Objectives To provide reference for the improve of health care system and healthcare insurance con-trolling method, through researching on the value-based healthcare paying system in South Korea. Methods The basic characteristics of the Korean health care system was researched, Specifically, its reform experiences of value-based health insurance review and assessment paying system,which government took. Results South Korea’s health care pay-ing system had achieved both good social and policy effects. Conclusions Value-based health care paying system is the main reason for the reducing of health care expenditures and making of scientific health policy.

Objective To observe the influence of epalrestat combined with insulin therapy on islet beta cell function in newly diagnosed type 2 diabetic patients.Methods 45 newly diagnosed type 2 diabetic patients were randomly treated with 4 times of subcutaneous insulin therapy(RI group) or epalrestat plus 4 times of subcutaneous insulin therapy(RI + EP group).Patients were followed up for 3 months.The fasting blood-glucose (FPG),the 2 hour postprandial blood glucose (2 h PG),fasting insulin (FINS),the 2 hour postprandial blood insulin (2 h INS),glycated hemoglobin (HbA1 C),superoxide dismutase (SOD),malondialdehyde (MDA),insulin resistance index (HOMA-IR) and insulin release index(HOMA-β) were observed at 3th month after the initiation of therapy.Results Follow-up evaluation of 22 cases in RI group,23 cases in group RI + EP were completed 3 months of treatment.After treatment,FPG,2 h PG,HbA1 C,MDA and HOMA-IR in the two groups were decreased than those before treatment,the serum FINS,2 h INS,SOD and HOMA-β were higher than those before treatment,the differences were statistically significant (all P ＜0.05).After treatment,FINS,2 h INS,SOD and HOMA-β of RI + EP group were higher than those in RI group,MDA was lower than that of RI group,the differences were statistically significant (t =3.228,2.536,3.021,2.343,2.122,all P ＜ 0.05).FPG,2 h PG,HbA1 C,HOMA-IR between the two groups had no significant differences (all P ＞ 0.05).Linear regression analysis showed that HOMA-β was positively correlated with SOD level (r =0.888,r2 =0.783,all P ＜ 0.01).Conclusion The results suggest that epalrestat combined with insulin therapy can inhibit oxidative stress,and improve islet beta cell function in newly diagnosed type 2 diabetic patients,and its clinical effect is better than monotherapy with insulin.

Objective To explore the effect of quality control circle (QCC) on health education in stroke rehabilitation nursing. Methods Such activities were conducted in the VIP ward of neurological rehabilitation in our hospital as: theme selecting, activity planning, status mastering, cause analyzing, countermeasures formulating and implementing, etc., in accordance with QCC theory from January to April, 2014. Results The satisfaction of stroke patients to health education rose from 80.1% to 91.1% (P<0.001), and the dissatisfaction to guidance of activities of daily living and prevention of complications decreased significantly (P<0.05) after the implementation of QCC program. All the circle members benefited from the improvement of QCC technique, team work, professional knowledge, communication and coordination, activity confidence, duty and honor. Conclusion Carrying out the QCC activities can play a positive role on health education in stroke rehabilitation nursing.

Objective To evaluate the role of chemokine CXC-ligand 16 (CXCL16) in renal fibrosis following renal ischemia-reperfusion (I/R) injury in mice.Methods Twenty-four healthy male C57BL/6 mice,aged 8-10 weeks,weighing 20-30 g,were divided into 4 groups (n =6 each) using a random number table method:sham operation group (group S),sham operation plus anti-CXCL16 antibody group (group S+A),group I/R,and I/R plus anti-CXCL16 antibody group (group I/R+A).Renal ischemia was induced by occlusion of the left renal artery for 30 min followed by 72-h reperfusion,and the fight kidney was removed on 5th day in anesthetized mice.CXCL16 antibody 5 mg/kg and the equal volume of normal saline were intraperitoneally injected at 72 h after reperfusion twice a week for 2 consecutive weeks in I/R+A and I/R groups,respectively.Sham operation was performed,and the equal volume of CXCL16 antibody 5 mg/kg and normal saline were intraperitoneally injected at 72 h after reperfusion twice a week for 2 consecutive weeks in S+A and S groups,respectively.Orbital venous blood samples were collected at day 14 after reperfusion for determination of serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations.Animals were then sacrificed and the left kidney was removed for measurement of the renal fibrosis size (using Sirius red staining),expression of t-smooth muscle actin (α-SMA),fibronectin (FN) and type Ⅰ collagen (Col-Ⅰ) in renal tissues by Western blot.Results Compared with group S,the serum BUN and Cr concentrations and renal fibrosis size were significantly increased,and the expression of α-SMA,FN and Col-Ⅰ was up-regulated in group I/R (P＜0.05).Compared with group I/R,the serum BUN and Cr concentrations and renal fibrosis size were significantly decreased,and the expression of α-SMA,FN and Col-Ⅰ was down-regulated in group I/R+A (P＜0.05).Conclusion CXCL16 is involved in the process of renal fibrosis following renal I/R injury in mice.

