Objective To understand the basic medical and health personnel's perception of fairness for pay for performance program .Methods This study used document analysis , expert consultation , pre-survey method to de-sign the questionnaire , and then was conducted on 367 medical and health personnel at the basic level in Zhejiang Prov-ince, analysis of variance , correlation analysis were used for statistical analysis .Results Only 0.13% of the basic medical and health personnel think pay for performance program is very fair;23.16%of people think pay for perform-ance program is fair;29.43%of people do not know whether pay for performance program is fair;34.06%of people think pay for performance program is not fair;11.99% of people think pay for performance program is very unfair . There were no significant differences between age , educational levels, working time, professional qualifications and po-sition(p>0.05).Staff in different areas of the perception of pay -for-performance fairness exists obvious difference (p<0.05).Conclusion Only a small portion of basic medical and health personnel think pay for performance pro -gram is fair, and it may directly affect the enthusiasm of staff , reduce the work quality and efficiency of basic medical and health personnel .It suggests that relevant departments should improve the pay for performance program .

Objective To study the influence of anesthesia methoda on early postoperative cognitive function in elder orthopedics patients. Methods Fifty patients aged more than 65 years old with fractured femur randomly received general anesthesia(group G, 28 cases) or unilateral combined spinal epidural anesthesia(group E,22 cases). The assessment of postoperative cognitive {unction referred to the scores that achieved in neuropsychological testing with mini mental state examination (MMSE) by special psychological person on the day before and the first day after surgery. It was considered to he postoperative cognitive dysfunction (POCD) when the score was ≥1 standard deviation(SD). Results The score of MMSE was lower in group G than that in group E on the first day alter surgery(P<0. 05). The incidence of POCD on the first day after surgery was higher in group G than that in group E(42.9% vs. 13. 6%) (P<0. 05). Conclusion Compared to combined spinal epidural anesthesia, more POCD takes place in the eldedy underwent orthopedic surgery under general anesthesia.

Objective To study changes of telomerase activity in transitional cell carcinoma after intravesical instillation of Serratia Marcescens . Methods TRAP-PCR and TRAP-sliver staining were used to detect telomerase activity in 20 patients with TCC after intravesical instillation of Serratia Marcescens . Results Positive rate of telomerase activity detection in TCC patients after intravesical instillation of Serratia Marcescens was 50%(10/20),significantly lowed than before the intravesical instillation (90%,18/20), P

Objective The purpose of this study was to determine the value of K-ras mutation in DNA extracted from the plasma as clinical indicator of colorectal cancer. Methods Point mutation at codon 12 of K-ras gene was assayed by polymerase chain reaction of sequence-specific primers in DNA extracted from the plasma and tumors from 32 patients with colorectal cancer. The mutation was further confirmed by dideoxy-mediated chain-termination method of DNA sequencing. Results Fourteen patients (44%) had a codon 12 K-ras mutation within their primary tumors and identical mutations were found in the plasma DNA of 13 patients (93%). Mutant DNA was not detected in the plasma specimens of 18 patients whose tumors tested negative for K-ras alterations or in 5 healthy control subjects. Conclusion Preliminary results suggest the detection of K-ras mutations in circulating DNA extracted from the plasma specimens may have some clinical uti- lity in the detection of colorectal cancer.

model rats group. Conclusion Bushenhuoluofang increased the weight of ovary and uterus, follicular number and endomelrium area of ASR. By affecting the level of FSH and LH of the rat, improves its endocrine function and the growth of follicle, Bushenhuoluofang achieved the purpose of promoting ovulation.

To explore the model of the standardized training for health management talents by referring to the standardized training for resident-doctors.This article analyzed the necessities of the model of the standardized training for health management talents from two aspects.After that,it elaborated on the significance of standardized training.At last,it proposed some ideas about constructing the standardized training for health management talents.

