Through analyzing domestic medical service payment method and day surgery payment method in USA and Australia, combine the current domestic progress of day surgery and its main prevailing payment to explore the future day surgery payment system in China.

Objective:To investigate the effect of heat shock protein 60(HSP60) on the functions of dendritic cells of ApoE-/-mice (mDCs) in vitro by signal transduction of mitogen-activated protein kinase (MAPK) family mediated by Toll-like receptors (TLRs).Methods:Myeloid mDCs were extracted in vitro from ApoE-/-mouse marrow,which were incubated as atherosclerotic animal model,and divided into three groups:HSP group,LPS group and control group.The three groups of mDCs were incubated to mature with mHSP60,LPS and normal saline,respectively and then examined the expression of TLR protein and mRNA by flow cytometry and real-time RT-PCR.In addition,the expression level of CD80 was examined by flow cytometry.The expression of MAPK family proteins was determined by Western blot analysis.The levels of cytokines secreted by mDCs,such as IL-6 and TNF-?,were analyzed by ELISA.Results:The expression of TLRs and MAPK families (p38 and ERK) was increased in the samples of HSP group,when compared with control group (P0.05).Conclusion:HSP60 is involved in activation of mDCs of atherosclerotic animal model by means of the signal transduction of MAPK family mediated by TLRs.

The Pricing and Payment Regulation on Chinese Diagnosis Related Groups (C-DRG) was designed by National Health Development Research Center,directly under the leadership of Department of Finance,NHFPC (formerly Dept.of Planning and Finance,Ministry of Health),which organized a large study group consisted of nearly 1 000 experts since 2010.It introduced the general design of C-DRG and the principles and main points of applying C-DRG system,which could be referenced by all countries in carrying out the pricing and payment reform system.

Objective To investigate the relationships between the severity of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS).Methods One hundred and twenty-seven cases of NAFLD patients were selected from March 2011 to August 2012 in the First Hospital Affiliated to Fujian Medical University,of them,61 patients with mild NAFLD,45 patients with moderate and 21 patients with severe.And 21 cases without NAFLD were selected as control group during the same hospitalized period.All objects received the measures of height,body weight,waist circumference (WC),blood pressure; Liver ultrasonic examination,the examination of fasting plasma glucose,blood fat and hepatic function detections were also handed by special people.Results The proportion of overweight in the control group and the three NAFLD subgroups were 57.1％ (12/21),88.5％ (54/61),95.6％ (43/45) and 100％ (21/21) respectively (x2 =18.376,P ＜0.001) ;The proportion of the obesity in control group and the three NAFLD subgroups were 19.0％ (4/21),44.3％ (27/61),64.4％ (29/45) and 71.4％ (15/21) respectively(x2 =16.440,P =0.001).The proportion of the metabolic syndrome of the control group and the three NAFLD subgroups were 14.3％ (3/21),45.9％(28/61),71.1％ (32/45) and 71.4％ (15/21) respectively (x2 =22.637,P ＜ 0.05).All three subgroups of NAFLD were higher than the control group (x2 =6.641,P ＜ 0.05 ; x2 =18.562,P ＜ 0.05 ; x2 =14.000,P ＜0.05,respectively).The severity of NAFLD was positively correlated with BMI,WC,TG,FBG,SBP,and DBP (r =0.467,0.503,0.386,0.369,0.279,0.295,P ＜ 0.01),and negatively correlated with HDL-C (r =-0.209,P ＜0.05).Conclusion The severity of NAFLD had significant correlations with metabolic syndrome's components.

