Endoscopy ; instrumentation ; methods ; trends ; General Surgery ; methods ; Humans

Objective To investigate the current policy of medical insurance expenditure control in Shanghai and put forward feasible advice. Methods Survey in 5 tertiary first-class hospitals in Shanghai involving 400 doctors and patients was conducted.The result of the questionnaire was tracked with Microsoft Excel 2000.The expense reports during 2001 to 2006 from the Office of Medical Insurance of Shanghai Renji Hospital was collected.All the data were statistically analysed. Results The global budget system was accepted by both the doctors and patients.Charging based on disease categories was proved a relatively satisfying method.Drug expenditure control was concerned by both the doctors and patients. Conclusion Ever since the global budget system of medical insurance is implemented in Shanghai,the medical insurance expenditure has been effectively controlled.The key point is the restraint of irrational consumption during the medical treatment.

To improve the precision of image registration based on corner detection, a relative position function between multiple points to determine matching points accurately. First the corners in images are detected using Harris detector, and clustering method is used to eliminate most wrong matches after coarse screening. Then the proposed relative position function is used as a criterion of precise matching. Finally the image registration process is accomplished by affine transformation. Results show that the proposed algorithm is more effective and accurate than conventional registration algorithm.

ObjectiveTo investigate the language cortex organization characteristics of native Chinese. Methods20 patients who underwent language mapping via intraoperative direct cortical electrical stimulation (ioDCES) under awake anaesthesia for glioma in dominant hemisphere were analyzed retrospectively. Results16 patients were identified at least one language site, 3 patients located in the frontal and 1 patient in the temporal lobe. The language sites mostly located in the perisylvian region. The frontal language sites conformed to traditional Broca's areas, but the superior temporal gyrus contained much more language sites than the middle temporal gyrus.ConclusionHigh individual variability in language organization indicates a need for revision of the classical model of language localization. Because of the samples were too small, our current dates can't fully reflect language cortex organization characteristics of native Chinese.

Objective:To compare the therapy effects of chemotherapy and non-chemotherapy groups and to determine the value of chemotherapy for adult diffuse low-grade gliomas. Methods:We reviewed and analyzed 64 patients with adult diffuse low-grade glio-mas admitted to the Beijing Tiantan Hospital from May 2005 to April 2008. Among the patients, 18 received 4 to 12 cycles of temozolo-mide chemotherapy after operation and radiotherapy, whereas the other 46 cases only received radiotherapy. The progression-free survival of the two groups was compared. Results:The median progression-free survival of the chemotherapy and the control groups were 67.8 and 51.3 months, respectively. The results of the comparison implied a significant difference (χ2=8.741, P=0.003). Conclu-sion:Chemotherapy can improve the progression-free survival of the patients with adult diffuse low-grade gliomas, and thus, can be recommended as its effective therapy.

Objective To investigate the effect of intrathecal (IT) dexmedetomidine on the expression of cAMP response element-binding protein phosphorylation (p-CREB) in spinal dorsal horn in a rat model of bone cancer pain. Methods Sixty-four adult female Wistar rats weighing 200-240 g were randomly divided into 4 groups (n = 16 each): sham operation group (group S); bone cancer pain group (group BP); normal saline group ( group NS) ; dexmedetomidine group (group D) . Bone cancer pain was induced by injecting Walker 2S6 mammary gland carcinoma cell suspension (2 ×106 cells/ml) 10μl into the medullary cavity of the tibia in BP, NS and D groups. Groups S and BP received no IT injection. Croups NS and D received IT injection of NS 10 μl and dexme detomidine 5 μg/kg respectively 7 days after successful establishment of the model. Ten animals were selected from each group at 1 day before IT administration (T0), immediately before IT administration (T1 ) and at 1, 6, 12 and 24 h after IT administration (T2-5 ) and paw withdrawal threshold (PWT) to mechanical stimuli was measured with von Frey filaments. The other 6 rats in each group were sacrificed at T4 and the spinal cord was removed for determination of p-CREB expression in the spinal dorsal horn.Results PWT was significantly decreased at T1-5 and pCREB expression up-regulated at T4 in BP, NS and D groups compared with group S ( P ＜ 0.05) . Compared with group BP, PWT was significantly decreased at T2-5 and p-CREB expression down-regulated at T4 in group D ( P ＜0.03), while no significant change in PWT and p-CREB expression was found in group NS (P ＞ 0.05) .Conclusion IT dexmedetomidine can reduce the bone cancer pain through inhibiting the phosphorylation of CREB in rat spinal dorsal horn.

