Objective To learn the impact of county-level public hospital reform on the expenditure of medical insurance fund.Methods Using the difference-in-differences model to analyze the differences incurred in both hospitalization expenditure and expenditure of the fund at two county-level public hospitals.Results The reform has reduced both the drug expenditure and examination expenses per hospitalization at such hospitals at 318.5 yuan and 410.2 yuan respectively,yet with an increase of treatment expenditure of 535.6 yuan per hospitalization.No significant growth rate was incurred by the reform to the medical insurance fund.A significant difference of both hospitalization expenditure of patients and the fund was found among patients covered by different medical insurance funds.Conclusions The reform has achieved initial success at such hospitals in reducing inpatients′drug and examination expenditures.However,it is important to prevent from the treatment expenditure from an offset increase;to further reform the payment modes for safety of the fund,to remove the differentiation found in the existing medical insurance system,and leverage the regulating role of various medical insurance funds on medical service behaviors and expenditures.

Objective:To investigate the middle-aged and elderly people′ willingness for family doctor service contracts and its influencing factors, and to provide feasible suggestions for the implementation and promotion of family doctor services.Methods:Stratified random sampling method was adopted to select middle-aged and elderly people aged 45 in 6 urban areas of Xuzhou city for questionnaire survey to investigate their illness, medical treatment and their willingness to contract a family doctor. The data acquired were analyzed with statistical description, univariate analysis( χ2 test), and multivariate logistic regression analysis. Results:Among the 927 valid questionnaires were recovered, 272(29.34%)of them intended to contract a family doctor, and 655(70.66%)had no such intention. Results of multivariate logistic regression showed that the influencing factors of the middle-aged and elderly people′ willingness of contracting family doctors were age, occupation, self-rated health, treatment status within two weeks, chronic diseases, referral experience and their knowledge of family physician contract system.Conclusions:Middle-aged and elderly people at large are not willing to sign up for family doctors. It is recommended to focus the publicity efforts on those who are relatively younger age, farming and healthier, enhancing their awareness of the service, and encouraging them to support the dual-referral policy. These efforts are expected to promote the coordinated progress of both dual referral and family doctor contract service, hence achieving the national coverage of the family doctor system.

OBJECTIVETo evaluate the influence of VPA treatment on neutrophils' oxidative metabolism and oxidant status in epileptic children.

METHODTwenty-six newly diagnosed epileptic children with idiopathic epilepsy and 30 healthy children were included in the study. The activation rates of neutrophils and stimulation indexes were detected in patients before and 6 months and 12 months after VPA treatment respectively and in all the healthy children by flow cytometry with dihydrorhodamine as fluorochrome. The activities of myeloperoxidase from neutrophils were also detected. Malondialdehyde as an indicator of lipid peroxidation and antioxidant enzymes including superoxide dismutase, catalase, and glutathione peroxidase were measured in plasma respectively.

RESULTThe activation rates of neutrophils in patients treated with VPA after 6 and 12 months were (11.50 ± 6.52)% and (14.31 ± 5.76)% respectively, which were significantly higher than the data of control group (5.90 ± 3.77)% and pretreatment level (7.42 ± 3.15)%. The stimulation indexes 6 and 12 months after VPA therapy were (474.88 ± 118.98) and (416.31 ± 110.00) respectively, which were lower than the data of control group (544.83 ± 140.83) and pretreatment level (535.23 ± 111.55). The plasma MPO activities and levels of malondialdehyde in VPA treated patients were also higher while the activities of SOD and CAT were significantly lower than the control and untreated groups. GSH-Px levels did not differ between the groups. Multiple linear regression analysis showed that the time of treatment and the activation rates of neutrophils were indicators which had positive correlation with the levels of plasma MDA and that SOD activities were inversely correlated with MDA levels.

CONCLUSIONVPA which is frequently used in childhood epilepsy may activate the neutrophils of patients and cause oxidative stress and prolonged treatment may aggravate it.

Anticonvulsants ; pharmacology ; therapeutic use ; Antioxidants ; pharmacology ; Case-Control Studies ; Catalase ; blood ; Child ; Child, Preschool ; Epilepsy ; blood ; drug therapy ; Female ; Glutathione Peroxidase ; blood ; Humans ; Lipid Peroxidation ; drug effects ; Male ; Malondialdehyde ; blood ; Neutrophils ; drug effects ; metabolism ; Oxidative Stress ; drug effects ; Superoxide Dismutase ; blood ; Valproic Acid ; pharmacology ; therapeutic use

Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Continuous Positive Airway Pressure ; Humans ; Lung ; Respiration ; Sleep Apnea, Central/therapy* ; Sleep Apnea, Obstructive

OBJECTIVEPrimary airway neoplasms are extremely rare in the pediatric age group. This paper reports 4 children with primary airway neoplasms to explore the clinical manifestations, safety and efficacy of bronchoscopic interventions.

