Objective: Through comparing the hospitalization costs of total knee replacement (TKR) in People’s Hospital of Peking University in 2005 and 2010, to investigate the changing status of hospitalization costs on this operation and the impact of clinical pathway ( CP ) on controlling the hospitalization costs during 5 years , and provide references for controlling medical treatment cost reasonably. Methods: The patients are grouped into undergoing unilateral and bilateral TKR. The total hospitalization cost and cost of each category during 5 years are compared, and SAS 9.2 statistic software is applied to deal the data. Results: Compared with 2005, the total cost for TKR in 2010 decreased. All the charging items decreased, except implant material increased, especially the cost of surgery, hospital room, nursing and pharmacy. Specific to one knee replacement group and both knees replacement, the changing trend of cost is coincident with the total cost. Conclusion: The total cost for TKR in 2010 was lower than that of 2005, which might be the result of adopting CP since 2010. Nevertheless, the implant material cost accounted large proportion of hospitalization cost in 2010, and it has obvious increasing trend compared to 2005. This result is related the increasing application of the new edition of Artificial knee joint prosthesis. Controlling implant material cost is the effective method of decreasing medical costs for TKR.

0.05).All cases showed normal bone formation. Conclusion:There is no significant influence on tibial growth if cancellous bone harvesting is controlled strictly in two third of total amount from tibial proximal metaphyses.

ObjectiveTo observe the therapeutic effects of calcium dobesilate combined with irbesartan in treating early diabetic nephropathy ( DN ).Methods65 patients with early DN were randomly divided into two groups,experiment group( irbesartan plus calcium dobesilate,n =34) and control group( irbesartan,n =31 ).After 24 week treatment,the urinary albumin excretion rate(UAER),fasting blood glucose ( FBG ),postprandial blood glucose (PBG) and glycosylated hemoglobin(HbA1c) were detected and compared between two groups before and after treat ment.ResultsUAER after treatment was significantly reduced in both 2 groups(t =8.074,12.89,all P＜0.01),and the decrement in the experiment group was more obvious than that in the control group with statistical significance ( t =3.965,P ＜ 0.05).ConclusionCalcium dobesilate combined with irbesartan has good effects in the treatment of early DN.

Objective To explore the impact of the ratio between pelvic tilt (PT) and sacral slope (SS) on the life quality of patients with ankylosing spndylitis (AS) after kyphosis correction. Methods From November 2008 to May 2011, 33 AS pa?tients were reviewed, including 31 males and 2 females, aged from 19 to 58 years old (average, 36 years old). The thoracolumbar kyphosis angle was 35.23° ± 13.98° (range, 15.12°-74.37° ) and the lumbar lordosis angle was 8.68° ± 18.27° (range,-23.70°-62.15°). The Scoliosis Research Society (SRS)?22 questionnaire was used to evaluate the quality of life and the Oswestry disability index (ODI) was used to evaluate the condition of pain. The pelvic incidence (PI), PT, SS, sagittal vertical axis (SVA) and osteoto?my angle were obtained from standing lateral full?spine radiographs. The correlations were analyzed from the subjective grading and the sagittal parameters in AS patients. Results The osteotomy site was in L1 (5 cases, 21.00°-54.59° , average 32.59° ± 13.44° ), L2 (19 cases, 28.63°-66.24° , average 37.89° ± 9.26° ), L3 (9 cases, 31.78°-60.90° , average 47.05° ± 9.20° ), respectively. The range of osteotomy angle was 39.59°±10.82° (range, 21.00°-66.24°). The subjective grading and spino?pelvic parameters were improved significantly after operation except PI, only postoperative PT/SS (0.93±0.65) and ODI standing (0.60±0.75)(r=0.681, P<0.05), osteotomy angle (39.59°±10.82°) and satisfaction of management (3.33±0.49)(r=0.478, P<0.05)had correlation with the subjective grading. Conclusion Compared with the change of PT, SS and SVA, the change of PT/SS is more closely related to the quality of life after operation in AS patients with kyphosis, which should be pay attention to by surgeon when designing operative schemes.

