Game analysis on hospital outpatient payment methods of Chinese basic health insurance based on principle-agent theory / 中华医院管理杂志

As the major means of outpatient payment for basic medical insurance (the insurance for short) relies on fee-for-service, it tends to encourage unreasonable growth of medical expenses. Based on the principal-agent theory, this paper analyzed the principal-agent relationship between the insurance handling agencies and the hospitals designated by the insurance, and constructed a benefit game model of outpatient payment methods and the supporting supervision game model. This practice aims to explore the optimal and balanced benefit of the insurance payment methods and supporting supervision mechanism, and provide decision support for promoting the reform of medical insurance outpatient payment in China. The analysis results of the benefit game model of payment methods showed that a system mixing the post-payment and pre-payment could optimize and maximize the total benefits and interests of all the stakeholders within the system. Specifically, the practice recommended was a mixed payment integrating ambulatory-payment-classification, fee-for-service and global-budget-payment. The analysis of the supporting regulatory game model found that the factors that must be considered to ensure the expected utility of the above mixed payment mode as follows: the gap between the unreasonable income obtained by the hospital by out-of-control charging and the reward obtained by under-control charging, the size of the penalty after the unreasonable income of the hospital was discovered, the size of the regulatory cost and the loss of benefits of the government and the insured group. It is suggested to adopt the mixed payment method mainly based on the ambulatory-payment-classification supported by fee-for-service and global-budget. At the same time, medical insurance agencies can improve their supervision mechanism from such aspects as perfecting penalties, reducing supervision costs, leveraging government administrative power and advocating public supervision.

Effect of laminaria japonica polysaccharides on laryngeal carcinoma cell proliferation and apoptosis in vitro / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effect and its mechanism of laminaria japonica polysaccharides(LJP) on human laryngeal carcinoma cell Tu212 growth. METHODS The laryngeal squamous cell Tu212 in logarithmic growth phase were treated by laminaria japonica polysaccharides(80, 160, 320 μg/ml) and cisplatin(1.8 mg/L). The MTT assay was used to evaluate cell growth inhibition rate after 24h, 48h and 72h. The flow cytometry with PI staining were used to estimate cell cycle distribution after 48h. The fluorescent microscopy was used to estimate cell apoptosis after 48h. The western blot was used to evaluate the expressions of Cyclin B1 and Bcl-2. RESULTS The cell proliferation was inhibited by cellular LJP in a dose and time dependent manner. Tu212 cells proliferation were stopped at the G2/M phase treated with LJP after 48h. Cell apoptosis was observed clearly by f luorescent microscope after 48h. The expressions of Cyclin B1 and Bcl-2 were suppressed significantly treated with LJP after 48 h. All of the differences were significant(P <0.05). CONCLUSION LJP has inhibitive effects on the Tu212 cells, this mechanism was probably through inhibition of the proliferation and promotion of the apoptosis.

Mortality and influencing factors on injecting drug users with HIV/AIDS in Guizhou province, 1996-2015 / 中华流行病学杂志

Objective@#To understand the mortality and influencing factors on injecting drug users (IDUs) with HIV/AIDS, in Guizhou province, 1996-2015.@*Methods@#A retrospective cohort study was conducted on IDUs with HIV/AIDS that were reported through national comprehensive HIV/AIDS information system, in Guizhou province during 1996-2015. Cox proportional hazard regression model was used to analyze the influencing factors on the mortality of HIV/AIDS.@*Results@#A total of 3 958 cases of IDUs with HIV/AIDS were recruited in this study, with all-cause mortality rate of 44.01% (1 742/3 958) and total mortality rate of 7.80/100 person-years, respectively. The median survival time between diagnosis and death was 8.08 years. Mortality rate was 3.57/100 person-years in the group receiving antiretroviral therapy (ART). The mortality appeared to be 4.08/100 person-years in the group who were on methadone maintenance treatment (MMT). Data from the multiple regression analysis indicated that factors of gender, ethnicity, age when HIV/AIDS diagnosis was made, CD4+T lymphocyte (CD4) count at the first testing, ART and MMT were significantly associated with deaths among these people. The risk of death in females was 0.82 times (95%CI: 0.69-0.98) higher than that in males. The risk of deaths among the ethnic minority subjects was 1.39 times (95%CI: 1.21-1.60) higher than that of the Hans. The risk of death appeared to be 2.44 times higher (95%CI: 1.07-5.56) in the over-50-year of age group than in the <20 year-old group, when HIV/AIDS was diagnosed for the first time. The risk of death in CD4 ≥500/μl group in the first time was 0.27 times (95%CI: 0.22-0.32) more than CD4 <200/μl group in the firs time. The risk of death in cases who were treated with ART or MMT was 2.83 times (95%CI: 2.45-3.26) and 1.35 times (95%CI: 1.15-1.59) higher than those who did not receive any treatment, respectively.@*Conclusion@#Higher risks on death seemed to be related to the following factors: being male, older age at the time of diagnosis, lower CD4 at diagnosis, not on ART or MMT among the IDUs with HIV/AIDS in Guizhou province, between 1996-2015.

