新疆南疆两县新型农牧区合作医疗参合农民受益情况调查分析

目的 通过对新疆南部地区开展新型农牧区合作医疗两个县的参合农民受益情况调查分析,了解新疆南部地区两个县参合农民受益情况,为卫生管理机构制定相关卫生政策和策略提供科学依据.方法 从南疆地区已开展新型农牧区合作医疗的42个县市中,采用随机抽样方法抽取两个县.结果 新农合实施以来,2008年两县的平均参合率为92.25%;筹资总额2008年较2005年投入增加了209.08.%,政府筹资占75.7%,个人占24.3%,没有社会救助;住院补偿人次增加了133.05%,住院补偿金额增加了355.19%;2005年～2007年两县参合农民门诊就诊补偿人次呈现逐年增长趋势,而2008年有所降低,2008年较2005年参合门诊就诊补偿金额增加了15.45%.结论 新疆南部地区两个县的参合农民住院、门诊受益情况均有提高,住院补偿金额高于门诊补偿,故应提高补偿比例,加快立法和基金管理.     

2005“两会”医疗卫生精品提案议案选登(五)——关于搞好新型农村合作医疗试点工作的几点意见

自2003年春夏新型农村合作医疗试点工作开始,至2004年10月31日的两年来,全国共有333个县(市)开展了试点,参合农民有8040.01万人,参合率为75.20%。中西部启动了233个县(市),参合4678.98万人,参合率为75.16%。全国新型农村合作医疗报销金额19.88亿元,西部地区占9.05亿元。新型农村合作医疗使农民感受到了政府对农民健康的关心,农民得到了实惠。同时医疗机构也增加了收入,如贵州的息烽县,2004年上半年,全县10个乡镇卫生院门诊、住院病人量达85248人次,业务收入168.93万元,比前年同比增加了20.26%和9.03%。所以合作医疗达到农民和医疗机构双赢的态势。新型农村合作医疗试点正在扩大,到2010年要覆盖全国,根据实地调研的结果,提出以下建议:     

都江堰市为新农合搭建“平台”

都江堰市是四川省首批新型农村合作医疗试点县之一，该市坚持“党委领导、政府组织、财政监管、卫生服务、农民享用”的工作思路，搭建信息化管理和规范、方便的诊疗服务平台，截至去年底全市共有37万农业人口参加新型农村合作医疗，参合率达92%，一年累计受益人数达37万人次，补偿金额722万元。     

河南某县新型农村合作医疗住院补偿情况分析

目的:了解新型农村合作医疗参合农民住院流向、费用及补偿情况,为制定和改善新型农村合作医疗补偿政策提供依据。方法:收集河南某县2007-2009年参合农民住院补偿数据,用SPSS12.0软件进行数据录入处理分析。结果:该县2007-2009年新型农村合作医疗的住院补偿人次、住院总费用、次均费用、补偿总费用、次均补偿费用、补偿比等均不断提高,且病人流向和补偿基金逐年向县级和县级以上级别医疗机构倾斜。结论:该县的新型农村合作医疗取得了良好的效果,但基层医疗机构资源使用率低下,住院总费用增长过快,需重点加强基层医疗卫生机构能力建设,进一步优化新农合住院补偿方案,合理控制医疗费用的增长。     

北京海淀区新农合人均筹资提至600元

12月22日从北京市海滨区卫生局获悉,2009年,北京市海滨区新型农村合作医疗参合人员人均筹资总额提高至600元,提前一年达到北京市2010年筹资水平,并将住院和特殊病种门诊补偿起付线由1500元调整为1300元,二级医院报销比例由50％提高到55％。     

辽宁：新农合资金使用率提高到70．6％

从辽宁省政府召开的2007年全省新型农村合作医疗工作会议上获悉，截至2006年10月，该省44个县（市）42个涉农区和11个涉农开发区全部启动了新型农村合作医疗工作，覆盖农业人口2154万人。农民参合率达84．4％。2006年全省共补偿562万人次，补偿资金支出3．9亿元，受益农户比例达71．13％。根据对27个县考评结果，资金使用率提高到70．6％。[第一段]     

南京市新型农村合作医疗运行情况分析

文章对南京市新型农村合作医疗的运行情况进行分析,发现参合人数不断增加,筹资水平逐年提高;实现了以大病统筹为主的政策要求,但资金结余率偏高;不同级别医院的住院人次分布不均衡?建议规范定点医疗机构的服务行为;实行逐级转诊制度;加强乡镇卫生院的建设;积极探索补偿方法和费用支付方式;建立健全新型农村合作医疗管理信息系统?     

山西某县2010-2013年新农合参合农民住院费用及负担的研究

目的：：了解长治市襄垣县2010—2013年新型农村合作医疗的参合率、住院率、补偿比例和负担比例等情况,发现存在的问题并提出政策建议,为新农合的可持续发展提供科学依据。方法：将2010—2013年的新农合报销的原始资料,统一汇总录入 Excel 2007数据库,运用 SPSS18.0软件,对住院人次、住院天数、住院费用、补偿比例和负担比例等指标进行描述性分析,组间比较进行Z2检验、χ2检验等。结果：襄垣县从2010—2013年,平均住院率为6.86%,住院补偿比由47.13%增加到55.12%,住院负担比由48.41%降低到45.02%;省级及以上医院住院人次下降了6.59%,乡镇医院提高了4.52%。结论：参合农民住院人次逐年提高,住院补偿比例逐步增加,负担比例逐步下降,提示新型农村合作医疗住院服务利用率稳步提高,基层医疗机构利用率正在逐步加强。但是负担比例仍很重,尤其是县外医院和恶性重大疾病补偿比例须待进一步提高。     

“出院即报“——新型农村合作医疗让农民称心

几年前,河北省迁安市杨店子镇的田老汉胃痛得直冒汗,到医院一检查,发现是肿瘤。医生告诉他,如果住院做手术,医药费至少要1万元。老汉被这“天文数字”吓得扭头就走,回家没多久就病逝了。这是河北省迁安市农民看病难、看病贵的真实写照。2003年8月,河北省迁安市成为全国新型农村合作医疗制度首批试点之一。今年,迁安市96%的农民自愿参加了新型农村合作医疗,共计53.3万人。两年来,共有46.9万人次报销医药费2701万元。通过新型农村合作医疗制度,农民的医疗经济负担有所减轻,因病致贫、因病返贫的状况初步缓解,新型农村合作医疗步入良性循环。出…     

浅谈县医院在新型农村合作医疗中的作用

宣汉县人民医院为宣汉县新型农村合作医疗(以下简称"新农合")定点医疗机构之一,是一所综合性国家二级甲等医院,全县医疗和应急救治的中心,因此县医院的医疗水平和服务质量直接关系着全县所有参合农民的切身利益,它运行的好坏决定着全县新农合制度运行的成败.从2007年5月8日～11月30日,我院已接诊来自全县55个乡镇的新农合患者3000人次,报销补偿费用280万元,对缓解农民看病难和因病致贫、因病返贫等问题发挥了重要作用.通过近半年的摸索,我们认为县医院在新农合中主要起着以下4个方面的作用.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.