Objective:To discuss the constraint mechanism of moral hazard from the supply side in the medical market of China.Methods:It analyzed the effectiveness of government regulation and of the influencing factors of the doctors and patients expected profits through the establishment 4 stage dynamic game model involved the doctors,patients and the government as the subject.Results:In the case of other conditions unchanged,the effective probability of government regulation would increase with the increase of profits made by excessive medical treatment,but would decrease with the increase of doctor's punishment cost and the increase of doctor's reputation value.Given the reasonable probability about medical treatment,the doctor's expected profits would increase with the increase of the value of a reasonable medical gain and doctor's reputation increase.The prospective profits of patients would increase as the doctor's profits increased,but decrease with the over-increased medical treatment.Conclusion:The effective restraint mechanism of moral hazard from the supply side of public hospitals in China included relax the price control,improve the market value of medical services,form effective doctor reputation incentive mechanism,reduce government supervision costs and improve government regulation on the basis of promoting incentive compatibility.

OBJECTIVE:To study the preventive and therapeutic effects of Xinmaitong tablets on model rats with atherosclero-sis (AS) and corresponding mechanism. METHODS:48 rats were randomized into normal group,model group,positive group (simvastatin tablets,2 mg/kg)and the groups of high,medium and low-dose(500,250,125 mg/kg)Xingmaitong tablets,with 8 rats in each group. The rats in all groups except for the normal group were fed high fat diets and given vitamin D3 ip for the estab-lishment of AS model. Meanwhile,the rats in the drug administration groups were given corresponding drugs ig,while those in the normal group and the model group were given normal saline ig,once a day,for 10 consecutive weeks. The levels of cholesterol (TC),triacylglycerol(TG),nitric oxide(NO)and endothelin 1(ET-1)in serum were determined. The pathological change of the aorta tissue was observed under the light microscope,and the size of the aortic atherosclerotic plaque and intima thickness were measured. RESULTS:Compared to the normal group,the rats in the model group had significantly higher levels of TC,TG and ET-1 in serum,a markedly larger aortic atherosclerotic plaque,remarkably thicker intima and much lower level of NO(P<0.01);and obvious aortic atherosclerotic plaque formation was found. Compared to the model group,the above-mentioned indexes of the rats in all drug groups all improved obviously (P<0.05 or P<0.01),except that the decrease in TC in serum of the rats in the group of low-dose Xinmaitong tablets was not significant,which were positively correlated with dose;and the aortic lesion in drug groups was found to be improved. CONCLUSIONS:Xinmaitong tablets have certain preventive and therapeutic effect on the model rats with AS by a mechanism which may be related to the reduction in lipid deposition and the size of an atherosclerotic plaque,the improvement in NO/ET balance and the alleviation of an endothelial injury.

Objective To investigate the enhanced osteogenesis during bone fracture healing after intracerebroven-tricular (ICV) leptin injection, using rabbit model with created segmental bone defect in right tibial. Method Segmental critical-sized defects were created at the right tibial bone of skeletally mature New Zealand white rabbits. In experiment group (leptin group), recombinant rabbit leptin was injected into cerebellomedullary cistern through foramen magnum. While in control group, normal saline was injected in the same way. Bone Mineral Density (BMD) was evaluated by qCT at 1st, 3rd, 7th, 14th and the 21st days. At the 21st days, all rabbits were euthanized to collect the right tibia for histomorphology, to ex-amine the BMP-2 expression in the bone callus by Fluorescence in situ hybridization (FISH). Result In the leptin group, body weight declined more obviously than control group then it start to arise at the 14th day;qCT showed significant higher BMD in leptin group than in control group at the 7th day;FISH showed a higher BMP-2 expression in leptin group than in control group. Conclusion Cerebellomedullary leptin injection through foramen magnum could accelerate limb fracture healing in rabbit model with right tibial bone defection.

