Objective To explore a clear picture of the health human resources allocation in tertiary general hospitals in Beijing ,and propose strategies to optimize the configuration of human resources at the same level hospitals ,so as to improve the medical service quality for society. Methods Basic operational data and human resources configuration of 16 tertiary general hospitals with more than 800 beds in Beijing were col?lected by using clustering sampling and literature review ,and then a descriptive analysis of the human resource configuration data at the same level hospitals was carried out by SPSS18.0 and Excel2010. Results The number of patients increased year by year,but the average days of hospitaliza?tion showed a downward trends during 2009?2011. According to the previous way of beds to determine personnel ,there was significantly different from the actual situation. A significant quantitative correlation was foung between the physicians and the nurses,pharmacists,medical laboratory technician,and the ratio between physicians and these staffs is stable. Conclusion With the development of hospital service and increase of health human resources,health manpower ratio has changed significantly in tertiary general hospitals. A stable proportion of physicians can be used as the reference standard for hospital human resources configuration at the same level hospitals.

Objective To investigate the dynamic changes in brain natriuretic peptide (BNP) and the outcome of patients with chronic congestive heart failure (CHF) after the treatment with metoprolol. Methods Sixty-five patients with CHF were admitted to the Forth Affiliated Hospital of Zhengzhou University during April 2004 to April 2007, and they fulfilled the diagnostic criteria of chronic CHF issued by New York Heart Association (NYHA). Of all the patients the left ventricular end-diastolic dimension (LVEDD) ≥65mm. All the patients were randomly assigned into metoprolol group (34 cases) and control group (31 cases), and received conventional therapies [rest, reduced sodium intake, administration of digitalis, diuretic, angiotensin-converting enzyme inhibitor (ACEI) and aldosterone antagonists, etc.]. The patients in metoprolol group were given metoprolol (6.25mg as initiative dose and dose was increased according to illness). NYHA functional classitication, cardiothoracic ratio on chest X-ray film, cardiac output (CO), cardiac index (CI), left ventricular ejection fraction (EF) and LVEDD in echocardiogram were observed, and the plasma BNP level was determined with an immunoradiometric assay (IRMA). Results After 5 months of treatment, the clinical symptoms of patients were improved obviously and p1asma BNP level was significantly lowered in both groups, while p1asma BNP level was significantly lower in metoprolol group compared with control group (200.6?12.1 vs 120.7?14.1, P

Objective To investigate the aesthetic efficacy of dental implant employed to the functional reconstruction of ectodermal dysplasia (ED) patients. Methods Dental implants were inserted into the jaw bone of ED patients according clinical and X-ray examination. The dentures were made after the osseous integration of implants. The proper attachments were employed to increase the retention of the dentures. The aesthetics, denture retention, phonation, mastication, and the health of soft and hard tissues of peri-implant were evaluated in the 6~48 months follow-up period. Results 12 dental implants were inserted into jaw bone in 5 ED patients and all implants were osseointegrated and remained in the 6-48 months follow-up period. Aesthetics, denture retention, phonation, mastication, and confidence were significantly improved. Conclusions Dental implants can be used to functionally reconstruct the dentition of ED. The aesthetics and functions are improved significantly.

Objective To investigate the risk factors of delirium in elderly patients with intertrochanteric fracture after internal fixation.Methods The data of 160 patients with intertrochanteric fractures who received internal fixation in our hospital from January 2012 to July 2014 were analyzed retrospectively.The risk factors such as age,sex,preoperative complications,preoperative cognitive function,fracture location,operation mode,operation time,anesthesia method,hospital-to-operation time and intraoperative blood loss were summarized.Results The incidence of postoperative delirium was 28.15％ in postoperative elderly patients with intertrochanteric fractures.Univariate analysis showed that delirium had correlated with preoperative cognitive impairment,preoperative preparation time,serum sodium,fentanyl,atrial fibrillation,anesthesia method,operation time and perioperative blood loss (P ＜ 0.05).The multivariate Logistic regression analysis showed that the independent risk factors of postoperative delirium were preoperative cognitive dysfunction,operative time more than 2 hours and preoperative preparation time more than 4 days.Conclusion The occurrence of postoperative delirium was associated with anesthesia method,cognitive deficits,preoperative preparation time and perioperative blood loss.The anesthesia method which had less effect on the whole body condition and less time of operation preparation can decrease the occurrence of postoperative delirium in a certain extent,which is conducive to improving the prognosis.

