This article discusses faults of the ruling Free Medical Service from the supply and demand of healthy system and analyses the ethical foundation of reform of free medical Service.

This paper analyzes social background and ethical problems of disposing and using unreasonably High-tech equipment, and puts forward relative proposals of contermeasure.

Objective To enhance the understanding of relapsing polychondritis (RPC).Method Clinical features,laboratory studies and prognosis of RPC in 20 patients were analyzed.Results The average age at the beginning of disease was 53 4 years (range from 35 to 86).The average course from initiation of clinical symptoms to diagnosis was 1 1 years.Of patients,90% had auricular chondritis,80% had respiratory system involvement,75% had nasal chondritis and 4 patients had severe tracheobronchial chondritis.Involvement in joints,skin,cardiovascular and neurotic system also existed in various frequencies,and 20% of the patients were associated with other rheumatic or autoimmune diseases.Conclusion Extensive laryngo tracheobronchial disease is a vital signal in RPC.Early diagnosis and treatment with corticosteroid and immunosuppressant can improve the prognosis.

Objective To explore the relation of the infantile acute upper respiratory tract infection(AURI) with myocardial injury.Methods Creatine kinase (CK) and its isoenzyme(CK-MB),lactate dehydrogenase(LDH),asparatic acid transminase (AST) were tested with the fully automatic analyser and electrocardiogram(ECG) were examined with AURI in 86 cases as experimental group and 30 cases of health infants as control group.Results The abnormal rates of CK,CK-MB,LDH,AST and ECG in the AURI group were higher than those of the control group.Conclusions There is different degree of myocardial injury in some children with AURI, the clinical doctor should pay more attention in the AURI cases companied with the myocardial injury and to prevent myocardial injury complicaton in these cases . [

BACKGROUND: It has been shown that Qiang Chang Heji (QCHJ) hadsome protective effects in rats with experimental brain injuries and couldimprove some hemorheological indices.OBJECTIVE: To observe effects of QCHJ on peripheral platelet in rats with experimental right brain insufficiency of blood supply.DESIGN: A randomized and controlled experiment.SETTING: Central Laboratory, General Hospital of Chengdu Military Area Command of Chinese PLA.MATERIALS: Totally 60 SD white rats (either sex, werghing from 150 g to 170 g) were used. They were divided randomly into 3 groups: sham-operation group (n=8), control group (n=18) and treatment group (n=34).QCHJ:Chinese herbal mixture, equal dosage of both Rhizoma seu Radix Notopterygii and Rhizoma Acori Graminei were decocted twice, each for 30minutes with mild fire after boiling. The two decoctions were mixed and concentrated to 1g raw herb per milliliter.METHODS: The experiment was carried out in Central Laboratory, General Hospital of Chengdu Military Area Command of Chinese PLA from July to September 2004. The right carotid artery (CA) of rats were separated,ligaturewas done in control and treatment groups ;but no ligature in sham operation group. Medication (po. by gastric perfusion) was given since the day of operation. In treatment group, 10 rats took QCHJ 10 g/kg per day for3 days; and others took 3.3, 6.7, 10 g/kg per day for 7 days respectively, (8 rats for each dose). In control group, equal volume physiological saline was given daily for 3 or 7 days. In sham operation group, equal volume physiological saline was given daily for 3 days. On the 3rd and 7th days after operation, platelet count (Plt), mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) of platelet were determined with a Bakeman Blood Cell Auto-analyzer. t test was used to compare the difference.MAIN OUTCOME MEASURES:Effects of QCHJ on peripheral platelet in rats with brain insufficiency of blood in brain.RESULTS: ①Day 3 after operation: PLt were similar between control group and sham-operation group (P ＞ 0.05); MPV, PDW and P-LCR were higher in control group than that in sham operation group (P ＜ 0.01); in QCHJ treated group (10 g/kg per day), MPV, PDW, and P-LCR were significantly lower than that in control group (P ＜ 0.01), and they were similar to that in sham operation group. ② Day 7 after operation: MPV, PDW, and P-LCR in control group were similar to that in sham operation group. In addition, P-LCR in control and QCHJ treatment group (3.3, 6.7, 10.0 g/kg per day) were lower than that in control group on the 3rd day of operation (P ＜ 0.01).CONCLUSION: Experimental brain injury induced by block blood supply may result in peripheral platelet abnormities. QCHJ has been shown to improve some of the abnormities.

