Objective To structure a preliminary indicators system for evaluating the projects of Hospital in finished phase.Methods With Delphi method,collect the experts' opinion of the importance of every item.With AHP (Analytic hierarchy process) method,calculate the weight coefficient of every item.Results The positivity of the experts was fine; The authority coefficient of two rounds were 0.859 and 0.833,the consultation results are reliable; The coordination coefficient of two rounds were 0.254 and 0.553,according to the significance test,p values were less than 0.05,indicating that the results were desirable.According to the score of every item,we got the weight index of every items based on the AHP method.Finally we structure the indicators system including 3 primary indicators and 10 secondary indicators.Conclusion The preliminary results of this study provide a reference for the performance evaluation of projects in finished phase of China-Japan Friendship Hospital.

Objective To evaluate the efficacy of telbivudine in HBeAg-positive chronic hepatitis B (CHB) patients by comparing the efficacy of initial telbivudine therapy in treatment-naive patients with sequential telbivudine therapy in patients with poor response to adefovir.Methods A total of 90 HBeAg-positive CHB patients were assigned to receive sequential telbivudine therapy following poor response to adefovir dipivoxil (n=45),or initial telbivudine therapy in antiviral treatment-naive patients (n=45).All patients were treated with telbivudine 600 mg daily for 104 weeks.The efficacy was evaluated in terms of liver function tests,serum HBV markers,HBV DNA and antiviral drug resistance.Results Telbivudine showed good overall efficacy after treatment for 104 weeks in terms of alanine aminotransferase normalization rate (91.1％),HBV DNA negative conversion rate (80.0％),HBeAg loss rate (57.8％),and HBeAg/HBeAb seroconversion rate (30.0％).The HBV DNA negative conversion rate in initial treatment group was significantly higher than that in sequential treatment group (P＜0.05).However,among the patients with early response,the efficacy did not show significant difference between groups (P＞0.05).The patients with early response showed significantly better efficacy than those without early response,in terms of higher HBV DNA negative conversion rate,higher HBeAg loss rate and HBeAg/ HBeAb seroconversion rate (P＜0.000 1 or P＜0.05),but lower virological breakthrough rate (P＜0.05).Conclusions Telbivudine has shown reliable efficacy in CHB patients.Initial telbivudine therapy is better than sequential therapy in CHB patients with poor response to adefovir.However,for patients with early response to telbivudine,no statistical difference is found between initial and sequential therapy in long-term treatment efficacy (104 weeks).The patients receiving sequential telbivudine therapy should be monitored closely for early antiviral response to optimize treatment.

Objective To analyze the radiologic characteristics of focal organizing pneumonia (FOP) and discuss its values in diagnosis of FOP.Methods 57 lesions of FOP proved by histological examination were studied retrospectively.All of the lesions could be classified into types of nodule(diameter≤30 mm, n=40) and mass(diameter>30 mm, n=17),which were analyzed to explore the imaging characteristics such as location, margin, internal state, and enhancement features.Results 39 lesions were located in the right lung and 18 lesions in the left lung, and 51 lesions in the peripheral and 6 lesions in the inner or middle of the lung.The differences between the location of lobe and lung field were statistically significant.The radiographic common features included air bronchogram were seen in 28 cases, while loose composition sign in 18 cases and vessel convergence in 21 cases.49 lesions occurred in subpleural region, including 34 lesions broad contract with pleura.In 54 lesions with contrast-enhanced CT scan, the difference between arterial phase and plain scan in CT value was 35 HU and difference of venous phase and plain scan was 45 HU, presenting gradual enhancement.14 lesions were inhomogeneous enhancement in mass type and 25 lesions were homogeneous enhancement in nodule type.There were statistic differences in margin, shape, round-glass opacity, necrosis, cave and the relationship with pleura between the nodule type and mass type.Conclusion FOP has specific radiographic features.Enhanced CT scan combining multi planar reformation images is helpful in differential diagnosis.

