Objective: To compare the advantages and disadvantages between Prospective Payment System based on Diagnosis Related Group System ( DRGs-PPS) mode and project payment mode. Methods: Historical review method, sampling and comparison are used to compare and analyze DRGs-PPS mode and project payment mode. Results: Through comparative analysis, it is founded that the application of DRGs-PPS mode could make the three wins of government, medical institutions and patients, which has more advantages than project payment mode. Conclusion: DRGs-PPS mode has important influences in controlling the increase of social health expenditure, improving the quality of medical services and standardizing medical behaviors.

Objective To study the roles of the contact heat evoked potential (CHEP) in evaluating the small nerve fibers of cranial and spinal in elderly diabetic patients,and to analyze the feature of the small fibers in order to provide scientific foundations for early diagnosis of diabetic neuropathy (DN).Methods Totally 50 diabetic patients and 40 healthy subjects were included in this study.The diabetic patients were divided into the normal nerve conduction group (n=17) and the abnormal nerve conduction group (n=33).CHEP was determined and thermal stimuli was given to the area of eyelid,forearm and peroneal.Sensory and motor nerve conduction velocity in the upper and lower limbs were tested in all diabetic patients.Results Compared with the healthy group,the N wave latencies were prolonged and the N-P amplitudes were reduced in the area of eyelid,forearm and peroneal in diabetic patients (all P＜0.01).Compared with the healthy group,the logarithm of N-P amplitudes were reduced in areas of forearm and peroneal [(1.70±0.10) vs.(1.60±0.14),(1.65±0.078) vs.(1.54±0.15),both P＜0.05] and N wave latencies were prolonged in eyelid area [(343.1±18.2) ms vs.(385.4±26.5) ms,P＜0.05] in normal nerve conduction group.Compared to group with normal nerve conduction velocity,the logarithm of N-P amplitudes was reduced in peroneal area [(1.54±0.15) vs.(1.44±0.15),P＜0.05] in abnormal nerve conduction group.Conclusions CHEP can detect the early impairment of the small fibers in elderly diabetic patients.The early smallfiber impairments in diabetic neuropathy may be axon-oriented in spinal nerves and myelin-oriented in cranial nerves.

Objective To evaluate the impairment of ulnar nerve and its relationship with sensory symptoms in the ulnar territory in patients with carpal tunnel syndrome (CTS) through electrophysiological approach.Methods We retrospectively reviewed 55 cases with CTS admitted in our hospital from January 2012 to February 2013.Patients with CTS were graded as mild-moderate (35 cases) and severe (20 cases) according to Stevens standard and were divided into symptomatic and non-symptomatic group according to the presence of sensory symptom in little finger region.Twenty healthy volunteers were included as control.Median and ulnar nerves electrophysiological study were performed using the Keypoint.net (Medoc Ltd) electromyogram device.Results Finger 5-wrist sensory conduction velocities (SCVs) of ulnar nerve were reduced ((51.71 ± 2.93) m/s vs (58.62 ± 3.21) m/s,t =8.80,P ＜ 0.01) in CTS group,compared with control group.But the sensory nerve action potential (SNAP) amplitudes had no difference.Pearson correlation analysis showed that finger 5-wrist SCVs and the SNAP amplitudes of ulnar nerve were negatively correlated with the distal motor latency of the median nerve,while positively correlated with the compound muscle action potential amplitudes,finger 1-wrist,finger 3-wrist SCVs and SNAP amplitudes of median nerve,in mild-moderate group,finger 5-wrist SCVs of ulnar nerve were slowed and the SNAP amplitudes were reduced ((51.59 ±2.70) m/s vs (53.72 ±2.58) m/s; (13.51 ± 1.84) μV vs (15.21 ±2.16) μV,t =2.24,2.30,P ＜ 0.05 respectively) in the symptomatic group,compared with the non-symptomatic group.However,in severe group,only 2 cases had sensory symptom in little finger region.Conclusions CTS patients may have impairments due to ulnar nerve entrapments at wrist,which aggravate with disease progression.Sensory symptoms in ulnar territory are more frequent during the mild-moderate stage,and may relate with ulnar nerve involvement.

