Twenty- five patients with severe head injury underwent early total parenteral nutrtion (TPN) support,and the blood glucose,serum albumin,body nutritional index and nitrogen balance were monitored in our case- controll study.We find that the patients with severe head injury could get more energy and protein from TPN than from enteral nutrition (EN) ,the mortality of the patients with TPN was significantly lower than the patients with EN.The total nutrient admixture(TNA) in our study can provide sufficient energy and protein,but cannot raise blood glucose,so it can make a good condition for the recovery of the severe head injuries.

The authors conceive of dispersing and transferring medical risks by means of insurance. They suggest developing two modules of insurance business, including malpractice insurance and medical accident insurance. They also discuss such basic issues as risk financing, financial compensation and choice of insurance undertakers.

In the progress of the new healthcare reform, China has carried out a series of reform exploration in the drug distribution system.But fluctuating markups of drugs are still the main cause of high drug price.In order to simplify the distribution procedure, the National Health and Family Planning Commission proposed to encourage the implementation of two-receipt system nationwide.As the important part of the price system of drug circulation, drug distribution system made a great impact on the implementation of two-receipt system policy.Focusing on two provinces namely Fujian and Shaanxi provinces, this paper will discuss the typical drug distribution system in china.This paper has evaluated the main body and operation pattern in the implementation of two-receipt system, and by analyzing the benefits and drawbacks, in the same provinces.It has put forward the optimized distribution mode and provided policy suggestions for strengthening the two-receipt distribution system.

Objective To investigate the effect of Intedeukin-18 (IL-18) on Th1/Th2 balance and its antitumor mechanism in C57BL/6 mice Lewis lung cancer model. Methods 24 C57BL/6 mice were randomly divided into three equal groups: group A(IL-18 injec-tion group, n = 8), group B (Lewis lung cancer model, n = 8) and group C (normal control group, n = 8). The Lewis lung cancer cells were cultured and implanted subcutaneously into the group A and group B. IL-18 and NS were given to group A and B respectively by intrap-eritoneal injection on the 7th day (once every day, 7 times altogether), but group C was not given any treatment. Enzyme-linked immunosor-bent assay (ELISA) was used to detect the Th1/Th2 cytokines. Health status in all the animals was evaluated; the volume and weight ofsubcutaneous tumors were measured. Results The concentration of IFN-γ in group A and C were significantly higher than those in group B (P <0.05), and the concentration of IL-4 in group A and C were significantly lower than those in group B (P<0.05), but there was no significant difference between group A and C (P>0.05). The tumor growth inhibitory rate was 75%. Conclusion IL-18 can effectively induced IFN-γ and inhibit IL-4 production, regulate Th1/Th2 balance in the C57BL/6 mice Lewis lung cancer model, and elicit the antitu-mor immunity of the host, which could obviously inhibit the growth of tumor cells and decelerate the proliferation of tumor cells.

Objective To discuss the selection of diagnosis for intracranial aneutysms,and to analyze thera-peutic efficacy of microsurgical treatment and endovascular embolizafion in the treatment of intracranial aneurysms.Methods 190 pailents suffeming from intracranial aneurysms experienced brain CT examination.37 cases detected by MRI.31 cases detected by MRA,134 were confirmed by computered tomographic angiography(CTA)or 3D-CTA,and 142 cases were confirmed by digital subtract angiography(DSA).96 patients underwent microsurgical treatment,4 of whom failed in endovascular embolization.92 cases underwent endovascufar therapy,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil(GDC).Results 9 patients died,2 of whorn died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications,and the others were cured.Conclusion CT is the first choice for the subarachniod hemorrhage;MBA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping.The size-form,relationship with patent arteries,and even the raptured point of aneurysms can be clearly demonstrated by CTA-and CTA can be used to the operation for intracranial aneurysms directly.DSA-especially 3D-DSA Call display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracnmial aneurysms directly.Endo-vascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasespasm should be treated with microsur-gical operation immediately and resolutely.The ruptured aneurysms in multiple intracraniul aneurysm should be iden-tified correctly and treated in the early stage.

