With the rapid increase in health cost and transformation of modern medicine, how to allocate the health care resources rationally and increase the efficiency and equity has become the common issues in all coun-tries. Health Economics, a new discipline, has provided possible answers to the issues and attracted attention from both government and academics. This paper introduces the goals, methods, contents and textbooks in US. universities and puts forwards suggestions for health economics education in China.

Objective To determine the dynamic changes of ileum epidermal growth factor(EGF),transforming growth factor-α(TGF-α)and epithelial growth factor receptor(EGFR)in neonatal rats with intestinal injury and to investigate their role in the neonatal necrotizing enterocolitis(NEC). Methods One-day-old Wistar rat pups were divided into two groups.The rats in the lipopolysaccharide(LPS)-injected group(n=40)received an intraperitoneal injection with 5 mg/kg LPS and those in the control group(n=8)did not.Control group and LPS-injected group at 1,3,6,12 and 24 h following LPS challenge were sacrificed for histological evaluation of NEC and for measurernents of EGF,EGFR,EGFR mRNA and TGF-α mRNA. Results Compared with the control group(0.12 0.17).the LPS-iniected pups showed a significant increase in injury scores at 1,3,6,12 and 24 h(1.28±0.62,1.75±0.74,1.98±0.75,2.85±0.41 and 2.35士0.63,respectively)(P<0.01).EGF protein levels at 1,3,6,12,24 h[(235.9±44.3)pg/mg prot,(231.8±30.0)pg/mg prot,(223.3±48.1)pg/mg prot,(211.7±47.0)pg/mg prot and(221.4±39.0)pg/mgprot,respectively]were significantly lower than that of the control group[(287.7±42.6)pg/mg prot](P<0.05).There was a negative correlation between the EGF levels and the grade of intestinal injury within 24 h(r=1.000,P<0.01).The expression of EGFR protein and mRNA was increased after LPS administration.There was no correlation between the EGFR protein and the grade of intestinal injury(r=0.800,P>0.05).The expression of TGF-α mRNA was significantly up-regulated at 1 and 3 h following LPS injection. Conclusions Reduced levels of EGF may play a pivotal role in the pathogenesis of NEC.

0.05). However, the MDA level in the experimental group was higher than that of the control on day 3 [(55.92?5.53)nmol/mg prot vs (22.52?4.36)nmol/mg prot, P

Objective The early stage of neonatal sepsis is short of specific clinical manifestations that easy to be misdiagnosed.This study aimed to demonstrate the clinical value of combined markers[proca-icltonin(PCT)and C-reactive protein(CRP)]in the early diagnosis of neonatal hospital-acquired infections by dynamic monitoring of PCT and CRP.Methods The study included 111neonates in the 1st Neonatal Ward of Shengjing Hospital from June 2013to August 2014which were divided into three groups and retro-spectively reviewed,including 37cases of diagnosed sepsis group,42cases of clinical sepsis group,and 32ca-ses of control group(non-sepsis neonates).We measured the serum levels of PCT and CRP in two sepsis group before antibiotic administration,12h and 24h after infection,3d and 7d after infection controlled,and in the control group before antibiotic administration.Results Before antibiotic administration,serum levels of PCT and CRP were significantly higher in two sepsis groups than in the control group(P﹤0.01).In two sepsis groups,PCT reached peak at 12h after infection[(15.00±15.51)ng/ml and(17.93±13.44)ng/ml] and decreased to normal at 3d after infection controlled[(0.49±0.47)ng/ml and(0.42±0.34)ng/ml];CRP reached peak at 24h after infection[(37.53±30.29)mg/L and(32.41±29.33)mg/L]and decreased to normal at 7d after infection controlled[(5.72±2.98)mg/L and(5.06±3.07)mg/L].The optimal cut-off values were PCT﹥2ng/ml and CRP﹥10mg/L(Youden index 76.11%,59.45%),the sensitivity were 88.61%and 75.70% ;specificity were 87.5% and 83.75% ;positive predictive value were 94.59% and 95.65% ;negative predictive value were 75.68%and 46.15%.Receiver operating characteristic area under the curve were 0.964,0.887.Conclusion In early stage of sepsis,both PCT and CRP increase.The optimal cut-off values are CRP﹥10mg/L and PCT﹥2ng/ml.CRP reaches peak at 24h after infection,decrease to normal at 7d after infection controlled,while PCT reaches peak at 12h after infection,decrease to normal at 3d after infection controlled.Combined detection of PCT and CRP can improve the sensitivity and specificity of the early diagnosis of neonatal hospital-acquired infections.

