Objective To develop a fair performance appraisal method for clinical departments,as a reference for grading performance pay.Methods Ridit method with consideration of medical risks is used to evaluate clinical departments'performance.Results Both quality of care and medical risk are graded and overlaid,to arrive at the comprehensive values on which the performance pay is divided into grades Ⅰ,Ⅱ,Ⅲ,and Ⅳ.In this practice,values 7 ~8 is grade Ⅰ,6 grade Ⅱ,4 ~ 5 grade Ⅲ,and 2~3 gradeⅣ.Conclusion A fair and justifiable department performance evaluation system that is based on performance proves vital for the sustainable development of the hospital. Ridit method with consideration of medical risk evaluation advocates the performance appraisal principle of encouraging better performance,high risk and high efficiency.

Autophagy is a lysosomal degradation of intracellular material composition,and plays an important role in nerve cell survival and clear senescent cells and misfolded proteins.Autophagy can protect nerve cells,but also can be used as one of the ways about nerve death.Repeated seizures can cause brain damage,but the specific mechanism is not clear.Recent studies have shown that,convulsion can activate apoptosis pathway and start autophagy,which can mediate the adaptation,injury or apoptosis of neurons.Convulsion brain injury is closely related to cell autophagy.Autophagy as a new important signaling pathway can provide a new therapeutic direction of convulsion brain damage.

Objective To study the clinical effect of nerve stimulator combined with low back piexus sciatic nerve block for the arthroscopic surgery anesthesia. Methods 86 patients who required the arthroscopic surgery from March 2010 to March 2013 in our hospital were randomly divided into observation group (43 cases) and control group (43 cases). The observation group accepted nerve stimulator combined with low back plexus sciatic nerve block under the arthroscopic surgery;the control group adopted waist hard joint anesthesia during the arthroscopic surgery. Data of hemodynamics, effects of anesthesia, anesthesias maintaining time, rehydration fluids and adverse effect in both groups were recorded and compared. Results The time for preparation and control of anesthesia operation (Tr), time for feeling completely block (T1), time for recovery (T2), time for completely blocking (T3), time for movement recovery (T4) in observation group were significantly shorter than that of the observation group (P<0.05); the first time of urination (Tu) after operation was significantly longer in control group than that in the observation group (P < 0.05); MAP in the control group were lower than that in the observation group 20 minutes after anesthesia (T20,P < 0.05); complications in the control group were more frequent than that in the observation group. Conclusion The clinical effect of nerve stimulator combined with low back plexus sciatic nerve block for the arthroscopic surgery anesthesia is more obvious , especially for patients with relatively long operating time.

Objective To investigate the turnover and factors influencing amniotic membrane transplantation into corneal stroma.Methods Amniotic membrane stained with dichlorotriazinyl aminofluoresclin (DTAF)was implanted into the corneal stroma of 1 5 New Zealand white rabbits.After transplantation,we observed the clinical changes.The tissue samples from grafted area were observed with HE staining and laser confocal microscope to trace amniotic membrane at 4,8,13,1 7 and 22 week after surgery.And the tissue samples at week 22 after surgery from grafted area were also observed by transmission electron microscopy.Results After 4 weeks of operation, amniotic membrane tissue bent with visible multi-layer homogeneous red dye.The structure remained intact;basement membrane and stroma were no dissolved.After 8 weeks, amniotic tissue was a strip structure of homogeneous red dye,and the substance layer was complete.After 13 weeks,amniotic membrane morphology appeared fuzzy,but still took the shape of strips;a small number of corneal cells accumulated around the amniotic membrane.At 1 7 weeks after operation,fragmented amnion was evident.At 22 weeks after operation,small pieces of amnion tissue remained in the corneal stroma.Laser scanning confocal microscopy revealed that amniotic membrane could retain for over 22 weeks in the corneal stroma.After 22 weeks,amnion stroma collagen fibers that were integrated into the corneal stroma were irregular.Corneal stromal ultrastructure surrounding the amniotic membrane did not obviously change.Conclusion Retention time of amniotic membrane transplanted into corneal stroma can be as long as over 22 weeks and amniotic membrane can be merged into the corneal tissue as a substitute, which wins time for corneal transplantation operation.

ObjectiveTo explore the changes of serum macrophage migration inhibitory factor (MIF),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF- α ) levels,and the relationship with creatine kinase-MB (CK-MB) in children with viral myocarditis induced by coxsackie virus type B,and its clinical significance.MethodsSerum MIF,IL-6 and TNF- α levels were detected by enzyme-linked immunosorbent assay (ELISA) in 58 cases with viral myocarditis induced by coxsackie virus type B in acute phase (viral myocarditis group) and 40 cases hospitalized children (control group).CK-MB was measured by Hitachi 7180 fully automated clinical chemistry analyzer.ResultsSerum MIF,IL-6 and TNF-o levels of viral myocarditis group [ (59.15 ± 25.35 ),(68.52 ± 12.78 ),(85.31 ± 34.18) ng/L] were significantly higher than those of control group [ ( 36.78 ± 12.06 ),( 28.75 ± 16.03 ),( 52.91 ± 14.39 ) ng/L ] (P ＜ 0.01 ),and CK-MB of viral myocarditis group [(46.74 ± 23.89) U/L] was also significantly higher than that of control group [ ( 19.23 ± 11.56 ) U/L ] (P ＜ 0.01 ).There was positive correlation in children with viral myocarditis between MIF,IL-6,TNF- α and CK-MB (r =0.74,0.63,0.69,P ＜ 0.05).ConclusionsIt suggests that immune dysfunction exist in children with viral myocarditis induced by coxsackie virus type B.MIF,IL-6 and TNF- αmight take part in development of myocarditis,and the detection of them can evaluate severity of myocarditis.

