Taking the integrated medical security mode of urban and rural residents in Zhangiang as research object, use the methodology of analyzing existing data to disclose Zhanjiang mode’ s starting background and its main practices. With the basic characteristics and developing power source as well as the key point for future development discussed, important experiences of the mode will provide new ideas to promote medical security system reform in China.

Symptomatology and medical history taking are the focuses of diagnostics study. With the improvement of teaching and learning, students can basically master the standard process of clinical inquiry of chief complaints to family history efficiently. However, due to the lack of systematic learning of clinical diseases, it's difficult for most students to form a targeted, logical and speculative inquiry thinking pattern, so they are unlikely to write a medical history of present illness that reflects their thinking on disease inclusion and exclusion. In this study, we come up with the characteristics and defects of symptomatology teaching at present, and put forward a new idea of symptomatology teaching by introducing clinical manifestations of diseases and examples of inquiry.

OBJECTIVETo study the curative effect of wilsonii injecta on severe head injury (SHI).

METHODSA total of 120 patients with SHI were divided randomly into 2 groups, the patients treated with conventional methods as Group A (n=60) and the patients treated with wilsonii injecta as Group B (n=60). The changes of neural function indexes were evaluated with Glasgow Coma Scale (GCS) before treatment and with Glasgow Outcome Scale (GOS) after treatment, simultaneously, the parameters of hemorrheological indexes (HI), brain electrical activity map (BEAM) and transcranial Doppler sonography (TCD) were observed before and after treatment.

RESULTSIn Group B, the clinical GCS, the HI, the BEAM and the prognosis GOS were improved much more than those in Group A. And the TCD parameters in Group B decreased, which had significant difference compared with that in Group A (P<0.01).

CONCLUSIONSWilsonii injecta can rapidly improve the injured p ersons' conscious states, the abnormal BEAM and the surviving quality. It suggests that the improvement of the HI is related to the relief of the vasospasm of the arterial blood vessels in the brain, which may be one of the important mechanisms of wilsonii injecta in improving the prognosis.

Adult ; Brain Injuries ; diagnostic imaging ; drug therapy ; Brain Mapping ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Injury Severity Score ; Male ; Plant Extracts ; administration & dosage ; Probability ; Reference Values ; Treatment Outcome ; Ultrasonography, Doppler

With the aging of the global population and changes of the lifestyle, the number of patients with comorbid sarcopenic obesity and diabetes mellitus is increasing. The pathogenesis of the two diseases is closely related, and the coexistence of them may lead to more adverse outcomes. This article reviews the diagnostic criteria and epidemiology of sarcopenic obesity, evidence on its relationship with diabetes, and the management of comorbidities, aiming to provide insights for clinical practice.

Comparison of survival curves between two groups is an important part of disease prognosis study.Log-rank test is commonly used,but when the two curves' later intersecting opening is too large,the proportion of assumptions is not established,thus the Log-rank test is ineffective.We introduces five statistical tests to compare two survival curves at a fixed time points:classic method,logarithmic transformation,cloglog transformation,arcsine transformation and logit transformation.Through the study we found that if the overall survival curves are difficult to compare between groups tested with Log-rank test method or Two-stage test method,the fixed time point test can effectively determine whether there was significant difference in survival rate at a fixed time point.Among the five fixed time point tests,cloglog transformation could give more precise result.

OBJECTIVE: To explore the clinical and genetic characteristics of a patient with 17-hydroxylase/17,20-lyase deficiency. METHODS: The patient was infertile without contraception. Laboratory examination showed her chromosomal karyotype to be 46, XX. DNA sequencing was performed to detect variants of CYP17A1 gene in the patient and her family members. RESULTS: Sanger sequencing revealed that the patient has carried homozygous variant c.1486C>T in the exon 8 of the CYP17A1 gene, which resulted in substitution of arginine by cysteine (p.Arg496Cys). Her family members were all heterozygotes for the same variant. CONCLUSION Homozygous variant of the CYP17A1 gene c.1486C>T probably underlay the 17-hydroxylase deficiency in this patient. Above finding has enabled accurate genetic counseling and prenatal diagnosis for her family.

