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Objective:To explore the employment experiences of coordinators of In-Hospital Organ Procurement Organization (OPO).Methods:Based on purpose sampling, 12 full-time In-Hospital OPO coordinators in Chongqing City were recruited from July to December 2020. A semi-structured and in-depth interview was performed and the data was analyzed by Colaizzi.Results:4 first-level themes were extracted, including professional identity process, negative emotional experience, improvement of professional practice competence and job expectancy. 12 second-level themes were identified including career expectations and identity confusion, professional values, shortage of respect and ratification, huge workloads, great psychological pressure, influence of the bereaved families, enhancement of the ability to communicate, improvement of problem-solving ability, improvement of team-work ability, optimization of scenario simulation, a perfection of the assessment system, a clear career path.Conclusions:In-Hospital OPO coordinators are lack of professional awareness in an initial stage. While feeling a sense of professional value, they also experience some negative emotions. Furthermore, their competences are improved in practice and they, meanwhile, express a strong desire for career development. It is suggested that the administrators could explore establishment of academic education, enhancement of psychological and social support, creation of pretty working environments and improvement of training, assessment and promotion systems to facilitate the career development of coordinators.
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Objective To establish a model for estimating the eye lens dose of the first operator in interventional therapy based on the Monte Carlo simulation, and to provide a scientific basis for the rapid and accurate evaluation of the eye lens dose for radiation workers in interventional therapy. Methods Based on the MIRD phantom and eye model for adult Chinese males, the MCNPX program was used to establish the physical model to calculate the spatial distribution of radiation field and eye lens dose for the first operator. A GR200 Type A LiF (Mg, Cu, P) thermoluminescence dosimeter was used for experimental measurement to verify the simulation results. Results Monte Carlo simulation and experimental measurements showed that the spatial distribution of radiation field was symmetrical. Compared with the measured doses, the errors of the simulated eye lens dose of the first operator were between −8.3% and 7.3%. The dose of the left eye lens was higher than that of the right eye. Conclusion The Monte Carlo model constructed in this study initially realizes the simulation of eye lens dose of the first operator in interventional therapy. In the future, the model will be further optimized based on irradiation parameters such as exposure time, tube voltage, tube current, and projection direction used in clinic practice, so as to more accurately evaluate the eye lens dose of interventional therapy staff.
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Objective: To explore the predictive values of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score on the death risk of severe burn patients. Methods: A retrospective case series study was conducted. From February 2018 to November 2019, 260 severe burn patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University, including 158 males and 102 females, aged 36 (3, 53) years. According to the final outcome, the patients were divided into survival group (n=229) and death group (n=31). Data of patients were compared and statistically analyzed with chi-square test or Mann-Whitney U test between the two groups, including the gender, age, cause of burn, site of burn, total burn area, depth of burn, combined inhalation injury, and combined underlying diseases on admission, and the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score calculated based on part of the aforementioned data. The Kendall tau-b coefficient method was used to analyze the consistency of the above-mentioned three scores in 260 severe burn patients. The receiver operating characteristic (ROC) curves of the above-mentioned three scores predicting the death risk of 260 severe burn patients were drawn, and the area under the curve (AUC), the optimal threshold, and the sensitivity and specificity under the optimal threshold were calculated. The quality of AUC of the above-mentioned three scores was compared by Delong test. Results: The gender, site of burn, and depth of burn of patients between the two groups were all similar (P>0.05). The age, total burn area, proportion of flame burn, proportion of combined inhalation injury, and proportion of combined underlying diseases of patients in death group were significantly higher than those in survival group (with Z values of 5.53 and 17.78, respectively, χ2 values of 16.23, 15.89, and 17.78, respectively, P<0.01); the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score of patients in death group were 142 (115, 155), 7 (5, 7), 2 (2, 3), all significantly higher than 64 (27, 87), 1 (0, 3), 0 (0, 1) in survival group (with Z values of 7.91, 7.64, and 7.61, respectively, P<0.01). In 260 severe burn patients, the results between the modified Baux score and Ryan score, modified Baux score and Belgian Outcome in Burn Injury score, Ryan score and Belgian Outcome in Burn Injury score were significantly consistent (with Kendall tau-b coefficients of 0.75, 0.71, and 0.86, respectively, P<0.01). The AUCs of ROC curves of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score for predicting the death risk of 260 severe burn patients were 0.92, 0.89, and 0.85, respectively (with 95% confidence intervals of 0.86-0.98, 0.83-0.95, and 0.78-0.93, respectively, P<0.01); the optimal thresholds were 106.5, 4.5, and 1.5 points, respectively; the sensitivity under the optimal threshold were 88.5%, 76.9%, and 73.1%, respectively, and the specificity under the optimal threshold were 88.5%, 87.2%, and 86.3%, respectively. The modified Baux score was similar to Belgian Outcome in Burn Injury score in the AUC quality (z=1.25, P>0.05), which were both significantly better than the AUC quality of Ryan score (with z values of 2.35 and 2.11, respectively, P<0.05). Conclusions: The modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score have good ability in predicting the death risk of severe burn patients. From the perspective of clinical practice, the modified Baux score is more suitable as a predictive tool for the prognosis of severe burn patients.
