This article reports the development of hyperosmolar hypernatremic hyperchloremic coma and acute renal failure in a male diabetic patient after recovery from hyperosmolar hypergly-cemic nonketonic coma, of which the cause is fluid retention in excess of urinary output due to the obstruction of lower urethra by diabetic neurogenic urinary bladder and hyper-plasia of prostate gland.By our experience each old diabetic man should be examined to confirm if he has neuro-genic urinary bladder and/or hyperplasia of prostate gland. Care should be taken to keep the balance of fluid intake and output provided that both of these conditions are present. The acute obstructive nephropathy can quickly ameliorate with release of the obstruction.

Objective To evaluate the outcomes of the payment reform at public hospitals in Sanming city.Methods Interrupted time series analysis was used to compare changes of the average days of stay,per capita hospitalization expense,outpatient expense per visit,proportion of medical expense and that of drugs during hospitalization at 21 public hospitals at or above county level before and after the DRGs reform.Results Comparisons before and after the reform found the average days of stay at the original momentum,poor control in curbing the proportion of medical expense and that of drugs during hospitalization,adropping followed by rising trend in the outpatient expense per visit,and minimal drop of the abovementioned proportions.Conclusions The rapid growth of outpatient and hospitalization costs at tertiary hospitals may be incurred by unreasonable cost transfer,structural trend of hospitalization expense makeup,and rationality pending scrutiny.

Tripartite-sector reform (a synergistic reform in public health services,medical insurance and medicine production-circulation) in Sanming city was described in the paper which centers on medical insurance.Tapping full potentials of the medical insurance,the city achieved efficient synergy among healthcare,medical insurance and medication systems.This reform has trimmed out inflated drug pricing to some extent for rooms of maneuver of medical service pricing changes,thus curbing excessive growth of medical costs successfully.The authors proposed areas of further improvements including the relationship between achieving such objective as curbing medical expenditure,and advancement of technical/medical service capacity;that between integrative control of medical insurance expenditure and protection of people's health;the equilibrium of interests between medical insurance,healthcare and medication.All these will contribute to the goal of healthy patients flow and a hierarchical medical system.

Objective To explore the difference in the incidence of deep vein thrombosis (DVT) following total knee arthroplasty (TKA) or total hip arthroplasty (THA) between different seasons.Methods The present retrospective study examined 2 363 patients undergoing TKA or THA from August 2008 to February 2016.There were 653 male and 1 710 female with the average age of 64.44±13.03 years old (17-91 years old),including 954 patients in TKA and 1 409 in THA.All of the patients received anticoagulant drugs and were compressed with a pressure pump starting on the first postoperative night.Routine venography of the bilateral lower limbs was performed at 3-5 days after the operation.The incidence of DVT in different seasons and different age groups (≥65 years old and ＜65 years old) were counted.Results The present study suggested that the probabilities of DVT after arthroplasty in spring,summer,fall and winter were 15.85％ (116/732),14.92％ (71/476),17.88％ (108/604),22.50％ (124/551) respectively with significantly difference (P＜0.05).The incidence of DVT in winter was higher than that in spring and summer (P＜ 0.017).The probabilities of DVT after TKA in spring,summer,fall and winter were 19.09％ (59/309),15.67％ (37/236),18.11％ (44/243),27.71％ (46/166) respectively with significantly difference (P＜0.05).The incidence of DVT in winter was higher than that in summer (P＜0.017).The probabilities of DVT after THA in spring,summer,fall and winter were 13.48％ (57/423),14.17％ (34/240),17.73％ (64/361),20.26％ (78/385) respectively with significantly difference (P＜0.05),and that in winter was higher than in spring (P＜0.017).The symptomatic DVT after arthroplasty in spring,summer,fall and winter were 3.55％ (26/732),3.78％ (18/476),4.97％ (30/604),6.90％ (38/551) with significantly difference in different seasons (P＜0.05),and that in winter was higher than in spring (P＜0.017).The symptomatic DVT after TKA in spring,summer,fall and winter were 3.88％ (12/309),4.24％ (10/236),4.94％ (12/243),9.64％ (16/166) with significantly difference in different seasons (P＜0.05).The symptomatic DVT in winter was higher than that in spring (P＜0.017).The symptomatic DVT after THA in spring,summer,fall and winter were 3.31％ (14/423),3.33％ (8/240),4.99％ (18/361),5.71％ (22/385) respectively (P＞0.05).The probability of DVT following arthroplasty in older patients (age≥65 years old) in spring,summer,fall and winter were 18.49％ (76/411),16.61％ (45/271),22.07％ (81/367),28.05％ (99/353) with significantly difference among the groups (P＜0.05),while symptomatic DVT in older patients (≥65 years old) in spring,summer,fall and winter were 4.38％ (18/411),4.43％ (12/271),5.72％ (21/367),8.78％ (31/353) respectively with significantly difference (P＜0.05).The probability of DVT in four seasons were 12.46％ (40/321),12.68％ (26/205),11.39％ (27/237),12.63％ (25/198) in younger patients (＜65 years old).However,the difference was not detected among different seasons (P＞0.05).The probability of symptomatic DVT in four seasons were 2.49％ (8/321),2.93％ (6/205),3.80％ (9/237),3.54％ (7/198) in younger patients (＜65 years old) without significant difference (P＞0.05).Conclusion Seasonal variations could place an important effect on the incidence of DVT following TKA or THA,especially for the old patients with age ≥65 years.

