Objective:To explore and test a blending prospective payment that suitable for integrated care delivery system in China.Methods:Referring to Accountable Care Organization and domestic reforms,it designed a performance-based and prospective global budget payment mechanism which mainly contained strategies as medical alliance contract,prepay by DRGs and performance-based management.Through a quasi-experiment,it tested its effects on controlling the inpatient spending and continuity of care.Results:There were 38 980 cases included from inpatient claims data out of 4 towns.194 medical records came from township and county hospitals.Compared to control group,the average hospitalization rate per capita every 5 months in treated group significantly declined by 0.08％,the likelihood of using upper level hospitalization significantly declined by 0.16％,and the continuity of care significantly increased by 33.80％.Global budget system would benefit decreasing hospitalization structure and improving medical collaboration.However,the effects of new model might be underestimated by the imperfect implementation of compulsory referral system.Conclusion:The medical alliances should center on combined objectives as stimulating medical cooperation and improving on quality of care.It should make the blending prospective payment decisions on basis of information-shared grading and referral medical system and empirical evidence.

0.05).On the day 3,7 postoperatively,IL-6 and CRP significantly increased as compared to those preoperatively in two groups(P

Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Objectives:To test the effect of continuous care on rural hypertension control , we developed a com-prehensive intervention strategy and implemented a community-based quasi-experiment in Southwestern rural China.Methods:The intervention took place in Qianjiang District , Chongqing Municipality from July 2012 to June 2014.4 towns were randomly selected and categorized into 2 groups based on a comprehensive consideration of population and social development level.All the rural hypertension patients in treatment group were intervened with the Multi-institu-tional Continuous Pathway which was consisted of three parts:the Continuous Primary-Care Pathway , the Continuous Clinical Pathway and the Continuous Management Pathway.The patients in the control group served as a blank com-parison using the usual care.Difference-in-differences Model was used to test the effect of blood pressure control in treatment group.Results:853 patients were sampled and investigated using the stratified randomly sampling strategy and 712 of them had been followed up by the end of this program.The potential bias of pilot and patient selection were eliminated through control before and after the intervention.The previous blood pressure trends showed no statis-tically significant difference between groups.The systolic blood pressure in treatment group declined by 10.156 mm-Hg ( P<0.001 ) compared to control group after intervention , and the blood pressure control rate had increased by 27.6% ( P<0.001 ).Other contributing factors besides intervention were family structure , education level and med-ical service availability.Conclusion:The continuous care pathway have a significant marginal positive effect on hyper -tension control besides the national compulsory primary care , and the control rate change of blood pressure is more sen-sitive compared to blood pressure change.The potential contributing factors show that other intervention strategies could be developed to improve the rural hypertension control by adding to the social capital of rural patient , reinforcing the health education and facilitating the village transportation.

Objective To study the effect of clinical nursing path with graph and text instructions (GTI) on health education to patients with complex retinal detachment.Methods Toally 76 inpatients with complex retinal detachment were enrolled in the study:38 of them hosptalized from March to August 2015 were put in the control group received routine treatment and the others hosptalized from September 2015 to March 2016 as the experiment group treated with GTI.The clinical outcomes were compared.Result The patients treated with GTI were better in the knowledge of the complex retinal detachment and moreover,they felt significantly more satisfied compared to that of the control group (P＜0.05).Conclusion It is beneficial to use GTI in the patients with complex retinal detachment.GTI is effective for improving their knowledge on the disease,and increasing their satisfaction with the clinical nursing.