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Adult , Female , Humans , Male , Burns , Hospitalization , Prognosis , ROC Curve , Retrospective StudiesABSTRACT
Objective:To explore the values of CTP score, MELD score, MELD-Na score, ALBI score and neutrophil-lymphocyte ratio (NLR) in predicting the short/long-term prognoses of patients with end-stage liver disease (ESLD) after liver transplantation (LT).Methods:From August 2015 to February 2017, basic preoperative profiles and survival status were retrospectively reviewed for 125 ESLD patients undergoing orthotopic LT.Receiver operating characteristic (ROC) curve was utilized for evaluating the capability of five scores for predicting short-term (3 months post-operation) and long-term (5 years post-operation) prognoses.Cut-off value was determined according to the Jordan index and Kaplan-Meier survival curve plotted.The difference in survival rate between upper and lower cut-off values was analyzed by Log-rank test.Results:Five-year survival rate post-LT was 69.6%(87/125), case fatality rate 30.4%(38/125) and case fatality rate within 3 months post-operation 12.8%(16/125). The AUROC values of CTP score, MELD score, MELD-Na score, ALBI score and NLR for short-term prognosis were 0.787, 0.767, 0.875, 0.801 and 0.837 and AUROC values for predicting long-term prognosis 0.744, 0.744, 0.817, 0.778 and 0.815 respectively.De Long test indicated that the capabilities of MELD-Na score for predicting short-term prognosis varied significantly from that of another four models ( P<0.05). No significant difference existed in capability of predicting long-term prognosis ( P>0.05). The cut-off values of MELD and MELD-Na scores at Month 3/60 post-LT were 20.09 vs.16.44 and 23.63 vs.17.79.The survival rates of upper and lower groups distinguished by cut-off values were 90.9% vs.50.0%, 86.5% vs.45.1% and 99.3% vs.55.6%, 93.9% vs.42.4% respectively.The differences were statistically significant ( P<0.05). Conclusions:Predictive value of MELD-Na score for short-term prognosis of LT is superior to than that of CTP, MELD score, ALBI score or NLR.However, it offers no significant superiority in predicting long-term prognoses.With a rising preoperative MELD/MELD-Na score, postoperative mortality spikes.
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Objective:To explore the effects of Tiaoren Tongdu Acupuncture on motor function and corticospinal tract (CST) remodeling after cerebral infarction. Methods:From February, 2017 to December, 2020, 54 patients with cerebral infarction were randomly divided into control group (n = 27) and acupuncture group (n = 27), each group was divided into subgroups 1, 2 and 3 according to the impairment of corticospinal tract, with nine cases for each subgroup. All the patients received routine medicine, while the acupuncture group received Tiaoren Tongdu Acupuncture, for four weeks. They were assessed with Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) before and after treatment, and scanned with diffusion tensor imaging and diffusion tensor tractography, to obtain the fractional anisotropy (FA) and the bilateral FA ratio (rFA). Results:The scores of FMA and MBI, and FA and rFA increased in both groups (t > 2.841, P < 0.05) after treatment, and increased more in the acupuncture group than in the control group (t > 2.140, P < 0.05). Conclusion:Tiaoren Tongdu Acupuncture can promote the recovery of CST to improve motor function for patients with cerebral infarction.