Study on operation service quality and safety management standard / 中华医院管理杂志

This study aimed at the quality and safety improvements of surgical services in terms of preoperative, intraoperative and postoperative sections, and at establishing corresponding restraint standards. To this end, such methods as literature analysis, dispute case analysis, surgical adverse event analysis, and system standard interpretation as well as clinical experts survey were called into play, to identify key elements in terms of the universality, high-prevalence rate, criticality and impact degree. A standard framework is established focusing on surgical service and such nodes as key components of the event; a standard text on surgical service quality and safety management is developed, comprising three sections, 8 nodes, 27 key elements and 82 standards.

Design of standard system framework for hospital quality and safety management in China / 中华医院管理杂志

A comprehensive literature review on medical quality and safety at home and abroad in recent years, rounded up cases of medical risks, quality defects and medical injuries faced by medical institutions. With reference to domestic and overseas experiences on standardization, the authors created the" Hospital Quality and Safety Management" of Chinese Hospitals Association, as institutional standard system framework and a system table. These contents comprise four parts and 62 sections, including general principles, patient service, medical support and medical management.

Overview on standardization of medical quality and safety management at home and abroad / 中华医院管理杂志

Based on a systematic literature review on medical quality and safety management at home and abroad, the authors presented such international standards as ISO, JCI, KTQ, NICE and ACHS, as well as China′s national and industrial standards for hospital grading appraisal and medical management, and introduced China′s standardization development. These efforts aim at referencing on domestic and international experiences for standard development by hospital quality and safety management entities.

Embryonal rhabdomyosarcoma of nasopharyngeal: a case report / 临床耳鼻咽喉头颈外科杂志

This case reports of nasopharyngeal embryonal rhabdomyosarcoma mainly for a stuffy nose, runny nose with blood, and without typical clinical manifestations. Electronic laryngoscopy tip: nasopharyngeal neoplasm. MRI tip: nasopharyngeal carcinoma. By pathological and immunohistochemical examinations, it finally was diagnosed with nasopharyngeal embryonal rhabdomyosarcoma.

Nasal endoscopic surgery for osteoid osteoma of the periorbital skull base: a case report / 临床耳鼻咽喉头颈外科杂志

Osteoid osteoma was first reported in 1935 by Jaffe. It is a kind of benign bone disease with the limitation of well-defined lesions. It is rarely seen in the periorbital region. The only symptom of the patient was unilateral proptosis of right. The result of MRI examination was cystic masses in the edge of the right orbit. The tumor was complete removed by the nasal endoscopic approach during the surgery. Pathology result was reported as osteoid osteoma. There was no significant complications of diplopia, visual acuity decreased, enophthalmos, cerebrospinal fluid leakage and others.

Change of CTR1 Expression after Round Window Niche Copper Sulfate and Cisplatin Infusion / 听力学及言语疾病杂志

