As a highly efficient protein degradation pathway,ubiquitin-proteasome system(UPS) plays an important role in maintaining cell function.The role of UPS is becoming a new research focus in molecular mechanism of cognitive function.UPS mainly acts on neurotrans mitter and its receptor,synaptic reguIation,long-term potentiation of postsynaptic poteraiais and neuronal signal transduction,and it may become a new target for the intervention of cognitive dysfunction.

Objective:To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. Methods:The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study em-ployed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and re-imbursements on inpatient services. Results: One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10 000 Yuan outpatient reimbursements saved 9 700 Yuan inpatient expenses. An increase of 10 000 Yuan outpatient expenses led to a decrease of 3 000 Yuan inpatient re-imbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/coun-ty levels, and no significant impacts on the outpatient services at the city levels. Conclusion:There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design out-patient and inpatient reimbursement policies.

In the occurrence and development of neurological diseases,it often accompanied by cognitive impairment,which severely decreases the quality of life of the patients.Therefore,it is necessary for patients with neurological diseases to rapidly screen cognitive function.This aricle reviews the advances in research on the brief cognitive rating scales commnly used in clinical.

Objective:To retrospectively evaluate the prognostic risk factors of patients with gallbladder carcinoma and the effect of normal prognostic nutrition index (PNI) on the survival. Methods:We retrospectively analyzed 63 patients with gallbladder carcino-ma treated in our hospital between January 2008 and December 2012. The independent prognostic factors of the patients were calculat-ed by the Cox proportional hazards model. The benefit of normal PNI status on the prognosis was further explored in the patients using survival analysis. Results:Lymph node metastasis, PNI≤50, squamous carcinoma, liver invasion and choledoch invasion were the risk factors of overall survival (OS) in the univariate analysis, while only lymph node metastasis (HR=4.495, 95%CI 2.380~8.488, P<0.001) and PNI(HR=0.195, 95%CI 0.098~0.389, P<0.001) were the dependent influential factors of the prognosis and OS in the multi-variate analysis. The effect of PNI on OS was even more statistically significant different in the younger patients (≤65y) than in the el-der (>65y) (younger group:P=0.011;elder group:P=0.078). Conclusion:The gallbladder carcinoma patients with normal PNI status (>50) have better OS compared to the patients with PNI≤50, with statistical differences between the two. And it is more significant in the patients of the younger group (≤65y), comparing with the elder group. PNI could be taken as a potential prognostic evaluation factor for the gallbladder carcinoma patients and can provide a more comprehensive evaluation of patients' conditions to clinician.

Cardiovascular Diseases ; Humans ; Trans Fatty Acids

Adolescent ; Alopecia ; diagnosis ; therapy ; Bone and Bones ; abnormalities ; Denture, Complete, Upper ; Diarrhea ; diagnosis ; therapy ; Female ; Humans ; Spasm ; diagnosis ; therapy

Chronic cerebral hypoperfusion (CCH) may result in neurovascular unit (NVU) injury,causing cognitive impairment.The NVU consists of neurons,glial cells,vascular cells and extracellular matrix.The damage of NVU can induce the blood-brain barrier dysfunction,abnormal cell signaling,as well as cognitive impairment.However,its molecular mechanism is unclear.Thus,investigating the role of NUV in CCH-induced cognitive impairment may provide a theoretical basis for the novel treatment of cognitive impairment.

