Objective To analyze factors affecting the expenses of inpatients and their comprehensive force of influence so as to check irrational increases of medical expenses. Methods Data on hospitalization expenses for disease entities ranking in the first ten places in a third tier hospital in 1997 were taken as samples and a statistical analysis was conducted of the medical expenses incurred in the discharged cases by means of the nerve network model. Results Major factors affecting hospitalization expenses were days of hospitalization, pre hospitalization conditions, pre operation length of stay and age, the comprehensive force of influence of which was respectively 0 4879 , 0 2124 , 0 1847 and 0 0612 . Conclusion To check the irrational increases of medical expenses, we must focus our efforts on the reduction of expenses for medicine and shorten days of hospitalization and pre operation length of stay.

Objective To evaluate the clinical characteristics,treatment,outcome and complications of child and adolescent nasopharyngeal carcinoma (NPC). Methods From January 1970 to April 1997, the records of 145 NPC patients younger than 21 years of age were reviewed. The clinical stages according to 92'Chinese NPC Staging System were :stageⅠin 1, Ⅱin 8, Ⅲ in 79 and Ⅳ in 57. All patients were treated with external beam radiotherapy. Before 1988, parallel opposed lateral pre-auricular portals were chiefly used in 75 patients and after 1988, parallel opposed lateral facio-cervical portals were adopted in 70. The radiation dose to the primary tumor ranged 45-80?Gy: 70?Gy in 50 cases and 32 of them also received chemotherapy. Results Distant metastasis developed in 26 cases, while local and/or regional recurrence in 14. The actuarial overall survival rates of 1-, 3-, 5, and 10-years were 96.3%, 79.9%, 76.5% and 69.4%, respectively. Among 45 dead cases, 16 did so of metastasis, 11 of local and/or regional recurrence and 18 of other reasons. Univariate analysis suggested that clinical stage, size and site of involved lymph nodes, skull base involvement were significant prognostic factors of survival, whereas sex、age、dose、therapeutic method and chemotherapy were not. Conclusions 1. Even though the majority of pediatric and adolescent NPC were advanced, it signifies a relatively good survival. 2. As the normal tissue of pediatric and adolescent patients tolerates radiation poorly, prudence should be meticulously practiced in deciding the radiation dose and radiotherapeutic fields.

Objective To study investigate the dose accuracy that can be achieved with the method of bulk density assignment.Methods Sixteen cases of nasopharyngeal cancer patients and nineteen cases of esophageal cancer patients who accept radiotherapy in our department were selected.The planning CT images with bulk density assignment to different classes of tissues were applied to calculate the dose distributions,and then the resulting dose volume histograms (DVH) of the tumor and organs of risk were compared with the original treatment plan.The paired t-test was taken for dose comparison between two plans.Results The DVH comparison based on the planning CT and the bulk density assignment CT showed good agreements.With nasopharyngeal cancer patients,differences between the two plans about target and normal tissue were less than 1％.With esophageal cancer patients,the dose differences were less than 2％.Conclusion Preliminary results confirm that the bulk density assignment method can be applied to calculate the dose distributions.

Objective To assess the efficacy and safety of nimotuzumab in combination with radiochemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC).Methods 42 patients with locoregionally advanced NPC were retrospectively analyzed.They all received the treatment of nimotuzumab in combination with radiochemotherapy.Intensity modulated radiationtherapy (IMRT) was applied and the prescribed radiation dose administered to the primary tumor was between 70 to 79.2 Gy in 32-37 fractions and 41-49 days.The dose administered to lymph nodes was between 65 to 76 Gy in 32-37 fractions and 41-49 days.Nimotuzumab was given weekly during irradiation.All patients received chemotherapy.Results The main adverse events were mucositis,bone marrow suppression,dermatitis and xerostomia.Grade 1 or 2 oropharyngeal mucositis occurred in 29 (69.0 ％) patients,and grade 3 in 2 (4.8 ％).Grade 1 or 2,3 or 4 leucopemia occurred in 25 cases (59.5 ％),16 cases (38.1％),respectively,without occurrence of febrile neutropenia.There was no treatment related death.Complete response (CR) rate was 90.5 ％ (38/42),partial response (PR) rate was 9.5 ％ (4/42) and the total efficiency was 100 ％.After a median follow-up of 22.5 months,the 1-year local control rate was 100 ％.1-year distant metastasis-free survival rate was 92.7 ％.1-year overall survival rate was 95.2 ％.Conclusion Nimotuzumab combined with radiochemotherapy was efficient and safe for locoregionally advanced NPC.

