Objective:To determine the cost of medical insurance macroeconomic factors,and propose countermeasures for macro-control health insurance costs.Methods:Principal component analysis was applied to screen dominant macroeconomic factors that influenced medical insurance costs of Shanghai.Results:From the macro perspective,the economy and technology were the main factors affecting medical insurance costs.Conclusion:It needed to increase government investment in public health finance,develop cost-declined medical technology and strengthen the construction of medical and health information,as well as to strengthen government oversight.

Objective: To study the influence of different telomere oligonucleotide on rat's thoracic aortic smooth muscle (A7R5 ) cell apoptosis and to clarify weather silent information regulator 1 (SIRT1)/cancer suppressor gene (P53) signaling pathway involved in oligonucleotide induced cell apoptosis. Methods: 3 telomere repeat sequences of TE-12 (TTAGGG)2, TE-24 (TTAGGG)4 and TE-36 (TTAGGG)6 were respectively transfected into rat's A7R5 cells as TE-12 group, TE-24 group and TE-36 group; in addition, blank A7R5 cells were used as Control group. Transfection induced A7R5 cell apoptosis was detected by flow cytometry, mRNA and protein expressions of SIRT1 and P53 in A7R5 cells were examined by RT-PCR and Western blot analysis in different groups. Results: Successful ransfection rates were similar among 3 groups. Compared with Control group and TE-36, TE-24 groups, the highest apoptosis rate of A7R5 cells was found in TE-12 group and the lowest was found in TE-24 group which was still higher than that in Control group, allP<0.05. mRNA and protein expressions of SIRT1 was obviously higher in TE-12 group than the other 3 groups, allP<0.05; mRNA and protein expressions of P53 was obviously lower in TE-24 group than the other 3 groups, allP<0.05. Conclusion: Telomere oligonucleotide sequence may promote rat's A7R5 cell apoptosis; different sequence had various influence and the strongest effect was observed in TE-12 sequence. The above impact might be related to SIRT1/P53 signaling pathway.

Objective To explore the clinical features of pulmonary tuberculosis complicated with DM and related factors. Method The manifestations of 87 newly diagnosed PTB patients with type 2 DM(DM-PTB group) at two hospitals in Tianjin during October 2003 to October 2004 were compared to 88 PTB patients without DM who were randomly choosen from the same hosipital.The factors related to sputum-positive TB or cavity were explored through unconditional logistic regression model. Results DM-PTB patients showed significanly lower frequencies of cough(66.7% vs 83.0%),toxicity symptoms(37.9% vs 62.5%) and haemoptysis(16.1% vs 33.0%) than those of PTB group.Positive-sputum(63.2% vs 34.1%),cavity(56.3% vs 13.6%),wide lesions and bilateral lesions on chest radiographs was more common in DM-PTB group than in PTB one.Introversion(OR=1.582, 95%CI:1.063 ～2.355),type 2 DM(OR =2.186,95% CI:1.082 ~4.420)and cavity(OR =2.793,95% CI:1.308 ～5.964)were factors independently associated with positive-sputum TB.The factors related to cavity included diabetes(OR=14.199,95%CI:5.376~ 37.501),cough,postive sputum and lore-up lobe lesion.Conclusion This study confirmed that clinical manifestations and chest radiographs of PTB patients complicated with type 2 DM significantly departed from the typical presentation.Type 2 DM seems to have a negative effect on postive-sputum and cavity.So it should be alarmed that DM-PTB patients who tend to have untypical clinical symptom and higher rate of positive sputum become the reservoirs of infection to cause the transmission of TB.

Objective To observe the prevalence of impaired glucose regulation (IGR) in ischemic stroke patients with or without inter-or extra-cranial arteries occlusive disease,and to analyze the relationship of IGR with large arteries occlusive disease.Methods lschemic stroke patients without diabetes history and with FPG

Objective To explore the influence of personality and negative life events on the development of pulmonary tuberculosis among diabetic patients.Methods A hospital-based case-control study was conducted from March 2005 to February 2006.158 newly-diagnosed pulmonary tuberculosis patients with diabetes (DMPTB) were reemited as cases and 281 diabetic patients (DM) as control group.Information on personality and negative life events was collected using Eysenck Personality Questionnaire (EPQ) and Life Events Scale (LES),respectively.Odds ratios(OR) and 95% confidence intervals (95% CI) were estimated using logistic regression models and the potential confounding bias was controlled through adjusted by education,income,glycemic control,previous maximal BMI,weight loss ratio,physical xercises,smoking,negative life events or personality.Results The proportions of introversion,medium,extroversion personality in DM-PTB and DM group were 38.6% ,11.4% ,50.0% vs.53.0% ,11.1% ,35.9% (X~2=9.280,P=0.010).Those with introversion personality had 1.91 (1.26～2.90) times higher risk of DM-PTB than those with extroversion personality,while this association became insignificant after adjustment(P=0.111) ; 35.4% and 19.6% in the two groups had experienced life events during the last one year,and such persons had 2.26(1.15～3.50) (unadjusted) or 1.82(1.07～3.10)(adjusted) higher risk of DM-PTB than those without life events,especially among male and younger (＜60y) diabetics.Conclusion Negative life events are the independent risk factor of pulmonary tuberculosis among male and younger diabetics.Thus,mental measures should be taken in corresponding risk populations to improve their capability of dealing with life events.

