It analyzed the structure and details of disease-based score payment,taking payment policy scheme in Huai-an and Nanchang for example.Disease-based score payment combined the globe budget control,payment of disease and point system to help controlling costs and incentive mechanism,which had certain achievement in the pilot areas.According to the research,it found that there were insufficient in the practical implementation,proposed the precondition for the popularization were higher medical agency capacity,establishing the negotiation mechanism with medical institutions and having intelligentized information system as the technical support.

Objective To compare the safety and effectiveness of three types of intrauterine device (IUD) inserted immediately after artificial abortion.Methods A randomized controlled clinical trial was performed in 4 family planning service stations in Pudong New Area from January to December 2012.Total 1 200 eligible women were randomly assigned to receive three types of IUD:MYCu,TCu380A or G-Cu200 (n =400 in each group) immediately after vacuum aspiration.All subjects were followed up for 12 months.The cumulative rates of termination of three IUD after 12 months were analyzed with WHO LTA 2.0 life table.Results Total 1 199 subjects were followed up for 12 months with a drop-out rate of 0.08％ (1/1 200).No any uterine perforation was found.During the 12 months the pregnancy rates with IUD in situ in MYCu,TCu380A and G-Cu200 groups were 0.26/100 women year,0 and 0.52/100 women year,respectively (x2 =1.951,P ≥ 0.2).The rates of expulsion in three groups were 0.26/100 women year,1.84/100 women year and 2.05/100 women year,respectively(x2 =5.539,P =0.066).The remove rates related to bleeding and paining in three groups were 1.26/100 women year,7.29/100 women year and 2.76/100 women year,respectively (x2 =21.625,P =0.001).The discontinuation rates related to IUD use in there groups were 3.25/100 women year,9.00/100 women year and 5.50/100 women year,respectively(x2 =12.191,P =0.004).The rates of Abnormal position in three groups were 1.51/100 women year,0 and 0.26/100 women year,respectively (x2 =8.649,P =0.014).Conclusion Three IUDs inserted immediately after vacuum aspiration are all effective.Among three IUDs,MYCu shows lower expulsion rate,lower discontinuation rate related to IUD use and higher continuous rate; but the abnormal position rate of MYCu is higher than other two types IUD.

Objective To explore the changes of deceleration capacity of rate (DC) and analyze its correlation with heart rate variability (HRV) and other factors in patients with coronary heart disease. Methods One hundred and twenty-nine patients with coronary heart disease (coronary heart disease group) and 109 healthy people (control group) were enrolled in this study. DC and HRV parameters were measured by using digitized 24 h Holter. The correlation between DC and HRV parameters, other factors were analyzed. Results The levels of DC, SDNN, SDANN, SDNNi, PNN50, TP, LF, HF, AC in coronary heart disease group were significantly lower than those in control group:(5.64±1.67) ms vs. (6.71±1.47) ms, (106.60±20.53) ms vs. (138.82±31.22) ms, (96.94±20.06) ms vs. (127.47±31.87) ms,(28.53±14.75) ms vs. (52.24±14.65) ms, 87.72%vs. 103.86%,(1 967.10±966.16) ms2/Hz vs. (2 846.70±1 443.41) ms2/Hz,(326.43±195.35) ms2/Hz vs.(457.64±254.30) ms2/Hz, 85.88 vs. 106.39, (-6.18±2.15) ms vs. (-7.00±2.51) ms, P<0.05 or<0.01. DC was correlated with SDNNi, PNN50,TP,LF, HF, AC both in total population or in coronary heart disease group and control group by using multiple linear correlation analysis ( r=0.586, 0.356, 0.531, 0.563, 0.435,-0.433, P<0.01). After removing confounders, DC was correlated with age, SDNNi, rMSSD, PNN50 and AC (P<0.01). Conclusions DC decreases in patients with coronary heart disease and is strong correlativity with HRV parameters. DC could be used for quantitative detection of autonomic nervous function.

