Association between private health insurance and medical use by linking subjective health and chronic diseases

This empirical study identifies the negative aspects of private health insurance (PHI) by analyzing the association between subjective health conditions, 2 weeks of outpatient care, chronic diseases, and hospitalizations for 1 year. We used frequency analysis, χ² testing, an analysis of variance, and logistic and multiple logistic regression models to analyze the association between PHI and subjective health conditions, outpatient care, chronic disease status, and hospitalization. The PHI group had good subjective health but had more outpatient care for 2 weeks. There were few chronic diseases in the private insurance group, and there was no significant difference in hospitalizations for 1 year. Hospitalization may occur when essential medical care is required, regardless of health insurance type. This study confirmed that as the PHI lowers the burden of personal medical expenses, the PHI can lead to an increase in the medical resource expenditures on the outpatient medical service and higher public health costs. The government should work to redefine the role of private and national health insurance. Also, the effectiveness of PHI should be reevaluated so that it does not lead to indiscriminate use of medical services by minimizing the burden of private insurance.     

阴道镜联合选择性液基细胞学检查对宫颈癌机会筛查人群的临床价值研究

目的：探讨具有质控功能的电子阴道镜联合选择性液基细胞学检查对宫颈癌机会筛查的可行性及其成本效益。方法：回顾分析2014年6月至2016年12月门诊就诊的1 055例患者的阴道镜、液基薄层细胞检测（thinprep cytology test,TCT）、人乳头瘤病毒（human papillomavirus,HPV）及宫颈活检病理结果;以病理活检为金标准,比较电子阴道镜、阴道镜联合选择性TCT、HPV联合TCT对宫颈上皮内瘤变筛查的灵敏度、特异度、阳性预测值、阴性预测值、漏诊率、ROC曲线下面积及成本效益。结果：具有严格质控的阴道镜检查对≥宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）Ⅱ型病变筛查的特异度为96.9%,阳性预测值为84.2%,高于其他检测方式（P＜0.05）,筛查成本最低（P＜0.05）,而灵敏度为65.9%,漏诊率为34.1%,筛查敏感性低于其他检测方式（P＜0.05）。阴道镜对Ⅰ型转化区筛查的灵敏度为88.4%,漏诊率为11.6%,筛查敏感性明显高于Ⅱ、Ⅲ型转化区（P＜0.05）。阴道镜若联合选择性液基细胞学检查后对Ⅱ、Ⅲ型转化区灵敏度及漏诊率均有改善（P＜0.05）,整体灵敏度升高至81.5%,漏诊率由34.1%降低为18.5%（P＜0.05）。结论：严格质控下的阴道镜联合选择性液基细胞学检查灵敏度高,漏诊率低,诊断成本低,适用于经济欠发达地区宫颈癌机会性筛查。     

血必净对大鼠肝缺血-再灌注后急性肺损伤的保护作用

目的观察肝脏缺血-再灌注后急性肺损伤的发病机制及血必净对其的干预作用。方法将健康雄性Wistar大鼠90只随机分3组:假手术组(SOG组)30只,缺血再灌注组(I/R组)30只,血必净组(XBJ组)组30只。XBJ组术前3d经尾静脉注射血必净注射液5ml·kg-1·d-1。于再灌注6h、12h、24h各组分别随机选取10只大鼠进行标本检测:观察大鼠肺脏组织病理切片;取新鲜肺组织测定湿/干重比(W/D)、肺组织髓过氧化物酶(MPO)含量,取动脉血检测血气分析(PaO2)。结果XBJ组较I/R组在相同时相点的肺脏病理改变较轻,MPO含量显著降低(P<0.01);W/D显著降低(P<0.01);PaO2升高(P<0.05)。结论血必净注射液对肝脏缺血-再灌注后急性肺损伤具有保护作用,该作用与抑制中性粒细胞在肺内集聚、减少氧自由基的产生有关。     

腔内微波和射频消融闭合大隐静脉主干的疗效及安全性对比分析

目的 探讨血管腔内微波消融（EMA）与射频消融（RFA）闭合大隐静脉主干的疗效和安全性差异。方法 收集2019年1—6月浙江省人民医院收治的316例大隐静脉功能不全患者的临床资料,并按照性别、年龄、病程、体重指数、身高、基础临床表现-病因-解剖-病理生理（CEAP）分级、大隐静脉主干直径的不同将患者筛选并分层配对为EMA组（n=157）和RFA组（n=159）。采用视觉模拟评分法（VAS）评价两组患者术后14 d的大隐静脉主干闭合段疼痛情况和皮肤瘀伤情况;术后第14天、6个月,所有患者均通过超声复查治疗段大隐静脉主干闭合情况。比较两组患者的术后并发症发生情况。结果 RFA组患者的术后VAS最高评分出现在术后第1天,EMA组患者的术后VAS最高评分出现在术后第3天。术后第1～10天,两组患者的VAS评分存在差异;与EMA组患者相比,RFA组患者的术后VAS评分更低。两组患者的皮肤瘀伤最高评分均出现在术后第4天;与EMA组患者相比,RFA组患者的皮肤瘀伤评分较低;术后第5～9天,两组患者的皮肤瘀伤评分差异较大。两组患者术后第14天、6个月的治疗段大隐静脉主干闭合率、术后并发症发生情况比较,...     

