Based on the needs of healthcare system reform, Australia has implemented activity based funding(ABF) payment mode nationwide, and established the Independent Hospital Pricing Authority as the specific implementation agency in 2011. The main responsibilities and functions of the ABF payment mode covers pricing of medical services, classification of healthcare services, collection of clinical data and cost accounting of healthcare services. ABF payment mode presents outstanding advantages in promoting the capacity of healthcare service, maintaining fairness of healthcare service supplies and carrying out cooperation across different institutions. These efforts provide important references for China in its top-level design of payment method, pilot project of classification system, medical service items and price dynamic adjustment, informationization and information standardization construction among public hospitals.

Abdominal Cavity ; Adult ; Anemia, Aplastic ; therapy ; Antigens, CD34 ; metabolism ; Carcinoma ; metabolism ; pathology ; Dendritic Cell Sarcoma, Follicular ; metabolism ; pathology ; Diagnosis, Differential ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Ki-67 Antigen ; metabolism ; Lymph Nodes ; pathology ; Male ; Neoplasms, Muscle Tissue ; metabolism ; pathology ; Platelet Endothelial Cell Adhesion Molecule-1 ; metabolism ; Sarcoma, Kaposi ; etiology ; metabolism ; pathology ; Viral Proteins ; metabolism

This study investigated the mental health status of medical students in China, and analyzed the influencing factors in order to provide evidence for mental health education for medical students. A stratified cluster sampling method was used to recruit medical students from Huazhong University of Science and Technology, China. The questionnaire survey on general information and Symptom Checklist 90 (SCL-90) were used for investigation and analysis. The results showed among the 1137 valid questionnaires, 278 (24.45%) participants had SCL-90 score ≥ 160. The top three mental problems of medical students were obsessive-compulsive disorder, interpersonal sensitivity and depression in terms of the factor score ≥ 2.5 and the number of participants who reflected on the diseases. The third-year medical students had the worst mental health status, and fifth-year medical students had the best mental health status. Students from rural area had more psychological problems than those from urban area; furthermore, students with high professional satisfaction, those who were the single child of the family, non-poor students, and those whose parents had high education level had better mental health status. It was concluded that the mental health of medical students is not optimistic in China. Medical students have some mental health problems of different degrees. Factors that influence the mental health of medical students include academic pressure, professional satisfaction level and family environment.

OBJECTIVETo investigate the correlation between left atrial size and left ventricular filling pressure (LVFP) and the value of left atrial size assessment on detecting diastolic dysfunction in hypertensive patients with preserved LVEF by echocardiography.

METHODSEchocardiography was performed in 346 hypertensive patients with preserved LVEF(≥ 50%), left atrial size including left atrial diameter (LAD) and left atrial area (LAA) was measured and indexed to body surface area (LADI, LAAI). The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) was determined and LVFP was calculated with the formula: LVFP = 1.24×E/Em + 1.9. Patients were divided into diastolic dysfunction group [DD group, LVFP > 15 mm Hg (1 mm Hg = 0.133 kPa), n = 81] and normal diastolic function group (NDF group, LVFP ≤ 15 mm Hg, n = 265).

RESULTSAs compared to patients in NDF group, the patients in DD group had larger LA [LADI: (21.4 ± 2.6) mm/m(2) vs. (19.6 ± 2.4) mm/m(2); LAAI: (12.1 ± 2.6) cm(2)/m(2) vs. (10.4 ± 1.7)cm(2)/m(2); all P < 0.01]. LA size parameters were positively correlated with LVFP (r = 0.211-0.450, all P < 0.01), LAAI was best correlated with LVFP (r = 0.450, P < 0.01). ROC analysis showed that LAAI ≥ 11.4 cm(2)/m(2) diagnosed DD with a sensitivity of 63%, specificity of 74% and accuracy of 72%.

CONCLUSIONLeft atrium dilation correlates positively with LVFP in hypertensive patients with preserved LVEF. The LAAI is a more accurate parameter for identifying patients with diastolic dysfunction in this cohort.

Adult ; Aged ; Aged, 80 and over ; Female ; Heart Atria ; diagnostic imaging ; physiopathology ; Humans ; Male ; Middle Aged ; Ultrasonography ; Ventricular Dysfunction, Left ; diagnostic imaging ; physiopathology ; Ventricular Function, Left

OBJECTIVETo study the effect of insulin, cyclic adenosine monophosphate (cAMP), and dexamethasone (DEX) on 550 bp (-600 -/+ 69) fragment of phosphoenolpyruvate carboxykinase (PEPCK) gene promoter by reporter gene.