METHODThe data of pathology, photographic documentation and imaging studies were analyzed.

RESULTOf the 4 reported lesions, 2 were characterized by low-grade (2 with mucoepidermoid carcinoma) and 2 by high grade malignant (spindle cell carcinoma and malignant lymphoma). Onset of clinical manifestations occurred at the ages of 7 months to 7 years. All of them were initially misdiagnosed as bronchitis, asthma or atelectasis. The lesions located in trachea in 2 patients, in left bronchus of 1 patient and in right middle bronchus of 1 case. Atelectases occurred in bilateral bronchus where the lesions obstructed almost the entire lumen at the time of diagnosis. The diagnosis of airway masses depends upon maintaining a high index of suspicion, complemented by imaging and timely diagnostic endoscopy. The lesions were completely removed in 3/4 patients except 1 died during bronchoscopic procedures.

CONCLUSIONThe children with malignant airway neoplasms were presented with cough and wheezing without specific manifestations. Bronchoscopic interventions were effective in the treatment of non-operative cases. General anesthesia is strongly recommended for interventional bronchoscopy.

Bronchoscopy ; Child ; Child, Preschool ; Female ; Humans ; Male ; Retrospective Studies ; Tracheal Neoplasms ; diagnosis ; therapy

OBJECTIVETo investigate the effect of piperphentonamine hydrochloride (PPTA) on cognitive deficits induced by ischemia-reperfusion and explore the possible mechanisms.

METHODSSD rats were randomly divided into sham-operated group, ischemia-reperfusion group (with saline injection), PPTA-treated groups (2.5, 5, 10 mg/kg) and edaravone-treated group (6 mg/kg). Cerebral ischemia-reperfusion injury was induced by middle cerebral artery occlusion, and the agents were administrated 1 h after ischemia. At 24 h after ischemia, step-through passive avoidance test was carried out, and 24 h later IL-1β, TNF-α, caspase-3 and HSP-70 mRNA expressions in the ischemic brain tissues were measured with RT-PCR.

RESULTSIn the step-through passive avoidance test, the rats in the ischemia-reperfusion group showed significantly shorter latency and more error times than those in the sham group, and these behavioral changes were improved significantly by treatments with PPTA and edaravone. Cerebral ischemia-reperfusion caused significantly increased expressions of IL-1β, TNF-α, caspase-3 and HSP-70 mRNA, and these changes were obviously reversed by PPTA, but not by edaravone.

CONCLUSIONSPPTA can reverse cognitive deficits induced by cerebral ischemia-reperfusion probably by decreasing the inflammatory responses and cell apoptosis in the brain, suggesting its potential as a new therapeutic agent for improving the cognitive function following cerebral ischemia-reperfusion.

3,4-Methylenedioxyamphetamine ; analogs & derivatives ; therapeutic use ; Animals ; Brain Ischemia ; drug therapy ; Cognition Disorders ; prevention & control ; Infarction, Middle Cerebral Artery ; drug therapy ; Male ; Neuroprotective Agents ; therapeutic use ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; drug therapy ; prevention & control

Objective To study the differences of efficacy and side effects between ziprasidone and clozapine for the treatment of first -epi-sode schizophrenia.Methods Nine comparative studies of ziprasidone and clozapine for the treatment of first -episode schizophrenia were rean-alyzed by meta analysis.Results The significant differences on symp-toms between prior and post treatment were found ( P<0.01 ) .Ziprasi-done was superior to clozapine in improving the total scores of positive and negative syndrome scale ( PANSS ) and the negative symptoms of schizophrenia ( P<0.05 ).The somnolence , constipation , salivation , ab-normal electrocardiogram , weight gain , blurred vision and abnormal liver function in ziprasidone group were significantly less than clozapine group (P<0.05 or P<0.01), but the extrapyramidal symptoms(EPS) in zi-prasidone group was significantly more than that of clozapine group ( P<0.01 ).Conclusion Ziprasidone has an advantage over clozapine in im-proving the total scores of PANSS and the negative symptoms in first -ep-isode schizophrenic , with less adverse drug effects.

