Objective Overall evaluation of the outcomes of the 10,000 primary care doctors to rural households campaign in Jining city,to provide a reference for further implementation of the policy.Methods Multi-stage stratified random sampling method was used for field questionnaires and interviews of rural residents,village doctors and medical workers sent from cities engaged in the campaign.Results The 90.0％ of the rural residents under contract feel satisfied with the level,items,attitude and activeness of the service provided by doctors from cities; 98.3％ of the village doctors said they have been trained by medical workers from cities; 87.0％ and 68.4％ of the village doctors and such medical workers hold that this campaign helps with sinking high quality health resources into rural areas.Conclusion The campaign and policy are conducive to upgrading health service in rural areas,which can be proliferated with further optimization.

Horn-Meter model was used to analyze the problems and obstacles in the10,000 primary care doctors to rural households campaign in Jining city,in terms of policy objectives sand standards,policy resources,institutional characteristics,execution mode,policy implementation environment,and preferences of those who carry out the policy.Based on the energy level and person-post matching,a policy sustainable development model was built and demonstrated,for policy recommendations of optimization and promotion.

Objective To study the comparison of the therapeutic effect of Ultrasound guided and freehand botulinum toxin type of the treatment in children with cerebral palsy.Methods From March 2014 to September 2016,98 cases of children with cerebral palsy in our hospital by injection of botulinum toxin were treated.According to the way of injection,the children were divided into ultrasound group and free group(n =49).They were respectively gave botulinum toxin injection by guided Ultrasound guided and freehand ultrasound injection of hotulinum toxin injection.The amount of two groups of children was 3U/kg.Children muscle spasm degree of before and after treatment was assessed by modified Ashworth spasm scale.And exercise capacity of children before and after treatment was assessed by the gross motor function rating scale.The follow-up time was 3 months,the clinical curative effect of two groups of children was observed.Results The total efficiency of ultrasound guided group (98.0％) was significantly higher than the free group (79.6％),with statistically significant (P ＜ 0.05).Both groups before and after treatment in children with Ashworth score and GMFM score were significantly improved,with statistical significance (P ＜ 0.05).Ashworth score and GMFM scores of ultrasound guided group were significantly better than the free group,with statistically significant (P ＜ 0.05).Conclusion Botulinum toxin injection in the treatment of cerebral palsy children can effectively solve the spastic problem.Treatment of children with cerebral palsy by injecting botulinum toxin with ultrasound guided injection of botulinurn toxin is better than manual injection of botulinum toxin.

Objective To compare the clinical effects of 2 common installation positions of the helical blade in the treatment of senile intertrochanteric fractures with proximal femoral nail antirotation (PFNA).Methods From January 2010 to December 2012,166 old patients with intertrochanteric fracture were treated by PFNA.According to the installation position of the helical blade in the femoral head on the postoperative X-ray films,they were divided into a C/C group (87 cases) where the helical blade was at the center of the femoral head in both anteroposterior and lateral views and an I/C group (79 cases) where the helical blade was at the inferior one-third of the femoral head in anteroposterior view and at the center in lateral view.There were no significant differences between the 2 groups in general data preoperation (P ＞ 0.05).The 2 groups were compared in terms of reduction quality,tip-apex distance (TAD),full weight bearing time,fracture healing time,and Harris Hip Score(HHS) at the last follow-up.Results C/C group had 83 patients followed for an average of 13.6 months and I/C group had 76 patients followed for an average of 13.3 months.There were no significant differences between the 2 groups regarding the good-to-excellent reduction rate [94.0％ (78/83) versus 94.7％ (72/76)],full weight bearing time (9.4 ± 1.5 weeks versus 9.3 ± 1.3 weeks),fracture healing time (17.8 ±2.3 weeks versus 17.2 ±2.3 weeks),or HHS (89.6 ±4.6 points versus 89.3 ±4.7 points) (P ＞ 0.05).There was a significant difference in TAD (21.14 ± 3.17 mm versus 24.96 ± 3.48 mm) between the 2 groups(t =-7.242,P =0.000).No infection or cut-out or other related complications of the helical blade occurred in either group.Conclusion The helical blade may lead to satisfactory clinical effects in the treatment of senile intertrochanteric fractures with PFNA no matter at which of the 2 positions it is installed.

