A study on the influence of medical insurance paying proportion to hierarchical diagnosis and treatment / 预防医学

Objective To analyze the influence of medical insurance paying proportion to hierarchical diagnosis and treatment, and to provide basis for the improvement of hierarchical diagnosis and treatment. Methods Data about average number of visits of insured residents in 2015 were obtained from Hangzhou medical insurance service database. Differences between visits to Community Health Service Centers (CHSC) of residents having Medical Insurance of Urban and Rural Residents (MIURR) and residents having Urban Employees' Basic Medical Insurance (UEBMI) were compared. And differences stratified by signed contracted services offered by General Practitioners (GPs) or not were further analyzed. Results Proportion of visits to CHSCs in all visits to medical institutions in residents with MIURR was 77.22%, which was significantly higher than the proportion in residents with UEBMI was 51.26%. In the residents with UEBMI, and the proportion of visits to CHSCs in all visits to medical institutions of the group sighed contracted services offered by GPs was significantly higher than the group non-sighed. Conclusion Increasing the gap between reimbursement ratio of CHSCs and higher medical institutions plays an important role in guiding health-seeking behavior of residents. Reformation of medical insurance payment and contracted services will guide residents to seek medical treatment and effective referral.

Relationship between somatostatin receptors and activation of hepatic stellate cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Somafostatin receptors (SSTRs) have been suggested to involve in mediating the effect of somatostatin on hepatic stellate cells (HSCs) in an activation-dependent way. We, therefore, try to investigate the relationship between expression of SSTRs and activation of rat HSCs.</p><p><b>METHODS</b>HSCs were isolated from rats by in situ perfusion and single-step density gradient centrifugation. SSTR1-5 mRNA levels in the differentiated first passage HSCs were detected by means of a reverse transcription polymerase chain reaction. On the other hand, hepatic fibrosis was induced in adult male Sprague-Dawley rats by carbon tetrachloride intoxication, and the expression of SSTR1-5 in normal as well as fibrotic livers was measured by immunohistochemical staining.</p><p><b>RESULTS</b>SSTR mRNA and SSTR could not be found in freshly isolated rat HSCs or normal rat liver. However, SSTR1-3 mRNA appeared as HSCs became wholly activated, and could also be identified on the membrane of activated HSCs in the perisinusoid space, fibrous septa, etc.</p><p><b>CONCLUSION</b>The expression of SSTR1-3 in the rat HSC is closely related to its activation. This may reflect one of the main negative regulation mechanisms in the course of HSC activation.</p>

Therapeutic effects of octreotide on hepatofibrosis-induced with carbon tetrachloride in rats / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To investigate the therapeutic effects and mechanism of octreotide on experimental hepatic fibrosis in rats.</p><p><b>METHODS</b>Hepatofibrotic rats models were established with carbon tetrachloride. All the experimental rats were divided into four groups: normal control group, pre-and post-treatment model group, and octreotide-treated group in which the rats were injected subcutaneously with octreotide at the dose of 50ng/100g, twice daily, for thirty days. Serum levels of hyaluronic acid (HA), laminin (LN) and pro-collagen type III peptide (PCIII) were detected by radioimmunoassay. Hepatic fibrosis scoring grade was assessed through Van-Gieson staining and observed under light microscope. Protein expression levels of alpha-smooth muscle actin (alpha-SMA) and transforming growth factor beta1 (TGFbeta1) were determined with immunohistochemical staining method. Messenger RNA (mRNA) levels of collagen type I and PCIII were detected by reverse transcription polymerase chain reaction.</p><p><b>RESULTS</b>Serum levels of HA (ng/L), LN (microg/L) and PCIII (ng/L) in pre- and post-treatment model groups were higher than those in normal control group (121.8+/-9.5 and 110.3+/-13.4 vs. 33.1+/-3.7, 85.7+/-12.1 and 78.2+/-7.9 vs. 37.1+/-6.3, 35.9+/-3.5 and 33.7+/-2.6 vs. 15.6+/-2.8, respectively, t > or = 9.41, P<0.05), and there was no significant difference between the two model groups. Concentrations of HA (55.8ng/L+/-7.2ng/L), LN (43.1microg/L+/-3.4microg/L) and PCIII (27.8ng/L+/-3.4ng/L) decreased significantly in octreotide-treated group, compared with those in model groups (t >or=2.76, P<0.05). With histological analysis, fibrotic scoring grade in octreotide-treated group was obviously ameliorated, compared with that in model groups (chi2 > or = 3.97, P<0.05). Imaging analysis revealed that alpha-SMA and TGFbeta1 immunohistological staining areas were markedly shrinked in octreotide-treated group (t > or = 2.47, P < 0.05). In two model groups, PCIII and type I mRNA levels significantly up-regulated as compared with those in normal group (t > or = 9.27, P<0.001), and they were inhibited by octreotide markedly (t > or = 2.47, P<0.05).</p><p><b>CONCLUSIONS</b>Octreotide can inhibit hepatic stellate cells transforming into myofibroblasts, down-regulate TGFbeta1, collagen type I and PCIII transcriptions, so that it has therapeutic effects on experimental hepatic fibrosis.</p>