The reform for medical insurance payment was the important method for standardizing medical service provider behavior,controlling costs and improving efficiency,which was also the important measurement for further improve and implement the reform of drug and health system.Since the new medical reform in 2009,the central and local government had paid more attention on the role of medical insurance payment reform.Local medical departments of different places implemented reform pilots.Through summarizing the foreign and domestic researches around capitation,bundle payment and global payment,the experiences and effectiveness of these pilots were evaluated so as to provide corresponding policy implications.

Objective To investigate the relationship between Helicobacter pylori(H. pylori)infection and gastric metaplasia in the duodenal bulb and to pursue whether they play critical roles in pathogenesis of duodenitis and ulcer.Methods Eighty-two archive paraffin blocks of duodenal biopsy were obtained. All sections were stained with H-E, AB/PAS and Giemsa stains for histology, gastric metaplasia and H. pyloriassessment. There were 10 patients with normal duodenum, 47 with duodenitis and 25 with ulcer confirmed by endoscopy. Results There was a discrepancy in diagosis of the normal duodenal bulb mucosa between endoscopy and histopathology. Mild to moderate infiltration of inflammatory cell without gastric metaplasia were detected in 60% of cases with the normal duodenal bulb mucosa judged by endoscopy. Gastric metaplasia in duodenal bulb was the major phenomena in the patients with duodenitis and ulcer (37/82, 45%). H. pyloriinfection in the duodenal bulb always appeared in areas of gastric metaplasia. H. pyloriwas identified in 28 out of 37 (76%) cases in the gastric metaplasia mucosa. The prevalence of gastric metaplasia in the duodenal bulb between the patients with ulcer (72%) and duodenitis (40%) was significantly different (P=0.0078). The frequency of H. pyloricolonization was higher in the patients with duodenal ulcer (89%) than the patients with duodenitis (63%), but did not reach statistical significance(P=0.062). H. pyloriinfection was also higher in the ulcer patients with active, healed or scar stage, being 9/10, 5/6 and 2/2, respectively. Conclusions There is a difference in the frequency of H. pyloricolonization in the gastric metaplasia mucosa in the patients with ulcer and duodenitis, which suggests that infection with H. pylorimay play an important role in ulcer recurrence.

Due to its exquisite sensitivity, excellent molecular specificity and reduced photobleaching, surface-enhanced Raman spectroscopy has wide potential applications in the fields of food and drug analysis, environmental monitoring and biological detection. However, SERS is only a qualitative or semi-quantitative detection technique at the present stage, and has not yet been widely recognized as a routine quantitative technique. This review discusses the pros and cons of the quantitative surface-enhanced Raman spectroscopic techniques developed so far in the literature, and looks forward to the future trend in this field.

Objective To investigate the factors that influence the fermentation process of compound Chinese medicine and determining the optimum fermentation with single factor experiment and response surface methodology. Methods Through controlling the factors in the fermentation process of compound Chinese medicine (such as fermentation bacteria, fermentation time, fermentation temperature, inoculum amount, etc.), with its increase rate of total peak area as evaluation indicator, the alcohol extracts before and after fermentation were monitored and comparative evaluated by HPLC, and the optimum fermentation process was determined by response surface methodology. Results The fermentation process optimized by single factor experiment and response surface methodology was as follows:SZ-2 strain served as the fermentation bacteria, temperature was 33 ℃, inoculum amount was 4%, and time was 3.5 d, the average increase rate of total peak area was 31.24%. Conclusion HPLC can be used to identify and evaluate the fermentation of compound Chinese medicine under the different factors, and to clarify the optimal fermentation process by response surface methodology, which provide reference for the development of fermentation process.

Objective To analyze the characteristic of auditory brainstem responses (ABR) evoked by chirp in normal hearing subjects .Methods Fifteen cases (30 ears) with normal hearing young people were recorded ABR by stimulation with two kinds of sounds :chirp and click .The data were compared .Results The response threshold of chirp-ABR were lower than that of click -ABR .The average difference was 8 .59 dB .At 90 dB nHL ,the wave V amplitude yield no significant difference between chirp -ABR and click-ABR .The wave V amplitude had a signifi-cant difference between chirp -ABR and click-ABR at 60 dB nHL .At 90 and 60 dB nHL ,the wave V amplitude of chirp-ABR had not a significant difference .The occurence rate was 40% for the wave I of chirp -ABR ,obvi-ously less than that of click -ABR .At 90 dB nHL ,the wave V latency of chirp -ABR was shorter than that of click-ABR .Conclusion The wave V response threshold of chirp -ABR is less than that of the click -ABR .The chirp-ABR is more advantageous than the click -ABR for assessing hearing threshold .

Objective The experimental evidences that long term colonization of H. pylori results in development of gastric cancer in Mongolian gerbils (MGs) have been reported only by two Japanese groups so far. This study aimed to investigate the carcinogenicity of long term H. pylori infection in MGs model. Methods Thirty six 6 week old outbred MGs (from Inner Mongolia, male∶female=1∶1) were orally inoculated with H.pylori ATCC43504 or H.pylori 161, which was isolated from a patient with gastric adenocarcinoma in our hospital. Another 10 MGs were inoculated with sterilized PBS served as controls. The animals were sacrificed 8, 20, 28 and 84 weeks, respectively, after inoculation for bacteria and histological examination. Results H.pylori was detected in 80%(23/29)of the inoculated MGs and the chronic active gastritis aggravated gradually during the course of experiment. At the 84th week, moderate to severe gastritis, characterized by diffuse infiltration of mononuclear cells and formation of multiple lymphoid follicles in the mucosa and submucosa, and even the lymphocytic epithelial lesions were observed. Atrophy and intestinal metaplasia were less common. The lesions of hyperplasia were dominating in almost all MGs, 24%(4/17)of the animals occurred hyperplastic polyps. Well differentiated gastric adenocarcinomas were developed in 18% (3/17) of the MGs by the end of the 84th week (1 infected with H.pylori 161 and 2 with H.pylori ATCC43504, two of them were female MGs). Conclusions The results reconfirm that H.pylori infection alone can cause gastric adenocarcinoma in MGs. It is suggested that different species of MGs and various strains of H.pylori can be utilized for carcinogenesis research. It is the first report of the development of gastric cancer in female MGs, which might make sense of investigation on the host susceptibility influenced by gender.

