0.05),but significant difference between the two groups of T2 patients(P=0.04

Objective To estimate the operational efficiency of 37 county level public general hospitals in Hubei province using the world popular method of Bootstrap-data envelopment analysis.The aim is to make up for the theory and methodology gaps on DEA research for hospitals in China,and to provide policy and management recommendations for their further improvement.Methods The input and output indicators of hospital efficiency evaluation were selected based on our previous research.R Software was used to describe the current input and output indicators,while FEAR package used to measure Bootstrap-DEA efficiency value of the sample hospitals with bias corrected,along with such applied analysis as efficiency benchmarking for the technical efficiency outcomes.Results There are great differences among the healthcare input and output of these hospitals.In particular,the difference in the number of actual beds was 4.67 times between the highest hospital and the lowest one.All of the bias corrected efficiency scores were lower than those before correction,and the average bias corrected score of the sample hospitals is 0.717 9.Moreover,only 20 hospitals(54.05%)have their efficiency scores above the median level.Conclusions The healthcare resources allocation of these hospitals needs to be further optimized.Hospitals still have big potential to improve their efficiency.Besides providing policy support,the government is advised to guide hospitals to innovate their management mechanisms,such as introducing and applying benchmarking,ranking,inter-hospital learning among others,so as to continuously improve their operational efficiency.

Objective To discuss the relative factors and clinical features of the elderly patients with craniocerebral trauma so as to improve the level of diagnosis and treatment of craniocerebral trauma.Methods A retrospective study was conducted on 139 patients with craniocerebral trauma treated in our department from June 2006 to August 2009. The post-injury pathogenesis, Glasgow Coma Scale (GCS)score, injury type, major complications and treatment method were summarized and analyzed to find the correlation of various factors with prognosis. Results It was revealed that the mortality was closely related with GCS score, injury type and post-tranmatic complications. The lower GCS score induced higher mortality. The high mortality was manifested in patients with craniocerebral trauma who presented diffuse cerebral edema, contusion and laceration combined with multiple hematomas and brain stem injury. The prognosis was impacted by lung infection, failure of respiratory function, hemorrhage in upper digestive tract, or simultaneous 2-3 complications after craniocerebral trauma. Conclusions The prognosis is directly affected by injury severity, injury type and complications of craniocerebral trauma. The elderly patients demonstrate delayed reaction, which deserves active early examinations and treatment to improve the prognosis.

Objectives:This study aims to summarize the research progress of multiple-site physician practice to determine further research directions. Methods:Literature on Chinese multiple-site physician practice between 1949 and 2013 was obtained from CNKI, Wan fang database and CQVIP database, the annual volume distribution of se-lected documents was been described and the topics and content of literature cited at least once were summarized through literature content analysis. Results:The volume of literature increased rapidly from 2009, guided by related government policies. Content analysis is insufficient in the research areas of supporting policies, international experi-ences, relevant laws and empirical studies. Suggestions: Further research should focus on multiple-site physician practice policies themselves and supporting policy analysis, international comparisons of multiple-site physician prac-tice systems, studies into relevant laws and regulations and empirical studies based on quantitative methods.

Objective:This study aims to ensure the private hospitals development strategy in the background of new healthcare reform and put forward some scientific suggestions to help promote their sustainable development. Methods:The SWOT analysis method was adopted to analyze the private hospitals’ internal strength, weakness, exter-nal opportunity and threats. Results: The results showed a clear property right, advanced management system and other outstanding advantages in the private hospitals. Opportunities like the improved policy environment and people’s medical demand expansion are also very prominent. Meanwhile, the private hospitals development also faces some disadvantages and challenges such as illegal operation, disorder in the market competition, vague orientation, etc. Conclusions:It suggests the strengthening of the personnel and hospital culture construction, adoption of the differen-tiation strategy, improvement of the diagnosis and treatment ability, etc.

