The increase of medical fees, which can be attributed to many factors, is inevitable. However, from the perspective of economics, medical services are characterized by monopolization, the dual nature of entrust-ment and agency and the inflexibility of demands. Driven by the pursuit of profits, suppliers are keen on the kind of medical programs they provide, leading in part to the excessively rapid increase of medical fees. One of the key mea-sures for checking this increase and deepening health reform is to replace payment by programs with payment by case groups. Payment by case groups can be implemented in many ways. A relatively scientific and rational way is payment by case mix.

Objective To investigate the value of dual‐energy CT iodine image morphology and iodine concentration in thyroid cancer diagnosis .Methods The patients underwent dual‐energy contrast scanning and confirmed with pathology results were en‐rolled .90 cases (60 malignant nodules and 30 benign nodules) were chosen with the CT value of internal carotid :110-250 HU at ar‐terial phase and 70-110 HU at venous phase .The iodine concentration of normal thyroid and neoplasms were measured respective‐ly ,as well as the NICnod (normalized iodine concentration) .Then the data was compared among each groups .The iodine image mor‐phology was also analyzed of each neoplasms ,and sensitivity ,specificity and accuracy were calculated .Results ①In the iodine image the characteristics of thyroid cancer ,including irregular shape ,invading neighbor structure and uncompleted enhanced ring around the tumor ,have significant differences compared with normal CT image (P all<0 .05) .Between iodine image and normal image ,the dis‐crete granular calcification has no difference (P>0 .05) .②There were significant differences in the venous phase NICnod value from normal groups ,malignant groups and benign groups (P<0 .05) .When diagnosed as malignant tumor ,the critical NICnod was under 0 .76 ,the area under the ROC curve of AUC value were 0 .91 ,the sensitivity and specificity were 74 .61% and 75 .60% ,respectively .③The sensitivity ,specificity and accuracy of iodine image combined with the NICnod to diagnose thyroid cancer were 91 .67% ,86 .67% , 94 .44% ,respectively .Conclusion Dual‐energy CT iodine image morphology and iodine concentration have important value in thyroid cancer diagnosis .

Objective To sum up the experience of position nursing of patients with ankylosing spondylitis and severe kyphosis. Methods Eleven patients with ankylosing spondylitis and severe kyphosis underwent surgery. The patients′spine and head were kept in a line during anesthesia to avoid spinal cord injury. The eye mask was used to make sure the eyelid close, so the bulbar conjunctiva and corneal did become dry. The angle of operation bed in time during operation was adjusted. The crushed area was observed and the position was changed to avoid pressure sores and edema. After surgery, they were keep inactive to make sure the spine stable and relieve the pressure. Results The 11 patients′surgery were successful. There were no pressure ulcer, fracture, spinal cord injury or eye injury occurs. The operation time was 9.3 ± 2.9 h. Conclusion Position nursing is very important to improve the success rate of surgery and reduce complications.

Objective To investigate the value of CT pulmonary artery obstruction index (PAOI)in evaluating the severity in patients of pulmonary embolism (PE)by a correlation study between CT PAOI and right ventricular function parameters and arterial blood gas analysis index.Methods CT PAOI,right ventricular function parameters and arterial blood gas analysis index were collected from 70 patients with PE,who had received CT pulmonary angiography (CTPA)examination in our hospital.Spearman rank correlation coefficient was used to evaluate the correlation between the PAOI and right ventricular/left ventricular maximum short axis diameter ratio (RVd/LVd),main pulmonary artery diameter (MPAd),superior vena cava diameter (SVCd),arterial oxygen partial pressure (PaO2 ),arterial carbon dioxide into pressure (PaCO2 ),oxygen saturation (SaO2 ),Alveolar arterial oxygen partial pressure difference (P(A-a)O2 ).Results PAOI and PaO2 were negative correlation,the correlation coefficient was -0.442;PAOI and RVd/LVd, MPAd,SVCd,P(A-a)O2 were positively related,correlation coefficients ranged between 0.163-0.675;PAOI was not related to SaO2 .Conclusion CT PAOI can be used to evaluate the severity of PE,it is not consistent with the severity of the patient’s clinical condition.

