Objective:To explore the propagable experience and methods of controlling the rate of cesarean sec-tion through the summary of the innovative measures in four counties. Methods:The cases of natural birth and cesare-an section from 2009 to 2013 in four counties were analyzed respectively. The interventions of controlling cesarean section rate have been summarized. Results:The average cesarean section rate of four counties in five years is on the decline, since 2009 the rate were 60. 2%,62. 3%,59. 3%,51. 4%,48. 1%. Conclusions: The interventions really worked, but did not do the best. Improving the social attention on these innovative measures, strengthening surveil-lance mechanism, regulating the medical behaviors of delivery hospitals, enhancing the midwifery training and promo-ting the interventions under the coordination of local government can further reduce the rate of cesarean section.

Objective To investigate the detection rate and missed diagnosis reason of sacral canal cyst with sacroiliac joint CT scan.Methods Retrospectively analyzed the changes of sacral canal in 1 286 cases with sacroiliac joint CT scan.CT scanning included bone algorithm reconstruction and standard algorithm reconstruction.Results Among 1 025 patients who had negative sacroiliac joint CT scan were found in 36 cases of sacral canal cyst,the detection rate was 3.5％ (36/1 025).Single cyst in 34 cases and multiple cysts in 2 cases.Cyst in S1 level 5 cases,S1-2 level 4 cases,S2 level 22 cases,S2-3 level 4 cases,S3 level 3 cases.The minimal short diameter of the cysts was 0.5 cm and the maximal diameter was 3.2 cm,average 1.2 cm.CT scan showed a round uniform cystic low density,and combined with sacral canal expansion in 19 cases.CT scan used bone algorithm reconstruction in 29 cases,used standard and bone algorithm reconstruction in 7 cases.Clinical findings and correctly diagnosed in 11 cases,accounted for 30.6％ (11/36),about 69.4％ (25/36) cases were missed diagnosis.Conclusions About 3.5％ patients are found sacral canal cyst who have negative sacroiliac joint CT scan.Both the standard and bone algorithm reconstruction should be used to avoid the missed diagnosis of sacral canal cyst.

Background Leber hereditary optic neuropathy (LHON) is a maternally inherited disease caused by mitochondrial DNA (mtDNA) mutation with the common mutation sites of m.3460 G＞A,m.11778 G＞A and m.14484 T＞C,and other mutation sites are rare.Understanding the mutation type of mtDNA in LHON patients has an important clinical significance.Objective This study was to analyze the clinical features of LHON and detect the mitochondrial mutation.Methods Twelve unrelated Chinese patients who was diagnosed as LHON were included in Peking University People's Hospital from 2010 to 2014.The visual acuity,perimetry,ocular segment,visual evoked potential,fundus were binocularly examined.The peripheral blood of 4 ml was collected from each patient and mtDNA was amplified and sequenced by using PCR.Three common genetic mutation sites for LHON and other mutation sites were determined and analyzed.This study protocol was approved by Ethic Committee of Peking University People's Hospital and complied with Helsinki Declaration.Written informed consent was obtained from each patient prior to any medical examination.Results Of the 12 patients,11 were male and 1 was female.The visual acuity of both eyes reduced simultaneously in 7 patients,and the visual acuity of left eye and the right eye first reduced in 3 patients and 1 patient,respectively.There was no significant correlation in the visual impairment between the left and right eyes (P＞0.05).In the near vision of the patients,J7 was invisible in 18 eyes,and J7 were obtained in 3 eyes,J6 were obtained in 2 eyes and J2 was obtained in 1 eye.In the distant vision of the patients,hand movement was obtained in 1 eye,light perception was obtained in 1 eye,0.01-0.1 were obtained in 18 eyes and 0.12-0.3 were obtained in 2 eyes.The visual field defect of nasal lateral was found in 7 eyes,visual field defect of temporal lateral was found in 3 eyes and the visual field defect of central was found in 8 eyes.mtDNA sequencing revealed that m.3460 G＞A mutation was seen in 3 patients,m.11778 G＞A mutation was seen in 5 patients and m.14484 T＞C mutation was seen in 2 patients.In addition,other 2 mutations were found in 2 patients,which were m.3497 C＞T and m.10663 T＞C mutations at the MT-ND1 and MT-ND4L genes,respectively.Conclusions LHON is more common in male.Visual impairment shows the varying degrees between both eyes of patients and appears to be severe in near vision.Central visual field defect is common in LHON patients.This study detects m.3497 C＞T and m.10663 T＞C mutation in Chinese LHON patients.