This paper reviews studies on the relationship between health insurance and health status both at home and abroad. First, we put forward three viewpoints on their relationship;Second, based on different data, we review the studies from three different perspectives; Third, we review the recent studies at home. The paper draws the conclusion as following:(1) most studies on observational data prove that there is relationship between health in-surance and health status. To establish the causal relationship between them, we must overcome the endogeneity of health insurance. ( 2 ) Different studies have different conclusions, which are caused by different methodology and subjects. (3)The conclusions cannot be generalized to whole populations. Future studies should focus on the effect of different health insurance on different populations.

Epithelial-mesenchymal transition( EMT) refers to the transdifferentiation from epithelial cells to mesenchymal cells. The initial understanding of EMT is originated from the research on embryonic develop-ment,followed by the discovery of EMT phenomenon in physiological and pathological process in multicellular organism. In recent years,the occurrence and development of infiltration and metastasis of tumor cells along with fibrotic diseases that related to EMT are becoming the hot researches nowadays.

Objective To investigate the expression and effect of elastin in full-term rats with hyperoxia induced by chronic lung diseases. Methods One hundred and forty-four full-term rats are randomly exposed to hyperoxia (hyperoxia group)and room air(room air group).Chronic lung disease(CLD)is induced by hyperoxia exposure. Gomori's stain for elastic fibers and in situ hybridization methods were used to detect the expressions of secondary crest and tropoelastin mRNA on the 1st,3 rd, 7th, 10th,14th and 21st days after exposure. Results The expressions of secondary crest decreased significantly in hyperoxia group, compared with room air group on the 3rd to 14th days(P＜0.05).The expressions of tropoelastin mRNA decreased significantly in hypemxia group, compared with room air group on the 3rd to 10th days (P＜0.05),otherwise increased significantly from the 14th to 21 st days(P＜0.05). Hyperoxia exposure can delay the peak of tropoelastin mRNA. Conclusion Elastin is involved in the inhibition of alveolarization and lung fibrosis in the development of CLD.

Objective To evaluate the effects of supine and prone position on ventilation function in neonates in the initial six-hour period after weaning. Methods Sixty-four neonates weaned from mechanical ventilation and with normal body temperature hospitalized from Sep. 2004 to Apr. 2006 in our NICU were randomly divided into prone group and supine group. All of them were oxygen administrated through head net, oxygen flow rate was adjusted continously to keep SpO2 at normal level by monitoring SpO2 and RR. FiO2、RR were recorded at 15 minutes,1 h,2 h,3 h,4 h,5 h,6 h after weaning. Arterial blood gas was meas-ured at 1 h ,6 h after weaning and A-aDO2, RI, OI were calculated. Results (1) At 1～6 h after weaning the values of FiO2 in prone group were significantly lower than those in the supine group(P<0.01). (2) After weaning there was a decreasing tendency of RR in the prone group and the significant decrease was found at 4 h ,5 h ,6 h compared with supine group (P<0.01). (3) At 1h and 6h after weaning, the value of PaO2 and OI were significantly higher and the value of A-aDO2, RI were lower in the prone group than in the supine group(P<0.05,P<0.01). (4) At 6 h the PaCO2 in prone group were obviously higher than that in supine group (P<0.05). Conclusion At first 6h after weaning prone position can improve ventilation functions.

