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China has entered the task stage of comprehensive medical insurance payment reform, but there are problems restricting the development of innovative medical technology in the reform of diagnosis-related groups(DRG) payment system. The author introduced the international definition and scope of innovative medical technology, and summarized the preconditions and payment policy of short-term payment of innovative medical technology under the DRG payment system; And put forward suggestions in line with China′s actual situation, including clarifying the definition of innovative medical technology, setting access conditions for additional payment or actual payment, setting up special transition funds for high-value innovative drugs, clarifying the payment amount of innovative medical technology, and formulating payment strategies for innovative medical technology.
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Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.
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<p><b>OBJECTIVE</b>To investigate the differences of metabolic pathways of leucocyte-deplated RBCs prepared by using lipid whole blood and nomal blood during routine storage so as to provide some reference for clinical blood use.</p><p><b>METHODS</b>Twenty U whole blood from 20 donors, including 10 U lipid blood and 10 U normal whole blood, were selected for preparing leukodepleted red blood cells, red blood cells were taken from storage bags on day 0, 14 and 35, respectively. Metabolites in the red blood cells were analyzed, red blood cell metabolic extracts were detected by UPLC-MS/MS. The metabolite data of RBC from 2 groups were analyzed by SIMCA-P 13.0 software using OPLS-DA and by SPSS 19.0 using Mann-Whitney U test. Difference of metabolic pathways was described according to different metabolites.</p><p><b>RESULTS</b>The glucose, adenine, pyruvic acid, GSH, GSSG and niacinamide levels on day 0 in lipid RBCs were higher than those in the control group(P<0.05). The glucose, pyruvic acid and GSH levels on day 14 in lipid RBCs were lower than those in the control group (P<0.05), and the levels of adenine, GSSG and niacinamide were higher than that in the control group (P<0.05). The glucose level on day 0 was lower than that in the control group (P<0.05), and the levels of adenine and niacinamide were higher than those in the control group (P<0.05). but the pyruvic acid, GSH and GSSG levels were not significantly different between 2 groups (P>0.05).</p><p><b>CONCLUSION</b>Compared with the normal red blood cells, the energy metabolism pathway decreases in lipid red blood cells within the storage period and pentose phosphate pathway increases.</p>
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Humans , Blood Preservation , Erythrocytes , Glucose , Lipids , Tandem Mass SpectrometryABSTRACT
Objective To explore the effects of water extract from Jiangtang Decoction (WEJTD) on PI3K/Akt signal pathway of skeletal muscle metabolism in KK-Ay diabetic mice.Methods Totally 50 KK-Ay mice were randomly divided into five groups:model group,metformin (positive drug,250 mg/kg) group,WEJTD low,medium,and high dose (2,4,and 8 g/kg) group,with 10 C57BL/6J mice as normal group.The relative drugs were ig administered once a day for 12 weeks,and mice in control group and model group were perfused with distilled water of equal volume.After 12 weeks' oral administration,mice were executed to separate serum,serum insulin level was detected by ELISA kit method;RNA was extracted from muscle tissue by Trizol,and real-time PCR were used to detect the level of PI3K,Akt,GLUT-4,GSK-3β,GS and IRS-1 mRNA.Results WEJTD can down-regulate concentration of insulin in serum and GSK-3β mRNA in skeletal muscle (P ＜ 0.05 and 0.001),and down-regulate mRNA of PI3K,Akt,IRS-1,GLUT-4,and GS in skeletal muscle (P ＜ 0.05,0.01,and 0.001).Conclusion WEJTD decreased glycogen deposition and stimulated glucose transport in skeletal muscle through upregulation of PI3K/Akt signaling pathway.
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Objective To study the effect and mechanism of Water extract from Jiangtang Decoction (WEJTD) on diabetes mellitus and diabetic nephropathy (DN) in spontaneous type 2 diabetes mellitus model KK-Ay mice.Methods Totally 50 KK-Ay mice were randomly divided into five groups:model group,metformin (positive drug,250 mg/kg) group,WEJTD low,medium and high dose (2,4,and 8 g/kg) group,with 10 C57BL/6J mice as normal group.The relative drugs were ig administered once a day for 12 weeks,and mice in control group and model group were perfused with distilled water of equal volume.After 12 weeks' oral administration,mice were put into metabolism cages,and the food-intake,water-intake and urine volume were calculated and collected.Blood were collected to detect the concentration of IL-6,ICAM-1 and TNF-α.Then mice were executed,and HE staining and PASM staining were used to check the effect of WEJTD on kidney.Western blotting and qRT-PCR were used to detect the concentration of PI3K,Akt,NF-κB,IL-6,ICAM-1 and TNF-α in kidney.Results WEJTD can alleviate the symptoms of diabetes,such as food ration,polydipsia and polyuria (P ＜ 0.05,0.01,and 0.001);Relief the pathological changes of kidney and significantly decreased glycogen deposition (P ＜ 0.001),down-regulate the increase of IL-6,ICAM-1 and TNF-α in serum and kidney (P ＜ 0.05,0.01 and 0.001),up-regulate the phosphorylation of PI3K and Akt (P ＜ 0.05,0.01,and 0.001),and inhibit the phosphorylation of NF-κB (P ＜ 0.001).Conclusion WEJTD had positive effects on kidney morphology of KK-Ay,and the underlying mechanism might be related to the regulation of PI3K-Akt and NF-κB-mediated inflammation.
