To establish the control model of medical insurance in hospitals, so as to improve the effectiveness of internal operation for medical insurance fund. Methods: Using the utility theory to establish the control model, with which the medical service provider is individual rationality constraints and incentive compatibility constraint. Results: The bonus coefficient and punishment coefficient can be calculated by means of evolutionary programming. Conclusion: The control model of hospital internal medical insurance fund is useful in controlling the medical insurance expense, it also provides the guidance and references for performance management and internal operation.

Objective To investigate the anatomy of the skull base for minimally invasive keyhole approach to sellar lesions.MethodsSixty-seven samples of adult skull bone(134 sides) were collected and sawed at the levels of the supraorbital arch and anterior skull base.After inspecting the opening of the frontal sinus,we observed the appearance of the orbit roof(cerebral juga),and measured the maximum height of the two cerebral jugas.Afterwards,the operation distances and angles with regard to the anterior and posterior clinoid processes through the trans-upper orbit,trans-lateral front,trans-pterion,and trans-sub-temple keyhole approaches in 15 skull bone samples were measured.And then,we statistically analyzed the variance in these measurements among the four operative approaches.ResultsOf the 67(134 sides) adult skull bone samples,52 sides showed frontal sinus openness(38.8%,52/134).Most of the skull bases were clawed(multicuspidity or oblique ridge multicuspidity).The maximum height of the cerebral juga that was less than 2.50 mm was found in 36 sides(26.9%),and over 2.51 mm in 98 sides(73.1%).Among the four methods,the shortest distances between the keyhole and the anterior and posterior clinoid processes were found in the trans-sub-temple keyhole approach [(4.87?0.47) cm and(4.93?0.45) cm],and the longest were observed in the trans-lateral front keyhole approach[(6.45?0.30) cm and(7.83?0.54) cm],and trans-upper orbit keyhole approach[(6.47?0.28) cm and(8.31?0.34) cm].The angle between the sagittal section and the keyhole in the trans-lateral front keyhole approach [(40.83?1.11) ? and(37.86?1.37)?] was larger than that in the trans-upper orbit one [(10.23?0.90) ? and(12.29?0.86)?],while the angle between the cross section and the keyhole in the trans-sub-temple keyhole approach [(21.21?0.45) ? and(20.10?0.63)?] was larger than that in the trans-pterion one [(5.49?0.30)? and(9.84?0.58)?].ConclusionsThe size of the frontal sinus,shape and height of the cerebral juga,depth of the skull base operation,and angle between the operational and the skull base planes play important roles in the selection of minimally invasive keyhole approach for sellar lesions.

Liver failure is characterized by rapid progress and extremely high mortality.Glucocorticoids are currently used in the treatment of liver failure to improve the prognosis,but they have not been widely recognized.This paper reviews the advances on pathogenesis of liver failure,the timing,efficacy and adverse effects of glucocorticoids treatment,so as to increase clinician's knowledge of glucocorticoids in treatment of liver failure,in order to increase the awareness and rational administration of glucocorticoids in treatment of liver failure.

Based on the pathogenic mechanisms of age-related macular degeneration (AMD),tremendous preclinical and clinical trials have demonstrated that cell transplantation which aim to replace impaired retinal pigment epithelium (RPE) with healthy RPE cells is a promising approach to treat AMD.So far,choices of cell sources mainly are autologous RPE,iris pigment epithelium,fetal RPE,human embryonic stem cell-derived RPE and human induced pluripotent stem cell-derived RPE,and some of them are undergoing clinical researches.Grafting manners in cell-based therapies are various including RPE sheet or RPE-choroid complex transplantation,RPE cell suspension injection,and RPE sheet transplantation with scaffolds.This review is limited to cell-based therapies for RPE that damaged first in the progress of AMD and focus on recent advances in cell sources,transplantation methods,preclinical and clinical trials,and the obstacles that must be overcome.

To examine the actual clinical diagnosis capability,the import of computer-based case simulations ( CCS ) technology in medical education is very important.The CCS examination system that integrated the ASP.NET and CCS technology can simulate doctor's clinical course more realistically and realize the students' practical skills evaluation.The system has a good prospect in medical education and clinical skills training.

Purpose　To investigate whether thoracotomy can induce lung injury in the operative side and the protection by ambroxol in this procedure.　Methods　24 patients with esophageal carcinoma who were performed esophagectomy with anastomosis over the arcus aortae were randomized into 2 groups:an ambroxol group (ambroxol 1 g iv gtt qd×3,preoperatively) and a controlled group without any respiratory medication.General anesthesia by tracheo-cannula combined with continuous epidual anesthesia were used in all the patients.Bilateral broncho-alveolar lavage(BAL) was carried out after intubation preoperatively and before removal of the cannula postoperatively.Total Phospholipid(TPL),Saturated Phosphaytidylcholine(SatPC) and Total protein(TP) in the BALF were measured.The ratio of SatPC/TPL and SatPC/TP represented the activity of PS.　Results　In the controlled group,SatPC/TPL and SatPC/TP of the left lung(operation side) showed significant difference(P<0.05),compared with the right side(non-operation side).In the ambroxol group,no significant difference of such ratio was showed.　Conclusions　Thoracotomy can induce lung injury and bring out the decrease of PS and increase of protein exudation in the operative side.Large dose of ambroxol can promote in synthesize and secretion of PS and protect those changes.

