At present, China's medical service costs keep rising, and residents' out-of-pocket medical expen-ses are also increasing heavily. The prepayment reform of medical insurance is considered as an important starting point to solve the problem. It is of great significance to evaluate the effect of prepaid medical insurance reform on con-trolling medical expenses and reducing economic burden when sick. In order to achieve the objective of this study, a use of CHARLS data 2011 &2015 and DIDPSM theory, and a combination of the Interaction Item Model and PSM model, and make use of a natural experiment developed from experimental reform stage for the comprehensive promo-tion stage of new rural cooperative medical system (NCMS) in 2012, were very crucial. This paper finds that:(1) Prepayment system can control the rise in outpatient and inpatient expenses. Compared with those who did not partici-pate in NCMS in the initial stage of reform, after the universal reform, outpatient and inpatient expenses dropped by 6. 3％ and 41％, the average decrease was 1041yuan and 2895yuan, respectively. (2) After the universal reform, the insured patients' medical burden of outpatient and inpatient reduced by 17％ and 33％. Prepayment system has, to some extent, resisted the rise in medical expense, and alleviated the burden of medical treatment. (3) On the basis of PSM, the estimated value and significance of coefficients have not changed, the effect of PPS reform is good. The poli-cy implication is that accelerating the prepayment system reform is the key way to control the growing medical expenses.

Alanine Transaminase/metabolism ; Liver/drug effects ; Plant Extracts/*pharmacology

Objective To compare the short-term prognostic value of glycohemoglobin (HbA1c) and admission plasma glucose in non-diabetic patients with acute ST-elevation myocardial infarction.Methods Eighty-four non-diabetic patients with acute ST-elevation myocardial infarction from January 2010 to June 2011 were included.Both HbA1c and plasma glucose was measured on admission.Cardiovascular event was followed up in 30 days.Results The average of HbA1c and admission plasma glucose was as cut-off point.The patients were divided into HbA1c ＜ 5.5％ group (40 cases) and HbA1c ≥5.5％ group (44 cases) according to HbA1c level.The patients were divided into admission plasma glucose ≤ 8.6 mmol/L group (42 cases) and admission plasma glucose ＞ 8.6 mmol/L group (42 cases) according to admission plasma glucose.The incidence of cardiovascular event in 30 days in admission plasma glucose ＞ 8.6 mmol/L group was higher than that in admission plasma glucose ≤ 8.6 mmol/L group [19.0％ (8/42) vs.2.4％ (1/42)],and there was significant difference(P＜ 0.05).There was no significant difference in the incidence of cardiovascular event in 30 days between HbA1c ≥5.5％ group and HbA1c ＜ 5.5％ group (P ＞ 0.05).Admission plasma glucose showed weak correlation with blood creatine kinase isoenzyme MB peak (r =0.233,P ＜0.05).Conclusion In non-diabetic patients with acute ST-elevation myocardial infarction,elevated admission plasma glucose levels are associated with higher cardiovascular event in 30 days.

Objective To explore the efficiency and safety of fondaparinux and low molecular weight heparin(LMWH) on the elder patients with non-ST-segnent elevation acute coronary syndromes (NSTE-ACS).Methods One hundred and forty patients over 75 years old with NSTE-ACS were randomly divided into treatment group(n =70) and control group (n =70).Patients in treatment group were given the conventional treatment combined with fondaparinux,and in control group were given the basis of conventional treatment combined with LMWH.The therapeutic efficacy,the cardiovascular events at 4 d,7 d and 30 d during the treatment and bleeding incidence rate were observed.Reslts There was no statistically significant difference between the treatment group and control group in the total effective rate (x2 =0.475,P ＞ 0.05.Meanwhile,no significant differences were found between the two groups in cardiovascular events at 4 d,7 d and 30 d (x2 =0.257,0.475 and 0.317,P ＞0.05).The incidence rate of bleeding in treatment group was obviously lower than that in control group and there was statistically significant difference (2.9％ vs.31.4％ ; x2 =20.115,P ＜0.01).Conclusion The effectiveness of fondaparinux used in elderly patients with non-ST-segment elevation acute coronary syndromes is similar with LMWH,but the incidence rate of bleeding is lower than LMWH.