Objective To investigate the species and DNA polymorphism of Candida strains from different individuals and to find the relationship between the species or DNA patterns of strains and different patient groups. Methods The present study chose the isolates from 3 different sources groups(from the patients with vulvovaginal candidiasis, recurrent vulvovaginal candidiasis or asymptomatic carriers respectively). Germ tube test, chlamydospore test, CHROMagar Candida and API20 kit system were applied to separate non-Candida albicans strains from Candida albicans. Random amplification of polymorphic DNA (RAPD) analysis was used to study DNA typing of 97 strains of Candida collected from different patients and to determine whether isolates from different patients were genetically similar or dissimilar. The data were analyzed by SPSS10.0. Results The ninety-seven isolates consisted of 83 strains of Candida albicans and 14 of non-Candida albicans. Of 9 random primers used, two primers (primer 4 and primer 7) gave good reactions, the sequences of which were 5′-ACCCGACCTG-3′, 5′-GGTGACGCAG-3′ respectively. The 99 isolates could be classified into 19 and 21 genotypes by the two primers respectively. Different genotype was not shown in most isolates from different groups. A particular genotype associated with different conditions was seen in only a few isolates. Conclusion Candida albicans is the main pathogenic yeasts and most strains of non-Candida albicans are C.glabrata in the vulvovaginal candidiasis. Genotyping of most isolates didn′t show obvious correlation with different patient groups.

Purpose To investigate the clinical application of iodine concentration using dual-energy contrast enhanced CT in distinguishing malignant from benign thyroid nodules. Materials and Methods Patients with a total of 90 pathology proven thyroid nodules (60 malignant, 30 benign) underwent dual-energy contrast enhanced CT scanning. The iodine concentration and CT value were measured in arterial phase and venous phase, then the normalized iodine concentration (NICnod) and the normalized CT value were calculated. All results were compared in each groups, while morphology and capsule of these nodules on iodine image were analyzed. Results The morphology and capsule of nodules on iodine image were significantly different between benign and malignant nodules (Z=- 4.55, P<0.05). On iodine image, the sensitivity of partial capsule diagnosing malignant nodules was 78.33% with specificity of 66.67%. The NICnod and normalized CT value for normal group, benign group and malignant group showed significant differences in arterial phase and venous phase (F=36.87-69.89, P<0.05); the NICnod and normalized CT value between benign group and malignant group showed statistic difference in arterial phase (Z=- 3.48- -2.33, P<0.05), and those among normal group, benign group and malignant group also showed statistic differences (Z= -7.01- - 4.87, P<0.05). NICnod had significant correlation with normalized CT value in each phases (r=0.89, 0.74 and 0.75, P<0.05). When using NICnod and normalized CT value of 0.76 and 0.79 to differentiate malignant thyroid nodules, the area under ROC curve values were 0.91 and 0.92. NIC and normalized CT value showed a good consistency with iodine map in venous phase (Kappa=0.762 and 0.768), Combining morphology and capsule of nodules on iodine image, the sensitivity was 90.01% and the specificity was 93.60%. Conclusion Iodine concentration with dual-energy contrast enhanced CT scanning can differentiate malignant from benign thyroid nodules; combining morphology and capsule of nodules improves the accuracy of diagnosis.

Objective To investigate the diagnostic accuracy factors for CT-guided percutaneous biopsy of spine lesions.Methods The clinical and pathological data of 128 patients who were undergone CT-guided percutaneous biopsy of spine lesions were collected.The multivariate stepwise Logistic retrospective study was performed to study the influence of the patient-related factors (sex,age),lesion-related factors (location,bone destruction characteristics,with or without necrosis,with or without calcification),and procedure factors (punc-ture target spot,tissue specimen size)on the diagnostic accuracy.Results The diagnostic accuracy rate of CT-guided percutaneous biopsy of spine lesions was 86.7% (1 1 1/128 ).By multi-factor analysis,bone destruction characteristics (OR = 3.428,P = 0.038 ),with or without necrosis (OR=0.1 93,P =0.012),with or without calcification (OR=0.266,P =0.036),tissue specimen size (OR=0.200, P =0.01 5)were incorporated into the regression equation of the diagnostic accuracy.Conclusion CT-guided percutaneous biopsy of spine lesions has a high diagnostic accuracy.Bone destruction characteristics,with or without necrosis,with or without calcification, tissue specimen size are the independent factors.

