Objective:To compare and analyze the changes and the influencing factors of out of pocket(OOP) expenditure before and after the new medical reform.Methods:2000-2015 time series data was used to compare the changes of OOP in different years.The cross-section data was applied to compare the OOP of China and other countries.The principle component analysis method was used to research the contribution rates of different factors for the OOP ratio changes.Result:According to the vertical comparison,it found that the OPP ratio showed steady decreasing trend.The horizontal comparison found that there were great gap for OOP ratios of China and other countries.The per capita GDP,under five mortality and proportion over 65 years were significant factors for OOP.Conclusion:The OOP ratio still needed to be devreased,which needed to promote the economic growth,implement medical insurance system,improve the public health input and decrease the health economic burden for residents.

Objective To study the protective effect of lycopene on vascular endothelial cell injury by cigarette smoke extract ( CSE) . Methods CSE was prepared and the human umbilical vein endothelial cells ( HUVECs) were assigned into four groups, cells in control were untreated, and cells in other three groups were treated by 10%CSE, 10%CSE+1. 0 μmol·L-1 lycopene and 1. 0 μmol·L-1 lycopene, respectively. Cell viability was evaluated using MTT assay. The intracelluar reactive oxygen species ( ROS) level was detected by ROS assay kits. Cell cycle and apoptosis were analyzed by flow cytometry. SIRT1 expression was detected by real-time fluorescence quantification PCR ( qRT-PCR) and Western blot. Results Cell viability in 10%CSE group, 10%CSE+1. 0 μmol·L-1 lycopene or 1. 0 μmol·L-1 lycopene group was (56. 7±5. 1)%,(75. 6±7. 1)% and (95. 5± 9. 7)%, respectively. ROS assay showed that the relative fluorescence intensity in the control was 25. 3±3. 9, however, in 10%CSE group, 10%CSE+1. 0 μmol·L-1 lycopene group or 1. 0 μmol·L-1 lycopene group were 67. 3±4. 6, 45. 3±3. 9 and 20. 8±2. 9, respectively. 10%CSE could induce G2 arrested and which could be antagonized by 1. 0 μmol·L-1 lycopene. The apoptosis rate in the control, 10%CSE group, 10%CSE+1. 0 μmol·L-1 lycopene group or 1. 0 μmol·L-1 lycopene group was (6. 2±0. 5)%,
(30.8±4.3)%, (18. 3±1. 9)% and (7. 6±0. 4)%, respectively. As shown in qRT-PCT testing, compared with the control, mRNA of SIRT1 in 10%CSE group, 10%CSE+1. 0 μmol·L-1 lycopene group and 1. 0 μmol·L-1 lycopene group was (0. 51± 0. 03) fold, (0. 84±0. 05) fold, and (1. 31±0. 08) fold compared to the control, the data from western blot were consistent with qRT-PCR results. Conclusion Lycopene can prevent HUVECs from injury induced by CSE by upregulation of SIRT1.

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on the peripheral blood levels of high mobility group box chromosomal protein 1 (HMGB-1) in patients with systemic inflammatory response syndrome (SIRS) or sepsis.Methods Thirty patients with SIRS or sepsis in Intensive Care Unit of our hospital were scheduled for treatment of CVVH.The replacement liquid was put in by the pattern of pre-dilution of 40％ and post-dilution of 60％.The flow-rate was 3 L/h.The blood flow-rate was from 200 to 300 ml/min.5 ml blood from right radial artery was got at the time points of preCVVH,CVVH 2 h,6 h,8 h and post-CVVH 12 h and the serum was stored at the temperature of-20 ℃ after high speed centrifugation,and 2 ml filter liquor was reserved at the time point of CVVH 6 h.The concentration of serum and filter liquor HMGB-1 was measured by ELISA,but that of TNF-α and IL-6 were measured by radioimmunity.Results 30 patients adept CVVH therapy within 24 h to the hospital,and their therapy time was 2 ～ 5(2.4 ± 1.5) d.Among them,17 cases survived and 13 cases died with a fatality rate of 43.3％.Serum concentration of HMGB-1 decreased from the baseline in patients,although this decrease was not statistically significant[(11.88 ± 6.06) ng/ml,(11.97 ± 5.66) ng/ml,(11.94 ± 5.94) ng/ml,(11.73 ± 5.19) ng/ml vs (13.87 ± 4.68) ng/ml,P ＞ 0.05],Serum concentration of both TNF-αand IL-6 after therapy significantly decreased compared to the baseline in patients [TNF-α: (0.28 ± 0.15)ng/ml,(0.30 ± 0.14) ng/ml,(0.29 ± 0.19) ng/ml,(0.33 ± 0.19) ng/ml vs (0.41 ± 0.12) ng/ml,IL-6:(408.20 ±92.18)pg/ml,(250.51 ± 107.34)pg/ml,(276.00 ± 126.20) pg/ml,(315.16 ± 130.97) pg/ml vs (513.35 ± 125.95) pg/ml,P ＜ 0.05].Conclusions CVVH could decrease the concentration of HMGB-1 in peripheral blood,which would be one of the mechanisms of action for CVVH on sepsis.

