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 study the skills and safety of breast conserving surgery in radical mastectomy.Methods A total of one hundred and seventy-eight patients with early breast cancer were randomly divided into two groups: 93 cases in the breast conserving surgery group and 85 cases in the radical group,according to the surgical method.The patients in the breast conserving surgery group received stageⅠbreast conserving surgery after modified radical mastectomy for breast cancer,while the patients in the radical group adopted modified radical mastectomy.Then the two groups were compared in terms of postoperative complications,breast appearance evaluation,follow-up on quality of life and tumor recurrence.Results There were not statistically significant differences in postoperative complication rate between the two groups(30.11% vs.23.53%, χ2=0.976,P=0.323);the rate of excellent breast appearance in the conserving surgery group was 86.02%,significantly higher than that of the radical group(38.82%,χ2=42.675,P<0.001);the scores of physiological status,psychologic status,social function and environmental circumstance in the conserving surgery group were significantly higher than those of the radical group,the differences were statistically significant(P<0.05);the difference on tumor recurrence rate of the two groups was not statistically significant(χ2=0.009,P>0.05).Conclusion After radical mastectomy,stageⅠbreast conserving surgery could help patients maintain their breast appearance and improve their life quality,without any increase in the rate of postoperative complications and long-term local morbidity.It is a safe and reliable surgical method.

Objective To compare the therapeutic effects of endoscopy,TEM,and transanal local resection in rectal adenomatous polyps.Methods Data of 195 patients with rectal adenomatous polypus,who underwent either endoscopic resection (EMR,ESD and conventional endoscopic resection,n =65),TEM (n =65) or transanal local resection (n =65) in the past two years (2009-2011) were retrospectively collected and analyzed.Results Distance from lesion to anus in endoscopic group was significantly longer than that in transanal group (P ＜ 0.05).Bleeding volume during the procedure in transanal group was significantly larger than that in endoscopic group (P ＜ 0.05).The operation time and hospitalization time in endoscopic group were significantly shorter than those in TEM group and transanal group (P ＜ 0.01).The total cost in endoscopic group was significantly lower than that in other 2 groups (P ＜ 0.01).Conclusion Endoscopic resection is a safe and effective therapy for rectal adenomatous polypus.

Complications that follow ischemic stroke are common,frequency ranging from 28% to 95%.It may either directly lead to death or prevent optimal recovery.54% of deaths after ischemic stroke are attributed to medical complications.Most complications occur during the first week,and stroke severity is the most important risk factor.The common serious medical complications are chest or urinary tract infection,deep venous thrombosis,pulmonary embolism,cardiac events,gastrointestinal bleeding,hyperglycemia,pressure sores.Falls,shoulder pain and depression are also common complications.Most of medical complications are preventable or treatable to some extent if recognized,so preventive strategies and appropriate treatment should be employed as early as possible.Prevention,early recognition,and management complications could improve short-term and long-term prognoses after ischemic stroke.

Objective To analyze the correlation between the early sacroiliitis in ankylosing spondylitis(AS) and clinical and laboratory parameters.Methods 39 patients with AS corresponding to the modified New York criteria for AS(0-Ⅲ)were included.According to pain score(BASDAI),the patients were divided into three groups,that were static group,suspicious active group and active group.The patients were examined by MRI and laboratory including erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP).The severity of activity of sacroiliac joint(SIJ) inflammation was evaluated using spondyloarthritis research consortium of Canada(SPARCC)score,comparative analysis was done among these three groups.Results There was significant differences among these three groups in SPARCC score(P0.05).The spearman correlation coefficient between SPARCC score and BASDAI score was rs=0.503,P0.05.Conclusion In early sacroiliitis of AS,the SPARCC score of SIJ lesions is positively correlated with the severity of BASDAI,but there is no correlation between the SPARCC score and ESR,CRP.

