Objective To describe and analyze the distribution of medical expenditure of Liaoning province in 2014 in terms of population beneficiary based on the System of Health Accounts 2011(SHA 2011).Methods By means of multistage and stratified sampling, a total of 252 medical institutions were selected from four cities in Liaoning province according to their economic status and geographical distribution.Macro data including the outpatient income and hospitalization income were taken into account, to calculate the beneficiary population of the province in 2014 according to SHA2011.Results GBD classification found that the highest medical expenditure category was non-communicable diseases, accounting for 63.02% in total medical expenditure.ICD classification found that respiratory disease as consuming the highest medical expenses (43.76%).The average medical expenditure of the elderly population was the highest per person, up to 3 041.70 yuan per person.Conclusions Medical expenses of non-communicable diseases, respiratory disease and elderly population were still high.Thus we need to emphasize disease prevention, and take efficient measures against such key diseases to curb the medical expenses.The elderly population calls for specific and effective measures to reduce their medical expenses.

AIM: To investigate the expression of Smad2 signal protein in peritoneal mesothelial cells and how transforming growth factor ?1 (TGF-?1) affects its expression. METHODS: Rat peritoneal mesothelial cells were cultured in different levels of TGF-?1 (0,1.25,2.5,10 ?g/L) for different time (0,5,15,30,60,120 min). Endogenous Smad2 expression was evaluated by RT-PCR and immunohistochemical assay. The alteration of subcellular location of Smad2 was determined by immunohistochemical assay. RESULTS: TGF-?1 induced Smad2 mRNA expression, which increased at 5 min, peaked at 30 min, and declined to baseline levels by 120 min, in a time-dependent manner. Smad2 mRNA expression induced by TGF-?1 was also in a dose -dependent manner. TGF-?1 induced Smad2 phosphorlylation and nuclear localization in both time-dependent and dose-dependent manner, which was concordant with mRNA expression. Smad2 translocated from cytoplasm to nuclear accumulation in response to TGF-?1, and peaked at 30 min. CONCLUSIONS: Smad2 is present in peritoneal mesothelial cells. TGF-?1 may activate Smad2 expression and translocation to nuclear in a time-dependent and dose-dependent manner. [

Objective To investigate the diagnostic value of high frequency ultrasound combined with esophageal filling in neonates with congenital esophageal atresia.Methods Fifty-eight newborns who were suspected with congenital esophageal atresia underwent ultrasound,the surgical results considered as the gold standard,then the ultrasound features of the congenital esophageal atresia were summarized.ResultsSeven cases were the type Ⅰ of the congenital esophageal atresia,1 case belongs to type Ⅱ,40 cases were considered as type Ⅲ,4 cases were classified type Ⅳ and 6 cases were type Ⅴ,the diagnostic accuracy of ultrasound in congenital esophageal atresia was 96.55% and the classification accuracy was 89.65%.Conclusions High frequency ultrasound combined with esophageal filling has a high accuracy and can be used as a new diagnostic method in diagnosing neonates with congenital esophageal atresia,and it′s worthy of further research and promotion.

AIM: To investigate the role of Smad7 in the Smad2 expression induced by transforming growth factor-?_1(TGF-?_1) in rat peritoneal mesothelial cells(PMCs).METHODS: Rat PMCs were cultured at different doses of TGF-?_1 (0,1.25,2.5,10 ?g/L) for different time(0,5,15,30,60,120 min).PCDNA3-Smad7 was then transfected into cultured rat PMCs by lipofectamine,and the cells were stimulated like the above.Endogenous Smad2 and Smad7 expression was evaluated by RT-PCR and Western blotting.RESULTS: TGF-?_1 induced increase in Smad2 mRNA and protein expression at 5 min,peaked at 30 min,and declined to baseline levels at 120 min, which was in a time-dependent manner.TGF-?_1 also induced Smad7 mRNA expression at 5 min,and then declined,down to the lowest at 30 min,but at 60 min it increased again.Smad2,Smad7 mRNA and protein expression induced by TGF-?_1 were also dose-dependent.After transfection,overexpressions of Smad7 mRNA and protein in rat PMCs were observed,which did not decline with time.The expression of Smad2 mRNA significantly decreased by 33%,56%,67%,71%,63% and 57%(P

High‐speed economic development and progress of medical technologies in China have significantly benefitted people′s health conditions.Significantly higher life expectancy in average ,as a result ,also contributed to population aging process.How to deal with the contradictions between population aging and rapid growth of medical costs is challenging the healthcare sector of the country.Analysis of medical costs at three tertiary hospitals in Liaoning Province discovered problems in out‐of‐pocket medical expenses of elderlies ,and proposed on measures to effectively ease their burden in medical expenditure .

