The reasonable distribution of healthcare human resources is the fundamental requirement to improve medical efficiency and service quality,satisfy public's diverse requirement for medical care,and realize medical service fairness.However,various factors hinder the reasonable distribution of healthcare human resources and the realization of medical service fairness in the present medical system,including the imperfect system of human resources management,the immature system of performance appraisal,the imbalanced development of different regions,and the unpleasant environment of medical practice.This paper reflects on those issues from an ethical perspective.

OBJECTIVE:To establish a HPLC method for the determination of gentamycin sulfate C component in medicinal albumin gel. METHODS: Samples was separated on Agilent ZORBAX Eclipse XDB-C8 at a column temperature of 26℃. The mobile phase was methanol-acetic acid-water (70∶5∶25, added with 0.02mol?L-1 sodium heptanesulfonate solution) for gradient elution at a flow rate of 1.0mL?min-1. The detection wavelength was set at 330nm. RESULTS: Baseline separation of gentamycin sulfate C component in medicinal albumin gel was achieved. The linear range of gentamycin sulfate C component was 0.26?g～6.50?g and its average recovery rate was 90.0%, RSD=0.43%, the lowest limit of detection was 0.368ng. CONCLUSION: The method was proved to be simple, accurate and reliable, and suitable for the content determination of gentamycin sulfate C component in related preparations.

[Objective]To investigate the surgical feasibility and efficiency with microendoscopy discectomy technique for the recurrent lumbar disc herniation.[Method]Ninteen cases underwent disc excision with different operative approaches,11 cases had undergone previous surgery with MED,7 cases with conventional approach,2 cases removing whole vertebrate plate approach,3 cases removing half vertebrate plate approach,2 cases with minor vertebrate plate window approach.There were 13 cases of ipsilateral protrusion and 2 cases of contralateral protrusion,3 cases of adjacent segment protrusion.All of these cases were revisioned by MED except for 1 case.[Result]Eighteen cases were finished by MED technique successfully except for 1 case which was changed to open operating.All cases were followed up from 6 months to 2.5 years,averaged 1.5 years.Postoperative JOA score was improved from preoperative average (9.61?3.40)? to average (26.17?2.60) ?,the rate of improvement final was 86.32%.In terms of Macnab scoring system,the satisfactory rate was 88.89%.[Conclusion]MED technique is an effective method for recurrent lumbar herniation,but the operator needs lots of experience in minimal invasive spine surgery.

[Objective]To treat stenosing tenosynovitis by a kind of mini-invasion operation with endscopy assisted,and to observe the clinical results,and to discuss the problem of open and percutaneous A1 pulley release.[Method]Eleven cases,suffering from stenosing tenosynovitis,were treated by the technique of mini-invasion operation with endscopy assisted with a kind of special release knife.The clinical results was investigated and the operative methods was investigated.[Result]All of the patients showed relieving of symptoms of disfunction and trigger finger.There was no serious complication,such as injury of nerves,infection,wound ununion and hand disability.None recurrent case in the follow-up period of 6 to 36 months.[Conclusion]The method of miniinvasion surgical treatment of stenosing tenosynovitis by endscopical technique assisted is safe,effective and low-cost with few complications,which fit for treating stenosing tenosynovitis,specially for those patients with cortisone injection,diabetes and thumb stenosing tenosynovitis.

