Objective: To understand the gambling relations between the stakeholders of catastrophic medical insurance policy under New Rural Cooperative Medical System ( NCMS) , and provide theoretical references for the smooth operation of catastrophic medical insurance policy of NCMS. Methods:Analyzing the game relationships among the four sides:the government, business insurance agencies, designated medical institutions and participating farmers suffering from catastrophic diseases through game theory. Results: The government and business insurance agency, and the government and designated medical institution belong to cooperative games. The farmers participated in catastrophic medical insurance tend to choose cooperative strategy. Non-cooperative games exist in business insurance agency, designated medical institution and participating farmers. Conclusion: Strategic relationship of close cooperation should be established between the business insurance agencies and designated medical institutions. The government should strengthen the regulatory constraints between the business insurance agencies and designated medical institutionsi, at the same time, it needs to establish the incentive mechanism soon.

Objective To explore the clinical application value of multi-slice spiral CT angiography.Methods 28 patients who were suspected cerebrovascular disease were taken cerebrovascular enhanced scan by 16-slice spiral CT,and VR,MIP and MPR post -processing were uset to reconstmct the cerebrovascular image.Results In 28 patients,11 cases were normal,17 cases were abnormal,and among these patients there were 8 cases of abnormal blood vessels,4 cases of aneurysms,1 case of cerebral arteriovenous malformation,4 cases of cerebral artery stenosis.Conclusion The multi-slice CT compared with ordinary spiral CT had the advantage of faster and more secure.It had an important role in guiding the screening and clinical treatment programs in cerebral infarction patients with suspected cerebral artery stenosis.It had a lot of advantages in diagnosis vascular disease and clinical observation after treatment.

Objective To investigate the relationship between polycystic ovary syndrome (PCOS) susceptibility single nucleotide polymorphisms (SNP) and metabolic phenotypes in glucose and lipid metabolism and explore the pathophysiological mechanism of the susceptibility genes.Methods Three of PCOS susceptibility locus 2p16.3 (rs13405728 of LHCGR gene),2p21 (rs13429458,rs12478601 of THADA gene) and 9q33.3 (rs2479106,rs10818854 of DENNDIA gene) were selected and the metabolic phenotypes were compared between different genotypes of SNP in PCOS patients (using dominant model).Results Low-density lipoprotein cholesterol was significantly increased in CC genotype group than in TC + TT groups at rs12478601 of THADA gene [(2.5 ± 0.8),(2.4 ± 0.8) mmol/L; P =0.01].Serum insulin level of 2 hours after 75 g glucose intake was significantly higher in GG + AG groups than that of AA group at rs2479106 of DENND1A gene[(71 ±65),(64 ±50) mU/L;P =0.05],and the prevalence of type Ⅱ diabetes in first-degree relatives of patients were also increased [9.9％ (66/666),6.9％ (52/751) ; P ＜ 0.05].No association was found between metabolic phenotypes and genotypes of rs13429458,rs10818854,and rs13405728.Conclusions Genetic factors probably have effect on the metabolic characteristics of PCOS.THADA gene is related to lipid metabolism,while DENND1A gene may be involved in insulin metabolism in patients with PCOS.

Objective To introduce and investigate internal-fixtion with outboard proximal tibia anatomic plates through cut of anterolateral aspect of the leg.Methods 56 cases fracture of proximal tibia were fixed with outboard proximal tibia anatomic plates.Results All cases were followed up ranging from 5～18 months,with an average of 9 months.The excellent and good rate was 94.6% on Merchant grading system.Conclusions Internal-fixtion with outboard proximal tibia anatomic plates for the fracture of proximal tibia is an effective and reliable operation.

