Objective To explore ways to make public hospitals more economically efficient in compliant with existing health economic policies.Methods The concept Medicare Value Added(MVA)is proposed,and used as a benchmark in summarizing the economic management mechanism reforms in Dongyang People's Hospital during the past five years.Centering on MVA,this mechanism consists of the framework assurance,economic management organizational structure,management tools,ways of business growth,cost control,and financial management.Results During the past five years,the net state-owned assets of the hospital increased 100%,out-patients and emergency patients increased by 129 percent in number,in-patients,by 100%,while the average per capita payment of out-patients hasdropped from 1 57.86 yuan to 1 30.23 yuan,and that of in-patients has been kept as unchanged.Ratio of drugs to total income is maintained below 42%.Conclusions The management approach emphasizing MVA is effective in improving economic efficiency of public hospitals

Objective:To determine the expression and localization of tumor necrosis factor alpha(TNF-α) in human middle ear cholesteatoma and its effects on bone resorption.Method:The distribution of TNF-α in 18 cholesteatoma tissues and 8 normal external ear canal skin, facial skin and tympanic memebrane were studied immunohistochemically with paraffin-embedded sections.Result:TNF-α was localized in the epitheliun and connective tissue of cholesteatomas studied, particularly on basal and spinous cells and macrophages.The epithelium of normal external ear canal skin , facial skin and tympanic membrane was slightly stained.Conclusion:This study revealed significantly increased level of TNF-α in cholesteatoma tissues.TNF-α acts both directly,by causing bone erosion as an autocrine growth factor,and indirectly as an important mediator by stimulating the release of enzymes causing bone destruction.

Objective To evaluate the clinical value of endobrochial ultrasound (EBUS) examination,a new ultrasound technique.Method 15 patients with space occupying lesions in lung or doubted obstructive pneumonia or atelectasis were examined by EBUS.The procedure was performed with ultrasound catheters,which were introduced into bronchi through the operating channel of fiberoptic bronchoscope and a full 360℃ cross-sectional image was obtained.Result The bronchial wall was highly echogenic and laminated.The lung parenchyma appeared echo rich and patchy.Pulmonary vessels can be identified by the echo free lumen and the pulsatile changes.Echo poor bronchial carcinomas proved in pathology destructed bronchial wall in different extent were detected in 10 patients.1 patient with nodule in right apical segment who had intact bronchial wall was with tuberculosis proved by operation.1 patient with pleural effusion and atelectasis was detected by EBUS and found no abnormal echo,showing that the reason for atelectasis was compression instead of obstruction.Among the 3 patients who were suspected to have obstructive pneumonia,in 1 case ultrasound scanning showed enlarged lymph node outside the bronchus compressing the wall caused the channel mild narrow;as to the other 2 cases,because bronchial wall was complete and no tumor like echo were found,the obstructive factor was excluded.The ultrasound examination had no particular risk and caused little discomfort.Conclusion Endobronchial ultrasound scan can clearly demonstrate the adjacent extraluminal lesion or structure within the brochial wall itself,which is safe and effective.

In view of the current conditions and reasons about the reform of medical and health system in China,the paper expounds the feasibility of authorized operation with state-owned assets of public hospital and the concrete operational pattern from the angle of hospital operational mechanism, which proposes a new idea about how to effectively solve the contradiction between the limited investment on state-owned health resources and the growing demands on medical health.

Objective To introduce a multifunctional thermostated instrument applied in pre-floats,floats,roast,special staining,immunohistochemical staining,situ hybridization and frozen sections in order to enhance speed and quality of slice-making.Methods Three lengths of vats were nested and overlaid each other to make up a thermostat box which could stretch out and contract back.Its control part consisted a timer,precise temperature control and adjustable power controller.Source of heat was provided by durable electric heat plate to keep the constant temperature for different operations.Results The equipment provided constant temperature and possesses all the necessary functions.It can be used for the pathological operation and compensate for the shortcomings of medical equipment.Conclusion With small volume and light weight,the equipment is easy to carry.Besides,it has less power consumption,so it is secure and easy to operate.The equipment can meet conventional pathology techniques both in peacetime and wartime.

Mini-clinical evaluation exercise(Mini-CEX) is a new tool used to evaluate clinical skill of internal residents.Through necessity,operation and practice of Mini-CEX applied in internal residents' clinical teaching,the paper makes it known that Mini-CEX is consistent with six requisitions of resident competence raised by Accreditation Council of Graduate Medical Education (ACGME).It increases medical and directorial quality,and is combined with doctor training abroad.Mini-CEX should be spread in training and examination of internal residents.

The paper explored the online real-time system built at the hospital to monitor clinical care quality using EMR.The methodology,procedures and index system were established for real-time clinical care quality control.With the online control in place,significant improvements were found in such care indexes as implementation of essential healthcare regulations,EMR quality,rational drug use and rational blood use,making quality control much efficient than before.EMR-based online clinical care quality control can improve quality of care,make it efficient and guide clinical care and quality control as well.

