Objective:To study the effects of basic medical insurance ecdemic settlement policy on health services utilization.Methods:Based on data from China Health and Retirement Longitudinal Survey conducted in 2011 and 2013, a multivariate logistic regression analysis was used to compare the effect of basic health insurance registering site on health services utilization before and after the implementation of basic medical insurance ecdemic settlement policy .Results:Af-ter the basic medical insurance ecdemic settlement policy was carried out , health services utilization was improved .Con-clusions:The basic medical insurance ecdemic settlement policy can effectively improve the portability of health insur-ances, reducing the crowd remote medical disorders of off-site medical services to improve health care accessibility .

Objective: To establish a HS CGC method for the analysis of residual petroleum ether (60～90?C) in Kanglaite Capsules.Methods: Headspace sampling, a fused silica analytical column with cross linked 95% dimethyl and 5% diphenyl siloxanes station phase (30m?320?m?0.25?m), column temperature at 40?C, a linear velocity of about 19 cm per second, FID detector.Results: The average recovery is 97.2% (RSD=2.87%, n=5). The minimal detection limit is 2.65?10 -8 g?mL -1 (signal/noise=1.3).Conclusion: The method is simple and accurate, and can be used as a control method for the residual organic solvent in the capsules.

Objective: To establish a new method for determination of ? pinene in Folium Pini. Method: The contents of ? pinene were determined by high performance capillary gas chromatography with sequential increase of temperature programming. Results: The calibration curve showed good linearity over the range of 0.424 2.12?g( r =0.9999). The average recovery was 97.9% and the relative standard deviation was 2.9%( n =5), and it was found that the contents of ? pinene in dry herbs were markedly different from the contents in fresh herbs. Conclusion: The method is simple, and accurate with a good reproducibility and can be applied as quantitative analysis method for Folium Pini.

Objectives To analyze pathogen distribution and antimicrobial resistance of bacilli among children with otitis media. Methods Pathogenic bacteria was isolated from children with suppurative otitis media. The VITEK32 was used for iden-tification. The bacterial susceptibility testing was done by Kirby-Bauer method. According to CLSI standard the antimicrobial susceptibility was determined. Results From Jan 2010 to Dec 2012, 425 children with suppurative otitis media were examined. 347 strains were isolated, of which the detectable rate was 81.65%. The detectable rate of bacteria and fungus was 93.37%(324/347) and 6.63%(23/347), respectively. Among bacteria, the detectable rate of streptococcus pneumoniae was 40.92%(142/347) and staphylococcus aureus was 33.43%(116/347). The detectable rate of haemophilus influenza was 7.78%(27/347). The preva-lence of streptococcus pneumoniae is high in children aged 1-3years, with detectable rate at 47.09%. There was no statistical dif-ference among different age groups. The prevalence of methicillin-resistant staphylococcus aureus (MRSA) in middle ear secre-tion was 1.11%(5/45), 18.75%(9/48)and 30.43%(7/23)in 2010, 2011 and 2012 respectively, with no statistical difference (χ2=3.86, P=0.145). The prevalence of penicillin-resistant streptococcus pneumoniae (PRSP) in middle ear secretion was 9.26%, 3.92%and 27.03%in 2010, 2011 and 2012 respectively, with statistical difference (χ2=11.47, P=0.003). Conclusions Choosing correct therapy according to the result of middle ear secretion culture and antibiotics sensitive test can increase the recovery rate of otitismedia.