Objective To study the expression of copper transport protein 1 in the inner ear of rat and the changes of CTR1 expression after those round window niche copper sulfate and cisplatin infusion .Methods 24 male wistar rats were randomly divided into 4 groups :Group I as the normal control group (nontreatment group);Group II as the round window niche cisplatin infusion group(0 .5 mg/ml);Group III as the round window niche cisplatin infusion group (1 mg/ml);group IV as the round window niche copper sulfate infusion (0 .02 mg/kg) .The CTR1 protein was detected by the immunohistochemical (IHC) otaining and Western-blot ,and the CTR1mRNA expres‐sion levels were detected by RT -PCR .Results The expression of CTR1 protein was observed in the cytoplasm and cell membrane of Corti organ cells ,spiral ganglion cells and stria vascularis in all groups .The average optical densi‐ties of CTR1 protein was a downward trend .The expression of CTR1 protein was observed in four different groups . The optical density analysis of CTR1 showed that the optical densities were 0 .532 ± 0 .031 ,0 .394 ± 0 .024 ,0 .234 ± 0 .030 and 0 .191 ± 0 .015 ,respectively .There was a downward trend ,and there were statistically differences among the groups (P<0 .05) .The CTR1 mRNA was observed in all groups .The optical density analysis of CTR1 mRNAshowed that the optical densities were 0 .508 ± 0 .035 ,0 .391 ± 0 .022 ,0 .240 ± 0 .02 and 0 .186 ± 0 .021 ,respective‐ly .It had a downward trend and were statistically differences among the groups (P<0 .05) .Conclusion The CTR1 protein was abundantly expressed in Corti organ ,spiral ganglion cells and stria vascularis of the cochlea .The round window cisplatin and copper sulfate infusion can change the expression of CTR1 proteins in inner ear .

Analysis of surgical methods and clinical analysis of its long-term effect of laryngeal carcinoma / 中国癌症杂志

Background and purpose:Surgical operation is the main method in the treatment of laryngeal carcinoma, but different patients have different impacts on the survival time and the quality of life with different type of operation. This study was to analyze the methods of surgical treatment and its long-term effect of laryngeal carcinoma, to increase survival rates, laryngeal function reservation and reconstruction and improve life quality.Methods:A total mumber of 424 patients of laryngeal carcinoma treated with surgical treatment during between Jan. 2002 and Dec. 2012 were researched by clinical follow-up and data analysis. Surgical method: CO2 laser-assisted laryngeal microsurgery for laryngeal tumors for 50 cases, frontal partial laryngectomy or modiifed thyroid cartilage window partial laryngectomy without tracheostomy for 42 cases, vertical frontolateral partial laryngectomy for 119 cases, horizontal partial laryngectomy and extended subtotal laryngectomy for 22cases, anastomosis of pharynx and trachea for 4 cases, supra cricoid partial laryngectomy for 129 cases (CHEP of them for 103 cases, CHP for 26 cases), total laryngectomy for 58 cases, cervical lymph node dissection at the same term for 121 cases.Results:Partial laryngectomy without tracheostomy for 92 cases (21.7%), total laryngectomy for 58 cases (13.7%); decannulation rate was 86.5%, vertical frontolateral partial laryngectomy of them for 93.2%, horizontal partial laryngectomy of them for 90.9%,supra cricoid partial laryngeal of them for 82.2%; laryngeal function reservation rate for 86.3%; all patients did outpatient review and telephone follow-up, 9 cases loss to follow-up, a total of tumor recurrence, cervical lymph node metastasis and distant metastasis were 41 cases, mostly occurred in 1 year after surgery; death for 57 cases, relapse of them for 8 cases, cervical metastasis for 13 cases, pulmonary metastasis for 5 cases, hepatic metastases for 2 cases, brain metastases for 1 case, esophagus metastases for 1 case, pulmonary infection for 6 cases, acute renal failure for 2 cases, unknown reason for 19 cases, according to Kaplan-Meier to count survival rate, 3-year and 5-year survival rate were 90.7% and 84.1%, relapse and metastasis were the main causes of death.Conclusion:Surgical treatment is the main therapy mode of laryngeal carcinoma. We choose individualized surgical methods for patients according to tumor staging, invasion site, age, occupation and education background of patient, health condition and so on. On the premise that tumor is completely cut off, we always advocate function surgery and minimally invasive surgery, and adopt comprehensive treatment at the same time, in order to increase survival rates, lesson suffering and improve life quality as far as possible.

