Objective: To examine the effect of diagnosis-related groups (DRGs) point payment on hospitalization costs of parturition among lying-in women, so as to provide the evidence for alleviating the burdens and saving medical resources among lying-in women. Methods: Lying-in women's age, gestational age, parity, duration of hospital stay, DRGs grouping and hospitalization costs were collected from the Inpatient Medical Record System and DRG Operation Analysis System in a tertiary women and children's hospital in Ningbo City from 2020 to 2021. The changes of hospitalization costs of parturition were compared among lying-in women before and after DRGs point payments, and the association between DRGs point payments and gross hospitalization costs of parturition was examined among lying-in women using a multivariable logistic regression analysis. Results: A total of 11 505 lying-in women after DRGs point payments, including 6 216 women at age of 30 years and below (54.03%), and 10 871 lying-in women before DRGs point payments, including 6 208 women at age of 30 years and below (57.11%), were enrolled. The median (interquartile range) gross hospitalization expenses, material expenses and laboratory testing expenses of parturition were 8 519.19 (2 456.61), 881.38 (816.16) and 939.00 (310.00) Yuan among lying-in women after DRGs point payments, which were significantly lower than those [9 123.13 (2 660.33), 915.57 (825.26), 1 036.00 (385.00) Yuan] among lying-in women before DRGs point payments (Z=-21.971,-16.061 and -27.199, all P<0.001). Multivariable logistic regression analysis showed that DRGs point payment was statistically associated with lower gross hospitalization expenses of parturition among lying-in women after adjustment for age, duration of hospital stay, gestational age, parity, type of delivery and development of complications (OR=0.462, 95%CI: 0.432-0.494). Conclusion DRGs point payment is beneficial to reduce the hospitalization cost of parturition among lying-in women.

Objective To investigate the therapeutic effects of recombinant adeno-associated virual gene serotype 1(rAAV1) mediated transfer of sarcoplasmic reticulum Ca2+ ATPase(SERCA2a) on beagle dogs with heart failure(HF).Methods The chronic HF model was reproduced in beagle dogs by giving rapid right ventricular pacing(230 beats/min) for 30 days.A reduced rate(180 beats/min)was continued for another 30 days.Sixteen beagle dogs were divided into four groups(4 each): control group,HF group,HF+EGFP group and HF+SERCA2a group.After rapid pacing for 30 days,rAAV1-EGFP(1?1012vg/ml) and rAAV1-SERCA2a(1?1012vg/ml) were respectively delivered via intramyocardial routes,while no treatment was given to the animals in both control and HF groups.At the end of the study,haemodynamics,echocardiography and the protein expression of SRCA2a were measured respectively.The apoptosis index of cardiac myocyte was evaluated by TUNEL.Bax expression was assessed by immunohistochemistry.Results After gene transfer of SERCA2a in HF beagle dogs for 30 days,the heart function was improved along with an increase in SERCA2a expression.Left ventricular systolic function was significantly increased,including the left ventricular systolic pressure(LVSP),left ventricular maximal rate of pressure rise(LV+dp/dtmax),left ventricular maximal rate of pressure decline(LV-dp/dtmax,P

Objective To explore the effect of sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) overexpression on neuroendocrine system in chronic heart failure beagles. Methods The cardiac contraction function of chronic heart failure beagles were assessed by echocardiography before and after SERCA2a gene transduction. Radiation immune method was used to test the serum level of neuroendocrine factors such as Angiotensin Ⅱ, atrial natriuretic peptide, endothelin-1 and TNF-α, IL-6. Results The cardiac contraction function of chronic heart failure beagles improved greatly (P<0.05), and the serum levels of neuroendocrine factors significantly reduced after SERCA2a overexpression (P<0.05). Conclusion The vicious circle of neuroendocrine system may be blocked partially by SERCA2a overexpression.

