As a mode of pay for performance,hospital value-based purchasing has been become widespread the US.Medicare managed to encourage the service providers to provide medical services with more value and quality.The implementation background,financing,payment mode and performance evaluation of hospital value-based purchasing were briefly introduced.In the payment reform of China,it also needed to focus on the medical service quality,learn from the performance evaluation system,incentive mechanism and multiple measurement,reasonably design the implementation scheme.

By improving the existing pattern that different medical institutions with competition fragmentary health care mode,the bundled payment could improve the coordination and cooperation between medical institutions,improve the overall medical service quality and reduce medical service cost.It provided a helpful thought for the supply-side reform in health field in China.Foreign experience indicated that in order to implement bundled payment mode,China should build a complete medical service supply chain to promote integration of medical institutions;shift economic stimulus to economic constraints,build orderly competition environment;strengthen the construction of informatization and promote the applications of healthy big data.

Animals ; Biomarkers ; Hexanes ; poisoning ; toxicity ; Humans ; Neurotoxicity Syndromes ; etiology

ObjectiveTo evaluate the effects of thoracic and lumbar epidural block on the depth of propofol sedation.MethodsForty-five ASA Ⅰ or Ⅱ patients with stomach cancer ( n =15) or colorectal cancer ( n =30) aged 20-64 yr weighing 46-79 kg with body height 151-179 cm undergoing elective radical operation were enrolled in this study.The 30 patients with colorectal cancer were randomly divided into 2 groups ( n =15 each):group control (group Ⅰ ) and group lumbar epidural group(group Ⅱ ).The 15 patients with stomach cancer received thoracic epidural block (group Ⅲ ).Epidural block was performed at L2.3 interspace in groups Ⅰ and Ⅱ and at T9.10 interspace in group Ⅲ.After a test dose of 3 ml 1.5％ lidocaine,a bolus of 1.5％ lidocaine 12 ml (in groupsⅡ and Ⅲ ) or 12 ml of normal saline (in group Ⅰ ) was injected into epidural space.Target-controlled infusion(TCI) of propofol was started at 12 min after epidural lidocaine.Target plasma concentration of propofol was set at 4 μg/ml.Fentanyl 4 μg/kg was injected iv as soon as the patients lost consciousness.Tracheal intubation was facilitated with vecuronium 0.1 ng/kg.The patients were mechanically ventilated.Radial artery was cannulated for direct BP monitoring and blood sampling.BIS value was monitored (Aspect Medical System).The number of spinal sequent affected in the subarachnoid epidural anesthesia was counted before propofol TCI.Arterial blood sampies were collected at 2,3,4 and 5 min of propofol TCI for determination of plasma concentration of propofol ( by HPLC).BIS value and plasma concentration of propofol calculated by TCI pump were recorded at 2,3,4 and 5 min of propofol TCI.ResultsThe BIS values were significantly lower in groups Ⅱ and Ⅲ than in group Ⅰ and in group Ⅲ than in group Ⅱ.There was no significant difference in plasma propofol concentration measured by HPLC and plasma concentration of propofol calculated by TCI pump.ConclusionThe efficacy of thoracic epidural block enhancing propofol sedation is higher than that of lumbar epidural block.

Adult ; Carbodiimides ; poisoning ; Humans ; Male ; Methylamines ; poisoning ; Occupational Exposure ; Young Adult

Acupuncture Points ; Acupuncture Therapy ; Adult ; Combined Modality Therapy ; Female ; Humans ; Intervertebral Disc Displacement ; therapy ; Male ; Massage ; Middle Aged ; Young Adult

Endocrine cells have been observed from 13 cases of human fetal lungs through the using of Grimelius silver staining technique, fluorescence microscopy and ultrastructural examinations. They were found in great number in the small bronchi than in any other part of bronchial tree. Most of them were round or oval in shape, and usually rest on the basement membrane of epithelium. They were stained by Grimelius silver stain. After incubation with L-Dopa they emitted a green glyoxylic acid-induced fluorescence. Typical feature of these cells was the numerous electron dense neurosecretory-type granules, 168-312 nm in diameter, which can be seen throughout the cytoplasm.

Objective To construct luciferase reporter plasmid containing synthetic CArG elements and to investigate their radiation-inducible property in tumor cells. Methods Insert chimeric regulation elements consisting of nine tandem-repeat copies of CArG sequence (CCATATAAGG) and CMV IE basal gene promoters into pGL3-Basic vectors to construct luciferase reporter plasmids. Tumor cells(HeLa, A549 and HepG2) were transiently transfected by reporter plasmids using lipofectamine, and transfected cells were irradiated by ?-ray with different doses. After 36 h, we assayed the level of reporter gene expression. Results The CArG elements could successfully induce the expression of a downstream reporter gene following irradiation, with maximal expression seen after 3 Gy irradiation. Conclusion The synthetic CArG elements are responsive to low dose of radiation and are able to enhance down-stream gene expression. It is expected to be the essential potential for future application of radiogenetic cancer therapy.

Objective To observe effect of astragalus injection on levels of blood selenium,T cell immunity function and cytokines with viral myocarditis in children. Methods Fourty two patients with viral myocarditis in children, receiving the therapy of Astragalus injection Observing the levels of blood selenium and cytokine, including interleukin-1 (IL-1), IL-6, tumor necrosis factor-alpha (TNF-?),and including estimation of T lymphocyte subsets and cardiac function too. Results The result showed that in post-treatment, the levels of blood selenium were significantly higher (P

Objective Regenerating genes express mainly in gastrointestinal tissues and the injured regenerating pancreatic tissues,which can promote the regeneration of pancreatic β cells and other tissue cells.In recent years,researches on Reg family mainly involved the gene structure of various subtypes of Reg,and its role in diabetes,gastrointestinal cancer,inflammation,anti-microbial and the related mechanisms.Among the various subtypes of Reg,regenerating geneⅢ(Reg3) plays a particularly crucial role in these diseases.Therefore,Reg3 is a promising target for the treatment of these diseases.Based on the relationships of Reg3 with a variety of diseases,our group devote to the role of Reg3 [human REG3A,and mouse Reg3γ(Reg3g)] in type 1 diabetes,inflammation-linked pancreatic carcinogenesis,and the immunological changes participated in these processes.Hence,this review will summarize serial studies on Reg3 and the feasibility of it as drug targets.