Purpose To explore the CT findings of gastric stromal tumor (GST) and primary gastric lymphoma (PGL) for differential diagnosis. Materials and Methods The CT findings of 26 patients with GST confirmed pathologically and 21 patients with PGL confirmed pathologically were retrospectively analyzed with regards to location of lesion, number, range, relation between lesion and gastric wall, density, enhancement pattern, change of gastric mucoma and serous layer, and encroachment of perigastric lymph nodes and other organs. Results CT scans demonstrated that all 26 GST cases had single localized mass with relatively well-defined margin (17 cases located in gastric fundus, 9 cases inside stomach body) and that all 21 PGL cases showed single irregular diffused thickening of gastric wall, and most of which located in 2 or 3 parts with ill-defined margin. On plain CT scan, all lesions of GST appeared slightly hypo-density or iso-density, or heterogeneous density [mean CT value (32±11) Hu];while all lesions of PGL presented homogeneous iso-density [mean CT value (52±9) Hu] with statistical difference (t=12.37, P<0.05). On contrast enhanced scan, GST showed obvious homogeneous or heterogeneous delayed enhancement whereas PGL displayed slightly homogeneous delayed enhancement with statistical difference (t=5.35, P<0.05). Smooth and clear gastric mucosa was found in 26 GST cases without any perigastric lymph node enlargement. Two PGL cases had obscure gastric mucosa and the other 19 PGL cases showed smooth and clear gastric mucosa, 6 PGL cases with lymph node enlargement. Conclusion On CT scan, lesions of GST are limited, with heterogeneous density and obviously heterogeneous enhancement; whilst PGL has diffuse lesions, associated with homogenous density and slightly homogeneous enhancement. The different features are helpful in the diagnosis for both diseases.

Objective To assess the MRI features of cerebrum in idiopathic hypoparathyroidism (IHP). Methods MR images of 27 IHP patients were analyzed retrospectively emphasized on the location, appearance and signal intensity of the lesions. Results MRI showed symmetric abnormal signals in basal ganglia in 27 patients, in thalami and dentate nucleus in 21 patients, and in corona radiata-centrum ovale in 9 patients. All the lesions were hyperintensity on T1WI. Local hypointensity in basal ganglia was found in 4 patients, while hyperintensity or slight hyperintensity on both T2WI and T2-FLAIR were found in 26 patients, and slight hyperintensity with hypointensity on both T2WI and T2-FLAIR in 1 patient. Conclusion MRI of IHP has some features. Symmetric high signals on both T1WI and T2WI in basal ganglia, thalami and dentate nucleus have important diagnostic value for IHP.

Objective To explore the indication and the functional advantages of the high-flexion posterior stabilized (PS) rotating-platform mobile-bearing (RP-MB) total knee system. Methods A prospective randomized, controlled trial was performed. Osteoarthritis was the indicators for total knee arthroplasty.From Feb. 2009 to Apr. 2009, 75 patients (94 knees) were randomly assigned to to receive either a highflexion PS, RP-MB total knee system(PFC sigma RPF) or a standard one (PFC sigma RP). There were no statistical difference in the baselines, the preoperative scores of the Hospital for Special Surgery (HSS) and the knee range of motion (ROM) of both groups. The functional status were assessed with Hospital for Special Surgery and the ROM of the knee at the postoperative 1, 6, 12, 18 months. The satisfaction rates were assessed at the postoperative 18 months. The radiographic measurements were t assessed at the postoperative 3days and 3, 6, 12, 18 months. Results A total of 70 participants (87 knees) completed the 18-month followup. At the time of the final follow-up, the average Hospital for Special Surgery knee score was 92.4±5.0points in the standard group and 94.7±7.0 points in the high-flex ion group. The difference was not statistically significant(P ＞0.05). The average maximal flexion was 131.9±14 degrees in the high-flexion group and 123.0±15.3 degrees in the standard group. There was a statistical difference. But it was not enough to confirm our hypothesis that the difference should be higher than 10 degrees. Moreover, the satisfaction rate were 100% in both groups, and no statistical significant difference was found. Conclusion No significant differences were found between standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee prostheses in terms of clinical outcomes or range of motion.

