The Risk-sharing agreements have achieved remarkable success in improving patients'access to drugs, lowering the uncertainty of the drugs cost-effectiveness, financial risk control and other aspects of medical in-surance fund , so they have attracted widespread attention by the concerned governments and insurers .This paper sys-tematically reviewed the patient access schemes in UK from several aspects , including the origin of the program , clas-sification , application processes and the implementation effects as well .The results of the research indicated that Chi-na has basically met the conditions for implementation of the risk-sharing agreements .In order to gradually promote the risk-sharing agreements implementation , this paper suggests that China should clarify the main root of risk-sharing agreements implementation , establish risk-sharing agreements standardization process and strengthen the application of health technology assessment in health resources allocation to improve the Chinese medicines bargaining system more scientifically and efficiently .

Objective To investigate the therapeutic effect of different doses of caffeine on premature apnea.Methods 80 patients with apnea were divided into observation group and control group,each group in 40cases.The two groups applicated caffeine citrate.The control group received the basal dose, first application of 20 mg/kg, intravenous injection, intravenous injection of 5 mg/kg after 24 h.The observation group was treated with intravenous injection of 10 mg/kg after 24 h.The treatment period was 7 d.The therapeutic effect, blood gas and oxygenation index and adverse reactions were observed in the two groups.Results The effective rate of the observation group was 92.5%,which was significantly higher than 75.0% of the control group(x2=4.501,P<0.05).After treatment, the duration[(9.05±1.82)s vs (13.53±2.63)s]and lost time[(2.52±0.94)h vs (3.42±1.13)h]of apnea in the observation group were longer than those of the control group.The number of seizures[(22.15±4.16) vs (33.53±8.48)]was less than that of the control group,the differences were statistically significant(t=8.767,5.434,9.231,all P<0.05).After treatment, PaO2[(84.74±9.74)mmHg vs (71.46±8.53)mmHg],PaCO2[(42.62±4.15)mmHg vs (48.54±5.18)mmHg]and PaO2/FiO2[(221.52±26.51)mmHg vs (197.76±21.71)mmHg]in the observation group were significantly better than those of the control group(t=7.574,4.765,8.643,all P<0.05).The incidence rate of adverse reactions include tachycardia, hyperglycemia, hypoglycemia and restlessness had no significant difference between the two groups (15.0% vs 10.0%, P>0.05).Conclusion In the treatment of premature apnea, advanced caffeine citrate treatment can better improve the clinical symptoms and blood gas index, the curative effect is reliable.

It is significantly important but difficult to establish healthcare payment standard system in case our country has cancelled government and government guidance prices. In 1989, Germany was the first country to intro-duce the medicine reference price system in Statutory Health Insurance. It does not only aim to regulate the medicine prices, but also defines a reimbursement level for a cluster of products considered to be therapeutically equivalent, and has a good influence on lowering the price of medicine. This paper systematically reviews the medicine reference price system in Germany, including four aspects:the reference price system overview, the reference price groups’ de-termination procedure, the reference prices calculation and the co-payment mechanisms. Based on the Germany refer-ence price system, we can establish healthcare payment standard in over-the-counter or chronic market first, then sci-entifically divide the reference price groups, formulate and adjust payment standard based on the market price, and perfect the co-payment mechanism to avoid moral hazard.

Objective:To investigate the expression and clinical significance of PD-L1 in colorectal cancer (CRC). Methods:A total of 210 CRC patients who accepted radical surgery in our hospital from January 2015 to January 2016 were divided into three groups, namely, high-frequency microsatellite instability (MSI-H), low-frequency microsatellite instability (MSI-L), and microsatellite stable (MSS). The expression of PD-L1 was detected by immunohistochemistry, and the expression characteristics of PD-L1 in different types of CRC were analyzed. Results:CRC cases with low differentiation had a higher expression of PD-L1 than CRC patients with high differ-entiation (P<0.05). PD-L1 had a positive rate of 75.8%in the MSI-H group and a rate of 9.3%in the MSI-L and MSS groups, wherein the difference between the two groups was statistically significant (P<0.05). Conclusion:PD-L1 was positively expressed in some CRC tu-mor tissues, and its positive rate was significantly higher in MSI-H than in MSI-L and MSS. The therapeutic effect of a PD-L1 blocker for patients with MSI-H CRC might be preferable.

It is important and difficult to establish the market competition mechanism in the health care re-form. Medical voucher system in Hong Kong and Macao can provide policy guidelines for Mainland China to promote institutional innovation, force public hospital reform and the rational allocation of medical and health resources. This paper introduced the origin and development of medical voucher system. Based on the description of the implementa-tion background, similarities and differences and effects of medical voucher system in Hong Kong and Macao, the pa-per found that medical voucher system could help encourage the demander to make more frequent use of medical serv-ices, improve their consciousness of prevention and health care and promote family doctor system. Through analyzing the applicability of medical voucher system in mainland China, the paper pointed out it was consistent with the reform orientation and could be served as a useful supplement to the health care system to improve medical insurance, medi-cal assisstance system as well as an effective measure to develop private medical institutions.

