我国基本医保门诊慢特病政策分析——基于内容分析法

目的:从保障病种、保障模式和患者认定三个方面回溯全国31个省、自治区、直辖市基本医疗保险门诊慢特病政策。方法:系统收集与梳理各地区城镇职工和城乡居民基本医保门诊慢特病相关政策文件,基于内容分析法提炼各地门诊慢特病病种的共性特点,总结保障模式,分析患者认定流程等。结果:各地纳入保障范围较多的疾病可总结为重度精神障碍、疾病负担较重的传染病、恶性肿瘤、器官移植术后治疗、神经系统疾病、需要长期治疗的血液病、慢性心脑血管疾病等11个病种大类。各地门诊慢特病保障病种因统计口径不同导致数量差异大,且缺乏认定的规范标准。结论:我国基本医保门诊慢特病政策仍处于探索改革创新阶段,尚缺乏国家顶层设计,各省份门诊慢特病政策共性和差异性并存。建议:(1)加强顶层设计,探索中央到地方"由粗到细"的病种目录;(2)引入卫生技术评估和医保精算,建立病种准入和调整机制;(3)确定公平合理的慢特病保障模式和病种保障限额;(4)科学制定慢特病认定标准,规范患者资格认证。

重特大疾病保障政策的实践与效果——基于延安市的实证研究

目的:分析多层次医疗保障制度对重特大疾病的实际保障效果。方法:分地区、总费用水平和病种计算延安市基本医疗保险、大病保险和医疗救助对重特大疾病的保障效果。结果:延安市重特大疾病医疗费用经基本医疗保险、大病保险和医疗救助三个层次的报销后,平均保障水平为77.14%;住院医疗费用的补偿比例随总费用上升而下降;总费用超过20万元的患者,个人自付比例超过35%。结论:持续完善医保药品目录、诊疗项目目录,在目录层面实现对基本诊疗需求的全覆盖,同时重视高额医疗费用的补偿,增强制度的兜底保障作用;各统筹地区应结合本地区实际,出台相适应的重特大疾病保障政策,做到精准施策。

肉制品中唾液酸含量和形态分析及在加工中的变化

本文主要运用了高效液相色谱法测量了我国牛肉、猪肉等常见肉类及常见熟食制品如火腿、香肠、卤牛肉、风干羊肉、香辣鸭脖中的两种唾液酸N-羟乙酰神经氨酸(N-Glycolylneuraminic acid,Neu5Gc)、N-乙酰神经氨酸(N-Acetylneuraminic acid,Neu5Ac)的含量、存在形式以及不同加工方式对其含量及存在形式的影响。结果表明红肉中Neu5Gc含量:牛肉46.57±2.53μg/g>猪肉28.69±1.03μg/g>羊肉29.09±2.32μg/g,红肉中同时含有结合态Neu5Gc和游离态Neu5Gc,结合态Neu5Gc含量普遍高于游离态Neu5Gc。红肉中Neu5Ac含量:羊肉200.15±24.96μg/g>猪肉110.89±5.71μg/g>牛肉80.97±5.60μg/g。白肉中不含Neu5Gc,鸭肉的Neu5Ac含量最高,为185.73±23.11μg/g。熟食肉制品中,牛肉制品的Neu5Gc含量仍高于其他红肉熟食制品,并在白肉熟食制品中检测出了Neu5Gc的存在。对红肉进行蒸煮、油炸及腌制处理后Neu5Gc和Neu5Ac含量都有所下降,其中经过油炸处理的样品Neu5Gc和Neu5Ac含量下降最为明显,其次是腌制、蒸煮。本文还研究了蒸煮时间对猪肉中唾液酸含量的影响,即随着蒸煮时间的增加,Neu5Gc、Neu5Ac含量变化的总体趋势减少,蒸煮45 min后结合态唾液酸明显减少,游离态增多。即红肉中特异性含有Neu5Gc,白肉类熟食制品中也可能含有Neu5Gc,通过加工可改变肉制品中唾液酸的含量和形式,但是每种加工方式对于唾液酸含量及形式的改变不同。

老年人轻度认知损害与相关危险因素的临床研究

目的:探讨老年人轻度认知损害(MCI)与相关危险险因素的关系。方法:选取在赣州市赣县区人民医院体检符合标准的老年人(>60岁),观察MCI的患病率,统计性别、年龄、教育程度、睡眠障碍、高血压、高血脂、糖尿病、同型半胱氨酸(Hcy)、吸烟、饮酒、喝茶等相关危险因素,并分析两者的关系。结果:总共入选1146例,有MCI 126例,MCI的患病率为10.99%。相关危险因素的单因素分析结果显示:年龄、教育程度、睡眠障碍、高血压、高血脂、糖尿病、同型半胱氨酸、吸烟及喝茶共9个因素与MCI有关(P<0.05);而经多因素回归分析发现,年龄、教育程度、吸烟、高血压、糖尿病、高同型半胱氨酸血症及喝茶与MCI有显著相关性(P<0.05)。结论:年龄、吸烟、高血压、糖尿病及高同型半胱氨酸血症为MCI的危险因素,而教育程度高和喝茶为其保护因素。