OBJECTIVE:To investigate the situation of pharmacoeconomic researches about lipid-lowering drugs in China, and to seek the regimen with good cost-effectiveness in order to provide reference for rational drug use in the clinic. METHODS:Retrieved from CNKI and Wanfang database,pharmacoeconomic literatures about lipid-lowering drugs,published in domestic jour-nals during 2011-2015,were included to discuss the problems of pharmacoeconomic researches about lipid-lowering drugs and put forward related suggestions. RESULTS:Rosuvastatin and other medicines showed good cost-effectiveness,while there were many problems of domestic published pharmacoeconomic researches about lipid-lowering drugs,such as different research methods,dif-ferent treatment courses,different methods of cost calculation,single effect index and absence of ADR. On the whole,the research-es were low in quality,which led the difficulty of accurately obtaining the drugs with best cost-effectiveness. CONCLUSIONS:In the future,related researches should confirm research duration and health output index,effect index and evaluation method accord-ing to disease types and research objectives;enhance the unity of research and design methods;pay attention to cost discount;in addition,strengthen pharmacoeconomic researches about lipid-lowering TCM and compare it with chemical drugs.

Aim To investigate the changes of intracellular calcium in primary cultured neurons after fluid percussion injury under the effects of cerebrolysin.Methods The neurons of rats were divided into: normal group,FPI group and cerebrolysin group(0 h and 1 h treatment after fluid percussion injury(FPI)).The intracellular calcium([Ca2+]i) at rats neurons in 24 h and 48 h postinjury were measured by using the laser scanning confocal microscope under calcium fluorescent indicator Fluo-3/AM.Results The [Ca2+]i at rats neurons were markedly increased after 24 h postinjury compared with normal neurons and maintained the higher level after 48 h.Cerebrolysin,whenever added at 0h or 1h after FBI,could significantly decrease the rise of [Ca2+]i on 24 h postinjury,which only happened in 48 h postinjury by 1 h treatment after FPI.Conclusion Cerebrolysin has the protective effects on primary cultured rat cortical neurons of rats and has the time-window treatment.

Objective To evaluate the diagnostic value of two tuberculosis-specific IFN-γ release assays in latent tuberculosis infection among HIV-infected individuals. Methods The levels of tuberculosis antigen-specific IFN-γin 102 HIV patients from AIDS Outpatient Clinic of Shenzhen Third People's Hospital were detected by in-house tuberculosis-specific IFN-γ ELISpot assay and commercial T-SPOT TB kit, and tuberculin skin test (TST) were done at the same time. There were 66 males and 36 females,and the average age was 35. Results Seventeen HIV infected patients were positive in both IFN-γ ELISpot and T-SPOT TB methods, the sensitivity, specificity positive predictive value(PPV), negative predictive value(NPV) and compliance rates of ELISpot were 94. 4% ,94. 0% ,77. 3% ,98. 8% and 94. 1% ,respectively. Three patients were positive in both IFN-γELISpot and T-SPOT TB methods, the sensitivity, specificity, PPV, NPV and compliance rates of TST were 16. 7%, 98. 8%, 75.0%, 84. 7% and 84. 3%, respectively. The average number of spots using three kinds of antigen ESAT-6, Pool A,Pool B obtained were 26. 89 ±5. 77,18. 96 ±4. 75 and 14. 51 ± 3.77, respectively. Only ESAT-6 and Pool B have a statistically significant difference (H=7.557,P = 0.022 9), no significant difference was shown between other groups. There was no significant difference between the positive rate and the CD4+ T cellls number(x2 =0. 860 8 ,P =0. 650 2) ,as the same as the T-SPOT TB (x2 = 1. 396 4, P = 0. 497 5 ). Conclusions The performance of this in-house tuberculosis-specific IFN-γ ELISPot assay was comparable to T-SPOT assay in diagnosis of latent tuberculosis infection, and the sensitivity and specificity of both these two assays were all much higher than TST. They canbe recommended in diagnosing latent tuberculosis infection in HIV infected patients.

