Objective:Based on the framework of reference point contract theory,the experimental economics methodwas used to explore the medical institution managers' motivation and reflection of the profit allocation in vertical integrated?medical service system.Methods:Z-tree software was applied to design the experimental program.40 undergraduate students majoring in health management were recruited as the subjects.Sharing rates and effort levels were collected and calculated by Excel 2007 and SPSS 17.0.Results:The median of sharing rate hospital managers allocated to community health centers?was 35.00％.The median of effort level that community health center directors chose was 8.00.The proportion of sharing rates equal to or less than 50.00％ accounted for 98％.The proportion of the highest effort level was 23.50％.The correlation between sharing rate and effort level was significant(P＜0.05).Conclusion:In the process of establishing vertical integration of medical service system,sharing rates and effort levels were closely related while the community health centers' effort was shading.

Objective To compare the effects of closed reduction and interlocking intramedullary nail and percutaneous minimally invasive locking compression plate in treatment of tibial fractures.Methods 70 patients with tibial fractures were selected as research subjects,and they were randomly divided into the control group and the observation group according to the digital table,each group in 35cases.The control group was treated with closed reduction and interlocking intramedullary nail,while the observation group was treated with percutaneous minimally invasive locking compression plate.Then,the operation index,postoperative complications,treatment effect after treatment between two groups were compared.Results The operation time,fracture healing time,length of stay in the observation group were less than those in the control group[(70.37±11.06)min vs.(82.13±12.15)min,(3.02±0.61)month vs.(4.21±0.70)month,(13.39±3.02)d vs.(16.26±3.21)d](t=4.234,3.852,7.582,all P<0.05).The incidence rate of complication in the observation group was lower than that in the control group[14.28%(5/35) vs.51.42%(18/35)](χ2=10.943,P<0.05).The excellent rate in the observation group was statistically higher than that in the control group[94.28%(33/35) vs.74.28%(26/35)](χ2=5.285,P<0.05).Conclusion Closed reduction and interlocking intramedullary nail and minimally invasive percutaneous locking compression plate are successful in the treatment of tibial fracture,but interlocking intramedullary nail easily leads to delayed healing,complications and higher rate of surgery two times,while minimally invasive percutaneous locking compression plate can promote healing,curative effect is better.

To evaluate the effect of endoscopic ultrasonography guided celiac plexus neurolysis (EUS CPN) on pain associated with pancreatic carcinoma. Methods EUS CPN was performed to relieve pain in 16 patients with advanced pancreatic carcinoma. By EUS, we used fine needle to puncture at the region of celiac ganglion and inject alcohol. The pain tensions were followed up under visual analogue scale rule at 2 days and weekly thereafter. Results All patients were performed EUS CPN successfully. No serious complications happened. No satisfactory pain control after the first 2 days of EUS CPN.Whereas it was relieved obviously after 7 days and the effects maintain a rather long term. Conclusion EUS CPN is a safe and effective method for releiving the pain in pancreatic carcinoma.

Objective To determine the diagnostic value of endoscopic ultrasound-guided cholangiography(EUSGC)with fine needle puncture .Methods Twenty-six patients with obstructive jaundice failed i n previous endoscopic retrograde cholangiopancreatography(ERCP) and magnetic res onance cholangiopancrcatography(MRCP) or have metallic foreign materials in some where of body. By a linear scanning echoendoscopy in conjunction with a 22-gau ge aspiration needle, transduodenal selective cholangiography was attempted.Results Cholangiography was successfully performed in all patie nts (EUSGC success 100% vs. ERCP 0%). No complications occurred in the patients. In 19 patients, abnormalities were found from EUSGC. Choledocholithiasis have b een confirmed by sphincterotomy(n=5),common bile duct strictures were confirmed by surgical operation(n=11).Three other patients have delayed excretion of co ntract medium.Conclusion EUSGC allows a safe and accurate alternative method for obtaining cholangiography in those patients when ERCP or MRCP failed.

0.05). The average amount of ammonia emission was 0.012%, 0.024% and 0.081% at pH values of 9, 11 and 13 respectively. Ammonia emission increased with the increasing pH values, especially for those admixtures containing carboxylate. Conclusion Ammonia emission from concrete admixtures sold in Lanzhou exceed the standard in different degree.Higher pH value may accelerate the ammonia emission from concrete admixtures and cause higher concentration of ammonia in indoor air.

Objective To evaluate the diagnostic value of endoscopic ultrasonic elastography in lymph node staging of gastrointestinal tumors.Methods Thirty-nine abdominal lymph nodes and 26 mediastinal lymph nodes of 35 patients with gastric cancer or esophageal carcer were examined by endoscopic ultrasonic elastography of five-point elastic score.Lymph node at 1-3 points was regarded as negative(benign),while 4-5 points as positive(malignant).The diagnostic value of EUS elastography was determined by comparing the results with pathological findings.Results Of all the 65 lymph nodes,49 were diagnosed as positive and 16 negative.The sensitivity and specificity of EUSE in the diagnosis of malignant lymph nodes were 91.1%and 60.0%.respectively.Conclusion EUSE is helpful for diagnosis of malignant metastasic lymph nodes.