Objective To observe the effects of different traditional Chinese medicine therapeutic methods on heart function and red cell volume distribution width (RDW) in patients with chronic heart failure (CHF). Methods A randomized, blinded and controlled study was conducted. One hundred and ninety patients with CHF accompanied by yang deficiency syndrome in Department of Cardiology of Chengdu Municipal First People's Hospital were divided into five contrast groups according to randomized envelope method:namely control group, warming yang group, nourishing yin group, activating blood group and combined warming yang and nourishing yin therapeutic group (combined group), each group being 38 cases. The patients not consistent with the criteria to enroll into the study and those lost contact were excluded from the study, thus the final total patients were 183 in number, including control 37, warming yang 36, nourishing yin 36, activating blood 37 and combined group 37 cases. All the cases were treated with routine medical therapy in accord to the guideline for CHF. In addition, placebo oral liquor was given to the control group, Wenyangjianxinling oral liquor (main ingredients:Aconiti Lateralis Radix Preparata, Astragali Radix, Chuanxiong Rhizoma, Epimedii Folium, Periplocae Cortex, Descurainiae Semen, Ginseng Radix et Rhizoma Rubra) was given to the warming yang group, Ophiopogonis Radix and Anemarrhenae Rhizoma oral liquor (main ingredients:Ophiopogonis Radix,Anemarrhenae Rhizoma) was taken by the nourishing yin group, Salviae Miltiorrhizae Radix and Chuanxiong Rhizoma oral liquor (main ingredients: Salviae Miltiorrhizae Radix, Chuanxiong Rhizoma) was administered by the activating blood group, and the main ingredients of oral liquors given to the warming yang and nourishing yin groups were assigned to the combined group, each group 10 mL, three times a day for one year. According to the prognosis, the patients were divided into survival group (168 cases) and death group (15 cases). The re-hospitalization situations such as aggravation of heart failure, acute myocardial infarction, angina, stroke, etc. were observed. The changes of hemoglobin (Hb) and RDW in the survival and death groups were investigated and compared between them. Results Compared with the control group, the rate of re-hospitalization was significantly decreased in the activating blood group [27.03% (10/37) vs. 54.05%(20/37), P<0.05];there were no statistical significant differences among all the other groups (all P>0.05). Before treatment, the levels of left ventricular ejection fraction (LVEF), fractional shortening (FS), the ratio of early to late ventricular filling velocities (E/A ratio) and E deceleration time (DT) showed no significant differences among five groups (all P>0.05). Compared with the control group at the same period, the LVEF, FS, E/A and DT were significantly increased in activating blood group and combined group after the treatment [LVEF: 0.453±0.131, 0.448±0.104 vs. 0.394±0.112, FS:(27.9±9.8)%, (27.0±11.5)%vs. (22.2±13.3)%, E/A:0.88±0.16, 0.92±0.20 vs. 0.75±0.27, DT (ms): 265.4±30.3, 251.4±37.5 vs. 225.7±35.4, all P < 0.05]. FS and DT were significantly increased in warming yang group after treatment [FS: (26.4±10.3)% vs. (19.7±7.4)%, DT: 242.0±38.7 vs. 216.3±50.9, both P < 0.05]. In the activating blood group, the level of RDW was elevated after treatment compared with that before treatment, but in the comparison with that in the control and nourishing yin groups, it was still obviously lower [(12.98±2.97)%vs. (14.37±2.52)%, (13.05±2.36)%, both P < 0.05]. The comparisons of Hb and RDW among other groups had no statistical significant differences (all P > 0.05). The level of Hb in death and survival groups also had no statistical significant difference (P > 0.05). The RDW of dead group was markedly higher than that of the survival group [(14.39±2.17)%vs. (13.02±2.08)%, P<0.05]. Conclusion The level of RDW is related to the prognosis of CHF patients, the level of RDW in death group is higher than that in survival group, and the activating blood circulation and removing blood stasis therapy can decrease the level of RDW, reduce the rate of re-hospitalization and improve the heart function in CHF patients.

