The new rural cooperative medical system(NRCMS)is a significant breakthrough for people's wellbeiug as emphasized by the government in the new century.To better the system and further the social and economic development,the instant reimbursement practice came into being under the NCRMS.The article introduced the background and implementation of the practice at provincial and municipal level at designated medical institutions in Fujian province.It also analyzed the benefits and initial outcomes of the practice for peasants at large,and proposed remedies for setbacks found in the practice of NRCMS.

Objective To study the therapeutic value of a second ERCP for the patients with failure of pre-cut ERCP.Methods A total of 167 cases of pre-cut ERCP failure were recruited to the study,among which 109 cases were diagnosed as common bile duct stones and/or benign papillary stenosis,and 58 cases as biliopancreatic lesion.ERCP failed with standard intubation for more than 20 minutes,even with pre-cut or fenestration.A second ERCP was preformed after rest of 3-5 days.The position sequence of intubation for most patients was horizontal,the front and rear.Results The success rate was 79.6％ (133 cases) for the patients with a second ERCP,85 patients received the procedures via the horizontal intubation,36 via anterior,and 12 via posterior intubation.The treatments were performed after successful completion of the endoscopic cannulation.One patient had retroperitoneal infection with duodenal perforation,another patient had severe pancreatitis,who were cured by the intervention methods.Conclusion The success rate of a second ERCP is high with proficient intubation skills.

Objective To explore the effect of early systemic phased exercise post mastectomy on the recovery of activities of daily living. Methods 100 patients who received modified radical mastectomy were assigned to the experimental group and control group with 50 patients in each group. They all accepted routine nursing, and the experimental group accepted early systemic phased exercise in addition. They were assessed with range of motion (ROM) of shoulder and modified Barthel Index (MBI). Results ROM of shoulder improved in 90% of the experimental group and 70% of the control group (P<0.05). MBI was (84.5±18.2) in the experimental group and (51.8±16.6) in control group (P<0.05) . Conclusion Early systemic phased exercises may promote the recovery of the affected arm for the patients post mastectomy.

OBJECTIVE:To discuss clinical efficacy and safety of leuprolide acetate in the treatment of endometriosis. METH-ODS:66 endometriosis patients were divided into observation group(37 cases)and control group(29 cases)according to random number table method. Observation group was treated with Leuprolide acetate microsphere for injection,3.75 mg/time,on the upper arm,abdomen or buttocks since the first-fifth day of menstrual cycle(administration time was available at hysterectomized patients disposal),and then every 4 weeks;one administration was recognized as a treatment course. Control group was treated with Ethi-nyl estradiol cyproterone tablet orally,1 tablets per day for 3 weeks,one week drug withdrawal,as a treatment course. 2 groups were given 3-5 courses of treatment according to their tolerance or the improvement of clinical symptoms. The improvement of clini-cal symptoms were compared between 2 groups,and the levels of FSH,LH and E2 were compared before and after treatment;the occurrence of ADR and the time of the return of menses were recorded. RESULTS:2 patients in observation group and 1 patient in control group withdrew from the test. After treatment,total effective rate was 97.14% in observation group,which was significant-ly higher than 75.00% in control group,with statistical significance (P<0.05). Before treatment,there was no statistical signifi-cance in the levels of FSH,LH and E2 between 2 groups (P>0.05). After treatment,the levels of FSH,LH and E2 were de-creased significantly,and the observation group was more significant than the control group,with statistical significance (P<0.05). Total incidence of ADR was 20.00% in observation group,compared to control group (21.42%),there was no statistical significance (P>0.05). The time of the return of menses in observation group was (89.75 ± 3.34) d after drug withdrawal,com-pared to control group [(88.46±2.94)d],there was no statistical significance(P>0.05). CONCLUSIONS:Leuprolide acetate can effectively improve clinical symptoms of patients with endometriosis,and reduce the levels of FSH,LH and E2 with slight ADR, and it doesn’t influence the time of the return of menses.

Objective The objectives of this study were to analyze the results of lung cancer screening from 9265 urban residents in Urumqi from year 2014 to 2016,and to evaluate the significance of early diagnosis and treatment of cancer for the lung cancer prevention.Methods A total of 31,177 people with high risk of lung cancer were assessed by cancer risk questionnaire surveyed from 40 to 69 years old residents in Urumqi.High-risk groups were assigned to low-dose spiral CT scan in Affiliated Tumor Hospital of Xinjiang Medical University.Results 9,265 people were scanned with low dose spiral CT and overall completion rate was 29.7％.There had 11.9％ detection rate in 1,005 people who were scanned positive pulmonary nodules.The detection rate was 31.9％ for 2,955 people who were scanned solid nodules(＜5 mm) and 2.5％ for 236 people who had the non solid nodules(＜ 8 mm).After screening,14 patients were diagnosed by pathology and the detection rate was 0.2％.The emphysema,pulnonary cysts,pulmonary bullae and other related lung disease were detected in 4,095 people and the detection rate was 44.2％.Conclusion The lung health status of Urumqi residents was found by a wide range of lung cancer screening,and the awareness of lung cancer prevention and control was greatly improved.It provided the basis for the establishment of effective prevention and treatment system,which was helpful to improve the early diagnosis and treatment rate of lung cancer.

