This paper analyzes the ERCP price setting policy and its impact on the patient''s cost and it puts forward possible price setting policy recommendations, according to the current situation of the disease payment system reform and promotion prospects of ERCP.ERCP belongs to the low-price high-value medical supplies, but hospitalization expenses data of 9 types of diseases show that consumables accounted for 35.81~48.25%.The main factor hindering widely the application of ERCP lies in high-ratio self-payment and high medical cost, in other words, as the ERCP supplies are not included in the scope of medical insurance payments, the current rate of patients with high surgical expenses, medical costs are expensive.As per the analysis of this paper, the following are the policy recommendations to put forward 1)Paying attention to historical settlement data and scientific formulation of disease charges;2)Considering different treatment methods and allocate appropriate disease payment standards;3)Standardize operation code to ensure the information quality of accurate disease expenses calculation.

Objective To investigate the feasibility of three-dimensional contrast-enhanced ultrasonic cholangiography(3D-CEUSC) in isolated porcine liver specimens.Methods The lobes of 5 isolated porcine livers were taken as scanning units and the lobular bile branches were cannulated.3D-CEUSC was performed after the administration of diluted ultrasonic contrast agents(SonoVue) through the cannula.The images were assessed in term of maximum visualization of branching orders and image quality.The coincidence of morphous was compared between 3D-CEUSC and cholangiagraphy using fluoroscopy.Results Fourteen lobular biliary branches were cannulated successfully in 5 isolated porcine livers.The maximum visualization of branching orders from the third- to first-order branches were 42.9% (6/14) ,42.9% (6/14), 14.2% (2/14) in sequence.The image quality was 21.4% (3/14) graded as well, 57.2% (8/14) as moderate, and 21.4% (3/14) as poor.Compare with cholangiagraphy using fluoroscopy, the coincidence of morphous was 42.9%(6/14) for well,42.9% (6/14) for moderate,and 14.2% (2/14) for poor.Conclusions 3D-CEUSC could be a new imaging method to evaluate the biliary anatomy.

Objective To evaluate the clinical value of three-dimensional contrast-enhanced ultrasonography(3D-CEUS) of hepatic arteries in liver transplant candidates.Methods Twenty-six liver transplantation donors and recipients were examined using two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS.The 3D image's qualities, reconstruction successful rates, and the diagnostic level of hepatic artery complications were estimated. Results Twenty-one hepatic arteries were reconstructed successfully (80.8%).The 3D images showed artery trees continuous, spatial relationship definite, fine and circuitous branches distinct, and the segmental hepatic arteries' origin could be recognized.In 4 of 5 hepatic artery complications,both 2D-CEUS and 3D-CEUS made the correct diagnoses.However,2D-CEUS made a false positive diagnosis and 3D-CEUS retrieved it.Conclusions The 3D-CEUS images of the hepatic arteries are direct and distinct.In evaluating hepatic artery complications, when artery spatial relationship is complicated, the 3D-CEUS could provide more information, and confirm or correct some diagnosis of 2D-CEUS.

Objective To assess the difference between two-dimensional contrast-enhanced ultrasonography ( 2D-CEUS ) and three-dimensional contrast-enhanced ultrasonography ( 3D-CEUS ) in evaluating hepatic arteries in the liver transplantation. Methods Both 2D-CEUS and 3D-CEUS were used to examine 26 liver transplantation donors and recipients. Fifteen patients who were confirmed by CTA or DSA or MRA were analyzed. The image' s quality and diagnostic levels of 2D-CEUS and 3D-CEUS were compared, and the diagnostic information about anatomic features of hepatic arteries provided by the two methods was evaluated. Results 1) The image' s quality of 2D-CEUS and 3D-CEUS were 3. 62 ± 0. 41, 2. 52 ± 0. 93, respectively. The difference between them was statistically significant ( P <0. 05). 2)When evaluating anatomic features ,2D-CEUS and 3D-CEUS had no significant difference in common hepatic artery (CHA) and proper hepatic artery (PHA). But 3D-CEUS was prior to 2D-CEUS in left hepatic artery (LHA) ,right hepatic artery(RHA) and segmental hepatic artery(SHA) ( P <0. 05). 3)Five hepatic artery complications were discovered by CTA or DSA or MRA in 15 patients. In 4 patients (80%) ,both 2D-CEUS and 3D-CEUS made the affirmative diagnoses in accordance with the results. However, 2D-CEUS made a false positive diagnosis and 3D-CEUS corrected it. Conclusions The 3D-CEUS could provide more diagnostic information,could confirm or correct some diagnosis of 2D-CEUS,but,its image's quality is not as good as 2D-CEUS. Therefore,combining the 3D-CEUS with 2D-CEUS has practical clinical value in liver transplantation.

