Objective:To determine the cost of medical insurance macroeconomic factors,and propose countermeasures for macro-control health insurance costs.Methods:Principal component analysis was applied to screen dominant macroeconomic factors that influenced medical insurance costs of Shanghai.Results:From the macro perspective,the economy and technology were the main factors affecting medical insurance costs.Conclusion:It needed to increase government investment in public health finance,develop cost-declined medical technology and strengthen the construction of medical and health information,as well as to strengthen government oversight.

Objective: To study the influence of different telomere oligonucleotide on rat's thoracic aortic smooth muscle (A7R5 ) cell apoptosis and to clarify weather silent information regulator 1 (SIRT1)/cancer suppressor gene (P53) signaling pathway involved in oligonucleotide induced cell apoptosis. Methods: 3 telomere repeat sequences of TE-12 (TTAGGG)2, TE-24 (TTAGGG)4 and TE-36 (TTAGGG)6 were respectively transfected into rat's A7R5 cells as TE-12 group, TE-24 group and TE-36 group; in addition, blank A7R5 cells were used as Control group. Transfection induced A7R5 cell apoptosis was detected by flow cytometry, mRNA and protein expressions of SIRT1 and P53 in A7R5 cells were examined by RT-PCR and Western blot analysis in different groups. Results: Successful ransfection rates were similar among 3 groups. Compared with Control group and TE-36, TE-24 groups, the highest apoptosis rate of A7R5 cells was found in TE-12 group and the lowest was found in TE-24 group which was still higher than that in Control group, allP<0.05. mRNA and protein expressions of SIRT1 was obviously higher in TE-12 group than the other 3 groups, allP<0.05; mRNA and protein expressions of P53 was obviously lower in TE-24 group than the other 3 groups, allP<0.05. Conclusion: Telomere oligonucleotide sequence may promote rat's A7R5 cell apoptosis; different sequence had various influence and the strongest effect was observed in TE-12 sequence. The above impact might be related to SIRT1/P53 signaling pathway.

Objective To investigate the incidence of adult epilepsy patients with attention-deficit hyperactivity disorder (ADHD) and the characteristics of ADHD subtypes, and to explore the correlations between several epilepsy-related factors and ADHD. Methods According to corresponding inclusion criteria and exclusion criteria, 82 adult epilepsy patients from March 2012 to March 2016 were enrolled as study group. Eighty-two healthy adults were enrolled as the control group. Using the Chi-square test and Logistic regression analysis and the other statistical methods, the phenomenon of ADHD in adults with epilepsy and the factors that may contribute to the phenomenon was analyzed. Results The detection rate of ADHD in 82 adult patients with epilepsy was 26.8%(22/82), significantly higher than that in the heathly control group which was 4.9%(4/82),χ2=18.672, P<0.05. Symptomatic epilepsy 8/17 and the electroencephalogram showed multifocal discharge 6/14 had higher detection rate of comorbid ADHD and the difference was statistically significant (P<0.01). The results of binary Logistic regression analysis showed that epilepsy age of onset was possibly an important factor for epilepsy with ADHD (B=-0.891, P<0.05). Conclusions The risk of ADHD in adults with epilepsy is higher than that in the healthy adults and attention-deficit is the common subtype. The etiology, age of onset and electroencephalogram features of adults with epilepsy may be associated with the occurrence of ADHD.

Objective To explore the diagnosis value of ultrasound real-time elastography in thyroid diffuse diseases.Methods Eleven elastic quantitative parameters of 123 patients with thyroid diffuse diseases and 42 healthy volunteers obtained from the ultrasound real-time elastography were analyzed with principal components analysis to attain a comprehensive evaluation value which was named stiffness index(SI),reflecting the organization elastic information of different thyroid diffuse diseases.SI among each group was compared by ANOVA.Results Chronic lymphocytic thyroiditis SI was 86.37±20.45,subacute thyroiditis SI was 86.14±19.95,primary hyperthyroidism SI was 54.68±21.69,normal control group SI was 41.34±15.59,respectively.The SI between chronic lymphocytic thyroiditis,subacute thyroiditis,primary hyperthyroidism and normal controls had significant statistical differences (P<0.05),the SI between primary hyperthyroidism and chronic lymphocytic thyroiditis,subacute thyroiditis had significant statistical differences (P<0.05),the SI between chronic lymphocytic thyroiditis and subacute thyroiditis had no significant statistical difference (P>0.05).Conclusions Ultrasound real-time elastography could indirectly reflect the stiffness information of thyroid lension tissue and have a certain degree of diagnosis value in thyroid diffuse disease.

