OBJECTIVE:To provide reference for setting reasonable medicines insurance payment price in China.METHODS:We retrieved and analyzed academic articles formally published at home and abroad,official websites and government documents,summarized.medicines insurance payment pricing mechanism as well as fair solutions to high-cost medicines,so as to put forward the suggestions to formulate reasonable medicines pricing policy in China.RESULTS&CONCLUSIONS:The international medicines payment prices are usually determined by internal reference pricing method,incremental cost-effectiveness evaluation method and external reference pricing method.The sustainable and fair accessibility of high-cost medicines are promoted by fair medicines pricing program,medicines patent pool,open source medicines discovery znitiative and so on.After the goal of universal health care has been achieved in china,reasonable medical insurance payment price should be explored and formulated.It is necessary to adopt,intemal reference pricing method to determine the payment standard of completitive eneric products,external reference pricing method or incremental cost-effectiveness evaluation method to determine the reference price for price negotiation of the innovative patented medicines;the concept of fair pricing for high-cost medicines.

Objective To investigate the correlation between blood routine test indicators and advanced saphenous vein graft disease (SVGD) in patients with coronary artery bypass grafting (CABG). Methods By defining SVGD as an occlusion of 50% or more of the saphenous vein graft (SVG) excluding distal anastomotic occlusion, patients were divided into SVGD group and non-SVGD group, who suffered CABG over 1 year with recurrent angina and underwent coronary angiography (CAG) operation from March 2015 to January 2016 in Tianjin Chest Hospital. Results of blood routine test data were compared between two groups. The multivariable Logistic regression was analyzed for the relationship between blood routine test indicators and advanced SVGD. Results There were 148 patients in the study, 109 patients in SVGD group and 39 patients in non-SVGD group. There were significant differences in level of red blood cell distribution width (RDW:0.123 2 ± 0.008 9 vs. 0.120 2 ± 0.005 2, P<0.05), neutrophil/lymphocyte ratio (NLR:3.40 ± 2.11 vs. 2.75 ± 0.82, P<0.05) and platelet and lymphocyte ratio (PLR:143.10 ± 54.70 vs. 124.57 ± 34.40, P<0.05) between SVGD group and non-SVGD group. Multivariable Logistic regression analysis showed that RDW>0.127 5[OR (95%CI):4.905 (1.058-22.747), P=0.042], NLR>3.34[OR(95%CI):4.013(1.466-10.987), P=0.007]were independent risk factors for advanced SVGD, as well as PCT>0.185 [OR(95%CI):2.636(1.098-6.324), P=0.030]might be risk factor for advanced SVGD. Conclusion RDW>0.127 5, NLR>3.34 could indicate advanced SVGD. We need more samples to support that PCT>0.185 is used to be risk indicators for advanced SVGD.

Animals ; Male ; Mice ; Mice, Inbred BALB C ; Myocarditis ; metabolism ; virology ; Myocardium ; metabolism ; Osteopontin ; metabolism ; Virus Diseases ; metabolism

Objective: To observe the impact of mind-regulating acupuncture plus donepezil on the cognitive ability, mean cerebral blood flow velocity, event-related potential P300, and activities of daily living (ADL) in the aged patients with Alzheimer disease (AD).Methods: Sixty senile AD patients were divided into a treatment group and a control group following the envelope method for random allocation, with 30 cases in each group. Based on the conventional treatment of the internal medicine, the control group received oral donepezil, and the treatment group received oral donepezil plus mind-regulating acupuncture. After 4-week treatment, the two groups were evaluated by the mini-mental state examination (MMSE), Alzheimer disease assessment scale-cognitive part (ADAS-Cog), and ADL; changes in P300 and the mean cerebral blood flow velocity were also observed.Results: Before treatment, there were no significant differences in the scores of MMSE, ADAS-Cog, or ADL between the two groups (P>0.05). The MMSE score increased after treatment in both groups and was notably higher in the treatment group than in the control group, showing intra-group and inter-group statistical significance (P<0.05). After treatment, the ADAS-Cog and ADL scores dropped in both groups and were markedly lower in the treatment group than in the control group, also showing intra-group and inter-group statistical significance (P<0.05). Compared with the same group before treatment, the latency of P300 was shortened and the amplitude was extended in both groups, all with statistical significance (P<0.05); the latency was shorter and the amplitude was larger in the treatment group than in the control group after treatment, presenting significant between-group differences (P<0.05). The mean blood flow velocity accelerated after the intervention in both groups, and the differences were statistically significant (P<0.05); the improvement in the treatment group was more notable than that in the control group (P<0.05).Conclusion: Mind-regulating acupuncture plus donepezil can regulate the latency and amplitude of P300, increase cerebral blood flow, and improve the learning and memory abilities of AD patients.

