Objective To study the distribution and related factors of curative care expenditure (CCE) of injury in Gansu Province in 2017. Methods Based on the "A System of Health Accounts 2011 (SHA 2011)", the curative care expenditure of injury in Gansu Province was calculated and analyzed. The five?stage stratified cluster sampling method was adopted to extract 149 medical and health institutions, 120 township hospitals (including community health service centers), 150 individual clinics and 600 village clinics (including community health service stations). The top?down allocation method was used to calculate the cost of injury treatment in Gansu Province, and the influencing factors were analyzed by multiple linear regression. Results In 2017, the CCE of injury in Gansu province was 3.831 billion yuan, and the expense in general hospitals was 2.708 billion yuan. Among them, the cost of lower limb injury and head injury were 1.090 and 0.847 billion yuan. People aged 40 to 69 years old spent 1.901 billion yuan on injury treatment, and the CCE of injury treatment for men and women were 2.422 and 1.409 billion yuan respectively. The results of multiple linear regression showed that hospitalization expenditure was significantly associated with length of stay, operation, hospital grade, age, payment method and gender (P<0.001). Conclusion The economic burden of injury in Gansu Province is relatively heavy, so it is necessary to focus on preventions for different groups and costly injury sites.

Objective To study the distribution and related factors of curative care expenditure (CCE) of injury in Gansu Province in 2017. Methods Based on the "A System of Health Accounts 2011 (SHA 2011)", the curative care expenditure of injury in Gansu Province was calculated and analyzed. The five?stage stratified cluster sampling method was adopted to extract 149 medical and health institutions, 120 township hospitals (including community health service centers), 150 individual clinics and 600 village clinics (including community health service stations). The top?down allocation method was used to calculate the cost of injury treatment in Gansu Province, and the influencing factors were analyzed by multiple linear regression. Results In 2017, the CCE of injury in Gansu province was 3.831 billion yuan, and the expense in general hospitals was 2.708 billion yuan. Among them, the cost of lower limb injury and head injury were 1.090 and 0.847 billion yuan. People aged 40 to 69 years old spent 1.901 billion yuan on injury treatment, and the CCE of injury treatment for men and women were 2.422 and 1.409 billion yuan respectively. The results of multiple linear regression showed that hospitalization expenditure was significantly associated with length of stay, operation, hospital grade, age, payment method and gender (P<0.001). Conclusion The economic burden of injury in Gansu Province is relatively heavy, so it is necessary to focus on preventions for different groups and costly injury sites.

OBJECTIVETo provide genetic diagnosis and counseling for a 2-year-old girl with typical Rett syndrome through analyzing the methyl-CpG binding protein 2 (MECP2) gene.

METHODSPotential mutation of the MECP2 gene was screened by DNA sequencing and multiplex ligation-dependent probe amplification (MLPA) analysis of members of the family as well as normal controls. Lymphocyte culture for karyotype analysis was carried out for the patient to exclude chromosomal abnormalities.

RESULTSThe karyotype of the girl was normal. No variation of the MECP2 gene was detected in the patient by direct sequencing. A heterozygosis variation, c.1072G>A in exon 4 of the MECP2 gene was detected in a normal female control, which was not found in other controls. The son and daughter of the female control were respectively heterozygous and homozygous carriers of the same mutation. By MLPA analysis, a heterozygosis deletion of exon 3 and part of exon 4 was detected in the patient. cDNA amplification and sequencing confirmed the presence of a 1176 bp deletion (c.27-1202del1176). The same deletion was not detected in the parents.

CONCLUSIONA large deletion in MECP2 gene was detected with MLPA in a patient featuring typical Rett syndrome. The same deletion was missed by sequencing analysis. With cDNA sequencing, the breakage point of the mutation can be mapped precisely.

