Transforming economic growth mode is one of the most important guiding ideologies of the National twelfth Five-year development program. Since governmental hospitals are non-profit institutional organizations, it is a new topic for hospital managers to transform economic growth. Current situation of governmental hospitals is analyzed and the three main misunderstandings are pointed out. Take the Taian central hospital as the main object and analyzed the practice process of “putting hospital development scale control and revenue growth as the base and premise, shortening the average hospital stay, reducing the medicine proportion and consumable items proportion as the main means, and usd charging level, patients personal commitment to the cost proportion as important evaluation indicators of transformation economic growth mode” . By analyzing the practice process, the experience of transformation of economic growth mode is concluded, which provides some references for transforming economic growth mode in governmental hospitals.

Objective To analyze the medical and audiological features of trauma induced stapes fracture ,and to summarize the key diagnostic points and to observe the effects of surgical treatment .Methods Five patients with trauma induced stapes fracture confirmed by the surgical exploration from January 1995 to October 2013 were retro_spectively reviewed .Ossicular chain reconstruction was performed on each patient .The preoperative and postopera_tive pure-tone thresholds were compared to judge the effects of surgical treatment .ResuIts The surgical explora_tion revealed 4 cases of stapes feet fracture ,1 case of stapes neck fracture with temporal bone fracture and peripheral paralysis of the facial nerve .Different types of ossicular reconstruction were performed according to the exploration results:2 cases with autogenous stapes remodeling ,1 case with allogenous stapes remodeling ,1 case with bone piece of external acoustic meatus ,and 1 case with artificial auditory ossicle(TORP) implanting .Additionally ,the case of peripheral paralysis of the facial nerve received facial nerve decompression .After the operation ,5 patients felt that their hearing was improved .The mean postoperative pure-tone threshold was 30 .7 dB HL ,and the mean ABG(air-bone-gap) was 18 dB HL while the mean preoperative pure-tone threshold was 61 dB HL(t=6 .725 ,P<0 .05) and the mean ABG was 38 .7 dB HL(t=3 .616 ,P<0 .05) .The facial nerve functions of the case with facial paralysis recovered to House-Brackmann Grade I three months after receiving facial nerve decompression .ConcIu_sion Stapes fractures are rare .Being different from the general conductive hearing loss ,patients with stapes fracture usu_ally have the acoustic stapedius reflex .Through ossicular reconstruction ,we can yield a satisfying hearing recovery .

Objective To introduce operative skill of liver resection by blocking hilum of liver under normal temperature.Method Retrospective analysis of experience treating 86 cases of liver cancer with the operation.Result Among 86 cases of hepatic malignant tumor,there were not serious complications such as death,massive haemorrhage etc.during operation;postoperative liver failure occurred in 7 cases,among them,cure 5 cases and 2 cases of death.The incision infection occurred in 5 patients;The thorax dropsy occurred in 19 cases, which was absorbed by oneself after treating in 14 cases,cured by puncture occurred in 5 cases.Conclusion Operative skill of blocking hilum of liver under normal temperature is more ideal means in treating the liver cancer.

