Objective To explore how to determine the designated hospitals for critical illness scientifically and reasonably.Methods Analyzing the choice of medical providers by inpatients with critical illness,by means of the database of NRCMS in 2009～2010 in one county,Guangxi province.And analyzing the current policies on the basis of general principals used in health policy analysis.Results The choices of medical providers made by inpatients with critical illness are influenced by various factors.Choice of such hospitals should only be dependent on scientific and reasonable determination of patients' reasonable medical needs,instead of on the medical competency of the hospitals only.Conclusion Maximal cost-effectiveness should prevail,be it the class-1 demand of complete healing which is highly dependent on medical technology,or class-2 demand requiring repeated hospitalizations and not highly dependent on medical technology.Reasonable designation of hospitals for critical illness should be based on reasonable medical needs of patients,instead of medical competency of hospitals only.

Objective:To evaluate the impact and predictive value of neutrophil-to-lymphocyte ratio( NLR) ,derived neutrophil-to-lymphocyte ratio( d-NLR) ,platelet-to-lymphocyte ratio( PLR) and lymphocyte-to-monocyte ratio( LMR) on the prognosis of patients with colorectal cancer with curative resection.Methods: Retrospective analysis of 205 cases of clinical data and returning data after patients with colorectal cancer surgery,ROC curve was applied to determine thresholds for four biomarkers and their prognostic values were assessed using Kaplan-Meier curve,univariate and multivariate COX regression models of patients with NLR,D-NLR,PLR and LMR and other clinicopathological factors and the relationship between the 5-year recurrent-free survival( RFS).Results:According to the ROC curve,LMR could not be used as a potential diagnostic biomarker for subsequently analysis,for its AUC was less than 0.50, The optimal cut-off values were 3.12 with the highest specificity and sensitivity ( 75% and 73.1%) for NLR, while in the univariate analysis show,NLR,D-NLR and PLR were all risk factors of poor recurrence-free survival ( P<0.05 ) , the multivariate regression analysis,NLR≥3.12 and colorectal cancer staging were independent risk factors of prognosis of colorectal cancer.Conclusion:NLR≥3.12 can provide improved accuracy for predicting clinical outcomes in surgical CRC patients under surgery resection.

ObjectiveTo observe the efficacy of pricking cupping in treating herpes zoster at acute stage.MethodSixty patients with herpes zoster at acute stage were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by pricking cupping, while the control group was by oral administration of Western medicine. The total effective rate and the improvement of symptoms and pain at different stages were observed afterintervention.ResultThe total effective rate was 90.0% in the treatment group versus 86.7% in the control group, and the difference was statistically insignificant (P>0.05); after the first treatment course, the decreases of symptom score and pain indexin the treatment group were significantly superior to that in the control group (P<0.05); after the second treatment course, there were no significant differences in comparing the decreases of symptom score and pain index between the two groups (P>0.05).ConclusionPricking cupping is an effective approach in treating herpes zoster of the acute stage, as it can produce a comparatively higher total effective rate and also significantly improve the symptoms and pain.

Objective To compare the sensitivity of the fluorescent quantitation PCR method (fluorescence quantitative method for short)and the gene chips typing method (gene chips method for short)in testing human papilloma virus(HPV) .Methods 305 outpatients in the gynecological clinic of the hospital from February 2010 to February 2013 were selected as the research subject . Then the cervical exfoliated cells were collected and detected HPV by the fluorescence quantitative method and the gene chips meth-od respectively .Those cases with inconsistent results were confirmed by the PCR sequencing method .305 cases were performed the liquid based cytology test .Results The sensitivity of the fluorescence quantitative method in detecting HPV was 33 .8% and which of the gene chips method was 37 .6% .The two methods had a higher conformance .The HPV infection rate was increased with the increase of cervical exfoliated cell atypia .Conclusion The fluorescence quantitative method and the gene chips method have a higher conformance .The sensitivity of the gene chips method is higher .The severity degree of cervical cytological change is positively cor-related with the HPV infection .

Objective To investigate the influence of the aberrant protein expression and mRNA transcription of transforming growth factor ? 1(TGF? 1) on the biological behavior of human bladder transitional cell carcinomas. Methods The expression of TGF? 1 was investigated in 74 specimens of TCCs by SP immunohistochemistry staining, and the level of TGF? 1 mRNA were determined in 43 cases of TCCs by the method of quantitative RT PCR. Results The positives expression rate of TGF? 1 was 89.2%. Superficial tumors had lower overexpressive rate of TGF? 1(33.3%) than the invasive TCCs(83.8%), P

OBJECTIVE:To study the pharmacokinetics of lidocaine and bupivacaine in children undergoing epidural anesthesia so as to evaluate the safety and efficacy of this anesthetic method.METHODS:A total of 30 children who were expected to undergo surgery for undescended testis,hernia or high ligature for hydrocele were assigned to receive 2% lidocaine(5 mg?kg-1) plus 0.75% bupivacaine(1.875 mg?kg-1)(single epidural dose) by epidural anesthesia.Plasma concentrations of lidocaine and bupivacaine were determined by HPLC.Pharmacokinetics parameters were calculated and fitted by using DAS ver 2.0 pharmacokinetic program.RESULTS:The plasma concentration-time curves of lidocaine and bupivacaine were in line with a two-compartment model.The main pharmacokinetic parameters of lidocaine vs.bupivacaine were as follows:tmax 27.0 vs.33.0 min;t1/2? 43.97 min vs.73.52 min;Cmax 2.411 mg?L-1 vs.1.475 mg?L-1;AUC0～∞ 144.714 mg?min?L-1 vs.168.541 mg?min?L-1.CONCLUSION:The dosages of the local anesthetics injected into the epidural cavity of children are proven to be safe and effective.