Objective To assess the efficacy and safety of methimazole combined with selenium therapy in the treatment of hyperthyroidism .Methods 130 cases with hyperthyroidism were selected , and according to the digital table they were randomly divided into methimazole plus selenium treatment group ( ATD +Se group ) and methimazole treatment group(ATD group),65 cases in each group.The patients were followed up for 3 months.The thyroid function index and thyroid antibody index were observed before and after treatment .The adverse reactions were observed,too.Results After treatment,the serum levels of FT3,FT4,TSH in the ATD +Se group were (3.32 ± 0.53)pg/mL,(1.02 ±0.17)ng/dL,(2.72 ±0.32)mIU/L,respectively,which in the ATD group were (4.82 ± 0.75)pg/mL,(2.41 ±0.32)ng/dL,(2.72 ±0.32)mIU/L,respectively.The change ranges of the ATD +Se group were better than those of the ATD group ,the differences were statistically significant (t=4.591,3.814,3.567,all P<0.05).The TPOAb,TGAb,TRAb in the ATD+Se group were (120.3 ±23.1) IU/mL,(123.3 ±26.5) IU/mL, (1.72 ±0.89)IU/mL,respectively,which in the ATD group were (132.8 ±21.1)IU/mL,(134.8 ±21.3)IU/mL, (3.68 ±1.06)IU/mL,respectively.The changes of the ATD+Se group were more significant than those of the ATD group,the differences were statistically significant (t=4.291,3.514,3.767,all P<0.05 ).The total effective rate of the ATD+Se group was higher than that of the ATD group (90.77％vs.76.92％χ2 =13.147,P<0.05 ).The incidence rate of adverse reactions in the ATD +Se group was lower than that in the ATD group (12.31％vs.27.69％χ2 =18.685,P<0.05 ).Conclusion The results suggest that methimazole combined with selenium treatment is effective and safe for hyperthyroidism .

Objective To investigate the correlation between the blood flow characteristics of contrastenhanced ultrasound (CEUS) and malignancy of patients with ovarian tumor.Methods 60 cases with ovarian tumors treated by surgery and confirmed by pathology were selected,including 28 cases of ovarian cancer and 32 cases of benign ovarian tumor.The time of arrival (AT),peak time (TTP) and intensity of enhancement (EI) were determined by CEUS,and microvessel density (MVD) of tumor tissue was detected by immunohistochemistry.The correlation of the above parameters with MVD and tumor staging was analyzed.Results AT,TTP of the malignant tumor group (10.8±2.1,25.3±10.5) was significantly lower than those of the benign tumor group (15.4±2.7,59.4±11.2).EI of the malignant tumor group (28.6±2.9) was significantly higher than that of the benign tumor group (14.9±2.6),with statistical significance (P＜0.05).MVD of the malignant tumor group (62.8± 13.6) was significantly higher than that of the benign tumor group (21.5±11.4),with significant difference (P＜0.05).AT and TTP were negatively correlated with MVD and FIGO staging (r=-0.562,r=-0.504,r=-0.636,r=-0.623),while EI was positively correlated with MVD and FIGO staging (r=0.839 and r=0.785),with statistical difference (P＜0.05).Conclusions Blood flow characteristics of CEUS are closely related to the malignancy of ovarian tumors.CEUS can accurately evaluate angiogenesis,blood perfusion and malignancy of ovarian tumors.

