Objective:To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. Methods:The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study em-ployed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and re-imbursements on inpatient services. Results: One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10 000 Yuan outpatient reimbursements saved 9 700 Yuan inpatient expenses. An increase of 10 000 Yuan outpatient expenses led to a decrease of 3 000 Yuan inpatient re-imbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/coun-ty levels, and no significant impacts on the outpatient services at the city levels. Conclusion:There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design out-patient and inpatient reimbursement policies.

Objective:To retrospectively evaluate the prognostic risk factors of patients with gallbladder carcinoma and the effect of normal prognostic nutrition index (PNI) on the survival. Methods:We retrospectively analyzed 63 patients with gallbladder carcino-ma treated in our hospital between January 2008 and December 2012. The independent prognostic factors of the patients were calculat-ed by the Cox proportional hazards model. The benefit of normal PNI status on the prognosis was further explored in the patients using survival analysis. Results:Lymph node metastasis, PNI≤50, squamous carcinoma, liver invasion and choledoch invasion were the risk factors of overall survival (OS) in the univariate analysis, while only lymph node metastasis (HR=4.495, 95%CI 2.380~8.488, P<0.001) and PNI(HR=0.195, 95%CI 0.098~0.389, P<0.001) were the dependent influential factors of the prognosis and OS in the multi-variate analysis. The effect of PNI on OS was even more statistically significant different in the younger patients (≤65y) than in the el-der (>65y) (younger group:P=0.011;elder group:P=0.078). Conclusion:The gallbladder carcinoma patients with normal PNI status (>50) have better OS compared to the patients with PNI≤50, with statistical differences between the two. And it is more significant in the patients of the younger group (≤65y), comparing with the elder group. PNI could be taken as a potential prognostic evaluation factor for the gallbladder carcinoma patients and can provide a more comprehensive evaluation of patients' conditions to clinician.

In the occurrence and development of neurological diseases,it often accompanied by cognitive impairment,which severely decreases the quality of life of the patients.Therefore,it is necessary for patients with neurological diseases to rapidly screen cognitive function.This aricle reviews the advances in research on the brief cognitive rating scales commnly used in clinical.

As a highly efficient protein degradation pathway,ubiquitin-proteasome system(UPS) plays an important role in maintaining cell function.The role of UPS is becoming a new research focus in molecular mechanism of cognitive function.UPS mainly acts on neurotrans mitter and its receptor,synaptic reguIation,long-term potentiation of postsynaptic poteraiais and neuronal signal transduction,and it may become a new target for the intervention of cognitive dysfunction.

Cardiovascular Diseases ; Humans ; Trans Fatty Acids

Adolescent ; Alopecia ; diagnosis ; therapy ; Bone and Bones ; abnormalities ; Denture, Complete, Upper ; Diarrhea ; diagnosis ; therapy ; Female ; Humans ; Spasm ; diagnosis ; therapy

Objective: To establish an HPLC fingerprint analysis method of Zhishi Xiebai Guizhi Decoction (ZXGD) and the content determination method of 10 index components of the decoction, and carry out the relevant evaluation and analysis. Methods: HPLC method was used to establish the fingerprint analysis method of ZXGD and then similarity evaluation was carried out. Ten index components of the decoction were determined, the influence of the change of compatibility of medicinal materials on the content of index components was analyzed. Cluster analysis and other chemometrics methods were used to analyze the relevant data and evaluate the impact and value of quality control related indicators of ZXGD. Results: The similarity of 10 batches of samples ranged from 0.376 to 0.990, and that of five batches was more than 0.9, which indicated that the similarity of 10 batches of samples was quite different. In 10 batches of samples, S1, S2, S3, S5, S6, S8 and S10 were in one group, S4 and S9 were in one group, S7 was in one group. In this study, 30 characteristic peaks were calibrated, and principal components 1-6 was the main factor affecting the quality evaluation of medicinal materials. Among the 30 characteristic peaks, peak 21 (neohesperidin), 26, 29 (honokiol), 3, 23, 17, 30 (magnolol), 5, 24 (coumarin), 28, and 7 were the key components. The results showed that except quercetin, the other nine components had good linear relationship, precision, stability and repeatability in the range of mass concentration. Different compatibilities could increase or inhibit the dissolution of related components in medicinal materials. Conclusion: The HPLC method can be used for the simultaneous determination of ten chemical components in ZXGD. The method is efficient, accurate and reproducible, and can be used for the quality control and evaluation of ZXGD.

