1.The Main Problems and Suggestions on Medical and Health System Reform in China
Chinese Health Economics 2013;(12):72-73
Objective: Through summarizing the main problems and challenges faced in the medical health system reform in China , suggestions are given: the government needs to erhance the health investment and play the role of market mechanism , make the use of electionical information technique, further change the community system of implementing medicine community system, implement the medical service supervision system.
2.The application and progress of contrast-enhanced ultrasound in rheumatoid arthritis
Run WANG ; Ligang CUI ; Ling JIANG
China Medical Equipment 2017;14(3):151-154
The contrast-enhanced ultrasound(CEUS) been equipped in most commercial ultrasound system, is a newer technology which could evaluate the blood flow of soft tissue. It could not only make qualitative and semi-quantitative analysis, but also the quantitative analysis could be acquired. At present, it has been applied on cardiovascular imaging and tumor perfusion assessment in clinical. The clinical usage of CEUS in rheumatoid arthritis(RA) was summarized in the paper which included its common clinical type, dose of ultrasound contrast agent and various method of usage described. Besides, the paper not only introduced the evaluation of the synovitis in RA with the parameters resulted from CEUS, but also illuminated the progress of the researches. Through compared these parameters, indexes and methods, this summary revealed the limitation and application value of CEUS to RA, and more exploration need be done in future.
3.Expression of peripheral blood CD54,CD106 and CD62p in patients with multi-infarct dementia
Jie WU ; Jinzhi YIN ; Baichun LIU ; Ping DING ; Ligang JIANG
Chinese Journal of Immunology 2001;0(07):-
Objective:To investigate the expression of peripheral blood CD54,CD106,CD62p in patients with multi-infarct dementia.Methods:The levels of serum CD54,CD106,CD62P of 82 patients with multi-infarct dementia were measured with ELISA,and were compared with 23 normal controls.Results:The levels of serum CD54,CD106,CD62p in patients with multi-infarct dementia(CD54:469?76.33 ng/ml,CD106:1 103.3?98.96 ng/ml,CD62p:18.22?8.90 ng/ml) were higher than those in normal controls(CD54:196?45.91 ng/ml,CD106:601.0?76.30 ng/ml,CD62p:6.70?3.30 ng/ml). There were significant difference between the two groups.The levels of serum CD54,CD106,CD62p were positively correlated with the degree of dmentia.Conclusion:CD54,CD106,CD62p are closely related to the development of MID and play an important role in pathlogical procedure of cerebral damage after MID.The levels of CD54,CD106,CD62p in patients with MID implies the degree of their neurological function deficit scores and might be an important indicator to observe the changes of disease.
4.Investigation of “practice teaching methods ”for musculoskeletal ultrasound imaging
Ling JIANG ; Ligang CUI ; Wen CHEN ; Bo ZHAO ; Jie JIANG ; Zhiqiang LI
Basic & Clinical Medicine 2017;37(1):142-144
Objective To discuss the effect of “practice teaching methods ” in musculoskeletal ultrasound diagnosis training process .Methods Thirty refresher doctors for a month with the method training .The effect training is evaluated by objective exam and questionnaire survey .Results Thirty refresher doctors received tests before and after the training .Test results showed that the accuracy after the training was significantly higher than that of before ( P<0.05 ) .Refresher doctors survey about satisfaction of the training method showed that whole satisfaction is 100%, in which 70%were very satisfied , 30%were satisfied .The self-assessment results for the improvement of the level of diagnosis musculoskeletal ultrasound showed that 45%doctors are very satisfied ,40%doctors are satis-fied, and 15%is not satisfied .Conclusions With the implementation of “teaching by practice” method, refresher doctors could master the knowledge of musculoskeletal anatomy as soon as possible , and have the ability to diagnose common musculoskeletal diseases independently .