Objective To analyze the effect of different treatment conditions on cells synchronization in G0/G1 phase to get the best con-dition, and to explore its effect on neural differentiation of bone marrow mesenchymal stem cells (BMSCs) induced by basic fibroblast growth factor (bFGF). Methods BMSCs were isolated and cultured in 5%, 1%, 0.5%, 0.1%, 0 fetal bovine serum (FBS) respectively, for 24 hours and 48 hours. After PI staining, cell cycle proportions of each phase were detected by flow cytometry, and were compared with the normal group (10%FBS). After the optimal treatment condition was got, 20 ng/ml bFGF was added into synchronization group and unsyn-chronization group 3 days and 7 days, respectively. The expression of Nestin and Tuj-1 were detected with immunofluorescence. Results Adult rat BMSCs were isolated from bone marrow and cultured, after passage, the cells were with long spindle shape. Compared with the normal group, the cell proportion of G1/G0 phase increased under different treatments, peaked with (94.274 ± 0.468)%under 1%FBS, 48 hours (F=39.91, P<0.001). After bFGF induction for 3 days, the Nestin+cell number was higher in the synchronization group than in the un-synchronization group [(80.3 ± 2.4)%vs. (12.1 ± 1.5)%] (F=28.25, P<0.001). After bFGF induction for 7 days, the Tuj-1+cell number was higher in the synchronization group than in the unsynchronization group [(74.8±3.2%)%vs. (19.3±2.5)%] (F=17.95, P<0.001). Conclusion 1%FBS, 48 hours is the optimal condition to BMSCs synchronization in G0/G1 phase, which can promote the neural differentiation of BM-SCs.

Objective To investigate the efficacy of widely used antibiotics for urogenital Chlamydia trachomatis infection in recent 5 years.Methods A total of 2 809 cases of Chlamydia trachomatis urogenital infected patients who visited STD clinics of Tianjin Medical University General Hospital from 2006 to 2010 were collected.All the patients had accomplished a course of treatment of azithromycin, minocycline, moxifloxacin or clarithromycin and followed up for 3 months (once every month).Cochran-Armitage trend test was used to analyzed the antibiotics effect changing trends overtime.Results From 2006 to 2010, the etiology clearance rates of azithromycin were 76.70% (79/103), 74.19% (92/124), 74.13% (106/143), 71.43% (100/140) and 70.77% (92/130), respectively;those of minocycline were 75.31% (61/81), 64.67% (97/150), 66.53% (159/239), 65.05% (188/289) and 63.03% (104/165), respectively;those of moxifloxacin were 88.82% (167/188), 86.23% (119/138), 82.96% (185/223), 81.19% (233/287) and 81.03% (158/37), respectively;those of clarithromycin were 82.93% (34/41), 80.49% (33/41), 79.25% (42/53), 78.18% (43/55) and 75.00% (18/24), respectively.Ochran-Armitage trend test showed that antimicrobial efficacy of moxifloxacin for urogenital Chlamydia trachomatis infection rates declined year by year (P<0.05), while those of azithromycin, clarithromycin and minocycline did not decline significantly (all P>0.05).Conclusions The etiology clearance rate of moxifloxacin is the highest but gradually declines by years, and that of azithromycin takes the second place, while the treatment efficacy of minocycline is lower but quite stable.The number of cases treated with clarithromycin is too small to draw a conclusion.

