By means of global budget,the disease-specific scoring method was put in place for both settlement and payment in Huaian,Jiangsu province,for the purpose of cost control by the hospitals.This reform consists of total cost accounting,rational performance-based distribution system,multi-approached regulation of medical behaviors,and individual disease management to regulate medical behavior.These efforts aim at aligning with medical insurance payment reform,so as to improve hospital management,operation quality and socio-economic outcomes.Problems found in practice were also reviewed.

Pediatric surgery is the important part of the paediatrics,and the complicated content,limited time and many difficulties are the main problems of pediatric surgery teaching. The multimedia courseware is used in teaching of pediatric surgery,which is convenient for teachers'preparing lessons and teaching and is beneficial to students'review and summary. After the technique is used,the teaching efficiency and the quality are obviously improved.

Objective To observe the changes of plasma neuropeptide Y(NPY) and neurotensin(NT) levels in patients with essential hypertension and the relationship between those changes and damage of cardiac function. Methods Eighty patients of essential hypertension and 28 normal controls were chosen. The cardiac function was divided into 3 classes on the standard of New York Heart Association(NYHA). The plasma NPY,NT concentration was determined by radioimmunoassay. Results The level of NPY in hypertension patients was higher than that of the normal controls(P

Multimedia is a widely-used teaching means in contemporary medical education.Establishing and improving the multimedia teaching material library is a strong guarantee for the smooth implementation of multimedia.The causes,significance and methods for establishment of pediatric surgery teaching multimedia material library according to the characteristics of pediatric surgery teaching are described in this article,with a view to provide a reference to other relevant professional institutions.

Minimally invasive neurosurgery techniques developing by leaps and bounds in the past few years,which is to be a great challenge for the clinical teaching of neurosurgery.Based on their own actual,neurosurgery department of the Children's hospital of Chongqing medical university enriched the teaching contents,improved teaching methods and trained microsurgical techniques for doctors at various levels,meanwhile,it strengthened participants'sterile awareness,set good team spirit,developed individualized assessment standards and achieved good results.

Objective To observe the changes of plasma neuropeptide Y (NPY) and neurotensin (NT) levels in patients with heart failure and investigate their clinical significance. Methods The levels of plasma NPY, NT of 76 patients with heart failure and 28 normal controls were determined by radioimmunoassay (RIA). The color echocardiogram was used to evaluate the cardiac structure, function and left ventricular ejection fraction (LVEF). Results The level of plasma NPY in patients with heart failure [(159.7 ± 56.3) ng/L] was higher than that in normal controls [(120.8 ± 51.9) ng/L] (P < 0.05), the level of plasma NT [(69.5 ± 29.6) ng/L] was significantly lower than that in normal controls [(99.1 ± 19.3) ng/L] (P < 0.01). Following the severity of heart failure, the level of plasma NPY increased, and the level of plasma NT decreased. The level of LVEF had negative correlative relationship with the level of plasma NPY (γ = -0.31, P < 0.05) and positive correlative relationship with the level of plasma NT (γ = 0.28, P < 0.05). The level of plasma NPY and NT in patients with heart failure had negative correlative relationship (γ = -0.26, P < 0.05). Conclusions The levels of plasma NPY, NT in patients with heart failure are unbalanced. This unbalance may participate in the damage of cardiac function.

Objective To explore the correlation between environmental selenium(Se) levels and cognitive ability among rural elderly population, and the effect of Se on cognitive skill of the elderly. Methods Two study sites(Zichuan district and Gaomi city of Shandong) with different environmental Se levels were selected according to rural elderly people ≥ 65 years were extracted by stratified random sampling method in each site. A retrospective survey was carried out using dietary intake questionnaire for the elderly for the past 1 year, and their daily total Se intake was calculated. Questionnaire was also used to obtain cognitive skill information in the elderly people. The Community Screening Instrument for Dementia, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test, the Indiana University (IU) Story Recall Test, the Animal Fluency Test, and the IU Token Test were applied to assess the cognitive ability. Se level in these samples was analyzed. Correlation between the Se levels of environment and those of human body were analyzed statistically. Results There were 0.163), (0.405 ± 0.086)]mg/kg and nail Se[(147.44 ± 17.42), (117.38 ± 22.48)μg/L]between the two groups (U = 31.59, 25.00, 23.67, all P ＜ 0.01 ). There were positive correlation among the nail Se, environmental Se and Se in all subjects(r = 0.51,0.46, 0.60, all P ＜ 0.01 ). The differences of the CSID total score, the CERAD Word List Learning Test, the CERAD Word List Recall Test and the IU Story Recall Test between the two sites were statistically significant(F = 2.56, 9.18, 7.48, 4.42, all P ＜ 0.05), excluding the Indiana University Story Recall Test.After eliminating possible confounding factors, the Se levels and the CSID total score, the IU Story Recall Test, the Animal Fluency Test and the IU Story Token Test had a significantly positive correlation (r = 0.076, 0.138, 0.042,0.107, P ＜ 0.05 or ＜ 0.01 ), excluding the CERAD Word List Learning Test. Conclusions This study supports the hypothesis that a life long low Se level is associated with lower cognitive ability. The cognitive abilities in the elderly population lived in areas with high environmental selenium levels are significantly higher than that of the elderly lived in areas with low environmental selenium levels.