The paper described the conception and forms of risks for public hospitals financing,proposing the risk avoidance strategy, loss control strategy, and risk transfer strategy against these risks. In addition, it is proposed to take proactive measures to build the financing risk management system for public hospitals, and construct an effective financing risk prewaming mechanism, raise the scientific standard of financial decision-making, and develop a clear-cut economic responsibility system for the hospital leaders during their term, for the purpose of effectively minimizing the risks.

This paper aims to summarize the clinical application of interventional technique via portal venous system, laying stress on the necessity of reinforcing, improving and comprehensively applying this interventional technique, and to provide new conception concerning the diagnosis and therapy of the diseases involving portal venous system.

[Objective]To observe the change of children necrotic femoral head repairing under low stress environment and to explore the effect of low stress environment on Perthes disease.[Method]The sick coxa was supported by Coxa Multi-functional External Fixation Shoring Fixator,which decreased femoral head stress and creates a low-stress environment for the sick coxa.Meanwhile,the affected extremity was kept abduction and internal rotation in order to increase femoral head containment.The coxa could flex and extend partly on sagittal plane.Twenty-eight patients(32 hips) were followed up with mean follow-up time of 3 years and 5 months(2~7 years).The radiological characteristics of pre-and post-operation was analyzed.[Result]At 3 months postoperatively,joint space was broadened,high density necrosis shadow became little and little,the femoral head became full,height of the femoral head epiphysis increased.If epiphyseal nucleus fragmentation vaded epiphyseal plate,the big head and pachy-neck and the subluxation of coxa would finally result.[Conclusion]Under low stress environment,child necrotic femoral head could be repaired.The prognosis is related to Catterall stage of Perthes disease.On Catterall Ⅱ and Ⅲ stage,the curative effect is fairly good.But on Catterall Ⅳ stage,the curative effect is not evident.

Objective To explore the relapse,therapeutic effect,risk and prognostic factors of the pulmonary invasive fungal disease(IFD)in patients with a history of pulmonary IFD following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Fourteen patients with a history of pulmonary IFD received allo-HSCT between March 2005 and October 2006.Before transplantation,10 patients obtained complete remission(CR)and 4 partial remission(PR)after antifungal therapy.Antifungal prophylaxis was initiated on the first day of the conditioning therapy.Logistic regression models were used for multivariable analyses.Results The relapse rate of pulmonary IFD after allo-HSCT was 71.43%(10/14).Of 10 patients in CR,6 relapsed and all four patients in PR relapsed.Seven patients relapsed less than 3 months and 3 relapsed between four and six months after transplantation.Among the 10 patients with a history of IFD who relapsed after transplantation,9 patients received antifungal therapy,4 obtained CR,2 PR again and the other 3 didn't obtain remission.The effective rate of anti-fungal therapy was 66.67% and the pulmonary IFD-related mortality was 35.71%(5/14).There was no significant difference between amphotericin B,itraconazde and voriconazole for antifungal prophylaxis in patients with a history of pulmonary IFD(P=0.122).No risk and prognostic factors of the pulmonary IFD was identified by multivariable analyses.Conclusion Pulmonary was not an absolute contraindication for allo-HSCT,and patients with a history of pulmonary IFD had a higher relapse rate and transplant-related mortality after receiving allo-HSCT.

[Objective]To observe the clinical effect of the treatment of hyperplastic nonunion of the tibia with interlocking intramedullary nailing,fascia pedicled callus flap and bone grafting.[Method]Twelve cases of nonunion of the tibia were treated with intramedullary interlocking nailing,fascia pedicled callus flap and bone grafting,and there were 8 males and 4 females.The patients age ranged from 26 to 64 years,with an average of 45 years.[Result]All cases were followed-up for an average of 48 months and achieved a solid union within 4～6 months.[Conclusion]Intramedullary interlocking nailing,fascia pedicled callus flap and bone grafting have the design of the reasonable biomechanics,the function of untispinning and unticurtailing,less partial blood decompose.The fascia pedicled callus flap and iliac bone grafting could result in solid union and it is a recomment method for promoting bone-healing up after grafting and forming.

Objective To observe the clinical efficacy of acupuncture in treating primary hypertension and the effect of twirling reinforcing-reducing manipulations on the treatment of primary hypertension. Methods Totally 126 patients with primary hypertension were randomized into treatment group 1 of 40 cases, treatment group 2 of 44 cases, and a control group of 42 cases. The treatment groups were both intervened by acupuncture at Quchi (LI 11), while twirling reinforcing-reducing manipulations (twirling towards left) were applied in treatment group 1, while the manipulations (twirling towards right) were applied in treatment group 2;the control group was intervened by medication. The change of blood pressure after 10 min treatment was observed, and the clinical efficacies were compared. Results The total effective rate was 85.0%in treatment group 1, versus 88.6%in treatment group 2 and 61.9% in the control group, and the total effective rates in the two treatment groups were significantly different from that in the control group (P<0.05). In the two treatment groups, the systolic pressure and diastolic pressure respectively after 10 min treatment and 30 min treatment were markedly different from those 10 min before treatment in the same group (P<0.05). In the two treatment groups, the systolic pressure and diastolic pressure after 30 min treatment were markedly different from those after 10 min treatment in the same group (P<0.05). In the control group, the systolic pressure and diastolic pressure were significantly different from those 10 min before treatment in the same group (P<0.05). There were no significant inter-group differences in comparing the systolic pressure and diastolic pressure after 30 min treatment (P>0.05). Conclusions Acupuncture at Quchi (LI 11) is an effective approach in treating primary hypertension, and the reinforcing manipulation and reducing manipulation are both effective.

