Discussed in the paper are case-based payment practice in China,and outcomes of this practice for the past ten years.The authors pointed out that compared with DRGs,such a practice is exposed to such risks as low coverage of diseases,incompatible policies,defective pricing method,and lack of comprehensive evaluation.It indicates that China is on the initial stage of case-based payment reform which should be promoted with reference to international experiences.

Objective To analyze the value of CT in diagnosing and following-up gastrointestinal stromal tumors(GIST).Methods 117patients with CT examination and histological diagnosis of GIST were retrospectively reviewed.Results 117 patients had 118 GIST.Thelocations of primary tumor were as follows: stomach(n=56),small intestine(n=40),esophagus(n=6),colorectum(n=6),mesentery(n=3),retroperitoneum(n=2) and indefinite origin(n=5).Size of tumor was 1.7~18 cm.Tumors(5 cm) often demonstrated lobulated shape with central low attenuation area and heterogeneous enhancement.There were 17 tumors with bubble,13 with scattered calcifications,12 with metastases of liver.With following-up,23 of 37 were developed local recurrence or hepatic metastases.Conclusion CT is aneffective and useful imaging modality in the diagnosis and follow-up gastrointestinal stromal tumors.

Dynamic and sustainable fundraising strategies are the prerequisite for the long-term and stable development of the New Rural Cooperative Medical Scheme(NRCMS).The paper analyzed the current situation and problems of NRCMS' fundraising,and proposed the principles for designing a sustainable financing strategy of NRCMS,and then its fundraising strategy.First,clarification of its fundraising sources and rational division of the sharing ratio of the funding bodies (individuals contributions account for 20％of the per capita fundraising) ; second,linking fundraising levels with net per capita net income(5 ％ ～ 6 ％) of peasants; third,expansion of the service scope and level coordinated within NRCM.

Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials (TES-MEP) and somatosensory evoked potential(SEP) in the monitor of the spinal operation.Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group.SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group.Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP.The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications.Results The successful detection rate of the observation group and the control group were respectively 100％ and 91.84％,and the difference was statistically significant(P ＜ 0.05).The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant(P ＞ 0.05).In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant (P ＜ 0.05).There was no significant difference in postoperation complication between the two groups (P ＞ 0.05).Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.

Objective To investigate the ability of electrocardiogram-gated multislice CT(MSCT)in the diagnosis of myocardial bfidging.Methods Fifty-one patients(82 coronary arteries)with suspected coronary artery disease underwent multi-detector row CT,conventional coronary angiography and intravascular ultrasonography as well.The sensitivity,specificity and accuracy of MSCT for the detection of myocardial bridging were determined.The interobserver agreement was calculated by using Cohen's Kappa test.Results A total of 26 tunneled arteries exclusively located near the middle segment of left anterior descending coronary artery were found by coronary angiography and intravascular uhrasonography.Compared to the invasive methods,MSCT correctly detected 23 of 26 myocardial bridges with a sensitivity of 88%(23/26),specificity of 96%(52/54)and accuracy of 94%(75/80).The Kappa value for overall interobserver variation Was 0.62.Two myocardial bridges diagnosed by MSCT were missed with the invasive method.With the results of invasive and non-invasive methods combined as the standard of reference,the overall sensitivity.specificity,and accuracy of MSCT in detecting myocardial bridging were 89%(25/28),91%(21/23),and 90%(46/51),respectively.Conclusion As a non-invasive imaging modality,MSCT is feasible and reliable in the detection of myocardial bridging.

Objective To investigate the CT and MRI findings of primary hepatic neuroendocrine carcinomas.Methods Imaging findings of 6 patients with pathologically confirmed hepatic neuroendocrine carcinomas were retrospectively analyzed.Four patients underwent plain CT and contrast enhanced CT examinations.The other 2 patients underwent plain MRI and contrast enhanced MRI.Results One out of the 6 cases manifested multicentric tumor which appeared as one large tumor surrounded with multiple small nodules peripherally,and the tumors of the other 5 cases were solitary.On plain CT images,all lesions were well-defined and hypoattenuating with central areas of even lower density except punctuate calcifications at tumor periphery in 1 case.On pre-contrast MRI,the cases manifested heterogeneous low signal intensity on T1 wI and slightly high intensity on T2 WI.On dynamic contrast enhanced CT and MRI,Tumors manifested slight to mild enhancement in arterial phase,slight enhancement in portal venous phase or delayed phase with no enhancement in the center,accompanied by dislocation of surrounding vessels.There Was no lymphadenopathy in peritoneal cavity and retroperitoniurm. Conclusion CT and MRI scanning can demonstrate specific features of primary hepatic neuroendocrine carcinoma,which may help the diagnosis and differential diagnosis of the tumor.