Objective To investigate the effect of ulinastatin in adjuvant treatment of ventilator-associated pneumonia(VAP)and preliminary clinical efficacy of the therapy mechanism.Methods 76 patients with ventilator-associated pneumonia from January 2015 to February 2016 in Qingyuan People's Hospital of Zhejiang Province were selected and randomly divided into control group and observation group,38 cases in each group.Two groups were given mechanical ventilation,phlegm,anti infection,rehydration,nutritional support and other conventional treatment,the observation group on the basis of routine treatment for ulinastatin adjuvant therapy,comparison of two groups of treatment,the simultaneous determination of serum interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)and tumor necrosis factor alpha(TNF-alpha)levels were measured before and after treatment.Results The total efficiency of the observation group was 94.74％,significantly higher than the control group 78.95％,the difference was statistically significant(P<0.05),the two groups after treatment of serum CRP and PCT levels were decreased significantly compared with before treatment,the observation group after treatment,serum CRP and PCT levels were(45.19+5.79)mg/L and(1.08+0.36)μg/L was significantly lower than that before treatment and control group after treatment,the difference was statistically significant(P<0.05),the two groups after treatment of serum IL-6 and TNF-α levels were decreased significantly compared with before treatment,the observation group after treatment,serum IL-6 and TNF-α levels were(165.29+19.23)pm/mL and(1.16+0.25)pm/mL,was significantly lower than that before treatment and control group after treatment,the difference was statistically significant(P<0.05).Conclusion The inflammatory reaction in patients with ventilator-associated pneumonia ulinastatin can effectively reduce auxiliary patients,reduce inflammatory factors on lung injury,can alleviate the disease progression and to improve its prognosis.

Objective To observe the effect of single and low dose propofol administered near the end of surgery on the cardiovascular and adverse response during extnhation in patients undergoing ovarian cancer operation. Methods Fifty ASA Ⅰ - Ⅱ patients undergoing selective ovarian cancer operation were randomly allocated into group S and group P,with 25 patients in each group. In group S, inhalation of sevoflurane was discontinued at about 2 minutes before the end of operation. In group P, inhalation of sevoflurane was discontinued at about 5 minutes before the end of operation,and at the same time,0.5 mg/kg of propofol was administered intravenously. The systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and recovery time of consciousness were recorded at 5 min before extubation (t_1),during extubation (t_2), 1 min after extubation (t_3), and 5 rain after extubation (t_4). The incidence of agitatian,bucking,nausea and vomiting were recorded by an observer who was blind to this study. Results There were statistical differences in HR,SBP,DBP at t_2-t_4 between two groups. The recovery time was (10.39 ± 1.26) min in group P,and(9.57 ± 1.25) min in group S,there was significant difference between group P (2 cases) and group S (9 cases)(P< 0.05). There was significant difference in the incidence of agitation between two groups (P< 0.05). Conclusion Low dose propofol before extubation can inhibit stress and cardiovascular response and decrease the incidence of agitation, bucking, nausea and vomiting.

Objective To explore the application effects of segmental design principles in the small incision approach rigid internal fixation for the treatment of maxillofacial fractures.Methods With a retrospective study,from September 2012 to April 2016,172 patients with maxillofacial fractures were selected as the research object in our hospital.All the patients were divided into the observation group of 100 patients and control group of patients according to the different treatment methods.Two groups were treated with mall incision approach rigid internal fixation.The observation group were given the preoperative design based on the segmental design principles.The other operation process were similar with the control group.Results All patients were completed the operation,the fracture were healed by Ⅰ stage.The postoperative 3months of total effective rates of the observation group and the control group were 98.0％ and 83.3％.The total effective rate of the observation group was significantly higher than that of the control group (P ＜ 0.05).The postoperative 3months of infection,nerve injury,salivary fistula,screw loosening and complication rate in the observation group was 3.0％,so that was 20.8％ in the control group,the observation group was significantly lower than the control group (P ＜ 0.05).The postoperative 3months of occlusal relationship and normal rates of the observation group were 99.0％ and 98.0％,respectively.The control group was 93.1％and 90.3％,respectively.There were between the two groups statistically significance difference(P ＜ 0.05).Conclusion The segmental design principles in the small incision approach rigid internal fixation for the treatment of maxillofacial fractures can improve the therapeutic effect,reduce the incidence of postoperative complications,improve the occlusal relationship with normal mouth opening rate.It is an ideal method for the treatment of maxillofacial fracture.

Objective To investigate the effect of single operation Mammotome system on breast benign tumor patients.Methods 86 cases of benign breast cancer patients admitted from Jan.2011 to Dec.2015 were divided into the control group (43 cases) and the observation group (43 cases) according to the random number table method.The control group were treated by traditional breast lesion resection and the observation group were treated by single operation of Mammotome system.The mean time of operation,the average blood loss and the size of surgical scar were recorded.The number of patients with deformity of breast and complications was recorded.The satisfaction of the two groups was evaluated by questionnaire.The recurrence rate of the two groups was statistically analyzed.Results The average operation time of the observation group was significantly shorter than that of the control group,and the scar size was significantly smaller than that of the control group (P＜0.05).The deformity rate of the observation group was 0％,significantly lower than that of the control group (11.6％).The satisfaction rate was 97.7％ in the observation group,significantly higher than that of the control group (83.7％,P＜0.05).The postoperative complication rate was 4.7％ in the observation group,significantly lower than that of the control group (18.6％,P＜0.05).There was no recurrence in the two groups during 6 months of follow-up.Conclusion The application of single breast operation Mammotome treatment for benign breast tumor has the advantages of simple operation,shorter operation time,less intraoperative blood loss and surgical scars.It also can reduce the postoperative complications,keep breast shape,reduce the recurrence rate,so as to improve the patient satisfaction.

