The paper aims to analyze the flaws of new medical reform policies of cost accounting and bonus based on performance by introducing encouraging mechanism in bonus of the front two wheels: workload efficiency management and cost control management and the refraining mechanism by the two wheels: daily flaws management and key KPI checking.This efficiency-oriented four-wheel driven management mode reflects the reality of work-performance-based distribution, avoidsNine Forbiddingand reflect the public welfare.

As the largest hospital group,performance payment distribution system directly affects the work enthusiasm of nurses.It analyzed and summarized the current 8 deficiencies and defects existing in the wage distribution.It proposed 5 measures and methods to focus on the performance payment so as to improve the enthusiasm of nurses work and promote the medical service quality and the comprehensive performance of hospitals.

Objective To observe the clinical characteristics and prognosis of primary nephrotic syndrome (PNS) in the elderly. Methods The clinical and pathological features of 52 elderly patients with PNS and 64 non-elderly patients with PNS were retrospectively analyzed and compared.The elderly patients with PNS received routine treatment:oral corticosteroids prednisone 1mg·kg-1 ·d-1.After 8 weeks maintenance treatment,if symptoms were alleviated,the prednisone dose was gradually reduced to a maintenance dose, then was stopped gradually. If symptoms were not alleviated, the cyclophosphamide or cyclosporine, mycophenolate mofetil was added. Results There were significant differences in the numbers of patients complicated with hypertension, infection,chronic renal insufficiency and hematuria between the elderly group and non-elderly group (P＜0. 05＝.But there were no significant differences in the level of blood albumin, quantitative measurement of 24 hours urinary protein and incidence rate of acute renal insufficiency between the two groups (P＞0.05). The major pathological types of PNS in the elderly were membranous nephropathy (46.2 %),IgA nephropathy (23. 1 %) and focal segmental glomerulosclerosis ( 11.5 %), respectively. And the major pathological types of PNS in non-elderly group were mesangial proliferative glomerulonephritis (32.8%), IgA nephropathy ( 25.0% ) and minimal change nephropathy ( 20. 3 %), respectively.Complete remission after treatment was found in 31 patients(59.6%), partial remission in 18 cases and inefficacy in 3 cases. Conclusions The major clinicopathological type of PNS in the elderly is membranous nephropathy and should be treated using corticosteroids and immunosuppressive agents,with different effects in different pathological types.

Objective To investigate the correlation between asymmetric dimethylarginine (ADMA) and endothelial dysfunction in patients with type 2 diabetic nephropathy.Methods The 81 patients with type 2 diabetic nephropathy were selected.According to the urinary albumin excretion rate (UAER),the patients were divided into micro-albuminuria group (DN1 group,UAER 21-199 mg/24 h,38 cases) and macro-albuminuria group (DN2 group,UAER ≥ 200 mg/24 h,43 cases).The 20 healthy people were defined as control group.Intimal-media thickness and endothelial dysfunction of the radial artery of right forearm were detected by color Doppler ultrasound.The serum level of ADMA was determined by enzyme-linked immunosorbent assay.Results There was no significant difference in radial artery inner diameter intimal-media thickness among the 3 groups (P ＞ 0.05).The Endothelial dependent diastolic function (EDD) and endothelial independent diastolic function (EID) in DN1 group and DN2 group were significantly lower than those in control group [(10.45 ± 2.58)％ and (7.56 ± 2.17)％ vs.(15.72 ± 3.05)％,(15.42 ± 2.71)％ and (15.37 ± 2.92)％ vs.(19.31 ± 3.76)％,P ＜ 0.05],and the EDD in DN2 group was significantly lower than that in DN1 group (P＜ 0.05).The serum ADMA in DN1 group and DN2 group was significantly higher than that in control group [(0.63 ± 0.08) and (0.92 ± 0.12) μ mol/L vs.(0.39 ± 0.05)μmol/L,P ＜0.05],and in DN2 group it was significantly higher than that in DN1 group (P ＜0.05).In patients with type 2 diabetic nephropathy,the serum ADMA and EDD had negative correlation (r =-0.81,P =0.020),but the serum ADMA and C reactive protein had positive correlation (r =0.75,P =0.034).Conclusions The serum level of ADMA is significantly increased in patients with type 2 diabetic nephropathy.There is a close correlation between ADMA and endothelial dysfunction of artery.

