Objective:In the performance appraisal of public hospitals,the lack of detailed degree of personalized appraisal,inadequate attention of hospital leaderships and unreasonable performance appraisal indexes were analyzed to provide measurement.Methods:Using the equity theory to conduct specific analysis on the problem.Results:To promote the stable and sustainable development of public hospitals,it mobilized the enthusiasm,initiative and creativity of the employees.Conclusion:It needed to create more economic and social benefits and enhance the core competitiveness of the hospital.

Atrial fibrillation is one of common arrhythmias and can significantly increase risks of stroke and heart failure with high rates of mortality and disability. The incidence of atrial fibrillation increases year by year due to aging population, high incidences of coronary heart disease and hypertension, and lifestyle changes. As one of widely consumed drinks in the world, coffee affects the daily life of modern people. The intake of caffeine, which is the main ingredient of coffee, can influence the incidence of atrial fibrillation, but the relationship between them is still controversial. Most studies deem that the intake of caffeine is negatively correlated with the incidence of atrial fibrillation. This paper reviews current studies in China and abroad on the relationship between the intake of caffeine and the incidence of atrial fibrillation.

Objective To analyze the risk factors of intracranial infection after neurosurgery and the effect of vancomycin.Methods 28 cases of craniotomy in this study, The First Hospital of Ningbo City from January 2011 to July 2014 during the years after the occurrence of intracranial infection patients as the research object, a retrospective analysis of the age, gender, emergency, basic diseases, mastoid airroom, ventricle drainage, posterior fossa surgery, reoperation and operation time (more than 4h).The clinical data, summarize the risk factors of postoperative intracranial infection in department of neurosurgery and to observe the clinical effect of vancomycin in the treatment of such patients.Result The high risk factors of intracranial infection include: Open mastoid gas room during operation, ireoperation, ventricular drainage and operative time (more than 4h).In 28 cases with intracranial infection after craniotomy, the total effective rate of vancomycin treatment was 100.00%.Conclusion The high risk factors of intracranial infection after operation include open surgery, mastoid room, reoperation, ventricular drainage and longer operation time.Vancomycin is an effective drug in the treatment of intracranial infection in the department of neurosurgery.

Objective To compare the isometric muscle strength of muscle groups in the lower extremities of children with spastic hemiplegia among sides or ages. Methods17 spastic hemiplegic children were measured the muscle strength of hip, knee and ankle muscle groups with hand-held dynamometry (HHD). ResultsMuscle strength was weaker in the involved side than in the other side. In younger children, it was weaker of overall extremity, while in the older it was of the distal end mainly. ConclusionWhen applying strength training to spastic hemiplegic children, it is important to notice strength of all groups in lower extremity in younger children and the distal groups in older ones.

Objective To investigate the relationship between depression and personality and social support of the urban and rural empty-nest, clear the influence factors of depression in the empty-nest elderly. Methods 398 cases of urban and rural empty-nesters selected from the Chifeng district, were valuated with the general information questionnaire, the Geriatric Depression Scale (GDS), Eysenck personality Questionnaire- Revised Short Scalr for Chinese (EPQ-RSC) and the Social Support Scale (SSRS), and to investigate the demographic data, depression, personality and social support. Results Rural cases had a higher level (14.41±3.09) points of depression than (12.90±2.64) points of urban cases, and the difference was statistically significant (t=5.254, P<0.01);rural empty nesters′subjective support (18.35 ± 2.14) points, objective support (6.37 ± 1.40) points, support utilization degree (6.01 ± 1.17) points and social support score (30.37 ± 4.24) points, were lower than (19.83 ± 2.27) points, (7.34 ± 1.13) points, (6.95 ± 1.12) points, (34.12 ± 3.73) points of urban′s, and the difference was statistically significant (t=6.673-8.490, P<0.01); the extraversion score of urban empty nesters was (7.58 ± 2.51) points which was higher than (6.37 ± 2.02) points of rural empty nesters, and the difference was statistically significant (t=5.273, P<0.01);the neuroticism score (10.38 ± 2.06) points and psychoticism score (9.42 ± 2.17) points of urban empty-nest were lower than (12.41 ± 2.25) points, (10.94 ± 2.10) points of empty-nest′s, and the difference was statistically significant (t=9.401, 7.107, P<0.01). Neuroticism and psychoticism was shown to be positively associated with depression while extraversion and social support to be negatively associated with depression (P<0.01). Regression analysis showed that marital status, income, children visit frequency and the education level were the main influencing factors of depression in the urban and rural empty-nesters. Conclusions There are differences between rural and urban empty-nest elderly in the aspect of general data, depression status, personality and social support, and should intervention them effectively according to their different characteristics.