Objective To explore the relationship between fetal heart size and gestational weeks (GW). Methods The size of left atrium (LA), right atrium (RA), left ventricle (LV), right ventricle (RV), aorta (AO), pulmonary artery (PA), foramen ovale (FO), heart area (HA), thoracic area (TA), heart circumference (HC) and thoracic circumference (TC) were measured for 512 fetal hearts at 14-39 GW. The relationship between GW and the measurement was evaluated. Results The size of fetal heart chambers, AO, PA and ventricular septum (IVS) increased with the development of GW. The PA/AO, LA/RA, LV/RV, HC/TC and HA/TA were stable compared with different GW. Conclusion Fetal heart chambers increase with the development of GW. HA is correlated well with GW.

Objective To observe the efficacy and safety of salvianolate injection combined with pemetrexed and carboplatin in the treatment of elderly patients with advanced non-squamous non-small-cell lung cancer.Methods 58 elderly patients with advanced non-squamous non-small-cell lung cancer in primary treatment were diagnosed by histopathology or cytology confirmation,and they were randomly divided into two groups (29 patients for control group and 29 patients for observation group).The control group was subjected to pemetrexed plus carboplatin chemotherapy,while the observation group was subjected to salvianolate injection based on the treatment of the control group by intravenous drip for 14 days,once a day,200 mg per day,and 21 days was a cycle.The changes of the efficacy,quality of life,the incidence of adverse reactions and the coagulation indicators in the patients of the two groups were compared after 4 cycles.Results The response rates and disease control rates in observation group were 44.8 ％ (13/29),86.2 ％ (25/29) and 37.9 ％ (11/29),75.8 ％ (22/29).It was found that the comparison of efficacy between the two groups did not make any statistical differences (P ＞ 0.05).The improvement of the quality of life in the observation group [82.7 ％ (24/29)] was better than that of the control group [65.5 ％ (19/29)] (P ＜ 0.05).The hematologic toxicity and gastrointestinal reaction rate in the observation group was lower compared with the control group (P ＜ 0.05).Moreover,the improvement of the hypercoagulable states in the observation group was better than that of the control group (P ＜ 0.05).Conclusions The treatment on elderly patients with advanced non-squamous non-small-cell lung cancer by salvianolate injection combined with pemetrexed and carboplatin can reduce the adverse effects caused by chemotherapy,improve the quality of life and the hypercoagulable states.Thereby it might prevent the occurrence of thromboembolic complications.

OBJECTIVETo search for an effective method for treatment of obstinate hiccup.

METHODSNinety cases of obstinate hiccup secondary to cerebral diseases were randomly divided into 3 groups, 30 cases in each group. Group A were treated by injection of compound chlorpromazine into Yintang (Ex-HN 3), group B by intramuscular injection of compound chlorpromazine and group C by acupuncture at Yintang (Ex-HN 3). Their therapeutic effects were compared.

RESULTSThe effective rate was 93.3% in the group A, 10.0% in the group B and 30.0% in the group C, the group A being better than the group B and the group C (P < 0.01).

CONCLUSIONInjection of compound chlorpromazine into Yintang (Ex-HN 3) has a significant therapeutic effect on obstinate hiccup.

Diagnosis, Differential ; Humans ; Parathyroid Glands

Objective To explore the association of Gly71Arg mutation in gene of bilirubin uridine 5'-diphosphate-glucuronosyltransferase(UGT1A1)and neonatal jaundice in Beijing city Han population.Methods The genotypes and alleles of the Gly71 Arg polymorphism for UGT1A1 gene were identified by polymerase chain reaction-restricted fragment length polymorphism assay in infants of Beijing city Han population of China,including 96 infants with neonatal jaundice[serum bilirubin(307.06?38.5)?mol/L,indirect bilirubin(292.9?35.9)?mol/L] and 101 healthy control infants [serum bilirubin(131.2?42.1)?mol/L,indirect bilirubin(126.3?39.7)?mol/L].The genotypes and allele frequencies of the polymorphism were compared between infants with neonatal jaundice group and healthy infant group(control group).The effect of polymorphism in infants with neonatal jaundice group on serum bilirubin level were analyzed.Results There were significant differences in genotypes distribution in Gly71Arg polymorphism for UGT1A1 gene between the 2 groups(?2=9.47 P=0.002).Compared with control group,neonatal jaundice group had significantly higher Arg allele frequency in the polymorphism for UGT1A1 gene(?2=10.34 P=0.001).There were independent effects of Gly71Arg mutation in the gene on serum bilirubin level in neonatal jaundice group,at the carriers of homozygote of the Arg allele of Gly71Arg polymorphism had higher serum bilirubin levels compared to carriers of heterozygote of the Arg allele of the polymorphism and non-carriers of the Arg allele of the polymorphism(Pa