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 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.

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.

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.

BACKGROUNDMultidrug resistance (MDR) is not only the main reason of the failure of chemotherapy, but also the largest obstacle of the increase of survival rate in lung cancer. MDR of lung cancer is a complex procedure involved in multiple genes and mutiple pathways. Combined examination of resistance-related genes in lung cancer tissues has an important clinical significance. The aim of this study is to explore the relationship among the expression, coexpression of five multidrug resistance factors of lung cancer tissues and clinicopathological characteristics in patients with lung cancer.

METHODSImmunohistochemical staining (EnVision method) was used to evaluated the expression of lung resistance protein (LRP), P-glycoprotein (P-gp), glutathione S-transferaseπ (GST-π), topoisomeraseII(TopoII), and multidrug-resistance-associated protein (MRP) in cancer tissues from 72 patients with lung cancer.

RESULTSThe positive rate of LRP, P-gp, GST-π, TopoII and MRP was 79.2%, 86.1%, 54.2%, 29.2% and 30.6% respectively. There was a significant difference of the expression of LRP and TopoII in different sex (Chi-square=11.460 and 4.877, P=0.001 and 0.027), of the expression of LRP, GST-π and TopoII in NSCLC and SCLC (Chi-square=15.104, 14.076 and 9.409, P=0.001, 0.001 and 0.009), of the expression of GST-π in various grade of cell differentiation (Chi-square=8.933,P=0.011), of the expression of TopoII in various T staging (Chi-square=3.963,P=0.049). Spearman analysis of rank relativity showed that there was a better relativity between the expression of LRP, TopoIIand sex (r=0.464 and -0.205, P=0.000 and 0.027), between the expression of LRP, GST-π, TopoII and histology. The expression of LRP and GST-π was significantly higher in NSCLC than in SCLC (r=-0.390 and -0.262, P=0.000 and 0.018), the expression of LRP was significantly higher in adenocarcinoma than in squamous cell carcinoma (r =0.604, P=0.000). The expression of GST-π and TopoII was significantly higher in squamous cell carcinoma than in adenocarcinoma (r =-0.257 and -0.264, P=0.015 and 0.012). There was a reverse relativity between the expression of GST-π and cell differentiation (r =-0.232, P= 0.012 ). There was a positive relativity between the expression of TopoII and T staging (r =0.200, P= 0.031 ) and a reverse relativity between the expression of GST-π and T staging (r =-0.182, P=0.050). Spearman analysis of rank relativity of five multidrug resistance factors' coexpression showed that there was a positive relativity beween LRP and P-gp, LRP and MRP, P-gp and GST-π, P-gp and MRP, GST-π and MRP (r = 0.283 , 0.234, 0.453, 0.204 and 0.323, P=0.002, 0.011, 0.000, 0.027 and 0.000), the coexpression rate was 70.8%, 27.8%, 52.8%, 29.2%, 23.6% respectively. There was a reverse relativity between LRP and TopoII (r =-0.183, P=0.048), and the coexpression rate was 19.4%.

CONCLUSIONSThe expression of partial multidrug resistance factors is relative significantly to sex, histology and cell differentiation, but not to T, N, M stage and clinical stage. The higher coexpression rate and positive relativity indicate MDR in lung cancer is affected by various multidrug resistance factors. It is important to detect coalescently various multidrug resistance factors.

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.

Background and purpose: Postoperative chemotherapy targets the metastatic cancer in the remaining lymph nodes, but the heterogeneity in multidrug resistance (MDR) of metastatic cancer cells is a main factor affecting chemotherapeutic efficacy. Recent studies only examined the primary lesion of esophageal squamous cell carcinoma(ESCC). There is no report about heterogeneity between the primary tumor and metastases lymph node. The purpose of this study was to explore the heterogenous expression and clinical signiifcance of multidrug resistance (MDR) associated proteins in primary tumors and metastatic lymph nodes in patients with thoracic ESCC. Methods:The expressions of lung cancer associated resistance protein (LRP), P-glycoprotein (P-gp), topoisomeraseⅡ(TOPO-Ⅱ), thymidylate synthase (TS), glutathione S-transferase-π (GST-π) were examined by immunohistochemistry in primary lesions and corresponding metastatic lymph nodes in 54 patients with thoracic ESCC. The differences between expression of primary lesions and matched metastatic lymph nodes were compared and analyzed in relationship with tissue differentiation degree. Results: The discordant rates of the expression and drug resistance between primary lesions and corresponding metastatic lymph nodes in LRP, P-gp, TS, TOPO-Ⅱ and GST-π were 63.0% and 26.9%, 42.6%and 22.2%, 48.1%and 25.9%, 50.0%and 29.6%, 18.5%and 1.9%respectively. The expression of LRP showed signiifcant difference between the primary tumors and lymph nodes (P=0.026). No signiifcant differences were found for the other four proteins, and GST-πwas expressed in all patients in both the primary tumors and lymph nodes. Protein expression was not associated with degree of differentiation. Conclusion:There is evident of heterogenous expression of MDR associated proteins in metastatic lymph nodes compared to the primary tumors of ESCC. The examination of expression levels of MDR associated proteins in metastatic lymph nodes is helpful to select the postoperative rational chemotherapy plan.