Objective To investigate the levels of small and dense low-density lipoprotein-cholesterol (sdLDL-C) and the influence of insulin therapy on lipid metabolism in type 2 diabetic patients.Methods The subjects were composed of a normal group (n =400,195 males and 205 females),and a type 2 diabetic patients group (n =193,108 males and 85 females) which was further divided into normal lipid (n =33),hypercholesterolemia (n =21,TC ≥ 5.18 mmol/L),hypertriglyceridemic (n =53,TG ≥ 1.7 mmol/L),combined hyperlipidemia (n =75),and low high-density lipoprotein-cholesterol(n=11,HDL-C＜ 1.04 mmol/L) subgroups.The pre-and post-treatment levels of sdLDL-C and the influence of insulin therapy on lipid metabolism in type 2 diabetic patients (n =122,70 males and 52 females) were compared.Serum concentrations of sdLDL-C (sdLDL-EX SEIKENreagent),triglyceride (TG),total cholesterol (TC),and fasting plasma glucose (FPG) were measured by automatic biochemical analyzer,fasting insulin and C-peptide were determined by chemiluminesence immunoassay,TG/HDL-C,sdLDL-C/ LDL-C,LDL-C/HDL-C,apoB/apoA Ⅰ,and other parameters were calculated.Results Compared with diabetic normal lipid group,the levels of sdLDL-C in hypercholesterolemia,hypertriglyceridemic,and combined hyperlipidemia subgroups were significantly higher(P＜0.05),the levels in combined hyperlipidemia subgroup were the highest.The levels of sdLDL-C in low high density lipoprotein cholesterol group showed no significantly difference (P＞0.05).While compared with normal group,the levels of sdLDL-C,TG,TC,LDL-C,ApoB,sdLDL-C/LDL-C,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,apoB/apoA Ⅰ,CRP,and HOMA-IR in type 2 diabetic patients were significantly higher(P＜0.05).Compared with pre-treatment group,the levels ofTG,TC,LDL-C,sdLDL-C,sdLDL-C/LDL,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,and apoB/apoA Ⅰ in post-treatment group were significantly lower(P ＜ 0.05).Conclusions sdLDL-C is the important indicator of lipid metabolism in type 2 diabetes,particularly in evaluating the changes in LDL particles.Insulin therapy is effective both in blood glucose control and improvement of dyslipidemia.Important information of clinical risk of dyslipidoses in type 2 diabetic patients provided by TG/HDL-C,LDL-C/HDL-C,sdLDL-C/LDL-C,and apoB/apoA Ⅰ ratios should be recognized and implemented in future clinical guidelines.

Objective To summarize and analyze the pathogenesis ,methods of hearing reconstruction and curative effect of mixed hearing loss .Methods Patients with mixed hearing loss who underwent hearing reconstruc-tion from Jan 2009 to Dec 2011 in the ENT department of PLA General hospital were reviewed retrospectively .Af-ter the operation ,air conduction (AC) ,bone conduction (BC) ,air-bone gap (ABG) at main frequencies and audi-ometry changes were analyzed .Results Among 32 cases ,15 cases were chronic otitis media ,13 cases otosclerosis , 2 cases Van der Hoeve ,and 2 cases congenital middle ear malformations .There were 26 cases with significantly im-proved hearing after surgery ,and the effective rate was 81 .25% .AC showed great improvement at 0 .25~4 kHz (P<0 .05) while there was no change at 8 kHz (P>0 .05) .BC showed improvements at 1 and 2 kHz and improved significantly only at 2 kHz .After operation ,pure tone audiometry at AC and BC separately improved 24 .94 ± 8 .15 dB and 5 .90 ± 7 .96 dB;ABG narrowed down to 19 .04 ± 11 .06 dB .Conclusion Mixed hearing losses are mostly seen in chronic otitis media and tympanosclerosis .After auditory rehabilitation ,patients can experience improved hearing .