Objective To investigate the effects of peroral catheter balloon dilatation on patients with dysphagia caused by cricopharyngeal achalasia after stroke.Methods Thirty-two stroke survivors with cricopharyngeal achalasia were randomly divided into a control group and a treatment group,each of 16.Both groups were given routine dysphagia rehabilitation training,but the treatment group was additionally given peroral balloon dilatation therapy six times a week for 2 weeks.Both groups were given swallowing function evaluations and videofluoroscopic swallowing examinations (VFSS) before and after the treatment.Results After the treatment,14 of the 16 patients in the treatment group demonstrated improved swallowing,significantly better than the control group,where only 9 patients had improved.The VFSS showed dysphagia to have been relieved in both groups,but significantly more in the treatment group.Transit duration in the pharnx was significantly shortened from 0.28 s to 0.16 s in the treatment group,but no significant difference was tound in the control group.Conclusion Peroral catheter balloon dilatation is effective for relieving cricopharyngeal achalasia after stroke.

Objective To explore clinical features and antimicrobial resistance of Klebsiella pneumoniae (K.pneumoniae) lower respiratory tract infection(LRTI) in children.Methods Clinical data of 107 children with K.pneumoniae LRTI confirmed by sputum culture from January to December 2015 were analyzed retrospectively.Results 62.62% of children with LRTI were aged less than 6 months and 64.49% episodes occurred in autumn and winter.All cases had cough and 39 had fever, the main complications were type I respiratory failure, type Ⅱ respiratory failure, cardiac insufficiency, and electrolyte disturbance, 39 cases(36.45%) had complications involving two systems, 5 cases(4.67%)had complications involving three systems,47 cases (43.93%) met the diagnostic criteria of severe pneumonia.43 cases (40.19%) had primary underlying diseases, the major were congenital heart disease, preterm and low birth weight, and malnutrition.Children with imipenem-resistant bacteria infection were more prone to develop extrapulmonary complications than those with non-resistant pathogenic infection.The resistance rate of K.pneumoniae to amikacin was the lowest(9.35%).90 cases were recovered and markedly effective, 11 cases were effective, 4 cases were not healed and voluntarily discharged from hospital, and 2 cases died.Conclusion Children aged less than 6 months and with underlying diseases are prone to develop LRTI, and complications are more.

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique.Methods Normal pelvic CT scans of 52 adults (27 males and 25 females;aged from 18 to 74 years,averaging 47.2 years) were obtained to create pelvic 3D models.After the acetabulum was thickened by 5 mm,the width (d) of the safe zone for placement of the medial iliosciatic plate was measured.After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured,the ratio (r) of d/w was calculated.The recombined innominatum model was cut through the center of the acetabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch.The cross-section was marked as M.In males,4 points at distances of 1.0 cm,1.5 cm,2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked.At the 4 points,the angulations (∠ a,∠b,∠ c and ∠ d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M.In females,3 points at distances of 1.0 cm,1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a,∠b,and ∠c were measured.The differences in the above parameters were compared between males and females.Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56 ±2.44 mm in males and 24.36 ±2.47 mm in females;the ratio (r) was 0.61 ± 0.07 in males and 0.54 ± 0.05 in females.The safe angulations for screw placement in males,∠ a,∠b,∠cand ∠d,were 88.04°±3.18°,77.81°±3.85°,68.01°±4.11°and56.81°±4.81° while those in females,∠a,∠b and ∠c,were 91.29°±4.52°,76.23°±3.82° and 62.79°±3.51°,respectively.There were statistically significant differences between males and females in values of d,r,∠ a and ∠ c (P ＜ 0.05).Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate,the differences between males and females should be taken into account.Besides,specific safe angles should be chosen according to the position of the plate.

ObjectiveTo observe the clinical effect of interventional embolization on hepatocellular carcinoma(HCC) with hepatic arterioportal shunts(APS) ,in the hope of improving patients' survival quality and time. MethodsTwenty-nine patients with HCC patients and APS after a successful PVA,steel coils embolization, all patients were given routine TACE therapy. The changes of gastrointestinal bleeding,ascites,diarrhea and aminotransferase were analyzed retrospectively. ResultsNineteen cases got successful embolization in the first time[achievement ratio 65.5％(19/29)]; 3 cases got recurrence after embolization [patency ratio 10.3％(3/29)],7 cases appeared new APS[incidence ratio 24.1％(7/29),5 cases were embolized 2 times, 2 cases were embolized 3 times]. The effective rate of gastrointestinal bleeding,diarrhoea,aacites were 91.7％ (11/12), 84.6％ ( 11/13 ), 83.3％ ( 15/18 ) respectively, which had significant difference between preoperative and postoperative condition. The survival rate of 3 months,6 months, 1 year,and 2 years after operation were 96.6％ (28/29),89.7％ (26/29),65.5％ (19/29),34.5％ (10/29). Conclusion Interventional therapy is a safe and effective treatment to HCC with APS.

