Moral hazard in the catastrophic disease health insurance has challenged the sustainability of med-ical budget funds. This paper studies the health care reimbursement rule to counteract moral hazard. Theoretical a-nalysis shows that in the target to maximize social welfare, the optimal rule is to provide consumers who choose low-cost treatment with subsidies and charge a co-payment to those who choose high-cost one. Adopting simulation ap-proach shows that this difference with respect to single reimbursement rules, healthcare expenses and medical insur-ance premiums will be significantly reduced compared to a unified co-payment ratio. This paper also selects the sensitivity test simulation parameters and the results show that different values will not change the herein disclosed mechanism results.

Objective To investigate the cause of vertical root fracture in pulpless teeth, and advance the measures of prevention. Methods The clinical data of 20 vertical root fracture in pulpless teeth (17 patients) were collected. The status of the teeth and periodontium before therapy were reviewed, the position and direction of the root fracture were observed, the type and position of the restoration and the occludent station of the teeth were analyzed. Results It was revealed that vertical root fracture frequently occurred in the molars (16/20). Vertical root fracture were frequently found in front teeth(4/20) and premolars (5/20)among those with coronal integrity. Decrease of alveolar level of various degrees was found in 19 cases, among which 8 were mild, 7 moderate and 4 severe. Vertical root fracture mainly took place in molars after coronal restoration (6/7). Vertical root fracture would likely to occur no matter whether they would be worked as the abutment teeth of the removable partial denture or fixed prostheses. Early contact occurred in lateral bite (6 cases) was more susceptible to vertical root fracture than that occurred in centric bite (1 case). Conclusion The causes of vertical root fracture in pulpless teeth are complicated. Due to unfavorable outcomes, it is important to take precautions for vertical root fracture.

The definition of esophagogastric junction (EGJ) adenocarcinoma and progress in multidisciplinary treatment for the tumor were revised in this review. Siewert classification is especially useful for the surgical approach of EGJ adenocarcinoma. Siewert I should be treated as esophageal cancer, and Ivor-Lewis esophagogastrectomy (right thoracotomy and laparotomy) is recommended as an extended two-field lymphadenectomy. For Siewert II or III tumors, left thoracophreno-laparotomy is preferred, especially in case of positive thoracic lymph nodes or positive resection margin. If there is any contraindication against thoracotomy, or a high operating risk, a transhiatal esophagectomy with lower mediastinal lymphadenectomy is an alternative. Preoperative chemoradiotherapy or perioperative chemotherapy improves overall survival and the rate of complete resection for patients with large tumor or lymph node metastasis. Neoadjuvant chemoradiotherapy is associated with high but acceptable postoperative complications. Adjuvant chemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.
Adenocarcinoma ; surgery ; therapy ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Esophagogastric Junction ; Humans ; Stomach Neoplasms ; surgery ; therapy

Child ; DNA Mutational Analysis ; Dystrophin ; genetics ; Exons ; Humans ; Male ; Muscular Dystrophy, Duchenne ; genetics ; Mutation

To clarify the origin and development of the traditional Chinese medicine "Duhuo" and "Qianghuo" with medicinal literatures. Medical literatures of past dynasties were analysed and combined with the modern material. The "Duhuo" in Herbal writing Shen Nong Ben Cao Jing include traditional Chinese medicine "Duhuo" and "Qianghuo", "Qianghuo" was separated from "Duhuo" due to the distinguish of clinical application. The origin of "Qianghuo" is Notopterygium incisum and N. forbesii, However, The origin of "Duhuo" is very complex, Angelica pubescens f. biserrata as authentic "Duhuo" was used from Song Dynasty. "Qianghuo" was originated from "Duhuo".
Angelica ; chemistry ; growth & development ; Apiaceae ; chemistry ; growth & development ; China ; Drugs, Chinese Herbal ; isolation & purification ; Geography ; Humans ; Medicine, Chinese Traditional ; Research ; Species Specificity

