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

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.

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.

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 establish an HPLC method for the determination of thymol in thymol alcoholic solutions. Methods: An Agilent Eclipse XDB-C18(250 mm ×4.6 mm,5μm) column was used with the mobile phase of methanol-water (65∶35), the flow rate was 1. 0 ml·min-1 . the detection wavelength was 275nm, the injection volume was 10μl, and the column tenperature was 25℃. Re-sults:A good linear correlation of thymol was observed within the range of 60-160 μg·ml-1(r=0. 999 5). The average recovery was 101. 59% with RSD of 1. 39%(n=9). Conclusion:The method is quick, simple and accurate, which can be used in the determina-tion of thymol alcoholic solutions with good selectivity and sensitivity.

Objective To investigate the efficiency and safety of agkistrodon hemocoagulase on coagulation function in pa?tients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods In this prospective,randomized controlled trial,80 eligible patients accepted valve replacement were assigned to control group (n=20) and agkistrodon hemoco?agulase groups (H1, H2, H3) according to the different timing of administration. Twenty patients were given treatment 20 minutes before anesthesia induction (H1 group), 20 patients were given treatment 20 minutes after CBP (H2 group) and 20 patients were given treatment after CBP (H3 group). Coagulation parameters including prothrombin time (PT), activated partial thromboplas?tin time (APTT), thrombin time (TT), fibrinogen (Fib) and platelet (PLT) were detected 20 minutes before surgery (T0), immedi?ately after surgery (T1) and 24 hours after surgery(T2). Data of 24-h postoperative drainage of mediastinal and pericardial, dura?tion of mechanical ventilation, stay time of intensive care unit (ICU), the actual days of hospitalization and hospital costs were recorded. The clinical parameters were also recorded including blood transfusion after surgery, secondary thoracotomy, aller?gies, liver and kidney dysfunction, deep vein thrombosis and neuropsychiatric symptoms. Results Compared with control group, values of PT, APTT and TT at T1 and T2 were significantly lower in H1, H2 and H3 groups (P<0.05). Compared with T0, values of PT, APTT and TT at T1 and T2 were significantly higher in all groups of patients (P<0.05). Values of PT and TT at T1 and T2 were significantly decreased in H3 group than those of H1 group (P<0.05). The pericardial and mediastinal drainage, the duration of ventilation support within 24-h after surgery were significantly lower in H1, H2 and H3 groups than those of control group (P<0.05). There was no significant difference in the incidence of adverse events between groups. Conclusion Agkis?trodon hemocoagulase is safe and effective in patients undergoing cardiac valve replacement with cardiopulmonary bypass.

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 feasibility and efficiency of monitoring noninvasive respiratory effort and respiratory load-capacity ratio in patients undergoing weaning from mechanical ventilation by mean inspiratory pressure(Pi) which were calculated on the basis of the formula, Pi = 5 × P 0.1 × Ti, as well as the noninvasire tension index calculated from Pi(TTIi). Method Totally 12 patients undergoing weaning from mechanical ventilation were enrolled in the study and their underlying diseases included COPD( n = 9), ARDS( n = 2) and status asthmaticus(n = 1) respectively. Esophageal pressure(PesoM) was monitored via the insertion of esophageal balloon and corrected esophageal pressure(Peso) was acquired by subtracting elastic pressure of chest wall from PesoM. P 0.1, Maximal inspiratory pressure on esophageal pressure curve(MIPeso) and on airway pressure curve(MIPaw) was measured with conventional technique. Pi was calculated on Pi = 5 × P 0.1 × Ti. Pi and MIPaw were used to calculate the noninvasive tension-time index TTIi, whereas Peso and MIPeso were used to calculate the invasive counterpart TTIeso. Comparisons, Correlation and Bland-Altman agreement analysis were made between P0.1 and Peso as well as between TIIi and TTIeso. Results There were no significant differences between Pi and Peso as well as between TTIi and TTIeso(P > 0.05) ,and the correlation coefficients were 0.974 and 0.957 respectively. In the agreement analysis, the mean difference between Pi and Peso, and between TTIi and TTIeso were lower than the minimal values of(Peso + PiSB )/2 and of(TIIi + TTIeso)/2, respectively. Conclusions There is a good correlation between Pi and Peso as well as between TTIi and TTIeso, in which Pi is calculated calculated from P 0.1 and in turn the TTIi is calculated from Pi. The noninvasive indices including Pi and TTIi can be used to monitor respiratory effort and respiratory load-capacity in patients undergoing weaning from mechanical ventilation.