Objective To analyse the long-term result and prognosis of 18 FDG PET/CT positioning three - dimensional conformal radiotherapy ( 3 DCRT ) for stage Ⅲ non - small cell lung cancer. Methods Sixty-four cases with stage Ⅲ non-small cell lung cancer (clinical stage Ⅲa- Ⅲb ) were randomly divided into two groups: PET/CT positioning three-dimensional conformal radiotherapy group (PET/CT group) and the conventional CT positioning three-dimensional conformal radiotherapy group (conventional CT group). In the PET/CT group, the target volume and critical organs were sketched according to PET/CT after fusion of the PET and the CT images; the treatment plan was worked out, then conventional fractionated 3DCRT ( total dosage around 40 Gy) followed by field-shrinked radiotherapy to a total dose of 65 Gy or sowas performed ;in the conventional CT group, the target volume and critical organs were sketched according to CT and 3DCRT were performed to the same total dose; All cases were treated with the TP scheme (paclitaxel 175 mg/m2,d1 ,cisplatin 40 mg,d2-4) adjuvant chemotherapy for 6 cycles after the radiotherapy. Results The followup rate was 100%. The number of patients who completed the 1-,2-and 5-year follow-up were 40,20 and 11 respectively ;The number of patients of the PET/CT group and conventional CT group were 23 and 17,11 and 9,7 and 4 respectively. Target volumes of 13 cases in the PET/CT group were changed. The complete remission and partial remission rates of the two groups were 13% 、66% and 19% 、53% (x2 = 0. 33, P =0. 564), respectively. The 1-,2-and 3-year local control rates of the PET/CT group and conventional CT group were84 % 、66% 、53 % an d72% 、59% 、44% ( x2 = 2.36, P = 0. 124 ) respectively. The1 -, 2-and 3-year survival rates were 72% 、34% 、22% and 53% 、28% 、13% (x2 =2. 46,P =0. 117) respectively. The level-1 and level-2 lungs' and trachea's late radiation injury of the PET/CT group and the conventional CT group were 28% and 53% ( x2 = 4. 14, P = 0. 042 ), respectively. The hilar and mediastinal lymph node recurrence rates of the PET/CT group were lower than those of the conventional CT group, were 3% ,25%(P = 0. 026) and 6%, 28% ( P = 0. 042 ), respectively. The main reason for treatment failure was distant metastasis both in the PET/CT group and conventional CT group,56% and 47% (x2 = 0. 56,P = 0. 453 ),respectively. Conclusions PET/CT, as a method of sketching the target of stage Ⅲ non-small cell lung cancer, can improve the radiation treatment plan, reduce the recurrence rate of hilar and mediastinal lymph nodes, meanwhile it can not improve the long-term survival rate; Distant metastasis was the main reason of failure.

Objective To compare the effect of active compression-decompression cardiopulmonary resuscitation(ACD-CPR) with standard- cardiopulmonary resuscitation(S-CPR) on ventricular function in a canine ventricular fibrillation model. Methods Ventricular fibrillation was induced in anesthetized and instrumented canine. Twenty-four dogs were randomly assigned to either ACD-CPR group or S-CPR group.After 4 minutes of untreated VF,two-dimension echocardiography was used to evaluate the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction (LVEF) of every canine of the two groups when they were undergoing cardiopulmonary resuscitation. Results During ventricular fibrillation, both ACD-CPR group and S-CPR group showed decreased LVEDV compared with pre-ventricular fibrillation, but not statistically significant( P ＞0.05).LVEDV was increased in ACD-CPR group compared with S-CPR group, but not statistically significant (P＞ 0. 05). Both ACD-CPR group and S-CPR group showed significantly increased LVESV compared with pre-ventricular fibrillation,of which the difference was statistically significant ( P ＜0. 001). Both ACD-CPRgroup and S-CPR group showed significantly decreased LVEF compared with pre-ventricular fibrillation,of which the difference was statistically significant (P ＜0. 001). LVEF was increased in ACD-CPR group compared with S-CPR group,of which the difference was statistically significant ( P = 0.019). Conclusions Compared with S-CPR,ACD-CPR resulted in higher LVEF.

Objective To discuss the imaging features of the localized fibrous tumor of pleura(LFTP).Methods 10 cases of LFTPproved patholgically were underwent CT scanning,while MRI scanning was performed in 3 cases.The imaging findings of LFTP wereanalysed.Results 9 cases were benign tumors and 1 case was malignant tumor.The main CT manifestations were single soft tissue massadhering to the pleural surface,clearly boundary,homogeneous or unhomogeneous density,obvious homogeneous or non-uniformityenhancement."Pleura mass hat"was characteristic appearance located the pleura mass.The mass formed acute angle or obtuse angle with the adjacent pleura,which was related to mass size and shape.MRI manifestations were hypointense or isointense on T_1WI and T_2WI,non-uniformity signal.1 case of giant LFTP showed scattered in disorder and clutter signal on T_2WI.Inside tumor peduncle of the giant LFTP was connected with the pericardium.Conclusion CT is a main imaging diagnostic technique for LFTP,while MRI is commonly superior to CT in localizing the mass and showing inner characteristics for the bigger pleural masses.The appearance of pleuraL tumor peduncle is an important sign in diagnosis of LFTP.

OBJECTIVE:To evaluate the therapeutic effect of clarithromycin on prostatitis induced by NG,CT and U?U.METHODS:56cases of venereal disease-related prostatitis were treated with oral clarithromycin in combination with prostatic massage and hip bath.7days after withdrawing drug,examination of prostatic secretion(EPS)and detection of pathogens were carried out.RESULTS:Total effective rate was82.1%;negative turn rate was92.9%;87.5%EPS routine came back to normal;no obvious ARDs were found.CONCLUSION:Clarithromycin is high in therapeutic effect,slight in ad?verse reactions and convenient in administration.It is suitable for treatment of venereal disease-related prostatitis.