Objective To evaluate the payment effect of hospitalization expense under the urban employee basic medical insurance in Guangzhou.Methods Analyze the differences between the expenses paid by medical insurance with actual hospitalization expenses of the 22 settlement units from 1 5 tertiary hospitals,and the expense settlement data of the insured patients,based on the early,the mid-term,and the recent periods since the urban employee basic medical insurance was implemented since 2002.Results The ratio of good payment effect units reduced to 9.09%(the recent)from 42.86%(the earlier).The ratio of poor payment effect units was 42.86% in the early,to mid-term 18.18%,and sharply increased to 77.27%in the near term.The settlement units which exceeded its flat standard accounted for 52%,50%, and 91%respectively(in the early,the mid-term,and the recent).The medical insurance agency and the hospital shared the overrun costs by 52.88%and 47.12%respectively in 201 1.Conclusion The payment effect of the urban employee medical insurance was greatly influenced by the adjustment of medical insurance policy and the payment ability of the pooling fund.It should improve the payment effect of the medical insurance timely,so as to ensure the hospitals’operation normally.The hospitals should take the effective cost management measures so as to deal with the increasing cost control pressure.

BACKGROUND: Nowadays, aerobic exercise has been a theme of mod ern body-building. Therefore, there are practical significance of under standing and mastering the effect of aerobic exercise on the constitution of body builder in instructing body-building practice. OBJECTIVE: To observe the effect of aerobic exercise on body composi tion, cardiore spiratory function and body figure of female college students. DESIGN: Non-randomized concurrent control experiment. SETTING: China Female College. PARTICIPANTS: The experiment was conducted from May 2003 to Oc tober 2004. 100 female college students were randomly selected from Chi na Female College and other three colleges and taken as the aerobic exer cise group. Another 100 female college students of the same age without systematic aerobic exercise were taken as the control group. METHODS: ①The course for aerobic exercise group were mainly aero bics, ballroom dancing and hexagram boxing, including 5-15 minutes of warming up, 30-45 minutes of aerobic exercise [the target heart rate in (75% maximal heart rate) exercise lasted for at least 15 minutes] and 15-20 minutes of cooling down, which were conducted for 60 minutes each time and twice a week. The exercise should be performed at 2.5 hours before supper for 1.5 years.②Subjects in the control group were not inter fered but kept in same diet and resting time as the aerobic exercise group. MAIN OUTCOME MEASURES: ①Body figure indexes: body height, body mass, chest circumference, waistline, hip circumferences.②Skinfold thickness, fat mass index and lean body mass. ③ Lung capacity, maximal breathing capacity in each minute, stroke volume, cardiac output, ejection fraction, heart rate, ejection time, mean normalized systolic ejection rate (MNSER) and left velocity of circumferential fiber shortening (LVCf). RESULTS: A total of 200 subjects, who had accomplished all tests were involved in the analysis of results. ①The waistline was smaller after exer cise in the aerobic exercise group than that in the control group, while the chest circumference and hip circumferences were bigger than those in the control group (P ＜ 0.05), and the waist-to-hip ratio was smaller than that in the control group (6.50±10.48, 70.39±11.24, P ＜ 0.05). There was no sig nificant difference in body mass index between the two groups (P ＜ 0.05). ②The skinfold thickness in rump, scapular region, thoracic region, abdom inal region as well as femoral region and region of shank were smaller after exercise in the aerobic exercise group than those in the control group (P＜0.05-0.005), and the body fat percentage was significantly smaller than that in the control group [(20.5±3.45)%, (26.5±4.58)%,P ＜ 0.005]. However, the lean body mass in the aerobic exercise group was greater than that in the control group [(41.8±9.86), (36.9±8.69) kg,P ＜ 0.01].③ After exercise, the lung capacity, maximal breathing capacity in each min utes, stroke volume, MNSER and LVCf in the aerobic exercise group were remarkably greater than those in the control group (P ＜ 0.05). CONCLUSION: ①Aerobic exercise can effectively ameliorate the body figure of female college students and coordinate three measurements with each other.②Aerobic exercise can greatly reduce the in vivo fat contents of female students and increase their lean body mass. ③Aerobic exercise can remarkably enhance the lung capacity, pulmonary ventilation volume as well as cardiac functions of blood-pumping and contraction etc. In female college students.

