critical incidents are significant for the management of hospitals,and it may even be critical to the survival and development of the hospital.This article introduces a series of practices adopted by the First People's Hospital of Changzhou conducted in cases of crisis,and discusses the strategies and measures in hospital crisis management.

The compensation mechanism reform is the key and difficult point of the public hospital reform.Although current health care reform has been carried out including strengthening public welfare of public hospitals and adjusting the compensation mechanism,the effect is not very obvious.How to conduct the compensation mechanism reform orderly and smoothly has become an important topic.I have analyzed the historical evolution,the status and problems of the hospital compensation mechanism.On the basis I have made views and suggestions about the current drive and the path optimization for the compensation mechanism reform.

There are three kinds mainly of the present government worldwide management of public hospital management system and public service system.This paper compares the management system of public hospitals of the United States of America,Britain,Singapore and other countries,discussion of foreign public hospital public welfare system arrangement.With a view to put forward effective suggestions for the reform of public hospitals in China and public hospital regression public.

Objective To evaluate the significance of arthroscopy in diagnosis and treatment of acute posterior dislocation of the hip. Methods From August 2005 to April 2009, 32 patients with acute posterior hip dislocation underwent hip arthroscopy in our hospital. All patients were confirmed by symptoms, signs, X-ray examination and CT scan. There were 26 males and 6 females, at mean age of 38.5 years (range 23-55 years). An arthroscope was introduced to evaluate the intraarticular lesions routinely. Then, arthroscopic debridement was performed. Eight patients with acetabular fractures were treated by open reduction and internal fixation after arthroscopy. The Sanders scores were employed to evaluate the postoperative hip functions. Results Among 32 patients, there were 29 patients with loose bodies, three with tear of the ligamentum, 12 with labrum injuries and eight with acetabulum fractures that required a second stage open reduction and internal fixation. There were no complications of vessel or nerve injuries peri- or post-operatively. An average period of follow-up for 10 months (range, 5-24months) were available for all patients, which showed excellent results in 23 patients, good in five and fair in four according to the Sanders scores. Conclusion Hip intraarticular lesions can be evaluated and confirmed by the arthroscope, under which the loose bodies, tear of the ligamentum teres and labrum injuries can be cleared effectively.

Objective To investigate the effect of the serum Clara cell secretory protein and IL-6 levels by Xiyanping injection adjuvant therapy in children with mycoplasma pneumonia .Methods 72 cases of children with mycoplasma pneumonia from October 2014 to August 2015 in our hospital department of pediatrics were selected and randomly divided into the control group and the experiment group ,36 cases in each group.The control group were treated by erythromycin erythromycin, and azithromycin, the experiment group were treated on the base of the control group with Xiyanping injection.two groups of patients were treated for two cycles.The CRP, PCT, CCSP, IL-6 and adverse reactions were compared after treatment. Results After treatment,the clinical total effective rate in experimental group was higher than in control group (P<0.05),the CRP,PCT,CCSP and IL-6 levels were lower(P<0.05).The incidence of adverse reactions in the experimental group 8.33%was obviously lower than that of the control group 19.44% (P<0.05).Conclusion Xianyanping injection adjuvant treatment of mycoplasma pneumonia in children with significant clinical efficacy,can significantly increase serum Clara cell secretory protein levels,reduce CRP, PCT, IL-6 levels,improve clinical symptoms and with high safety.

Objective: To review the results with an approach of primary repair for tetralogy of Fallot (TOF) and double-outlet right ventricle (DORV) with anomalous coronary arteries. Methods: From June 1995 to June 2002, 12 patients with TOF and DORV associated with anomalous coronary arteries crossing an obstructed right ventricle outflow tract underwent primary surgical repair. To avoid injury of the anomalous coronary arteries, some modified surgical techniques were used. Main pulmonary artery translocation in 2 patients, repair under a mobilized left anterior descending coronary artery in 3, displaced ventriculotomy with subcoronary suture lines in 5, and the right ventricle outflow tract was repaired via the arteriotomy and/or pulmonary incision in 2. Results: There were no early or late death, and no myocardial infarction. Follow-up ranged from 3 months to 6 years, there were no residual leakage and obstruction of right ventricle outflow tract. Conclusion: Primary repair of TOF with anomalous coronary arteries can be done with excellent results. A proper surgical technique should be used during operation.

