Medical insurance payment reform is an important part of healthcare reform in China. Based on the practice and research of China Rural Health Project ( hereinafter referred asHealth XI Project) financed by World Bank (WB) and UK Department for International Development (DFID) implemented in 40 counties of 8 Chinese provinces between 2009 and 2014 , this thesis analyses the principle and feasible policy route of medical payment re-form for the country, by ways of reviewing the policy evolution, and summarizing the process of project pilot from sin-gle mode of payment-a simple mixed payment-to the comprehensive payment system reform and analyzing the advanta-ges and disadvantages of medical insurance payment methods.

Objective To reduce the rate of unscheduled nasogastric extubation for the patients in neurology department.Methods A nursing care team was set up for a thematic activity to reduce the rate of nasogastric tube unscheduled extubation.The team analysed the situations of 164 patients with nasogastric intubation in the neurology department,specifying the problems,deciding their aims and working out the strategies.Result The rate of unscheduled nasogastric extubation decreased from 19.63％ to 2.12％ and the rate of nursing omission decreased from 9.93％ to 2.59％ (P＜0.05).Conclusion The improvement activity of nursing projects can effectively reduce the rate of unscheduled nasogastric extubation and improve the quality of nursing care.

Objective To study the effect of multimedia on the home care to the patients with double lumen catheter.Methods Totally 100 patients with double lumen catheter for dialysis were divided into control group and observation group according to the registration order,50 cases in each group.In the control group,the home care was done to nurse the catheter and in the observation group,multimedia was used to guide home care to the catheter.The incidence of catheter-related complications was compared between two groups.Result The toal rate of catheter-related complications in the observed group was significantly lower than that of the control group (P＜0.05).Conclusion The multimedia for home care to the catheter for dialysis are easy for the patients to master so that the can change better their home care and avoid (or decrease) catheter-related complications.

AIM:To investigate the production and activation of caspase-3 in primary rat renal proximal tubule cells in response to tumor necrosis factor-α(TNF-α) and the implication of nuclear factor-κB (NF-κB) in the process. METHODS:Isolated rat renal proximal tubule cells (PTCs) from male adult Sprague Dawley rats were treated with TNF-α according to the indicated time courses. A specific NF-κB inhibitor,Bay11-7082,was used alone or as a pretreatment for 1 h followed by exposure to TNF-α for 24 h.The protein levels of cleaved caspase-3,caspase-3,I-κBα,phosphorylated I-κBα,and GAPDH were detected by Western blotting using specific antibodies. RESULTS:The protein level of cleaved caspase-3 relative to caspase-3 was significantly increased in the presence of TNF-α for 6 h,12 h,and 24 h. Protein levels of caspase-3 were significantly decreased by 12 h and returned to baseline by 24 h in the presence of TNF-α. Treatment with Bay11-7082 for 25 h alone or pretreatment with Bay11-7082 for 1 h followed by addition of TNF-α for 24 h caused a remarkable reduction in both cleaved caspase-3 and caspase-3 as compared to control and TNF-α treated groups. An increase in phosphorylated I-κBα was observed from 15 min to 60 min after treatment with TNF-α at a dose of 10 μg/L in PTCs. CONCLUSION:NF-κB is not only associated with the activation of caspase-3 but also the production of caspase-3 in primary rat renal proximal tubule cells in response to TNF-α.

