The paper gives a detailed description of the main features of American medical services,the characteristics of American hospitals,the responsibilities of hospital presidents and the problems faced by them.In addition,it introduces the macro-management of American hospitals and the existing problems.

OBJECTIVE: To observe the effects of combined application of Radix Salviae Miltiorrhizae injection and dopamine injection on peritoneal dialysis patients.METHODS: By self-control method,the peritoneal dialysis solution of 22 patients with ambulant continued peritoneal dialysis was added with 20 mg dopamine injection and 12 mL Radix Salviae Miltiorrhizae injection for dialysis of 14 days.The D/P values of urea nitrogen(UN) and creatinine(Cr),week's peritoneal UN clearance index(KT/V),the clearance rate of Cr(Ccr),week's total KT/V,Ccr,reabsorption rate of glucose and the net amount of 24 hours' ultrafiltration were recorded before and after medication.RESULTS: The addition of dopamine injection and Radix Salviae Miltiorrhizae injection to the peritoneal dialysis solution resulted in significant higher values in week's peritoneal KT/V,Ccr and week's total KT/V,Ccr and the net amount of 24 hours' ultrafiltration as compared with before medication(P

0.05); and more 5 years,length of service also between doctors. There were 98.3% of medical staffs being aware of health care law for six-step hand-washing and hand hygiene 97.8% being aware of hand hygiene compliance and 86.7% obtained knowledge after proper training,but most of them did not know the relationship between hand hygiene and hospital infection. CONCLUSIONS A good hand hygiene compliance need not only a reliable and convenient environment,but also training,inspection,supervision and management.

Objective To investigate the relationship between myeloid-derived suppressor cell ( MDSC) levels and immune function and hepatitis B virus DNA ( HBV-DNA) replication level in patients with hepatitis B. Methods 96 patients with hepatitis B were included in the study.40 normal persons who received physical examina-tion in the hospital during the same period were included as the control group.The content of MDSC was detected by flow cytometry and HBV-DNA level was detected by real-time fluorescence quantitative PCR technique.Statistical analysis was performed.Results The content of MDCS in hepatitis B group (8.77 ±3.69)%was significantly high-er than (1.64 ±1.26)%in the control group (t=16.80,P<0.05).The content of MDCS in HBsAg positive group (11.29 ±3.39)%was significantly higher than (4.71 ±2.88)%in HBsAg negative group (t=10.76,P<0.05). The proportions of HBA DNA<103 IU/mL,103 -104 IU/mL and 105 -106 IU/mL in HBsAg positive group(0.00%, 0.00%,9.09%) were significantly lower than those in HBsAg negative group (54.05%,22.97%,20.27%),while the proportion of HBA DNA>107 IU/mL ( 90.91%) was significantly higher than that in HBsAg negative group (2.70%)(P<0.05).The content of MDSC in HBV DNA positive group[(10.82 ±3.26)%] was significantly higher than that in HBV DNA negative group[(5.84 ±2.16)%](t=8.42,P<0.05).Spearman's correlation analy-sis showed that the level of MDCS expression was positively correlated with the level of DNA replication (r=0.769, P<0.05).Conclusion The increased level of MDSC content can cause the immune suppression and is positively correlated with the degree of HBV DNA replication.

Objective: To establish the assay of berberine hydrochloride for Sanhuang Tablets (Radix et Rhizoma Rhei, Extractum Scutellariae and berberine hydrochloride). Methods:The HPLC with a KF C 18 column (250mm?4.6mm,10?m) was used. Acetonitrile-0.05 mol?L -1 triethylamine buffer solution (adjusted pH to 3.0 with conc. H 3PO 4) (35∶65) was used as mobile phase. The flow rate was 1.0mL?min -1 , and the detection wavelength was at 347nm. Results: The method has a good linear dependuce. The average recovery of loading sample was 98.21% with RSD 1.01%. ( n =9). Conclusion: The method is convenient for a good resolution and can be used for the quality control of Sanhuang Tablets.

