Payment system reforms have become an important part of Chinese healthcare reforms, and global budget has been seen as a major trend. Based on the practice and data of four pilot hospitals in Beijing which have implemented the global budget, this paper focuses on analyzing the effects of implementation on the following aspects and provides references for policy improvements: medical services, average medical cost, total health expenditure, medical cost structure, average length of stay and out-of-pocket expense percentages.

AIM: To investigate the clinical effect of phacoemulsification and intraocular lens ( IOL ) implantation for cataract patients after corneal refractive surgery, and to compare the accuracy of the different refractive IOL.
METHODS:The data of 120 myopia cases (160 eyes) in our hospital, who underwent cataract surgery and corneal refractive surgery were analyzed. Corneal curvature K value before corneal refractive surgery were obtained and calculated by using history method. Corneal curvature correction numerical method and corneal topography were used to record K value of patients with incomplete data before and after treatment. The K value was substituted into the formula. By comparing the actual cataract surgery and refractive state expected refractive status (-0. 50D), the accuracy of IOL refractive obtained from three methods was compared.
RESULTS: The average best corrected visual acuity before cataract surgery was 0. 25 ± 0. 05, and it was improved ( 0. 80 ± 0. 05 ) after surgery. The average spherical equivalent (SE) was -1. 98±1. 75 before surgery and +0.85±3.38 after surgery (P<0.05). The K values of 48 cases were calculated by clinical history method ( CHM ) and that of 73 cases was calculated with the adjusted keratometry method ( AKM) . The K values of 39 cases were calculated using the corneal topography method ( CTM) .
CONCLUSION: For patients with corneal refractive surgery, the appropriate method can be selected according to clinical symptoms, history, etc. and this may help to accurately calculate IOL. For patients with complete data, CHM can be used to provide corneal K values, while for those with incomplete data, AKM and CHM can be used.

Objectives To explore the effects of control measures and dynamic prevalence of drinking water endemic fluorosis in China, to provide basis and technique support for endemic fluorosis control in China. Methods The survey was carried out according to the national surveillance Scheme of Endemic Fuorosis. The fulfillment of control measures and the quality of water improving projects were surveyed. Household water sample and urine of children aged 8-12 years were collected and fluoride content was detected by iron selective electrode method. Check the teeth of children aged 8-12 years. Dental fluorosis was diagnosed by Dean's method. Results projects were build in 84 endemic villages in 2006, and the average water improving rate came to 73.98% fluoride contents of half the surveyed spots were over the standard, mainly between 1.0-2.0 mg/L, and the urine controlled just in only few spots and it was in moderate or severe status in some endemic areas for many years. Conclusions Little progress of control measures in drinking water endemic fluorosis counties surveyed has been made in these two years. Projects of running out of status and over standard of water fluorosis are frequently seen. Dental fluorosis in many spots is not controlled.

Objective:To study the relationships between age,the state of genital tract and vaginitis,cervical erosion and vulvae leukoplakia in married women.Methods:Gynecologic inspection and laboratory examination were performed in 1 253 patients diagnosed vaginitis,cervicitis and vulvae leukoplakia in a women screen in a certain area in Chongqing in 2007.Statistics analysis was made by SAS8.1.Results:Of 1 253 patiens,45.89% had vaginitis,44.69%,cervical erosion,and 3.35%,vulvae leukoplakia,6.07%,the other conditions.Age,vaginal cleanness degree,candida infection were risk factors of vaginitis;Age,vaginal cleanness degree were related to cervical erosion and vulvae leukoplakia.Conclusion:Vaginitis,cervical erosion and vulvae leukoplakia should arouse more attention in the prevention and treatment of women genital tract disease in the future,and the standard etiology treatment should be performed to get microcosmic ecological balance.The perfect control and monitoring system for gynecologic disease should be established,and service quality of women health care should be improved.

Medical metrology work is the base of quality control for hospital medical equipment.It guarantees the accuracy of hospital medical instruments.It is important to set up a complete management system for hospital metrology institutions.

Caudal-related homeobox transcription factor (CDX-2) is selectively localized in the fetal and adult mu-cosal epithelial nuclei of normal small and large intestines.CDX2 plays an important role in the regulation of cell proliferation and differentiation of the intestinal epithelium. Ec-topic expression of CDX-2 in the stomach, esophagus and other hollow organs might be a cause of intestinal metaplasia and adenocarcinoma. CDX-2 is expressed in both cultured and primary gallbladder carcinoma cells, and dysplasia.CDX2 is not detected in normal gallbladder and biliary tract mucosa. Ectopic CDX2 expression is an early event in gallbladder carcinogenesis. The frequency of CDX-2 expression is significantly higher in well-differentiated type than in the moderately and poorly differentiated tumors. The present study clearly showed that MUC2 expression in intestinal differentiation was dependent on the nuclear expression of CDX-2 in intraductal papillary neoplasia of the liver (IPNL)and mucinous intrahepatic cholangiocarcinoma (ICC) in the same manner as in the gastric mucosa and Barrett s esophagus. CDX-2 may also be a key factor in gallbladder carcinogenesis with intestinal differentiation and is a useful immuno-histochemical marker of intestinal differentiation in intestinal metaplasia of the gallbladder. CDX2-dependent regulation of cell proliferation may be an important factor in defining prognosis of patients with BTC.