Objective To investigate the effect of suberoylanilide hydroxamic acid (SAHA) on sufentanil postconditioning-induced cardioprotection in rats with type 2 diabetes mellitus (T2DM).Methods Male SPF Sprague-Dawley rats,weighing 250-300 g,aged 5-6 weeks,were used in the study.T2DM was induced by high-fat diet (4 weeks) and intraperitoneal 1％ streptozotocin 35 mg/kg,and confirmed by fasting blood glucose level≥ 16.7 mmol/L.Forty rats with T2DM were divided into 5 groups (n=8 each) using a random number table:sham operation group (grou T2DM-S);ischemia-reperfusion group (group T2DM-I/R);sufentanil postconditioning group (group T2DM-SP);SAHA group (group T2DM-SA);SAHA plus sufentanil postconditioning group (group T2DM-SASP).In T2DM-SA and T2DM-SASP groups,SAHA 25 mg/kg was injected intraperitoneally once a day for 5 consecutive days before operation.Their hearts were excised and retrogradely perfused in a Langendorff apparatus.The hearts were subjected to 30 min of global ischemia followed by 120 min of reperfusion to establish the model of ischemia/reperfusion injury.At 30 min of equilibration and 30,60 and 120 min of reperfusion,the left ventricular systolic pressure (LVSP),heart rate (HR),and the maximum rate of increase and decrease of ventricular pressure (±dp/dtmax) were recorded.At 120 min of reperfusion,the left ventricular mass (LVM) and infarct size (IS) were measured,and IS/LVM ratio was calculated.The expression of glycogen synthesis kinase 3β (GSK-3β) and phosphorylated GSK-3β (p-GSK-3β) in the myocardium was detected by Western blot.Results Compared with group T2DM-S,the LVSP,HR and ±dp/dtmax were significantly decreased,the IS and IS/LVM ratio were significantly increased,and the expression of myocardial p-GSK-3β was significantly down-regulated in group T2DM-I/R (P＜0.05).Compared with group T2DM-I/R,the ±dp/dtmax was significantly increased,the IS and IS/LVM ratio were significantly decreased,and the expression of myocardial p-GSK-3β was significantly up-regulated in group T2DM-SASP (P＜0.05),and no significant change was found in the parameters mentioned above in T2DM-SA and T2DM-SP groups (P＞0.05).Compared with group T2DM-SP,the ±dp/dt was significantly increased,the 1S and IS/LVM ratio were significantly decreased,and the expression of myocardial p-GSK-3β was significantly upregulated in group T2DM-SASP (P＜0.05).Conclusion SAHA can improve cardioprotection induced by sufentanil postconditioning to some extent in the rats with T2DM.

Objective To evaluate the effect of sufentanil postconditioning on acetylated histon H3 (Ac-H3) expression during myocardial ischemia-reperfusion (I/R) in rats.Methods Thirty-six adult male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (S group),I/R group,and sufentanil postconditioning group (SP group).Myocardial I/R was induced by 30 min occlusion of the left anterior descending branch of the coronary artery followed by 120 min reperfusion in anesthetized rats.Sufentanil 1 μg/kg was injected through the femoral vein at 5 min before reperfusion in group SP,while the equal volume of normal saline was given in S and I/R groups.The rats were sacrificed at 120 min of reperfusion,and the myocardial specimens were obtained from the anterior wall of the left ventricle for determination of myocardial infarct size and cell apoptosis (by TUNEL),and myocardial specimens were obtained from the apex for detection of Ac-H3 expression (using Western blot).Apoptotic index was calculated.Results Compared with S group,the myocardial infarct size and apoptotic index were significantly increased,and Ac-H3 expression was down-regulated in I/R and SP groups (P＜0.05).Compared with I/R group,the myocardial infarct size and apoptotic index were significantly decreased,and Ac-H3 expression was up-regulated in SP group (P＜ 0.05).Conclusion Sufentanil postconditioning attenuates myocardial I/R injury through up-regulating AcH3 expression and restoring histone acetylation in rats.

Objective:To detect the serum level of microRNA-146b (miR-146b)in patients with viral myocarditis,and prelimi-narily explore its clinical significance.Methods:Forty patients with viral myocarditis and forty healthy controls were enrolled in the study.The serum level of miR-146b was detected with reverse transcription-polymerase chain reaction (RT-PCR).The level of cardiac troponin T (cTnT)in the serum of patients with viral myocarditis was detected with electrochemical lumines-cence method.The relationship between miR-146b and cTnT level was statistically analyzed.Results:Compared with the ser-um level of miR-146b (1 .35±0.42)in healthy controls,the serum level of miR-146b(1 .85 ±0.68)in the patients with viral myocarditis increased significantly(t=3.957,P <0.01).The serum level of miR-146b was positively correlated with the level of cTnT in the patients with viral myocarditis (r=0.635,P <0.05).Conclusions:The serum level of miR-146b in the patients with viral myocarditis increased,and it was correlated with the severity of myocardial injury.It indicates that miR-146b may be involved in the pathogenesis of viral myocarditis.