Objective:To predict the financial impact of artificial intelligence (AI)-assisted community-based screening for primary angle-closure glaucoma (PACG) among the elderly on health expenses and medical insurance expenditures in remote areas of China.Methods:A total of 19 395 people aged more than 65 years old from Changjiang Li autonomous county, Hainan province were enrolled.A health economic model for glaucoma screening in Wenzhou, Zhejiang province was adopted.PACG was classified as suspected primary angle closure, primary angle closure, PACG, monocular blindness and binocular blindness according to its severity.The model was adjusted in combination with the epidemiology, metastasis probability and treatment compliance, screening and referral compliance, sensitivity and specificity of AI screening from glaucoma related literature and using data on local epidemiology and health costs of glaucoma from the Changjiang Hospital of Integrated Traditional Chinese and Western Medicine from 2016 to 2019.The health outcome, total health expenses and medical insurance expenditures of AI-assisted community-based screening and no screening for PACG in 15 years were compared and analyzed.Results:It is found that the AI-assisted community-based screening would prevent disease progression and reduce the number of PACG patients by 43% (134 cases) and blind patients by 50% (9 cases) in 15 years in comparison with no screening.Under the AI-assisted community-based screening system, the early diagnosis and intervention of positive PACG patients will cause the dramatic increase of both total health expenses and medical insurance expenditures compared with no screening in the short term.It was predicted that the increasing trend of medical insurance expenditure would turn to a downward trend and show cost saving advantage at the third year, whereas the declining trend of total health expense would not occur until 10 years later.Without screening, a large number of PACG patients would progress to advanced stages, so the medical costs would continue to rise and exceed the medical costs of the screening system at the 14th year.Conclusions:The AI-assisted community-based screening for PACG is cost-effective and can prevent disease progression, save health expenses and medical insurance expenditures in the long run in remote areas of China.

Hippocampus,as an important organization of the nervous system,has a close relationship with the biology function of learning,memory and spatial cognition.It is very important to clarify the specific influence of non-ionizing radiation on the hippocampus.This paper summarized briefly the effects of nonionzing radiation on hippocampus and relevant research method.

Objective To investigate the effect of electromagnetic wave power density on the expression of glial fibrillary acidic protein(GFAP)in the hippocampus of SD rats under 1800 MHz electromagnetic wave irradiation,and whether it exhibits a"window effect".Methods Ninety-eight 4-week-old SPF-grade SD rats were randomly divided into 14 groups,with 7 rats in each group.Seven groups were exposed groups(frequency:1800 MHz,power densities:0.1 mW/cm2,0.3 mW/cm2,0.5 mW/cm2,0.7 mW/cm2,0.9 mW/cm2,1.0 mW/cm2,1.2 mW/cm2)and corresponding 7 groups were control groups(power density:0 mW/cm2).Exposure was conducted for 12 hours daily for 3 weeks.After exposure,Western Blot was used to detect the expression level of GFAP in the hippocampal tissue,and immunohistochemistry staining was performed to determine the average optical density(MOD)value of GFAP-positive expression products in the DG,CA3,and CA1 regions of the hippocampal tissue,to determine the power density window of GFAP expression in the hippocampus of SD rats under 1800 MHz exposure.Results At power densities of 0.1 mW/cm2 and 0.3 mW/cm2,Western Blot results showed increased expression of GFAP in the rat hippocampus(P<0.05),and immunohistochemistry staining demonstrated increased MOD values of GFAP in the three regions(P<0.05).Conclusion Long-term exposure to 1800 MHz elect-romagnetic radiation has a"window effect"on the expression of GFAP in the DG,CA3,and CA1 regions of the hippocampus in SD rats,with power density windows of 0.1 mW/cm2 and 0.3 mW/cm2.

Objective: To evaluate the efficiency and safety of endoscopic trans-fistula drainage (ETFD) for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy. Methods: Among 456 esophageal cancer patients receiving esophagectomy between February 2012 and February 2017 in Sir Run Run Shaw Hospital, 15 cases were diagnosed as gastroesophageal anastomotic fistula with para-fistula abscess after surgery. Seven cases received ETFD treatment (ETFD group), and 8 cases received conventional treatment (control group). Recovery of inflammatory markers and fistula, length of hospital stay after esophagectomy and total medical expenses were compared between ETFD group and control group. Results: All patients recovered in ETFD group. Time of white cell count returning to normal and decline of C-reactive protein, time of fistula healing and length of hospital stay after esophagectomy in ETFD group were significantly shorter than those of control group (all P<0.05). And medical expenses in ETFD group was also lower (P<0.05). Conclusion: ETFD is effective and safe for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy.
Abscess ; Anastomotic Leak ; Drainage ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Fistula ; surgery ; Humans ; Retrospective Studies

