Enlightenment of the cooperative mode between social and commercial of Medicare in the United States on development of " City-customized Medical Insurance" in China / 中华医院管理杂志

As a powerful attempt by government to promote the construction of the multi-level healthcare security system and social and commercial integration in China, " City-customized Medical Insurance" still has many problems to be solved at the beginning of its development, such as unclear boundary between government and enterprises, limited coverage and strength of security. On the basis of clarifying the current situation of " City-customized Medical Insurance", and combing the management experience of social and commercial integration in Medicare Part C plan of the United States, the authors put forward that China should make full use of the advantages of the combination of promising government and efficient market, guide differentiated product design, and establish market access and evaluation mechanism, so as to promote the effective connection between China′s commercial health insurance and basic healthcare insurance, and further reduce the people′s medical burden.

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital / 中华创伤杂志(英文版)

PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

Advances in the research of exosome and exosomal non-coding RNA in the pathogenesis, diagnosis and treatment of polycystic ovary syndrome / 药学学报

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease, which is mainly characterized by hyperandrogenemia, rare or anovulation, and polycystic ovarian changes. PCOS is seriously harmful and its causes are complex, which has not yet been clarified. Studies have shown that non-coding RNAs play important roles in the development of PCOS, including the regulation of hormone metabolism and follicle development. Exosomes are natural nano-scale membrane vesicles that contain cell-specific proteins, lipids, nucleic acids, and other biologically active molecules. Exosomes are important mediators for intercellular communication and new targets for disease diagnosis and treatment. Recent studies have shown that as an important component of follicle microenvironment, exosome is closely related to the pathogenesis of PCOS. Exosome and exosomal non-coding RNAs are expected to serve as potential new diagnostic and therapeutic targets for PCOS. In this review, we will summarize the function of exosome and exosomal non-coding RNA in the pathogenesis, diagnosis, and treatment of PCOS.

Aapplication and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor / 中国实用外科杂志

OBJECTIVE: To investigate the application and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor. METHODS: The clinical data concerned about 12 patients of pancreatic neck tumor accepted total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways in Changhai Hospital,Naval Military Medical University between March 2015 and March 2017 were analyzed retrospectively. The clinical data especially the data in general situation,operation,hospital stay,perioperative complications,postoperative pathology,condition of surgical margin,postoperative survival time and prognosis were analyzed. RESULTS: All of the 12 patients were diagnosed with pancreatic neck tumor infringing the peripancreatic arteriovenous vein and had accepted total pancreatectomy joint with intravenous resection and reconstruction. The median age of patients was 58 years,whose median BMI reached 23.41,and the number of males was up to 6,equal as females. The information about the operation was as follows:no intraoperative death case,median surgery time being 235 min,median intraoperative blood loss being 800 m L,median plasma-reduced blood transfusion volume being 600 mL,median resection length of vessel being 4.10 cm,median time of portal vein blocking being 15 min. After the operation,9 cases were conducted to large tissue biopsy examination with R0 resection rate of 91.7%. Besides,all the patients were managed with ERAS technique with the postoperative pain relief rate of 100%. Only one case suffered from gastric emptying disorder(Grade A)and two cases had infection. No patients died 30 days after operation,whose median postoperative hospital stay was 12 days and median survival time was 19.8 months. CONCLUSION: The total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways is safe and efficient to treat pancreatic neck tumor,improving operation security and living quality of patients. However,the surgery is so difficult that it could only be applied in certain pancreatic surgery centers with high levels.

A study on prediction algorithm for respiratory movement in the radiotherapy of thoracic and abdominal tumor / 中国医学装备

Due to the influence of respiratory movement in thoracic and abdominal radiotherapy, the real-time tracking technique was effective solution in the contemporarily precise radiotherapy. This article summarized prediction algorithm of several respiratory movement that was used to compensate the delay caused by system response in the real-time tracking radiotherapy, and compared the characteristics, performance and developing situation of various algorithm, and prospected the development and tendency of real-time tracking technique in future.