Objective To explore the effect of residual renal function(RRF)on the quality of life in uremia patients with peritoneal dialysis(PD).Methods 64 patients with uremia who underwent PD for 3 months or more were selected.According to the residual glomerular filtration rate(rGFR),the patients were divided into RRF group[35 cases with rGFR≥1mL· min-1·(1.73m2)-1] and non-RRF group[29 cases with rGFR≤1mL· min-1 ·(1.73m2)-1].The patients were followed up at 3-month intervals.The quality of life was assessed using the SF-36.Results The calcium,phosphorus,parathyroid hormone,serum creatinine,C-reactive protein,serum albumin,total urea removal,serum potassium,total urea clearance in the non-RRF group were(2.29±0.25)mmol/L,(1.68±0.42)mmol/L,275.68 ng/L,(1 121.58±215.36)μmol/L,(11.02±14.35)mg/L,(31.01±3.26)g/L,(100±50)mL/d,(3.48±0.78)mmol/L,(1.71±0.28),respectively,which in the RRF group were(2.21±0.19)mmol/L,(1.59±0.35)mmol/L,147.43ng/L,(872.56±264.68)μmol/L,(5.34±8.97)mg/L,(3.43±0.59)mmol/L,(33.21±4.62)g/L,(5.34±8.97)mg/L,(33.21±4.62)g/L,(800±200)mL/d,(3.79±0.59)mmol/L,(2.01±0.41),respectively,the differences between the two groups were significant(t=2.316,2.149,2.353,3.881,2.229,7.213,2.243,2.212,4745,all P<0.05).The total physical health measurement[(48.13±18.32)points and the physiological function[(46.61±21.79)points] in the non-RRF group were significantly lower than those in the RRF group[(56.02±18.12)points,(46.61±21.79)points,t=2.379,2.341,all P<0.05].There was no significant difference between the two groups in the total mental health and SF-36(P>0.05).Univariate linear regression analysis showed that rGFR was not associated with SF-36 overall score.Multivariate linear regression analysis found that SF-36 overall score and serum calcium,phosphorus,parathyroid hormone,serum creatinine,C-reactive protein,peritoneal ultrafiltration volume had relevance(t=4.102,2.412,2.174,4.259).Conclusion There was no significant difference in overall quality of life scores and mental health scores between the RRF group and the non-RRF group.RRF was not directly related to the quality of life of the patients.

Objective To investigate the effect of rosiglitazone(RGZ) on peritoneal morphology,function and the expressions of Aquaporin 1 (AQP-1),vascular endothelial growth factor A (VEGF-A) and cyclooxygenase 2(COX-2) in uremic rat of peritoneal dialysis.Methods Thirty Sprague-Dawley rats were randomly divided into five groups.Group S (n=6) was subjected to sham operation.Group N (n=6) was subjected to nephrectomy with silicon catheter inserted,but no peritoneal exposure.Group P (n=6) was subjected to nephrectomy with silicon catheter inserted and receiving daily peritoneal injection through the catheter,using 4.25％ peritoneal dialysis fluid 10 ml twice a day for 2 weeks.Group R (n=6) was subjected to nephrectomy with silicon catheter inserted and receiving daily peritoneal injection through the catheter,using 4.25％ peritoneal dialysis fluid containing rosiglitazone (0.2 mg/kg) 10 ml twice a day for 2 weeks.Group GW (n=6) was subjected to nephrectomy with silicon catheter inserted and receiving daily peritoneal injection through the catheter,using 4.25％ peritoneal dialysis fluid containing rosiglitazone (0.2 mg/kg) and GW9662 (0.2 mg/kg) 10 ml twice a day for 2 weeks.After two weeks of dialysis,a 90 min peritoneal equilibration test was performed and the amount of ultrafiltration was accurately measured.The partial peritoneum tissues of rats were harvested and stained by hematoxylin-eosin (HE),then morphology changes of partial peritoneum were examined by light microscopy.The expression of AQP-1,VEGF-A and COX-2 in omentum were detected with immunohistochemistry assay.AQP-1,VEGF-A and COX-2 mRNA were detected by qRT-PCR.Results Morphology changes of partial peritoneum showed that compared with Group S,a dramatic increase in thickness of the mesothelium-to-muscle layer of peritoneum in Group N,P,R and GW(P ＜0.05).Compared with group P,the thickness significantly decreased in Group R(P ＜ 0.05).PET results showed that compared with Group S,ultrafiltration (UF) significantly reduced in Group P,R,and GW (P ＜ 0.05).Compared with Group P,ultrafiltration significantly increased in Group P,R,and GW (P ＜0.05).Compared with group S,the expressions of AQP1,VEGF-A and COX-2 mRNA and protein were significantly increased in group P,R and GW(P ＜ 0.05).Compared with group P,the expressions of AQP1,VEGF-A mRNA and protein were significantly decreased in Group R and GW(P ＜ 0.05).Compared with group P,the expressions of COX-2 mRNA and protein were significantly decreased in group R (P ＜ 0.05),while no differences in the expression of COX-2 mRNA and protein in group GW (P ＜ 0.05).Conclusions Rosiglitazone can inhibit peritoneal interstitial and vascular proliferation,protect peritoneal function and increase ultrafiltration.Rosiglitazone can protect peritoneal function probably by inhibiting expression of VEGF-A and COX-2.