OBJECTIVE To investigate thechanges and clinical significance of serum Nesfatin-1 in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and type 2 diabetes mellitus (T2DM).METHODS 25 OSAHS cases who visited the department of otolaryngology, pneumology department, endocrinology department, physical examination center and sleep monitoring room from December 2014 to April 2015 were assigned as OSAHS group, and 25 patients with OSAHS and T2DM as OSAHS combination T2DM group, and 25 other patients as control group. All patient were took polysomnography, and the height, waist, neck circumference and BMI with all subjects were recorded. The serum Nesfatin-1 and fast blood glucose levels of all patients were measured.RESULTS The gender, age, height, waist and neck circumference had no statistical difference among all groups. The height and BMI in OSAHS group and OSAHS combination T2DM group were statistically significant difference compared with the control group (P<0.05); the FBG in OSAHS combination T2DM group and OSAHS group were significantly higher than that of the control group, and the FBG in OSAHS combination T2DM group were significantly higher than that of the OSAHS group, with statistically significant(P<0.05); The AHI in OSAHS combination T2DM group were significantly higher than that of the OSAHS group, with statistically significant(P<0.05); the serum Nesfatin-1 in OSAHS combination T2DM group and OSAHS group were significantly higher than that of the control group, with statistically significant(P<0.05); FBG, AHI and Nesfatin-1 were positively correlated with each other.CONCLUSION The serum Nesfatin-1 in patients with OSAHS combination T2DM are in a high level.

This study is to investigate the tumor invasion and metastasis inhibition effects of the immunoconjugate composed of lidamycin and anti-type IV collagenase monoclonal antibody Fab' fragment. Boyden chamber assay was used to evaluate the influence of Fab'-LDM on HT-1080 cells invasion ability, gelatinase spectrum was used to measure the change of invasion factor MMP-2 and MMP-9's secretion, and RT-PCR was adopted to determine TIMP-1 mRNA expression level. The immunoconjugate inhibition of tumor in situ metastasis was also tested in nude mice. The Fab'-LDM conjugates had dose-dependent inhibition effect on HT-1080 cells' invasion. At the concentrations of 5 and 10 nmol L(-1), the Fab'-LDM inhibited the invasion by (60 +/- 12) % and (79 +/- 11) % respectively. At the concentration of 5 and 10 nmol L(-1), the Fab'-LDM inhibited the secretion of MMP-2 by (42 +/- 8) % and (54 +/- 6) % and that of MMP-9 by (57 +/- 3) % and (87 +/- 1) %, respectively. RT-PCR indicated that conjugates increased the anti-invasion factor TIMP-1 level. The in vivo experiment showed that, compared with the control group, the tumor inhibition rate in Fab', Fab'-LDM, and LDM group equaled to (30 +/- 13) %, (86 +/- 26) %, (74 +/- 22) % respectively. In conclusion, Fab'-LDM could inhibit the invasion and metastasis of tumor and it might be a new tumor biotherapy agent.

BACKGROUND:Constant magnetic field of proper intensity can inhibit the proliferation of vascular smooth muscle cells,and it can be used to inhibit the restenosis following percutaneous coronary intervention.OBJECTIVE: To observe the effect of constant magnetic field of different intensities on the expression of osteopontin gene in rat aorta smooth muscle cells, so as to investigate whether magnetic field can be used to prevent and treat restenosis following percutaneous coronary intervention.DESIGN: A randomly grouping and controlled observation.SETTING: Department of Cardiology, Xijing Hospital of the Fourth Military Medical University of Chinese PLA.MATERIALS: The experiments were carried out in the laboratory of Department of Cardiology (Military Institute of Cardiovascular Disease), Xijing Hospital of the Fourth Military Medical University of Chinese PLA from February to December in 2006. Male pure SD rats of 200-250 g were used.METHODS : Rat aorta smooth muscle cells were cultured in vitro in DMEM medium containing fetal bovine serum (0.1 in volume serum), and then the cells were randomly divided into control group, constant magnetic field of 1, 5, 10 and 50 Gs groups, those in the control group were not treated with magnetic field, and those in the other groups were treated with magnetic field and cultured for another 48 hours. Reverse transcription-polymerase chain reaction and Western blotting were combined with absorbance (A) scanning analysis to observe the effect of constant magnetic field on the expressions of osteopontin and its mRNA in smooth muscle cells.MAIN OUTCOME MEASURES: Expressions of osteopontin and its mRNA in smooth muscle cells.RESULTS: The expressions of osteopontin and osteopontin genes in the constant magnetic field groups were significantly decreased as compared with that in the control group (P ＜ 0.05), there were also significant differences among the constant magnetic field groups of different intensities (P ＜ 0.05). It was indicated that the stimulation of constant magnetic field was in an intensity-dependent manner, and the expressions of osteopontin and osteopontin mRNA were enhanced as the intensity of magnetic field was increased.CONCLUSION: Constant magnetic field of proper intensity can inhibit the osteopontin expression in vascular smooth muscle cells on the gene level, and magnetic field may play a role in preventing and treating the restenosis following percutaneous coronary intervention.