[Objective]To study and evaluate the result of the surgical treatment for arthroscopic reconstruction of anterior cruciate ligament(ACL) with double-bundle semitendinosus.[Method]Thirty-one cases who underwent surgical treatment of arthroscopic reconstruction of ACL with double-bundle semitendinosus during 1990～1998 were analyzed retrospectively.The mean follow up time was 127.36 months(98～168 months).Among them,11 case was simplicity ACL injury,15 cases associated with medial meniscus injury,8 cases combined with lateral meniscus injury,6 cases combined with medial collateral ligament injury,2 case combined with lateral collateral ligament injury.All the patients with medial collateral ligament injury were associated with medial meniscus injury.The analysis was performed on the symptom,physical sign,Lysholm score system and IKDC score pre and postoperation recently.[Result]All the patients had good clinical results with no click,locking,"give way",extra-extension pain,and floating patella test were negative.There were no other complications correlated with semitendinosus grafting.But mild pain were seen in 11 cases,Lachman test were positive in 3 cases,anterior drawer test were positive in 8 cases without complications of instability.The Lysholm score:preoperation was 49.62?8.22 and 76.60?7.68 in follow-up time(P

Objective To analyze family clustering of inpatient service utilization in rural areas of Hubei Province.Method Inpatient service information of all families in rural areas of sample counties was obtained on the basis of New Cooperative Medical System (NCMS) inpatient database;Lorentz curve was drawn by area graph and scatter diagram of Excel 2010,so was Gini coefficient;descriptive statistic,variance analysis and so on were carried by IBM SPSS Statistic 20.0.Result 3％ family takes up 19％ inpatient service,and rural family's Gini coefficient of inpatient service utilization is 0.366;high inpatient service utilization family(HIUF) uses less outpatient service(29.2±26.9) than middle inpatient service utilization family (31.7±23.5).Inpatient member of HIUF used more inpatient service than other families,except the low inpatient service utilization member(NHH9.2＞NMH4,NHM2.4＞NMM2.2＞NLM1.7);HIUF use least time to reach county hospital(tH44.3＜tM44.9＜tL45.2),have more inpatient members than others (NM＞4.5＞NH4.4＞NL3.9).Conclusion Great family clustering of inpatient service utilization exists in rural area,and irrationality exists in some way;more outpatient service utilization may reduce inpatient service utilization.

Objective To analyze family clustering of outpatient service utilization in rural areas of China.Method Outpatient service information of all families in rural area of sample county was obtained on the basis of new cooperative medical system (NCMS) outpatient database,and family outpatient service utilization database was cleared out with the help of functions like IF,LOOKUP and so on in Excel 2010.Lorentz curve was drawn by area graph and scatter diagram with Excel 2010,so was Gini coefficient.Descriptive statistic,variance analysis and so on were carried by IBM SPSS Statistic 20.0.Result 20％ family takes up 53％ of outpatient service,and rural family's Gini coefficient of outpatient service utilization is 0.516.Members of high outpatient service utilization family (HOUF) used (17.7) more outpatient service than other families (10.4,4.2).HOUF were mainly distributed in towns with high capability of township hospital and low capability of township hospital.Conclusion Great family clustering of outpatient service utilization exists in rural areas.Family homogenization is distinct,in which irrationality exists.The capability of primary medical institutions influences the outpatient service utilization of residents in rural area.

Objective To discuss the design of arthroscopic reconstruction of posterior cruciate ligament (PCL) with quadriceps tendon fixed by a patellar block and an allograft bone plug, and its clinical outcome. Methods Thirteen patients suffering from PCL injury were treated by the technique mentioned above. The connection between quadriceps tendon and superior patellar pole was preserved in the harvest process of quadriceps tendon. The femoral tunnel was made like a bottle neck, which was clogged with the patellar bone block. The quadriceps tendon strip was fixed by an allograft bone plug pressed into the tibial tunnel. Their functional recovery was evaluated by Lysholm scoring and IKDC(International Knee Documentation Committee) criteria. Results In the average follow-up period of 19 months, there were not any severe nerve or blood vessel lesions, or failures of transplanted ligament None of the patient complained of knee instability after the operation. The pain was relieved in most patients, but three complained of pain after knee movement A little calcification was found in the quadriceps tendon at the superior patellar pole one year after the operation in the X-ray of a patient There was significant difference in Lysholm scale between pre-operation and post-operation (P