Objective To investigate the effects of different stabilizers, time and temperature before centrifugation on the stability of homocysteine (Hcy) and other related thiols levels involving EDTA-containing whole blood.Methods Blood was drawn from 17 healthy adults and collected into tubes containing EDTA, EDTA plus NaF and EDTA plus 3-deazaadenosine(3DA),then stored on crush ice(0-4 ℃) immediately or at room temperature(25 ℃).Plasma was separated at 0, 3, 6, 24 and 48 hours, respectively.The levels of plasma total Hcy (tHcy), total cysteine (tCys), tatal cysteinylglycine (tCysGly) and tatal glutathione (tGSH) were measured by HPLC.The plasma immediately separated was used as baseline sample. Results In EDTA tubes stored at room temperature, tHcy levels increased by 38.5%, 64.2%, 141.9%, 225.4% for 3, 6, 24, and 48 h, respectively.The levels of tCysGly and tGSH increased by 20.0% and 37.9% within 3 h, however, tCys decreased by 3.5%.The levels of the thiols increase by less than 5% up to 6 h in EDTA tubes stored on crush ice.In EDTA-3DA and EDTA-NaF tubes, no statistical differences were observed in the plasma levels of tHcy, tCys,tCysGly and tGSH compared with their respective baseline values at room temperature for 3 h(EDTA-3DA tubes:F=0.01,0.94,0.09,0.01,all P>0.05;EDTA-NaF tubes:F=0.85,0.04,0.03,0.02,all P>0.05).Conclusions The EDTA-plasma levels of tHcy and other related thiols are time and temperature-dependent. There is a strong need for standardization of blood sample collection and processing in tHcy and other thiols assays. The plasma concentrations of tHcy, tCys, tCysGly and tGSH were stable for 3 h at least in the EDTA-3DA and EDTA-NaF tubes kept at room temperature.

Objective To investigate the changes in concentrations of the homocysteine (Hey) and other aminothiols (ESRD) in plasma of end-stage renal disease (ESRD) patients before and after hemodialysis (HD). Methods 26 chronic renal failure patients treated with hemodialysis plus 54 healthy controls were randomly chosen. The concentrations of plasma total homocysteine (they), total cysteine ( tCys), total cysteinylg]ycine (tCysGly), total glutathione (tGSH) were determined by HPLC-fluorescence detection (FD). The concentrations of serum lipids were detected and several renal function tests were conducted. Results The concentrations of they ( 16. 70 ± 3.51 μmol/L vs 10. 95±3.07 μmol/L, t =3. 625,P <0. 01),tCys(341.87±70.65 μmoL/L vs 249.76 ± 13.18 μ mol/L,t =6.219,P <0.01), tCysGly(41.33 ± 32. 95 μmol/L vs 31.3 ± 11.78 μmol/L, t = 3. 530, P <0.01 ) in pre-hemodialysis plasma were significantly elevated , and tGSH ( 5.91 ± 0. 08 μmol/L vs 9. 33 ± 2. 62 μ mol/L, t =-5.404, P < 0. 01 ) was significantly decreased compared with the control group. The concentrations of tHey and tCys (11.74 ± 3.42 μmol/L and 272. 67 ± 64. 18 μmol/L) in post-hemodialyais plasma were significantly decreased compared with in pre-hemodiaIysis plasma, but they could not be restored to normal levels. However, the concentrations of tCysGly(41.33 ± 32. 95 μmol/L vs 44. 93 ± 13.88 μmol/L,t =-0.758, P>0.05) and tGSH (5.91±0.08 μmol/L vs 5.93±0.38 μmol/L,t = -0.068,P >0.05) in pre-hemodialysis plasma and post-hemodialysis plasma didn't change significantly. There were significant positive correlations between plasma levels of they and tCys(r =0. 458 2 ,P <0. 01 ). There was significant negative correlations between plasma levels of tHcy and tGSH ( r =-0.609 9, P=0.000 9). Nevertheless, tHcy levels were was not correlated with tCysGly levels and other serum lipid parameters. Conclusion There is a high prevalence of metabolic disturbance in Hcy and other related aminothiols in ESRD patients.

