It analyzed the structure and details of disease-based score payment,taking payment policy scheme in Huai-an and Nanchang for example.Disease-based score payment combined the globe budget control,payment of disease and point system to help controlling costs and incentive mechanism,which had certain achievement in the pilot areas.According to the research,it found that there were insufficient in the practical implementation,proposed the precondition for the popularization were higher medical agency capacity,establishing the negotiation mechanism with medical institutions and having intelligentized information system as the technical support.

Objective To investigate the correlations of the single nucleotide polymorphism (SNP) 344-35C/T of growth arrest-specificgene 6 (GAS6) gene and cerebral infarction in Han population in the western Guangdong province. Methods The restriction fragment lengthpolymorphism (PCR-RFLP) was used to determine the 344-35C/T polymorphism in the intron region of GAS6 gene in the case group (n=180) and healthy control group (n=150). Results There was no significant association between GAS6-344-35C/T and cerebral infarction (P<0.05). After stratified by gender in chi-square test in women population, the frequency of C allele was significantly higher in cases (77.9%)than that in controls (66.4%) (P=0.040); The frequency of the CC genotype was significantly higher in cases (61.8%) than that in controls(43.1%) (P=0.036). Conclusion In Han women in western Guangdong province, C allele of GAS6-344-35C/T polymorphism is a risk factorof cerebral infarction, CC genotype is a susceptible genotype of cerebral infarction.

Objective To investigate the effects of pharmaceutical interventions on parenteral nutrition.Methods Data collection sheet (with data,ward,patient general information,type of irrational prescribing,type of error,process of error,intervention content,and intervention results) for recording pharmaceutical interventions was designed.The prescriptions of total parenteral nutrition in our hospital from January 1st,2013 to December 31st,2013 were retrospectively analyzed.Pharmaceutical interventions were carried out for unreasonable prescriptions.Results A total of 6 454 prescriptions were reviewed during the research period,among which pharmaceutical interventions were provided for 154 prescriptions (2.39％).Totally 160 errors were identified,and 44 were prevented.The intervention acceptance rate was 98.70％.Conclusions Pharmaceutical interventions can adjust unreasonable prescriptions and modify errors.It is useful to promote the clinical drag use in a safe,rational,effective,and economical manner.

Objective To investigate the status of patient safety culture cognition and safety nursing behavior among nurses and examine the influence of patient safety culture cognition on safety nursing behavior of nurses using structural equation model. Methods A total of 350 clinical nurses were recruited in a hospital in Dalian with multi-stage sampling method. Patient Safety Culture Assessing Scale, Safety Behavior Scale were delivered to the investigation object. Results The mean score of the patients safety culture was 4.09±0.47, which was above average;the total score of nurses′safety nursing behavior was 4.74 ± 0.31, which was at high level; the causality model of patient safety culture cognition and the safety nursing behavior was accepted (path coefficient=0.35,P<0.01). Conclusions Nurses′ patient safety culture cognition has a significant impact on safety nursing behavior. Hospital should cultivate the awareness of the patient safety culture, so as to promote the safety nursing behavior.

Objective To observe the results of preventing knee postoperative adhesions after synovectomy by chitosan membrane. Methods Thirty-two New Zealand white rabbits were randomly divided into two groups, the chitosan membrane experimental group and the control group. All animals underwent synovectomy of the right knee joint. Chitosan membrane was inserted in the suprapatellar pouch areas in the experimental group, whereas no film was inserted in the control group. After operation, the knee joints were immobilized with a plaster cast for 4 weeks. Rabbits in each group were assessed macroscopically, semiquantitatively, biomechanically and biochemically. All quantitative data were analysed by t test. Results Macroscopical finding: dense fibrous adhesion was observed in the control group, whereas little adhesion was found in experimental group. The former groups scores was higher than the later groups(P

Objective:To explore the correlation among ECG indexes,myocardial enzyme peak and short term cardi-ac function in patients with acute anterior ST elevation myocardial infarction (STEMI).Methods:A total of 150 pa-tients with acute anterior STEMI were selected from our hospital.According to left ventricular ejection fraction af-ter three months (3m LVEF),they were divided into cardiac dysfunction group (n=78,LVEF<50%)and normal cardiac function group (n= 72,LVEF≥ 50%).Following indexes were compared between two groups,including sum of ST elevation extent (ΣST),R wave (ΣR),Q wave (ΣQ),maximum value of ST elevation (STm)and Q wave (Qm)etc.on infarct related leads,and peak value of creatine kinase (CKm),CK isoenzyme (CK-MBm)and cardiac troponin T (cTnTm)etc.Results:Compared with normal cardiac function group,there were significant rise in ΣST,ΣQ,STm,Qm,CKm,CK-MBm,cTnTm,left ventricular end-diastolic diameter (LVEDd),3mLVEDd and significant reduction in ΣR and LVEF,3mLVEF in cardiac dysfunction group,P <0.05 or <0.01;Spearman correlation analysis indicated that ΣST,ΣQ,STm,Qm,CKm,CK-MBm and cTnTm were positively correlated with 3m LVEDd (r =0.18~0.63,P <0.05 or <0.01),and inversely correlated with 3m LVEF (r =-0.88~-0.42, P <0.01 all).ΣR was inversely correlated with LVEDd and 3m LVEDd (r =-0.46、-0.51,P <0.01 both),and positively correlated with LVEF and 3m LVEF (r =0.81,0.71,P <0.01 both).Conclusion:In patients with ante-rior STEMI,the higher ST elevation,the higher Q wave,the lower R wave,the higher myocardial enzyme peak is, the poorer short term cardiac function is.

