Effect evaluation of comprehensive reform of medical price in urban public hospital: A case study of Nanjing city / 中国卫生政策研究

Objectives:This study aims to analyze the change of income and medical service revenue of hospi-tals in Nanjing after the comprehensive reform of the medical prices of public hospitals,evaluate the effect of compen-sation and explore the differentiated compensation plan, and provide the basis for establishing the compensation mechanism of dynamic adjustment. Methods: A total of 10 municipal-affiliated hospitals were selected to collect fi-nancial income and expenditure data for the 48 months before the reform (2011.11—2015.10) and the 12 months after the reform(2015.11—2016.10) in Nanjing,and used interrupted time series model to estimate the growth rate of drug profit and service revenue,and finally made a comparison between the counterfactual and actual figures. Re-sults:It was found that,after the form,the drug profit decreased by 14.98%,and the service revenue increased by 24.79%. The revenue from medicines accounted for 42.7% and 36.9% before and after the reform respectively, and service for 28.9% and 30.3% respectively. The net financial aid accounted for 20.43% of the total drug-sales loss in average,and the net service revenue rate averaged 87.3% meeting the policy target,but within the 10 hospi-tals these rate ranged diversely from -21.9% to 712.5%,and 28.9% to 712.5%. The regression analysis indica-ted that the service compensation rate was significantly positively correlated with the proportion of service revenue in the total medical revenue before the reform. Conclusions:The Nanjing Pricing Reform basically achieved its desired goals of abolishing the drug-sales addition and the hospital compensation effect of 80% service +20% fiscal structure from service revenue and financial aid in average. However, the compensation differences among the hospitals are quite large with service-dependent hospitals compensated by over 400% and drug-dependent hospital less than 30%. However,for general hospitals,the compensation rated directly depended on the revenue structure before the reform and management performance and varied from 50% to 100%. The study at last gave its advices on improvement to further increase the service prices and establish a yearly-adjusted individualized compensation mechanism.

Association of epithermal growth factor receptor expression and its downstream gene mutation status with radiosensitivity of colorectal carcinoma cell lines in vitro / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of epithermal growth factor receptor (EGFR) expression and K-ras, B-raf and PIK3CA mutation status on the radiosensitivity of human colorectal carcinoma (CRC) cell lines in vitro.</p><p><b>METHODS</b>Real-time RT-PCR was used to measure EGFR mRNA expression in nine human CRC cell lines, and K-ras, B-raf and PIK3CA mutation status of each CRC cell line was also identified respectively. After treatment with irradiation at graded dose, the cell viability was measured by clonogenic survival assay. The rate of cell apoptosis and cell cycle distribution were tested by flow cytometry. The cell morphology was observed with hoechst 33258 staining to analyze the correlation between EGFR mRNA expression and radiosensitivity of CRC cell lines.</p><p><b>RESULTS</b>A positive correlation between EGFR mRNA expression and survival fraction of 2 Gy(SF2) was observed (r=0.717, P=0.030). Association was also identified between the mutation status of PIK3CA and radiosensitivity (t=2.401, P=0.047), while mutation status of K-ras and B-raf was not associated with radiosensitivity. At 48-hour after exposing to irradiation, the apoptosis rate of radiosensitive cell line (HCT116) was significantly increased in a dose-dependent manner (P<0.05), while the apoptosis rate of radioresistant cell line (HT29) was significantly increased only when radiation dose increased to 6 Gy. The ratio of G0/G1 phase was reduced significantly with the increase of radiation dose in radiosensitive cell line (HCT116, P<0.05), while this trend was not observed in radioresistant cell line (HT29, P>0.05).</p><p><b>CONCLUSIONS</b>Over-expression of EGFR mRNA is correlated to radioresistance of human CRC cell lines, and mutation status of PIK3CA is closely related with radiosensitivity of CRC cells. The inhibition of apoptosis and G0/G1 arrest may induce the radioresistance of CRC cell lines.</p>

Impacts of preoperative radiochemotherapy on operation and postoperative complications in patients with mid-low rectal carcinomas / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the impact of preoperative radiochemotherapy on postoperative complications in patients with mid-low rectal carcinomas.</p><p><b>METHODS</b>Clinicopathologic data of T3 and T4 patients with mid-low rectal carcinomas in the Department of Colorectal Surgery at the Changhai Hospital of The Second Military Medical University from January 2009 to December 2010 were analyzed retrospectively. This cohort included 81 patients treated with preoperative radiochemotherapy followed by operation(radiochemotherapy group) and 93 cases who underwent surgery alone(control group).</p><p><b>RESULTS</b>Both resection rate and sphincter preservation rate were higher in the radiochemotherapy group(100% and 86.4%) than those in the control group(94.6% and 73.1%), and the difference in sphincter preservation rate was statistically significant(P=0.039). There were no significant differences in the mean operative time [(130±15) min vs.(125±20) min, P>0.05] and mean amount of bleeding [(100±15) ml vs. (95±10) ml, P>0.05] between the two groups. The overall incidence of postoperative complications was similar(9.9% vs. 9.7%, P>0.05).</p><p><b>CONCLUSIONS</b>Preoperative radiochemotherapy can significantly increase sphincter preservation rate of mid-low rectal carcinomas, and does not increase the difficulty in surgical procedure and postoperative complications.</p>