Objective To investigate the value of the application of fibrobronchoscopy in extubation for patients suffering from acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with low cough peak expiratory flow(CPEF). Methods A single-center prospective controlled study was conducted. The ventilated AECOPD patients who were cooperative at the time of extubation in Department of Critical Care Medicine of Guangzhou Institute of Respiratory Disease of Guangzhou Medical University from June 2009 to May 2014 were enrolled. All patients successfully passed the spontaneous breathing trial(SBT). Extubation was performed after determination of CPEF following energetic coughing. According to the CPEF,the patients were divided into CPEF≥60 L/min group (high CPEF group)and CPEF<60 L/min group(low CPEF group). After extubation,fibrobronchoscopic drainage was given to the patients in high CPEF group when necessary. Fibrobronchoscopic drainage was given to the patients in low CPEF group at least once a day,and the frequency of such treatment could be increased according to the patient's condition. If the patients did not require re-intubation within 48 hours,extubation was recorded as successful. The gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score before extubation,ventilation time,the time of intensive care unit(ICU)stay,the mortality in ICU,the rate of re-intubation,the ability to cough and the frequency of application of fibrobronchoscopy after extubation were recorded. Results A total of 102 patients with AECOPD were enrolled,58 patients in high CPEF group and 44 in low CPEF group. Compared with high CPEF group,the mean age in low CPEF group was older(years:74.3±15.2 vs. 69.5±11.4,t=2.164,P=0.041),the time of ICU stay was significantly longer(days:20.1±11.2 vs. 17.4±7.3,t=2.274,P=0.030), but there was no significant difference in gender〔male/female(cases):35/9 vs. 45/13,χ2=0.057,P=0.812〕, APACHEⅡscore(11.9±1.9 vs. 10.3±4.2,t=1.290,P=0.200),mechanical ventilation time(days:14.8±10.8 vs. 13.3±9.6,t=0.677,P=0.501)and the rate of re-intubation〔18.18%(8/44)vs. 12.07%(7/58),χ2=1.412, P=0.235〕between low CPEF group and high CPEF group. The cough strength of patients in high CPEF group was almost alwaysstrong(52 cases),and in the low CPEF group,most of them wasmoderate(14 cases)orweak(26 cases). The frequency of application of fibrobronchoscopy in low CPEF group was higher than that in high CPEF group(times:4.1±1.8 vs. 1.3±0.9,t=2.626,P=0.011). All patients underwent weaning successfully,and no death occurred. Conclusion The application of fibrobronchoscopy in the extubated AECOPD patients with low CPEF can reduce the rate of re-intubation,avoid the prolonged ventilation,but cannot reduce the time of ICU stay.

Objective To compare the role of Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with multi-detector row computed tomography (MDCT),and to determine the sensitivity,specificity and accuracy in focal hepatic lesions.Methods A retrospective analysis was conducted on 32 patients with focal hepatic lesions who had undergone MRI and MDCT examinations.These patients were divided into two groups:the CT group and the MRI group.The results were analysed using receiver operating characteristic (ROC) curves.Result There were 185 focal hepatic lesions.The sensitivity,specificity and the area under the ROC curve (AUC) were 86.5％,90.9％,0.855,respectively for the MRI group and they were significantly higher than the CT group (63.6％,54.5％,0.532).For detection of lesions ＜1 cm,the sensitivity,specificity and the area under the ROC curve (AUC) for the MRI group were 90％,86.6％,0.886,respectively,which were also significantly higher than the CT group (50.5％,45.5％,0.500).When combined with pathological findings and follow-up,the diagnostic accuracy was 40.6％ using Gd-EOB-DTPA DCE-MRI.Conclusion Gd-EOB-DTPA DCE-MRI has a higher detection rate,better accuracy and diagnostic value for focal liver lesions (＜1 cm) than MDCT.