BACKGROUND: Previous research reveals that, single-layer human amnion is effective to cure superficial bums, but it is still unsatisfactory.OBJECTIVE: To observe the effects of double-layer radiation-treated human amnion on the healing of deep second-degree burn wound.DESIGN, TIME AND SETTING: Randomized control study was performed at the Animal Experimental Center in the First Affiliated Hospital of Harbin Medical University (Harbin, Heilongjiang, China) from December 2006 to May 2007.MATERIALS: Fifty adult Wistar rats of clean grade were burned and then assigned into five groups at post-injury 4, 6, 8,10 and 12 days, with ten rats in each group. Subsequent to the chorion removal, the fresh human amniotic membrane was dried and prepared into double-layer films, which were aporate or porous. Human amnion was then radiated using γ-ray for further use.METHODS: Following dorsal skin epilatiou and the anesthesia, all the rats were immersed for 8 seconds in boiling water to induce rat models of deep second-degree burns. One side of the burn wound was applied human amnion, while the other side was applied oil gauze.MAIN OUTCOME MEASURES: Gross observation of the bum wound was carried out at post-injury 4, 6, 8, 10 and 12 days. Meanwhile, light microscope, scanning electron microscope and transmission electron microscope were employed to detect the histological changes of the burn wound, as well as bacteriological examination.RESULTS: Fifty rats were all involved in the result analysis. Sphacelism and crust were found in the burn wound treated with oil gauze, with the presence of focal ulcer at post-injury 12 days. Under light microscope, few hairs regenerated in dermis, especially hair follicle and hair root; Scanning electron microscope suggested a large amount of inflammatory exudates and leukocytes; Transmission electron microscope revealed an unclear structure of the cells. Bacteriological examination also indicated that the bacteria aecreted on the surface of burn wound. The treatment of double-layer radiation-treated human amniou healed the burn wound at post-injury 10 and 12 days, and the hairs grew with the same manner as that of normal skin. Epidermis tissues were proved to be normal skin at post-injury 12 days by means of light microscope, scanning electron microscope and transmission electron microscope. Bacteriology was detected to be negative.CONCLUSION: Double-layer radiation-treated human amnion plays a protective role on the burn wound in rats. It may facilitate epithelial growth, avoid wound infection and accelerate the healing of deep second-degree burn.

Objective To investigate the effects of lappaconitine on the perioperative immune function.Methods Twenty-four ASA I or II patients aged 23-64 yr undergoing elective radical mastectomy (8 patients),iaminectomy and vertebral canal decompression (8 patients) or femoral head replacement (8 patients ) were randomly divided into 2 groups (n=12 each): control group (C) and lappaconitine group (L).In group L ondansetron 4 mg was given IV and lappaconitine 8 mg was infused IV over 30 rain before induction of anesthesia.In group C equal volume of normal saline was infused instead of lappaconitine.Anesthesia was induced and maintained with propofol,remifentanil and rocuronium.Lappaconitine 0.28 mg/ml was continuously infused at 2 ml/h after induction of anesthesia in group L.When the patients recovered from anesthesia after operation,PCA with 0.28 mg/ml lappaconitine was started (background infusion 2 ml/h,bolus dose 0.5 ml and lockout interval 15 min).In group C pethidine 50 mg and droperidol 2.5 mg were given IM on demand.Venous blood samples were taken at 30 rain before induction of anesthesia(T1,baseline),immediately (T2) and at 24 h(T3) and 48 h (T4)after operation for determination of TNF-α,IL-2,IFN-γ and sIL-6R concentration by ELISA.CD3,CD4,CD8 and NK cell expression was determined using flow cytometry and the ratio of CD4/CD8 was calculated.The concentrations of IgA,IgM,IgG,CD3 and CD4 were determined by radioimmunoassay.Results Plasma SIL-6R and TNF-α concentrations were significantly lower while IL-2,IgA,IgG,IgM concentrations and CD4/CD8 ratio were significantly higher after operation in group L than in group C.Conclusion Lappaconitine can improve perioperafive humoral immune function thus contributing to its analgesic and anfi-inflammatory effects.

The rate of stroke has been rising year by year and become the world's major cause of mortality and disability. The high rate of disability did not only bring economical burden to society and family, but also induce psychological damage to patients. Post-stroke depression (PSD) is a most common mental complications of stroke. In recent years, More and more attentions have been paid to PSD. This article reviewed the cause and mechanism of PSD and the treatment with Chaihu Shugan Powder on it.