Tibial anteroposterior axis measured by CT scan in optimizing tibial prosthesis rotation during total knee arthroplasty / 中国组织工程研究

BACKGROUND: The osteotomy and prosthesis placement of the traditional total knee arthroplasty is mostly done by visual measurement and lacks more precise measurements. OBJECTIVE: To identify rotational alignment of tibial prosthesis using preoperative calculation of tibial anteroposterior axis by CT scan and to compare the clinical efficacy of tibial prosthesis placement in traditional total knee arthroplasty. METHODS: Data of 50 patients with knee osteoarthritis who underwent primary total knee arthroplasty in Department of Orthopedics, Renmin Hospital of Wuhan University from January 2014 to April 2015 were retrospectively analyzed. All patients were randomly divided into two groups: 23 cases (25 knees) received preoperative CT to measure the tibial anteroposterior axis in CT assistant group; 27 cases (29 knees) received the method of medial 1/3 of the tibial tubercle in traditional surgery group. We recorded operative time and hospital time, pre- and post-operative Hospital for Special Surgery score, patellar score, knee range of motion and Visual Analogue Scale score. At 3 days after surgery, X-ray images were obtained to measure tibial valgus β and tibial slope valgus θ. All operations were performed by the same team. RESULTS AND CONCLUSION: (1) All patients were followed up. There was no significant difference between two groups in the general information (P > 0.05). (2) Operative time, tibial valgus β and tibial slope valgus θ assessed in CT assistant group were better than in traditional surgery group (P < 0.05); there was no significant difference in hospital time between the two groups (P > 0.05). (3) There was no significant difference in Hospital for Special Surgery score, patellar score, range of motion, and Visual Analogue Scale score between the two groups pre-operatively, 1 and 3 months after operation (P > 0.05). However, above indexes were better in the CT assistant group than in the traditional surgery group at 6 months after operation (P < 0.05). (4) Results indicated that the tibial anteroposterior axis measured by CT for guiding tibial prosthesis position was more precise than the traditional surgery to make the femur prosthesis and the tibial prosthesis have better rotating alignment.

Comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and PLIF treatment for lumber spondylolisthesis / 临床外科杂志

Objective To comparison of clinical efficacy between mini-invasive transforminal lumbar interbody fusion(mis-TLIF) assisted by Quadrant system and open posterior lumbar interbody fusion (PLIF)treatment for lumber spondylolisthesis,to find a better treatment for lumbar spondylolisthesis.Methods A total of 65 cases who were under lumber spondylolisthesis were retrospectively selected from our hospital,26 cases in mini-invasive transforminal lumbar interbody fusion assisted by Quadrant system (mis-TLIF group).39 cases in open posterior lumbar interbody fusion(PLIF group).Record the incision length,intraoperative blood loss,opertive time,bed time,hospital time,pre-and post-operative visual analogue scale(VAS) and Oswestry disability index(ODI) score were recorded respectively.After surgery,the imaging(X-Ray) evalute the vertebral fusion status.Results There were no significant difference between mis-TLIF group and PLIF group in BMI [(22.77 ± 4.38) kg/m2 and (21.28 ± 5.24) kg/m2],preoperative VAS score [(6.46 ± 1.67) and (6.59 ± 1.56)],preoperative ODI score [(58.70 ± 7.19) ％ and (60.10 ± 9.56) ％] (all P ＞ 0.05).There were significant difference between two groups in incision length [(6.10 ± 0.95) cm and (11.12 ± 2.02) cm],intraoperative blood loss [(247.31 ± 36.72) ml and (340.51 ± 64.32) ml],opertive time[(179.96 ± 17.54) min and(151.85 ± 16.06) min],bed time[(3.62 ± 1.44) d and (4.98 ± 1.74) d],hospital time [(9.38 ± 2.60) d and (11.95 ± 3.61) d] (all P ＜ 0.05).Postoperatively VAS score was assesssd at 1 month [(3.15 ± 1.08]),3months [(1.58 ± 0.81)],6months [(1.08 ± 0.74)] and ODI score was(30.77 ± 6.45) ％,(25.54 ± 6.33) ％,(20.23 ± 7.05) ％,respectively in mis-TLIF group were lower than those of PLIF group (P ＜ 0.05).There were no significant difference between two groups in the fusion rate in 3 months,6 months after operation.Conclusion Mis-TLIF had a lot of advantages relative to PLIF in the treatment of lumber spondylolisthesis,be like less trauma,less bleeding,less hospital time,quick rehabilitation and good curative effect,provide a new minimally invasive method for lumber spondylolisthesis patient.

