This paper analyzes the reform backgrounds, mechanisms and measures of financing and payment taken in the second-generation national health insurance (NHI) in Taiwan. The results indicate that in 2nd NHI, the rate was adjusted more flexibly, supplementary insurance premium was charged to enlarge the financial source by im-plicating additional subsidies and expanding the sources of financing, multiple payment methods and auxiliary assis-tive means were used to control the growth of medical expenses, social insurance payments are specified in terms of category or clear payment projects and standards, new health technology assessments are used as new basis for deci-sion making, etc. by greatly alleviating the financial deficit, which helped achieve the financial balance again. Many features of the 2nd NHI in Taiwan, especially like its diversified financial resources and financing methods, global budget of control fees and DRGs payment systems, making evaluation criteria for medical quality control and health insurance reimbursement project development and so on, are worth learning for the mainland China.

Objective To analyze setup errors for irradiation of pelvic carcinoma by online conebeam CT (CBCT) scanning and to calculate the external margins from clinical target volume (CTV) to planning target volume (PTV) in treatment planning. Methods Twelve patients with rectal or prostate cancer were enrolled in this study. Translational errors (x,y,z) and rotational errors (u,v,w) were obtained by using CBCT in radiotherapy. Results The set-up errors were gathered from 229 sets of CBCT in 12patients. The systemic ± random errors on x,y,z, u,v and w axes were (0.49 ± 1.18) mm, (-0. 11 ±3.45) mm, (-2. 00 ± 1.59) mm, 1.14°±0. 67°, 0. 42°±O. 94°and -0. 32°±±0. 68°, respectively. Setup errors in the left-right, anterior-posterior, and superior-inferior directions were 4. 6 mm, 12. 5 mm, and 6. 2 mm, respectively. Conclusions Set-up errors were unavoidable in pelvic carcinoma irradiation. To minimize the influence of set-up errors, we suggest a PTV margin of 5 mm, 15 mm and 10 mm in the leftright, anterior-posterior and superior-inferior directions, respectively.

OBJECTIVETo study the effect of waterlogging stress on medicinal Chrysanthemum morifolium during the seedling stage and build a reliable evaluation of flooding tolerance indicator system.

METHODThe three cultivars: C. morifolium cv. Hongxinju, C. morifolium cv. Xiaobaiju and C. morifolium cv. Changbanju were studied for the and the effect of waterlogging stress on their physiological and biochemical chracteristics.

RESULTWith the extension of waterlogging, the content of chlorophyll and relative leaf water potential were decreased, meanwhile malonaldehyde (MDA), glutathione (GSH) and soluble sugar were increased. The catalase (CAT) of C. morifolium cv. Hongxinju rose at first and then dropped and CAT of C. morifolium cv. Xiaobailu and C. morifolium cv. Changbanju declined at first before decreased, and then dropped again. The peroxidase (POD) rose firstly before decrease and then increases again. After the waterlogging treatments which last for 4 days, the physiology and biochemistry characteristics can not restore to the comparison (CK) within 3 days.

CONCLUSIONFour days waterlogging treatment had made serious damage on medicinal Chrysanthemum. Among three cultivars, C. morifolium Ramat. cv. Hongxinju showed the highest tolerance ability, while C. morifolium cv. Changbanju was the lowest, and C. morifolium cv. Xiaobaiu was in the middle. The malonaldehyde (MDA) and catalase (CAT) could be the main physiological and biochemical indexes to reflect the tolerance ability against waterlogging.

Carbohydrate Metabolism ; Carbohydrates ; analysis ; Catalase ; analysis ; metabolism ; Chrysanthemum ; chemistry ; enzymology ; physiology ; Dehydration ; Malondialdehyde ; analysis ; metabolism ; Peroxidase ; analysis ; metabolism ; Plant Proteins ; analysis ; metabolism ; Seedlings ; chemistry ; enzymology ; physiology ; Water ; metabolism

OBJECTIVETo study the effects of soil factors on the active component content of Chrysanthemum morifolium and screen out the leading factors.

METHODThe active component of water soluble extracts, flavonoids, phenolic compounds and mineral elements were determined and chemical properties and mineral elements of soil were analyzed for studying the effects on Ch. morifolium through correlation, stepwise regression, path and grey correlation analysis.