Objective To study the effects of electrical stimulation of efferent vagus nerve on the endotoxic shock in rabbits. Method Sixteen Newzealand rabbits were randomly divided into 2 groups, namely group S as the stimulation group and group C as the control group). Rabbits were subjected to bilateral cervical vagotomy and had challenge with intravenous injection of lipopolysaccharide (LPS) (E. COLI O111: B4 , DIFCO, USA) in a dose of 600 μg/kg. The distal end of the left vagus nerve trunk was connected to an electric stimulator with bipolar electrode and controlled by an acquisition system. Stimuli with stable voltage (10 V,5 Hz,5 ms) were applied twice to the nerve for 10 minutes just before and after the administration of LPS in group S. At the time before and after the infusion of LPS 30 min,60 min, 120 min, 180 min,240 min and 300 min respectively, the heart rate(HR)and the mean arterial blood pressure (MABP) in each animal were recorded, and blood samples were taken for measuring serum tumor necrosis factor-αa(TNF-α) and interleukin-10 (IL-10). Results Compared with group C,the electrical stimulation of efferent vagus nerve could significantly attenuated the LPS-induced hypotension and de-creased the contents of TNF-α[(38.12±7.85) pg/mL vs. (55.12±7.89) pg/mL, P <0.01], but increased the contents of IL-10[(55.12±9.37)pg/mL vs. (40.15±5.44) pg/mL, P <0.01]afar LPS challenge. Conclusions The stimulation of the efferent vagus nerve can down-regulate systemic TNF-α, production and attenu-ate the development of shock after LPS challenge.

Objective To investigate the tracking neurofibra pathway from the hippocamlpal neurons to septal nucleus,and to explore the effects and mechanisms of ghrelin on the learning and memory in septal nucleus lesion rats.Methods Retrogradely tracing method was used to observe Fluorogold (FG) reaching sites in hippocampus.The septal nucleus was destructed by direct current using stereotactic technique.Step-down test and morris water maze were used to test the effects of learning and memory ability by means of microinjecting ghrelin into hippocampal CA1 area in rats.Results After injection of FG into septal nucleus,retrogradely labeled neurons and neurofibra were found in the hippocampal neurons with FG.Ghrelin injection of hippocampal CAI area could promoter learning and memory ability in rats.It showed that the escaped latent period was significantly lengthened ( (3.2 ± 0.9) s vs (6.9 ± 1.1 ) s,P ＜ 0.05) and the wrong numbers in 5 min were obviously decreased in escape response test; and the latency of looking for the plat was significantly shorter in morris water maze test ( 1.8 ±0.4vs 0.8 ± 0.1,P ＜ 0.05 ).However the effects above-mentioned on learning and memory was significantly weak after septal nucleus lesioning.It showed that the escaped latent period was markedly shortened ( ( 19.5 ±3.2)s vs ( 10.5 ± 2.1 ) s,P ＜ 0.05 ) and the wrong numbers in 5 min were obviously increased ( ( 3.9 ± 0.8 ) s vs ( 1.8 ±0.5 ) s,P＜0.05 ) in escape response test.The latency of looking for the plat was significantly lengthened in morris water maze (P＜0.05).Conclusion Ghrelin could elevate the learning and memory ability in hippocampus,and the effects may be related to the septal-hippecampus pathway.

