It analyzed the structure and details of disease-based score payment,taking payment policy scheme in Huai-an and Nanchang for example.Disease-based score payment combined the globe budget control,payment of disease and point system to help controlling costs and incentive mechanism,which had certain achievement in the pilot areas.According to the research,it found that there were insufficient in the practical implementation,proposed the precondition for the popularization were higher medical agency capacity,establishing the negotiation mechanism with medical institutions and having intelligentized information system as the technical support.

Objective To investigate the clinical and pathological features of 21 elderly patients with tuberculosis detected at autopsy. Methods Retrospectively analyzed the data of underlying diseases,clinical characteristics,clinical diagnosis,and causes of death for these 21 elderly patients with tuberculosis detected at autopsy. Results All the 21 patients were man,mean age was(88.0±6,9)years and had one or more concomitant diseases.Cough,sputum and fever were frequent due to other complicated respiratory infection.Anemia,hypoalbuminemia,decreased body mass index,increased erythrocyte sedimentation rate were very common in elderly patients,sputum acid-fast bacillus was positive in 11.8%cases.There was no primary tuberculosis.There were 9 secondary tuberculosis,3 disseminated pulmonary tuberculosis,19 tuberculous pleurisy and 9 non-pulmonary tuberculosis detected at autopsy.Compared with the result of autopsy,the clinical and radiography diagnosis accuracies were poor.Only 5 patients were clinically diagnosed as tuberculosis.All 5patients received antitubereulous chemotherapy,2 of them ceased therapy due to liver or renal toxicity. Conclusions Tuberculosis is a systemic disease in elderly patients.Because of medical aspects of ageing,co-morbid states,ignorance and mis-perception of symptoms,and atypical manifestation of disease,the diagnosis is difficult in this population.Our study confirms the importance of considering tuberculosis as a diagnosis in elderly even in the absence of typical clinical radiological presentations.

Objective To explore the causes of misdiagnosis of lung abscess and its clinical pathological characters. Methods The clinical data of autopsy-proven lung abscess in Beijing Hospital from 1980 to 1995 were reviewed. Results Twelve patients consisted of 11 males and 1 female. Their age ranged from 60 to 88 years. None of them was clinically diagnosed lung abscess before death. Concomitant dieases were severe and complex, mostly coronary disease, hypertension, COPD, cerebrovascular disease and diabetes mellitus. The clinical presentation and chest X-ray of lung abscess in the elderly were deceptively nonspecific and variable. Over 2 types of pathogens were isolated from sputum culture, mostly klebsiella pneumoniae, pseudomonas aeruginosa, candida. The autopsy showed 3 cases with a isolated lung abscess and 9 cases with lung multi-abscess. Conclusions The reasons for misdiagnosis of lung abscess in the elderly might be the variability of clinical presentation, the other concomitant disease. Frequent pursuit of chest CT scan in suspected cases is guarranted .

Objective To assess the relative value of individual positions in the functional departments of a general hospital in Beijing,for reference of improving the salary allocation system and fine management of human resources.Methods The expert consultation method and International Position Evaluation system were used to quantitatively assess the tasks,work difficulty,size of responsibility and the qualifications required for every.Results A total of 38 experts contributed to this research which studied 140 positions including all functional departments of this hospital.The department having the most positions is the finance department(17)and the least is the Youth League committee(1).The position scoring the highest(805)was the director of medical affairs department;that scoring the lowest(263)was the food and beverage service positions of the diet and nutrition department.There was an evident turning point at score 547.Conclusions Functional departments′ position setting of this hospital proves reasonable,and the assessment scoring can reflect the value of the position in related dimensions.The result can be used as reference indexes for the hospital to perfect its human resource management system and improve the remuneration precision.

Objective To investigate the morbility and epidemic characteristics of hair dye dermatitis in individuals who dyed their hair in Tianjin.Methods Questionnaires were distributed to the outpatients in the Gerneral Hospital of Tianjin Medical University,students and teachers in Tianjin Medical University,residents in the community and customers in barber shop from Aug.2007 to Mar.2008.The personal data including the methods and site of coloring hair and something correlated to hair dyes were investigated.Results A total of 597 cases with the history of coloring hair were enrolled in the study,including 485 women and 112 men,with mean age of 41 years (ranged from 16- 74years).Among 597 cases,69 cases had allergic reactions to hair dye,including 51 women and 18 men,with mean age of 44 years (ranged from 19-65 years).The median age of the first coloring hair was 40 years (ranged from 3-50 years).The comparison between the sites of coloring hair had no statistic significance (P ＞0.05),but there was a significant difference between black dyed hairs and col or dyed hairs (P ＜0.05).Conclusions People with black hair dye are prone to be allergic.

