Objective: In order to provide references for drawing up related health policy reasonably, the current status of medical insurance payment in third level hospital. Methods: Through analyzing the payment situation of medical insurance in third level hospital from 2010 to 2012, to understand the related situation of gross prepayment system in large publich hospital since this year. Results: In recent years, the coverage rate of health insurance in the whole city is increasing continuously, while the rising extend of annual gross prepayment limit is not obvious, refusal in medical insurance fund is serious and the accounting method of prepay limit is not scientific. Conclusion: While satisfying the quality of patients’ visiting, it needs to implement gross prepay accounting method, enhance medical management and reduce the economic burden of the hospital.

In this paper, the concept, policy support and existing modes of transitional care in America were introduced in detail. It can provide reference for the development of transitional care mode in our country, provide continuous nursing services for the elderly, and improve the health status of the elderly.

Background and purpose: NF-?B is activated by tumor necrosis factor,some chemotherapeutic agents,and ionizing radiation.The activation of NF-?B could result in inhibition of apoptosis.NF-?B,regulated by PDTC(pyrrolidine dithiocarbamate),is a specific inhibitor of NF-?B.The purpose of our study was to explore the impact of inhibiting expression of NF-?B on radiation-induced apoptosis of uterine cervix cancer HeLa cells.Methods:Inhibition of NF-?B in HeLa cells was performed by treatment with 100 ?mol/L PDTC for 2 hours.Cells were irradiated at 0,2,4 and 6 Gy with or without PDTC.The expression of NF-?B in nuclear was determined by western blot,and apoptosis was evaluated by using the TUNEL assay.Cell proliferation was evaluated by using MTT assay.Results:NF-?B activation was induced by radiation and inhibited by PDTC.Inhibition of radiation-induced NF-?B activation resulted in inhibiting cell proliferation(P

Objective To investigate the clinical value and pathogenic mechanism of virulence genes of Helicobacter pylori from different sources of digestive diseases patients.Methods From January 2015 to July 2016,628 cases of gastric biopsy samples were collected from gastroscopy room of People′s Hospital of Wuwei City,through separating and culturing of Helicobacter pylori,detecting of viral virulence genes,to explore the relationship between Helicobacter pylori and chronic atrophic gastritis CAG),chronic superficial gastritis(CSG),peptic ulcer(PUD).Results Among the 628 gastric biopsy specimens,214 cases of Helicobacter pylori were successfully isolated,and 172 strains were serected to extracting DNA,which contained various virulence genes of cagA,vacA,dupA,iceA,oipA and luxS.VacA s1m1 was a risk factor for CSG,VacA s1m2 and iceA1+/iceA2+ increased the incidence of PUD,DupA + increased the risk of duodenal ulcer.Conclusion Different digestive diseases and Hp infection were related closely,dupA was considered as Hp induced duodenal ulcer marker gene,vacA s1m2 and iceA1+/iceA2+ increased the risk of PUD.

Objective To explore MR imaging features of synovial chondromatosis,and evaluate the diagnostic value of MR imaging.Methods The imaging data of 16 cases with pathologically confirmed synovial chondromatosis were analyzed retrospectively,who underwent the preoperative X-ray plain film and MR plain-scan and enhanced-scan.Two cases of should joint,4 cases of hip joint,8 cases of knee joint(ten joints),2 cases of ankle joint.Results Eleven cases (13 joints) were truly diagnosed according to X-ray plain film,the typical features of synovial chondromatosis were hyperdense free bodies in the joint space and adjacent soft tissue,which showed the concentric lamina sign.Fourteen cases (16 joints) were truly diagnosed according to MR imaging,which clearly showed thickened synovium with significant enhancement,multiple intraarticular cartilage or bony nodules with the surface enhanced,and some nodules connected with thickening synovial membrane,joint effusion and joint degeneration.MR could display the synovial abnormalities that could not be displayed in X-ray plain film,which was helpful to distinguish the characteristics of free bodies in joint,and superior to X-ray plain fdm in showing the lesions in detail.Conclusion MR could clearly show the synovial abnormalities and free body in the joints,which has important value for the diagnosis of synovial chondromatosis,determination of the extent of lesions and the characteristics of free body.

Objective To test the reliability and validity of the Chinese Version of the Depressive Cognition Scale (DCS) among the older people.Methods The sample consisted of 570 old people,collected by a demographic questionnaire,the Chinese version of DCS,and the Center for Epidemiological Studies Depression Scale (CES-D),then all the data was analyzed by SPSS 21.0.Results The item-to-total correlation coefficients of DCS ranged from 0.65 to 0.84 (P＜0.01),and the average coefficient was 0.77.The content validity index(CVI) was 0.88.The result of exploratory factor analysis (EFA) was that one factor explained 59.72％ of the total variances,and the concurrent validity between DCS and CES-D was positive related (r=0.24-0.82,P＜0.01).Regarding CES-D as the gold standard,the sensitivity was 84.7％ and the specificity was 90.7％.The inter-item correlation coefficients of DCS ranged from 0.40 to 0.73 (P＜0.01);the Cronbach α was 0.82,and the retest reliability (intra-class correlation coefficient,ICC) was 0.92 (95％CI=0.86-0.95,P＜0.01).Conclusion DCS is proved to be a reliable and valid instrument,and it can be used to assess the depressive cognition and screen the early depressive symptoms of Chinese old adults.