Objective: To explore the short-term effects of communicated activities regarding the China Healthy Lifestyle for All workshop held during September 2018. Method: "National action for three reductions and three health activities" and related content ( "salt reduction," "oil reduction," "sugar reduction," "oral health," "healthy bones," and "healthy weight" ) were used as keywords. Starting September 1, thematic publicity topics were launched and implemented throughout the month. The National Action Office issued promotional materials one day in advance through the WeChat Work Group known as the health promotion network in the mainland, which had been developed by members from different provinces, cities, and counties, to disseminate the materials for use both offline and online. Using search engines such as Baidu search and Sogou search, a third-party professional evaluation agency intelligently captured relevant information and texts from various organizations (including provinces, cities, and countries). The information was gathered and sorted according to different channels and forms; thereby, a database was formed for analysis. The content analysis method was used to quantitatively analyze the change trend of the release volume of related reports, and classified statistics were conducted according to different communication channels and forms. Baidu index, WeChat interactive volume, WeChat index, and Weibo hit times were used for evaluation. Researchers analyzed the difference of release volumes in different provinces (municipalities directly under the central government and autonomous regions), as well as in eastern and central regions. Results: The daily communication trend increased significantly after September, with 42 176 reports on related topics, peaking on September 3 (2 703 reports in a single day); effects of the topic establishment and publicity were shown during the entire month. The Badu index showed the same tendency. The keywords "three reductions," "three health," "all-people action," "oil reduction," "sugar reduction," "salt reduction," "oral health," "healthy bones," and "healthy weight" had become high-frequency words. From the perspective of communication channels, there were 17 576, 11 453, and 8 034 reports by WeChat, the news, and Weibo, respectively, accounting for 41.76%, 27.16%, and 19.05% of the total; these report rates were obviously higher than those of other communication channels. WeChat’s interactions reached 4 064 699, and the WeChat index rose to a peak of 858 275 on September 1, which was 194.44 times higher than on August 10 (before the promotional month); additionally, the number of micro-blogging hits reached 130 907 879. Regarding the form of presentation, in descending order, the most frequent type was graphics, followed by star propaganda, radio drama, and health super material. In addition, the gap between the top five provinces ranked by each channel was large. The number of daily releases varied significantly among provinces (municipalities and autonomous regions), with Beijing taking the top spot with 81 articles, while the western provinces of Xinjiang, Ningxia Hui Autonomous Region, Qinghai Province, and Tibet had relatively low daily releases. Even the gap of rank among the top five in WeChat, news, and individual micro-blogs were larger: Beijing, Shandong Province, and Zhejiang Province were the country’s top three regions in WeChat publishing volume. The communication effect in the eastern, central, and western regions was considerably different, with the eastern region clearly responding better than the other two regions, and the western region had insufficient propaganda capacity as a whole. Conclusion The communication effect of the China Healthy Lifestyle for All month activities in 2018 was quite effective, but the gap in communication effect by provinces was large.

Brown adipose tissue (BAT) increases energy consumption by directly dissipating stored energy in the form of heat through the role of uncoupling protein (UCP1). Recent studies have found that brown adipocytes may also regulate metabolism through autocrine, paracrine, and endocrine mechanisms. A growing body of evidences have shown that the BAT has a close relationship with bone metabolism, in which BAT secretes a variety of factors to regulate bone metabolism, while bone also secretes a variety of bioactive substances to control BAT function. In addition, BAT may indirectly participate in bone metabolism through muscle-mediated regulation or SNS activity and improvement of body metabolism, thus forming a BAT-skeletal axis. In this paper, we try to explain the relationship between brown adipose tissue and bone, and to discuss their interactive mechanisms.

Objective: To discuss possible ethical and boundary issues when contacting clients through WeChat in different situations. Methods: Self-made questionnaires were utilized to investigate 194 counselors' (18 counselors gave clients their job WeChat ID, 64 counselors gave their private WeChat ID, and 115 counselors do not give WeChat toclients) attitudes and behaviors of encountering multiple relationship issues when using WeChat Results: For WeChat boundary, counselors who had job WeChat ID would post more private photos and videos on the post than counselors with no job ID and without ID(P <0.01). Although 41％ of counselors would use WeChat during the counseling and other related activities, only 10％ of the counselors had job ID. Counselors with no ID tended to accept clients breaking the boundaries through other ways (P <0.01). Conclusion: The study indicates that counselors have encountered ethic issues of multiple relationships when using WeChat Counselors who only have private WeChat ID should increase their sensitivity of the boundary issues in the use of WeChat.

Objective:To explore the price formation method and price standard in the big data diagnosis-intervention packet.Methods:The expenditure data and income data of 95 medical institutions in Shanghai in 2018 were used for analysis, including 33 municipal hospitals and 62 district hospitals. After using the standardized data of disease score, the medical institutions in the region were divided into four quadrants with the regional average of unit price per index and cost per index as the coordinate axis. The best quadrant of income and cost was found out, namely the high quality range. The geometric center was calculated in the high quality range, and the unit price per index of the geometric center was taken as the cost standard.Results:For the district hospitals, there were 20 hospitals in the first quadrant, 8 in the second quadrant, 24 in the third quadrant and 10 in the fourth quadrant; For the municipal hospitals, there were 7 hospitals in the first quadrant, 5 in the second quadrant, 12 in the third quadrant and 9 in the fourth quadrant. In the third quadrant, the average income and cost of medical institutions were lower than the average of the city, and the income could cover the cost. The third quadrant was the high quality range. The unit price per index of the third quadrant geometric center of district hospitals was 14 115.4 yuan, and that in municipal hospitals was 15 559.1 yuan, which could be used as the corresponding cost standard.Conclusions:The price discovery mechanism based on objective data and high-quality interval geometric center method can remove the impact of unreasonable charges or unreasonable behavior on medical income, and reflect the guidance of the standard price of medical insurance payment.