Objective:To investigate the expressions of peripheral lymph node addressin(PNAd)andGlcNAc-6-sulfotransferase(GlcNAc6ST)in endometrium and their impacts on implantation.Methods:PNAd expression in endometrium was examined by immunohistochemistry and Western Blot from 75women(12 from healthy women,in proliferative phase;63 from sterile women,of whom,27 were inearly-secretory and 36 in mid-secretory phase).GlcNAc6ST mRNA was examined by real-time PCR in41 sterile women.The 63 sterile women had underwent ⅣF-ET and were consequently divided into clini-cal pregnant(29 cases)and nonpregnant(34 cases)groups.Results:(1)PNAd localized to the mem-brane and cytoplasm of luminal and glandular epithelia.Staining was patchy and much less intense duringthe proliferative phase than during the secretory phase.In Western Blot of PNAd,four bands appeared,which were Sgp200,CD34,MAdCAM-1,GlyCAM-1 respectively,and each was positively correlatedwith the others significantly.The former three molecular levels were significantly higher during the secre-tory phase as compared with the proliferative phase.Message RNA of GlcNAe6ST was positive in all ca-ses and showed no correlation with any component of PNAd.(2)The expressions of CD34 and GlyCAM-1,but not Sgp200 and MAdCAM-1,were significantly higher in pregnant women than in nonpregnantones.However,the GlcNAc6ST mRNA level did not differ between groups.(3)No significant differ-ence was found in female age,methods of fertilization,thickness of endometrium on day hCG,cumulativeembryo score(CES)and mean score of transferred embryo(MSTE)between the groups.Conclusion:PNAd expression in the human endometrium fluctuates with the menstrual cycle.Elevated CD34 and Gly-CAM-1 during the secretory phase might be stimulative factors for embryo implantation.Defect in PNAdexpression may account for a portion of unexplained infertility.

Objective To census the preoperative prevalence rate of deep venous thrombosis (DVT) and to evaluate the risk factors of DVT in senile osteoporotic hip fractured patients.Methods The object of study were patients aged 60 and above, and osteoporotic hip fracture by low energy injury in 2013.Based on medical records, all the patients with osteoporotic hip fracture were evaluated the signs and symptoms of DVT in 24 h, D-dimer test and underwent Doppler ultrasound screening of bilateral venous system in lower extremity after admission, and all the patients received preoperative prophylactic anticoagulation.Patients with popliteal and proximal level thrombus or floating thrombus underwent inferior vena cava (IVC) filter insertion.Outcome measures: age, gender, fracture type, D-dimer value in 24 h preoperatively, occurrence time of DVT and region, grade of preoperative American Society of Anesthesiologists, preoperative medical diseases.Results 702 of 946 hip fracture inpatients were comprised in this retrospective study.All were not founded any symptom or signs of DVT.All patients were took preoperative Doppler ultrasound screening and the results as follows: 36 of 302 patients (11.9％) with femoral neck fracture were proved preoperative thrombosis(13 male, 23 female), the average age was 72.7 year-old(range from 62-90 year-old), on the same side as the fractured hip in 31 patients, bilateral thrombosis in 5 patients.74 of 400 patients (18.5％) with intertrochanteric fracture were proved preoperative thrombosis(38 male, 36 female), the average age was 76 year-old (range from 60-95 year-old), on the same side as the fractured hip in 68 patients, bilateral thrombosis in 6 patients.The most prevalence rate of DVT were in the first day after osteoporotic hip fracture, 15 patients (41.7％) with femoral neck fracture and 38 patients (51.40％) with intertrochanteric fracture.There were more proximal level and multiple level involment thrombosis over 5 days after injury.The most thrombosis were proven at calf and popliteal vein.Conclusion The prophylaxis of DVT should be started even in the emergency department in senile patient with osteoporotic hip fracture.To avoid the risk factors, early surgery and early postoperative mobilization will be effective.

