One hundred forty-four residents registered at department of anesthesia of West China Hospital from 1999 to 2010.The duration of residency training is 5 years (3 + 2).The residents enrolled during 1999-2002 were on the staff.They were assigned to work at this hospital after graduation from medical school and became staff anesthesiologist of this hospital after 5 year training.The residents enrolled during 2003-2010 were trainees and not on the staff.They had to apply for a job as anesthesiologist somewhere after 5 year training.After 3 year training the residents are qualified to undergo subspecialty training.Thirty-nine of the 144 residents dropped out of the training program.The reasons for their withdrawing from the program included finding a regular job,failing the qualifying examination,changing profession studying abroad and death.In order to reduce dropout rate,correct public opinion on the importance of residency training,raising the quality of the residents and improving income of the residents are needed.

Objective To study the clinical significance of detection of infectivity index in patients before transfusion. Methods A total of 12 863 patients in hospital were examined for hepatitis B virus surface antigen(HBsAg),anti-hepatitis C virus(anti-HCV),anti-AIDS virus(anti-HIV)and treponemiasis test(TRUST)before operation and transfusion. Results The positive rates of HBsAg,anti-HCV,anti-HIV and TRUST were 12.59%,1.90%,0.02%and 0.80%respectively.Conclusion The detection of infectivity index before transfusion has a very,important role in the prevention of blood transmissible disease and reduction or medical treatment dispute caused by infection after transfusion.

Objective To explore the effect of GAS MAN assisted instruction on theory learning of volatile anesthetics in anesthesiology residency training.Methods A total of 32 residents in the first stage of anesthesiology training were enrolled and randomly assigned to either study(S) or control (C) group.Theory-test l(Test-1) was conducted for all residents after the lecture-based learning (LBL).Next,reference book self-reading strategy was used in both groups while computer-based simulation(CBS) using GAS MAN was only developed in S group.Then,theory-test 2(Test-2)was conducted for residents in both groups and residents in S group completed the questionnaire smvey.In addition,thirty-four resident teachers observed the CBS courses and completed the questionnaire smvey.Results The mean scores of Test-1 did not differ significantly between the two groups(P=0.64).However,the mean Test-2 score of S group(81.3 ± 13.6) was significantly higher than that of C group(61.3 ± 15.4) (P=0.001).100％(16/16) residents believed that CBS was beneficial to the theoretical study of volatile anesthetics,93.8％(15/16) residents considered GAS MAN could help understand the concepts and improve efficiency during self-learning.97.1％ (33/34) and 91.2％ (31/34)resident teachers agreed that CBS was helpful for analyzing complex concepts and improving study effectiveness,respectively.Conclusions CBS using GAS MAN improves theory knowledge and study effectiveness for anesthesia residents.Both residents and resident teachers find GAS MAN highly ac ceptable.Therefore,GAS MAN has the potential to be the assistant teaching tool for LBL in anesthesiology residency-training program.

Objective To observe the effects of scalp acupuncture on cognitive impairments after traumatic brain injury (TBI). Methods 42 cases of TBI were randomized into experiment group (n=23) and control group (n=19). The control group accepted cognitive training and Donepezil, and the experiment group accepted scalp acupuncture in addition for 3 months. They were assessed with event related potential P300 and Montreal Cognitive Assessment (MoCA) before, 1 and 3 months after treatment. Results The results of P300 and MoCA improved significantly 3 months after treatment (P<0.001) in both groups, and improved more in the experiment group than in the control group (P<0.001). Conclusion Scalp acupuncture could improve outcomes of cognitive impairments after TBI.

