To establish the control model of medical insurance in hospitals, so as to improve the effectiveness of internal operation for medical insurance fund. Methods: Using the utility theory to establish the control model, with which the medical service provider is individual rationality constraints and incentive compatibility constraint. Results: The bonus coefficient and punishment coefficient can be calculated by means of evolutionary programming. Conclusion: The control model of hospital internal medical insurance fund is useful in controlling the medical insurance expense, it also provides the guidance and references for performance management and internal operation.

Objective To explore the association between circulating endothelial cells (CECs)and atherosclerosis in maintenance hemodialysis(MHD)patients. Methods A crosssectional study was performed to investigate the association between CECs and carotid atherosclerotic change in 65 MHD patients,25 non-hemodialysis patients with chronic kidney disease(CKD)of stage 4 or 5(CKD-non-HD)and 24 age-and Sex-matched healthy controls. CECs in peripheral blood were determined by multiparametrie flow cytometry(FCM).CECs were labeled with CD3-PerCP and CD146-PE before FCM and identified as CD3dim,CD146bright.Atherosclerosis in both groups Was assessed by the measurement of common carotid arery intimamedia thickness (CCA-IMT)and plaque of the common carotid arteries with ultrasound scanner. Results CECs were significantly higher in pre-dialysis patients[(151.52±98.24) cell/ml]and CKD-non-HD patients[(183.00±81.38)cell/ml ] compared with control group[(106.50± 24.14)cell/ml](P<0.05 and P<0.01,respectively).But the number of CECs was not significantly different between MHD and CKD-non-HD patients.CCA-IMT was also significantly higher in MHD patients[(0.94±0.36)mm]and CKD-non-HD patients [(1.02±0.37)mml compared with control group[(0.75±0.15)mm](P<0.05 and P<0.01,respectively).The number of pre-dialysis CECs was positively correlated with CCA-IMT in MHD patients(r=0.328,P<0.01).Multivariate analysis showed that CEC level was a strong independent risk factor of CCA-IMT. Conclusion InMHD patients, CEC level is associated with carotid atherosclerosis and may be used as a marker to evaluate the endothelial damage.

