Objective To analyze the impact of the declining balance rate in military hospitals during new healthcare reform.Methods A military medical expense model was established,the parameters of the model were changed and the impact of the declining balance rate was analyzed.Results and Conclusion Military hospitals have to face up to the negative influence caused by the declining balance rate,actively promote expenditure compensation mechanism reforms,increase funding,enhance supervision,and separate revenues from expenditures.

Objective To explore the application of a system dynamics(SD) model to military medical expenses in PLA hospitals.Methods According to relevant theories of SD, the study has selected some important variables and defined the primary function relations in order to establish a military medical expenses SD model.Results and Conclusion The SD model is suited to modeling the PLA medical expenses and can serve as a theoretical basis for the policy innovation of the PLA medical system.

Objective To investigate the changes of plasma soluble CD40 (sCD40) and soluble CD40L (sCD40L) in patients with chronic renal failure( CRF) and their potiential mechanisms in renal injury and immunodeficiency. Method From September to December 2006, 30 CRF patients without hemodialysis (CRF group) in department of Nephrology and 30 uremic patients receiving maintenance hemodialysis for more than 3 months ( HD group) in dialysis center in Beijing TongRen Hospital of Capital Medical University, were enrolled in this study. The normal control group consisted of 20 healthy volunteers who matched with study subjects for age and gender. The levels of plasma sCD40 and sCD40L were measured by the method of enzyme linked immunosorbent assay (ELISA). The relationship between sCD40, sCD40L and related factors were analyzed, and the influence of hemodialysis on sCD40 and sCD40L were observed. ANOVA and Pearson correlation analysis were used in statistical analysis. Results (1) The sCD40 levels in CRF group and HD group were significantly higher than those in control group(P ＜ 0.01). The sCD40 levels in HD group were also higher than those in CRF group(P ＜ 0.01). (2) The sCD40L levels in CRF group and HD group were significantly higher than those in control group (P ＜ 0.01). The sCD40L levels in HD group were slightly higher than those in CRF group, but without significant difference (P ＞ 0.05). (3) In CRF group, the sCD40 levels correlated positively with serum creatinine (Scr) and C-reactive protein(CRP) (r = 0.637,P ＜ 0.01,r = 0.551,P ＜ 0.05). The correlations between sCD40L and Scr and CRT were also seen (r = 0.553, P ＜ 0.05, r = 0.686,P ＜ 0.01), whereas the correlation with blood pressure,hemoglobin (Hb), platelet(PLT), white blood cell(WBC), serum albumin(Alb), glucose (Glu),blood urea nitrogen(Bun)and serum lipid was no seen (P ＞ 0.05). In HI) group, there were no correlations between sCD40,sCD40L and above parameters (P ＞ 0.05), there were also no correlations between sCD40, sCD40L and duration of the treatment by dialysis and dialysis adequacy(Kt/V) (P ＞ 0.05). (4)After one HD session, the post-HD levels of sCD40 were slightly higher than pre-HD levels, but without statistical difference ( P ＞ 0.05). The post-HD levels of sCD40L were obviously lower than pre-HD levels, with significant difference (P ＜ 0.01). Conclusions The levels of sCD40 and sCLMOL in CRF patients,particularly in HD patients, were significantly higher than those of controls, which may participate in pathogenesis of renal injury and immunodeficiency.

Objective To investigate the affecting mechanism of Jie Yu No.1 Decoction(JY),which was a complex prescription with the function of adjusting spleen and stomach,on the HPA-axis function of depression model rats.Methods60 SD rats were randomly divided into the normal,the model,the Amitriptyline and the JY decoction groups,with 15 each.Isolated-living condition and chronic mild unpredictable stress were applied suceessively to set up DEP rat model.Radiative immunotherapy was used to measure the content of hormone(CRH),somatostatin(SS) and Cortisol(CORT) in the blood plasma.The correlativity was Analyzed between SS,CRH and CORT to preliminary discuss the affecting mechanism of JY on the function of SS adjusting HPA-axis,and to clarify the antidepressant mechanism of the JY.ResultsThe correlation coefficient between SS and CRH was r=-0.5094,P=0.1972,t=1.4501.The result indicated that SS and CRH had the remarkable negatively correlation.The correlation coefficient between SS and CORT was r=0.010,P=0.9613,t=0.0244.The result indicated that SS and CORT had no remarkable correlation.ConclusionThe antidepressant mechanism of JY may be as that SS reduces CRH contents and reaches the adjustment of HPA-axis function in order to play its antidepressant effect.