Base Sequence ; Child, Preschool ; Exons ; Female ; Genetic Testing ; Genotype ; Humans ; Karyotyping ; Methyl-CpG-Binding Protein 2 ; genetics ; Mutation ; Rett Syndrome ; genetics

OBJECTIVETo investigate the causes of acute respiratory distress (ARDS) after thoracotomy and to find out the measures to prevent ARDS.

METHODSThe characteristics of incidence, pathogenicity and treatment of ARDS after thoracotomy in 31 patients were analysed.

RESULTSThe patients who had chronic obstructive pulmonary disease, long history of smoking, hypertension were prone to ARDS. Injury to lung in operation, shock and pulmonary infection probably caused ARDS. Clearing away respiratory tract secretion, preserving of a clear airway, controlling pulmonary infection, alleviating pneumonedema by diuresis, early executing tracheotomy or mechanic assistant ventilation by tracheointubation were keys to rescuing patients successfully.

CONCLUSIONSIt is suggested that multi factors were related to ARDS after thoracotomy. Shock, injury to lung in operation, pulmonary infection, are important factors that lead to post-operative ARDS after thoracotomy. Early treatment can reduce mortality of ARDS.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Respiratory Distress Syndrome, Adult ; etiology ; prevention & control ; therapy ; Thoracotomy ; adverse effects

OBJECTIVETo study the effects of tetramethylpyrazine (TMP) on cardiac function and mortality rate in septic rats.

METHODSFifty male Sprague-Dawley rats were randomized into a sham-operation group (sham group, n=10), normal saline group (NS group, n=20), and TMP group (n=20). The rats in the NS and TMP groups underwent cecal ligation and puncture (CLP) to induce sepsis. Rats in the NS group were injected with NS (10 mL/kg) immediately after CLP and 6 h after CLP. Rats in the TMP group were injected with TMP (10 mg/kg) at the same time points. Twenty-four hours after modeling, the mortality rates were observed in each group. Cardiac function and serum concentration of tumor necrosis factor α (TNF-α) were also tested. The correlation between TNF-α and the ejection fraction (EF) was observed. Left ventricle specimens were reserved for histomorphologic study.

RESULTSCompared with the sham group, the NS and TMP groups had decreased EF values and increased mortality rates and serum TNF-α levels (P <0.05). The TMP group had a comparatively lower mortality rate and TNF-α level and a higher EF value compared with the NS group (P <0.05). Histomorphology indicated that myocardial inflammation in the TMP group was mild compared with that in the NS group. There was a negative correlation between TNF-α level and EF value (r=-0.583,P=0.000).

CONCLUSIONTMP could reduce the mortality rate of septic rats and had certain protective effects on cardiac function.

Animals ; Heart Function Tests ; drug effects ; Male ; Myocardium ; pathology ; ultrastructure ; Pyrazines ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Sepsis ; blood ; diagnostic imaging ; drug therapy ; physiopathology ; Stroke Volume ; drug effects ; Survival Analysis ; Tumor Necrosis Factor-alpha ; blood ; Ultrasonography