OBJECTIVE:To investigate the protective effects of insulin-glucose on myocardium in patients receiving cardiac valve replacement under cardiopulmonary bypass. METHODS:Totally 120 patients receiving combined cardiac valve replacement under cardiopulmonary bypass were divided into control group and observation group according to random number table,with 60 cases in each group. All patients were given routine operation. Control group was given Thomas cardioplegia and oxygenated blood with a ratio of 1:4(V:V)to protect myocardium at 4 ℃. Besides that,the observation group was additionally given Insulin injec-tion 10 IU/L and Glucose injection 10 g/L added into Thomas cardioplegia at 4 ℃ to protect myocardium. The levels of plasma brain natriuretic peptide(BNP)and cardiac troponinⅠ(cTnⅠ)before anesthesia induction(T0),at the end of cardiopulmonary by-pass(T1),12 h(T2),24 h(T3),48 h(T4),and 72 h(T5)after surgery,the rate of recovery of automatic heartbeat after opening aor-ta,the application of vasoactive agent(dopamine)at T1 and the occurrence of postoperative complications were observed and com-pared between 2 groups. RESULTS:At T0,there was no statistical significance in the levels of plasma BNP and cTnⅠ between 2 groups(P>0.05). The levels of plasma BNP and cTnⅠin 2 groups at T1-5 were significantly higher than T0,with statistical signifi-cance(P<0.05);the levels of cTnⅠ began to decrease at T4 and cTnⅠbegan to decrease at T5. However,the levels of BNP and cTnⅠwere significantly lower in observation group than in control group at T1-5,with statistical significance(P<0.05). After open-ing aorta,there was no statistical significance in the rate of recovery of automatic heartbeat between 2 groups(P>0.05). The dos-age of dopamine (at T1) and the incidence of complications in observation group were statistically lower than control group,with statistical significance(P<0.05). No severe ADR was found in 2 groups during or after surgery. CONCLUSIONS:Insulin-glucose can alleviate myocardial damage, reduce the dosage of vasoactive agent and the incidence of postoperative complications in pa-tients receiving combined cardiac valve replacement under cardiopulmonary bypass with significant protective effect on myocardium with good safety.

Objective To investigate the correlation between asymmetric dimethylarginine (AD-MA) and endothelial dysfunction in patients with uremia.Methods Uremic patients who did not receive hemodialysis were defined as A group (n =40) ; uremic patients who had received hemodialysis were divided into B group (n =45) ;healthy people were defined as C group (n =20) ;and chronic kidney disease (stage 2 ～ 4) patients were defined as D group (n =20).The diameter of intima-media thickness,and endothelium-dependent or independent dilation (EDD or EID) of radial artery in right forearm were detected with diasonography.The levels of ADMA were determined by high-performance liquid chromatography.Results Compared to C group,the levels of ADMA in A,B and D groups were significantly increased [C:(0.78 ±0.19) μmol/L,A:(1.51 ±0.16) μ mol/L,B:(1.13 ±0.14) μmol/L,D:(0.92 ±0.11) μmol/L; P ＜0.05].Compared to A group,the levels of ADMA were significantly decreased in B group (P ＜0.05).EDD and EID were decreased significantly in A,B and D groups compared to C group [EDD:C:(13.52±1.73)％ vs A:(7.32 ±0.54)％,B:(9.02 ±0.86)％,D:(10.13 ±1.25)％,P ＜0.05;EID:C:(14.45±1.85)％ vsA:(10.37 ±1.51)％,B:(9.54±1.39)％,D:(11.17±1.56)％,P ＜0.05].EDD in B group was significantly lower than A group (P ＜0.05).In group A,a negative correlation was found between EDD and the level of ADMA (r =-0.81,P =0.020).Conclusions ADMA level was significantly increased in uremic patients.A close correlation existed between ADMA and endothelial dysfunction of radial artery.