Objective To investigate the outcome of a new designed extramedullary femoral alignment system and to compare with conventional intramedullary system in clinical results.Methods Twenty consecutive patients (3 males and 17females with an average age of 70.1 (range,52-82 years old) with osteoarthritis (OA) or rheumatoid arthritis (RA) who were treated with the extramedullary method between January 2015 to August 2015 and 20 consecutive patients (5 males and 15 females with an average age of 65.9 (range,52-87 years old) with OA or RA treated with conventional intramedullary method between April 2015 to September 2015 were studied.In extramedullary group,CT scan was used to evaluate the relation between the hip (femoral head) center and anterior superior iliac spine preoperatively.During the total knee arthroplasty,the hip joint center was defined according to the anterior superior iliac spine (ASIS).Knee joint center was defined as the center of the line connecting medial and lateral epicondyle.The terminal femoral bone cut plane was defined as the line between femoral and knee center.In intramedullary group,the traditional intramedullary method was adopted.The coronal and sagittal alignment,blood loss and drainage at one week postoperatively and the range of motion at one week,6 weeks and 3 months were evaluated.Results There was no significant difference in age,hip-knee-ankle (HKA) angle,the Hospital for Special Surgery (HSS) Knee Score,BMI,operation time within the two groups.Blood loss and drainage in extramedullary group (121 ±64 ml and 181±149 ml) was significantly less than that in intramedullary group (177±47 ml and 292±156 ml).There was no significant difference in coronal alignment of the femoral prosthesis within the two groups (89.8°±2.1° v.s.89.8°±2.2°,P＞0.05).However,the two groups had significant difference in sagittal alignment (-0.8°±2.2° v.s.2.5°±2.1 °,P＜0.05).The alignment of extramedullary group had much more tendency in flexion degree.No difference was found in range of motion at 1 week,6 weeks and 3 months postoperatively (103.8°±7.8° v.s.102.5°±7.2°,108.5°±8.0° v.s.108.3°±7.4°,117.0°±7.1° v.s.114.5°±8.1°,P＞0.05).Conclusion The present designed extramedullary system is practical in total knee arthroplasty and has more accuracy in sagittal plane.The patients treated with extramedullary system have less blood loss and drainage and have similar range of motion in early stage after operation when compared with the intramedullary method.

Objective To analyze the characteristics of proximal deep vein thrombosis (DVT) after total joint arthroplasty.Methods 40 cases of proximal DVT were collected from May 2007 to October 2016 which were all diagnosed by lower limb venography or sonography.There were 9 males and 31 females aged from 38 to 86 years,average 67 years,and body mass index was from 16.94 to 31.25kg/m2,with an average of 24.3 kg/m2.29 cases of THA patients and 11 cases of TKA patients.The anatomical distribution,size,radiological performance,local physical findings were recorded and multivariable analysis was performed to evaluate the relationship between distribution of proximal DVT and related parameters including age,gender (male/female),side of leg(left/right),surgery type(knee and hip),preoperative diagnosis(femoral neck fracture/other disease),time of diagnosis with DVT (during hospitalization/after discharge).Results Among 40 proximal DVT cases,31 cases diagnosed by phlebography and 9 cases were diagnosed by ultrasound.2 cases were isolated proximal DVT while 38 cases connected with distal DVTs.9 cases of blood clots in the proximal and distal thrombosis connected discontinuously.There was no isolated proximal DVT in TKA group and 10 cases (90.9％) of blood clots in the proximal and distal thrombosis connected continuously while there were 2 cases (6.9％) isolated proximal DVTs in THA group and 21 (77.8％) of blood clots in the proximal and distal thrombosis connected discontinuously,and there was no statistic significant difference between the two groups.The average length of proximal was 8.85±9.3 1cm (range from 2-35cm) with 5.0±2.05 cm in TKA group and 10.31 ± 10.55 cmin THA group.A significant difference was found between the 2 groups (P=0.014).13 cases located in femoral veins and upper venous region which were all from THA group.There was a significant difference in the distribution between surgery type and preoperative diagnosis.However,there was no significant difference between other potential factors and distribution of proximal DVT.25 cases accepted the evaluation of symptom of DVT before scanning.However,no significant difference were found in edema,VAS score,Homans sign,Neuof sign between 9 TKA and 16 THA cases.Conclusion Proximal DVTs after knee and hip arthroplasty are more preferred to connect with distal DVT continuously.Surgery type and preoperative diagnosis have a significant effect on the distribution of proximal DVT.Proximal DVTs in THA and patients with preoperative femoral neck fracture could be more easily involving femoral veins and upper parts.

