d infrastructure quality.Conclusions Raising responsiveness for special medical services will be conducive for improving the quality of non-medical services for these inpatients when they are in the hospital.

An analysis is made on major issues and difficulties in the application of the performance appraisal system structure,appraisal model and appraisal outcomes.It was discovered that the performance appraisal system,if used in clinical medical technology departments in the hospital,should focus on the system itself,the appraisal process and re-improvement of the system.These three factors are key to determining whether the system is effective and efficient,and key to transforming the system into departmental and hospital performance,even into overall enhancement of hospital performance in general.

Objective The sponge of the small intestinal submucosa(SSIS) is established by the material chemistry,in order to supply the database for the scaffold of the dermic tissue engineering.Methods At the regular temperature,the SSIS was conducted firstly by the physiochemical method.Then,the SSIS was crosslinked by the 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) so as to get the three dimentional SSIS.The morphological feature was obtained by the lighting and electron microscope,ophthalmic oberservation,the embedding in the mouse of the SSIS was used to observe the adsorbing and immunology.The results were analyzed by statistic software.Results The crosslinked SSIS was regular in the structure and not loosen,the framework was equilibrium,the pore was abundant with the diameter of the 100 ～ 200μm,the difference was obvious (all P ＜ 0.05).The firstweek after embedding did not exist the adherence leukocyte infiltration,the vascularization occur in the third week.The material was completed and had no elastic degradation.Conclusion Reconstructed SSIS has completed structure,elastic with the vascularization and minor immunology,which could be used as the extracellular scaffold for the dermic tissue engineering.

Objective To set up the method of estimation of age for Chinese girls at the age of 11-16 years according to their characteristic of radiographic changes in articulations of bone. Methods The samples of the X-ray photograph were come out of 6 articulations of humeri, cubiti, manus, coaxe, genus and ankle from 150 girls, ranging in age from 11-16 years old, in Henan province, North of China. The radiographic characteristics of osteoepiphysis at these joints were observed carefully and classified. The data were analyzed with the SPSS package. Result Regression equation was made for radiographic determine of age for Chinese girls at the age of 11-16 years. Conclusion The equation can be used for forensic practice about the determine of age.

Objective To analyze the flow tendency of elderly patients,create a better mechanism to help guide elderly patients to form a good order in seeking medical care,and consequently improve the resource operational efficiency in medical service.Methods Analyzing the data by the descriptive,χ2 test and logistic regression of SPSS 20.0.Results Elderly patients prefer community health service centers and tertiary hospitals;of those visiting tertiary hospitals,nearly 30% seek medical advice for common chronic diseases.Main influencing factors for patient flow are medical insurance coverage and education. They tend not to embrace the two-way referral service,due to such factors of inconvenient process and defective mechanisms.Conclusion Transition from medical demand management to medical supply management.Such factors as quality cost,expense cost,time cost,and public opinion cost should be used to replace and weaken their mindset of the medical hierarchy,and embrace the concept of “seeking medical advice by grades”,thus improving the utilization of medical resources,and optimizing medical service accesibility.

Objective To observe the influence of Shenkang injection with Irbesartan on urinary albumin excretion rate(UAER)in 24 hours,serum lipid and blood rheology in early diabetic nephropathy.Methods One hundred and fifty normotensive early diabetic nephmpathy were randomly divided into control group,Shenkang injection group and Shenkang injection with Irbesartan group.Three groups were treated with diabetic education,dietary regimen,suitable physical activity and oral anti-hyperglycemic agents till their fasting blood glucose(FBG)was less than 7.0 mmol/L and postprandial blood glucose(PBG)was less than 10.0 mmol/L.The control group was treated with oral anti-hyperglycemic agents or/and insulin.Shenkang injection group was additionally treated with Shenkang solution.Shenkang solution was mixed by Shenkang injection 100 ml,5% glucose 250 ml and insulin 2-3 U.Shenkang solution was intravenously guttaed once a day.Shenkang injection with Irbesartan group was additionally treated with Irbesartan 0.15 g,once a day,taken orally.A course was taken for 3 weeks.The levels of UAER,serum lipid and blood rheology were detected immediately and 9 weeks after treatment.Results In the Shenkang injection group,compared with those before treatment,them were significant difference in UAER (87.44 ±10.06)μg/min vs.(116.55 ± 33.42)μg/min),serum lipid( (4.22 ± 0.70)mmol/L vs.(4.88 ± 0.69 )mmol/L)and blood rheology( (5.77 ±0.53)mPa·s vs.(7.38 ± 0.41)mPa·s)(P ＜ 0.05).In the Shenkang injection with Irbesartan group,compared to those before treatment,there were also significant difference in UAER ( (61.90 ±28.02)μg/min vs.(123.37 ± 29.98)μg/min),serum lipid( (4.00 ± 0.14)mmol/L vs.(4.90 ± 0.12)mmol/L)and blood rheology( (5.11 ±0.41)mPa·s vs.(7.27 ± 0.44)mpa·s)(P ＜ 0.05).Whearas in the control group,no significant difference were found compared with those before treatment.Furthermore,the improvements in the Shenkang injection with Irbesartan group were better than those in the Shenkang injection group(P ＜ 0.05).Conclusions Shenkang injection can reduce UAER,decrease serum lipid and improve renal blood rheology.Iteffectively prevents diabetic nephropathy in earlier period and maybe have synergy with Irbesartan.