Objective To investigate the diagnostic value of high frequency color Doppler ultrasound combined with gastrointestinal filling in infants with duodenal obstruction . Methods One hundred infants who were suspected with duodenal obstruction underwent both gastrointestinal ultrasound and upper gastrointestinal tract ,put the surgical results as the ?gold standard ,the values of ultrasonic and upper gastrointestinal tract in the diagnosis of pediatric congenital duodenal obstruction were compared . Results The diagnostic accuracy of ultrasound and upper gastrointestinal tract in duodenal obstruction was 100%and 94% respectively ,the difference was statistically significant ( P = 0 .041) . The accuracy rate of obstruction location was 98 .04% and 84 .31% respectively , also was considered to denote statistical significance ( P = 0 .023 ) . The total diagnostic accuracy of congenital disorders caused by duodenal obstruction was 89% and 49% respectively ,and P = 0 .001 implies statistically significant difference . Conclusions There is a high diagnostic accuracy in high frequency ultrasound combined with gastrointestinal filling in children with congenital duodenal obstruction ,and the diagnosis of some diseases is better than that of the upper gastroenterography .

This study is to investigate the effects of phenytoin sodium, lidocaine (sodium channel blockers), propranolol (beta-adrenergic receptor antagonist), amiodarone (drugs prolonging the action potential duration) and verapamil (calcium channel blockers) on arrhythmia of mice induced by Bufonis Venenum (Chansu) and isolated mouse hearts lethal dose of Chansu. Arrhythmia of mice were induced by Chansu and then electrocardiograms (ECGs) were recorded. The changes of P-R interval, QRS complex, Q-T interval, T wave amplitude, heart rate (HR) were observed. Moreover, arrhythmia rate, survival rate and arrhythmia score were counted. Isolated mouse hearts were prefused, and the lethal dose of Chansu was recorded. Compared with control group, after pretreatment with phenytoin sodium, broadening of QRS complex and HR were inhibited, and the incidence of ventricular arrhythmia was reduced dramatically, while survival rate was improved; the isolated mouse hearts lethal dose of Chansu was increased significantly. After pretreatment with lidocaine, the prolongation of P-R interval and broadening of QRS complex were inhibited, and the incidences of ventricular arrhythmia were reduced dramatically, while survival rate was improved; the isolated mouse hearts lethal dose of Chansu was increased significantly. After pretreatment with propranolol, prolongation of P-R interval, broadening of QRS complex, prolongation of Q-T interval and HR were inhibited, and the incidences of both supraventricular and ventricular arrhythmias were reduced dramatically, while survival rate was improved. After pretreatment with amiodarone, HR was inhibited, the incidences of ventricular tachycardia were reduced dramatically. Lastly, after pretreatment with verapamil, the prolongation of P-R interval and Q-T interval were inhibited and the incidences of both supraventricular and ventricular arrhythmias were reduced dramatically; the isolated mouse hearts lethal dose of Chansu was reduced significantly. In in vivo experiments, phenytoin sodium was most effective against the mice arrhythmias induced by Chansu while cautious use of verapamil for Chansu inducing arrhythmia should be noted. It is also concluded that mice ventricular arrhythmias induced by Chansu might be most closely related to sodium channel, supraventricular arrhythmias might be related to beta-adrenergic receptor, and calcium channel plays an important role in conduction block. In in vitro experiments, phenytoin sodium was most effective, followed by lidocaine and propranolol, and amiodarone had no obvious effect and verapamil reduced the lethal dose of Chansu.

