Objective To identify objective methods for medical service performance evaluation,and means to improve the efficiency of medical services.Methods By means of collection of medical records from 10 tertiary hospitals in Yunnan in 2012,and Diagnosis-related groups of Beijing version(BJDRGs)as a risk-adjustment tool,medical service performance was made to such hospitals.Results The capacity,efficiency and medical safety of hospital of the hospitals were subject to a comprehensive evaluation of their medical service capabilities.In terms of discharged inpatients and total weight,hospital A were found to be the highest(77 458 cases,104 227.5 respectively),and hospital I the lowest(25 450 cases,38 162.28)among these hospitals in 2012; compared with other hospitals,DRG groups of hospitals A,b and D were found higher,while the case mix index(CMI)of hospitals e and I were higher.The expenditure index of hospital C is the lowest(0.9359,0.8514); the mortality in cases of low risk of hospitals B,c and D were the lowest,while hospital F was the highest.Conclusion DRGs as a risk adjustment tool,can significantly improve the reliability,science and continuity of medical service performance evaluation,providing reliable basic data for hospitals accreditation in Yunnan.

Objective To explore the anxious condition of nurses and correlative factors,and to explore the relationship between the nurses' anxiety and the correlative factors,so that can help the management echelon and nurses to correctly understand the relationship of anxiety and pressure,and control and handle the anxiety problem of nurses fundamentally,and improve the physical and mental health,work efficiency and nursing quality of nurses. Methods A questionnaire investigation was conducted in 85 nurses from a certain hospital in Harbin about the anxiety,life events,work stressor and the relationship between them. Results 30 nurses had anxiety(the anxiety group),another 55 nurses showed no anxiety(the nonanxiety group).The comparison of items in life events inventory showed that great difference existed in pregnancy,addition of new family members,the difficulty of training their children,property damage or being stolen,living apart with the spouse,magnificent changes of the life style,having got severe illness or wound.In the aspect of work sttessor scale,professional and career issues,workload and allocation of time,working environment,patient care and interaction showed significant difference.The work pressure was significantly associated with the level of anxiety. Conclusions Our finding suggest that effective stress management strategies should be implemented to reduce or eliminate work pressure of nurses,carry out training to improve the self-regulation ability of nurses,and if necessary biofeedback therapy can be introduced.

Postoperative peritoneal adhesion represents a major complication of surgery. Recently, the angiogenesis which cyclooxygenase-2 enzyme induced was found to play an important role in the adhesion synthesis. This review summarized the relationship between COX-2 induced angiogenesis and peritoneal ad- hesion.

Objective To study the correlation between chronic gastritis with benign mucosal nodular-change,Helicobacter pylori(H.pylori)infection and lymphoid follicles infiltration.Methods During July 1,2004 to June 30,2005 patients with chronic gastritis and benign mucosal nodular-change were identified by chromo-endoscopy with anabrosis indigo carmine staining at the antrum.Multiple biopsies were obtained for H.pylori detection with quick test and for pathology examination of mucosal lymphoid follicles formation and lymphocyte infiltration,as well as H.pylori infection.Results The patients were divided into nodular gastritis group,atrophy gastritis group and verrucous gastritis group with mean age of(31.00?11.62),(58.61?12.14)and(51.29?12.99)years old,respectively.The patients with nodular gastritis were the youngest(P

It is now clear that both endogenous and exogenous sources of nitric oxide(NO) exert important modulatory effects on cardiac mitochondrial function.There is also growing evidence that NO can be produced within the mitochondria themselves.NO can influence respiratory activity,both through direct effects on the respiratory chain or indirectly via modulation of mitochondrial calcium accumulation.At pathological concentrations,NO causes irreversible alterations in respiratory function and also interacts with reactive oxygen species(ROS) to form reactive nitrogen species(RNS),which may further impair mitochondrial respiration and even lead to open the mitochondrial permeability transition pore and induce cell death.Diabetes,aging,myocardial ischemia,and heart failure are all associated with altered ROS generation,which can alter the delicate regulatory balance of effects of NO in the mitochondria.

Objective To explore the correlation of the apoptosis of peripheral blood mononuclear cell (PBMC) with plasma 8-iso-prostaglandin F2? (8-iso-PGF2?) level in order to confirm the peroxidation damage of hyperbilirubinemia in neonates with jaundice.Me-thods One hundred and twenty-nine neonates who were 2 to 7 days old were divided into 4 groups:slight jaundice (43 cases),moderate jaundice (38 cases),serious jaundice (18 cases),and healthy control(30 cases)groups.Plasma 8-iso-PGF2? levels were assayed by enzyme immunoassay(EIA),and the apoptosis rates of PBMC were determined by flow cytometry.Results 1.There was no significant difference in the apoptosis rate of PBMC between normal and slight jaundice neonates (P=0.108);apoptosis rate of PBMC was increasing with the aggravation of jaundice.2.Plasma 8-iso-PGF2? level in normal neonates was 14.74?6.71 ng/L,there was no difference between normal neonates and neonates with slight jaundice(P=0.502).Plasma 8-iso-PGF2? levels in neonates with moderate and serious jaundice were much higher(Pa=0).3.Positive correlation existed between plasma 8-iso-PGF2? level and PBMC apoptosis rate (r=0.602 P=0).Conclusions Hyperbilirubinemia can induce peroxidation damage,resulting in increase of PBMC apoptosis.Plasma 8-iso-PGF2? level can accurately eva-luate the peroxidation damage in neonates with jaundice.