Objective:To observe the changes of blood cell count, and levels of hormone, glucose, and electrolytes at adrenocorticotrophic hormone (ACTH) and thyrotropic hormone (TSH) axes in patients with traumatic brain injury (TBI) at early stage, and explore the correlations among these indicators.Methods:Prospective selection of 93 patients with TBI (TBI group), admitted to our hospital from March 2018 to July 2019, and 18 health subjects accepted physical examination (control group) during the same period was performed. TBI patients were divided into mild, moderate, and severe subgroups according to Glasgow coma scale (GCS) scores at admission. The changes of blood cell count, and levels of hormone, glucose, and electrolytes of these TBI patients and the control subjects were detected on the 2 nd, 8 th, and 15 th d of TBI. Results:(1) The cortisol (COR) level in TBI group was significantly higher than that in control group on the 2 nd and 8 th d of TBI (P<0.05); COR level in TBI group was decreased on the 2 nd, 8 th, and 15 th d of TBI, successively. TSH level in the TBI group was significantly lower than that in control group on the 2 nd d of TBI; TSH level in patients from the TBI group on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI (P<0.05). Triiodothyronine (T3) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T3 level in TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; T3 level in the TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Tetraiodothyronine (T4) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T4 level in the control group was significantly higher than that in the mild and severe TBI subgroups on the 8 th d of TBI(P<0.05); patients in the severe TBI subgroup had increased T4 level successively on the 2 nd, 8 th, and 15 th d of TBI. Free triiodinated thyroxine (FT3) level in the control group, and mild, moderate and severe TBI subgroups decreased successively on the 2 nd d of TBI; and FT3 level in the TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; FT3 level in TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Free tetraiodothyronine (FT4) level in the control group and moderate TBI subgroup was significantly higher than that in the mild and severe TBI subgroups on the 2 nd and 8 th d of TBI (P<0.05). (2) The white blood cell (WBC) count of the TBI group was significantly higher than that of the control group on the 2 nd d of TBI (P<0.05); the WBC count in the moderate TBI subgroup, severe TBI subgroup, mild TBI subgroup and control group decreased, successively, on the 8 th d of TBI; the WBC count in the severe TBI subgroup, mild TBI subgroup, moderate TBI subgroup and control group decreased, successively, on the 15 th d of TBI; the WBC count in the patients of mild TBI subgroup on the 8 th and 15 th d of TBI was significantly lower than that on the 2 nd d of TBI, and that in patients of moderate and severe TBI subgroups on the 15 th d of TBI was significantly lower than that on the 2 nd and 8 th d of TBI (P<0.05). The red blood cell (RBC) count in the mild, moderate, and severe TBI subgroups, and control group were increased, successively, on the 2 nd, 8 th, and 15 th d of TBI. The platelet (PLT) count in the TBI group was significantly lower than that in the control group on the 2 nd d of TBI, and the PLT count in the mild and moderate TBI subgroups, and control group was significantly lower than that in the severe TBI subgroup on the 15 th d of TBI (P<0.05); the PLT count in the TBI group increased successively on the 2 nd, 8 th, and 15 th d of TBI. The blood glucose level in the control group, and mild, moderate and severe TBI subgroups increased, successively, on the 2 nd d of TBI, and the blood glucose in the severe TBI subgroup was statistically higher than that in the control group on the 8 th d of TBI; the blood glucose level in the TBI subgroup decreased, successively, on the 2 nd, 8 th, and 15 th d of TBI. Potassium level in the mild, moderate and severe TBI subgroups was significantly higher than that in the control group on the 15 th d of TBI; significantly higher potassium level on the 8 th and 15 th d of TBI was noted than that on the 2 nd d of TBI in patients from the moderate and severe TBI subgroups (P<0.05). The sodium content in the severe TBI subgroup was significantly higher than that in the mild and moderate TBI subgroups and control group on the 2 nd d of TBI; the sodium content in the severe TBI subgroup was statistically lower than that in the control group on the 15 th d of TBI (P<0.05). In patients from the severe TBI group, the sodium and chlorine contents on the 8 th and 15 th d of TBI were significantly lower than those on the 2 nd d of TBI. The blood calcium content in the moderate TBI subgroup and control group was significantly higher than that in the mild and severe TBI subgroups on the 2 nd d of TBI, and the calcium content in the severe TBI subgroup was significantly lower than that in the control group on the 15 th d of TBI; calcium content in the mild and severe TBI subgroups on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI ( P<0.05). (3) In TBI patients, WBC count and blood glucose level were positively correlated with COR, and negatively correlated with TSH, T3 and FT3 levels ( P<0.05). RBC count was negatively correlated with TSH level, and positively correlated with FT4 level ( P<0.05). PLT count was negatively correlated with COR and positively correlated with ACTH, TSH, T3, T4 and FT3 levels ( P<0.05). Potassium was positively correlated with TSH, T3, T4, FT3 levels, and negatively correlated with COR ( P<0.05). Sodium was negatively correlated with TSH, T4, FT3 and FT4 levels, and positively correlated with COR ( P<0.05). Chlorine was negatively correlated with COR, TSH, T4, FT3 and FT4 levels ( P<0.05). Calcium was positively correlated with T3, T4, FT3 and FT4 levels ( P<0.05). Conclusions:The more severe the injury of TBI patients, the more significant the decline of T3, FT3, and FT4 levels and RBC count, and the more significant the increase of WBC count and glucose level. Most of them gradually returns to normal within one-2 weeks of injury. It is recommended to evaluate ACTH axis and TSH axis functions when blood cell count, glucose, and electrolytes are abnormal after TBI.

