The hospital the authom work with, the first one to undergo the second-cycle nation-wide hospital evaluation, was assessed by a third party and the hospital evaluation experts. The two cycles of hospital evaluation were entirely different in historical background, priorities and procedures. The evaluation standards for the second cycle, which were on a par with internafional ones, set the right track of development for medical institutions, emphasizing quality, security, service and performance and highlighting the delivery of quality patient care. The gains from the second-cycle hospital evaluation can be summarized as follows: more highly emphasized continuous improvement of service quality, enhanced awareness of people-oriented management, reinforced medical quality and medical security control, heightened hospital infection control, greater capability of responding to emergencies, and strengthened for-malation of hospital rules and regulations. In the end five suggestions are put forward with regard to the second-cycle hospital evaluation.

OBJECTIVE To strengthen the management of medical refuse in order to control the onset of hospital(infection.) METHODS It has been done including setting up special tissue,formulating supervising system,strengthening training,carrying out supervising measures and strengthening examination and inspection.(RESULTS) It could prevent hospital infection effectively to regulate the whole course of the medical refuses(collection,) storage,dealing with and registration.CONCLUSIONS It is very important to strengthen the management of medical refuse in order to prevent hospital infection.

Objective To investigate the serum therapeutic concentration of tramadol during intravenous analgesia for postoperative pain relief. Methods Twenty adult patients ASA Ⅰ-Ⅱ (10 male, 10 female) undergoing elective radical operation for cancer of stomach were treated with intravenous tramadol for postoperative pain relief. Patients addicted to any drug or tolerant to opioid and patients with epilepsy or liver and/or renal dysfunction were excluded. All patients were premedicated with intramuscular phenobarbital 0.1g and atropine 0.5mg. Anesthesia was induced with midazolam 0. 1mg/kg and fentanyl 5 μg/kg and intubation was facilitated with vecuronium 0.16mg/kg. Anesthesia was maintained with continuous intravenous infusion of propofol 4-6 mg@ kg 1 @ h 1, fentanyl 2-3 μg@ kg-1 @ h-1 and vecuronium 0.1mg@ kg-1@ h-1 combined with inhalation of 1% isoflurane. After surgery in ICU when patients felt slight pain (VAS 1-2), intravenous tramadol 1.5mg/kg was given as initial dose. Whenever patients felt slight pain (VAS 1-2) again, a bolus of tramadol 20 mg was given intravenously every 10 min until VAS was 0. The onset time (from the end of iv injection of initial dose of tramadol to VAS 0), the duration of action (from VAS 0 to VAS 1-2) and the time when accumulated dose of tramadol amounted to twice the initial dose were recorded. HR, MAP, respiratory rate (RR) and SpO2 were monitored and recorded before and 10, 20, 30 min after administration of tramadol. Venous blood samples were taken before each additional tramadol administration on demand for determination of serum tramadol concentration by high performance liquid chromatography. Results The mean serum therapeutic level of tramadol during period of analgesia was (370±148)ng/ml(248.6-615.7ng/ml). The mean onset time of the initial dose was (9.2± 2.1 )min. The mean duration of action was (2.3 ± 1.0)h. The time when accumulated dose of tramadol amounted to twice the initial dose was (6.4 ± 2.7)h on average. There were no significant changes in HR,MAP, RR and SpO2 after tramadol. Conclusions It is safe and effective to give intravenous tramadol for postoperative pain relief. Serum therapeutic concentration of tramadol varies greatly from patient to patient,so the dose of tramadol should be individulized.[Key Words] Pain, postoperative; Tramadol; Plasma concentration; Injections, intravenous

Objective To acknowledge the present status of clinical use of nonsteroidal antiinflammatory drugs(NSAIDs) in China. Methods Five hundred and seventy-five valid questionnaires were collected from 50 hospitals in different areas of China including Shanghai, Beijing, Tianjin, Shenyang and Guangzhou. Results 54.7% of doctors used cyclooxygenase-2 (COX-2) selective inhibitors. The ratio of the doctors prescribing loxoprofen, diclofenac, meloxicam were 22.6%, 23.3%, 14.60%, respectively. The ratio of the doctors who prescribe uncoated routine-dose aspirin, uncoated low-dose aspirin, enteric-coated routine-dose aspirin, enteric-coated low-dose aspirin and others were 17.0%, 14.7%, 36.8%, 28.5% and 3.0%, respectively. The ratio of doctors who only "some-times" prescribed co-medicine to prevent gastrointestinal damages when they prescribed aspirin, conventional NSAID and COX-2 selective inhibitors were 41.10%, 40.70% and 45.1%, respectively, while the most commomly used co-medicine were H2 receptor antagonist (H2 RA) and proton pump inhibitor respectively. 37.1% of doctors examined H. pylori infection status, and 76.3% of doctors would eradicate H. pylori if positive. Conclusions The most commonly used conventional NSAID is diclofe-nac. The most commonly used formulation of aspirin is enteric-coated aspirin. Most doctors only "sometimes" prescribe co-medicine together with aspirin, conventional NSAID and COX-2 selective inhibitors to prevent gastrointestinal damages, and the most commonly used co-medicine is acid inhibitor. Only a few doctors examine H. pylori infection prior to the administration of NSAID.