To investigate the intracellular mechanism of activity-dependent synapses formation and redistribution, we studied the electrophysiological and morphological characteristics of neurons of the developing visual cortex, and observed the level of synchronism of age and changes in the properties. Whole cell patch-clamp recordings and intracellular biocytin staining were used to record postsynaptic currents (PSCs) from neurons in the visual cortex of Sprague-Dawley rats (postnatal d 4-28). The histological processing was made. There were three types of PSCs in 156 cells: silent response, monosynaptic response and polysynaptic response, during the first developmental month. Before eyes opened the number of the neurons with the silent response (57.3%) was significantly higher than that after the eyes opened (11.9%) (P<0.001). However, the incidence of polysynaptic PSCs increased from 12.4% before eyes opened to 28.9% after eyes opened (P<0.01). During postnatal week 1, all cells were classified as immature. The immature cells had very high input resistances (R(N)>1.0 G Omega), low amplitude (-0.87 mA) and short decay time (-0.98 ms). During postnatal week 4, all cells were mature with lower input resistance (R(N)<310 M Omega), larger amplitude (-66 mA), and longer decay time (-225 ms). From postnatal weeks 1 to 3, the cells had electrophysiological properties that were intermediate between the immature and mature types of cells. With biocytin intracellular staining, five types of neurons were obtained: pyramidal cells, satellite cells, basket cells, neuroglial cells and immature cells. On the basis of their electrophysiological and morphological characteristics, pyramidal cells were classified into three categories: immature, intermediate, and mature cell types. During postnatal week 1, cells were immature with very high input resistance. Morphologically immature cells had short simple dendritic arborizations which incompletely penetrated the layer where the cell body lies. From postnatal weeks 2 to 4, the cells were mature with low input resistance. They were morphologically more complex with dendritic arborizations which completely penetrated the whole layers of the visual cortex. From postnatal weeks 1 to 2, a third, intermediate cell type had electrophysiological properties that were intermediate between the immature and mature cell types. Three distinctive types of pyramidal cells in visual cortex only co-exist during postnatal weeks 1 to 2. Data show that activity-dependent synapes are formed and integrated into local neuronal networks with visual stimulation. In the critical period of visual development, the level of synchronism of age and changes in electrophysiological and morphological properties in the visual cortex is higher than that in the subcortex.
Animals ; Animals, Newborn ; Excitatory Postsynaptic Potentials ; physiology ; Neurons ; cytology ; physiology ; Pyramidal Cells ; cytology ; physiology ; Rats ; Rats, Sprague-Dawley ; Synapses ; metabolism ; physiology ; Visual Cortex ; cytology ; growth & development ; physiology

OBJECTIVEA randomized trial of breast self-examination (BSE) Program was carried out to evaluate whether the intensive BSE could reduce the number of deaths among women from breast cancer.

METHODSThis study was a randomized controlled trial (RCT). A total of 266 064 women (age of 30 to 64 years) associated with 519 textile factories in Shanghai had been randomly assigned to a BSE group (132 979 women) or a control group (133 085 women) since 1989. Initial instruction in BSE group would include demonstration of proper palpation techniques and was followed by 2 reinforcement sessions during the subsequent 4 years including video shows, BSE instruction sessions and BSE practice under medical supervision. These activities were continued for 5 years. Attendance at all events was recorded. The cohort was followed through July 2000 for development of breast diseases, and the breast cancer cases were followed through 2001 for vital status. Data analysis methods used would include Kaplan-Meier plots, log-rank test and Cox modeling.

RESULTSAmong women under instruction, 864 breast cancers detected and 133 breast cancer deaths occurred while 896 breast cancers were detected and 130 deaths recorded in the control group. The tumor size (P = 0.07), TNM stage (P = 0.39) and cumulative breast cancer mortality rate (P = 0.72) were not significantly different between the 2 groups. However, more and smaller fibroadenomas were detected in the instruction group than in the control group (P< 0.01).

CONCLUSIONIntensive instruction in BSE did not seem to have reduced the mortality rate of breast cancer, but more and smaller benign breast lumps could be detected.

Adult ; Breast Diseases ; diagnosis ; Breast Neoplasms ; diagnosis ; mortality ; Breast Self-Examination ; China ; Female ; Humans ; Middle Aged ; Patient Education as Topic

BACKGROUNDPrimary malignant germ cell tumors (GCTs) of mediastinum are rare neoplasms. We introduce our institutional experience in managing patients with primary malignant GCTs of the mediastinum, focusing on the analysis of therapeutic modalities.

METHODSA retrospective review was done in 39 consecutive patients with mediastinal malignant GCTs treated in our institution between 1991 and 2007.

