OBJECTIVE:To provide reference for setting reasonable medicines insurance payment price in China.METHODS:We retrieved and analyzed academic articles formally published at home and abroad,official websites and government documents,summarized.medicines insurance payment pricing mechanism as well as fair solutions to high-cost medicines,so as to put forward the suggestions to formulate reasonable medicines pricing policy in China.RESULTS&CONCLUSIONS:The international medicines payment prices are usually determined by internal reference pricing method,incremental cost-effectiveness evaluation method and external reference pricing method.The sustainable and fair accessibility of high-cost medicines are promoted by fair medicines pricing program,medicines patent pool,open source medicines discovery znitiative and so on.After the goal of universal health care has been achieved in china,reasonable medical insurance payment price should be explored and formulated.It is necessary to adopt,intemal reference pricing method to determine the payment standard of completitive eneric products,external reference pricing method or incremental cost-effectiveness evaluation method to determine the reference price for price negotiation of the innovative patented medicines;the concept of fair pricing for high-cost medicines.

Objective To compare the effects between dilation and curettage (D&C) and hysteroscopic electroresection (HE) in the management of endometrial polyps. Methods Entered into the study there were 86 patients with endometrial polyps, 32 of them were treated by D&C (Group D&C) and 54 by HE (Group HE). The operation time, pre- and post- operative complications, and recurrence of 2 groups were compared. Results Of the Group D&C and Group HE, the operation time were (8.5?4.2) min and (9.0?3.1) min, without statistically significant differences (t=0.632, P=0.529), while the recurrence numbers and recurrence time of the 2 groups were 9 (36.0%) and 3 (7.5%) cases, (5.3?3.5) months and (11.2?4.8) months, respectively, with significant differences (?2=6.516, P= 0.011; t=6.058, P=0.000). Conclusions Compared with D&C, HE is characterized by lower recurrence rate and longer recurrence time.

Objective:To investigate the wether vascular endothelial growth factor (VEGF) and endostatin could be used as new serum markers of endometriosis. Methods:Preoperative serum levels of VEGF and endostatin in 82 women with endometriosis(stage Ⅰ-Ⅱ 43 cases and stage Ⅲ-Ⅳ 39 cases) were assayed in duplicate using enzyme linked immunoadsordent assay. Serum levels were compared with levels of 60 healthy controls. Results: Serum VEGF and endostatin levels in endometriosis were significantly higher than that of controls. The levels of VEGF and endostatin of endonmetriosis stages Ⅰ-Ⅱ were significantly lower than those of stage Ⅲ-Ⅳ. The sensitivity, specificity, positive predictive value and negative predictive value of serum VEGF in detecting endometriosis were 0.92,0.78,0.82 and 0.90, respectively; those of enedostatin were 0.95, 0.84, 0.86 and 0.95, respectively. When both factors were used concomitantly, they were 0.98,0.75,0.76 and 0.98, respectively. Conclusion:These results indicates that the balance of angiogenic stimulators and inhibitors may regulate the development and progression of endometriosis and demonstrates that the circulating levels of both VEGF and endostatin maybe useful markers for endometriosis.

Objective Our research aimed to investigate the efficacy and the nursing characteristics of allogenic bone marrow mesenchymal stem cell (BM-MSCs) transplantation in HBV related acute-on-chronic liver failure (ACLF) patients.Methods A total of 91 HBV related ACLF patients were enrolled,among whom 45 patients received allogenic BM-MSCs transplantation via peripheral vein and other 46 patients received medical treatment only.We assessed the 12-week survival rates and the variation of model for end liver disease (MELD) score.Besides,we administrated comprehensive nursing for these patients in different stages of the transplantation.Results The cumulated survival of patients received BM-MSC transplantation was 75.6％,which was higher than the control group (54.5％).The level of total bilirubin and International Normalized Ratio (INR) had greatly improved.41 of 45 patients passed through perioperative period safely,without any severe adverse events.11 patients died due to exacerbation of liver failure,among whom 3 happened in perioperative period.But none was related with the operation.Conclusions Allogenic BM-MSCs transplantation can improve the survival rate of HBV related ACLF patients.The psychological nursing pre-operation,skilled operation,intensive care and observation post operation were beneficial to the patients' recovery after transplantation.

Objective To summarize the experience in nursing the patients with chronic severe hepatitis complicated with hypoglycemia. Method Five chronic severe hepatitis patients with hypoglycemia were cared and by monitoring blood glucose, observing the state of disease, correcting low blood sugar and safety control, providing an appropriate nutritional support, arranging the speed of infusion in a proper order and offering related disease knowledge. Results After the treatment, the blood sugar was 3.3~4.9 mmol/L, with a median of 4.2 mmol/L. One patient died of liver and kidney failure, one gave up the treatment because of deterioration and the rest three got better. The hospital stay was 42~120 d with an average of 88.0 d. Conclusion Relevant nursing intervention for the hypoglycemia of chronic severe hepatitis can promptly correct low blood sugar , maintain normal level of blood sugar and avoid serious complications.

Objective To investigate the effect of transforming growth factor-β1(TGF-β1) on the expression of matrix metal-loproteinase-9(MMP-9) in cultured mouse endometrial stromal cells .Methods After separation and purification ,the mouse endom-etrial stromal cells were cultured with different concentrations of TGF-β1 ,and the final concentrations were 0 .1 ,2 .5 ,5 .0 ,10 .0 , 20 .0 ng/mL ,respectively .ELISA method was used to detect the content of MMP-9 in the the culture medium after 48 h culture . Results Compared with the control group ,the expression of MM P-9 in mouse endometrial stromal cells in the experimental groups increased with the TGF-β1 concentration elevation ,and the difference was statistically significant (P < 0 .01) .Conclusion In the mouse endometrial stromal cell system ,TGF-β1 may be involved in the regulation of extracellular matrix metabolism through regu-lating the expression of MMP-9 .