Drug resistance is the main restriction factor for clinical usage of taxanes.This review concentrates on drug-resistance mechanisms of taxanes that include drug target change,avidity change between drug-target interaction,decrease of cellular effective drug concentration,downstream cellular responses to a drug target molecular lesion,and cell cycle regulation-mediated drug resistance.

Objective To investigate the feasibility of construction of orthotopic ileal neobladder after laparoscopic radical cystectomy(LRC)for female patients with bladder carcinoma.Methods From February 2003 to July 2006,we had performed construction of orthotopic ileal neobladder after laparoscopic radical cystectomy,hysterectomy,and ovariectomy on 8 women with bladder carcinoma.Under general anaesthesia,the patients were placed in the supine position with the head down at 15?,the thighs abduced,and the knee flexed.A 5-port transperitoneal approach was used.Under a laparoscope,the peritoneum was incised at the level of the bifurcation of the iliac vessels,and then the ureter was freed,and the round ligament of the uterus and the ovarian ligament were cut.Afterwards,the broad ligament was separated and pelvic lymphadenectomy was done.Then,the cardinal and uterosacral ligaments,bilateral ureters,and the lateral pedicles of the bladder were cut;the peritoneum was incised along the base of the broad ligament to open the vaginal vault so that the peritoneal reflection can be transected to expose the retropubic space.After that,the deep dorsal vein of the clitoris and the ureter was cut successively(the ureter was cut at 0.5 cm downwards from the neck of the bladder.Finally,the vagina was transected at the level adjacent to the vaginal vault,and the residual vagina was sutured.After the laparoscopy,the resected tissues were removed through a 4-to 5-cm incision on the midline of the lower abdomen,and then a M-shape ileal neobladder was constructed outside the incision.The ureter was reimplanted to the posterior wall of the pouch and replaced into the peritoneal cavity.The urethra-pouch anastomosis was completed by laparoscopy.Results The mean operation time in the 8 patients was(344.5?42.1)min,mean blood loss was(373.9?81.3)ml.The patients were followed up for 6 to 46 months with a mean of 26 months(over 12 months in 6 patients).During the follow-up,all the patients achieved automatic micturition in half a year.One patient had urinary incontinence occasionally,one had night-time urinary incontinence,and one had dysuria.The mean volume of the neobladders was(333.6?40.4)ml,and residual urine volume was(51.2?18.1)ml.After the operation,one patient developed uretero-neobladder anastomotic occlusion,and one had fistula of the neobladder.Conclusions Laparoscopic radical cystectomy,hysterectomy,and ovariectomy is feasible for female patients with bladder carcinoma.After the procedure,which is mini-invasive,most patients had automatic micturition;however,the rates of urinary incontinence and dysuria are relatively high.Further investigations are needed to study the long-term outcomes of LRC and reconstruction of orthotopic ileal neobladder.

Objective To study expression and clinical significance of nm23 genes in primary breast carcinomas. Methods The expression of nm23 was detected by immunohistochemical S-P method in 286 cases of primary breast carcinomas. Results The positive rate of nm23 expression was 65.7%. There was not a significant correlation between the positive rate of nm23 and patients' age, tumor pathological types. There was a significant relation between the expression of nm23 and tumor clinical stage, axillary lymph node metastasis, and the positive rate of nm23 expression in the cases of clinical stage I without axilliary lymph node metastasis was significantly higher than that in the cases of clinical stage III with axilliary lymph node metastasis. Conclusion The expression of nm23 gene was negatively related with clinical stage and axilliary lymph node metastasis in breast carcinomas, which indicated that nm23 gene expression may serve as an index for predicting lymph node metastasis and the prognosis of breast carcinoma.