Objective To discuss the indications and efficacy for treating tibia insertion avulsion fracture of the posterior cruciate ligament(PCL)by the mean of the end of ligament suture via arthroscopy.Methods Twenty-one cases of tibia insertion avulsion fracture of PCL were treated with suture the end of ligament via arthroscopy from June 2007 to June 2009,including 14 males,7 females,with a mean age of 31.5 years(range,13-52 years).The insertion avulsion fragment was fixed to the tibia with two strands of 5Ethibond threads via arthroscopy.Two bone tunnels(2.5 mm in width)were made from the anterior part of the tibia to the posteromedial(at 4:30 toward)and posterolateral(at 7:30 toward)of the tibia bone bed respectively.Then the sutures were pulled out through the two bone tunnels and tied to the door-nail.Reduction and healing of the avulsion fragment,relaxation and mobility degree of knee,and the influence of osteoepiphysis to teenage patients were observed after surgery.KT-2000 value and Lysholm score were calculated.Results All cases were followed up from 10 to 24 months,with an average of 13.5 months.All the fragments were united without displacement in all cases according to X-ray films.One case showed posterior drawer test(+),but the tibia insertion was healed.The knee extension in all cases was unlimited,and 10° to 15° flexion limitation was found in 2 cases.The average range of flexion was 140.5°±3.8°.On average,KT-2000 value was(1.2±0.4)mm,Lysholm score was 95.2±2.7.Conclusion For treating the avulsion fracture of PCL,suture the end of ligament via arthroscopic transfixion can get a reliable fixation and a satisfied function of the knee,especially,which is suitable for the small avulsion fracture fragments,the adolescent patients with premature epiphysis.

Caudal-type homeoboxgene transcription factor 2 is one member of the caudal- related homeobox family,is a transeription factors important in intestinal epithelial development and in the differentiation and maintenance of the intestinal phenotype.In adulthood,these two proteins are strictly confined to the gut and are predominantly expressed by the epithelium of the small intestine and colon,but not by the normal epithelium of the oesophagus and stomach.In intestinal metaplasia,caudal-type homeohoxgene transcription factor 2 upregulation can be a direct effect of injurious agents on epithelial cells and/or can be due to the inflammatory environment of EpM,exposure to acid and/or bile acids may activate caudal-type homeoboxgene transcription factor 2 expression in human esophageal epithelial cells through promoter demethylation,and ectopie caudal-type homeoboxgene transcription factor 2 expression in esophageal squamous epithelia.It has been suggested to play an important role with retinoic acid,MUC2,p63 gene,BMP4 and many other factors working together to promote the development of this process in intestinal metaplasia and cancers.

Objective To discuss the factors which are related with curative effects of endoscopic sinus sur-gery of sinusitis and nasal polyps. Methods 480 patients with rhinosinusopatia who were received endoscopic sinus surgery were retrospectively analyzed. Results The curative rate was 74.5% ,improved rate was 18.1% ,ineffective rate was 7.3%,the effective rate was 92.7%. Conclusion ESS is an effective method for the treatment of chronic sinusitis and nasal polyps. However,the therapeutic effects were closely related with the clinical types of lesion. Ap-propriate treatment to the diseased middle turbinate and deviated nasal septum during the period of surgery and effec-tive combined treatment after operation are very importint to the long-term therapeutic effects of ESS on these lesion.

Objective To assess short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy induced by perinatal asphyxia. Methods Twenty-three infants of moderate/severe hypoxic ischemic encephalopathy (HIE) were divided into treatment group ( 14 cases) and control group (9 cases). The head hypothermia in the treatment group [rectal temperature ( 34. 0 ～ 35.0) ℃, nasopharyngeal temperature (34. 0 ± 0. 5 ) ℃]was induced by circulating water cooling cap for up to 72 h. Control group were treated routinely. All newborns were monitored and analyzed for blood pressure, heart rate, neurological function. Neonatal behavioral neurological assessment (NBNA) was conducted for assessment of neurobehavioral development on day 28 after birth. Results Treatment group showed slower hear rate as nasopharyngeal temperature decreased and there was significant difference as compared with the control group ( P ＜ 0.05 ). Apnea and arrhythmia were not found in either group. As compared with the control group, treatment group showed better results in seizure incidence, recovery of neonatal reflex( embracing reflection, sucking reflex and grasp reflex), and improvement of limb muscle tension. The NBNA score on day 28 was much higher in hypothermia group(35.00 ± 1.41 ) than that of control group(30. 67 ± 1.58) and there was significant difference (P ＜ 0.05). Conclusion Selective head cooling is safe for newborns with moderate/severe HIE if the nasopharyngeal temperature maintains at (34 :± 0. 5 ) ℃, rectal temperature at 34 ～ 35 ℃. Selective head cooling can effectively improve the short-term nervous symptoms and the neurobehavioral score,but the long-term efficacy remains to be further studied.