Objective To observe the dynamic changes and the effects of Captopril on interstitial fibrosis in lung tissue of neonatal rats with lung fibrosis induced by hyperoxia. Methods Two hundred and forty neonatal Wistar rats were randomly assigned into model group, air control group, normal saline control and Captopril-trcated group (n=60 each).The air control group was exposed to room air (FiO2 = 0.21), and the rest three groups were continuously exposed to hyperoxia (FiO2 = 0.9) for 21 days. During the exposure, the Captopril-treated group received Captopril [ 30 mg/( kg·d) ] by intragastric administration, and the normal saline control group was administrated with normal saline instead, the model group did not receive any treatment. On the 1 st, 3 rd, 7 th, 14 th and 21 st day of exposure, the subjects were sacrificed. And then, the protein levels of collagen Ⅲ (Co-Ⅲ ) were measured by enzyme-linked immunosorbent assay and angiotensin Ⅱ(Ang Ⅱ )by radio-immunity technique, and the mRNA expression of Ang Ⅱ, Co- Ⅲ was measured by RT-polymerase chain reaction. The changes of lung histomorphology were observed. Results On the 14 th day, The Ang Ⅱ, Co- Ⅲ protein levels and their mRNA expression of modal group and normal saline control group increased significantly as compared to the air control group ( P < 0.05 ), except the Ang Ⅱ mRNA expression of normal saline control group. The Ang Ⅱ and Co-Ⅲ protein levels of model group was (838.22 ± 197.75 ) and ( 104.21 ± 43.37) ng/mg respectively, and normal saline control group was ( 759.97 ± 60.81 ) and ( 128.69 ± 54.74) ng/mg respectively on the 21 st day, their mRNA expression of two groups also increased to the peak on the 21 st day(P< 0.05).The AnglI and Co- Ⅲ protein levels of Captopril-treated group was (554.52 ± 59.32) and (39.90 ± 13.45) ng/mg on the 21 st day respectively, their mRNA expression was (1.50 ± 0.84 ) and (1.13 ± 0.55) respectively, and decreased significantly as compared to the model group and normal saline control group respectively (P<0.05), but increased significantly as campared to the air control group (P < 0.05). The histopathological examination demonstrated different degrees of alveolitis, broaden interstitium and reduced alveolar quantity in the model group and normal saline control group compared with air control group. The pathological changes were markedly alleviated in the Captopril-treated group. Conclusion Captopril may have protective effects on lung injury induced by hyperoxia.

Objective To investigate the changes of epithelial sodium channel(ENaC) expression and sodium and water transport function in the neonatal rat pulmonary edema induced by hyperoxia.Methods The neonatal rats were randomly divided into the hyperoxia group and the control group.After 1,3,5 and 7 d hyperoxia exposure,the lung tissues were collected to measure the wet-to-dry weight ratio and the expression of α-,β-and γ-ENaC subunits were detected by western blot analysis.Alveolar fluid clearance (AFC) and amiloride-sensitive AFC were measured after 5 d to reveal the effect of hyperoxia on the activity of ENaC.Results The lung water contents significantly increased in the hyperoxia group indicating that pulmonary edemahappened(3 d:(6.37 ±0.64) vs (5.56±0.15),t=3.46,P＜0.01;5 d:(5.86 +0.52) vs (5.11±0.21),t=-3.82,P ＜0.01;7 d:(5.56±0.45) vs (4.80±0.09),t =-4.72,P ＜0.01).AFC increased significantly,but no significant difference was found in amiloride-insensitive AFC between the two groups which indicate that amiloride-sensitive AFC increased significantly (AFC:(20.32 ± 3.33) ％ vs (12.97 ± 2.46) ％,t =-6.16,P ＜ 0.01 ; amiloride-insensitive AFC:(10.42 ± 3.44) ％ vs (8.67 ± 3.13) ％,t =-1.30 P =0.21).The expression of α-,β-and γ-ENaC did not reduced after hyperoxia exposure compared with the control group.Conclusion Although bronchopulmonary dysplasia of early pulmonary edema induced by hyperoxia,dysfunctional transport of Na + may not be a key factor involved in pulmonary edema at the early stage of bronchopulmonary dysplasia.