ObjectiveTo study the types of anatomical variations of hepatic arteries. Methods Hepatic arteries of 64-slice spiral CT scanning data were three-dimensional constructed by using self-designed software. The types of anatomical variations were analyzed and classified with Michels' classification criteria. Results The model presented with realistic profile of hepatic arteries which allowed vivid three-dimensional observation. Of these patients, 40 had normal hepatic arteries (60.61%), 26 had variations (39.39%), and 5 had infrequent aberrant hepatic arteries that was not included in Michels' classification (7.58%). Conclusion Three-dimensional model of hepatic arteries can volumetricly display the anatomical variations of hepatic arteries.

Objective To compare the effects of fluvastatin and valsartan on the inflammatory cytokines in the early stage of type 2 diabetic nephropathy and their protective effects on to diabetic nephropathy. Methods Ninety patients with early stage of type 2 diabetic nephropathy were divided into three groups, 30 patients receiving routine hypoglycemic agents (DN1) as control,30 patients receiving routine hypoglycemic agents plus valsartan (DN2) and the other 30 receiving routine hypoglycemic agents plus fluvastatin (DN3). Blood glucose, blood lipid,serum creatinine and C reactive protein(CRP),24-hour urine protein,urinary albumin excretion rate (UAER) and several inflammatory cytokine were measured before and after treatment. Results ( 1 ) No significant difference of the levels of serum CRP,TGF-β1,IL-6,TNF-α, IL-18 at the baseline were observedamong these three groups.In the DN2 group,after treatment,IL.6 was([15.99±2.87]ng/L and[17.64±2. 131 ,P <0. 05) ,TGF-β1 was ( [33.54 ±10. 69] μg/L and [40. 11 ± 12. 08] μg/L,t = -2. 921 ,P <0. 01 ),IL-18 was ( [139.65±66. 37] ng/L and [158.74±74. 20]ng/L,t = -2.053,P <0. 05),CRP was ( [5. 12±3. 54] mg/L and [6. 08 ±3. 39] mg/L, t = - 2. 072, P < 0. 05 ) after and before treatment, respectively. All abovemented indices significantly decreased after treatment. In the DN3 group, IL-6 was ( [15. 39 ±2. 77] ng/L ng/L,t = -3. 651 ,P <0. 01 ) ,TGF-β1 was ( [31.19 ±10. 48] μg/L and [37. 11± 11.76] μg/L,t = -2. 963,P<0.01),IL-18 was ([141.54 ±66.65] ng/L and [158.01±73.23] ng/L,t = -2. 182,P <0.05),CRP respectively. All abovemented indices significantly decreased after treatment No significant difference was observed on inflamaory factors after treatment between the DN2 and DN3 group ( P > 0. 05). (2) In the subgroup that there was no difference in blood pressure between before and after treatment in both the DN2 and DN3 group,in the DN3 group,UAER was ([63. 1 ±31.7] μg/min and[82.9±40.0] μg/min,t = -2. 145,P <0. 05) ,24 h total urokinase protein was ( [0. 14 ±0. 11] g/24 h and [0. 18±O. 15] g/24 h, t = - 2. 438, P <0. 05 ), microalbuminuria/urine creatinine was ( [ALb/Cr] [114. 7±68. 1] mg/g and [162.0±83.8] mg/g,t = - 2. 399, P < 0. 05 ) after and before treatment. All abovemention indices significantly decreased after treatment. In the DN3 group, UAER was ( [65.5 ±32. 6]μg/min and [83.5 ±42. 1]μg/min,t = - 2. 131, P <0. 05 ),24 h total urine protein was ( [0. 14 ±0. 11] g/24 h and [0. 18±0. 15] g/24 h, t = - 2. 438, P < 0. 05 ),0. 05 ) after and before treatment. All abovemention indices significantly decreased after treatment. No significant difference was observed after treatment between the DN2 and ON3 group ( P > 0. 05 ). Conclusion Both valsartan and fluvastatin are able to protect the renal function of patients with type 2 diabetic nephropathy by decreasing the levels of urine proteins and correlated serum inflammatory cytokines.

