Objective:To study direct medical cost of hypertensive patients without complicated disea-ses,to analyze substitution impacts of outpatient expenditure on inpatient expenditure,and then to make recommendations to health policy makers and hypertensive patients for managing hypertension.Methods:The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 201 3 were analyzed,descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases,hyper-tension with complicated diseases,and other diseases),and the differences between groups compared by t test.The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services,and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis.Results:For the hypertensive pa-tients,the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 201 3.After being divided into three groups,for hypertensive patients without complicated diseases,the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 201 3.In the total cost of the outpa-tient,45.73% was for the hypertensive patients without complicated diseases;in the total cost of the in-patient,only 9.29% was for the hypertensive patients without complicated diseases.By calculating the marginal effect of parameter estimation through the fixed effect two-part model,the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reim-bursement.For example,in 201 3,a 1 % rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan,which could reduce inpatient expenditures by 39.86 million Yuan.The substitu-ted ratio of outpatient cost on inpatient cost had been around 5 in 201 0 and later.Conclusion:The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost,especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.

Authors described characteristics of medical service performance evaluation,and strategy options for scientifically evaluating such performance,and systematically presented the conditions and methodology of DRGs-based evaluation of medical service performance.Six evaluation indicators were cited in terms of the capacity,efficiency and medical safety of medical service providers,with detailed introduction to the computation process of such indicators.Cases in hand indicate that the first-page data completeness and accuracy of medical records are preconditions for using DRGs in medical service performance evaluation.

This article reviewed the connotation,developing process and utilization theory of diagnosis related groups (DRGs).DRGs,which is one of ease mix systems,is now used widely in healthcare management.DRGs classify inpatient based on diagnose and procedure.Practices have shown that it has relative high capacity for the risk adjustment of acute care cases; therefore,it can improve the efficiency of expenditure and performance management of inpatient services.Currently,there are more than 30 countries and regions using DRGs,and the theories and methodologies of DRGs get mature.China's new round healthcare reform have developed in depth.The study and development of DRGs related health management tool will promote China' s healthcare system becoming more scientific,normalized and systematic.

Objective To investigate the effect of inhibiting the expression of Navl. 8 sodium channels by an antisense oligodeoxynudeotide(ODN) on visceral hypersensitivity. Methods The visceral hypersensitivity animal models induced by giving neonatal Sprague-Dawley rats colorectal distention(CRD) after postnatal days 8, 10 and 12. Animals were injected intrathecally either Navl. 8 antisense ODN (research group) or mismatch ODN (control group) twice a day for 3 days at the 8th week. After that, the expression of Navl. 8 in each group was examined by RT-PCR, and abdomiral withdrawal reflex(AWR) score and spinal c-Fos expression were evaluated to assess whether the intervention can relieve the visceral hypersensitivity. Results After intrathecal injection with the antisense ODN, the expression of Navl. 8 in each group decreased.AWR score and the number of c-Fos positive neurons in the spinal cord, especially in the area 1 and 3, decreased in the model group, while they did not change in the control group. Conclusions Interventing the expression of Nav1.8 may relieve the visceral hypersensitivity in this model of irritable bowel syndrome.

ObjectiveTo explore the effects of Yiqi Yangyin Huoxue principle on the expression of neurotrophin-3 of the frontal lobe cortex neurons in diabetic rat brain. Methods The diabetic rat model was produced by intraperitoneal injection of streptozotocin(STZ).The Yiqi Yangyin Huoxue drugs was poured into the stomach of the treated group. The brains were taken and the expression of neurotrophin-3 was estimated with immunochemistry 8 weeks later. Results Immunochemistry showed that there were many positive cells in the frontal lobe cortex of the normal group and they were deeply dyed.Positive cells of the model group decreased and their color was shallow .The number and the color of positive cells in the treated group were close to that of the normal group. Conclusion The Yiqi Yangyin Huoxue principle can effectively improve the degenerating of the frontal lobe cortex neurons in diabetic rat brain.