Objective To determine the prognostic factors in systemic sclerosis.Methods Clinical data of definite systemic sclerosis patients were collected,including disease onset age,sex,disease course,Raynaud's phenomenon,skin involvement,gastroesophageal reflux,interstitial pneumonia,cardiac lesions,kidney lesions and scleroderma renal crisis.serum antibodies to scl-70.RNP and anti-centromere antibody were detected.Pulmonary artery pressure was measured by ultrasound cardiography.Cox hazard ratio model was employed to assess the mortality risk of systemic sclerosis patients.Results No difference in Raynaud's phenomenon,gastroesophageal reflux,anti-nuclear antybody,anti-sol-70 antibody,anti-centromere antibody,interstitial pneumonia,diffusion capacity (DLco),coronary artery disease,and peripheral artery atherosclerotic disease could be found between the dead and alive systemic sclerosis patients(P>0.05).Dead systemic sclerosis patients had later disease,onset(older than 60 years old)(P=0.002).Male gender(P=0.023),more diffuse skin involvement(P=0.000),more positive anti-RNP antibody(P=0.014),more pulmonary artery hypertension(P=0.000).more cardiac lesions(P=0.000),more cerebral infarets (P=0.035),more kidney lesions(P=0.000),and more scleroderma renal crisis(P=0.000) could be found jn dead sclerosis patients.Cox regression analysis showed that,onset later than 60 years old(OR=5.441.95% CI 2.126～13.926,P=0.000),male sex (OR=5.531,95%CI 2.014～15.190,P=0.001),anti-RNP antibedy positivity (OR=2.664,95%CI 1.016～6.592,P=0.034),diffuse skin involvement(OR=3.432,95%CI 1.400～8.411,P=0.007),pulmonary artery hypertension (OR=25.718,95% CI 5.954～111.085,P=0.000),cardiac lesions (OR=4.141.95%CI 1.685～10.159,P=0.002),kidney lesions(OR=4.214,95%CI 1.654～10.737,P=0.003) and scleroderma renal crisis (OR=20.677,95% CI 4.161～102.764.P=0.000)were risk factors for mortality in systemic sclerosis.Severe pulmonary hypertension was the most strong predictive factor for mortality in systemic sclerosis (OR=55.809,95% CI 12.879～241.832.P=0.000).Conclusion Aggressive therapy should be given to those systemic sclerosis patients with onset later than 60 years old,male sex,diffuse skin involvement,anti-RNP antibody positivity,cardiac involvement,kidney lesions,scleroderma renal crisis and pulmonary artery hypertension,especially seevere pulmonary hypertension.

BACKGROUND: It has been discovered in experimental researches that qiang chang heji acts on prevention and treatment of brain injuries induced by insufficient blood supply and improvement of blood rhelogical property.OBJECTIVE: To study on the effects of qiang chang heji on peripheral red blood cell in rats with insufficient blood supply to brain so as to probe into its mechauism on improving blood rhelogical property.DESIGN: A randomized controlled trial.SETTING: Central Laboratory of General Hospital of Chengdu Military Area Command of Chinese PLA.MATERIALS: The experiment was performed in Central Laboratory of General Hospital of Chengdu Military Area Command of Chinese PLA from July to September 2003. Totally 50 SD white rats of either sex were employed, weighted varied from 150 g to 170 g.METHODS: The common carotid artery(CA) on the right side was ligatured to induce insufficient blood supply in the brain. The control and qiang chang heji(QCHJ) group were designed for comparison. On the same day of CA ligature, in treatment group, QCHJ of various dosages were applied daily for gastric perfusion; and in the control, physiological saline was applied. Three or seven days later, the parameters of peripheral red blood cell and its rhelogical property were analyzed with equipment.the sham-operation group, mean cell hemoglobin (MCH), haematocrit(HCT) (%) and RBC aggregation index were in the tendency of increase and mean cell hemoglobin concentration (MCHC) (g/L) was increased obviously (375±7 vs 363±13) (P ＜ 0.05) .In the treatment group of 10 g/kg QCHJ, HGB(139.2±12.4 vs 153.6±9.6), MCHC(355±7 vs 375±7) and haematocrit(HCT) (35.4 ±0.9 vs 42.8 ±4.5) were significantly lower the control compared with the sham-operation group, both rigidity index and aggregation index of RBC were in the tendency of further increase. In treatment of QCHJ 10 g/kg, MCHC(354±4 vs 361 ±4), RBC rigidity index (1.02±0.35 vs 4.54±3.04) and aggregation index (2.76±0.66 vs 4.67 ± 1.21 ) were significantly lower than the control( P ＜ 0.05).CONCLUSION: Treatment with QCHJ can prevent changes in peripheral red blood cell in rats with insufficient blood supply in the brain and reduce MCHC and RBC rigidity index and aggregation index so as to improve RBC deformability and rhelogical property.