Objective To investigate the effect of intraperitoneal injection of thalidomide on pain behaviors in a mouse model of bone cancer pain. Methods 36 male C3H/HeJ mice were divided randomly into tumor group (n= 18) and sham group (n= 18) ,six mice from each group were chosen to examine the time course of changes in behavior after tumor cells inoculated to the bone. 2 × 105 osteosarcoma NCTC 2472 cells were implanted into the intramedullary space of the right femurs of mice to induce ongoing bone cancer related pain behaviors. The sham group was inoculated by α-MEM without any cells. On the day before inoculation,the tumor mice were divided randomly into tumor + thalidomide group and tumor + vehicle group. The sham group mice were further divided randomly into sham + thalidomide group and sham + vehicle group. Pain ethology indexes such as paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were observed on 1 d before inoculation and on 3 d ,5 d ,7 d, 10 d, 14 d after inoculation. Results ( 1 ) At day 7 after the operation, compared with sham mice ( 1. 70 ± 0. 33 ) g, PWMT of tumor mice decreased to ( 1.07 ± 0. 30) g (P ＜ 0. 05 ). At day 10, PWTL shortened to ( 12.60 ± 1.69 ) s (P ＜ 0. 05 ) compared with sham mice ( 17.70 ± 1.54 ) s. And the pain behaviors of tumor mice were aggravated along with the development of cancer pain. (2) At day 7 after the operation, compared with tumor + vehicle group ( 1. 07 ± 0.39 ) g, PWMT of tumor + thalidomide group increased to ( 1. 53 ± 0. 39 ) g (P ＜0.05). At day 10, PWTL extended to ( 16.48 ± 1.13 ) s compared with sham mice ( 12.64 ± 1. 56) s (P ＜0. 05 ). Conclusion Intraperitoneal injection of thalidomide can efficiently relieve mechanical hyperalgia and thermal hyperalgia in a mouse model of bone cancer pain.

Objective To detect the expression of inducible nitric oxide synthase (iNOS) and heme oxygenase-1(HO-1) in human colon of irritable bowel syndrome(IBS), aim at finding out the role of gas messenger molecule such as nitric oxide(NO) and carbon monoxide(CO) in the pathogenesis of IBS. Methods The expression of iNOS and HO-1 in human colonic tissue specimen of enteroscope was detected by En vision and SABC immunohistochemistry each in 34 cases of IBS and 16 cases of normal control group. Results The expression of iNOS and HO-1 expressed mainly in the colonic mucous membrane epithelia, and the expression in IBS group was higher than that in normal control group(P

Objective: To study the effect of and possible mechanism of knockinng down PI3Kp85α using siRNA in MCF-7 human breast cancer cell line. Methods: Oligofectamine was used to transfect PI3Kp85α siRNA to knock down the PI3Kp85α expression level in MCF-7 human breast cancer cell line in vitro. Real-time PCR was conducted to detect the expression of PI3Kp85α. The effect of PI3Kp85αsiRNA on the growth of MCF-7 cells was measured by MTT. The cell cycle distribution and cell apoptosis were detected by cell flow cytometry. Protein expression was evaluated by immunofluorescence staining and Western blot. Results: The expression of PI3Kp85 α was knocked down with PI3Kp85α siRNA in MCF-7 cells. Cell growth was delayed in PI3Kp85αsiRNA-treated group. Conclusion: The suppressive effect of PI3Kp85αsiRNA on the growth of MCF-7 human breast cancer cell line is significant and PI3Kp85α could be a candidate for gene therapy for breast cancer.