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In hospital performance evaluation, significant differences in the work objects, work content and economic operation of various departments result in the lack of indicators comparability between different departments. This has become a prominent problem that hospitals have been unable to effectively solve for a long time, and has also affected the fairness of performance distribution to a certain extent. Starting from the dilemma of cost-benefit evaluation, the authors put forward the basic concepts of the sequence advance and retreat method, and comprehensively elaborated the implementation steps and operating points of the performance assessment using the sequence advance and retreat method. It is pointed out that the sequence advance and retreat method has four characteristics: weakening the differences between departments by vertical and horizontal combination, avoiding the deviation of guidance by scientific comparison, highlighting the incentive effect by grade differentiation, and reflecting the advantages and disadvantages by end adjustment. The value of this method in the hospital performance appraisal system is discussed from three aspects: promoting the de-profitization process of hospitals, achieving fair distribution of hospital performance, and strengthening the guidance of hospital performance management. Based on such studies, this article provides new methods and ideas for building a more scientific and fair performance evaluation system.
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In hospital performance evaluation, significant differences in the work objects, work content and economic operation of various departments result in the lack of indicators comparability between different departments. This has become a prominent problem that hospitals have been unable to effectively solve for a long time, and has also affected the fairness of performance distribution to a certain extent. Starting from the dilemma of cost-benefit evaluation, the authors put forward the basic concepts of the sequence advance and retreat method, and comprehensively elaborated the implementation steps and operating points of the performance assessment using the sequence advance and retreat method. It is pointed out that the sequence advance and retreat method has four characteristics: weakening the differences between departments by vertical and horizontal combination, avoiding the deviation of guidance by scientific comparison, highlighting the incentive effect by grade differentiation, and reflecting the advantages and disadvantages by end adjustment. The value of this method in the hospital performance appraisal system is discussed from three aspects: promoting the de-profitization process of hospitals, achieving fair distribution of hospital performance, and strengthening the guidance of hospital performance management. Based on such studies, this article provides new methods and ideas for building a more scientific and fair performance evaluation system.
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OBJECTIVE@#To study the clinical effect of psychological and behavioral intervention combined with biofeedback in the treatment of preschool children with attention deficit hyperactivity disorder (ADHD).@*METHODS@#Sixty children each with inattentive, hyperactive/impulsive or combined type ADHD were enrolled. According to the intervention measure, they were randomly divided into 4 groups: control, psychological and behavioral intervention, biofeedback treatment and comprehensive treatment (psychological and behavioral intervention + biofeedback). Attention concentration time and impulse/hyperactivity and hyperactivity index scores of the Conners Parent Symptom Questionnaire (PSQ) were evaluated after 4 months of treatment.@*RESULTS@#The attention concentration time increased in all types children with ADHD after psychological and behavioral intervention, biofeedback treatment or comprehensive treatment (P<0.05). In children with inattentive ADHD, hyperactive/impulsive ADHD or combined-type ADHD, biofeedback or comprehensive treatment reduced the impulse/hyperactivity index score (P<0.05). In children with inattentive or combined-type ADHD, psychological and behavioral intervention or comprehensive treatment reduced the hyperactivity index score (P<0.05). In children with hyperactive/impulsive ADHD, biofeedback treatment, psychological and behavioral intervention or comprehensive treatment reduced the hyperactivity index score (P<0.05).@*CONCLUSIONS@#In children with ADHD, psychological and behavioral intervention combined with biofeedback treatment can improve the attention concentration and impulsive/hyperactive and hyperactive symptoms. The treatment strategies are slightly different for children with different types of ADHD.
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Child, Preschool , Humans , Attention Deficit Disorder with Hyperactivity , Biofeedback, Psychology , Parents , Surveys and QuestionnairesABSTRACT
OBJECTIVE@#To study the clinical efficacy of interactive group sandplay versus individual sandplay in the treatment of preschool children with autism spectrum disorder (ASD).@*METHODS@#A total of 80 ASD children, aged 4-6 years, were enrolled and randomly divided into experimental and control groups, with 40 children in each group. The children in the experimental group joined group sandplay with normal children at a ratio of 1: 3, and those in the control group were treated with individual sandplay. The Aberrant Behavior Checklist (ABC) and Autism Treatment Evaluation Checklist (ATEC) were used to evaluate the treatment outcome after three months of intervention.@*RESULTS@#There were 33 children in the experimental group and 28 in the control group. After three months of intervention, the experimental group had significant reductions in the scores of irritability, social withdrawal, and stereotypic behavior and the total score of the ABC scale (P<0.05), and the control group had significant reductions in the scores of behavior and inappropriate speech and the total score of the ABC scale (P<0.05). Compared with the control group, the experimental group had significantly greater improvements in the score of social withdrawal and the total score of the ABC scale after three months of intervention (P<0.05). After three months of intervention, the experimental group had significant reductions in the scores of sociability, sensory and cognitive awareness, and physical/health behavior and the total score of the ATEC scale (P<0.05), and the control group had significant reductions in the scores of speech, sociability, and physical/health behavior and the total score of the ATEC scale (P<0.05). Compared with the control group, the experimental group had significantly greater improvements in the scores of speech, sociability, and sensory and cognitive awareness and the total score of the ATEC scale after intervention (P<0.01). Compared with the control group, the experimental group also had significantly greater improvements in eye contact and sand stereotyped arrangement (P<0.05).@*CONCLUSIONS@#Both interactive group sandplay and individual sandplay are effective in the treatment of ASD in preschool children. Interactive group sandplay is better than individual sandplay in the treatment of ASD, with significant improvements in sociability, emotion and stereotypic behavior.
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Child , Child, Preschool , Humans , Autism Spectrum Disorder , Therapeutics , Emotions , Play Therapy , Treatment OutcomeABSTRACT
Objective Doppler ultrasonography was used to screen the incidence of central venous catheter (CVC) thrombosis in severe patients to observe the incidences of catheter-related thrombosis (CRT) at subclavian (SC) and internal jugular (IJ) venous insertion sites, and to analyze the factors affecting the thrombosis. Methods One hundred and twenty three adult patients with IJ or SC CVC admitted to the Department of Intensive Care Unit (ICU) of Zhongnan Hospital of Wuhan University from May to December 2015 were enrolled to be the research objects, they were divided into an IJCVC group (35 cases) and a SCCVC group (88 cases) according to different catheterization sites; they were divided into an operation group (85 cases) and a non-operation group (38 cases) according to whether operation was performed or not; and they were also divided into an anticoagulation group (25 cases) and a non-anticoagulation group (98 cases) according to whether anticoagulation therapy was used or not. Doppler ultrasonography was performed every day to observe the incidences of CRT during ICU stay. Results One hundred and twenty-three patients were included in this study. CRT was detected in 11 (8.9%) patients, with an incidence of 22.1 per 1 000 catheter-days. All the 11 cases with CRT were presented within 3 days after the insertion, with 9 cases (81.8%) on the first day and 2 cases (18.2%) on the third day. The incidence of CRT in SCCVC group was significantly lower than that in IJCVC group [5.7% (5/88) vs. 17.1% (6/35), P < 0.05], with the rates of 12.6 and 59.4 per 1 000 catheter-days, respectively. There were no statistical significant differences in the incidences of CRT between operation group and non-operation group [11.8% (10/85) vs. 2.6% (1/38)], and between anticoagulation group and non-anticoagulation group [8.0% (1/25) vs. 9.2% (2/98), both P > 0.05]. Conclusions The incidence of CRT at IJCVC site is estimated to be 3-times higher than that at SCCVC site, anticoagulants or surgical operation may have impacts on the incidence of CRT, although there were no statistically significant differences. The CRT usually occurs within 3 days after the catheter insertion. Frequent bedside ultrasonography in the first 3 days after catheterization can confirm the diagnosis and guide clinical treatment.