Objective To report the preliminary results of placing metallic stent and ~(125)Ⅰ seed strand combined with transcatheter arterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) with inferior vena cava (IVC) obstruction. Methods From March 2009 to June 2009, implantation of radioactive ~(125)Ⅰ seed strand and metallic stent combined with TACE treatment was performed in 8 cases of HCC with malignant IVC obstruction. All patients were males with a mean age of (60.6 ± 9.6) years, ~(125)Ⅰ seed strand and Z-type soft-expandable metallic stent were placed in the obstructive segment of IVC, which was followed by TACE. Before and after the treatment, the diameter of the obstructive segment of IVC, the pressure gradient between right atrium and distal end of obstructive segment of IVC, and the symptoms related to the obstruction were estimated and recorded, the results were compared individually. Clinical follow-up was conducted in all patients. Results A total of 8 stents and 10 ~(125)Ⅰ seed strands were placed in the obstructive segment of IVC. Altogether 138 ~(125)Ⅰ seeds were implanted in 8 patients. Obvious clinical improvements were obtained after therapy. No complications occurred in all patients except one patient who experienced acute renal dysfunction at the second day after therapy. During a mean of (2.1 ± 0.6) months follow-up, occlusion of IVC stent was detected in 1 patient. The remaining stents remained patent. Conclusion Our initial results indicate that placement of ~(125)Ⅰ seed strand and metallic stent combined with TACE is a safe and feasible therapeutic option for advanced HCC with malignant IVC obstruction.

Objective To retrospectively analyze the mid-term clinical results of direct intrahepatic portosystemic shunt (DIPS) in treating patients with portal hypertension. Methods DIPS were created in 23 patients with portal hypertension. Both preoperative and postoperative portal systemic pressure gradient (PPG), liver function and clinical symptoms were recorded and compared. Shunt patency was checked by color Doppler ultrasonography and the data were statistically analyzed by Kaplan-Meier method. Results DIPS creation was successfully accomplished in all 23 patients. No serious complications occurred after DIPS except for hemorrhagic ascites (n = 1) and mild hepatic encephalopathy (n = 3). Mean PPG significantly decreased from preoperative (32.6 ? 5.3) mmHg with a range of (23 - 43) mmHg to postoperative (10.1 ? 2.7) mmHg with a range of (5-14) mmHg (P

Objective To report the preliminary results of placing metallic stent and 125I seed strand combined with transcatheter arterial chemoembolization(TACE) for the treatment of hepatocellular carcinoma(HCC) with inferior vena cava(IVC) obstruction.Methods From March 2009 to June 2009,implantation of radioactive 125I seed strand and metallic stent combined with TACE treatment was performed in 8 cases of HCC with malignant IVC obstruction.All patients were males with a mean age of(60.6 ? 9.6) years.125I seed strand and Z-type self-expandable metallic stent were placed in the obstructive segment of IVC,which was followed by TACE.Before and after the treatment,the diameter of the obstructive segment of IVC,the pressure gradient between right atrium and distal end of obstructive segment of IVC,and the symptoms related to the obstruction were estimated and recorded,the results were compared individually.Clinical follow-up was conducted in all patients.Results A total of 8 stents and 10 125I seed strands were placed in the obstructive segment of IVC.Altogether 138 125I seeds were implanted in 8 patients.Obvious clinical improvements were obtained after therapy.No complications occurred in all patients except one patient who experienced acute renal dysfunction at the second day after therapy.During a mean of(2.1 ? 0.6) months follow-up,occlusion of IVC stent was detected in 1 patient.The remaining stents remained patent.Conclusion Our initial results indicate that placement of 125I seed strand and metallic stent combined with TACE is a safe and feasible therapeutic option for advanced HCC with malignant IVC obstruction.

Percutaneous transhepatic biliary drainage(PTBD) is an effective therapeutic option for obstructive jaundice.With various novel puncture instruments being created,the manipulating technique being improved and medical idea being updated,PTBD has been widely employed in clinical practice for alleviating the biliary tract obstruction.In order to standardize this technique this paper aims to make some suggestions for the PTBD guidelines concerning the indications,contraindications,operative skill,postoperative management,complications and their preventions,points for attention,etc.