Objective To investigate whether vitamin B complex supplements would reduce stroke-related disabili-ty in hyperhomocysteinemia (Hhcy) patients with recent ischemic stroke. Methods One thousand patients with brain infarc-tion and Hhcy were assigned to receive either a daily dose of vitamin B complex (treatment group, n=500) or not (control group, n=500) on the base of conventional secondary prevention medications for a period of 2 years. The neurological dys-function was assessed by National Institutes of Health Stroke Scale (NIHSS) and stroke disability was evaluated by Barthel Index (BI) score. High performance liquid chromatographic method with fluorescence detection was used for the determina-tion of total plasma homocysteine levels. After 2 years of follow-up, the patients in the treatment group, whose tHcy level was reduced by 3-μmol/L or more, was defined as the treatment subgroup. Results The homocysteine levels were significantly reduced after 3, 12 and 24-month treatment than those of control group (P＜0.05). A lower NIHSS scale was found at 12, 18 and 24-month in treatment group compared with that in control group (P＜0.05), no significant differences at other time points between two groups (P>0.05). For the BI score, there were no significant differences at any time points between two groups (P>0.05). After 2 years of vitamin B complex supplementation, there were lower NIHSS scale and higher BI scale in treatment subgroup than those of control group (P＜0.05). Conclusion The lower level of tHcy induced by vitamin B inter-vention may be beneficial to the improvement of neurological deficit in patients with ischemic stroke.

Objective To investigate the correlation between serum cystatin C (CysC) levels and cerebral microbleeds (CMBs) in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled.Susceptibility weighted imaging was used to identify the presence of CMBs.Particle-enhanced turbidimetric immunoassay was used to detect the levels of serum CysC.Results A total of 485 patients with acute ischemic stroke were enrolled,including 151 (31.1％) with CMBs.The level of serum CysC of the CMB group was significantly higher than that of the non-CMB group (1.24± 0.13 mg/L vs.1.02± 0.11 rmg/L; t=4.261,P＜ 0.001).Multivariate logistic regression analysis showed that the increased serum CysC level was an independent risk factor for the presence of CMBs in patients with acute ischemic stroke (each increase in one standard deviation,odds ratio 4.063,95％ confidence interval 2.142-8.127; P ＜0.001).Multiple linear regression analysis showed that the number of CMBs in patients with acute ischemic stroke increased with the increasing serum CysC level after adjusting for other confounders (r2 =0.361,P =0.017).Conclusions In patients with acute ischemic stroke,the serum CysC levels are independently associated with the CMBs,and the number of CMBs increases with the serum CysC level.

Eukaryotic expression plasmid pCI-neo-mdr1 which contains human multidrug resistance gene 1(mdr1),was constructed and transferred into human hepatocarcinoma HepG2 cells by use of liposome. G418 was used to screen the cells successfully with mdr1 and the selected cells was named HepG2/mdr1 Morphological and biological properties of HepG2/mdr1 cells were observed. The results show that the constructed HepG2/mdr1 cell line was high efficient and stationary in the expression of mdr1. The work was valuable and desirable for the establishment of multidrug resistant cell models,and for the study of MDR in human hepatoma. Furthermore,the work also provided a perfect model for the research of relationship between insulin resistance and MDR in hepatocarcinoma cells.

0.05).P300 and amplitudes of the mismatch negativity(MMN) of group A were lower than that of group B.PL of MMN was obviously prolonged.By comparing PL of group A with thar of group B,there was obvious difference(P