Objective To study early changes in biochemical markers of bone turnover for prodicting the bone mineral density(BMD) response to alendronate therapy in Chinese men with osteoporosis. Methods Seventy-eight men aged 60 to 82 years with osteoporosis [mean age (69.8 ±11.8) years]were treated with alendronate sodium 70 mg/week for 12 months. Serum bone gla-protein (BGP) and serum pyridinoline-eross-linked earboxyterminal telopeptide of type I collagen (ICTP) level were measured by chemiluminescence (equipment is Roche E170). Serum BGP, ICTP and BSALP levels were measured before and 3 months and 12 months after treatment. BMD in lumbar spine and femoral neck were measured with dual energy X-ray absorptiometry (GE PRODIGY Inc. ) at L1-4 and at the left hip(total hip,trochanter,Ward's area and femoral neck)before and 12 months after treatment. Results After 3-months and 12-months treatment, the percent reductions of serum ICTP levels were 45.8% and 51.6%, serum BGP level 32.0% and 37.5%, serum BSALP level 35. 3% and 39.9% ,respectively. After 12-months treatment, the percent increase of lumbar BMD was 11.8%, femoral neck BMD 11.4 %. The percent reductions of serum ICTP level at months 3 and 12 after treatment were positively correlated to the percent increase of lumbar BMD (r=0.28, 0.295,P <0.05 and P<0.01)and of fermoral neck BMD at 12 months after treatment(r=0.262, 0.333, P＜0.05 and P<0.01)respectively. The percent reductions of serum BGP level at months 3 and 12 after treatment were positively correlated to the percent increase of lumbar BMD (r=0. 322, 0.401,all P<0.01) and of fermoral neck BMD at 12 months after treatment (r=0.277,0.284, all P＜0.05)respectively. The percent reductions of serum BSALP level at months 3 and 12 after treatment were positively correlated to the percent increase of lumbar BMD (r=0.133,0.231,all P＜0.05) and of fermoral neck BMD at 12 months after treatment(r=0.248, 0.317, all P＜0.01)respectively.Conclusions Early changes in biochemical markers of bone turnover rates can predict BMD response to alendronate in Chinese men with osteoporosis.

OBJECTIVETo investigate the effect of Xianxiong decoction on the mice with acute lung injury induced by lipopolysaccharide.

METHODEighty female ICR mice were randomly divided into 8 groups: model group, Xianxiong decoction group, Daxianxiong decoction group, Xianxiong decoction group without Kansui Radix group, Xianxiong decoction group without Glycyrrhizae Radix et Rhizoma group, Glycyrrhizae Radix et Rhizoma and Kansui Radix group, normal group and control group. Animals of each group, except normal group, were undertaken intraperitoneal injection and intranasal inhalation of lipopolysaccharide (LPS) on day 1, 2, 3 to establish acute lung injury (ALI) model. 30 min after modeling, 0.2 mL corresponding drugs were administrated to each mice, dexam ethasone and normal saline were given to the mice of control group and normal group respectively. White blood cell in blood, neutrophil percentage of blood and bronchoalveolar lavage fluid (BALF) supernatant, the ratio of wet and dry lung tissue ( W/D), histopathological changes of lung tissue were estimated. Sixty ICR mice were randomly divided into normal, model, control, high, middle and low dose Xianxiong decoction groups and were modeled in the same way. ELISA was applied to detect the level of NF-kappaB, TNF-alpha and IL-6 in BALF, PCR for NF-kappaB and TNF-alpha mRNA in lung tissue, and Western blot for NF-kappaB and TNF-alpha. Half of 20 ICR mice were administrated with Xianxiong decoction of its maximum tolerant normal saline.

RESULTCompared with model group, the number of WBC in blood of Xianxiong decoction group mice decreased (P < 0.01), percentage of neutrophils in both blood and BALF decreased as well (P < 0.01, P < 0.05); it also significantly reduced the ratio of W/D (P < 0.01); and found the alveolar wall, the number of inflammatory cells infiltrating improved, compared with model group. Xianxiong decoction reduced the level of NF-kappaB, TNF-alpha and IL-6 in BALF (P < 0.01, P < 0.01, P < 0.05); its high and low dose groups only found TNF-alpha level declined. Five mice died 24 h after administration of Xianxiong decoction which indicated its toxicity when other influential factors were considered.

CONCLUSIONXianxiong decoction is effective on the ALI mice induced by LPS, but it is of toxicity at 3 g x mL(-1).

