Over 170 million people worldwide are infected with hepatitis C virus (HCV), a major cause of liver diseases. Current interferon-based therapy is of limited efficacy and has significant side effects and more effective and better tolerated therapies are urgently needed. HCV is a positive, single-stranded RNA virus with a 9.6 kb genome that encodes ten viral proteins. Among them, the NS3 protease and the NSSB polymerase are essential for viral replication and have been the main focus of drug discovery efforts. Aided by structure-based drug design,potent and specific inhibitors of NS3 and NSSB have been identified, some of which are in late stage clinical trials and may significantly improve current HCV treatment. Inhibitors of other viral targets such as NSSA are also being pursued. However, HCV is an RNA virus characterized by high replication and mutation rates and consequently, resistance emerges quickly in patients treated with specific antivirals as monotherapy. A complementary approach is to target host factors such as cyclophilins that are also essential for viral replication and may present a higher genetic barrier to resistance. Combinations of these inhibitors of different mechanism are likely to become the essential components of future HCV therapies in order to maximize antiviral efficacy and prevent the emergence of resistance.

Objective To analyze the role of Clinical Pathway in controlling hospitalization cost and to provide the basis for reasonable control of medical cost.Methods The data of patients undergoing unilateral and bilateral total hip replacement in 2005 and 2010 in Arthritis Clinical and Research Center of Peking University People's Hospital were retrospectively analyzed.There were 70 unilateral and 14 bilateral total hip replacement cases in 2005,whereas the number of those in 2010 was 173 and 46 respectively.All charges were assigned to 1 of 9 categories:hospital room,nursing,radiology and laboratory,prosthesis,blood transfusion,surgery,pharmacy,treatment,diagnosis.We compared the total costs and cost of each category between 2005 and 2010.Results There was no statistical significant difference between 2005 and 2010 in terms of age,gender distribution,pri mary disease and type of prosthesis.The total costs for unilateral and bilatcral total hip replacement was 40 852.72 yuan and 73 020.28 yuan in 2010,respectively.They were both significantly lower than those of 2005 (49 371.35 yuan and 80 962.61 yuan respectively).The charge for each category of total hip replacement in 2010 was 585.88,145.38,2 885.47,3 222.32,1 776.15,3 805.29,132.79,4 100.88,and 3 0953.75 yuan.Compared with 2005,each category of charge dropped in 2010,especially the cost of surgery,treatment,diagnosis and hospital room,which decreased by 35.11％,31.76％,31.40％ and 30.67％ respectively.The tendency of each category change in charge of unilateral and bilateral total hip replacement was similar to the overall costs.Conclusion The total costs for total hip replacement (unilateral and bilateral total hip replacement) in 2010 were lower than those of 2005,which might be the result of adopting Clinical Pathway since 2010.Nevertheless,the prosthesis cost accounted for a large proportion in both years.Therefore,controlling the prosthesis cost might be an effective way to reduce medical costs for total hip replacement.

Arrhythmias, Cardiac ; etiology ; Birth Weight ; Electrocardiography ; Female ; Humans ; Hypocalcemia ; complications ; Infant, Newborn ; Male

Objective To compare the development of postoperative cognitive dysfunction ( POCD) under total inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-77 yr, weighing 43-78 kg, with preoperative Mini?Mental State Examination ( MMSE) score≥25, scheduled for elective surgery for oral and maxillofacial carcinoma, were divided into 2 groups ( n=30 each) using a random number table: total inhalation anesthesia with sevoflurane group ( group S) and total intravenous anesthesia with propofol?based anesthesia group ( group P ) . The patients were tracheally intuba?ted under local infiltration anesthesia. In group S, anesthesia was induced with inhalation of 8% sevoflurane (oxygen flow rate 8 L∕min), rocuronium 0?9 mg∕kg was injected intravenously when the bispectral index ( BIS) value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with inhalation of sevoflurane with the end?tidal concentration of 2%-3%. In group P , anesthesia was induced with iv propofol 2 mg∕kg and sufentanil 0?3μg∕kg, rocuronium 0?9 mg∕kg was injected intravenously when the BIS value reached 45, and the patients were mechanically ventilated; anesthesia was maintained with target?controlled infusion of propofol ( target plasma concentration 3-5μg∕ml) and remifentanil ( target plas?ma concentration 3-5 ng∕ml). In both groups, intermittent iv boluses of cisatracurium 0?04 mg∕kg were given to maintain muscle relaxation during operation, and BIS value was maintained at 40-60 during opera?tion. Before intubation ( T1 ) , immediately after onset of intubation ( T2 ) , at 10 min of intubation ( T3 ) , immediately after begninning of skin incision ( T4 ) , while operating on the base of tongue or sawing the low?er jaw ( T5 ) , at the end of operation ( T6 ) and on the morning of the postoperative day 1 ( T7 ) , blood sam?ples from the elbow vein were collected for determination of plasma norepinephrine and epinephrine concen?trations by high?performance liquid chromatography and electrochemistry. At T1?7 and on the morning of the postoperative day 3 ( T8 ) , blood samples from the elbow vein were collected for measurement of plasma cor?tisol concentrations by radioimmunoassay. MMSE was used to assess the cognitive function on the postopera?tive day 7. MMSE score< 24 was defined as POCD, and the occurrence of POCD was recorded. Results Compared with group S, the plasma concentrations of norepinephrine and epinephrine were significantly de?creased at T4 and T5 , the plasma cortisol concentration was significantly decreased at T4?7 ( P<0?05) , and no significant change was found in the incidence of POCD on the postoperative day 7 in group P ( P>0?05) . Conclusion Although the probability of the development of POCD is low when the two anesthetic methods are used, total intravenous anesthesia with propofol?based anesthesia induces a marked decrease in periop?erative stress responses when compared with total inhalation anesthesia with sevoflurane.