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AIM:To investigate the effect of urantide on the liver function and histomorphology in the rats with atherosclerosis (AS).METHODS:The AS Wistar rat model was induced by intraperitoneal injection of vitamin D3 (VD3) and feeding with high-fat diet.The rats were randomly divided into normal control group, AS model group, positive medicine group and urantide group.The liver function indexes of the rats were measured by biochemical test, and the pathological changes of the aorta and liver of the rats were observed by hematoxylin-eosin (HE) staining.The mRNA expression of urotensinⅡ (UII) and GPR14 at mRNA and protein levels in rat livers was determined by RT-qPCR and Western blot.RESULTS:The levels of alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , γ-glutamyltransferase (γ-GT) , lactate dehydrogenase (LDH) , total bilirubin (TBIL) , indirect bilirubin (IBIL) and alkaline phosphatase (ALP) in AS model group were significantly increased compared with normal control group (P<0.05).The above indexes in urantide group were remarkably decreased compared with AS model group (P<0.05).No change of the levels of direct bilirubin (DBIL) , total protein (TP) , globulin (GLB) and albumin (ALB) in each group was observed.Urantide postponed hepatocyte fatty degeneration and repaired hepatocyte injury in the AS rats.Compared with normal control group, the mRNA and protein levels of UII and GPR14 in the liver were significantly increased in AS model group (P<0.05).With the prolongation of dosing time, the mRNA and protein levels of UII and GPR14 in the liver were significantly decreased in urantide group compared with AS model group (P<0.05).CONCLUSION:Urantide significantly attenuates the liver damage caused by liver fatty degeneration in AS rats.
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Objective To find out research progress for remote medical treatment of basic medical insurance in China,in order to provide evidences for further research and policy-making.Methods Doing literature research.Results Research progress is summarized from five aspects,such as concepts and theoretical basis,causes of remote medical treatment and different social problems caused by it,the observation of domestic and foreign experiences,shift and continuity of basic medical insurance for rural residents,as well as instant reimbursement.Conclusion The enlightenment from the existing research is put forward,that is to solve the related problems of remote medical treatment.The most important thing is to classify the people who need remote medical treatment,and then to give solutions acording to different categories.
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Objective To investigate the expression and significance of Toll-like receptors-4 in peripheral blood and placental tissue in gestational diabetes mellitus (GDM) patients.Methods From February 2013 to February 2015.a total of 30 cases of gestational diabetes mellitus patients(GDM group) and 30 cases of normal pregnant people(health group)were selected as research objects.Peripheral blood and placental tissue of two groups were collected.The expression of TLR4 mRNA in peripheral blood mononuclear cells was detected by RT-PCR,the expression of TLR4 protein in placenta tissue was detected by immunohistochemistry.Results The expression of TLR4 mRNA in peripheral blood mononuclear cells of the observation group was significantly higher than that of the health group[(0.63±0.12) vs.(0.32±0.07)],the difference was statistically significant(t=12.223,P<0.05).The expression of TLR4 in villous trophoblast cells,decidual cells and amniotic epithelial cells in GDM group was significantly higher than that in the health group(Z=2.325,2.374,2.162,P<0.05).Conclusion The expression of TLR4 in peripheral blood mononuclear cells,villous trophoblast cells and decidual cells in gestational diabetes mellitus patients significantly enhanced,suggesting that TLR4 might be related to the e gestational diabetes mellitus.
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A series of 5H-benzo[b] carbazole derivatives were synthesized to find new TopⅡ inhibitors.The substitution pattern at C-9 was discussed.All 16 compounds were tested for their antiproliferative activities against 4 tumor cell lines (SMMC-7721,S1,HCT116,and HeLa) by sulforhodamine B assay.Four compounds were found to inhibit the proliferation of all tested cell lines.And compound 10e displayed the best antiproliferative activity against all 4 tested cell lines with IC50 values of 5.06,4.50,5.29,and 6.32 μmol/L,respectively.
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<p><b>OBJECTIVE</b>To investigate the influence of home nurture environment on language development and social emotion in children with developmental language disorder (DLD).</p><p><b>METHODS</b>The 1-3 Years Child Home Nurture Environment Scale, Gesell Developmental Scale, and Infant-Toddler Social and Emotional Assessment Scale were used for the evaluation of 125 children with DLD. A total of 130 children with normal language development matched for age and sex were enrolled as control group.</p><p><b>RESULTS</b>Compared with the control group, the DLD group had a significantly higher proportion of children in a bad home nurture environment and significantly lower scores of all domains of home nurture environment (P<0.05). In children with DLD, the home nurture environment score was positively correlated with the level of language development (r=0.536, P<0.01) and the score of ability domain in social emotion (r=0.397, P<0.01) and was negatively correlated with the scores of the domains of explicit behavior, covert behavior, and imbalance in social emotion (r=-0.455, -0.438, and -0.390 respectively, P<0.01). Home nurture environment had direct influence on language development in children with DLD and affected their language development via the mediating effect of social emotion.</p><p><b>CONCLUSIONS</b>Home nurture environment influences language development and social emotion in children with DLD, and social emotion has a partial mediating effect between home nurture environment and language development.</p>
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Child, Preschool , Female , Humans , Infant , Male , Emotions , Environment , Language Development , Language Development Disorders , Psychology , Social BehaviorABSTRACT
<p><b>OBJECTIVE</b>To investigate the difference in the efficacy between clonidine transdermal patch and haloperidol tablets in the treatment of moderate to severe tic disorders in children.</p><p><b>METHODS</b>A total of 134 children with moderate to severe tic disorders were randomly divided into clonidine group (n=70) and haloperidol group (n=64). The clonidine and haloperidol groups were treated with clonidine transdermal patch and haloperidol tablets respectively, and the treatment lasted for 8 weeks in both groups. The Yale Global Tic Severity Scale (YGTSS) was used to evaluate the conditions of the children before and after treatment, and the adverse events during the treatment were recorded.</p><p><b>RESULTS</b>The haloperidol group had a significantly better treatment outcome than the clonidine group after one week of treatment (P<0.05); the treatment outcome showed no significant difference between the two groups after 3, 5, and 8 weeks of treatment (P>0.05). The clonidine group had significantly less reductions in the motor tics, vocal tics, and function impairment scores and total score of YGTSS than the haloperidol group after one week of treatment (P<0.05); there were no significant differences in YGTSS score reductions between the two groups after 3, 5, and 8 weeks of treatment (P>0.05). The clonidine group had a significantly lower overall incidence of adverse events than the haloperidol group (8% vs 37%; P<0.01).</p><p><b>CONCLUSIONS</b>Clonidine transdermal patch and haloperidol are both effective in the treatment of moderate to severe tic disorders in children. The clonidine transdermal patch, despite slow action, has comparable efficacy and fewer adverse effects compared with haloperidol.</p>
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Child , Child, Preschool , Female , Humans , Male , Clonidine , Haloperidol , Therapeutic Uses , Severity of Illness Index , Tic Disorders , Drug Therapy , Transdermal PatchABSTRACT
@#BACKGROUND: MicroRNAs are small non-coding RNAs of approximately 22 nucleotides in length, and play important regulatory roles in normal heart development and the pathogenesis of heart diseases. Recently, a few prospective studies have implicated the diagnostic role of microRNAs in congenital heart defects (CHD). DATA RESOURCES: This review retrieved the research articles in PubMed focusing on the altered microRNAs in cardiac tissue or serum of patients with CHD versus healthy normal controls, as well as the studies exploring circulating microRNAs as potential biomarkers for (fetal) CHD. RESULTS: Most of the studies of interest were conducted in recent years, implicating that the topic in this review is a newly emerging field and is drawing much attention. Moreover, a number of differentially expressed microRNAs between CHD specimens and normal controls have been reported. CONCLUSION: Circulating microRNAs may serve as potential biomarkers for diagnosis of CHD in the future, with more efforts paving the road to the aim.
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<p><b>BACKGROUND</b>The New Rural Cooperative Medical Scheme (NCMS) has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years.</p><p><b>METHODS</b>The research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS.</p><p><b>RESULTS</b>In the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund of NCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively.</p><p><b>CONCLUSIONS</b>With the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers' medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.</p>
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Female , Humans , Male , China , Health Expenditures , Hospitalization , Inpatients , Insurance, Health , Economics , Rural PopulationABSTRACT
AIM@#To study the bufadienolides in the Chinese traditional drug "Ch'an Su" and their cytotoxic activity.@*METHOD@#Various chromatographic techniques were used to isolate the constituents, and their structures were elucidated through physical and spectroscopic data.@*RESULTS@#Twenty compounds were isolated, and eighteen were evaluated in vitro for their cytotoxic activity against A-549 and K-562 cells.@*CONCLUSION@#Compound 1 (bufalin 3β-acrylic ester) was a new bufadienolide and exhibited the most potent activity against the two tumor cell lines with IC50 values of 7.16 and 6.83 nmol · L(-1). The relationships between structure and activity are discussed.