Objective To assess response of rectal carcinoma to preoperative chemoradiation therapy(CRT)using DWI and tumor ADC values,and to investigate the value of ADC in predicting and monitoring therapeutic effect of CRT.Methods Twenty-six patients with primary rectal carcinoma undergoing preoperative CRT were recruited to the study.DWI was performed on a 1.5 T MR scanner in all patients at the time point of pre-therapy,the end of the 1st,2nd week of therapy and pre-operation,respectively.ADC values of the tumors were calculated on the workstation.Randomized block design was applied to analyze change in ADCs following treatment Results All patients were divided into T-downstaging group(n=12)and T-non-downstaging group(n=14).In T-downstaging group,the mean tumor ADC values were(1.10±0.13)×10~(-3),(1.32±0.19)×10~(-3),(1.35±0.13)×10~(-3),(1.32±1.00)×10~(-3) mm~2/s at the time point of pretreatment,week 1,week 2,pre-operation,respectively(F=16.420,P＜0.01).The mean tumor ADC value in T-non-downstaging had a slight increase from(1.16±0.16)×10~(-3) mm~2/s to(1.23±0.13)×10~(-3) mm~2/s at the time of week 1(P＞0.05).The ADC value in T-non-downstaging group continuously increased to(1.30±0.16)×10~(-3) mm~2/s at the end of the 2nd week of CRT(F=5.023,P＜0.01)and appeared statistical difference.The evolution of tumor ADC values in the two groups was significantly different.Early increases in tumor ADC were observed in T-downstaging group.Regarding the increase percentage of ADC value at 1st week as a diagnostic marker of tumor downstaging,when it was set as 11.6%,the sensitivity,specificity,positive predictive value and negative predictive value is 75.0%,78.6%,75.0% and 78.6% respectively,the area under curve(Az)was 0.774(95% confidence interval:0.583 to 0.964).Conclusions An early significant increase of mean tumor ADC value in rectal carcinoma has a potential to predict therapeutic effect of CRT.One week after beginning CRT is an early time point to monitor therapy efficacy.

Objective To evaluate the efficacy of different three-dimensional CTA methods on 64-slice sprial CT in the preoperative assessment of gastric arteries and their variations.Methods Sixty-six consecutive patients with gastric cancer who underwent 64-slice spiral CT examinations preoperatively were retrospectively studied.To get the STS-MIP images, the thickness of slab was adjusted according to the inner diameter of targeted blood vessels and their cross-layer distribution.After four weeks, the AVVR images of all cases was got by the auto-vessel technique.The demonstration rates and origins of the direct and indirect feeding arteries were analyzed on AVVR and STS-MIP.McNemar tests were used to compare the detection rates of gastric feeding arteries by STS-MIP and AVVR.The relationship between CT value and display rate of vessels was analyzed using independent-samples t test The variations of blood vessels were analyzed.Results The display rate of indirect feeding arteries were all 100% (66/66) by STS-MIP and AVVR.The display rates of left gastric artery (LGA) and right gastroepiploic artery (RGEA) were 98.5% (65/66), 100.0% (66/66) and 97.0% (64/66), 100.0% (66/66) by STS-MIP and AVVR respectively.The display rates of right gastric artery (RGA), left gastroepiploic artery (LGEA), short gastric artery (SGA) and posterior gastric artery (PGA) by AVVR were lower than those of STS-MIP with statistical significances [RGA:68.2%(45/66) vs.98.5% (65/66), P<0.01; LGEA: 53.0% (35/66) vs.97.0% (64/66), P<0.01; SGA: 7.6% (5/66) vs.59.1 %(39/66), P<0.01; PGA: 18.2% (12/66) vs.63.6% (42/66), P<0.01 ].The demonstration rates of LGEA, RGEA and SGA increased accompanied with the increasing of CT value in celiac axis (LGEA: 35 cases displayed with mean CT value of (272±44) HU, 31 cases did not display with mean CT value of (229±42) HU, t=4.043, P<0.01; RGEA: 64 cases displayed with mean CT value of (256±44) HU, 2 cases did not display with mean CT value of (141 ±26)HU, (=3.641, P<0.01; SGA:5 cases displayed with mean CT value of (298 ±39),61 cases did not display with mean CT value of (249±47)HU, t=2.278,P<0.01). Thirteen cases (19.7%) with accessory left hepatic artery were identified, and seven cases (10.6%) with celiac axis variances were depicted.Conclusion 64-slice spiral CT can clearly demonstrate gastric feeding arteries and related variations, which may provide useful information for the operation of gastric cancer.Stomach neoplasm; Tomography, X-ray computedAVVR.The display rates of left gastric artery(I,GA) and fight gastroepiploic artery(RGEA)were 98.5%(65/66),100.0%(66/66)and 97.0%(64/66),100.0%(66/66)by STS-MIP and AVVR respectively.The display rates of right gastric artery(RGA),left gastroepiploic artery(LCEA),short gastric arterysignificances [RGA:68.2%(45/66)VS.98.5%(65/66), P<0.01;ICEA:53.0%(35/66)VS.97.0%(64/66),P<0.01;SGA:7.6%(5/66)VS.59.1%(39/66),P<0.01;PGA:18.2%(12/66)VS.63.6%(42/66).P<0.01 1.The demonstration rates of I.GEA,RGEA and SGA increased accompaniedwith the increasing of CT value in celiac axis(LGEA:35 cases displayed with mean CT value of(272±44)HU,31 cases did not display with mean CT value of(229±42)HU,t=4.043,P<0.01;RGEA:64 cases displayed with mean CT value of(256±44)HU,2 cases did not display with mean CT value of(141±26)HU,t=3.641, P<0.01;SGA:5 cases displayed with mean CT value of(298±39),61 casesaccessory left hepatic artery were identified.and seven cases(10.6%) with celiac axis variances werevariations.which may provide useful information for the operation of gastric cancer.

Background and purpose:Loss or altered expression of Ras association domain family 1A gene (RASSF1A) through DNA methylation has been associated with the pathogenesis of a variety of cancers, which suggests the tumor suppressor function of this gene. This study aimed to explore the effect of DNA methyltransferase inhibitor 5-Aza-2’deoxycytidine (5-Aza-dc) on demethylation and expression of RASSF1A in cervical cancer cell lines. Methods:HPV positive cervical cancer cell lines HeLa and Caski, HPV negative cell lines HT-3 and C-33A were treated with two different concentration of 5-Aza-dc (5 μmol/L, 10 μmol/L). MSP (methylation-specific PCR) and Bisulfite genomic sequencing PCR (BGS) combined with TA clone were used to investigate methylation status of RASSF1A gene promoter and exon 1 before and after treatment of 5-Aza-dc. RASSF1A gene mRNA expression was detected by RT-PCR. Results:Two HPV positive cell lines showed hypomethylated RASSF1A promoters and expressed RASSF1A mRNA, and after treatment with 5-Aza-dc, the mRNA expression of RASSF1A did not change significantly (FHeLa=3.003, P=0.125; FCaski=0.045, P=0.956). Two HPV negative cervical cancer cell lines showed hypermethylation status of RASSF1A promoter and silenced RASSF1A. After treatment with 5-Aza-dc, demethylation occurred in the promoter region of RASSF1A gene, which subsequently induced re-expression of this gene in HT-3 and C-33A. The F test (FHT-3=18.002, P=0.03;FC-33A=17.179, P=0.03) and LSD-t test (P<0.05) demonstrated that significant difference in the expression of RASSF1A was found upon two different concentrations drug treatment.Conclusion:The methylation status of promoter and exon 1 of RASSFIA gene in HPV positive and HPV negative cervical cancer cell lines are different. The promoter hypermethylation is correlated with RASSF1A gene expression in HPV negative cervical cancer cell line HT-3 and C-33A, and plays a key role in RASSF1A silencing. 5-Aza-dc may effectively reverse the methylation status of RASSFIA gene promoter in cervical cancer HT-3 and C-33A cells and reactivate gene expression silenced by aberrant hypermethylation in a dose-dependent manner within certain extent.

