It analyzed the structure and details of disease-based score payment,taking payment policy scheme in Huai-an and Nanchang for example.Disease-based score payment combined the globe budget control,payment of disease and point system to help controlling costs and incentive mechanism,which had certain achievement in the pilot areas.According to the research,it found that there were insufficient in the practical implementation,proposed the precondition for the popularization were higher medical agency capacity,establishing the negotiation mechanism with medical institutions and having intelligentized information system as the technical support.

Objective To investigate the clinical and pathological features of 21 elderly patients with tuberculosis detected at autopsy. Methods Retrospectively analyzed the data of underlying diseases,clinical characteristics,clinical diagnosis,and causes of death for these 21 elderly patients with tuberculosis detected at autopsy. Results All the 21 patients were man,mean age was(88.0±6,9)years and had one or more concomitant diseases.Cough,sputum and fever were frequent due to other complicated respiratory infection.Anemia,hypoalbuminemia,decreased body mass index,increased erythrocyte sedimentation rate were very common in elderly patients,sputum acid-fast bacillus was positive in 11.8%cases.There was no primary tuberculosis.There were 9 secondary tuberculosis,3 disseminated pulmonary tuberculosis,19 tuberculous pleurisy and 9 non-pulmonary tuberculosis detected at autopsy.Compared with the result of autopsy,the clinical and radiography diagnosis accuracies were poor.Only 5 patients were clinically diagnosed as tuberculosis.All 5patients received antitubereulous chemotherapy,2 of them ceased therapy due to liver or renal toxicity. Conclusions Tuberculosis is a systemic disease in elderly patients.Because of medical aspects of ageing,co-morbid states,ignorance and mis-perception of symptoms,and atypical manifestation of disease,the diagnosis is difficult in this population.Our study confirms the importance of considering tuberculosis as a diagnosis in elderly even in the absence of typical clinical radiological presentations.

Objective To explore the causes of misdiagnosis of lung abscess and its clinical pathological characters. Methods The clinical data of autopsy-proven lung abscess in Beijing Hospital from 1980 to 1995 were reviewed. Results Twelve patients consisted of 11 males and 1 female. Their age ranged from 60 to 88 years. None of them was clinically diagnosed lung abscess before death. Concomitant dieases were severe and complex, mostly coronary disease, hypertension, COPD, cerebrovascular disease and diabetes mellitus. The clinical presentation and chest X-ray of lung abscess in the elderly were deceptively nonspecific and variable. Over 2 types of pathogens were isolated from sputum culture, mostly klebsiella pneumoniae, pseudomonas aeruginosa, candida. The autopsy showed 3 cases with a isolated lung abscess and 9 cases with lung multi-abscess. Conclusions The reasons for misdiagnosis of lung abscess in the elderly might be the variability of clinical presentation, the other concomitant disease. Frequent pursuit of chest CT scan in suspected cases is guarranted .

Objective To study cellular immune responses induced by DNA vaccine against Chlamydia trachomatis (Ct) serotype E. Methods BALB/c mice were divided into three groups to be intramuscularly immunized by blank plasmid (negative control group), DNA vaccine against Ct serotype E (vaccine group), and inactivated Ct elementary body (positive control group), respectively. Two weeks after the last immunization,delayed-type hypersensitivity (DTH) response was evaluated; MTT assay was performed to detect the proliferation of spleen lymphocytes, ELISA to measure the serum level of interferon-γin mice. Some immunized mice underwent a genital challenge with Ct elementary body followed by isolation of Ct from exfoliated epithelial cells in genital tract and pathological examination of cervical tissue from the challenged mice. Results Compared to negative control group, vaccine group and positive control group experienced a stronger DTH response.The lymphocyte stimulating index and serum level of IFN-γwere highest in the positive control group (3.81 ±0.30, 2891.7 ± 1048.8 μg/L), followed by vaccine group (2.35 ± 0.25, 593.3 ± 342.6 μg/L) and negative control group (1.48 ± 0.15, 309.2 ± 157.9 μg/L), and significant difference was observed between the three groups (P ＜ 0.05 or 0.01 ). After Ct challenge, Ct was isolated from exfoliated epithelial cells and cervical tissue was damaged in the negative control group, while in the other two groups, Ct was undetected and genital tract tissue was intact. Conclusions The DNA vaccine against Ct serotype E could induce Ct-specific cellular immune responses to some extent, and offer a protection against vaginal challenge with Ct.