Objective To investigate the role of circulating neutrophil extracellular trap (NET) levels in the postoperative formation of deep vein thrombosis (DVT) in patients undergoing total knee arthroplasty (TKA). Methods Circulating NET levels were measured preoperatively and on postoperative days 1, 3, and 7 in 30 patients diagnosed with DVT by venography after TKA and 30 controls from May 2014 to July 2015. Results In patients with DVT, the mean circulating NET levels were significantly higher on postoperative days 1 and 3 compared with those in the non?DVT group (postoperative day 1, 1.598 ± 0.067 vs. 1.212 ± 0.037, t=7.514, P=0.000;postoperative day 3, 1.305±0.044 vs. 1.167±0.032, t=2.675, P=0.015). ROC curve analysis revealed the inferior sensitivity and specificity of NET levels on postoperative day 3 compared with postoperative day 1. Area under the curve (AUC) postoperative day 1 was 0.828 (95%CI:0.722, 0.933, P=0.000);AUC postoperative day 3 was 0.677 (95%CI:0.541, 0.814, P=0.018). The cutoff point for NET levels on postoperative day 1 was 1.294, with a sensitivity of 80%, a specificity of 80%, a posi?tive predictive value of 80%, and a negative predictive value of 80%. After Logistic regression, the NET level on postoperative day 1 was considered an independent predictor of DVT (OR:24.08, 95%CI:4.94, 117.28, P=0.000). Conclusion High circulating NET levels are associated with DVT in patients who undergo TKA. NETs may serve as a potential biological marker to delineate patients undergoing TKA who are most at risk for DVT.

Objective To explore the effects of physiological deep-sea water(PDSW) on hyperthermal tolerance of Kunming (KM ) mice in the 45 .0 ℃ environment .Methods Deep-sea water from the south Chinese sea was processed ,and the metallic ele-ments dissolved in the DSW were analysed .The mice were randomly divided into 2 groups :the control group received tap water ;the experimental group treated with PDSW for 15 d .And then the mice were fed in the 45 .0 ℃ conditions .The survival time and histo-morphometric analyses of the brain ,lung ,heart ,liver and kidney were investigated .Results The survival time in PDSW-fed group was significantly longer than that of the control group (P< 0 .05) .Moreover ,histomorphometric analyses showed that PDSW could protect the brain ,lung ,heart ,liver and kidney of KM mice from the 45 .0 ℃ conditions .The results of western blot revealed that ex-pression of HSP72 of liver tissues for PDSW-fed group substantially increased ,when compared with the control mice(P< 0 .05) . Conclusion PDSW could improve hyperthermal tolerance of KM mice ,which maybe in the relation with expression of HSP72 pro-moted by PDSW .

The countywide healthcare reform in Anhui province since 2015 was analyzed in the paper.The reform is based on the integration of healthcare management system and health service system of the new rural cooperative medical system (NCMS).The core of reform is regional global per capita budget of NCMS.The reform promotes the county′s healthcare institutions to shift from profit oriented to costs control, improves their quality of care, emphasizes disease prevention and control, and maintains residents health.Next, we should pay attention to the rationality of funds balance and benefits distribution, and the training of county healthcare personnel.

OBJECTIVETo observe the changes of nuclear factor-kappa B (NF-kappaB) in the course of N-methyl-N-nitrosourea (MNU)-induced apoptosis of rat retinal photoreceptor cells and investigate the mechanism of MNU-induced retinal damage.

METHODSA single intraperitoneal injection of 60 mg/kg MNU was given to 50-day-old female rats, which were sacrificed at different intervals after MNU treatment. The retinal damage was examined with optical microscopy and photoreceptor cell apoptosis detected by TUNEL assay. Western blotting was performed to analyze the changes in NF-kappaB.

RESULTSPyknosis of the photoreceptor cell nuclei and disorientation of the outer segment of the photoreceptor layer was observed 24 h after MNU treatment, and the outer nuclear layer and photoreceptor layer were almost completely lost on day 7. Photoreceptor cell apoptosis peaked at 24 h, and in the apoptotic cascade, NF-kappaB p65 protein was only detected 12 and 24 h after MNU treatment, whereas the amount of I kappa B alpha, in contrast, markedly increased in the cytoplasm as well as in the nuclei.

CONCLUSIONMNU-induced retinal damage might be mediated through the signaling pathway of NF-kappaB/I kappa B alpha.

Animals ; Apoptosis ; drug effects ; Blotting, Western ; Female ; I-kappa B Proteins ; metabolism ; In Situ Nick-End Labeling ; Methylnitrosourea ; toxicity ; NF-kappa B ; metabolism ; Rats ; Rats, Sprague-Dawley ; Retinal Diseases ; chemically induced ; metabolism ; pathology