Objective To assess the efficacy and safety of sequential type artificial liver with regional citrate anticoagulation in patients with hepatic failure at high risk of bleeding.Methods Fifteen patients with hepatic failure at high risk of bleeding treated with plasma exchange(PE)plus continuous veno -venous hemofiltration (CVVH)for 4h anticoagulation selected anticoagulant citrate dextrose solution A (ACD -A),blood flow velocity was setted to 100 -120mL/min.In the former,ACD -A solution was delivered pre -filter,with the rate adjusted to maintain a postfilter ionized calcium (iCa2 +)level between 0.35 -0.45mmol/L.Before the extracorporeal blood returned to the patients, 10% calcium gluconate was infused to maintain a systemic iCa2 + level between 0.90 -1.20mmol/L.Hypoxemia and hypocalcemia were correctted before treatment.Acid -base changes,serum sodium,total calcium -ionized calcium ratio were recorded at 2h,4h and 6h during the treatment.Effective therapeutic time (the therapy was completed successfully)also was recorded.Results The total 38 sessions were performed,effective performance was 35 sessions. 3 sessions were stopped because of high transmembrane pressure.Acid -base change,serum sodium had no significant changes.Serum iCa2 + concentration was detected 110 times,16 times were below 0.9mmol/L,the lowest concentration was 0.62mmol/L.Convulsion of the limbs appeared two times because of hypocalcemia.The total calcium -ionized calcium ratio above 2.5 appeared totally 6 times.The events improved after augmented substitution fluid.All events presented in advanced hepatic failure.Conclusion Under closely monitoring and application of preventive measures, regional citrate anticoagulation sequential type artificial liver is safe and efective for patients with hepatic failure at high risk of bleeding.The application in patients with advanced hepatic failure still is cautious.

Objective To probe into the employment and turnover changes of health workers at township health centers,for analysis of the incentive preferences and methods characteristic of such people.Methods Questionnaire and interview investigations were made for 16 health centers to learn their personnel turnover from 2008 to 2010 in Junan county,Shandong province,and to learn their incentive preferences.Results Health workers of turnover tendency are mostly found among women,clinicians and nurses of college or above degree and those less than 39 years old.The top five incentive factors for such health workers are as follows:better working environment; better pay; better security for living; better hospital management; and better career development opportunities.Conclusion Township health centers should seize policy support of the health reform,by focusing on not only economic incentives such as the income and living conditions of health workers of turnover tendency,but also on non-economic factors such as career development opportunities.

Objective:This article discusses the status of the health behaviors of rural people with diabetes, to explore effect of doctors’ home-visiting on the behavior of patients with diabetes in rural areas, and to promote chronic disease management and public health service equalization in rural areas . Methods:Junan, Liangshan, and Pingyin counties in Shandong province were sampled using a multi-stage stratified sampling method, and data was collected from 401 questionnaires issued to people with diabetes. A chi-square test and multivariate logistic regression were used to analyze the determinants. Results:Only 52. 0% of diabetes patients received home-visiting from doctors in the surveyed rural areas. Doctors’ visiting works on medication behavior on time and appropriate exercise of patients with diabetes in rural areas was statistically significant, but did not work on measuring blood glucose and periodic review and other health-related behaviors. Conclusion:The rate of doctor home-visiting is low, and the effect is not obvious. More attention should be paid to the content and quality of doctors’ home visiting, and strong policies should support and guide it. According to the characteristics of the rural and patients behavior changing, it is necessary to take flexi-ble modes of health service, improve the diabetes management in rural areas, and promote the equalization of public health service.

Objective To investigate the benefit finding for caregivers of patients with cancer and its influencing factors. Methods Totally 330 couples of cancer patients and caregivers were investigated from October 2014 to September 2015 by convenience sampling method. The cancer patients were investigated with the Hospital Anxiety and Depression Scale. The caregivers of cancer patients were investigated with Benefit Finding Scale, Zarit Caregiver Burden Interview, Medical Outcomes Study Social Support Survey. Results The total score of benefit finding was (59.65 ± 11.12) points. Regression analysis indicated that caregivers' education, religious, informational and emotional support, caregiver burden, patients' depression symptom, cancer stage and self-caring were influencing factors of benefit finding for caregivers (t=-3.689-5.913, P<0.01 or 0.05), which explained 30.0% of the variance. Conclusions The caregivers of patients with cancer have a low level of benefit finding. Oriented by influencing factors of benefit finding, the health workers should enhance targeted interventions, promote positive perception in the process of caring, develop the quality of caring and life.

Objective Studying the status quo and constraints for rural healthcare service in grassroot rural healthcare units,for policy recommendations.Methods Using data from the fourth healthcare service investigation,by means of quantitative interview and qualitative interview,for an investigative interview of 348 township hospitals and 251 village clinics in 31 provinces in China.Results Deployment percentage of primary heahhcare services at township hospitals level is 49.1% (28.0/57),and that for village clinics is 60.6%(5.4/9).Conclusions The key to upgrading rural healthcare service system at grassroots level is to deploy better diagnostic equipments,upgrade the diagnostic competence of grassroots healthcare personnel and build a continuous service system for primary healthcare service.

OBJECTIVETo establish a animal model of biliary leakage in pigs with laparoscopy.

METHODSEight healthy Bama minipigs were subject to laparoscopic surgery under general anesthesia.The cystic duct was resected at 0.5-1.0 cm from the root and the stump was left open with the gallbladder removed. Blood routine and hepatic functions of the pigs were tested before and 24 h after the surgery, and endoscopic retrograde cholangiography (ERC) was performed 24 h after the surgery. At 48 h after the surgery, the pigs were sacrificed for observation of the stump of the cystic duct.

RESULTSThe gallbladder, cystic duct, cystic artery, and the anatomical relations between the gallbladder and liver and between the cystic duct and common bile duct were fully exposed under laparoscopy. White blood cells, neutrophils and direct bilirubin increased significantly after the operation (P<0.05). The cystic ducts were resected at 0.5-1 cm away from the roots of the cystic ducts in 7 pigs and at 2 cm in 1 pig.

CONCLUSIONLaparoscopy is safe and feasible for establishing the porcine model of biliary leakage.

Animals ; Biliary Fistula ; Cystic Duct ; surgery ; Disease Models, Animal ; Female ; Laparoscopy ; Male ; Swine ; Swine, Miniature