From the aspects of strengths,weaknesses,opportunities and threats,this paper analyzed external factors of the reorganizations and group building reform of public hospitals in Shanghai.Points made are as follows:Characteristics of individual hospitals should he respected instead of a generalized pattern for all;the role of the government to play in this regard should he guidance of an orderly competition,Strengthen Supervision,and promotion of the reform in property rights,These efforts will create a desirable environment for hospital groups;mid- and long-term goals for the reform should consolidate the independent legal entity status of such groups.

Objective To investigate the effects of tetanic stimulation of peripheral nerve on intracranial direct electrical stimulation motor-evoked potentials (MEP) in patients undergoing cerebral functional area operation. Methods Eight patients undergoing elective brain tumor resection under propofol-fentanyl anesthesia with partial neuromuscular blockade were enrolled in the study. Both conventional MEP (C-MEP) monitoring and posttetanic MEP (P-MEP) monitoring were performed throughout the operation for each patient, and the two groups of data were recorded. For one group, direct electrical stimulation with a train of five pulses was delivered to motor cortex and pyramidal tract, C-MEP was unilaterally recorded from the abductor pollicis brevis, and P-MEP was obtained 1 s after tetanic stimulation (frequency 50 Hz, intensity 50 mA, duration 5 s) to the ipsilateral tibial nerve.For the other group, direct electrical stimulation with a train of five pulses was delivered to motor cortex and pyramidal tract, C-MEP was unilaterally recorded from the tibialis anterior, and P-MEP was obtained 1 s after tetanic stimulation (frequency 50 Hz, intensity 50 mA and duration 5 s) to the contralateral tibial nerve. Randomized crossover method was used for C-MEP and P-MEP recording in each group, with an interval of 120 s. The adverse effects were observed. Results Amplitudes of P-MEP from the abductor pollicis brevis and tibialis anterior were significantly higher than those of C-MEP. Three patients had body movement during intraoperative cortex stimulation, while there was no awareness during operation and other electrical stimulation-related nervous system impairment and complications. Conclusion The application of tetanic stimulation of peripheral nerve before direct electrical stimulation can augnent the amplitudes of MEP from the abductor pollicis brevis and tibialis anterior in patients undergoing cerebral functional area operation.

Objective:To investigate cytokine(TNF-?,IL-1) effect on apoptosis and express of related protein in thyrocytes and the relationship with pathogenesis in Graves' disease(GD).Methods:To test thyroid tissues from 50 patients with GD Fas expression by immunohistochemical method.Thyroid tissues were collected from samples of GD operation and were cultured by primary culture method.Content of sFas in culture medium was tested by ELISA.Fas/sFas mRNA were tested by RT-PCR.Cytokine inducing apoptosis in Graves' disease showes observation group,normal people showes control group.Results:Compare apoptosis culture rate there is significant difference(P

Objective To investigate the reliability and validity of Hospice care quality assessment scale. Methods Eight experts in the field of hospice revised the Scale after Chinese localization. The scale data were analyzed after collation of 181 families fulfill the scale. Results The total scale Cronbach′s a coefficient was 0.851. The first dimension′s coefficient was 0.796. The second dimension′s coefficient was 0.622 and the third dimension′s coefficient was 0.827. In factor analysis of the scale, after varimax rotation, the number of characteristic roots>1 was 10 and made up of 70.88%of the total variance. Conclusions The hospice care quality assessment scale after Chinese localization has good reliability and validity and could be a tool to evaluate the clinical quality of care for dying patients.

Objective:To explore the efficacy and safety of escharectomy and skin grafting combined with negative pressure wound treatment in the treatment of patients with deep burn.Methods:A total of 208 deep burn patients who were treated in Haining People's Hospital from May 2018 to May 2019 were selected in the research.They were randomly divided into observation group and control group according to the random digital table method, with 104 cases in each group.The observation group was treated with escharectomy and skin grafting combined with negative pressure wound treatment.The control group was treated with escharectomy and skin grafting combined with traditional pressure bandaging.The general treatment, wound healing rate, changes of serum inflammatory factors before treatment and after treatment for 7 days, and complications of the two groups were compared.Results:The total excellent and good healing rate of the observation group (92.31%) was higher than that of the control group (79.81%) (χ 2=6.772, P<0.05). The granulation growth time [(8.23±2.16)d], wound healing time [(17.64±2.58)d], postoperative pain score[(3.16±1.24)points] and hospitalization time [(22.61±2.47)d] in the observation group were lower than those in the control group [(12.15±2.33)d, (20.25±3.16)d, (5.33±1.27)points and (26.13±2.55)d] ( t=12.582, 6.525, 12.468, 10.111, all P<0.05). At 7 days after treatment, the levels of CRP[(21.12±2.48) ng/L], TNF-α [(3.27±0.38)ng/L], IL-6 [(5.32±1.46)ng/L] and C3a [(12.13±1.62)μg/L] in the observation group were lower than those in the control group [(28.06±2.62)ng/L, (5.13±0.43)ng/L, (6.68±1.51)ng/L and (16.43±1.26)μg/L] ( t=19.618, 33.055, 6.603, 21.367, all P<0.05). The total incidence of complications in the observation group (7.69%) was lower than that in the control group (22.12%) (χ 2=8.529, P<0.05). Conclusion:Escharectomy and skin grafting combined with negative pressure can improve the wound healing rate, improve the body's inflammatory response, shorten the recovery time, reduce the occurrence of complications and has good safety.

Objective To investigate the prevalence rate of hyperlipidemia in the middle-aged and elderly in Guangxi Hei Yi Zhuang population. Methods A total of 657 people of Hei Yi Zhuang nationality aged 40 years and over were surveyed. Blood pressure, body height, body weight, serum lipid and apolipoprotein levels were measured, and both body surface areas and body mass index were calculated. The results were compared with those in 520 people of Han nationality who also live in that district. Results The prevalence of hypercholesterolemia, hypertriglyceridemia, and hyperlipidemia in Hei Yi Zhuang vs. Han population were 28.9% vs. 35.8%(P0.05), and 36.2% vs. 42.3%(P0.05) respectively. Conclusions Prevalence of hyperlipidemia of Hei Yi Zhuang is lower than that of Han ethnic group, which might results from different dietary habit, life style, physical activity, and even genetic background.

Objective: To investigate the application effect of Power port in contrast-enhanced CT scans. Methods: Totally 220 cancer patients who needed contrast-enhanced CT scans after chemotherapy were selected in Changhai hospital From September 2017 to September 2018, including 110 cases in the observation group and 110 cases in the control group with convenient sampling method.The observation group was injected contrast medium through Power port for CT scans. Contrast medium was injected into the control group by 22G of Peripheral venous access devices (Introcan®). The incidence of contrast medium exosmosis, nursing time and patient satisfaction were compared between the two groups. Results: The incidence of extravasation of contrast medium in the observation group was 0, lower than that in the control group 9.1% (10/110), the difference was significant(χ²=10.476,P=0.015); the nursing time in the observation group was (2.60 ±0.15) minutes per time, which was lower than that in the control group (5.60 ± 5.29) minutes per time), the difference was significant (t=5.934, P=0.000); the patient satisfaction in the observation group was higher than that in the control group, the difference was statistically significant (Z=-12.695, P=0.000). Conclusions Contrast medium injection through Power port for CT scans can reduce the incidence of contrast medium exosmosis, reduce nursing hours and improve patient satisfaction.