The establishment of a scientific and reasonable medical service price dynamic adjustment mechanism is the focus of the current reform of public hospitals in China.This paper analyzed the medical service price reform history in the United States, the price dynamic adjustment of the main body and its process, as well as the development trend of medical service price reform.At the same time, the existing problems of medical service price adjustment in China were briefly analyzed, and put forward 1) the establishment of multi-participant dynamic adjustment model;2) the establishment of the medical service standard value system, strengthening Medicare payment standard construction;3) and gradually changing the current fee-for-service payment system and establishing DRGs and performance based payment mechanism and other policy recommendations.

OBJECTIVE:To review economics of budesonide/formoterol and fluticasone/salmeterol for asthma systematically, and to provide evidence-based basis for rational selection of drug to treat asthma. METHODS:Retrieved from Medline,EMBase, EBM reviews (HTA,NHSEED),CBM,CJFD,Wanfang database,researches about pharmacoeconomics of budesonide/formoterol (test group) versus fluticasone/salmeterol (control group)for asthma were collected,and analyzed with qualitative systematic re-view method. RESULTS:A total of 7 researches and 13 comparative data were included,containing 6 682 patients. The incidence of severe acute asthma of test group were lower than those of control group,with significant difference(P<0.05). The total costs and direct costs of test group were lower than those of control group. Good effect had been achieved in test group with low cost. CONCLUSIONS:Budesonide/formoterol is more cost-effective than fluticasone/salmeterol in teenagers patients and adults who fail to control asthma. Due to limitation of included studies,large-scale and high-quality studies are required for further validation of the conclusion.

The paper reviewed the medical service pricing at home and abroad and progress in the price comparison system,and introduced the price comparison system of Shanghai's medical services. Proposals in the paper include building the price parameters fitting local conditions,and setting prices using the standardized price model;forming a comprehensive price adjustment scheme with reference to international price comparison relations and domestic pricing level; upgrading the fine pricing management level of medical service pricing and improving charging management dimensions;enhancing interactions and assessment of price-related departments to guide public hospitals to enhance.

Objective To analyze the concentration, distribution and decreasing trend of niclosamide in soil through soil heaping mixed with niclosamide and the effect of Oncomelania control, and to explore the appropriate dosage for the 'heaping' method. Methods The soil samples were collected from six groups in Tezi township, Puge county, Sichuan Province, and the dosages were 16, 8, 4, 2, 1 and 0 g/m~2, respectively. After ultrasonic extraction, centrifugence and concentration, the samples were finally determined by high-performance liquid chromatography (HPLC). The mortality rate of snails was observed after 3 days and 7 days. Results The standard error and range of niclosamide in soil were large. There was no significant difference in concentration of niclosamide between the surface layer and deep layer of soil (P>0.05). After 5 months, niclosamide still could be determined in groups of 4 g/m~2. The mortality rate of snails decreased as the concentration of niclosamide decreased (P<0.05). After 5 months, in the group of 4 g/m~2 dosage, the 3 and 7 days mortality rate of snails were 5.33% and 9.33% in the surface layer, higher than the control group (P<0.05). Conclusions The heaping method is an efficacious measure of controlling snails and its recommended dosage is 4 g/m~2.

Objective To study the relationship between personality and defense mechanism of obsessivecompulsive disorder (OCD) patients.Methods Thirty-four OCD patients were tested with Swedish University Scales of Personality(SSP) and defensive style questionnaire( DSQ), and the result was compared with that of thirty-one normal controls.Results The SSP scores of STA,PsTA,SS,E,TI and M of OCD patients were significantly higher than that of normal controls (t = 2.06 ～ 5.10, P ＜ 0.05 ).Comparing with normal controls, OCD patients tended to use immature and intermediate mechanism such as projection, passive aggression, unconscious emerge, phantasy, withdrawl and reaction formation, but less used mature mechanism such as sublimation, suppression and humor (t = -2.27 ～ 6.73, P＜ 0.05 ).All subscales of SSP in OCD patients, excluding SD and D, had positive correlation with total score of immature mechanism (r = 0.375 ～ 0.719, P ＜ 0.05 ).The OCD patients' SSP scores of STA had positive correlation with mature mechanism (r = 0.378, P ＜ 0.05 ).The OCD patients' STA, PsTA, I, AS, E, M,VTA and PhTA score of SSP had positive correlation with intermediate mechanism (r= 0.381 ～0.548, P＜ 0.05 ).All subscales of SSP in OCD patients, excluding SD, had positive correlation with total score of concealment (r =0.342 ～ 0.530, P ＜ 0.05 ).Conclusion OCD patients have the neurotic and aggressive features of personality;and the personalities of OCD patients have significant correlation with defense mechanism.

ObjectiveTo investigate the effect of flurbiprofen axetil on lung ischemia-reperfusion(I/R) injury in rats.MethodsSixty healthy male SD rats weighing 250-300 g were randomly divided into 3 groups( n =20 each): group sham operation(group S) ;group I/R and group flurbiprofen axetil (group FA).The animals were anesthetized with intraperitoneal 2％ pentobarbital 50 mg/kg and tracheostomized and mechanically ventilated.Lung I/R was induced by 60 min occlusion of left hilus pulmonis followed by 120 min reperfusion.In FA group flurbiprofen axetil 10 mg/kg was injected iv at 15 min before occlusion of left hilus pulmonis.The rats were sacrificed at 120 min of reperfusion and then the lungs were removed for measurement of lung wet/dry weight ratio,apoptosis index,NF-κB activity,Bcl-2 and Bax protien expression,and microscopic examination.Bcl-2/Bax ratio was caculated.ResultsI/R significantly increased lung wet/dry weight ratio,apoptosis index,NF-κB activity,Bcl-2 and Bax protien expression,and decreased Bcl-2/Bax ratio.Flurbiprofen axetil preconditioning significantly attenuated the I/R-induced changes in lung wet/dry weight ratio,apoptosis index,NF-κB activity,Bcl-2 and Bax protien expression,and Bcl-2/Bax ratio in group FA as compared with group I/R.Flurbiprofen axetil preconditioning also ameliorated I/R-induced lung damage.ConclusionFlurbiprofen axetil can attenuate lung I/R injury in rats by inhibiting NF-κB activity,up-regulating Bcl-2 expression and down-regulating Bax expression and inhibiting apoptosis.