METHODSThe recombinant pGL2-PEPCK-Luc and the control plasmid pSV-beta-Galactosidase were co-transfected to rat hepatoma cell line (CBRH7919) by lipofectin. By measuring luciferase activity, we evaluated in vitro regulation of PEPCK gene promoter on reporter gene transcription.

RESULTScAMP and DEX stimulated PEPCK promoter obviously; meanwhile, they also had accumulative effects. At different physiological concentrations, insulin had a suppressive effect on PEPCK promoter, which was dose-independent.

CONCLUSIONThere is a perfect feedback mechanism for PEPCK promoter in hepatoma cell. 550 bp (-600 -/+ 69) fragment of PEPCK may be a candidate gene in the gene therapy of diabetes.

Animals ; Cell Line, Tumor ; Cyclic AMP ; pharmacology ; Dexamethasone ; pharmacology ; Dose-Response Relationship, Drug ; Gene Expression Regulation, Enzymologic ; drug effects ; Insulin ; administration & dosage ; pharmacology ; Liver Neoplasms, Experimental ; pathology ; Luciferases ; genetics ; metabolism ; Phosphoenolpyruvate Carboxykinase (GTP) ; genetics ; metabolism ; Promoter Regions, Genetic ; drug effects ; genetics ; Rats ; Recombinant Proteins ; genetics ; metabolism ; Transfection

OBJECTIVETo evaluate in vitro regulation of phosphoenolpyruvate carboxykinase (PEPCK) gene promoter on gene transcription, and construct luciferase reporter plasmid pGL2-PEPCK-Luc.

METHODSA 550 bp fragment of PEPCK promoter cut from plasmid pPEPCK-int was inserted into transitional vector PBS-SK to construct a transition plasmid PBS-PEPCK. Then the recombinant luciferase reporter plasmid pGL2-PEPCK-Luc was cloned.

RESULTSRestriction enzymes and nucleotide sequence conformed that the coupling site of recombinant plasmid was correct without base mutation and deletion, and the sequence inserted was the same as data of GeneBank. The luciferase could be expressed in hepatoma cell transfected by pGL2-PEPCK-Luc.

CONCLUSIONEstablished a new means to study transcriptional regulation of PEPCK promoter.

Animals ; Base Sequence ; Gene Expression Regulation, Enzymologic ; drug effects ; Humans ; Liver Neoplasms ; genetics ; Luciferases ; genetics ; Molecular Sequence Data ; Phosphoenolpyruvate Carboxykinase (GTP) ; genetics ; metabolism ; Plasmids ; genetics ; Promoter Regions, Genetic ; genetics ; Protein Binding ; Rats ; Recombinant Fusion Proteins ; genetics ; metabolism ; Transcription, Genetic ; Transfection ; Tumor Cells, Cultured

Objective To investigate the variance of cost-effectiveness when treat acute myocardial infaretion of different severe extents with different pattern.Methods Acute myocardial infarction patients were selected from emergency eommand center of Guangzhou from October 2003 to December 2005.These patients wew assigned by the center to First-Class Hospitals at Grade 3 and First-class Hospital at Grade 2,and were followed up after 6 months after post-discharge.Cost in hospital and mortality in hospital were registered.The health of all patients were quantificated using SF-36.According to the assigned hospitals,the patients were divided into single infarction group and complex infarction group.Cost in hospital,mortality in hospital,short-term quality of life were compared between the them.Results Compared with and First-Class Hospital at Grade 2 (101 cases),the single infarction patients in First-Class Hospitals at Grade 3 had higber costs in hospital (P=0.016),better society function,affection role,mental health and health status (P

OBJECTIVETo explore the effect of rosiglitazone on the activity of signal transducer and activator of transcription 1 in rats with severe acute pancreatitis.

METHODSFifty-four male Wistar rats were randomly allocated into three groups (n = 18). SO group: sham-operated animals served as control, operation was executed and sodium chloride but not sodium taurocholate was injected. SAP group: SAP was induced by the retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. ROSI group: same as SAP group, but rosiglitazone (6 mg/kg) was administered intravenously 30 min before operation. Rats in each group were sacrificed at 3,6 and 12 h after operation. The levels of serum amylase and histologic scores of pancreatic tissue were measured. The expression of TNF-alpha mRNA in pancreatic tissue were determined by reverse transcription-polymerase chain reaction (RT-PCR). The expression of phosphorylated STAT1 in pancreatic tissue was assayed by immunohistochemistry.

