"Technology-consumption separation"in pricing of medical testing programs,refers to the medical testing programs in the pricing process will be the cost of technology and consumables cost accounting separately,this is the basis for large-scale centralized procurement of test reagents,for the standardization of medical testing programs to carry out,reduce the cost of medical testing programs is critical.The medical testing programs pricing"technology and consumption separation"of the connotation is deeply analyzed.It is considered that the main difficulties in the implementation of the"technology-consumption separation"in the pricing of medical testing programs are the difficulty of costing,the difficulty of calculating the use of special reagents,and the difficulty of policy implementation.The implementation of the"technology-consumption separation"in the pricing of medical testing programs are proposed from"pricing according to the current price minus the cost of specialized reagents","based on big data to measure the loss of specialized reagents"and"appropriate increase in the pricing level".

"Technology-consumption separation"in pricing of medical testing programs,refers to the medical testing programs in the pricing process will be the cost of technology and consumables cost accounting separately,this is the basis for large-scale centralized procurement of test reagents,for the standardization of medical testing programs to carry out,reduce the cost of medical testing programs is critical.The medical testing programs pricing"technology and consumption separation"of the connotation is deeply analyzed.It is considered that the main difficulties in the implementation of the"technology-consumption separation"in the pricing of medical testing programs are the difficulty of costing,the difficulty of calculating the use of special reagents,and the difficulty of policy implementation.The implementation of the"technology-consumption separation"in the pricing of medical testing programs are proposed from"pricing according to the current price minus the cost of specialized reagents","based on big data to measure the loss of specialized reagents"and"appropriate increase in the pricing level".

In recent years， neurotoxicity caused by traditional Chinese medicine （TCM） has frequently occurred and has become one of the important factors restricting the development and application of TCM. TCM contains active components and its dosage-effect relationship is the key to determine its pharmacological activity and toxic effects. Among them， the endogenous toxic components include alkaloids， glycosides， diterpenoids， animal and plant toxic proteins and heavy metals， and so on； exogenous toxic components mainly refer to some harmful elements and pesticide residues during the cultivation， processing， transportation and storage of medicinal materials that are not synthesized by themselves. Effect on the processes such as oxidative stress， inflammation， ion exchange， and energy metabolism may be important mechanisms of TCM-induced neurotoxicity. Neural cells， myelin cells， axons and neurotransmitter systems are common targets of TCM-induced neurotoxicity. In the future， we can use modern research methods and big data mining means to establish a safety evaluation mode of “toxic symptoms-poisoning dose-toxic original agent-detoxification scheme” with the basic component group of toxic substances as the core， so as to provide support for development and clinical intervention of neurotoxic traditional Chinese medicine.

Objective:To summarize the nursing experience in 2 patients with cardiogenic shock combined with acute respiratory distress syndrome(ARDS) treated by extracorporeal membrane oxygenation (ECMO) and transferred outer-hospital in long distance.Methods:There were many risk factors in this transport: high parameters of ECMO included V-A mode, 100% oxygen, and a flow of oxygen from 6 L/min to 10 L/min. High ventilator parameters included oxygen concentration of 100% and positive end-expiratory pressure of 15-17 cmH 2O(1 cmH 2O=0.098 kPa). Transport distance was up to 196 km. And the transport time was up to 2 h 36 min. In this regard, we carried out adequate preparations before transport and professional cares during transport. The main points were as follows: setted up a professional transport team; prepared adequate power and oxygen supply; reduced the number of interruption of ECMO and ventilator support during transport; provided the reasonable remedial actions when ECMO and ventilator support were interrupted. Results:Two patients arrived at the destination safely.Conclusions:Adequate preparations before transport and professional cares during transport could effectively avoid and respond to the occurrence of adverse events, and it is feasible and safe to patients supported by ECMO for long distance outer-hospital transport.

