Objectives:This paper evaluates the rationality and feasibility of pharmaceutical price reform in dis-trict public hospitals in Nanjing .Methods:Pharmaceutical expense data before and after pharmaceutical price reform was collected from databases , changes of some major index about expenditures of medical insurance fund was simula -ted.Results:In Jiangning district hospital which had been reformed ,inpatient and outpatient expenses decreased while patient burden rate was the same or changed only slightly .Under the same stimulation , in four other district hospitals which is about to reform , the drug proportion of inpatient and outpatient and outpatient expenses per -time decreased , while inpatient expenses per-time increased .The hospitalization burden rate decreased by 3 .21%, and health insurance expenditure of inpatient accounted for 7 .74%of the whole fund pool .Conclusions:Pharmaceutical price reform reduced patient financial burden;health insurance fund spending increased and needs more attention in order to guard against the fund risk .The structure of pharmaceutical pricing tended to be reasonable and medical technology and medical service was more helpful .Compensation rates of medical insurance weren't equal, and the higher the compensation rates , the more both patient burden and health insurance fund expenditures were .Sugges-tions:It is crucial to eradicate the system of “subsidizing hospitals by charging more medicine fees” by leading the patient to primary medical situation , pushing the implementation of hospital payment reform and uniting of city inte-gration and urban-rural integration in order to ensure scientific development of district public hospitals .

【Objective】To compare different approaches and their effectiveness on the treatment of the femoral neck fracture in children,in order to provide a reliable and effective way for the treatment of the disease.【Methods】Clinical data of 21 cases with femoral neck fracture from 1983 to 1993 were analyzed retrospectively.【Results】21 cases were divided into three groups:① group Ⅰ:14 cases underwent closed reduction and internal fixation with multiple Kirscher′s pins or cannulate compression screws under C-arm X-ray monitor.Of the 14 cases,11 cases were healed,3 cases developed ischemic necrosis of femoral head;② group Ⅱ:4 cases was treated with skin traction and hip spica cast plaster fixation,3 cases was healed,1 case developed ischemic necrosis of femoral head;③ group Ⅲ:3 cases underwent opened reduction and internal fixation with multiple pins or cannulate compression screws,1 case was healed,2 cases developed ischemic necrosis of femoral head.【Conclusion】Closed reduction and multiple pins internal fixation under C-arm X-ray monitor may be the best choice of treatment of femoral neck fracture in children.

Objective To observe the effects of Yukouning on immunologic function in recurrent aphthous ulcer (RAU) patients with brimming heat of heart and spleen (BHHS type).Methods The study was composed of 30 patients with RAU (BHHS type) and 30 healthy individuals.All patients with RAU (BHHS type) were divided into levomisole group and Yukouning group (n =15).Patients of levomisole group were give 50 mg of levomisole,bid,lasted two days.Patients of Yukouning group were give Yukouning decoction.The changes of the class of T-cells and the levels of immunoglobulins (IgA,IgG,IgM) and complement (C3,C4) in different groups were tested by flow cytometry (FCM) and single immunodiffusion method.Results The levels of CD8+,IgG,IgA,C3 and C4 in RAU (BHHS type) patients increased significantly as compared with those in healthy group (P ＜ 0.05).The level of CD4+ and the ratio of CD4+/CD8+ decreased significantly as compared with those in healthy group (P ＜0.05).Furthermore,the levels of CD8+,IgG,IgA,C3 and C4 in RAU (BHHS type) patients decreased significantly after different drug treatment,respectively (P ＜ 0.05).At the same time,the level of CD8+ and the ratio of CD4+ / CD8+ increased significantly after different drug treatment,respectively (P ＜ 0.05).But all the above-mentioned indexes had no significant differences between the two drug groups (P ＞ 0.05).After 1-year follow-up,the effective rate (both 93.3％) had no significant difference between the two groups (P ＞ 0.05).Conclusion Imbalance of immune function is correlated with RAU (BHHS type).Yukouning plays a therapeutic role by regulating cellular and humoral immunity in RAU (BHHS type) patients.

Objective To assess the effects of different administration timing of prophylactic antibiotics on infections after hip arthroplasty. Methods 535 patients having undergone arthroplasty were divided into two groups: the experiment group (n=273)and the control group (n=262): The former groupwere administered with antibiotics until 24 hours postoperatively and the latter until 72 hours postoperatively. The two groups were compared in terms of postoperative infection rate. Results The infection rates in the experimental groupand the control group were 4.396%and 3..817%, with insignificant differencebetween them. Conclusion For those patients undergoing hip arthroplasty, extended administration of antibiotics after operation (over 48 hours) may not reduce the risk of recent the infection rate.