BACKGROUND: Visual-motor integration (VMI) test was introduced into China in the 1970s and 1990s and widely used for evaluation and identification of problems in intellectual development and learning ability in children due to its good applicability without limitations by language and cultural background.OBJECTIVE: To assess the value of developmental test of VMI in children with hearing handicap, and evaluate its practical feasibility in largescale screening of intelligence problems in these children by comparing its reliability and validity with the norms of children in Shaanxi Province and the USA.DESIGN: A controlled correlation and multiple stepwise regression analysis with randomized cluster sampling.SETTING: Neurological Department of the First Hospital Affiliated to Medical College of Xi' an Jiaotong University.PARTICIPANTS: From January 1998 to December 2000, 638 children under 18 years of age with hearing handicaps were chosen from 6 schools of deaf-mutes in Xi'an City, Xianyang City, Chang'an County, Huxian County,and Lintong County in Shaanxi Province. Another 43 children with hearing handicap including 23 male and 20 female children aged (11.62±1.98) years were selected randomly for EEG and brain electrical activity mapping (BEAM) examination, who had a mean development quotient of VMI of 86.60±15.68. The children were divided by the development quotient into two groups, namely those with development quotient ＜ 86.6 (n=20) and those with development quotient ≥ 86.6 (n=23). METHODS: ① The VMI test was performed in accordance with the Fourth edition of VMI Manual by Beery K.E. The test was terminated when the testee failed to correctly copy three consecutive geometrical figures without time limit. The scale score varied from 0 to 27. ② The reliability test included split-half reliability test in which the items were split into two parts according to odd-even number, re-test reliability that tested the same group of children again in two months and inter-examiner reliability in which two examiners were asked to grade the same test paper.③ The validity test included structural and correlation validity test. Three well-revised and already established norms of scales in China, including Hiskey- Nebraska test of learning aptitude (H-NTLA), performance scale of Wechsler intelligent scale for children (PS-WISC) and Combined Raven's test (CRT), have been chosen as the structure validity criteria. The performance IQ of PS-WISC, learning quotient of H-NTLA, percentile rank of CRT and standard score of VMI were taken respectively for each test in this study.Academic achievements and teachers' and parent's rating were used as the validity correlation criteria. During the administration procedure, a card describing the requirements in detail were presented to the deaf children with reading capacity, while for those too young to read, the teacher was asked to help translate the requirements using standard sign language, but no any hints or clues in relation with the test contents were given. ④ The test did not start until the subjects fully understood the requirement (7314/F/W DYD-300A).EEG recording was performed with the leads deposited according to the international standard 10/20 lead system. Routine EEG had been recorded at least 30 minutes for visual assessment, and stable and representative waves for 120 seconds free of biases or inferences were recorded using unipolar lead from the subjects at rest with the eyes closed and stored in computer.Experienced EEG experts were asked to select the most representative waves of 20 seconds in a double-blind manner to compute the absolute power spectrum of the brain wave.MAIN OUTCOME MEASURES: Reliability and validity of VMI test,relationship between VMI ability and cerebral electrophysiological changes.RESULTS: Totally 638 children under 18 years old with hearing handicap were involved, of whom 72 were eliminated because of lack of data, congenital disease or central nervous system diseases. Finally 566 cases were available for analysis, including 346 male and 220 female children with an average age of (12±3) years. ① The reliability of VMI reached an average of 0.92, varying from 0.63 to 0.99 in each group. The equivalent age corresponding to the scores of the VMI test norm established for the 566 healthy deaf children was lower by an average of (1.79±0.9) years than the equivalent age in the norms of the normal children in Shaanxi Province delayed and USA. ② The standard score of VMI test showed the highest correlation coefficient of 0.661 0 with the learning quotient of H-NTLA, while the correlation with PS-WISC and CRT were 0.357 6 and 0.517 4, respectively.③ Children with higher VMI score showed more powerful absolute spectrum among frequency rangesδ,θ,αl and total power spectrum in the central, parietal and occipital regions of the left hemisphere, respectively.CONCLUSION: VMI test can efficiently reflect the development status of visual-motor integration or intelligence of the school-age deaf children and represent the level of central EEG activity.

Objective To explore possible associations between osteopontin(OPN) and intact parathyroid hormone(iPTH),to investigate effects of them on the progression of carotid artery calcification in patients receiving long-term hemodialysis.Methods Forty-eight maintenance hemodialysis (MHD) patients and 28 age-and sex-matched healthy volunteers were recruited.The concentration of OPN in peripheral blood was determined by enzyme linked immunosorbent assay (ELISA).Levels of iPTH and presence of plaques in the common carotid arteries were also measured.The demographics were recorded.Results Compared with controls,levels of OPN[(137.4±80.8) ng/L vs (31.6±6.7) ng/L,P ＜ 0.01] and iPTH[(456.4±326.4) ng/L vs (66.9±19.3) ng/L,P ＜ 0.01] were higher in MHD patients before hemodialysis,the numbers of calcific plaques in the common carotid arteries were increased in MHD patients (P ＜ 0.01).There was a positive correlation between pre-dialysis OPN levels and iPTH levels (r =0.620,P ＜ 0.01) in MHD patients.Higher levels of OPN and iPTH correlated with greater numbers of calcific plaques in the common carotid arteries after division into three subgroups of MHD patients based on calcific plaques.In multiple linear regression analysis,the correlation between the pre-dialysis OPN and iPTH levels remained the same even if adjusting for confounding effects[β =0.468,95％C1 (0.036,0.195),t =2.936,P =0.005].Conclusion OPN level is positively correlated with iPTH level in hemodialysis patients,which suggesting that both of them play important roles in the progression of carotid artery calcification.