Objective:To discuss the relationship between supracapsular secretion drainage of tracheal intubation before percutaneous dilational tracheotomy (PDT) and the incidence of early-onset VAP (within 5 days) after PDT.Methods:By the convenient sampling method, a total of 160 patients who underwent PDT in ICU of Shaoxing People's Hospital from March 2013 to March 2019 were selected as the research objects and they were divided into group A and group B according to the random number table method, 80 cases in each group. In group A, the research team intervened to drain supracapsular secretion before PDT and bedside nurses cooperated with the doctor to complete other operations on the PDT. In group B, the PDT operation was entirely completed by the bedside nurses and the research team did not intervene. The drainage volume of supracapsular secretion in group A was recorded and the proportion of patients who underwent supracapsular secretion drainage in group B was calculated. The incidence of VAP, ICU mechanical ventilation time, ICU hospitalization time and ICU hospitalization cost within 5 d after PDT were compared between the two groups.Results:Before PDT, patients in group A drained (3.88±2.34) ml of supracapsular secretion. The proportion of bedside nurses in group B who drained secretions before PDT was 53.75% (43/80) . The incidence of VAP within 5 d after PDT in group A was 6.25% (5/80) , which was lower than 17.50% (14/80) in group B, and the difference was statistically significant ( P<0.05) . The ICU mechanical ventilation time and hospital stay of patients in group A were respectively (28.75±8.59) d and (30.91±9.12) d, which were lower than (32.91±8.53) d and (34.28±9.54) d in group B, and the differences were statistically significant ( P<0.05) . The ICU hospitalization cost of group A was (14.98±4.54) ten thousand yuan, which was lower than (16.93±5.37) ten thousand yuan in group B, and the difference was statistically significant ( P<0.05) . Conclusions:Supracapsular secretion drainage of tracheal intubation before PDT can reduce intraoperative aspiration of supracapsular secretion, reduce the incidence of early-onset VAP after PDT and improve prognosis of patients.

Objective: To investigate the effect of leader-member exchange on nurses’sense of calling in workplace based on self-determination theory. Methods: A total of 381 nurses were randomly selected from five tertiary general hospitals in Zhejiang province, China from October to December, 2016. They were subjected to a survey using the Leader-Member Exchange Scale, Job Autonomy Scale, Core Self-Evaluation Scale, and Calling Scale. The mediating effect was used to test the procedures and the data were subjected to hierarchical regression analysis. Results: The leader-member exchange was positively correlated with job autonomy, core self-evaluation, and sense of calling (r=0.471, P<0.001; r=0.373, P<0.001; r=0.475, P<0.001) ; the leader-member exchange had a positive predictive effect on job autonomy and sense of calling (β= 0.47, P<0.001; β=0.48, P<0.001) ; the job autonomy had a partial mediating effect on the relationship between leader-member exchange and sense of calling (F=66.50, P<0.001) ; the core self-evaluation negatively adjusted the positive relationship between leader-member exchange and job autonomy (F=27.81, P<0.001) . Conclusion High-quality leader-member exchange enhances the sense of calling by improving staffs’ job autonomy and the core self-evaluation reduces the positive relationship between leader-member exchange and job autonomy.

Objective To investigate the mechanism of family-supportive supervisor behavior (FSSB) influencing nurse silence behavior,and explore the mediating role of organizational identification between them. Methods Based on the social exchange theory (SET),916 nurses were selected to complete FSSB scale, organizational identification scale and silence behavior scale from 8 hospitals in Zhejiang Province by convenient sampling method.Results The total scores of FSSB,organizational identification and silence behavior were (3.85±0.66),(3.15±0.62),(2.82±0.46) respectively in 916 nurses. The silence behavior was negatively related to the FSSB and organizational identification (r=-0.27,-0.36;P<0.01). The FSSB was positively related to organizational identification (r =0.53,P<0.01) and negatively influenced silence behavior (β= -0.39,P<0.01),while positively influenced organizational identification (β=0.42,P<0.01) in mediating-effect analysis. Organizational identification partially mediated the relationship between the FSSB and silence behavior. Conclusions Nursing managers should give nurse more family care and support to promote organizational identification,thus decreasing silence behavior.

