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.

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.

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 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 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 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 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 analyze influencing factors of physicians' turnover intention at public county hospitals from career stage perspective.Methods Physicians career life was divided into three stages according to professional ranks and titles.The sample was drawn using stratified multistage random methods from public county hospitals in Shandong province and 677 questionnaires were completed,giving a 90.3％ valid response rate.Data were analyzed using multi-group stepwise linear regression.Results The percentage of responders with middle and high-level turnover intention was 23.0％and 6.5％ respectively,and there was no statistically significant difference in turnover intention across three stage subgroups.In physicians at stage 1,the most important factors to predict turnover intention were superiors ' appreciation (r =-0.22,P ＜ 0.05) and payment rationality (r =-0.21,P＜0.05),while in physicians at stage 2,the most important predicting factors were autonomy (r=-0.39,P＜0.05)and learning demand(r=-0.22,P＜0.05),and in physicians at stage 3 were career development(r=-0.31,P＜0.05)and autonomy(r=-0.21,P＜0.05).Conclusion Autonomy and workload are common factors of turnover intention with different predicting power across three career stages.Physicians adjust their career needs to self-actualization with development of career stage,so welltargeted incentives should be taken to stabilize the medical staff of public county hospitals.

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.

One hundred patients were diagnosed with coronary heart disease through dual-source CT coronary angiography (DSCTA) in our hospital,including 53 cases aged ≥60 y (elderly group) and 47 cases ＜60 y (middle-aged group).The curved-planar reconstruction (CPR),maximal intensity projection (MIP) and other post-processing reconstruction techniques were used to evaluate the indicators and differences of coronary stenosis ≥ 50％ ; the X-ray coronary angiography (CAG) findings were regarded as the gold standard.The evaluable rates of coronary arteries through DSCTA were 97.0％ and 98.6％ for two groups (P ＞0.05).The positive rate of coronary artery stenosis ≥ 50％ in elderly group was higher than that of middle-age group ( 12.6％ vs 9.0％ P ＜0.05 ).The rates of multi-vessel disease in elderly group (28.3％ ) was also significantly higher than that of middle-age group (6.4％,P ＜0.05 ).The sensitivity,specificity,positive predictive value and negative predictive value in evaluation of coronary artery stenosis ≥ 50％ for elderly patients were 92.3％,98.0％,88.0％ and 98.9％ respectively; those for middle-aged patients were 96.0％,99.0％,90.6％ and 99.6％ respectively ( P ＞0.05 ).DSCTA imaging provides an effective screening and evaluation method for coronary heart disease in elderly and middle-aged patients.