Objective To investigate the expression of COX-2,MMP-2 and TIMP-2 ,the pathological fea-tures ,and their relationship in breast cancer. Methods The expressions of COX-2 ,MMP-2 and TIMP-2 were deter-mined by S-P immunohistochemical method on tissue chips,which containing 127 cases of breast carcinoma. Results The positive rates of COX-2,MMP-2 and TIMP-2 protein were 81.1 (103/127)% ,96.9(123/127)% and 60.6 (77/127) % respectively;The expression of COX-2 was positively related to auxiliary lymph node metastasis and TNM staging (P<0.01 and P<0.05, respectively), and inversely related to PR expression (P<0.05). Further-more,the expression of COX-2 was positively correlated with MMP-2 (r=0. 290 ,P<0.01). Conclusions The ex-pression of COX-2 might be closely related to the invasion and metastasis of breast cancer and has a close relation-ship with MMP-2. The levels of MMP-2 might be partly regulated by COX-2.

BACKGROUND:With the extensive application of anterior titanium plate, postoperative complications such as dysphagia, titanium loose, screw exit and disc degeneration of neighboring segments induced more and more attention of researchers. However, the application of anterior cervical cage is expected to avoid these complications. ＜br> OBJECTIVE:To observe primary curative effect of anterior cervical cage ROI-C in anterior cervical spine surgery. ＜br> METHODS:A total of 32 patients with cervical spondylosis were treated with anterior cervical cage ROI-C in the Wuxi Ninth Hospital Affiliated to Soochow University from April to December 2013. The cage was implanted to promote interbody fusion. Of 32 cases, 23 cases affected cervical spondylotic myelopathy, 2 cases affected nerve root type cervical spondylosis, 3 cases affected cervical hyperextension injury, 1 case affected cervical disc herniation, 2 cases affected cervical instability and 1 case affected segmental cervical ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association and NDI scores were determined to assess neurological symptoms and functional improvement before internal fixation and during final fol ow-up. Simultaneously, adverse reactions were recorded. ＜br> RESULTS AND CONCLUSION:A total of 32 patients finished the regular fol ow-up for 4 to 8 months. Clinical symptoms and spinal cord function of al patients were obviously improved. No ROI-C loosing or displacement or secondary surgery was found. The average fusion time was 4.2 months (3 to 5 months). Mean score of Japanese Orthopaedic Association was increased from 9.2 points pre-surgery to 13.8 points post-surgery. Japanese Orthopaedic Association and NDI scores were higher during final fol ow-up than before fixation (P＜0.05). These data indicated that ROI-C effectively restored intervertebral height in anterior cervical spine surgery, stably reconstructed cervical vertebra, obtained interbody fusion, effectively avoided related surgical complications induced by plate implantation, improved neurological symptoms and function, and showed good short-term effects.

Objective To investigate the relationship between waist-to-height ratio and metabolic syndrome,in order to identify the optimal cut-off point of waist-to-height ratio for predicting metabolic syndrome.Methods In this cross-sectional study,we recruited 343 people who received physical examination in First Hospital of Quanzhou between January 2012 and June 2014,and collected the information of their waist circumference,height,weight,blood pressure,laboratory test results (including fasting blood glucose,2-hour glucose after oral glucose tolerance test,triglyceride,high-density lipoprotein cholesterol) and visceral fat area assessed by computed tomography.Then a receiver operating characteristic (ROC) curve analysis was used to estimate the optimal cut-off points of waist-to-height ratio for the prediction of metabolic syndrome.Results Among the 343 people,there were 195 metabolic syndrome patients,the prevalence rate was 56.8％,which was 70.2％ in men (127/181) and 42.0％ in women (68/162).In ROC curve analysis,the area under the curve of waist-to-height ratio for the prediction of metabolic syndrome was 0.664 for men,and 0.673 for women.The optimal cut-off point of waist-to-height ratio for predicting metabolic syndrome was 0.543 0 (sensitivity 88.2％,specificity 44.4％) for men,and 0.568 3 (sensitivity 86.8％,specificity 46.8％).Conclusion The optimal cut-off point of waist-to-height ratio for predicting metabolic syndrome in Quanzhou population is 0.543 0 for men and 0.568 3 for women.

