Since there is dissymmetry of information in medical insurance market,it is inclined to result in moral hazard.In our country,moral hazard in medical insurance has always been very conspicuous.To maximize their profit,doctors and patients either excessively supply or excessively demand the medical service.This has led to unreasonable and remarkable increase in medical expenditure and great waste in medical resources.At the same time,Moral hazard has deteriorated the relationship between doctors and patients and degraded the social integrity.This thesis adapts the document research method to discuss the appearance,causes and influences of moral hazard in medical insurance in order to put forward some measures for its precaution.

BACKGROUND: Acute respiratory insufficiency is common complication of surgical treatment of adolescent scoliosis patients. The preventive effects of breathing exercise before surgery is still uncertain.OBJECTIVE: To explore the feasibility and efficacy of breathing exercises for scoliosis patients before operation.DESIGN: Nonrandomized cross sectional study.SETTING, PARTICIPANTS and METHODS: Totally 35 hospitalized kids with scoliosis and pulmonary dysfunction aged from 9 to 15 years old were selected from Shanghai Changhai Hospital. A set of breathing exercise including which included pursed lip breathing, abdominal breathing, diaphragmatic breathing and blowing balloon was performed to these patients one week before surgery. The changes of pulmonary function were recorded and compared before and after exercises.MAIN OUTCOME MEASURES: The change of vital capacity, lung capacity, forced ventilation capacity(FVC), maximal ventilation volume(MVV) before and after breath exercises.RESULTS: All sorts of indes are improved comparing with those before exercises. The vital capacity, lung capacity, FVC and MVV were greatly improved from(1.77 ±0. 36), (2.67 ±0. 84), (2.07 ±0.46), (52.5 ± 14.0) L before exercises to(2.65 ±0. 29), (3.56 ±0.79), (2.41 ±0.41), (70. 1 ± 17.0) L respectively( t = 3.63 - 11.28, P < 0.01).CONCLUSION: Preoperative breathing exercises can improve the pulmonary functions of kids with scoliosis and improve their tolerance to surgery and prevent the postoperative respiratory insufficiency.

Objective To investigate the clinical characteristics,diagnosis and therapeutic principle of thyroid microcarcinoma(TMC).Metllotis Clinical data of 29 TMC cases from January 1997 to December 2006 were retrospectively analyzed.Results 27 cases were performed B-ultrasonography and minimal lesion of thyroid Was detected in all patients,5 cases were diagnosed as TMC suspiciously,of whom 1 case was found to have lymph node swell in cervical part and was diagnosed as metastasis thyroid cancer by lymph node biopsy.All cases took operation and experienced intra operative frozen section and paraffin section evaluation,indicating that 23 cases were confirmed by intra operative frozen section and 6 cases were confirmed by paraffin section.All cases were followed up after operation,of whom 2 patients undergoing homo-lateral near total thyroidectomy experienced recurrent after 2 years and 3 years operation respectively,and one patient died from cerebral hemorrhage.Conclusion Though it is difficult to confirm the diagnosis of TMC before operation,B-uhrasonography before operation combined with frozen section intra operation is the effective diagnostic method,and homolateral lobe and isthmus total thyroidectomy is the fundamental operation management.

Case based learning/problem-based learning ( CBL/PBL ) is a new teaching method based on traditional medical education methods.In order to conquer the deficiency of traditional education methods in autonomous study motivation and ability of knowledge integration, CBL/PBL has been introduced into vascular surgery teaching procedure since 2006.The quality and effort of CBL/PBL compared with lecture-based learning ( LBL ) were evaluated and scored. The outcome of this teaching innovation shows CBL can arouse students' desire in autonomous study and enhance their ability in clinical analysis.But, its superiority is difficult to develop in the current medical education system.

Objective To observe the mechanism of Siwu Decoction (Decoction of four ingredients) on blood deficiency syndrome.Methods Wistar rats were randomized into 3 groups: model group, treatment group, and normal group, 6 ones in each. Rats of the model group and the treatment group were injected 2% acetylphenylhydrazine (APH) saline subcutaneously on the first, forth and seventh day. From the forth day, the model group was treated with saline by gavage, the treatment group was treated with Siwu Decoction by gavage, and the normal group was treated with saline for 7 days in succession. Then the amount of peripheral blood cells, wet weight of liver and spleen were detected. Liver mitochondrial proteome of all rats were extracted. Proteomic technology was used to measure the regulated proteins by Siwu Decoction.Results In the model group, the rats had decreased general status significantly such as pale, enlarged liver and spleen, lowered red blood cells (RBC) and hemoglobin (HGB), increased white blood cells (WBC) and reticulocyte (RCT) (P

[ABSTRACT]OBJECTIVEThe purpose of the study is to put forward some ideas and suggestions for the future research of allergic rhinitis.METHODSThe experimental animal species, strains, methods of replicating animal model and the judging standard of allergic rhinitis in China from January 1998 to December 2014 were reviewed and analyzed.RESULTSThe experimental animal species, strains, methods of replicating animal model and the judging standard of allergic rhinitis used in 137 articles were different.CONCLUSIONOnly standardized and unified experimental animal model can ensure the implementation of scientific research successfully and the reliability of the experimental results.

AIM: To identify an unknown peak in Guanxinning Injection(Radix et Rhizome Salviae Miltiorrhizae,Rhizoma Chuanxiong) chromatographic fingerprint. METHODS: The elution(44-46 min) separated and collected by HPLC was analyzed by GC-MS and HPLC-PDA-MS-MS. RESULTS: The unknown peak was corresponding to senkyunolidel I. CONCLUSION: It is quick method to identify the reported chemical in herbal medicine based on a small quantity of sample by GC-MS and HPLC-PDA-MS-MS.

