Objective To probe into a doctor-seeking medical management model for China's urban hypertension patients under medical insurance, and enhance the level and quality of medical insurance management. Methods Hypertension patients were surveyed with a structured questionnaire, and the staff at community health centers and medical insurance management centers received qualitative interview. Results The hypertension patients are found to see doctors mostly at community health centers and tertiary hospitals; complaints among hypertension patients for existing medical insurance vary with their areas, mostly targeting on complicated reimbursement procedure, high threshold of medical insurance payment and low level of reimbursement. Recommendation Experiment with the single-disease payment for hypertension, with the total prepayment in per capita and per disease; greater efforts in hypertension control in communities, with more favorable medical insurance policies for communities;elevated collaboration with medical institutions at all levels, and building and standardizing the management information network for hypertension patients.

Objective To investigate the effects of angelica solution on chronic hypoxic pulmonary hypertension in rats.Methods Thirty SD rats were randomized into normoxic group,hypoxic group and angelica solution-protected group.The model of rat chronic hypoxic pulmonary hypertension was made by method of isobaric hypoxia.Angelica solution were injected before hypoxia,while the other two groups were injected normal saline.After 28d of hypoxia,pulmonary artery pressure were measured.Expressions of proliferating cell nuclear antigen (PCNA) and inducible nitric oxide synthase (iNOS) in pulmonary artery were detected by immunohistochemical staining.The index of wall thickness of rat pulmonary arteriole-percentage of the wall area in the total vascular area(wA%) were measured by a computerized image analyzer.Results The mean pulmonary artery pressure (mPAP) of normoxic group,hypoxic group and angelica solution-protected group were10.50±1.90,35.36±9.11,18.32±2.30 (mm Hg);wA% of the three groups were 52.71±5.16,82.38±8.43,64.58±9.54 (%),mPAP and wA% were significantly higher in the hypoxic group than those in the normoxic group (P<0.01) and angelica solution-protected group (P<0.01).PCNA expression of normoxic group,hypoxic group and angelica solution-protected group were 3.15±1.10,24.50±5.72,12.67±3.46 (%).The PCNA expression in the pulmonary artery was significantly higher in the hypoxic group than those in the normoxic group (P<0.01) and in the angelica solution-protected group (P<0.01).iNOS expression of normoxic group,hypoxic group and angelica solution-protected group were 2.13±1.01,17.33±3.53,37.50±7.04 (%).iNOS expression in the pulmonary artery was higher in the hypoxic group than those in normoxic group (P<0.01),and angelica significantly increased iNOS expression in comparison with the normoxic and hypoxic groups (P<0.01).Conclusion Angelica solution alleviates chronically hypoxia induced pulmonary hypertension in rats by inhibiting the espression of PCNA in pulmonary artery and up-regulating the expression of iNOS.

Objective To observe the action of narcotrend monitoring for perioperative anesthesia management in donor and acceptor with living donor renal transplantation. Methods 80 pairs of receptor and donor haing electie living donor renal transplantation surgery, 28 ~ 56 years. The ASA of receptor Ⅲ ~ Ⅳ, and the donerⅠ ~ Ⅱ. The receptor and donor were randomly divided into four groups , the narcotrend monitoring receptor group (R-N), the clinical experience receptor group (R-C), the narcotrend monitoring donor group (D-N), and the clinical experience donor group (D-C). Record the vital signs, the last time of anesthesia induction, operation , extract the endotracheal catheter , and the observation time in post anesthesia care unit , the dosage of propofol and dopamine, the adverse reaction, and postoperative visual analogue scale. Results The dosage of propofol in R-N group is less then the R-C group (P < 0.05). The time of extract the endotracheal catheter,and the observation time in post anesthesia care unit in R-N group was shorter then the R-C group (P < 0.05). No statistical differences between the D-N group and D-C group. Conclusions Narcotrend monitoring can significantly reduce the dosage of propofol , the observation time in post anesthesia care unit , and the postoperative adverse reactions. But there is little effect to the donor.

Objective To evaluate the reliability of mannitol for fluid responsiveness test in the patients undergoing intracranial surgery.Methods Sixty-two ASA physical status Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective intracranial surgery,were enrolled in the study.The patients were mechanically ventilated after induction of anesthesia.The radial artery and central vein were cannulated,and FloTracTM/VigileoTM system was connected for stroke volume variation monitoring.Before infusion of mannitol,effective circulating blood volume was confirmed according to stroke volume variation.20％ mannitol 250 ml was infused over 20 min starting from onset of craniotomy.The fluid responsiveness test was recorded at the end of mannitol infusion.Results The sensitivity of fluid responsiveness test was 43％,and the specificity of fluid responsiveness test was 44％.Conclusion Mannitol can not be used for fluid responsiveness test in the patients undergoing intracranial surgery.