Objective To evaluate the effect of captopril and isoflurane preconditioning on cell apoptosis during myocardial ischemia/reperfusion (I/R) in rabbits.Methods Forty New Zealand white rabbits of both sexes,weighing 1.8-2.5 kg,were randomly divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),group I/R,isoflurane preconditioning group (group I),captopril preconditioning group (group C) and captopril and isoflurane preconditioning group (group C + I).The animals were anesthetized with 3％ pentobarbital sodium 30 mg/kg.Myocardial ischemia was induced by occlusion of the left anterior descending branch of coronary artery for 30 min followed by 120 min of reperfusion.1.1％ isoflurane was inhaled for 30 min followed by 15 min washout before myocardial ischemia in group I.Captopril 25 mg/kg was given through a gastric tube into the stomach at 24 h before myocardial ischemia in group C.Captopril 25 mg/kg was given through a gastric tube into the stomach,24 h later 1.1％ isoflurane was inhaled for 30 min followed by 15 min washout,and then myocardial ischemia was performed in group C + I.The rabbits were sacrificed at the end of reperfusion and myocardial specimens were removed for microscopic examination and observation of ultrastructure,and for determination of the expression of Bcl-2 and Bax proteins (by Western blot).The apoptosis rate was detected by flow cytometry.Bcl-2/Bax ratio was calculated.Results Compared with group S,the apoptosis rate was significantly increased,the expression of Bcl-2 and Bax proteins was up-regulated,and Bel-2/Bax ratio was decreased in I/R,I,C and C + I groups (P ＜ 0.05).Compared with I/R,I and C groups,the apoptosis rate was significantly decreased,Bcl-2 protein expression was up-regulated,Bax protein expression was down-regulated,and Bcl-2/Bax ratio was increased (P ＜ 0.05),and the pathological changes were significantly attenuated in group C + I.Conclusion Regulation of Bcl-2/Bax ratio and inhibition of apoptosis in myocardial cells are involved in the mechanism by which isoflurane and captopril preconditioning reduces I/R injury in rabbits.

Objective To investigate the relationship between the incidence and grade of diabetic nephropathy (DN) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. Methods A total of 154 patients with type 2 diabetes mellitus (80 males and 74 females) were investigated, ocular fundus were examined after mydriasis, at the same day, blood urea nitrogen, creatinine, glycosylated hemoglobin, blood fat, serum albumin were determined, the microalbuminuria and the glomerular filtration rate were performed. Results The incidences of DR with each stage were significantly different according to different DN stages. Univariate analyses revealed that the disorder of DR was positively correlated with the duration of diabetes, microalbuminuria, blood cholesterol (P<0.01 or <0.05), and negatively correlated with the glomerular filtration rate (P<0.01). Conclusion The incidence OFDN and DR has the highly concordance, and their lesions have some parallel relationship.

Objective: To observe the effect of 2 Hz electroacupuncture (EA) on long term depression (LTD) of synaptic transmission in the spinal dorsal horn in rats with neuropathic pain, so as to explore the central mechanisms of the antinociceptive effects of 2 Hz electroacupuncture on neuropathic pain. Methods: The neuropathic pain models were produced by tight ligation of the L5/L6 spinal nerves in Sprague Dawley rats. The C fiber evoked field potentials in the spinal dorsal horn were recorded with extracellular recording techniques. The parameters of the electroacupuncture were as follows: frequency of 2 Hz, wavelength of 0.6 ms, intensity of 1,2,3 mA lasting 10 min for each intensity, stimulation time of 30 min. The positive stimulating electrode was placed in acupoint “sanyinjiao” and the negative electrode in “zusanli”. Results: (1) 2 Hz electroacupuncture significantly decreased the amplitudes of C fiber evoked field potentials in the spinal dorsal horn in rats with neuropathic pain to (49.4?0.6)% of the control, compared with that (100.1?1.2) % of the control before EA (unpaired t test, P