RESULTSA total of 39 patients were enrolled in this study with a median age of 27 years. The 5-year overall survival (OS) and progression-free survival (PFS) rates of the whole population were 60.2% and 57.7%, respectively. Stratified by the histology, 18 patients (46.2%) had seminoma and 21 patients (53.8%) had nonseminomatous germ cell tumors (NSGCTs). The 5-year OS rate of patients with seminoma was 87.4% as compared with 36.7% in patients with NSGCTs (P = 0.0004). The 5-year PFS rate was also significantly higher in seminoma patients (87.4% vs. 31.6%, P = 0.003). For 19 patients with NSGCTs managed with multi-modality treatment, chemotherapy exposure appeared to impact the prognosis. The 5-year OS rate was 44.9% in patients with chemotherapy exposure as compared with 20.0% in patients without it (P = 0.43).

CONCLUSIONOur study confirmed the significance of systemic chemotherapy in the treatment of primary mediastinal GCTs.

Adolescent ; Adult ; Disease-Free Survival ; Female ; Humans ; Male ; Mediastinal Neoplasms ; drug therapy ; radiotherapy ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; drug therapy ; radiotherapy ; Retrospective Studies ; Seminoma ; drug therapy ; radiotherapy ; Testicular Neoplasms ; Young Adult

BACKGROUNDThe transradial approach is regarded as a useful vascular site for coronary procedures. The aim of this study was to test whether 4Fr catheters assisted by ACIST variable rate injector system can produce comparable angiographic quality and reduce the risk of radial artery injury compared to hand manifold 6 Fr catheters.

METHODSA total of 1816 patients were studied consecutively, among whom 856 patients received coronary angiography by 4 Fr catheters (4Fr group) and 960 patients by 6 Fr catheters (6Fr group). Angiographic and procedural characteristics were observed and recorded. The luminal inner radial arterial diameter before and after the procedure were collected.

RESULTSThe baseline clinical characteristics were similar in both groups. There were no significant differences in procedure time, radiation dose and quality scores in both groups (P > 0.05), but more contrast media was delivered in the 6Fr group (P < 0.001). The mean radial arterial diameter six months after the procedure in the 6Fr group reduced significantly compared to that measured one day prior to the procedure (P < 0.001).

CONCLUSIONSCoronary angiography using the 4Fr catheters with Acist power injection system can achieve an acceptable diagnostic quality while at the same time minimizing radial artery injury and contrast media consumption.

Aged ; Cardiac Catheterization ; instrumentation ; Coronary Angiography ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; diagnostic imaging ; Ultrasonography

OBJECTIVETo investigate the effect of local application of bFGF and sucralfate during continuous tissue expansion (CTE).

METHODSCTE combined with local administration of bFGF and sucralfate was used in twelve patients with scar and nasal tip defects. Twenty three expanders were placed in the subcutaneous pockets through intralesion short incisions. Continuous expansion began at 1-3 days after expander implantation. The histomorphological changes and epidermal cell proliferation were observed. The clinical results were investigated.

RESULTSThe average inflation time was 8.9 days. The average interval of the two operations was 13.5 days. The average hospitalization was 28.4 days. The average immediate stretch-back rate of the expanded skin was 25.7%. The clinical results were satisfactory without any complications. Histological examinations showed that the epidermal, granular and spinous layer became thicker. The basal cells increased significantly. The dermis thinned slightly and the collagen fibers became thicker. The elastic fiber regenerated significantly. Fibroblast and capillary density increased obviously. The immunohistochemistry analysis showed that the proliferation of epidemic basal cells was significant postoperatively.

CONCLUSIONLocal application of exogenous bFGF and sucralfate during CTE was feasible in patients. It could accelerate tissue expansion and improve the quality of expanded skin flap.

Capillaries ; anatomy & histology ; Cell Proliferation ; Collagen ; analysis ; Dermis ; blood supply ; pathology ; Epidermis ; cytology ; Fibroblast Growth Factors ; pharmacology ; Fibroblasts ; cytology ; Humans ; Length of Stay ; Nose Deformities, Acquired ; surgery ; Sucralfate ; pharmacology ; Surgical Flaps ; blood supply ; Time Factors ; Tissue Expansion ; instrumentation ; methods ; Tissue Expansion Devices ; Treatment Outcome