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Objective To compare the realtime effects of scalp cluster acupuncture versus nape cluster acupuncture on the cerebral blood flow in patients with vertigo due to cerebral circulation insufficiency (CCI). Methods Fifty-seven patients with vertigo due to CCI were randomized into a treatment group of 29 cases and a control group of 28 cases. The treatment group was intervened by scalp cluster acupuncture, while the control group was by nape cluster acupuncture. The systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), and mean blood flow velocity (Vm) of the middle cerebral artery (MCA), internal carotid artery (ICA), basilar artery (BA), posterior inferior cerebellar artery (PICA), and vertebral artery (VA) were observed before and after intervention by Transcranial Doppler (TCD). Results After intervention, the Vs, Vd, and Vm of MCA, ICA, BA, PICA and VA were significantly changed in the treatment group (P＜0.01, P＜0.05). The blood velocities of MCA, ICA, VA, and PICA were significantly changed after intervention in the control group (P＜0.01). The Vs and Vm of BA were significantly changed in the control group after intervention (P＜0.05). There were no significant differences in comparing the blood velocities of the observed arteries between the two groups after intervention (P>0.05). Conclusion Scalp cluster acupuncture and nape cluster acupuncture both can improve the Vs, Vd, and Vm of the low-velocity cerebral arteries.
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With the unique structure and manipulation techniques of blood-letting and cutting, hook needle serves as a role in dredging meridians, removing blood stasis, purging heat for resuscitation and relaxing synechial tissues. There are three needling techniques of hook needle: swift pricking, bleeding and pricking. Six manipulations are commonly used as lifting-thrusting, plucking, pulling, pushing-scraping, vibration and massage. The mechanism and manipulations of hook needling are summarized systematically in the present paper. In this way, its manipulations, indications and contraindications are expounded in detail.
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Humans , Acupuncture Therapy , Methods , NeedlesABSTRACT
This paper introduces the old nine-needle including its name, shape, function, manipulation and origination, as well as systematically introduces the new nine-needle as a new product which has been developed under the guidance of modern science and technology based on the old nine-needle since 1949. As a new tool, the new nine-needle provide much more choice for acupuncture treatment and obtained satisfied clinical effect. During the development of research and clinical practice on the new nine-needle, its theory has been consummated successively. Combining various kinds of needles for treatment is not only paying attention to the specificity of one kind of needles, but also emphasizing the whole function of all kinds of needles, which makes the new nine-needle formed the characteristic and distinct theory of its own.
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Acupuncture Therapy , History , Methods , China , History, Ancient , NeedlesABSTRACT
A comparison of recognition to migraine and treatment methods for it was made between traditional Chinese medicine and western medicine in this paper. Emphasis was made on standardized manipulation processes and techniques of sharp hooked needling for treating the disease, based on both the organic conception of the human body, the theory held by TCM, and on the principle of treatment according to pathogenesis obtained through differentiation of symptoms and signs. The necessary preparation before operations, methods for its application and announcements in the standardized manipulations of sharp hooked needling were all explained in detail. Based on its needling, pricking, dissecting and relaxing effects, the mechanisms of sharp hooked needling in treating the disease were investigated. It is concluded that sharp hooked needling is very effective in treating migraine.
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Humans , Acupuncture Points , Acupuncture Therapy , Methods , Reference Standards , Medicine, Chinese Traditional , Methods , Reference Standards , Migraine Disorders , Therapeutics , Needles , Reference StandardsABSTRACT
<p><b>OBJECTIVE</b>To investigate the mechanism of acupuncture at "Neiguan" (PC 6) and "Ximen" (PC 4) of the Pericardium Meridian in treatment of myocardial ischemia.</p><p><b>METHODS</b>Rats were randomly divided into 5 groups, sham-operation group, ischemia-reperfusion model group, Neiguan acupuncture group, Ximen acupuncture group and Zhigou acupuncture group. Electroacupuncture (EA) was given at corresponding acupoints for 20 min in the later 3 groups, followed by ligation of the left anterior descending branch of the coronary artery and 40 min later, acupuncture was given at the points for another 20 min, reperfusion for 60 min, with ECG monitoring. Then the myocardial tissue sample (below the ligation site) of the left cardiac ventricle was taken for preparation of sarcoplasmic reticulum, and determination of Ca2+-ATPase activity according to quantitative analysis of phosphorum. The relative mRNA levels were determined by Northerm Bolt analysis.</p><p><b>RESULTS</b>In the acupuncture groups, both the activities of Ca2+-ATPase and the gene expressions increased significantly as compared with the model group (all P < 0.01).</p><p><b>CONCLUSION</b>The points of the Pericardium Meridian can obviously improve the Ca2+-ATPase activity and the gene expressions, reduce the degree of myocardial ischemia and reperfusion injury, and strength myocardial functions.</p>
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Animals , Male , Rats , Acupuncture Points , Acupuncture Therapy , Calcium , Metabolism , Calcium-Transporting ATPases , Genetics , Metabolism , Myocardial Ischemia , Therapeutics , Myocardial Reperfusion Injury , Therapeutics , Myocardium , RNA, Messenger , Rats, WistarABSTRACT
Mechanisms of acupuncture and moxibustion for treatment of hypertension have been studied extensively from poly-aspects, poly-levels and poly-links. The present paper reviews the studies on nervous regulation, humoral regulation and regulation of peripheral vessel resistance and other pathways and their relationships in recent ten years, and indicates further perfecting these studies from the following aspects: studies on the mechanism of section and combination of blood pressure-decreasing points, relationship of time-effect and dose-effect of acupuncture and moxibustion, and studies on mechanisms of functions of nerve-endocrine-immune system.