Objective To evaluate the effect of the comprehensive reform of medical prices of traditional Chinese medicine hospitals in Jiangsu Province,to provide empirical support for the effectiveness of the reform of government drug prices,and to provide suggestions for further deepening the reform.Methods Based on the effect model of Wei Tang's public policy evaluation model,according to the comprehensive reform goal of medical price,analyzing the effect before and after the implementation of the policy.Results After the reform,the financial subsidy income,medical insurance income and service income have increased,the proportion of drug revenue has dropped by 3.3％,and some medical control fee indicators have reached the policy standards,but the asset liability ratio has increased.Conclusion The reform has achieved some initial results.The income compensation is basically reasonable,but still not enough.The income structure is obviously optimized.The control of medical expenses has improved,but it has not reached the ideal state.

Controlled clinical trials of integrative therapies available to patients with rheumatoid arthritis (RA) improved dramatically in the past 20 years, largely because of the growing need and the methodologies improvement. Tripterygium wilfordii Hook. F., a typical example of popular use herb, has been extensively studied in trials. However, clear and convincing evidence of integrative therapy, effectiveness and safety, remains insufficient to make decision. Many research efforts are hampered by standing problems with 'syndrome' recruitment failure. In addition, the outcome multiplicity induces the findings inefficiency to generalize to RA patients at large. Development of validated syndrome outcomes and methodologies has also been critical. Current efforts to enhance the understanding of integrative treatment options for patients with RA include the development of drug-specific rather than disease-specific strategies, studies in predictive biomarkers, and development of peer-review trial protocol for regular clinical trials.
Antirheumatic Agents ; adverse effects ; therapeutic use ; Arthritis, Rheumatoid ; drug therapy ; Clinical Trials as Topic ; Humans ; Integrative Medicine ; Tripterygium ; chemistry

BACKGROUNDChemokines and their receptors have been a research focus in transplantation immunology. Chemokines and their receptors play a role in lymphocyte recruitment and differentiation process. This study aimed to observe whether IL-4 and IL-10 may regulate the expression of chemokine receptors CCR3, CCR5 and CXCR3 on CD4(+) T cells in CBA/JxDBA/2 mouse model and to explore the role of CCR3, CCR5, CXCR3 in immune tolerance in pregnancy.

METHODSThe mouse model of spontaneous abortion (CBA/JxDBA/2) and the normal pregnant mouse model (CBA/JxBALB/c) were used. CBA/JxDBA/2 mice were injected with IL-4 (CBA/JxDBA/2-IL-4), IL-4 and IL-10 (CBA/JxDBA/2-IL-4+IL-10), or normal saline (CBA/JxDBA/2-NS) as a control. The expression of CCR3, CCR5 and CXCR3 on CD4(+) T cells from mouse peripheral blood was measured by the double-labelled FCM method, and the embryo resorption rate was also examined.

RESULTSThe embryo resorption rate in the CBA/JxDBA/2 group without any treatment was significantly higher than that in the CBA/JxBALB/c group (17.9% vs 3.7%, P < 0.01). The embryo resorption rate in the CBA/JxDBA/2 group immunized with IL-4 or IL-4 together with IL-10 was significantly decreased, compared with that in the control and NS groups respectively. CCR3 expression on CD4(+) T cells in the CBA/JxDBA/2 group without any treatment was significantly lower than that in the CBA/JxBALB/c group (0.3738 +/- 0.3575 vs 1.2190 +/- 0.2772, P < 0.01); both CCR5 (3.0900 +/- 1.5603 vs 1.2390 +/- 0.6361, P < 0.01) and CXCR3 (2.4715 +/- 0.9074 vs 0.9200 +/- 0.5585, P < 0.01) expressions on CD4(+) T cells of the CBA/JxDBA/2 group without any treatment were significantly higher than those of the CBA/JxBALB/c group. Significant up-regulation of CCR3 and down-regulation of CXCR3 were found in the CBA/JxDBA/2 group treated with IL-4 (CCR3: 2.0360 +/- 0.6944, CXCR3: 1.3510 +/- 0.5263, P < 0.01) or IL-4 and IL-10 (CCR3: 1.8160 +/- 1.0947, CXCR3:1.0940 +/- 0.7168, P < 0.01). Because of the CCR5, IL-4 and IL-10 (1.9400 +/- 0.8504 vs 3.0900 +/- 1.5603, P < 0.05), but IL-4 alone (2.5310 +/- 1.3595 vs 3.0900 +/- 1.5603, P > 0.05) treatment significantly decreased the expression of CCR5 in CBA/JxDBA/2.

