Objective: This study aims to analyze the effects of catastrophic disease insurance (CDI), especially to evaluate the influences of CDI on the discrepancy of benefits between the patients covered by the Employee's Medical Insurance (EMI) and the Resident's Medical Insurance (RMI).Methods: The data used in the study are collected from the health insurance database of Zhuhai City in the years of 2012 and 2014.A descriptive analysis is made to depict the general situation of CDI in the city, and a logistic regression model is used to analyze the factors that affect the probability to get the benefits of CDI.Moreover, a triple difference model is built up to probe into the CDI's effects on the discrepancy of reimbursement ratio between patients covered by EMI and RMI.Results: The benefits of CDI favor the patients with old age, high medical expenditures and chronic diseases.When other factors are controlled, patients covered by EMI have lower probability to get CDI benefits than those covered by RMI.Within the patients with high medical expenditures who have gotten the CDI benefits, those covered by EMI enjoy higher reimbursement ratio than those covered by RMI, but CDI decreases the discrepancy by 3.2%.Conclusions: Since the CDI gives more favor to the vulnerable population and narrows the gap of the benefits between EMI and RMI, the policy improves the equity of health security.

Objective:To observe the therapeutic effect of recombinant human brain natriuretic peptide (rhBNP)on patients with cardiorenal syndrome.Methods:The data of 75 patients,who were diagnosed as cardiorenal syndrome and hospitalized in our hospital,were retrospectively analyzed.They were randomly divided into routine treatment group (n=40,received routine treatment)and rhBNP group (n=35,received rhBNP based on routine treatment) according to number table method.The rhBNP was pumped with 0.0075μg·kg-1 ·min-1 using micropump intrave-nously,once/day,about 10h/time and 7d was regarded as a course of treatment.Changes of 24h urine volume,N terminal pro brain natriuretic peptide (NT-proBNP),glomerular filtration rate (GFR)and echocardiograph were recorded in all patients before and 7d after treatment.Results:Compared with routine treatment group after treat-ment,there were significant increase in total effective rate (62.5% vs.94.3%),24h urine volume [(785.2 ± 143.4)ml vs.(965.34±171.8)ml],GFR [(34.1±2.6)ml/min vs.(45.2±5.6)ml/min]and left ventricular e-jection fraction [(35.6±5.5)% vs.(45.9±6.8)%],and significant reduction in NT-proBNP level [(3451.1± 1314.2)pg/ml vs.(1516.43 ± 431.52)pg/ml]in rhBNP group,P<0.01 all.Conclusion:Recombinant human brain natriuretic peptide is safe,effective and can improve renal function in treating patients with cardiorenal syn-drome.

Objective: To explore the relationship between the ratio of neutrophil/lymphocyte (NLR) and in-hospital major adverse cardiac events (MACE) in patients with acute ST-elevation myocardial infarction (STEMI) at early admission.
Methods: A total of 420 acute STEMI patients admitted and received primary PCI in our hospital from 2010-01 to 2014-12 were retrospectively studied. The patients were divided into 2 groups:In-hospital MACE group, n=47 and Normal discharged group, n=373. Uni-and multivariate analyses were conducted to assess whether high NLR is the independent predictor for in-hospital MACE occurrence.
Results: Univariate regression analysis indicated that the occurrence rate of in-hospital MACE in high NLR patients were higher than those in low NLR patients (OR=3.19, 95%CI 1.55-2.65, P=0.012). Multivariate regression analysis showed that high NLR was the independent risk factor for in-hospital MACE occurrence in STEMI patients (OR=3.05, 95%CI 1.59-10.54, P=0.015).
Conclusion: High NLR is the independent risk factor for in-hospital MACE occurrence in STEMI patients at the early admission.

