OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are hierarchical medical system and two-way referral system;for-profit hospitals and non-profit hospitals are mutually complementary;different natures of health insur-ance system,different payment methods and strict“commercial bribe”monitoring system are carried out;doctors,hospitals and health insurance restrict each other. Not only there are many advantages in theory,but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a cer-tain extent. Combined with our national conditions,learning from the United States experience,restrictive relationship among doc-tors,hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing infor-mation asymmetry and standardizing payment audit;establishing a scientific pattern of mixed payment;strengthening the indirect impact of the health insurance institutions on doctors and hospitals,etc.

Objective To study the relationship between rs290487,rs7903146 of transcription factor 7-Like 2 (TCF7L2) gene and post-transplantation diabetes mellitus in Han Zhejiang population.Method We genotyped two single nucleotide polymorphisms (SNPs) across the TCF7L2 gene in 90 unrelated post-transplantation type 2 diabetes mellitus (PTDM) patients,112 unrelated non-PTDM patients,and a set of post-transplantation diabetes mellitus patients (n =68).Genotyping was performed using direct sequencing SNP Genotyping Assays.The association of SNPs with post-transplantation diabetes mellitus was analyzed.Result In this study,there was statistically significant difference in the T-allele of TCF7L2.rs7903146 between PTDM group (5.1％) and non-PTDM group (1.3％) (P＜0.05).For rs7903146,the frequencies of genotype C/C,C/T (70.0％) and T/T (35.8％) was statistically significant in PTDM group (P＜0.05).For rs290487,the frequencies of genotype C/C,C/T and T/T was 14.7％,38.2％ and 47.1％ respectively in PTDM group,P＞ 0.05.The incidence of PTDM was significantly higher in patients with the CT genotype (odds ratio 18.54 [95％ CI 1.21-282.26],P =0.03).Conclusion With the current sample size,we found that the CT genotype of rs7903146 was significantly associated with post-transplantation diabetes mellitus.

Objective: To explore regulating effect of protosappanin A (PrA) on dendritic cell (DC) maturation.Methods: SPF male Wistar rats and SD rats were selected as subjects.During DC maturation induced by lipopolysaccharide (LPS), methyl thiazolyl tetrazolium (MTT) method was used to screen proper concentrations of PrA.Different concentrations of PrA were used to pretreat LPS-induced DC, difference of DC surface molecule CD80 and CD86 expressions were analyzed;DC's ability in activating T cell proliferation, expression levels of CD4, CD25 and Foxp3 on surface of regulatory T cells (Treg), and levels of interleukin (IL)-10 and IL-12 secreted by DC in supernatant were measured.Results: Compared with immature DC (imDC) group, there were significant rise in expressions of DC surface molecule CD80[(31.50±29.04)% vs.(63.80±14.03)%] and CD86[(36.10±27.21)% vs.(62.60±12.37)%] in LPS-DC group, P<0.01 both;compared with LPS-DC group, there were significant reductions in expressions of CD80[(63.80±14.03)% vs.(39.70±26.60)] and CD86[(62.60±12.37)% vs.((37.90±26.93)] in 20-DC group (DC cultured with 20nmol/L PrA), P<0.05 both.Compared with LPS-DC group, there were significant reductions in DC-activated T cell proliferation capacity [(0.39±0.06) vs.(0.32±0.46) vs.(0.28±0.08)] and IL-12 level [(250.00±89.81) pg/ml vs.(176.80±49.89) pg/ml vs.(134.30±60.64) pg/ml], and significant rise in expression of Treg [(0.42±0.23) vs.(0.76±0.20) vs.(0.93±0.52)] and IL-10 level [(145.80±70.28) pg/ml vs.(274.00±131.93) pg/ml vs.(354.00±146.22) pg/ml] in 5-DC group and 20-DC group (P<0.05 all for 5-DC group, P<0.01 all for 20-DC group).Conclusion: PrA can inhibit LPS-induced DC maturation, including reducing expressions of surface molecule CD80 and CD86, suppressing the capacity to activate allogeneic T lymphocyte proliferation, inducing Treg proliferation and affecting levels of relative cytokines.

Objective To obtain differentiated osteoblast-specific inactivation of fgfr1 mice Methods To obtain fgfr1△/+/OC-CreTG/+ mice,fgfr1flox/flox mice obtained from NIH were crossed with OC-Cre mice To obtain fgfr1△/△/OC-CreTG/+ mutant mice,fgfr1△/+/OC-CreTG/+ further crossed with themselves or fgfr1flox/flox mice After fgfr1△/△/OC-CreTG/+ crossed with fgfr1flox/flox mice,half of their offspring were mutant mice Results Differentiated osteoblast-specific fgfr1 knockout mice were obtained Conclusion fgfr1△/△/OC-CreTG/+ mice were obtained through proper crossing strategy,which provides a suitable platform for studying fgfr1 function in bone development and fracture healing

