Impact of separating drug sales from medical services reform on Beijing Cancer Hospital from the perspective of medical insurance data / 中国卫生政策研究

objective:To analyze the policy impact of separating drug sales from medical services on a certain oncology hospitals in Beijing,and provide the basis for further development and adjustment of the reform. Methods:Using interrupted time series segmented regression model to analyse the instant change and trend change of medical service utilization by outpatient(including tumor-specified outpatient) and overall inpatient services,especially in in-dicators of drug proportion,self-pay ratio,and so on after the reform. Results:Tumor treatment is a relative specific-ity. The proportion of previous inpatients in tumor specialized hospitals ranged between 49.31% and 49.96%, and the actual compensation rates were between 57.05% and 63.57%. In our case analysis, the expenditure of outpa-tients dropped after this reform,with RMB 4.33 monthly decline on average cost and with 2.32 percentage monthly decrease on a self-pay rate. Drug proportion was declined expectedly,and the proportion of outpatient and inpatient drugs immediately decreased by 4.63% and 2.98% respectively after the reform. Therewith consumptive material proportion was raised, and the proportion of outpatient and inpatient materials instantly increased by 0.22% and 1.17% respectively. Conclusion:As per the results of this study,the reform has weakened the economic dependence on drug income in sample hospital and reduced the burden on patients. However,tumor treatment is on rigid demand and brings about a relatively great impact on hospital's finance and medical insurance fund. The rationality regards of cost-shifting should be investigated in the long run.

Protective effects of epigallocatechin-3-gallate on intestinal ischemia reperfusion injury through enhanced activation of PI3K/Akt pathway in rats / 华中科技大学学报（医学）（英德文版）

Inflammation plays a critical role in intestinal ischemia reperfusion injury (IRI). Epigallocatechin-3-gallate (EGCG) has been demonstrated to possess anti-inflammatory effect. This study examined the effect of EGCG on intestinal IRI and explored the possible mechanisms. Male Wistar rats were randomly divided into three groups: sham-operated group (Sham), IRI control group (IRI) and IRI-EGCG group (EGCG). Rats in IRI-EGCG group were administered dissolved EGCG in drinking water (0.4 mg/mL) for 14 days prior to IRI induction. A rat model of intestinal IRI was established by ligating the superior mesenteric artery (SMA) for 30 min, followed by reperfusion for 1 h. Intestinal histology, pro-inflammatory cytokines and mediators were examined and the effect of EGCG on PI3K/Akt signalling was assessed. EGCG significantly alleviated the pathological changes of the intestine and suppressed the IRI-induced up-regulation of TNF-α, IL-1 and IL-6 mRNA and protein expression in the serum and intestine. The mechanism might be that EGCG enhanced the activation of PI3K/Akt signalling pathway. In conclusion, the administration of EGCG can significantly mitigate the acute intestinal IRI in rats by enhancing the activation of PI3K/Akt signalling pathway to suppress inflammatory response and might be a promising alternative for the prevention or treatment of intestinal IRI in the clinical practice.

Protective effects of epigallocatechin-3-gallate on intestinal ischemia reperfusion injury through enhanced activation of PI3K/Akt pathway in rats / 华中科技大学学报（医学）（英德文版）

Inflammation plays a critical role in intestinal ischemia reperfusion injury (IRI). Epigallocatechin-3-gallate (EGCG) has been demonstrated to possess anti-inflammatory effect. This study examined the effect of EGCG on intestinal IRI and explored the possible mechanisms. Male Wistar rats were randomly divided into three groups: sham-operated group (Sham), IRI control group (IRI) and IRI-EGCG group (EGCG). Rats in IRI-EGCG group were administered dissolved EGCG in drinking water (0.4 mg/mL) for 14 days prior to IRI induction. A rat model of intestinal IRI was established by ligating the superior mesenteric artery (SMA) for 30 min, followed by reperfusion for 1 h. Intestinal histology, pro-inflammatory cytokines and mediators were examined and the effect of EGCG on PI3K/Akt signalling was assessed. EGCG significantly alleviated the pathological changes of the intestine and suppressed the IRI-induced up-regulation of TNF-α, IL-1 and IL-6 mRNA and protein expression in the serum and intestine. The mechanism might be that EGCG enhanced the activation of PI3K/Akt signalling pathway. In conclusion, the administration of EGCG can significantly mitigate the acute intestinal IRI in rats by enhancing the activation of PI3K/Akt signalling pathway to suppress inflammatory response and might be a promising alternative for the prevention or treatment of intestinal IRI in the clinical practice.

Renal function of donors and recipients after living donor kidney transplantation in a Chinese cohort / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Living donor kidney transplantation (LKT) has been booming in China. This study aimed to elucidate the renal function of both Chinese donors and recipients after the donation and transplantation.</p><p><b>METHODS</b>One hundred and forty-one pairs of donors and recipients for LKT were randomly selected and followed up for up to seven years. The donors' and recipients' renal function was recorded before and after operation.</p><p><b>RESULTS</b>The donors presented a mean age of (43.9 ± 7.5) years at donation. The female contributed 101/141 (71.6%) in all donors, and no effect was shown between genders on healthy donors' renal function. The donors' glomerular filtration rates (GFR) were (119.5 ± 20.4) ml/min, (85.2 ± 17.6) ml/min, (87.2 ± 15.9) ml/min, (82.1 ± 14.6) ml/min and (83.0 ± 13.7) ml/min preoperatively, and for five days, three months, one year and beyond one year after the operation. The donors for the period of 1 - 3 years, 3 - 5 years and more than 5 years after donation showed GFR as (83.9 ± 12.7) ml/min, (83.0 ± 17.6) ml/min, and (80.9 ± 20.8) ml/min, respectively, no statistically significant difference was found. Moreover, no significant clinical changes in blood pressure and proteinuria were found among the donors. In the recipients, delayed graft function (DGF) rate was 6.4%, acute rejection rate was 11.3%, and GFR were (66.5 ± 16.4) ml/min, (73.2 ± 19.6) ml/min and (63.9 ± 18.6) ml/min respectively at three months, one year and beyond one year post-transplantation respectively.</p><p><b>CONCLUSION</b>The donors/recipients of LKT in Chinese population experience well-functioning remaining/donor kidneys.</p>

Inducing of epithelial mesenchymal transition of HK-2 cells by connective tissue growth factor in vitro / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the role of connective tissue growth factor (CTGF) in epithelial mesenchymal transition of HK-2 cells in vitro.</p><p><b>METHODS</b>HK-2 cells were randomly divided into two groups: (1) control group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum only; and (2) experimental group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum and recombinant CTGF at a final concentration of 5 microg/L. The cells were collected at 72 h time points. Direct immunofluorescence staining and immunohistochemistry were used to evaluate the E-cadherin, Vimentin, alpha-SMA and ERK2 in cells. Western-blotting was used to detect the E-cadherin, Vimentin and ERK2 protein expression. Boyden Chamber was used to detect the migration of tubular endothelium at 1 d, 3 d and 5 d.</p><p><b>RESULTS</b>There were less E-cadherin but more Vimentin expressed in cells of the experimental group. The presence of alpha-SMA was detected at 48 h with peak at 72 h in the cells of the experimental group. On the first day, the cellular migration in the two groups showed no difference. However, after 3 days, the transformed cells migrated surpassed the control group with peak at the 5th day [(45.0+/-1.1):(14.0+/-1.2), P<0.05)].</p><p><b>CONCLUSION</b>Connective tissue growth factor induces mesenchymal transformation of HK-2 cells, in which the ERK2 signaling pathway may play an important role.</p>

Ideas and methods for treatment of gastrointestinal diseases by integrated Chinese and Western medicine / 中国中西医结合杂志

The fundamental mechanism of gastrointestinal diseases is the imbalance between the attack factor and the protective factor of stomach mucous membrane. It can not outbreak if the protective factor is stronger than the attack factor; otherwise, it will. Attack and protective function inside the stomach are mediated by various factors. These related factors interaction constitutes a complicated network system. This kind of outbreak theories of imbalance in Western medicine is same as that, "The sense of right saves inside, the evil can't do" and "Evil is competing with right, all diseases occur", in Chinese medicine. So, it is the key which points to futher study the interaction between gastrointestinal attack factors and protective factors by traditional Chinese medicine, thus improving the clinical effect.

The protective effects on allografts of adeno-associated heme-oxygenase-1 gene therapy against chronic rejection injury / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the protective effects on allografts and the possible mechanism of adeno-associated heme-oxygenase-1 (AdHO-1) gene therapy against chronic rejection injury.</p><p><b>METHODS</b>Ex vivo AdHO-1 gene therapy was performed in vascular and renal transplantation models. The structure and function, the expression of therapeutic genes and proteins, and the immune modulation were analyzed.</p><p><b>RESULTS</b>AdHO-1 gene therapy protected renal transplant against chronic rejection, but the effect was not as remarkable as that in vascular transplant. The transfected empty vehicle aggravated chronic rejection damage in renal transplantation. AdHO-1 decreased the infiltration of macrophages and CD4(+) T cells.</p><p><b>CONCLUSIONS</b>AdHO-1 gene therapy can lessen damage of chronic rejection in allografts. It plays roles by protecting transplants, down-regulating immune response and inducing immune deviation.</p>

Technology and application of simultaneous pancreas-kidney transplantation with modified enteric drainage / 中华外科杂志

<p><b>OBJECTIVE</b>To report the modified technique and the short-term results of simultaneous pancreas-kidney transplantation (SPK) with the enteric drainage (ED) of exocrine secretions.</p><p><b>METHODS</b>From June 2000 to August 2006, thirty-eight patients with diabetes complicated with uremia underwent SPK. The pancreas graft was placed intraperitoneally with exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean cold ischemic times of pancreas and kidney were (10 +/- 2.0) h and (7 +/- 2.0) h, respectively. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody, tacrolimus, mycophenolate mofetil and steroids was adopted except one patient.</p><p><b>RESULTS</b>The 6-month survival rates of patients and grafts were both 97.4% after transplantation. All patients achieved insulin-free euglycemia at (7 +/- 6.9) d postoperative except one. For preoperative patients, mean fasting insulin and C-peptide values were (9 +/- 8.1) mU/L and (6 +/- 4.5) mU/L. After operation, fasting insulin and C-peptide values of patients were (12 +/- 5.8) mU/L and (6 +/- 4.7) mU/L, respectively, which peaked to an insulin level of (57 +/- 43.0) mU/L and a C-peptide level of (11 +/- 6.8) mU/L with stimulation. There were eight cases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or intra-abdominal infection. The most common surgical complications were wound infection (n = 12), enteric anastomostic hemorrhage (n = 5) and perirenal hemorrhage (n = 2). Three patients (7.9%) had been reoperated for the reasons of intra-abdominal hemorrhage and perirenal hemorrhage.</p><p><b>CONCLUSIONS</b>SPK is an effective treatment option for selected patients with diabetes mellitus and approaching end-stage renal disease. Enteric exocrine drainage by direct side-to-side anastomosis (without Roux-en-Y) seems to be a simple and reliable technique.</p>