With the full coverage of China 's basic medical insurance, medical costs showed a rapid growth trend. It is becoming more and more important to control the cost of medical treatment. Strengthening the control of medical insurance providers is the experience of international health insurance management and an important direction of China's basic medical insurance system reform. Many areas explore the reform of basic medical insurance payment actively and accumulated a lot of typical experience. When exploring the reform of basic medical insurance payment, the practical experience proposes that we should avoid the shortcomings of the post-payment system and prospective payment system, and push a combination of a variety of payment methods such as the capitation, the Pay per bed day, the DRGs etc. , and the promotion of comprehensive reform of public hospitals to establish a classification diag-nosis and treatment.

Objective To observe the expression of interferon gamma receptor on neuron and astrocyte of the hippocampus of depressed rats.Methods The depressed rats were produced by separation raise and unpredictable mild stressors.Their behaviors were evaluated in open-field test.The rats underwent electro-convulsive treatment(ECT)or modified electric convulsive therapy(MECT).The expression of interferon gamma receptor on neuron and astrocyte of the hippocampus was detected by immunofluorescence and in situ hybridization.Results There were significant differences among the stress plus ECT group,the stress plus MECT group,the stress plus sham electroshock group in all the three tests.Conclusion ECT and MECT can both reduce the expression of interferon gamma receptor on neuron and astrocyte of the hippocampus of depressed rats,and MECT shows more stronger therapeutic effect.Cytokine may play an important role in the pathophysiologic mechanism of depression.

ObjectiveTo evaluate the value of endoscopy in the diagnosis of biliary tract roundworm disease.Methods32 cases of biliary tract roundworm diseases were diagnosed and treated with fibre (electron) stomach duodenum endoscopy and fibre biliary tract endoscopy under the direct-view.Results32 cases were all clearly diagnosed and the worms were taken out with direct-view endoscopy or direct cholangiography with no complications.ConclusionEndoscopy is effective and accurate for the biliary tract roundworm disease and has the advantage of rapidly dispelling the sufferings of the patients.

ObjectiveAssess the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of schizophrenia and its social function .Methods 156 patients with schizophrenia were randomly assigned to a real rTMS treatment group (n=78) or a sham rTMS treatment group(n=78) ,each patient in the real rTMS group received 20 rTMS sessions over 4 weeks .Efficacy was evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 4 weeks .Social function was evaluated u-sing the Personal and Social Performance Scale(PSP) at baseline and at 4 weeks .Results The study group is better than the control group in PANSS total and negative symptoms and PSP total after treatment (P<0 .05) .There is not serious adverse reactions in the treatment .Conclusion rTMS can reduce the negative symptoms and improve social function in schizophrenia with high safety .

Objective To investigate prevalence of associated diseases in patients with gout as well as their diagnoses and treatment. Methods Two hundreds out-patients diagnosed with gout from April to October 2008 were investigated at Peking University People's Hospital, and information collected included their general characteristics, associated diseases, diagnoses and treatment, as well as blood lipid profiles, serum creatinine, uric acid, results of routine urine tests and glomerular filtration rate estimated by MDRD formula in the past three months. Results Among patients with gout, prevalence of associated hypertension, obesity, renal calculi, coronary heart disease, cerebral infarction and diabetes were 54.5% (109/200), 23.2% (42/181), 20.0% (40/200), 12.0% (24/200), 8.0% (16/200) and 7.0% (14/200), respectively, and 53.7% (101/188) of them associated with hypertriglyceridemia, 63.7% (114/179) with impaired renal function and 15.1% (27/179) with chronic kidney disease. In acute attack of gout, 124 (62.0%) of them were treated with non-steroidal anti-inflammatory drug (NASID), 72 (36.0%) with colchicines, 12 (6.0%) with corticosteroid and 30 (15.0%) with urate-lowering drugs, respectively, and during its intermittent period, 69. 8% (81/116) of them received urate-lowering therapy with indications generally accepted internationally, but serum level of uric acid could be maintained below 0.06 g/L in only 8.6% (10/116) of them. And 73.8% (48/65) of the patients with no therapy indications also were treated with urate-lowering drugs. Conclusions The most commonly associated diseases in gout patients are hypertension, hyperlipidemia and obesity, followed by renal calculi, chronic kidney disease and coronary heart disease, and so on. At present, oral NSAID is the first choice of drugs for its acute attack. Indications for urate-lowering therapy in this hospital usually are not consistent with those by generally international acceptance, with lower therapeutic effectiveness achieved.