OBJECTIVE: Investigate the effect of oxidative stress on the occurrence and development of laryngeal squamous cell carcinoma associated with smoking, and the clinical diagnostic value of catalase on smoking related laryngeal squamous cell carcinoma. METHOD: Collecting 119 smokers(including the smoking related laryngeal cancer group 68 cases, the control group 51 cases), the indexes of catalase (CAT), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH), nitric oxide (NO) in blood plasma and cancerous tissue in two groups were compared. The association between these oxidative stress indicators and the occurrence and severity of smoking related laryngeal squamous cell carcinoma was analysised by SPSS 17.0. RESULT: (1) Compared with control group, the smoke frequency and amount, CAT, MDA, GSH increased significantly in the smoking related laryngeal cancer group (P = 0.000; 0.000; 0.000; 0.000; 0.000); whereas SOD, NO decreased (P = 0.000; 0.000). (2) The lower the differentiation degree, the higher the serum CAT (P = 0.000) and the higher CAT, MDA, GSH of larynx tissue (P = 0.000; 0.000; 0.000), but the lower the serum NO (P = 0.000) and the lower SOD, NO of larynx tissue (P = 0.000; 0.000); The higher the clinical stage, the higher CAT of serum and larynx tissue and the higher GSH of larynx tissue (P = 0.000; 0.001), the lower NO of larynx tissue (P = 0.009). (3) The serum CAT, MDA were independent risk factors of smoking related laryngeal squamous cell carcinoma (OR = 1.060, 2.475; P < 0.01, P < 0.05). CONCLUSION Oxidative stress is the key factor of the occurrence of smoking related laryngeal squamous cell carcinoma, and the CAT can be used as the indicator of clinical diagnosis of smoking related laryngeal squamous cell carcinoma.
Antioxidants ; metabolism ; Carcinoma, Squamous Cell ; enzymology ; Catalase ; metabolism ; Glutathione ; metabolism ; Head and Neck Neoplasms ; enzymology ; Humans ; Laryngeal Neoplasms ; enzymology ; Malondialdehyde ; metabolism ; Nitric Oxide ; metabolism ; Oxidative Stress ; Risk Factors ; Smoking ; adverse effects ; Squamous Cell Carcinoma of Head and Neck ; Superoxide Dismutase ; metabolism

Objective To analyze the characteristics of the common first attack of headache in patients with cerebral venous sinus thrombosis (CVST). Methods The clinical data of 51 patients who were diagnosed as CVST with MR venography (MRV)or DSA were collected retrospectively. The patients were divided into either a acute group (≤3 week,n= 32)or a chronic group (>3 weeks, n=19). Results (1)The age of onset of symptoms in these patients was 20 to 40 years,and most of them were females. Of all the first symptoms,headache ranked first,accounting for 84. 3%(43/51 );headache only accounted for 52. 9%(27/51 ),headache with other symptoms (ophthalmic symptoms, hemiplegia,and aphasia,etc. )accounted for 31. 4%(16/51 ),and other symptoms such as epilepsy, paralysis,and ophthalmic symptoms accounted for 15. 7%(8/51). (2)The proportion of headache only as the first symptom in the acute group was higher than that in the chronic group (65. 6% vs. 31. 6%,P<0. 05), and the proportion of chronic headache with other symptoms as the first symptom in the chronic group was higher than that of the acute group (P<0. 05). In addition,the proportion of the first symptom including ophthalmic manifestations in the chronic group was higher than that of the acute group (P <0.01 ). (3)Forty-three patients with headache,dull headache or distensible pain accounted for 72. 1%(31/43), thunderclap headache accounted for 11. 6%(5/43),and other kinds of headache accounted for 16. 3%(6/43),however,there were no significant differences about the types of headache between the two groups (all P>0. 05 ). Conclusion Young patients without previous history of migraine,especially women of childbearing age with sudden onset and progressive worsening headache,and the patients with idiopathic intracranial hypertension,CVST should be considered as an important possibility.

Objective To use Q value method to assess the effect of combination therapy with vitamin E and vitamin C for idiopathic asthenospermia. Methods 76 patients diagnosed as idiopathic asthenospermia by computer-assisted semen analysis according to the WHO criteria were selected at the andrology clinic from August 2012 to November 2013. Malondialdehyde (MDA) concentration was measured by using thiobarbituric acid (TBA) assay. The patients were randomly divided into three groups. Vit C group received vitamin C 200 mg thrice daily, vit E group received vitamin E 100 mg thrice daily , and the combination group received vitamins E and C for 12 weeks. Repeat semen analysis and MDA measurement were conducted after treatment, and the Q value which evaluated whether a synergistic interaction existed was calculated. Results MDA concentration decreased in all the groups, with the lowest concentration in the combination group. While all the groups achieved improvement in term of progressive motility , with the combination group presented far more better than the other two groups , exhibiting a synergistic interaction, with a Q value of 1.18. Conclusion Combination therapy with vitamin E and vitamin C has a marked internal synergistic effect on antioxidation in the treatment of idiopathic asthenospermia.