Objective: In order to provide references for drawing up related health policy reasonably, the current status of medical insurance payment in third level hospital. Methods: Through analyzing the payment situation of medical insurance in third level hospital from 2010 to 2012, to understand the related situation of gross prepayment system in large publich hospital since this year. Results: In recent years, the coverage rate of health insurance in the whole city is increasing continuously, while the rising extend of annual gross prepayment limit is not obvious, refusal in medical insurance fund is serious and the accounting method of prepay limit is not scientific. Conclusion: While satisfying the quality of patients’ visiting, it needs to implement gross prepay accounting method, enhance medical management and reduce the economic burden of the hospital.

Study on the scientific essence of traditional Chinese medicine (TCM) syndrome is the key in TCM modernization. This paper showed new research ideas for TCM syndrome, which was based on the pediatric adenovirus pneumonia and its TCM treatment, metabonomics and its application in TCM syndrome research, in order to discuss its application value in the diagnosis and treatment of pediatric viral pneumonia. This method was mainly implemented through the metabonomics technology, which reflected TCM holism concept. The syndrome of phlegm-heat obstructing the lung, which was the most frequent syndrome in the pediatric viral pneumonia, was studied. Through the comparison with metabolites of healthy children, the biomarkers of syndrome of phlegm-heat obstructing the lung in pediatric viral pneumonia were identified.

Objective To investigate the effect of swimming exercise on insulin sensitivity and interleukin-1 beta(IL-1β)mRNA expression in muscle tissue of insulin-resistant (IR) rats induced by high-fat diet.Methods The IR rat model was induced by high-fat diet feeding for 10 weeks and assessed by hyperinsulinemic-euglycemic clamp technique (HEC). The rats were divided into the fllowing three groups: normal group without exercise, IR groups with and without swimming exercise. After 4 weeks swimming excersie, insulin sensitivity and serum IL-1β levels were measured.Results Glucose infusion rate (GIR) of the IR rats was significantly elevated than that of non-exercise IR rats (P<0.01). Moreover, serum IL-1β levels were reduced markedly in IR rats (P<0.01). Conclusion High-fat diet feeding can partly reverse IR of rats to normal value. Swimming exercise improves insulin sensitivity and reduces the levels of IL-1β in IR rats induced by high-fat diet.

Objective To explore the improvement effect of humanistic care on cognitive function impairment and living ability of patients with Alzheimer's disease. Methods 76 patients with Alzheimer's disease from January 2009 to May 2011 were taken as the research object.They were randomly divided into the control group and the observation group with 38 cases in each group.The control group was given conventional procedures for nursing care,and the observation group used humanistic nursing care as the guidance.The MMSE scale score,living ability index and family satisfaction degree before nursing and 1 month and 3 months after nursing for the two groups were taken for statistical comparison. Results The proportion of patients whose MMSE scale≥ 21 points and living ability score ranging from71 to 95 1 month and 3 months after care were higher than those of the control group.The satisfaction degree of patients in the observation group was also higher than the control group. Conclusions Humanistic care can significantly improve the cognitive dysfunction and living ability of patients with Alzheimer's disease,besides,family members of patients are more satisfied with this nursing model.

High-fat diet-induced insulin resistance rat model was assessed by euglycemic-hyperinsulinemic clamp technique.Compared with the control group,the vaspin mRNA expression in adipose tissue was significantly decreased in insulin resistant rats induced by high-fat diet( P＜0.05 ),which was increased by metformin( P＜0.05 ).These data indicate that metformin may ameliorate insulin resistance in rats via upregulating vaspin mRNA expression.

OBJECTIVE Topreparealipidderivativeofgemcitabine(Gem)anditspolymericmi-celles to overcome the disadvantages of Gem.METHODS N-benzyl-3′-acetyl-gemcitabine(BAG)was synthesized.A BAG-loaded poloxamer polymeric micelle (BAG∶poloxamer 188 =10∶1 ,mol/mol)was prepared using an injection method.The micelles were characterized with a laser particle size and elec-tric charge instru ment and negatively-stained trans mission electron microscopy.Hu man breast cancer cells MCF-7 were cultured with Gem or BAG polymeric micelles of 5,10,20,30,50,70,90 μmol·L-1 for 24,48 and 72 h,respectively.The inhibitory rate of cells was measured with an MTT method.The MCF-7 cytotoxicity of BAG polymeric micelles was investigated.A pharmacodynamic study was per-formed on the mice bearing mouse hepatocellular cancer cells H22.Intravenous (iv)and oral (ig)ad-ministration was used at the dose of Ge m 40 mg·kg -1 or BAG polymeric micelles 62 mg·kg -1 .The mice were administered on the 1 st,4th and 7th day and sacrificed on the 8th day.Tumor inhibitory rates were measured.RESULTS TheBAGstructurewasidentifiedbythinlayerchromatograph,1Hand13C NMR,infrared ray chromatograph and mass spectrum.The appearance of BAG micelles was a slightly blue suspension.The micelles were spheres according to the electron microscopic observation.Their size was 62.82 nm and the zeta potential was -18.8 mV.The half inhibition concentration (IC50)of Gem and BAG polymeric micelles was 40.6 and 90.0 μmol·L-1 ,5.0 and 14.9 μmol·L-1 ,5.0 and 1 3.6 μmol·L-1 at 24,48 and 72 h,respectively according to the MTT results.According to the in vivo results,compared with the tumor model group,Gem (ig),Gem (iv)and BAG polymeric micelles (iv and ig)had significant effect on the tumor weight of H22 cell xenograft mice (P<0.01 ).As for anti-tumor efficiency,BAG polymeric micelles (ig)were better than Gem (ig)(P<0.05);BAG polymeric micelles (iv)were better than BAG polymeric micelles (ig)(P<0.05),and BAG polymeric micelles (iv)were almostequaltoGem(iv).CONCLUSION ThelipidderivativeofGemcanbeloadedinthepoloxamer 1 88 polymeric micelles.BAG polymeric micelles show in vitro MCF-7 cell inhibition and in vivo inhibition of mouse H22 xerografts;iv or ig.BAG polymeric micelles (ig)show better anti-tumor effect than Gem (ig),indicating that BAG polymeric micelles are a promising novel anti-tumor oral preparation.

