OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are hierarchical medical system and two-way referral system;for-profit hospitals and non-profit hospitals are mutually complementary;different natures of health insur-ance system,different payment methods and strict“commercial bribe”monitoring system are carried out;doctors,hospitals and health insurance restrict each other. Not only there are many advantages in theory,but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a cer-tain extent. Combined with our national conditions,learning from the United States experience,restrictive relationship among doc-tors,hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing infor-mation asymmetry and standardizing payment audit;establishing a scientific pattern of mixed payment;strengthening the indirect impact of the health insurance institutions on doctors and hospitals,etc.

Objective To construct recombinant prokaryotic plasmid DNA encoding mycobacterium tuberculosis (TB) heat shock protein 70 (HSP70) - Dnak gene obtained from pMT70, then purify its characterizes and the role of rHSP70 in tumor therapy. Methods Amplified by polymerase chain reaction (PCR) and with terminal modification, the Dnak gene was cloned into the vector with T7 promoter and was confirmed by restriction endonuclease digestion. So a new plasmid pMT70 - 3 was constructed and transformed in E. Coli. Strain BL21DE3. The engineering bacteria were induced by IPTG. Western-blot,natine-page and scanning were used to analyze the results. The human HSP70 were induced with peptides of lymphocytic leukemia cells of L1210 of mice in binding buffer which contain MgCl2 and ADP at 37 ℃ , then mice were given rHSP70 peptide - complex by SV injection twice at weekly intervals. Results The Dnak gene could be highly expressed in E. Coli as soluble protein. The expressing efficiency was 65% of the total cell protein and the soluble protein was 90% of the expressed protein. The rHSP70 - peptide complex could improve the immune protective function which had significant difference compared with controls (P

AIM:To compare the efficiency of fibrin glue to suture technique in pterygium surgery performed with limbal autograft under different methods of anesthesia.
METHODS: A prospective randomised clinical trial was carried out in 60 eyes of 55 patients operated for primary nasal pterygium, which were divided into two groups randomly: experimental group ( 30 eyes in 27 patients ) was under surface anesthesia ( oxybuprocaine ) and control group ( 30 eyes in 28 patients ) was under local anesthesia ( 20g/L lidocaine ). Autologous limbal graft taken from the superotemporal limbus was used to cover the sclera by a fibrin tissue adhesive after pterygium excision. Patients were followed up at least for 6mo. Time of operation, matching degree of graft and VAS score were mainly observed and recorded.
RESULTS: In experimental group the average surgery time was shorter (P=0. 008) and matching degree of graft ( 93%) was better than control group ( 83%) , the differences had statistical significance(P<0.05).
CONCLUSION: The surface anesthesia is enough when using fibrin glue for graft fixation in pterygium surgery, which will shorten surgery time and get better matching degree of graft.

Objective To investigate the prevalence and associated factors of fecal incontinence (FI) and urinary incontinence (UI) in postpartum Chinese women.Methods Questionnaires about FI and UI symptoms were completed via telephone interviews conducted within six months after delivery.Multi-variant Logistic analysis was applied for relation between delivery mode and FI or UI.Results (1) Two thousand and twelve postpartum women were admitted into this study,among which 14 (0.7％) had FI within 6 months after delivery.Logistic regression analysis showed that FI was significantly associated with forceps delivery (OR =20.09,95 ％ CI:3.64-110.90,P =0.000),and mediolateral episiotomy (OR=6.11,95％ CI:1.29-28.80,P=0.024).(2) Among the 2012 women,the prevalence of UI,stress urinary incontinence (SUI),urgent urinary incontinence (UUI)and mixed urinary incontinence (MUD was 10.04％ (n=202),8.15％ (n=164),0.94％ (n=19)and 0.94 ％ (n =19),respectively.Logistic regression analysis found that SUI prevalence was related to maternal age (OR =1.07,95％ CI:1.04-1.11,P =0.000),maternal weight before delivery (OR=1.04,95％ CI:1.02-1.06,P=0.001),neonatal head circumference (OR=1.20,95％ CI:1.05-1.39,P =0.010),mediolateral episiotomy (OR =4.96,95 ％ CI:3.05-8.07,P =0.0005 ),spontaneous vaginal delivery (OR=5.22,95％ CI:2.53-10.76,P=0.000) and forceps delivery (OR=9.20,95％ CI:4.07-20.79,P=0.000).UUI was related to maternal weight before delivery (OR=1.51,95％ CI:1.12-2.05,P=0.008).MUI was related to maternal weight before delivery (OR=1.06,95％ CI:1.00-1.11,P=0.049),duration of second stage of labor (OR=1.01,95％ CI:1.00-1.03,P =0.010),mediolateral episiotomy (OR =7.76,95％ CI:1.42-42.52,P=0.017) and forceps delivery (OR=15.21,95％ CI:1.61-143.44,P=0.018).(3) The prevalence of SUI was higher at 4 days and 42 days after delivery (7.95％ and 9.10％).Conclusions (1) F1 and UI prevalence is lower in this study than in other reports.(2) Vaginal delivery is a risk factor for women's FI and UI,especially forceps delivery and mediolateral episiotomy.(3) Maternal age,pre-delivery weight,newborn head circumference,spontaneous vaginal delivery,forceps delivery and mediolateral episiotomy might increase the risk of UI.