ObjectiveTo investigate the changes and functions of T lymphocyte subsets,immune globulin and complement in children with mycoplasma pneumoniae pneumonia(MPP) on different disease stages.MethodsThe levels of T Iymphocyte subsets of CD3,CD4,CD8 and immunoglobulin ( IgG,IgA IgM),and complement ( C3,C4 ) in the peripheral blood were detected on acute and recovery stages in 28 children with MPP by flow cytometry and immune nephelometry.Twenty-five healthy children were recruited as control group.ResultsAmong these subjects of MPP children on acute stage,the levels of CD3,CD4,CD8,and CD4/CD8 in the peripheral blood were (58.71 ± 11.63)％,(32.36 ± 8.06)％,(28.19±6.23 ) ％ and 1.15 ± 0.41 respectively,and on recovery stage,the levels of CD3,CD4,CD8,and CD4/CD8 were (61.29 ±10.17)％,(34.14 ±7.22)％,(26.47 ±6.01)％,and 1.29 ±0.37 respectively.Both on acute stage and on recovery stage of MPP children,the levels of CD4,CD4/CD8 were significantly lower than those in control group [ (39.53 ± 6.16 ) ％,1.83 ± 0.49 ],and CD8 was significantly higher compared to thecontrol group( 1.83 ± 0.49 ),P＜0.01.CD3 were lower than that in control group [ (63.03 ± 12.32) ％ ] on acute stage (P＜0.01 ),and no significant difference on recovery stage (P＞0.05).During the acute stage of MPP,IgG [ ( 14.50 ±3.86) g/L] and IgM [ ( 1.67 ±0.56) g/L] were obviously higher than those in control group [ (7.92 ± 2.62 ) g/L,( 1.06 ± 0.32 ) g/L,P＜0.01 ],and C3 [ ( 0.83 ± 0.42 ) g/L ] were obviously lower compared to the control group [ ( 1.37 ± 0.33 ) g/L,P＜0.05].There were no significant differences of IgA and C4 between MPP and control groups ( P＞0.05 ).ConclusionChildren with MPP had celhilar immune and humoral immune disorders.Through the detection of T lymphocyte subsets,immunoglobulin and complement,it will be helpful to judge the effectiveness of clinical treatment,which provides a theoretical basis for the clinical application of immune regulators.

Objective To investigate the protective role of dexmedetomidine in rats with endotoxin-induced acute lung injury (ALI).Methods Forty-eight adult male SD rats were divided into four groups (n=12 each) according to the random number table: control group, lipopolysaccharide (LPS) group, dexmedetomidine (DEX) treatment group and DEX pretreatment group.ALI was induced in rats by femoral intravenous injection of LPS (8 mg/kg).Rats in DEX treatment group was given DEX (50 μg/kg) for 2 minutes via the femoral intravenous injection 0.5 hour after LPS injection, followed by maintenance pump injection of DEX (5 μg·kg-1·h-1).Analogously, rats in DEX pretreatment group was given DEX (50 μg/kg) for 2 min via the femoral intravenous injection 0.5 hour before LPS injection, followed by maintenance pump injection of DEX (5 μg·kg-1·h-1).By contrast, control group received the same amount of normal saline intravenously.All rats were sentenced to death and their carotid blood samples were collected6 hours after all injections.Superior lobe of the right lung was examined under light microscope and the histologic findings were tested using the difusse alveolar damage (DAD) score.Middle lobe of the right lung was used to calculate the lung tissue wet/dry weight (W/D) ratio.Samples of collected carotid blood were taken to measure levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6.Bronchoalveolar lavage fluid (BALF) obtained from bronchoalveolar lavage was collected to measure levels of TNF-α and IL-6.Results Lung tissue injury was obvious after LPS injection and DAS score was improved as well.However DEX therapy reduced the lung damage as well as the DAD score, especially obvious in DEX pretreatment group (P<0.05).W/D ratio was obviously increased in other three groups compared to control group, but further comparison showed that W/D ratio was lowered in DEX treatment and pretreatment groups compared to LPS group, especially obvious in DEX pretreatment group (P<0.05).Levels of TNF-α and IL-6 were higher in other three groups than control group, but further comparison showed that levels of TNF-α and IL-6 were decreased in DEX treatment and pretreatment groups compared to LPS group, especially obvious in DEX pretreatment group (P<0.05).Levels of TNF-α and IL-6 in BALF were higher in LPS and DEX treatment groups than control group and were higher in LPS group than DEX treatment(P<0.05).Further comparison showed level of TNF-α in BALF similar between DEX treatment and pretreatment groups (P>0.05), but IL-6 in BALF was significantly lower in DEX pretreatment group than DEX treatment group (P<0.05).Level of total protein in BALF was increased in LPS group compared to control group and was decreased in DEX treatment and pretreatment groups compared to LPS group, but there were no significant differences between DEX treatment and pretreatment groups (P>0.05).Conclusion Either preoperative injection of DEX or DEX treatment has protective effect in rats with LPS-induced ALI, while preoperative injection of DEX has been proved to be more effective.

