The paper discusses the evidence-based decision-making framework for medical insurance reimbursement based on big data concept through expert consultation,defines the dimension of decision-making,analyzes the evidence-based decision-making steps in combination with big data resources,proposes suggestions on how to make full use of big data resources around medical insurance decision-making practice.

BACKGROUND:Fibrin glue introduced into calcium phosphate cement has not been confirmed whether this way could overcome the compressive limits and the low degradation of calcium phosphate cement and to modify the biological properties of calcium phosphate cement. OBJECTIVE:To explore the mechanical and biological properties of calcium phosphate cement/fibrin glue at different powder/liquid ratio for bone regeneration in vitro. METHODS:Calcium phosphate cement and fibrin glue were mixed at ratios of 1:1, 3:1, 5:1 (mL/g), and the pure calcium phosphate cement served as controls. Setting time, scanning electron microscope and the biomechanical test were used to analyze the composite scaffold structure, physical performance and the mechanical properties. Passage 3 osteoblasts were respectively inoculated on the material surface of the four groups, and pure cells served as blank controls. celladhesion, proliferation and alkaline phosphatase activity were observed. RESULTS AND CONCLUSION:The initial and final setting time of calcium phosphate cement/fibrin glue at 1:1 and 3:1 (mL/g) was higher than that in the control group (P<0.05), while the initial and final setting time of calcium phosphate cement/fibrin glue at 5:1 (mL/g) was lower than that of the control group (P<0.05). Scanning electron microscope showed smoother and denser surface of composite scaffolds compared with the pure calcium phosphate cement. The aperture of the composite scaffolds was decreased with the increasing concentration of fibrin glue. The compressive strength of composite scaffolds at 3:1 and 5:1 was higher than that of the control group (P<0.05), while the modulus of the composite scaffolds at 1:1, 3:1, 5:1 was higher than that of the control group (P<0.05). celladhesion, proliferation and alkaline phosphatase activity showed no difference among the three composite scaffold and control groups, but al higher than the blank control group (P<0.05). These findings indicate that fibrin glue introduced into calcium phosphate cement can overcome the low-strength limits of calcium phosphate cement, and maintain the good biological properties of calcium phosphate cement for bone regeneration.

Calibration ; Chemistry Techniques, Analytical ; methods ; Humans ; Lead ; blood

Objective To reverse P-glycoprotein-mediated muhiple drug resistance using RNA interference(RNAi)in cultured rat astrocytes.Methods Astroeytes overexpressing P-glyeoprotein induced by coriaria lactone were transfected with the short-hairpin RNA expression vector-p-SIREN shuttle designed to target Mdrl mRNA.The mRNA level of Mdrl gene was evaluated by real-time PCR;the P-glycoprotein was examined by immunocytochemistry and image analysis,meanwhile the rhodamine efflux was assessed by flow cytometry.Results The astrocyte model overexpressing P-glycoprotein were established and successfully transfected with the short-hairpin RNA expression vector-p-SIREN shuttle.The mRNA level of Mdrl gene was knocked down by 67.70%(P

Objective To investigate the effect of acute myocardium ischemic on heart function of pregnancy rat.Methods 13 female SD rats and 6 early pregnancy rats were divided into normal group, unpregnant group with acute myocardial infarction and early pregnant group with acute myocardial infarction. The anterior branch of the left coronary artery was ligated. 3 weeks later, Image 1.31 software was used to measure areas of myocardial infarction,and to evaluate hemodynamics of heart with powerLAB4.12, and cardiac tissues were stained with Massion. Results Compared with unpregnant group with acute myocardial infarction , the early pregnant group with acute myocardial infarction had less myocardial infarction area (28. 86% vs. 36. 8%), and had a higher left ventricle end systolic pressure, ±dp/dt max, and lower left ventricle end diastolic pressure. Massion stain showed the amount of collagen of the lesion was less in the early pregnant group with acute myocardial infarction than that in unpregnant group.Conclusion The early pregnant group with acute myocardial infarction had better heart contractive and diastolic function.