Moxibustion,which is simple for manipulation and effective,has always been a very important way for external treatment.Acupuncture and moxibustion were complementary to each other sincc ancient times.but modem people usually only pay attention to acupuncture and neglect the usage of moxibustion.In this paper the importance of moxibustion is expounded briefly.

Objective To investigate the effects of an enriched environment (EE) on the psychological and behavioral symptoms of senescence and on the level of plasmic adrenocorticotropic hormone (ACTH) and serum corticosteroid (Cor). MethodsTwenty male senescence-prone SAMP8 mice of 3 months old were divided randomly into an enriched environment (EE) group and a standard environment (SE) group.Five male senescence-resistant SAMR1 mice of the same age served as the control group.Behavioral symptoms were assessed after 2 months using autonomic activity and elevated-plus maze (EPM) test performance.Plasma ACTH and serum Cor were detected using radio-immunologic methods. ResultsAverage autonomic activity frequency and EPM open-arm times were significantly lower with the SAMP8 mice than among the control group,and the autonomic activity frequency was significantly higher in the EE group than in the SE group of SAMP8 mice.The average EPM open-arm times of the EE group and the SE were not significantly different.Average ACTH and Cor levels were both significantly lower in the SAMP8 mice,and the level of ACTH was significantly higher in the EE group than in the SE group.There was no significant difference in these groups' average Cor levels. ConclusionsThe SAMP8 mice of 5 months demonstrated significant mental and behavioral abnormalities,as well as down-regulated plasma levels of ACTH and Cor.EE An enhanced environment can reduce behavioral disturbance through up-regulating ACTH.

Objective To investigate the effect and mechanism of decitabine (DAC) on the proliferation of human cholangiocarcinoma CCLP1 cells in vitro and in vivo.Methods After treated with various concentrations of DAC,cell growth inhibition rates were determined by CCK-8 assay.Cell cycle and cell apoptosis were analyzed by flow cytometry.Cell autophagy was observed under fluorescence microscope.The effect of DAC on the growth of cholangiocarcinoma in vivo was determined in a CCLP1 mice xenograft model.Results The proliferation rate of CCLP1 cells in the DAC-treated group decreased in a time-concentrated dependent manner.After treatment with DAC,the cell cycle of CCLP1 cells was arrested at the G2/M phase.The apoptosis rate was significantly higher in the treatment group over the control group.Cell autophagy was observed after treatment with DAC in CCLP1 cells.The tumor growth of implanted CCLP1 cells significantly slowed down after the mice were treated with 0.8 mg/kg DAC,6 times weekly for 2 weeks.Conclusion DAC can inhibit the proliferation of cholangiocarcinoma in vitro and in vivo.