Objective To investigate the possibility and utility of metformin alone or in combination with fosinopril to reduce blood pressure in patients with essential hypertension.Met hods A total of 140 cases of non-diabetic essential hypertension with hyperinsulinemia were recruited and randomly assigned to two groups: a group of 68 treated with metformin 500 mg tid and a group of 72 treated with fosinopril 10 mg qd.The duration of the treatment was 8 weeks.Combination therapy with the two drugs was used after 4 weeks of treatment if needed.If the target goals of systolic blood pressure (SBP) < 140 mm Hg (1 mm Hg =0.133 kPa) and /or diastolic blood pressure (DBP) <90 mm Hg were not attained 4 weeks, combination therapy with two drugs was used in either group in the next 4 weeks.The changes of blood pressure and insulin sensitivity of the two groups were observed before and after treatment.Results (1) After 4 weeks of treatment, SBP in metformin group and fosinopril group decreased by ( 13.0 ± 1.2) mm Hg and (15.4 ± 1.4) mm Hg, and DBP decreased by (9.0 ± 1.0) mm Hg and ( 10.4 ± 1.1 ) mm Hg respectively.After 8 weeks of treatment, SBP in metformin group and fosinopril group decreased by (17.8 ± 1.5) mm Hg and (20.9 ± 1.5) mm Hg, and DBP decreased by (13.2 ±0.9) mm Hg and (15.3 ± 1.1) mm Hg respectively.There was no significant difference in the decline of blood pressure between the two groups (P >0.05).The rates of combination therapy were both 54% in the two groups.(2) Fasting insulin as well as 30 min and 120 min insulin levels after oral glucose tolerance test and insulin area under the curve in the metformin group were significantly reduced after 4 and 8 weeks of treatment as compared with those of baseline(P < 0.05 and P < 0.01 ) .In the fosinopril group, however, they decreased only after 8 weeks treatment (P < 0.05).The insulin action index in the metformin group was higher than that in the fosinopril group after 4 weeks of treatment (P <0.05) ,but there was no significant difference between the two groups after 8 weeks of treatment (P > 0.05).Conclusion Metformin and fosinopril have similar antihypertensive effect and a good synergy in essential hypertension with hyperinsulinemia.

29.3% decrease in ejection fraction).4 of 11 were used as heart failure group(HF,n=4).9 HF beagles were randomized to receive either a recombinant adeno-associated viral carrying the SERCA2a gene(HF+SERC A2a,n=5) or the reporter gene enhanced green fluorescent protein(HF+EGFP,n=4) by thoracotomy.All HF beagles paced by 180 beats/min in order to maintain failing state.Thirty days after infection,parameters of systolic and diastolic function were measured by doppler echocardiography and hemodynamic monitor in all beagles.RESULTS:At 30 days after gene transfer,symptoms of HF+SERCA2a dogs improved.Echocardiogram parameters were superior to those in HF+EGFP group(P

Ten adult male rats of 250～300 g were used. These animals were divided into the control and experimental groups of 6 and 4 rats respectively. The changes of the ultrastructure of adrenocortical cells under acupuncture analgesia were observed with electron microscopy.1. The volumes of cells, nuclei and nucleoli in zona fasciculata were increased. The mitochondria was hypertrophic; its cristae transformed from the tubules into the vesicles in the external zone fasciculate. The giant mitochondria which contained paracrystallin and lipid osmiophilic substance was observed.2. The surface volume of SER membrane was increased. The smooth membrane vesicles and tubules with filaments and granules were dilated. The SER membrane vesicles were arranged around the mitochondria or lipid droplets.3. The lipid droplets with low density were dilated and accumulated in the middle part of cytoplasm. These findings might be correlated with enhancement of synthesis and utilization of cholesterol ester.4. The free ribosomes and polysomes which scattered in cytoplasm were increased. The Golgi apparatus were well developed. The lysosomes of variable sizes and densities (primary or secondary lysosomes) were abundent.5. The number and diameter of the microvilli were increased. The spaces between the adjacent cells of zona fasciculata were dilated and the intermedian junctions and gap junctions had disappeared. The subsinus space was dilated and contained numerous longer microvilli. The changes discribed above suggested that the acupuncture analgesia may enhance activity of the adrenocortical cells, both synthesis and discharge of corticoid hormone.