OBJECTIVE: To analyze the diagnosis, therapy and prognosis of the rare cases of malignant tumors in external auditory canal. METHOD: Eight cases of rare malignant tumors in external auditory canal were collected except squamous cell carcinoma and adenoid cystic carcinoma. The clinical manifestation, staging, surgical method, secondary treatment and prognosis were analysed. RESULT: There were 5 cases of basal cell carcinoma and 2 cases of mucoepidermoid carcinoma and 1 case of myoepithelial carcinoma. Three cases of the 5 basal cell carcinoma in external auditory canal have been misdiagnosed for a long time. After admission, 4 of the 5 basal cell carcinoma were T1 stage and cured only by a complete resection of tumor. One case of T2 stage basal cell carcinoma was found recurrence 2 years later after the first excision of tumor, and was treated with radiotherapy. Tumor was controlled. Two cases of mucoepidermoid carcinoma had been misdiagnosed as a benign tumor and received a resection. One case was found metastasis to the parapharyngeal space and nasopharynx and was treated with concurrent chemotherapy. Tumor was also controlled after 5-years follow-up. Another case was found metastasis to parotid gland and received an expanding tumor resection. No recurrence was detected after a 1-year followed up. One case of T4 stage myoepithelial carcinoma in external auditory canal was a metastasis of parotid and received a partial temporal bone resection. No-recurrence was found 1 year later. CONCLUSION Because the tumors above have a very low incidence in external ear canal and the location of tumors are hidden, they are often misdiagnosed and delayed in treatment. Therefore, otologists should pay more attention to avoid the misdiagnosis. To the treatment, complete surgical resection of early-stage tumor is important and for late-stage tumor, a supplemented by chemoradiotherapy may be needed.
Carcinoma, Adenoid Cystic ; diagnosis ; surgery ; Carcinoma, Basal Cell ; diagnosis ; surgery ; Carcinoma, Squamous Cell ; diagnosis ; surgery ; Ear Canal ; pathology ; Ear Neoplasms ; diagnosis ; surgery ; Humans ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Parotid Gland ; pathology ; Prognosis ; Retrospective Studies ; Temporal Bone ; surgery

OBJECTIVE: To investigate the clinical features of labyrinthine fistula and obtain the diagnosis, treatment and prognosis of different types of fistula. METHOD: A retrospective analysis of 42 cases (43 ears) with labyrinthine fistula in our hospital from January 2007 to November 2014 was conducted. Data of preoperative clinical manifestation, auditory function, CT image, operative findings, treatment and postoperative recovery were collected and statistically analysed. RESULT: Thirty-nine cases (40 ears) of the 42 cases (43 ears) which were diagnosed as labyrinthine fistula according to operative findings occurred in the lateral semicircular canal, 1 case occurred in the posterior semicircular canal, 1 case occurred in the superior semicircular canal, and 1 case occurred both in lateral and posterior semicircular canal. Before operation, 24 ears (55.8% ) experienced vertigo and 14 ears (32.6%) showed impaired bone conduction hearing threshold. According to Dornhoffer classification standard, 22 cases (23 ears) were diagnosed as type I fistula, 9 cases as type II fistula and 11 cases as type III fistula. There was no statistical difference among the 3 groups on type of hearing loss, vertigo, CT, facial nerve canal damage before operation and bone conduction hearing threshold, vertigo after operation. CONCLUSION An accurate diagnosis of labyrinthine fistula relies on the operative findings rather than preoperative clinical manifestation, auditory function or CT The surgical intervention should be individualized. There is no significant difference on postoperative recovery among different types of labyrinthine fistula.
Bone Conduction ; Cholesteatoma, Middle Ear ; complications ; Deafness ; Facial Nerve Injuries ; Fistula ; etiology ; Humans ; Labyrinth Diseases ; etiology ; Otitis Media ; complications ; Postoperative Period ; Prognosis ; Retrospective Studies ; Vertigo

The aim of this study was to investigate the effect of Compound Yihe Tea on improving insulin resistance in obesity mice. Thirty-two male C57BL/6J mice were randomly divided into 4 groups: the normal fat diet group(NFD group), high fat diet group(HFD group), Compound Yihe Tea low dosage group［20 mg/(kg ·d), YH-L group］ and high dosage group［40 mg/(kg ·d), YH-H group］. NFD group was given standard feed, and the remaining mice were administered with high fat diet. After 6 weeks, YH-H and YH-L groups were given Compound Yihe Tea for 6 weeks. Blood glucose was measured at week 11 and serum levels of total cholesterol(TC), serum triglyceride(TG), low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)were measured at week 12. Liver tissues were prepared for oil red O and HE staining. Immunohistochemical analysis was used to test the protein expression of GLUT4 in liver. Protein expressions of PI3K, Akt and GLUT4 in epididymis white adipose tissue(WAT)were tested by Western blot. The results showed that Compound Yihe Tea could effectively reduce body weights and the serum levels of TC, TG and LDL-C. Furthermore Compound Yihe Tea could improve the histopathological changes of liver, up-regulate the protein expression of PI3K, Akt and GLUT4 in epididymis WAT and the protein expression of GLUT4 in liver. Compound Yihe Tea can reduce the fat accumulation in liver tissue, improve the indexes of blood glucose and lipid levels, and improve insulin resistance via PI3K-AKT-GLUT4 pathway.

