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.

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 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.

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.

Objectives To investigate the application modes of indocyanine green (ICG) angiography,digital subtraction angiography (DSA) and methylene blue angiography in the hybrid surgery of cerebral and spinal arteriovenous malformations (AVMs) and to compare the application value of different intraoperative angiographic methods.Methods From July 2013 to December 2015,55 patients treated with hybrid surgery of cerebral and spinal AVMs in Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 8 patients with cerebral AVM(Spetzler-Martin grade ≥Ⅲ) and 47 with spinal AVM.Their mean age was 33.8±15.6 years.Intraoperative DSA was performed in a hybrid operation room and methylene blue angiography was performed via the feeding artery.ICG angiography was performed in 4 cases in the initial stage as a comparison.Anatomic cure was confirmed by DSA at 3 months after surgery and the results were assessed.Results All 55 patients performed intraoperative DSA,32 underwent methylene blue angiography and 4 performed intraoperative ICG angiography.The frequency of intraoperative DSA was 3.6±1.3 times for each case.After the resection of the first lesion,the residual lesions revealed by DSA accounted for 27.3% (15/55).85.5% (47/55) patients achieved anatomic cure,in which the patients with midbrain AVM (8/8) and spinal AVM 83.0% (39/47) achieved anatomic cure.Three patients were lost to follow up at 1 year after procedure.The median modified Rankin scale (mRS) score of the cerebral AVMs was 2.0 (0.0-3.8).Compared with 3.5 (2.0-4.0) before procedure,there was significant difference (Z=-2.264,P<0.05).The Aminoff score in patients with spinal AVM after procedure was 3.5 (1.0-6.0).Compared with 4.0 (1.0-6.0) before procedure,there was no significant difference (Z=-0.262,P>0.05).The patients with function preservation (function score equal or better than pre-operation) accounted for 88.5% (46/52).Conclusions Intraoperative DSA could precisely localize the nidi and verify the complete resection.Intraoperative methylene blue angiography could selectively reveal the feeding artery supplied nidi in the operative field and identify the angioarchitecture.ICG angiography could reveal the structures of nidi on the surface of the operation area.The intraoperative methylene blue angiography could replace ICG angiography and achieve the treatment target of anatomical cure of the hybrid surgery of the cerebral and spinal cord vascular malformations.

Objective To discuss the technical essentials of microsurgery using suboccipital muscle stratification for the treatment of complex vertebrobasilar aneurysms via far lateral approach.Methods The clinical data of 8 patients with vertebrobasilar aneurysm underwent suboccipital muscle stratification via far lateral approach at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 5 patients with subarachnoid hemorrhage (Hunt-Hess grade Ⅱ 3 cases;grade Ⅲ 1 case;grade Ⅳ 1 case),and 3 with symptomatic dissecting aneurysm.Six patients underwent occipital artery-posterior inferior cerebellar artery and anterior inferior cerebellar artery bypass grafting,and aneurysm trapping,and the aneurysms of the other 2 cases were clipped directly in the operation.The modified Rankin scale (mRS) was used to evaluate the clinical efficacy.Results Postoperative digital subtraction angiography (DSA) revealed that all the bridge vessels were patent.The obtained length of occipital artery in the actual measurement of the operation was 12.5±1.1 cm.The distance between the anastomosis site and the skin incision in 6 cases was 50±6 mm.They were followed up for 4-21 months after procedure.The mRs score in 7 cases was 0-1.Two patients had new-onset hoarseness and recovered completely within 3 months after procedure.Another patient had postoperative cerebellar hemisphere dominant regional cerebral infarction and the mRs score was 4.None of them had poor wound healing,infection and cerebrospinal fluid leakage after procedure.Conclusion Suboccipital muscle stratification via far lateral approach can effectively obtain a longer occipital artery,reduce the occupation effect of muscle and depth of field.It is beneficial to expose lesions and operation of deep anastomosis.It is a more safe and practical technique in neurosurgery for the treatment of vertebrobasilar artery aneurysms.

Objective To investigate the diagnostic and treatment results of arteriovenous fistula of cauda equina.Methods From January 2000 to December 2015,9 Patients with arteriovenous fistula of cauda diagnosed and treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively,including 6 males and 3 females.Their ages were 17-58 (mean 39±14) years.The diagnoses were confirmed by digital subtraction angiography (DSA) or surgery (the lesions were located on the cauda equine,which were fed by the arterial supply of the nerve root,and the drainage vein flowed upward into the perimedullary vein).The clinical data,imaging data,and treatment follow-up results of the patients were analyzed.Results The patients presented with weakness of both lower extremities and disturbances of bowel movement and urination.Aminoff Logue score for spinal function was 7.2±3.2 before procedure.The median course of disease was 6.0 (4.5-18.0) months.Angiography showed that the vascular architecture types of the lesions were divided into simple fistula type and micro-nidus type.The feeding arteries were all the nerve root branches of the internal iliac artery.Three patients complicated with conical part of the intramedullary arteriovenous malformations.Eight patients were treated with endovascular embolization,one was treated by operation.No patients were treated with combined interventional surgery,and no surgery-related complications were observed.The mean follow-up duration was 20.1±6.7 months.Imaging follow-up showed that they all reached anatomic cure.Aminoff Logue score dropped to 4.6±2.8 after treatment.There were significant differences before and after treatment in Aminoff Logue score of the patients (t=4.276,P<0.05).Conclusions The nerve root arteriovenous fistula of the cauda equina can be diagnosed by DSA findings.Symptomatic patients are eligible for the indication of endovascular or surgical treatment.Anatomy and functional prognosis are satisfactory after 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.