Objective To explore the clinical features of pulmonary tuberculosis complicated with DM and related factors. Method The manifestations of 87 newly diagnosed PTB patients with type 2 DM(DM-PTB group) at two hospitals in Tianjin during October 2003 to October 2004 were compared to 88 PTB patients without DM who were randomly choosen from the same hosipital.The factors related to sputum-positive TB or cavity were explored through unconditional logistic regression model. Results DM-PTB patients showed significanly lower frequencies of cough(66.7% vs 83.0%),toxicity symptoms(37.9% vs 62.5%) and haemoptysis(16.1% vs 33.0%) than those of PTB group.Positive-sputum(63.2% vs 34.1%),cavity(56.3% vs 13.6%),wide lesions and bilateral lesions on chest radiographs was more common in DM-PTB group than in PTB one.Introversion(OR=1.582, 95%CI:1.063 ～2.355),type 2 DM(OR =2.186,95% CI:1.082 ~4.420)and cavity(OR =2.793,95% CI:1.308 ～5.964)were factors independently associated with positive-sputum TB.The factors related to cavity included diabetes(OR=14.199,95%CI:5.376~ 37.501),cough,postive sputum and lore-up lobe lesion.Conclusion This study confirmed that clinical manifestations and chest radiographs of PTB patients complicated with type 2 DM significantly departed from the typical presentation.Type 2 DM seems to have a negative effect on postive-sputum and cavity.So it should be alarmed that DM-PTB patients who tend to have untypical clinical symptom and higher rate of positive sputum become the reservoirs of infection to cause the transmission of TB.

Objective To explore the influence of personality and negative life events on the development of pulmonary tuberculosis among diabetic patients.Methods A hospital-based case-control study was conducted from March 2005 to February 2006.158 newly-diagnosed pulmonary tuberculosis patients with diabetes (DMPTB) were reemited as cases and 281 diabetic patients (DM) as control group.Information on personality and negative life events was collected using Eysenck Personality Questionnaire (EPQ) and Life Events Scale (LES),respectively.Odds ratios(OR) and 95% confidence intervals (95% CI) were estimated using logistic regression models and the potential confounding bias was controlled through adjusted by education,income,glycemic control,previous maximal BMI,weight loss ratio,physical xercises,smoking,negative life events or personality.Results The proportions of introversion,medium,extroversion personality in DM-PTB and DM group were 38.6% ,11.4% ,50.0% vs.53.0% ,11.1% ,35.9% (X~2=9.280,P=0.010).Those with introversion personality had 1.91 (1.26～2.90) times higher risk of DM-PTB than those with extroversion personality,while this association became insignificant after adjustment(P=0.111) ; 35.4% and 19.6% in the two groups had experienced life events during the last one year,and such persons had 2.26(1.15～3.50) (unadjusted) or 1.82(1.07～3.10)(adjusted) higher risk of DM-PTB than those without life events,especially among male and younger (＜60y) diabetics.Conclusion Negative life events are the independent risk factor of pulmonary tuberculosis among male and younger diabetics.Thus,mental measures should be taken in corresponding risk populations to improve their capability of dealing with life events.

Objective Through investigating the situation of health care resources in Shanghai ,from the point of population and geographical area distribution, the article analyze the fair allocation of medical resources in Shanghai to provide the basis of decision-making in rational allocation of medical resources. Methods Use Lorenz curve and the Gini coefficient indicators, as well as Chain Proportion Method. Results The allocation of medical resources in population of Shanghai is fairly,and the trend of fairness will be enhanced. In the geographical allocation in space is more unfairness in Shanghai,and the fairness will be reduced. Conclusion The allocation of medical resources Municipal Population has few gap between urban and rural areas in the Shanghai which reached a fair comparison, but in the geographic distribution of has a larger gap between urban and rural areas. Most of the medical resources concentrated in large hospitals in the urban centers. The distribution of Medical resources should be rational and the health service system should be improved to improve medical and health service accessibility.