Acute Lung Injury ; drug therapy ; genetics ; metabolism ; pathology ; Animals ; Bronchoalveolar Lavage Fluid ; chemistry ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Interleukin-6 ; genetics ; metabolism ; Lipopolysaccharides ; adverse effects ; Lung ; drug effects ; metabolism ; pathology ; Mice ; Mice, Inbred ICR ; NF-kappa B ; genetics ; metabolism ; Tumor Necrosis Factor-alpha ; genetics ; metabolism

Objective To explore the best time point for the ipsilateral hepatocellular apoptosis and the contralateraI hepatic hypertrophy after selective portal vein embolization(SPVE)in rabbit.Methods In a randomized study design,forty rabbits were divided into 5 groups with 8 rabbits per-group,including one as the control and the other 4 were treated with SPVE during open surgery.The rabbits were killed postoperatively,in 3,7,14,21 days respectively after the embolization.The hepatic lobes volume,the ipsilateral hepatocellular necrosis rates and apoptosis index,and liver functions were determined as well. Results In the treatment groups,the average amount of the right liver volumes decreased from 46.4 cm~3 preoperatively to 46.0,44.4,42.0,39.7 cm~3 in groups of 3,7,14,21 days postoperatively;meanwhile,the left liver volumes increased from 54.0 cm~3 preoperatively to 54.5,56.3,61.7,63.9 cm~3 respectively during 3, 7,14,21 days after the procedures.The rates of future remaining live volumes(FRLV)increased from 53.8% preoperatively to 54.2%,55.9%,59.0%,61.0% at 3,7,14,21 days postoperatively.The apoptosis indexes of hepatocells from group A to E were 8.1%,12.2%,19.4%,20.1%,14.2% respectively.Conclusions SPVE leads to atrophy of the ipsilateral hepatic lobe and hypertrophy of contralateral lobe,indicating that hepatocytes undergone apoptosis,rather than necrosis.The time point is 7 to 14 days.

Objective To study the clinical outcomes of assistant treatment proposals for infertile women with polycystic ovary syndrome (PCOS). Methods PCOS patients were divided into four groups according to the assistant treatment proposals between Jan 2003 and Dec 2007 in Reproductive Medicine Center of the Provincial Hospital Affiliated to Shandong University. The four proposals were letrozole(LE) or clomiphene(CC) citrate ovulation induction group, in vitro fertilization and embryo transplantation group, ultrasound-guided immature follicle puncture group, and in vitro maturation and fertilization of oocytes from unstimulated cycles group. The treatment results were analyzed. Results (1) The ovulation rate was 66% (38/58) vs 47% (21/45). The mean endometrial thickness [ (0. 89±0. 13) vs (0. 78±0. 08) cm] and cervical mucus score (11.9±1.8 vs 9. 9±1.8 ) on the day of human chorionic gonadotropin ( hCG ) administration in LE group were both higher than that in CC group, while mature follicle ( 1.08±0. 28 vs 1.73±0. 59) and serum estradiol level [ (983±138) vs (1676±372) pmol/L] in LE group were lower than that in CC group(P <0. 05). (2) One southend five hundred and eighty-four patients accepted in vitro fertilization-embryo transplantation therapy because of PCOS (PCOS group) and 1615 patients because of tube factors (control group). The patients′ ages and infertility years were matched between the two groups. Total doses of Gn [ (980±1192) vs ( 1194±1389) IU] of PCOS group were lower than those of control group. The mean days of using gonadotropin [ (9.6±1.8) vs (9. 5±1. 8) d], serum estradiol (E2) levels on the hCG day [ ( 15 752±6206) vs (9675±4818) pmol/L], mean obtained oocytes (21±6 vs 9±3), mean fertilized oocytes ( 15±6 vs 7±3) and mean cleavaged oocytes ( 12. 9±5.7 vs 5.7±2. 8 ) of PCOS group were higher than those of the control group( P < 0. 05 ). Moderate and severe ovarian hyperstimulation syndrome (OHSS) rates (4. 86% vs 1.67% ) of PCOS group were higher than that of the control group. The pregnant rate (44. 7% vs 45.0% ) of PCOS group was similar to the control group ( P > 0. 05 ). (3) One hundred and nine PCOS patients were given ultrasound-guided immature follicle puncture therapy. After treatment, the testosterone level, luteinizing hormone (LH) level and LH/follicle stimulating hormone (FSH) ratio of the patients became normal. The basic follicle number decreased. (4) A total of 304 in vitro maturation cycles were performed. After embryo transfer, 76 pregnancies were reported. Conclusions There are many choices for the infertile patients with PCOS, such as LE or CC citrate ovulation induction, in vitro fertilization and embryo transplantation, ultrasound-guided immature follicle puncture, and in vitro maturation and fertilization of oocytes from unstimulated cycles. We can provide individualized treatment according to the medical treatment conditions, doctors′ professional capability and the patients′ situation.

