Objective The turnover intention and the work states of the health technicians were investigated to analyze the influencing factors of turnover and the relationship between turnover intention and work state,to guide the health technicians who want to dimission to make a correct decision,and to make some suggestions to improve their work states.Methods Multistage stratified cluster random sampling method was adopted to survey 2903 health workers on the job of all the county-level public hospitals in Shandong Province by the questionnaire of the Fourth National Health Services Survey.Analysis methods included Two Logistic classification regression and three evaluation methods based on two weights.Results 32.4 percent health technicians had turnover intention.The risk factors of the turnover intention were as follows:medical department,bad assessments of the practice environment,low degree of the diversity of job skills,small level of improving the individual's capacity,low degree of job satisfaction,high degree of job autonomy,high requirement for the expression of individual emotions,high working pressure,high job burnout.The higher turnover intentions were,the lower synthetical evaluation scores of the work states were.Conclusion The county hospitals ought to pay more attention to the health technicians with high tumover intention,and to guide the health technicians who want to dimission to make a correct decision,and to make some suggestions to improve their work states through having a heart-to-heart talk,training,and career planning,etc.

Objective To provide a reference for prevention of trace elements deficiency in children by investigating the distribution and variation law of Ca,Cu,Zn,Fe,Mg of children in Beijing area.Methods Five kinds of trace elements( Ca,Cu,Zn,Fe,Mg) in peripheral blood of 7972 children of Beijing Children's Hospital for health examination from 2010 to 2011 were detected by atomic absorption spectrometer.The children were Beijing urban residents.They were divided into five age groups:infancy group ( 1 - 12 months,1506 cases),toddler age group ( 1 - 2 years,2766 cases),preschool age group ( 3 - 6 years,1918 cases),school age group (7 - 11 years,1576 cases) and adolescence group ( 12 - 18 years,206 cases).According to gender,each group was sub-divided into male and female group.The distributions of the 5 kinds of trace elements were analyzed among different age and gender groups.Results With the age increasing,the trend of the levels of Ca and Cu were downward,but the levels of Zn and Fe were upward,and the level of Mg was stable.For boys and girls,the levels of Cu in infancy group were (21.90 ±2.89) and(21.25 ±2.80) μmoL/L; in toddler age group,they were (21.76 ±2.78)and (21.29 ±2.69) μmol/L; in preschool age group,they were ( 21.32 ± 2.83 ) and ( 20.88 ± 2.84 ) μ mol/L; and in school age group,they were (20.81 ± 3.02 ) and ( 20.36 ± 3.37 ) μmol/L,respectively.The distribution of Cu showed significantly different among different gender groups ( t =4.640,4.475,3.290,2.894; P ＜ 0.01 ).In adolescence group,the levels of Cu were ( 19.53 ± 2.91 ) and (20.30 ± 2.90) μmol/L for boys and girls respectively and there was no significant difference ( t =- 1.796,P ＞ 0.05 ).In each gender group,the content of Ca,Zn,Fe,and Mg was not significantly different between boys and girls.It was common for the deficiency of Zn and Fe in all ages.Their total deficiency rates were 58.9％ and 19.2％.The deficiency rates of Zn and Fe in infancy were 67.7％ and 42.3％.Conclusions The distributions of Ca,Cu,and Mg in peripheral blood of children in Beijing become reasonable.Fe and Zn are deficient in different degree,and should be rationally used according to clinical guide.

Objective To study the changes of the contents of serum HDL subclasses in type 2 diabetic patients. Methods The contents of serum HDL subclasses in healthy controls (n=38) and patients (n=38) were determined by two-dimensional gel electrophoresis associated with immunodetection method. Results The contents of pre-?1, HDL(P

Objective:To explore the therapeutic effect of acupuncture plus Zi Shen Tiao Gan (Kidney-reinforcing and Liver-regulating) Decoction for perimenopausal women with insomnia.
Methods:A total of 126 eligible cases were randomly divided into two groups, 63 cases in each group. Patients in the observation group were given acupuncture plus Zi Shen Tiao Gan (Kidney-reinforcing and Liver-regulating) Decoction. Those in the control group were treated with the same acupuncture treatment as the observation group. The therapeutic effects were assessed after continuous treatment for four weeks.
Results:The total effective rate was 96.8%in the observation group and 74.6%in the control group. The comparison of the total clinical effects between the two groups was statistically significant (P<0.01). After treatment, the intra-group comparisons of SPIEGEL score were statistically significant in both groups (P<0.05, P<0.01);the inter-group comparison of SPIEGEL score difference between before and after treatment was statistically significant (P<0.05).
Conclusion: Acupuncture plus Zi Shen Tiao Gan (Kidney-reinforcing and Liver-regulating) Decoction for perimenopausal insomnia is affirmative in the therapeutic effect, and the therapeutic effect is better than simple acupuncture treatment.