Case based learning ( CBL ) teaching method was applied to the experiment group in radiology internship teaching,and conventional teaching in control group.Two mentors would evaluate and score their radiological case analysis.The aim of this research was to explore the application and effect of case-based learning ( CBL ) teaching method in radiology internship teaching.

Objective To study characteristics of hospital infection and bacterial drug-resistance in our new Intensive Care Unit (ICU) to provide evidence to clinical rational use of drugs. Methods The data of 142 patients in our ICU last year were analyzed retrospectively, and compared to other inpatients treated in general ward during the same time period. Results Among the 142 ICU inpatients,31 times of hospital infection occurred in 22 patients,gave rise to a infection rate of 15.49% and case time infection rate of 21.83% in ICU; but among the 15 978patients treated simultaneously in general ward,413 times of hospital infection occurred in 324 inpatients, gave rise to a infection rate of 2. 03% and case time infection rate of 2. 58% outside of ICU. The hospital infection rate and case time infection rate were significantly different between the ICU and general ward (P ＜ 0. 01 ). Among the ICU infections, the lower respiratory tract infection accounted for 70. 96% ;the main pathogens were Gram-negative bacilli (65. 12% ) and Gram-positive bacilli (23.26%), follwed by fungus (11.63%). The most common bacteria were Escherichia ( 32. 65% ) and Staphylococcus ( 11.63% ). Gram-negative microorganisms were highly sensitive to cefoperazone/sulbactam,imipenem, meropenem and piperacillin/tazobactam; all Gram-positive microorganisms were sensitive to vancomycin,linezolid and teicoplanin. Conclusions The constitution,distribution and drug-resistance of pathogens in new ICU are similar to previous domestic reports. Gram-negative organisms are the main photogenic bacteria of hospital infection in ICU, and Escherichia is the most popular type in nosocomial infection.

Objective To compare the difference of echocardiography and magnetic resonance imaging (MRI) in measurement of cardiac function in patients with dilated cardiomyopathy (DCM).Methods Totally 41 patients with DCM underwent echocardiography and MRI to measure cardiac function,the parameters included left ventricular end-diastolic volume (LVEDV),end systolic volume (LVESV),left ventricular ejection fraction (LVEF) and stroke volume (SV).The vertical long axis (VLA),horizontal long axis (HLA) and short axis (SA) of heart were measured by echocardiography.The differences of echocardiography and MRI were compared by linear regression and linear correlation.Results ①The value of LVEDV and LVESV obtained by the two methods:the value of LVEDV [(262.6 ± 117.0) ml] and LVESV [(196.4 ± 109.8) ml] obtained by MRI were higher than those of echocardiography [(211.4 ± 90.6),(216.5 ± 71.5),(219.1 ± 80.1) ml;(153.3 ± 76.1),(153.9 ± 54.1),(157.0 ± 61.1) ml,all P ＜ 0.05].②The value of SV and LVEF obtained by the two methods:the value of SV[(66.2 ± 21.3) ml] obtained by MRI was higher than that of echocardiography VLA [(58.1 ± 14.4) ml,P ＜ 0.05].The value of LVEF [(25.2 ±7.2)％] obtained by MRI was lower than those of echocardiography HLA and echocardiography SA [(28.9 ± 6.1)％,(28.3 ± 6.1)％,all P ＜ 0.05].③The value of LVEDV and LVESV obtained by echocardiography SA were associated with those obtained by MRI (r =0.785,0.653,all P ＜ 0.05).The value of LVEF obtained by echocardiography VLA was associated with it obtained by MRI (r =0.690,P ＜ 0.05).The value of SV obtained by echocardiography HLA and echocardiography SA were associated with those obtained by MRI (r =0.734,0.701,all P ＜ 0.05).Conclusion There are differences in accuracy and reliability using echocardiography and MRI when measuring dilated cardiomyopathy heart function,which must be treated differently.

Aim To study the protective effect and mechanism of geniposide on human umbilical vein endothelial cell(HUVEC) injury induced by H2O2.Methods The injured model was established by HUVEC treated with H2O2.HUVECs were cultured in vitro and divided into five groups:control group,H2O2 group and geniposide with different concentrations plus H2O2 group respectively.HUVECs were incubated with 400 ?mol?L-1 H2O2 for 12 hours in the absence or presence of various concentrations of geniposide pre-incubation.Survival rate of HUVECs was determined by tetrazolium assay.The intracellular activities of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),total nitric oxide synthase(NOS) and extracellular nitric oxide(NO) level were detected.The intracellular reactive oxygen species(ROS) level and the apoptotic index and cell cycle alteration were detected by flow cytometry.Results Geniposide concentration-dependently increased the viability of injured endotheial cells,while increased the activity of SOD,GSH-Px,NOS and NO production.The intracellular ROS level and the apoptotic index were reduced by geniposide.The cell proliferation was increased with geniposide incubation.Conclusion Geniposid may be a potential anti-oxidation agent which has a protective effect against HUVEC injuries induced by H2O2.