Objective To explore the effect of quality control circle ( QCC ) on postoperative ambulation among patients with lumbar spinal stenosis. Methods The QCC group had been established. 5M selection method was used for the topic “To improve the correct rate to get out of bed for postoperative patients with lumbar spinal stenosis”, and then we made plan time table, set up the goal-89. 44% correct rate o get out of bed for postoperative patients with lumbar spinal stenosis after analyzing the incorrect reasons, confirmed 5 reasons after argument, formulated countermeasure and checked out the effects. Results After QCC activities, the rate of correct ambulation ( get out the bed ) amounted 92%, while 76% before the activities, with a significant difference (χ2 =9. 52,P<0. 01). Level of specialty, working passion, team spirit, ability of QCC activity, problem solving skills and communication skills had been improved. Conclusions QCC activities can significantly improve the correct rate of getting out bed, effectively shorten the average length of hospitalization, and improve patients′satisfaction and professional level in clinical nursing.

AIM: To investigate the effect of dihydroartemisinin (DHA) on the proliferation of murine T lymphocytes stimulated by Con A in vitro and its related immunosuppressive mechanism. METHODS: Murine T lymphocytes were stimulated by Con A and treated with different concentrations of DHA. Cell proliferation was measured by carboxyl fluoresce in diacetate succinmidyl ester (CFDA-SE) staining. The expression of CD69, CD25 and CD71,which was the marker of early, middle, later activation of CD3~+ T lymphocytes, was measured by flow cytometry (FCM) combined with two-color immunofluorescent staining of cell surface antigen. Fluorescence calcium indicator fluo-4/AM was used to measure the change of the intracellular calcium concentration ([Ca~(2+)]_i) of murine T lymphocytes. The distribution of the cell cycle was analyzed by PI staining. The expression of CD69, the early activation antigen on CD4~+CD25~(high) Treg was also measured by FCM combined with three-color immunofluorescent staining. RESULTS: The result of CFDA-SE staining showed that DHA efficiently inhibited the Con A-induced proliferation of T-lymphocytes in a time-and dose-dependent manners. DHA showed modestly increased proportions of CD69 and CD25 on Con A-stimulated CD3~+T cells, but inhibited the expression of CD25 in a dose dependent manner. DHA with Con A, but not DHA alone, caused an increase in intracellular calcium concentration of T cells. The results of FCM analysis with PI staining showed that DHA imposed a total cell cycle arrest in G_0/G_1 and prevented cells entering S phase and G_2/M phase. Furthermore, DHA reduced the expression of CD69 on CD4~+CD25~(high) Treg. CONCLUSION: DHA, which exhibits immunosuppressive effect on the proliferation of murine T-lymphocytes, is promising to be developed as an immunosuppressive reagent.

Objective To investigate the T cell cytotoxicity induced by recombinant adenovirus carrying HIV-1 vpr gene.Methods C8166 cells infected with rAd-vpr or negative control rAd-vector,were analyzed for cell cycle distribution and cell death by flow cytometry.The discrimination of living cells,apoptotic and necrotic cells were differentiated with Hoechst-PI double staining under the confocal microscopy.Changes of mitochondrial membrane potential(△ψm)were monitored by JC-1 staining method.Results Annexin V-PI and Hoechst-PI staining indicated the death effects of HIV-1 Vpr on C8166 cells.PI flow cytometric analysis showed that cell cycle arrested in G2 phase.C8166 cell△ψm collapse mediated by Vpr was detected by JC-1 fluorescent staining.Conclusion The ability of recombinant adenovirus carrying HIV-1 vpr gene to induce mitochondria dysfunction,cell cycle G2 phase arrest and cell death was confirmed in C8166 cells.