Melorheostosis is a rare disorder of osteopathia. The clinical characteristics of melorheostosis in children is totally different from that in adults. The radiographic features of melorheostosis include the hyperostosis in endosteal on the one side of the cavum medullare and formed streakiness. The soft tissue contracture of the limb and joint deformities are the symptoms of melorheostosis. Here, the authors reported a melorheostosis case of 6 years old girl who suffered from severe valgus deformity of the right knee with permanent patellar dislocation. A surgical stabilization was applied with lateral soft tissue release, medial soft tissue stabilization and transferred the vastus medialis laterally (kinetic stability). After 19 years follow up postoperatively, the limb developed well in satisfied alignment with good function of knee joints, even participated in some sports activities. Other authors reported a similar case of melorheostosis with surgical treatment and achieved good outcomes in limb realignment and reduction. The further suggested that the surgical treatment should be produced before epiphyseal closure.

Objective　To evaluate the clinical value of detection of urinary interleukin-8（IL-8） in patients with lupus nephritis （LN）.Methods　Urinary levels of IL-8 were determined by using sandwich ELISA in 38 LN patients.Results　In the LN patients during the　stage　of　normal renal function and diminished renal reserve stage， urinary levels of IL-8 were significantly higher than those in healthy controls（P＜0.001），and urinary levels of IL-8 in the patients during diminished renal reserve stage were significantly higher than those in the patients during normal renal function stage（P＜0.01）.High IL-8 levels in LN patients were associated with high levels of erythrocyte sedimentation rate and lower levels of C3 complement components. Urinary levels of IL-8 in LN patients with microscopic leukocyturia were significantly higher than those without microscopic leukocyturia. In LN patients treated with cyclophosphamide （CTX） and prednisone， urinary IL-8 levels of post-treatment were significantly lower than those of pre-treatment（P＜0.01）. Conclusions 　Urinary levels of IL-8 may be a useful indicator for monitoring disease activity and degree of renal damage in LN. The mechanism of noninfective leukocyturia may be associated with the elevation of urinary IL-8 levels in LN. CTX and prednisone may have a significant effect on inhibiting the production of IL-8 in the immunocytes and renal intrinsic cells.

Objective To investigate the impact of ultrapure dialysate on long-term survival rate and complication in maintenance hemodialysis patients.Methods Seventy maintenance hemodialysis patients were selected,and they were divided into ultrapure dialysate group (36 cases) and control group (34 cases) by random digits table method.The 1-,3-,5-year mortality,death causes and the incidences of cardiovascular complication,infection,cerebrovascular accident were recorded.Results The 3-and 5-year mortality in ultrapure dialysate group were significantly lower than those in control group:30.6％ (11/36) vs.41.2％ (14/34) and 41.7％ (15/36) vs.82.4％ (28/34),and there were statistical differences (P ＜ 0.05).The mortality of infection in ultrapure dialysate group was significantly lower than that in control group:1/15 vs.21.4％ (6/28),and there was statistical difference (P ＜ 0.05).The incidences of cardiovascular complication,cerebrovascular accident,infection in ultrapure dialysate group were significantly lower than those in control group:47.2％ (17/36) vs.79.4％ (27/34),27.8％ (10/36) vs.41.2％ (14/34) and 41.7％ (15/36) vs.73.5％ (25/34),and there were statistical differences (P ＜ 0.05).Conclusion Ultrapure dialysate can increase long-term survival rate and decrease incidence of complication in maintenance hemodialysis patients.

OBJECTIVE: To compare the clinical effect between Gamma nail and proximal femoral nail (PFN) on the treatment for femoral intertrochanteric fractures in the elderly.METHODS: A total of 131 cases (39 males and 92 females; aged 70?81 years, mean age of 76 years) with femoral intertrochanteric fractures were collected from the Department of Orthopaedics, the Affiliated Changhai Hospital of the Second Military Medical University of Chinese PLA from January 2005 to January 2008. Femoral intertrochanteric fractures were classified based on AO system, including type A1 (n=56) and type A2 (n=75). All cases were randomly divided into Gamma nail group (n=65) and PFN group (n=66). Pre- and post-operative blood loss, blood transfusion volume, operating time, and length of stay were recorded, while the complications were detected following nail implantation. Functional changes of injured limbs were detected after 9 months.RESULTS: At 9 months after following up, there was no significant difference in blood loss, blood transfusion volume, operating time, and length of stay between the two groups before and after implantation (P> 0.05). Furthermore, complications did not occur during or after implantation. Six cases in the PFN group had infection in which of them had diabetes mellitus. There were no complications such as cutting out of femoral head, femoral shaft fractures, breakage of internal device or pushing out phenomenon. All cases got bone union at the final follow-up of nine months and did not get nonunion, delayed union of fractures or shortening of injured extremity.CONCLUSION: Gamma nail and PFN have equal effect on the treatment of femoral intertrochanteric fractures in the elderly.