Objective To compare of clinical and pathological features between gastric polyps and colorectal polyps.Methods The clinical characteristics and pathological features of 2 125 patients with gastric polyps and 4 924 patients with colorectal polyps admitted in Wenzhou People's Hospital from 2004 to 2013 were compared.The detection rates,the indication of endoscopy,distribution,number,size and pathological type of gastric polyps and colorectal polyps were analyzed.Results The detection rate of gastric polyps was 3.1％ (2 125/69 575) and that of colorectal polyps was 24.5％ (4 924/20 124) (χ2 =9 886.401,P ＜0.01).The detection rates of gastric polyps in age groups ＜ 20,20-39,40-59 and ≥60 were 1.8％ (23/1 302),1.8％ (399/22 600),3.4％ (1 137/33 087) and 4.5％ (566/12 586),respectively (χ2 =238.867,P ＜ 0.01);and those for colorectal polyps were 6.6％ (14/211),11.6％ (623/5 385),26.0％ (2 622/10 070) and 37.3％ (1 665/4 458),respectively (χ2 =934.724,P ＜ 0.01).The detection rates of gastric polyps in age groups 20-39,40-59 and ≥60 were lower than those in colorectal polyps(all P ＜ 0.01).The detection rate of gastric polyps in males was lower than that in females(2.3％,848/36 447 vs.3.9％,1 277/33 128,χ2 =273.807,P ＜0.01),while the detection rate of colorectal polyps in males was higher than that in females (28.8％,3 239/11 230 vs.18.9％,1 685/8 894,χ2 =262.518,P ＜ 0.01).Diarrhea and gastrointestinal bleeding in patients with colorectal polyps was more common than those in patients with gastric polyps (23.5％,1 156/4 924 vs.2.5％,54/2 125,χ2 =558.080,P＜0.01;12.1％,597/4 924 vs.2.4％,51/2 125,χ2 =168.150,P ＜0.01).Single polyps were more common in gastric polyps than colorectal polyps(80.7％,1 714/2 125 vs.67.6％,3 331/ 4 924,χ2 =186.337,P ＜0.01).Polyps with size ≥ 1.0 cm were more common in colorectal polyps than those in gastric polyps (24.3％,1 197/4 924 vs.13.6％,289/2 125,χ2 =102.333,P ＜ 0.01).The proportion of inflammatory and hyperplastic types in gastric polyps was higher than that in colorectal polyps (67.1％,1 378/2 125 vs.27.5％,1 273/4 924,χ2 =934.394,P ＜0.01;26.9％,552/2 125 vs.9.9％,459/4 924,χ2 =319.588,P ＜0.01);while the proportion of adenoma and canceration in gastric polyps was lower than that in colorectal polyps (1.7％,34/2 125 vs.62.4％,2 893/4 924,χ2 =2 135.743,P ＜0.01;0.4％,9/2 125 vs.4.8％,221/4924,χ2 =80.362,P＜0.01).Conclusions In comparison with gastric polyps,the detection rate of colorectal polyps is higher.The detection rate of gastric polyps is higher in females,w hile that of colorectal polyps is higher in males.The detection rates of gastric polyps andcolorectal polyps increase with the age.The main pathological type of gastric polyps is inflammatory,while that of colorectal polyps is adenoma.The canceration of colorectal polyps is more common than that of gastric polyps.

