Objective:The characteristics and changes of the three-dimensional micro structure of human placenta in Early-onset severe preeclampsia (EOSP) were quantified, and the relationship of morphologic features and the poor fetal prognosis was explored. Methods:10 patients were recruited in EOSP group, 10 normal blood pressure premature pregnancy were as control group. Ultrathin sections were observed by elec-tron microscope. The Vv,Sv,Nv of plancenta were measured by stereology method. These parameters were compared between the two groups. Results:①In EOSP group, the miorovillus at the bottom of syncytial was sparse and swollen. The mitochondria and endoplasmic reticulum were swollen and dilated. The deposition of lipid granules were increased.②The Vv, Sv of mitochondrial and endoplasmic reticulum in EOSP group were significant augmented than control groups( P<0.01 ). There was no significant difference of Nv in mitochon-drion and endoplasmic reticulum between two groups ( P >0.05). ③The Vv,Sv, Nv of microvilli in EOSP group were smaller than those in control group ( P < 0.01 ). Conclusions. In EOSP, the microstructure of placenta is impaired, thus the synthesis and transportation function of placenta were affected, so fetus could be injured subsequently.

Based on a description of the evolution,main reform practices and effects of public hospital payment system reforms,this paper focused on analyzing the existing problems found in the reforms.Such problems namely include lack of scientific and reasonable design of payment standards,lack of systemic and coordinated system reforms,and failure to fully mobilize the enthusiasm of medical workers to participate in the reforms,as well as other underlying causes.Based on such suggestions were put forward to promote public hospital payment system reforms,as negotiation of the payment standard between purchasers and providers,combined approaches in innovation in payment methods,advancing systemic payment system reform,and establishing a transmission mechanism of incentive to the medical personnel.

The paper presented the payment system theory of the primary health care service in China,the current status of the health service system,and analyzed main challenges for the time being.Based on such studies,the authors made the following policy proposals.The first is adjustment of the fiscal payment method of the government to such institutions in line with the classification guidance principle; the second is to shift the payment method of primary public health services to the post payment of fee-for-service; the third is reform of the performance-based salary system to link payment to medical workers directly with the amount and quality of their services; the fourth is a set of result-oriented performance appraisal indicators,with rising proportion of performance pay; the fifth is to integrate the outpatient clinic fund covered by medical insurance and the primary public health service fund,into a capitation payment.

DRG-based prospective payment system ( DRG-PPS ) is one type of mature inpatient care payment mechanisms in most countries and pilot projects would be introduced to China in 2017. This article provides an overview of the previous typical DRG-PPS reform initiatives on provincial, municipal and county level respectively. It also summa-rizes the characteristics of the reform programs, describes the diversities of policy implementation, and discusses the suc-cessful experience and implications of the initiatives. The paper puts forward some suggestions on the upcoming DRG-PPS pilot projects based on the progress and problems of the initiatives, to promote the DRG-PPS reform in China.

To discover medical teaching method which is more funny and effective in early clinical contact education, Eye optical hospital affiliated to Wenzhou Medical University set up oph-thalmic microsurgery experience teaching course for junior medical students and set a variety of eye surgery simulation experience content, such as conjunctival suture surgery, corneal suture surgery, cataract surgery, eye surgery simulation and so on, which can effectively arouse students' professional interest in learning and promote students' thinking and exploration to their profession.

