Objective:To analyze the impact of Recombinant Human Tumor Necrosis Factor-α Receptor Ⅱ:IgG Fc Fusion Protein (rhTNFR:Fc) on medical insurance budget.Methods:Rheumatic drugs were select from the IMS data 2015.The drug quantity unit was converted to defined daily dose(DDD).The quantity of rhTNFR:FC in IMS data 2015 was taken as the baseline.The expenditure growth and its impact on rheumatic drugs and all drugs were calculated under 90％ and 80％ reimbursement rate as the different incremental proportion of the quantity of rhTNFR:Fc.National health insurance expenditure data was derived from statistical data of government departments.Results:According to 90％ reimbursement rate,medical insurance expenditure increased by 5.22～10.43 billion yuan.rheumatic drugs and all medical insurance drugs expenditure increased by 63.44～126.87％ and 0.04～0.08％ respectively while the consumption of rhTNFR:Fc increased 0-100％ in 2015.The increment of medical insurance expenditure reduced accordingly under the reimbursement ratio of 80％.Conclusion:The budget impact of rhTNFR:Fc was great on medical insurance expenditure of rheumatic drugs,which was very limited on the medical insurance expenditure of all drugs.

Objective:To investigate the changes of expression of CD28 on T cells and activation of various population of T cells in peripheral blood of lung cancer patients and to study the relations of these changes with clinical stages.Methods:Three color immunofluorence staining and flow cytometry was used to detect the expression of CD28 on various population of T cells and the activation of CD28+ T cells in peripheral blood both of 38 normal persons and 42 patients with lung cancer.Results:Comparing blood of lung cancer patients were remarkably decreased(P

There is a unification of the social pooling accounts and personal saving accounts of Urban Employees' Basic Medical Insurance ( UEBMI) in Shanghai. In recent years, the revenue and expenditure of UEBMI funds increased, and the fund balance sprouted year by year, and mostly concentrated in personal health insurance saving accounts. On the whole, the vast majority of insured personal saving accounts have balances, but the balance is not high, i. e. less than 1000 yuan accounted for 52. 3%. Judging from the age group, the personal health insur-ance saving account funds is mainly concentrated in the 30-year-old and over working population. Because of its par-ticularity, the personal health insurance saving accounts can only be invested in current deposit (bank live), time deposit and national debt, bonds and other hedge. Compared with the price index devaluation, the personal health insurance saving accounts somehow failed to give full play to the personal attributes. It is suggested to explore the use function of personal health insurance saving accounts by establishing family saving accounts-family coexistence, pur-chasing of supplementary medical insurance and so on. Simultaneously, the channels of maintaining and increasing the value of personal health insurance saving accounts could be broadened.

The relevant policies of national essential medicine system were reviewed, major concerns and actions in the implementation of essential medicine system in Shanghai were introduced, and the suggestions to improve the implementation of essential medicine system of Shanghai were made. These provided the information for policy making and provided a useful experience for facilitating the establishment of essential medicine system and the improvement of its implementation in Shanghai as well as China.

Objective To study NonO protein expression changes in murine erythroleukemia ( MEL ) cell differentiation induced by sodium butyrate .Methods Benzidine staining was used to test sodium butyrate-induced erythroid differentiation of MEL cells .We detected NonO protein expression changes in MEL cell differentiation induced by sodium butyrate and NonO protein localization in MEL cells by Western blotting and immunocytochemistry .Furthermore , we applied PCR technique to detect NonO RNA expression in differentiation process .Results We found that NonO protein was upregulated at gene and protein levels in the erythroid differentiation process of MEL cells induced by sodium butyrate and located in cytoplasm and nucleus in MEL cells .Conclusion These results show that NonO protein is closely related with MEL cell differentiation induced by sodium butyrate , which may provide important clues for further study of the mechanism of leukemia .