Objective To explore the value of Multiple b value DWI ( MbDWI ) in the short-term efficacy evaluation of cyberknife radiotherapy for locally advanced pancreatic cancer ( LAPC ) .Methods A total of 36 patients underwent both conventional sequence and respiratory triggered MbDWI ( b=0, 25, 50, 75, 100, 150, 200, 400, 600, 800, 1 000 s/mm2 ) before cyberknife radiotherapy, 1month and 3 months after the radiotherapy, respectively.ADCtot, f, Dfast and Dslow were calculated using single and double exponential model and the changes before and after radiotherapy were observed.Results Before radiotherapy, 1 month and 3 months after radiotherapy, the ADCtot values of solid lesions were (1.56 ±0.29) ×10-3 mm2/s, (1.75 ±0.31) ×10 -3 mm2/s and (18.6 ± 0.46) ×10 -3 mm2/s;the values of Dslow were (1.10 ±0.73) × 10 -3 mm2/s, ( 1.19 ±0.97 ) ×10 -3 mm2/s and ( 1.49 ±04.6 ) ×10 -3 mm2 s/; the values of Dfast were (83 .33 ±62 .57) ×10 -3 mm2/s,(124.57 ±123.10) ×10 -3 mm2/s and (108.07 ±96 .67) ×10 -3 mm2 /s; f values were (26.81 ±23.74)%,(23.61 ±22.75)% and (21.34 ±15.36)%, respectively.ADCtot values 1 month and 3 months after treatment were significantly higher than those before treatment and Dslow 3 months post-treatment was higher than that before treatment, and the differences were statistically significant ( both P<0.05) and no other differences between two groups were significant.There were no statistical differences on Dfast and f before and after radiotherapy.Conc lusions ADCtot and Dslow both showed a significant growth trend after cyberknife radiotherapy.The advanced degree of parenchymal cystic in the targeted lesion could reflect the short-term efficacy of cyberknife treatment.

Objective To explore the role of viral infection in the development of drug eruption in patients with HIV infection, and to evaluate the efficacy of antiviral treatment. Methods This study enrolled 87 HIV-positive patients, including 11 with and 76 without drug eruption, all of whom received highly active antiretroviral therapy(HAART). Clinical data on, baseline CD4+ and CD8+ T cell counts and CD4/CD8 ratio in these subjects were retrospectively analyzed. Results The severity of drug eruption was mild in the 11 HIV-positive patients, with a mean latency period of (14.00 ± 8.10)(range, 8 - 34)days. Of the 11 patients with drug eruption, 7 had liver function impairment, which was not in accordance with the severity of skin lesions. Drug eruption was controlled in all the 11 patients after anti-anaphylactic treatment without withdrawal of antiviral drugs. Compared with 75 HIV-positive patients without drug eruption, the 11 HIV-positive patients with drug eruption showed significantly increased baseline CD4 + T cell counts (493.00 ± 245.68 (range, 42 - 810)/μl vs. 347.81 ± 167.00 (range, 11 - 814)/μl, t = 647.50, P < 0.05), but decreased proportion of patients with baseline CD4+ T cell counts below the lower limit of normal(3/11 vs. 48/75(64.00%), X2 = 3.95, P < 0.05). There were no significant differences between 10 patients with drug eruption and 69 patients without drug eruption in the baseline CD8+ T cell count(1472.30 ± 858.55/μl vs. 1356.59 ± 684.06/μl, P > 0.05), CD4/CD8 ratio(0.40 ± 0.27 vs. 0.29 ± 0.16, P > 0.05), or percentage of patients with a CD4/CD8 ratio below the lower limit of normal (9/10 vs. 68/69 (98.55%), P >0.05). Conclusions The latency period of drug eruption seems to be long in HIV-positive patients receiving HAART, and mild drug eruption can be complicated by liver function impairment in the patients. Relatively high CD4 + counts may be a risk factor for the development and aggravation of drug eruption in HIV-positive patients.

Objective To investigate the phenotypic and genetic characteristics of the lysostaphin‐resistant Staphylococcus aureus variants induced by recombinant lysostaphin in vitro .Methods Three clinical isolates of S . aureus ,including two resistant to methicillin (MRSA ) and one susceptible to methicillin (MSSA ) were induced by treatment with sub‐MIC of recombinant lysostaphin via one‐step selection in vitro .Susceptibility of the variants to antibiotics were determined and compared with their parental strains .The full length of femABX genes was amplified by polymerase chain reaction and sequenced to identify the potential mutation sites in these genes .The growth‐curve in liquid medium and virulence in a mouse systemic infection model of both parental and variant strains were observed . Results The frequency of lysostaphin resistance in S . aureus was between 10-4 to 10-8 following induction by lysostaphin . Resistance to lysostaphin was associated with a significant decrease in growth rate in vitro and virulence in vivo ,as well as increased susceptibility toβ‐lactams evidenced by the M IC of β‐lactams against the variants as low as 1/4 000 to 1/2 of the M IC against their parental strains . Sequencing of f emA BX genes showed mutation in femA gene in both variants ,which resulted in a premature termination codon .Conclusions Resistance of S . aureus to lysostaphin may develop following induction by recombinant lysostaphin in vitro . The lysostaphin‐resistant S . aureus variants are characteristic of lower growth rate , decreased virulence ,and higher susceptibility to β‐lactams .