Objective Controversies remain as to the recovery time, recovery quality, and incidence of peri-recovery adverse reactions of the patient receiving general anesthesia with remifentanil and sufentanil.This study aimed to systematically assess the qual-ity of recovery from general anesthesia with remifentanil and sufentanil. Methods Randomized controlled trials ( RCTs) were re-trieved from The Cochrane Library, PubMed, MEDLINE, EMbase, Ovid, Springer, Web of Science, CNKI, CBM, VIP, and Wan-Fang Data.According to the modified Jadad quality scale, the literature retrieved was screened and subjected to quality evaluation and meta-analysis was performed on the included studies using the RevMan 5.1 software. Results Thirty-three RCTs involving 2175 pa-tients were finally included.The results of meta-analysis showed no significant differences between the remifentanil and sufentanil groups undergoing thyroid surgery either in the recovery time to spontaneous breathing ( T1) and eye-opening ( T2) and endortracheal extubation time ( T3 ) ( P >0.05 ) or in the incidence rate of postoperative nausea and vomiting (PONV) (P>0.05).T1, T2 and T3 were significantly shorter in the sufentanil than in the remifentanil group in other types of surgery (P<0.05).The patients with level-1 Ramsay score were remarkably more in the remifentanil than in the sufentanil group ( MD =13.67, 95% CI 2.67 -69.91 ) ( P <0.05), and the VAS scores were markedly higher in the former than in the latter group at 30 minutes (MD=3.37, 95% CI 3.28-3.46) and 1 hour after extubation (MD=2.53, 95% CI 2.43 -2.63) (P<0.05). Conclusion Compared with sufentanil, remifentanil provides a quicker recovery but a weaker analgesia effect and a higher rate of post-operative agitation.However, sufentanil produces a better pain relief and a higher quality of recovery after operation.

Objective To investigate the anti-tumor effects of total saponins,extracted from stems and leaves ofParispolyphyllavar.yunnanensis. Methods Taking mouse stomach carcinoma MFC cell line,human mammary cancer cell line(MCF-7)and human cervical carcinoma cell line(Hela),and their tumor-bearing mice as models,the antitumor activity was carried out in vitro and in vivo. CCK-8 assay was used to determine the inhibitory effect in vitro. The tumor-bearing mice model was induced by tumor cell vaccination in normal mouse forelimb left axillary subcutaneous and these mice were randomized into NS group,cytoxan group(30 mg/kg),saponins high-dose,medium-dose and low-dose groups(60,30 and 15 mg/kg). They were given intraperitoneal injection once a day for consecutive 15 days. The tumor inhibition rate and survival of the tumor-bearing mice were measured. Results Saponins,extracted from both aboveground and underground ofP.polyphyllavar.yunnanensis could significantly inhibit the growth of MFC,MCF-7 and Hela cells in time- and dose-dependent manners. The tumor weight in each drug treated group was significantly lower than that in the control group. Conclusion Saponins,extracted from both aboveground and underground ofP.polyphyllavar.yunnanensis have antitumor activity.

AIM:To investigate the effects of peroxiredoxin 4 ( Prdx4) protein expression levels on the migra-tion and invasion of human cervical cancer HeLa cells.METHODS:The plasmid pcDNA3.0-HA-Prdx4 was transfected into HeLa cells.The HeLa cells were infected with LV-Prdx4 RNAi vector to establish stable Prdx4 shRNA HeLa cells. The change in the expression of Prdx4 protein was validated by Western blotting.The wound-healing assay, and Transwell migration and invasion assays were performed to detect the migration and invasion of HeLa cells, respectively.RESULTS:The expression of Prdx4 protein was up-regulated in the HeLa cells after transfection with pcDNA3.0-HA-Prdx4 plasmid ( P<0.05), whereas it was down-regulated in the Prdx4 shRNA HeLa cells (P<0.05).The abilities of migration and inva-sion were significantly increased in Prdx4-overexpressing HeLa cells compared with non-transfected and mock plasmid trans-fected control groups ( P<0.01) .When Prdx4 was knocked down by shRNA, the migration and invasion of the HeLa cells were remarkably repressed compared with blank control group and negative control group ( P<0.01 ) .CONCLUSION:The up-regulation of Prdx4 expression facilitates the migration and invasion of HeLa cells, and the down-regulation of Prdx4 expression inhibits the migration and invasion of HeLa cells, indicating that Prdx4 may be a potential molecular target for cervical cancer therapy.