With the rapid growth of incidence of non-small cell lung cancer (NSCLC),more and more studies have been made about its occurrence,development and metastatic mechanism m recent years.Researches about Fas/FasL protein expression and Fas/FasL-mediated apoptosis,immune escape mechanism and their roles in the pathogenesis,progression and prognosis of lung cancer are constantly emerging.Discussion about the roles of Fas/ FasL system in NSCLC could provide evidence for early diagnosis,prognosis prediction and new treatment of NSCLC.

Objective To explore the clinical efficacy of nasal irrigation for pediatric chronic sinusitis. Methods 92 children with chronic sinusitis were selected and randomly divided into treatment group(48 cases) and control group(44 cases) .The two groups were treated with routine clinical basic drugs,and the treatment group took nasal irrigation in addition.The efficacy after 1 month was compared, and then the patients were followed up for 3 months.Results The total effective rate of the treatment group was 91.7% after 1 month,which of the control group was 72.7%.After 3 months,the total effective rate in treatment group was 95.9%,which of the control group was 86.4%.There were statistically significant differences between the two groups in treatment outcomes( P=0.024, 0.011) .Conclusion The therapeutic effect of nasal irrigation for pediatric chronic sinusitis is obvious, safe and reliable.

Objective To evaluate the clinical effect of cluster nursing measures and conventional nursing measures to prevent the ventilator associated pneumonia.Methods The domestic related literatures were searched using computer,and the results underwent comprehensive analysis according to RevMan 5.2 in the Cochrane collaboration.The quantitative comparison of two different nursing measures in reducing the incidence of ventilator associated pneumonia was conducted.Results A total of 23 articles which contained 6 146 patients met the inclusion standard.Due to heterogeneity between the included studies,the random effects model analysis was adopted to merge the RR combined (Total)=0.46,95％ CI(0.38,0.56),showed that cluster of nursing measures to significantly reduce the incidence of ventilator associated pneumonia.Conclusions The effect of cluster nursing measures for ventilator associated pneumonia prevention is superior to the conventional nursing measures,which should vigorously be advocated in clinic.

This article selects chronic disease management research of academic literatures published in the national library in PubMed database from January 2000 to December 2013.Literature Bicomb co-occurrence analysis system was used for data extraction,analysis on the current international research achievements of chronic disease management,development situation and existing problems,reveal the research trend of chronic disease management and the status quo,which provided reference for the similar domestic research.

Purpose CT spectroscopy imaging was used in the preoperative differentiation evaluation of renal clear cell carcinoma, to access its malignant degree preoperatively, and to guide the operation treatment. Materials and Methods The spectral characteristics of 40 patients with renal clear cell carcinoma (RCCC) were analyzed retrospectively, all the RCCC patients underwent gemstone spectral imaging (GSI) scans, to obtain spectral serial images for the arterial phase and medulla phase. Spectral characteristic parameters and spectrum curve between different grades of renal cell carcinoma was compared, and the results were compared with pathology. Results Among the 40 cases of patients, carcinoma of grade I, II and III were 13 cases, 15 cases and 12 cases respectively. CT value ratio of renal clear cell carcinoma of grade I, II and III under 70 keV were 1.17±0.25, 0.84±0.85 and 0.64±0.19 (F=23.697, P<0.05) in arterial phase and 0.83±0.12, 0.64±0.07 and 0.54±0.08 (F=30.975, P<0.05) in medulla phase;iodine concentration ratio was 1.19±0.40, 0.60±0.10 and 0.25±0.94 (F=32.932, P<0.05) in arterial phase, and 0.69±0.18, 0.43±0.94 and 0.26±0.51 (F=28.673, P<0.05) in medulla phase. Spectrum curve slope of renal clear cell carcinoma of grade I, II, III in arterial phase was 4.00±1.24, 2.16±0.95 and 0.92±0.64 (F=23.392, P<0.05), and 3.54±1.20, 2.70±0.71 and 1.20±0.44 (F=24.272, P<0.05) in medulla phase. Differences of water concentration in arterial and medulla phase between renal clear cell carcinoma with different grade were not statistically signiifcant (P>0.05). Conclusion The differences of CT value, energy spectrum curve slope, iodine value under CT spectroscopy single energy imaging between renal clear cell carcinoma with different nuclear grade were statistically signiifcant, which can be expected to provide the basis for preoperative therapy selection.