Sphincter of Oddi manometry (SOM) is considered the gold standard for the diagnosis of sphincter of Oddi dysfunction (SOD),especially the type Ⅰ SOD.The dysfunction of sphincter of Oddi can lead to other comorbidity.Therefore,SOM is of special importance for such patients.When performing SOM,we need to intubate into the papilla,so it requires high technique and is associated with a relatively higher risk of post-ERCP pancreatitis.Recently,the equipment of SOM is being updated constantly.The use of modified catheter and high resolution gastrointestinal dynamic system for recording and analyzing has made the technology more accurate and safe than ever before.Due to the widespread use of ERCP,SOM is expected to be one of the routine examinations in clinical practice and its application has a promising prospect.This article reviews the latest research progress on SOM in recent years.

BACKGROUND: Simply used natural materials-prepared scaffolds such as collagen, gelatin and fibrin solve problems of biocompatibility, but its degradation is rapid, and cannot induce new tissues, but collapse is found as cell scaffolds.OBJECTIVE: To explore and determine the property of biological degradable three-dimensional porous scaffolds using silk fibroin-chitosan composite.DESIGN, TIME AND SETTING: The material observational study was performed at the Institute of Bioengineering, Zhejiang Academy of Medical Science from June 2008 to June 2009.MATERIALS: Spring silk cocoon was presented by a silkworm farmer from Huangdunmiao village, Maqiao town, Haining City,Zhejiang Province, China. Chitosan was produced by Shanghai Bo'ao Biological Technology.METHODS: 15 g/L silk fibroin solution was made by degumming, salvation and dialysis. Chitosan was dissolved in 2% acetic acid solution to prepare 25 g/L chitosan-acetic acid solution. Two solutions were mixed to prepare six silk fibroin/chitosan solutions, and mass ratio was 10: 0, 5: 5, 4: 6, 3: 7, 2: 8, 0:10. These solutions were separately sucked in a 24-well plate. Following exhausting gas vacuole at 4 ℃, precooling was performed at -20 ℃ for 12 hours, followed by cryodesiccate for 30 hours. Samples were then hydrated in ethanol, neutralized in NaOH-alcohol for 1 hour, washed and then frozen to dry.MAIN OUTCOME MEASURES: Optical microscope and scanning electron microscope were used to observe pore size and structure of various mass ratio-prepared scaffold. Modified liquid substitution method was utilized to measure porosity of various scaffolds. The degradable rate of various scaffolds was determined at 4 weeks in vitro.RESULTS: Silk fibroin/chitosan of 10: 0 mass ratio-prepared scaffold had rough fluffy pore, was brittle, with high dissolve-loss rates. On the contrary, chitosan-prepared scaffold was hard, without enough elasticity following freeze-dry. The composite scaffold of 5: 5, 4: 6, 3: 7 and 2: 8 following freeze-dry was loose and soft, similar to sponge. With increased chitosan concentration,scaffold hardness increased. There were evenly distributed, detailed eyelets on the scaffold. Under the optical microscope,various pores were irregular; each pore closely connected and linked together; pore size was even, 20-100 μm. With increased chitosan concentration, pore size was gradually reduced. Scaffold porosity determination results displayed that mass ratio of silk fibroin/chitosan 4: 6 group > 5: 5 group > 3: 7 group > 2: 8 group. Compared with 2: 8 group, the porosity was significantly increased in the 5: 5 and 4: 6 groups (P < 0.05). No significant difference was detected in volume expansibility in the silk fibroin/chitosan composite scaffold of various mass ratios (P > 0.05). The degradation was slowest in the 2: 8 group, and fastest in the 5: 5 group at 4 weeks.CONCLUSION: Regarding physical and chemical properties, composite scaffold made by silk fibroin/chitosan showed significant superiority compared with scaffold made by silk fibroin or chitosan alone. Of them, silk fibroin/chitosan mass ratio of 5: 5 and 4: 6 are accorded with the requirement of cartilage tissue engineering.