Discussions on Commercial Insurance Agencies Undertaking Claiming Services for Basic Medical Insurances / 中国卫生经济

It started with the legitimacy of commercial insurance agencies undertaking claiming services for basic medical insurances.Experiences and warnings from the international world in this area were examined and causes behind it were scrutinized,under a context of the contracting-out of public services.The domestic picture was also drew and arguments were given.A three-step strategy was suggested for China's contracting-out of claiming services for basic medical insurances.

Effect of stress-induced hyperglycemia on myocardial perfusion and prognosis in elderly patients ;with acute myocardial infarction undergoing primary percutaneous coronary intervention / 中国医师进修杂志

Objective To investigate the effect of stress-induced hyperglycemia (SHG) on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods In this study, 459 elderly patients with first-time occurrence of acute ST-elevation myocardial infarction (STEMI) who underwent primary PCI within 12 h from January 2012 to January 2015 were enrolled and followed up. All patients were divided into three groups according to serum glucose (SG) on admission: normal group (SG11.1 mmol/L, 142 patients). Myocardial perfusion indexes, including ST segment resolution (STR), TIMI myocardial perfusion grade (TMPG), peak value of creatine kinase (CK)-MB, left ventricular ejection (LVEF), and major adverse cardiac events (MACE) of patients in three groups were measured and compared after emergency PCI. Results The blood glucose levels were increased, ST-elevation 2 h after PCI were well declined, the percentages of patients with TMPG 2-3 were decreased and peak values of CK-MB were increased in the three groups (P<0.05). After 12 months of follow-up, Kaplan-Meier survival analysis showed that cumulative non-events survival rates in three groups had significantly different: 89.2% (132/148) vs. 85.8% (145/169) and 76.1% (108/142), P<0.05. Multivariate Cox regression analysis showed that SHG was the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender (P<0.05). Conclusions SHG in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI, which will lead to high incidence of MACE.

Investigation of the current state of pension security for rural doctors in several provinces / 中国卫生政策研究

Objectives: To investigate the current state of pension security for rural doctors in 12 provinces those have not introduced related policies. Methods:Two counties were chosen in each province. Data was analyzed in terms of coverage, types and intention of pension security for rural doctors in these areas. Results:The study found that the proportion of rural doctors with pension security was 81. 4% in these areas. 57. 1% of rural doctors with pen-sion security had urban and rural pension insurance. Differences exist among these areas. The safeguard level is too low, and the willingness of rural doctors to attend to pension security is not strong enough. Results:The mechanism of pension security for rural doctors must be improved. These areas should implement classified guidance and syn-chronize various models to solve the problem of pension security for rural doctors.

Impact of exogenous fibroblast growth factor 21 on atherosclerosis in apolipoprotein E deficient mice / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the effects and related mechanisms of exogenous fibroblast growth factor (FGF) 21 on atherosclerosis in apolipoprotein E deficient (apoE-/-) mice.</p><p><b>METHODS</b>Male 17-week-old C57BL/6J mice and apoE-/- mice were randomly divided into three groups (n = 12 each): blank control group (C vehicle), atherosclerosis group without FGF21 (apoE-/- vehicle) and apoE-/- plus FGF21 (100 µg × kg⁻¹ × d⁻¹ subcutaneously treatment) . All mice were fed with high-fat diet for 4 weeks. After 4 weeks treatments, atherosclerotic lesions in aortic arch and inner diameter of abdominal aorta were measured by ultrasonography. Plasma lipid profiles, CRP and TNFα were measured. The whole aorta and aortic root were prepared for HE and oil red O staining to analyze lesion areas.</p><p><b>RESULTS</b>There was no evident plaque in C vehicle group. TC/HDL-C, LDL-C/HDL-C, non-HDL-C, expression of CRP and TNFα were significantly higher in apoE-/- vehicle group than in C vehicle group (all P < 0.05). IMT of aorta [(156.4 ± 17.6)µm vs. (57.8 ± 7.4)µm] were significantly higher in apoE-/- vehicle group than in C vehicle group (all P < 0.05). While FGF21 significantly reduced the lesion area in aorta arch [(1.42 ± 0.16) mm² vs. (2.30 ± 0.10) mm², P < 0.05] and the inner diameter of abdominal aorta [(0.97 ± 0.03) mm vs. (0.75 ± 0.18) mm, P < 0.05] compared to apoE-/- vehicle group. Similarly, TC/HDL-C(5.11 ± 0.70), LDL-C/HDL-C(3.90 ± 0.76), non-HDL-C[(6.33 ± 1.22)mmol/L], plasma CRP[(4.20 ± 1.03)mmol/L] and plasma TNFα[(1.29 ± 0.47)mmol/L] were also reduced by FGF21( all P < 0.05 vs. apoE-/- vehicle). Moreover, FGF21 decreased the IMT[(107.2 ± 33.5)µm vs. (156.4 ± 17.6)µm], lesion area of aorta [(14.26 ± 3.5)%] vs. [(23.06 ± 4.16)%] and plaque size of aorta root [(21.75 ± 7.14)% vs. (38.03 ± 5.76)%] (all P < 0.05 vs. apoE-/- vehicle).</p><p><b>CONCLUSIONS</b>FGF21 can protect apoE-/- mice from atherosclerosis by modifying lipid profiles and downregulating CRP and TNFα expressions.</p>

Association of atherosclerotic renal artery stenosis with major adverse cardiovascular events after acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients with atherosclerotic renal artery stenosis (ARAS) are in substantial risk of cardiovascular adverse events. We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events.</p><p><b>METHODS</b>In this retrospective study, 257 patients with type 1 myocardial infarction were enrolled. Median follow-up was 42 months. Composite endpoint events are analyzed by definitions of ARAS as ≥ 50% or ≥ 70% diameter stenosis.</p><p><b>RESULTS</b>Defining ARAS as ≥ 70% diameter stenosis, ARAS was a significant predictor for composite endpoint events including death, non-fatal myocardial infarction, ischaemic stroke and intracranial haemorrhage, rehospitalisation for cardiac failure (HR: 4.381; 95% CI: 1.770-10.842) by Cox regression analysis, but not for death. Diabetes mellitus was also a significant predictor for composite endpoint events (HR: 2.756; 95% CI: 1.295-5.863). However, defining ARAS ≥ 50% diameter stenosis, ARAS was no longer a significant predictor for composite endpoint events or death.</p><p><b>CONCLUSIONS</b>Although not associated with mortality, ARAS ≥ 70% is associated with major adverse cardiac events after acute myocardial infarction. For prognosis, ≥ 70% diameter stenosis is a more appropriate criteria for ARAS definition than ≥ 50% diameter stenosis.</p>

Prognostic factors for patients after curative resection for proximal gastric cancer / 华中科技大学学报（医学）（英德文版）

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, 30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (chi (2)=4.57, P=0.0325), gross type (chi (2)=21.38, P/=5 cm (chi (2)=6.31, P=0.0120), Borrmann III/IV (chi (2)=7.96, P=0.0050), T4 (chi (2)=4.57, P=0.0325), pN2 (chi (2)=5.52, P=0.0188), MLR 10%-30% (chi (2)=4.46, P=0.0347), MLR >30% (chi (2)=13.34, P=0.0003), TNM III (chi (2)=14.05, P=0.0002) or TNM IV stage (chi (2)=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (chi (2)=5.68, P=0.0171) or MLR >30% (chi (2)=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.