Objective To analyze the clinical feature and prognostic predictors of disseminated herpes zoster.Methods A retrospective study was carried out on 76 patients with disseminated herpes zoster collected from 2005 to 2012 in the Department of Dermatology,Anhui Provincial Hospital.Statistical analysis and comparisons were done.Results The incidence rate of disseminated herpes zoster was highest in the three age groups:70-79 years,30-39 years,and 60-69 years.Of these patients,59.21％ suffered from complications,and 44.74％ from postherpetic neuralgia.Logistic regression analysis showed that the occurrence of complications was significantly associated with age and impaired cellular immune function,and the incidence of postherpetic neuralgia with age,impaired cellular immune function and presence of underlying diseases.Conclusions There is a high incidence of complications in patients with disseminated herpes zoster,and impaired cellular immune function may be an important factor affecting its prognosis.

Objective To investigate effect of hypertonic-hyperoncotic solution (HHS,namely 4.5 g/ml NaCl plus 6.0 g/ml hydroxyethyl starch) on brain protection in rabbits with pulmonary trauma combined with hemorrhagic shock and the possible mechanism.Methods Thirty New Zealand white rabbits were randomly divided into control group (Group A),lactated Ringer' s solution (LRS) treatment group (Group B) and HHS treatment group (Group C),with 10 rabbits per group.Models of pulmonary trauma with hemorrhagic shock were established in Groups B and C.Later,fluid resuscitation,including LRS at 3-fold the volume of blood loss and HHS at dose of 5 mL/kg,was respectively given for Groups B and C at 60 minutes after shock.Rabbits in each group were sacrificed at 4 hours after resuscitation for brain tissue harvest.Evan blue exudation in the parietal cortex of rabbit brain in each group was observed by fluorescence microscope.Brain water content was weighed and calculated.Neuron apoptosis was tested by TUNEL method.Expressions of Bcl-2 and Bax proteins were detected by Western blot.Resalts Group B showed massive exudation of Evan blue,notable increase of brain water content,large apoptosis of neurons,up-regulation of Bcl-2 and Bax proteins,but a decline of Bcl-2 to Bax ratio,as compared with Group A (P ＜ 0.01).However,Group C showed significant decrease regarding Evan blue exudation,brain water content and apoptotic neurons,and significant increase of ratio of Bcl-2 and Bax,as compared with Group B (P ＜ 0.05).Conclusion HHS improves blood brain barrier,inhibits neuron apoptosis and thus protects brain function.

Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as "destructive injury" indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term "destructive fractures" after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types: a1 type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type, open joint-involved destructive fracture; c1 type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructive fracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures.
Fracture Fixation, Internal ; Fractures, Closed ; Fractures, Comminuted ; surgery ; Fractures, Open ; surgery ; Humans