Objective To understand the undergraduate nursing students’ awareness of the basic situation of occupational exposure in Kunming Medical University, and to understand their knowing status of occupational exposure knowledge. Methods We used self- designed questionnaire to investigate 449 undergraduate nursing students in Kunming Medical University to obtain the status of occupational exposure and protection knowledge level of students.Results (1) 449 students were investigated, and 258 of them had been in clinical practice, and occupational exposure occurred in 48.8% of them. (2) Occupational exposure factors included grade, washing hands and wearing gloves;The results showed that:Grade was a risk factor and wearing glove and washing hands were protective factors. (3) There was relevance between accepting the occupational protection education and the occupational exposure. Conclusions A useful measure to reduce the occurrence of occupational exposure is Pre-service training for undergraduates nursing students. Operation should be in strict accordance with operating specifications. Schools and departments should implement occupational protection system, so as to strengthen the related knowledge vocational education,enhance self-protection awarenes,and reduce or minimize the occurrence of occupational exposure.

Objective To detect the physical and psychological function of traditional Chinese emotional nursing versus normal nursing on coronary heart disease patients. Methods Searching the major clinical databases of Cochrane library, PubMed, China National Knowledge Infrastructure, Wanfang database and VIP database to collect the relevant randomized controlled trial (RCT) about routine nursing combined with traditional Chinese medicine emotion care on coronary heart disease. After study selection, assessment and data extraction for RCT according to the inclusion and exclusion criteria, Meta-analysis were performed by using the RevMan5.2 software. Results Fourteen relevant studies as much as 1 164 patients were included in the study. Compared with the normal therapy, the figures support that the Chinese medicine emotional care group had a better curative effect (Z=6.74, P<0.01, OR=0.21, 95%CI:0.15-0.26), and the score of Hamilton Depression Scale (Z=8.84, P<0.01, MD=6.64, 95%CI:5.11-8.18), Self-Rating Depression Scale (Z=4.79, P<0.01, MD=8.21, 95%CI:4.89-11.66), and Self-Rating Anxiety Scale (Z=11.15, P < 0.01, MD=8.23, 95%CI:6.79-9.68) were all significantly decreased. Conclusions Compared to the conventional nursing combined with traditional Chinese emotional nursing and coronary heart diseaseroutine nursing care, the degree of depression and anxiety in patients is decreased significantly, and the total clinical efficacy is dramatically increased. However, the original study of quality constraints, muchmore high-quality, large sample of RCT is needed for further demonstration.

