Payment system reforms have become an important part of Chinese healthcare reforms, and global budget has been seen as a major trend. Based on the practice and data of four pilot hospitals in Beijing which have implemented the global budget, this paper focuses on analyzing the effects of implementation on the following aspects and provides references for policy improvements: medical services, average medical cost, total health expenditure, medical cost structure, average length of stay and out-of-pocket expense percentages.

Medical metrology work is the base of quality control for hospital medical equipment.It guarantees the accuracy of hospital medical instruments.It is important to set up a complete management system for hospital metrology institutions.

Objective:To study the relationships between age,the state of genital tract and vaginitis,cervical erosion and vulvae leukoplakia in married women.Methods:Gynecologic inspection and laboratory examination were performed in 1 253 patients diagnosed vaginitis,cervicitis and vulvae leukoplakia in a women screen in a certain area in Chongqing in 2007.Statistics analysis was made by SAS8.1.Results:Of 1 253 patiens,45.89% had vaginitis,44.69%,cervical erosion,and 3.35%,vulvae leukoplakia,6.07%,the other conditions.Age,vaginal cleanness degree,candida infection were risk factors of vaginitis;Age,vaginal cleanness degree were related to cervical erosion and vulvae leukoplakia.Conclusion:Vaginitis,cervical erosion and vulvae leukoplakia should arouse more attention in the prevention and treatment of women genital tract disease in the future,and the standard etiology treatment should be performed to get microcosmic ecological balance.The perfect control and monitoring system for gynecologic disease should be established,and service quality of women health care should be improved.

AIM: To investigate the clinical effect of phacoemulsification and intraocular lens ( IOL ) implantation for cataract patients after corneal refractive surgery, and to compare the accuracy of the different refractive IOL.
METHODS:The data of 120 myopia cases (160 eyes) in our hospital, who underwent cataract surgery and corneal refractive surgery were analyzed. Corneal curvature K value before corneal refractive surgery were obtained and calculated by using history method. Corneal curvature correction numerical method and corneal topography were used to record K value of patients with incomplete data before and after treatment. The K value was substituted into the formula. By comparing the actual cataract surgery and refractive state expected refractive status (-0. 50D), the accuracy of IOL refractive obtained from three methods was compared.
RESULTS: The average best corrected visual acuity before cataract surgery was 0. 25 ± 0. 05, and it was improved ( 0. 80 ± 0. 05 ) after surgery. The average spherical equivalent (SE) was -1. 98±1. 75 before surgery and +0.85±3.38 after surgery (P<0.05). The K values of 48 cases were calculated by clinical history method ( CHM ) and that of 73 cases was calculated with the adjusted keratometry method ( AKM) . The K values of 39 cases were calculated using the corneal topography method ( CTM) .
CONCLUSION: For patients with corneal refractive surgery, the appropriate method can be selected according to clinical symptoms, history, etc. and this may help to accurately calculate IOL. For patients with complete data, CHM can be used to provide corneal K values, while for those with incomplete data, AKM and CHM can be used.

Objectives To explore the effects of control measures and dynamic prevalence of drinking water endemic fluorosis in China, to provide basis and technique support for endemic fluorosis control in China. Methods The survey was carried out according to the national surveillance Scheme of Endemic Fuorosis. The fulfillment of control measures and the quality of water improving projects were surveyed. Household water sample and urine of children aged 8-12 years were collected and fluoride content was detected by iron selective electrode method. Check the teeth of children aged 8-12 years. Dental fluorosis was diagnosed by Dean's method. Results projects were build in 84 endemic villages in 2006, and the average water improving rate came to 73.98% fluoride contents of half the surveyed spots were over the standard, mainly between 1.0-2.0 mg/L, and the urine controlled just in only few spots and it was in moderate or severe status in some endemic areas for many years. Conclusions Little progress of control measures in drinking water endemic fluorosis counties surveyed has been made in these two years. Projects of running out of status and over standard of water fluorosis are frequently seen. Dental fluorosis in many spots is not controlled.

Objective To assess short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy induced by perinatal asphyxia. Methods Twenty-three infants of moderate/severe hypoxic ischemic encephalopathy (HIE) were divided into treatment group ( 14 cases) and control group (9 cases). The head hypothermia in the treatment group [rectal temperature ( 34. 0 ～ 35.0) ℃, nasopharyngeal temperature (34. 0 ± 0. 5 ) ℃]was induced by circulating water cooling cap for up to 72 h. Control group were treated routinely. All newborns were monitored and analyzed for blood pressure, heart rate, neurological function. Neonatal behavioral neurological assessment (NBNA) was conducted for assessment of neurobehavioral development on day 28 after birth. Results Treatment group showed slower hear rate as nasopharyngeal temperature decreased and there was significant difference as compared with the control group ( P ＜ 0.05 ). Apnea and arrhythmia were not found in either group. As compared with the control group, treatment group showed better results in seizure incidence, recovery of neonatal reflex( embracing reflection, sucking reflex and grasp reflex), and improvement of limb muscle tension. The NBNA score on day 28 was much higher in hypothermia group(35.00 ± 1.41 ) than that of control group(30. 67 ± 1.58) and there was significant difference (P ＜ 0.05). Conclusion Selective head cooling is safe for newborns with moderate/severe HIE if the nasopharyngeal temperature maintains at (34 :± 0. 5 ) ℃, rectal temperature at 34 ～ 35 ℃. Selective head cooling can effectively improve the short-term nervous symptoms and the neurobehavioral score,but the long-term efficacy remains to be further studied.