Objective To evaluate the effect of intrathecal ketamine on nitric oxide synthase (NOS)activity in the spinal dorsal horn via a rat model of sciatic constriction injury(SCI). Methods Thirty-six male SDrats weighing 160-180g were randomly divided into six groups(n = 6 in each group): group Ⅰ sham operation;group Ⅱ SCI; group Ⅲ-Ⅵ intrathecal ketamine + SCI. In group Ⅰ right sciatic nerve was exposed but noligature was placed around sciatic nerve. In group Ⅱ-Ⅵ four ligatures were placed around the right sciatic nerveand hed without obstructing the blood supply of the nerve. In group Ⅲ -Ⅵ ketamine 12. 5?g (group Ⅲ ),50?g(group Ⅳ ), 0?g (group Ⅴ ) or 300?g (group Ⅵ ) was given intrathecally 30 min before and 1,2 and 3 daysafer surgery. On the 7th and 14th day after operation thermal and mechanical hyperalgesia were measured with ice-cold water and von-Frey filaments. The animals were decapitated 14 days after SCI. The I_(4-6) lumbar spinal cordwas immediately removed and the spinal dorsal horn was dissected on ice and homogenized. The homogenate wascentrifuged at 3 500 r/min for 10 min and the protein content was determined. NOS achvity in the spinal dorsal hornwas measured using ultraviolet spectrophotometer. Results In group Ⅱ and Ⅲ pain threshold was significantlylowered and NOS activity significantly increased compared with those in group Ⅰ(sham operation) (P0 .05),but therewas signilicant difference in NOS activity between group Ⅱ and group Ⅳ, Ⅴ, Ⅵ (P

Objective To investigate the imbalance of Th1/Th2 cell response in patients with systemic lupus erythematosus (SLE) combined with coronary heart disease .Methods SLE patients ,SLE patients with coronary heart disease and healthy con-trols were enrolled and blood samples were collected .T-bet/GATA-3 ,the transcription factors of Th1/Th2 cells ,were detected by real-time PCR ;the intracellular cytokines IFN-γ and IL-4 in CD4 + T cells were stained by fluorescent antibodies and detected by flow cytometry ;the level of serum IFN-γ and IL-4 were detected by ELISA .Results Comparing with healthy control group ,the ex-pression level of Th1 transcription factor T-bet ,the introcellular secretion of IFN-γ in CD4 + T cells and the serum IFN-γ were all decreased in non-coronary heart disease patients with SLE( P < 0 .05) .Comparing with non-coronary heart disease patients with SLE or healthy control group ,the expression level of Th1 transcription factor T-bet ,the introcellular secretion of IFN-γ in CD4 + T cells and the serum IFN-γ were all increased in patients with SLE combined coronary heart disease(P< 0 .05) ;while the expression level of Th2 transcription factor GATA-3 ,the introcellular secretion of IL-4 in CD4 + T cells and the serum IL-4 were all decreased in patients with SLE combined coronary heart disease(P< 0 .05) .Conclusion There were imbalance towards Th1 cell response in patients with SLE combined coronary heart disease ,which may related to the occurrence and development of disease .

Objective To explore the diagnosis value of ultrasound real-time elastography in thyroid diffuse diseases.Methods Eleven elastic quantitative parameters of 123 patients with thyroid diffuse diseases and 42 healthy volunteers obtained from the ultrasound real-time elastography were analyzed with principal components analysis to attain a comprehensive evaluation value which was named stiffness index(SI),reflecting the organization elastic information of different thyroid diffuse diseases.SI among each group was compared by ANOVA.Results Chronic lymphocytic thyroiditis SI was 86.37±20.45,subacute thyroiditis SI was 86.14±19.95,primary hyperthyroidism SI was 54.68±21.69,normal control group SI was 41.34±15.59,respectively.The SI between chronic lymphocytic thyroiditis,subacute thyroiditis,primary hyperthyroidism and normal controls had significant statistical differences (P<0.05),the SI between primary hyperthyroidism and chronic lymphocytic thyroiditis,subacute thyroiditis had significant statistical differences (P<0.05),the SI between chronic lymphocytic thyroiditis and subacute thyroiditis had no significant statistical difference (P>0.05).Conclusions Ultrasound real-time elastography could indirectly reflect the stiffness information of thyroid lension tissue and have a certain degree of diagnosis value in thyroid diffuse disease.

Objective To investigate the incidence of adult epilepsy patients with attention-deficit hyperactivity disorder (ADHD) and the characteristics of ADHD subtypes, and to explore the correlations between several epilepsy-related factors and ADHD. Methods According to corresponding inclusion criteria and exclusion criteria, 82 adult epilepsy patients from March 2012 to March 2016 were enrolled as study group. Eighty-two healthy adults were enrolled as the control group. Using the Chi-square test and Logistic regression analysis and the other statistical methods, the phenomenon of ADHD in adults with epilepsy and the factors that may contribute to the phenomenon was analyzed. Results The detection rate of ADHD in 82 adult patients with epilepsy was 26.8%(22/82), significantly higher than that in the heathly control group which was 4.9%(4/82),χ2=18.672, P<0.05. Symptomatic epilepsy 8/17 and the electroencephalogram showed multifocal discharge 6/14 had higher detection rate of comorbid ADHD and the difference was statistically significant (P<0.01). The results of binary Logistic regression analysis showed that epilepsy age of onset was possibly an important factor for epilepsy with ADHD (B=-0.891, P<0.05). Conclusions The risk of ADHD in adults with epilepsy is higher than that in the healthy adults and attention-deficit is the common subtype. The etiology, age of onset and electroencephalogram features of adults with epilepsy may be associated with the occurrence of ADHD.