Objective To investigate CT features of primary ileocecum lymphoma (PIL),to improve the ability of CT diagnosis for the disease.Methods CT data of 12 patients with PIL confirmed by surgery and pathology were analyzed retrospectively.All of the patients underwent plain CT, and 8 cases of them also underwent enhanced CT.Results Among the 12 cases of PIL, there were mass type in 2 and diffused thickness type in 10.The length of the intestinal lesions ranged from 7.8 to 18.5 cm (mean 10.2 cm).Lumen was irregular or aneurysmal dilation in 9, and obvious stenosis in 3.Intestinal wall was soft in 10,and rigid in 2.Plain CT showed that the thickened intestinal wall was soft tissue density.Among the 8 cases performed enhanced CT,6 were approximately homogeneous enhancement, and 2 had small necrosis area without enhancement.Maximum intensity projection(MIP) displayed the lesion had blood supply from the branches of the superior mesenteric artery.Enlarged lymph nodes were detected around the lesions, in root of the mesentery, and in the retroperitoneum in 9.1 case was accompanied with intestinal obstruction,1 case was accompanied with intestinal perforation.Conclusion If CT examination found a homogeneous soft tissue mass in ileocecum with long extent, lumen dilation, soft intestinal wall,mild-to-moderate delayed homogeneous enhancement, PIL should be considered.

Objective To study the correlation among property, efficacy and target of herbal Chinese materia medica; To analyze the molecular mechanism of cold and heat property of Chinese materia medica; To provide references for explaination of microcosmic mechanism and scientific connotation of property of Chinese materia medica. Methods Recordings about property and efficacy of single medicine in 2015 edition of Pharmacopoeia of the People's Republic of China were sorted out. According to Pharmacological Research of New Ideas and New Targets and Pharmacology, 509 kinds of herbal Chinese materia medica were selected. Relevant articles about property, efficacy, pharmacologic action, and target in CNKI and Chinese Academic Journal Database (Wanfang Data) were searched by computers. The target information was screened and standardized, and the database was constructed by using MySQL5.7.13. The correlation between the property, efficacy and the target of the herbal Chinese materia medica was studied by using the frequency analysis and correlation rule algorithm of R software platform 3.3.1. Results 509 kinds of herbal Chinese materia medica were selected, including 227 kinds of cold-property medicine, 106 kinds of neutural-property medicine and 176 kinds of hot-property medicine. According to the result of data mining, efficacy of cold-roperty medicine was quenching thirst, clearing liver and treating stranguriaetc. The target was transforming growth factor β2 and liver microsome, etc. The efficacy of hot-property medicine was warming the middle, releasing cold and dissolving lumps. The target was bone morphology protein 2, rheumatoid factor, etc. The efficacy of neutural-property medicine was clearing lungs, diminishing distension and increasing energy. The target was β-amyloid and prostaglandin E2 receptors. Conclusion There is certain correlation in property, efficacy and target in Chinese materia medica.

Lymph metastasis has great impact on the prognosis of pancreatic cancer patients, which can relfect the biological and invasive potential of pancreatic cancer. However, currently, there is no standard in the clinical management of the lymph metastasis in pancreatic cancer. In this report, we will discuss and summarize the followings:lymph metastatic rate and its impact on prognosis, the rule of lymph metastasis, sentinel lymph node, intra-operative lymph nodes mapping, TNM staging, regional lymph nodes resection, number of lymph nodes examined, lymph node ratio, guiding adjuvant treatments, lymphatic targeted therapy.