BACKGROUND:As a traditional treatment for multilevel cervical myelopathy,nterior long-segmental decompression has the shortcomings of great operative trauma,high difficulty,low fusion rate,etc.,which can affect the postoperative efficacy.OBJ ECTIVE:To evaluate the clinical effects of three different anterior surgeries on multilevel cervical myelopathy.DESIGN:A comparative observation.SETTING:Department of Orthopaedics,Changzheog Hospital,the Second Military Medical University of Chinese PLA.PARTICIPANTS:Thirty-six patients with multilevel cervical myelopathy of 3 consecutive segments,who were surgically treated,were selected from the Department of Orthopaedics,Changzheng Hospital,the Second Military Medical University of Chinese PLA from June 1999 to June 2003,including 25 males and 11 females,35-62 years of age,the disease course ranged from 3 to 26 months. According to the clinical manifestations and imaging esults,they were diagnosed as multilevel cervical myelopathy,and they were not suffering from consecutive ossification of posterior longitudinal ligament and ossification of ligamenta flava. Informed contents were obtained from all the patients and their relatives.METHODS:All the patients were grafted with utologous bone. Autologous ilium or cancellous bone excluding vertebral body was filled into titan net or Cage,which were made of titan and characterized by high intensity,tolerance to decay,good biocompatibility,etc. According to the operative manner,the patients were divided into 3 groups:① two-level corpectomy with fusion group(long-segmental decompression group,n =11):There were 4 cases grafted with long-titan net,and 7 cases grafted with autologous iliac bone. Sub-total two-level corpectomy with fusion was performed. ②segmental decompression group(n =16):including 12 cases of titan net+cage graft,4 cases of autologous bone+cage graft. One-level decompression and sub-total single corpectomy with fusion were performed. ③three-level decompression group(n =9):Only discectomy without corpectomy was performed. After complete decompression,3cages were used to fill artificial bone or grafted with autologous bone.MAIN OUTCOME MEASURES:Cervical anteroposterior and lateral radiographies,flexion and extension radiograph were reexamined within 1 week and at 3,6 and 12 months postoperatively. The neurological function was assessed using the Japanese Orthopaedic Association(JOA) scoring method preoperatively and 3 months postoperatively. The total score was 17 points,the higher the score,the better the neurological function. The duration of operation,perioperative bleeding amount,length of stay,cost of hospitalization,graft fusion at 3 months postoperatively,improved JOA score at 3 months postoperatively were recorded in the three groups. The occurrence of postoperative complications was observed by means of return visit.RESULTS:All the 36 patients with multilevel cervical myelopathy were involved in the analysis of results. The mean duration of operation,mean perioperative bleeding amount and mean length of stay in the segmental-decompression group and three-level decompression group were obviously fewer or shorter than those in the long-segmental decompression group(P ＜ 0.05),and the average cost of hospitalization was obviously higher than that in the long-segmental decompression group(P ＜ 0.05). The postoperative improved JOA score and graft fusion rate were close among the groups(P ＞ 0.05).CONCLUSION:Segmental anterior cervical decompression is a recommendable technique for multilevel cervical myelopathy by comprehensively considering the fusion rate,recovery of neurological function,duration of operation,perioperative bleeding and length of stay.

Objective To investigate the value of dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) in differentiating serological negative early stage rheumatoid arthritis (RA) from osteoarthritis (OA)in hand. Methods Plain MRI, enhanced MRI of whole hand and DCE-MRI of single slice were performed in 53 patients suspected of RA or OA and 18 healthy volunteers. Twenty-three of them were diagnosed as RA,including 18 cases of serological negative RA and 18 of them were diagnosed as OA after 3 to 6 months follow-up. The contrast rate,slope, thickening of synovial membrane were measured on DCE-MRI in three groups and the MRI findings were also were detected in both RA and OA groups. The contrast rate and slope of synovial membrane were compared among three groups using rank sum test. The thickening of synovial membrane were compared among three groups using variance analysis. MRI signs of RA and OA group were evaluated with rank sum test Results The dynamic contrast rate of synovial membrane in RA group,OA group and control group was(100.78±61.96)%,(40.44±15.43)% and (23.56±9.14)%,respectively.Individually,RA group to OA group,u=3.101,P=0.002;RA group to control group,u=4.669,P=0.000;OA group to control group,u=3.482,P=0.000.The slope of contrast curve of synodal membrane of RA group,OA group and control group was 72.50°±13.34°,45.39°±9.94°,14.56°±5.75°,respectively.Individually,RA group to OA group,u=8.002,P=0.000;RA group to control group,u=17.102,P=0.000;OA group to control group,u=9.100,P=0.000.The synovial membrane thickening of RA group,OA group and control group was(3.3±0.5),(2.8±0.7)and (1.4±0.6)mm,respectively.Individually,RA group to OA group,q=2.622,P=0.011;RA group to control group,q=9.583,P=0.000;OA group to control group,q=6.961,P=0.000.Conclusion The quantitative index of DCE-MRI,including contrast rate and synovial membrane thickening may provide useful information for differentiating OA from semlogical negative early stage RA.The contrast rate and thickening of synovial membrane in RA group are higher than those in OA group.Many signs of MRI Can help differentiate OA from RA.