Effective analgesia was induced by electro-acupuncture stimulating the "Zusanli"(足三里) point in the rats. The animal were sacrificed and as soon as possible and the median eminence were taken out from the brian. The specimens were fixed in glutaraldehyde, then were prepared for electron microscope observation.Twelve male adult rats were divided into control and experimental groups. There were many terminal enlargements in the fibrous zone of rat's median eminence. Different types of vesicles were found in the terminal buttons, they were round clear and flattened clear vesicles, and large or small vesicles with a dense core. There were also mixed forms, and irregular vesicles in the same button. Synapses may be axo-dendrits, axo-axon or axe-somatic synaptic types.The neurous in the fibrious zone could be classified into "light" and "dark" cells. The light cells might be the neurosecretory neurons. The neuroglia cells were oligodendrocytes and astrocytes.In acupuncture analgesia experimental group the terminal enlargment contained less number of round clear vesicles than that of the control group, and sometime they were empty. This may indicate the discharge of acetylcholine, to increase the secretion of the neurosecretory substance and enkephalin. But the flattened clear vesicles had no change in the terminal button. The neurons and neroglia also exhibited some morphological changes which may indicate the cells were in active functional state.

ObjectiveTo assess the safety of intramyocardium injection of sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) to rescue chronic heart failure beagles. MethodsThe heart failure beagles were assessed with myocardium enzymology, cAMP content of myocardium, myocardial oxygen consumption, arrhythmia, systemic inflammation factors, and the function of liver and kidney after SERCA2a gene transferred. ResultsThere were no increase of cAMP content, no more arrhythmia, myocardial oxygen consumption, no apparente systemic inflammation, and no injures to hepatic and renal function. ConclusionOverexpression of SERCA2a by intramyocardium injection is relatively safe.

Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.Methods Forty-two patients of either sex with intracranial aneurysm,aged 57-78 yr,weighing 53-86 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia,were assigned into 2 groups (n =21 each) using a random number table:propofol conbined with remifentanil group (group PR) and dexmedetomidine combined with propofol and remifentanil group (group DPR).In group DPR,dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5 μg · kg-1 before induction of anesthesia,followed by an infusion of 0.3 μg · kg-1 · h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion (TCI) after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows:propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml,respectively,in group DPR;propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml,respectively,in group PR.Bispectral index (BIS) value was maintained at 40-60.Before wakeup test,propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups,and the infusion rate of dexmedetomidine was decreased to 0.1 pg · kg-1 · h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room (T0,baseline),at 10 min before wake-up test (T1),immediately after patients were wakened (T2),at 10 min after patients were wakened (T3) and at the end of wake-up test (T4),the mean blood pressure (MAP),heart rate,respiratory rate (RR),SpO2 and BIS values were recorded.The development of intraoperative awareness,emergence time,postoperative agitation,nausea and vomiting,regurgitation and aspiration and severe pain was recorded.Results MAP,heart rate,SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at To,MAP was significantly decreased at Ti,3,4 in group PR,and BIS value was decreased at T1-4 in DPR and PR groups (P＜0.05).Compared with group PR,MAP was significantly increased at T1.3,BIS value was decreased at T24,the wake-up time was shortened,Ramsay sedation score and wake-up quality were increased,the emergence time was shortened,and the incidence of agitation was deceased (P＜0.05),and no significant change was found in verbal rating scale scores assessed after extubation in group DPR (P ＞ 0.05).No cardiovascular events,respiratory depression,intraoperative awareness,postoperative nausea and voniting,regurgitation and aspiration or severe pain was found in two groups.Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.