Objective To obtain fairly exact patient information before the implementation in an all-round way of the basic medical insurance system and find out about the current situation of the hospital, the needs of patients, etc. so as to predict the trends of outpatient sources after the implementation. Methods Using the status-quo whole sampling survey method, an imvestigation and analysis on the outpatient services for one day was made by means of questionnaires, including the sources of outpatients to the hospital, the form of medical security, the specialties involved, the aims of patients visits, and the spectrum of outpatient diseases. Results The investigation covered 3 806cases of outpatients during the whole day and involved 25 specialties. Conclusion Adoption of the new medical insurance system will produce some impact on the outpatient volume of the hospital. Under the new situation, it is imperative to take appropriate strategies and give play to the strong points of the hospital according to the demands of the market.

OBJECTIVE:To observe clinical efficacy and safety of edaravone combined with butyl phthalide in the treatment of acute ischemic stroke (AIS). METHODS:258 AIS patients were randomly divided into observation group and control group, with 129 cases in each group. Both groups were given routine treatment as antiplatelet,improving microcirculation,controlling blood pressure,lowering blood glucose,regulating blood lipid,keeping plaque stable,nourishing brain cells. Control group was additionally given Butyl phthalide capsules orally,200 mg,tid. Observation group was additionally given Edaravone injection 30 mg added into Sodium chloride injection 100 ml,ivgtt,bid,on the basis of control group. Both groups continuously received 14 days of treatment. The serum inflammatory factor,miR-222 and neurologic impairment score of 2 groups were observed before treatment,7,14 d after treatment. Clinical efficacies and the occurrence of ADR were compared between 2 groups. RESULTS:There was no statistical significance in the serum inflammatory factor,miR-222 and neurologic impairment score between 2 groups before treatment(P>0.05). The serum inflammatory factor and neurologic impairment score of 2 groups were decreased significant-ly 7,14 d after treatment,while serum levels of miR-222 were increased significantly;the observation group was significantly bet-ter than the control group,with statistical significance(P<0.05). Total effective rate of observation group was 92.2%,which was significantly higher than that of control group (69.8%),with statistical significance (P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Edaravone combined with butyl phthalide is effective in the treatment of AIS,and can significantly de-crease serum inflammatory factor level,promote the expression of miR-222 and improve neurologic function with good safety.

60 years, 13.3% of the total sarcoidosis patients) diagnosed as sarcoidosis based on national criteria from the year 1965 through 1999 were reviewed. Results The clinical degree was as follows: phase I, 8 cases; phase Ⅱ, 6 cases; phase Ⅲ, 2 cases. The elderly sarcoidosis patients manifested variously, with misdiagnosis rate being 50%. The active degree of pulmonary sarcoidosis was correctly evaluated after the diagnosis was confirmed and the patients was strictly observed during the treatment since it was very important for avoiding the occurrence of complications. Conclusions The early diagnosis in elderly patients with sarcoidosis should be emphasized to prevent them from missing and misdiagnosis. The elderly patients with treating indications in phases Ⅱ and Ⅲ could be given steroids and constant observation and regular examinations are important during the treatment.

OBJECTIVE:To observe the clinical efficacy and safety of recombinant human endostatin (rh-endostatin) combined with Lobaplatin for injection and irinotecan injection in the treatment of advanced recurrent small cell lung cancer (SCLC). METHODS:A total of 88 patients with advanced recurrent SCLC in our hospital were divided into control group (41 cases) and observation group (47 cases) according to random number table. Control group was given Irinotecan injection+Lobaplatin for injection. Observation group was additionally given Recombinart human endostatin injection 15 mg added into 0.9%Sodium chloride injection 250 mL,ivgtt,qd,for consecutive 14 d,every 14 d. A treatment course lasted for 28 d,and both groups were treated for 2 courses. The clinical efficacy,the levels of serum carcinoembryonic antigen(CEA),the scores physical state (ECOG) and quality of life (QOL) before,after treatment were observed in the two groups,and the survival and adverse reactions of the two groups were compared. RESULTS:The total response rate of observation group was 59.6%,which was higher than 43.9% of control group,but there was no statistical significance (P>0.05). Before treatment, there was no significant difference in serum CEA levels,ECOG scores or QOL scores,between 2 groups(P>0.05);after treatment,the serum CEA levels of the two groups were significantly decreased,and the observation group was significantly lower than the control group,with statistically significant (P<0.05). In observation group,ECOG scores decreased while QOL scores increased significantly,and significantly better than the control group,with statistical significance(P<0.05). The overall survival(OS)of observation group was 16.8 months,which was significantly higher than 11.5 months of control group,with statistical significance (P<0.05). The incidence of leucopenia in observation group was significantly higher than control group;the incidence of leucopenia and abnormal liver function were significantly lower than control group,with statistical significance(P<0.05). CONCLUSIONS:Rh-endostatin injection combined with lobaplatin and irinotecan can improve serum CEA levels and the quality of living aswell as prolong the survival time.