OBJECTIVE:To observe therapeutic efficacy of ulinastatin in the treatment of acute pancreatitis. METHODS:A to-tal of 80 acute pancreatitis patients were randomly divided into control group and observation group,with 40 cases in each group. Control group was given conventional treatment as gastrointestinal decompression,analgesia and spasmolysis,anti-infective treat-ment,fluid replacement,electrolyte disturbances balance,in vivo microcirculation improvement;observation group was additional given ulinastatin 100 000 U added into 5% Glucose injection 250 ml,ivgtt,bid,on the basis of control group,and then given medicine qd after improving symptoms;finally,stopped taking medicine immediately the symptom disappeared. Both groups was given 8d of treatment. Serum levels of IL-6 and TNF-α were observed in 2 groups before and after treatment,and clinical symp-tom,the time of sign and lab index improvement were also observed. Clinical efficacy was evaluated. RESULTS:After treatment, serum levels of IL-6 and TNF-α in observation group was significantly lower than in control group;the time of clinical symptom and sign,lab indicator improvement were significantly shorter than in control group,with statistical significance(P<0.01). The ef-fective rate (95.00%) of observation group was significantly higher than that (70.00%) of control group,with statistical signifi-cance(P<0.05). CONCLUSIONS:Ulinastatin can significantly reduce acute pancreatitis significantly,improve clinical symptom, promote disease recovery and clinical efficacy.

Objective To explore the relationship between humor style and attribution style.Methods A total of 193 college students were studied by means of cluster random sampling with the Students Humor Style Questionnaire and the Multidimensional Multiattributional Causality Scale.Results (1) Self-enhancing humor had positive correlation with internal control,controllability and stability(r =0.293,0.308,0.172; P＜ 0.01).Affiliative humor had no positive correlation with attribution style.Aggressive humor and self-defeating humor had positive correlation with internal control (r =0.146,0.167 ; P ＜ 0.01),external control (r =0.402,0.339 ; P ＜0.01),stability(r=0.286,0.306 ; P＜0.01) and instability(r =0.296,0.227; P ＜ 0.01).(2) Self-enhancing humor could predict internal control and controllability significantly;and aggressive humor and self-defeating humor has significantly positive prediction to stability,instability,internal control and external control.Conclusion Humor style has significant correlation with attribution style.Humor style can predict attribution style in some degree.

Objective: To discuss the application value with two-dimensional ultrasound speckle tracking technique in the evaluation of left ventricular function in patients with OSAS. Methods: Selected 110 cases of hospital patients with OSAS in recent years, used STI technical analysis of left ventricular myocardium using different directions overall resilience, Left ventricular torsion and systolic mitral annular midpoint of the maximum displacement (MAD) and left ventricular ejection fraction (LVEF) relationship, performed using SPSS 17.0 statistical correlation analysis. Results: MAD had a significant correlation with LVEF(r=0.81, P<0.01); GLS(r=-0.74, P<0.01),GRS GRS(r=0.57, P<0.01),GCS (r=-0.55, P<0.01) and LVtw(r=0.65, P<0.01)were significantly associated with LVEF;MAD and GLs(r=-0.69, P<0.01),GRs (r=0.49, P<0.01), LVtw (r=0.45, P<0.01)were significantly associated;MAD and GCs (r=-0.39, P<0.05)with a negative correlation. Conclusion:STI resilience through the myocardium, ventricular torsion and systolic mitral annular maximum displacement at the midpoint of the analysis, can accurately evaluate left ventricular longitudinal, radial and torsional motion synchronization, highly correlated with left ventricular ejection fraction, good consistency, with a very broad application prospects.