Objective To explore the effect of hemeoxygenease/carbon monoxide system on hypoxic pulumonary vascular structural remodeling. Methods Twenty six Wister rats were randomly divided into four groups:control groups( n =6),hypoxia group( n =7),hypxia+ZnPP group( n =6) and hypoxia+CO group( n =7).Pulmonary artery mean pressure(mPAP) of each rat was elaluated by using right cardiac catheterization,the ultrastructaral changes in intra acinar pulmonary muscularized arteries were observed. Results mPAP was significantly increased in hypoxic rats(22?2 31?mmHg)as compared with that of normal controls(16 57?2 51mmHg)( P

Objective To make a systematic review of pressure ulcers risk factors in critically ill patients. Methods We systematically reviewed all articles related to the pressure ulcers risk factors in critically ill patients. The Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, CNKI, WANFANG and SinoMed were searched to August 2016. Results In total, 13 eligible articles were included. These studies included 18, 184 critically ill patients, six studies were classified as high quality, and seven were classified as moderate quality. Risk factors for the development of pressure ulcers include age, ICU stay, diabetes, mean arterial pressure<60-70 mmHg (1 mmHg=0.133 kPa), mechanical ventilation and mechanical ventilation, drugs, sedation and postural changes. Conclusions There is no single factor that can explain the occurrence of pressure ulcers. So it is in a variety of factors interaction, the occurrence of a significant increase in risk.

Objective To compare the effects of different surgical techniques for treatment of concealed penis. Methods A retrospective review of 219 patients underwent surgical correction of concealed penis between 1986 and 2007 was performed. The mean age was (10.3±2.4) years(3-15 years). The penile length was (1.9±0. 5)cm(0. 5-3. 0 cm)before operation. Ninty-three patients were the severe degree of concealed penis. The others were the moderate degree. All patients under-went operation with different techniques, including Johnston's technique in 34, Devine's technique in 42, modified Devinds technique in 125 and Brisson's technique in 18. The increased length of penile af-ter operation was compared among the 4 groups with different surgical techniques by statistical meth-od. Results The postoperative increased length of penile in Johnston's technique, Devine's tech-nique, modified Devine's technique and Brisson's technique was (1.8 ± 0. 4) cm, (2. 0 ± 0. 5) cm, (2.1±0.4)cm and (2.3±0.4)cm respectively. The difference was significant by ANOVA test (F=13.1,P<0. 001). Devines technique, modified DevineSs technique and Brisson's technique were better than Johnston's technique considering the increased length of penile. The complication of severe penile lymphedema of 4 groups developed in 8, 5, 6 and 2 patients respectively. Conclusion Modified De-vine's technique has the satisfactory increasing of penile length for treatment of concealed penis and less complication rate after operation.

Objective To investigate the role of endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD)in the treatment of non-biliary severe acute pancreatitis(SAP).Methods 73 patients were randomly divided into the endoscopic treatment group(35 cases)and control group(38 cases).The patients in control group received non-surgical treatment.EST plus ENBD were performed in patients in the endoscopic treatment group 72h within hospitalization.Serum levels of amylase before EST and 1d,3 d,7 d after EST were measured;the ease of pain and recovery of bowel function were documented;the mortality rate,complication rate,surgery rote and hospital stay were also observed.Results The successful cannulation rate in the EST group was 94.3%(33/35),and there was no procedure related complication.Serum levels of amylase before EST and 1d,3 d,7 d after EST were(1376±131)U/L,(675±49)U/L,(238±49)U/L,(75±13)U/L,the serum levels of amylase before EST and 1d after EST in the EST group were not significantly different from those in the control group,but the corresponding values at 3 d,7 d were significantly lower than those in the control group(P＜0.01).The apparent effective rate and total effective rate of pain relief was 37.1%and 48.6%.which was significantly higher than those in the control group (26.3%and 28.9%,P＜0.05).There was no mortality in both groups.The complication rate in the EST group within 30 d was 14.3%,which was signiilcanfly higher than that in the control group(44.7%,P＜0.01).The gurgery rate in EST group was 2.86%,which was significantly lower than that in the control group (21.1%,P＜0.05).The hospital stay in EST group was(27.6±4.0)d,which was significantly shorter than that in the control group[(41.7±5.9)d,P＜0.05].Conclusions EST and ENBD treatment for non-biliary SAP was superior to non-surgical treatment within 72 h of symptom onset with excellent safety and feasibility profile.

Objective To study cutaneous ultrastructural changes and FERMT1 gene mutations in a patient with Kindler syndrome. Methods Clinical data were collected, and tissue samples obtained from the lesions of poikiloderma were observed by using transmission electron microscopy. Fifteen coding exons and their flanking sequences of the FERMT1 gene were amplified by PCR and DNA sequencing was followed.Results Reduplication of lamina densa was seen between the dermal-epidermal junctions of the lesional skin. The patient was found to be homozygous for a novel splice-site mutation (IVS9 + 1G ＞ A) in FERMT1 gene, and his parents were heterozygous for it. The mutation was undetected in fifty normal control individuals.Conclusions Transmission electron microscopy may serve as an ancillary examination for the diagnosis of Kindler syndrome. The IVS9+1G＞A mutation of FERMT1 gene may contribute to the clinical phenotype of Kindler syndrome in this patient.