CONCLUSIONSThe abnormal expression of CCR3, CCR5 and CXCR3 on CD4(+) T cells may play an important role in the pathogenesis of spontaneous abortion. The pregnancy immune tolerance may be induced through selective induction of CCR3, CCR5 and CXCR3 expressions by IL-4 together with IL-10.

Animals ; CD4-Positive T-Lymphocytes ; drug effects ; metabolism ; Cells, Cultured ; Embryo Loss ; metabolism ; Embryo, Mammalian ; Female ; Interleukin-10 ; pharmacology ; Interleukin-4 ; pharmacology ; Mice ; Mice, Inbred BALB C ; Pregnancy ; Receptors, CCR3 ; metabolism ; Receptors, CCR5 ; metabolism ; Receptors, CXCR3 ; metabolism

OBJECTIVETo investigate the effect of acupoint injection of oxymatrine (OM) on experimental hepatocellular carcinoma and the mechanism.

METHODSThe rats of hepatocellular carcinoma induced by 2-acetoaminoflurence (2-AAF) were randomly divided into a normal control group (group N), a model group (group M), a control group of oxymatrine intraperitoneal injection (OM ip group) and a treatment group of small dose oxymatrine injection into Zusanli (OM ZSL group). At the end of 12h week, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (gamma-GT) were determined. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expressions of cyclin D1 and cyclin-dependent kinase 4 (CDK4) mRNA in hepatocellular carcinoma tissues.

RESULTSThe number of cancer nodes on the surface of liver in th Om ip group and the Om ZSL group was lower than in the group M, with the serum ALT, AST, and gamma-GT levels significantly decreased (P<0. 01), and significantly inhibited expressions of cyclin D1, CDK4 mRNA (P<0. 01).

CONCLUSIONOM ip and small dose oxymatrine injection into ZSL can treat or delay hepatocarcinogenisis of hepatocellular carcinoma induced by 2-AAF. Partial mechanism of this anti-carcinoma is protecting hepatocytes possibly through improving hepatic functions, and inhibiting excessive proliferation of liver cancer cells via inhibiting the expressions of cyclin Dl, CDK4 mRNA.

Acupuncture Points ; Alanine Transaminase ; blood ; Alkaloids ; administration & dosage ; Animals ; Aspartate Aminotransferases ; blood ; Cyclin D1 ; genetics ; Cyclin-Dependent Kinase 4 ; genetics ; Injections ; Liver Neoplasms, Experimental ; drug therapy ; Male ; Quinolizines ; administration & dosage ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; gamma-Glutamyltransferase ; blood

Objective To explore the specific model of preoperative psychological nursing of patients in minimally invasive spine surgery in one-day hospital ward. Methods The characteristics of preoperative psychological nursing of 584 patients in minimally invasive spine surgery in one-day hospital ward were summarized and effective psychological nursing were performed on them. Results Patients under the local anesthesia could initiatively cooperate in the surgery, recognize the outcomes of operations and accept training at home after surgery. Conclusions Good perioperative psychological nursing can effectively promote the surgical safety, help patients to build confidence, improve their initiative in the operation and surgical efficacy, increase patients' satisfaction.