Objective To evaluate the multi-slice spiral CT (MSCT) features of crush pulmonary parenchymal injuries in the massive Wenchuan earthquake. Methods One hundred and seventeen patients with crush pulmonary parenchymal injuries in the massive Wenchuan earthquake were reviewed, the location, extent and MSCT appearances of the injuries and associated thoracic injuries were evaluated. The MSCT appearances of the injuries on 1 d, 2--5 d and 6--14 d were compared using Chi-square test. Results One hundred and thirteen patients had pulmonary contusion and bilaterally in 70 cases, 7 had pulmonary laceration. A total of two hundreds and eighty-three lung lobes were involved and 3 or more lobes involved in 47 patients. Ill-defined patchy opacity was detected in 75 patients, associated ground-glass opacity (GGO) in 24 cases. Lung laceration presented as pneumatocele in 4 cases and demarcated hematoma in 3 cases. Coexisted rib fractures were detected in 98 patients and flail chests were in 29 patients. Forty-three patients had coexisted fractures of scapula, clavicle and (or) sternum. Ninety-nine patients had coexisted pleural injuries. Conclusions Crush pulmonary parenchymal injuries in the Wenchuan earthquake are severe. The bilateral, multifocal and multiple lobes involved injuries with a high incidence of coexisted other severe thoracic injuries are the noticeable features.

Objective To study the effects of the interaction of advanced glycation end products (AGEs) and the receptor of AGEs (RAGE) on apoptosis of mice podocytes. Methods Podocytes were exposed to soluble AGEs such as bovine serum albumin (BSA), carboxymethyl-lysin (CML)-BSA, AGE-BSA and matrix-bound AGEs (AGE-modified collagen Ⅳ ), and to different concentrations of AGE, such as 10 mg/L, 50 mg/L, 100 mg/L. Apoptosis was assessed by TUNEL staining. Fluorescence-activated cell sorting (FACS) was used for the quantification of apoptotic andnecrotic podocytes after Annexin V-fluorescein isothiocyanate (FITC) and propidium iodide (PI) labeling. Apoptosis was described as the ratio of apoptotic cells to the total number cells under the high-power field, siRNA was transfected into podocytes through combining Dharmacon on Targetplus SMART pool siRNA reagents and Amaxa RNAi nucleofection kit. Results The apoptosis rate was higher in podoeytes exposed to either CML-BSA or AGE-BSA than that exposed to BSA. There was a two- to three-fold increase in apoptosis when podocytes were cultured in AGE-modified collagen Ⅳ as compared with native collagen Ⅳ. The apoptotic response of podocytes to AGE-BSA exposure occurred in a dose-dependent manner. Podocyte necrosis occurred only at the highest concentration of AGE-BSA(100 mg/L). AGE-BSA failed to induce apoptosis in podocytes transfected with RAGE siRNA. RAGE-specific gene knockdown did not significantly reduce the apoptosis of podocytes cultured in AGE-modified collagen IV. Conclusions The AGE-RAGE interaction plays a major role in the apoptosis of podocytes triggered by soluble AGEs, but not by matrix-bound AGEs. Reduction of AGE burden and RAGE expression may be important therapeutic approaches to prevent the progression of kidney disease.