5.Sonographic fingdings of pectoralis major and its tears
Jie JIANG ; Ligang CUI ; Jinrui WANG ; Ling JIANG ; Zhiqiang LI ; Bo ZHAO
Journal of Peking University(Health Sciences) 2016;48(1):166-169
Objective:To investigate the normal sonographic anatomic characteristics of the pectoralis major and the clinical value of ultrasound in diagnosing the extent and location of the pectoralis major tears.Methods:High frequency transducer was used in scanning the pectoralis major.The ultrasono-graphic images of 40 normal pectoralis major were obtained from 20 healthy volunteers with both sides. Longitudinal and transversal views were performed and stored.The distal tendon was identified in the transverse plane coursing superficially to the long head of the biceps brachii tendon inferior to the level of the subscapularis tendon.Eighteen cases of pectoralis major tears were analyzed retrospectively,with MRI,surgical and ultrasound follow-up results correlation respectively.Results:High-frequency ultra-sound could clearly show the anatomic orientation of the normal pectoralis major.The fibers converge was like a fan into three laminae that twisted upon each other at 90°before coalescing into a single tendon of insertion.In the study,1 8 patients of pectoralis major muscle tears [average age:(37.2 ±1 5.6)years] sustained injuries during weightlifting,basketball and impact.Three of the eighteen patients had MRI re-sults;nine had surgical correlation;six were followed by ultrasound.Eleven were injured on the left side,and 7 on the right side.Seven were involved in the distal tendon (1 in sternal head,2 in clavicular head,4 in both sternal and clavicular head),five were involved the musculotendinous junction,6 were involved muscle belly.Twelve cases were partial-thickness petoralis major tears(4 in the distal tendon, four in the muscle tendon junction,4 in the muscle belly),with the partial fiber intact,echogenicity de-creased and the internal structure disordered;6 cases (3 in the distal tendon,1 in the muscle tendon junction,2 in pectoralis major muscle belly)were completely disrupted,with fiber fracture and retrac-tion,accompanied with or without hematoma formation.Conclusion:High-frequency ultrasound can clearly show the anatomic structure of the pectoralis major.Ultrasonography can diagnose the pectoralis major tears with the extent and location of injuries,and can be used to help the clinical treatment.
6.Concentration changes of serum neuron-specific enolase and S100β protein in response to edaravone in patients with moderate and severe brain injury
Liang LIU ; Huajin YIN ; Yang MING ; Luotong LIU ; Ling ZHANG ; Yong JIANG ; Ligang CHEN
Chinese Journal of Trauma 2011;27(7):583-587
Objective To evaluate the effect of edaravone on moderate and severe brain injury patients by observing the change of the serum neuron-specific enolase ( NSE) and S100β protein. Methods A total of 90 patients with acute moderate and severe brain injury were selected and randomly divided into three groups, ie, control group (Group A), postoperative edaravone treatment group (Group B) and preoperative edaravone treatment group (Group C), 30 patients per group. In the meantime, 20 normal persons were set as the healthy control group. The concentrations of serum NSE and S100β protein of each group was measured by using the enzyme-linked immunosorbent assay ( ELISA) on admission and at days 1,3,5 and 7 after operation. Results The serum NSE and S100β protein levels in the Group A, B and C was higher than that in the healthy group on admission and at days 1,3,5 and 7 postoperatively and reached the peak at day 1 after operation (P <0.05). The level of serum NSE and S100β protein in the Group C was lower than that in the healthy group, Group A and Group B at day 1 postoperatively (P<0.05), with no statistical difference between Group B and Group A at day 1 postoperatively (P >0.05). The serum NSE and S100β protein levels in the Group C was lower than that in the Group A at days 3, 5 and 7 postoperatively (P <0.05). The serum NSE and S100β protein levels in the Group C with severe brain injury was lower than that in the Group B at days 3, 5 and 7 postoperatively (P < 0.05), but there was no statistical difference in moderate injury group between Croup C and Group B. The serum NSE and S100β levels in the Group B was lower than that in the Group A at days 3, 5 and 7 postoperatively ( P < 0. 05). Conclusions Edaravone can effectively reduce the serum NSE and S100β levels in the moderate and severe brain injury patients after operation. The earlier use of edaravone may beget the more significant effect, especially in patients with severe brain injury. The application of edaravone before operation can more effectively reduce the concentration of serum NSE and S100β protein.