Objective To establish a luciferase labeled McA-RH7777 hepatoma rat model,which could be used for gross observation to further observe the effect of selective ligation of the portal vein and bile duct on tumor growth and metastasis.Methods The luciferase gene was transfected into rat McA-RH7777 hepatoma cells with pCDH-puromycin-CMV as the carrier,which were subcutaneously inoculated into Buffalo rats.Tumor pieces were then heterotransplanted into the left lateral lobe of the allogenic rat liver to observe the tumor growth in vivo.After the successful hepatoma modeling,the rats were randomly divided into three groups,namely the implanted portal vein group with combined portal vein and bile duct ligation,the implanted portal vein group with single portal vein ligation and sham operation group.The rats were executed at the 1 st week and 2nd week after ligation,and the livers were dissected to record the tumor growth and metastasis inside and outside the liver,respectively.Results The tumor formation rates of Buffalo rats after subcutaneous and intrahepatic implantation were both 100％.The fluorescence signal implanted into the liver lobe could be observed in vivo after the intrahepatic implantation of luciferase transfected Luc-McA-RH7777 at 2nd week,the range and intensity of which increased over time.Only local tumor growth could be found at the 4th week,without obvious intrahepatic and lung metastasis.However,both an increased in situ tumor volume and the pulmonary metastasis could be observed in the implanted portal vein group with combined portal vein and bile duct ligation at 2nd week after the ligation.Immunohistochemistry showed AFP positive immunoreactions in the vast majority of intrahepatic tumor cells and Luc positive immunoreactions in part of tumor cells.Conclusion Luc-McA-RH7777 cells could be used to establish the heptoma rat model and the in vivo analysis within the Buffalo rat liver demonstrated that the combined ligation of the portal vein and bile duct can accelerate the development and metastasis of liver cancer.

Objective To investigate the expression and clinical significance of androgen receptor (AR) and embryonic stem cell associated transcripts 4 (NANOG) in breast cancer patients with human epidermal growth factor receptor 2 (HER-2) over-expression, and to analyze its relationship with clinicopathologic features of breast cancer. Methods 143 breast cancer patients with HER-2 over-expression were selected from the screening of 1052 cases of invasive breast cancer according to estrogen receptor (ER), progesterone receptor (PR) and HER-2 status. The protein expression of AR and NANOG was assayed by using immunohistochemistry.The relationship between AR expression and clinicopathological features was analyzed by χ2 test. The correlation between AR expression and NANOG expression was analyzed by Spearman correlation analysis. Results The positive expression of AR was 35.7 % (51/143). The AR expression was not associated with age and menstruation status (both P>0.05), and was associated with tumor size, clinical TNM staging and lymphatic metastasis (all P< 0.05). The positive rate of NANOG were 53.1 %(76/143), and NANOG proteins were negative in adjacent normal breast tissue and benign breast lesions. The positive rate of AR was 27.6%(21/76) in NANOG-positive cases, whereas the positive rate of AR was 44.8%(30/67) in NANOG-negative cases, and the difference was statistically significant (χ2=4.526, P=0.033). There was an inverse correlation between NANOG and AR expressions (r= -0.255, P= 0.002). Conclusion AR and NANOG may be new targets for endocrine therapy and molecular biological therapy.

Aim To investigate the protective effects of high concentration fentanyl on the brain slice injury induced by oxygen glucose deprivation(OGD).Methods Rat brain slices were made and randomly assigned to four groups:control(n=10),OGD(n=10),fentanyl 50 ?g?L~(-1)(F_(50),n=10) and fentanyl 500 ?g?L~(-1)(F_(500),n=10).Changes of the neuron injury and apoptosis were observed with TTC staining,LDH releases,TUNEL staining,immunohistochemistry and electromicroscope.In addition,changes of intracellular calcium were measured with confocal laser-scanning microscopy.Results F_(50) and F_(500) attenuated the decrease of TTC staining and the increase of LDH release induced by OGD in brain slices.Neuronal apoptosis and changes of neuronal ultrastructures were attenuated by F_(50) and F_(500).Bcl-2 and Bax protein expressions were increased after OGD.Bax protein expression was decreased by F_(50) and F_(500),while Bcl-2 protein expression was increased by F_(50)and F_(500).Intracellular calcium concentration was increased by OGD and then it was lowered by F_(50) and F_(500).The protective effects of F_(50) were more obvious than that of F_(500).Conclusions High concentrations of fentanyl have neuron protective effects against OGD injury in rat brain slices,and fentanyl 50 ?g?L~(-1) has more obvious protective effects than fentanyl 500 ?g?L~(-1).

