The establishment of a scientific and reasonable medical service price dynamic adjustment mechanism is the focus of the current reform of public hospitals in China.This paper analyzed the medical service price reform history in the United States, the price dynamic adjustment of the main body and its process, as well as the development trend of medical service price reform.At the same time, the existing problems of medical service price adjustment in China were briefly analyzed, and put forward 1) the establishment of multi-participant dynamic adjustment model;2) the establishment of the medical service standard value system, strengthening Medicare payment standard construction;3) and gradually changing the current fee-for-service payment system and establishing DRGs and performance based payment mechanism and other policy recommendations.

Objective Analysis of the operational efficiency trends of and problems with the public tertiary hospitals. Methods A retrospective statistics analyzed the indicators of ten public tertiary general hospitals in Shanghai during 1997-2006. Results The outpatients number per capita for the hospital staff maintains an rising trend, averaging 12.2% per year prior to year 2000; The yearly-averaged total assets turnover of the hospitals decreases from 0.89 in 1997 to 0.69 in 2003, then maintaining unchanged; The yearly-averaged receivables turnover began to fall since 1999, falling from 21.4 in 1999 to 9.7 in 2006; hospital income growth fluctuated during the years, yet with a high level of total assets growth; given the fluctuations in asset-liability ratio, such ratio has been growing slowly, maintaining at 20 % since 2004. Conclusion Problems are found with the operational efficiency of these public tertiary general hospitals as follows: the rapid growth of productivity in such hospitals finds no concurrent improvements in assets related indicators. Against a low income ratio, high debt ratio will plague hospital development to some extent.

Objective To discuss the clinical influence and advantages of applying the local flap of finger tip lateral skin to repair the fingertip defective injuries.Methods From August,2013 to December,2015,used the way of local the flap of finger tip lateral skin to repair the first-fourth fingertip defects for 32 cases and 32 fingers,among which there were 20 males and 12 females;finger categories:11 thumbs,9 index fingers,8 middle fingers and 4 ring fingers.The defective area of fingertips was 0.5 cm×0.8 cm-1.0 cm×1.5 cm,all with bone exposure,23 cases had defects at the end part of phalanx,32 cases had different extent of nail bed defects.Reasons for the injuries:13 cases of grind injuries,11 cases of punch pressing injuries,8 cases of sharp tool cutting injuries.The time from injury to the treatment was 0.5-3.0 h,all of them had no associated injuries.Results Thirty-two cases of finger flaps all survived,with the follow-up for 3-24 months and average follow-up of 6 months,the flaps were slightly bloated after 3 months comparing with the normal skin,there was no contracture in the flap area and pedicle scars,two-point discrimination was 4-5mm,the farinterphalangeal joint flexion was normal.Conclusion The local flap of fingertip lateral skin can repair the defects of fingertip with less scar,not bloated flap,satisfying appearance,operation is simple,and good function,so it's the ideal way to repair the defects of fingertip.

Objective To investigate radiation induced bystander effect and its mechanism on hepatoma HepG2 cells under hypoxia condition. Methods Non-irradiated bystander hepatoma cells were co-cultured with irradiated cells or treated with the conditioned medium (CM) from irradiated cells, then micronuclei (MN) were measured for both irradiated cells and bystander cells. Results The MN yield of irradiated HepG2 cells under hypoxic condition was significantly lower than that under normoxia, the oxygen enhancement ratio of HepG2 cells of MN was 1.6. For both hypoxic and normoxic condition, the MN yield of bystander cells were obviously enhanced to a similar high level after co-culturing with irradiated cells or with CM treatment, and it also correlated with the irradiation dose. When the hypoxic HepG2 cells were treated with either DMSO, a scavenger of reactive oxygen species (ROS), or aminognanidine, an iNOS inhibitor, the yield of bystander MN was partly diminished, and the reducing rate of DMSO was 42.2%-46.7 %, the reducing rate of aminognanidine was 42 %. Conclusion ROS, NO and their downstream signal facets are involved in the radiation induced bystander effect of hypoxic HepG2 cells.

Objective Establishing the scientific research competitiveness evaluation index system of Shanghai hospitals.Methods Delphi method and Analytic Hierarchy Process were applied.Results Thirty-four experts were invited to provide evaluation index and weighted scores.The positive coefficient from two rounds of expert's consultation were 88.24％ and 94％.The expert's opinion of authority coefficient of each indicator's was greater than 0.7.The degrees of coordinative consistency was high.Kendall concordance coefficient was increasing with the increasing of consulting times.After two rounds of Delphi expert consultation,2 level-one indictors,10 level-two indictors and 47 level-three indictors were confirmed.Conclusions After two rounds of Delphi expert consultation,using all objective indicators,an Index System for research competitiveness evaluation in the hospitals in Shanghai has been created and could be used with scientific,objectivity and feasibility.