RESULTSoil available P and K were the most important factors that affected the active component content of Ch. morifolium, followed by urease, phosphatase and invertase activities and organic matter. The mineral elements in Ch. morifolium and in soil correlated well, P and K were enriched in the plant mostly, followed by Cd, Ca, Zn, Cu. The main leading factors of mineral elements in soil were P and K, followed by Fe, Cu and Zn.

CONCLUSIONSoil was one of the important factors which affected the active component content of Ch. morifolium.

Agriculture ; methods ; Chrysanthemum ; chemistry ; drug effects ; metabolism ; Ecosystem ; Environmental Monitoring ; methods ; Minerals ; pharmacology ; Pleasure ; Potassium ; pharmacology ; Soil ; analysis ; Soil Pollutants ; pharmacology ; Water ; physiology

Objective:To explore the safety, feasibility and clinical value of the "posterior colon approach, uncinate process first" of total laparoscopic pancreaticoduodenectomy in low volume hospitals.Methods:The clinical data of 3 patients who underwent complete laparoscopic pancreaticoduodenectomy were analyzed from January 2020 to August 2020.Results:All the 3 patients successfully underwent total laparoscopic pancreaticoduodenectomy. For the 3 patients, the operative time was 430, 385 and 425 min, and the blood loss was 550, 420 and 400 ml. After the operation, no pancreatic fistula, bile leakage, intestinal fistula and astric emptying disorder were found in the patients. The exhaust time of the 3 patients was 4, 5 and 5 days after the operation, respectively. On the 6th day after the operation, the gastric tube was removed. The extraction time of the abdominal drainage tube of the 3 patients was the 7th, 7th and the 9th day, and the postoperative hospital stay was 18, 15 and 16 days, respectively. Postoperative pathological diagnosis results showed that the 3 patients included 1 case of pancreatic head high-moderately differentiated ductal adenocarcinoma, 1 case of duodenal ampullary high-moderately differentiated adenocarcinoma, and 1 case of duodenal papillary well-differentiated adenocarcinoma.Conclusions:"Posterior approach of uncinate process" is safe and feasible in laparoscopic pancreaticoduodenectomy. It can be popularized in low volume hospitals.

In the emergency department, open endotracheal suctioning for mechanically ventilated patients with endotracheal intubation will lead to the spread of respiratory droplets and aerosols, polluting the surrounding environment and medical staff. The traditional heat-and-moisture exchanger has the effect of warming and humidifying, and can block pathogenic microorganisms, but it does not have the function of inserting a sputum suction tube. When the heat-and-moisture exchanger is pulled out for sputum suction, it is easy to cause sputum splash, which pollutes the surrounding environment and medical personnel. The addition of closed sputum suction devices will increase the economic burden on patients. Thus, the medical staff of emergency department of the First People's Hospital of Tongxiang City of Zhejiang Province designed a new type of heat-and-moisture exchanger with anti-splash sputum suctioning function and obtained the National Utility Model Patent of China (ZL 2021 2 0017615.0). The new heat-and-moisture exchanger is mainly composed of a receiving cavity, a connecting tube, a sputum suction tube intubation tube, a sealing valve, etc. The disposable sputum suction tube can be used to insert sputum suction, and at the same time, it can prevent the secretion from splashing to ensure sealing. The patent combines the humidification and pathogen blocking functions of the heat-and-moisture exchanger with the anti-splash sputum suctioning function, which is suitable for use in the emergency and critical care medicine departments and has clinically practical value.

Tolfenamic acid (TA) is a traditional non-steroid anti-inflammatory drug (NSAID) and has been broadly used for the treatment of migraines. Nuclear factor kappa B (NF-kappaB) is a sequence-specific transcription factor and plays a key role in the development and progression of inflammation and cancer. We performed the current study to investigate the underlying mechanisms by which TA suppresses inflammation focusing on NF-kappaB pathway in TNF-alpha stimulated human normal and cancer cell lines and lipopolysaccharide (LPS)-stimulated mouse macrophages. Different types of human cells (HCT116, HT-29 and HEK293) and mouse macrophages (RAW264.7) were pre-treated with different concentrations of TA and then exposed to inflammatory stimuli such as TNF-alpha and LPS. Transcriptional activity of NF-kappaB, IkappaB-alpha-degradation, p65 translocation and mitogen-activated protein kinase (MAPK) activations were measured using luciferase assay and Western blots. Pre-treatment of TA repressed TNF-alpha- or LPS-stimulated NF-kappaB transactivation in a dose-dependent manner. TA treatment reduced degradation of IkappaB-alpha and subsequent translocation of p65 into nucleus. TA significantly down-regulated the phosphorylation of c-Jun N-terminal kinase (JNK). However, TA had no effect on NF-kappaB signaling and JNK phosphorylation in HT-29 human colorectal cancer cells. TA possesses anti-inflammatory activities through suppression of JNK/NF-kappaB pathway in different types of cells.
Animals ; Blotting, Western ; Cell Line ; Colorectal Neoplasms ; Humans ; Inflammation ; JNK Mitogen-Activated Protein Kinases ; Luciferases ; Macrophages ; Mice ; Migraine Disorders ; NF-kappa B* ; Phosphorylation ; Protein Kinases ; Transcription Factors ; Transcriptional Activation ; Tumor Necrosis Factor-alpha