BACKGROUND: The biomechanics of cervical spine is complicated. It is an important way to select the appropriate biomechanical model and research method so as to explore the diagnosis and evaluation mechanism of cervical spine injury and prognosis judgement.OBJECTIVE: To discuss the alternation of cervical biomechanics after the degeneration of cervical disc and the influence of degeneration on cervical stability.METHODS: (1) A three-dimensional finite element model of cervical spine was established from the CT scan images of cervical spine of a healthy male volunteer, Solid-Works2015, HyperMesh and ANSYS11.0. We created a cervical three-dimensional finite element model. To simulate the degenerative disc by modified the mechanical characters and height of the disc model, we observed the biomechanics of the impact on the cervical spine (the range and the stress on intervertabral disc).RESULTS AND CONCLUSION: (1) The entire model with a total of 97705 nodes and 372896 elements. Ligament and joint capsule were also constructed. Face to face contact element was used in the facet joint, with complete structure and high accuracy of measurement of spatial structure. (2) The range of motion of cervical spine increased during degeneration compared with normal cervical segments (P < 0.05). (3) Intervertebral disc degeneration caused angle increase at disc and motion segment. Osteophyte formed on vertebral edge. Intervertebral disc degeneration caused cervical instability. Simultaneously, instability increased the disc degeneration.

BACKGROUND:In the development of nervous system, the main effect of sonic hedgehog signaling pathway is to induce the partition of dorsal and ventral sides in the central nervous system. When above signaling pathway is destroyed, ventral neurons in the central nervous system wil completely lose. OBJECTIVE: To establish adult rat models of acute compressive spinal cord injury, to detect the expression of development-related sonic hedgehog after acute compressive spinal cord injury, and to explore its effects on neural regeneration. METHODS:A total of 30 Sprague-Dawley rats at the same age were placed in a posterior compression device to establish models of acute compressive spinal cord injury. They were then randomly divided into lamina driling group (n=5) and acute spinal cord injury group (n=25). Sonic hedgehog mRNA was detected by in situ hybridization method at the injury site at 1, 3, 5, 7, and 14 days after spinal cord. RESULTS AND CONCLUSION:The expression levels of sonic hedgehog increased to the maximal expression levels in grey and white matters 10 mm distal to the lesion site at 7 days after injury. Sonic hedgehog expression was apparently less in ependymal cels than in grey and white matters and was restricted to 5 mm distal to the lesion site, being narrower in its distribution than its occurrence in grey and white matters. These data indicated that acute compressive spinal cord injury can induce the expression of sonic hedgehog. This expression maybe relates to adult neural cel regeneration.

Objective To discuss the mechanism of injury,treatment decisions,complications and surgical results of the floating hip injuries (FHI).Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001to June 2011.There were 25 males and 8 females,with an average age of 34.6 years (range,4-73 years).The mechanism of injury was motor vehicle collision for 20 patients,fall down from a height for 11,crushed injury for 1,and sports-related injury for 1.According to Liebergall classification for the floating hip injuries,there were 7 cases for type Ⅰ (21.2％),9 for type Ⅱ (27.2％)and 17 for type Ⅲ (51.6％).All patients had associated injuries,the average injury severity score (ISS) was 28.9.Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures.Surgical stabilization methods included ORIF or intramedullary nailing (29 cases),external fixation (1 case),total hip arthroplasty (2 cases).Acetabular fractures were treated with open reduction and internal fixation (ORIF) in 16 cases.Thirteen patients suffered pelvic fractures underwent surgical stabilization for at least one component of ring disruption.Results Twenty-eight cases (84.8％) were followed up for 2.3 to 10.1 years (average,3.5 years).Thirteen patients were followed up in the 16 patients who suffered type Ⅰ or Ⅱ fractures.According to Majeed functional evaluation,the results were excellent in 8 cases,good in 3 and fair in 2,with the excellent and good rate being 84.6％.Fifteen patients with type Ⅲ were followed up,according to D'Aubigné and Postel evaluation criterion.The joint functions were excellent in 7 cases,good in 4,fair in 3,and poor in 1,with the excellent and good rate being 73.3％.According to Ma Yuanzhang functional evaluation,the knee functions of the all patients were excellent in 23 cases,good in 3,and fair in 2,with the excellent and good rate being 92.9％.Complications seen in these patients included post-traumatic osteoarthritis of the hip developed in one hips,2 patients developed heterotopic ossification (HO),one case of avascular necrosis of the femoral head,and two femoral nonunions.The most severe complication was traumatic sciatic nerve palsy,which was found in 5 patients.Conclusion Ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip) are severe injuries usually caused by high-energy trauma.The femur fracture will most commonly be addressed first,and surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.

OBJECTIVE To evaluate application of cefoxitin disk diffusion method in detecting meticillin-resistant staphylococci(MRS)mediated by mecA gene.METHODS The cefoxitin disk diffusion method,oxacillin disk(diffusion) method,oxacillin agar dilution test,VITEK automicroscan as well as PCR amplification were performed and compared simultaneously for detection of MRS,and VITEK automicroscan was used in testing MIC.(RESULTS)(Among) 96 strains of Staphylococcus(16 S.aureus and 80 coagulase-negative staphylococci strains),54 strains of MRS(2 S.aureus and 52 coagulase-negative staphylococci strains) were identified by oxacillin disk(diffusion) method,oxacillin agar dilution test and VITEK automicroscan,48 mecA-genes were identified by PCR amplification(2 S.aureus and 46 coagulase-negative staphylococci strains) which was the same as by cefoxitin disk diffusion method.CONCLUSIONS The(cefoxitin) disk diffusion method is highly consistent with mecA gene method,and a reliable one of screening and(identifying) MRS mediated by mecA gene.