Objective:To analyze the pay for performance related costs and provide suggestions for further stud-y. Methods:Empirical literatures from inside the country and overseas were collected with a systematic review. Costs were summarized on the basis of three drivers ( performance appraisal, performance improvement and incentive per-formance) . Results:A total of 141 papers, 47 in Chinese and 94 in English were enrolled. Most papers in Chinese were subjected on healthcare facilities while the English ones emphasized on hospitals. Pay for performance may lead to the healthcare service costs, regulation costs and the resources allocation related costs reduction. In addition to these visible costs, a large amount of others hidden from different hospital management levels were also due to pay for performance. Conclusions:(1) Differences in costs could be found from home and overseas experience which per-haps resulted from the pay for performance, the supporting measures and the policy development. (2) More attention should be paid to the quantification researches on the health facilities’ hidden costs. (3) Most available researches fo-cus on pay for performance cost-effectiveness from the society and service purchase but not the providers’ perspective and the hidden costs were also ignored.

Objective To present one case of bronchial artery aneurysm successfully treated with endovascular interventional procedure and review literature. Methods A 67-year-old man was diagnosed with mediastinal bronchial artery aneurysm accompanied with tuberculous pleurisy by chest imaging. The aneurysm was treated via transcatheter bronchial artery embolization combined with endovascular stent-graft placement in the thoracic aorta under DSA guidance. Results Postprocedural angiography showed satisfactory exclusion of the aneurysm and no endolead. Conclusion Interventional therapeutic management of bronchial artery aneurysm is feasible and accurate.

Background Diabetic retinopathy (DR) is a common complication of diabetic mellitus,but its pathogenesis is still unclear.Adiponectin may restrain inflammatory reaction and reduce adhesion of vascular endothelial cell to influence diabetic microangiopathy.Relation between adiponectin and nitric oxide synthase (NOS)is less reported.Objective This study was to observe the effect of adiponectin on the expression of NOS in the retinas of diabetic rats.Methods Forty 8-10 weeks Sprague-Dawley (SD) female rats were collected.The rats were randomized into the normal control group (10 rats),adiponectin group (15 rats) and diabetic model control group (15 rats) using the random number table method.Tetraoxypyrimidine was intraperitoneally injected to establish the diabetic model in the rats of the adiponectin group and diabetic model control group,and 10 μg/kg of adiponectin was then injected into the rats of the adiponectin group.Western blot was used to detect the expression of the adiponectin protein in the rat retinas,and the expression of NOS in rat retina was located by immunochemistry.The use of the animals complied with the Regulations for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission.Results The relative amount of adiponectin (adiponectin/β-actin)in the retinas was 0.85 ± 0.21,0.79 ± 0.17 and 0.42 ± 0.08,respectively,in the normal control group,adiponectin group and diabetic model control group,with significant differences among the 3 groups (F =4.236,P =0.000).The adiponectin/β-actin ratio in the retinas of the diabetic model control group was significantly declined in comparison with the normal control group and adiponectin group (q =6.615,P =0.000 ; q =6.026,P =0.000).The NOS levels (A value) in the retinas were 0.244 ± 0.035,0.262 ± 0.032 and 0.367 ± 0.066,respectively,in the normal control group,adiponectin group and diabetic model control group,showing a significant difference among them (F =3.752,P =0.001).The A value of NOS in the diabetic model control group was significantly increased in comparison with the normal control group and adiponectin group (q =3.488,P =0.002 ; q =3.079,P =0.005).NOS expression was localized to the inner nuclear layer and retinal ganglion cell layer.Conclusions Adiponectin reduces NO content in diabetic rat retinas by regulating NOS expression.

BACKGROUND: Central oxytocin (OT) may be a neurotransmitter or neuromodulator and play an important role in learning and memory, sexual behaviour, pain modulation and opiate tolerance and dependence. To research the interactions between oxytocinergic and opioidergic system in hippocampus has some significance.OBJECTIVE: To investigate the effects of OT administered intracerebroventricularly on evoked discharge of left dorsal hippocampal CA1 neurons in rats and the possible interactions between oxytocinergic and opioidergic system.DESIGN: A randomised controlled study.SETTING: Department of Physiology of Guangdong Medical College; Department of Physiology and Pathology of Medical College of Wuhan University.MATERIALS: The study was conducted in the Physiology Department of Medical College of Wuhan University from September 2002 to September 2003. A total of 36 male Sprague-Dawley rats were selected and randomly divided into six groups: control (NS), OT groups (0.2 mg/L, 2 mg/L and 20 mg/L), [d (CH2)5-OVT]+OT (2 mg/L), naloxone+OT (2 mg/L), with 6 rats in each group.METHODS: Single-unit recording was performed with glass microelectrode. The glass microelectrode was inserted by a micromanipulator into hippocampal CA1. The electrical activity was amplified by a microelectrode amplifier and then recorded by the biological experimental system,monitored at the same time with oscilloscope. When recording the neural discharge, electrical stimulation of the sciatic nerves was performed once 5minutes through a double stainless electrode. 5 μL oxytocin in dosage of 0.2, 2 and 20 mg/L were injected slowly into lateral ventricle via microlitre syringe. [d(CH2)5-OVT]+OT (2 mg/L) group: 2.5 μL [d(CH2)5-OVT](80 mg/L) was injected into lateral ventricle and then 2.5 μL oxytocin (2 mg/L). Naloxone+OT (2 mg/L) group: 2.5 μL naloxone (400 mg/L) was injected into lateral ventricle and then 2.5 μL oxytocin (2 mg/L). According to frequency of discharge, effect of oxytocin at various dosages on discharge induced by neurons in hippocampal CA1 area and [d (CH2)5-OVT]and naloxone on oxytocin was assayed. MAIN OUTCOME MEASURE: Changes of discharge frequency after stimulation.RESULTS: Data of totally 36 rats were entered the final analysis. ① OT (0.2 mg/L, 2 mg/L and 20 mg/L) administered by intracerebroventricularly could decrease the evoked discharge of hippocampal CA1 neurons in a dose-dependent manner. ② The inhibitory effects of OT (2 mg/L) could be blocked by pretreated intracerebroventricularly injection of [d (CH2)5-OVT](80 mg/L, 2.5 μL). ③ Intracerebroventricular injection of naloxone (400 mg/L, 2.5 μL) could attenuate the effects of OT (2 mg/L) significantly.CONCLUSION: OT can inhibit the electrical activities of hippocampal CA1 neurons to external electrical signal through activating the oxytocin receptor. Moreover, central opioid receptor is involving in the inhibitory effects of OT.