Objective To investigate the diagnostic value of ultrasound ADNEX model in ovarian tumors.Methods 226 patients with pathological-confirmed ovarian tumor from Jun.2014 to Jun.2018 were selected,and the preoperative ultrasound imaging,clinical and pathological data were analyzed.The ultrasound imaging was recorded,and ovarian tumor was diagnosed through ADNEX model.The diagnostic efficiency of ADNEX model for ovarian benign and malignant tumors was analyzed with pathological findings as the gold standard.Results The differences of onset age,CA125 level,tumor solid components maximum diameter and ratio,＞10 locules and ascites were all statistically significant between each ovarian tumor group (P＜0.05).The overall accuracy rate of ADNEX model in diagnosing different ovarian tumors was 83.2％,which has a good consistency with histopathological findings (Kappa=0.782,P＜0.05).The sensitivity and specificity of the prediction model in predicting benign,borderline,stage Ⅰ,stage Ⅱ-ⅣV and metastatic ovarian tumor were respectively 85.5％ and 95.7％,69.2％ and 96.0％,81.6％ and 93.8％,89.1％ and 94.4％,80.0％ and 98.5％.Conclusion Ultrasound ADNEX model is helpful in differential diagnosis of benign and malignant ovarian tumor,and it has important significance for clinical treatment and prognosis evaluation.

OBJECTIVETo propose a new method for automatic segmentation of manually determined knee articular cartilage into 9 subregions for T2 measurement.

METHODSThe middle line and normal line were automatically obtained based on the outline of articular cartilage manually drawn by experienced radiologists. The region of articular cartilage was then equidistantly divided into 3 layers along the direction of the normal line, and each layer was further equidistantly divided into 3 segments along the direction of the middle line. Finally the mean T2 value of each subregion was calculated. Bland-Altman analysis was used to evaluate the agreement between the proposed and manual subregion segmentation methods.

RESULTSThe 95% limits of agreement of manual and automatic methods ranged from -3.04 to 3.20 ms, demonstrating a narrow 95% limits of agreement (less than half of the minimum average). The coefficient of variation between the manual and proposed subregion methods was 4.04%.

CONCLUSIONThe proposed subregion segmentation method shows a good agreement with the manual segmentation method and minimizes potential subjectivity of the manual method.

Adult ; Cartilage, Articular ; anatomy & histology ; Humans ; Knee Joint ; anatomy & histology ; Magnetic Resonance Imaging ; methods ; Young Adult

Objective To evaluate the effect of clemastine fumarate on Toll-like receptor 4/phosphatidylinositol-3-kinase/serine-threonine kinase (TLR4/PI3K/Akt) signaling pathway during hypoxia-reoxygenation (H/R) in rat cardiomyocytes.Methods H9C2 cells of rats cultured in vitro were seeded in culture wells or dishes at a density of 1×105 cells/ml and divided into 3 groups (n=11 each) by using a random number table method:control group (group C),H/R group and clemastine fumarate group (CF group).Cardiomyocytes were exposed to 5％ CO2-95％ N2in a low-glucose DMEM medium at 37℃ for 4 h followed by 4 h reoxygenation.At 4 h of reoxygenation,the cell viability was detected by CCK-8 assay,the ultrastructure was observed with a transmission electron microscope,the expression of TLR4,PI3K,phosphorylated Akt (p-Akt) and caspase-3 was detected by Western blot,and the expression of TLR4,PI3K and caspase-3 was detected by immunofluorescence.Results Compared with group C,the cell viability was significantly decreased,the expression of TLR4 and caspase-3 was up-regulated,and the expression of PI3K and p-Akt was down-regulated in group H/R (P＜0.05).Compared with group H/R,the cell viability was significantly increased,the expression of TLR4 and caspase-3 was down-regulated,the expression of PI3K and p-Akt was up-regulated (P＜0.05),and the mitochondrial damage was significantly attenuated in group CF.Conclusion The mechanism by which clemastine fumarate alleviates H/R injury to rat cardiomyocytes may be related to inhibiting TLR4 expression and activating PI3K/Akt signaling pathway.