Based on summarizing the international experiences and reviewing the historical evolution and current situation of the physicians'compensation system of public hospitals in China,this paper clarified the existing problems of the current compensation system.Such problems namely included lack of security on the source of the physicians'compensation,low level of sunshine salary which caused thecompensatory mechanism,lack of scientific design of the salary structure and allocation,as well as other underlying causes.Drawing lessons from reform practices at home and abroad,the basic principles and reform directions were put forward,as well as 4 route selections,namely establishing an security investment system to guarantee a stable and higher level salary under the current compensation system, implementing a high level of flip-type annual compensation with locking the current salary into files, establishing an appropriate compensation system referring to an innovated evaluation system of physicians in public hospitals,and coordinating closely with public institution reforms to promote physicians' compensation system reform.

BACKGROUND: Lentivirus can infect divided and undivided cells. It remains uncertain whether the lentivirus can successful y infect primary ovarian granulosa cells. OBJECTIVE: To investigate infecting ratio and cel apoptosis of lentivirus carrying bcl-2 gene in primary human ovarian granulose cells cultured in vitro. METHODS: The lentiviral vector carrying bcl-2 gene was constructed using molecular biology, and packaged into lentivirus with high titer. The resulting recombinant lentivirus carrying bcl-2 genes were then used to infect primary human ovarian granulosa cells in vitro at different multiplicity of infection, 10, 50, 100, 200, and 400. Infection efficiency and cel proliferation were observed at 24, 48, 72, and 96 hours fol owing infection. Cel apoptosis was detected by flow cytometry, and bcl-2 gene transcription was assessed using reverse transcription PCR. RESULTS AND CONCLUSION: Primary human ovarian granulosa cells adhered at 24 hours, and exhibited polygon- or fusiform-shape and colony-like growth. When multiplicity of infection was 100, cel appearance and growth remained unchanged, and infection efficiency was high, which reached the peak up to 72 hours. Moreover, the positive rate was up to 60% in granulosa cells. Lentivirus carrying bcl-2 gene could increase expression of Bcl-2 protein and inhibit apoptosis of primary ovarian granulosa cells.

Objective To compare the clinical effects of mini phalangeal external fixation and mini plate in the treatment of intraarticular fractures of the metacarpal bone head,and to provide a theoretical basis for clinical selection of surgical plan. Methods Seventy?four cases of metacarpal bone head intraarticular fractures treated in Huizhou People′s Central Hospital from March 2014 to March 2016 were selected as the research object. All cases were closed fractures and were randomly divided into the external fixation group and the mini plate group,37 cases in each group and treated respectively with the mini phalangeal external fixator and mini AO plate. The patients were followed up for 6 months to 1 year,the function of the metacarpophalangeal joint,the union of the fracture and the incidence of side effects were compared between the two groups. Results The excellent rates of the external fixation group at 6 months and I year after operation were 91. 9% ( 34/37) and 97. 3%( 36/37) respectively,which were significantly higher than those of the mini plate group ( 73. 0%( 27/37) ,81. 2%( 30/37 ) ) , the difference was statistically significant (χ2 = 7. 120, 7. 062, P<0. 05 ) . The complication rate of the external fixation group was 2. 7%( 1/37) ,which was significantly lower than that of the mini plate group ( 24. 3% ( 9/37 ) ) , the difference was statistically significant ( P=0. 014 ) . The average fracture healing time in the external fixator group was (2. 6±0. 4) months,which was significantly lower than that in the mini plate group (3. 1±0. 7) months,the difference was statistically significant (t=2. 40,P<0. 001) . Conclusion In the treatment of metacarpal bone head fracture,the external fixation has small trauma,can do cross joint fixation,and maintain a good fixation strength,and promote the healing of fracture and the recovery of metacarpophalangeal joint function. It is worthy of clinical application.

Objective To study the role of D‐lactate gradient across the lung in the rapid diagnosis of pneumonia and evalua‐tion of therapeutic efficacy .Methods Patients were divided into pneumonia group (n=46) and non‐pneumonia group (n=28) in ICU .D‐lactate gradient across the lung were calculated by the difference between arterial and mixed‐venous D‐lactate concentrations before the treatment ,after 3 and 7 days of treatment .Serum procalcitonin (PCT) ,Oxygenation index ,the lung injury score (LIS) and clinical pulmonary infection score(CPIS) were recorded at the same time .Results The mean D‐lactate gradient across the lung in pneumonia group was significantly higher than that in non‐pneumonia group[(163 .84 ± 10 .72) ng/mL vs .(30 .33 ± 7 .25) ng/mL ,P<0 .01) ]before treatment .Using a cut‐off value of 106 .11 ng/mL ,D‐lactate gradient across the lung′s sensitivity for di‐agnosis pneumonia was 90 .7% and its′specificity was 75 .5% .D‐lactate gradient across the lung correlated with LIS (r= 0 .554 , P<0 .01) and CPIS(r=0 .543 ,P<0 .01) .Conclusion D‐lactate gradient across the lung correlates with lung injury and pulmonary infection positively and may be a potential biomarker for rapid diagnosis of pneumonia .