Hybrid operation for the treatment of Stanford type B aortic dissection / 介入放射学杂志

Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of (50±12) years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali-zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no typeⅠendoleak; complications included pulmonary infection (n=1), strokes (n=1), reversible abnormal renal function (n=6) and retrograde aortic arch dissection (n=1). No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.

CD36 expression in monocytes and ankylosing spondylitis / 中国组织工程研究

BACKGROUND:Ankylosing spondylitis is an autoimmune disease involved in chronic systemic inflammation. Tumor necrosis factor and interleukin-6 levels increased in patients with ankylosing spondylitis. Inflammatory factors such as tumor necrosis factor and interleukin-6 can suppress CD36 expression in monocytes. OBJECTIVE: To analyze the correlation between CD36 expression in monocytes and ankylosing spondylitis. METHODS:A total of 84 newly diagnosed ankylosing spondylitis patients and 111 healthy individuals were included in this study. CD36 expressions in monocytes in ankylosing spondylitis patients and healthy individuals were tested using flow cytometer; meanwhile, biochemistry, immunology, routine blood examination and related inflammatory markers were determined between the two groups. RESULTS AND CONCLUSION:Results of baseline data in both groups demonstrated that CD36 fluorescence intensity in monocytes was significantly lower in patients with ankylosing spondylitis compared with healthy controls (P < 0.01). CD36 fluorescence intensity in monocytes was negatively correlated with C-reactive protein, erythrocyte sedimentation, interleukin-6 and tumor necrosis factor. In addition, CD36 fluorescence intensity in monocytes was negatively correlated with BASDAI score. Logistic regression analysis showed that erythrocyte sedimentation, interleukin-6, tumor necrosis factor and CD36 fluorescence intensity in monocytes were associated with ankylosing spondylitis, and risk factors for ankylosing spondylitis (P < 0.05). These findings confirm that inflammatory cytokine in patients with ankylosing spondylitis weakened the expression of CD36 in monocytes. There was a remarkable association between low expression of CD36 expression in monocytes and ankylosing spondylitis. CD36 expression of monocytes clinicaly may be considered to be an effective indicator to evaluate inflammation and disease activity in patients with ankylosing spondylitis.

Immunological characteristics of Mycobacterium tuberculosis antigen Rv2628 / 生物工程学报

Antigen Rv2628 of Mycobacterium tuberculosis is associated with latent tuberculosis infection. In this study, Rv2628 was prokaryotic expressed and purified, its immunological characteristics was evaluated with macrophage cell line RAW264.7 and BALB/c mice. The results show that Rv2628 was mainly expressed in form of inclusion body confirmed by SDS-PAGE, and could react with rabbit anti-H37Rv polyclonal antibody detected by Western blotting assay, indicating that the protein had an effective immunoreactivity. The interactions between Rv2628 and macrophage cell line RAW264.7 confirmed that it could effectively induce cells to produce pro-inflammatory cytokines, the relative expression level of IL-6 mRNA was higher than the control group in 1-12 h. BALB/c mice were subcutaneously immunized with Rv2628 protein, the production of IFN-gamma and IL-4 in the spleen cells was determined by Sandwich ELISA, in the Rv2628 immunized group, the level of IFN-gamma was significantly higher than that of IL-4 (P < 0.000 1). It indicated the protein induced Th1-tendency immune responses. At the same time, Rv2628(11-30) peptide used as coating antigen, the murine serum antibody titer detected by indirect-ELISA was 1:1 600, which demonstrated that Rv2628 could also induce humoral immune responses. In summary, Rv2628 could induce specific pro-inflammatory cytokines, affectively induce strongly Th1-tendency immune response and humoral response, it could be a potential target for developing subunit vaccine against TB. In addition, it laid foundation for probing the cross-talk between M. tb and host.