AIM: To investigate the primary culture method for coronary artery smooth muscle cells (CASMCs), and to establish the endoplasmic reticulum stress ( ERS) model in CASMCs of SD rats.METHODS:CASMCs were cultured by tissue explant method .The morphological characteristics were observed under optical micro-scope.The marker proteins of CASMCs , including α-SMA and SM-MHC, were identified by immunofluorescence tech-nique.The protein expression levels of BiP and CHOP , the marker molecules of ERS, were determined by Western blot . RESULTS:The spindle-shaped CASMCs climbed out from the edge of coronary artery tissues after 6 d, and formed the typical hill and valleygrowth pattern of CASMCs at 9~10 d.The result of immunofluorescence technique showed that α-SMA and SM-MHC were positively expressed .The results of Western blot showed that the protein expression of BiP and CHOP in TG ( 1 and 2 μmol/L ) treatment groups was increased compared with control group .Compared with control group, the protein expression of BiP and CHOP was significantly increased after 1 μmol/L TG treatment for 24 and 48 h. CONCLUSION:CASMCs can be successfully cultured by tissue explant method .ERS model of CASMCs was established by 1 μmol/L TG treatment for 24 h.

Objective To investigate the mechanisms of astrocytes modulating neurons in rat supraoptic nucleus induced by hypotonic stimulation and the effect of 6-aminomethyl-3-methyl-4H-1,2,4-benzothiadiazine-1,1dioxide HCl(TAG,a antagonist for taurine) or carbenoxolone(CBX,a gap junction blocker)on the responses of astrocytes and neurons in SON.Methods Adult male Sprague-Dawley rats were divided into four groups: the control group was injected with 5.5ml/kg 0.9% NaCl solution into the caudal vein;the hypotonic group was injected with 5.5 ml/kg hypo-saline(0.83% glucose plus 0.3% NaCl);TAG + hypotonic and CBX + hypotonic groups were injected with TAG(100?mol/L) or CBX(10g/L) into the lateral ventricle respectively,and were injected 2 hours later with hypotonic saline into the caudal vein.With anti-Fos,anti-vasopressin(VP),anti-glycine receptor(GlyR),anti-glial fibrillary acidic protein(GFAP) and anti-connexin43(Cx43) immunofluorescent staining methods,the responses of neurons and astrocytes in SON were studied.Results In control rats,Fos-,VP-,and GlyR-expression in the neurons and GFAP-or Cx43-expression in the astrocytes were lower.In hypotonic rats,GFAP-,Cx43-and GlyR signals were more than those in control rats,while Fos-and VP-signals were less.Compared with those in hypotonic rats in TAG + hypotonic or CBX + hypotonic rats,GFAP-and Cx43-signals in the astrocytes were the same,GlyR-signals in the neurons decreased,and Fos-and VP-signals increased.Conclusion Hypotonic stimulation activates SON astrocytes,which then release taurine through gap junction signaling to the neurons and inhibit the release of VP from the neurons.

Objective To explore the risk factors of urolithiasis incidence of migrant workers in Zhongshan,in order to provide the scientific evidence for preventing urolithiasis.Methods 1 630 workshop migrant workers and 1630 office white collar workers were selected as the subjects of this study.The questionnaire was conducted according to the age,gender,genetic factors,occupation,past illness factors,living environment,work environment factors,diet habit,the habit of drinking water survey,B ultrasound examination,the detection of blood uric acid.Results The incidence rate of urolithiasis was 6.53％,the incidence rate of workshop migrant workers was 8.28％,which was significantly higher than that of white collar 4.72％ (x2 =16.972,P ＜0.01).Conclusion Work environment,eating habits,drinking habits,smoking and sweating are related risk factors of urolithiasis.

AIM:To determine circular RNA (circRNA) profiles in the diabetic mouse myocardium , and to investigate the effect of circRNA_000203 on fibrotic phenotypes in cardiac fibroblasts .METHODS:Masson trichrome stai-ning was performed on the myocardium of the diabetic db /db mice and the non diabetic db/m control mice .circRNA ex-pression profile in the diabetic myocardium was detected by circRNAs microarray .The expression of circRNA_000203 was determined by real time fluorescence quantitative PCR ( RT-qPCR ) .Recombinant circRNA_000203 adenovirus was pre-pared for enforced the expression of circRNA_000203 in mouse cardiac fibroblasts.The expression of Col1a2, Col3a1andα-SMA was determined in circRNA_000203-modified cardiac fibroblasts , respectively .RESULTS:Masson trichrome stai-ning showed that fibrosis was increased in the diabetic mouse myocardium .The results of circRNA array detection revealed that circRNAs were dysregulated in the diabetic myocardium .circRNA_000203 was up-regulated in the diabetic myocardi-um.Significant over-expression of circRNA_000203 was achieved in the cardiac fibroblasts after infection with the recombi-nant circRNA_000203 adenovirus.The mRNA and protein expression of Col1a2, Col3a1 and α-SMA was significantly in-creased in the cardiac fibroblasts with over-expression of circRNA_000203.CONCLUSION:circRNA_000203 is up-regu-lated in the diabetic mouse myocardium .It has pro-fibrotic effect on the cardiac fibroblasts .