This article provides an overview of the severe acute respiratory syndrome (SARS) epidemics in mainland China and of what we have learned since the outbreak.The epidemics spanned a large geographical extent but clustered in two regions:first in Guangdong Province,and about 3 months later in Beijing and its surrounding areas.The resulting case fatality ratio of 6.4％ was less than half of that in other SARS-affected countries and regions,partly due to younger-aged patients and a higher proportion of community-acquired infections.Strong political commitment and a centrally coordinated response were most important for controlling SARS.The long-term economic consequence of the epidemic was limited.Many recovered patients suffered from avascular osteonecrosis,as a consequence of corticosteroid usage during their infection.The SARS epidemic provided valuable experience and lessons relevant in controlling outbreaks of emerging infectious diseases,and has led to fundamental reforms of the Chinese health system.Additionally,the epidemic has substantially improved infrastructures,surveillance systems,and capacity to response to health emergencies.In particular,a comprehensive nationwide internet-based disease reporting system was established.

Objective To study the difference and clinical significance of serum Angiopoietin-2 (Ang-2) level in gastric cancer, precancerous disease and the changes in post operation follow-up patients.MethodsSerum Ang-2 and CEA levels were detected with ELISA method in 158 gastric cancer patients, 31 chronic astrophic gastritis patients, 38 gastric adenomatous polyp patients, 28 chronic gastritis patients with benign gastric ulcer and 30 healthy controls.The changes of serum Ang2 levels in 131 patients with radical gastrectomy were measured in 2-year post-operational followed-up and the prognosis was also evaluated.The correlation between serum Ang-2 level and the pathologic character of gastric cancer was analyzed.ResultsThe serum Ang-2 and CEA levels of gastric cancer group were (331.8± 64.3) μg/L and (42.6 ± 37.3) μg/L, respectively, which were significantly higher than those of healthy control group [(187.4±32.7) μg/L and (4.2±3.1) μg/L]and benign gastric ulcer group [(197.3±35.4) μg/L and (4.5±3.2) μg/L](all P ＜0.01).The serum Ang-2 level in chronic astrophic gastritis group was also markedly increased (P＜0.05), however there was no significant change in CEA level.There was no obvious change of Ang-2 and CEA level in gastric adenomatous polyp group (P＞0.05).Pre-operation serum Ang-2 levels of the relapse group and the metastasis group were significantly higher than that of no relapse group (P＜0.05).Post-operation serum Ang-2 level of no relapse group decreased to normal range in 1 month and without obvious increase in 2 years follow-up.The serum Ang-2 level of the relapse group also decreased to normal range in 1 month post-operation, while which was significantly higher than that of no relapse group and normal control group from 6 months to 2 years after operation (P＜0.01).Serum Ang-2 level of the metastasis group was markedly higher than that of no relapse group and normal control group during 2 years after operation (P＜0.01).The 2-year survival rate of no relapse group was significant higher than that of relapse group and metastasis group.The change of serum Ang-2 level was correlated with in the gastric cancer differentiation degree, TNM pathologic classification, lymphatic metastasis, distant metastasis, the depth of invasion and the tumor size (P＜0.01), however not correlated with histopathology type and the location of tumor.ConclusionSerum Ang-2 level may be a new and valuable gastric cancer marker, which will help to monitor tumor relapse, migration and prognosis assessment.

Objective To understand the infectious pathogens distribution and drug resistance in the surgical departments of our hospital from 2007 to 2011 to provide the basis for the anti-infective therapy in the surgical patients.Methods TheVitek automatic microbial identification system was used to identify bacteria and fungi.The Kirby-bauer (KB)method was used to study the antibi-otic resistance in the pathogens isolated from the patients in the surgical departments.Results 1218 strains of pathogens were iso-lated,including 669 strains(55%)of Gram-negative bacteria,440 strains(36%)of Gram-positive bacteria and 109 strains (9%)of fungi.The top five of bacteria in turn were Escherichia coli in 182 strains(15%),Pseudomonas aeruginosa in 171 strains (14%), Staphylococcus aureus in 105 strains (9%),Klebsiella pneumoniae in 86 strains (7%)and Enterococcus faecalis in 61 strains(5%). Among 283 strains of Escherichia coli,Klebsiella pneumoniae and proteus mirabilis,the detection rate of ESBLs producing strains was 29.7%.Methicillin-resistant Staphylococcus aureus(MRSA)accounted for 63% of Staphylococcus aureus.The resistance rates of Staphylococcus and Enterococcus to multiple antibacterial drugs were above 50%.Enterobacteriaceae bacteria were more sensi-tive to carbapenems as well as compound antibacterial drugs containing enzyme inhibitor.The lowest resistance rate of Acinetobact-er to cefoperazone/sulbactam was 21.1%.Pseudomonas aeruginosa showed the most sensitive to compound antibacterial drugs con-taining enzyme inhibitor and its lowest resistance rate to cefoperazone/sulbactam was 17.4%.Conclusion The drug resistance phe-nomenon in the pathogens isolated from the surgical patients are relatively serious,this study provides some basis for the preventive antimicrobial drugs use in the perioperative period and the empirical medication in the infection therapy.