Objective: To select suitable conditions for prokaryotic expression and purification of rhIL-17. Methods: rhIL-17 was expressed in E. coli host under heat induction. After compared among the expression amounts in different media under different heat induction time, the most suitable conditions was selected. The target protein was present in the form of inclusion body. The precipitate of inclusion was obtained and purified after 6M guanidine solublization or 2% SDS solublization. Results: Either protocol could yield rhIL-17 with high purity and stable activity. The SDS solublization mehthod gives rise to much more higher productivity than the guanidine solublization method. Conclusion: rhIL-17 were expression in E. coli system and purified to homogenicity by SDS solublization methods with high productivity.

Objective:To establish the quality standard system of Gui Erbai gel based on a method ofa system to multiple evalu-ation and discuss the feasibility of the method used for the quality standard for traditional Chinese medicine. Methods:TLC identifi-cation of Gui Erbai gel was established by one thin layer system. An HPLC method was used to detect 6 active components in Gui Erbai gel. Results:Five active components in the gel could be identified by one thin layers system simultaneously with clear spots and good separation. Six active components in the gel could be determined by the same HPLC system with high accuracy. The average content of podophylotoxin,quercetin,kaempferol,imperatorin,dictamnine and rutin is as follows 0. 154,0. 052,0. 138,0. 051,0. 060,0. 048 mg· g-1 . RSD<3％. Conclusion:The established method based on a system to multiple evaluation can be used for the quality standard establishment for Gui Erbai gel with the properties of promising feasibility, simple operation, low cost, high accuracy and good stabili-ty.

Objective To explore the protection of valsartan combined with simvastatin on kidney in early diabetic nephropathy rats. Methods Diabetic nephropathy rats model were induced by streptozocin (STZ) ,the experimental rats were randomly divided into 5 groups: control (group C), diabetic nephropathy (group D) ,diabetes treated with valsartan (group X) ,diabetes treated with simvastatin (group Z) ,and diabetes treated with combined valsartan and simvastatin ( group L). Blood glucose (BG), HbA1c, blood cholesterol ( TC), trigalloylglycerol ( TG ), blood ureanitrogen ( BUN ), serum creatinine (SCr) , urinary albumin excretion rate (UAER) were measured, and the podocyte ultrastructure was observed by transmission electronic microscopy. Results The levels of BG, HbA1c,TC,TG and UAER in group D increased significantly compared togroup C(BG:[20.3 ±3.2]mmol/L vs [6.1 -±0. 4]mmol/L;HbA1c:[7.18 ±0.47]% vs [3.37 ±0. 15]% ;TC: [2. 69 ±0. 35] mmol/L vs [1.28 ±0. 24] mmol/L;TG: [3.09 ±0. 37] mmol/L vs [1.18 ±0. 25]mmol/L) (P ＜ 0. 05 ). Creatinine clearance rates (Ccr) in group D ( [0. 89 ± 0. 19] ml/min ) decreased significantly compared to group C( [1.27 ±0. 33] ml/min) ,as well as group X,Z and L( Ps ＜ 0. 05 ). UAER in group D was significantly higher than that in group C ( [19. 87 ±3. 85] μg/24 h vs [3. 67 ± 1.01] μg/24 h) (P ＜ 0. 05 ), as well as group X, Z and L ( P ＜ 0. 05 ), and the improvement in group L was particularly significant ( P ＜ 0. 05 ). The projections of podocyte in group D severely syncretized, there were slightly improvement in group X, Z and L compared to group D, and the improvement in group L was remarkable. Conclusion The treatment with valsartan, simvastatin and their combination will effectively protect the kidney in early diabetic nephropathy rats,and the effect of using the combination therapy is much better.

Objective To investigate the clinical characteristics and related factors of diagnosis and treatment of patients with hypertensive cerebral hemorrhage,and provide basis for clinical treatment and prognosis.Methods The clinical diagnosis and treatment data of 96 patients with hypertensive cerebral hemorrhage,admitted to our hospital from February 2010 to February 2013,were analyzed.Results In all the 96 patients,improvement was noted in 76 accounting for 79.17％,limb paralysis in 74 accounting for 77.08％ and death in 17 accounting for 17.71％; death within 24 hours of onset was noted in 11 accounting for 11.46％ and within 24-72 hours in 6 accounting for 6.25％.Automatic discharge was observed in 3,accounting for 3.13％.Conclusion Choosing corresponding treatments according to the hematoma sizes in patients with hypertensive cerebral hemorrhage plays important role in improving the prognosis.