7.Radiofrequency Catheter Ablation of Left Bundle Branch Guided by Left Bundle Potential, X-ray Image With EnSiteNavX System in Experimental Canine Model
Ligang DING ; Chi CAI ; Wei HUA ; Xu LIU ; Gang CHEN ; Yong JIANG ; Yue TANG ; Shu ZHANG
Chinese Circulation Journal 2015;(1):72-75
Objective:To explore the efifcacy and safety for radiofrequency catheter ablation (RFCA) of left bundle branch guided by left bundle potential (LBP), X-ray image with EnSiteNavX System in canine model.
Methods:The RFCA of left bundle branch was conducted in 13 dogs. A mapping catheter was positioned in right atrium to record right-sided His-bundle (R-His) potential, and an ablation catheter via right femoral artery was retrograded to left ventriclefor LBP mapping and ablation. Meanwhile, EnSiteNavX System was used to identify R-His, L-His and LBP at the same time. The potential characteristics in dogs with successful ablation were observed, the PR interval, QRS shape and time limit, AH interval, HV interval, the A/V electro-gram ratio in ablationcatheter at before and after ablation were recorded. The procedural time and X-ray exposure time between LBP with X-ray image method and LBP, X-ray image with EnSiteNavX System method were compared.
Results: There were 9/13 dogs received successful left bundle branch ablation, 3 dogs failed and 1 suffered from complete A-V block. At the successful ablation target site, the LBP-V was (17.8 ± 2.6) ms with the range of (13-21) ms, and the A/V electro-gram ratio<1/10. The procedural time and X-ray expose time were signiifcantly decreased in LBP, X-ray image with EnSiteNavX System method than those in LBP with X-ray image method P=0.007 and P<0.001.
Conclusion:Under the LBP, X-ray image with EnSiteNavX System guidance method, left bundle branch could be safely and effectively ablated to establish left bundle branch block (LBBB) model in experimental canine.
8.Clinical value of dynamic noninvasive monitoring technique after operation for traumatic brain injury
Xinghu QIN ; Yitian CHEN ; Hong XU ; Liang LIU ; Yuqiu CHEN ; Ligang CHEN ; Yong JIANG
Chinese Journal of Trauma 2017;33(8):719-723
Objective To investigate the clinical value of noninvasive monitoring technique in intracranial hemorrhage and secondary brain edema after operation for traumatic brain injury (TBI).Methods A retrospective case-series analysis was done on 196 TBI patients (128 males and 68 females,aged 18-60 years old,median age 36.5 years old) admitted from January 2014 to December 2015 and treated surgically with simultaneous implantation of intracranial pressure (ICP) probe.There were 89 patients with Glasgow coma score (GCS) 6-8 points and 107 with GCS 9-12 points.The values of ICP were recorded.The changes of cerebral electrical impedance (CEI) were monitored in all patients through the BORN-BE noninvasive monitor.Results The disturbance factor of the BORN-BE noninvasive monitor in brain edema in the cerebral stage exhibited a strongly positive correlation with ICP (R =0.954,R2 =0.910,P < 0.05).All the rebleeding occurred within 24 hours after operation in the study.The disturbance factor showed a significant reduction in the bleeding side,which exhibited a strongly negative correlation with the volume of cerebral hemorrhage (R =-0.982,R2 =0.964,P < 0.05).Conclusion After operation for TBI,the ICE changes from dynamic noninvasive monitor can reflect the severity of brain edema digitally,indicating that the postoperative rebleeding and its volume may play an important role in selection of optimal treatment.