Objective To evaluate the clinical features and early management of combined thoracoabdominal injury (CTI).Methods A retrospective study was carried out in 29 cases with CTI treated surgically.There were 21 cases with penetrating injuries and 8 cases with blunt injuries.All cases were associated with penumothorax and/or hernothorax at various degrees and 13 cases complicated with shock.In this study thoracotomy was performed in 17 cases,laparotomy in 6 cases,thoracotomy plus laparotomy in 5 cases and combined thoraco-laparotomy in 1 case.Results The injury severity score in this series was (40.16±15.23) scores.Four cases were died from hemorrhagic shock (2 cases),pericardial tampenade(1 case) and multiple organ failure(1 case).Conclusions CTI has high mortality rate,and the most frequent cause of death is hypovolemic shock.The operative approach is based on individual injury condition.Early diagnosis and timely surgical intervention are key to improving the cure rate and reducing mortality in severe CTI.

Objective To evaluate the effect of ecoimmunonutrition enteral nutrition on systemic inflammatory response and prognosis in patients with acute severe acute pancreatitis. Methods Fifty-seven patients with severe acute pancreatitis were randomly divided into two groups: parenteral nutrition (PN) group(28 cases), and ecoimmunonutrition(EIN) group (29 cases), each of the two nutrition formulas was given to each group respectively for 7 days. The level of plasma endotoxin and serum concentrations of TNF-α ,IL-1β ,IL-6 and IL-10 and monocyte NF-κB were tested at admission,1 d,3 d,5 d,7 d after nutrition support. Statistics the two groups results of clinical prognosis. Results The levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were no significant difference compared with PN group at admission. After nutrition support 7 d, the levels of endotoxin, TNF-α ,IL-1β ,IL-6 and IL-10 , NF-κB activities in EIN group were (2.70 ± 0.13) ng/L, (30.13 ± 8.12) ng/L, (20.17 ± 8.04) ng/L, (36.43 ± 8.24)ng/L, (86.45 ± 14.54) ng/L, (70.4 ± 3.2)% respectively, which all were significantly lower than those in PN group [(3.25 ±0.32) ng/L, (313.42 ± 144.35) ng/L,( 155.29 ±32.78) ng/L, (324.15 ± 31.47) ng/L, (472.72 ±48.55) ng/L, (88.4±53)% ](P<0.05 or <0.01). Conclusion EIN can attenuate endotoxemia.decrease NF-κB activities and concentrations of cytokines, maintain the balance of pro-and anti-inflammation, improve patients' condition and prognosis.

Objective To explore the role of depression as a moderator of self-concept on self-care behaviors in patients with chronic heart failure(CHF).Methods A sample of 160 in-patients with CHF were recruited from a cardiovascular hospital in Beijing.Data were collected by self-report questionnaires assessing self-care behaviors,self-concept and depression.Analysis of Moment Structures (AMOS) version 17.0 software was used to conduct the path analyses.Results Body sensation,self-consistency,self-ideal,moral-ethical-spiritual self and depression revealed direct effects on self-care behavior.Body sensation,self-ideal,moral-ethical-spiritual self affected self-care indirectly via depression.These paths' total coefficients were 0.09,0.15,0.31,0.09 and -0.26,respectively.Conclusion Self-care behaviors are directly affected by self-concept and depression.Depression has a greater moderating effect on these relationships.The findings provide a theoretical basis to direct the development of interventions for improving self-care in individuals with heart failure.

ObjectiveTo identify the association of HLA-DQA1*0302 and DQB1*0303 alleles with vitiligo in Uygur nationality in Xinjiang Uygur Autonomous Region. MethodsPolymerase chain reaction with sequence-specific primers(PCR-SSP) was performed to analyze the distribution of HLA-DQA1*0302 and HLA-DQB1*0303 alleles among 300 patients with vitiligo and 300 normal human controls of Uygur nationality in Xinjiang region. ResultsA significant increase was observed in the frequency of HLA-DQA1*0302 and -DQB1*0303 alleles in patients with vitiligo compared with the controls(20.5％ vs. 13.83％, 30.17％ vs. 13.33％, both P ＜ 0.01 ). Increased frequency of HLA-DQA1*0302 and -DQB1*0303 alleles was also seen in patients with adult vitiligo (onset age ＞ 12 years) and those with childhood vitiligo (onset age ≤≤ 12 years) ascompared with the normal controls(both P ＜ 0.01). The frequency of DQB1*0303 allele was higher in both patients with and without family history of vitiligo than in the normal controls(both P ＜ 0.01), while that of DQA 1*0302 was higher in only patients without family history (P ＜ 0.01 ). No significant difference was observed in the frequency of HLA-DQA 1*0302 or HLA-DQB1*0303 between patients with adult vitiligo and those with childhood vitiligo or between patients with and without family history(all P ＞ 0.05). Conclusions HLADQA 1*0302 and DQB 1*0303 alleles may be associated with vitiligo in Uygur nationality in Xinjiang region,and there seems to be genetic heterogeneity between patients with adult and childhood vitiligo and between vitiligo patients with and without family history.