Shanghai began to strengthen the community health service system in 1997 , and had officially en-tered the period of “connotation construction” with the core policy of family doctor system in 2011 after the period of“service framework and network establishment” and“operational mechanism reform”. Through summarizing the poli-cy files related the family doctor system and based on 2013 report on monitoring and evaluation of family doctor system in Shanghai, the paper presented the progress of the system from aspects of system coverage, signature relationship, service mode and operational mechanism, and analyzed the development bottlenecks of the system from aspects of the policy itself, service principal, service supervision and service objects. Finally, the paper proposed some suggestions in order to give some references for further development of national general practitioner system.

Objective:To analyze the value of low dose enteral nutrition (EN) in treatment of septic shock combined with acute gastrointestinal injury Ⅲ (AGI Ⅲ).Methods:Clinical data of septic shock patients combined with AGI Ⅲ admitted at our hospital were analyzed.Patients were divided into two groups according to the nutrition therapy they received:treatment group (EN,n =41) and control group (no EN,n =46).The mortality and ICU hospital stays were collected.The intestinal barrier,inflammatory cytokines,and oxidative stress were evaluated before and after EN treatment.Results:For patients in the treatment group,the dosages of EN ranged from 200 to 410 kcal/d,with the median dose of 350 kcal/d.No significant differences were found on death rates between the two groups (24.4％vs 32.6％,P =0.398).Patients in the treatment group had shorter ICU hospital stays than those of the control group (11.8 ± 3.7 vs 16.2 ± 5.3,P ＜0.01).After one week EN treatment,patients in the treatment group had lower levels of CRP,IL-6,TNF-α,diamine oxidase,endotoxin and D-lactate than those of the control group (P ＜ 0.05).Conclusion:For septic shock patients combined with AGI Ⅲ,low dose EN can improve the intestinal barrier function and systemic inflammatory responses.

Biopsy ; Endopeptidase K ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA ; pathology ; Glomerulonephritis, Membranous ; pathology ; Humans ; Kidney ; pathology ; Lupus Nephritis ; pathology ; Paraffin Embedding ; Staining and Labeling

The study introduced the general evaluation indicator system for community health services in Shanghai and its characteristics,analyzing the results of the comprehensive evaluation from the aspects of regions and institutions.From six aspects of financial input,human resource construction, operation mechanism,family doctor system,information system construction and the application of the comprehensive evaluation results,the paper recommended on deepening the reform of community health services.

OBJECTIVE: To conduct the economic evaluation of recombinant human type Ⅱ tumor necrosis factor receptorantibody fusion protein (trade name: Etanercept) in the treatment of rheumatoid arthritis.METHODS: By literature retrieval, foreign literatures about Etanercept "head to head" research or Chinese literatures about the comparison of recombinant human type Ⅱ tumor necrosis factor receptor-antibody fusion protein with infliximab and adalimumab were collected. The costs were localized, indicators of effectiveness were converted into quality-adjusted life year (QALY), then cost-utility analysis (CUA) and incremental cost-utility ratio (ICUR) were conducted. RESULTS: Three qualified literatures were acquired. The translational research of the first report of WU B and so forth (2012 year) showed that CUA of Etanercept, infliximab and adalimumab were 48. 2, 36. 6 and 104. 6 thousand yuan/QALY, and ICUR were 119. 8, 116. 4 and 313. 4 thousand yuan/QALY, respectively. The translational research of the second report of Santos-Moreno P and so forth (2015 year) showed that CUA of Etanercept, infliximab and adalimumab were 93. 1, 118. 2 and 249. 2 thousand yuan/QALY, and ICUR were 117. 5, 151. 3 and 327. 9 thousand yuan/QALY, respectively. The translational research of the third report of Santos-Moreno P and so forth (2016 year) showed that CUA of Etanercept, infliximab and adalimumab were 107. 0, 131. 6 and 273. 8 thousand yuan/QALY, and ICUR were 139. 6, 172. 5 and 369. 8 thousand yuan/QALY, respectively. ICUR of Etanercept were all smaller than 3 times of GDP 148. 1 thousand yuan in 2015. CONCLUSIONS: From the results of the study of these 3 literatures, compared with infliximab and adalimumab, Etanercept shows economy for rheumatoid arthritis.