Background Visual impairment influent the life quality of patient and bring about the economical burden to their families and society.Epidemiology survey of the prevalence and main causes of visual impairment is the basis of the prevention of blindness.Objective The goal of this survey was to investigate the visual impairment in the subjects aged 40 years or older living in Shunyi district and assist in the design of intervention programs.Methods A cross-sectional survey was performed in this study.Cluster sampling was used to randomly select 4549 individuals aged ≥40 years in Shunyi district,and visual impairment was evaluated based on WHO criteria and analyzed based on the 10-year interval groups.The questionnaire,best corrected visual acuity (BCVA)and comprehensive eye examination were provided for eligible residents.To evaluate the independentassociation of significant sociodemographic variables with visual impairment,a regression model was constructed including age,sex and education level.This study was approved by the Ethic Committee of Peking University Medical Department.Written informed consent was signed by each subject before any medial survey.Results A total of 4167 subjects participated in this survey with the response rate of 91.6％.The age of the subjects ranged from 40-94 years(mean:56.61±11.10 years).The numbers of visual impairment was 161 with the prevalence 3.9％.Trend x2 test showed that the number and percentage of visual impairment were elevated as the increase of age,showing a significantly difference among different age groups(x2 =159.487,P＜0.01).The prevalence rate of visual impairment in 70 and older group was 15 times more than that of 60-69-year-old group(OR =0.114,95％ CI:0.056-0.234).No significant difference was found between gender and prevalence of visual impairment(OR =0.901,95％ CI:0.627 -1.295).The prevalence rate of visual impairment in illiterate group was 5.5 fold more than that of educated group (OR =2.743,95％ CI:1.830-4.111).Conclusions Ageing and low education degree are the important factors of visual impairment.Education attainment is an independent protective factor of visual impairment.

Background There are no noticeable symptoms in early stages of diabetic retinopathy(DR)and the detection of presymptomatic DR remains challenging. Therefore, data on the prevalence and progress of DR will help in prevention and treatment programs in China. Objective This study was to survey the prevalence and risk factors of diabetic retinopathy( DR ) in a population aged 40 years or older in the Shunyi district of Beijing city.Methods A cross-sectional study was designed. Cluster sampling was used to randomly select 4167 (91.6%)individuals aged ≥40 years in 24 clusters in the Shunyi district of Beijing city in China. The Questionnaire data,including general information, living habits, present history, past history, family history, education level etc., were obtained from each subjects. The height, body weight and blood pressure were examined, and slit-lamp examination, direct ophthalmoscopy,indirect ophthalmoscopy and nonmydriatic fundus photography were performed during the study duration. Diabetic mellitus (DM)was diagnosed and graded according to the criteria of Early Treatment Diabetic Retinopathy Study Research Group(ETDRS). The associated factors with DR were analyzed byx2 test,trend x2 test,and multivariate Logistic regression analysis. This protocol was approved by the Ethic Committee of Peking University. Informed consent was obtained from each individual prior to the survey. Results A total of 4167 ( 91.6% )individuals were examined from the 4549 samples with a response rate of 86. 4%. This study showed a prevalence of 29. 2% for DR, 5.4% for sight-threatening diabetic retinopathy ( STDR), and 1.3% for prolifrative retinopathy (PDR) in type 2 DM subjects. Of the type 2 DM subjects,0. 4% (4/445)had social blindness( VA＜0. 1 ) ,and 6. 3% (28/445) presented with visual impairment (VA ＜ 0. 3 )in bilateral eyes. Univariate Logistic regression analysis indicated that insulin therapy ( P = 0.011 ) and lower body mass index ( BMI, kg/m2 ) ( P = 0. 022 ) appeared to be significantly associated with DR, and the multivariate Logistic regression analysis demonstrated that longer duration of diabetes( P＜ 0. 01 ) , increased fasting glucose ( P ＜ 0.01 ) and lower education level ( P = 0. 031 ) were significant independent predictors of DR. Conclusion The prevalence of DR is lower among diabetic Chinese aged ≥ 40 years than those of matched population in Western countries. Lower BMI and insulin therapy were the significantly associated factors of DR, and a longer duration of disease and higher fasting glucose level are independent risk factors of DR. Education attainment is important for the DM patients as a protective factor of DR.

