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

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 compare the effect of Buzhong Yiqi Decoction (BYD) containing different doses of Radix Astragali on fibulin-3 expression in the hemorrhoid tissues of stage Ⅲ internal hemorrhoids patients with spleen deficiency and sinking of qi, and to evaluate its therapeutic efficacy and possible mechanism. Methods Fifty-five qualified patients were randomly divided into control group(N = 15), Chinese medicine group 1(N =20), and Chinese medicine group 2(N=20). All of the 3 groups were treated with operation, and additionally, Chinese medicine group 1 was given BYD containing Radix Astragali 20 g, and Chinese medicine group 2 was given BYD containing Radix Astragali 50 g orally after operation. The scores of anal pendant expansion and anal prolapse were evaluated, and the expression level of fibulin-3 in the hemorrhoid tissues was detected by Western blot method. Results After treatment, the symptoms of anal pendant expansion and anal prolapse were improved in the 2 Chinese medicine groups (P < 0.05) , and the improvement of anal pendant expansion symptom in Chinese medicine group 2 was superior to that of Chinese medicine group 1(P<0.05). Compared with the control group, the expression level of fibulin-3 in the hemorrhoid tissues of the two Chinese medicine groups was increased (P < 0.05); the expression level of Chinese medicine group 2 showed an increasing trend as compared with that of Chinese medicine group 1, but the difference was statistically insignificant (P > 0.05). Conclusion BYD with large dose of Radix Astragali exerts stronger therapeutic efficacy for the treatment of prolapsed hemorrhoids than BYD with small dose of Radix Astragali, and its therapeutic mechanism has no obvious relation with promoting the increase of fibulin-3 expression.

Objective: To develop an HPLC-ELSD method for the simultaneous determination of six saponins constituents including notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1, ginsenoside Rc and ginsenoside Rd in Xinling pills.Methods: HPLC-ELSD was used, and the chromatographic separation was performed on an Agilent Eclipse XBD-C18 column (150 mm×4.6 mm,5 μm) with acetonitrile-water as the mobile phase with gradient elution at the flow rate of 1.0 ml·min-1, the column temperature was maintained at 20℃, the drift tube temperature was 60℃, and the gas pressure was 4.00 bar.Results: Notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1, ginsenoside Rc and ginsenoside Rd was linear within the range of 0.30-6.00μg(r=0.999 5), 1.14-22.80μg (r=0.999 6), 0.17-3.40 μg (r=0.999 7), 0.81-16.20 μg (r=0.999 7), 0.08-1.60 μg (r=0.999 8) and 0.07-1.40 μg (r=0.999 8), respectively.The average recovery was 98.23%, 97.98%, 99.14%, 99.15%, 98.72% and 98.37%, and the RSDs were 1.56%, 1.31%, 1.16%, 1.07%, 0.73% and 0.92%(n=6), respectively.Conclusion: The method is convenient, accurate and reproducible in the quality control of saponins components in Xinling pills

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 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.

This paper aims to develop a method for the determination of aloe-emodin, rhein, chrysophanol and physcion and study the pharmacokinetic properties of four anthraquinones in rat plasma after oral administration of gardenia and rhubarb decoction. The plasma concentrations at different time points of four anthraquinones were determined by HPLC-FLD method. Plasma samples were extracted with liquid-liquid extraction procedure. Plasma samples were separated on a C18 column (4.6 mm x 150 mm, 5 μm), using 0.2% acetic acid and methanol as mobile phase at a flow rate of 1.0 mL min(-1) with gradient elution. The excitation and emission wavelengths were set at 430, 525 nm, respectively. DAS 2.0 software was applied to calculate the pharmacokinetic parameters. The results showed four anthraquinones can be absorbed. The main parameters of aloe-emodin, rhein, chrysophanol and physcion were as follows: C(max) for aloe-emodin was (0.085 ± 0.058), (3.772 ± 1.152), (0.464 ± 0.267), (0.028 ± 0.008) mg x L(-1) respectively; t(max) for rhein was (1.042 ± 0.510), (0.805 ± 0.307), (1.167 ± 0.283), (0.616 ± 0.162) h respectively; t½ for chrysophanol was (3.557 ± 1.250), (6.879 ± 1.126), (5.196 ± 2.032), (4.337 ± 1.816) h; AUC(0-t) for physcion was (0.504 ± 0.130), (9.558 ± 1.106), (2.545 ± 1.554), (0.052 ± 0.018) mg x h x L(-1). This paper developed a selective, accurate and sensitive HPLC-FLD method for the simultaneous determination of four anthraquiones in rat plasma.
Animals ; Anthraquinones ; blood ; pharmacokinetics ; Chromatography, High Pressure Liquid ; instrumentation ; methods ; Drugs, Chinese Herbal ; analysis ; pharmacokinetics ; Male ; Rats ; Rats, Sprague-Dawley