The key policy for the Chinese governments to support the health insurance development has been to provide high percentage of premium subsidies in the 1 . 1 billion Yuan insured for the two of the basic medical insur-ance systems. According to the current policy, governments should share the responsibility of several hundreds of bil-lions Yuan of subsidies per year. However, because of the indistinct of the responsibility between governments at all levels and the shortage of systematic and long-term duty share mechanism, the current system has been directly affect-ing the fairer and more sustainable health insurance system development. Concerning these issues, this paper primari-ly thought about the contributory principle of subsides after analyzing the present situation and the main problems. Therefore, taking the three factors including disposable income per capita, consumption expenditure per capita and fi-nancial revenue per capita into account, it provides a“5 steps approach” about the contribution of the central govern-ment fiscal subsides using entropy evaluation method, and suggests a proposed program on the governments contribu-tion liability at the provincial or decentralized level based on the “fiscal subsides index”. Thoughts and conclusions drawn from this paper have a significant meaning into the establishment of a fairer and more sustainable financial sup-port mechanism for the basic medical insurance.

AIM: To study the effects of NF-?B decoy oligonucleotides(ODNs) modified with locked nucleic acids(LNA) on gelatinases(MMP-9 and MMP-2) expression and NF-?B activity induced by TNF-? in alveolar macrophages(AM) from patients with chronic obstructive pulmonary disease(COPD).METHODS: AM was collected from bronchoalveolar lavage fluid from patients with COPD.NF-?B decoy ODNs and mismatch ODNs were modified with LNA, and transfected into AM by using Lipofectamine 2000.Then the AM were stimulated for 24 h with TNF-?.Semi-quantitative reverse transcription-polymerase chain reaction(RT-PCR) was used to detect the mRNA expression levels of MMP-9 and MMP-2.MMP-9 protein expression was detected by Western blotting.NF-?B activity was detected by electrophoretic mobility shift assay(EMSA).RESULTS: NF-?B decoy ODNs significantly inhibited MMP-9 and MMP-2 expression induced by TNF-? in AM(P

目的观察中药汽化熏蒸加肩关节运动治疗肩周炎的疗效。方法将128例肩周炎患者分成治疗组68例和对照组60例,前者采用中药汽化热疗加肩关节运动疗法治疗,后者采用口服止痛药加外贴止痛膏治疗。结果治疗组有效率97%,对照组有效率80%,两组间有显著性差异(P<0.05)。结论中药汽化熏蒸加肩关节运动疗法治疗肩周炎可获得明显疗效。

Objective To investigate the effect of bilevel positive airway pressure (BiPAP) ventilation on N terminal pro-brain natriuretic peptide (N proBNP) in patients with chronic pulmonary heart disease (CPHD) and hypercapnic respiratory failure.Methods Eighty patients with CPHD and hypercapnic respiratory failure were randomized into the conventional group (n=40) and BiPAP ventilation group (n=40).The COPD assessment test (CAT) score,APACHE Ⅱ score,arterial blood gas were measured and plasma level of N proBNP was detected by electrochemiluminescence immunoassay before and 120 h after treatment.The correlations of plasma N-proBNP levels with CAT scores,APACHE Ⅱ scores,levels of PaO2 and PaCO2 were analyzed.Results The plasma NT-proBNP level had positive correlations with PaCO2 level (r=0.539,P =0.003),CAT score (r＝0.506,P＝0.002,APACHEⅡ score (r=0.603,P=0.003),and had negative correlation with PaO2 level (r=-0.465,P=0.014) in the patients with CPHD and hypercapnic respiratory failure before treatment.Compared with pre-treatment,the scores of CAT and APACHE Ⅱ,the levels of PaO2 and PaCO2 were significantly improved 120 h after treatment.The improvements in APACHE Ⅱ,PaO2 and PaCO2 were more obviously significant in BiPAP ventilation group than in conventional group (t=5.55,5.92,4.12,respectively,P=0.002,0.001 and 0.000).The plasma levels of NT proBNP in both conventional and BiPAP ventilation groups were significantly descended 120 h after treatment than pre-treatment [(341.2±107.6) ng/L vs.(823.8±149.0) ng/L,(273.3±82.2) ng/L vs.(832.7± 163.0) ng/L,t=21.72,28.19,both P＜0.001],and the decrease of NT-proBNP level was more significantly in BiPAP ventilation group than in conventional group (t=4.17,P=0.002).Conclusions Plasma NT-proBNP level can reflect the severity of chronic pulmonary heart disease combined with hypercapnic respiratory failure.BiPAP ventilation can decrease the plasma level of NT proBNP in patients with CPHD and hypercapnic respiratory failure,which is an effective treatment for chronic pulmonary heart disease combined with hypercapnic respiratory failure.

