens were detected by immunohistochemistry. Results Immunohistochemical examination revealed that ACTH was positive in 8 cases and negative in 2 cases. Patients were followed up for 12 to 63 months, 7 cases (70%) were cured, one (10%) achieved remission, and the other two (20%) experienced recurrence. Conclusion BIPSS is helpful in the diagnosis and localization of pediatric and hebetic ACTH pituitary microadenoma, and transsphenoidal surgery is the optimal choice of treatment.

Objective To investigate the clinical application of minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates. Methods The clinical data of 38 patients with minimally invagive fixation of complex proximal tibia fractures by uniaxial(n=21)and polyaxial(n=17)locking plates from January 2008 to June 2009 were retrospectively analysed,and the union rates and function recovery were compared between groups.Results All patients were followed up for 3 to 20 months,with an average of 12 months.All patients had bone union.The time of fracture union for fixation by uniaxial locking plates was 10 to 20 weeks,with an average of 14 weeks;and that for fixation by polyaxial locking plates was 11 to 18 weeks,with au average of 13 weeks.Evaluated by Johner-Wruhs method, there were 14 "excellent" cases,5 "better" eases,2 "good" cases and 0 "poor" case for fixation by uniaxial locking plates (rate of "excellent and better",90.4%),and there were 11 "excellent" cases,5 "better" cases,1 "good" cage and 0 "poor" case for fixation by polyaxial locking plates (rate of "excellent and better",94.1%). Conclusion Minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates is stable,has less effects on bone blood supply,high bone union rate and favourable function recovery,and is an effective way in the treatment of complex proximal tibia fractures.Fixation by uniaxial locking plate has a better mechanical intensity,while fixation by polyaxial locking plate can adjust the screw angle according to fracture situation,which can be clinically applied accordingly.

Objective To investigate the influence of nebulized Pulmieort respules inhalation after endoscopic sinus surgery (ESS)on the expression of epithelial Na~+ channel(ENaC)protein in nasal mucosa. Methods Forty-four patients with nasal polyps undergoing ESS were randomly divided into Pulmieort respules treatment group(n=21,nebulized Pulmieort respules inhalation for 10 d after ESS)and Rhinocort control group(n=23,Rhinoeort aqueous nasal spray for 10 d after ESS).All the patients were performed biopsy of membrane on the residual middle turbinate 14 d after ESS,eosinophils (Eos)and neutrophils(Neu)per hundred inflammation cells were counted under microscope during ESS and after ESS,and the expression of ENaC protein was detected by immunofluorescence assay. Results The percentages of Eos and Neu decreased in two groups after treatment,and the percentage of Neu in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.05).The expression of ENaC protein after treatment in Pulmieort respules treatment group was significantly lower than that in Rhinoeort control group(P<0.01). Conclusion Application of pulmieort respules after ESS can decrease Neu infiltration and inhibit expression of ENaC protein,which can relieve acute inflammation and edema of nasal mucosa.

Hypertonic saline solutions have received more attention as effective agents for the treatment of brain damage. Studies indicated the beneficial action of hypertonic saline solutions in intracranial pressure, cerebral blood flow and neurologic outcome. This article reviews the available evidence on hypertonic saline solutions as they relate to traumatic brain injury.

Objective To design a quantitative criterion and grading system for injury from adverse drug reaction (ADR) in order to serve the compensation system of injury from ADR. Methods Based on the other grading system of injury cases, the independent scores and serial grades were given to the ADR injury of different organs or different levels through two turns of consultation to 27 experts from Shanghai. Results Injury from ADR was graded from stage 1 to stage 10 according to the damage degree, with 1 stand for death and 10 for slightest injury. Conclusion The grading method of ADR based on the characteristics of injury accords with the condition of China, and can provide reference for making up the compensation system of ADR injury.

Objective To apply data mining to risk prediction of sudden deafness, and form the association rules.Methods The clinical data of 517 patients with sudden deafness was collected, including the characteristics of 19 attributes: sex, age, season, hypertension, diabetes, heart disease, hypercholesterolemia, atherosclerosis, long-term smoking, alcoholism, mental tension, insomnia, weakness, bedridden, infection, congenital malformation, trauma, tumour and autoimmune diseases. The source database were cleaned, then mapped for mining database. Minimum support to 0.1 and minimum confidence level to 0.9 were set for analysis of association rules. Results One hundred and six strong association rules were formed, and the rules contained the relation between the incidence of sudden deafness and the characteristics of 19 attributes. Conclusion This method is conducive to make the abstract theory of mathematical statistics into useful association rules to guide the practice of disease prevention and control.

Objective To observe the therapeutic effects of different doses of recombinant human tumor necrosis factor-receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) on rheumatoid arthritis (RA). Methods Seventy-six patients with RA were randomly divided into rhTNFR:Fc treatment group A (n=22; rhTNFR:Fc 25 mg, twice/week and methotrexate 10 mg/week), rhTNFR:Fc treatment group B (n=24; rhTNFR:Fc 12.5mg, twice/week and methotrexate 10 mg/week) and control group (n=30; methotrexate 10 mg/week). Joint function related parameters including number of swollen joints, number of tenderness, pain degree, time of morning stiffness, Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were detected before and 2, 4, 6, 8, 12, 16 and 24 weeks after treatment in all the patients. After being treated for 3 months, the changes of joint function related paramters were evaluated and compared among groups. ACR20, ACR50 and ACR70 criteria were employed to evaluate the therapeutic effects. Results There was no significant difference in joint function related parameters among three groups before treatment (P＞0.05), while those improved significantly after treatment for 3 months (P<0.05), with more favorable results in rhTNFR:Fc treatment group A and B than in control group (P<0.05). The percent of patients with ACR50 in rhTNFR:Fc treatment group A was significantly higher than that in rhTNFR:Fc treatment group B 2 and 4 weeks after treatment (P<0.05), while there was no significant difference in total effect between these two groups 8, 12, 16 and 24 weeks after treatment(P＞0.05). Conclusion Small dose of rhTNFR:Fc in combination with methotrexate may yield effective and economical results for treatment of RA.