Abstract: There are both market mechanism that does not work and government without working in the medical service field, so it is necessary to be supported by the third parties, such as patient's right committee, doctor's association, and so on, which contribute to forming high-efficient and rational medical care pricing system.

Extracorporeal membrane oxygenation(ECMO)is more and more widely used in children as a supporting technology for cardiopulmonary organ failure, but bleeding and thrombus are still the most common and serious complications during the use of ECMO.Heparin is the most commonly used anticoagulant in children with ECMO.Activated clotting time, activated partial thromboplastin time, and anti-Ⅹa activity are often monitored to guide the dosage of heparin.However, the optimal dosage of heparin and the appropriate monitoring method are still unclear.This study aimed to summarize the research progress of anticoagulation and monitoring methods in children′s ECMO.

The elderly in the community who is the focus of the family doctor services , because of his special physical and mental condition , their demands for health care services showing the features of dependence , Recur-rence and urgency .Therefore, as the provided entity of community health service , the family doctor should care for the elderly in the community .In order to promote the realization of Healthy aging , we can build the system of the humane care for the elderly in the community , through the education and guidance of health、conducting psychologi-cal counseling , providing emotional support、building family sickbeds , providing regular visits、emphasizing clinical narrative, establishing mutual participation model and other measures .

The therapy of acute promyelocytic leukemia (APL) with all-trans retinoic acid and arsenic trioxide was first discovered in China, which made a great contribution worldwide to APL treatment. However, foreign guidelines did not include the Chinese chemotherapy regimens, and our regimens were inconsistent with foreign guidelines. Therefore, it is necessary to interpret the home and international guidelines and to explore standard treatment of APL by analyzing APL guidelines of the China, Europe and the United States. Owing to several discrepancies between domestic and foreign APL guidelines, unifying the APL's diagnosis and treatment standard is desperately needed at present according to the evidence-based medicine. It is hoped that Chinese chemotherapy regimens will be more acceptable to other countries of the world, and would benefit the diagnosis and treatment of human APL.

In recent years , with the development of medical health and the progress of economy , the citizens'demands for daily health are improved continually , and health services need to be rapid development .However , in the principle of medical ethics and humanism humanistic care of patients , it is easy to ignore the other two key as-pects -the medical staff and patients with the family .This paper analyzed the emotion and psychology of patients'families and medical staff in caring for the patients and corresponding solutions , so that the three can effective communication to build a harmonious doctor -patient relationship , and then promote patient recovery and be advan-tageous to the long-term development of the reform of health services .

With a long duration of the CHB, patients who have economic pressures and physical problems will get changes in their psychological status, which are involved in the development of the disease. Moreover, poor thera-py compliance and insight of their disease, negative mood of anxiety and depression also have effects the prognosis of disease. Therefore, mental factors play a vital important role in the development and prognosis of CHB patients, health education and mental intervention are the most effective way to avoid the psychological disorder of patients.

This paper mainly discussed the present situation of the pension mode transformation from traditional family pension to social pension. The existing ethical issues in pension institution include: old filial piety thought deeply rooted;institutional care services cannot be carried out caused by unfair distribution balance; humanistic thought of human ethical care implementation does not do well; some agencies have occasional bad behavior. Therefore, this paper proposed some advices based bioethical perspective:for old people and their children, advo-cate the new filial piety;pension institutions not only improving the quality of the hardware but also should strength-en humanistic ethics concern;establish and perfect the laws and regulations, combining the rule of law with moral and ethical;the relevant government departments should insist on and strengthen the principle of fair justice.

Objective To study and observe the clinical efficacy of using non skid plate by posteromedial approach for fixing splitting or compression tibial plateau fracture.Methods Twenty eight cases of patients who were treated for fixing splitting or compression tibial plateau fracture from January 2014 to January 2016 in people's hospital of Xinyu were retrospectively reviewed.All patients were treated byposterior medial approach with non skid plate for fixation,all patients were followed up by postopera tive imaging and clinical follow-up to observe its clinical curative efficacy.Results Twenty-eight patients were followed up,the mean follow-up time was 12 months.All patients had no internal fixation loosening fracture,send,vascular and nerve damage and other adverse reactions.All the patients were healed within 4 to 7 months,the average healing time was 18.5 weeks.After healing,knee joint function was evaluated,18 cases were excellent,5 cases were good,the excellent and good rate was 82.1 ％.Conclusion The efficacy of using non skid plate by posteromedial approach for fixing splitting or compression tibial plateau fracture is good,it is worthy of clinical application.

Doctors must carry out informed consent in medical treatment.However,to ensure patients' rights and interests mostly,this obligation needs exempted in some special cases.This article studies the insufficiency in the existing regulation on doctors' obligations exemption.It also lists some constructive suggestions based on the existing theory to solve this problem.

Objective To analyze the therapeutic effect of the radical operation for gastric cancer in elderly patients and to investigate relevant factors affecting the efficacy Methods 216 cases of elderly patients with gastric cancer were divided into two groups:radical distal-and proximal-gastrectomy group (n=108,each).The therapeutic effect in the near future,intraoperative and postoperative recovery,numbers of lymph nodes resection as well as factors affecting the long-term survival rate were compared between two groups.Results The radical distal-versus proximal-gastrectomy group showed that the mean operation time was (241.8 ± 40.2) min vs.(244.7 ± 39.7)min,blood loss was(299.5 ± 114.9) ml vs.(273.8-± 121.4) ml,the number of lymph node dissection was(28.4± 9.4) vs.(27.7 ± 9.1) particles,the complication rate was[14/108 (13.0％)] vs.[15/108 (14.0 ％)],3-year survival rate was (46.9 ％) vs.(47.5 ％),without statistically significant differences (all P ＞ 0.05).Multiple regression analysis showed that TNM stage (OR =1.536),lymph node metastasis(OR =0.739),cancer infiltration depth (OR =1.534) and chemotherapy regimens (OR =1.337)are risk factors for the postoperative 3-year survival rate.Conclusions Surgical treatment of elderly patients with gastric cancer is significantly effective,TNM stage,lymph node metastasis,depth of invasion,tumor size and the chemotherapy regimens are closely associated with the life quality of patients.