Objective To investigate the role of Th17 cells in chronic myeloid leukemia (CML) pathogenesis. Methods 33 CML patients [15 newly diagnosed (ND)- and 18 chronic-phase (CP)- CML patients] and 15 healthy controls were enrolled. The percentage of Th17 cells in the peripheral blood (PB) of CML and controls were evaluated by flow cytometry. RORC mRNA expressions were examined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). The levels of IL-17 in PB of CML and controls were measured by enzyme-linked immunoadsorbent assay (ELISA). The relationships between Th17 cells and clinical characteristics in CML were analyzed. Results The percentage of Th17 cells in PB of ND-CML patients [(0.71±0.41) %] was significantly lower than that of CP-CML patients [(4.08±0.74) %, P<0.05] and healthy controls [(3.18±1.32) %, P<0.05]. The mRNA level of RORC in PB of ND-CML patients (0.043 3±0.040 5) was significantly decreased compared with that in CP-CML patients (0.086 1±0.052 3, P<0.05) and healthy controls (0.091 0±0.058 4, P<0.05). The levels of IL-17 in PB of ND-CML patients [(1.43±0.22) pg/ml] and CP-CML patients [(1.36±0.19) pg/ml] were slightly higher than that of healthy controls [(1.23±0.14) pg/ml, P< 0.05]. The percentage of Th17 cells had significantly negative correlations with white blood cell counts in PB or bcr-abl (IS). Conclusion Th17 cells may play an important role in CML pathogenesis, which has potential implication for immunotherapy of this malignancy.

Objective To investigate therapeutic effect for older patients suffering from stroke sequela combined hip fracture and discuss the influence factors of prognosis.Methods The clinical data of 62 older patients suffering from stroke sequela combined with hip fracture were retrospectively analyzed.The therapy approach included the conservative treatment group (12 cases),the joint replacement group (18 cases) and the internal fixation group (32 cases).The data of the American association of anaesthetists (ASA) score,daily life activities ability index (Barthel life index),complications,mini-mental state examination (MMSE) scale score,proximal femur trabecular bone type index (Singh index),complications after fracture (infection,recurrent stroke,bedsore,deep vein thrombosis,heart failure) were collected and analyzed.Results There was no statistical significance in terms of age,gender,ASA grade,and complications among three groups.In the conservative treatment group,the joint replacement group,and the internal fixation group,the Bart index were (52.1 ± 11.4),(74.5 ± 21.3) and (63.8 ± 15.7) respectively,and the cases of postoperative complications were 10,3 and 13.There were significant difference in terms of Bart index and complication rate among the three groups (F =2.45,P ＜ 0.05 ; x2 =9.32,P ＜ 0.05).The differences of Singh index (x2 =11.05,P ＜ 0.05) and MMSE scale score (x2 =7.40,P ＜ 0.05) were statistically significant between the conservative treatment group and the two surgical treatment groups.No significant difference were found regarding of Singh index and MMSE scale score between the two surgical treatment groups.The relationship between ASA score,complication,MMSE scale score,treatment strategies and Bart index after fracture were found (OR =5.726,7.152,0.047,1.221,and 5.312 respectively ;P ＜ 0.05).Conclusion Joint replacement treatment is a preferred choice for older patients suffering from stroke sequela combined hip fracture.The prognosis is strongly influenced by the physical and mental state of patients.Comprehensive evaluation is an indispensable step to choose treatment strategies.