Objective To explore the effect of high quality nursing care performing in the operating room and reasonable approach for assessment. Methods Stratified random sampling was used to select 93 nurses from two tertiary hospitals. The task performance and contextual performance was assessed before and after implementing a range of high quality nursing care program. Results The task performance scores and patient care, nursing information, nurse skills dimension scores respectively were 58.59 ±1.77, 19.27±1.16, 19.50±1.11, 19.80±0.70 after the operating room junior high quality nursing service project, which were 37.21 ± 1.92, 5.55 ± 0.86, 13.78 ± 1.12, 17.87 ± 0.98 before the implementation, the differences were statistically significant (t=-82.48--15.15, P<0.01). The performance scores and mutual support between colleagues, work out the extra burden, organizational support dimension scores were respectively 70.43 ± 2.94, 28.23 ± 1.21, 18.52 ± 1.29, 23.67 ± 1.86 after the operating room junior high quality nursing service project, which were 36.20 ± 1.79, 15.52 ± 1.94, 7.33 ± 1.11, 13.34 ± 0.87 before the implementation, the differences were statistically significant (t=-91.99--46.68, P<0.01). Conclusions The high quality nursing care program is a range of nursing service which can advance task performance and contextual performance of nurses in the operating room. Task performance and contextual performance are effective approaches by which high quality nursing care in operating room could be reasonably assessed.

Objective To establish the method for determining the content of cryptotanshinone and tanshinone ⅡA in Zhiwei Fuwei Wan. Methods The determination of cryptotanshinone and tanshinone ⅡA was performed on Symmetry C18 column with mobile phase consisted of acetonitrile-0.2%phosphate (60∶40) at flow rate of 1.0 mL/min. The detection wavelength was set at 262 nm. Results The linear ranges of cryptotanshinone and tanshinone ⅡA were 0.081 4-0.407 2 μg (r=0.999 7) and 0.163 6-0.81 8 μg (r=0.999 5) respectively, the average recoveries were 99.70% (RSD=1.37%) and 99.22% (RSD=0.94%) respectively. Conclusion The method is simple and rapid for the quality control of the product.

Aim To study the inhibitory effects of ex-tractive pericarpium trichosanthes ( EPT) on high glu-cose-induced apoptosis in human umbilical vein endo-thelial cells ( HUVECs ) and its underlining mecha-nisms. Methods HUVECs were cultured. Effects of EPT at different concentrations on the high-glucose-in-duced apoptosis in HUVECs were observed. The cell viability of HUVECs was determined by MTT colori-metric method. Cell apoptosis was identified by Ho-echst staining. The intracellular activity of Caspase-3 was detected with colorimetry. Protein expression and p65 nuclear translocation of NF-κB were detected by Western blot and immunofluorescence staining. Re-sults Treated with 30 mmol · L-1 glucose for 48 hours had a significantly decrease on cell viability com-pared with control, and the apoptotic rate and Caspase-3 activity were increased markedly, the protein expres-sion of NF-κB was upregulated and p65 nuclear trans-location in HUVECs increased; Pre-incubation with EPT(12. 5,25,50 mg·L-1 ) for 1 hour enhanced the cell viability, and decreased the apoptotic rate and Caspase-3 activity and downregulated the expression of NF-κB in a dose-dependent manner. Moreover, EPT could inhibit p65 translocation. Conclusion EPT can protect HUVECs against the apoptosis induced by high glucose in vitro,and its mechanism may be related with downregulation of NF-κB expression and inhibition of the intracellular activity of Caspase-3 .

Objective To evaluate the incidence and epidemiologic characteristics of Kawasaki disease (KD)in Nanjing.Methods We reviewed the medical records and reports of all patients admitted to Nanjing Chil-dren′Hospital with KD diagnosed during 3 -year periods from 2012 to 2014.Results We studied 1 446 inpatients diagnosed with KD from 2012 to 2014.There were 1 135 cases(78.5%)with complete KD.The ratio of male to female was 1.7241.The disease occurred in all of the seasons,but the peak was from spring to summer.Age at onset ranged from 1 month to 14 years old,and the peak age group was 1 year old.Fever(99.45%)was the most common clinical symptom,followed by conjunctive congestion(93.15%),rash(73.32%),oral changes(51.76%), extremities desquamate(75.08%)and lymphadenopathy(45.89%).There were 131(9.05%)patients with coronary aneurysm,the ratio of male to female was 3.02  1.14 patients (0.97%)developed recurrent KD.Conclusion Patients with KD has become more and more in Nanjing,and clinical doctors should improve the understanding of KD. Early diagnosis and treatment is very important to reduce the sequelae and reduce the mortality of KD.