RESULTSCompared to SO group, the levels of serum amylase and phosphorylated STAT1, TNF-alpha mRNA and histologic scores of pancreatic tissue were significantly elevated at the same time points after SAP (P < 0.01). The levels of these detection in ROSI group were lower than those of the SAP group at the same time points (P < 0.05), but higher than SO group (P < 0.05).

CONCLUSIONSSTAT1 was activated in severe acute pancreatitis. Rosiglitazone has a protective effects in rats with severe acute pancreatitis. The mechanism of its protective effects maybe that it inhibits the activation of JAK/STAT pathway, which can down-regulate the expression of TNF-alpha mRNA and block the the inflammatory cascade partially.

Acute Disease ; Animals ; Disease Models, Animal ; Male ; Pancreas ; metabolism ; pathology ; Pancreatitis ; drug therapy ; metabolism ; pathology ; Random Allocation ; Rats ; Rats, Wistar ; STAT1 Transcription Factor ; metabolism ; Thiazolidinediones ; pharmacology

OBJECTIVESTo analyze the clinical characteristics of the atlantoaxial dislocation (AAD) in craniovertebral junction (CVJ) abnormalities and to study the setup of its surgery strategy.

METHODSFrom April 2009 to November 2011, 56 patients of AAD and CVJ abnormalities including 22 male and 34 female patients who had received surgery were analyzed. There were 2 cases of reducible AAD and 54 cases of irreducible AAD. The age of the patients ranged from 9 to 56 years (mean 34 years). Among them, 14 cases achieved reduction/partial reduction via direct posterior fixation, 41 cases had transoral anterior deconpression and occipito-cervical/C₁-C₂ fusion and 1 case had the posterior odontoidectomy and spinal fusion.

RESULTSFifty-three cases had a follow-up between 6 months and 36 months (mean 20 months) and 3 cases lost follow-up (had improvement at discharge). Seven cases had complications as follows: 1 case had irreversible spinal cord injury and muscle weakness of extremities, 2 cases had cerebrospinal leak, 2 cases had pulmonary infection, 1 case had local granuloma hyperplasia and 1 case had delayed healing of the incision. The later 6 cases all got recovery after reasonable treatments. The grades of Nurick at last follow-up were as follows: 6 cases (11.3%) improved by 3 grades, 30 cases (56.6%) improved by 2 grades, 13 cases (24.5%) improved by 1 grade, 3 cases (5.7%) without change, 1 case (1.9%) get worse.

CONCLUSIONSReducible AAD could achieve direct reduction and fixation via posterior pathways. Irreducible AAD needs individualized treatment. To choose the direct reduction and fixation or transoral odontoidectomy and posterior fixation and fusion should consider the pathogenetic condition, the image data and personal clinical experience.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Child ; Decompression, Surgical ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Spinal Fusion ; methods ; Young Adult

BACKGROUNDBronchial carcinoids are rare malignant neuroendocrine neoplasms. Some issues regarding surgical treatment of bronchial carcinoids remain controversial, including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy.

METHODSThis retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010.

RESULTSEighty-nine (67.9%) of the patients were male, and the mean age was 46 years, ranging from 17 to 81 years. Preoperative fiberoptic bronchoscopy was performed in all patients. Endoscopic biopsy was performed in 100 patients with central tumors, and 70 (70%) patients were diagnosed as bronchial carcinoid. The resections performed consisted of 31 pneumonectomie, 32 lobectomies, 26 bilobectomies, 34 sleeve lobectomies, six bronchoplastic procedures without lung resection, and two segmentectomies. During a median of 87 months follow-up, there were nine recurrences including three local recurrences and 6 distant recurrences. No bronchial recurrences were observed. The 3-, 5- and 10-year overall survival rates of pneumonectom and bronchoplastic surgery (including sleeve lobectomy and bronchoplastic procedure without lung resection) were 93.2%, 81.0% and 69.4%, 97.5%, 91.9% and 70.0%, respectively. Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors.

CONCLUSIONSBronchoplastic surgery should be considered whenever possible for central carcinoids. Systematic lymphadenectomy is recommended for bronchial carcinoid patients. Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoid Tumor ; mortality ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome