International innovative health technology payment strategy and enlightenment under diagnosis-related groups payment system / 中华医院管理杂志

Under the diagnosis-related groups(DRG) prospective payment system, innovative health technologies with high costs and risks may be limited to some extent. How to balance the increase of health care cost and the development of innovative health technology is a difficult problem to be solved in the current reform. By studying the relatively mature payment systems of innovative health technologies in the world, the authors found that countries generally adopted additional payment or compensation to encourage the development of new technologies. But at the same time, a relatively perfect health technology assessment and payment management mechanism had been established to ensure the standardized operation of payment plan. These international advanced experience and practice could provide references for China′s innovative health technology payment strategy under the DRG payment system. It is suggested to establish a scientific and reasonable assessment mechanism of innovative health technology, create a special access channel for innovative health technology with limited short-term evidence, and gradually form a long-term incentive mechanism of innovative health technology in DRG payment system.

Improving effect of exosomes of mesenchymal stem cells with high expression of miR-132-3p on hypoxia/reoxygenation impaired brain microvascular endothelial cell function / 中国脑血管病杂志

Objective To study the effect of exosomes ( EXs) released from high expression of miR-132-3p mesenchymal stem cells (MSCs) on hypoxia/reoxygenation (H/R) injured endothelial cell function. Methods MSCs extracted from bone marrow of C57BL/6 mice were cultured primarily. MSCmiR-132-3p was obtained from MSCs infected with lentivirus loaded with miR-132-3p vector. At the same time,MSCNC was obtained by infecting MSCs with control lentivirus loaded with scramble sequence. EXs released from MSCNCand MSCmiR-132-3pwas isolated,and MSC-EXs and MSC-EXsmiR-132-3pwere obtained respectively. The obtained EXs and H/R damaged mouse brain microvascular endothelial cells (bend3) were co-cultured. According to culture conditions,the cells were divided into normal culture group (normal cell culture),H/R group (making a H/R model),MSC-EXs group (MSC-EXs co-culture),MSC-EXsmiR-132-3p group (MSC-EXsmiR-132-3pco-culture), and MSC-EXsmiR-132-3p+ LY294002 group ( before the cells and MSC-EXsmiR-132-3pwere co-cultured,treated by adding phosphatidyl alcohol 3 kinase [ PI3K] signaling pathway blocker LY294002 [20 μmol/L]). Quantitative real-time quantitative polymerase chain reaction was used to detect the expression of miR-132-3p in MSCs,MSC-EXs,and bend3 cells. Angiogenesis kit was used to detect angiogenic ability of bend3 cells,and 3-(4,5-dimethylthiazole-2)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect the proliferative capacity of bend3 cells. Scratch test was used to detect the migration ability of bend3 cells. hochest33258 staining showed cell apoptosis. Western blot was used to detect the phosphorylation level of protein kinase B ( Akt) . Results Compared with the H/R group, the MSC-EXs treatment group significantly improved the angiogenesis,proliferation,migration abilities, and Akt phosphorylation level of bend 3 cell damage induced by H/R (The H/R group were 3 ± 1,0. 275 ± 0. 020,147 ± 8 μm,and 0. 89 ± 0. 12,respectively;the MSC-EXs treatment group were 8 ± 3,0. 358 ± 0. 030,218 ± 10 μm, and 1. 37 ± 0. 25 μm,respectively;all P<0. 01). Apoptosis was significantly reduced (47 ± 2% vs. 63 ± 2%,all P<0. 01). Compared with the MSC-EXs treatment group,the angiogenesis,proliferation,migration abilities,and Akt phosphorylation level of bend 3 cells in the MSC-EXsmiR-132-3ptreatment group were increased (14 ±3,0. 444 ± 0.050,357±10μm,and1.67±0.23,respectively,all P<0.01).Apoptosis was significantly reduced (34±1%,all P<0. 01) . Compared with the MSC-EXsmiR-132-3ptreatment group, cell proliferation, migration, angiogenesis abilities,and Akt phosphorylation level in the MSC-EXsmiR-132-3p+LY294002 group were significantly reduced (5 ± 2,0. 304 ± 0. 050,175 ± 8 μm and 0. 95 ± 0. 11,respectively,all P<0. 01). Conclusion MSC-EXs with high expression of miR-132-3p may improve many physiological functions of H/R-induced damaged cerebrovascular endothelial cells by activating PI3K/Akt signaling pathway.

Effect of TLR4/NF-κBp65 Signaling Pathway on Acute Kidney Injury of Rats With Severe Acute Pancreatitis / 胃肠病学

Background:TLR4/NF-κBp65 signaling pathway plays an important role in triggering inflammatory response,and regulates releasing of cytokines in acute pancreatitis. However,the role of this pathway in inflammation in severe acute pancreatitis(SAP)associated with acute kidney injury(AKI)is not clear. Aims:To investigate the effect of TLR4/NF-κBp65 signaling pathway on AKI in experimental SAP. Methods:Thirty-two male Sprague-Dawley rats were randomly assigned into 4 groups(8 each):normal control group,SAP 6 h,12 h,and 18 h groups. SAP was induced by retrograde injection of 4% sodium taurocholate into biliopancreatic duct. Serum levels of creatinine(Cr)and blood urea nitrogen (BUN)were measured dynamically. Pathological changes of kidney were observed macro- and microscopically. Serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were determined by ELISA,and the localization and expressions of TLR4 and NF-κBp65 in kidney were determined by immunohistochemical staining and Western blotting. Results:Compared with normal control group,the kidney injuries in SAP groups were gradually aggravated with disease progression;meanwhile,serum levels of Cr,BUN,TNF-α and IL-6 increased significantly,and the expressions of TLR4 and NF-κBp65 in kidney became more intensive(P all <0.05). Expressions of TLR4 and NF-κBp65 in kidney were positively correlated with the serum levels of Cr,BUN,TNF-α and IL-6. Conclusions:In experimental SAP,the changes of TLR4 and NF-κBp65 expressions in kidney are coincidence with the severity of kidney injury and the serum levels of proinflammatory cytokines,which indicates that TLR4/NF-κBp65 signaling pathway plays an important proinflammatory effect in disease progression of SAP associated with AKI.

Treatment of single one-stage posterior atlantoaxial fixation in Chiari malformation / 中华外科杂志

Objective@#To explore the effects of surgical technique of single one-stage posterior C1-2 screw rod fixation of Chiari malformation (CM) associated with occipitalization and without atlantoaxial dislocation.@*Methods@#A total of 23 patients with CM treated between January 2014 and October 2015 in Department of Neurosurgery of Chinese People′s Liberation Army General Hospital were retrospective reviewed. All of them were diagnosis with CM associated with occipitalization and without atlantoaxial dislocation, including 8 males and 15 females, aging from 11 to 57 years (mean (35.5±10.52) years). Single one-stage posterior C1-2 screw rod fixation with bone grafting fusion was performed. Operation time and intraoperative blood loss were recorded. Japanese Orthopaedic Association (JOA) scores and Odom rating were used to evaluate the clinical effects at pre- and post-operative. Regression of the cerebellar tonsillar was measured by MRI. The results were analyzed by paired samples t test.@*Results@#Twenty-three patients were implanted screws successfully, the vertebral artery injury and cerebrospinal fluid leakage were not found. The mean operation time was (172.7±19.9) minutes, the intraoperative blood loss was (153.9±49.3) ml. Compared to preoperative, the JOA score increased (13.7±1.6 vs. 11.5±1.4) and the tonsillar herniation decreased ((0.8±0.6)cm vs. (1.9±0.6) cm) in the last follow-up, there were statistical difference (t=13.386, P<0.01; t=17.995, P<0.01). The results of the postoperative Odom grading were as follows: 6 cases were perfect (26.1%), 13 cases were good (56.5%), 4 cases were moderate (17.4%) and no case was poor.No signs of instrument loosen or screw broken was noticed. 100% bony fusion rate was achieved. The follow-up time was 6 to 23 months (mean (10.5±3.2) months). One case developed internal fixator related discomfort, the symptom was relieved by internal fixator removal surgery performed 4 months after the operation when osseous fusion had already been achieved. No new neurologic symptoms were observed in other 22 patients.@*Conclusions@#The results of the study substantiates the effectiveness of single one-stage posterior fixation strategy for CM, which is associated with occipitalization and without atlantoaxial dislocation. This technique could be an alternative choice for this type of CM.

