The Effect of Health Plan Characteristics on Medicare+Choice Enrollment

Objective. To provide national estimates of the effect of out-of-pocket premiums and benefits on Medicare beneficiaries' choice among managed care health plans.
Data Sources/Study Setting. The data represent the population of all Medicare+Choice (M+C) plans offered to Medicare beneficiaries in the United States in 1999.
Study Design. The dependent variable is the log of the ratio of the market share of the j th health plan to the lowest cost plan in the beneficiary's county of residence. The explanatory variables are measures of premiums and benefits in the j th health plan relative to the premiums and benefits in the lowest cost plan.
Data Collection Methods. The data are from the 1999 Medicare Compare database, and M+C enrollment data from the Centers for Medicare and Medicaid Services (CMS).
Principal Findings. A $10 increase in an M+C plan's out-of-pocket premium, relative to its competitors, is associated with a decrease of four percentage points in the j th plan's market share (i.e., from 25 to 21 percent), holding the premiums of competing plans constant.
Conclusions. Although our price elasticity estimates are low, the market share losses associated with small changes in a health plan's premium, relative to its competitors, may be sufficient to discipline premiums in a competitive market. Bidding behavior by plans in the Medicare Competitive Pricing Demonstration supports this conclusion.     

胫骨前肌疲劳时比目鱼肌诱发肌电图H波的变化及其机制探讨

为了解主动肌疲劳时拮抗肌脊髓运动神经元兴奋性变化的规律 ,本研究采用踝关节背屈运动形式 ,对胫骨前肌 (主动肌 )疲劳状态下的比目鱼肌 (拮抗肌 )诱发肌电图H波成分进行了观察。并以压迫阻断胫骨前肌Ⅰa类神经纤维传导的方法 ,对比目鱼肌H波变化机制进行了分析探讨。结果发现 :(1)胫骨前肌疲劳后 ,比目鱼肌H波明显受到抑制 ,与安静时比较呈非常显著性差异 ;(2 )胫骨前肌Ⅰa类神经纤维传导被阻断后 ,比目鱼肌H波的抑制现象没有解除。表明 ,胫骨前肌疲劳时比目鱼肌H波被抑制的原因 ,可能是由于主动肌内的代谢产物激活了Ⅲ·Ⅳ类神经纤维的感受器 ,Ⅲ·Ⅳ类神经纤维的传入冲动增加 ,使Ⅰa抑制性中间神经元被激活 ,导致拮抗肌脊髓运动神经元的兴奋性受到了抑制     

两种不同方法定位肌间沟臂丛神经阻滞的临床观察

目的 观察经肩胛舌骨肌定位和运用神经刺激器定位肌间沟臂丛神经阻滞两种方法的临床效果。方法 选择ASAⅠ-Ⅱ级的择期上肢手术患者60例，随机分为两组：I组（30例）通过肩胛舌骨肌定位穿刺点寻找异感；Ⅱ组（30例）使用神经刺激器定位肌间沟臂丛神经，观察肌肉节律性收缩。两组分别观察进针深度，阻滞效果及不良反应。I组还同时观察肩胛舌骨肌触摸难易度，穿刺部位以及一次异感获得率等。结果 I组肩胛舌骨肌触摸容易者27例（90％），穿刺部位距锁骨上缘1.6-3.1cm，进针深度0.5-1.5cm，一次获得异感26例（87％），阻滞效果完善，无不良反应。Ⅱ组有28例阻滞完善，另2例阻滞不全，2例出现不良反应。结论 运用神经刺激器定位肌间沟臂丛神经阻滞切实可行。而以肩胛舌骨肌定位肌间沟臂丛神经阻滞定位明确，效果满意，简单易行。     

带腹直肌蒂胸骨翻转术治疗漏斗胸10例疗效分析

目的:探讨漏斗胸的外科治疗。方法:应用带腹直肌蒂胸骨翻转术对10例漏斗胸病人进行外科治疗。结果:本组病例手 术效果满意,术中翻转胸骨片血运丰富,术后长期随诊,无复发。结论:带腹直肌蒂胸骨翻转术治疗漏斗胸具有手术操作简便、出血少、 术后恢复快、矫正效果满意、术后无复发等特点。     

