This article elaborated the connotation of public hospital medical insurance payment system and the importance of reform,summarizing and analyzing the practical exploration of promoting medical insurance payment system reform in the localities.Then it moved on to introduce new progress of medical insurance payment system reform abroad and the emerging mode of medical insurance payment, such as pay for performance,payment by results,and bundled payment.In the end,the authors put forward policy suggestions to improve medical insurance payment system at public hospitals in China, namely to build a modern healthcare payment system in line with the needs of medical service system.Such a system should be guided by comprehensive performance,restrained by cost budgeting, based on a diversified payment mode,and supported by information technology.In addition,it should have scientific payment standard and modern governance mechanism,and keep interactive development with commercial health insurance.

BACKGROUND:The repair method of proximal humeral comminuted fractures in the elderly remains controversial. OBJECTIVE:To compare the recovery of shoulder joint function using the hemiarthroplasty of shoulder and locking proximal humeral plate fixation for complex proximal humeral fracture in the elderly. METHODS:A total of 22 elderly patients with complex proximal humeral fracture, who were treated from October 2012 to October 2014, were retrospectively analyzed. 12 cases underwent hemiarthroplasty, and 10 cases received locking proximal humeral plate fixation. Al patients were folowed up after treatment. X-ray films were rechecked during the folow-up. The recovery of shoulder function was evaluated with Neer score. RESULTS AND CONCLUSION:During final folow-up, no prosthetic loosening or avascular necrosis of humeral head was found in the shoulder hemiarthroplasty group, and the Neer score was (81±5) points. In the locking proximal humeral plate fixation group, there was fixator loosening in four cases and avascular necrosis of humeral head in three cases, and the Neer score was (69±5) points (P < 0.05). During repair, mean operation time was shorter in the shoulder hemiarthroplasty group than in the locking proximal humeral plate fixation group. The amount of bleeding was higher in the shoulder hemiarthroplasty group than in the locking proximal humeral plate fixation group (P > 0.05). These data suggest that locking proximal humeral plate fixation and shoulder hemiarthroplasty are effective repair methods for complex proximal humerus fractures, but the hemiarthroplasty had the advantage of early functional exercise and good recovery of shoulder joint.

BACKGROUND:Studies about low-frequency pulsed electromagnetic fields interfering with bone marrow mesenchymal stem cells proliferation and differentiation are many, but the Raman spectra of single stem cells irradiated in electromagnetic fields analyzed by surface Raman spectroscopy analysis are rarely reported. OBJECTIVE:To compare the difference in Raman spectra of bone marrow mesenchymal stem cells with or with no irradiation of 3 000 Hz pulsed electromagnetic fields. METHODS:Bone marrow mesenchymal stem cells isolated from Sprague-Dawley rats were cultured and identified. Passage 3 cells were inoculated into 6-wel plates and divided into two groups:pulsed electromagnetic field irradiation group and blank control group. After cultured for 7 days, cells in the two groups were transferred to physiological saline, and 30 cells were randomly col ected from each group. Four Raman spectra were harvested from each celland the average relative intensity of Raman spectra was calculated and compared between two groups. RESULTS AND CONCLUSION:There were the same Raman peaks in the two groups, and the waveforms were basical y same in the two group based on the curve mapping by origin 7.0 software. The peak value in the irradiation group was decreased compared with the blank control group. Laser optical tweezers Raman spectroscopy can be applied to study the biochemical changes of a single stem cellat the molecular level. The Raman spectra of bone marrow mesenchymal stem cells irradiated by 3 000 Hz pulsed electromagnetic fields differ from those without irradiation, and the peak also lowered after irradiation.

Objective:To evaluate the cytotoxicity of different dental bonding agents to human dental pulp cells. Methods:Four dental bonding agents(Prime & Bond NT,Single Bond,Xeno Ⅲ and iBond) were diluted with the culture medium by a ratio of 1∶1 000,1∶2 000 and 1∶4 000(v/v), and the fourth passage of dental pulp cells were then exposed to agent dilutions for 12, 24 and 48 h respectively, then the morphological changes of pulp cells were observed with microscopy and cytotoxicity was analyzed with modified 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay.Results:There was significant influence of the type of dental bonding agents,exposure time and concentration on the cell morphology. Total-etch system was more toxic than self-etch system.Conclusion:Dental bonding agents are toxic to pulp cells,Single Bond is the strongest cytotoxic agent among the 4 adhesive agents.

Objective: To investigate the changes of brain gray matter volume in patients with occupational noise-induced hearing loss by voxel based morphometry (VBM) . Methods: 16 age-and education-matched healthy controls and 42 patients with occupational noise induced hearing loss, including 27 in mild group and 15 in severe group, received MRI 3D-FSPGR sequence T1WI sagittal scan, and then underwent VBM of brain gray matter volume data analysis. Results: The brain gray matter volume of the left occipitotemporal lateral gyrus, the anterior cingulate gyrus, the bilateral angular gyrus, the precuneus and the near midline area of cerebellum differed between experimental group and control group (P<0.01) . Conclusion The volume of gray matter in specific brain areas of patients with occupational noise-induced hearing loss was changed, and the effect of noise on brain structure was revealed from the perspective of imaging.