Objective To investigate the efficacy and safety of adefovir dipivoxil (ADV) in treatment of chronic hepatitis B (CHB) patients with lamivudine (LAM) resistance. Methods There were treatment group (32 CHB patients with LAM resistance) and historical control group (24 CHB patients with LAM resistance) in this study. The treatment group received ADV 10 mg/d and LAM 100 mg/d for 48 weeks; the historical control group continued to use LAM monotherapy. During the treatment causes, serum HBV DNA levels, liver function and HBV serology were monitored regularly, and safety assessments were also conducted. Results In treatment group, mean HBV DNA levels decreased by 2.56 log10 eopies/ml and 2.93 log10 copies/ml, virus response rates were 50. 0% and 75.0%, ALT normalization rates were 53.1% and 68.8% after 24 and 48 weeks of treatment, respectively. The histological improvement rate was 65.6% after 48 weeks. Comparing with those in control group, the differences were statistically significant ( P <0. 05), while there was no significant statistical differences in HBeAg loss rate and HBeAg seroconversion rate between two groups. There was no severe adverse event during the treatment. Conclusion ADV is effective and safe in treatment of lamivudine-resistant CHB.

Objective To study effect of drug treatment in polycystic ovary syndrome patients withhyperprolactinemia.Methods We retrospectively studied 63 women with polycystic ovary syndrome and hyperprolactinemia from the Reproductive Medicine Center,Provincial Hospital between January 2005 andMarch 2007.According to the beginning time of bromocriptine,all women were divided into two groups.Group Ⅰ was composed of 48 cases who received bromocriptine administration before induction of ovulation cycles,and the dose of bromocriptine was modulated depending on the level of serum prolactin.When serum prolactin was controlled at normal levels,we decreased the dosage of bromocriptine step by step(1.25 mgonce),and then continued the treatment at maintenance dosage for no less than 3 weeks.After a baselineultrasonographic examination on day 3,patients were treated with clomiphene citrate at a dosage of 100 mg (2 tablets/day)for 5 days of a normal cycle or progesterone-induced bleeding.On day 9,we monitored the growth conditions of follicles routinely with trans-vaginal uhrasound.If there was no dominant follicle,we added human menopausal hormone(hMG,75 U/d)to the protocol.Human chorionic gonadotropin(hCG,6000-10000 IU)was given intramuscularly when the mean diameter of a follicle reached at least 18 mm.At the same time we instructed the patients to have sexual intercourses or carried out artificial inseminationsbefore and after ovulation.Group Ⅱ were 15 cases in which induction of ovulations were commenced almostsimultaneously with beginning of bromocriptine.The same protocol was given to patients in group Ⅱ.The procedures of ovulation induction and the outcomes of treatment were analyzed and compared.Results Compared with groupⅡ.the days of using hMG in Group Ⅰ was shorter by instructing the time of sexualintercourse.The difference was significant(P=0.004).And there were similar results in the artificial insemination cycles(P=0.009).The rate of pregnancy in group Ⅰ(40%,19/48)was higher than that in groupⅡ(27%,4/15),but the difference was not obvious(P=0.525).Conclusion Bromocriptine administration before the stimulated ovulation therapy can decrease the total dosage and treatment course of ovulating drugs.Induction of ovulations simultaneously with start of bromocriptine therapy can shorten the treatment time of infertility.