Objective To analyze the topological characteristics of the brain structural network in primary angle-closure glaucoma (PACG) patients by applying graph theoretical approaches.Methods From October 2015 to April 2017, nineteen PACG patients and nineteen gender-and age-matched healthy controls (HCs) were enrolled to undergo MRI scan. The whole brain was parceled into 90 regions by automated anatomical labeling template, and the brain structural network was constructed by the fiber distribution of continuous tracking method.Both the weighted and unweighted network analyses were performed.The global and regional properties were computed by graph theoretical analysis.To compare the brain network regional properties between two groups, two-sample t-test was utilized.The correlations between the brain structural network properties and clinical parameters were further analysed. Results Both two groups were found to follow the efficient small-world characteristics. Compared to HCs, the brain structural network in PACG patients showed no statistical significance in the small-worldness, average shortest path, clustering coefficient, global efficiency and local efficiency(P＞0.05). Compared to the HCs, the PACG patients showed decreased nodal efficiency in the right superior frontal gyrus, right inferior frontal gyrus, left median cingulate and paracingulate gyri, left amygdala and left cuneus(P＜0.05). Compared to HCs, the PACG patients showed decreased node degree in left superior frontal gyrus, medial orbital, right inferior frontal gyrus, left amygdala, left cuneus and left lingual gyrus(P＜0.05). Compared with the hub regions in healthy controls'network, we found that two hub regions disappeared.Those hubs were right inferior parietal lobule and left middle temporal gyrus. Node degree in left amygdala showed negatively correlated with visual ability (r=-0.679, P=0.001). Node degree in left lingual gyrus showed negatively correlated with vertical CDR(r=-0.791, P=0.001),which showed positively correlated with visual acuity(r=0.538, P=0.018).Conclusions The brain structural network in PACG patients showed small-worldness properties as HCs group. The alterations of local properties in visual, emotion-cognition brain regions were observed, manifesting that PACG can affect the topology properties of the structural brain network.

Objective To investigate CT and MRI findings of primary malignant fibrous histiocytoma (MFH)in the kidney. Methods The clinical data and imaging findings of 7 patients with primary renal MFH proved by histopathology were reviewed retrospectively.Results Tumors were unilateral in all patients,in which 5 cases were in the left kidney and 2 cases in the right kidney.The maximum diameter of the lesions ranged from 3.5 to 17.1 cm,with a mean of (8.7±3.9)cm.All the masses showed shallow lobulated or oval, with obscure boundary.On CT plain scan,heterogeneous isodensity/hypodensity were showed in 7 cases,necrosis occured in 7 cases, intratumoral hemorrhage in 2 cases and calcification in 3 cases.MRI also showed heterogeneous signal intensity.No obvious pseudocapsule was found in 6 cases.On dynamic contrast enhancement scan mild-moderate progressive enhancement was showed in corticomedullary and parenchymal phase in all 7 cases.In delay phase slightly decreased enhancement were showed in 5 cases,and similar or slightly higher enhancement corresponding to the parenchymal phase was showed in 2 cases.However,lower enhancement was showed in the tumors on all 3 phases than that in the renal cortex.Besides,the tumors invaded the renal vein (n=1)and the adjacent structure (n=3).Conclusion No specific imaging findings of primary renal MFH are found.The dynamic contrast enhancement might be helpful for its diagnosis to some extent,and clinical data should be integrated with imaging findings together to differentiate renal MFH from other renal neoplasms.The final diagnosis relies on pathology and immunohistochemistry examination.

Objective To investigate the feasibility of the highGresolution MRI (HRGMRI)in diagnosing the intracranial artery dissection (IAD)and to improve radiological diagnostic accuracy in clinical practice.Methods The clinical data and imaging data of 43 patients with suspected IAD were analyzed retrospectively.HRGMRI and DSA examinations were performed.HRGMRI images were reviewed by two experienced radiologists independently,and DSA images were analyzed by a neurosurgeon.FollowGup durations were from 3 months up to 12 months,and then the clinical diagnoses of IAD were made.The sensitivity,specificity,positive predictive value (PPV),and negative predictive value (NPV)of HRGMRI were calculated,and the consistency of HRGMRI and DSA in the diagnosis of IAD was made.Results 32 over 43 patients were detected to be positive by HRGMRI,however,34 of 43 patients were diagnosed as IAD clinically.The sensitivity and specificity of HRGMRI for detecting IAD were 9 1.2% and 88.9%,respectively.The PPV was 96.9%,and the NPV was 72.7%.For DSA,30 patients with IAD were detected and 1 3 patients had negative results.Compared with the HRGMRI (3 2/43),the coincidence rate of two examinations was 86.0%.McNemer test (P＝0.687)indicated that there was no significant difference between two methods.Conclusion HRGMRI has excellent soft tissue contrast and spatial resolution.As a nonGinvasive modality with good tissue contrast and spatial resolution,it plays an important role in the diagnosis,differential diagnosis and followGup of IAD.