9.Clinical analysis of 25 cases of Beh?et′s disease complicated with pulmonary hypertension
Hua ZHONG ; Wenjie ZHENG ; Ligang FANG ; Hong JIANG ; Lidan ZHAO ; Li WANG ; Xiaomei LENG ; Yong HOU ; Xiaofeng ZENG
Chinese Journal of General Practitioners 2016;15(10):770-774
Objective To understand the clinical features of Behcet′s Disease( BD) with pulmonary hypertension( PH) .Methods The etiology, clinical features, treatment and prognosis of 25 patients with Bahcet′s disease ( BD) complicated with pulmonary hypertension ( PH) admitted in Peking Union Medical College Hospital from January 2000 to August 2015 were retrospectively reviewed.Results Total 912 BD patients were hospitalized during the same period, among whom 25 cases were complicated with PH accounting for 3%.There were 15 males (60%) and 10 females (40%), with the mean age of (33 ±12) years (range 19 to 66 years).The median interval from the diagnosis of BD to the onset of PH was 1 year (range 0 to 40 years).The most common cause of PH was heart valve disease (n=10, 40%), followed by pulmonary arterial stenosis or occlusion (n=6, 24%), pulmonary arterial aneurysm with thrombus (n=1, 4%), pulmonary thrombosis (n=1, 4%), cardiomyopathy (n=1, 4%);there were no causes identified in 6 cases (24%).Pulmonary arterial pressures estimated by echocardiography were 40 to 117 mmHg (1 mmHg=0.133 kPa) with a mean pressure of (60 ±22) mmHg.When the PH developed, elevated erythrocyte sedimentation rate ( ESR ) and increased hypersensitive C-reactive protein ( hs-CRP ) were founded in 48% ( 11/23 ) and 82% ( 14/17 ) of patients, respectively.After treated with glucocorticoid (96%,24/25), immunosuppressive agents(92%, 23/25), anticoagulation or thrombolysis(36%,9/25) and specific targeted vasodilator(32%,8/25), the levels of ESR and hs-CRP declined in 91% (10/11) and 71%(10/14) of patients, respectively; and pulmonary arterial systolic pressure declined in 50% of cases (8/16).Among 9 patients followed for 2 to 96 months, 4 died, 1 aggravated, 2 kept stable and 1 improved.Conclusion PH is an uncommon complication in disease.Heart valve disease, pulmonary artery involvement are the major causes of PH.The therapeutic effect and prognosis are poor.
10.Early predictors of refractory epilepsy: a case-control study
Yanfang ZHANG ; Qing DI ; Nian YU ; Lingling WANG ; Ligang XU ; Weiwei JIANG ; Feng SUN ; Yong HU ; Lingying SU
Chinese Journal of Neurology 2011;44(10):666-669
ObjectiveTo identify the early predictors of refractory epilepsy (RE). MethodsAll 173 epileptic patients with correct diagnosis and reasonable treatment were enrolled. The 106 patients were classified as drug non-responsive epilepsy (DNR-EP). The remaining 63 patients were classified as drugresponsive epilepsy (DR-EP). With multiple logistic regression, the clinical characteristics between the two groups were compared to identify the early predictors of RE. ResultsMultiple logistic regression analysis demonstrated that more than 10 seizures before treatment (OR =4. 46, 95% CI 1.60-12. 40, P =0. 004),mental retardation at early time ( OR =19. 87, 95% CI 3. 60-109. 78, P =0. 001 ) and abnormal electroencephalogram(EEG) with epileptiform wave after treatment ( OR =7.57, 95% CI 2. 54-22. 56,P <0. 01 ) were independent predictors of RE.Response to initial therapy was a protective factor of RE (OR=0.05, 95% CI 0.018-0. 139, P<0.01). ConclusionPatients who have many seizures before treatment, mental retardation at the early time, epileptiform abnormality in EEG after treatment and who are resistant to initial therapy are likely to develop into refractory epilepsy.