Objective To identify the chief factors influencing health insurance patients' hospitali-zation expenses so as to provide basis for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods All the medical insurance cases involving the three disease entities in two hospitals of a certain city for the past three years, which totaled 647, were collected and a statistical analysis was made of the possible influencing factors using multi-stepwise regression analysis. Results The factors influencing the health insurance patients' hospitalization expenses included choice of hospitals, length of stay, performance of operations, proportion of drug fees, and province- wide readjustment of medical service prices. Reducing length of stay and lowering proportion of drug fees were the key to controlling expenses. Conclusion It is imperative to formulate scientific diagnostic and treatment routines and expense standards for single disease entities, speed up and deepen reform in the medical insurance system, and, on the basis of trying out payment based on certain single disease entities, implement payment based on disease entities.

Objective To examine the blood lead levels and influencing factors among infants living in urban areas in Taiyuan.Methods A total of 216 healthy infants living in urban areas in Taiyuan who came to seek routine care during 2010 and 2012 were enrolled using questionnaire survey.Blood samples were collected and lead was meas-ured according to standard procedures.Results The total blood lead level was (31.54 ±22.24)μg/L,there was no significant difference between male and female.The infants whose blood level was less than 50 μg/L took the biggest proportion(80.56%),the infants whose blood level was among 50 -99μg/L and whose blood level more than 100μg/L were 19.44% and 0.00% respectively.Coal to cook,mother often catching hair,using prickly heat,sucking on the hand,washing hands before meals,living in storefront and playing time in roadside were associated with infantile blood lead level.Conclusion The key influencing factors the of the blood lead levels of infants are infantile living environ-ment and the keeper's awareness of preventing lead.

Objective To search for the anticancer active substance from Caesalpinia sappan wood extractions. Methods Crude extracts were extracted from Caesalpinia sappan wood with different solvents.Liquid chromatography was applied to analyze the content of each essential component in the extraction fractions. Trypan blue exclusion test was performed to detect the growth suppression rate of human bladder carcinoma cell line T24 treated by the extraction fractions at different time course (20,40,60,80,100 min).The main component positively correlated with the cell suppression rate was separated out using repeated chromatography, thus the anticancer active monomer was obtained, with purity over 98 ％. The chemical constitution was determined using NMR (nuclear magnetic resonance), mass spectrum and infrared spectrum methods. T24 cell line, human ovarian cancer cell line SKOV3, mice sarcoma S180 and hepatic carcinoma H22 cell were chosen as target subjects, with mitomycin, hydroxycamptothecin as positive control drug, the inhibitory activity of the monomer was tested by trypan blue chromophobia method. Results Among the extraction fractions, R12 has a positive correlation with the cell suppression rate (r100 min=0.941, P＜0.001).Brazilin is the key component in R12.The inhibition rate of brazilin could reach 90.89 ％,98.65 ％,99.82 ％ and 100.00 ％ on T24,SKOV3,S180 and H22 respectively in 40 min at the concentration of 1.2 mg/ml,and its effect is much superior to that of the control drug mitomycin and hydroxycamptothecin. Conclusion Brazilin is one of the essential anticancer principles in Caesalpinia sappan wood.

Objective To investigate the status and influencing factors of breastfeeding among infants of 0 to 6 months in urban areas in Shanxi,to increase the rate of breastfeeding.Methods A total of urban infants aged 0 -6 months were selected and their mothers were investigated by the questionnaire on site.Results A total of 4 868 urban infants aged 0 -6 months and their mothers were investigated.The rate of breastfeeding was 64.60%,the rate of mixed feeding was 27.90%,the rate of artificial feeding was 7.40%.The infants′mother′s age,culture level, the way of delivery(natural labor,dystocia,cesarean delivery),the situation of the nipple(normal,flat,concave), nutritional status during pregnancy,mother's self awareness of the amount of breasts supply(enough,not enough)were associated with breastfeeding(χ2 =62.367,25.021,67.419,60.941,16.675,8.241,3.081,all P <0.05 or P <0.01).Conclusion The corresponding measures should be taken according to the factors affecting breastfeeding in order to improve the rate of breastfeeding.

Objective To evaluate the clinical efficacy and safety of high-dose Ambroxol in treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Retrieved from PubMed, EMbase, Cochrane Library, CNKI, VIP and WanFang databases by computer, randomized controlled trials (RCTs) about high-dose of Ambroxol in treatment of AECOPD were included. According to the inclusive and exclusive criteria, literatures and data were independently screened and extracted by two researchers, and the quality of the studies were assessed, Meta-analysis was conducted by RevMan 5.2 software. Results A total of 7 RCTs were included, involving 534 patients. Meta-analysis showed that experiment group can obviously improve the overall effective rate [OR = 4.11, 95%CI (2.31, 2.31), P < 0.000 01), shorten hospital stays(OR = 3.60, 95% CI (4.66, 2.55), P < 0.00001), compared with the control group was statistically difference, and no obvious adverse reactions. Conclusion High-dose of Ambroxol could improve AECOPD overall effective rate, shorten hospital stays, improve pulmonary function and blood gas analysis, and no serious adverse reactions, be worth clinical promote using.

