Objective: In order to provide references for drawing up related health policy reasonably, the current status of medical insurance payment in third level hospital. Methods: Through analyzing the payment situation of medical insurance in third level hospital from 2010 to 2012, to understand the related situation of gross prepayment system in large publich hospital since this year. Results: In recent years, the coverage rate of health insurance in the whole city is increasing continuously, while the rising extend of annual gross prepayment limit is not obvious, refusal in medical insurance fund is serious and the accounting method of prepay limit is not scientific. Conclusion: While satisfying the quality of patients’ visiting, it needs to implement gross prepay accounting method, enhance medical management and reduce the economic burden of the hospital.

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses for preoperative risk factors were performed. Prolonged length of ICU stay was defined as initial admission to ICU exceeding 72 h. Results The mean age of patients ( 322women and 996 men) was (67.4±9.4) years. Of 1318 patients undergoing isolated CABG from 1997 to 2009, 205 experienced prolonged length of ICU stay. The length of ICU stay was (40.1 ± 22.5 ) hours and ( 122.6 ± 48.7 ) hours separately.Overall in-hospital mortality was higher among these 205 patients ( 13.7% vs. 1.2%, P ＜0.05 ). The overall mortality was 3.1%. In univariate analyses, there were statistically significant differences with respect to the percentage of CPB, total bypass time, cross-clamp time, number of distal anastomoses, use of pressor agent, use of intro-aortic balloon pump,time of ventilation and hospital mortality. The significant risk factors were age, NYHA class Ⅲ/Ⅳ, left ventricular ejection fraction(LVEF) ＜0.40, renal failure, cerebrovascular and/or peripheral vascular disease, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, left main stenosi, three-vessels disease. The variables entered into the multivariate logistic regression were age, NYHA class Ⅲ/Ⅳ, LVEF ＜0.40, renal failure, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, three-vessels disease. According to the outcome of multivariate logistic regression, we can conclude the model of probability forecast and create a new variable named Pre. The area under ROC curve of the new variable Pre was larger than other variables. Conclusion The main risk factors of prolonged ICU length of stay were LVEF ＜ 0.40, recent acute myocardial infarction, renal failure and chronic obstructive pulmorary disease. The AUC of variable Pre was higher than other' s , which indicated that new variable Pre combining each variable was more valuable than single variable with respect to prediction. A predicted probability of 0. 754 was used as cut-off point for the prognostic test.

Objective To find the best sample collecting and template making methods. Methods The multiplex PCR results of three sample collecting methods and eight template making methods in malaria diagnosis were compared. Results Conserved blood sample collecting, and Na 3PO 4 template making were sensitive and simple. Conclusion Conserved blood of sample collecting and Na 3PO 4 in template making are the best methods in multiplex PCR diagnosis of malaria, and are worthy of wide use.

Objective To study the exposure dose-effectiveness of ? irradiation on killing the plasmodium in the mice RBC,for the further exploration on the method that could kill the plasmodium in RBC without affecting the activity and function of normal RBC. Methods After infection with Plamodium yoelii (P.y),blood was collected from mice and exposed to ? irradiation (radiated group). An unirradiated group served as control. In the irradiated group,P.y infected blood was divided into three aliquots,each aliquot was irradiated one time by ? radiation using Gammacell 1000 Elite blood radiation apparatus. The dosage of each aliquot was 25,35 and 45Gy. After irradiation,the blood samples were stored at 4℃. Then mice were inoculated with these irradiated blood stored for 1,3 or 5 days after irradiation,or with unirradiated blood. Two days later,the blood samples were taken from inoculated mice and were examined under microscope and plasmodium infection rates were calculated. Results The mice in the control group had parasitemia much earlier than those in irradiated group (1—2 days),and the plasmodium infection rate in the control group was significantly higher than that in the irradiated group(3.7% vs 0.07%). With increasing dosage of irradiation,the survived plasmodium in blood decreased,and survival of mice increased(8—12 days). After 45 Gy irradiation and 5 day storage at 4℃,there were no plasmodium found in the red blood cell of inoculated mice. In the control group,blood testing result was positive,and all the mice died.Conclusion Plasmodium in mice RBC can be killed effectively when blood is exposed to 45Gy irradiation and stored at 4℃ for 5 days.