Objective To investigate the morbility and epidemic characteristics of hair dye dermatitis in individuals who dyed their hair in Tianjin.Methods Questionnaires were distributed to the outpatients in the Gerneral Hospital of Tianjin Medical University,students and teachers in Tianjin Medical University,residents in the community and customers in barber shop from Aug.2007 to Mar.2008.The personal data including the methods and site of coloring hair and something correlated to hair dyes were investigated.Results A total of 597 cases with the history of coloring hair were enrolled in the study,including 485 women and 112 men,with mean age of 41 years (ranged from 16- 74years).Among 597 cases,69 cases had allergic reactions to hair dye,including 51 women and 18 men,with mean age of 44 years (ranged from 19-65 years).The median age of the first coloring hair was 40 years (ranged from 3-50 years).The comparison between the sites of coloring hair had no statistic significance (P ＞0.05),but there was a significant difference between black dyed hairs and col or dyed hairs (P ＜0.05).Conclusions People with black hair dye are prone to be allergic.

Objective To assess the influence of the risk factors of coronary heart disease(CHD) on the prognosis of pereutaneous coronary interventions (PCI). Methods The risk factors of CHD was retrospectively col-lected from 446 patients (mean age (SD) : 60.23(9.75) yrs,84.97% male )who were admitted to the First Affili-ated Hospital of Lanzhou University from January, 2007 to July, 2008. These patients were diagnosed as CHD and treated with PCI. Major adverse cardiac events (MACE) were followed up for 12 months after PCI,and its associatian with the risk factors of CHD was investigated. Results Among all the patients,2.24% (10/446) had family history of CHD, 20.63% (92/446) was complicated with diabetes, 52.26% (242/446) with hypertension, 42.15% (118/446) with dyslipidemia, 62.33% (278/446) of the patients was overweight, and 57.85% (258/446) was smoker. Within 12 months of follow-up, MACE incidence rate were 5.83%. Univariate analysis showed the propor-tions of female,family history of CHD, overweight, hypertension and smoker were significandy different between the patients with MACE and those without MACE (χ~2=4.133,6.848,3.997,3.939,4.120, respectively,P<0.05). Logistic regression analysis showed family history and overweight increased the risk of MACE (OR=7.383 and 10. 504,respectively,95% CI=1.639-33.246 and 1.231-59.598, P<0.05), being male protected against MACE (OR=0.058,95%CI=0.014-0.236,P<0.05). Conclusions The prognosis of patients of CHD under-went PCI was good. After PCI,the risk factors of CHD such as smoking,hypertension ,overweight,ete should be un-der control to decrease the occurrence of MACE.

Objective To evaluate the perfusion parameters in different zone of placenta using CPS,to research placental blood perfusion of different zone. Methods A total of 60 pregnant rats were divided into 3groups, 15 day,17 day and 20 day of gestation with 20 animals in each group,the placenta was divided into the central zone and marginal zone. SonoVue was injected by tail vein of rat using CPS, the time-intensity curves of the central zone and marginal zone were drawn and perfusion paramcters were calculate by software ACQ and Sonoliver. Surface area densities of different zone of placental maternal blood space was measured with histoligical method,and using immunohistochemical marked the placenta vascular. Results Arrivel time(AT) and time-to-peak(TTP) of placenta central zone was earlier than marginal zone,the peak intensity(PI) of the central zone was higher than that of the marginal zone ( P ＜ 0.05). There was significant difference between the central zone and marginal zone of surface area densities of placental maternal blood space ( P ＜0.05). PI of the central zone and marginal zone and the surface area densites of placenta was positively correlated ( P ＜0.05). The placental blood vessels was not expressed by factor Ⅷ.Laminin in the placental basement membrane expression of 20 day of gestation was not continuous or missing. Conclusions The surface area densities of central zone and marginal zone was different. CPS technique can be sensitive to detect changes of the placenta vascular bed in different zone.