Objective To analyze the clinical and genetic features of immunodeficiency,centromeric instability,and facial anomalies (ICF) syndrome with a case report and literature review.Methods The clinical data and genetic test of a girl diagnosed with ICF syndrome in the Department of Nephrology and Immunology in Qingdao Women and Children's Hospital in December 2016 were extracted and analyzed."ICF syndrome" "immunodeficiency,centromeric instability and facial anomalies syndrome" "ICF syndrome and DNMT3B" were used as key words to search Chinese databases and Pubmed for literature until March 2018,and the literature was reviewed.Results A female patient aged 22 months old with ocular hypertelorism and low-set ears was admitted due to recurrent infection over one year.Laboratory tests showed humoral immune deficiency with IgG＜ 1.34 g/L,IgA＜0.060 g/L,and IgM＜0.179 g/L,but normal cellular immunity (total T lymphocyte 0.503,hepler T lymphocyte 0.328,cytotoxic T lymphocyte 0.166,natural killer cell 0.184,total B lymphocyte 0.276).Whole-exome sequencing revealed a de novo heterozygous splice site mutation c.922-2A＞G in intron 8,and a de novo heterozygous missense mutation c.2477G＞A in exon 23 of DNMT3B gene.Chromosome karyotype analysis showed 46,XX,with 64 out of 100 karyotypes showing centromere instability in chromosome 1.Five papers were found which were all in English,with total of 29 patients.Forty-three mutations were reported,including 34 missense,2 deletion,1 insertion,6 splice site mutations.Eleven patients had complex heterozygosis mutations.All patients had centromere instability,humoral immune deficiency and facial dysplasia which were mainly ocular hypertelorism and low-set ears.Most patients had language and motor development delay,and a few were combined with mental retardation.Conclusions ICF syndrome is a rare autosomal recessive primary immunodeficiency with classic clinical triad manifestations.De novo mutation of DNMT3B gene is one of etiologies according to genetic test.

Objective:To investigate the expression of replication factor C5 (RFC5) in cervical cancer, and its effect on the prognosis and immune regulation as well as its related mechanism.Methods:RFC5 mRNA expression data and the clinical data of 280 cervical cancer patients were downloaded from the Cancer Genome Atlas (TCGA) database in May 2023. The difference of RFC5 mRNA expression between cervical cancer tissues and paracancerous normal tissues was compared and the expression of RFC5 mRNA in patients with different clinicopathological characteristics was analyzed. According to the median expression level of RFC5 mRNA in cancer tissues, 280 patients were divided into the high expression group and the low expression group. Kaplan-Meier method was used for survival analysis, and log-rank test was used for comparison. Gene Expression Profiling Interactive Analysis (GEPIA) 2 online tool was used to verify the relationship between RFC5 gene expression and the prognosis of cervical cancer. Univariate and multivariate Cox proportional risk models were used to analyze the factors influencing the overall survival (OS) of patients with cervival cancer in TCGA database. LinkedOmics database was used to screen the co-differentially expressed genes (DEG) related to RFC5 in cervical cancer. Gene Ontology (GO) and Kyoto Encyclopedia of Genesand Genomes (KEGG) pathway enrichment analysis of DEG related to RFC5 were performed based on the DAVID database. Based on the Tumor Immune Estimation Resource (TIMER) database, the relationship between RFC5 expression and tumor infiltrating immune cells in cervival cancer was analyzed by using Spearman method. The relationship between RFC5 expression and immunomodulatory factors in cervical cancer was analyzed based on tumor-immune system interactions database (TISIDB). The expression of RFC5 protein in cervical cancer tissues was analyzed based on Human Protein Atlas (HPA) database. The expression of RFC5 in pan-cancer and its correlation with OS were analyzed based on GEPIA2 online tool.Results:In TCGA database, the relative expression level of RFC5 mRNA in cervical cancer tissues (277 cases) was higher than that in paracancerous normal tissues (3 cases), and the difference was statistically significant ( P < 0.001), while there were no significant differences in the relative expression level of RFC5 mRNA in cancer tissues of patients with different age, pathological type and clinical staging (all P > 0.05). The OS of cervival cancer patients in high RFC5 expression group (139 cases) was better than that of patients in low RFC5 expression group (138 cases), and the difference was statistically significant ( P = 0.027). GEPIA tool verification indicated that expression of RFC5 in cervical cancer and its relationship with OS showed the same results. GO and KEGG enrichment analysis showed that RFC5-related genes were mainly involved in DNA replication, cell cycle, Fanconi anemia, mismatch repair, base excision repair, nucleotide excision repair and other signaling pathways. Multivariate Cox regression analysis showed that age ≥ 65 years, clinical staging Ⅳ and the low expression of RFC5 were independent risk factors of poor OS in patients with cervical cancer (all P < 0.05). TIMER database analysis showed that the expression of RFC5 was positively correlated with tumor purity ( rho = 0.198, P < 0.001), while weakly correlated or not correlated with the infiltration levels of B cells ( rho = 0.062, P = 0.306), CD8 + T cells ( rho = 0.168, P = 0.005), CD4 + T cells ( rho = -0.049, P = 0.418), macrophages ( rho = 0.034, P = 0.577), neutrophils ( rho = 0.169, P = 0.005) and bone marrow dendritic cells ( rho = 0.026, P = 0.667). Analysis of TISIDB data showed that RFC5 expression was mostly negatively correlated with immunosuppressive factors and immunostimulatory factors. HPA database showed that the expression level of RFC5 in cervical cancer tissues was higher than that in normal cervical tissues. GEPIA online tool database analysis showed that RFC5 expression was up-regulated in a variety of malignant tumors. The OS of thymoma patients with high RFC5 expression was better than that of those with low RFC5 expression, while the OS of acute myeloid leukemia patients with high RFC5 expression was worse than those with low RFC5 expression, and the differences in OS were statistically significant (both P < 0.05). Conclusions:RFC5 is highly expressed in cervical cancer and its expression is associated with prognosis of patients with cervival cancer. Overexpression of RFC5 may inhibit the expression of immunomodulatory factors, and it may regulate the development and progression of cervical cancer through DNA replication, cell cycle, mismatch repair, base excision repair and other related pathways.