To investigate the relationship between intracellular free Ca2+ concentration ([Ca2+]i) and calcium-activated chloride (Clca) channels of pulmonary artery smooth muscle cells (PASMCs) in rats under acute and chronic hypoxic conditions, acute hypoxia-induced contraction was observed in rat pulmonary artery by using routine blood vascular perfusion in vitro. The fluorescence Ca2+ indicator Fura-2/AM was used to observe [Ca2+]i of rat PASMCs under normal and chronic hypoxic condition. The effect of Clca channels on PASMCs proliferation was assessed by MTT assay. The Clca channel blockers niflumic acid (NFA) and indaryloxyacetic acid (IAA-94) exerted inhibitory effects on acute hypoxia-evoked contractions in the pulmonary artery. Under chronic hypoxic condition, [Ca2+]i was increased. Under normoxic condition, [Ca2+]i was (123.63 +/- 18.98) nmol/L, and in hypoxic condition, [Ca2+]i was (281.75 +/- 16.48) nmol/L (P<0.01). Under normoxic condition, [Ca2+]i showed no significant change and no effect on Clca channels was observed (P> 0.05). Chronic hypoxia increased [Ca2+]i which opened Clca channels. The NFA and IAA-94 blocked the channels and decreased [Ca2+]i from (281.75 +/- 16.48) nmol/L to (117.66 +/- 15.36) nmol/L (P<0.01). MTT assay showed that under chronic hypoxic condition NFA and IAA-94 decreased the value of absorbency (A value) from 0.459 +/- 0.058 to 0.224 +/- 0.025 (P<0.01). Hypoxia increased [Ca2+]i which opened Clca channels and had a positive-feedback in [Ca2+]i. This may play an important role in hypoxic pulmonary hypertension. Under chronic hypoxic condition, Clca channel may play a part in the regulation of proliferation of PASMCs.

Objective To investigate the value of retraction phenomenon in coronal plane at threedimensional ultrasonography(3D-US) in preoperative assessment of prognostic factors in breast cancer.Methods Surgical resection specimens of 66 malignant breast lesions in 66 women who had undergone 3D-US were included.The presence of the retraction phenomenon in the coronal plane was evaluated.Pathologic prognostic factors,including tumor size,histologic grade,lymph node status,estrogen receptor (ER) and progesterone receptor (PR) status,and human epidermal growth factor receptor 2 (Cerb-B2) and p53 expression were determined.Correlation of the retraction phenomenon and prognostic factors was analyzed.Results The retraction phenomenon was correlated to the tumor size,histologic grade,and estrogen and progesterone receptor status.Compared with the breast cancer without the retraction phenomenon,the tumor foci with the retraction phenomenon were more likely to show a smaller diameter less than 2 cm (73.7％ vs 46.4％,P ＜0.05),a lower histologic grade with grade Ⅱ (88.2％ vs 42.9％,P ＜0.01),and a higher positive rate of ER and PR (86.8 ％ vs 64.3 ％,P ＜0.05;81.6 ％ vs 57.1％,P ＜0.05).The lymph node status and the expression of the CerB-2 and p53 in the two groups had no significant difference (P ＞0.05).Conclusions The retraction phenomenon in the coronal plane of three-dimensional US may be useful in the noninvasive prediction of prognostic factors of breast cancers.

