The strategic cost management of the hospital means setting the cost management of the hospital in the realm of strategic management and analyzing the hospital and its cost behavior and structure from a strategic level so as to create advantages in competition, attain the goal of adapting the hospital to the continuously changing environment and facilitating stralegic management. Strategic cost management is characterized by a protracted, overaU, extensional and innovative nature and methods for it include value chain analysis, strategic positioning analysis, cost agent analysis and many others. Clarifying the goals of strategic cost management, selecting different strategies according to strategic cost information, perfecting the cost management of the hospital and enhancing cost awareness, and giving play to the functional role of economic management personnel are some of the prerequisites for the hospital to implement strategic cost management.

Objective To explore the efficacy of endoscopic surgery for juvenile nasopharyngeal angiofibroma.MethodsDuring 27 years from March 1980 to July 2007,we performed endoscopic surgery on totally 19 patients with nasopharyngeal angiofibromas.According to Radkowski Stating,five of the patients were stage ⅠA,ten were stage ⅠB,and 4 were stage ⅡA.Before the endoscopy,superselective embolization was performed in all the cases via bilateral maxillary arteries.Results All tumors were successfully resected by endoscopy.The intraoperative blood loss was 200-600 ml.One of the stageⅡA patient developed cerebrospinal rhinorrhea during the endoscopic resection,and thus received repair of the middle turbinate by a mucosal patch immediately.In this series of patients,no massive epistaxis,intracerebral infection,or blindness occurred.Follow-up at three months after the surgery by nasoscopy showed epithelialisation of the nasal mucous membrane without residual tumor tissues.Meanwhile,otoscopy revealed normal light reflex of the eardrum,no fluid in the middle ear.Of the patients,eleven were followed up for one to five years,during which none of them had recurrent tumors confirmed by nasoscopy or CT scan.Conclusions Endoscopic resection of nasopharyngeal angiofibroma results in little trauma and few blood loss after superselective embolization.Experience and surgical skills are key points for the operation.

0.05).The effect on traditional Chinese medical syndrome in the treatment group was superior to that in the control group(P 0.05).The average insulin dosage and hypoglycemia incidence were reduced,and the time for blood glucose becoming normal was shortened in the treatment group(P

The paper first analyzes the intrinsic need for cultural integration in hospital regrouping and sums up its content, including the integration of values, management ideas, institutional cultures and institutional frameworks. It then introduces some methods of cultural integration in hospital regrouping, such as running in on the basis of respecting human nature, resolving conflicts on the basis of being mutually tolerant, and merging completely on the basis of optimizing means of integration. The paper points out that success or failure of cultural integration in hospital regrouping depends on the thinking of the leaders. For this reason, it is imperative to enhance integration awareness and improve integration capability.

OBJECTIVE To discuss the diagnosis and treatment of cholesterol granuloma of the middle ear and the choice and effect of surgical methods. METHODS A retrospective analysis was conducted on 18 cases of cholesterol granuloma of the middle ear confirmed by surgery and pathology. Different choices of surgical methods were made according to the lesion extension of this disease. RESULTS All patients were followed up for at least 6 months. Two cases with eustachian tube obstruction had ventilation tube inserted for a long time. One case who had recurrence and metastasis of nasopharyngeal carcinoma in the middle ear was transferred to oncology department for further treatment. Post-operative dry ears were obtained in the other cases whose pure tone thresholds were improved to different degrees. CONCLUSION Etiology of cholesterol granuloma of middle ear remains controversial. It's supposed to result from the bleeding, occlusion of ventilation and disturbance of drainage of the air cavity because of the middle ear inflammation, and bone marrow exposure. The middle ear and mastoid surgery can completely remove the disease tissues, and establish ventilation system of mastoid-tympani-eustachian, which is the key point of the middle ear surgery.

Objective To evaluate the application of totally implantable central venous access ports. Methods A retrospective a-nalysis of 217 cases was made on the application and complication of totally implantable central venous access ports from October 2003 to May 2008. Results Venous access ports, which were connected to central venous system via subclavian vein in 199 cases and jugularis interna vein in 17 cases, were implanted into subcutaneous of chest wall. The success rate of implantation was 99.6% (216/217). The ports worked well in 207 cases (95.8%), and 9 ports (4.2%) were removed due to complications. Associated complications included subclavi-ana arterial puncture in 3 cases (1.4%) and local hematoma in one patient. Ventricular tachycardia occurred in one patient due to catheter was inserted into the right ventricle (0.4%). Five patients had soft tissue infections around ports (2.3%) and the ports were removed in 2 eases due to anti-infections therapy failure. Catheter dislocation happened in 2 cases (0.9%). The catheter obstruction was observed as a complication, which comprised three instances of catheter distortion and three of catheter-associated venous thrombosis, the ports in these six patients were removed (2.8%). The overall complication was 7.8%. Conclusions Totally implantable central venous access ports can provide a long-term and safe intravenous access to patients who need long-term intravenous infusion, especially for cancer patients received chemotherapy. Although the operation is simple, there are some complications and need to be carefully monitored.

