Objective: To understand the gambling relations between the stakeholders of catastrophic medical insurance policy under New Rural Cooperative Medical System ( NCMS) , and provide theoretical references for the smooth operation of catastrophic medical insurance policy of NCMS. Methods:Analyzing the game relationships among the four sides:the government, business insurance agencies, designated medical institutions and participating farmers suffering from catastrophic diseases through game theory. Results: The government and business insurance agency, and the government and designated medical institution belong to cooperative games. The farmers participated in catastrophic medical insurance tend to choose cooperative strategy. Non-cooperative games exist in business insurance agency, designated medical institution and participating farmers. Conclusion: Strategic relationship of close cooperation should be established between the business insurance agencies and designated medical institutions. The government should strengthen the regulatory constraints between the business insurance agencies and designated medical institutionsi, at the same time, it needs to establish the incentive mechanism soon.

Objective To investigate the operation key points and therapeutic effect using the pressure cooker technique (PCT)for embolization of the dural arteriovenous fistula (DAVF)at the petrous apex region. Methods The clinical data of 4 patients with DAVF at the petrous apex region admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University from October 2015 to February 2016 were analyzed retrospectively. The PCT technique was used to conduct embolization therapy. Results DSA confirmed that 4 patients had DAVF at the petrous apex region with the multi-branch artery blood supply and they were drained via the superior petrosal veins. The patients were embolized by using PCT. DSA confirmed that they were embolized completely after procedure. They were followed up at 3months after surgery and their symptoms were improved. Conclusion For DAVF at the petrous apex region with the multi-branch artery blood supply,the preliminary experience shows that PCT technique may improve the efficiency of embolization,thereby obtaining anatomical cure.

Objective To investigate the effects of exercise on memory impairment in demented mice and possible molecular mechanisms.Methods Thirty Kunming nice were divided into a normal control group,a dementia group and a dementia plus exercise training group (exercise training group),10 mice/group. Dementia models were established by intraperitoneal injection of scopolamine.Exercise training was begun 30 min after the injection and lasted for a 6-week period. A water maze test was performed after the exercise training. Brain-derived neurotrophic factor (BDNF) expression and protein kinase (Akt) phosphorylation in the hippocampus were detected by Western blot analysis.Nitric oxide (NO) content and superoxide dismutase (SOD) activity in the hippocampus were also measured.ResultsDementia models were successfully induced as indicated by prolonged escape latency in the water maze test.After exercise training the escape latency had shortened significantly and hippocanpal BDNF expression and Akt phosphorylation had increased.NO content increased and SOD activity decreased after the injections,but these effects were partially reversed after exercise training.Conclusions Exercise can improve spatial memory significantly after scopolanine-induced dementia in mice.The increased hippocampal BDNF expression and Akt phosphorylation,increased SOD activity and decreased NO content may partially explain the behavior improvement induced by exercise.

Ischemic stroke has become one of the leading causes of disability and death in China.A number of studies have confirmed that hypoalbuminemia is an independent risk factor for ischemic stroke.It affects the severity of ischemic stroke and outcomes.This article reviews the rehtionship between serum albumin and ischemic stroke,the cause of low albumin level,the effect of albumin on ischemic stroke,and how to supplement albumin in order to improve the clinician's attention for hypoalbuminemia in patients with ischemic stroke and supplement nutrition timely and reasonably.