Objective To investigate the clinical effects and complications of uterine artery embolization (UAE) therapy using different embolic agents in treating uterine adenomyosis. Methods During 2004—2011, a total of 45 female patients with uterine adenomyosis were admmitted to authors’ hospital to receive uterine artery embolization therapy. The embolic agents used in the procedures included domestic iodized oil, sodium alginate microspheres and Embosphere microspheres. The patients were randomly divided into group A (n=15, using domestic iodized oil as embolic agent), Group B (n=13, using sodium alginate microspheres as embolic agent) and group C (n = 17, using Embosphere microspheres as embolic agent). After the treatment, all the patients were followed up for over 2 years, focusing on the observation of the clinical symptoms such dysmenorrheal, changes of MRI signs and severe complications. The results were analyzed and compared among the three groups. Results After UAE, the clinical symptoms such as the degree of dysmenorrhea, menstrual quantity, etc. were improved in all patients. Six months after UAE, the obvious remission rate of dysmenorrheal in group A, B and C was 33.3% (5/15), 30.8% (4/13) and 41.1%(7/17) respectively. Twelve months after UAE, MRI scanning showed that the uterine sizes in group A, B and C were reduced to 49.19%, 48.25% and 50.05% respectively. Follow-up examination at 24 months after UAE showed that recurrence of dysmenorrheal in group A, B and C was seen in 2, 4 and 2 cases respectively, and amenorrhea was seen in 2 cases of group A and one case in group C. Conclusion The use of domestic iodized oil, sodium alginate microspheres or Embosphere microspheres as embolic agents in performing super-selective uterine artery embolization for adenomyosis can effectively relieve the degree of dysmenorrheal, decrease the uterine size. In addition to ovarian dysfunction, the uterine cavity adhesion may be also a possible cause of amenorrhea occurring after UAE may. In order to ensure a similar clinical efficacy, the use of granular solid embolic agent is preferred as its safety is possibly higher than the liquid embolic agents.

Objective To search for the gene encoding specific antigen of Ancylostoma caninum that induces host′s protective immunity. \ Methods\ A lambda ZAPⅡ cDNA library of A.canium was screened with sera from dogs \{immunized\} subcutaneously with hookworm larvae(L3). After sequencing, insert gene (AcAg) from positive clones was \{ligated\} into PUC18 and PET28C. Recombinant pET28C plasmid was induced to expressed protein in the E.coli BL21. The \{characteristic\} of recombinant protein is analyzed by SDS\|PAGE and Western bloting assay. \ Results \ Five positive \{clones\} were obtained, and proved to be the same. The insert gene (AcAg) in pET28C vector expressed a recombinant \{protein\} of about 43 kDa. Using Western bloting assay, this protein was recognized by the sera from dog immunized with \{Ancylostoma\} caninum third\|stage infected larvae and used for screening library. \ Conclusion \ The AcAg, which \{exhibits\} 35% homologous to Caenorhabditis elegans gene unc\|89, is a novel specific antigen of A.caninum. Its ability to elicit the \{protective\} immunity and the probability of the recombinant protein as a vaccine need to be further evaluated.

This article elaborated the connotation of public hospital medical insurance payment system and the importance of reform,summarizing and analyzing the practical exploration of promoting medical insurance payment system reform in the localities.Then it moved on to introduce new progress of medical insurance payment system reform abroad and the emerging mode of medical insurance payment, such as pay for performance,payment by results,and bundled payment.In the end,the authors put forward policy suggestions to improve medical insurance payment system at public hospitals in China, namely to build a modern healthcare payment system in line with the needs of medical service system.Such a system should be guided by comprehensive performance,restrained by cost budgeting, based on a diversified payment mode,and supported by information technology.In addition,it should have scientific payment standard and modern governance mechanism,and keep interactive development with commercial health insurance.

AIM: To observe the effects of norepinephrine (NE) on the cardiopulmonary and lung injury in goats with acute respiratory distress syndrome (ARDS) induced by endotoxin. METHODS: A model of septic ARDS was induced by intravenous infusion of low dose endotoxin in six goats. Then 40?10~ -6 NO inhalation was applied to the animals. After 30 min, combined intravenous infusion of NE at concentration of 0.5 mg?kg~ -1 ?min~ -1 was conducted. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan-Ganz catheter. Arterial blood gas analysis before and after the onset of ARDS, 30 min after NO inhalation and combined NE was detected. Histology of the lung was also observed. RESULTS: Inhalation of NO rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO_2, decreased P_ (A-a) O_2 and Qs/Qt in septic ARDS goats. These decrease and increase were more significant than those in NO inhaled alone when animals received NE. The combination of NO inhalation and NE injection resulted in increase in mean arterial pressure. NO inhalation did not ameliorate lung injury and combined NE intravenous injection ameliorated lung injury. CONCLUSION: Injection of low dose norepinephrine improves the beneficial effects of inhaled nitric oxide on lung gas exchange and ameliorates lung injury in goats with acute respiratory distress syndrome induced by endotoxin.