OBJECTIVE: To seek approach for the protection of domestic pharmaceutical enterprises with immature creativity and to ensure drug accessibility. METHODS: An analysis was performed applying the theory of demand elasticity by comparing the attributes of health right and patent right etc based on TRIPS protocol and the related practice abroad. RESULTS & CONCLUSIONS: For a developing country, China should give top priority to the short-term urgent needs, such as to meet people's medication demands, followed by meeting the long-term demands, such as to encourage independent intellectual property rights. Hence, drug accessibility-related system in drug patent system should be evolved step by step.

Objective To study the pathological characteristics of delayed xenograft rejection and the expression of donor ICAM-1 in mouse-to-rat cardiac xenografts. Methods BALB/c mice and Lewis rats served as donors and recipients respectively. The model of mouse-to-rat heterotopic heart xenotransplantation was established. The cardiac xenografts were harvested at 12 h, 24 h, 36 h, 48 h after transplantation and at the time when no pulsations could be detected in the transplanted heart respectively. The normal BALB/c mouse hearts were harvested as control group. The grafts were col lected to receive pathological and immunohistochemical examinations as well as to detect the level of ICAM-1 mRNA in the xenografts. Quantitive measurement of ICAM-1 expression in the grafts was done by using multimedia pathology imaging analysis system. RT-PCR products of xenografts were separated by agrose gels and the densities of the bands were determined by density scanning. Results The pathologic examination of xenografts showed hyperemia, hemorrhage with inflammatory cells infiltrated at 12 h after transplantation and they became more and more serious as time went on. The pathologic examination of rejected xenografts showed widespread intravascular thrombosis, hyperemi-a, hemorrhage, coagulative necrosis with a large number of inflammatory cells infiltrated. The stained color of vascular endothelial cells and cardiac myocytes was significantly more intensive in the xeno-grafts than that of normal BALB/c mouse hearts in the control group. The relative density values (ICAM-1/?-actin) were also significantly higher in the xenografts than that of the control group. Conclusion ICAM-1 expression in the xenografts was up-regulated, which was related with the development of the delayed xenograft rejection.

Objective To investigate the inhibitory effect of intercellular adhesion molecule-1 antisense oligodeoxynucleotide (ICAM-1-ASO) on the rejection of cardiac xenograft as well as the expression of ICAM-1 in the xenograft.Methods BALB/C mice and Lewis rats served as donors and recipients respectively. The mouse-to-rat heterotopic heart transplantation model was established. The hearts of normal BALB/C mice were harvested as control group. The xengrafts were divided into three groups: ddH2O group, control oligodeoxynucleotide group and ICAM-1-ASO group (n=10 in each group). Each donor was injected intravenously with ddH2O, control oligodeoxynucleotide or ICAM-1-ASO 6 h before operation respectively. At 48th h after transplantation, 5 xenografts in each group were collected for histopathological examination. The expression of ICAM-1 protein and mRNA in cardiac xenografts was detected by immunohistochemical method and semiquantitative reverse transcriptase polymerase reaction method. The mean survival time (MST) in each xenograft group was recorded in terms of the other 5 transplanted grafts by palpation per 12 h.Results Faint ICAM-1 expression was observed in the control group. In ddH2O group and control oligodeoxynucleotide group, capillary endothelial cells and myocytes of the grafts strongly expressed ICAM-1 and the relative density values (ICAM-1/?-actin) were also significantly higher with extensive hyperemia, edema, hemorrhage and inflammatory cells infiltrated in both groups than those in the control group. Comparatively, in the ICAM-1-ASO group, fainter ICAM-1 expression was observed and the relative density value (ICAM-1/?-actin) was also significantly lower with pathological improvement compared with those in ddH2O group and control oligodeoxynucleotide group. The MST in ICAM-1-ASO was (66.4?2.61) h, which was significantly prolonged as compared with ddH2O group and control oligodeoxynucleotide group.Conclusion ICAM-1-ASO can sequence-dependently inhibit the ICAM-1 expression of xenografts, suppress xenograft rejection and prolong the survival time of xenografts.

The clinical data of 23 cases with emergent hematochezia endoscopically diagnosed as non-ulcerous duodenum diseases were retrospectively analyzed.Majority of cases were misdiagnosed and delayed to transfer to emergency room because of lack of knowledge and experiences of local medical workers.After referral to our emergency department,all 23 cases obtained appropriate management and cured successfully.