Objective:To explore the value of lactic acid (Lac), procalcitonin (PCT), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in assessing the severity and predicting the prognosis in sepsis shock.Methods:A retrospectively study was conducted. Patients with septic shock hospitalized in the department of critical care medicine of the Affiliated Hospital of Jining Medical University from April 2015 to June 2019 were enrrolled. The patient's gender, age, body mass index (BMI), infection site, organ dysfunction status; Lac, PCT, C-reactive protein (CRP), heart rate and body temperature immediately after admission to the intensive care unit (ICU); APACHEⅡ and SOFA scores within 24 hours, and 28-day prognosis were collected. According to the 28-day prognosis, the patients with septic shock were divided into the survival group and the death group, and the differences in the indicators between the groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of 28-day death in patients with septic shock; receiver operating characteristic curve (ROC curve) was used to analyze the value of Lac, PCT, SOFA, APACHEⅡ, and age in predicting the 28-day prognosis of patients with septic shock.Results:A total of 303 septic shock patients were enrolled, of which 124 cases survived and 179 died on the 28th day, and the 28-day mortality was 59.08%. ① Compared with the survival group, patients in the death group were older (years old: 66.58±15.22 vs. 61.15±15.68), APACHEⅡ, SOFA, proportion of lung infections, Lac increased [APACHEⅡ score: 22.79±7.62 vs. 17.98±6.88, SOFA score: 9.42±3.51 vs. 5.65±1.59, proportion of lung infections: 53.63% (96/179) vs. 39.52% (49/124), Lac (mmol/L): 5.10±3.72 vs. 3.71±2.56], oxygenation index (PaO 2/FiO 2) and ICU body temperature decreased [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 198.94±80.15 vs. 220.68±72.06, ICU body temperature (℃): 37.47±1.08 vs. 37.80±1.14], and the differences were statistically significant (all P < 0.05).②Multivariate Logistic regression analysis results: after adjusted for potential confounding factors, APACHEⅡ, PCT, Lac, age and SOFA were independent risk factors for death in patients with septic shock [APACHEⅡ: odds ratio ( OR) =1.05, 95% confidence interval (95% CI) was 1.01-1.10, P = 0.039; PCT: OR = 0.99, 95% CI was 0.98-1.00, P =0.012; Lac: OR = 1.23, 95% CI was 1.08-1.40, P = 0.002; age: OR = 1.03, 95% CI was 1.01-1.05, P =0.009; SOFA score: OR =1.88, 95% CI was 1.59-2.22, P < 0.001]. ③ROC curve analysis showed that APACHEⅡ, Lac, age and SOFA could predict the prognosis of patients with septic shock [APACHEⅡ: the area under the ROC curve (AUC) = 0.682 4, 95% CI was 0.621 7-0.743 1, P = 0.000; when the best cut-off value was 18.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 72.63%, 54.84%, 69.89%, 58.12%, 1.608 1 and 0.499 2, respectively. Lac: AUC = 0.604 5, 95% CI was 0.540 8-0.668 2, P = 0.002; when the best cut-off value was 3.550 mmol/L, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 50.84%, 73.39%, 73.39%, 50.94%, 1.910 3 and 0.669 9, respectively. Age: AUC = 0.599 1, 95% CI was 0.535 4-0.662 7, P = 0.003; when the best cut-off value was 72.500 years old, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 42.46%, 75.00%, 71.03%, 47.45%, 1.698 3 and 0.767 2, respectively. SOFA: AUC =0.822 3, 95% CI was 0.776 7-0.867 9, P = 0.000; when the best cut-off value was 7.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 68.72%, 87.90%, 89.13%, 66.06%, 5.680 4, 0.355 9 respectively]. The combined prediction had a good sensitivity (72.63%) and specificity (84.86%), and AUC (0.876 5) was higher than that of a single variable, suggested that the multivariate combination was more accurate in predicting the short-term outcome of septic shock. Conclusion:Lac, PCT, SOFA score, APACHEⅡ score and age were independent risk factors for death in patients with septic shock, and the accuracy of Lac, SOFA score, APACHEⅡ score and age in predicting short-term prognosis of septic shock was better than that of single variable, and the diagnostic value was higher.

AIM: To investigate the role of intracellular free Ca2+ concentration ([Ca2+]i) in the regulation of calcium-activated chloride (ClCa) channels in pulmonary artery smooth muscle cells (PASMCs) of rats under normoxic, acute and chronic hypoxic conditions. METHODS: Acute hypoxia-induced contraction was observed in rat pulmonary artery by using routine blood vascular perfusion in vitro. The fluorescence Ca2+ indicator Fura-2/AM was used to observe [Ca2+]i of rat PASMCs in normal and chronic hypoxic condition. The influences of ClCa channels on PASMCs proliferation were assessed by MTT assay. RESULTS: (1) The ClCa channel blockers niflumic acid (NFA) and indaryloxyacetic acid (IAA-94) produced inhibitory effects on acute hypoxia-evoked contractions in pulmonary artery. (2) Under chronic hypoxic condition, [Ca2+]i was increased. In normoxic condition, [Ca2+]i was (123.63?18.98) nmol/L, and in hypoxic condition, [Ca2+]i was (281.75?16.48)nmol/L (P0.05). (4) Chronic hypoxic increased [Ca2+]i which opened ClCa channels. The NFA and IAA-94 blocked them and decreased [Ca2+]i from (281.75?16.48)nmol/L to (117.66?15.36)nmol/L (P

Objective To establish the culture of Blastocystis hominis in vitro in Medium 199 for further research on the biological characteristics of this intestinal parasite.Methods The growth, reproduction and relevant factors of B.hominis under different culture conditions including pHs, sorts and concentrations of serum, and the number of inoculation were compared. Results The optimal conditions for the continuously anaerobic culture of B.hominis in Medium 199 were as follows: concentrations of new born bovine serum (or human serum and horse serum) ranged from 10%-20%, the number of inoculation was no less than 1?10~5 organisms per tube, pHs ranged from 7.0-8.0, penicillin, streptomycin should be added, anaerobic cultured at 37 ℃.The reproductive peaking-days were 4, 8 at pH 7.0; 3, 6, 9 at pH 7.5 and 2, 4, 7, 9 at pH 8.0. Conclusion B.hominis could be continuously cultured in vitro in Medium 199.

The sperm antigens were examined using the method of ELISA and specific monoclonal antiboby against human sperm.The results of ELISA method of 10 fresh seminal fluid samples and 15 seminal stains showed 100% positive rate. Even diluted the fresh seminal fluid to 10~6 times of seminal stains extract to 51?0~5 times,both were positive also.However,it was negtive for testing other specimens such as saliva stains,urine stains,colostrum stains,sweat stains, vaginal secretion stains and human seminal stains after vesoligation. The result certificate that using specific antibody to the sperm,the ELISA method is high sensitive and specific for the sperm antigen assay.