Objective To investigate the expression of μ-opioid system in the epidermis of patients with atopic dermatitis and its role in the pathogenesis of atopic dermatitis. Methods Thirty-two mice were equally divided into 4 groups, negative control group, pre-treatment group, naloxone group, and physiological saline group. Ovalbumin was used to sensitize mice in pretreatment group, naloxone group, and physiological saline group for 7 weeks, then, mice in naloxone group and physiological saline group were treated with intracutaneous naloxone or physiological saline solution for 1 week, respectively. Mice were killed in negative control group and pre-treatment group at the end of sensitization, and in naloxone group and physiological saline group after 1-week injection with naloxone or physiological saline, skin tissues were obtained from the back of killed mice and subjected to histological examination with HE staining and quantitative fluorescent PCR for the detection of mRNA expression of μ-opioid receptor (MOR) and its ligand (β-endorphin) in epidermis. The atopic dermatitis severity index of lesions and histological changes were assessed before and after the treatment. Results In comparison with the negative control mice, the epidermal expression level of MOR was signifieantly decreased (t = 2.549, P ＜ 0.05 ) in pre-treatment group, but increased in naloxone group and showed no statistical difference from the negative control group (t = 0.671, P ＞ 0.05). No significant difference was observed in the epidermal β-endorphin mRNA expression between negative control group and pre-treatment group or naloxone group (both P ＞ 0.05 ). The improvement of lesions could be visualized after treatment with naloxone (t = 8.338, P ＜ 0.01 ), which was concordant with the histological changes in naloxone group. Conchusions As an antagonist of MOR, naloxone can restore the expression of epidermal MOR in mice model for atopic dermatitis, and shows a certain efficacy in the treatment of atopic dermatitis, which proves that μ-opioid system is somewhat associated with the pathogenesis of atopic dermatitis.

Objective To investigate whether oral administration of probiotics can reduce complications induced by interventional therapy in patients with primary hepatic carcinoma and liver cirrosis.Methods Two hundred and sixty four patients with primary hepatic carcinoma and liver cirrhosis who underwent transarterial chemoembolization(TACE) were randomly divided into two groups.and patients in experimental group were given probiotics but not in control group.Shoa-term clinical manifestations.liver functions,blood routine and pain scores were compared between two groups.Results On the day 3 after therapy,the incidence of abdominal distension and constipation in experimental group were less than that in control group(x2=18.22 and 55.22,P=0.000);On the day 7 after therapy,the incidence of abdominal distension,constipation and infection in experimental group were less than that in control group(x2=5.35,13.5 and 19.14,P=0.021,0.000 and 0.000).There were no significant difference in other clinical manifestations,liver function,blood routine and pain scores between the two groups. Conclusion Oral administration of probiotics can reduce the incidence of some short-term complication induced by interventional therapy in patients with hepatic carcinoma and liver cirrhosis.

Obstructive sleep apnea (OSA) is characterized by repeated intermittent hypoxia (IH), hypercapnia, sleep fragmentation and intrathoracic pressure change. IH is related to the clinical pathophysiological processes of hypertension, atherosclerosis, coronary heart disease, arrhythmia, stroke, heart failure and sudden death. IH from OSA can lead to metabol-ic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and the change of nerve body fluids, which has been shown to increase the risk of cardiovascular diseases. This study mainly describes the pathogenesis of IH leading to the various cardiovascular diseases.

Objective:To investigate the effects of Bailing capsules on the expression of TGF-β1 in the peritoneal dialysis solution for peritoneal dialysis patients. Methods: Totally 40 patients treated with peritoneal dialysis ( PD) were randomly divided into two groups (20 cases in the control group and 20 cases in the experimental group). All the patients were treated with PD by 1. 5% perito-neal dialysis effluent (6 000 ml everyday), and the patients in the experimental group were additionally treated with Bailing capsules (5 capsules each time, three times a day after meals) for 6 months. The adequacy of PD (including Kt/V and Ccr) of the two groups was examined after the one-month treatment. The renal function and the level of TGF-β1 in the effluent in 1, 3 and 6 month were com-pared between the two groups. Results:The adequacy of PD ( Kt/V and Ccr ) had no significant difference between the two groups (P<0. 05). The level of serum creatine was decreased significantly in both groups after the one-month treatment (P<0. 05), and no significant change was shown in 3 and 6 month (P>0. 05). In the control group, the expression of TGF-β1 in the effluent in 1, 3 and 6 month was increased gradually with significant difference (P<0. 05). In the experimental group, the expression of TGF-β1 in the effluent had no significant difference in 1, 3 and 6 month (P>0. 05), which was lower than that in the control group (P<0. 05). Conclusion:Bailing capsules can decrease the expression of TGF -β1 in the effluent for the patients treated with PD and inhibit the peritoneal fibrosis.