Objective To investigate platelet α and β secretase activities and the amounts of platelet soluble fragment of APP (sAPPα) produced by α-secretase in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD).Methods The neurological functions of 48 nondemented patients,42 MCI and 40 AD patients were evaluated by neuropsychological examinations.The platelet α and β secretase activities and sAPPα production in each group were measured by fluorescence and Western blotting analysis respectively.Results The α secretase activities in non-demented,MCI and AD group were 100.0％ ± 10.6％,78.2％ ± 9.4％ and 61.8％ ± 7.2％ respectively.As compared with nondemented group,the α secretase activities in MCI and AD group were decreased (F =22.935,P =0.001).The α secretase activity in AD group was significantly lower than MCI group.The β secretase activities in non-demented,MCI and AD group were 100.0％ ± 11.2％,145.8％ ± 12.7％ and 189.8％ ± 14.2％respectively.The β secretase activities in MCI and AD group were significantly higher than that in nondemented group (F =16.368,P =0.001).The β secretase activity in AD group was significantly decreased as compared with MCI group.The sAPPα amounts in MCI group and AD group were all decreased as compared with that in control group; the sAPPo amount in AD patients was significantly decreased as compared with that in MCI group.Conclusions The platelet α secretase activity and its production sAPPα in MCI and AD patients are decreased,while β secretase activity is increased,as compared with that in control group; the altered α and β secretase activities may participate in the pathogenesis of MCI and AD patients and may have diagnostic potential for them.

Objective To evaluate the effect of self-treatment and observe the change of heart morphology and function in patients with Keshan disease by echocardiography.Methods The left atrium diameter(LAd),left ventricular end-diastolic diameter(LVEDd),the thickness of interventricular septum in end diastolic(IVSTd),the thickness of left ventricular posterior wall in end-diastolic(LVPWTd),the left ventricular mass(LVM),the left ventricular mass index(LVMI),the relative wall thickness(RWT),the left ventricular ejection fraction(LVEF)and the mitral valve flow E/A ratio(E/A)were measured before the self treatment by echocardiography,and also measured on the 3rd month and 6th month after self-treatment with the same method,and observed the change of the parameters above.Results The LAd,LVEDd,IVSTd,LVPWTd,LVM,LVMI and RWT decreased on the 3rd month after self-treatment compared with prior self-treatment,and decreased on the 6th month further.There was significant difference between the prior self-treatment and post self-treatment(P＜0.05).The mitral valve flow E/A ratio and LVEF increased on the post self-treatment compared with the prior self-treatment slightly,but there was no statistical difference(P＞0.05).Conclusions Left ventricular hypertrophy and remodeling in patients with Keshan disease were prevented and reversed,and the cardiac function were improved after the self-treatment.Echocardiography can be used to evaluate the effect of self-treatment on patients with Keshan disease and can provide direction for clinical treatment.

Objective To assess the characteristics and influencing factors of non-motor symptoms (non-motor symptoms) in untreated patients with Parkinson's disease (PD) at early stage.Methods A total of 106 untreated patients with PD at early stage and 108 healthy controls (HC) matched for age,gender,education status and occupation were investigated by non-motor symptoms questionnaire.And both of them were divided into two groups:aged group (≥60 years old) and nonaged group (＜60 years old).76 cases with an average of (66.8±6.6) years old were selected in the aged group,and 30 cases with an average of (57.3± 5.2) years old were selected in the non-aged group.The distribution of non-motor symptoms items was analyzed between two groups.The clinical characteristics of PD patients were also collected to assess the dominant influencing factors for the prevalence of non-motor symptoms.Results The total number of non-motor symptoms was significantly higher in aged PD patients and non aged PD patients than in age-matched control groups [(13±7) vs.(4±2),t=10.843; (11±4) vs.(2±1),t=12.145,both P＜0.001].The incidence of non-motor symptoms was significantly higher in aged PD patients (20 items) and non-aged PD patients (9 items) than in age-matched control groups (both P＜0.05).The constipation in aged PD patients and the olfactory disturbance in non-aged PD patients were the most frequent ones.The number of non motor symptoms was positively correlated with course of disease(r=0.413),age(r=0.385) and Hoehn-Yahr stage (r =0.318) in aged PD patients (all P ＜ 0.05).The number of non motor symptoms was positively correlated with Hoehn-Yahr stage in non-aged PD patients (r=0.306,P＜0.05).Conclusions non-motor symptoms are more frequently seen in aged and non-aged PD patients than in age-matched controls.non-motor symptoms are more common in PD patients at earl stage and the number of non-motor symptoms increases with the degree of disease severity and age.More attention should be paid to the diagnosis and rational treatment of the non-motor symptoms so as to increase treatment effectiveness.