OBJECTIVETo investigate the antiatherogenic effect and possible mechanisms of the extracts of Radix Salviae Miltiorrhizae (RSM) or Fructus Crataegi (FC), as well as their interaction.

METHODWistar rats were randomly divided into 2 groups: normal group and model group. The atherosclerotic model rats were injected VD3 and ovalbumin, while fed with high cholesterol diet. After the model was determined successfully, all model rats were divided into normal group, model group, Xuezhikang group, RSM group, FC group, mixture of RSM and FC group. Each group was given the corresponding drugs for 4 weeks. After 12 weeks, blood serum were analyzed for total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C), superoxide dismutase ( SOD), malondialdehyde (MDA) and nitric oxide (NO). And the blood plasma also analyzed for levels of endothelin (ET), 6-keto prostaglandin F1alpha (6-keto-PGF1alpha), thromboxane B2 (TXB2), C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-alpha) and so on. At last, the pathological observation of aorta was carried out.

RESULTCompared with those in model group, the TC, TG, LDL-C, ET, TXB2 and MDA levels and TXB2/PGF1alpha ratio were reduced, while the HDL-C, the serum SOD, No and 6-keto-PGF1alpha level were raised in the intervention groups. Although the levels of CRP, IL-6 and IL-8 were lower than model group, there was no obvious effect on the releasing of TNF-alpha.

CONCLUSIONRSM and FC could inhibit the atherogenesis formation and development, which might be due to regulating the lipid metabolism, enhancing the antioxidation, and reducing the release of inflammatory factors.

Animals ; Atherosclerosis ; prevention & control ; C-Reactive Protein ; analysis ; Crataegus ; Disease Models, Animal ; Interleukin-6 ; blood ; Lipid Peroxidation ; drug effects ; Lipids ; blood ; Male ; Plant Extracts ; therapeutic use ; Rats ; Rats, Wistar ; Salvia miltiorrhiza

OBJECTIVETo explore the influence of recombinant human growth hormones (rhGH) postburn systemic metabolism.

METHODSTwenty-four burn patients were randomly and equally divided into treatment and control groups. Same amount of rhGH (9 U/d) or isotonic saline was injected subcutaneously to respective patients during 3 approximately 17 postburn days (PBDs). Blood samples were harvested at 3, 10 and 17 PBDs for the determination of serum growth hormone, insulin-like growth factor (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), serum proteins, plasma insulin, plasma glucagons and blood glucose, which were then compared and analyzed between two the groups.

RESULTSThe serum levels of GH, IGF-1, IGFBP-3, serum prealbumin and transferrin in rhGH treatment group were evidently higher than those in control groups at 10 and 17 PBDs (P < 0.05 approximately 0.01). But there was no obvious difference in serum albumin, plasma insulin, glucagon and blood glucose (P > 0.05).

CONCLUSIONSmall dose of rhGH could promote systemic protein synthesis with no side effects on blood glucose levels.