Objective To compare the efficiency and safety of dezocine and morphine combined with flurbiprofen for gynecologic postoperative analgesia.Methods Ninty patients for elective hysterectomy,ASA (American Society of Anesthesiologists) Ⅰ - Ⅱ,were randomly divided into three groups,given postoperative intravenous analgesic pump:dezocine 50 mg + flurbiprofen 100 mg( Group D) ;morphine 50 mg + flurbiprofen 100 mg ( Group M) ;dezocine 25 mg + morphine 25 mg + flurbiprofen 100 mg ( Group DM ).Anesthesia were induced by midazolam,etomidate,fentanyl and cisatracurium,maintained with propofol and remifentanil.At 15 -30 min before the end of surgery,flurbiprofen 50 mg was given,if pain was not relieved statsifically,morphine 5mg/per time was given additionally.VAS Pain relief scores,Ramsay sedation Score,usage of morphine and side effects such as nausea,vomiting and itch of skin were recorded at 4,8,24,48 h after surgery.Results At 4,8,24 and 48 h after surgery,VAS score at sedation was ( 2.27 ± 0.64 ),( 2.17 ± 0.65 ),( 1.97 ± 0.67 ),and ( 1.60 ± 0.56) in Group D,and ( 2.50 ± 0.63 ),( 2.40 ± 0.62),( 2.20 ± 0.61 ) and ( 1.87 ± 0.57 ) in Group DM at sedation,which were all significantly low than those of ( 3.10 ± 0.76),( 3.00 ± 0.74 ),( 2.80 ± 0.71 )and (2.40 ±0.72)in Group M.At 4,8,24 and 48 h after surgery,VAS score at active was (3.10 ±0.76),(2.97 ±0.76),(2.70 ±0.84) and (2.17 ±0.70)in Group D,(3.43 ±0.63),(3.30 ±0.65),(3.03 ±0.76)and (2.43 ± 0.68 )in Group DM,which were all significantly lower than those of (4.13 ± 0.94),(3.93 ±1.05),(3.60 ± 1.05 ) and ( 3.03 ± 0.96 ) in Group M ( Ps ＜ 0.05).And the VAS scores of Group DM was significantly higher than those of Group D.Sedation score at 48 h after surgery in group D was better than that in Group M ( x2 =4.812,P ＜ 0.05 ),The side effects at 48 h after surgery was 26.7％ in Group D,46.7％ in Group DM and 80％ in Group M,and there significant difference among these 3 groups (P ＜ 0.05 ).Conclusion Compared to Morphine and or Morphine combined with Dezocine,Dezocine 50 mg + flumazenil 100 mg group is better to release the postoperative pain,and withless adverse effects.

Objective To evaluate the value of Disposcope-guided the left-sided double-lumen tube (DLT) intubation.Methods Fifty ASA physical status Ⅰ or Ⅱ patients,aged 47-69 yr,without difficult airway,scheduled for elective thoracic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:Disposcope (group D) and Macintosh direct laryngoscope (group M).Anesthesia was induced with iv injection of midazolam,propofol,sufentanil and rocuronium.Before induction (baseline,T1),before intubation (T2),immediately after successful intubation (T3),and at 1 and 3 min after intubation (T4-5),systolic blood pressure (SBP),mean airway pressure (MAP) and heart rate (HR) were recorded,and rate-pressure (SBP) product (RPP) was calculated.Arterial blood samples were obtained at T1-5 for measurement of plasma epinephrine (E),norepinephrine (NE),and dopamine (DOPA) concentrations.The success rate of DLT intubation at first attempt,total success rate of DLT intubation,intubation time,and development of sore throat within 24 h after surgery were recorded.Results Compared with group M,the intubation time was significantly shortened,the success rate of DLT intubation at first attempt was increased,the incidence of sore throat was decreased,and the levels of MAP,HR,RPP,E,NE and DOPA were decreased at T3-5 in D group (P ＜ 0.05).Compared with the baseline value at T1,the levels of MAP,HR,RPP,E,NE and DOPA were decreased at T3-5 in M group (P ＜ 0.05),and no significant change was found in D group (P ＞ 0.05).Conclusion Disposcope-guided left-sided DLT intubation provides significant clinical value.

BACKGROUND:Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods.
OBJECTIVE:To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques.
METHODS:Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups:fixation was accomplished with modified tension band wiring (wire group);modified tension band with braided cable (cable group);interfragmentary screws (screw group);cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows:(1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;(2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group.
RESULTS AND CONCLUSION:Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P<0.05). Under 5 000 N load of dynamic compression, similar compression among broken bone ends was visible among wire group and cable group, screw group and cannulated screw group (P>0.05). Dynamic compression was higher than static compression in the wire group (P<0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends.