Objective To investigate the surgery opportunity choice of congenital esotropia.Methods A retrospective research was taken using the clinical data and the results of the treatment of 146 inpatients with congenital esotropia in our department from Mar 2012 to Mar 2015.The correction rate,lackingcorrection rate,and over-correction rate were compared between early surgery group and late surgery group on time of 1 week after surgery and 6 months after surgery,respectively.Results In all the 146 patients,88 (60.3％) had an esotropia deviation greater than or equal to 40 pupil distance (PD),38 (26.0％) combined with amblyopia,12 (8.2％) combined with nystagmus,30 (20.5％) combined with inferior oblique muscle overaction,6 (4.1％) combined with dissociated vertical divergence (DVD).There was no significant difference between early surgery group and late surgery group on correction rate,lacking-correction rate,and over-correction rate on the time of 1 week after surgery and 6 months after surgery,respectively.Conclusions Congenital strabismus should take surgery at the early-stage,especially for those have large angles.It is better to be operated before 2-year old for a better formation and recovery of binocular visual function.

Objective To further elaborate the clinical characteristics,diagnosis,treatment and prognosis of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma.Methods The clinical characteristics,diagnosis and treatment of a patient with primary cutaneous invasive epidermotropic CD8 positive cytotoxicity T-cell lymphoma were summarized,and diagnosis and treatment of the disease from published literature were reviewed.Results After one year long,recurrence of exudative maculopapule on his body and limbs,a middle-aged male patient visited our hospital.Then,the patient was diagnosed as T2N0M0 Ⅰ phase of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma based on results of skin biopsy,immunohistochemistry,T-cell gene rearrangement and PET-CT.Through integrative medicine treatment (combination of bruceolic oil emulsion and chemotherapy with GDP regimen),the patient achieved complete remission (CR).The treatment and follow-up continues till now and his condition was stable.Conclusions Clinical occurrence of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma is rare and early diagnosis is difficult.It could be diagnosed with histopathology combined with T-cell gene rearrangement.In order to avoid misdiagnosis,great caution should be taken during disease history inquiry and physical examination,should be early lesion for delayed healing of recurrent lesions,biopsy should be conducted as soon as possible and immunohistochemistry should be performed simultaneously,which will provide a good basis for further treatment.

Along with the development of society and the rapid economic growth in the past decades,hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China.This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID),including 3229 people in Hubei province and 2628 people in Guangdong province.One-way ANOVA was used to compare the total medical expense,out-of-pocket (OOP)expense and hospital stay between variables.A multiple linear regression analysis was done to identify possible risk factors of total medical expense.The results showed that the average total medical expense per capita was 5709.89 yuan,and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province,respectively.The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuanin 2013.There were no significant differences in medical expenses between different genders of hypertensive patients (P＞0.05).People of different ages,provinces,medical insurances and medical institution levels showed significant differences in medical expenses.The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region.Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances.And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.

Objective To evaluate the olfactory functions in patients with Parkinson's disease (PD) with a smell identification test developed for the Chinese population and to examine possible factors contributing to PD patients' olfactory performance.Methods Fifty-five patients with idiopathic and nondementia PD and 55 demographically matched healthy controls (HC) were recruited and their olfactory identification tested using the Chinese Smell Identification Test developed by the Institute of Psychology at Chinese Academy of Sciences.Results Olfactory identification score was significantly lower (t =-6.827,P＜0.01) in the PD group (19.3 ±5.4) as compared with the HC group (26.5 ±5.7).Of all PD patients,63.6％ scored over 1 SD below the age norm.In particular,of those with Hoehn-Yahr ratings between 2 to 3,77.8％ scored over 1 SD below the age norm.Receiver operating characteristic (ROC) curve analysis indicated that a cut-off score of 22.5 on the Chinese Smell Identification Test distinguished between PD patients and HC with a sensitivity of 74.6％ and specificity of 70.9％.Within the PD group,age,education,Hoehn-Yahr rating and Mini-Mental State Examination score were not found to correlate with olfactory performance (all P ＞ 0.05).Conclusion PD patients in China show significant impairment of olfactory identification,which is effectively captured by the Chinese Smell Identification Test.

BACKGROUNDThe peritoneal dialysis (PD) therapy for end stage renal disease (ESRD) is expensive. The main reason for non-acceptance onto dialysis programs is the great cost. In the present study, we design an auxiliary business insurance program to provide the potential ESRD patients who have no access to governmental medical insurance or can not afford the remaining part besides the limited reimbursement for peritoneal dialysis therapy.

METHODSThe information applied in this study was extracted from the medical records of 641 PD patients, who were treated in two dialysis centers of the first and the third teaching hospitals of the Peking University respectively. A collective risk model was employed to estimate the expenses on PD therapy. Survival analyses were performed to obtain the average survival time of PD patients and the average length of time from the onset of the primary disease to the beginning of PD. An annuity method was used to determine the pure premium.

RESULTSFor chronic nephritis, diabetes mellitus and hyperpietic as primary diseases, the mean survival time +/- standard errors were (55.1 +/- 3.7) months, (38.9 +/- 3.2) months and (61.4 +/- 4.6) months respectively, and they were significantly different from each other (all P = 0.000). The expenses of whole PD therapy were 242 159.05 Yuan, 182 525.02 Yuan and 284 579.24 Yuan respectively.