Adolescent ; Adult ; Blood Proteins ; drug effects ; metabolism ; Burns ; blood ; Female ; Growth Hormone ; blood ; pharmacology ; Humans ; Insulin ; blood ; Insulin-Like Growth Factor I ; analysis ; drug effects ; Male ; Middle Aged ; Recombinant Proteins ; pharmacology

To investigate the role of cardiac magnetic resonance imaging (CMRI) in evaluating pulmonary hemodynamics and right ventricular function in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PAH); and the relationship between CMRI parameters and pulmonary function parameters, blood gas analysis parameters and 6-minute walk test (6MWT) parameters in patients with COPD complicated with PAH. Methods Thirty-seven patients were diagnosed with COPD in the department of respiratory and critical care discipline of Ningxia Medical University General Hospital from October 2013 to October 2016, who underwent transthoracic echocardiography (TTE) to measure pulmonary arterial systolic pressure (PASP), and were divided into COPD group and COPD+PAH group according to whether there was PAH [PASP > 40 mmHg (1 mmHg = 0.133 kPa) was defined as PAH]. All patients completed pulmonary function tests [1 second forced expiratory volume to forced vital capacity ratio (FEV1/FVC), FEV1 predicted value (FEV1pred)], blood gas analysis [arterial blood oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2)], CMRI examination [relative dilatation of the main pulmonary artery (mPAD), mean pulmonary artery pressure (mPAP), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), right ventricular end-diastolic myocardial mass (RVMED), right ventricular end-systolic myocardial mass (RVMES)], and 6MWD [6-minute walk distance (6MWD)] within 1 week. The obtained clinical parameters had been compared between the groups, and correlation was analyzed. Results Among the 37 patients with COPD, 16 patients were complicated with PAH. There were no significant differences in FEV1/FVC, FEV1pred, PaO2, PaCO2 and other baseline indicators between the two groups. In the COPD group, TTE obtained PASP of 2 patients were normal (PSAP < 40 mmHg), while CMRI measured mPAP were higher than the normal limit (> 25 mmHg). Compared with the COPD group, mPAD, RVEF and 6MWD were significantly decreased in the COPD+PAH group [mPAD: (25.64±5.01)% vs. (44.00±22.52)%, RVEF: 0.525±0.054 vs. 0.592±0.071, 6MWD (m): 319.3±116.5 vs. 408.2±38.0, all P < 0.01], mPAP, RVMED and RVMES were significantly increased [mPAP (mmHg): 28.89±3.16 vs. 20.18±2.43, RVMED (g): 57.19±15.46 vs. 40.71±15.44, RVMES (g): 45.99±11.16 vs. 33.71±13.39, all P < 0.01], and there was no significant differences in LVEF (0.663±0.082 vs. 0.699±0.075, P > 0.05). Correlation analysis showed that mPAD was positively correlated with FEV1/FVC and FEV1pred (r1 = 0.538, P1 = 0.021; r2 = 0.448, P2 = 0.049);RVMED was negatively correlated with PaO2 (r = -0.581, P = 0.015), and positively correlated with PaCO2 (r = 0.592, P = 0.014); 6MWD was positively correlated with RVEF (r = 0.485, P = 0.041), and had no correlation with LVEF (r = 0.271, P = 0.104). Conclusions Compared with COPD patients, changes in pulmonary hemodynamics and right ventricular function in COPD patients with PAH are related to the severity of airflow limitation. CMRI can early monitor pulmonary hemodynamics and right heart function changes in patients with COPD. Once PAH appears, pulmonary hemodynamics, right heart function and exercise tolerance have changed.

The access negotiations of National Reimbursement Drug List (NRDL) in China from 2017 to 2019 effectively improved the availability and affordability of high-value innovative drugs. However,the actual outpatient reimbursement of most negotiated drugs is lower,which affects the patients" health insurance funds. In this paper,97 negotiated drugs in 337 overall planning cities were selected as samples to analyze the outpatient reimbursement for negotiated drugs. The results showed that the reimbursement level of 40 negotiated drugs was less than 50% in over 70% cities,which can be mainly interpreted as absence or imperfection of outpatient reimbursement policies for special diseases. Finally,this paper puts forward suggestions and protocols for improving the outpatient medical insurance through realizing outpatient overall planning,improving outpatient reimbursement policies for special diseases,and exploring innovative payment,ensuring the achievement of the access to NRDL.