Objective To investigate the impact of the"micro-monovision"approach with ex-tended depth of focus(EDOF)intraocular lens on visual quality in elderly patients with senile cata-racts.Methods A retrospective analysis was conducted on the clinical data of elderly patients with senile cataracts treated from January 2020 to December 2023.Forty-six patients who received trifocal intraocular lens were randomly selected and included in trifocal group,while 53 patients who under-went the"micro-monovision"approach with EDOF intraocular lens were included in EDOF group.Preoperative and 3-month postoperative uncorrected distance visual acuity(UCDVA),uncorrected in-termediate visual acuity(UCIVA),uncorrected near visual acuity(UCNVA)and visual function in-dex(VF-14)scores were recorded for both groups.Defocus,contrast sensitivity(CS)and spectacle independence were also evaluated at 3 months postoperatively.Results At 3 months postoperatively,both groups showed significantly higher UCDVA,UCIVA,UCNVA and VF-14 scores compared to preoperative levels;the UCIVA,UCNVA and VF-14 scores in the EDOF group were significantly higher than those in the trifocal group(P＜0.05).At 3 months postoperatively,both groups a-chieved visual acuity greater than 0.35 at refractive errors from-4.0 D to+2.0 D.The EDOF group achieved visual acuity greater than 0.9 at refractive errors from-1.5 D to+1.5 D,and greater than 0.8 at refractive errors from-2.5 D to-1.5 D.Within the refractive range of 0.5 D to+2.0 D,the EDOF group had better visual acuity than the trifocal group,with more stable visual acuityin the range of-2.0 D to 1.0 D.Under photopic and mesopic conditions,the EDOF group demonstrated significantly higher CS values at different spatial frequencies(3,6,12,18 degree per week)compared to the trifocal group(P＜0.05).Conclusion In elderly patients with senile cat-aracts,the"micro-monovision"approach with EDOF intraocular lens implantation provides superior visual quality andintermediate and near vision compared to trifocal intraocular lens.

Objective To investigate the impact of the"micro-monovision"approach with ex-tended depth of focus(EDOF)intraocular lens on visual quality in elderly patients with senile cata-racts.Methods A retrospective analysis was conducted on the clinical data of elderly patients with senile cataracts treated from January 2020 to December 2023.Forty-six patients who received trifocal intraocular lens were randomly selected and included in trifocal group,while 53 patients who under-went the"micro-monovision"approach with EDOF intraocular lens were included in EDOF group.Preoperative and 3-month postoperative uncorrected distance visual acuity(UCDVA),uncorrected in-termediate visual acuity(UCIVA),uncorrected near visual acuity(UCNVA)and visual function in-dex(VF-14)scores were recorded for both groups.Defocus,contrast sensitivity(CS)and spectacle independence were also evaluated at 3 months postoperatively.Results At 3 months postoperatively,both groups showed significantly higher UCDVA,UCIVA,UCNVA and VF-14 scores compared to preoperative levels;the UCIVA,UCNVA and VF-14 scores in the EDOF group were significantly higher than those in the trifocal group(P＜0.05).At 3 months postoperatively,both groups a-chieved visual acuity greater than 0.35 at refractive errors from-4.0 D to+2.0 D.The EDOF group achieved visual acuity greater than 0.9 at refractive errors from-1.5 D to+1.5 D,and greater than 0.8 at refractive errors from-2.5 D to-1.5 D.Within the refractive range of 0.5 D to+2.0 D,the EDOF group had better visual acuity than the trifocal group,with more stable visual acuityin the range of-2.0 D to 1.0 D.Under photopic and mesopic conditions,the EDOF group demonstrated significantly higher CS values at different spatial frequencies(3,6,12,18 degree per week)compared to the trifocal group(P＜0.05).Conclusion In elderly patients with senile cat-aracts,the"micro-monovision"approach with EDOF intraocular lens implantation provides superior visual quality andintermediate and near vision compared to trifocal intraocular lens.

It is a new attempt to interpret the essence of doctor-patient relationship and reveal the mechanism of doctor-patient conflict by using game theory. According to James Cass’s philosophy theory of finite and infinite games, this paper applies the four elements of finite and infinite games: "goal-actor-rule-boundary". Combined with the four elements of game theory, the doctor-patient relationship was systematically interpreted, and the evolution model of finite games and infinite games was constructed. This paper held that the essence of doctor-patient relationship is an infinite game in theory, the nature of doctor-patient relationship is a finite game in reality, and doctor-patient conflict is the result of the evolution of the finite game of doctor-patient relationship. Based on the finite game evolution model, this paper analyzed the causes of doctor-patient conflict in the specific narrative of doctor-patient conflict, and pointed out that the doctor-patient relationship can only be resolved by changing their "game view", so as to achieve the transcendence of the doctor-patient relationship from finite game to infinite game.

The chromosome 17q21.31 inversion is a 900-kb common structural polymorphism found primarily in European population. Although the genetic flux within inversion region was assumed to be considerable suppressed, it is still unclear about the details of genetic exchange between the H1 (non-inverted sequence) and H2 (inverted sequence)haplotypes of this inversion. Here we describe a refined map of genetic exchanges between pairs of gene arrangements within the 17q21.31 region. Using HapMap phase Ⅱ data of 1,546 single nucleotide polymorphisms, we successfully deduced 96 H1 and 24 H2 haplotypes in European samples by neighbor-joining tree reconstruction. Furthermore, we identified 15 and 26 candidate tracts with reciprocal and non-reciprocal genetic exchanges, respectively.In all 15 regions harboring reciprocal exchange, haplotypes reconstructed by clone sequencing did not support these exchange events, suggesting that such signals of exchange between two sister chromosomes in certain heterozygous individual were caused by phasing error regions. On the other hand, the finished clone sequencing across 4 of 26 tracts with non-reciprocal genetic flux confirmed that this kind of genetic exchange was caused by gene conversion.In summary, as crossover between pairs of gene arrangements had been considerably suppressed, gene conversion might be the most important mechanism for genetic exchange at 17q21.31.