Objective To investigate the cause and development of atrioventricular block (AVB) occurred during and after transcatheter closure of ventricular septal defect (VSD), and to explore its feasible prevention and treatment. Methods From Mar, 2005 to Dec, 2005, 157 patients who suffered from congenital VSD underwent transcatheter interventional occlusion. Transient Ⅲ degree AVB occurred in 2 patients during the transcatheter therapy and Ⅱ degree AVB in 2 patients and Ⅲ degree AVB in 3 patients were observed 4 hours to 8 days after the therapy. Two of them suffered from Adams-Stokes syndrome. All patients were treated by intravenous injection of glucocorticosteroid, diuretic and dehydrator. One of them was also treated with temporary pacing. Results AVB did not re-occurred after the transcatheter closure in 2 patients who suffered from transient Ⅲ degree AVB during the transcatheter interventional therapy. The cardiac rhythm in 3 patients who suffered from Ⅲ degree AVB after the transcatheter closure reverted to sinus rhythm in 7, 8 and 18 days after the operation respectively. However, 2 of them suffered recurrent Ⅲ degree AVB after discharge, and one of them could not be restored to sinus rhythm. Three patients who suffered from the Ⅱ degree AVB resumed to sinus rhythm in 5, 7 and 8 days after the transcatheter closure respectively, and the type Ⅰ and the type Ⅱ of Ⅱ degree AVB alternated before the rhythm completely reverted. Conclusion AVB is a frequent complication during and after transcatheter closure of VSD. AVB occurred after transcatheter occlusion should be treated actively, or it may become permanent AVB. Improving the cardiac transcatheter interventional device and technique can prevent the high degree AVB in certain degree.

[Objective] To observe the effects of spleen-strengthening and kidney-invigorating prescription (SSKTP) on nutritional status in rats with chronic renal failure (CRF) . [Methods] CRF rat models were established by 5/6 subtotal nephrectomy. Rats were divided into group A (normal control) , B (model), C (high- dose SSKIP) and D (low-dose SSKIP). Contents of serum creatinine (Cr), blood urea nitrogen (BUN), C-reactive protein (CRP), urine Cr and hemoglobin (Hb) in peripheral blood , glomerular filtration rate (GFR), area body weight (ABW) index and pathological features of renal tissues were observed. [ Results ] In SSKIP groups, Hb content and ABW index were increased (P

Objective To evaluate the accuracy of core needle biopsy (CNB) in diagnosing breast masses and its coherence with immunohistochemical (IHC) examination results of estrogen receptor (ER), progesterone receptor (PR) and Her2 protein between pre-and post-chemotherapy in invasive breast cancer. Methods The results of 516 CNB cases from June, 2005 to April, 2008 were analyzed retrospectively. The pathological examination was performed by two pathologists independently. Results 484 cases of malignant tumor, carcinoma in situ and phyllodes tumor were found in this group with the sensitivity of 96.7%. Sixteen cases of false negative (3. 3% ) were demonstrated by surgical biopsy. The accurate rate of CNB was not influenced by the maximum diameter of masses ( P = O. 423 ). The agreement rate of IHC results of ER, PgR and Her2 between pre- and post-chemotherapy were 90. 3%, 76. 8% and 82.5%, respectively. Conclusion CNB is a useful diagnostic method with a satisfactory accuracy in any size of breast masses. Given the histological heterogeneity of invasive breast cancer and the influence of ehemotherapy, the coherence of prechemotherapy IHC for ER, PgR and Her2 is not optimal with that of post-chemotherapy.

Objective To explore the molecular regulation mechanism of asporin in the matrix synthesis and secretion of the intervertebral disc,and to clarify its role in degenerative lesions of intervertebral disc.Methods There were 8 cases of intervertebral disc tissue in patients with severe intervertebral disc herniation (including typical clinical symptoms,signs and Pfirrmann's grade Ⅲ).There were 6 male and 2 female with an average age of (20.25 ± 3.37) years old (ranged from 11 to 28 years).After primary culture and redifferentiation in alginate beads,cells were reseeded and treated with different concentrations of TGF-β1 for 6,12,18 and 24 h.Total RNA extracted from the cells and was subjected to real-time PCR analysis to examine the expression of asporin.After silencing the expression of endogenous asporin by siRNA,the cells stimulated 24 h with TGF-β1.Total RNA extracted from the cells and was subjected to real-time PCR analysis to examine the expression of asporin,collagen Ⅱ and proteoglycans.After treatment of specific p38 inhibitor or ERK inhibitor for 12 h,cells were stimulated with TGF-β1 for 24h.Protein extracted from the cells by protein extraction kit to examine the level of asporin.Results In the primary intervertebral disc cell experiment,TGF-β1 stimulation induced asporin transcription significantly in a dose and time dependent manner.After 24 h stimulation,a significant difference between different concentration groups (5,10 and 15 ng/ml) was observed,2.754±0.24,3.651 ±0.319 and 4.583±0.38,respectively (F=24.782,P=0.001).Knockdown of endogenous asporin led to the upregulated expression of aggrecan and collagen]Ⅱ (aggrecan:t=7.387,P=0.002,collagen Ⅱ:t=4.443,P=0.0113).Specific p38 inhibitor was used to block p38 phosphorylation,and TGF-β1 on asporin induction was significantly inhibited.Conclusion Our results have verified a functional feedback loop between TGF-β1 and asporin in human intervertebral annulus cells indicating that TGF-β1 can increase asporin expression,whereas asporin inhibits TGF-β 1 signaling pathway by negative feedback,thereby inhibiting TGF-β1 mediated synthesis of extracellular matrix,and TGF-31 can increase asporin expression by p38 in human intervertebral disc cells.