Protective Effect of Erythropoietin on Anoxia of Motoneurons after Spinal Cord Injury in Rats / 中国康复理论与实践

@#Objective To observe the protective effect of erythropoietin (EPO) on anoxia of motoneurons after spinal cord injury in rats.Methods The motoneuron was dissociated from neonate Wistar rats and cultivated in vitro with deprivation of oxygen in the medium. The changes of morphology were observed by phase-contrast microscopy, and the expression of EPO receptor (EPOR) was detected with Western blotting. The survival rate of motoneuron was measured with methyl thiazolyl tetrazolium (MTT) assay, and the level of lactate dehydrogenase (LDH) was observed. Results Compared with the control group, the expression of EPOR and the level of LDH increased (P<0.01),and the survival rate of motoneuron decreased (P<0.01) in the anoxia group. Compared with the anoxia group, the expression of EPOR and the level of LDH decreased (P<0.05), and the survival rate of motoneuron increased (P<0.01) in the EPO group, which was related with the level of EPO. Conclusion EPO could relieve the damage of motoneuron caused by anoxia, especially by upregulating EPOR.

Epidemiology of listeriosis infection in humans and animals, China, 2002-2012 / 中国人兽共患病学报

The prevalence of human and animal listeriosis for nearly 11 years in China was investigated in this study . The literature information about listeriosis in China from 2002 to 2012 was collected through retrieval system to make clinical and epidemiological statistical analysis of listeriosis .Cases of listeriosis were reported in 27 (79% ) provinces of China .The re-sult showed that animal listeriosis was reported for 123 times ,among these reports ,most were from pigs (39% ) ,and the sheep was in second place .Central nervous system infection was the main clinical manifestation of listeriosis in animals (72% ) . For human listeriosis ,84 clinical cases of listeriosis were reported ,including 35% cases in non-perinatal stage and 65% cases in perinatal stage .The main clinical manifestation of listeriosis was septicemia (51% ) .According to the result of investigation about listeriosis based on literatures information ,Listeriamonocytogenes caused humans and animals listeriosis annually ,which were reported in most provinces of China .The epidemic characteristics for listeriosis suggested that it was essential to strength-en the prevention and control of listeriosis .

Digital orthopedic technology in the positioning of volar plate in distal radius fracture / 中国组织工程研究

BACKGROUND:Volar locking plate is the dominant treatment of distal radial fractures, but it is difficult to judge the distance between the plate position and the carpal articular surface, thus leading to screw penetration of the articular surface. Arthroscopy or operative perspective has their pros and cons, there is no simple and effective method of positioning the plate. OBJECTIVE:To find the optimal position of Volar LCP in distal radius fractures and explore the role of computer simulation in this treatment. METHODS:The CT data of the wrists in 20 adult patients were col ected to calculate 3D models of the radius by MIMICS software. 3D model of the LCP was calculated by UG in working station. The distance between the plate and the distal radius joint was measured by computer simulation, and the mean value was calculated. A total of 33 Patients with distal radial fractures were divided into two groups:conventional treatment group (regular X-ray and CT) and computer simulation group (preoperative plan based on the computer-measured data). RESULTS AND CONCLUSION:The safe distance between the screw center and the articular facet was 11.13 mm in males and 10.97 in females. The number of radiation and operating time were shortened significantly in computer simulation group (P<0.05). Experimental findings indicate that, computer simulation is a powerful tool to find the optimal position of volar LCP in the distal radius fractures. The time of the operation and X-ray fluoroscopy are also shortened significantly.