Objective To investigate the inhibitory effects and possible related mechanism of OTX008 [a selective inhibitor of galectin-1 (Galectin-1)] on retinal neovascularization (RNV) in mouse model of oxygeninduced retinopathy (OIR).Methods 7-day-old (P7) C57BL/6J mice were randomly (according to random number table) divided into 4 groups including normal group,OIR group,OIR-OTX008 group and OIRphosphate buffered saline (PBS) group.To establish the OIR mouse model,mice from all groups except normal group were expose to (75±2)％ oxygen for 5 days and then to room air.OIR-OTX008 group received an intravitreal injection of 1 μl (0.25 μg/μl) OTX008 at P12,OIR-PBS group received the equal volume (1 μl) of PBS injection.Mice from 4 groups were euthanized at P17,and retinas were collected for molecular biological analysis and morphological study.RNV was evaluated by counting the number ofpre-retinal neovascular nuclei and the whole-mount immunofluorescent staining of mouse retina.Cyrosections of retinas were imaged via confocal microscopy to observe the enrichment of staining of Galectin-1.Protein levels of Galectin-1,Neuropilin-1 and phosphorylation of vascular endothelial growth factor receptor 2 (pVEGFR2) were determined with Western blot.Results At P17,Galectin-1 expressed higher in retinal ganglion cell layer,inner plexiform layer and inner nuclear layer from OIR group and OIR-PBS group than normal group.Galectin-1 expressed less in cryosection retinas from OIR-OTX008 group than OIR group and OIR-PBS group.The numbers ofpre-retinal neovascular cell nuclei from OIR group and OIR-pBS group were obviously more than that from normal group (t=9.314,P＜0.05).The number of pre-retinal neovascular cell nuclei from OIR-OTX008 group were obviously lower than those from OIR group and OIR-PBS group (t=8.038,7.774;P＜0.05).The RNV tufts area (t=13.250,12.570),non-perfusion area (t=15.590,12.430) and hypoxic area (t=9.542,9.928) from OIR-OTX008 group were significantly smaller than those in OIR group and OIR-PBS group (P＜ 0.05).Protein levels of Galectin-1 (t=24.800,23.060),Neuropilin-1 (t=4.120,3.530) and pVEGFR2 (t=25.880,15.480) in the OIR-OTX008 group were significantly down-regulated than those from OIR group and OIR-PBS group (P＜0.05).Conclusion Intravitreal injection of OTX008 inhibits RNV and ameliorates retinal hypoxia in mice model of OIR possibly through down-regulating Galectin-1,Neurolinpin-1 and pVEGFR2.

Objective This study aimed to investigate the expression of SOX7,β-catenin and cyclin D1 in invasive breast cancer and hyperplastic disease of the breast,and explore their relationship with clinical pathology charactersis in invasive breast cancer in order to provide valuable biomarkers for the treatment and prognosis.Methods The expression of SOX7,β-catenin and cyclin D1 was neasured in 50 invasive breast cancer tissues and 30 hyperplastic disease of the breast by immunohistochemical SP method.The correlations of SOX7,β-catenin and cyclin D1 in invasive breast cancer to clinicopathologic features were analyzed,such as age,size of tumor,axillary lymph node metastasis,histological grade,pTNM stage,ER,PR,Her-2 expression and the risk.Results Immunohistochemical results showed that the positive rates of SOX7 and cyclin D1 in invasive breast cancer were 42％ (21/50)and 70％ (35/50),and the abnormal expression rates of β-catenin in invasive breast cancer was 70％ (35/50).The positive rates of SOX7 in invasive breast cancer was significantly lower than that in hyperplastic disease of the breast 70％ (21/30).The expression of SOX7 had difference between two groups (P =0.021 ＜0.05).The abnormal expression rates of β-catenin and the positive rates of cyclin D1 in invasive breast cancer wcre significantly higher than that in hyperplastic disease of the breast 43.3％ (13/30) (P =0.033 ＜ 0.05) and 20％ (6/30) (P =0.000 ＜ 0.001).The expression of β-catenin and cyclin D1 had difference between two groups.In invasive breast cancer,SOX7 and β-catenin protein expression in 12 cases,while negative expression in 5 cases; SOX7 and cyclin D1 protein positive expression in H 1 cases,while negative expression in 5 cases; β-catenin and cyclin D1 protein positive expression iu 28 cases,while negative expression in 8 cases.Results of the analysis by Spearman showed that in invasive breast cancer the SOX7 protein expression was negatively correlated with the abnormal expression of β-catenin protein and the expression of cyclin D1 protein(r =-0.282,P =0.046 ＜ 0.05 ;r =-0.327,P =0.020 ＜ 0.05)while the abnormal expression of β-catenin protein was positively correlated with the expression of eyclin D1 protein(r =0.333,P =0.018 ＜ 0.05).In invasive breast cancer the expression of SOX7 protein was correlated with age,axillary lymph node metastasis,histological grade,pTNM stage,ER,PR,Her-2 expression and the risk(P ＜0.05),but with no correlation with size of tumor (P ＞ 0.05).However,the abnoral expression of β-catenin and the positive expression of cyclin D1 in invasive breast cancer were correlated with size of tumor,axillary lymph node metastasis and pTNM stage(P ＜ 0.05),but with no correlation with age,histological grade,ER,PR,Her-2 and the risk(P ＞0.05).Conclusions SOX7.β-catenin and cyclin D1 are frequently abnormality-regulated in invasive breast cancer tissues,and the three protein may play a regulatory role through the same pathway in the development and progression of invasive breast cancer.SOX7,β-catenin and cyclin D1,s abnormal expression in invasive breast cancer correlate with the clinical pathology charactersis,and the three protein may be valuable marker for assessing the prognosis for invasive breast cancer.