OBJECTIVE:To systematically evaluate the efficacy and safety of cetuximab in the adjuvant chemotherapy treat-ment of advanced non-small cell lung cancer(NSCLC),and to provide evidence-based reference for clinical treatment. METH-ODS:Retrieved from Cochrane Library,PubMed,CJFD and Wanfang database,randomized controlled trials (RCT) about cetux-imab adjuvant chemotherapy (test group) versus single chemotherapy (control group) in the treatment of advanced NSCLC were collected,and Meta-analysis was performed by using Rev Man 5.2 statistical software after extracting data and evaluating quality. RESULTS:A total of 8 RCT were included,involving 2 367 patients. Results of Meta-analysis showed survival rate in 1 year [OR=1.33,95%CI(1.08,1.64),P=0.006],partial remission rate [OR=1.48,95%CI(1.23,1.78),P<0.001],total effective rate [OR=1.34,95%CI(1.19,1.51),P<0.001],incidence of leucopenia [OR=1.50,95%CI(1.23,1.83),P<0.001],incidence of rash [OR=53.26,95%CI(13.09,216.65),P<0.001] and incidence of infusion reactions [OR=3.72,95%CI(1.86,7.42),P<0.001] in test group were significantly higher than those of control group,there were significant differences in 2 groups. However,there were no significant differences in the complete remission rate [OR=1.57,95%CI(0.91,2.70),P=0.11] and incidences of other ADR(P>0.05). CONCLUSIONS:Cetuximab has good efficacy in the adjuvant chemotherapy treatment of advanced NSCLC,however,the incidence of ADR should be prevented in clinic. Duo to the methodology limit of included studies,large-scale and high quality RCT are required for further validation of the conclusions.

Objective To establish the nursing care for the patients with pulse steroid therapy, and to investigate its effect. Methods 78 patients who accepted pulse steroid therapy in the past 4 years were analyzed retrospectively, in which, 42 within past 2 years （2008 and 2007) were as pulse steroid nursing care group, and other 36 patients before 2 years (2007 and 2006) were as routine nursing care group. Results 3 weeks after the pulse steroid therapy, in pulse steroid nursing care group, proximal muscle weakness were found in 8 patents, insomnia in 18 patients; while in routine nursing care groups, proximal muscle weakness were found in 16 patents, and insomnia in 25 patients（P<0.05）. Conclusion Pulse steroid nursing care can reduce the incidence of muscle weakness and insomnia after pulse steroid therapy significantly.

Objective To observe the effect of muscone on the blood-brain barrier and neuropathological changes after complete cerebral ischemia/reperfusion of rats.Methods The global cerebral ischemia/reperfusion injury model was established by the four-vessel occlusion(4VO) method,and then the model animals were given high-,middle-and low-dose muscone.Meanwhile,sham-operation group,model group,and positive control group were also set up.The rats neuroethology behavior,and the contents of superoxide dismutase(SOD),malondialdehyde(MDA) and excitatory amino acid(EAA) in ischemic brain tissue were examined.Results Muscone increased SOD content,lowered MDA content,reduced the increase of EAA content caused by ischemia and hypoxia,and inhibited the excitatory neurotoxicity caused by EAA.Conclusion Muscone has obvious protective effect on rats with complete cerebral ischemia/reperfusion injury.

Objective To investigate the changes of urinary brush border membrane enzymes and serum cystatin C (Cys C) in newborns in order to develop early diagnostic indicators for sclerema neonatorum (SN) renal dysfunction.Methods Sixty-night cases with sclerema neonatorum and 30 cases of normal newborns were enrolled in this study.Of all sclerema neonatorum cases,39 cases were mild and 30 cases were moderate to severe sclerema neonatorum.Immunoca talytic assay method was adapted to detect the level of urinary brush border membrane.The levels of serum Cys C,blood urea nitrogen (BUN),creatinine (Cr) and urinary β32 microglobulin (β2-MG) in two groups were also measured.Results The levels of urinary brush border membrane enzyme,β2-MG and serum Cys C in sclerema neonatorum group were (40.09 ± 7.29) U/L,(4.65 ± 1.33) mg/L and (1.84 ± 0.32) mg/L,higher than those in control group ((23.19 ± 5.62) U/L,(2.49 ± 0.77) mg/L and (1.07 ± 0.25) mg/L; t =10.34,7.47 and 10.55,P ＜ 0.01).The levels of urinary brush border membrane enzyme and serum Cys C in moderate to severe sclerema neonatorum group were (42.06 ± 7.59) U/L and (1.93 ± 0.34) mg/L,higher than those in the mild group ((38.57 ± 6.70) U/L,(1.77 s0.29) mg/L;t =2.24,2.11,P ＜0.05).The abnormality rates of urinary brush border membrane enzyme and serum Cys C in sclerema neonatorum group were 79.7％ (55/69) and 72.5％ (50/69),higher than β2-MG abnormal rate (52.2％ (36/69),x2 =12.95,12.11,P ＜ 0.01).In sclerema neonatorum group,urinary brush border membrane enzyme was positively correlated with β2-MG (r =0.560,P ＜ 0.01),and serum Cys C was positively correlated with BUN,Cr (r =0.314,0.287,P ＜ 0.05).Conclusion Renal injury is common in SN.Urinary brush border membrane enzyme and serum Cys C are served as the diagnostic parameters for early detection of renal injury in SN.

Objective: To investigate the expression of recombinant human intedeukin-18 (hIL-18) in 3.7 L fermenter with the constructed engineer train Pichia pastoris X-33/hIL-18, and the procedures of expression and purification thereof.Methods: The train X-33/hIL-18 was inoculated in BMGY medium and then inoculated into the fermenter until the A600 of the culture reached about 6. The supernatant of fermentation was isolated and purified with centrifugal fiher devices, hydrophobic chromatography column and anion exchange chromatography column. Results: The recombinant hIL-18 was expressed in 3.7 L fermenter with batch feed methanol and the concentration reached 202 mg/L. After the purification, the purity could be more than 97%. The recombinant hIL-18 was shown to induce interferon-gamma (IFN-γ) production by human peripheral blood mononuclear cells (PBMCs), and enhanced NK cell cytotoxicity synergistically with IL-2. Conclusion: A great deal of the recombinant hIL-18 with higher purity could be harvested by Pichiapastoris expression system. This study showed a new potential for further study of its function and activities.