Objective:To study direct medical cost of hypertensive patients without complicated disea-ses,to analyze substitution impacts of outpatient expenditure on inpatient expenditure,and then to make recommendations to health policy makers and hypertensive patients for managing hypertension.Methods:The claims data of hypertensive patients insured by the rural new cooperative medical scheme in a city in northern China from 2008 to 201 3 were analyzed,descriptive statistics employed to analyze direct medical cost of hypertensive patients and hypertensive patients without complicated diseases which was one of the three groups divided by medical treatment conditions (hypertension without complicated diseases,hyper-tension with complicated diseases,and other diseases),and the differences between groups compared by t test.The fixed effect two-part model was employed to analyze the substitution effect of outpatient services on inpatient services,and specific effects of outpatient times and reimbursement expenses on the inpatient expenditure were calculated by Logistic regression analysis.Results:For the hypertensive pa-tients,the average cost of outpatients was 283.49 Yuan in 2008 and rose to 370.93 Yuan in 201 3.After being divided into three groups,for hypertensive patients without complicated diseases,the average cost of outpatient was 449.79 Yuan in 2008 and rose to 582.53 Yuan in 201 3.In the total cost of the outpa-tient,45.73% was for the hypertensive patients without complicated diseases;in the total cost of the in-patient,only 9.29% was for the hypertensive patients without complicated diseases.By calculating the marginal effect of parameter estimation through the fixed effect two-part model,the inpatient cost could be significantly reduced by increasing the visit times of outpatient utilization or the cost of outpatient reim-bursement.For example,in 201 3,a 1 % rise of outpatient visit times increased outpatient expenditures by 6.48 million Yuan,which could reduce inpatient expenditures by 39.86 million Yuan.The substitu-ted ratio of outpatient cost on inpatient cost had been around 5 in 201 0 and later.Conclusion:The health policy-makers and hypertensive patients should pay more attentions to the substitution of outpatient cost for inpatient cost,especially for the hypertensive patients without complicated diseases whose direct medical cost was mainly due to outpatient rather than inpatient costs.

Angiodysplasia ; Child, Preschool ; Humans ; Male ; Pulmonary Artery ; abnormalities ; Pulmonary Veins ; abnormalities

Objective To investigate the feasibility of construction of orthotopic ileal neobladder after laparoscopic radical cystectomy(LRC)for female patients with bladder carcinoma.Methods From February 2003 to July 2006,we had performed construction of orthotopic ileal neobladder after laparoscopic radical cystectomy,hysterectomy,and ovariectomy on 8 women with bladder carcinoma.Under general anaesthesia,the patients were placed in the supine position with the head down at 15?,the thighs abduced,and the knee flexed.A 5-port transperitoneal approach was used.Under a laparoscope,the peritoneum was incised at the level of the bifurcation of the iliac vessels,and then the ureter was freed,and the round ligament of the uterus and the ovarian ligament were cut.Afterwards,the broad ligament was separated and pelvic lymphadenectomy was done.Then,the cardinal and uterosacral ligaments,bilateral ureters,and the lateral pedicles of the bladder were cut;the peritoneum was incised along the base of the broad ligament to open the vaginal vault so that the peritoneal reflection can be transected to expose the retropubic space.After that,the deep dorsal vein of the clitoris and the ureter was cut successively(the ureter was cut at 0.5 cm downwards from the neck of the bladder.Finally,the vagina was transected at the level adjacent to the vaginal vault,and the residual vagina was sutured.After the laparoscopy,the resected tissues were removed through a 4-to 5-cm incision on the midline of the lower abdomen,and then a M-shape ileal neobladder was constructed outside the incision.The ureter was reimplanted to the posterior wall of the pouch and replaced into the peritoneal cavity.The urethra-pouch anastomosis was completed by laparoscopy.Results The mean operation time in the 8 patients was(344.5?42.1)min,mean blood loss was(373.9?81.3)ml.The patients were followed up for 6 to 46 months with a mean of 26 months(over 12 months in 6 patients).During the follow-up,all the patients achieved automatic micturition in half a year.One patient had urinary incontinence occasionally,one had night-time urinary incontinence,and one had dysuria.The mean volume of the neobladders was(333.6?40.4)ml,and residual urine volume was(51.2?18.1)ml.After the operation,one patient developed uretero-neobladder anastomotic occlusion,and one had fistula of the neobladder.Conclusions Laparoscopic radical cystectomy,hysterectomy,and ovariectomy is feasible for female patients with bladder carcinoma.After the procedure,which is mini-invasive,most patients had automatic micturition;however,the rates of urinary incontinence and dysuria are relatively high.Further investigations are needed to study the long-term outcomes of LRC and reconstruction of orthotopic ileal neobladder.