Study of epidemic area on Tsutsugamushi disease in Taizhou from 2013 to 2014 / 中华预防医学杂志

Objective@#To study the epidemiological characteristics of tsutsugamushi disease, and to confirm the existence of the disease's epidemic foci in Taizhou.@*Methods@#From 2013 to 2014, Dongxing town hospital and Xingqiao town hospital were selected as specimen collection sites in Jingjiang city. Blood samples (5 ml) were collected from 40 patients with acute tsutsugamushi disease. A total of 59 rodents were captured with cage night method in the survey sites at 5, 7, 9, 10, and 11 months in 2013, from which, the spleen, liver, and kidney specimens were selected. Chigger mites were captured by small blackboard method and from the ears of the captured rodents. A total of 226 small blackboards were laid, 27 mites were captured, and the samples were grounded into suspension. Nested-polymerase chain reaction and cell and tissue culture techniques were used to test the specimen from the probable patients, host animals and chigger mites.@*Results@#Among the 40 acute tsutsugamushi disease blood samples, 29 were found to meet the test requirements, 17 were positive for orientia tsutsugamushi nucleic acid with 59% of the positive rate, and 1 stran orientia tsutsugamushi was isolated. 59 rats were captured and the density of mice was 5.5%. Among them, there were 26 Mus musculus (2.4%), 18 Rattus flavipectus (1.7%) and 15 Smelly shrew (density 1.4%). 1 Smelly shrew was tested positive for orientia tsutsugamushi nucleic acid, and the negative results were found in the other rodent specimens. 27 Chigge mites were collected by small blackboard method and the density of mites was 0.12 for each blackboard, among which 3 larvae and 24 nymphs were found. 33 Chigger mites were collected from the ears of 3 Smelly shrew, and the density of the mite was 11 per mouse. All the captured Chigger mites were identified as Leptotrombidium scutellare and 1 group of specimens of Chigger mites from the external environment were positive for orientia tsutsugamushi nucleic acid.@*Conclusion@#There was a high density of mice in the epidemic area from May to November and the species of the chigger mites were Chigger mites in Taizhou. The nucleic acid of the oriental tsutsugamushi was detected in the patients with acute scrub typhus, rodents and vectors. According to the above-mentioned results, it was considered that the scrub typhus epidemic area of Taizhou city has the natural foci of scrub typhus.

Research on inhibitory effect of celecoxib against migration of vascular endothelial cells / 医学研究生学报

Objective The mechanism of celecoxib in influencing the migration of vascular endothelial cells is still not clear.The aim of this study was to investigate the effect of celecoxib against migration of vascular endothelial cells and its mechanism.Methods Human umbilical vein endothelial cells (HUVECs) were obtained from the cell bank of Central Laboratory of Nanjing General Hospital of Nanjing Military Command.Transwell was used to measure the migration rate of HUVECs after the administration of 0μmol/L, 10μmol/L and 20μmol/L celecoxib.Immunofluorescence, western blot, and qRT-PCR were used to detect protein and mRNA expression of COX-2 and PTPRJ in HUVECs.Results The expression of COX-2, PTPRJ in HUVECs were detected by immunofluorescence.After the administration of 20μmol/L, 10μmol/L and 0μmol/L celecoxib, HUVEC migration rate was (12.35±3.61), (32.80±5.92) and (63.15±5.83) respectively, representing significant difference (P<0.01).COX-2 protein expression in 20μmol/L group (0.16±0.03) and 10μmol/L group (0.36±0.05) decreased significantly compared with that of 0μmol/L group (0.77±0.07) (P<0.01).Moreover, COX-2 protein expression in 20μmol/L group significantly decreased compared with that of 10μmol/L group(P<0.05).PTPRJ protein expression in 20μmol/L group (0.82±0.05) and 10μmol/L group (0.51±0.02) was respectively higher than that of 0μmol/L group (0.27±0.04) (P<0.01).Moreover, PTPRJ protein expression in 20μmol/L group significantly increased compared with that of 10μmol/L group (P<0.05).COX-2 mRNA expression in 20μmol/L group (0.06±0.02) and 10μmol/L group (0.22±0.05) decreased significantly compared with that of 0μmol/L group (1.05±0.13) (P<0.01).PTPRJ mRNA expression in 20μmol/L group (60.27±11.31) and 10μmol/L group (16.50±3.18) increased significantly compared with that of 0μmol/L group (0.99±0.25) (P<0.01).Conclusion Celecoxib inhibits the migration of vascular endothelial cells, which may be related to the inhibition of COX-2 expression and the up-regulation of PTPRJ expression in vascular endothelial cells.