Objective To study the prevalence and associated factors of loneliness in individuals with speech disability.Methods Using multi-stage stratified random cluster sampling method,170 community-residing ver-bally disabled persons were selected and administered with a general information questionnaire,one single -item loneliness self-rating question and social support scale.A total of 204 study questionnaires were distributed to the subjects;170 subjects(mean age:43.1±13.7 years)completed the survey.Results As high as 46.47% (79/170)of these verbally disabled individuals reported to feel lonely often.Females (OR=2.45),unemployment (OR=2.95), first and second degrees of disability (OR=4.35),co-existence of chronic illnesses (OR=6.50)and low utiliza-tion of social support (OR=2.58)were significantly associated with the increased risk of loneliness in persons with speech disability (P =0.002~0.046).Conclusion Loneliness is highly prevalent in individuals with speech disabili-ty.Verbally disabled persons,who are female,unemployed,severely disabled,and chronically ill and have a low use of social support,are the target population of mental health services.

OBJECTIVETo examine the expression changes of activin beta A, beta C, beta E and follistatin mRNA in the development of rat hepatic fibrosis induced by carbon tetrachloride (CCl(4)).

METHODSHepatic fibrosis was induced in rats by subcutaneous injections of 40% carbon tetrachloride oily solution for a period of 1 to 7 weeks. After carbon tetrachloride injection of 1, 2, 3, 4, 5, 6, and 7 weeks, the 6-12 rats were killed every time. The kinetics of activin beta A, beta C, beta E and follistatin mRNA expression were assessed by the semi-quantity RT-PCR.

RESULTSActivin beta A, beta C, beta E and follistatin mRNA could be detected in normal rat livers. After CCl(4) injection for 2 or 3 weeks, beta A mRNA was transiently decreased and became undetectable, then increased gradually. After CCl injection for 6 and 7 weeks, beta A mRNA level was significantly higher than controls (P<0.01). beta C mRNA could be detected after CCl(4) injection for 1 to 4 weeks and was significantly increased after 5 weeks over controls (P<0.05). beta E mRNA could not be detected after CCl(4) injection for 1 to 5 weeks, but significantly increased after CCl(4) injection for 6 or 7 weeks compared with controls (P<0.01). Except for normal rat liver, no follistatin mRNA was detected in rats after CCl(4) injection.

CONCLUSIONSActivins and follistatin have different expression changes in the development of hepatic fibrosis and the imbalance of activins and follistatin expression may involve in the formation of hepatic fibrosis.

Activins ; genetics ; Animals ; Carbon Tetrachloride ; Follistatin ; Gene Expression ; Inhibin-beta Subunits ; genetics ; Liver Cirrhosis, Experimental ; chemically induced ; genetics ; pathology ; Male ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction

Objective To establish the method for simultaneous determination of six index components in the water extract of Weile Prescription;To optimize the water extraction process.Methods UPLC-MS/MS was used with Waters CORTECS C18 column(2.1 mm×100 mm,1.6 μm)as the chromatographic conditions;the mobile phase was 0.1%formic acid water-acetonitrile with gradient elution;the flow rate was 0.25 mL/min;the column temperature was 40℃;the sample volume was 2 μL.Electrospray negative ion source,positive and negative ion switching multi-reaction monitoring(MRM)mode were detected.Taking the content of six index components(gallic acid,vitexin,paeoniflorin,naringin,hesperidin and glycyrrhizic acid)and extraction rate as evaluation indexes,the weight coefficient of each index was determined by G1-entropy weight method,and the optimum parameters of extraction process were determined by orthogonal experiment design with the amount of water,extraction time and extraction times as investigation factors.Results There was a good linear relationship of the six components in the water extract of Weile Prescription in the concentration range(r>0.999),and the average recovery rate was 96.83%-102.56%,RSD<4.0%.The best technological parameters were as follows:Chinese decoction pieces were soaked in 12 times of water for 2 h,and extracted twice,each time for 1.5 h.Conclusion The UPLC-MS/MS method established in the study for simultaneous determination of six components in Weile Prescription is rapid,simple and sensitive,and the optimized extraction process is stable and feasible,which provides experimental basis for the development and research of the preparation.