Objective: To investigate whether grain-sized moxibustion at Xinshu (BL15) and Shenshu (BL23) can alleviate cognitive decline and other pathologic features in early-stage Alzheimer disease (AD) using transgenic mice with 5 familial AD mutations (5XFAD). Methods: The genotype of transgenic mice was detected by polymerase chain reaction. A total of 40 transgenic mice (1.5 months old) were randomly and equally allocated to an AD model group (5XFAD group) or a grain-sized moxibustion group (5XFAD + GM group), with 20 wild-type (WT) mice (C57BL/6J) serving as the normal control group (WT group). Mice in the 5XFAD + GM group were treated by grain-sized moxibustion at bilateral Xinshu (BL15) and Shenshu (BL23). Mice in the WT group and 5XFAD group received no treatment but were restrained to ensure exposure to a similar experimental condition. Cognitive function and memory were assessed with the Morris water maze and Y-maze tests. The amyloid β 40 (Aβ40) and amyloid β 42 (Aβ42) levels in the brain were evaluated by enzyme-linked immunosorbent assay; amyloid plaque deposition in brain tissue sections was detected by thioflavin-S staining; the expression of glial fibrillary acidic protein (GFAP), cluster of differentiation 11b (CD11b), brain-derived neurotrophic factor (BDNF), and choline acetyltransferase (ChAT) in the hippocampus and prefrontal cortex was analyzed by immunohistochemistry. Results: In the Morris water maze test, compared with the 5XFAD group, mice in the 5XFAD + GM group had a shorter escape latency and more target area crossings and spent more time in the target quadrant (P<0.05). In the Y-maze test, compared with the 5XFAD group, the number of training times of the 5XFAD + GM group was significantly decreased (P<0.05), together with more correct responses (P<0.05). Compared with the 5XFAD group, the levels of Aβ40 and Aβ42 in the brain tissue of the 5XFAD + GM group were significantly lower (P<0.05); in the hippocampus and prefrontal cortex, the total number of amyloid β plaque deposition were significantly lower (P<0.05); the expression levels of GFAP and CD11b were significantly reduced (P<0.05); and the expression levels of ChAT and BDNF were significantly increased (P<0.05).Conclusion: Grain-sized moxibustion at Xinshu (BL15) and Shenshu (BL23) greatly improves learning and memory functions, decreases the levels of Aβ40 and Aβ42, inhibits amyloid β plaque deposition, decreases the expression of GFAP and CD11b, and increases the expression of ChAT and BDNF in AD mice to inhibit the progression of AD.

AIM:To investigate the effect of rosiglitazone on the expression of aquaporin-1 (AQP1), vascular endothelial growth factor-A ( VEGF-A ) and cyclooxygenase-2 ( COX-2 ) in human peritoneal microvascular endothelial cells.METHODS: Cultured peritoneal microvascular endothelial cells were divided into 4 groups.The morphological changes of the cells were observed under inverted microscope .The protein expression of AQP1, VEGF-A and COX-2 in hu-man peritoneal microvascular endothelial cells was determined by Western blotting .The mRNA expression of AQP1, VEGF-A and COX-2 in the cells was measured by real-time PCR.RESULTS:Rosiglitazone stimulated the proliferation of the cells.Rosiglitazone up-regulated the expression of AQP1, and down-regulated the expression of VEGF-2 and COX-2 at mRNA and protein levels in the cells .The PPAR-γantagonist GW9662 partly inhibited the up-regulation of AQP1 expres-sion by rosiglitazone (P<0.05), but had no obvious effect on the expression of VEGF-A and COX-2 (P>0.05).CON-CLUSION:Rosiglitazone up-regulates the expression of AQP 1 and down-regulates the expression of VEGF-A and COX-2 in human peritoneal microvascular endothelial cells , thus promoting water transportation and attenuating peritoneal fibrosis during peritoneal dialysis .