3D Finite Element Analysis of a Man Hip Joint Femur under Impact Loads

Objective: The biomechanical characters of the bone fracture of the man femoral hip joint under impact loads are explored. Methods:A biosystem model of the man femoral hip joint by using the GE (General Electric) lightspeed multi-lay spiral CT is conducted. A 3D finite element model is established by employing the finite element software ANSYS. The FE analysis mainly concentrates on the effects of the impact directions arising from intense movements and the parenchyma on the femoral hip joint on the stress distributions of the proximal femur. Results:The parenchyma on the hip joint has relatively large relaxation effect on the impact loads. Conclusion:Effects of the angle δ of the impact load to the anterior direction and the angle γ of the impact load to the femur shaft on the bone fracture are given;δ has larger effect on the stress and strain distributions than the angle γ, which mainly represents the fracture of the upper femur including the femoral neck fracture when the posterolateral femur is impacted, consistent with the clinical results.

Icariin associated with exercise therapy is an effective treatment for postmenopausal osteoporosis

Background There are no conclusive studies evaluating the interaction between icariin and exercise for treatment of osteoporosis; the efficacy and safety of this treatment combination remains to be evaluated. The purpose of this study was to investigate the effects of icariin treatment combined with exercise therapy on bone parameters and body weight of ovariectomized rats. Methods Ovariectomized rats were used as a model of postmenopausaJ osteoporosis and were exposed to either icariin treatment, exercise, hormone replacement therapy, or a combination of the above. Untreated, ovariectomized rats and sham operated rats were used as controls. After 3 months of experimental interventions the effects of the treatments on the body and uterine weights, the physical and biomechanical properties of bones, and the expression of the osteoblast-specific gene Osterix （Osx）, were assessed. Results The weight gain of the ovariectomized rats was greater than that of the treated experimental groups. Uterine weight and serum estradiol levels were significantly greater in sham operated and estrogen-treated ovariectomized rats than in the other groups. Biomechanical parameters were improved significantly in ovariectomized rats treated with exercise alone or treated with exercise and icariin. Osx expression was increased in ovariectomized rats treated with exercise and icariin or treated with just icariin. Conclusions Exercise combined with icariin had a synergistic effect in the early prevention of osteoporosis in ovariectomized rats. The effects of icariin and exercise on osteoporosis are worth further exploration.

Changes in expression of adrenomedullin in the myocardium of streptozotocin-induced diabetic rats

Background Adrenomedullin is a potent vasodilating peptide and involved in many cardiovascular diseases. However, whether adrenomedullin is involved in the pathogenesis of diabetic cardiomyopathy is still unknown. Our aim was to characterize the expression pattern of adrenomedullin in the myocardium of streptozotocin-induced diabetic rats. Methods The weight, blood glucose, and urine glucose of 20 streptozotocin-induced diabetic rats were measured before and after model induction in the diabetic and control groups. The alteration of the adrenomedullin expression was explored in the left ventricular myocardium in both groups by immunohistochemistry. Changes in heart ultrastructure were also analyzed by using hemotoxylin and eosin staining and transmission electron microscopy. All data were analyzed by the independent samples ttest. Results The data of weight, blood glucose, and urine glucose had no significant difference between the control and the diabetic groups before animal model induction. Four weeks after the induction of diabetes, the differences between the two groups in weight, blood glucose, and urine glucose were distinct. When compared with the control group, the diabetic group showed ultrastructural changes including hypertrophy, fibrosis, myofibrillar disarrangements, mitochondrial disruption, and increase in nuclear membrane invaginations. A significant decrease of adrenomedullin expression was also observed in cardiac myocytes of the diabetic rats （P〈0.01）. Conclusions Our study provides experimental evidence that hyperglycemia could damage cardiac myocytes. Down-regulation of cardioprotective peptide adrenomedullin in the myocardium of streptozotocin-induced diabetic rats may contribute to the diabetic cardiomyopathy and left ventricular dysfunction.

Effects of electromagnetic fields on bone regeneration in experimental and clinical studies： a review of the literature

Objective To assess the experimental and clinical data regarding the effects of electromagnetic fields （EMFs） on fracture non-union.Data sources The English language literature regarding EMFs on fracture non-union were searched using MEDLINE,Web of Science and Embase,for the period January 2006 to June 2011.The search terms were electromagnetic fields and non-union/bone marrow stem cells （BMSCs）/bone.Study selection Articles were included in the review if they were related to the use of EMFs on BMSCs or bone tissue.Papers without full manuscripts available were excluded.Results The basic and clinical research in this field,while somewhat limited,supports the insightful application of EMFs to ameliorate disability due to fracture non-union.Conclusions Further basic and clinical research to validate the use of EMFs in facilitating function and bone reparative processes in fracture non-union is required.Keywords：