Objective To investigate the effect of mild hypothermia on neuroprotection and prognosis prediction of rats with traumatic brain injury (TBI) by dynamically monitoring the somatosensory evoked potentials (SEP) and quantitative electroencephalogram (QEEG).Methods Forty healthy adult male SD rats were randomly divided into four groups according to random number table,ie,normal control group (with no intervention),sham operation group (fenestration only,without drilling),TBI group (fluid percussion was used to produce moderate to severe TBI),and mild hypothemia group (ice blanket was used immediately after TBI for continuous physical cooling and rectal temperature was maintained at 32-35℃ and rewarmed to 37℃ 6 hours after the initiation of cooling),with 10 rats per group.Changes of SEP and QEEG in all groups were monitored at 6,24 hours,and 7 days after TBI.Results (1) Compared with TBI group,the latency of SEP waves (P1 and N1) on the injured side in mild hypothemia group began to shorten at 24 hours(P ＜ 0.05) and were close to that in the sham operation group at 7 days.(2) Except for normal control group and sham operation group,QEEG in TBI group showed decrease of α rhythm,increase of reactivity slow waves,and decrease or disappearance of QEEG relative power spectral values at all time points.In mild hypothermia group,the reactivity slow waves were decreased with a small amount of α wave; QEEG relative power spectral values were increased at 24 hours and 7 days (especially at 24 hours),but werc still lower than those in normal control group (P ＜ 0.05).Conclusion Mild hypothermia exerts neuroprotective effect through reducing SEP latency,raising relative power spectral values of QEEG,and improving the nerve conduction and brain electrical activity of the injured side.

Objective To investigate effect of taurine on respiration chain enzyme activity of mitochondria 24 hours after severe traumatic brain injury (TBI) in rats.Methods Fifty-six SD rats were divided into sham group,TBI group,taurine treatment group,and taurine prevention group according to the random number table,with 14 rats per group.Fluid percussion brain injury models were used.Via the caudal vein,normal saline was administered to animals in sham and traumatic brain injury groups immediately after injury,while taurine (200 mg/kg)was administered to animals in taurine treatment group after injury and in taurine prevention group 4 days before injury.Brains were harvested 24 hours postinjury for assays of HE staining and electron microscopy.Mitochondrial respiratory chain complex Ⅰ-Ⅴ activities were detected.Results TBI group presented swelling neurocytes,cell loss,karyopyknosis,shortened even vanished process,and inflammation cell infiltration at the edge of necrosis in HE staining.By contrast,morphological improvement was significant in taurine treatment group but only some neurons were intact in taurine prevention group.Swelling mitochondria and broken or vanished mitochondrial crests were seen in TBI group under the electron microscope.However,normal or minor swelling mitochondria was seen in taurine treatment group and cytoplasm slightly porous and absence of mitochondrial crests were seen in taurine prevention group.Activities of complex Ⅰ,Ⅱ and Ⅴ were significant lower in TBI group (32.52±2.41,4.68 ±0.15,2.49 ±0.73) compared to those in sham group (34.03 ±0.46,5.04 ±0.29,3.20±0.68) and in taurine treatment group (33.95±0.85,5.12-±0.23,3.53 ±0.48) (P＜0.05).And complex Ⅰ in taurine prevention group was significantly enhanced as well (34.44 ± 0.36,P ＜ 0.05).Conclusion Taurine may protect the brain tissues and mitochondrial structure from impairment in TBI rats by improving mitochondrial enzymes activity and reducing secondary energy loss.

Objective:To understand the employment psychology of college students in traditional Chinese medicine universities through analyzing relevant influencing factors, and to provide solutions to improve employment quality of the medical students.Methods:An online questionnaire survey on employment psychology and employment situation was conducted from August to September in 2017 among 384 students who had graduated from Longhua Hospital of Shanghai University of Traditional Chinese Medicine from 2013 to 2017. SPSS 19.0 was used for chi-square test and linear trend test on the survey results.Results:A total of 374 valid questionnaires were recovered, with the effective recovery rate of 97.4%. The results showed that the most important factors to be considered were professional counterparts (77.01%, 288 students), salary (75.67%, 283 students) and development prospect (69.52%, 260 students) and the most important psychological characteristics were hesitation and contradiction (50.8%, 190 students) and anxiety (25.13%, 94 students). The study found that employment psychology was related to students' family situation, category, temperament and performance during their education period.Conclusion:Students have different employment psychology, which can be improved by consummating career planning, broadening employment channels, combing employment policies, supplementing professional shortcomings, and improving comprehensive skills. Meanwhile, colleges and universities can expand their practice bases, provide employment counseling, and improve education resources, speed up the construction of the second classroom, pay attention to special groups to conduct employment guidance and improve the quality of employment.