OBJECTIVETo study the clinicopathologic features of uterine papillary serous carcinoma (UPSC) and the roles of adjuvant therapy.

METHODSSixty-one cases of UPSC with operation done and followed up for a period of 4 to 9 years were enrolled into the study. The histology of slides specimens were reviewed and immunohistochemical study was performed. The follow-up and survival data were analyzed.

RESULTSAll of the 61 patients were post-menopausal, with a median age of 68 years. The clinical presentations included abnormal vaginal bleeding, abdominal symptoms and abnormal Pap smears. The median size of the tumors was 7.5 cm (range=1.2 to 14.8 cm). There were 27.9% cases in FIGO stage I (8.2% in stage IA, 14.8% in stage IB and 4.9% in stage IC), 9.8% in stage II, 32.8% in stage III and 29.5% in FIGO stage IV. The histologic features were similar to those of the ovarian counterpart, with tumor cells containing the high-grade nuclei and arranged in complex papillae. Psammoma bodies were identified in 24.6% of the cases. Immunohistochemical study showed that the tumor cells demonstrated diffuse and strong nuclear staining for p53 and Ki-67. They were negative for estrogen receptor and progesterone receptor. Fifteen of the 61 cases (24.6%) showed no evidence of myometrial invasion. However, ten of the 15 cases had extrauterine disease, with peritoneal (6/15) and nodal (9/15) involvement. Tumors with deep myometrial invasion, lymphovascular permeation and nodal metastasis were associated with worse prognosis by univariate analysis. Fifty-six patients received adjuvant therapy. The number of patients receiving adjuvant chemotherapy alone, adjuvant radiotherapy alone and combined adjuvant chemotherapy/radiotherapy were 42, 24 and 10, respectively. The median survivals of the chemotherapy group and non-chemotherapy group (with or without radiotherapy) were 66.4 months and 32.8 months, respectively.

CONCLUSIONSUPSC has distinctive clinical and pathologic features. The tumor stage, lymph node status, lymphovascular permeation and depth of myometrial invasion were important prognostic factors. Adjuvant chemotherapy for stage III/IV tumors or recurrent UPSC may have survival benefit.

Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Papillary ; drug therapy ; pathology ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Cystadenocarcinoma, Serous ; drug therapy ; pathology ; radiotherapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Menopause ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Radiotherapy, Adjuvant ; Survival Rate ; Uterine Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery

OBJECTIVEIn this study, a growing rat model of zinc deficiency was established to investigate the effect of zinc deficiency on intestinal mucosal morphology and digestive enzyme activity as well as to provide a scientific basis for zinc supplementation therapy in patients with diarrhea.

METHODThree-week-old weaned Sprague-Dawley male rats (n = 30) were randomly divided into 3 groups with 10 in each: rats in the control group (ZA) were fed with a normal diet containing 30 µg/g zinc; rats in the zinc deficient group (ZD) were fed with a zinc-deficient diet containing 0.4 µg/g zinc (refer to AIN-76 formula); and rats in the paired fed group (PF) were fed with a normal diet, but the food intake was limited to intake of rats in ZD group in the previous day. All rats were provided with deionized water for drinking. Their body weight was measured and the food intake during the previous day was recorded early in the morning of the following day. Symptoms of zinc deficiency, such as anorexia, diarrhea, dermatitis, and growth retardation, were observed. Two weeks later, the rats were sacrificed and serum zinc concentration was measured. Jejunal mucosa was taken for biopsy and was stained with hematoxylin and eosin (HE). The height ratio of the jejunal mucosal villi and crypts was measured. In addition, the activity of lactase in the jejunal mucosal brush border, γ-glutamyl peptidase (GGT), and aminopeptidase N (APN) were measured.