Objective To study the short-term efficacy of arthroscopic debridement,lateral patellar decompression,and rehabilitation thearpy for osteoarthritis of the knee joint,and to discuss the long-term outcomes of the treatments.Methods A total of 85 cases of osteoarthritis that were diagnosed according to the clinical diagnostic criteria of ACR were enrolled in this study.The patients were randomly divided into groups A(39 cases) and B(46 cases) to underwent arthroscopic debridement and arthroscopic debridement combined with lateral patellar decompression respectivley.All the operations were performed by a same surgeon.Postoperative rehabilitation thearpies were carried out by one group of therapist.The Lysholm,HSS,and PPI scores were evaluated before the operation,as well as patellar tilt test and patellar gliding test.The examinations were repeated in 3 and 6 months respectivley after the surgery.Results In group A,the scores of Lysholm,HSS,and PPI determined at month 3 were significantly higher than those before the operation,but not changed markedly at month 6.Whereas,in group B,the scores kept being increased after the surgery.At month 3,the scores in group A were higher than those in group B,however,at month 6,the Lysholm score in group B was higher than that in group A.Conclusions Arthroscopic debridement and postoperative rehabilitation are effective for imroving the symtoms and knee function in patients with osteoarthritis and limited ROM of the patella.Combining with lateral patellar decompression,the treatments can achieve better outcomes in 6 months.

Objective To explore the expression of singal transducers and activators of transcription(STAT 3) during focal cerebral ischemic reperfusive injury in rats and the relationship between ischemic neuronal damage and it.Methods Using immunohistochemical method of avidinbiotin peroxidase complex (ABC) we observed the distribution of positive cells in STAT 3 protein immunoreaction after focal cerebral ischemic reperfusive injury in rats.Results STAT 3 immunoreactive positive cells were not found in the cortex and striatum of normal and sham operative rat brains and nonischemic hemisphere brain after cerebral ischemia,small amount of STAT 3 immunity positive cells were induced in the embolism la teral infarction area 12 h after reperfusive injury,and peaked after 24 h,especially in ischemic lateral striatum and around cortex,small number of nerve cells in around infarction still showed positive expression after one week.The difference had remarkable significance( P

OBJECTIVE:To observe the efficacy and safety of insulin in the treatment of gestational diabetes in different gesta-tional age. METHODS:The data of 121 women with gestational diabetes were retrospectively analyzed,and divided into observa-tion group (63 cases) and control group (58 cases) based on first use of insulin in different gestational age. All patients received dirt control [(calorie control in 30-35 kJ/(kg·d),55% carbohydrates,25% fat and 20% protein)];based on it,Biosynthetic hu-man insulin injection was injected before meals and at bedtime by 4∶2∶3∶1 with 4-6 units before pregnant 30 weeks according to the FPG and postprandial 2 h blood glucose(2 h PG)levels in observation group,the blood glucose of women with gestational dia-betes was monitored to prevent the occurrence of complications such as hypoglycemia. Control group received Biosynthetic human insulin injection(the same dosage with control group)when no less than 30 weeks. The treatment course for both groups was 15 d. FPG and 2 h PG levels when first diagnosed and delivery,pregnancy outcomes and neonatal conditions in 2 groups were observed, and the incidence of adverse reactions was recorded. RESULTS:When first diagnosed,there were no significant differences in FPG and 2 h PG levels in 2 groups(P>0.50). When delivery,FPG and 2 h PG levels in 2 groups were significantly lower than first di-agnosed,and observation group was lower than control group,the differences were statistically significant (P<0.05). The inci-dence of premature delivery,gestational hypertension,neonatal asphyxia,low-weight children and neonatal hypoglycemia in obser-vation group were significantly lower than control group,Apgar score was significantly higher than control group,the differences were statistically significant(P<0.05);and there were no significant differences in the incidence of polyhydramnios,multi-cesare-an and fetal macrosomia in 2 groups(P>0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Based on diet control,insulin in the treatment of gestational diabetes before pregnant 30 weeks can effectively control blood glucose level and improve pregnancy outcomes,with good safety.

cloned human have been put forward from gestation to practice study,but the cloning will face many problems about society ,ethic and law,such as family,prepotency or low birth,social identity,population etc.All should be solved by the means of the social control including morality policy and law,etc.

Confronted with the complex and volatile situation of the medical market, hospitals must formulate long-term development strategies, enhance their core competitiveness, and secure or maintain an undefeatable position amidst competition. The paper discusses the strategic management of large hospitals from five dimensions: improving hospital leaders' strategic-thinking and decision-making skills, continuously implementing brand marketing strategies, adopting the ideas and methods of strategic cost management, constructing information-based hospitals, and creating vigorous and dynamic hospital culture. It argues that only by strengthening strategic management can the sustainable and concerted development of hospitals be promoted.