Objective To evaluate the value of 3.0T susceptibility-weighted magnetic resonance imaging (SWI) in the diagnosis of cerebrovascular malformations. Methods Forty-six patients with cerebrovascular malformations, admitted to our hospital fiom May 2008 to December 2010, were examined with a 3.0T MR scanner. All patients were examined with MRI conventional sequences T1WI,T2WI, 3DTOF, and their results were compared with SWI sequence so as to evaluate the value of SWI in the diagnosis of cerebrovascular malformations.Results Twenty-five patients had arteriovenous malformation (AVM), 10 with cavernous hemangioma, 8 with venous malformations, and 3 with telangiectasis in the 46 patients with cerebrovascular malformations. SWI could delineate all the cerebrovascular malformation lesions, especially small lesions, but could not display all supplying artery in AVM. 3DTOF was a better technique in delineating large AVM lesions. Conclusion SWI is much more sensitive in showing small cerebrovascular malformations; and combined with other MR sequences,clear diagnosis of cerebral vascular malformations can be made by SWI.

This study was aimed to evaluate the in vivo antitumor effect of genetically modified myeloma cell vaccine on human myeloma xenografts implanted into nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mice. Human immune system was established in NOD/SCID mice by intraperitoneal injection of human peripheral blood lymphocytes (PBLs). After being inoculated subcutaneously with irradiated myeloma cell line sko-007, adenovirally transferred with GFP or p53, granulocyte-macrophage colony-stimulating factor (GM-CSF) and B7-1 genes, huPBL-NOD/SCID mice were challenged by subcutaneous injection of non-transferred sko-007 cells. The results indicated that Ad-p53/GM-CSF/B7-1-infected sko-007 cell vaccination significantly reduced local tumor growth compared with controls. Histopathological and immunohistochemical analysis showed that tumor tissues increasingly displayed diffuse necrosis, mainly caused by apoptosis, accompanied with significant fibroplasias and blood vessel hyperplasia, and human T cells infiltrated into the tumor tissues. It is concluded that transgenic p53, GM-CSF and B7-1 expression produces an immune response against myeloma cells and may be of therapeutic value for multiple myeloma in human being.
Adenoviridae ; genetics ; Animals ; B7-1 Antigen ; genetics ; immunology ; Cancer Vaccines ; immunology ; Genes, p53 ; immunology ; Genetic Vectors ; Granulocyte-Macrophage Colony-Stimulating Factor ; genetics ; immunology ; Immunotherapy ; Mice ; Mice, Inbred NOD ; Mice, SCID ; Multiple Myeloma ; immunology ; Neoplasm Transplantation

OBJECTIVETo explore dysfunction mechanism of rat alveolar type II (AT-II) injured by bleomycin (BLM).

METHODSSD rats were injected with a single intratracheal dose of bleomycin or control saline. On day 7, 14, and 28 following intratracheal bleomycin or saline instillation, animals were killed under overdose of 1.5% sodium pentobarbital (0.25 ml/100 g, i.p.) and bronchoalveolar lavage fluid (BALF) from the lung was tested for the activity of pulmonary surfactant (PS) by the Whihelmy Film Balance. Several concentrations of bleomycin stimulated the culture of rat AT-II cells, and surfactant protein (SP) A, B, and aquaporin-1 (AQP) mRNA were analyzed by fluorescent quantitative polymerase chain reaction (FQ-PCR).

RESULTSThe activity of PS and hypoxemia significantly decreased on day 7 and improved on day 14 and completely recovered to normal status on day 28. SP-A, B, and AQP-1 mRNA expression in BLM-stimulated group were significantly lower than those in the control group (P<0.001).

CONCLUSIONBLM-injured AT-II cells decrease the levels of SP-A, B, and AQP-1 mRNA and cause PS dysfunction, resulting in hypoxemia and pneumonedema.

Animals ; Aquaporin 1 ; biosynthesis ; genetics ; Bleomycin ; administration & dosage ; toxicity ; Cells, Cultured ; Dose-Response Relationship, Drug ; Epithelial Cells ; drug effects ; metabolism ; Hypoxia ; chemically induced ; metabolism ; pathology ; Male ; Pulmonary Alveoli ; cytology ; drug effects ; Pulmonary Surfactant-Associated Protein A ; biosynthesis ; genetics ; Pulmonary Surfactant-Associated Protein B ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Time Factors