Objective:To investigate the characteristics of phrenic nerve motor conduction (PNC)and motor evoked potentials of diaphragm elicited through magnetic stimulation (dMEP)in mechanical ventilation of patients with chronic obstructive pulmonary disease(COPD).Methods:PNC and dMEP were performed in 10 COPD patients with regular mechanical ventilation(the duration of mechanical ventilation≤7 d),10 COPD patients with prolonged mechanical ventilation(the duration of mechanical ventilation＞7 d),and 10 healthy subjects(control group).Results:There were significant differences in the latency and the common logarithm of the amplitude of PNC,cervical dMEP and cortical dMEP between three groups before and after weaning(P＜0.01 or P＜0.05).There were significant differences in central motor conduction time(CMCT)in three groups before and after weaning(P＜0.01).There was longer CMCT before weaning in two COPD groups than that of control group(P＜0.01).It showed no statistical difference in CMCT before weaning between two COPD groups(P＞0.05).There was a longer CMCT after weaning in prolonged mechanical ventilation than that of regular mechanical ventilation(P＜0.01).However,there was no statistical difference in CMCT after weaning between the regular mechanical ventilation group and the control group(P＞0.05).Conclusion:There were dysfunctions in the cortico-diaphragmatic pathway in COPD patients with mechanical ventilation,which may be aggravated by the prolonged mechanical ventilation.PNC and dMEP may help to define the cause of respiratory dysfunction in COPD patients with mechanical ventilation.

Objective To investigate the relationship between total homocysteine (tHcy) and carotid intima-media thickness (CIMT) in brain infarction patients. Methods Sixty patients with fasting plasma tHcy levels ≤10μmol/L (non-Hhcy group), 60 patients with fasting plasma tHcy levels>10μmol/L and≤15μmol/L (H1 group), and 60 patients with fast-ing plasma tHcy levels>15μmol/L (H2 group) were chosen in hospitalized patients with acute cerebral infarction. Values of CIMT were detected in three groups of patients. The clinical biochemical indicators including triglyceride (TG), total choles-terol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood sugar (FBS), folic acid (FA), Vitamin B12 (VitB12) and glycated hemoglobin (HbA1c) were also detected. Results There was signifi-cant difference in CIMT between three groups (P<0.01). The value of CIMT increased in H2 group [0.98(0.90, 1.05)mm] com-pared with that of non-Hhcy group [0.85(0.80, 0.95)mm]. The value of CIMT increased in H2 group compared with H1 group [0.98(0.90, 1.05)mm vs 0.85(0.85, 0.95)mm], P<0.05). There were significant differences in tHcy, FA and VitB12 between three groups. Based on the log-transformed values of CIMT as the dependent variable, multiple stepwise linear regression showed significant associations of the following variables with increased CIMT: increasing age, the history of smoking, the history of diabetes, higher LDL-C and tHcy levels. Conclusion Brain infarction in patients with higher tHcy level often have lower levels of FA and VitB12, and increased CIMT. When the level of tHcy >15 μmol/L, there is more significantly higher level of CIMT. The increased CIMT level was associated with some cerebrovascular risk factors in patients with brain infarction.

Objective To investigate whether the B vitamins supplements would lower total homocysteine and reduce the risk of recurrent stroke in patients with recent ischemic stroke.Methods A prospective,open,case-controlled clinical trial.One thousand ischcmic stroke patients with hyperhomocysteinemia were followed up.They were assigned to receive either a daily dose of B vitamins (folic acid 2.5 mg,B6 25 mg,B12 500 μg,treatment group,n =500) or not ( control group,n =500) for a period of 2 years.Total homocysteine level,demographic information and traditional risk factors were collected as well as recurrent cerebral infarction were noted.Results Homocysteine levels were significantly reduced in the active treatment group,reduction of total homocysteine was 14.7％ at 3 months and 19.2％ at 24 months ( F =94.39,P ＜0.05 ).The risk of ischemic recurrent stroke with clinical sign within 2 years was 13.6％ for the active treatment group and 14.0％ for the control group ( risk ratio =0.99,95％ CI 0.68—1.42).The risk of recurrent stroke with only MRI or CT brain scan evidence was 4.8％ for both groups (risk ratio =1.11,95％ CI 0.62—2.02 ).The risk of total recurrent stroke was 18.4％ for the treatment group and 18.8％ for the control group ( risk ratio =0.96 ; 95％ CI 0.73—1.26 ),but these effects were not significant.Conclusion A significant benefit of secondary prevention with long-term reductions in blood homocysteine levels with B vitamins supplementationin during the 2 years of follow-up is not yet proven.