Objective Our purpose was to investigate the pathogenic gene mutation of a Han Chinese family with vitreous amyloidosis.Methods The 9 individuals(proband,1 affected member and 7 unaffected members) of the family were selected and their DNA was extracted from peripheral blood.The 4 exons of transthyretin(TTR) gene were amplified by polymerase chain reaction(PCR) technique.The amplified products of TTR gene were sequencing by Sanger technique.We also selected 100 unrelated healthy individual as the control group.Results By DNA sequencing,a heterozygous mutation was found in 4 of the 9 subjects from the family.The transition of adenine to cytosine(AAG ＞ ACG) was detectable in exon 2 of TTR,which changed the amino acid composition at codon 35 (Lys35Thr).This mutation did not presented in control group.Conclusion The heterozygosis mutation of TTR gene Lys35Thr should be a pathogenic mutation for the family with vitreous amyloidosis.

Objective: To explore effect of AMP-activated protein kinase (AMPK) /mammalian target of rapamycin (mTOR) /ribosomal protein S6 kinase-1 (S6K1) signaling pathways and the insulin-sensitizing effect by adiponectin in endometrial cancer HEC-1B cells. Methods: The experiments were divided into 4 groups, adiponectin (Ad) group (HEC-1B cells treated with 20 μg/ml adiponectin for 30 minutes) , inhibitor group (HEC-1B cells treated with 10 μmol/L compound C for 30 minutes) , inhibitor+ Ad group (HEC-1B cells treated with 10 μmol/L compound C for 30 minutes following incubation with 20 μg/ml adiponectin for 30 minutes) , control group (only added the culture medium without serum DMEM) . (1) Real-time quantitative PCR and western blot analysis were used to detect the level of mRNA and protein of adiponectin receptor (AdipoR) 1 and AdipoR2. (2) Western blot analysis were used to detect phosphorylation of AMPK, mTOR, S6K1 or insulin receptor substrate 1 (IRS1) protein expression with stimulation in different concentrations of adiponectin (2.5, 5, 10, and 20 μg/ml) , or following incubation with insulin 50 nmol/L for 5 minutes; or treated with 20 μg/ml adiponectin for different times (15, 30, 45, and 60 minutes) , or following incubation with insulin 50 nmol/L for 5 minutes. (3) Cell counting kit-8 (CCK-8) assay was performed to investigate the cell proliferation, and transwell chamber assay was used to detect the cell migration in different groups. Results: (1) The relative expression level of AdipoR1 mRNA and protein were higher than AdipoR2 in HEC-1B cell (8.50±0.09 to 1.00±0.00, and 0.91±0.03 to 0.69±0.03; P<0.05) . (2) The phosphorylation level of p-AMPK was significantly induced, and the phosphorylation level of p-mTOR and p-S6K1 proteins, and 20 μg/ml adiponectin at 30 minutes, AMPK protein had the highest level of activation. (3) Adiponectin induces increased tyrosine phosphorylation of IRS1 in a time-and concentration-dependent manner. (4) The proliferation inhibition ratio in Ad group (0.68±0.34) % was much more than that in inhibitor+Ad group (0.24±0.04) % (t=17.88, P<0.05) . The number of cell migration in Ad group (77±8) was much more than that in inhibitor+Ad group (132±13; t=-7.34, P<0.05) . Conclusions Adiponectin maybe inhibit proliferation and migration of endometrial cancer cells through AMPK/mTOR/S6K1 signal pathway. Adiponectin insensitizes insulin signaling may by regulating by the AMPK/S6K1/IRS1 pathway.

A lot of evidence have proved that low level of cardiopulmonary fitness (i.e.functional capacity ) is related to high risk of cardiovascular diseases (CVD) ,high all‐cause mortality and high mortality of cancer .Cardiopulmonary fitness low level combined traditional risk factors can improve risk prediction for CVD .The present article aimed at reviewing cur‐rent knowledge about correlation among CVD ,other diseases and cardiopulmonary fitness ,improving people＇s consciousness for impact of cardiopulmonary fitness on risk prediction in order to optimize prevention and treatment of diseases .

Objective:To systematically review the resilience intervention in patients with cancer, so as to evaluate its effectiveness. Methods: Studies published until March 2017 were searched in CNKI, VIP, WanFang Data, CBM, PubMed, Cochrane library, Wiley Online Library, Elsevier ScienceDirect, Springer Link and EBSCO. The randomized controlled trials(RCTs) about resilience intervention in patients with cancer were included. Two reviewers independently performed screening, quality assessment and data extraction Qualitative synthesis was adopted to review the resilience intervention and to evaluate its effectiveness of included studies. Results: Totally 14 studies were included for the analysis. Eight studies evaluated the effectiveness of individuation intervention, and 6 studies evaluated the effectiveness of group intervention. Thirteen studies suggested that individuation intervention and group intervention might significantly improve the resilience in cancer patients. Conclusion: The results suggest individuation or group intervention may improve the resilience in patients with cancer. Current studies on resilience intervention are limited, and the measure has been taken seems lacks of high-quality research design.