Iron is an essential trace element for both humans and bacteria. It plays a vital role in life, such as in redox reactions and electron transport. Strict regulatory mechanisms are necessary to maintain iron homeostasis because both excess and insufficient iron are harmful to life. Competition for iron is a war between humans and bacteria. To grow, reproduce, colonize, and successfully cause infection, pathogens have evolved various mechanisms for iron uptake from humans, principally Fe 3+ -siderophore and Fe 2+ -heme transport systems. Humans have many innate immune mechanisms that regulate the distribution of iron and inhibit bacterial iron uptake to help resist bacterial invasion and colonization. Meanwhile, researchers have invented detection test strips and coupled antibiotics with siderophores to create tools that take advantage of this battle for iron, to help eliminate pathogens. In this review, we summarize bacterial and human iron metabolism, competition for iron between humans and bacteria, siderophore sensors, antibiotics coupled with siderophores, and related phenomena. We also discuss how competition for iron can be used for diagnosis and treatment of infection in the future.
Humans ; Siderophores/metabolism* ; Iron/metabolism* ; Bacteria ; Anti-Bacterial Agents/pharmacology* ; Biological Transport

Objective: To evalate the effectiveness and suitability of a wearable health monitoring device for community-based management of hypertension. Methods: In December 2015, 400 patients with hypertension were enrolled from Beijing, Chaoyang. Subjects were divided into an experimental group (220 cases) and control group (180 cases), and baseline data were collected. The control group received follow-up with general planning while the experimental group received wearable health devices. Follow-up was performed three times using a questionnaire (April, August, and December 2016), and medical staff provided feedback and guidance. The experimental group was also classified according to risk factors and intervention measures were individually designed, and included monitor and medication compliance, self-management ability, and social support. Communication between patients and medical staff was recorded to form a case system. Evaluation indexes included accuracy and reliability, blood pressure management efficacy, behavior intervention efficacy, satisfaction, and disease burden. A t-test, non-parametric test, and chi-square test were used to compare the experimental and control groups before and after intervention. Results: At 1-year follow-up, after correcting for differences in baseline information between the two groups, statistically significant differences in numerical indexes were observed for number of visits within 1 month [1(1) vs. 1(1), Z=5.42], payment within 1 month [85(141) yuan vs. 40(70) yuan, Z=-2.66], visiting time [20(20) min vs. 20(15) min, Z=-2.82], exercise times [4.79(2.24) times/week vs. 4.09(2.00) times/week, Z=9.27], medication compliance score [7.33(5.77) vs. 8.70(5.24), Z=6.86], satisfaction [9.27(0.08) vs. 8.88(0.10), Z=11.77], diastolic pressure [(78.93±0.56) mmHg vs. (81.32±0.61)mmHg, F=8.70] (1 mmHg=0.133 kPa), and body mass index [(25.55±0.27) kg/m² vs. (27.74±0.43) kg/m², F=-2.24]. In addition, classification indexes adjusted for normalized blood pressure and habitus were different between experimental and control groups (χ²=3.89, 8.38, P≤0.05). The equipment worked well, with performance rates of over 90% (90.9%, 97.3%, and 92.7%). Conclusion The wearable health monitoring equipment showed good stability and reliability, and was able to effectively support health management in patients with hypertension in the community. At the same time, the equipment can improve healthy lifestyle compliance and awareness or self-management of blood pressure. In this manner, the burden of disease is reduced and the quality of life is improved.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.