葛根素对抗H2O2引起血管平滑肌细胞凋亡及坏死

目的：研究葛根素对过氧化氢引起无血清培养的小牛主动脉血管平滑肌细胞凋亡和坏死的影响。方法：通过体外细胞培养，以噻唑兰（MTT）法测定细胞存活率，用流式细胞术检测细胞DNA含量及凋亡细胞百分率；DNA琼脂糖凝胶电泳法观察细胞凋亡过程中DNA断裂程度。结果：H2O2诱导无血清培养的平滑肌细胞凋亡，葛根素可显著降低平滑肌细胞中凋亡细胞百分率，并减少凋亡细胞DNA断裂，同时也减少其引起的平滑肌细胞坏死。结论：葛根素可对抗H2O2引起的无血清培养的血管平滑肌细胞凋凋亡及坏死。     

尾部悬吊与30月龄大鼠比目鱼肌的形态学特征比较

目的 观察尾部悬吊和30月龄大鼠比目鱼肌发生萎缩过程的异同点.方法 SD雄性大鼠42只,随机分为7组,即尾部悬吊5 d、7 d、14 d组,相应的同步对照和30月鼠龄组,在各时间点制备比目鱼肌横截面冰冻切片标本,用抗MHC Ⅱ单克隆抗体进行免疫组织化学染色,计算比目鱼肌Ⅰ、Ⅱ型肌纤维横截面积并计数各型肌纤维数目.结果 与同步对照组相比,悬吊组大鼠比目鱼肌的湿重,相对湿重,Ⅰ、Ⅱ型肌纤维横截面积,经体重归一化的肌纤维横截面积均显著降低,Ⅱ型肌纤维比例显著增加,而Ⅰ型肌纤维比例减少.与14 d对照组相比,30月龄组大鼠比目鱼肌湿重和Ⅰ、Ⅱ型肌纤维横截面积均明显增大,但其相对湿重和经体重归一化的肌纤维横截面积却显著降低,与悬吊14 d组无显著差异.30月龄组大鼠比目鱼肌中Ⅰ、Ⅱ型肌纤维比例与各对照组相比亦无显著差异.结论 30月龄大鼠比目鱼肌萎缩以首先出现相对湿重与归一化肌纤维横截面积降低为特征,且发生较慢,而尾部悬吊大鼠比目鱼肌则在较短时间内发生全面萎缩.     

钾通道开放剂降低血管平滑肌细胞内游离钙浓度(英文)

目的:研究PCO—Pin,Nic,Lem及RP对VMSC内[Ca~(2 )]_i的改变及其可能机制。方法:VSMC加入Fura-2 AM 2.5μmol·L~(-1)37℃下孵育50min,[Ca~(2 )]_i用荧光分光光度计检测。结果:4种PCO能较弱地抑制K~ 30 mmol·L~(-1)诱导的[Ca~(2 )]_i增加,但明显抑制ATP 0.1mmol·L~(-1)诱导的[Ca~(2 )]_i峰相及持续相增加,且呈剂量依赖性。格列苯脲完全阻断Pin,Lem及RP的作用,只部分抑制Nic的作用。无钙液中先给4种PCO,能显著抑制ATP诱导的[Ca~(2 )]_i峰相增加。结论:4种PCO均抑制ATP诱导的[Ca~(2 )]_i增加,此作用与减少细胞外钙内流及细胞内钙释放有关。     

Influence of stretch-shortening cycle on mechanical behaviour of triceps surae during hopping