不明原因智力障碍/脑发育迟缓患儿染色体亚端粒重组突变的检测

目的联合应用多重连接依赖的探针扩增法和荧光原位杂交法检测染色体亚端粒重组,进行不明原因智力障碍／脑发育迟缓（mental retardation／developmental delay,MR／DD）的病因学研究。方法人选病例必须满足：①中一重度MR／DD;②无明确围产期异常病史;③无明确生后中毒、缺氧、中枢神经系统感染及头颅外伤等病史;④常规核型分析显示正常;⑤头颅影像及尿有机酸、氨基酸分析未提示典型遗传代谢性疾病或神经变性病;⑥男性患儿FMR1基因检测未提示脆性X综合征。并至少符合以下条件之一：①MR家族史阳性;②反复流产或围产期死亡家族史阳性;③体格发育异常;④面部畸形;⑤非面部畸形或发育异常。联合应用多重连接依赖的探针扩增法过筛和荧光原位杂交技术验证对患儿及父母标本进行染色体亚端粒重组检测。结果人组39例中发现4例阳性病例,重组分别为：①新发der（2）t（2;4）（pter;pter）,文献未见报道;②新发8pter缺失,国外曾有报道,但临床表型不同;③新发15q11．2缺失,属中间重组,结合患儿临床表型,Angelman综合征可能性大;④新发11qter缺失,文献未见报道。结论首次报道2种新重组,其新发出现提示致病性可能性大;染色体亚端粒重组是遗传性MR／DD的重要病因,临床表型差异大,对原因不明的常规染色体检查无异常的MR／DD患者均应进行检测,联合应用多重连接依赖的探针扩增法和荧光原位杂交法是相对经济的确诊手段。     

儿童肾小球疾病不同标本转化型生长因子-β1检测结果的比较

目的　比较评价儿童肾小球疾病血浆、血清、尿液不同标本的转化型生长因子 β1(TGF β1)水平。方法　用ELISA方法测定 30例轻微病变、30例系膜增生性肾小球肾炎、2 4例IgA肾病、2 4例局灶节段性肾小球硬化患儿和 30例健康对照组儿童血浆、血清、尿液中的TGF β1水平。结果　尿液标本的TGF β1水平对各组的诊断有显著意义 (P <0 0 5 ) ,而血浆、血清标本没有诊断意义 (P >0 0 5 )。血浆测定TGF β1灵敏度较血清好。血浆、尿液指标有较好的相关性 (r=0 85 ,P <0 0 5 ) ;血清与尿液仅有一定的相关性 (r=0 5 3,P <0 0 5 ) ;血浆与血清无显著相关性 (r =0 4 9,P >0 0 5 )。结论　尿液为检测肾炎患儿TGF β1水平的较好指标 ,血浆次之 ,血清最差。     

新天然来源抗生素-抗霉素A_(18)的抗肿瘤活性及其产生菌I07A-01824的生物学特征

目的检测抗霉素A18的体外抗肿瘤活性并对其产生菌I07A-01824的形态及培养特征,生理生化特征等进行研究。方法用MTT法检测抗霉素A18的肿瘤细胞生长抑制作用,用流式细胞术测定其对细胞周期的影响;按分类学常规方法研究菌株I07A-01824的形态及部分生理生化特征。结果抗霉素A18能够抑制人肝癌细胞HepG2、人口腔上皮癌细胞KB的生长;这两个细胞株均被阻滞在细胞周期的S期。菌株I07A-01824的形态及培养特征与已知种——黄白链霉菌(Streptomyces albidoflavus)一致。结论红树林内生放线菌是新抗生素的重要来源。     

Resistin induces insulin resistance, but does not affect glucose output in rat-derived hepatocytes

AIM: The aim of the present study was to observe the effects of resistin on insulin sensitivity and glucose output in rat-derived hepatocytes. METHODS: The rat hepatoma cell line H4IIE was cultured and stimulated with resistin; supernant glucose and glycogen content were detected. The insulin receptor substrate (IRS)-1 and IRS-2, protein kinase B/Akt, glycogen synthase kinase-3beta(GSK-3 beta), the suppressor of cytokine signaling 3 (SOCS-3) protein content, as well as the phosphorylation status were assessed by Western blotting. Specific antisense oligodeoxynucleotides directed against SOCS-3 were used to knockdown SOCS-3. RESULTS: Resistin induced insulin resistance, but did not affect glucose output in rat hepatoma cell line H4IIE. Resistin attenuated multiple effects of insulin, including insulin-stimulated glycogen synthesis and phosphorylation of IRS, protein kinase B/Akt, as well as GSK-3beta. Resistin treatment markedly induced the gene and protein expression of SOCS-3, a known inhibitor of insulin signaling. Furthermore, a specific antisense oligodeoxynucleotide directed against SOCS-3 treatment prevented resistin from antagonizing insulin action. CONCLUSION: The major function of resistin on liver is to induce insulin resistance. SOCS-3 induction may contribute to the resistin-mediated inhibition of insulin signaling in H4IIE hepatocytes.     

2011年版《英国药典》概览

目的简要介绍《英国药典》2011年版的基本情况、编排结构。方法分析比较了《英国药典》2011年版和2010年版的不同。结果与结论英国药典委员会每年都对《英国药典》进行更新和修订,值得学习和借鉴。     

环孢素A的血药浓度监测(HPLC)法的改进

改进环孢素A（CsA）的高效液相色谱法（HPLC）测定方法。方法：全血经乙醚提取后,吹干,用甲醇、稀HCI定容,正己烷脱脂后进样。流动相为乙腈：水（100：20）,色谱法为YWG-C184.6×150mm,检测波长为214nm。结果：CsA与CsD峰分离效果良好,最低检测限为5ng（信噪比是2.65）,最低检测浓度为10μg·L-1。提取步骤少,方法简便、快捷。结论：本方法适用于临床器官移植中CsA的大量快速的样本测定。