Objective Antibodies against citrulline-containing peptides such as anti-perinuclear factor (APF), anti-keratin antibodies (AKA), anti-filaggrin antibodies (AFA) and anti-cyclic citruilinated peptide (CCP) antibodies are very specific in RA. In recent years, detection of APF, AKA and anti-CCP antibodies have been widely used in clinical practice. Studies on the combined detection of these ACPA in diagnosing RA are limited in number. The aim of this study is to detect combined examination of APF, AKA, and anti-CCP antibodies and compare their values in the diagnosis of rheumatoid arthritis. The significance of combined detection of these ACPAs in rheumatoid arthritis is also investigated. Methods Five hunndred and fifly-one patients who suffered from arthritic problems during the recent two years were selected from the Department of Rheumatology and Immunology of Peking University People's Hospital. 304 of the patients were RA and 247 were diagnosed to have other rheumatic diseases based on the corresponding classification criteria. AKA and APF were tested by indirect immunofluorescence assay. Anti-CCP antibodies were tested antibodies, AKA and APF tests for RA were 76.2%, 43.6%, and 34.5%, respectively, and the specificities were highest specificity (100%), but it had a rather low sensitivity (28.3%). When two of the three ACPA were positive, the sensitivity and specificity for the diagnosis of RA was 48.4% and 99.2%, respectively. When either anti-CCP antibodies, AKA, or APF was treated as an individual parameter, the sensitivity was slightly increased (77.3%). However, the specificity decreased to 94.7%. Conclusion Anti-CCP antibodies are the most helpful makers for the diagnosis of rheumatoid arthritis among the three ACPAs which are used in clinical practice. The combined detection of anti-CCP antibodies, AKA, and APF cannot increase the diagnostic sensitivity and specificity of rheumaotid arthritis.

Objective To evaluate the prevalence and clinical significance of IgG,IgA and IgM isotypes of anti-peptidylarginine deiminase 4 (anti-PAD4) antibodies in early rheumatoid arthritis (RA).Methods IgG,IgA and IgM isotypes of anti-PAD4 antibodies were measured in the sera of 88 RA patients with disease duration less than 2 years,62 patients with other rheumatic diseases and 57 healthy subjects.The diagnostic performance of IgG,IgA and IgM isotypes of anti-PAD4 antibodies and their relationship with disease duration,DAS28,ESR,CRP,anti-CCP antibodies and rheumatoid factor (RF) were evaluated.Data analysis were performed using t test,U test and Spearman's association analysis.Results ① The sensitivities of IgG,IgA,and IgM isotypes for early RA were 28.41％,36.36％ and 9.09％ respectively.The specificities of IgG,IgA and IgM isotypes were 94.12％,93.28％ and 95.80％ respectively.② IgA isotype was positively correlated with age (r=0.234,P=0.028),DAS28 (r=0.309,P=0.007),ESR (r=0.382,P=0.000) and CRP (r=0.291,P=0.008),while negatively correlated with disease duration (r=-0.295,P=0.006).③ IgA isotype was positively correlated with IgG isotype (r=0.451,P＜0.01).In the IgG negative patients,the positivity of IgA isotype was 29％(18/63),which indicated that the IgA isotype might be helpful in diagnosing RA in IgG isotype negative patients.Conclusion Anti-PAD4 antibodies can be detected in early RA,primarily with IgA and IgG isotypes.IgA isotype has negative correlation with disease duration,indicating that IgA isotype of anti-PAD4 antibody may play a role in the very early stage RA.

Objective To study the clinical characteristics of the onset of systemic lupus erythematosus(SLE) in postmenopausal patients. Methods The clinical features and prognosis of 20 SLE patients whose onset was at least one year after menopause,and 70 patients with the onset during normal menstruation and 43 male patients between 1992 and 2003 were comparatively analyzed. Results The onset of SLE was seen after menopause in 20 out of 699 (2.9%) female patients. The average age at the onset of the disease was 55 years with a peak from 50 to 59. The common clinical manifestations were arthritis,lassitude,fever,alopecia,malar rash,cardiac impairment and weight loss,while laboratory abnormalities were high ESR,decreased C3,ANA≥1∶80,hypergammaglobulinemia and positive anti-RNP antibody. As compared with normal menstruation onset group,the postmenopausal onset group was more likely to have weight loss( P