Objective:To evaluate the left ventricular segmental strains,global strains and systolic function in the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention(PCI)with three-dimensional speckle tracking echocardiography(3D-STI),and to clarify the characteristics of early myocardial strain changes after PCI and their clinical values.Methods:Thirty patients received PCI for left anterior descending branch disease were enrolled as case group;at the same period, 30 healthy middleaged and elderly people were selected as control group.After two-dimensional ultrasound data were obtained regularly, the myocardial motion and systolic functions of the patients in two groups were detected with 3D-STI, and all segmental strain, global longitudinal strain(GLS), global radial strain(GRS), global circumferential strain (GCS)and global area strain(GAS) values of left ventricle and left ventricular ejection fraction (LVEF) values were collected.Results:Compared with control group, the global strain values of the patients in case group were lower than those in control group;9/16 longitudimal strain(LS), 8/16 circumferential strain(CS), 5/16 radial strain(RS) and 11/16 area strain(AS) were significantly lower than those in control group(P<0.05).The decrease of strain value was mainly concentrated in the anterior segment of the anterior wall, the anterior segment of the anterior wall, anterior apical segment, anterior septal basal segment, anterior septal segment, posterior septal basal segment, posterior septal segment, and posterior septal segment.The GLS,GAS and GCS in case group were negatively correlated with LVEF(r=-0.819,r=-0.897,r=-0.807,P<0.0001);the GRS was postively correlated with LVEF(r=0.862,P<0.0001).Conclusion:3D-STI can quantitatively analyze the segmental wall motion of left ventricle and could apply the parameters to evaluate the therapeutic efficacy after PCI.

BACKGROUND: The frequency of body ailments combined with depression is relatively higher, and hence post stoke depression(PSD) has gained more and more concentration.OBJECTIVE: To investigate the morbidity, related factors and pathophysiological mechanism of PSD.DESIGN: Case analysis and observation study.SETTING: Department of eurology in a hospital of a university; Third department of internal medicine in a hospital of Chinese People' s Armed Police Force; Department of neurology in a province hospital.PARTICIPANTS: This study was carried out at the Neurological Department of First Clinical Hospital Affiliated to Harbin Medical University and the General Hospital of Armed Police Army in Heilongjiang Province from January 2001 to May 2004. A cohort of 312 stroke patients was followed up in this study.METHODS: All 312 patients scored for Hamilton rating scale for depression (HAMD) and European stroke scale(ESS) within 48 hours of hospitalization. Meanwhile their clinical presentations and social-psychological factors were also collected.MAIN OUTCOME MEASURES: The stroke morbidity in patients with different sex, age, personality, educational degree, as well as stroke type, lesion location and extent of neurological functional deficit.RESULTS: The morbidity of PSD was 40. 1%, predominated by mild and medium stroke; amongst which PSD was found more frequent in women than men( P ＜ 0.01), as well as in elders than youngers( P ＜ 0.01); Patients who has diffidence personality are liable to suffer from PSD; and it was found more common in patients with over middle school education than those received only elementary school education ( P ＜ 0.01 ); depression was more frequent in left-sided stroke than right-sided stroke( P ＜ 0.01 ), especially in frontal lobal stroke; PSD was found negatively correlated with the scores for ESS(r= -0.846, P ＜0.05).CONCLUSION: As the result of the interaction of multiple factors, the development of PSD is found accorded with biology-psychology-society mode.

Objective Articular cartilage injury is one of the most common orthopedic diseases with high morbidity and morbidity,especially in the elderly. Articular cartilage injury causes degenerative changes of articular cartilage, such as osteoarthritis, which can lead to disability, pain during joint movement and deformation of bone and joint. The prevalence of osteoarthritis accounts for 10% ～12% of the total population in the world. It is a common disease. The prevalence of osteoarthritis has increased to 49. 7% for the elderly aged over 65 years old ( Statistics of the World Health Organization ( who) in 2010 show that with the development of social aging and obesity and other adverse factors,these figures will continue to rise. It is known that osteoarthritis is related to aging,trauma,genetic susceptibility,obesity and inflammation,but the specific cause of osteoarthritis has not been fully identified, which leads to many obstacles in clinical treatment of osteoarthritis. At present,most of the clinical and research work in this field is focused on the restoration of cartilage trauma. In this review, we summarize and discuss the methods of cartilage defect repair,as well as the hot spots and directions of future research work.

Objective Toinvestigatethealteredspontaneouscerebralactivitypatternsinpatientswithtype2diabeticretinopathy (DR).Methods 21patientswithDRand17healthycontrolsubjectswereprospectivelystudied.Allindividualsunderwentlaboratoryand neuropsychologicaltests.Thedifferencesintheamplitudeoflow-frequencyfluctuation (ALFF)valuesbetweentwogroupswere comparedandanalyzedstatisticallyusingDPRASFV2.3andREST1.6software.TherelationshipsamongALFFvaluesofbrainregionswith statisticalsignificance,HbA1c,durationofdiseaseandneuropsychologicalscoreswereanalyzedusinga multiple-factoranalysis.Results Comparedtothecontrols,theDRgroupshowedsignificantlyincreasedALFFvaluesinthebilateraloccipitalgyrus,rightlingualgyrus,and precuneus(P<0.01),anddecreasedvaluesintherightposterior/anteriorcerebellarlobe,fusiform,superiortemporal,inferiorparietal,and angulargyrus(P<0.05).Furthermore,theMoCAscoreswerenegativelycorrelatedwithdecreasedALFFvaluesintherightoccipitallobe oftheDRgroup,whileincreasedALFFvaluesintherightprecuneusandlingualgyruswerefoundtobepositivelycorrelatedwithglycosylated hemoglobin(HbA1c)levels.Conclusion PatientswithDRshowspontaneouscerebralabnormalactivityin manycerebralregions.ALFF valuechangesinthevisualcortexareassociatedwithcognitiveimpairments.Itisofimportantvaluetoevaluatebraindysfunctionin patientswithDRusingALFF method.

Objective To investigate germline mutation of breast cancer susceptibility genes BRCA1/2,TP53 and PTEN in Chinese breast cancer patients. Methods All of128 female breast cancer patients in Peking University People′s Hospital from January 2016 to August 2018 were selected as objects. Among them,44 cases were sporadic breast cancer and 84 werebreast cancer patients with genetic high risks. Germline mutations of BRCA1,BRCA2,TP53 and PTENwere detected by NGS.χ2 test was used to analyze the difference of pathogenic mutation rates between sporadic breast cancer group and breast cancer with high genetic risks.Groups were divided according to the clinical features of the patients(family history, triple-negative breast cancer,age and bilateral breast cancer).Among them,there were 42 cases with family history of breast cancer,34 cases of triple-negative breast cancer,33 cases of early-onset breast cancer and 7 cases of bilateral breast cancer. Fisher′s exact probability test compared the relationship between pathogenic mutations of BRCA1/2 gene and clinical characteristics of breast cancer patients with hereditary risk factors. Results In 128 cases of breast cancer,30 germline mutations of BRCA1/2 were detected, including 13 pathogenic mutations and 3 newly discovered mutations(BRCA1:c. 4760C>G,BRCA2:c. 44134414del and BRCA2:c. 64826485del). The new mutations may be unique mutations of Chinese population. There were 3 cases of TP53 mutations,including 1 pathogenic mutation. All of the 3 mutations were found in early-onset breast cancer. Germline mutation of T53 has important detection significance for early-onset hereditary breast cancer. There were 5 cases of PTEN mutations,including 3 pathogenic mutations. Among 84 breast cancer patients with genetic high risks,the carry mutation rate was 40.5％(34/84)and the pathogenic mutation rate was 15.4(13/84). Among 44 sporadic cases,the carry mutation rate was 9％(4/44). The pathogenic mutation rate was 6.8％(3/44). Breast cancer susceptibility genes were carried at a higher rate in breast cancer patients with genetic high risks(P<0.001). BRCA1/2 mutations did not show statistical differences among groups of breast cancer patients with hereditary high risk factors . Conclusion Germline mutation detection of breast cancer susceptibility genes by next-generation sequencing is of great significance in breast cancer risk prediction and prognosis evaluation.