ObjectiveToinvestigatetheroleofimmuneinflammatoryreactionintheformationof intracranial aneurysm. Methods The intracranial aneurysms in 40 patients of craniotomy ( intracranial aneurysm group) and the vascular specimens in 20 craniotomy patients w ith traumatic brain injury (control group) w ere col ected. Fluorescence quantitative polymerase chain reaction w as used to detect the expression of interleukin (IL)-17 receptor in the arterial w al . Flow cytometry w as used to detect the Th-17 cel s in peripheral blood. Enzyme-linked immunosorbent assay w as used to measure the levels of IL-17, IL-6 in the arterial w al and tumor necrosis factor-α( TNF-α) in peripheral blood. Results There w ere no significant differences in the age (62.6 ±8.7 years vs.61.4 ±7.9 years;t=0.342;P=0.681), proportions of male (60.0%vs.65.0%; χ2 =0.246, P=0.434), hypertension ( 12.5%vs.10.0%; χ2 =0.315, P=0.492), diabetes (75.0%vs.10.0%; χ2 =0.284, P=0.482), and smoking (35.5%vs.30.0%; χ2 =0.224, P=0.413) betw een the intracranial aneurysms group and the control group. The expression of IL -17 receptor in the arterial w al (0.106 ±0.032 vs.0.264 ±0.071; t=5.115, P=0.001) and the proportion of Th17 cels in peripheral blood (2.75%±0.53%vs.7.18%±1.54%; t=8.436, P<0.001) and IL-17 level ( 7.32 ±1.82 μg/L vs.22.64 ±4.51 μg/L; t= 8.357, P< 0.001 ) in the control group w ere significantly low er than those in the intracranial aneurysm group. The levels of IL-6 (1.15 ±0.24 μg/L vs. 19.64 ±4.16 μg/L; t=9.527, P<0.001) and TNF-α(1.43 ±0.31 μg/L vs.26.17 ±4.32 μg/L; t=9.816, P<0.001) in the arterial wal in the control group were significantly lower than those in the intracranial aneurysm group. Conclusions The expression of IL-17 receptor in the arterial w al , the proportion of the Th17 cels and IL-17 level in peripheral blood were increased in patients with intracranial aneurysms. Immune inflammation may be involved in the formation of intracranial aneurysm.

OBJECTIVE To summarize the clinical experience of endoscopic thyroidectomy via suprasternal approach. METHODS Endoscopic thyroidectomy via suprasternal approach was performed in 35 patients with ultrasonic scalpel. RESULTS Operations were successfully performed in 35 patients. The mean operation times were 130 (105～190) minutes in 24 cases with subtotal lobectomy and 4 case with total lobectomy, 60 (50~70) minutes in 2 cases with isthmectomy, 228 (185～270) minutes in 2 case with bilateral subtotal lobectomy, 163 (140～215) minutes in 3 case with subtotal lobectomy and the contralateral ademona resection. The bleeding during operation was 5 to 40ml and the average hospital stay time was 4 (3～5) days. CONCLUSION Endoscopic thyroidectomy via suprasternal approach is a safe way with good cosmetic value.

ObjectiveTo investigate the effects of Shenmai Injection(SI) on chronic systolic heart failure patients.Methods120 chronic heart failure patients were randomly divided into routine treatment and the routine treatment and SI group. The changes of angiotension Ⅱ(Ang Ⅱ), aldosterone(Ald), endothelin-1 (ET-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), plasm rennin activity (PRA), cardionatrin(ANP), brain natriuretic peptide (BNP), cardiac function were observed.ResultsAfter treatment, LVEF,stage of NYHA increased in two groups,LVDs, LVDd and the level of Ang Ⅱ,Ald, ET-1, IL-6, TNF-α,PRA, ANP and BNP decreased in both groups(P<0.05). LVEF, stage of NYHA in the routine treatment and SI group incresed more significantly than those in routine treatment group(P<0.05). LVEDs, LVEDd and the level of Ang Ⅱ,Ald, ET-1, IL-6, TNF-α,PRA, ANP and BNP in the routine treatment and SI group were decreased more significantly than those in routine treatment group (P<0.05).ConclusionSI can improve not only the disturbed endocrine function and cytokines, but also left ventricular function.