Objective To use clustering analysis to help physicians detect abnormal parameters in radiotherapy treatment plans and improve the efficiency of plan verification. Methods From 2010 to 2015, 835 breast cancer treatment plans for using 4?field hybrid intensity?modulated radiotherapy from MOSAIQ were collectted. Fractional dose, beam angle, and monitor unit were used as featured parameters of a treatment plan to generate a dataset. The K?means clustering algorithm based on principal component analysis was used to perform a clustering analysis of the dataset and divide the dataset into different clusters. The outliers of clusters were automatically detected based on the distance threshold. The outlier?contained treatment plans were manually verified by physicians to determine the accuracy of clustering analysis in detection of abnormal plans. Results In the clustering analysis, the sample space composed by parameters of treatment plans for breast cancer was divided into 4 clusters, 3 of which had outliers detected. In the targeted treatment plans, 3 plans became outliers because of special target volume and the other 4 plans needed improvement. Conclusions Clustering analysis is effective to help physicians to independently verify treatment plans.

Objective To investigate the effect of sevoflurane on blood pressure in patients with different ages and the optimal concen-tration of sevoflurane. Methods 60 patients underwent selective LC operation with conventional induction and sevoflurane maintenance were divided into three groups:the youth group (34 patients), the middle age group (20 patients) and the older age group (6 patients). The SBP, DBP, MAP, CETsev, number of patients, age of patients before induction and 10 min(T1), 20 min(T2), 30 min (T3), 60 min (T4) after induction were recorded. Results Fluctuate of blood pressure were in the normal range after anesthesia maintenance, and MAP were fluctuated within the range of ± 20% before induction. The age under different CETsev were of no significant difference in each time point (P>0. 05). The age composition ratio in different CETsev were of no significant difference in each time point (P>0. 05). As the time of anesthesia extended, the number of patients under 0% ~1%CETsev decreased from 35 to 11; the number of patients under 1% ~2%CETsev increased from 10 to 20;and the number of patients under 2% ~3%CETsev maintened in 14 approximately. Conclusion The effect of sevoflurane on blood pressure of different ages is approximate. 2% ~3% CETsev is the most optimal concentration during the main-tenance of anesthesia.

AIM: To explore the patterns of the usage of traditional Chinese medicines in prevention and treatment of osteoporosis (OP) so as to give full play of their superiority, in view of the drawbacks of the severe toxic side-effect,the doubtful long-term therapeutic effect and the expensive drug cost in the western study of therapy of OP.METHODS: To study the patterns of the use of traditional Chinese medicines in prevention and treatment of OP, correlative data between 1979 and 2002 were collected, and statistical analysis was performed on 208 prescriptions (totaling 1 522 counts of herbs) of confirmed efficacy,which were prescribed by experts and renowned Chinese medical practitioners. Special attention was placed on the 127 herbs that were prescribed most frequently. Their uses and collocations were analyzed with the aim to reveal their medical regularities.RESULTS: [1] In treating OP, the principle should be using drugs that were able to nourish liver and kidney, cultivating blood and essence, and strengthening sinews and bones as the mainstay, and supplementing them with drugs that were able to activate blood and remove blood stasis, dredge collaterals to relieve pain, and dispel wind and eliminate dampness. More than 10 classes of drugs had been used, including tonics, drugs that activated blood and removed blood stasis, drugs that cleared excess heat, drugs that cleared excess wind and dampness, drugs that regulated flow of qi,drugs that eliminated dampness through diuresis, drugs for indigestion, and drugs that soothed liver and stopped endopathic wind. The tonics and drugs activating blood and removing blood stasis were used most frequently, accounting for 69.71% and 15.67% respectively. Among the tonics, the most frequently used (＞ 50 in 422 counts) were Herba Epimedii, Cortex Eucommiae, Radix Astrag ali and Fructus Psoraleae. Among drugs of activating blood and removing blood stasis, prepared rhizome of RadixRehmanniae, Radix Angelicae sinensis and Radix Salviae Miltiorrhizae were used most frequently. [2] It was showed that the property of herbs used to treat OP was mainly warming, and a small number of them calming character. Flavour of the drugs was chiefly sweet and pungent, and a small number of them had bitter and salty flavours; Channel tropism of the drugs was classified under liver primarily, and a small number of them classified under heart, spleen and lung. The main functions of the most frequently used 16 herbs were chiefly tonifying liver and kidney, strengthening sinews and bone, activating blood and alleviating pain. There were many literatures reporting Herba Epimedii, Radix Rehmanniae, Radix Astragali, Cortex Eucommia, and Fructus Psoraleae about their applications in the treatment of OP. Through clinical trials and animal studies, it was proved that these herbs had steroid-like actions, and antibacterial, anti-inflammatory,pain-killing, smooth-muscles relaxing, anti-platelet aggregation, vasodilation, enhancing immune system actions, etc. [3] Treatments were on the basis of rectifying deficiency as the primary, and rectifying excess as the secondary. Totally 45 kinds of yang tonic, accounting for 40.04% were selected firstly. This category of all the herbs was classified under the channel tropism of kidney. Of 18 kinds of yin tonic, accounting for 32.73%, amounted to 403 herb counts (38.24% of the total employment of tonic). This kind of drugs was classified under the kidney and liver channel tropism. Ten kinds of qi tonics, accounting for 18.18%, amounted to 189 herb counts(17.93% of the total employment of tonic). This kind of drugs was classified under the spleen channel tropism. Six kinds of blood tonics, accounting for1.09%, amounted to 40 herb counts (3.79% of the total employment of tonic). Therapy should be supplemented with herbs that enrich blood.CONCLUSION: Treatment of OP should place prime emphasis on replenishing deficiency, and supplementing it with removal of blood stasis. It is also advocated that replenishing deficiency of kidney is beneficial to producing essence and nourishing liver; replenishing deficiency of bone is beneficial to invigorating the spleen and activating blood and so on. Yang tonic is selected firstly, then yin tonic, qi tonic and blood tonic.