Ultrasonic microbubbles were used to open blood-brain barriers (BBB) with a reversed and limited behavior feature in the study, which could improve the brain-targeted delivery of anti-tumor drugs. The glioma rat model was prepared. Low-frequency ultrasound was combined with microbubbles to affect the permeability of BBB compared with the permeability of independently administered Evans blue (EB) crossing BBB. Time point and length of ultrasound were investigated whether they affect the permeability of BBB and the damage of brain tissue. The effect of the growth time of glioma on BBB permeability was explored. Only glioma had a very little impact on BBB permeability. However, ultrasonic microbubbles opened the BBB with the features of temporary, limited and reversed behavior and improved EB and magnetic resonance imaging contrast agent penetrating BBB. A length of 30 s ultrasound is appropriate for opening BBB and no damage of brain tissue. Drugs should be injected before ultrasound so that they enter into brain as BBB opening. Ultrasonic microbubbles can open BBB effectively and safely, which improve drugs penetrating BBB under proper time point and length.

Objective To develop a clinical practice satisfaction scale for the nursing interns,and to test its reliability and validity.Methods Original scale was formed on the basis of literature review and existing clinical practice satisfaction measurement tools of nursing interns.Totally 270 nursing interns of six tertiary first-class hospitals were investigated with the clinical practice satisfacfion scale of nursing intern by convenience sampling.SPSS13.0 and AMOS 17.0 were used to test the reliability and validity.Then the original scale was modified and the eventual scale was formed.Results The Cronbach's Alpha between each entries and the total scale were 0.548～0.752.The Cranbach's Alpha of total scale was 0.965and the split-half reliability of Guttman was 0.885.Five factors were extracted by exploratory factor analysis and they could explain 65.307％ of the total variance.The confirmatory factor analysis revealed a good model fit of the first and second order,and the fit indices x2/df,GFI,AGFI,RMR,RMSEA,NFI,CFI,TLI were 1.176/1.095,0.893/0.900,0.856/0.864,0.034/0.033,0.026/0.019,0.918/0.924,0.987/0.993,0.983/0.991.Conclusions The clinical practice satisfaction scale of nursing intern is reliable and valid,and can be used to assess the clinical practice satisfaction of nursing intern.

Objective To study the clinical and genetic features of Lowe syndrome. Methods The clinical data and test results of OCRL gene from two children with Lowe syndrome were analyzed. The related literatures were reviewed. Re-sults Two male patients all presented with low molecular proteinuria, hypercalciuria, rickets and nephrolithiasis. Patient 2 had renal tubular acidosis, glycosuria and cryptochism. Patient 1 was found to have abnormal vision and congenital cataract soon after birth and treated surgically. Patient 1 also had psychomotor retardation and the cranial magnetic resonance ima-ging (MRI) showed agenesis of the corpus callosum. Patient 2 did not have obviously extra-renal symptoms, but was found to have mild cataract by a meticulous ophthalmological examination. MRI showed cerebral hypoplasia and myelination delay and mental retardation was gradually appeared during follow-up. Two OCRL gene mutations were detected. A splice site mutation NG_008638.1:g.46846-46848delTAA/insC was found in patient 1 and a frame shift mutation NM_000276.3:c.321delC in exon 5 was found in patient 2. Both mutations were not reported previously. Conclusions The diagnosis of Lowe syndrome is mainly by clinical manifestations and test of OCRL gene. Lowe syndrome needs to be included in the differential diagnosis of a patient with congenital cataract and renal tubulopathy. Two novel mutations in the OCRL gene were identiifed.

Objective To study the effect of transcranial ultrasound (US) on arterial recanalization in acute ischemic stroke patients.Methods Patients with acute middle cerebral artery (MCA) main stem occlusion after 6 h were randomized into a target group receiving low-frequency,pulse-wave mode,transcranial US for 30 min or a control group.All were treated with intravenous urokinase for thrombolysis.Transcranial doppler sonography (TCD) was used to document vascular occlusion and confirm recanalization at 2 h and 24 h after treatment,and the patients were evaluated using the National Institutes of Health Stroke Scale ( NIHSS).Results Recanilization (complete or partial) after 2 hours was significantly higher in the US group (44.4％) compared with the control group ( 10.5％ ).Recanalization had occurred in 50％ of the US group 24 hours after treatment compared with 15.7％ of the controls.At 2 h after treatment,33.3％ of the US group and 5.5％ of the controls had improved at least 4 points on the NIHSS assessment.After 24 hours the figures were 44.4％ and 10.5％.After 3 months,11 subjects from US group (61.1％ ) had a modified Rankin score ≤2 compared with 4 subjects (21％) from the control group.Conclusions In acute ischemic stroke,transcranial US has positive effects on recanalization and neural function.