Objective To observe the differences of the radio-biological characteristics between the human malignant glioma cell line SHG-44 and its progeny cells SHG-4410 Gy and to probe the underlying mechanism.Methods The SHG-4410 Gy cells were the progeny of SHG cells that had been irradiated with 10 Gy X-rays and then passaged for 15 generations.The radiosensitivity of SHG-44 and SHG-4410 Gy wre measured by clonogenic assay and the multi-target single-hit model was used to fit the survival curve.The cell cycle redistribution and apoptosis were analyzed by flow cytometry assay.Quantitative Real Time-PCR (qRT-PCR) was used to determine the relative levels of cyclin B1 mRNA and miR-21.Stat3 protein levels were detected by Western blot.Results The values of D0,Dq and SF2 of SHG-4410 Gy cells were significantly higher than those of SHG-44 cells.Flow cytometric analysis showed that there was less G2/M phase arrest in SHG-4410 Gy (F =22.21,P ＜ 0.05).Radiation-induced early apoptotic population was increased from (17.60 ± 0.26) ％ to (28.00 ± 0.36) ％ for SHG-44 cells,but increased from only (4.20 ± 0.30)％ to (5.17 ± 0.65)％ for SHG-4410 Gy.miR-21 in SHG-4410 Gy cells were increased by 1.44 fold of SHG-44 cells,which was associated with the increase of Stat3 protein expression.Conclusions Radioresistance is observed in the progeny of human malignant glioma cell line SHG-44 which had been irradiated with 10 Gy X-rays.The underlying mechanisms may be relative to the upregulation of cyclin B1 that acts as a key downstream gene in the signaling pathway of G2/M phase transition.In addition,the upregulation of miR-21 may be involved in the apoptosis of SHG-4410 Gy cells.

Objective To determine the risk factors for emergence agitation (EA) during the recovery period after general anesthesia.Methods One thousand and thirty-four patients of both sexes aged 18-89 yr undergoing general anesthesia were divided into EA group and non-EA group.EA occurring during recovery from general anesthesia was assessed by using Riker sedation-agitation scale.Age,sex,complication,education,medical history,ASA physical status,type and duration of anesthesia and operation,volume of blood loss,fluid replacement,urine volume,duration of stay in PACU,number of drainage tubes and so forth were recorded.Multivariate logistic regression was used to analyze the risk factors for the occurrence of EA.Results Thirty-six patients developed EA during recovery from anesthesia.The incidence of EA was 3.5 ％.Logistic regression indicated that high risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation were the risk factors for EA (P ＜ 0.05).Conclusion High-risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation are the risk factors for EA during recovery from general anesthesia.

Objective To observe the clinical effect of glucocorticoid treatment in children with Mycoplasma pneumo-nia. Methods A total of 45 cases of children with mycoplasma pneumonia were randomly divided into two groups, 25 cases in the control group were given azithromycin injection continuous intravenous infusion of 5D. And then changed to Azithromycin for Suspension oral(3D stop 4D), 2-3 courses. The observation group of 20 cases based on the control group were treated with injection of methylprednisolone 1-2 mg/(kg od), intravenous infusion of 3 d, in the two 7 d af-ter treatment groups, the fever, cough relief time time, the improvement of chest X-ray film and duration of hospitaliza-tion were compared. Results Hormone treatment group 13 cases were cured, 6 cases effective, 1 cases ineffective, the total effective rate was 95.0%. Non hormone treatment group 7 cases were cured, 11 cases effective, 7 cases ineffective, the total efficiency of 72.0%. Cure rate of hormone treatment group was significantly higher than that of non steroid group, there was statistically significant differenc(P<0.05). Conclusion Early application of low-dose, short term glucocor-ticoid treatment in children with Mycoplasma pneumoniae pneumonia,it can effectively improve the clinical symptoms, reduce or avoidthe occurrence of lung, pulmonary complications, improve the cure rate, to avoid the occurrence of seri-ous complications.