Objective To study the outcomes and problems of comprehensive medical pricing reform in Jiangsu.Methods The business operations,drug proportion and patient′s expenses of 28 pilot hospitals in 1 5 counties of the province before and after the reform were compared,to learn the impacts of the pricing reform on both hospitals and patients.Results Medical revenue and medical service quantity of these hospitals during this period(January to June)of 2012—2014 maintain a fast growth,with lower drug proportions,and patients′expenditure unchanged.Compared with data of the same period in 2012, the total revenue growth rates of the hospitals in 2013 and 2014 were 13.4% and 1 1.1% respectively;and their drug proportions were 44.9% and 42.3%;and the expenditure growth rates for outpatient/emergency service were 5.9% and 3.1% respectively.Conclusions The reform has achieved an initial success.However the pricing system,needs to be further rationalized to build a better price formation mechanism,in line with relevant reforms.

ObjectiveTo evaluate the therapeutic efficacy of low-dosage methyltestosterone or andriol in men with senile osteoporosis. MethodsA total of 134 male patients with senile osteoporosis and the decreased serum level of free testosterone were divided into three groups. 45 patients were treated with low-dosage methyhestosterone(100 mg, once a day, sublingual) and 46 patients were treated with low-dosage andriol (40 mg, once a day, orally), while 43 patients were treated with placebo. The duration of treatment in each group was 1 year. The bone density, blood and urine biochemical indexes related to bone metaholites,the quality of life indexes, ultrasonography for prostate,serum prostate specific antigen,blood routine, urine routine, hepatic and renal function were detected before and after the treatment. ResultsBoth low-dosage methyltestosterone and low-dosage andriol could prevent the decrease of bone mineral density and improve patients' general health, role-emotional function and vitality (all P＜0.05). The difference values of femoral neck bone mineral density before and after treatment with low-dosage andriol and low-dosage methyltestosterone were (0.14+0.18)g/cm2 and (0.12±0.09)g/cm2 , respectively(P＜0.05). Low-dosage andriol hadstronger effects in increasing the level of estradiol (32.5±14.2 )ng/L than low-dosage methyltestosterone(19.3±9.2)ng/L(P＜0.05) and showed more notable effects in improving the physical functioning and role-physical function than low-dosage methyhestosterone. The use of the two androgenic hormones at low dosage showed safety. ConclusionsBoth low-dosage methyltestosterone and low-dosage andriol can be used to treat senile osteoporosis in men and to improve life quality. Both of them are effective and safe therapeutic choices.

Objective To explore the clinical value of GLCCI1 gene detection in guiding administration of inhaled corticosteroids in patients with asthma.Methods Eighty asthma patients were divided into wild type allele group (n =64) and mutant type allele group (n =16) according to GLCCI1 gene detection.Both groups were treated with budesonide aerosol,and the clinical effect was compared between two groups.Results In wild type allele group,the total effective rate was 92.2％ and the incidence rate of adverse reaction was 7.8％,which were significantly better than 75.0％ and 25.0％ in mutant type allele group (P ＜ 0.05).There were significant differences in FEV1,FEV/FVC ratio,FVC and PEF between two groups (P ＜ 0.05).Conclusion The GLCCI1 gene detectiou can significantly improve the effect of inhaled corticosteroids and reduce the incidence rate of adverse reactions.

Objective To explore the clinical value of GLCCI1 gene detection in guiding administration of inhaled corticosteroids in patients with asthma.Methods Eighty asthma patients were divided into wild type allele group (n =64) and mutant type allele group (n =16) according to GLCCI1 gene detection.Both groups were treated with budesonide aerosol,and the clinical effect was compared between two groups.Results In wild type allele group,the total effective rate was 92.2％ and the incidence rate of adverse reaction was 7.8％,which were significantly better than 75.0％ and 25.0％ in mutant type allele group (P ＜ 0.05).There were significant differences in FEV1,FEV/FVC ratio,FVC and PEF between two groups (P ＜ 0.05).Conclusion The GLCCI1 gene detectiou can significantly improve the effect of inhaled corticosteroids and reduce the incidence rate of adverse reactions.