Objective To evaluate roles of color doppler echocardiography(CDE)and angiocardiography(ANGI)in diagnosis of children's combined with congenital heart diseases(CHD).Methods From Jan.2006 to Jun.2008,31 children with combined with CHD underwent not only CDE but also ANGI.Of those,18 cases were subjected to surgical operation.Main diagnosis and concomitant cardiovascular malformations derived from CDE and ANGI,operative findings as well,were compared.Results In 18 cases undergoing surgery,diagnosis of 15(83.33%)cases from CDE and 17(94.44%)cases from ANGI were in line with the operative findings.Of intracardiac malformations,diffe-rences between CDE and ANGI were:CDE diagnosed 1 case with pulmonary atresia /ventricular septal defect(PA/VSD)as persistent truncus arteriosus(PTA),2 cases with tetralogy of Fallot(TOF)as PA/VSD by mistake,and 1 case with partial anomalous pulmonary venous connection(PAPVC)was suspected by CDE but missed by ANGI,all above mentioned confirmed by sugery;except main diagnosis,CDE missed atrial septal defect(ASD),anomalous origin of right coronary artery and single left coronary for 1 case,respectively.In diagnosing extracardiac abnormal structures:1 case of interrupted aortic arch(IAA)was suspected by CDE but diagnosed and classified by ANGI;for double aortic arch(DAA),pulmonary arteriovenous fistula(PAVF),patent ductus arteriosus(PDA)and absence of right pulmonary artery,1 case of each was missed by CDE;furthermore PDA reported by CDE but not found by ANGI in 4 cases with PA/VSD.Conclusions The diagnostic difference between CDE and ANGI mainly lies in extracardiac malformations including coronary arteries.In diagnosing combined CHD,combination of CDE and ANGI can improve accurate rate.J Appl Clin Pediatr,2009,24(1):44-45

OBJECTIVE: To extract sperm DNA from mixed stain by the modified differential lysis method combined with silicon bead method and to evaluate its application value. METHODS: Fifty-two mixed stains containing female STR genotypes detected by differential lysis method were collected. The sperm DNA was extracted by the modified method combined with silicon bead method, then genotyped with the Identifiler Kit, and compared with the results of genotyping by the conventional differential lysis method as control. RESULTS: Of the 52 samples, 38 samples with sole male STR genotypes in all loci were detected. The detection rate of male STR genotypes was 98.08% through the modified method combined with silicon bead method. CONCLUSION The modified differential lysis method combined with silicon bead method can be used in extraction of sperm DNA from mixed stain.
DNA/isolation & purification* ; DNA Fingerprinting ; Female ; Genotype ; Humans ; Male ; Polymerase Chain Reaction ; Silicon ; Spermatozoa

BACKGROUND AND OBJECTIVEThe brain is one of the most common metastatic sites of breast cancer. Brain metastases develop in 10%-15% of patients with breast cancer and are associated with poor prognosis. The purpose of this retrospective study was to analyze the clinical characteristics and survival of patients with brain metastases due to breast cancer of different subtypes and to identify the prognostic factors that affect clinical outcome.

METHODSA total of 89 patients with breast cancer brain metastases diagnosed between October 1997 and July 2008 at Sun Yat-sen University Cancer Center were included in this study. Among the 89 patients, the number of luminal A, luminal B, human epidermal growth factor receptor 2 (HER-2), and triple-negative (TN) subtypes were 30, 20, 16, and 14, respectively; 9 patients had an unknown subtype. The clinical characteristics, pathologic features, and prognostic factors were analyzed both at the initial diagnosis and at the diagnosis of brain metastases. Endocrine therapy for patients with luminal subtypes was further studied.

RESULTSThe median age of patients was 46 years (range 28-74 years). The median survival time was 8.0 months (range, 0-80 months), the 1-year survival rate was 32% and the 5-year survival rate was 4%. The time to brain metastasis differed according to clinical stage at the initial diagnosis, and the time for patients with the luminal A subtype was the longest (P < 0.001). Multivariate analysis demonstrated that performance status score > 1, multiple brain metastases and without whole brain radiotherapy (WBRT) in combination with chemotherapy were associated with poor prognosis. Compared with the luminal A subtype, features of the HER-2 and TN subtypes included early metastases, rapid progression after first-line treatment (8.0 months vs. 11.0 months), and poor overall survival (25.0 months vs. 63.0 months). The luminal A subtype showed a tendency for good prognosis and slow growth. Tamoxifen could improve the survival of luminal A/B subtypes (median survival 24.0 months vs. 7.0 months, respectively, P = 0.002).

