The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medi-cal expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation be-tween quality of care and medical expenditure. Based on Donabedian’s structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common;more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, ac-cording to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way.

Objective:To explore means of process quality assessment for antibacterial drug utilization among a-cute appendicitis patients under the New Rural Cooperative Medical Scheme ( NCMS) through the use of the explicit method in order to provide evidence for the rationality of drug utilization in NRCMS. Methods: Data was collected from the NCMS information system of one county in Shandong Province from 2007 to 2011 and included 1 ,721 cases of acute appendicitis in county and town-level hospitals. The explicit method was employed, which adopted the ad-herence rate to represent drug process quality by comparing the actual antibacterial drug utilized with those recom-mended by quality standards. Descriptive statistics were used to analyze quantitative data with Excell2007, Microsoft SQL 2005 and SPSS 17 . 0 . Results: The average overall adherence rate from 2007 to 2011 was 22 . 4% ( SD =22. 3%) at the individual level. The overall adherence rate of township health centers was very low, between 14. 6%and 19. 6%, with no significant difference among the five years. The utilization of cephalosporin drugs was relatively stable at town-level hospitals, that is, third-generation cephalosporins was used most frequently, while cephalosporin, recommended by quality standards, was the least utilized in all five years. At county-level hospitals, fourth-genera-tion drugs were gradually substituted with second and third-generation drugs. Utilization of the recommended drug metronidazole of the nitromidazoles drug group decreased over time at both the town and county-level hospitals, and the drug was gradually substituted by tinidazole and ornidazole, especially in county-level hospitals. Conclusions:From 2007 to 2011 , the rationality of drug utilization was low in the NCMS designated hospitals at both town and county-level hospitals, particularly in town-level hospitals. The underuse of recommended quality standard drugs was the main issue at hand, and this situation experienced no significant changes during the study period.

Objective To probe into the employment and turnover changes of health workers at township health centers,for analysis of the incentive preferences and methods characteristic of such people.Methods Questionnaire and interview investigations were made for 16 health centers to learn their personnel turnover from 2008 to 2010 in Junan county,Shandong province,and to learn their incentive preferences.Results Health workers of turnover tendency are mostly found among women,clinicians and nurses of college or above degree and those less than 39 years old.The top five incentive factors for such health workers are as follows:better working environment; better pay; better security for living; better hospital management; and better career development opportunities.Conclusion Township health centers should seize policy support of the health reform,by focusing on not only economic incentives such as the income and living conditions of health workers of turnover tendency,but also on non-economic factors such as career development opportunities.

The cytotoxicity of medical ultrasonic couplant was tested by MTT assay and agar overlay test. By MTT assay, when the inoculum density was high, the cytotoxicity level was low, or vice versa. The cytotoxicity grade tested by agar overlay was not accord to MTT assay's too. MTT assay is suitable to test the cytotoxicity of medical ultrasonic couplant because it is quantitative and more sensitive, however, the experimental condition and the preparative method of extraction should be determined.
Animals ; Cell Line ; Colorimetry ; Cytotoxicity Tests, Immunologic ; methods ; Mice ; Ultrasonics

Objective To evaluate expression and significance of TLR4 and NF-κB on inflammatory injure after intracerebral hemorrhage in rats .Methods 60 Sprague Dawley maleness rats were randomly divided into Sham group ,12 h ,24 h ,72 h and 7 d af-ter ICH group(12 s) .The ICH was induced by injection of autologous blood in rats .The behavioral changes were detected by neu-rologic deficit score .The water content of the brain was used to evaluate brain edema changes .Number of TLR4 and NF-κB positive cells by Nissl staining and the expression of protein determined by immunohistochemistry and Western blot .Results After ICH 12 h ,expression of TLR4 and NF-κB positive cells around the hematoma were expressed ,with the extension of the time ,expression was gradually increasing ,and after ICH 72 h the expression of protein were the highest .Cerebral edema and severe neurological damage occurred .Western blot shows the amount of TLR4 expression and NF-κB were in line with the result .Conclusion After in-tracerebral hemorrhage in rat causing inflammatory injure of brain tissue around the hematoma .TLR4 may activate the expression of NF-κB involved in the secondary inflammatory injure after intracerebral hemorrhage in rats .

OBJECTIVE:To study chemical compounds of Monoraphidium dybowskii,and to investigate the in vitro antibacte-rial and antioxidant activities of isolated compounds. METHODS:The ethanol extract of M. dybowskii were extracted with aether petrolei,ethyl acetate and n-butyl alcohol. The ethyl acetate extract was separated from M. dybowskii and chemical components were analyzed by sillica gel column chromatogram,HPLC and GC-MS. Their structures were identified according to physicochemi-cal properties and NMR. MIC of 4 isolated compounds to Pseudomonas aeruginosa,Candida albicans,Bacillus subtilis and Esche-richia coli were determined by resazurin disc test. Free radical scavenging rate(concluated by IC50)and reducing capacity were mea-sured by 1,1-diphenyl-2-picryl-diazanyl (DPPH) and ferric reducing antioxidant power (FRAP) assay. RESULTS:Compounds 1-6 were obtained from E4 and E5 segments of ethyl acetate extract of M. dybowskii,and their structures were identified as stigmas-terol,diisonoyladipate,indole-3-carboxylic acid,(+)-epiloliolide,(-)-loliolide,5-hydroxy-3,4-dimethy-5-pentyl-2(5H)-furanone. MIC of compounds 3-6 were 10-500 μg/mL,and IC50 ranged 22.02-71.01 μg/mL;FRAP ranged (62.04 ± 5.36)-(281.22 ± 8.3) μmol/L. CONCLUSIONS:M. dybowskii contains multiple lipid and alkanoic acid,and possesses certain in vitro antibacterial and antioxidant activities.

Objective To investigate the effects of recombinant adeno-associated virus-mediated myostatin propeptide (MPRO) on uptake and oxidation of glucose,and glycogen synthesis in C2C12 myotubes,as well as the associated molecular mechanism.Methods Mature C2C12 myotubes were assigned to the following 6 groups:control,insulin,green fluorescent protein (GFP),insulin + GFP,MPRO,and insulin + MPRO groups.Glucose uptake,glucose oxidation,and glycogen synthesis were detected by counting radioactivity of 14CO2 or 14C labeled glycogen derived from 2-deoxy-[1-14 C] glucose.The activity of insulin signal pathway was evaluated by Western blot.Results Compared with control group,glucose uptake and glycogen synthesis were significantly increased in insulin and insulin+GFP groups,and further increased in insulin+MPRO group as compared with insulin alone(all P＜ O.05).However,MPRO and insulin had no effect on glucose oxidation.The phosphorylations of insulin receptor (IR) β,insulin receptor substrate 1 (IRS-1),protein kinase B (Akt),glycogen synthase kinase-3 β (GSK-3β),and the expressions of phosphatidylinositol 3-kinase (PI3K) and glucose transporter 4 (Glut4) in membrane were significantly increased in insulin and insulin+GFP groups compared with control group(all P＜0.05),and were further increased after MPRO transfection (all P ＜ 0.05).Conclusion MPRO may increase insulin-stimulated glucose uptake and glycogen synthesis in C2C12 cells by activating the IRS/PI3K/Akt signal pathway.

The ancient books on traditional Chinese medicine are mainly covered in the comprehensive bibliogra-phies and special bibliographies of traditional Chinese medicine in the past ages.Their classification was thus de-scribed in the Seven-Classification System, Four-Classification System, Twelve-Classification System,Bibliogra-phy of medical collection and General Bibliography of ancient books on traditional Chinese medicine, followed by an analysis of the classification systems of ancient books on traditional Chinese medicine in the past ages and their evo-lution, which helps to search the medical literature from the vast ancient books according to their classification.

_ Objective_ To study whether quinoid dihydropteridine reductase ( QDPR ) expression level change can affect oxidative stress of NRK-52E renal tubular cells in a high glucose environment. Methods The NRK-52E model of overexpression, knockdown QDPR gene and respective control were constructed by lentivirus. All groups were given 5. 4 mmol/L and 30 mmol/L glucose culture medium respectively to imitate normal and high glucose condition. The level of superoxide anion ( O-2 ) was detected by flow cytometer dihydroethidium method. The protein expression level of superoxide dismutase 1 (SOD1)was tested by Western blot. Results QDPR over-expression can decrease O-2(P<0. 01)and SOD1(P<0. 05)levels in high glucose condition;QDPR knockdown increases O-2(P<0. 01) and does not change SOD1. Conclusion Under high glucose condition, overexpression of QDPR gene decreases NRK-52E cell oxidative stress. Knockdown QDPR gene increases NRK-52E cell oxidative stress. QDPR gene may influence the development of diabetic nephropathy by oxidative stress.

This study was aimed to reveal the species characteristics of Chinese patent medicines for antitussive ef-fect and provide references for developing new drugs. This research targeted Chinese patent medicines for antitussive effect which were included in the Pharmacopoeia of the People's Republic of China and the New National Chinese Patent Medicines as well as those characterized by keywords such as cough cure, cough alleviating, antitussive effect, cough, persistent cough. The analysis was made on the species characteristics, such as the number of Chinese patent medicines for antitussive effect, license number, ethnomedicine patent medicines, drugs for children use, protection of varieties of traditional Chinese medicine, the number of drugs, the generic names of drug, and drug forms. The results showed that 684 Chinese patent medicines for antitussive effect collected in this research had ac-counted for 8.60% of the total 7 260 of Chinese patent medicines. A total of 7 450 license numbers were approved, and 33% of the Chinese patent medicines shares one license number. One Chinese patent medicine owns 16.6 li-cense numbers on average. Ethnomedicine patent medicines had 3 Tibetan prescriptions such as the Shiwuwei Chenxiang pill and 4 Mongolian prescriptions, such as the Siwei Tumuxiang powder. Drugs for children accounted for 14%, including 9 forms. The type of the generic names of drug reached 16 and most of them originate from abbrevia-tions of the main drug in prescription. The number of drugs in prescription ranges from 8 to 16. Chinese patent medicines for antitussive effect involved 16 forms, of which the proportion of the use of solid preparation was higher than the liquid preparation. It was concluded that Chinese patent medicines for antitussive effect were characterized by such advantages such as a variety of species, various forms, the reasonable number of drugs, considerable medicine retail market share and drug for children use which can meet the clinical needs, and meanwhile some prob-lems, such as a lack of criteria for the generic names of drug, the homogenization of fierce competition, and inade-quacy of ethnomedicine patent medicines.