Objective To investigate the value of acoustic radiation force impulse (ARFI) on evaluating the renal tubular atrophy and interstitial fibrosis of IgA nephropathy(IgAN).Methods 117 patients diagnosed with IgAN,and 80 normal cases were examined with conventional ultrasonography and ARFI,recording the shear wave velocities(SWV),the hemodynamics and the renal biopsy results to quantify the elastic changes of renal cortex,with the aim of assessing AFRI's advantages on early diagnosing the impair of kidney.Results The SWV value of renal cortex,renal medulla of IgAN group were smaller than that of normal group (P ＜0.05),while the collective system SWV value had no difference(P ＞0.05).According to the ROC curve,the cut-off value of SWV in renal cortex was 2.7 cm/s.The accuracy of the diagnosis was 71 ％,which was better than RI (61.9％).The SWV value of the renal cortex decreased with the different stage of 1,2,3,4,but stage 5 was larger than stage 4.The degree of renal tubular atrophy and interstitial fibrosis(T) can be classified by the SWV of renal cortex,and the SWV of T2 was larger than T1 (P ＜0.05).Conclusions By quantifying the elastic change of kidney,ARFI technology is able to distinguish the degree of renal tubular atrophy and interstitial fibrosis,diagnose renal impairment early and judge the clinical stages.Furthermore the sensitivity,specificity,accuracy of it are superior to hemodynamic.

Background Cataract surgery with replacement of the natural lens with an artificial intraocular lens(IOL) has developed into refractive surgery.Visual acuity is not the only evaluation criterion,but more focus has been put into the visual quality postoperatively.Aspherical IOL could improve the visual quality by decreasing the aspherical aberration.Objective This study was to investigate the short-term visual acuity,aberration alteration and clinical application of unsteady aberration aspheric IOL.Methods A retrospective case-controlled study was designed.Forty-two eyes of 30 patients with age-related cataract were included and divided into two groups.Phacoemulsification combined with unsteady aberration aspheric IOL implantation was performed in 21 cataractous eyes of the ZO group,and phacoemulsification combined with spherical IOL implantation in the other 21 eyes of the ADAPT group.Visual acuity,best corrected visual acuity (BCVA),contrast visual acuity,spherical aberration of the whole eye,contrast sensitivity (CS),dare sensitivity,modulation transfer function (MTF) and apparent accommodation were measured three months after surgery.All the parameters were compared between the two groups.The correlation of CS with the root mean square of spherical aberration,root mean square of comatic aberration and age was analyzed by multiple linear regression analysis.Written informed consent was obtained from each patient prior to operation.Results No significant differences were found in unconnected visual acuity,BCVA and spherical degrees between the ZO group and ADAPT group 3 months after surgery(P＞0.05).The CS value in the ZO group was significantly higher than that of the ADAPT group under scotopic background condition with spatial frequencies of 6,12,18 cpd,low glare the spatial frequencies of 6,12 cpd,as well as high glare with 12,18 cpd(P＜0.05).Under a scotopic background with 100％ contrast or a photopic background with 5％ contrast,the contrast visual acuity of the ZO group was significantly higher than that of the ADAPT group (t =20.217,P =0.000 ; t =4.568,P =0.039).At pupil diameters of 3,4 and 5 mm,the Z4 value was significantly lower in the patients of the ZO group than that of the ADAPT group (U =63.000,P =0.000 ; U =52.000,P =0.000 ; U =36.000,P =0.000).However,no significant differences were seen in the Trefoil aberration (Z6)value at 3 mm and 4 mm of pupil diameter(U =204.000,P =0.678;U =215.000,P =0.890) and coma aberration (Z7,Z8) value at 3,4 and 5 mm of pupil diameter between ZO group and ADAPT group(Z7:U=156.000,P =0.159 ; U =196.000,P =0.538 ; U =199.000,P =0.587 ; Z8:U=163.000,P =0.148 ;U=214.000,P =0.870;U =143.000,P =0.061).When the pupil diameter was 5 mm,Z6 value was significantly lower in the patients of the ZO group than that of the ADAPT group (U =4.000,P =0.000).The higher-order aberration MTF was significantly elevated in the ZO group compared with the ADAPT group from 5 through 20 cpd at a pupil diameter of 4 mm (P＜0.05) and 10,20,25,30 cpd at a pupil diameter of 5 mm (P＜0.05).A slightly lower objective accommodation was found in the ZO group compared with the ADAPT group without statistically significant difference(t =0.003,P＞0.05).Multiple linear regression analysis showed that the change in CS was associated with the root mean square of the spherical aberration and IOL type(β=0.544,R2=0.519,P =0.000)rather than with the root mean square of the comatic aberration and age.Conclusions The postoperative visual quality in the unsteady aberration aspheric IOL implanted eye is superior to that in the spherical IOL implanted eye due to a reduction in spherical aberration.