Objective:To explore the feasibility of artificial intelligence ultrasound to diagnose of biliary atresia (BA) based on deep learning.Methods:A total of 531 gallbladder ultrasound images in 177 cases of BA patients (BA group) and 585 gallbladder ultrasound images in 195 cases of Non-BA patients (Non-BA group) were collected in Hunan Children′s Hospital from September 2018 to October 2020. For the BA and Non-BA groups, all images were divided into training set and test set according to the ratio of 2∶1. The Mask R-CNN model was trained by training samples, and then the model was tested, according to patient and image as a unit respectively, to evaluate the gallbladder organ detection rate and the diagnostic accuracy of BA. In addition, the images of the test set were randomly numbered.Four sonographers were invited to interpret the images to calculate the diagnostic accuracy individually. Last, the diagnostic accuracy of the Mask R-CNN model was compared with that of sonographers.Results:In terms of the automatic detection of gallbladder organs, the detection rate in both BA and Non-BA group reached 100%, but there were 17 false alarms in 372 test images, with a false alarm rate of 4.57%. In terms of the diagnostic rate of gallbladders, when taking patient as a unit, the total diagnostic accuracy of the model in the test set was 95.97%, which was higher than that of the sonographers in other hospitals and the sonographer with intermediate professional title in our hospital, and the difference was statistically significant ( P<0.005). It was slightly higher than that of sonographer with senior professional title in our hospital (91.94%), but the difference was not statistically significant ( P=0.183). When taking picture as a unit, the total diagnostic accuracy of the model was 97.04%, which was higher than that of the sonographers in other hospitals and the sonographer with intermediate professional title in our hospital, and the difference was statistically significant ( P<0.001). It was slightly higher than that of sonographer with senior professional title in our hospital (94.09%), but the difference was not statistically significant ( P=0.05). Conclusions:The artificial intelligence technology based on Mask R-CNN can automatically and accurately detect gallbladder organs and diagnose BA, which is worthy of further study.

Objective To investigate the aggressive signs of benign spinal lesions appearing on medical imaging and their impact on diagnosis.Methods 139 cases of benign spinal lesions with aggressive signs confirmed by pathology of needle aspiration or surgery were reviewed,including 18 cases of osteoblastoma(OB),12 cases of aneurysmal bone cyst(ABC),14 cases of osteoenchondroma (OC),19 cases of Langerhans cell histiocytosis (LCH),15 cases of hemangioma (HA),34 cases of tuberculous spondylitis (TS),and 27 cases of pyogenic spondylitis (PS).All patients underwent radiography,119 cases CT plain scan,75 cases MRI scan,and 57 cases performed all the three imaging modalities.The aggressive signs,including bulging of posterior margin of the vertebral body,pathological compression fractures,ill-defined boundary,abnormal soft tissue mass,bone marrow and soft tissue edema were showed.The benign and malignant misdiagnosis rate,the consistent rate of diagnosis with pathology were statistically analysed.Results Bulging of posterior margin of the vertebral body were found in 2 cases of OB,1 case ABC,3 cases LCH,1 case OC,6 cases HA,6 cases TS,2 cases PS.Pathological compression fracture were found in 6 cases of OB,10 cases ABC,16 cases LCH,4 cases HA,21 cases TS,16 cases PS.Ill defined boundary were found in 3 cases of OB,8 cases HA,34 cases TS,27 cases PS.The abnormal soft tissue around spine were found in 6 cases of OB,2 cases ABC,15 cases LCH,10 cases TS,15 cases PS.Bone marrow and soft tissue edema were found in 5 cases of OB,4 cases ABC,10 cases LCH,4 cases HA,30 cases TS,27 cases PS.For benign and malignant misdiagnosis rate,MRI was better than CT(P＜ 0.05).For accuracy of the consistent rate with pathology,CT was better than MRI(P＜0.05).The integrated application of the three imaging methods could significantly improve diagnostic accuracy (P＜0.05).Conclusion The imaging features benign spinal lesions are various,which may be associated with aggressive signs.A comprehensive method combined with three kinds of imaging methods,is a simple and feasible way to avoid the misdiagnosis.

Objective To observe the abdominal ultrasonic manifestations of children with Langerhans cells histiocytosis (LCH).Methods Imaging features of histopathologically proved LCH in 28 children were retrospectively analyzed.Results Among 28 eases,multi system involvement was found in 25 cases,while only liver and bile duct involvement were detected in 3 cases.Different degrees of enlarged liver,inhomogeneous echo of liver parenchyma,scattered or diffuse hypoechoic regions were found in all 28 cases.Uneven thickening and echo enhancement of the bile duct wall,as well as local expansion or stricture of bile duct cavity were found in 13 cases.Splenomegaly was found in 17 cases,swelling of the pancreas was found in 5 cases,varying degrees of ascites were found in 13 cases,and hepatic hilar lymphadenectasis were found in 14 cases.Conclusion There are specific ultrasonographic manifestations of LCH in children,which may be helpful to improving diagnostic accuracy of LCH.