Objective:To prepare a bone substitute using microsphere scaffold containing adiponectin(APN)and to investigate the release behavior of the scaffold in vitro.Methods:Chitosan microsphere was developed by an emulsion-ionic cross-linking method. Poly (L-lactic-co-glycolic)acid (PLGA)and β-tricalcium phosphate (β-TCP)were used to prepare microsphere scaffold containing APN.The morphology,particle size,drug loading,incorporation efficiency and release behavior of the microsphere were examined. Results:The APN containing microsphere showed good spherical geometry,suitable size and microporosity under scanning electron microscope.The average diameter of the milipore was 20 -200 μm;the drug loading and incorporation efficiency were 1 .3% and 70.3% respectively.The controled-release process continued for 91 days.The extract solution from the APN microsphere-scaffold promoted MC3T3 cell proliferation without cytotoxicity.Conclusion:The APN microsphere-scaffold has sustained release function and may promote osteoblast proliferation.

Objective:To report a rare case of early onset epileptic encephalopathy caused by YWHAG gene mutation, and discuss the clinical and genetic characteristics as well as the diagnosis, treatment and prognosis of the disease.Methods:Clinical data of the patient with YWHAG gene deficiency from Department of Neurology, Children′s Hospital Affiliated to Zhengzhou University were collected in January 2018. The whole exome sequencing was performed on the core members of the family, and the characteristics of gene mutations were analyzed.Results:The proband is a girl, three years and 10 months old, presented to the outpatient department of neurology with a history of six-month intermittent convulsions, manifested as epilepsy seizures, mental retardation, motor delay and gait instability, ataxia. The brain magnetic resonance imaging showed myelinated dysplasia, and long-term video electroencephalogram (EEG) showed extensive 1.5-3.0 Hz slow spikes, and multiple spikes during sleep. During the monitoring, the children had clinical seizures and abnormal EEG discharges, indicating that myoclonus was accompanied by atypical absence of consciousness. Whole exome sequencing on the proband detected a de novo mutation c.169C>T (p.Arg57Cys) in YWHAG gene. According to American College of Medical Genetics guidelines (2015), the mutation was considered potentially pathogenic.Conclusion:Early epileptic encephalopathy caused by YWHAG gene mutation is very rare, and the variation of YWHAG gene c.169C>T is the possible pathogenic variation of the genetic cause of early onset epileptic encephalopathy in the proband.