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.

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.

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.

BACKGROUND:Cartilage is an avascular tissue and has a limited capacity for self-repair after injury. There are various methods for the treatment of articular cartilage injury ranging from conservation therapy to invasive surgery. With the development of tissue engineering technology, it provides a new way for treating articular cartilage injury. OBJECTIVE:To review the new development of tissue engineering technology for repairing articular cartilage injury. METHODS:The PubMed database and CNKI database were retrieved for articles from 2000 to 2013 by the first author with computer in May 2013. The key words were“cartilage tissue engineering, cartilage defect, stem cell, scaffold, growth factor”in English and Chinese. A total of 64 articles were included which related to cartilage regeneration and cartilage tissue engineering. For the articles in the same field, those published recently or in authorized journals were selected. RESULTS AND CONCLUSION:The three elements of cartilage tissue engineering, seed cells, scaffolds and cytokines, must be coordinated and mutual y beneficial development. At present, the research of tissue engineering for repairing articular cartilage injury has made a great progress. But the application in clinic has not enforced yet which is limited in experimental exploration stage. With the continuous development of new materials, the new tissue engineering cartilage repair materials should meet the requirement of material science and biological science, thus making the materials closely meet the biological characteristics of the self tissues. The animal studies wil turn to clinical experiments with the support of new technique, which make a breakthrough in the treatment of articular cartilage injury.

The frequency and influence on prognosis of hemorrhagic transformation (HT) after acute ischemic stroke are still uncertain with mixed results in previous studies.Slight hemorrhage transformation may will not worsen stroke patients' short-and long-term prognosis,but some MRI studies suggest that HT may impede patients to get a dramatical improvement of neurological function.We aimed to determine the overall frequency of and risk factors for HT.More importantly,we discussed the mechanism,subtypes of HT and the influence of HT subtypes on prognosis.

Objective To investigate the effects and adverse reactions of high-dose glucocorticoid on early active rheumatoid arthritis patients.Methods The early active rheumatoid arthritis patients were randomly divided into three groups:high dose group (16 patients,with large doses of glucocorticoid therapy),low dose group (17 patients,with small doses of glucocorticoid therapy),and control group (41 patients,with no glucocorticoid therapy).Compared the differences among the three groups.Results The changes in the three groups were different in joint pain,joint swelling,morning stiffness,erythrocyte sedimentation rate,rheumatoid factor and C-reactive protein (P ＜ 0.05).The high dose group was significantly better than the other two groups in the above variables alleviating,in the 1 week after the treatment.The changes in the three groups had no significant difference of bone mineral density,Larsen hip score (P＞ 0.05).The NSAIDs days in the control group was significantly longer than the high dose group,low dose group [(51.17 ± 2.56) d vs.(14.16 ± 0.71) d,(26.50 ± 1.59) d],the difference was statistically significant (P ＜ 0.05).Rate of weight gain in the high dose group,low dose group was significantly higher than the control group [5/16,4/17 vs.4.9％ (2/41)],the difference was statistically significant (P ＜ 0.05).Body weight increased in the high dose group and low dose group occurred mainly in the following 1.5 months of therapy,with the discontinuation of cortices-teroids,weight gradually fell to normal.Gastrointestinal discomfort incidence in the control group was significandy higher than that in the high dose group,low dose group [51.2％ (21/41) vs.2/16,3/17],the difference was statistically significant (P＜ 0.05).Conclusions High-dose glucocorticoid can rapidly relieve clinical symptoms and inflammation in early active rheumatoid arthritis patients.High-dose corticosteroids do not bring too many side effects to patients but weight gain,and it reduces the patients' gastrointestinal discomfort greatly,because of the decrease use of NSAIDs.

Objective To explore the clinical significance of two new indexes including approximate entropy of oxygen saturation (SpO2ApEn) and saturation impairment time index (SITi) in assessing the severity of hypoxemia in obstructive sleep apnea hypopnea syndrome (OSAHS) patients.In addition,to investigate the correlation betewwn new indexes and other parameters.Methods The six hour polysomnography (PSG) of 500 patients with OSAHS and snorers in our hospital was retrospectively analyzed.According to the level of apnea hypopnea index (AHI),subjects were divided into four subgroups,namely 113 healthy controls,121 mild OSAHS,118 moderate OSAHS,and 148 severe OSAHA patients.SpO2 ApEn and SITi values among the four groups were compared.the correlations between SpO2 ApEn,SITi and other parameters were analyzed,including AHI,oxygen desaturation index (ODI),the lowest oxygen saturation(LSpO2) and the duration of oxygen saturation lower than 90％ (T ＜ 90％).Next,taking AHI as the gold standard,the significance of SpO2ApEn and SITi in assessing the severity of hypoxemia in OSAHS patients was explored by ROC curve analysis.Results SpO2ApEn and SITi between two each groups were significantly different (P ＜ 0.001) and increased synchronously with AHI.Spearman correlation analysis showed that SpO2ApEn and SITi had a good correlation with AHI (correlation coefficient r =0.765,r =0.678,P ＜ 0.O1).SpO2ApEn and SITi also had a good correlation with ODI,LSpO2and T ＜ 90％.According to the ROC analysis,the Boundary values of SpO2ApEn for mild,moderate and severe OSAHS patients were 16.70,17.81,and 20.03,respectively,and the corresponding SITi values were 3.685,4.055,and 4.445.Conclusion In this study,SpO2ApEn and SITi increased synchronously with AHI,SpO2ApEn and SITi had good correlations with AHI,ODI,LSpO2and T ＜90％.SpO2ApEn and SITi have important clinical significance for assessment of hypoxia severity in OSAHS patients.

BACKGROUND:Wtih hyaluronic acid and col agen by cellautocrine as endogenous scaffolds, cellsheet technology can eliminate the disadvantages of exogenous scaffolds. Human adipose-derived stem cells combined with cellsheet technology used in the study of ful-thickness skin defects have become the current hot spot.
OBJECTIVE:To summarize the research progress in adipose-derived stem cellsheet.
METHODS:Articles related to adipose-derived stem cells, cellsheet technology and tissue-engineered skin were retrieved in VIP information and PubMed database from January 1993 to April 2014. The key words were“adipose-derived stem cell, wound healing, tissue-engineered skin, cellsheet”in English and Chinese, respectively. Total y 27 relevant articles were analyzed.
RESULTS AND CONCLUSION:Adipose-derived stem cells derived from discarded human adipose tissue are immmunocompatible and multi-potent, rendering them ideal for regenerative medicine applications. cellsheet technology seemingly provides several advantages over traditional tissue reconstruction with biodegradeable scaffolds. Adipose-derived stem cells combined with cellsheet technology can enhance tissue vascularization, promote wound healing, the secreted extracellular matrix provides the microenvironment for the celldifferentiation and growth, so it is expected to build a real three-dimensional tissue-engineered skin.