The body is exposed to various organic anions,so it is the best way to remove the toxic substances in the body quickly and effectively.Cross epithelial active transport mediated by organic anion transporter is the rate limiting process.Renal secretion and re-absorption of a variety of endogenous and exogenous organic anions are occurred in the proximal tubular epithelial cells of the organic anion transporter family.The expression of organic anion transporter-1 (OAT1) in proximal tubular epithelial cells plays an important role in the introduction of organic anion into the renal tubular epithelial cells.This article reviewed the renal expression,the substrate and the polymorphism of the organic anion transport protein OAT1,the renal toxicity of adefovir dipivoxil,the interaction between organic anion transporters and drug,and the influence of the renal toxicity on the renal toxicity of adefovir dipivoxil.

OBJECTIVE:To provide reference for the clinical rational application and preventing the adverse reactions of hy-droxyethyl starch(HES). METHODS:The HES application of inpatients in a hospital in Jul. 2014 were retrospectively analyzed, the usage and dosage,indications,and the changes of renal functions and blood coagulation function before and after HES treat-ment were detected,and the application rationality was evaluated. RESULTS:The usage of HES in the hospital was hydroxyethyl starch 200/0.5 and Sodium chloride injection,which was the second generation of HES. In the 347 patients,295 patients had moni-tored the renal functions before the HES treatment,the result was normal;and 21 patients had monitored the renal functions after HES treatment,the result was normal. Meanwhile,326 patients had monitored the blood coagulation functions before and after HES treatment,the results were normal. HES was not used for the patient of severe sepsis,renal dysfunctions and coagulopathy in this hospital. CONCLUSIONS:The application of HES can induce renal damage and coagulation disorder,so relevant indicators should be closely monitored before and after treatment to prevent the incidence of adverse reactions;further more,clinicians should strictly handle indications,usage and dosage and precautions during the clinical application;in addition,it is suggested to replace the second generation of HES by the third generation,which is more safer.

0.05)between left AF(238,36.62%)and right AF(220,33.85%).More HIZs(446,68.62%)were located in inferior AF than that of middle or superior AF.The motion segments from L3、4 to L5S1 were the region that the HIZ occurred frequently and it could present in single segment or multi-segment.In anterior AF,HIZs often occurred at L2、3 and/or L3、4 discs.Whereas,they usually developed at L4、5 and/or L5S1 in posterior AF. Conclusion The incidence rate of HIZ in lumbar disc is higher.Posterior and inferior AF of discs and lower motive segments have more risk of HIZs.It could develop in single motive segment or multi-segments at one time.

Objective To evaluate the clinical efficacy of transthoracic two dimensional echocardiography, cardioangiography (CAG), and MRI in the diagnosis of cor triatriatum. Methods Twelve cases of cor triatriatum were confirmed by operation. Imaging examination was performed in 12 cases by transthoracic two dimensional echocardiography, 6 cases by CAG, and 8 cases by MRI. Results The diagnostic accuracy of cor triatriatum was 7 out of 12 by UCG, 4 out of 6 by CAG, and 8 out of 8 by MRI, respectively. MRI provided excellent delineation of the intraatrial membrane and the size of the membrane orifice. Conclusion MRI was of great value in the diagnosis of cor triatriatum.

Objective To observe the changes of the content of ATP,lactate and the activity of phosphofructokinase(PFK) in perihemotoma region in rabbit brain after intracerebral hemorrhage. Methods(The rabbits) were divided into 3 groups: normal group(N),hemorrhage group (H) and the sham group(S). The H and S groups were subdivided into 1 h, 6 h, 12 h, 24 h, 48 h and 72 h groups. A model of cerebral hemorrhage in rabbit with autologous blood infusion was set. The contents of ATP, lactate and water in perihemotoma region were measured and the metabolite concentration in edematous brain regions were corrected for dilution. The activity of phosphofructokinase was also determined.Results There was obvious edema in perihemotoma region at 1 hour postinfusion and getting more serious at 72 hours. ATP was moderately decreased at 1 hour, and remained in a similar level until 12 hours. There appeared another evident decrease in 24 hours [(13.29?2.92) ?g/g, about 58% of N group], and no obvious changes from 24 to 72 hours. The content of lactate increased in 1 hour and reached the peak at 12 hours [(21.01?0.18) ?mol/g]. Until 72 hours , the level of lactate [(12.89?0.25) ?mol/g] in hemorrhage group reach higher than in the normal and sham group. The activity of phosphofructokinase was decreased at 1 hour [(3.98?0.02) U/mg] and remained in a decreasing tendency to 72 hours. Conclusion The failure of energy metabolism occurs in 24 hours postinfusion,coming late somewhat to the brain edema. The result might be related to the changes of some enzymes, maybe a key role in energy metabolism.