Objective To investigate the effect of tandem mass spectrometry and gas chromatography-mass spectrometry to make prenatal diagnosis of methylmalonic acidemia (MMA) by detecting organic acid and acylcarnitine in amniotic fluid.Methods From October 11,2007 to December 20,2014,131 pregnant women with MMA proband received prenatal diagnosis of MMA in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (case group).Another 120 cases of pregnant women for conventional prenatal diagnosis at the same period were as control group.The pregnant women of two groups had the amniocentesis at 16 to 20 weeks of gestation.The levels of propionylcarnitine(C3) and acetylcarnitine(C2)in amniotic fluid were detected by tandem mass spectrometry.The methylmalonic acid and methylcitrate acid were detected by gas chromatography-mass spectrometry.MMA gene of cells in amniotic fluid of eighty fetuses with proband clearly diagnosed were detected by gene testing.Data were analyzed by Wilcoxon test.Results In case group,29 fetuses were found positive for higher level of C3,C3/C2,methylmalonic acid and methylcitrate acid compared with normal reference value,and the detected rate of fetal MMA was 22.1％(29/131).The levels of C3 and C3 / C2 in amniotic fluid of these 29 cases were higher than those in control group[8.13(2.42-16.70) vs 1.04(0.52-3.40) μmol/L,Z =-8.313; 0.77(0.30-1.79) vs 0.10(0.05-0.22),Z=-8.374; P ＜ 0.05 respectively].The levels of methylmalonic acid and methylcitrate acid were also higher[9.13(1.68-61.78) vs 0.00(0.00-1.31) mmol/mol Crea,Z=-11.348; 0.58(0.00-1.90) vs 0.05(0.00-0.52) mmol/mol Crea,Z=-6.632,P ＜ 0.05 respectively].For the other 102 cases in case group,the levels of C3,C3/C2,methylmalonic acid and methylcitrate acid were not higher than normal reference value,and were similar to those in control group (P ＞ 0.05); while they were lower than those of positive MMA fetuses (all P ＜ 0.05).Among 29 positive fetuses,16 fetuses were detected MMA gene,five were diagnosed as MUT forms of MMA and 11 were MMACHC forms of MMA.In 102 MMA negative fetuses,64 fetuses were detected MMA gene,44 were found one mutant site and 20 were found no gene mutation.The coincidence rate between gene detecting and mass spectrometry was 100％(80/80).Conclusions Mass spectrometry could be used to measure the C3,methylmalonic acid and methylcitrate acid levels in amniotic fluid of pregnant women with MMA proband to make prenatal diagnosis.

Objective To investigate hemodynamic changes of deep vein in lower limb during the perioperative period of total hip arthroplasty (THA) and early diagnosis of deep vein thrombosis (DVT). Methods Doppler ultrasound, hemorheology detection and plasma D-dimer testing were done on 62 patients treated with THA. Statistical analysis was carried out on the data of patients with or without DVT to study the early diagnosis of DVT. Results The results of Doppler ultrasound showed DVT in 8 patients. Compared with postoperative concentration of plasma D-dimer, the preoperative con-centration of plasma D-dimer was significandy higher in patients with or without DVT (P < 0.05). The levels of hemorheological indices were significantly increased at postoperative day 7 (P < 0.05). Con-clusions Doppler ultrasound combined with plasma D-dimer testing and hemorheology detection are helpful in early diagnosis of DVT.

Objective:To investigate the killing effects in vitro of a new photosensitizer black titanium dioxide b-TP-700-mediated photodynamics on prostate cancer cell line PC-3 cells.Methods:The b-TP-700 was successfully prepared by using solid phase in situ thermal reduction method. PC-3 cells were treated with 31.25, 62.5, 125, 250, 500, 1 000 μg/ml b-TP-700 for 12, 24, 48 h. The cell activity was detected by using CCK-8 method, and the morphology of PC-3 cells was observed by using confocal fluorescence microscope, the toxicity of b-TP-700 to PC-3 cells was also judged. PC-3 cells were treated with different concentrations of b-TP-700 (31.25, 62.5, 125, 250, 500 μg/ml) and irradiated with laser (1 W/cm, 808 nm) for 1, 3, 5, 7 min. The cell activity was detected by using CCK-8 method. The production of reactive oxygen species in PC-3 cells cultured in 250 μg/ml b-TP-700 after laser irradiation for 5 min was detected by using confocal fluorescence microscopy. The non-laser irradiation cells were selected as the control group.Results:There were no statistically significant differences in cell activity of PC-3 cells treated with different concentrations of b-TP-700 for the same time ( F value was 1.26, 0.39 and 0.37, respectively; all P > 0.05). PC-3 cells were treated with 1 000 μg/ml b-TP-700 for 24 h, no obvious morphological changes and no obvious dead cells were observed under fluorescence microscope. When PC-3 cells were treated with the same concentration of b-TP-700, the activity of PC-3 cells was decreased with the extension of laser excitation time. Under the same laser excitation time, the activity of PC-3 cells was decreased with the increase of b-TP-700 concentration (all P < 0.05). Under laser irradiation, obvious green fluorescence could be detected in the PC-3 cells treated with 250 μg/ml b-TP-700, while almost no green fluorescence could be observed in the control group. Conclusions:A new photosensitizer b-TP-700 has the good reactive oxygen generation ability. b-TP-700-mediated photodynamics show obvious killing effects on prostate cancer PC-3 cells in vitro, which is expected to be a new method for the treatment of prostate cancer.