Belli , A. & Bosco, A. 1992. Influence of stretch-shortening cycle on mechanical behaviour of triceps surae during hopping. Acta Physiol Scand 144 , 401408. Received 20 March 1 991 , accepted 3 December 1991. ISSN 0001–6772. Laboratories of Physiology, Universities of St Etienne and Lyon, France and Departments of Biology and Physical Activity, University of Jyväskylä, Finland. Six subjects performed a first series of vertical plantar flexions and a second series of vertical rebounds, both involving muscle triceps surae exclusively. Vertical displacements, vertical forces and ankle angles were recorded during the entire work period of 60 seconds per series. In addition, expired gases were collected during the test and recovery for determination of the energy expenditure. Triceps surae was mechanically modelled with a contractile component and with an elastic component. Mechanical behaviour and work of the different muscle components were determined in both series. The net muscular efficiency calculated from the work performed by the centre of gravity was 17.5±3.0% (mean ± SD) in plantar flexions and 29.9 ± 4.8% in vertical rebounds. The net muscle efficiency calculated from the work performed by the contractile component was 17.4 %% 2.9% in plantar flexions and 16.1 ± 1.47; in vertical rebounds. These results suggest that the muscular efficiency differences do not reflect muscle contractile component efficiency but essentially the storage and recoil of elastic energy. This is supported by the relationship (P < 0.01) found in vertical rebounds between the extra work and the elastic component work. A detailed observation of the mechanical behaviour of muscle mechanical components showed that the strategy to maximize the elastic work depends also on the force-velocity characteristics of the movement and that the eccentric-concentric work of the contractile component does not always correspond respectively to the ankle extension-flexion.     

High proportion of type I fibres in thigh muscle of young dancers

A previous study showed that adult female dancers have a high percentage of type I fibres in vastus lateralis. similar to that of endurance-trained female runners ar female cross-country skiers. It is not known if dancers already at an early age are characterized by a high percentage of type I fibres or develop a high percentage of type I fibres as a consequence of dance training. Furthermore. the muscle fibre composition of male dancers has not previously been studied. Therefore the aim of the study was to analyse skeletal muscle fibre characteristics in 10-year-old and 20-year-old dancers of both sexes. Age-matched boys and girls whose physical activity was average for their age groups served as controls. Muscle biopsies for histochemical analysis were obtained from vastus lateralis using the percutaneous needle technique. The major finding of the present study was that the vastus lateralis of young dancers of both sexes had a higher percentage of type I fibres than that of controls. Moreover. the higher type I percentage was seen not only in 20 year aids. but also in 10 year aids. who had begun their dance training at a professional level only a few weeks earlier. No significant difference in this respect was found between female and male dancers. In conclusion. the muscle fibre type composition in young dancers of both sexes differs from that of the average individual of the same age and is characterized by a high percentage of type I fibres.     

Mechanisms of pinacidil-induced vasodilatation

The mechanism of the vasodilator effect of pinacidil was examined. Pinacidil (0.1–100 μM) inhibited the increases in cytosolic Ca²⁺ ([Ca²⁺]_i) and muscle tension due to norepinephrine in rat aorta. In contrast, a Ca²⁺ channel blocker, verapamil, inhibited the norepinephrine-stimulated [Ca²⁺]_i more strongly than the contraction. Higher concentrations of pinacidil (3–100 μM) inhibited the verapamil-insensitive portion of the contraction and [Ca²⁺]_i. An inhibitor of ATP-sensitive K⁺ channels, glibenclamide, antagonized the inhibitory effect of low concentrations ( 10 pM) of pinacidol. Pinacidil did not change the contraction induced by Ca²⁺ in vascular smooth muscle permeabilized with Staphylococcus aureus -toxin. Norepinephrine (in the presence of GTP), 12-deoxyphorbol 13-isobutyrate (in the absence of GTP), and treatment with GTP_γS potentiated the contraction of permeabilized smooth muscle induced by the addition of Ca²⁺. Pinacidil (100 μM) inhibited the potentiation due to GTP_γS or noepinephrine but not to phorbol ester. These results suggest that pinacidil has dual effects on vascular smooth muscle contraction. At lower concentrations (>0.1 μM), it decreases [Ca²⁺]_i, possibly by activating ATP-sensitive K+ channels. At higher concentrations (> 3 μM), it may additionally inhibit the receptor-mediated, GTP-binding protein-coupled phosphatidyl inositol turnover.