Objective To review the experience of perioperative management and effect of coronary artery bypass grafting (CABG) for patients of aged＞80 years.Methods We studied 118 cases with CABG for patients of age＞80 years from January 2002 to December 2012.The other 1034 cases with CABG for patients aged 60-80 years were enrolled as control group.Logistic regression analysis was used to assess the effect of age on operative mortality and morbidity.Results The recent mortality was higher in group aged＞80 years [6.8％(8 cases) vs.3.1％(32 cases)].Through multivariate logistic regression,the patients aged＞80 years versus control were concerned about some postoperative adverse events as follows:higher mortality (OR =3.45,95 ％ CI:2.86-4.23),dialysis (OR=3.56,95％CI:3.01-4.32) and re-intubation(OR=3.87,95％CI:3.45-4.87),delayed healing of incision(OR=4.05,95 ％ CI:3.47 5.74),prolonged mechanical ventilation(OR=3.76,95 ％ CI:3.435.01),prolonged ICU stay (OR =2.98,95 ％ CI:2.67 4.12),prolonged hospital stay (OR =2.87,95％CI:2.36-3.96).Conclusions Age＞80 years is an important factor of postoperative mortality and morbidity for CABG.We need pay more attention to perioperative management.

Objective To compare the outcomes of off-pump versus on-pump CABG.Methods From 2002 to 2008,CABG was performed in 105 patients aged 80 years and over,including 45 without cardiopulmonary bypass (CPB) or off-pump (OP) CABG (OPCAB) and 60 with CPB (onpump CABG).The outcomes were compared between two groups.Results The mean ICU stay was (37.1±30.3) h in OPCAB group and (60.6±58.2) h in on-pump CABG group (P＜0.01).Average ventilator-assisted time was (10.8±9.7) h for OPCAB group versus (22.3±35.7) h for onpump CABG group (P＜0.01).Postoperative atrial fibrillation occurred in 31.1％ of OPCABG patients and 41.7 ％ of on-pump CABG patients (P＜0.01).The mortality rate was 5.0％ in OPCABG group versus 8.3％ in on-pump CABG group (P＜0.05).Conclusions OPCABG is a safe and efficient method of myocardial revascularization in the elderly patients with lower morbidity and complications.

Objective To isolate and identify pancreatic stem cells of Kunming mouse and to observe the differentiation potency of those cells. Methods Pancreas of postnatal Kunming mice were digested by enzymes to isolate pancreatic stem cells. The potency of the cell differentiation was then identified with special marker of cytokeratin 19(CK 19), insulin and glucagons by immunocytochemical staining. Results Few epithelioid cells could be found to survive at the beginning of isolation, but when medium was replaced by that with growth factor, the cells proliferated quickly in fusiform shape and formed colony gradually. The cells were CK 19 immunoreactive positive after transfer of culture. After differentiation induced by high glucose, the cells formed the pancreatic islet like structures. Immunocytochemical staining showed that part of the cells of pancreatic islet like structures were insulin immunoreactive positive and few of the cells were glucagon immunoreactive positive. Conclusion Pancreatic stem cells of Kumming mouse can proliferate when cultured in vitro and have the potency of differentiation into ? and? cells of pancreatic islet.

Objective To observe DAT1 expression in neural stem cells (NSCs) and the effects of DAT1 on the differentiation of NSCs. Methods Eukaryotic expression vectors pEGFP-C1-DAT1 and pcDNA4/hisA-DAT1 were constructed and transfected into NSCs of rat cerebellum by lipofectamine2000. The transfected NSCs were observed by immunohistochemistry under fluorescent microscope. Results The overexpression of DAT1 could increase the number of Mash-1 staining cells and promote the NSCs to differentiate into neuron progenitors, and the high levels of DAT1 in NSCs facilitated the differentiation of neurons. The localizations of DAT1 protein in Mash-1 staining cells and NF 200 staining cells changed. This shift may result from the two distinct inducing factors, FBS and nature differentiation, or distinct stages in differentiation of NSCs. Conclusion DAT1 functions in differentiation of NSCs as a multiprotein combined with distinct transcription factors by virtue of different inducer or varied stage of differentiation.

Objective To review the experience of perioperative management and effect of valve replacement combined with renal dysfunction.Methods 536 cases of valve replacement.According to preoperative glomerular filtration rate(GFR),renal dysfunction was classified as normal in 322 cases,mild in 162,moderate in 40 and severe in 12.Logistic regression analysis was used to assess the effect of preoperative renal dysfunction on operative mortality and morbidity.Results Patients with a lower GFR were older and more likely to have hypertention.They also tended to have larger left ventricular end-diastolic diameter and worse left ventricular ejection factor.Operative mortality rose inversely with declining renal function,from 2％ for those with normal renal function to 17％ for patients with severe renal dysfunction.Renal dysfunction was significantly associated with a large blood transfusions,re-intubation,longer mechanical ventilation,intensive care unit stay and hospital stay.Conclusion Preoperative renal dysfunction is an important factor of postoperative mortality and morbidity for valve replacement.We must pay more attention to perioperative management.