Objective To observe the effects of levodopa on verbal and spatial working memory in elderly patients with Parkinson's disease (PD).Methods The modified Smith working memory software were applied to study the verbal and spatial working memory in 32 PD patients before and 8 weeks after treatment with levodopa and benserazide hydrochloride tablets.The results of PD patients were compared with those in 32 normal controls matched for age,sex and education.Results The correct rates of phonological verbal and coordinate visuospatial working memory were significantly lower in the PD patients without treatment than in the normal controls (both P＜0.01).The correct rates of semantic verbal and categorical visuospatial working memory had no significant differences between the PD patients without treatment and the normal controls (both P＞0.05).The correct rates of phonological verbal working memory and coordinate visuospatial working memory were significantly higher in the PD patients after administration of levodopa and benserazide tablets than in PD patients without treatment [(88.6±6.5)％ vs.(82.1 ± 6.6)％,(84.2±8.8)％ vs.(75.2±8.9)％,respectively,both P＜0.01],but there were no significant differences in the correct rates of semantic verbal working memory and categorical visuospatial working memory between the above two groups (both P＞0.05).The correct rates of phonological verbal,semantic verbal,coordinate visuospatial and categorical visuospatial working memory were negatively correlated with the course of disease,and had no correlations with age and the degree of education.Conclusions Levodopa can improve the functions of phonological verbal working memory and the coordinate visuospatial working memory,but has no effect on the semantic verbal working memory and the categorical visuospatial working memory.It is postulated that dopamine replacement therapy may have double dissociable effects on the different working memories.

Objective Treatment and histopathological observation of demodex canis in beagle dogs .Methods Using the method of direct smear for microscopic examination of demodex canis.Histopathological observation on the skin of the parasitic parts after routine paraffin section and HE staining .Results (1) Clinical observation: The red spots and hair removal was appeared on limbs , eyes, lower abdomen and other parts of the skin of canine patients .The skin of the limbs becomes thicker and wrinkles .(2) Blood routine examination:Basically normal.(3) Microscope observation:The results showed that a large number of worms and eggs of small demodex canis could be found .(4) Histopathological observation:Hair follicles showed a large number of demodex mites and eggs.The sebaceous glands and sweat glands have normal morphology and no mites was found .A large number of eosinophils and neutrophil infiltration were seen around the hair follicles.It was also found that the formation of multifocal granuloma:the granuloma was oval shaped .(5) Treatment programme:The combination of medication and the strengthening of environmental control has been shown to be effective . Conclusions Granuloma caused by demodex canis can be divided into immune granuloma .It may not be possible to destroy the sebaceous glands after infection with small demodex canis.Whether the sebaceous gland is infected with the demodex canis may be associated with the worm species or course of disease .

Objective To characterize emotional memory impairment in untreated patients with Parkinson' s disease (PD) in the early stages of the disease. Methods Emotional memory tasks using standardized sets of emotional pictures including positive, neutral and negative valence were tested in 33 untreated patients with PD in the early stages and 31 healthy controls matched with age, sex, and education.Results Compared with the healthy adults (13.4 ± 1.4), PD patients had significant loss of negative valence picture memorizing ( 8. 9 ± 1.0; t = - 14. 87, P ＜ 0. 01 ).There was no significant difference between PD patients and normal controls in positive ( 11.8 ± 1.0 vs 12. 4 ± 2. 2 , t = - 0. 95 ) and neutral (7.9 ± 1.4 vs 8.2 ± 1.3, t = - 0. 89) valence picture memorizing ( both P ＞ 0. 05 ). ConclusionThe emotional memory for negative valence pictures is impaired but the emotional memory for positive and neutral is relatively spared in early PD patients without treatment.