The treatment effects analysis of 164 patients with sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effective treatment of sudden sensorineural hearing loss and factors affecting its prognosis.@*METHOD@#The clinical data and follow-up results of 164 patients with sudden sensorineural hearing loss were analyzed retrospectively. All the 164 patients were given intravenous vasodilator, neurotrophic drugs treatment, oral prednisone treatment, and intratympanic dexamethasone injection. All patients were divided into low frequency hearing loss type,intermediate frequency hearing loss, high frequency hearing loss, all frequency hearing loss and total deafness group. Pure tone hearing threshold test were performed before and 3 months after treatment. All patients and different groups were compared before and after treatment damage frequency of average air conduction and various frequency air conduction hearing. Analysis of gender, age, process and hearing curve type, frequency hearing of impaired before treatment, the symptoms with or without vertigo.@*RESULT@#All the patients' hearing improved after treatment. The treatment efficiency was 46.3%, and low frequency hearing improvements were better than the high frequency hearing. Including age, process, frequency hearing of impaired before treatment, with or without vertigo isindependent factors influencing its prognosis.@*CONCLUSION@#Based on the regular treatment,oral and intratympanic injection glucocorticoid therapy are safe and effective for sudden hearing loss,The prognosis and age, course, impaired hearing before curve type, treatment frequency hearing level is closely related, with or without vertigo.

Nasal primitive neuroectodermal tumor: a case report / 临床耳鼻咽喉头颈外科杂志

Primitive neuroectodermal tumor (PNET) is a small round cell malignancies, normally confined to the chest wall and soft tissues of children and young adults, and reports of this tumor existing in nasal cavity are scarce. We herein present a case of nasal PNET. A 35-year-old male patient presented with a chief complaint of stuffy nose was diagnosed with a primary nasal pPNET by the clinical, microscopic, immunohistochemical features. Since these tumors are highly aggressive and patient prognosis is typically very poor, early diagnosis, immediate surgical resection and re-resection if possible, early radiotherapy and chemotherapy and close follow-up are required. We also review literatures on pPNET.

Gastroesophageal reflux and otitis media with effusion / 临床耳鼻咽喉头颈外科杂志

Otitis media with effusion (OME), a kind of inflammatory disease of the middle ear, is characterized by the retention of middle ear effusions and hearing loss. There are many factors involved in the development of OME including bacterial infection, formation of bacterial biofilms, eustachian tube dysfunction, adenoid hypertrophy, immune system disorders. Recently, some studies showed that gastroesophageal reflux has correlation with OME.

The curative effect of cognitive behavior therapy for the treatment of chronic subjective tinnitus / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the efficacy of the cognitive behavior therapy (CBT) for the treatment of chronic subjective tinnitus.@*METHOD@#One hundred and fifty-seven patients were randomly divided into two groups. Sixty-eight patients of the control group were treated by masking therapy; and the other 89 patients of the experimental group were treated by CBT therapy. The score of tinnitus handicap inventory (THI) was utilized to analyze the treatment efficacy in the two groups respectively.@*RESULT@#The effective rate assessed by of THI score in the experimental group was not significantly higher than the control group 2 months after treatment (P > 0.05), but was significantly higher than the control group 6 months and 12 months after treatment (P < 0.05 respectively).@*CONCLUSION@#The CBT therapy contributed to achieve rapid adaptation of tinnitus feeling, which shows great value of further clinical application.

A systematic review of adenoidectomy in the treatment of otitis media with effusion in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Systematic reviews and Meta-analysis were conducted to assess the efficacy and security of adenoidectomy for the treatment of otitis media with effusion in children.@*METHOD@#Based on the principles and methods of Cochrane systematic reviews, literature was searched in PubMed, Medline, Elisevier, Ovid, CBM, CNKI, VIP and Wanfang datebases. Randomized controlled trials about treatment of otitis media with effusion in children using adenoidectomy were included. Meta-analysis was performed for the result of homogeneous studies using RevMan 5.2 software.@*RESULT@#Adenoidectomy (combined with myringotomy or puncture) was superior to non-surgical (combined with myringotomy or puncture) treatment in reducing the incidence of acute otitis media and removing the middle ear effusion. Adenoidectomy combined with tympanostomy tube was superior to tympanostomy tube alone in the removal of the middle ear effusion and improvement of hearing level. Three trials described some postoperative complications including haemorrhage, incipient malignant hyperthermia, postoperative pneumonia and velopharyngeal insufficiency.@*CONCLUSION@#Our research shows a benefit of adenoidectomy in the removal of middle ear effusion in children with OME. Adenoidectomy combined with tympanostomy tube was superior to tympanostomy tube alone in improving hearing level. At present, there is no evidence of serious postoperative complications after adenoidectomy.