OBJECTIVE: To investigate the sources of foreign bodies in the middle ear, and to analyze experience and lessons of clinical diagnosis and therapy. METHOD: Five cases of foreign bodies in the middle ear with general information presenting to our department and receiving surgical treatment were reviewed retrospectively. RESULT: The foreign bodies of 4 cases were inserted by trauma, while 1 case by iatrogenic injury. The remain of foreign bodies result in symptoms such as otorrhea and hearing loss, and long-term foreign bodies in the middle ear might cause mental effects. All 5 patients received surgical intervention under general anesthesia to remove the foreign bodies. We found that the foreign bodies of 3 cases located in the mesotympanum, 1 located in the epitympanum and the aperture of the eustachian tube, 1 located in the squamous portion of the temporal bone and the gas room of lateral wall of epitympanum. CONCLUSION Foreign bodies in the middle ear are prone to be missed diagnosed and misdiagnosed. Careful specialized examination is appreciated. Patients who are suspected with foreign bodies in the middle ear should regularly take temporal bone HRCT scan. Foreign bodies could be removed by surgery when a definite diagnosis is made.
Adult ; Ear, Middle ; Female ; Foreign Bodies ; diagnosis ; surgery ; Humans ; Male ; Retrospective Studies

Objective:To investigate the effect of anterior or posterior debridement on infections of the lumbar vertebral fusion with cage and pedical screw system.Methods:A total of 10 cases (3 males and 7 females, age 49.80±13.29 years) with infections in the lumbar fusion device were admitted from January 2013 to December 2019. The cases were diagnosed with deep infections after the preview surgery at 10.80±13.24 months, including 10 cases with 12 cages infections and 8 cases with screw system infections. 7 cases were done with debridement and removal of the cages via the anterior approach. And another 3 cases underwent posterior debridement and removal of lumbar fusion cages. The changes in laboratory examination such as WBC count, ESR, CRP, visual analogue scale (VAS) and Oswestry Disability Index (ODI) score were compared preoperatively, 2 months and 6 months postoperatively.Results:No patients were lost in the follow-up. The average follow-up time periods is 16.30±5.10 months (range 9-24 months). There was no significant difference in WBC count between 2 and 6 months after surgery compared with preoperation ( F=0.855, P=0.436). The ESR, CRP, VAS and ODI scores decreased in 2 months and 6 months after sugery, which has significant differences compared preoperation ( P<0.05). The abnormal signals in the lambar vertebral showed a gradual fading trend in the postoperative MRI. The completely fading time was 5.00±1.33 months (range 3-7 months). One-stage bone grafting was performed in 6 cases with 8 spaces via anterior approach, 5 cases with 7 spaces showed the intervertebral fusion after postoperative with 6.80±2.28 months (range 4-10 months), 1 case wirh 1 space was not fused. One-stage bone grafting was performed in 2 cases via posterior approach: 1 case was fused after postoperative and the other patient was not, which due to bone graft area infection. Postoperative bone graft displacement occurred with 1 case and 1 case with L 5 nerve root pulling injury during the operation. Conclusion:The fusion cage can be removed by debridement via posterior approach, but it is difficult to done the completely debridement, which the main reason is the obstruction of the posterior nerve and bone structure. Posterior approach also have risks of infection recurrence and nerve root injury. Cage removal via anterior approach was relatively easy and debridement was thoroughly, which has the risk of injury of important adjacent vessels.