The purpose of this study was to reveal the current situation of health technology transfer in Shanghai hospitals,and to analyze the problems and needs.Questionnaire and interview were adopted for the study.We found that in the past 3 years,the transformation rate of patent technologies at Shanghai Tertiary Hospitals was 5.88％.The transfer routes mainly involves proactive enlist of enterprises by project leader,technology brokerage,exhibitions of patents achievements,friends' recommendation,etc..The main factors impacted the transfer included poorer quality of patent,lacking efficient management,and lacking channels for transfer.In order to improve the transfer of patents,hospitals need to provide information service,technology assessment,project packaging,patents application,consultant,and relevant trainings etc.Other things that could promote health technology transfer are to improve scientific research system,to enhance the quality of scientific achievements,and to develop technology brokerage.

Objective To evaluate the effect of percutaneous coronary intervention (PCI) on left ventricular function in patients with different types of myocardial infarction and to explore the correlation factors for the left ventricular function.Methods A total of 43 patients diagnosed as acute myocardial iffarction were enrolled in this study.The perfusion and delayed enhancement magnetic resonance imaging (DE-MRI) was applied to observe the following parameters before the PCI and at month 6 after the procedure:infarct mass,left ventricular ejection fraction (LVEF) and abnormal wall motion score.The subjects were divided into the following three groups by the transmural extent of myocardial infarction manifested in the DE-MRI:the transmural enhancement group,the nontransmural group and the mixed group.Laboratory test was done to detect the level of endothelin (ET),matrix metal enzyme 9 (MMP-9) and high sensitive C reactive protein (hsCRP) before PCI and at month 6 after the procedure.The t test was used to compare the differences among the groups and the multiple regression analysis was taken to explore the correlation factors for the left ventricular function.Results Compared with the parameters before PCI,the infarct mass after PCI significantly decreased in the nontransmural group and the mixed group [(4.0 ± 2.9) g/cm3 vs (9.8 ±5.6) g/cm3 and (6.0 ±3.5) g/cm3 vs (11.8 ±6.2) g/cm3,all P ＜0.05],while LVEF was significantly improved after PCI in both groups [(52.6 ± 15.4) ％ vs (41.9 ± 16.3) ％,(45.6 ± 15.4)％ vs (38.9 ± 16.3)％,all P ＜0.05].The infarct mass was an independent correlation factor for LVEF before PCI (RR =0.318,P ＜0.05) and LVEF after PCI(RR =0.293,P ＜0.05).LVEF before PCI was independently correlated with the level of hsCRP (RR =0.318,P ＜ 0.05).Conclusion The effect of PCI on the improvement of left ventricular function differs in patients with different extent of myocardial infarction,which is correlated with the amount of survival myocardium and the inflammatory factors.

Objective This paper analyzed the development and current situation of patents from first class hospitals in Shanghai,reflecting the development of scientific researches,providing medical science research management with data support as the basis of decision making.Methods Based on patent search and analysis of State Intellectual Property Office of The P.R.C and Incopat,a technology innovation intelligence platform with global patent information,patents from first class hospitals in Shanghai published before the year of 2015 are analyzed from aspects including patent category,legal status,time trend,applicants of invention patent,proprietor and inventors of authorized invention patents,transfer of invention patents,etc.Results First class hospitals in Shanghai had 1979 invention patents,which accounted to 56.38％ of the total.71.21％ of invalid invention patents fell into abeyance because of withdraw,rejection,and abandon,which was 2.47 times of those due to termination.Eight hospitals including Shanghai Ninth People's Hospital and Huashan Hospital were at the top of both the invention patent application list and the authorized invention patent list,both accounting to more than sixty percent.Conclusions The number of invention patents has gone through germination stage,developing rapidly in recent years,the ratio of authorized inventions appears to decline slightly after rise.The reasons of patent invalidation are worthy of attention,the information about legal status of patents can be reasonably used,applicants and inventors shows uneven distribution,patent quality should be emphasized with quantity rise,cross regional and cross border cooperation can bring about complementary advantages.

Objective To find out the satisfaction changes among young medical workers and explore the influence of the healthcare reform on such people.Methods A survey was conducted by means of random sampling among 716 medical workers under 45 years old from 6 hospitals,and combined with the survey data in 2009,young medical workers′satisfaction changes and the influencing factors were analyzed.Results Young medical workers′satisfaction is generally low,with declining satisfaction of social respect as well;satisfaction of medical workers in community medical institutions and secondary medical institutions was found declining dramatically.Conclusions Healthcare reform should pay more attention to these young people in terms of their own satisfaction,especially for those working at primary healthcare institutions.

Objective To find out about the intention of medical workers with regard to reward for personal services and explore the value of their labor. Methods An intention survey through questionnaires was conducted by means of random sampling among 1 424 medical workers from 6 hospitals in Shanghai with regard to reward for personal services and a model of expected income was obtained via multivariate stepwise regression analysis. Results Only 2.9% of the medical workers felt satisfied with their current total income. Such factors as professional titles, educational backgrounds, working years, and specialties all exerted some impact on the medical workers expected income. The expected income was several times that of the actual income, and there was a large difference between the expected incomes of people at different levels. Conclusion Reward to medical workers for personal services in China needs to be enhanced and reform of the distribution system should keep step with the reform of the personnel system.