Observation of postoperative recovery time with different surgical procedures for treatment of vocal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare postoperative voice recovery time of vocal polyps treated with different power levels of CO2 laser and conventional laryngeal microsurgery on vocal polyps.@*METHOD@#Two hundred patients with vocal polyps were randomly divided into four groups, which were respectively treated with conventional laryngeal microsurgery and different power levels of CO2 laser (2 W, 4 W and 6 W) under laryngoscope. The postoperative voice recovery time were analyzed.@*RESULT@#All vocal polyps were resected at one time without any serious complications like dyspnea or bleeding. The postoperative voice recovery time were 7.2 days for the group of patients received conventional laryngeal microsurgery and 7.6 days for the group of patients treated with 2 W CO2 laser, which were hoch significantly different from that in the group of patients treated with 6 W CO2 laser (P < 0.05).@*CONCLUSION@#The postoperative recovery time of patients treated with conventional laryngeal microsurgery and small power of CO2 laser is shorter than those operated with the other larger power of CO2 laser.

Mechanism of eosinophil apoptosis and its regulation in allergic reaction / 临床耳鼻咽喉头颈外科杂志

In allergic reaction activated eosinophils have been known to accumulate at the site of inflamma tion. Apoptosis of eosinophils may be involved in the inflammation resolution. In this review, we state that the apoptosis of eosinophils play a direct role in allergic reaction. Regulating the apoptosis of eosinophils can effectively alter the development of allergic inflammatory reaction.

Surgical methods and clinical analysis of early-stage glottic carcinoma involved anterior commissure / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the surgical methods for management of early-stage glottic carcinoma involved anterior commissure.@*METHOD@#Fifty-eight cases of early-stage glottic carcinoma (T1, n = 23; T2, n = 35) treated with vertical frontolateral partial laryngectomy and frontal partial laryngectomy or modified window partial laryngectomy without tracheostomy were retrospectively reviewed.@*RESULT@#All patients can swallow smoothly and phonate clearly after operation. And the extubation rate with vertical fronto vertical partial laryngectomy is 97.2%. Tracheostomy was performed in one case after operation because of dyspnea. The most common postoperative complication was subcutaneous emphysema which developed postoperatively in 6 patients, but subsided after discharge. Follow-up was conducted for 8 months to 7 years, recurrence was observed in 3 cases. The 3 and 5 year survival rates were 97.5% and 91.8% respectively.@*CONCLUSION@#To choose the optimal surgical method for patients with early-stage glottic carcinoma not only can reduce the risk of recurrence but also can save the laryngeal function and thus improves the quality of life.

Significance of ENG and DPG in the vestibular function examination in patients suffering BPPV / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect the significance of the electronystagmography (ENG) and the dynamic posturography (DPG) in the vestibular function examination in patients suffering BPPV.@*METHOD@#Forty, 34 to 79 old vertigo patients were examined with DPG and ENG. DPG evaluation parameters includes sense organization test from vestibular sensory score, proprioception score, visual score, Romber's score and composite score. ENG examination include caloric test.@*RESULT@#Twenty-six out of 40 BPPV patients got abnormal caloric test results; 33 patients got DPG abnormality which led to a low vestibular perception scores. Twenty-four out of these patients got abnormal results in both caloric test and DPG, while in 9 patients that got normal caloric results came up with low vestibular perception scores, except for which there was no significant abnormality in SOT. Besides, the BPPV patients, compared with normal, got abnormal scores in caloric test of ENG and vestibular perception test of DPG (P < 0.05), if course of BPPV was over 12 months, higher abnormal degrees appeared (P < 0.05).@*CONCLUSION@#ENG and DPG are important methods in vestibular function tests, a comprehensive analysis of both is applied to value the severity of vestibular function in patients with BPPV and the duration of BPPV directly affects the vestibular function.

A case of fibrous dysplasia of temporal bone / 临床耳鼻咽喉头颈外科杂志

Osteofibrous dysplasia is a kind of innocent bone tumor derived from fibrous tissue. Its pathogens has not been identified, it rarely affects the temporal bone, its clinical manifestations mainly is hearing loss. Imageological examination, for example, CT and MRI, is valuable for the diagnosis of this disease,the histopathological evidence is absolutely necessary to make definite diagnosis. Surgery is an effective method to treat the fibrous dysplasia of temporal bone.