A hybridoma cell line(B10)was established by fusing spleen cells of BALB/c mou- se immunized with human thyroglobulin(HTG) with SP2/0 myeloma cells. An averagefusing rate of 6.3% and antibody-secreting positive well rate of 58.3% were obtained.During the first two months, the supernatant of B10 culture had a titer of 1/128 to1/2048 measured by hemagglutination method, and the ascites was positive at 1/64000-128000 and 1/320000 respectively as measured by hemagglutination and radioimmunoass-ay.The B10 cell line is very stable and has very high activity to produce anti-HTGmonoclonal antibodies. After several times of preservation in liquid nitrogen andpassage in culture for one year,a recent determination shows that cell culture super-natant and ascites still have very high titer,being 1/4096 and 1/1048576 respectively asmeasured by hemagglutination method. The chromosome number of the B10 hybridomacell is 99.5?7.4.The success of the establishment of this cell line is briefly discussed.Attempt to establish diagnostic kit with this monoclonal antibody is being undertaken.

AIM:To investigate effects of propolis-ethanol extract on platelet activity in flowing blood.METHODS: Intima-injury model was made by in vitro perfusion.Coverslips was coated by using fibrinogen and human Ⅲ type collagen to detect platelet adhesive rate when blood went through fibrinogen and collagen surface in 1 000/s shear rate.Three experimental groups were set up: negative control group(24% ethanol),experimental group(0.1 g/L,24% propolis-ethanol extract) and positive control group(0.1 g/L,ferulic acid).RESULTS: Intima-injury model was made.On fibrinogen and collagen,platelet adhesion on area of experimental group was lower than that in negative control group(P0.05).Propolis-ethanol extract decreased more obviously the platelet adhesion area on fibrinogen surface than that in collagen surface(P

Objective To evaluate the concordance of two-dimensional echocardiography (2DE) and intelligent spatiotemporal image correlation (iSTIC) in measuring fetal aortic and aortic arch diameters during the second and third trimesters.Methods Data were collected by a prospective cross-sectional study of 140 normal singleton fetuses with the gestational age from 22 to 32 weeks.A total of 6 dimensions of the fetal aortic and aortic arch,including aortic annular diameter (AO),ascending aorta diameter (AAO),aortic arch diameter [AO Arch (INA to LCCA)],aortic arch diameter [AO Arch (LCCA to LSA)],aortic isthmus diameter and descending aorta diameter (DAO),were measured by two different methods.Concordance was assessed by comparing the measurements acquired by iSTIC with those determined by 2DE and depicted by Bland-Altman plots.Inter-and intra-observer variability was evaluated by the intraclass correlation coefficient (ICC) test.Results A total of 137 iSTIC volumes in 140 cases were found to be suitable for further analysis.Good correlation was observed in the measurements that determined by 2D or iSTIC (Pearson's R2 =0.977-0.983).There was no significant difference in the mean values of all the parameters that measured by two methods.Bland-Altman plot showed that the 95％ limits of agreement (LOA) in AO,AAO,AO Arch (INA to LCCA),AO Arch (LCCA to LSA),aortic isthmus diameter and DAO were (-0.1260/+ 0.2299),(-0.1707/+ 0.2241),(-0.1547/+ 0.2190),(-0.1736/+ 0.2024),(-0.1514/+ 0.2039) and (-0.1485/+ 0.2228),respectively.The points in the outside of LOA were 5.11％ (7/137),4.38％ (6/137),5.11％ (7/137),5.84％ (8/137),4.38％ (6/137)and 4.38％ (6/137),respectively.Conclusions iSTIC has a good agreement with 2DE in measuring fetal aortic and aortic arch dimensions during the second and third trimesters.