The tumor multidrug resistance reversal effect of NPB304, a novel taxane, was studied. MTT assay was used to determine the IC50 of chemotherapy drugs. Western blotting assay was applied to analyze the expression of P-glycoprotein (P-gp). The effect of compounds on the P-gp function and P-gp ATPase activity was determined by rhodamine 123 (Rh123) accumulation assay and analysis kit, respectively. Molecular docking was employed to predict the binding force between compounds and P-gp. Transmembrane transport of NPB304 was analyzed using MDCK II and MDR1-MDCK II cell model. NPB304 displayed multidrug resistance reversal effect on KBV cells and MCF-7/paclitaxel cells, NPB304 collaborative with P-glycoprotein (P-gp) inhibitors verapamil enhanced the reversal activity, specifically, 10 μmol x L(-1) verapamil in combination with paclitaxel reversed resistance by 56.5-fold, while combined with NPB304 increased the reversal fold; NPB304 synergistically increased Rh123 accumulation in the resistant cells when combined with verapamil, and NPB304 at 0-1 μmol x L(-1) enhanced the ATPase activity activated by verapamil was observed. NPB304 existed the hydrophobic interactions with the TM regions of P-gp, and the binding force between NPB304 and the A chain of the TM region was stronger. P-gp ATPase activity assay demonstrated NPB304 at lower concentrations (0-1.5 μmol x L(-1)) could activate the P-gp ATPase, playing a role on inhibition of P-gp function. However, NPB304 did not have an obvious feature of P-gp substrate. NPB304 exerted itself and synergy with verapamil activity on reversing tumor resistance via inhibiting the P-gp function.

Abstract: Objective　To understand the distribution and drug resistance of bacteria in clinical blood culture specimens in Ningxia in recent years, and to provide a basis for the prevention and treatment of bloodstream infection diseases. 　　　Methods　The blood culture isolation bacteria and drug resistance of Ningxia bacterial resistance monitoring network hospitals from 2018 to 2020 were statistically analyzed by WHONET5.6 software. Results　In the past three years, a total of 6 757 strains of bacteria were isolated from blood samples, including 3 697 strains (54.7%) of gram-negative bacteria and 3 060 (45.3%) of gram-positive bacteria. Among the gram-negative bacteria, Escherichia coli (2 074 strains,30.7%), Klebsiella pneumoniae (696 strains), Pseudomonas aeruginosa (139 strains), and Acinetobacter baumannii (121 strains). Among the gram-positive bacteria, coagulase-negative Staphylococcus (1 691 strains,25.0%), Staphylococcus aureus (442 strains), Streptococcus spp. (431 strains), Enterococcus spp. (379 strains). Resistance to Escherichia coli and Klebsiella pneumoniae was 56.6% and 22.6% against third-generation cephalosporins, and resistance to carbapenems was 1.0% and 3.7%, respectively. Pseudomonas aeruginosa and Acinetobacter baumannii were resistant to carbapenems at 9.0%（12/139） and 80.7%（71/121）. Methicillin-resistant Staphylococcus aureus (MRSA) was detected at 26.8%, methicillin-resistant coagulase-negative Staphylococcus was detected at 70%, and no Staphylococcus bacteria resistant to vancomycin and linezolid were found. For three years, only 1 strain of vancomycin-resistant Enterococcus faecalis was detected, and no linezolid-resistant Staphylococcus and Enterococcus were detected. Conclusions　Ningxia clinical blood specimen isolates of Escherichia coli, coagulase-negative Staphylococcus, and Klebsiella pneumoniae are more common. Among them, the resistance rate of Escherichia coli and Klebsiella pneumoniae to the third generation of cephalosporins is relatively stable, and the resistance rate to carbapenems is low. Acinetobacter baumannii is highly resistant to carbapenems, and methicillin-resistant Staphylococcus aureus detection rates are on the rise and should be closely monitored.

ObjectiveTo explore the appropriate teaching methods for medical international students.MethodsTotally 84 students in grade 2005 and 63 students in grade 2006 took part in clinical skills training in 2010 and 2011.The traditional method was employed in grade 2005 and interactive teaching and imagery training was applied in grade 2006 combined with the traditional methods.ResultsThe scores of clinical skill tests ( posterior thorax puncture test,abdomen puncture test,bone puncture,catheterization test) were significantly higher in grade 2006 than in grade 2005 with statistical differences,P ＜ 0.01.The clinical skill test scores were not statistically different between grade 2005 and 2006 before training,P ＞ 0.05,but the scores were statistically different between grade 2005and 2006 after training,P ＜ 0.05.Conclusion Using polynary teaching methods synthetically is helpful to improve the clinical skill training effect for medical international students.