In recent years many reports on the progress of mammary tumors treated by traditional Chinese medicine ( TCM) have appeared in the literature.In this article, progress of clinical and experimental study between human and canine mammary tumors was compared.Ways and methods of how TCM treat mammary tumors were exhibited such as Chinese medicinal formulae, herbal extracts and active ingredients.Meanwhile, mechanisms of TCM treating mammary tumors were pointed out.The purpose of this article is to provide idea about TCM clinical therapy methods for canine mammary tumors, and to provide research foundation and important models for study of human mammary tumors.

Objective To explore the feasibility of laparoscopic common bile duct exploration without T-tube drainage.Methods A to-tal of 37 patients who were addmitted into our hospital from May 2014 to August 2015 with common bile duct stones were analyzed.Among these patients,22 cases were given T-tube drainage while the other 15 cases were not.The operation time,hospitalization expenses,anal ex-haust time,postoperative hospitalization time,bile leakage rate and the satisfaction of patients after surgery in the two groups were observed. Results In the non-T-tube group,the anal exhaust time was (1.41 ±0.82)d and the hospitalization time was(4.82 ±1.61)d,which were lower than(3.81 ±1.09 )d and (11.17 ±1.19 )d respectively in the T-tube group,and the differences were statistically significant (P <0.05).The number of bile leakage (0%)in the non-T-tube group was also significantly lower than 31.82% in the T-tube group (P <0.05).The satisfaction rate of patients in the non-T-tube group(100%)was significantly higher than that in T-tube group (50%),and the difference was statistically significant(P <0.05).Conclusion The laparoscopic common bile duct exploration without T-tube drainage is feasible and it can be popularized in clinic.

OBJECTIVE:To investigate the clinical efficacy and safety of recombinant human epidermal growth factor(rhEGF) combined with lipoic acid in the treatment of diabetic foot. METHODS:A total of 68 patients with diabetic foot were randomly divid-ed into observation group and control group with 34 cases in each group. Both groups were given conventional therapy and Lipolic acid injection 0.6 ml added into Sodium chloride injection 250 ml. ivgtt(protecting form light),qd;observation group was additionally giv-en rhEGF for external use 1 ml and vaseline on the wounds,gauze dressing,qd. Treatment course of 2 groups lasted for 7 d. Clinical efficacy,ulcer area,the expression of Bcl-2 and Bax were compared between 2 groups as well as the occurrence of ADR. RESULTS:The total effective rate of observation group(94.1%)was significantly higher than that of control group(67.6%),with statistical sig-nificance (P<0.05). Before treatment,there was no statistical significance in ulcer area,the levels of Bcl-2 and Bax between 2 groups(P>0.05). After treatment,ulcer area decreased significantly, the level of Bcl-2 increased significantly in 2 groups,while the level of Bax decreased significantly;the improvement of observation group was more significant than that of control group,with statis-tical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLU-SIONS:rhEGF combined with lipoic acid is effective for diabetic foot with good safety.

Air ; analysis ; Chromatography, Gas ; methods ; Ketones ; analysis ; Workplace

Objective To examine the effect of donepezil on cognitive function of Alzheimer's disease from a naturalistic observation in memory clinic.Methods From the subject pool in memory clinic,thirteen patients with mild to moderate Alzheimer's disease(meeting NINCDS-ADRDA criteria of probable AD)were enrolled in the naturalistic observation.Donepezil with dosage of 5 mg daily Was administered.Cognitive Ability Screening Instrument (CASI)Was used to assess the cognitive function,and was administered at baseline,3 and 6 months after treatment with donepezil.Resuits After 6-month treatment with donepezil,the change of score of verbal fluency from baseline Was significant[(4.3±3.1)vs(6.2±2.7),P＜0.05].There was a trend that constructional praxis was also improved after 6-month treatment(P=0.06).The change of scores of other cognitive domains remained the sanle(P＞0.05).Conclusion In the naturalistic observation at memory chnic,donepezil may improve verbal fluency of AD patients,and keep most cognitive function stable.

BACKGROUND:Basic fibroblast growth factor is a pluripotent cytokine that can promote the proliferation of mesodermal and neuroectodermal cells.
OBJECTIVE:To observe the effect of basic fibroblast growth factor in human periodontal ligament cells cultured in vitro.
METHODS:Human periodontal ligament cells at passage 5 were inoculated into the 96-wel plates at the density of 1×108/L, and were randomly divided into four groups. The cells were cultured inα-MEM containing 15%fetal bovine serum and 0, 1, 10, 100μg/L basic fibroblast growth factor, respectively. At 1, 3, 5, 7 days of the culture, the cellproliferation was determined, and the activity of alkaline phosphates was detected at 1 and 7 days.
RESULTS AND CONCLUSION:There were significant differences in the proliferation of human periodontal ligament cells among the four groups (F=6.586, P=0.024). As the increase of the basic fibroblast growth factor concentrations, the absorbance value was gradual y increased and reached the peak in 100μg/L basic fibroblast growth factor group (P<0.05). The alkaline phosphatase activity in basic fibroblast growth factor groups was lower than that of the control group (P=0.000), the higher the concentration was, the lower activity was (P<0.05). Results show that basic fibroblast growth factor can promote the proliferation of human periodontal ligament cells and inhibit the activity of alkaline phosphatase, and the effect is concentration-dependent.