By improving the existing pattern that different medical institutions with competition fragmentary health care mode,the bundled payment could improve the coordination and cooperation between medical institutions,improve the overall medical service quality and reduce medical service cost.It provided a helpful thought for the supply-side reform in health field in China.Foreign experience indicated that in order to implement bundled payment mode,China should build a complete medical service supply chain to promote integration of medical institutions;shift economic stimulus to economic constraints,build orderly competition environment;strengthen the construction of informatization and promote the applications of healthy big data.

As a mode of pay for performance,hospital value-based purchasing has been become widespread the US.Medicare managed to encourage the service providers to provide medical services with more value and quality.The implementation background,financing,payment mode and performance evaluation of hospital value-based purchasing were briefly introduced.In the payment reform of China,it also needed to focus on the medical service quality,learn from the performance evaluation system,incentive mechanism and multiple measurement,reasonably design the implementation scheme.

Animals ; Biomarkers ; Hexanes ; poisoning ; toxicity ; Humans ; Neurotoxicity Syndromes ; etiology

Adult ; Carbodiimides ; poisoning ; Humans ; Male ; Methylamines ; poisoning ; Occupational Exposure ; Young Adult

ObjectiveTo evaluate the effects of thoracic and lumbar epidural block on the depth of propofol sedation.MethodsForty-five ASA Ⅰ or Ⅱ patients with stomach cancer ( n =15) or colorectal cancer ( n =30) aged 20-64 yr weighing 46-79 kg with body height 151-179 cm undergoing elective radical operation were enrolled in this study.The 30 patients with colorectal cancer were randomly divided into 2 groups ( n =15 each):group control (group Ⅰ ) and group lumbar epidural group(group Ⅱ ).The 15 patients with stomach cancer received thoracic epidural block (group Ⅲ ).Epidural block was performed at L2.3 interspace in groups Ⅰ and Ⅱ and at T9.10 interspace in group Ⅲ.After a test dose of 3 ml 1.5％ lidocaine,a bolus of 1.5％ lidocaine 12 ml (in groupsⅡ and Ⅲ ) or 12 ml of normal saline (in group Ⅰ ) was injected into epidural space.Target-controlled infusion(TCI) of propofol was started at 12 min after epidural lidocaine.Target plasma concentration of propofol was set at 4 μg/ml.Fentanyl 4 μg/kg was injected iv as soon as the patients lost consciousness.Tracheal intubation was facilitated with vecuronium 0.1 ng/kg.The patients were mechanically ventilated.Radial artery was cannulated for direct BP monitoring and blood sampling.BIS value was monitored (Aspect Medical System).The number of spinal sequent affected in the subarachnoid epidural anesthesia was counted before propofol TCI.Arterial blood sampies were collected at 2,3,4 and 5 min of propofol TCI for determination of plasma concentration of propofol ( by HPLC).BIS value and plasma concentration of propofol calculated by TCI pump were recorded at 2,3,4 and 5 min of propofol TCI.ResultsThe BIS values were significantly lower in groups Ⅱ and Ⅲ than in group Ⅰ and in group Ⅲ than in group Ⅱ.There was no significant difference in plasma propofol concentration measured by HPLC and plasma concentration of propofol calculated by TCI pump.ConclusionThe efficacy of thoracic epidural block enhancing propofol sedation is higher than that of lumbar epidural block.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Combined Modality Therapy ; Female ; Humans ; Intervertebral Disc Displacement ; therapy ; Male ; Massage ; Middle Aged ; Young Adult

AIM: To study the effect of crocetin on the formation of advanced glycation end products(AGEs) and receptor for AGEs(RAGE) protein expression in diabetic rats induced by streptozotocin(STZ).METHODS: Rats were injected STZ in tail vessel with a dose of 45(mg?kg~(-1)).3 d later,the rats whose blood glucose were over(11.1)(mmol?L~(-1)) were regarded as diabetic rats,and were divided randomly into two groups: diabetic mellitus(DM) group,crocetin(50(mg?kg~(-1)),po) group.At the same time,8 normal rats were regarded as control group.After 21 d treatment,The levels of fasting blood glucose(FBG),serum fructosamine(FMN) and glycosylated hemoglobin(GHb) were measured.The contents of AGEs in aorta and mesenteric vessel were detected by fluorospectrophotometry.HE staining for mesenteric aorta was performed,and RAGE protein expression was studies with immunohistochemical method.RESULTS: Compared with DM group,crocetin did not decrease the level of FBG.However,it could decrease the levels of FMN and GHb in blood and AGEs in aorta and mesenteric vessel(P

PURPOSE To investigate the methylation of p53 gene in human thyroid carcinoma. METHODS The DNA of 12 thyroid carcinomas and 5 adjacent tissues of thyroid carcinoma were digested by restriction endonuclease enzymes Hap I and Msp I . Polymerase chain reaction (PCR) followed by agarose gel electrophoresis was used to detect the methylation in the exon 5 of p53 gene. RESULTS 5'-CCGG-3' site was methylated at the exon 5 of p53 gene in 9 thyroid carcinomas. However hypomethylation was found to exist in 5 adjacent tissues of thyroid carcinoma. CONCLUSION Hypermethylation of p53 gene plays an important role in thyroid carcinogenesis and the mutation of p53 gene.

Objective To investigate the impact of photodynamic therapy (PDT) with verteporfin on the expression of pigment epithelial derivative factor (PEDF) mRNA and vascular endothelial growth factor (VEGF) mRNA in adult retinal pigment epithelial (RPE) cells in vitro. Methods The changes of cellular viability before and after PDT were assessed by methyl thiazolyl tetrazolum (MTT) colorimetric assay. Semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) was conducted to detect the expression of PEDF and VEGF mRNA in RPE cells before and after PDT. Results PDT caused the death of RPE cells. The cellular mortality was positively correlated with the power of photocoagulation and the concentration of verteporfin. Conclusion PDT could down-regulate the expression of PEDF and VEGF mRNA in adult RPE cells in vitro, which may relate to the cure or relapse of subfoveal choroidal neovascular membrane after PDT.

Aim To investigate the effect of oral itraconazole on pharmacokinetics of viaminate and under-stand the metabolism pathway of viaminate in healthy humans,as well as guide the reasonable medication for viaminate and itraconazole coadministration.Methods The study was conducted in a double-blind randomized and crossover manner with two phases of treatment with placebo-viaminate or itraconazole-viaminate.Eight healthy male subjects received an oral dose of 200 mg itraconazole(QD) or matched placebo for five consecutive days,and took an oral 100 mg dose of viaminate on day 4 after each treatment phase.The liquid chromatography-mass spectrometry(LC-MS) was established to measure the blood drug concentration of viaminate.Results Our results showed that the mean peak concentration of viaminate was increased with itraconazole [(21.21?11.65) ?g?L~(-1) vs(27.12?13.83) ?g?L~(-1),P0.05].Additionally,the mean elimination half life was prolonged [(2.71?0.38) h vs(4.43?0.93) h,P