A 54-year-old man diagnosed with chronic lymphocytic leukemia (CLL) was admitted in our department in June 2014. After one cycle of FC chemotherapy, a bone marrow examination revealed normalized lymphocyte count and another acute myeloid leuke-mia (AML)-M5 clone. The patient refused sequential treatment and only received follow-up examination. He had continuous hemato-logically stable disease and died of pulmonary infection on July 2015. After a multidisciplinary team discussion, we confirmed the si-multaneous diagnosis of CLL and AML-M5. Through this discussion,tumor second hit model,tumor evolution model,andtumor heterogeneitywere further defined.

Objective To investigate the function of the post cingulate in triggering voluntary swallowing by examining the activated areas in the brain of dysphagic patients with and without delayed pharyngeal swallowing using magnetoencephalography.Methods Videofluoroscopy was used to detect the latency of pharyngeal swallowing of 6 dysphagic patients.Magnetoencephalography (MEG) was used to monitor the whole course of voluntary swallowing,and an equivalent current dipole was applied to the activated areas of the brain 2500 ms before the subconscious electromyographic signals appeared.Magnetic resonance imaging (MRI) was performed just after the magnetoencephalography.A magnetic source image (MSI) was generated by overlaying the MRI and MEG results.Results The MSIs of five of the patients were derived.Three had delayed initiation of pharyngeal swallowing (with the latency being 0.03-0.12 s) and the other two showed normal latency during pharyngeal swallowing.In the former 3 patients,the post cingulate was activated at 1426 ms,1138 ms and 1675 ms before the burst of electromyography signals,which was later than that of the anterior cingulate and the insular cingulate.The 2 patients without delayed pharyngeal swallowing had their post cingulate activated at 1971 ms and 2483 ms before or at almost the same time as the anterior cingulate and insular.Conclusion Post cingulate activation occurs later than that of the anterior cingulate and insular in patients with delayed pharyngeal swallowing,the reverse of normal swallowing.This result indicates that the post cingulate may play an important role in triggering voluntary swallowing.

Background and purpose:Hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare, vascularly original tumor, and would be misdiagnosed easily in the clinical and imaging characteristics. This study aimed to investigate the imaging features of HEHE and our experience in clinical diagnosis and treatment, and to provide important reference for the diagnosis and treatment of HEHE in the future.Methods:This study retrospectively analyzed clinical manifestations, imaging features, pathological characteristics and treatment effects of 5 HEHE cases confirmed by pathology at Department of Integrative Cancer, Fudan University Shanghai Cancer Center.Results:The ratio of male to female patients was 2 to 3. HEHE predominantly occurred in middle-aged female patients whose ages range from 26 to 65 (mean=45.6). Imaging features of HEHE included multifocal hepatic disease (n=2), systemic multi-center multi-tissue occurrence (n=3). The ultrasound images showed isoechoic or hypoechoic lesions with no obvious blood lfow signal in the lesions. CT plain scan showed isointensity or hypointensity, while MR unenhanced with hypointense T1 signal and hyperintense T2 signal. The density or signal was uneven. Contrast-enhanced CT and MR images showed “slow in slow out”, obvious and variable degrees of peripheral rim enhancement. High FDG uptake showed delayed imaging characteristics (PET/CT). DSA angiography showed the tumor blood vessels were slim. After transcatheter arterial chemoembolization (TACE) surgery, lipiodol deposition within the lesion was not ideal. Under the microscope, tumor cells showed epithelial differentiation; angiogenesis was also visible. Immunohistochemistry staining showed CD31 and CD34 positive in all the 5 cases. Two cases treated with TACE combined with high intensity focused ultrasound (HIFU) and/or radiofrequency ablation (RFA) had good result.Conclusion:The clinical and radio-logical characteristics of HEHE are distinctive. Currently, for patients with systemic multi-organizational multi-center lesions, TACE combined with HIFU and/or RFA might be the most effective treatment method.