Since the launch of the comprehensive public hospital reform in Zhejiang Province, the price of medical services has been adjusted, and the charging structure of medical services has been improved. Likewise, medical insurance policies have been optimized. Through several price adjustment strategies, such as the“loosen-re-strain” policy, the labor of medical personnel has been better valued, the operation of public medical institutions has been stabilized, and the allocation of medical resources has been optimized. Hence, this paper aims to measure the achievements and drawbacks of the medical service price adjustments by analyzing the various strategy. It is suggested that the comprehensive public hospital reform should be further intensified via the advancement of coordination of healthcare, medical insurance and medicine, the exploration of new procurement mechanisms for drugs and medical equipment, the establishment of dynamic adjustment mechanisms for medical service pricing, the exploration of new management mechanisms for medical services, and the strengthening of medical service supervision.

Objective:To explore the effect of 3D printing periodontal bone defect model of anterior teeth combined with case-based learning (CBL) teaching mode in the standardized residency training of loose teeth fixation.Methods:Sixty general practitioner of stomatology students were equally divided into two groups, with one group receiving CBL teaching (CBL group) and the other group receiving 3D printing model combined CBL teaching (3D+CBL group). After the teaching, the teacher evaluated the overall practice effects, tested the residents' theory and practice scores, and designed a questionnaire to evaluate the teaching effect. SPSS 16.0 software was used for statistical analysis, and t test was used for comparison between the two groups. Results:The theoretical score (89.0±3.2) and the practical score (90.0±2.5) in the 3D+CBL group were significantly higher than the theoretical score (83.3±3.6) and the practical score (84.2±3.5) in the CBL group ( P<0.05). The questionnaire showed that the students of the 3D+CBL group performed significantly better than those in CBL group in the following eight aspects, including mastery of basic periodontal knowledge, professional knowledge of loose teeth fixation, ability to diagnose cases and formulate treatment plans, clinical operation ability, interesting teaching content, willingness to communicate with teachers, awareness of actively receiving patients, and satisfaction of standardized residency training ( P<0.05). Conclusion:The 3D printing periodontal bone defect model of anterior teeth combined with the CBL teaching mode has achieved good results in the teaching of loose teeth fixation, and it provides a reference for the application of 3D printing in clinical teaching for periodontology.

Objective To research clinical application of rotating platform knee prosthesis Gemini MK II in the total knee arthroplasty. Methods From August 2010 to July 2013, 87 patients (106 knees) underwent total knee arthroplasty using rotating platform knee prosthesis Gemini MK II. The average ages of the cases were 65.3 years (52-81 years). The clinical results were evaluated by the HSS knee rating score system as well as X-ray films. Results The patients were followed up for mean 24.2 months (7~40 months). The pain caused by the illness of knee obviously alleviated and the function of knee significantly improved. The complications such as osteolysis around the prosthesis, prosthesis loos-ening and dislocation of meniscus bearings were not found. The HSS knee rating score was (51.5±9.7) before total knee arthroplasty, which improved to (87.3±6.4), The difference was significant(P<0.01). Conclusion There are satisfactory results in a short time for rotating platform knee prosthesis Gemini MK II in the total knee arthroplasty. A long term follow-up is obviously necessary to make more precise statement about the knee replacement system.

Objective To evaluate midterm outcomes of thoracic endovascular aortic repair (TEVAR) with in situ fenestration (ISF) to revascularize the aortic arch vessels.Methods From Feb 2012 to Dec 2014,10 patients underwent TEVAR with aortic arch vessels revascularized via ISF.There were 6 patients of thoracic aortic aneurysms (TAA) and 4 of type B aortic dissection (TBAD).Patients were followed for all-cause mortality,endoleak of post-TEVAR,integrity and patency of aortic endograft and branch vessels.Results Totally 11 branch vessels [10 left subclavian arteries (LSA),1 left common carotid artery (LCA)] via ISF were revascularized in 10 patients.Patients were followed-up for 24-55 mouths,mean of 42.80 months.1 TAA patient died in 2 years post-TEVAR unrelated to the operation.All fenestrations remained patent,and there were no endoleaks and no occlusion,compression,or fracture of stents.There were no postoperative strokes and left upper limbs ischemia.1 patient had distal aortic endograft pseudoaneurysms formation in 2 years post-TEVAR and underwent reTEVAR treatment.Conclusion Aortic arch vessels revascularization via ISF in TEVAR is safe and feasible.Midterm outcomes is satisfactory.