Objective To investigate the correlation of serum high-mobility group box-1 (HMG-B1) with the severity of lesion of coronary artery disease (CAD) and its prognosis in elderly patients.Methods A total of 180 CAD patients with coronary stenosis exceeding 50 percent by coronary angiography were divided into three groups:one branch stenosis;two branches stenosis and three branches stenosis.The control group included 50 patients without coronary stenosis.The degrees of coronary stenosis were diagnosed as mild stenosis,moderate stenosis and severe stenosis based on improved Gensini scores.The severity of decrements of left ventricular ejection fraction (LVEF) by echocardiogram were divided into three groups:mild,moderate and severe LVEF.Levels of HMGB1,hs-CRP and glucose were measured in all the patients.According to whether there was a complication of type 2 diabetic mellitus (T2DM),the 180 patients were classified as two groups.The patients were also divided into two groups according to whether there were adverse events.Results The HMGB1 levels of the CAD group were increased along with the number of affected vessels [three bunch group (40.5±6.0) ng/ml,double bunch group (33.1±4.9)μg/L,single bunch group (20.5±3.3)μg/L and control group (6.2±1.4)μg/L (all P＜0.05)].And the HMGB1 levels of the CAD group were increased along with the degrees of CAD stenosis [severe stenosis group (43.0±5.8)μg/L,medium stenosis group (32.1±4.5)μg/L,mild stenosis group(19.3±2.0)μg/L] (all P＜0.05).Meanwhile,the levels of HMGB1 were increased along with the decrement of left ventricular ejection fraction [left ventricular severe dysfunction group (41.0 ± 5.5) μg/L,medium dysfunction group(33.1± 4.3)μg/L,mild dysfunction group (21.3± 2.0)μg/L] (all P＜0.05).CAD with T2DM had a higher HMGB1 level than non-T2DM group[(35.7±5.0) (C)/L vs.(23.3±3.0) (C)/L,P＜0.05].The adverse events group had a higher HMGB1 level than non-adverse events group[(38.7±5.5) (C)/L vs.(25.3±3.3)μg/L,P＜0.05].Besides,HMGB1 had a positive correlation with levels of hs-CRP and glucose(r=0.680,0.571,P＜0.05).Conclusions Serum HMGB1 change is closely related to morbid change degree of elderly CAD patients as well as prognosis.As a new type of inflammatory factor,HMGB1 may serve as a new target for disease treatment.

By participating in the national medical colleges and universities students' clinical skill competition and summarizing the experiences after the competition,we reflected on problems and weakness in the past clinical teaching including weak sterile concept and lack of clinical thinking,humanities,communication skills,teamwork awareness,etc.We should take methods to future improve medical students' clinical training capabilities including strengthening the concept of sterile and clinical skills,promoting training of comprehensive clinical thinking ability and problem-solving ability,emphasizing on humane care and communication between doctors and patients; cultivating teamwork awareness thus to comprehensively enhance the overall quality of medical students.

BACKGROUND: Fructose-1,6-diphosphate (FDP) of certain dosage plays a protective role in the pancreatic islets damaged by interleukin-1 beta (IL-1β), and there are different effects of FDP of low and high dosages.OBJECTIVE: To investigate the effects of FDP of low and high dosages on the islet cells damaged by IL-1β.DESIGN: A grouped design and controlled animal experiment.SETTING: Department of Physiology, North Sichuan Medical College.MATERIALS: The experiments were carried out in the Tumor Laboratory and Central Laboratory of Rheumatology and Immunology, Department of Surgery, North Sichuan Medical College between July 2004 and February 2006. Twenty Wistar rats within 1-3 days after birth were selected.METHODS: The pancreases of the rats were removed to collect islet cells, and then the cells were divided into normal control group, IL-1β damaged group, IL-1β+1, 25, 50 mmol/L FDP groups. The cellular activity was detected with methyl-thiazol-tetrazolium (MTT) assay, basic amount of insulin secretion and that stimulated by high glucose with radioimmunoassay, content of nitric oxide and activity of nitric oxide synthase (NOS) with nitric oxide and NOS kits, and the with [Ca2+]i with Fura-2fluorescent assay.MAIN OUTCOME MEASURES: Activity of islet cells; basic amount of insulin secretion and that stimulated by high glucose; content of nitric oxide and activity of NOS; [Ca2+]i.RESULTS: ① The activities (A values) of the islet cells in the IL-1β damaged group, IL-1β+1, 25, 50 mmol/L FDP groups were obviously lower than that in the normal control group (0.116±0.012, 0.129±0.008, 0.125±0.015, 0.120±0.016, 0.252±0.020, P ＜ 0.01). The activities (A values) of the islet cellswere not significantly different from that in the IL-1β damaged group (P ＞ 0.05) when the FDP dosage was too low (1 mmol/L) or too high (25 mmol/L). ② The basic amount of insulin secretion and that stimulated by glucose were significantly lower in the IL-1β damaged group, IL-1β+1, 25, 50 mmol/L FDP groups than in the normal control group [(237.00±22.21), (230.83±11.58), (225.16±12.46), (220.50±15.63),(425.67 ±16.85) mIU/L; (90.17 ±6.11), (96.62 ±8.64), (87.66-±8.24),(85.46±9.59), (204.50±10.78) mIU/L, P ＜ 0.01], and there were no significant differences between the FDP groups of Iow and high dosages and the IL-1β damaged group (P ＞ 0.05). ③ The NOS activity and content of nitric oxide in the supernatant were obviously higher in the IL-1β damaged group than in the normal control group [(332.07±25.34), (144.86±12.17) μkat/L;(457.64±19.29), (84.67±10.23) μmol/L, P ＜ 0.01], and those in the IL-1β+1, 25, 50 mmol/L FDP groups were not significantly different from those in the IL-1β damaged group. ④ The [Ca2+]i concentration in islet cells was obviously higher in the IL-1β damaged group than in the norrmal control group [(328.50±26.28), (73.42±1.79) nmol/L, P ＜ 0.01], but obviously lower in the IL-1β+1, 25, 50 mmol/L FDP groups than in the IL-1β damaged group [(152.72± 11.86), (216.39±15.32), (233.61±21.76),(328.50±26.28) nmol/L, P ＜ 0.01].CONCLUSION: FDP of low and high dosages can not protect the islet cells damaged by IL-1β.