Objective To understand the relation between smoking and serum uric acid level and to investigate whether the ser-um uric acid has the correlation with the gender,age and smoking history.Methods The data of the gender,age,blood uric acid in1 847 individuals aged 20-80 years with the healthy physical examination and without underlying diseases were performed the statisti-cal analysis.Results With male and female as the research objects,the serum uric acid level of smokers were higher than that of non-smokers and occasional smokers,the difference was statistically significant;the serum uric acid level had no statistically signifi-cant difference between smokers and occasional smokers;the serum uric acid level had no statistically significant difference among non-smoking,occasional smoking and smoking groups for males as the research objects alone;to divide the male subjects into groups according to age,the serum uric acid level of non-smokers,occasional smokers and smokers were not statistically significant among all age groups;serum uric acid level showed the increasing trend with the increase of smoking history,but there was no statistically significant difference.Conclusion The serum uric acid level of smokers is significantly higher than that of non-smokers and occa-sional smokers with male and female as the research objects;the difference in serum uric acid level between smokers and occasional smokers has no statistical significance;excluding the gender factor interference,the serum uric acid level of males is not affected by smoking or age;serum uric acid mean value demonstrates the increasing trend with the increase of smoking history.

Objective To investigate the expression level of lipocalin-type prostaglandin D synthase (L-PGDS) mRNA and its protein in glioma.Methods The L-PGDS mRNA was determined by real-time quantitative RT-PCR in 23 glioma and 5 healthy brain specimens. L-PGDS protein was detected by Western blot in cerebrospinal fluid (CSF) and brain tissue specimens.Results In 23 glioma specimens L-PGDS mRNA expression ranges from 1.5?10 3～7.0?10 4 copy/?g RNA, mean value is 1.6?10 4 copy/?g RNA. In 5 normal brain specimens, the mean value is 8.1?10 5 copy/?g RNA, statistic analysis indicates a distinct discrepancy ( P

OBJECTIVE: To review the pathological and clinical features and treatment of sinonasal malignant melanoma. METHOD: A retrospective analysis of 23 cases of sinonasal malignant melanoma. All the patients were conformed by histopathology, the most common symptoms were nasal obstruction and epistexis. Eight cases were treated with surgery, 8 with surgery and radiotherapy, 5 with surgery and chemotherapy, 2 with surgery and ra- diotherapy plus chemotherapy. RESULT: Twenty patients were followed up, the survival rates of 3 and 5 years were 50% (10/20) and 35% (7/20), respectively. CONCLUSION Sinonasal malignant melanoma has an aggressive behavior and easy recurrence and poor prognosis. Early diagnosis and reasonable treatment can increase the survival rate of the disease.
Humans ; Melanoma ; mortality ; pathology ; therapy ; Nasal Obstruction ; Neoplasm Recurrence, Local ; Nose Neoplasms ; mortality ; pathology ; therapy ; Paraganglioma ; Paranasal Sinus Neoplasms ; mortality ; pathology ; therapy ; Retrospective Studies ; Survival Rate

Aim To observe the effect of mycophenolate mofetil(MMF) on expressions of MCP-1 and CD68 in renal tubulointerstitial injury of diabetic rats and explore the mechanism of MMF′s protective role.Methods Diabetes was induced in uninephrectomized male Wistar rats by peritoneal injection of STZ (65 mg?kg-1). Rats were randomly divided into three groups:control group (NC),diabetic group (DM) and treated group (DM+MMF) with MMF(15 mg?kg-1?d-1).This study lasted for 8 weeks. 24 h urinary protein,blood glucose and the ratio of left kidney weight/body weight were determined after 8 weeks.The renal tubulointerstitial morphological change was observed,immunohistochemical method was used to analyze expressions of MCP-1 protein and CD68. Expression of MCP-1 mRNA in renal tissue was measured by quantitative Real-time PCR.Results Compared with NC group, serum glucose level,24 hour urinary protein and the ratio of left kidney weight/body weight were significantly increased(P