Objective To evaluate the efficacy of D98A,a newly developed superparamagnetic oral MRI contrast agent,in the diagnosis of abdomen.Methods Plain and contrast MRI after taking 500～1000 ml D98Ain 80 patients were performed by using different field strength MR scanners,and the sequences included T 1WI,T 2WI,and fat suppressed sequences.The contrast effect,distribution,influence on demonstration of contours of abdominal organs,and side effects were studied concerning this suspension.Results It showed that this oral contrast agent had good security character,wide consideration area,low cost,good contrast effect,and high value of clinical application.The gastrointestinal tracts appeared as hypointensity on various MR sequences,and thus,made them easy to be identified.The margins of abdominal organs were easier to be located after taking the contrast,and the distinction had statistical denotation.The demonstration rate of gastrointestinal tracts was raised from 10% to 89% after using D98A.There were no side-effects in all patients. Conclusion D98A is safe and effective in facilitating the localization of the abdominal organs.It can improve the accuracy in delineating the gastrointestinal tracts and in diagnosing the lesions of abdominal organs.

Objective To evaluate the therapeutic effect of total mesorectal excision in radical operation of rectal carcinoma.Methods From 1997 to 2007,126 consecutive patients with middle and inferior rectal carcinoma underwent surgical operation according to the principle of total mesorectal excision.Results Two patients(1.6%) died of postoperative pulmonary infection,and postoperative anastomotic leakage occurred in 2 cases(1.6%).The postoperative follow-up of 1-5 years showed that local recurrence rate 2 years after surgical operation was 4%(5/126),the 3-,5-year survival rate was 93.6%(116/124) and 84.7%(105/124),respectively.Conclusions Total mesorectal excision can decrease the frequency of postoperative local recurrence of rectal cancer without increasing complications as long as its correct indications are selected.

Objective:To discuss the changing position in three dimensions of maxillary dentition magnetic arch expansion after.Methods: Thirty patients who were in-patient cases were selected, and received three-dimensional data measured before and after treatment it its spiral CT, observed the three-dimensional position of maxillary dentition before and after treatment, and the angle of landmarks change data paired sign test for comparison.Results: Patients in the vertical position of maxillary dentition before and after treatment, sagittal and horizontal direction are changed. First premolars, first molars occurred cheek overall movement and dumping; the maxillary first premolar region is the largest widening position; three-dimensional position of the maxillary central incisor forward, the next move.Conclusion: Patients before and after the change of maxillary dentition MPE can be clearly presented in accordance with spiral CT, lay the foundation for further research MPE mechanism.

Objective To investigate the occurence of glomus tumor and investigate its diagnosis and treatment. Methods 13 cases of glomus tumors were analyzed retrospectively. There were 9 females and 4 males. All 13 cases were surgically treated under megaloscpe. Results All the cases were testified as glomua tumors by pathology. There was no recurrence during the follow up of 6 months to 1 year. All the patients were symptom free. Conclusion Glomus tumor has specific features on clinical presentation. Mierosurgieal excision under megaloscpe is fill elective method.

Objective To analyze 3 different methods for treatment of Tossy Ⅲ acromioclavicular dislocation. Methods Sixty-two patients with Tossy Ⅲ acromioclavieular dislocation who had been treated by 3 different treatment methods in our department were analyzed. Of them, 18 cases were treated with Kirschner wire and tension wire fixation plus repair of coracoacromial and acromioelavicular ligaments(Group A), 21 with clavicle claw steel plate fixation plus repair of acromioelavicular ligament (Group B ), and 23 with intersecting Kirschner wire plus repair and strengthening of acromioclavieular ligament(Group C). Results After follow-ups for 9 to 24 months (with an average of 15. 6), therapeutic effect(by Karlsson system), operation duration, intraoperative blood loss and cost were evaluated for all the pa-tients. The differences in the therapeutic effect between all groups were not significant ( P ＞ 0.05 ). Group C needed less operation time and had less bleeding than groupA ( P ＜ 0. 05), and group C needed less oper-ation time and cost and had less bleeding than group B ( P ＜ 0. 05). Conclusion Intersecting Kirsehner wire plus repair and strengthening of aeromioclavieular ligament is an efficient, convenient and less costly method for treatment of TossyⅢ aeromioclavicular dislocation.