Objective To discuss the value of high-resolution magnetic resonance imaging (HR-MRI) in the etiological diagnosis of patients with head and neck artery occlusion.Methods From December 2015 to February 2017,25 consecutive patients with acute head and neck artery occlusion in Xuanwu Hospital,Capital Medical University were enrolled prospectively.The 32-channel head-neck combined coils were used to conduct head-neck integrated HR-MRI.The characteristics of proximal vascular wall of the occluded vascular segments and the signal features of thrombi in the middle and distal segments of occlusion were analyzed.The evaluation of the occlusive etiology was performed by two neurologists according to the clinical history,laboratory examinations,and imaging examinations of the patients,and the accuracy of conventional lumen imaging and conventional lumen imaging combined with HR-MRI in etiological classification were compared.Results Twenty-five patients with acute head and neck artery occlusion completed HR-MRI examinations.A total of 31 segments of the occluded vessels were diagnosed,and 21 of these were diagnosed with the conventional luminal imaging,30 were diagnosed with the conventional luminal imaging+HR-MRI,including 24 segments of atherosclerotic occlusion (n=19),4 segments of arterial dissecting occlusion (n=4),and 3 segments of arteritis occlusion (n=2).(2) In patients with atherosclerotic occlusion,the eccentric thickening was observed in the proximal wall of occlusive segment;the typical double-lumen or crescent-shaped hyperintense hematoma were observed in occlusive arterial dissection;long-segment annular thickening and enhancement were observed in the segment of arteritis occlusion.(3) The accuracy of the cause classification diagnosis of conventional luminal imaging and conventional luminal imaging+HR-MRI were 67.7% (21/31) and 96.8% (30/31) respectively (P<0.01).Conclusions Compared with the luminal imaging,the head and neck combined HR-MRI can reveal the arterial wall characteristics of the initial segment of occlusion.It has certain advantages in the interpretation of the causes,such as atherosclerosis,arterial dissection and arteritis.

Objective To evaluate the outcomes of the payment reform at public hospitals in Sanming city.Methods Interrupted time series analysis was used to compare changes of the average days of stay,per capita hospitalization expense,outpatient expense per visit,proportion of medical expense and that of drugs during hospitalization at 21 public hospitals at or above county level before and after the DRGs reform.Results Comparisons before and after the reform found the average days of stay at the original momentum,poor control in curbing the proportion of medical expense and that of drugs during hospitalization,adropping followed by rising trend in the outpatient expense per visit,and minimal drop of the abovementioned proportions.Conclusions The rapid growth of outpatient and hospitalization costs at tertiary hospitals may be incurred by unreasonable cost transfer,structural trend of hospitalization expense makeup,and rationality pending scrutiny.

Tripartite-sector reform (a synergistic reform in public health services,medical insurance and medicine production-circulation) in Sanming city was described in the paper which centers on medical insurance.Tapping full potentials of the medical insurance,the city achieved efficient synergy among healthcare,medical insurance and medication systems.This reform has trimmed out inflated drug pricing to some extent for rooms of maneuver of medical service pricing changes,thus curbing excessive growth of medical costs successfully.The authors proposed areas of further improvements including the relationship between achieving such objective as curbing medical expenditure,and advancement of technical/medical service capacity;that between integrative control of medical insurance expenditure and protection of people's health;the equilibrium of interests between medical insurance,healthcare and medication.All these will contribute to the goal of healthy patients flow and a hierarchical medical system.