Effect of alprostadil on early proinflammatory cytokines and its therapeutic effect in patients with severe acute pancreatitis / 解放军医学杂志

Objective To investigate the effects of alprostadil on expression of proinflammatory cytokines in patients with severe acute pancreatitis (SAP) and evaluate the clinical efficacy.Methods Seventy-three SAP patients were collected from January 2014 to May 2016,and then were randomly divided into control group (n=37) and experimental group (n=36).On the basis of routine treatment,the experimental group patient was given alprostadil at a dose of 15μg/d.The expression of C-reactive protein (CRP),white blood cell (WBC) count,amylase,alanine aminotransferase (ALT),aspartate aminotransferase (AST),creatinine,serum proinflammatory cytokine tumor necrosis factor alpha (TNF-α),interleukin-1 beta (IL-1[β),interleukin-6 (IL-6) were detected in serum on the 1st,3rd and 7th day.Results The biochemical indexes and expression ofproinflammatory cytokines were significantly increased in the two groups on the 1st day,and decreased gradually,with a significant difference between the time points (P＜0.05),but the between-group difference was not significant (P＞0.05).These indexes were decreased significantly with the passage of time and there were significant differences between the two groups at the 3rd and 7th day (P＜0.05).Conclusion Alprostadil can effectively reduce the severity of early inflammatory reaction in SAP patients,and has important significance for improving the prognosis.

Thalidomide in combination with interferon in the induction therapy for relapsed refractory T-cell lymphoma:two cases report and literature review / 白血病·淋巴瘤

Objective To observe the effectiveness and side-effect of two cases of relapsed and refractory T-cell lymphoma (TCL) treated with thalidomide and interferon.Methods Two cases of relapsed and refractory TCL was treated with thalidomide and interferon, the efficacy and side-effect were observed, and the relevant literature was reviewed.Results The patients achieved partially remission after being treated with thalidomide and interferon.Conclusion Thalidomide in combination with interferon can be used as a second line therapy for relapsed and refractory TCL.

Anti-tumor activity of angiotensin-converting-enzyme inhibitors / 医学研究生学报

Angiotensin-converting-enzyme inhibitors(ACEI) are generally used in the treatment of cardiovascular system diseases.They are found by epidemiological studies to have an anti-tumor activity and are shown to play various roles in suppressing carcinogenesis and tumor growth,preventing angiogenesis,inhibiting matrix degradation and reducing cancer cachexia.

Advancement on the therapy of somatostatin on liver fibrosis / 中国临床药理学与治疗学

Somatostatin,a cyclopeptide hormone,is generally distributed in vivo.Some studies have indicated that somatostatin can reduce proinflammatory cytokine in hepatic stellate cells and extracellular matrix,and inhibit their proliferation and contraction,promote their apoptosis.It can also regulate the function of Kupffer cells,influence the homing of hepatic stem cells.Somatostain has therapeutic effect on liver fibrosis,especially on the liver fibrosis caused by schistosoma mansoni.