Objective To investigate the native vessel percutaneous coronary intervention (NV-PCI) and bridge vascu-lar interventional therapy (graft-PCI) strategies on prognosis in patients with coronary artery bypass grafting (CABG), by fol-lowing up the occurrence of major adverse cardiovascular events (MACE). Methods A total of 312 patients who relapsed chest pain after the CABG and had a successful interventional treatment were divided into two groups:215 patients for NV-PCI group and 97 patients for graft-PCI group. We observed cardiac death, acute myocardium infarction (AMI) and target vessel revascularization (TVR) after visiting the patients out of hospital for 34 months on average. The risk factors of MACE were analyzed by multivariable Logistic regression after the interventional treatment for the bridge vascular lesions. Re-sults The proportions of patients without MACE, AMI and TVR were significantly higher in NV-PCI group than those in graft-PCI group (P<0.05). There were no significant differences in death rate and survival rate between two groups (P<0.05). Multivariable Logistic regression analysis showed that age of bridge [OR(95%CI):1.011(1.002-1.020), P=0.017], diabe-tes mellitus [OR(95%CI):2.375 (1.414-3.989), P=0.001] and graft-PCI [OR(95%CI):1.873(1.090-3.219),P=0.023] were in-dependent risk factors for prognosis of impacting the bridge vascular interventional treatment. Conclusion The clinical prognosis is much better in NV-PCI group than that of graft-PCI group. The age of bridge, diabetes mellitus and graft-PCI are independent risk factors for clinical prognosis of impacting the bridge vascular interventional treatment.

Objective To analyze the epidemic characteristics of mushroom poisoning incident in order to find the regularity of outbreak and provide the fundamental guidelines of prophylaxis,control,diagnosis and treatment.Methods According to the reported information from the Management Information System of Public Health Emergency in China mainland,the area-time distribution of mushroom poisoning incidents from 2004 to 2014 was analyzed,and the descriptive analysis of mushrooms poisoning incidents including causes,places,occupation of victims and incidents identification were made from 2010 to 2014.Results In China (excluding Hong Kong,Macao and Taiwan),the top five provinces of mushroom poisoning incidents were Yunnan,Guizhou,Sichuan,Guangxi and Hunan.The epidemic peak was reached in summer-autumn season.The major and significant incidents accounted for 76.56％ of overall mushroom poisoning incidents,and the fatality rate of 3 701 patients accounted for 21.24％ (786 deaths).The causes were mistaking poisonous mushrooms as edible mushrooms or purchasing poisonous mushrooms in the market by accident.About 87.50％ incidents happened at home.Farmers,workers,children and students were easily subjected to mushroom poisoning because of their large range of activities,strong curiosity and lacking related ability for distinguishing edible mushroom from poisonous mushrooms.No identification was done in 200 mushroom poisoning incidents from 2010 to 2014,which accounted for 92.59％ of mushroom poisoning incidents in the corresponding period.Standard species identification was carried out only in two poisonous mushroom incidents.Conclusions Mushroom poisoning incident was one of the most important causes of death in per-oral poisoning incidents.It should to cope with surveillance and meticulous management during high prevalence season and in high-risk provinces.At the same time,it should be strengthened to train doctors and health professionals with the knowledge of identification of mushroom poisoning in key areas as well as to develop the health promotion of mushrooms poisoning prevention.

Objective To investigate the relationship between PCSK9 gene polymorphism with lipid metabolism and CHD risk among population within Tianjin, China. Methods Patients from Tianjin Chest Hospital were selected (n=778) and divided into coronary heart disease (CHD) group (n=502) and control group (n=276). Immediately after admission, tri?glyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), apolipoprotein A (ApoA 1) and apolipo?protein B (ApoB) were tested and genotype TT,TC and CC were determined. Results In CHD group, LDL-C level is higher in TC genotype individuals than that in TT genotype individuals with statistical significance (P<0.05). CHD group and the control group were dominated by TT genotype with no statistical difference between their allele frequency distribution nor genotype frequency distribution(P>0.05). The total population allele frequencies were T 96.1%(1 495/1 556), C 3.9%(61/1 556);genotype frequencies were TT 92.2%(717/778), TC 7.8%(61/778). Multivariate Logistic regression analysis revealed that ApoA1 and HDL-C were inversely associated with coronary heart disease, therefore are protective factors for coronary heart disease. Conclusion The study found that TC genotype is correlated with serum LDL-C increase in group CHD, and the incidence of allele C showed no obvious connection with CHD.