Objective The purpose of this study was to investigate the chemical constituents of Pierre. Methods The chemical compositions were isolated by silica gel column chromatography, semi-preparative HPLC,Sephadex LH-20, and MPLC packed with MCI gel, and their structures were identified on the basis of chemical and spectroscopic evidence (NMR and MS) . Results Eight compounds were obtained and determined as fibraurin (1),makisterone A (2),cycloartenol (3),feruloylphenethylamine (4),trans- -feruloyltyramine(5),β-sitosterol(6),1-monopalmitin(7),1-sinapoyl-β-D-glucopyranoside(8). Conclusion Compounds 2-8 were isolated from this plant for the first time.

Aim To investigate the inhibitory effect of hydrogen sulfide on expression of elastin in hypoxic pulmonary hypertensive (HPH) rats. Methods Twenty-four rats were randomly divided into three groups:control group (n=8), hypoxic group (n=8) and hypoxia+NaHS group (n=8). Pulmonary artery mean pressure (mPAP) of three group rats was measured via right ventricular catheterization. Right ventricle and left ventricle+septum of each rats were isolated from intact rats and weight of right ventricle/(weight of left ventricle+septum) ratio was calculated. The percentage of muscularized arteries of small pulmonary arteries was measured using a light microscope. The expression of elastin and TGF-? in pulmonary artery smooth muscle cells was observed with immunohistochemistry. Results mPAP and weight of right ventricle/(weight of left ventricle+septum) ratio were significantly higher in rats of hypoxic group than those of control group (P

Objective To investigate the difference of quality of life in patients with different symptom dimensions of obsessive-compulsive disorder(OCD).Methods Collected 54 cases of outpatient and the first inpatient with OCD to be the research group and 54 normal persons were the control group.The quality of life was assessed with SF-36,and compared the scores.An analysis was performed on the major categories of the YBOCS-SC to derive symptom dimension scores.Results Compared to the control group,patients with OCD showed significant impairment in seven domains of quality of life,especially in the mental health(t=12.474,P＜0.01),the roleemotional(t=9.407,P＜0.01),the social functioning(t=8.862,P＜0.01) and the vitality(t=8.057,P＜0.01).The patients with distinct symptom dimensions of ①symmetry/order,contribution rate 21.60％ ; ②contaminate/clean,contribution rate 16.37％; ③ aggression/religion,contribution rate 12.34％; ④ sex/check,contribution rate 10.90％.They showed different severity of the impairments in four domains of quality of life,the role-physical(F=5.199,P=0.004),the bodily pain (F=3.169,P=0.034),the role-emotional (F=9.350,P=0.000),the mental health(F=4.854,P=0.005).The differences mainly found between the ①②③group and the ④group by LSD multiple testing.Conclusion The mental health is severely damaged with OCD patients.There is stability with the structure of the symptom dimensions of OCD.And it maybe showed the heterogeneity of the symptoms for the significant difference of impairments of quality of life in patients with OCD.

Objective：To explore the distribution of personality disorder tendency of outpatients in psychological counseling departments.Methods：Systematic sampling was used to get the sample population from Shanghai Psychological Counseling Center.The Personality Diagnostic Questionnaire(PDQ~(+4))was administered to 1402 clients to screen personality disorders.Results：The subscales for different type of personality disorder(PD)and total score of PDQ~(+4) were higher than normal sample(e.g.total score of PDQ~(+4):client(38.23±17.04)vs.normal sample(22.79±14.10),P<0.001).The score of borderline subscales in female clients were higher than that of males [borderline:female(4.25±2.48)vs.male(3.97±2.41),P<0.05],the score of antisocial,paranoid and schizotypal subscales in male clients were higher than that of females [antisocial:female(1.31)vs.male(1.71),P<0.001;paranoid:female(2.75)vs.male(3.02),P<0.01;schizotypal:female(3.31)vs.male(3.56),P<0.05].Age stratification showed that the subscales for different type of PD of PDQ~(+4) were decreased with age [e.g.,total score of PDQ~(+4):18～24 years(41.73)vs.25～34 years(39.46)vs.35～44 years(33.88)vs.≥ 45 years(30.64),Ps<0.001],the positive rate of PDQ~(+4) subscales of obsessive-compulsive(58.5%)and avoidant PDs(54.0%)were higher than others,followed by borderline PD(44.4%).Factor analysis was used for the score of PDQ~(+4),factor 1 to 3 corresponded to cluster C,B and A personality disorders respectively,and the total variance explained 67%. Conclusion：There are different rates of personality deviation between psychological counseling clients and normal sample in China.Some traits of personality disorders can be improved with the increasing of age.The abstracted factors by factor analysis are very consistent with what originally proposed in the theory of personality disorder.It should be paid attention to PD tendency of clients during psychological counseling.