Objective To explore the clinical features of late-onset neuromyelitis optica spectrum disorders (LON?MOSD). Methods A retrospective analysis was performed to evaluate 61 patients with LONMOSD admitted to our hospital from January 2010 to May 2015. Results (1) The median age at onset was 57 (53, 63) years, male/female was 1∶3.7. Thirty-two patients (52.5%) had transverse myelitis (TM) and 16 patients (26.2%) had optic neuritis (ON) at the disease onset. Fifty-one patients (83.6%) experienced recurrent attacks. Forty patients (65.6%) showed abnormal brain magnetic resonance imag?ing (MRI). Spinal cord MRI showed more frequently present in thoracic regions (39.3%). (2) There were no significant differ?ences in clinical features between AQP-4 seropositive and seronegative groups. (3) By Spearman analysis, it was obvious that EDSS scores at acute phase and remission were positively correlated to AQP-4 antibody levels (rs=0.389, P<0.01;rs=0.380, P<0.01). But there was no correlation between the mean segments of spinal cord and relapse rates with AQP-4 anti?body levels (rs=0.146, P>0.05;rs=0.096, P>0.05). Conclusion LONMOSD patients are more prone to present with TM at onset and have more lesions in thoracic spinal cord and brain. The AQP-4 antibody titres can indicate the severity of disease in acute phase.

Objectives To compare the characteristics of myasthenia gravis (MG) with different antibodies.Methods The muscle specific receptor tyrosine kinase (MuSk) and acetylcholine receptor (AChR) antibodies were detected in the sera of 119 MG patients,and fluoroimmunoprecipitation assay and cell based assay were applied. The clinical features of AChR-Ab positive,MuSK-Ab positive and serum negative MG patients were compared.Results There were 90 AChR-Ab positive sera tested out from the 119 MG sera,and 5 sera found with MuSK-Ab in the 29 AChR-Ab negative sera.There was no significant difference among the three groups regarding sex and age at onset.There were 3/5 of MuSK-Ab positive patients with predominantly bulbar paralysis,2/5 of MuSK-Ab positive patients were classified as MGFA Ⅲ to Ⅴ,and 79.2% (19/24) of serum negative patients were classified as MGFA Ⅰ.There was significantly positive relation between the levels of MuSK antibodies and disease severity (r=0.941,P=0.014).Neither thymic hyperplasia nor hymoma were found in MuSK-Ab positive patients.Conclusions MuSK antibodies are only detected out in the sera without AChR-Ab.The MuSK-Ab positive patients are mainly involved bulbar muscles,and without thymus abnormality.MuSK-MG is different with the AChR MG.

BACKGROUND: With deepening of spinal biomechanics, artificial lumbar disc replacement is considered to be the optimal choice for treating degenerative lumbar disease. However, studies concerning biomechanics of artificial lumbar disc are insufficient. OBJECTIVE: To establish the three-dimensional (3-D) finite element model of artificial lumbar disc replacement and to explore the effects of artificial lumbar disc replacement on zygapophyseal joints using biomechanical analysis. METHODS: Based on normal 3-D finite element model of lumbar motion segment, L4-5 intervertebral disc, superior and inferior endplates were removed, and then, the model of SB-Charite Ⅲ disc prosthesis was added, which remained annular fibrosus and ligaments at L4-5 intervertebral space. Thus, 3-D finite element model of L4-5 segments artificial lumbar disc replacement was constructed. Biomechanical analysis of this model was processed under axial load, forward flexion, lateral bending or posterior extension moments. The stress data were contrasted with the normal 3-D finite element model of artificial disc replacement. RESULTS AND CONCLUSION: After artificial lumbar disc replacement, the data of biomechanical analysis indicated: ①There was no significant differences between the zygapophyseal joint and normal segment of stress under axial load (P > 0.01).②Compared with normal segment, the stress of anterior, posterior of upper and lower vertebral body and bilateral zygapophyseal joint had no obviously difference under forward flexion and posterior extension moments (P > 0.01). ③The stress differences between the both sides of upper and lower vertebral body and bilateral zygapophyseal joint were not significant under lateral bending moment (P > 0.01). Artificial lumbar disc replacement can keep the stress of motion segment at normal level, which can meet the needs of spinal functional reestablishment.