Objective To test the reliability and validity of the Chinese version of the sense of coherence (SOC) scale (13-items) among the older people.Methods A random sample of 1 032 old adults was selected from community in Jinzhou,Shenyang,Dalian of Liaoning.A demographic questionnaire,the SOC-13 scale,the WHO-5 and the Center for Epidemiological Studies Depression Scale (CES-D) were used to collect the data.All the data was analyzed by SPSS 21.0 and AMOS17.0.Results The item-total correlation coefficients of SOC-13 ranged from 0.625 to 0.760 (P＜ 0.01).The result of exploratory factor analysis (EFA) was that three factors explained 74.745％ of the total variances,and the CFA confirmed the hypothesized three-factor model.SOC scale had an ideal criterion(x2/df =2.908,CFI =0.975,GFI =0.949,NFI =0.963,IFI=0.975,RMSEA=0.061).Criterion related validity test showed that the total score of SOC-13 was negatively correlated with CES-D(r=-0.55,P＜0.01),and positively correlated with WHO-5 (r=0.73,P＜ 0.01).SOC-1 3 had a Cronbach's α of 0.916,the Guttman split-half coefficient was 0.828,and the retest reliability (intra-class correlation coefficient,ICC) was 0.872 (P＜0.01).Conclusion SOC-13 is a reliable and valid instrument,which can be used to measure the lever of sense of coherence among Chinese old adults.

BACKGROUND: Studies about the mechanism of laser occlusion on the varicose great saphenous vein are rare.OBJECTIVE: To explore the ultrastructural changes of the great varicose saphnous vein after it was occluded with laser.DESIGN: An observational study.SETTING: Laser Department of the General Hospital of Chinese PLA .PARTICI PANTS: There were 42 patients with varicose great saphenous veins that were occluded with laser in clinic of the General Hospital of Chinese PLA from January to April 2004. The inclusive criteria: There must be obvious vein tangles beneath the undystrophic skin at ankle without apparent thrombus inside the vein. The patients involved should be voluntary to take part in the study. Finally 9 patients were enrolled in this study.INTERVENTION: The great saphenous vein was intravenously occluded with laser of 810 nm and the working power was 12 W and the exposure time was 1 s. The occluded vein sample was taken out 3 hours after the occlusion.MAINOUTCOME MEASURES: The ultrastrncture of the occluded vein was observed histopathologically. Normal vein and prereatment varicose vein served as control.RESULTS: The normal vein wall can be divided into 3 layers: the internal layer was composed of the simple endothelial cells; the median layer was composed of the smooth muscle cells, elastic fibers and collagenous fibers; the external layer was composed of the loose connective tissues. However, the internal layer of the varicose vein was incomplete, and the endothelial cells were loosely connected. The smooth muscle cells became hyperplasic, hypertrophic or atrophic. The elastic fibers decreased in number in contrast to the increase of collagenous fibers. After laser occlusion, in the vein lumen there was a large number of blood cells. The platelets became flattened with pseudopods and adhered to collagenous fibers. The endothelial cells and smooth muscle cells near the lumen were damaged and the cytoplasma leaked and fused with extracellular matrix. Broken collagenous and elastic fibers could be seen near the lumen and some were observed in the lumen. There was no structure change in the external layer and adjacent elastic fibers and collagenous fibers.CONCLUSION: Laser occlusion damaged the internal layer and part of median layer of the varicose vein, caused aggregation of the blood cells in the lumen and promoted the adhesion of platelets to vein walls.

Objective To explore the relationship among structural empowerment,psychological empowerment and nurses' job burnout,and to provide new approach for relieving nurses' job burnout.Methods Conditions for Work Effectiveness Questionnaire-Ⅱ (CWEQ-Ⅱ),Psychological Empowerment Scale (PES),and Maslach Burnout Inventory (MBI) were used to investigate 233 nurses working at three general tertiary-level hospitals in Tianjin.Results The total scores of structural empowerment,psychological empowerment,and burnout were (43.498 ±9.977),(38.871 ±7.052) and (45.489 ± 11.331),respectively.Relevant Analysis results showed that structural empowerment,psychological empowerment and nurses' job burnout had significant correlation,and the absolute value of coefficient of correlation between 0.358-0.560.The structural equation modeling results showed that fit indexes for fully mediating effect model were excellent(x2 =57.703,x2/df =1.202,GFI =0.965,AGFI =0.933,NFI =0.948,RFI =0.916,IFI =0.991,TLI =0.985,CFI =0.991,RMSEA =0.030,CN =263).Structural empowerment had a positive significant influence on psychological empowerment; structural empowerment and psychological empowerment had a negative significant influence on nurses' job burnout; psychological empowerment played a fully mediating role between structural empowerment and nurses' job burnout.Conclusion Nurse psychological empowerment has direct effect on job burnout.Nurse structrual empowerment affects job burnout via the full effects of psychological empowerment.

A gold nanoparticle ( GNP)-based dynamic light scattering ( DLS) assay has been developed for detecting mercury ion ( Hg2+) in aqueous solution. The GNPs are able to maintain monodisperse state in relative high ionic strength ( 0. 1 mol/L NaCl ) aqueous solution because Hg2+ aptamer 5’-TTTCTTCTTTCTTCCCCCCTTGTTTGTTGTTT-3’( Probe DNA ) can adsorb on the GNP surface by electrostatic interaction. In the presence of Hg2+, the Probe DNA molecules easily desorb from GNP surface because of T-Hg2+-T formation. The unprotected GNPs form aggregates in 100 mmol/L NaCl solution, resulting in increased significantly the average hydrodynamic diameter of GNPs. Under the conditions of pH 7. 43, 110 nmol/L aptamer, 100 mmol/L NaCl and 30 minutes incubation time of Hg2+with aptamer, the difference of average hydrodynamic diameter (△D ) of GNPs was increased linearly with logarithm of Hg2+concentration over the range from 0. 1 nmol/L to 5 μmol/L, with a detection limit of 0. 1 nmol/L. Moreover, satisfactory results were obtained when the proposed method was applied to detect Hg2+ in real samples.