Objective To investigate the dynamic changes of microglial polarization at the perihe-matoma area and provide timepoint evidence for interventing microglial polarization as well as studying the polarization mechanism after intracerebral hemorrhage ( ICH ) . Methods Healthy male Sprague Dawley (SD) rats were randomly divided into sham group,ICH-4 h,1 d,3 d,7 d and 14 d groups with 6 in each group. The rats in ICH groups were injected collagenase VII-s into the caudate nucleus to establish the in-tracerebral hematoma model and rats in sham operated group were treated with the same amount of saline. The brains were taken at 4 h,1 d,3 d,7 d,14 d in the ICH group,1 d in sham group. Microglia typeⅠ( M1, CD11b++CD86+) and microglia typeⅡ( M2,CD11b++Arg-1+) were examined by immunofluorescence and the number of M1 and M2 around hematoma were analyzed. Results ( 1) The M1 and M2 were both ob-served at 4 h after ICH and a small quantity of branches were still presented on M1. ( 2) M1 took the main position in acute stage (1~3 d),early subacute stage(3~7 d) and chronic stage (>14 d) after ICH.The number of M2 was elevated transiently in superacute (<24 h) and late subacute stage (7 d).The number of M2 (31.40±1.69) was more than M1 (21.43±1.81) at 4 h after ICH ( t=- 4.085, P=0.002),and the number of M2 (116.25±5.06) significantly exceeded M1 (85.75±7.32) again on day 7 ( t=-0.690, P=0.001). Conclusion M1 is in a dominant position in acute,early subacute and chronic stages after ICH;M2 is dominant in superacute and late subacute stages. Investigating the mechanism of M2 formation at acute period ( such as 4 h) or late subacute stage ( such as 7 d) ,and inhibiting M1 formation in the early subacute stage ( 1~3 d) have important significance for clinical treatment of ICH.

Objective To investigate the feasibility of Doppler ultrasonography in evaluating the vulnerability of carotid atherosclerotic plaque prospectively. Method A total of 44patients (46plaques) who performed carotid endarterectomy were continuously enrolled in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University from March 2019 to October 2019. Several examinations such as carotid Doppler ultrasonography (CDU) , CT angiography, CT perfusion imaging, and/or digital subtraction angiography were scheduled conventionally before surgery. Pathologic examination, including the plaque morphology, histopathologic hematoxylin eosin(HE) staining, and immunohistochemical CD31 staining, were evaluated after surgery. The plaque vulnerable score was calculated based on the parameters of CDU consisting of plaque morphology, characteristic of echo, fiber cap integrity, presence of ulcer, degree of vascular stenosis, assigned with 0 to 3 points, respectively. The plaque was defined as the vulnerable plaque if vulnerable score was more than 4, otherwise, the plaque was the stable plaque. Then the plaques were divided into vulnerable group ( n =36) and stable group ( n = 10) according to the pathological results. The patients were divided into the stroke group ( n = 33) and the non-stroke group (n = 11) based on the incidence of ischemic stroke within the last 6 months. The evaluation of neovascularization in the plaque was referring to the immunohistochemical CD31 staining. The independent-sample t test, Wilcoxon rank-sum test, and χ2test were used to compare the differences between the two groups in general data, laboratory tests, clinical symptoms, vulnerable scores, and the rates of vulnerable plaques. Kappa value was used to evaluate the consistency between CDU and histopathological HE staining in the evaluation of plaque vulnerability. Results ( 1) The differences in the National Institute of Health stroke scale score and neurological symptoms between the vulnerable group and stable group were statistically significant (all P < 0. 05). (2) The vulnerable score was significantly different between the vulnerable group and stable group (6.00 [5.00,7.00] scores vs. 4.00 [4.00,4.25] scores, P<0.01), and between the stroke group and non-stroke group (6.00 [5.00,7.00] scores vs. 4.00 [4.00,5.00] scores, P = 0.002). (3) Diagnostic efficacy: compared with histopathologic results, the sensitivity and specificity of CDU were respectively 88.9% and 8/10, positive predictive value was 94. 1% .negative predictive value was 8/12, and the Youden index was 68. 9%. The consistency between CDU and histopathological HE staining was strong ( Kappa = 0. 642, P < 0. 01). (4) Neovascularization; immunohistochemical CD31 staining showed neovascularization in vulnerable plaque; the microvessel density in vulnerable group was higher than that in stable group([2. 84 ± 1. 56] mm3vs. [ 1. 38 ±0. 61 ] mm3). (5) The relationship between plaque vulnerability score and ischemic stroke: the rates of vulnerable plaques in the stroke group was higher than that in the non-stroke group (88. 6% [31/35 ] vs. 3/11 ;χ2= 13. 286, P < 0. 01 ). Conclusion The plaque vulnerable score evaluating by vascular ultrasound can accurately and quantitatively assess the vulnerability of carotid plaques, and angiogenesis can be observed in the vulnerable plaque, which provides a theoretical basis for clinical diagnosis and accurate treatment.