Objectives: China has observed an increasing prevalence of cardiovascular diseases among its population, which is putting heavy economic burden both on individuals and the whole society.Conducting a multi-angle study of cardiovascular patients with economic burden can help adjust the health care policy to reduce the economic burden of patients.Methods: Using the baseline data (2011) and follow-up data (2013) of the China Health and Retirement Longitudinal Survey, this study selected cardiovascular patients aged 45 and above to calculate their direct medical cost, direct non-medical cost as well as self-paid cost before and after reimbursement.The total cost and self-paid cost are both calculated, and gender difference and rural-urban difference are also analyzed.Results: The prevalence of cardiovascular disease among the population age 45 and above was 13.9% in 2013 and 12.1% in 2011, while the prevalence in women was higher than in men and urban areas higher than rural areas.The average annual total costs for individual patient before reimbursement in 2013 was lower than that in 2011, but contrary to the trend of self-pay costs.Urban patients had higher amount of direct medical cost, lower co-payment rate and lower non-medical cost such as transportation and accommodation than their rural counterpart.Both urban and rural patients self-paid more on outpatient services than inpatient services.Conclusion: Based on these analyses, this paper suggests that Chinese policy makers should look deeper into patient behaviors as well as their economic burden before revising the current health policy.More practices regarding to the unbalanced distribution of health resources between urban and rural areas are needed, in order to ensure patients living in remote areas could get access to appropriate treatment without paying heavy non-medical cost.

Neuropathic pain is a common chronic pain with complicated underlying mechanisms and difficult to treat, which badly disturbs the daily life of the patient and presents a significant burden to society by increasing healthcare resource utilization and costs. In the recent years, the pivotal role of glia-centered neuroinflammation and neuroimmunity in the development and maintenance of neuropathic pain has been recognized gradually. This review presents the current understanding of the role of glia in neuropathic pain and therapies of glia modulation.

Objective:To assess whether intrathecal orphanin FQ can develop the antinociceptive effect tolerance,and whether there is a cross tolerance between the antinociceptive effect of intrathecal orphanin FQ and the ? opioid receptor agonist morphine.Methods: Tail flick test was used to observe the change of antinociceptive effect after orphanin FQ/morphine intrathecal microinjection into the rats tolerant to acute or chronic morphine/orphanin FQ.Results:Like morphine,large dosage of continuous intrathecal orphanin FQ microinjection produced tolerance to the antinociceptive effect,but there was no apparent cross tolerance between the orphanin FQ and morphine; Hyperalgesic response was found in morphine tolerant rats,but not in orphanin FQ tolerant rats.Conclusion:Lack of cross tolerance between the antinociceptive effect of intrathecal orphanin FQ and morphine indicates that the mechanism of tolerance to orphanin FQ may differ from that to morphine; The antinociceptive effect of intrathecal orphanin FQ may be largely related with its specific receptor in the spinal cord.

Esophageal cancer is the leading cause of cancer-related deaths worldwide.A single intraoperative intervention is unlikely to benefit the outcome.A multimodal management plan that includes the use of TEA seems to demonstrate improved results in high-volume centers.Anesthetic management may contribute to the containment of pulmonary morbidity and anastomotic leakage by the use of TEA,protective ventilation strategies during OLV,prevention of tracheal aspiration,and judicious fluid management.

Objective:To compare the cardiovascular effects of sufentanyl and fentanyl as combined with propofol in anesthesia during laparoscopic cholecystectomy(LC).Methods:Patients undergoing LC were randomly divided into two groups: 60 patients in the Sufentanyl group(group S,0.3 ?g/kg) and 53 patients in the Fentanyl group(group F,3 ?g/kg).The mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),and cardiac index(CI) were recorded before induction,before pneumoperitoneum,after pneumoperitoneum and at the end of operation.Results:There was no difference in MAP,HR,CO or CI between the two groups before induction.The values of HR and CO increased significantly in group F after preumoperitoneum comparing with the values before preumoperitoneum(P

20(S)-9-nitrocamptothecin was synthesized from camptothecin by nitration reaction using mixed nitrate salts in sulfuric acid medium.The yield was raised from 31% to 40% after chromatographic purification treatment.The best reaction conditions was as follows:0.5 g of camptothecin;30ml of sulfuric acid;0.007mol of nitrate salts(NH4NO3/CaNO3=1/1).The reaction was completed in 24h at 20℃.The advantage of this method is high yield and easily purification.

BACKGROUND:Poly-L-lactide sternal coaptation pins have been gradual y used in clinic, but there are stil few reports about the clinical effects of poly-L-lactide sternal coaptation pins in sternal fractures and sternal fixation after heart surgery.
OBJECTIVE:To summarize the clinical effects of poly-L-lactide sternal coaptation pins in coronary artery bypass grafting.
METHODS:Total y 150 patients who had received coronary artery bypass graft were enrol ed. Ninety-five out of 150 patients received sternal fixation using steel wires as control group, and the other 55 patients underwent sternal fixation using steel wires and poly-L-lactide sternal coaptation pins as test group. Pethidine dosage, incidence rates of pulmonary complications and wound infection, postoperative hospitalization days and hospital costs were compared between the two groups.
RESULTS AND CONCLUSION:During the fol ow-up period (3-8 years), there was no sternal infection and nonunion in the two groups. In the test group, pethidine dosage and hospitalization days were fewer than those in the control group (P<0.05). No significant differences were found in the incidence rates of complications and wound infection and hospital costs between the two groups (P>0.05). These findings indicate that poly-L-lactide sternal coaptation pins are feasible in the coronary artery bypass grafting.