Objective:To understand the activity concentration of 131I aerosol in the air of the iodine treatment workplace and estimate the internal dose of 131I inhaled by medical staff in nuclear medicine. Methods:Using CF-1001BRL portable large capacity air sampler, the 131I aerosol in the iodine treatment workplace of nuclear medicine department of 6 hospitals in Shandong province was collected by iodine box, and the HPGe-γ energy spectrometer was used to measure the samples. The 131I activity concentration in iodine treatment workplace at 6 hospitals was obtained, and the internal dose to medical staff was estimated. Results:The 131I activity concentration in the air in iodine treatment workplaces at 6 hospitals ranged from 3.64 to 2.94×10 3 Bq/m 3. The 131I activity concentration in the controlled area (ward, patient passageway, subpacking room, operation administration room) was significantly higher than that in the supervised area. The highest 131I activity concentration, 2.62×10 2 Bq/m 3, in the supervised area was found in the medical care passageway. The estimated effective dose to nuclear medicine workers was 0.07-5.68 mSv, not exceeding the national limit. Conclusions:The phenomenon of 131I aerosol contamination still exists in the iodine treatment workplaces of nuclear medicine departments in hospitals, so it is necessary to carry out internal radiation monitoring for nuclear medicine departments all around the country, and explore more reasonable protection standards and methods.

Objective:To investigate 131I activity in thyroid of workers at the place of radioiodine therapy and its main influencing factors. Methods:In terms of the types of hospitals, six hospitals that performed radioiodine therapy procedure were selected by quota sampling in the provinces of Shandong and Shanxi. 131I activity in thyroids of 76 workers at the place of radioiodine therapy was measured directly, and their internal doses were estimated. Results:131I activity in thyroids was found to be above the detection limit for 29 subjects (38.16%) in five hospitals. The maximum value of 131I activity was 2 468.45 Bq for a doctor who was responsible for manual distribution of radioisotopes. In general 131I activities in thyroid of workers at the place of radioiodine therapy of six hospitals were not significantly different ( P>0.05). But the measurement result in the hospitals where radioiodine was distributed manually were significantly higher than that in the hospitals where radioiodine was distributed automatically ( Z=1.75, P<0.01). Thyroid measurement result of 12 workers in two hospitals where radioiodine was distributed manually were all above the detection limit, with medians of 324.59 Bq and 331.98 Bq, respectively. The medians of 131I activities in thyroid of 12 staff in the remaining 4 hospitals were all below the detection limit. The detection frequencies of 131I above dose limit were 32.61%, 25.00%, 10.00% and 0. The measurement result for the doctors who participated in distributing 131I and the relevent cleaners were significantly higher than for the doctors who did not participate in distributing 131I at the same hospital ( Z=2.44, 2.12, P<0.05). Conclusions:There was a significant difference in the internal exposure level among workers at the different places of radioiodine therapy. Using automatic loading device could reduce the internal exposure level of the workers at the place of radioiodine therapy. It is necessary to strengthen the radiological protection for workers at the control area of the place of radioiodine therapy.

Objective:To understand the 131I activity in thyroid of therapy workers in nuclear medicine department, and estimate the annual committed effective dose, in order to analyze the internal exposure of them. Methods:Six hospitals were investigated and 131I activity of thyroid was measured. The detection rate and activity value of thyroid 131I activity of therapy workers in nuclear medicine department were obtained from the six hospitals, and then the intake and annual committed effective dose were calculated. Results:A total of 63 iodine therapy workers from six hospitals were measured and 131I was detected for 52 workers among them, with the detection rate of 83% and 131I activities mostly lower than 200 Bq. The estimated annual committed effective dose ranged from 0.23 to 7.78 mSv. The annual committed effective dose to 84.6% of the workers was less than 2 mSv. Conclusions:Iodine therapy workers in nuclear medicine department should receive routine internal exposure personal monitoring, and the radiation protection system in all hospitals needs to be further improved.

【Objective】 To evaluate the efficacy of Nd: YAG laser therapy adjunct to subgingival scaling and root planning (SRP) for treating severe chronic periodontitis. 【Methods】 We selected patients with severe chronic periodontitis whose teeth were distributed in 4 quadrants of the mouth, with probing depth (PD) of 5-8 mm, attachment loss (AL)≥5 mm and bleeding on probing (BOP). These teeth were randomly divided into three groups: SRP group, SRP+L group (Nd: YAG laser after SRP treatment), and L+SRP group (SRP after Nd: YAG laser treatment). We recorded parameters including BOP, PD and AL of the three groups at baseline and 8 weeks after treatment and made statistical analysis. 【Results】 At 8 weeks after treatment, BOP, PD and AL of the three groups were improved than those in the baseline (P<0.05). BOP positive percentage of SRP+L group and L+SRP group significantly reduced compared with SRP group (P<0.05). PD of SRP+L group significantly decreased compared with SRP group and L+SRP group (P<0.05), for sites with PD=7 mm, SRP+L group was significantly decreased compared with SRP and L+SRP groups (P<0.05). AL of SRP group significantly decreased compared with SRP+L group and L+SRP group (P<0.05). 【Conclusion】 Severe periodontal treatment with Nd:YAG laser adjunct to SRP is more effective in reducing BOP and PD, and for deeper pockets PD is significantly decreased in SRP+L group, but there is no advantage in the improvement of AL.