OBJECTIVES: Acute kidney injury (AKI) can be caused by ischemia/reperfusion (I/R), nephrotoxin, and sepsis, with poor prognosis and high mortality. Leptin is a protein molecule that regulates the body's energy metabolism and reproductive activities via binding to its specific receptor. Leptin can inhibit cardiomyocyte apoptosis caused by I/R, but its effect on I/R kidney injury and the underlying mechanisms are still unclear. This study aims to investigate the effect and mechanisms of leptin on renal function, renal histopathology, apoptosis, and autophagy during acute I/R kidney injury. METHODS: Healthy adult male mice were randomly divided into 4 groups: a sham+wild-type mice (ob/+) group, a sham+leptin gene-deficient mice (ob/ob) group, an I/R+ob/+ group, and an I/R+ob/ob group (n=8 per group). For sham operation, a longitudinal incision was made on the back of the mice to expose and separate the bilateral kidneys and renal arteries, and no subsequent treatment was performed. I/R treatment was ischemia for 30 min and reperfusion for 48 h. The levels of BUN and SCr were detected to evaluate renal function; HE staining was used to observe the pathological changes of renal tissue; TUNEL staining was used to observe cell apoptosis, and apoptosis-positive cells were counted; Western blotting was used to detect levels of apoptosis-related proteins (caspase 3, caspase 9), autophagy-related proteins [mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), LC3 I, LC3 II], mTOR-dependent signaling pathway proteins [phosphate and tension homology (PTEN), adenosine monophosphate-activated protein kinase (AMPK), protein kinase B (AKT), extracellular regulated protein kinase (ERK), phosphorylated PTEN (p-PTEN), phosphorylated AMPK (p-AMPK), phosphorylated AKT (p-AKT), phosphorylated ERK (p-ERK)]. RESULTS: There was no significant difference in the levels of BUN and SCr between the sham+ob/+ group and the sham+ob/ob group (both P>0.05). The levels of BUN and SCr in the I/R+ob/+ group were significantly higher than those in the sham+ob/+ group (both P<0.05). Compared with the mice in the sham+ob/ob group or the I/R+ob/+ group, the levels of BUN and SCr in the I/R+ob/ob group were significantly increased (all P<0.05). There was no obvious damage to the renal tubules in the sham+ob/+ group and the sham+ob/ob group. Compared with sham+ob/+ group and sham+ob/ob group, both the I/R+ob/+ group and the I/R+ob/ob group had cell damage such as brush border shedding, vacuolar degeneration, and cast formation. Compared with the I/R+ob/+ group, the renal tubules of the mice in the I/R+ob/ob group were more severely damaged. The pathological score of renal tubular injury showed that the renal tubular injury was the most serious in the I/R+ob/ob group (P<0.05). Compared with the sham+ob/+ group, the protein levels of caspase 3, caspase 9, PTEN, and LC3 II were significantly up-regulated, the ratio of LC3 II to LC3 I was significantly increased, and the protein levels of p-mTOR, p-PTEN, p-AMPK, p-AKT, and p-ERK were significantly down-regulated in the I/R+ob/+ group (all P<0.05). Compared with the sham+ob/ob group, the protein levels of caspase 3, caspase 9, PTEN, and LC3 II were significantly up-regulated, and the ratio of LC3 II to LC3 I was significantly increased, while the protein levels of p-mTOR, p-PTEN, p-AMPK, p-AKT, and p-ERK were significantly down-regulated in the I/R+ob/ob group (all P<0.05). Compared with the I/R+ob/+ group, the levels of p-mTOR, p-PTEN, p-AMPK, p-AKT were more significantly down-regulated, while the levels of caspase 3, caspase 9, PTEN, and LC3 II were more significantly up-regulated, and the ratio of LC3 II to LC3 I was more significantly increase in the I/R+ob/ob group (all P<0.05). CONCLUSIONS Renal function and tubular damage, and elevated levels of apoptosis and autophagy are observed in mice kidneys after acute I/R. Leptin might relieve I/R induced AKI by inhibiting apoptosis and autophagy that through a complex network of interactions between mTOR-dependent signaling pathways.
AMP-Activated Protein Kinases/metabolism* ; Acute Kidney Injury/pathology* ; Animals ; Apoptosis ; Apoptosis Regulatory Proteins/pharmacology* ; Autophagy ; Caspase 3/metabolism* ; Caspase 9/metabolism* ; Female ; Humans ; Ischemia ; Kidney/pathology* ; Leptin/pharmacology* ; Male ; Mammals/metabolism* ; Mice ; Proto-Oncogene Proteins c-akt/metabolism* ; Reperfusion/adverse effects* ; Reperfusion Injury/metabolism* ; TOR Serine-Threonine Kinases/metabolism*