Objective To investigate the different changes in the regulation and gene expression of mu opioid receptor (MOR) in rat brain after acute and chronic morphine dependence.Methods Forty male SD rats weighing (210?35)g were randomly divided into five equal groups of eight animals each: (1) control; (2) acute dependence: (3) chronic dependence;(4) acute abstinence; (5) chronic abstinence. In acute dependence group rats received eight consecutive subcutaneous injection of morphine 5mg?kg-1 at 2h interval. In chronic dependence group morphine was injected subcutaneously three times a day(8:00, 15: 00, 22:00) for six days. The doses of morphine were 5, 10, 20, 40, 50, 60 mg? kg-1?day-1 from the 1st day to the 6th day respectively. In the two abstinence groups, the withdrawal syndromes were induced by intraperitoneal naloxone 5 mg ? kg-1. The rats in control group received saline. 30 min after the end of all procedures the animals were decapitated on ice. Brain was removed immediately and kept in liquid nitrogen. The Bmax and Kd values of 3H-DAMGO saturation binding to MOR were measured by Scatchard analysis. The gene expression of MOR was appraised by RT-PCR. Results (1) In the acute dependence group the Bmax value(the specific binding capacity of MOR) significantly increased and the affinity decreased. After abstinence the Bmax value returned to normal, but the affinity was still low. In chronic dependence and abstinence groups Bmax value decreased significantly and there was no change in Kd value. (2) The level of MOR mRNA increased significantly in acute dependence group and returned rapidly to normal after abstinence . In chronic dependence and abstinence groups the transcription of MOR was significantly lower than in control group. Conclusions The modulation of MOR in rat brain is different between acute and chronic dependence and there must be similar post-receptor mechnism involved.

Objective To evaluate the effects of edaravone on postoperative delirium in aged patients following total hip -re-placement surgery . Methods Two hundred and forty-six patients undergoing unilateral hip replacement surgery were randomly divided into edaravone group and control group .Patients in the edaravone group were intravenous injected with edaravone 30 mg before anesthesia induction, whereas patients in the control group received the same volume of saline solution .On preoperative day 1 and postoperative day 1, confusion assessment was applied to evaluate the consciousness of patients .The length of hospital stay , incidence of myocardial infarc-tion, stroke, pulmonary embolism, pneumonia and transfusion volume were also recorded .Also, the levels of plasma malondialdehyde ( MDA) superoxide dismutase ( SOD) , neuron-specific enolase ( NSE) and S100βprotein ( S100β) were measured on the preoperative and postoperative day 1. Results There was no difference in the length of hospital stay , the incidence of perioperative acute pulmonary embolism, myocardial infarction and stroke (P>0.05).POD was significantly lower in the edaravone group than the control group (P<0.05).Plasma levels of MDA, SOD, NSE and S100βwere comparable between the two groups (P>0.05).On the postoperative day 1, plasma levels of MDA and NSE were significantly lower in the edaravone group than the control group (P<0.05). Conclusion Edar-avone can reduce the incidence of POD in aged patients following total hip-replacement surgery .

Objective To investigate molecular epidemiology and antimicrobial susceptibility of carbapenem-resistant strains of Klebsiella pneumoniae isolated from children.Methods From July 2010 to June 2011,twelve non-replicate clinical isolates of carbapenem-resistant Klebsiella pneumoniae were consecutively collected from children inpatients in the Second Hospital of Wenzhou Medical Colloge.All of the isolates were identified by the automated microbiology systems.Modified Hodge test was used to screen strains producing carbapenemases.Pulsed field gel electrophoresis(PFGE) was performed to analyze the homogeneity of genomic DNA of Klebsiella pneumoniae.KPC,IMP,GIM,SPM,SME,OXA-10,bla(s),VIM gene and integrase gene were amplified by PCR and then sequenced to cofirm the genotypes;Plasmid conjugation experiment was used to study the transfer method of bacterial resistance.Plasmid-curing test were used to initally locate the resistant genes.Results One(8.3％),5(41.7％),7(58.3％),1(8.3％),1(8.3％) and4(33.3％) of12isolates were susceptible to gentamicin,tobramycin,amikacin,ciprofloxacin,levofloxacin and trimoxazole,respectively.All isolates carried KPC-2,TEM-1 and SHV genes(six for SHV-11-like,six for SHV-12-like).Eleven of twelve isolates with KPC-2 gene carried CTX-M genes(4 for CTX-M-14-like,6 for CTX-M-15-like).Two isolates carried OXA-10 genes,and one isolates carried PER-1 gene.None of NDM-1,GIM,SPM,SIM and VIM carbapenemase genes was detected in 12 isolates.All of 12 isolates carried Int 1 genes.The plasmids of 2 isolates were transgerred into the recipients E.coli EC600.PCR and sequence analysis revealed that blaTEM-1 and blaCTX-M-15-like were co-transferred with the KPC-2 gene to the recipients.Elimination of KPC-2-encoding plasmid from Kp7 and Kp12 resulted in imipenem susceptibility in the two isolates.Amplification revealed that KPC-2 gene was lost by the plasmid-curing test.Of the 12 isolates,5 patterns were obtained by PFGE.Pattern B and C were the main drug resistant clones.Conclusion KPC-2 gene are the major carbapenemase genes in Klebsiella pneumoniae isolated from children,including ESBLs and integrase.Some resistance genes can be disseminated by plasmids.