Executive function is an important advanced cognitive process, and it is the function that integrates different cognitive processes to achieve one's aim. Updating is an important component of executive function. According to the classifications of Miyake & Colletee on executive function, two study paradigms on memory updating are discussed: n-back paradigm & running memory paradigm. A new study method called latent variable analysis and new studies of cognitive neuroscience on memory updating are introduced. Issues on ethics and morality in research on cognitive experiment of psychology are briefly demonstrated to explore appropriate direction for research of executive function in future.

Lennox-Gastaut syndrome ( LGS) is an globally recognized refractory epilepsy,also known as an age-dependent epileptic encephalopathy. It is characterized by multiple seizure types, mental retardation, and slow spike-wave complexes discharges or fast rhythmic bursts during sleep on electroencephalographic re-cordings. Many antiepileptic drugs were reported for the treatment of LGS,but it was difficult to compare their efficacy because of the small sample size and design limitations. Valproate,topiramate and lamotrigine are rec-ommended to be the first-line drugs by most guidelines or expert consensus,and the combination of valproate and lamotrigine or the combination of lamotrigine and topiramate should be preferred as early as possible for initial treatment of LGS in children. Recent progresses of medical treatment of LGS are reviewed and some optical re-gimes are proposed in this paper.

Objective To study the effectiveness of Ginsenoside on serum IL-17 and IL-23 in patients with systemic lupus erythematosus.Methods According to the digital table,86 patients with systemic lupus erythematosus (SLE) were randomly divided into two groups,the control group (n =43 cases) and the observation group (n =43 cases).The patients in the control group were treated through prednisone,while the patients in the observation group were treated through prednisone plus ginsenoside.They were all treated for three months,systemic lupus erythematosus activity index(SLEDAI),serum complement 3 (C3),IL-17 and IL-23 were evaluated.Results SLEDAI after treatment were significantly decreased,compared with the control group,the observation group decreased more significantly (t =2.73,P ＜ 0.05).Mtertreatment,serum C3 were significantly elevated,compared with thecontrol group,the observation group increased more significantly(t =3.04,P ＜0.05).After treatment,serum IL-17 and IL-23 were significantly reduced,and after treatment compared with the control group,the observation group decreased more significantly (t =2.13,3.06,all P ＜ 0.05).The rates of adverse reactions were 25.6％ in the control group and 7.0％ in the observation group.There was a statistically significance between two groups (x2 =4.89,P ＜ 0.05).Conclusion Ginsenoside can decrease serum IL-17 and IL-23 in patients with systemic lupus erythematosus.

This paper analyzed some policies of new health care reform from the perspective of doctor -patient trust.The implementation of the policy of income and expenses in two lines has changed the management mode of township hospitals , eliminated some factors harming the doctor -patient relationship .The policy of equalization of public healthand other policies have guided the hospitals to change the way of service , service and health man-agement into the village increased the degree of doctor -patient trust .But at the same time , to ensure the new health care reform run smoothly , township hospitals introduced various ways of prescribing restraints .In addition , the policy of zero profit for basic drugs also brought some restrictions and regulations , resulting in a decline of satis-faction of patients , who have a tendency to blame the hospitals and doctors for these inconveniences .This misun-derstanding has becomed the new difficulties for doctor -patient trust as policy running .

Objective To explore the significance of thyroid function determination at the first and second trimesters of pregnan‐cy .Methods Electrochemiluminescence immunoassay was used to detect the levels of TSH ,FT3 and FT4 in first trimester women (T1 group) ,second trimester women (T2 group) and non‐pregnant women (control group) ,respectively .And the results were an‐alyzed .Results There were significant difference in the levels of TSH ,FT3 and FT4 between T1 group and control group (P<0 .05) .The total prevalence rate of thyroid diseases in pregnant women was 28 .85% ,which was significantly higher than that in control group(15 .00% ) ,P<0 .05 .Hypothyroidism and subclinical hypothyroidism were the main forms of thyroid dysfunction in pregnant women .Conclusion The determination of thyroid function at the first and second trimesters of pregnancy will benefit pre‐natal and post‐natal care .