Objective To compare the efficacy of low temperature controlled plasma technology by nasal endoscopy and cystectomy via labiogingival groove approach in treatment of nasal vestibular cyst. Methods 38 patients with nasal vestibular cyst from Jan 2013 to Nov 2016 were selected and randomly divided into control group (n = 20) and observation group (n = 18). The control group received cystectomy via labiogingival groove approach and the observation group received low temperature controlled plasma technology by nasal endoscopy. The time of surgery, bleeding volume in surgery, hospitalization, postoperative complications and relapse were collected and compared between the two groups. Results We found that the observation group have less surgery time than that in control group [(65.45 ± 27.51) vs (34.72 ± 17.61) min, P = 0.000], less bleeding volume in surgery [(22.35 ± 18.41) vs (3.17 ± 1.69) ml, P = 0.000), less postoperative complications [(6.35 ± 0.75) vs (3.61 ± 1.19) d, P = 0.000] and less postoperative complications (16 vs 1, P = 0.000), but relapse of the two groups have no statistical difference (1 vs 0, P = 0.783). Conclusions Low temperature controlled plasma technology by nasal endoscopy in treatment of nasal vestibular cyst have many advantages than cystectomy via labiogingival groove approach such as shorter time of surgery, less bleeding volume in surgery, shorter hospitalization and less postoperative complications. Therefore it's worth of applying clinically.

Objective To evaluate the clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and pcrcutaneous transhcpatic insertion of biliary stent (PTIBS) for malignant biliary obstruction.Methods PTBD or PTIBS were performed in 56 patients with malignant biliary obstruction, which were aused by hepatic carcinoma (n = 14), biliary duct carcinoma (n = 11), gallbladder carcinoma (n = 5),stomach carcinoma accompanied with metastasis of lymph node (n = 14), carcinoma of ampulla (n = 1 ) or carcinoma of pancreatic head (n = 11 ). The diagnosis was confirmed by ultrasonography, CT or MRI in all patients. The obstructed site was well identified, including high obstruction in 19 patients and lower obstruction in 37 patients. Based on the imaging findings, suitable interventional procedure was employed.Results PTBD or PTIBS were performed successfully in all 56 patients, of them PTBD was adopted in 11,PTIBS in 40 and both PTBD and PTIBS in 5. The serum total bilirubin decreased from (295.65±152.86)μmol/L before the procedure to (151.05 ± 107.36) μmol/L after the procedure, (P < 0.01 ). Postoperative infection could affect the fading of jaundice (P < 0.01 ), but the location of the obstruction carried no relationship with the fading of jaundice (P = 0.063). Conclusion Both PTBD and PTIBS are safe and effective palliative therapies for malignant biliary obstruction, which can markedly relieve patient of jaundice,improve the quality of life and elongate the survival period.

Objective To explore the role of OAZ gene in the pathogenesis of systemic lupus erythe-matosus (SLE) by using RNA interfering technique. Methods Peripheral blood mononuclear cells (PBMC) from SLE patients were collected. Each sample was equally divided into four groups for cell culture in 96 well plates. Specific siRNA for OAZ and GAPDH were concordantly added to the experimental group and the positive control group, while nonspecific siRNA was added to the negative control group and only culture medium was added to the Mock control group. Cells and supernatants were harvested after culturing for 72 hours, then RNA was extracted and reverse transcripted to cDNA. OAZ, Id1, Id2, Id3, Id4 mRNA expression levels were analyzed by using real-time PCR. Levels of IFN-γ, IL-4, IL-10, IL-12, IL-21, CCL2, ANA in the supernatant were tested by ELISA. Relationships between the expression levels of OAZ mRNA with levels of cytokines and ANA were analyzed. Results OAZ, Id1, Id2, Id3 gene mRNA expression levels (△Ct: 12.5±1.4, 8.9±1.5, 4.3±0.8, 8.04±1.1) in the experimental group were significantly decreased comparing to those in the negative control group (△Ct: 10.2±1.1, 6.5±1.2, 2.4±1.3, 6.2±1.2 respectively, P<0.05). Levels of IFN-γ, IL-10, IL-12, IL-21 and ANA in the experimental group were significantly lower than those in the negative control group (P< 0.05), but level of CCL2 was higher than the negative control group (P<0.05). Difference of OAZ mRNA expression levels (△△Ct) between the experimental group and the negative control group was negatively correlated with changes of ANA, IL-21 levels, but positively correlated with changes of Th1/Th2, CCL2. Conclusion OAZ siRNA can effectively reduce the expression of genes involved in the OAZ signaling pathway in SLE. OAZ may lead to abnormal production of ANA via regulating Id genes and cytokines.