OBJECTIVE:To compare the preventive and therapeutic effect of Vinegar testudinis carapax (VTC) water decoc-tion and powder on mice with hemopenia or osteoporosis. METHODS:Mice were randomly divided into normal group (1%CMC-Na),model group (1% CMC-Na),positive group (Compound e-jiao slurry 20 mL/kg or Gusongbao capsule 1.98 g/kg), VTC water decoction and powder low-dose,medium-dose,high-dose groups(1.95,3.90,7.80 g/kg),10 in each group. In hemo-penia mice model experiment,except for the normal group,mice in other groups were intraperitoneally injected cyclophosphamide 0.1 g/kg for modeling,and intragastrically given medicines from the first day(positive drug was Compound e-jiao slurry),once a day,for 8 d. After administration,peripheral blood levels of white blood cells (WBC),red blood cells (RBC),hemoglobin (HG),hematocrit(HCT),platelet(PLT)and bone marrow nucleated cells(BMNC)numbers in femur of mice were determined. In osteoporosis mice model experiment,except for the normal group,mice in other groups were intragastrically given retinoic acid 0.105 g/kg for modeling,and intragastrically given relevant medicines from the first day(positive drug was Gusongbao capsule), once a day,for 30 d. After administration,alkaline phosphatase(ALP)level,organ(thymus,liver,spleen,ovary)coefficients, dry masses and degreasing,ash quality of the femur,and contents of femur calcium and phosphorus in serum of mice were detect-ed. RESULTS:In hemopenia mice model experiment,compared with normal group,WBC,RBC,HG,HCT,PLT levels in pe-ripheral blood and BMNC numbers in femur of mice in model group were decreased (P<0.01). Compared with model group, HCT,PLT,BMNC levels in peripheral blood of mice in VTC water decoction low-dose group,and RBC,HG levels in medi-um-dose group and HCT level in high-dose group were significantly increased (P<0.05). And WBC level in peripheral blood of mice in powder low-dose,high-dose groups and HG level in medium-dose group were significantly increased(P<0.05). In osteo-porosis mice model experiment,compared with normal group,ALP level in serum of mice in model group,dry mass and degreas-ing,ash mass,ash mass/dry mass of degreasing of the femur,and the contents of femur calcium and phosphorus were significantly decreased (P<0.01),there was no significant difference in each organ coefficient (P>0.05). Compared with model group,ALP level in serum and dry mass,phosphorus content of femur of mice in VTC water decoction high-dose group were significantly in-creased (P<0.05);ALP level in serum and dry mass,phosphorus content of femur of mice in VTC,powder medium-dose, high-dose group,the ash mass,ash mass/dry mass of degreasing,contents of femur calcium and phosphorus in VTC powder medi-um-dose group were significantly increased(P<0.05). CONCLUSIONS:VTC water decoction shows better preventive and thera-peutic effect on hemopenia mice;while VTC powder shows better preventive and therapeutic effect on osteoporosis mice.

The aim of the present paper intends to explore the international experiences of healthcare profes-sional organizations and its enlightenment for China. The functions of health professional organizations in advanced countries include certification and accreditation, self-discipline, academic exchanges, political participation, service for industry, member rights protection and so on. The legal authorization, comprehensive supervision and competitive market mechanisms which make sure these functions perform well are worth learning for China.

This article is based on a questionnaire survey of healthcare professional organizations and interview leaders of them. The results of this investigation show that the number of staff is small, and lack of highly qualified human resources. The organizations rely on donation for income and some of them run at a deficit. The functions such as professional self-discipline are not well performed. The analysis reveals four reasons why functions are not well per-formed:the bureaucratic style of the professional organizations and unclear legal status;the limited authorization from legal and administrative bodies;the defects in the governance system and the lack of capacity. Four aspects of policy recommendations are were proposed: to clearly define the role of the professional organizations and authorization through legal and administrative procedures; to strengthen support of professional organizations through various poli-cies;to improve governance and build comprehensive regulation mechanisms;to enhance the capacity of these organi-zations and so on.

The characteristics of health care require that health care professional organizations play an impor-tant role in health governance. The role of health care professional organizations in China has not been clearly defined and their functions have not been fully developed. This paper explores the nature, and the functions of health care professional associations in China. Based on the analysis of health governance characteristics in China, the role, and functions of the health care professional organizations in China’s health governance were defined and relevant policy recommendations are were proposed.

Objective To improve the diagnosis and differential diagnosis of adrenal incidentalomas for the optimal management of adrenal masses. Methods The clinical data of 52 cases (35 men and 17 women;mean age,42 years;age range,23-65 years) of adrenal incidentalomas was reviewed.Among them, 33 cases had tumors ≥ 3.0 cm in diameter.None of 52 cases had clinical symptoms and signs of hypertension and endocrine dysfunction.All of the tumors were incidentally found by ultrasonography or CT on regular physical examination.A series of blood chemical examinations (including electrolytes,adrenal cortical and medullary metabolic biochemistry),abdominal ultrasound and CT were performed in all 52 cases;and MRI,PET and  131 I-MIBG imaging were performed in 6,2 and 1 cases,respectively.Surgery and postoperative pathological study were performed in all. Results Postoperative pathology showed adrenocortical adenoma in 27 cases,adrenal metastatic carcinoma in 7,adrenal pheochromocytoma in 5,adrenal cyst in 4,primary aldosteronoma in 3,adrenal neurinoma in 2,adrenocortical carcinoma in 1,retroperitoneal neuroblastoma in 1,retroperitoneal primary lymphoma in 1 and adrenal ganglionic fibroma in 1.Diagnoses based on the results of imaging examinations and laboratory tests were correct in 14 cases (27%).Of the 10 patients with malignancies,5 with primary diseases died 6-10 months after chemotherapy and 5 were lost to follow-up.The remaining 42 patients were followed up for 6 months to 9 years with no evidence of recurrence. Conclusions Multidisciplinary approaches are required to identify and differentiate adrenal incidentalomas, and early surgical treatment is suggested.