OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are hierarchical medical system and two-way referral system;for-profit hospitals and non-profit hospitals are mutually complementary;different natures of health insur-ance system,different payment methods and strict“commercial bribe”monitoring system are carried out;doctors,hospitals and health insurance restrict each other. Not only there are many advantages in theory,but also in practice the growth rate of medical cost and the percentage of drug expenditure are superior to our country. Finally it controls the rapid growth of medical cost to a cer-tain extent. Combined with our national conditions,learning from the United States experience,restrictive relationship among doc-tors,hospitals and health insurance institutions is established to control the increase of medical cost in China through reducing infor-mation asymmetry and standardizing payment audit;establishing a scientific pattern of mixed payment;strengthening the indirect impact of the health insurance institutions on doctors and hospitals,etc.

Objective:To prepare poly-L-lactic acid(PLLA)electrospun nanofibers carrying icariin(ICA)(ICA /PLLA)and to evaluate the effects of the ICA /PLLA on MC3T3-E1 cells.Methods:ICA solution was dispersed into PLLA solution,and electrospun fibers were fabricated by W/O emulsion method.The morphology of ICA /PLLA was observed by SEM.The in vitro release kinetics of ICA /PLLA was examined.The attachment of MC3T3-E1 cells on ICA /PLLA was examined by propidiumiodide(PI)labling and ob-served under fluorescent microscope.The proliferation of the cells was measured by MTT assay.The differentiation of the cells was ob-served by alkaline phosphatase (ALP)assay.Results:In vitro,ICA was effectively released from ICA /PLLA for 22 days,cells were attached well on the surface in all groups,ICA did not affect the proliferation of MC3T3-E1 cells(P >0.05),but increased the ALP activity(P <0.05)of the cells.Conclusion:ICA /PLLA can effectively control the release of ICA and promote the differentiation of MC3T3-E1 cells.

OBJECTIVE: Mitochondrial deoxyribonucleic acid (mtDNA) 8344 A>G (m.8344A>G) mutation is the common mutation associated with mitochondrial myoclonus epilepsy with ragged-red fibers (MERRF) syndrome. Herein we report a rare case with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes/MERRF/Leigh (MELAS/MERRF/Leigh) overlap syndrome caused by m.8344A>G mutation. METHODS: The clinical and imaging data of the patient were collected and an open muscle biopsy was carried out. We further employed molecular genetic analyses to detect mtDNA mutation in the proband and his mother. And then a clinical and neuroimaging follow-up was performed. RESULTS: This patient was a 25-year-old male, who developed exercise intolerance since the age of 6. At age 10, he suffered from acute episodes of hemianopia, and cranial magnetic resonance imaging (MRI) showed occipital stroke-like lesions and cranial magnetic resonance spectroscopy (MRS) revealed a lactate peak corresponding to the lesion. After that the patient presented slowly progressive psychomotor decline. He had myoclonic seizures and cerebellar ataxia since the age of 12. At age 21, he was admitted to our hospital because of confusion and cranial MRI revealed symmetrical lesions in bilateral posterior putamen, thalami and midbrain. Then repeated MRI showed progression of original lesions and new frontal multiple stroke-like lesions. Symptomatic and rehabilitation treatment relieved his condition. Follow-up cranial MRI at age 24 showed the lesions in basal ganglia and thalami diminished, and the midbrain lesions even completely vanished. Muscle pathology indicated the presence of numerous scattered ragged-red fibers (RRF), suggestive of a mitochondrial disorder. Polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) detected the m.8344A>G mutation of the MT-TK gene encoding mitochondrial transfer RNA for lysine in the patient's blood. Next generation sequencing (NGS) of the whole mitochondrial genome identified that the proportion of m.8344A>G was 90%, and no other mtDNA mutation was detected. Sanger sequencing further identified this mutation both in the proband and his mother's blood, although the mutation load was much lower in his mother's blood with approximately 10% heteroplasmy. CONCLUSION The present study is the first to describe a patient with m.8344A>G mutation in association with the MELAS/MERRF/Leigh overlap syndrome, which expands the phenotypic spectrum of the m.8344A>G mutation.
Acidosis, Lactic ; Adult ; Child ; DNA, Mitochondrial/genetics* ; Humans ; Male ; Mitochondrial Encephalomyopathies ; Mutation ; Stroke ; Young Adult

Objective To observe the dynamic changes of endothelial progenitor cells (EPC)and vascular endothelial growth factor (VEGF) in the patients with acute myocardial infarction (AMI)after percutaneous transluminal coronary intervention (PCI). Methods The level of VEGF before and after PCI in 50 cases with AMI were determined by fluorescence immunoassay and enzyme-linked immunosorbnent assay (ELISA),and the ratio of EPC in flood was checked by flow cytometry.Results The level of EPC was higher after PCI than before PCI [(4.15 ± 0.22)％ vs.(0.59 ±0.02) ％,P＜0.01],and there were positive correlations between EPC and number of coronary artery disease (r=0.45,P ＜ 0.05 ),coronary artery lesions ( r =0.76,P ＜ 0.01 ),left ventricular enddiastolic diameter (r=0.68,P＜0.01),ejection fraction (r=0.75,P＜0.01).The VEGF levels after PCI was increased [(506± 120)μg/L vs.(204±98)μg/L,P＜0.01],and its level was positively related with coronary lesions (r=0.66,P＜0.01),left ventricular ejection fraction(r=0.90,P＜0.01).There was association between rising rates of EPC and VEGF in a short time after PCI within 24 h period (r=0.56,P＜0.01). Conclusions The clinical efficacy and prognosis can be assessed by the changes of VEGF level and EPC ratio before and after PCI operation in AM1 patients.

Objective To evaluate the effectiveness and safety of hyperbaric oxygen (HBO) therapy as an adjunctive therapy for children with dyskinetic cerebral palsy. Methods Seventy-one children with dyskinetic cerebral palsy aged 6 mouths to 2 years were randomly assigned to a HBO group ( n = 35 ) or a control group ( n = 36).All children were given conventional rehabilitative treatment, but the children in the HBO group in addition received 40 sessions of HBO therapy. HBO was administered for 1 h with 85% ～ 90% oxygen at 1.4 atmospheres absolute pressure. All the treatments in both groups continued for 8 weeks. Gross motor function was evaluated with a gross motor function measure ( GMFM ), global motor performance was assessed with a psychomotor development index (PDI), and intelligence was assessed with a mental development index (MDI). Clinical assessments were done before and after treatment. At the same time, hearing impairment was measured using brainstem auditory evoked potentials (BAEPs) in the HBO group. Results All outcomes in both groups improved significantly over the course of study. The average improvement in GMFM in the control group was significantly greater than in the HBO group but other differences were not statistically significant. Hearing impairment developed in 8 children treated with HBO.Conclusion There was no evidence that HBO therapy improved the condition of children with dyskinetic cerebral palsy, and there is a risk of side effects with HBO therapy.

Objective To evaluate 99Tcm-MIBI imaging in patients with hyperparathyroidism and its correlation with serum intact PTH level. Methods Seventy patients with suspicious hyperparathyroidism underwent 99Tcm-MIBI imaging and serum intact PTH measurement. Abnormal increased uptake lesion appeared at early phase and even more clearly at delayed phase was considered as the positive by 99Tcm-MIBI imaging. A cut-off value of PTH ＞ 88 ng/L was taken as the criteria for hyperparathyroidism diagnosis. The diagnostic efficacy of 99Tcm-MIBI imaging combined with serum PTH measurement was assessed according to post-surgical histopathology or clinical follow-up. For those operated patients, Pearson correlation coefficient between serum PTH and the gland volume was calculated. Results Hyperparathyroidism was confirmed in 38 patients by histopathology (n = 36) or follow-up (n = 2). The overall diagnostic accuracy of 99Tcm-MIBI imaging was 90.0% (63/70), in which the accuracy was 80.0% (12/15) for patients with normal serum PTH and 92.7% (51/55) for those with elevated serum PTH. False positive 99Tcm-MIBI imaging were found in 3 patients with normal serum PTH. The diagnostic accuracy of abnormally high serum PTH combined with 99Tcm-MIBI imaging was 94.3% (66/70). There was a positive correlation between serum PTH level and the volume of pathologic parathyroid glands (r = 0.782, P ＜ 0.001 ). Conclusions Serum PTH measurement may help to improve the diagnostic accuracy of 99Tcm-MIBI imaging in patients with hyperparathyroidism.

Objective To explore the reconstructive methods of keeping cardiac function after resec- tion of cardiac carcinoma. Methods After anastomosis of esophageal mucosa and sub-mueosa with gastric counterparts, oblique invagination with gastric ehorion and visceral muscle were adopted in experimental group to keep cardiac anatomical and physiological function.Additionaly, tissues around pylorus were suffi- ciently dissociated to keep pylorie function.Contrastively,regular anastomosis with GF-1 26/28 after resection of cardiac carcinoma was adopted to reconstruct cardia,with thread marked 4 intervally used to reinforce anastomotic ostium in control group.The sphincter of pylorus was dilated to prevent pylorospasm and obstruc- tion.Results In experimental group,no anastomotic leakage,anastomotic stricture and gastroesophageal re- flux occurred.In control group,the incidence of anastomotic leakage and anastomotic stricture were 2.8 %(1/ 36)and 50 %(18/36)respectively,and pH≤4 at anastomotic ostium were found in 12 eases,accounting for 33.3 %, and pH≤6 in 29 cases, accounting for 80.6 %(29/36). Conclusion The reconstructive method of keeping cardiac and pyloric function in resection of cardiac carcinoma benefits recovery of post-operation pa- tients and improve their life quality.

Objective To explore the expression and function of miR-125b, miR-30b and miR-424 in endometrial cells. Methods Human endometrial samples were obtained in natural cycles and stimulating cycles. Endometrial epithelial cells (EECs) and endometrial stromal cells (ESCs) were isolated and confirmed by immunofluorescence. The expressions of miR-125b, miR-30b and miR-424 were detected by real-time PCR. Results The expression levels of miR-125b, miR-30b and miR-424 were higher in proliferative phase in ESCs than those in EECs. And in EECs, the expression levels of miR-125b, miR-30b and miR-424 were significantly up-regulated in secretory phase than in proliferative phase, while it was stable in ESCs. In addition, the expressions of miR-125b in EECs and miR-30b were increased in ESCs in women with elevated progesterone on the day of HCG administration than those of the control. The target genes of miR-125b, miR-30b and miR-424 mainly participated in cell migration and motion, cell-cell adherens junction and Wnt signaling pathway. Conclusion miR-125b, miR-30b and miR-424 were differently expressed in endometrial cells in different phases, and may participate in regulation of endometrial receptivity.

OBJECTIVE:To screen and identify endophytic fungi from Schisandra chinensis with antioxidant activity. METH-ODS:The tissue isolation skill was used to isolate endophytic fungi from roots,leaves,stems and fruits of S. chinensis. And anti-oxidant activity of endophytic fungi were screened by DPPH radical scavenging assay and hydroxyl radical scavenging assay. The to-tal DNA were extracted;the 18S rDNA ITS were amplified and sequenced with primer ITS1 and ITS4;the results of sequencing were analyzed comparatively based on homology to confirm the classification of active strains. RESULTS:23 strains were isolated from S. chinensis. GSR-12,isolated from roots of S. chinensis,had strong antioxidant activities. The scavenging rate on DPPH and the hydroxyl radical were 87.96% and 82.31% respectively. GSR-12 strain was identified as Clonostachys rosea by analyzed com-paratively. CONCLUSIONS:1 strain of C. rosea,isolated from roots of S. chinensis,has strong antioxidant activity.

Objective To define dynamic changes of viral loads and antibody responses in ICR mice naturally infected with hepatitis virus in an MHV contaminative facility .Method A total 50 ICR were housed by different “dirty bedding” exposure.Antigen and antibody was detected after 2,4,8,14,21,28,35,42,56 and 84 days.Result Mouse hepatitis virus (MHV) was detected in lung after 2 days, and positive rate is 20% (1/5).MHV was detected in lung, liver, cecal and feces during 4 and 56 days.The positive rate was 0/5 in lung, liver, cecal and feces on 84 days after experiments.Antibody positive rates were 100%during 8 and 84 days.Conclusion Serological method can be used as the main method for the diagnosis of the daily supervision , and antigen detection method can only be applied to early diagnosis .