BACKGROUND:Proximal humeral internal locking system fixation for complex humeral fractures via deltoid splitting approach provides good clinical results, but certain complications stil existed.
OBJECTIVE:To explore the postoperative complications and the related risk factors for displaced three-part and four-part fractures of proximal humerus treated with proximal humeral internal locking system fixation via deltoid-splitting approach, and to propose the corresponding countermeasures.
METHODS:106 cases with displaced three-part and four-part fractures of proximal humerus were retrospectively analyzed. The relationship between postoperative complications and the related risk factors was analyzed with Logistic regression analysis.
RESULTS AND CONCLUSION:A total of 81 patients were fol owed-up for 12 to 30 months. The mean Constant score at 12 months after operation was (76.57±4.70) points. The postoperative complications occurred in 31 patients (38.3%) of which impingement syndrome involved in 16 cases (19.8%), head-shaft angle loss in six cases (7.4%), head-shaft angle loss combined with screws cut-out in two cases (2.5%), pure screws cut-out in two cases (2.5%), humeral head necrosis in two cases (2.5%), fat liquefaction in five cases (6.2%). Single factor analysis showed that there were significant differences in the superiorly located greater tuberosity, superiorly located plate and Neer classification between impingement group and un-impinged group (P<0.05). There were statistical y significant differences in age, postoperative medial cortical defects and Neer classification between head-shaft angle loss group and un-loss group (P<0.05). By means of logistic regression analysis, the superiorly located greater tuberosity, superiorly located plate and Neer classification were the individual predictors for postoperative impingement syndrome;postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.

The effects of fucoidan on the lipidomics profiling of juvenile yellow catfish (pelteobagrus fulvidraco) during different feeding time (week 1, week 2, week 3 and week 8) were investigated by ultra-performance liquid chromatography-quadrupole-time-of-flight-mass spectrometry (UPLC-Q-TOF-MS) combined with multivariate data analysis, e.g.principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA).Based on VIP and p values, 11 lipid biomarkers were screened including lysophosphatidylcholine (Lyso-PC) 16∶0, phosphatidylcholine (PC) 22∶6/16∶0, phosphatidylethanolamine (PE) 22∶6/16∶0, phosphatidylinositol (PI) 18∶0/22∶6, diacylglycerol (DAG) 16∶0/16∶0,DAG 16∶0/18∶1, DAG 18∶1/18∶1, triglycerides (TAG) 20∶5/16∶0/18∶3, TAG 20∶4/16∶1/18∶2, TAG 16∶0/18∶2/20∶5 and TAG 18∶2/14∶0/18∶1.It was found that Lyso-PC, PC, PE and PI had the largest levels at the eighth week;the levels of DAG were decreased at the second and fourth weeks, and increased at the eighth week.While TAG was different: the content of TAG 18∶2/14∶0/18∶1, TAG 20∶5/16∶0/18∶3 and TAG 20∶4/16∶1/18∶2 increased in response to fucoidan, but TAG 16∶0/18∶2/20∶5 decreased little.Therefore, for juvenile yellow catfish, fucoidan can affect its lipid metabolism, which provides a theoretical basis for investigation of the influence of fucoidan on the response mechanism of lipid metabolism of juvenile yellow catfish.

Objective To investigate the internal quality control ( IQC ) on clinical chemistry , clinical immunology and clinical hematology in mutual recognition laboratories in medical institutions in Beijing.Methods By means of questionnaire survey and on -site investigation, fresh frozen serum and whole blood samples with assigned values by reference method were measured to investigate the status of IQC on clinical chemistry , clinical immunology and clinical hematology in 142 mutual recognition laboratories in medical institutions of Beijing,and results were analyzed.Results 142 copies of questionnaireson clinical chemistry, clinical immunology and clinical hematology were send out and 120, 97, and 101 laboratories returned the questionnaires respectively .The information feedback rate was 84.5%, 68.3% and 71.1%respectively .All the questionnaires were effective .Questionnaires survey results showed that more than 50%laboratories set up quality control goals and the most of the goals were probability for error detection ( Ped) 95%, probability for false rejection(Pfr)5%;About 70% laboratories usecd the same quality control plan for different tests ;The most frequently used quality control rules are 12s/13s/22s.On-site investigation showed that ,take the results of clinical chemistry for example , based on the desirable biological variation and WS/T 403 -2012 , most of the tests can't meet the quality control goalsunder the existing quality controlcondition.Conclusion Clinical laboratories should consider their actual situations , assess their own qualitylevels that they can reach , set reasonable quality standards for themselves , and make appropriateindividualized quality control plan.