This study was designed to investigate the impact of ultra-filtration extract mixture from Astragals mongholicus (UEMAM) o radiosensitivity of H22 ascitic tumor in mice to 12C6+ ions radiation. The H22 ascitic tumor model was established in mice by intraperitoneal injection of 0.2 mL H22 ascitic cells. The animals were subsequently divided into 4 groups randomly, treated with normal saline, UEMAM, heavy ion beam radiotherapy and UEMAM plus heavy ion beam radiotherapy, respectively. The body weights, abdomen circumference of the mice were measured and the mouse behavior was monitored every day; survival time was recorded to evaluate life extension effect; flow cytometry technique was used to detect H22 cell apoptosis and cell cycle; protein levels of p53, Bax, Bcl-2 and cleaved Caspase-3 were analyzed by Western blot; the single cell gel electrophoresis was used to detect the level of deoxyribonucleic acid damage (DNA damage). The results suggest that UEMAM significantly increased survival time, and decreased body weights and abdomen circumference over the saline control group. The treatment increased cell apoptosis, cycle arrest and DNA damage compared to the saline control group. UEMAM significantly enhanced the therapeutic effect of heavy ion beam radiation in survival time, and decreased body weights and abdomen circumference in the tumor-baring mice. The combination increased cell apoptosis, cycle arrest and DNA damage compared to the radiotherapy group. The results of Western blot suggest that the treatment significantly enhanced p53-induced apoptotic signals. The experiment discovered that UEMAM could improve radiosensitivity of H22 ascitic tumor through activation of p53-mediated apoptotic signal pathway.

Objective To determine the sera levels of anti-nuclear matrix protein (NXP)-2 autoantibodies and their clinical associations in patients with idiopathic inflammatory myopathies (IIM).Methods Sera from 198 Chinese patients with IIM including 15 juvenile dermatomyositis (JDM),133 dermatomyositis (DM) and 50 polymyositis (PM),other connective tissue diseases (CTDs) including 70 systemic lupus erythematosus,60 rheumatoid arthritis,15 systemic sclerosis,46 primary Sj(o)gren syndrome,10 mixed connective tissue disease and 60 healthy controls were measured by enzyme linked immunosorbent assay.The anti-NXP-2 antibodies were detected.The positive sera were further examined by immunoprecipitation assays.Statistical analyses were performed using student's t test or Mann-Wittney U test and x2 test.Results The positive rate of sera anti-NXP-2 autoantibodies in patients with IIM was 5.1％ (10/198),20.0％ (3/15) in patients with JDM,3.7％ (5/133) in patients with dermatomyositis,and 4.0％(2/50) in patients with polym-yositis.There was statistical significant difference in anti-NXP-2-positive rates between JDM,DM and PM (P＜0.05).However,the autoantibody did not present in patients with other CTDs as well as healthy controls.The anti-NXP-2-positive patients had significantly younger age [(33±20) vs (45±17) years old (t=-2.09,P＜0.05)] and higher incidence of calcinosis [30.0％(3/10) vs 2.6％(15/188)] compared with the anti-NXP-2-negativepatients (x2=0.7,P＜0.01).There were no statistical difference between the two groups in gender,disease duration,arthritis,rash,dysphagia,myasthenia,conccurrence with interstitial lung disease and cancer.In follow-up assessment,among the three JDM patients with anti-NXP-2 autoantibodies,one of them who died 10 months later had increased serum level of anti-NXP-2 autoantibody,extensive subcutaneous calcinosis,severe myasthenia and rapid progress.Conclusion This is the first report of the serum levels of anti-NXP-2 antibodies in Chinese patients with IIM and other CTDs.We find that anti-NXP-2 antibodies only exist in patients with IIM and are associated with early and calcinosis.