Objective To study the changes of S100βin serum and brain tissue of rats with sepsisassociated encephalopathy (SAE).Methods After placement of pole plates of electroencephalogram (EEG) on the brain cortex,thirty SD rats were randomly (random number) divided into three groups post hoc:sepsis group in which rats were made to be sepsis models by cecal ligation and puncture (n =18),normal group (n =6) and sham operation group (n =6).The sepsis-associated encephalopathy was diagnosed with electroencephalogram taken by RM6240 physiological signal recorder.Meanwhile,heart rate and blood pressure were recorded.Eight hours later,serum and brain tissue of sacrificed rats were taken for measuring S100β.The results ware analyzed with one-way ANOVA.Results Of 18 sepsis rats,3 were dead,8 without SAE and 7 with SAE.The levels of S100βin serum and brain tissue of rats with SAE group were significantly higher than those in normal group and sham operation proup (P ＜ 0.05).The Ratio of brain/serum S100βin rats with SAE group was higher than that in rats without SAE (1.74 vs 1.51,P ＜ 0.05).Conclusions Significantly high level of serum S100βwas a reliable bio-marker for diagnosis of SAE in rats.

Analyzed in the paper is the current subsidy mechanism for public hospitals in Zhejiang province, with analysis of problems found. The authors recommended to build a mass fraction subsidy mechanism to cover up the insufficiency of government financial subsidy; to fully leverage the price compensation of medical services; to subsidize in view of the functional positioning of various medical institutions;and explore more channels for public hospitals′subsidies.

Antiviral Agents ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Humans

Antiviral Agents ; therapeutic use ; Congresses as Topic ; Hepatitis B, Chronic ; drug therapy ; Hepatitis C, Chronic ; drug therapy ; Humans

Objective To evaluate the neurotoxicity induced by multiple exposures to sevoflurane anesthesia in the neonatal rats.Methods Thirty-two healthy SPF Sprague-Dawley rats of both sexes,aged 7 days,weighing 15-20 g,were randomly divided into 2 groups (n=16 each) using a random number table:control group (group C) and multiple exposures to sevoflurane anesthesia group (group Sev).On postnatal day 7,14 and 21,2.6％ sevoflurane was inhaled for 2 h in group Sev,while the mixed gas of oxygen and air was inhaled instead of sevoflurane in group C.Morris water maze test was carried out on postnatal day 32-36 to assess the cognitive function.On postnatal day 21 and 36,8 rats in each group were selected and anesthetized,and the cerebrospinal fluid was collected for determination of the concentrations of amyloid β-protein by enzyme-linked immunosorbent assay.Results Compared with group C,no significant change was found in the escape latency,movement time spent in the effective region of the platform,movement distance,the number of entries into the effective region,percentage of residence time,percentage of movement distance,and percentage of the number of entries (P＞0.05),and the concentrations of amyloid β-protein in the cerebrospinal fluid were significantly increased on postnatal day 36 in group Sev (P＜0.05).Conclusion Multiple exposures to sevoflurane anesthesia can induce central neurotoxicity,but do not induce changes in the cognitive function in the neonatal rats.

Aim To observe the change of NF-?B and expression of Bax and Bcl-2 related to apoptosis regulation in the cerebral infarction rat and study the protective effect of iridoid glycoside(IG) extracted from cornus officinalis on focal cerebral ischemia injury and its mechanism of action.Methods Rats were pretreated with drugs by mouth for 7 d and a focal cerebral infarction model of rat was induced by photochemical reaction.Immunohistochemistry and western blot were used to detect the change of expression of NF-?B,Bax and Bcl-2 in the cortex.Results Compared with control group,expression of NF-?B and Bax were increased while expression of Bcl-2 was decreased.Compared with model group,IG(IG 20、60、180 mg?kg~(-1)) markedly decreased the expression of NF-?B and Bax and increased expression of Bcl-2.Conclusion IG has therapeutical effect on cerebral infarction through regulating the expression of NF-?B and apoptosis related genes

Objective To investigate the clinical value of ventricular intracranial pressure monitoring in treatment of severe craniocerebral trauma with high intracranial pressure.Methods A retrospective analysis was conducted on forty cases of severe craniocerebral trauma with GCS score of 3-5 undergone bilateral decompressive craniectomy from October 2010 to January 2012.The patients were divided into three groups:Group A (12 cases received craniotomy after the placement of ventricular intracranial pressure probe) ; Group B (15 cases had craniotomy ahead of the probe placement) ; control group (13 cases had probe placement alone).Intracranial pressure control,dose and duration of administration of dehydrator and prognosis were compared among groups.Results Groups A and B showed a better result in aspects of controlling intracranial pressure within 15 mm Hg,dose and duration of mannitol treatment,and prognosis,as compared with control group (P ＜ 0.05).Furthermore,Group A had seven cases of severe disability or in vegetable state,but only three cases in Group B (P ＜ 0.05).Conclusion Ventricular intracranial pressure monitoring can effectively reduce intracranial pressure,raise treatment success rate and decline the use of mannitol in management of severe craniocerebral trauma.