ObjectiveTo evaluate the diagnostic value of multi-slice CT (MSCT) and multi-dimensional reconstructions for congenital pulmonary stenosis (PS) in children.MethodsThe enhanced thin CT images of 33 patients with PS were retrospectively analyzed,the data was transmitted to the workstation for multi-planar reformation ( MPR),volume rendering technique (VRT) and maximum intensity projection (MIP).The CT imaging features of PS were analyzed combining with operation resul ts and Ultrasonic Cardiogram (UCG).ResultsIn 33 cases of PS,there were 17 cases with pulmonary valve stenosis (PVS),10 cases with right ventricular infundibulum stenosis (RVIS),and 6 cases with pulmonary trunk stenosis (PTS).The first two were correctly diagnosed by UCG,5 cases of PVS and Icases of RVIS were correctly diagnosed by MSCTA,the later was correctly diagnosed by UCG and MSCTA.In 14 cases with collateral circulations between aorta and pulmonary artery ( APC ),all were correctly diagnosed by MSCTA,only 3 case was diagnosed by UCG,1 case was misdiagnosed as PDA.UCG can clearly demonstrate the others intra-cardiac deformities,such as ASD,VSD,RVH,PFO,SV,DORV,TECD and TBD,the accuracy rate of MSCTA was 39.4％,and MSCTA can clearly demonstrate the origin,course and diameter of extracardiac vascular abnormalities,such as PDA,RAA,TGA,TAPVD,CoA,PLSV and VLSA,the accuracy rate of UCG was 697％.ConclusionsMSCT and multi-dimensional reconstruction were a kind of non-invasive method,it was a good approach for extra-cardiac vascular malformations and APC in PS.Combining with UCG,it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and supply diagnostic evidence for clinical treatment.

Study found that in some human tumors such as breast cancer,SOX7 gene is highly likely to be a tumor suppressor gene.The tumor suppressor role of SOX7 may be accomplished by regulating the Wnt/β-catenin signaling pathway mediated the transcription process,and the abnormal Wnt/β-catenin signaling pathway is likely to play its role through the regulation of its downstream target gene Cyclin D1,etc,so that the ahnormal cell proliferation activity is unable to carry on,and thus plays the function of tumor suppressor.This review will summarize the research progress of the role of SOX7 geue and its closely related β-catenin,Cyclin D1 gene in breast cancer.

Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures.Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department.Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data.Using Mimics 15.0 software,cross sections were created at 5 cm,10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PT5,PT10 and PT15.The long and short axles on the left and right sides were measured and compared (LL vs.RL;LS vs.RS).After the STL files for 3D models were generated using Mimics 15.0 software,a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed.The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model.The real operation used the implants preoperatively designed;the actual screw lengths were measured and compared radiographically with those designed in the preoperative manoeuvre.Results All the data were collected of the long and short axles on the 3 cross-sections (PT5,PT10 and PT15) of the left and right sides of the proximal tibia.The samples were paired into 6 groups.The correlation coefficients of paired samples were greater than 0.95,showing an extremely strong correlation.The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5,PT10 and PT15 cross-sections (P ＞ 0.05).All the 35 cases received surgical operation.The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy.The deviations were in an allowable range,leading to satisfactory internal fixation.Conclusions A mirror 3D model of the healthy side is of clinical value to some extent because it can serve as one for an anatomically reduced fracture which can be used for preoperative manoeuvre and preparation of implants.The contrasts between the long and short axles on the 3 cross-sections may simplify and facilitate comparisons of bilateral similarity,avoid the blindness in direct application of the health side mirror model for preoperative planning.