Protective Effect of Erythropoietin on Anoxia of Motoneurons after Spinal Cord Injury in Rats / 中国康复理论与实践

Objective To observe the protective effect of erythropoietin (EPO) on anoxia of motoneurons after spinal cord injury in rats. Methods The motoneuron was dissociated from neonate Wistar rats and cultivated in vitro with deprivation of oxygen in the medium. The changes of morphology were observed by phase-contrast microscopy, and the expression of EPO receptor (EPOR) was detected with West-ern blotting. The survival rate of motoneuron was measured with methyl thiazolyl tetrazolium (MTT) assay, and the level of lactate dehydro-genase (LDH) was observed. Results Compared with the control group, the expression of EPOR and the level of LDH increased (P<0.01), and the survival rate of motoneuron decreased (P<0.01) in the anoxia group. Compared with the anoxia group, the expression of EPOR and the level of LDH decreased (P<0.05), and the survival rate of motoneuron increased (P<0.01) in the EPO group, which was related with the level of EPO. Conclusion EPO could relieve the damage of motoneuron caused by anoxia, especially by upregulating EPOR.

Treatment of complex acetabular fractures with combined ilio-inguinal and Kocher-Langenbeck approach / 中华骨科杂志

ObjectiveTo investigate the clinical effect and treatment experience of complicated acetabular fractures treated with open reduction with combined ilio-inguinal and Kocher-Langenbeck (K-L) approaches.MethodsSixty-six patients with complicated acetabular fractures were treated surgically with combined ilio-inguinal and K-L approaches from February 2004 to December 2009.Among them,45 cases were followed up for 8-45 months,with the average 26 months.ResultsOperation time was 1.4-5.7 h,with the average of 2.8 h.Intraoperative blood loss was 530-2300 ml,with the average of 1250 ml.According to Matta's score system,the excellent and good rate was 86.7％.According to modified Merle d' Aubigne and Postel score system,the excellent and good rate of function of hip was 86.7％.According to Brooker heterotopic ossification standard assessment system:Ⅰ degrees in 6,Ⅱ degrees in 3.According to Letournel and Judet clinical classification system,postoperative traumatic arthritis were 6 patients.Among them,3 patients with Ⅲ- Ⅴ period with symptoms of serious hip pain and joint activities obstacles were treated with total hip replacement secondly.Six cases of sciatic nerve injury and 9 cases of lateral femoral cutaneous nerve damage were recovered gradually after six months to a year.All incisions healed primarily.All got bony union,the healing time was 8 to 16 weeks,with the average of 10.4 weeks.None was complicated with femoral head necrosis.ConclusionFor the patients with complicated acetabular fractures,open reduction with combined ilio-inguinal and K-L approaches can get clinical advantages of revealed fully,fracture restoration convenient,fixed tightly,fewer complications and satisfactory result.

Anti-infective reconstituted bone xenograft used for primary bone grafting to repair contaminated defect in the radius in dogs / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effect of anti-infective reconstituted bone xenograft as a primary graft to repair a segmental with severe contamination.</p><p><b>METHODS</b>A canine model of contaminated defect of 1.5 cm in size in the radius was used, in which anti-infective reconstituted bone xenograft or reconstituted bone xenograft was implanted as a primary graft followed by internal fixation. The effectiveness of the two grafting materials in repairing a contaminated segmental defect was compared.</p><p><b>RESULTS</b>The animals which had received implant of anti-infective reconstituted bone xenograft should largely healed defects 6 months after operation while the defects implanted with reconstituted bone xenograft remained unrepaired with bone infection.</p><p><b>CONCLUSIONS</b>Besides its strong osteoinductive and osteoconductive activity, anti-infective reconstituted bone xenograft is highly antibacterial and can be used as a primary graft to repair the severely contaminated segmental defect.</p>