Objective:To apply cardiovascular magnetic resonance (CMR) to quantitatively evaluate the morphology and tissue characteristics of thoracic skeletal muscle (TSM) in patients with Danon disease and hypertrophic cardiomyopathy (HCM), in order to provide auxiliary differential diagnostic information.Methods:A retrospective study was conducted on 15 Danon disease patients (Danon disease group) who completed CMR examination, and 15 HCM patients (HCM group) and 15 healthy volunteers (control group) who were matched by gender and age were compared. TSM (pectoralis major, pectoralis minor, erector spinae, and subscapularis) area index (TSMAi), T1 relaxation time of four groups, and extracellular volume (ECV) of skeletal muscles of two groups (pectoralis major and subscapularis) were measured for all subjects. Single factor analysis of variance and KruskalWallis test were used to compare three sets of values.Results:The total TSMAi of the Danon disease group was lower than that of the HCM group and the control group [(15.37±3.28)cm 2/m 2 vs (23.02±3.88)cm 2/m 2 vs (22.33±4.67)cm 2/m 2, P<0.001], and the TSMAi of each TSM was also lower than that of the HCM group and the control group (all P<0.05). There was no statistically significant difference in TSMAi between the HCM group and the control group (all P>0.05). The native T1 values of the pectoralis major muscle in the Danon disease group and HCM group were higher than those in the control group (all P<0.05). The ECV of the pectoralis major muscle and subscapularis muscle in the Danon disease group were higher than those in the HCM group and control group, and the enhanced T1 values were lower than those in the HCM group and control group (all P<0.05); There was no statistically significant difference in ECV and the enhanced T1 values between the HCM group and the control group ( P>0.05). Conclusions:The application of CMR can effectively evaluate the changes in TSM morphology and tissue characteristics in Danon disease patients. Compared with HCM patients, Danon disease patients showed significant atrophy of TSM with increased extracellular volume. CMR provides a quantitative reference for TSM in the differential diagnosis of the two.

Objective:To investigate the hemodynamic changes in the ascending aorta (AAo) before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy (HOCM) using cardiac magnetic resonance four-dimensional blood flow (CMR 4D Flow) technology.Methods:HOCM patients who underwent interventricular septal myocardial resection at Guangdong Provincial People′s Hospital from May 2021 to September 2022 were prospectively included. Age and gender matched healthy volunteers (control group) were included during the same period. Both the control group and HOCM patients underwent CMR examination (including cine sequence and 4D Flow sequence) before and 6 months after surgery. CMR 4D flow technology was used to evaluate changes in AAo preoperative and postoperative blood flow patterns (eddy currents, spiral flow), maximum energy loss (EL max), and average energy loss (EL avg). HOCM patients underwent laboratory tests, including N-terminal pro-brain natriuretic peptide (N-pro BNP) and high-sensitivity troponin T (hsTnT). At the same time, the correlation between postoperative energy loss in HOCM patients and the degree of improvement in laboratory biomarkers was explored. Results:A total of 15 HOCM patients and 15 healthy volunteers were included. (1) In terms of blood flow patterns, the preoperative spiral flow degree of HOCM patients was significantly higher than that of the control group ( P=0.001), but the postoperative difference was not statistically significant ( P=0.059). The degree of eddy currents in HOCM patients before and after surgery was higher than that in the control group (all P<0.05). (2) In terms of energy loss, the preoperative EL max [21.17(14.30-28.10)mW vs 10.17(7.66-13.07)mW, P<0.001] and EL avg [4.87(3.46-5.77)mW vs 2.27(2.19-2.27)mW, P=0.023] of HOCM patients were higher than those of the control group, but there was no statistically significant difference between the postoperative and control groups (all P>0.05). Compared with preoperative, the postoperative EL max [12.33(8.70-17.41)mW] and EL avg [3.10(2.25-4.40)mW] of AAo in HOCM patients were significantly reduced (mean P=0.001). (3) Correlation analysis showed that there was a positive correlation ( r=0.587, P=0.021) between the EL max of AAo and the degree of improvement in hsTNT after interventricular septum myocardial resection, but no significant correlation ( r=0.229, P=0.413) with the degree of improvement in NT-pro BNP. Conclusions:The degree of postoperative AAo blood flow disorder in HOCM patients is reduced, and EL max and EL avg are significantly reduced. The EL max of postoperative AAo is positively correlated with the degree of improvement in hsTNT, suggesting that EL max may be applicable for prognostic evaluation of patients.

Medical insurance payment model is transforming from project-based purchases to service bundle-based strategic purchases. The new form of bundled purchases should found on a scientifically-led design process of such bundles. The core to bundled purchase would be the payment standard, and the key to its success would be process control. Establishment of such a foundation, a core, and a key, would promote the current price standards, and lead service providers to a standardized medical service standard, so as to ensure a precise rewarding system of payment and service. The big data diagnosis-intervention packet(DIP)is able to fulfill mentioned ambitions by integrating insurance payment and supervision into one management. DIP is a full-process payment mode that encompasses pre-service estimation, in-service process control, post-service grading, and resource allocation. It is an innovative practice in line with China′s national conditions for the modern governance of medical security and medical services.