Objective To explore the chain mediating effect of mastery and self-efficacy between optimism and resilience of breast cancer patients.Methods Totally 262 breast cancer patients were investigated with general information questionnaire,resilience scale (RS-14),mastery scale for Chinese version (MSC),general self-efficacy scale (GSES) and revised life orientation test (LOT-R).Causual steps and Bootstrap method were used to test the chain mediating effect of mastery and self-efficacy between optimism and resilience.Results The media score of the participants was 18 for optimism,and the average score of the participants was 27.1±4.6 for mastery,26.0±5.9 for self-efficacy,76.6± 13.9 for resilience.There existed a significant difference in RS-14 scores among the patients with different family relationships,family income,and form of payment (all P＜0.05).Correlation analysis showed that optimism,mastery,self-efficacy,and resilience were positively correlated with each other(r=0.57-0.74,all P＜ 0.01).Mediation modeling analysis showed that optimism had a direct effect on resilience.The effect value was 0.361,and the effect was 49.7％.Mastery and self-efficacy mediation effect value were 0.123 and 0.162,and the mediation effect were 16.9％ and 22.3％.While chain mediating effect of mastery-self-effcacy was also significant,and the mediation effect value was 0.081 and the mediation effect was 11.1％.Conclusion Optimism influences breast cancer patients' resilience,not only through the direct path,but also through the indirect path of mastery and self-efficacy,as well as the chain mediating path between these two variables.

Objective: To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period. Methods: Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample ttest and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis. Results: (1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 (F=7.428, P<0.01). The PCCI values of patients at PIH 4, 8, 12, 16, 20, and 24 were (2.4±0.9), (2.6±1.2), (2.2±0.6), (2.6±0.7), (2.8±0.6), and (2.7±0.7) L·min^-1·m^-2, respectively, and they were significantly lower than the normal value 4 L·min^-1·m^-2(t=-3.143, -3.251, -11.511, -8.889, -6.735, -6.976, P<0.05 or P<0.01). At PIH 76, 80, 84, 88, 92, and 96, the PCCI values of patients were (4.9±1.5), (5.7±2.0), (5.9±1.7), (5.5±1.3), (5.3±1.1), and (4.9±1.4) L·min^-1·m^-2, respectively, and they were significantly higher than the normal value (t=2.277, 3.142, 4.050, 4.111, 4.128, 2.423, P<0.05 or P<0.01). The PCCI values of patients at other time points were close to normal value (P>0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 (F=7.863, P<0.01). The SVRI values of patients at PIH 12, 16, 20, 24, and 28 were (2 298±747), (2 581±498), (2 705±780), (2 773±669), and (3 109±1 215) dyn·s·cm^-5·m^2, respectively, and they were significantly higher than the normal value 2 050 dyn·s·cm^-5·m²(t=0.878, 3.370, 2.519, 3.747, 3.144, P<0.05 or P<0.01). At PIH 4, 8, 72, 76, 80, 84, 88, 92, and 96, the SVRI values of patients were (1 632±129), (2 012±896), (1 381±503), (1 180±378), (1 259±400), (1 376±483), (1 329±385), (1 410±370), and (1 346±346) dyn·s·cm^-5·m^2, respectively, and they were significantly lower than the normal value (t=-4.593, -0.112, -5.157, -8.905, -7.914, -5.226, -6.756, -6.233, -7.038, P<0.01). The SVRI values of patients at other time points were close to normal value (P>0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 (F=0.704, P>0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value (t=-3.112, -3.554, -2.969, -2.450, -2.476, P<0.05). The GEDVI values of patients at other time points were close to normal value (P>0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 (F=1.859, P<0.01). The EVLWI values of patients at PIH 16, 20, 24, 28, 32, 36, and 40 were significantly higher than normal value (t=4.386, 3.335, 6.363, 4.391, 7.513, 5.392, 5.642, P<0.01). The EVLWI values of patients at other time points were close to normal value (P>0.05). (5) The fluid infusion coefficients of patients at the first and second 24 hours post injury were 1.90 and 1.39, respectively. The blood lactic acid values of patients from PID 1 to 7 were 7.99, 5.21, 4.57, 4.26, 2.54, 3.13, and 3.20 mmol/L, respectively, showing a declined tendency. (6) There was obvious negative correlation between PCCI and SVRI (r=-0.528, P<0.01). There was obvious positive correlation between GEDVI and PCCI (r=0.577, P<0.01). There was no obvious correlation between GEDVI and SVRI (r=0.081, P>0.05). There was obvious positive correlation between blood lactic acid and SVRI (r=0.878, P<0.01). (7) All patients were cured except the one who abandoned treatment. Conclusions PiCCO monitoring technology can monitor the changes of early hemodynamic indexes and volume of burn patients dynamically, continuously, and conveniently, and provide valuable reference for early-stage comprehensive treatment like anti-shock of patients with large area burns.