Castleman disease (CD) is an uncommon non-clonal lymphoproliferative disorder with unknown etiology.No standard therapy is recommended for relapsed/refractory CD patients,thus requiring development of novel experimental approaches.Our cohort of three adult patients with multicentric CD (MCD) were treated with refractory to traditional chemotherapy ienalidomide-containing regimens (10-25 mg lenalidomide perorally administered on days 1-21 in 28-day cycle) as second-to fourth-line treatment.Partial remission was achieved in first plasma-cell CD patient,who relapsed seven months after autologous hematopoietic stem cell transplantation and then failed to respond to four cycles of chemotherapy.Partial remission was obtained in second patient with CD and polyneuropathy,organomegaly,endocrinopathy,monoclonal gammopathy,and skin changes syndrome.Third case showed complete remission with complete disappearance of pleural effusion and ascites and normalization of platelet count.To conclude,encouraging clinical responses were achieved in cohort of three patients with lenalidomide-based regimen,though long-term efficacy remains to be observed.We propose further investigation of therapeutic potential of this drug in treating MCD.

Angelica dahurica,as a medicinal and edible traditional Chinese medicine,is widely used in clinical practice.It is mainly cultivated in Henan,Hebei,Sichuang and Zhejiang provinces.At present,the study found that the main chemical components of this plant contained coumarins,volatile oil,polysaccharides,alkaloids,and amino acids and other components.It has anti-inflammatory,analgesic,anti-oxidant,anti-tumor,whitening effect and other pharmacological activities.In this paper,the chemical composition,pharmacological action of Angelica dahurica were summarized.Based on the core concepts of quality markers,the quality markers of Angelica dahurica were predicted and analyzed from the aspects of plant relativity and chemical component specificity,traditional medicinal properties,traditional efficacy,measurability of chemical components,Sulfur Fumigated,so as to provide reference for establishment and development of quality evaluation system of Angelica dahurica.

A 3-week practice-oriented training course on chronic obstructive pulmonary disease (COPD) management was conducted in December 2020, 34 primary care physicians from township or community health service centers attended the course. The impact of the training course on the knowledge levels of COPD management was evaluated with a questionnaire survey, the questionnaire contained the knowledge of COPD and its management. The survey showed that before the training, the participants had low knowledge levels on the definition of COPD and its risk factors; 67.6% (23/34) were not aware of COPD-related guidelines and new developments, and 17.6%(6/34) had conducted COPD follow-up assessments, pulmonary rehabilitation, and health education; only 8.8% (3/34) had used the improved British Medical Research Council Dyspnea Index (mMRC) and the chronic obstructive pulmonary disease assessment test (CAT) for patient self-assessment; there was no pulmonary function instrument in their units, and only 3 doctors (8.8%) had previously participated in pulmonary function training and knew indications and contraindications of the pulmonary function test, and complete report interpretation; all participants were unable to use common inhalation devices and master inhalation techniques completely and correctly; 11.8% (4/34) had assessed patients′ handling inhalation devices and performing inhalation. After the training, the knowledge levels of COPD clinical features, lung function and inhalation technique were significantly improved, and the scores were significantly increased compared with those before the training ( P<0.001). The study shows that primary care physicians have insufficient knowledge and management skill of COPD. The practice-oriented training can significantly improve the knowledge and skills of primary care physician for COPD management in the community.