Objective To explore the cognitive process in children with attention deficit hyperactivity disorder (ADHD) using Das-Naglieri Cognitive Assessment System (DN:CAS).Methods Sixty-one children with ADHD and sixty-one healthy controls were enrolled in this study.The cognition of all the studies individuals was evaluated by the DN:CAS.Results Compared with the control group,children with ADHD had significantly lower scores in planning[(24.18 ±5.64) scores vs (30.07 ±5.28) scores,t =-6.985,P ＜ 0.01],simultaneous processing[(33.97 ± 7.64) scores vs (36.90 ± 7.20) scores,t =-2.211,P ＜ 0.05],attention [(26.52 ± 6.80) scores vs (31.21 ± 5.86) scores,t =-4.909,P ＜0.01] in the 4 subtests of DN:CAS,and the total scores [(117.85 ±21.45) scores vs (132.48 ± 17.95) scores,t =-5.286,P ＜ 0.01] are same.And there were significant differences in matching numbers [(8.77 ± 2.33) scores vs (10.87 ± 2.31) scores,t =-5.220,P ＜ 0.01],planned codes [(7.87 ± 2.37) scores vs (9.44 ± 2.61) scores,t =-4.006,P ＜ 0.01],planned connections [(7.54 ± 2.29) scores vs (9.75 ± 2.01) scores,t =-6.643,P ＜0.01];verbal-spatial relations in simultaneous processing [(10.05 ±2.79) scores vs (11.23 ± 3.19) scores,t =-2.382,P ＜ 0.05] and expressive attention [(9.02 ± 2.47) scores vs (10.34 ± 3.03) scores,t =-2.938,P ＜0.01],number detection [(8.16 ±2.31) scores vs (10.08 ± 1.86) scores,t =-5.028,P ＜ 0.01],receptive attention [(9.34 ± 3.68) scores vs (10.78 ± 3.20) scores,t =-3.215,P ＜ 0.01] between ADHD group and the control group.There were significant differences of the percentile rank distribution of the scores between ADHD group and the control group in planning,attention and full score (all P ＜ 0.05).Conclusions Children with ADHD have cognitive deficits in the cognitive processing,and planning and attention deficits are the main features.The DN:CAS could be a useful tool in evaluating cognition of children with ADHD.

Objective To determine the reliability of hand-held electronic dynamometer (HHD) tests for lower limb muscle strength measurement in children with spastic cerebral palsy (CP). Methods Twenty-eight children ( 15 boys and 13 girls; mean age 5 years 8 months) with different types of CP (2 with spastic quadriplegia,8 spastic diplegia, 6 hemiplegia, 1 triplegia and 1 monoplegia) , and at different functional levels ( 19 graded at gross motor function classification system level Ⅰ, 6 level Ⅱ, 2 level Ⅲ and 1 level Ⅳ ) were recruited from the Rehabilitation Center of the Children's Hospital of Fudan University. Standardized HHD protocols were used to measure the strength of their hip, knee and ankle muscles. The HHD test was performed by the same examiner twice with an interval of 10 min in between. The HDD test was also performed with 15 randomly selected CP children by 2 examiners with an interval of 10 min in between. The test-retest and inter-rater reliabilities of the HDD readings were determined by calculating the intra- and inter-class correlation coefficients. Results The HHD measurements showed fine testretest reliability ( ICC = 0.74-0.97 ) and inter-rater reliability ( ICC = 0.63-0.97 ) in measuring lower-limb muscle strength of children with spastic CP, with the highest test-retest reliability for the hip flexion, foot plantar flexion and knee extension muscle groups. The highest inter-rater reliability was achieved with the hip flexion and foot dorsiflexion muscle groups. Conclusions Standardized HHD testing of lower-limb muscle strength in children with spastic CP shows fine test-retest and inter-rater reliability. The HHD can reliably assess the lower-limb muscle strength of children with spastic CP.