Objective To analyse and compare the effects and safety of early use (in emergency room, intravenous loading followed by infusion) with bolus injection during primary PCI of tirofiban, on post-procedural TIMI flow and 30d clinical outcomes. Methods Seven hundred and seven patients with acute STEMI treated by primary PCI in Ruijin hospital were retrospectively and enrolled screened. Among them, 86 patients with single bolus intra-coronary injection of tirofiban (25 μg/kg) during the procedure were served as observation group. Baseline, angiographic, PCI features and rate of major adverse cardiac events (MACE) at 30 d follow-up were compared with those received early intravenous infusion of tirofiban (10ug/kg bolus followed by 0.15μg/(kg·min) intravenous infusion)(control group, n=239). Results Compared with control group, patients in observation group were older[(63.8±11.4) vs. (57.9±8.8), P=0.01], had higher prevalence of hypertension (58.6%vs. 51.0%, P=0.005), multivessel disease (57.0%vs. 34.3%, P<0.001), and female in gender (40.7%vs. 25.1%, P=0.006). Post-procedural TIMI flow in culprit vessel and TMP grade were comparable between the two groups (P=0.66 and P=0.48, respectively). Reduction in TIMI minimal bleeding events were found in the observation group (2.3%vs. 9.6%, P=0.03). MACE free survival rate at 30d clinical follow-up was similar between the two groups (P=0.48). Conclusions Single bolus intra-coronary injection of tirofiban exerts similar effects in post-procedural TIMI flow, TMP grade in culprit vessel and 30d clinical outcomes compared with early use in emergency room with intra-venous loading and infusion, nevertheless, intra-coronary injection resulted in significantly reduced TIMI minimal bleeding events. Prospective, randomized clinical study is mandatory to prove our current results.

Objective:To investigate the efficacy and safety of partial resection or enhanced suture of retro-orbicularis oculi fat (ROOF) through double eyelid or subeyebrow incision to correct upper eyelid swelling and depression.Methods:From May 2017 to June 2018, 166 beauty seekers underwent the operation. Among them, 81 cases were corrected by double eyelid incision, 33 cases were corrected by double eyelid incision, 30 cases were corrected by subeyebrow incision and 22 cases were corrected by subeyelid incision.Results:The swelling and depression of the upper eyelid were improved and the patients were satisfied. Two of the patients developed hematoma after operation and all healed after debridement.Conclusions:Preorbital septum fat combined with ROOF partial excision or enhanced suture can effectively improve the upper eyelid swelling or depression, with high satisfaction, safety and less trauma, which can be an important supplement for upper eyelid plastic surgery.

Objective:To investigate the effects of anemoside B4 on apoptosis of retinal cells in diabetic rats.Methods:Sixty Sprague-Dawley rats were randomized into three groups: the normal control(control), diabetic rats(DM)and diabetic rats treated with Anemoside B4(B4)groups(n=20, each group). Rats in the DM and B4 groups were rendered diabetic with an intraperitoneal injection of streptozotocin(STZ, 60 mg/kg). After 3 days of successful modeling, rats in the B4 group were intraperitoneally injected with anemoside B4(5 mg/kg), twice/day, for 8 weeks, while rats in the control and DM groups were injected with an equivalent volume of normal saline.After 8 weeks of anemoside B4 and normal saline injection, rats were sacrificed and retinas were harvested for examination.Paraffin sections of retina were stained with the hematoxylin-eosin(H-E)method for morphological evaluation.Protein levels of Bax and Bcl-2 were detected by using Western blot.The expression of caspase-3 mRNA was detected with quantitative PCR.Results:H-E staining results showed the control group had intact retinal structure and clear morphological features, whereas disordered retinal structure, thinner layers, and sparse and disorganized cells were seen in the DM group.However, retinal structure and morphology were improved after treatment with anemoside B4.Compared with the control group, the protein expression of Bcl-2 was lower( t=57.81, P<0.01), the protein expression of Bax was higher( t=10.47, P<0.01), and the Bcl-2/Bax ratio was lower( t=23.98, P<0.01)in the DM group.Compared with the DM group, the protein expression of Bcl-2 was higher( t=41.07, P<0.01), the protein expression of Bax was lower( t=6.811, P<0.01), and the Bcl-2/Bax ratio was higher( t=14.70, P<0.01)in the B4 group.Caspase-3 mRNA expression was higher in the DM group than in the control group( t=7.916, P<0.01), but was lower in the B4 group compared with the DM group( t=6.221, P<0.01). Conclusions:Anemoside B4 can inhibit the apoptosis of retinal cells by up-regulating Bcl-2 expression and down-regulating Bax and caspase-3 expression in diabetic rats.