CONCLUSIONSThe prognosis of brain metastases from breast cancer was poor, especially in patients with HER-2 and TN subtypes. Generally, WBRT in combination with chemotherapy was the standard treatment modality. Patients with the luminal subtypes could benefit from tamoxifen.

Adult ; Aged ; Antineoplastic Agents, Hormonal ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Brain Neoplasms ; secondary ; therapy ; Breast Neoplasms ; classification ; pathology ; therapy ; Carcinoma, Ductal, Breast ; classification ; pathology ; secondary ; therapy ; Chemotherapy, Adjuvant ; Cranial Irradiation ; methods ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; methods ; Middle Aged ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Receptor, ErbB-2 ; blood ; Receptors, Estrogen ; blood ; Receptors, Progesterone ; blood ; Retrospective Studies ; Survival Rate ; Tamoxifen ; therapeutic use

OBJECTIVETo investigate the roles of matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) in dentinogenic ghost cell tumor (DGCT) and ghost cell odontogenic carcinoma (GCOC).

METHODSThe expressions of MMP-2, MMP-9, MMP-14, TIMP-1 and TIMP-2 were examined in 15 DGCT cases and 9 GCOC cases by immunohistochemistry. Their mRNA expression in one DGCT case and one GCOC case were investigated by RT-PCT.MMP-2 and MMP-9 protein activities in the two cases were analyzed by gelatin zymography.

RESULTSMMP-9 and TIMP-1 expressions elevated greatly in GCOC, and there was a significant difference (P < 0.05) in TIMP-1 expression between GCOC and DGCT.Pro-MMP-9, MMP-9 activated form, pro-MMP-2, and MMP-2 activated forms were detected in the GCOC case, while pro-MMP-9 and MMP-9 activated form were very faint in the DGCT case. The mRNA level of MMP-9 elevated obviously in the GCOC case, which was similar to that of TIMP-1.

CONCLUSIONSThe elevated expression of MMP-9 and TIMP-1 may influence the behaviour of GCOC.

Adolescent ; Adult ; Aged ; Child ; Dentin ; Humans ; Mandibular Neoplasms ; metabolism ; pathology ; Matrix Metalloproteinases ; metabolism ; Middle Aged ; Odontogenic Tumors ; metabolism ; pathology ; Tissue Inhibitor of Metalloproteinases ; metabolism ; Young Adult

OBJECTIVETo investigate the susceptibility of von Willebrand factor (VWF) type 2A mutant A1500E to proteolysis by metalloprotease ADAMTS13 and to provide the direct supports for the pathogenesis of VWF mutation A1500E responsible for von Willebrand disease (VWD) type 2A.

METHODSRecombinant wild-type VWF (WT-VWF) and A1500E mutant VWF transiently expressed on transfected HeLa cell lines. Expression media were collected and concentrated, then cleaved directly by recombinant ADAMTS13 (rADAMTS13). Compared with WT-VWF, the susceptibility of A1500E mutant VWF to proteolysis by ADAMTS13 was analyzed using SDS-agarose gel VWF multimers analysis.

RESULTSIn vitro the expression of VWF:Ag in the supernatants of WT-VWF and A1500E mutant VWF were 1.10 U/ml and 0.78 U/ml, respectively, while VWF:Ag in cells lysates of A1500E mutant VWF was 90.6% of that of WT-VWF. The SDS-agarose gel VWF multimers analysis showed that there were no differences between WT-VWF and A1500E mutant VWF. The A1500E mutant VWF could be efficiently cleaved by ADAMTS13 under static condition without denaturants such as urea and guanidine HCl. VWF multimeric analysis showed that high and intermediate molecular weight multimers dramatically decreased while low molecular weight multimers obviously increased. Conversely, WT-VWF could not be cleaved by ADAMTS13 under the same condition.

CONCLUSIONThe A1500E mutation resulted in VWF more susceptible to ADAMTS13-dependent proteolysis, which belonged to VWD type 2A group 2 mutation.

ADAM Proteins ; genetics ; metabolism ; ADAMTS13 Protein ; Genotype ; HeLa Cells ; Humans ; Hydrolysis ; Mutation ; Recombinant Proteins ; genetics ; metabolism ; von Willebrand Disease, Type 2 ; genetics ; metabolism ; von Willebrand Factor ; genetics