RESULTThe average weight of the rats in the ZA, ZD, and PF groups at the beginning of the experiment was (67.4 ± 5.3) g, (64.7 ± 4.8) g, and (66.5 ± 4.1) g, respectively, and the average daily food intake was (11.2 ± 1.0) g, (11.6 ± 1.6) g, and (11.2 ± 1.4) g, respectively. The intergroup differences were not significant. On the 7(th) day of experiment, no significant differences in average food intake were observed between the ZD group and the ZA and PF groups, but the average body weight in the ZD group was significantly lower than that in the ZA and PF groups (P < 0.01). At the end of the experiment (2 weeks), the average weight in the ZD group (112.0 ± 11.5) g was significantly lower than that in the ZA (164.0 ± 15.9) g and PF groups (137.5 ± 16.2) g. The average food intake in the ZD group (13.4 ± 5.1) g was significantly lower than that in the ZA group (18.2 ± 2.4) g (P < 0.01). Serum zinc level in the ZD group (733 ± 231) µg/L was significantly lower than that in the ZA (1553 ± 159) µg/L and PF groups (1457 ± 216) µg/L (P < 0.01). The height ratio of jejunal mucosa villus and crypt in the ZA, ZD, and PF groups was 2.98 ± 0.5, 2.77 ± 0.5, and 2.81 ± 0.7, respectively, and lactase activity was (26.1 ± 15.0) U/mg, (27.4 ± 12.8) U/mg, and (40.8 ± 18.5) U/mg, respectively, without significant intergroup differences. The GGT activity in the jejunal mucosa in the ZD group (12.7 ± 6.5) U/g was significantly lower than that in the ZA (19.1 ± 10.4) U/g and PF groups (18.5 ± 7.7) U/g, but the difference was not significant. The activity of APN in the jejunal mucosa in the ZD group (25.5 ± 7.5) U/g was significantly lower than that in the ZA (48.7 ± 16.8) U/g and PF groups (43.9 ± 14.5) U/g (P < 0.01).

CONCLUSIONZinc deficiency can cause loss of appetite, weight loss, and decreased activity of peptidase in the jejunal mucosal brush border. Zinc deficiency has little effect on the height ratio of the villus and crypt and lactase activity, thereby indicating that zinc deficiency may first affect protein digestion and absorption.

Animals ; Intestinal Mucosa ; enzymology ; metabolism ; pathology ; Jejunum ; metabolism ; pathology ; Lactase ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Zinc ; deficiency

BACKGROUNDImplantation of tissue-engineered scaffolds is one of the most promising therapeutic strategies for inducing nerve regenerations following spinal cord injuries. In this paper, we report a novel bioengineered hybrid scaffold comprised of three major extracellular matrix (ECM) proteins.

METHODSECM-scaffolds (ECM-S) were prepared by gelling fibrinogen, fibronectin and laminin using fresh rat plasma. Olfactory ensheathing cells (OECs) were isolated from fresh rat olfactory mucosa, purified under differential adhesion, and assessed by immunofluorescent staining. OECs were seeded onto ECM-S and cultured. The effects of the scaffolds on the seeded cells were detected using the immunofluorescent staining, Western blotting, scanning electron microscopy and transmission electron microscopy.

RESULTSTissue-engineered ECM-S could be easily molded into mat-like or cylindrical shapes and gelled by addition of fresh plasma. Observations by electron microscopy show that the ECM-S forms a stable three-dimensional porous network. Studies on the effects of the ECM-S on the biological behaviors of OECs in vitro indicate that the scaffold can promote OEC adhesion, proliferation and process extensions. Additionally, OECs seeded on the scaffold maintained the expression of nerve growth factor, matrix metalloproteinase-3 and matrix metalloproteinase-9.

CONCLUSIONWe developed a biosynthetic hybrid gel which could be used as a scaffold for OEC transplantation; this gel can promote nerve regeneration following spinal cord injuries.

Animals ; Cells, Cultured ; Immunoblotting ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Olfactory Bulb ; cytology ; physiology ; transplantation ; Olfactory Mucosa ; cytology ; physiology ; transplantation ; Rats ; Spinal Cord Injuries ; therapy ; Tissue Engineering ; methods ; Tissue Scaffolds