Objective:To observe the protective effect of deproteinized extract of calf blood (DECB)on the ethanol-induced liver injury of the mice,and to preliminaryly discuss its mechanism. Methods:Sixty healthy ICR mice were divided into control group,model group,positive drug group,low,medium and high doses of DECB groups (n=10).By intragastric administration,the mice in control group were given 20 mL·kg-1 saline solution, the mice in low,medium and high doses of DECB groups were administrated with 0.125,0.250,0.500 g·kg -1 DECB,and the mice in positive drug group were administrated with 0.63 g·kg -1 Hugan Tablets;once a day for 30 d. 1 h after the last administration,except control group,the mice in other groups were administrated with one-time grant of 50% ethanol 14 mL·kg -1 ,and fasted for 16 h to establish the models of acute alcohol liver injury.The endurance alcohol time and drunk time of the mice were determined,the activities of aspartate aminotransferase (ALT)and alanine transaminase (AST)activity in serum of the mice were detected,the levels of triglyceride (TG),glutathione (GSH)and malonic dialdehyde (MDA)in liver tissue were determined,and the pathological changes of liver tissue were detected.Results:Compared with model group,the drunk symptoms of the mice in different doses of DECB groups were obviously reduced,the endurance time of the mice in high dose of DECB group and positive drug group was prolonged (P <0.05),and the drinking time was shortened (P <0.05);the ALT and AST activities in serum in mediun and high doses of DECB groups were significantly lower than those in model group (P <0.05).Compared with model group,the MDA and TG levels in liver tissue of the mice in medium and high doses of DECB groups and positive drug group were obviously reduced,and the GSH levels were increased (P <0.05);compared with model group,the pathological damages of liver tissue of the mice in high dose of DECB group caused by ethanol were significantly reduced.Conclusion:DECB can improve ethanol-induced liver injury which may be related to the inhibition of hepatic oxidative stress response.

Objective To explore the effects of the systematic "three preventions and three positions" nursing on preventing arthritic prosthesis dislocation after total hip arthroplasty (THA) for different diseases. Methods Based on historical control,459 patients who received THA in the orthopedics department of a hospital between January 2012 and December 2013 were selected as a control group. Patients in the control group received conventional nursing as well as health education and perioperative care as per routines. Totally 768 patients who received THA in the same hospital between January 2014 and December 2016 were selected as a treatment group. On the basis of conventional nursing,patients in the treatment group received targeted holistic nursing derived from the systematic "three preventions and three positions" nursing. The incidence of arthritic prosthesis dislocation between the two groups 3 months after THA was then compared.Results The incidence of arthritic prosthesis dislocation of the treatment group was 0.65%,including 1.56% for revision of THA,0.90% for femoral neck fractures,0.64% for osteonecrosis of the femoral head (ONFH),and 0.70% for congenital hip disorder (CHD) patients,while the incidence of arthritic prosthesis dislocation of the control group was 2.18%, which included 33.33% for revision of THA,1.25% for femoral neck fractures,0.70% for ONFH,and 0.70% for CHD patients. The treatment group′s incidence of arthritic prosthesis dislocation was lower than that of the control group (χ2=5.552;P<0.05):The incidence of arthritic prosthesis dislocation of THA revision patients in the treatment group was significantly lower than that of the patients in the control group (χ2=5.485;P<0.05);and the incidence of arthritic prosthesis dislocation among femoral neck fractures,ONFH and CHD patients in the treatment group was lower than the patients in the control group (χ2=0.309,0.743,2.771;P>0.05). Conclusions The systematic "three preventions and three positions" nursing helps to reduce the incidence of arthritic prosthesis dislocation after THA and THA revision,which is worthy of application and expansion.