French hospital administrators have undergone several changes to meet the needs of economic and social development,resulting in the pattern of hospital administration by both the central government and regional organizations.This paper made descriptions and analysis of the French hospital administrators and came up with the following insights:Making public hospitals as the main health service provider benefits provision of public services; public and private hospitals can jointly meet public service needs under government regulation; the government should focus on controlling health care resources;medical service system needs an overall policy guidance; hospital management organizations should streamline in the reform.

ObjectiveTo study the effect of a recombinant plasmid encoding mouse interleukin 2 (mlL-2) on the immunogenicity of DNA vaccine against Chlamydia trachomatis(Ct) serovar E.Methods BALB/c mice were divided into 4 groups to be intramuscularly inoculated with blank plasmid(negative control group),DNA vaccine against Ct serovar E(DNA vaccine group),DNA vaccine against Ct serovar E and a recombinant plasmid containing mIL-2(combination group),and inactivated Ct serovar E elementary bodies (positive control group),respectively.The immunological effects were evaluated by posterior foot pad thickness,proliferation level of spleen lymphocytes,serum level of IL-4 and interferon (IFN)-γ in mice,and the capability to clear Ct genital tract infection.ResultsThe proliferation index of spleen lymphocytes in the combination group and positive control group was similar(3.64 ± 0.41 vs.3.77 ± 0.34),but was significantly different from that in the blank control group and DNA vaccine group (1.37 ± 0.21 and 2.52 ± 0.30).The serum level of IL-4 was(38.49 ± 12.24) pg/ml in the positive control group,significantly higher than in the negative control group,DNA vaccine group and combination group ((25.37 ± 18.93),(24.75 ± 8.49),(21.74 ± 6.43) pg/ml,respectively).With respect to the serum level of IFN-γ,the combination group and positive control group were similar ((1923.3 ± 518.1) pg/ml vs.(2712.5 ± 887.2) pg/ml),but were significantly different from the negative control group and vaccine group((310.8 ± 160.7) pg/ml and(601.3 ± 357.9) pg/ml).Six days after Ct challenge,the exfoliated cells from genital tract were positive for Ct culture in the negative control group,but negative in the other 3 groups.ConclusionIL-2 genetic adjuvant can enhance the immune response,especially Th1 type response,induced by the DNA vaccine against Ct serovar E.

Objective To quantitatively measure the perfusion parameters of placenta in different stage of pregnant rats using contrast-enhanced ultrasonography (CEUS) with contrast pulsed sequencing (CPS), and to analyze the relationship between perfusion parameters and changes of placental vascular bed. Methods Sixty healthy pregnant rats in according to the requirements of the experiment was divided into three groups: 15 days, 17 days and 20 days of gestation with 20 animals in each group. One blous injection of SonoVue (Sonovue 1.0 ml/kg) via a tail vein was administered to each rat, and the time-intensity curves (TIC) of placenta and uterine muscle wall were drawn with ACQ using CPS technique with MI 0.20, and the perfusion parameters were calculated. Then 4 μm vertical placenta sections were cut and stained with hematoxylin and eosin. Surface area densities of placental maternal blood space was measured with image analysis software. Results The peak intensity (PI) of 17 days and 20 days was higher than that of 15 days pregnant rats (P＜0.05). There was no difference in PI between 17 days and 20 days (P＞0.05), and nor of arrivel time (AT) and time-to-peak (TTP) (P＞0.05) among the three groups. There was significant difference of surface area densities of placental maternal blood space among the three groups (P＜0.05). PI was positively correlated to the surface area densites of placenta (P＜0.05). Conclusion There is close relationship between peak intensity and area densities of placental maternal blood space. CPS technique can sensitivly detect changes of the placenta vascular bed in different stage of pregnant rats.

Objective To evaluate the perfusion parameters in different zone of placenta using CPS,to research placental blood perfusion of different zone. Methods A total of 60 pregnant rats were divided into 3groups, 15 day,17 day and 20 day of gestation with 20 animals in each group,the placenta was divided into the central zone and marginal zone. SonoVue was injected by tail vein of rat using CPS, the time-intensity curves of the central zone and marginal zone were drawn and perfusion paramcters were calculate by software ACQ and Sonoliver. Surface area densities of different zone of placental maternal blood space was measured with histoligical method,and using immunohistochemical marked the placenta vascular. Results Arrivel time(AT) and time-to-peak(TTP) of placenta central zone was earlier than marginal zone,the peak intensity(PI) of the central zone was higher than that of the marginal zone ( P ＜ 0.05). There was significant difference between the central zone and marginal zone of surface area densities of placental maternal blood space ( P ＜0.05). PI of the central zone and marginal zone and the surface area densites of placenta was positively correlated ( P ＜0.05). The placental blood vessels was not expressed by factor Ⅷ.Laminin in the placental basement membrane expression of 20 day of gestation was not continuous or missing. Conclusions The surface area densities of central zone and marginal zone was different. CPS technique can be sensitive to detect changes of the placenta vascular bed in different zone.