Objective To learn the HPV infection situation of gynecological patients ,so as to provide a scientific basis for the epidemiological studies in Chongqing area .Methods Totally 12 196 gynecology clinic patients in January 2010 to December 2013 were registered whose cervical secretions was collected as specimens ,was type testing was carried on by PCR‐reverse dot hybridiza‐tion ,age distribution ,infected type and multiple infection of the patients were counted .Results There were 3 745(30 .8% ) patients with a positive test specimen of 12 196 patients detected in this study ,the high‐risk HPV infection rate was 61 .67% ,the top three high‐risk HPV subtype were HPV58 ,HPV16 and HPV52 ;the low‐risk HPV infection rate was 21 .23% and the main subtypes were HPV6 and HPV43 .The majority of multiple infections was double infection .There were significant differences between each age groups (χ2 =129 .76 ,P<0 .05) ,the paragraph of HPV infection rate present as U shaped curve .Conclusion The HPV in‐fection of gynecology clinic patients in Chongqing area has obvious regional specificity and age differences .HPV58 ,HPV16 and HPV52 should be pay attention in clinical diagnosis .The age group ≤25 and ≥46 years old are two peaks of HPV infections ,and it should be strengthen the screening of the two age groups .

Objective To quantitatively measure the perfusion parameters of placenta in different stage of pregnant rats using contrast-enhanced ultrasonography (CEUS) with contrast pulsed sequencing (CPS), and to analyze the relationship between perfusion parameters and changes of placental vascular bed. Methods Sixty healthy pregnant rats in according to the requirements of the experiment was divided into three groups: 15 days, 17 days and 20 days of gestation with 20 animals in each group. One blous injection of SonoVue (Sonovue 1.0 ml/kg) via a tail vein was administered to each rat, and the time-intensity curves (TIC) of placenta and uterine muscle wall were drawn with ACQ using CPS technique with MI 0.20, and the perfusion parameters were calculated. Then 4 μm vertical placenta sections were cut and stained with hematoxylin and eosin. Surface area densities of placental maternal blood space was measured with image analysis software. Results The peak intensity (PI) of 17 days and 20 days was higher than that of 15 days pregnant rats (P＜0.05). There was no difference in PI between 17 days and 20 days (P＞0.05), and nor of arrivel time (AT) and time-to-peak (TTP) (P＞0.05) among the three groups. There was significant difference of surface area densities of placental maternal blood space among the three groups (P＜0.05). PI was positively correlated to the surface area densites of placenta (P＜0.05). Conclusion There is close relationship between peak intensity and area densities of placental maternal blood space. CPS technique can sensitivly detect changes of the placenta vascular bed in different stage of pregnant rats.

ObjectiveTo study the effect of a recombinant plasmid encoding mouse interleukin 2 (mlL-2) on the immunogenicity of DNA vaccine against Chlamydia trachomatis(Ct) serovar E.Methods BALB/c mice were divided into 4 groups to be intramuscularly inoculated with blank plasmid(negative control group),DNA vaccine against Ct serovar E(DNA vaccine group),DNA vaccine against Ct serovar E and a recombinant plasmid containing mIL-2(combination group),and inactivated Ct serovar E elementary bodies (positive control group),respectively.The immunological effects were evaluated by posterior foot pad thickness,proliferation level of spleen lymphocytes,serum level of IL-4 and interferon (IFN)-γ in mice,and the capability to clear Ct genital tract infection.ResultsThe proliferation index of spleen lymphocytes in the combination group and positive control group was similar(3.64 ± 0.41 vs.3.77 ± 0.34),but was significantly different from that in the blank control group and DNA vaccine group (1.37 ± 0.21 and 2.52 ± 0.30).The serum level of IL-4 was(38.49 ± 12.24) pg/ml in the positive control group,significantly higher than in the negative control group,DNA vaccine group and combination group ((25.37 ± 18.93),(24.75 ± 8.49),(21.74 ± 6.43) pg/ml,respectively).With respect to the serum level of IFN-γ,the combination group and positive control group were similar ((1923.3 ± 518.1) pg/ml vs.(2712.5 ± 887.2) pg/ml),but were significantly different from the negative control group and vaccine group((310.8 ± 160.7) pg/ml and(601.3 ± 357.9) pg/ml).Six days after Ct challenge,the exfoliated cells from genital tract were positive for Ct culture in the negative control group,but negative in the other 3 groups.ConclusionIL-2 genetic adjuvant can enhance the immune response,especially Th1 type response,induced by the DNA vaccine against Ct serovar E.