BACKGROUND:The oxygen free radicals and apoptosis play an important role in limb ischemia/reperfusion injury, so we can al eviate limb ischemia/reperfusion injury by inhibiting the production of oxygen free radicals and apoptosis.
OBJECTIVE:To discuss the application and effect of edaravone on limb ischemia/reperfusion injury in rats.
METHODS:Of the 30 female Sprague-Dawley rats, 20 rats were randomly selected to make models of limb ischemia/reperfusion injury by ligating the root of right lower limb with a self-made bal oon cuff at 40 kPa pressure to block blood flow for 4 hours and reperfusing. After success model establishment, they were randomly assigned to two groups. In the edaravone perfusion group, edaravone 3 mg/kg was injected via the left femoral vein at 5 minutes before reperfusion. In the model group and normal group (the remaining 10 rats), an equal volume of physiological saline was given at the same time point. At 24 hours after reperfusion, the right anterior tibial muscle of each group was removed and these ultrastructural changes were observed by transmission electron microscope. Bcl-2 mRNA and Bax mRNA of rat anterior tibial muscle of each group were semiquantitatively detected with the RT-PCR and the ratio of bcl-2/bax was calculated.
RESULTS AND CONCLUSION:(1)Electron microscope results:compared with the model group, the muscle fibers were neater;the M line and the N line were clearer;the swel ing of mitochondria was al eviated;the numbers of mitochondria and mitochondrial crista were also increased in the edaravone perfusion group. (2)RT-PCR results:At 24 hours after reperfusion, the relative expression of bcl-2 mRNA and the ratio of bcl-2 mRNA to bax mRNA in right anterior tibial muscle were lower in the model group compared with the edaravone perfusion group (P<0.05). However, relative expression of bax mRNA was greater in the model group than that in the edaravone perfusion group, which were both higher than the normal group (P<0.05). Results indicated that the free radical scavenger edaravone relieved limb ischemia/reperfusion injury by improving the mitochondrial ultrastructure and promoting expression of bcl-2 mRNA and inhibiting expression of bax mRNA, and could provide a new choice for the treatment of limb ischemia/reperfusion injury.

Objective To evaluate the impacts of DRGs payment reform on patients, medical insurance fund and hospitals, then to steadily promote the payment reform. Methods The reimbursement data of inpatients covered by NCMS yet beyond the single-disease payment were collected from two DRGs pilot hospitals from January 2016 to June 2018. Such means as descriptive statistics, t test and method of interrupted time series analysis were used to compare the changes found in the average out-of-pocket payment, actual reimbursement rate, average per-hospitalization compensation, average length of stay, and average hospitalization expense before and after the DRGs payment reform. Results After the reform, the average out-of-pocket payment and average length of stay began to fall slightly instead of the increasing trend (β3 were -72.79,-0.11, respectively, and P<0.01), the upward trend of average hospitalization expense slowed down ( β3 was -113. 55, and P<0.01), actual reimbursement rate and the average per-hospitalization compensation stayed the original growth trend (β3 were 0.10,-31.15, respectively, and P values were 0.08, 0.09, respectively). Conclusions DRGs encourages the hospitals to curb the average hospitalization expenses, with the growth trend kept at a slower pace. The payment reform does not increase the financial burden of patients, and tends to ease such pressure on funds, but the long-term effect remains to be seen.

Objective To analyze the operation of the diagnosis-related groups ( DRGs) pilots for inpatients in the new rural cooperative medical system in Yulin city of Shaanxi province. Methods The medical records of 33306 inpatients discharged from the 3 pilot hospitals between January and July in 2017 were analyzed, aided by expert discussions, on-site assessment and medical records examinations. Results By the end of July 2017, the DRGs grouping tool had been running stably. The DRGs enrollment rates of discharged inpatients were all up to 99% in the 3 pilot hospitals. The coefficient of variation ( CV) was higher than 1 only in a few DRGs. The average length of stay and the average hospitalization expenses growth rate were both found declined. However, there also exist problems in the pilots, namely incomplete regulations for DRGs, low clinical path coverage rate, hysteretic supervision and assessment, uneven quality of medical records management and so on. Conclusions The pilots operated smoothly as evidenced in their initial success. Yet the following recommendations were raised for the improvements: To strengthen the organization and leadership to improve the DRGs related supporting system in pilot hospitals; To strengthen the promotion and application of clinical paths for standardization of the medical service process;To improve the DRGs assessment program and establish DRGs operation monitoring and tracking analysis system; To strengthen the training of medical record coding staff to improve continuously the quality of medical records.