Objective To evaluate the short-term therapeutic efficacy of Cyberknife in alleviating the pain of locally advanced pancreatic cancer (LAPC) and explore the application of DWI in the pain evaluation.Methods Visual analogue scale (VAS) and Quality of life score KPS were conducted in 36 LAPC patients before and 1 month,3 month after radiotherapy,who underwent conventional MRI examination and DWI scan.The changes of VAS and KPS scores were observed before and after the treatment,as well as the apparent diffusion coefficients (ADC) changes of region of interest (ROI) in the DWI images,and the correlation of ADC with KPS and VAS was analyzed.Results VAS before and at 1 month and 3 month after the treatment was (4.89 ± 2.89),(1.08 ± 2.06) and (0.51 ± 1.48).KPS before and at 1 month and 3 month after the treatment was (72.47 ± 14.74),(93.33 ± 10.69) and (92.86 ± 10.73).ADC of DWI before and at 1 month and 3 month after the treatment was 1.47 ± 0.28,1.79 ± 0.33 and 1.94 ± 0.41,and the differences were statistically significant (all P values ＜0.001).VAS was obviously decreased at 1 month and 3 month after the treatment,while KPS and ADC were greatly increased,and the differences were statistically significant (P value ＜ 0.05).There was no statistical difference between those at 1 month and those at 3 month.There was no obvious correlation between ADC and VAS and KPS at 1 month and 3 month after the treatment.Conclusions After Cyberknife treatment,the pain was obviously relieved and the life quality was greatly improved within short period,but ADC of DWI can not sensitively monitor the changes of the pain.

A U-Net incorporating improved Transformer and convolutional channel attention module is designed for biventricular segmentation in MRI image.By replacing the high-level convolution of U-Net with the improved Transformer,the global feature information can be effectively extracted to cope with the challenge of poor segmentation performance due to the complex morphological variation of the right ventricle.The improved Transformer incorporates a fixed window attention for position localization in the self-attention module,and aggregates the output feature map for reducing the feature map size;and the network learning capability is improved by increasing network depth through the adjustment of multilayer perceptron.To solve the problem of unsatisfactory segmentation performance caused by blurred tissue edges,a feature aggregation module is used for the fusion of multi-level underlying features,and a convolutional channel attention module is adopted to rescale the underlying features to achieve adaptive learning of feature weights.In addition,a plug-and-play feature enhancement module is integrated to improve the segmentation performance which is affected by feature loss due to channel decay in the codec structure,which guarantees the spatial information while increasing the proportion of useful channel information.The test on the ACDC dataset shows that the proposed method has higher biventricular segmentation accuracy,especially for the right ventricle segmentation.Compared with other methods,the proposed method improves the DSC coefficient by at least 2.83%,proving its effectiveness in biventricular segmentation.

Artificial joint replacement is an important means for the treatment of severe joint end-stage diseases such as hip and knee joint,which has obtained satisfactory clinical efficacy,but the postoperative periprosthetic osteolysis (PPO),which is mediated by wear particles,restricts the long-term effect of artificial joints.It is found that wear particles increase the expression of cytokines and inflammatory factors by stimulating the cells around the prosthesis,activate different signaling pathways,promote the imbalance between bone formation mediated by local osteoblasts and bone resorption mediated by osteoclast so as to lose of the local bone mass,and eventually produce osteolysis and aseptic loosening.This article reviews the different signal pathways activated by wear particles in recent years,in order to explore the pathogenesis of PPO and to open up new avenues for its prevention and treatment.

Objective To investigate the role of signal transducer and activator of transcription 3 (STAT3) on the expression of surfactant proteins (SP) in alveolar epithelial cells line A549.Methods STAT3 overexpression lentivirus vector was constructed and transfected into A549 cells.Three small interfering RNAs (siRNA) were chemically synthesized and transfected into A549 cells by Lipofectamine 3000 to construct cells that silenced STAT3.The expression of STAT3,SP-A,SP-B,SP-C and SP-D were detected by Real-time PCR and Western blot.Results In A549 cells,over-or under-regulation of STAT3 were constructed successfully.When STAT3 was rendered over-expressed,the expression of SP-A,SP-B,SP-C,SP-D mRNA was significantly increased compared with Mock group(P ＜ 0.05).The proteins were found to be significantly increased as well.By contrast,when STAT3 was under-expressed,SP was down-regulated (P ＜ 0.05).Conclusion STAT3 regulates the expression of pulmonary surfactant proteins in A549 cells.Over-expression of the STAT3 gene promotes the expression of SP,and its under-expression inhibited it.