Objective To investigate the association of SLC34A1 ( rs6420094 ) and RGS14 (rs4074995) polymorphisms with serum level of phosphorus in chronic hepatitis B virus (HBV) infection patients following long-term adefovir dipivoxil ( ADV ) treatment.Methods Ninety one patients with chronic HBV infections admitted in Third Hospital of Hebei Medical University during October 2012 and August 2013 were enrolled in the study.All patients received ADV treatment ( monotherapy or combination therapy) for at least two years, among whom 31 had hypophosphatemia and 60 had normal serum phosphorus levels.rs6420094 and rs4074995 were genotyped by polymerase chain reaction-restrictive fragment length polymorphism ( PCR-RFLP ) analysis.The relationship between allele frequency and serum phosphorus concentration was analyzed by Chi-Square test.Results In hypophosphatemia group, there were 13, 13, and 5 patients with genotype A/A, A/G and G/G at rs6420094, respectively;while in patients with normal serum phosphorus levels, there were 35, 24 and 1 patients with genotype A/A, A/G and G/G at rs6420094.The frequency of allele A at rs6420094 in patients with normal serum level of phosphorus was higher than that in hypophosphatemia group ( 78.3% vs.62.9%, χ2 =4.947, P <0.05 ).In hypophosphatemia group, there were 2, 11, and 18 patients with genotype A/A, A/G and G/G at rs4074995, respectively;while in patients with normal serum phosphorus level, there were 1, 21 and 38 patients with genotype A/A, A/G and G/G at rs6420094.There was no difference in the frequencies of alleles at rs4074995 between two groups (χ2 =0.625, P >0.05).Conclusion The polymorphism of rs6420094 gene may be associated with the serum level of phosphorus in patients with chronic HBV infections following long-term treatment of ADV.

Objective To investigate the role of connexin 43(Cx43)in the apoptosis of pancreatic cancer cell line BxPC and its possible mechanism.Methods pcDNA-Cx43,pcDNA-Cx43N,pcDNA3.0,siRNA-Cx43 and siRNA-NC were transfected into BxPC3 cells via liposome method.Cx43 protein and Cytochrome C(Cyt C)concentration was determined by Western blot,and the apoptosis was analyzed by Annexin V/PI binding assay.The mitechondria apoptosis pathway involved in Cx43 associated apoptosis was examined which contains the depolarization of mitechondrial membrane potential (MMP);fluorospectrophotometer was used to measure the activities of caspase-3 and caspase-9. Gap junction intercellular communication(GJIC) was determined by dye-transfer method.Results Cx43 protein expression increased after BxPC3 transfeetion,apoptosis rate increased from(6.35±0.43)%in empty vector transfection group to(14.29±1.24)%;after H202 treatment,apoptosis rate increased from(20.34±2.47)%to(31.27±2.56)%(P<0.05).Meanwhile,mitochondrial membrane potential was decreased,Cyt C was increasingly released from mitochondria,caspases activities were increased;after siRNA43 interference,apoptosis rate decreased from(7.42±0.47)% to(5.19±1.37)%,after H_2O_2 treatment,apoptosis rate decreased from (19.43±1.71)%to(11.67±1.97)%(P<0.05).Decreased mitochondrial membrane potential and Cyt C release were observed,caspases activities were decreased.GJIC of pcDNA-Cx 43 transfection group increased from 14.52±0.57 to 23.05±3.84.and it increased from 1.70 ±0.24 to 3.84 ±0.45 in the presence of β-GA(P<0.05).But the apoptosis rate was not significantly different.Conclusions Cx43 could promote BxPC3 apoptosis via mitochondrial apoptotic signal pathway,and the possible mechanism included signal pathway other than GJIC.