Objective: To prepare an immunoconjugate of anti-EGFR monoclonal antibody (ETS) and adriamycin(ADR) and to investigute it's inhibitory effect on human epidermoid carcinoma (A431) in vitro and in vivo and it's side effect on C57BL/ 6J mice.Methods:The immunoconjugate(ETS-ADR) was prepared with an improved glutaraldehyde conjugate method and the cytotoxicity effects of EQ75-ADR on A431 cells and Wish cells were measured by MTT assay. A431 tumor-bearing nude mice and C57BL/6J experimental model were established and were used for testing the inhibitory edicts of EQ75-ADR. The side effect of EQ75-ADR was compared with ADR. Results:The EQ75-ADR showed specific cytotoxicity on A431cells,the ytotoxicity of EQ75-ADR was 50-fold, 14-fold and 10-fold more efficient than that of EQ75, ADR and mixture of EQ75 and ADR (EQ75+ ADR) respectively.The effect of EQ75-ADR on with cells was 10-fold less efficient than that of ADR and EQ75+ADR. As compared with the cytoxicity effect of EQ75-ADR on Wish cells with A431 cells, it showed 300-fold less efficient.Similar cytotoxicity results were shown in 2 h treatment experimental group. The EQ75-ADR exhibited significant anti-tumor activity on tumor-bearing nude mice,and the inhibition late is 92.2% (P

Objective To analyze the diagnosis and treatment of intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history ,in order to raise awareness .Methods Clinical data of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history were retrospectively analyzed.The clinical manifestations ,type,and risk factors were analyzed .And its diagnosis and prevention was dis-cussed.Results 23 patients were caused by intestinal blood circulation disorders ,in which there were 11 cases small intestine mesentery hernia ,2 cases duodenal hernia ,2 cases pericecal hernia ,3 cases omentum hernia ,1 case obturator hernia,2 cases congenital dysplasia and intestinal mesenteric torsion induced small hernia ,2 cases formation of intra-abdominal pressure alone belted intestine ,8 cases of intestinal necrosis .22 patients were cured after surgery ,1 case died,12 cases had postoperative complications .The incidence rate of postoperative complications of patients with in-testinal necrosis was 59.3%( wound infection 37.1%, pneumonia 22.2%), which was significantly higher than 11.8%of patients without intestinal necrosis (wound infection 5.9%,pneumonia 5.9%)(χ2 =3.861,3.861,all P<0.05).Conclusion The intestinal obstruction caused by intra-abdominal hernia with no abdominal surgery history is closed loop obstruction , preoperative diagnosis is difficult , with the rapid progression of the disease , and intestinal strangulation ,intestinal necrosis can occur in the short term whithout timely surgical treatment .Therefore ,early diagno-sis and prompt surgical treatment is the key to the diagnosis and treatment of intestinal obstruction caused by intra -ab-dominal hernia with no abdominal surgery history .

Objective To study the preventive effect of biliary duct injury(BDI)of three-dimensional spiral CT cholangiography(SCTC)before laparoscopic cholecystectomy(LC).Methods A retrospective analysis was carried out for 30 patients suffering from cholelithiasts concurrent with choledocholithiasis from July 2007 to June 2009.EAndoscopic sphincterotomy(EST),then three-dimensional SCTC was carried out through endoscop-ic nasobiliary drainage(ENBD)before IX,and the preventive effect of BDI was evaluated.Results The visibility of intra-hepatic bile duct,the hepatic bile duct and the common bile duct were 100% the visibility of chol-ecyst bile duct was 73% ,and three-dimensional SCTC can tell the position of cholecyst duct,BDI was not happened in all these patients.Conclusion Three-dimensional SCTC before LC can decrease the possibility of BDI.