Objective To study the clinical application of self-expanding nitinol stent in benign and malignant esophageal obstruction as well as in postoperative anastomotic stenosis and anastomotic leakage. Methods 22 cases of benign or malignant esophageal stenosis were treated by placing metallic stents inserted into the stenosis segment through per-oral intubation under the fluoroscopic guidance. Results The degreee of dysphagia was improved, Stooler′s staging of dysphagia was down from 3.1 preoperatively to 1.2 postoperatively. 2 cases of anastomotic leakage and 1 case of esophagorespiratory fistula were cured. All have been followed up for one to twelve months. 3 cases died with carcinoma cachexia and one succumbed to severe hemorrahage of digestive tract. The other 18 cases are still followed up. Conclusions Placement of esophageal expandable stent is one of the ideal methods to treat benign and malignant esophageal stenosis and anastomotic leakage. It can also play an important role in the improvement of the patients' life quality and prolongation of life.

Objective To explore the effects of glargine combined metformin and repaglinide combined metformin treatment on metabolism of free radicals in elderly patients with type 2 diabetes(T2DM ) .Methods Selected 90 cases of elderly T2DM pa‐tients were divided into 2 groups:group A (glargine combined metformin treatment group) ,group B (repaglinide combined met‐formin treatment group) .Each group had 45 patients ,they were all treated for four weeks in antidiabetic therapy ,select 40 healthy people in physical examination center of hospital as controls .They were measured in patients with fasting plasma glucose (FPG) ,2h postprandial blood glucose(2hPG) ,malondialdehyde (MDA) ,glutathione peroxidase (GSH‐PX) ,8‐iso‐prostane (8‐iso‐PGF2a) , Hcy and so on ,before and after treatment .Results (1)Before treatment ,the FPG ,2hPG ,HbA1c ,MDA ,8‐iso‐PGF2a ,Hcy of group A and B were higher than the control group ,while the level of GSH‐PX was lower than the control group ,the difference was statis‐tically significant(P<0 .05);(2)After treatment ,the levels of FPG ,2hPG ,MDA ,8‐iso‐PGF2a ,Hcy were significantly reduced and the levels of GSH‐PX was significantly elevated in group A ,the differences were statistically significant (P<0 .05);(3)There were no obvious difference in reduce the levels of FPG ,2hPG and HbA1c between group A than group B(P>0 .05) ,While 8‐iso‐PGF2a , MDA ,Hcy of group A had a bigger decline rate than group B ,the GSH‐PX in group A increased more compared with group B ,the difference was statistically significant (P<0 .05) .Conclusion (1)There is a high oxidative stress state in elderly patients with T2DM ;(2)Both treatments could improve diabetics oxidative stress levels ,but glarginecombined metformin to reduce diabetics oxi‐dative stress is superior to repaglinide combined metformin .

Objective To investigate the effect of advanced glycation end products(AGEs)on expression of vascular endothelial growth factor(VEGF)in rabbit retinal M?ller cells in vitro.Methods We successfully cultured rabbit retinal M?ller cells and made AGEs-BSA as well as its control in vitro.Study with M?ller cells were divided into AGEs-BSA group,AGEs-BSA control group and blank control group.AGEs-BSA group and AGEs-BSA control group were respectively treated with 5 different concentration series of AGEs-BSA and AGEs-BSA control and cultured for 3,6 and 9 days,while blank control group was incubated without any intervention.Then VEGF expression in M?ller cells was observed by immunocytochemistry(ICC).Results Compared with control group,VEGF expression in cultured retinal M?ller cells was significantly enhanced in AGEs-BSA group.And the effects were in the time-and concentration-dependent manners.Conclusions AGEs increases VEGF expression in rabbit retinal M?ller cells in vitro,which indicates that AGEs may promote the progression of diabetic retinopathy(DR)through the induction of VEGF expression.

Objective To discuss the causes leading to dissatisfying result after operation therapy for BPH.Methods 42 patients who had not acquired satisfying result after operation therapy for BPH were underwent the urodynamic examination.Results 42 patients were classified into two groups according to their different symptoms:difficuhy to void,32 case8,including 8 cases with low contractifity of detrusor,and 24 cases with Madder outflow obstruction(BOO);incontinence,10 eases,including 6 cases of urgency incontinence and 4 cases of stress incontinence.Condusion We can see that the causes leading to dissatisfying resuh after operation for BPH are mainly the dysfunction of detmsor and BOO,and the result of urodynamic examine can guide us the causes and the next therapy.