CONCLUSIONSAn auxiliary business insurance for PD patients was designed with the pure premium for any individual who had chronic nephritis, diabetes mellitus or hyperpietic as primary disease was RMB 35.94 Yuan/year, 87.73 Yuan/year or 7.71 Yuan/year respectively without considering the additional premium for coping with the business expenditures and accidental risks.

Adult ; Aged ; Female ; Humans ; Insurance, Health ; Male ; Middle Aged ; Peritoneal Dialysis ; economics ; mortality

Five field strains of infectious bronchitis virus (IBV) were isolated from suspected flocks from different time and different regions of Shanxi province,respectively,and characterized by a series of systematic identification assays,such as morphological observation by electron-microscope,interfering with the propagation of NDV,virus pathological role to chicken embryo,virus pathological role to SPF chickens,hemagglutination activity,physiscochemical,and reverse transcription polymerase chain reaction(RT-PCR).The results showed:The typical coronavirus which the spherical virions 60-120 nm in diameter and surface covered with spike like corona were observed under electron-microscope)The propagation of NDV strain was seriously interfered by the 5 isolates respectively;The embryonated chicken egg passages of the 5 isolates could dwarf with chicken embryos;The five isolates had no hemagglutination activity,but after treatment with 1% trypsin,it can agglutinate chicken red blood cell.The strains are sensitive to chloroform and ethyl ether.The SPF chickens which inoculated with the 5 isolates showed clinical sign and result in respiratory and kidney diseases,flower-steak,and swollen with severe urate deposition.The specific fragments of N gene of the 5 isolates were amplified by RT-PCR,respectiveiy.On the basis of all above mentioned results,the 5 isolates were classified as IBV.The study got a good preparedness for further study on molecular epidemioogy of the 5 IBV isolates.

Objective:To analyze the incidence and risk factors of non-acute symptomatic portal vein thrombosis (PVT) after endoscopic gastric variceal injection (GVI) in the treatment of liver cirrhosis with gastric variceal bleeding (GVB).Methods:66 patients with GVB who were treated with GVI for the first time from July 2017 to October 2019 in Minhang Hospital Affiliated to Fudan University were retrospectively analyzed. The data of gender, age, preoperative Child-Pugh grade, preoperative platelet count, preoperative plasma D-dimer concentration, preoperative splenic length, preoperative portal vein velocity, preoperative splenic vein velocity, preoperative portal vein diameter, preoperative splenic vein diameter, treatment times, total number of injection points, total dose of sclerosing agent and tissue adhesive agent were collected. The patients were divided into PVT group and non-PVT group according to the occurrence of non-acute symptomatic PVT within one year after GVI. Univariate analysis was performed first, and then the factors with P<0.2 were included in the binary logistic regression model to screen the risk factors of PVT after GVI. Results:There were 25 cases (37.88%) in PVT group and 41 cases (62.12%) in non-PVT group. There were significant differences in D-dimer concentration, spleen length, Child-Pugh grade and total dose of sclerosing agent between the two groups ( P<0.05). The D-dimer concentration ( OR=2.319, 95% CI:1.359-3.956), spleen length ( OR=1.044, 95% CI:1.007-1.081) and total dose of sclerosing agent ( OR=1.075, 95% CI:1.004-1.152) were independent risk factors for PVT ( P<0.05). Conclusions:Preoperative D-dimer concentration, spleen length and total dose of sclerosing agent can predict the risk of PVT after GVI. In order to reduce the risk of PVT after GVI, the dose of sclerosing agent should be reduced as much as possible.

Objective To explore the open experimental training model using multimedia control system for nursing students to develop their core competencies. Methods Different model designs of multimedia control system were applied in the study group. After the one year training program, a self-designed survey was used to collect the students' evaluation. A comprehensive test was carried out and the scores of it were compared to the traditional training group. Results Test sores of the study group was significantly higher than of the control group's (P<0.01), and the survey results showed that using multimedia control system in the open experimental training program was highly accepted by the nursing students (97.1%). Conclusions Using multimedia control system in the open experimental training program can improve the nursing students' competencies and comprehensive quality.

Diabetes Mellitus ; economics ; Hospitalization ; Humans ; Insurance Claim Review ; Insurance, Health ; Normal Distribution ; Probability ; Risk

Aim To explore the anticomplementary ac-tivity and active constituents of Phyllanthus urinaria. Methods Being guided by bioactive screening,the anticomplementary constituents of P.urinaria were iso-lated and purified by solution partition and chromato-graphic techniques,and their structures were identified by 13C-NMR spectrum and the comparison of reported data. The anticomplementary activity and possible mechanism were assayed.Results The EtOAc fraction of the methanol extract of P.urinaria was shown to be the active fraction,and two compounds were purified from the fraction and were identified as corilagin and ellagic acid.The EtOAc and the two compounds signifi-cantly inhibited the hemolysis of the complement classi-cal pathway,with IC50values of 53.77 mg·L-1, 176.54 mg·L-1and 102.23 mg·L-1,respectively. While they just showed slight effect on inhibiting the hemolysis of the complement alternative pathway. All of them affected the formation of C3 convertase of the classical pathway. Conclusions The polyphenols are main anticomplentary constituents of P. urinaria,and its mechanism is related to inhibiting formation of C3 convertase of the classical pathway.