Objective To compare the effects of ephedrine and phenylephrine on hemodynamics in the patients undergoing surgery in prone position under general anesthesia.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 20-60 yr, with body mass index of 18.5-2:5.0 kg/m2, scheduled for elective posterior lumbar interbody fusion under general anesthesia, were randomized to ephedrine group (group E, n =30) or phenylephrine group (group P, n =30).When hypotension [decrease in systolic blood pressure (SBP) ＞20％ of the baseline value, T0] occurred in supine position, SBP, diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI) and central venous pressure (CVP) were recorded, and ephedrine 0.1 mg/kg (group E) or phenylephrine 1 μg/kg (group P) was injected via the central veins.The parameters mentioned above were recorded within 10 min after administration (T1-T10).Results Both ephedrine and phenylephrine could maintain the parameters of hemodynamics at the normal level.Compared with the baseline values at T0 , SBP, DBP, MAP and HR at T1-T10 and CO and CI at T2-T10 were significantly increased, and no significant change was found in CVP at each time point after administration in group E, and SBP and MAP at T1-T6, DBP at T1-T5, CVP at T2 and T3, and CO and CI at T1-T3 were significantly increased, and HR was decreased at T2 and T3 in group P.Compared with group P, SBP was significantly decreased at T1, and increased at T2-T10, DBP and MAP were decreased at T1, and increased at T3-T10, HR was increased at T1-T10, CO and CI were increased at T2-T10, and CVP was decreased at T1-T3 in group E.Conclusion Compared with phenylephrine, although ephedrine provides no significant effect on hemodynamics clinically, it can increase cardiac output to some extent in the patients undergoing surgery in prone position under general anesthesia.

Objective To investigate the clinical efficacy and prognosis of early protective pulmonary ventilation and intra-aortic balloon pump(IABP)combined with percutaneous coronary intervention(PCI)in treating patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)and hypoxemia.Methods The 49 patients diagnosed as AMI complicated with CS and hypoxemia and treated with early protective pulmonary ventilation and IABP combined with PCI in Tianjin Chest Hospital from January 2015 to December 2015 were retrospectively analyzed.Major adverse cardiovascular events(MACE)including sudden cardiac death,recurrent myocardial infarction,heart failure and development of target vessel revascularization were recorded during one year of follow-up visits.Survival rate was analyzed and Cox regression analysis was used to explore risk factors for occurrence of MACE after the treatment.Results The revascularization of target vessel was successfully operated on all of the 49 patients.The mean time from attack to hospitalization was(6.2±1.5)hours,while the mean time from emergency room to balloon dilatation was(118.55±28.28)minutes.In these patients,30(61.2%)cases were diagnosed as STEMI,among which 23(76.6%)cases as anterior wall myocardial infarction and 5(16.7%)cases as inferior wall myocardial infarction.While the other 19(38.8%)cases were diagnosed as non-STEMI.Using coronary arteriography,46(93.9%)cases had multi-vessel coronary artery disease,among which 13(26.5%)cases were complicated with severe left main coronary artery disease and 27(55.1%)cases had severe vascular calcification.44(89.8%)cases had TIMI perfusion grade 3 blood flow after PCI,while 5(10.2%)cases did not achieve TIMI grade 3 blood flow.One(2.0%)case had serious complications and 12(24.5%)patients died in hospital.31(63.3%)patients survived 1 year during follow-up visits.Total number of MACE was 32(65.3%).Among these events,18(36.7%)died,4 cases(8.2%)had recurrent myocardial infarction,13 cases(26.5%)had heart failure(HF)and 5 cases(10.2%)had target vessel revascularization(TVR).The total event-free survival rate was 34.7%.Multivariable Cox regression analysis showed that severe vascular calcification〔HR(95%CI):2.677(1.184-6.054),P=0.018〕,TIMI grade blood flow less than level 3 after PCI〔HR(95%CI):26.289(6.314-109.470),P=0.000〕and more than 120 minutes from emergency room to balloon dilatation〔HR(95%CI):2.923(1.325-6.446),P=0.008〕were risk factors for MACE.Conclusions Early protective pulmonary ventilation and IABP combined with emergency PCI are safe and effective for treatment of patients with AMI complicated with CS and hypoxemia.The pattern of treatment can significantly decrease death rate and increase 1-year survival rate.

Objective:To explore the clinical value on application of laparoscopic ultrasonography (Lap US) in the adnexal operation. Methods:Eleven patients including 7 cases of tubal pregnancy, 3 cases of teratoma of ovary and 1 case of endometrial cyst of ovary were examined by LapUS, then operated with laparoscopy.Results:The results showed that the modality presented is a big progress over the traditional operative management for adnexal diseas. Conclusions:It is a good approach for micro-surgery in the adnexal operation by laparoscopy.