Business process cost management is key to hospital business process management It mostly consists of process cost accumulation and cost analysis. The paper probed into theories of Activity Based Costing (ABC), and built a model for hospital process costing based on the hospital organizational structure Discussed herein include the items of hospital medical services and their activity costs, followed by a case study to prove ABC as practical in the analysis and calculation of hospital business process costs.

Objective To explore the effectiveness and feasibility of microwave Hesetor in resection of soft tissue sarcoma of deep thigh. Methods From January 2009 to August 2014, 33 patients underwent tumor resection of soft tissue sarcoma of deep thigh (10-37 cm in diameter).The high frequency electroscalpel was used in 15 cases before December 2012 (electroscalpel group) whereas the microwave Hesetor was used in 18 cases after January 2013 ( microwave group) .The intraoperative blood loss, operation time, transfusion proportion, length of hospital stay and postoperative drainage volume were compared between the two groups. Results The intraoperative blood loss was significantly decreased in the microwave Hesetor group as compared with that in the electroscalpel group [(175.0 ±129.8) ml vs.(356.7 ±238.2) ml, t=-2.645, P=0.015].Three patients in the electroscalpel group were given blood transfusion of 200 ml, 400 ml and 400 ml, respectively, due to a massive intraoperative hemorrhage, while none in the microwave group required blood transfusion.There was no statistical difference between the two groups regarding to the operation time, length of hospital stay and postoperative drainage volume (P>0.05). Conclusion Microwave Hesetor is of great value in the resection of soft tissue sarcoma of thigh for significantly reducing intraoperative bleeding and obviating blood transfusion.

Objective To investigate the effects of edaravone pretreatment on the lung injury during onelung ventilation (OLV) in patients.Methods Forty ASA Ⅰ or Ⅱ male patients, aged 48-64 yr, with body mass index 18-26 kg/m2, undergoing elective resection of esophageal carcinoma, were randomly divided into 2 groups (n = 20 each): control group (group C) and edaravone group (group E). Anesthesia was induced with fentanyl,propofol and rocuronium and maintained with sevoflourane, remifentanil and atracurium. The patients were mechanically ventilated (during OLV VT 8 ml/kg, RR 15 bpm, I:E 1:1.5). In group E edaravone 0.5 mg/kg (in normal saline 100 ml) was infused over 30 min after skin incision. PETCO2 and peak airway pressure (Ppeak) were recorded during operation. Venous blood samples were obtained before opening the thoracic cavity and at the end of operation for determination of serum SOD activity and the levels of serum surfactant protein A (SP-A), MDA and TNF-α. Results There was no significant difference in PETCO2 and Ppeak during operation between the two groups (P ＞ 0.05). Serum SOD activity was significantly decreased, while the levels of serum SP-A, MDA and TNF-α were significantly increased after OLV in both groups (P ＜ 0.05). Serum SOD activity was significantly higher,while the levels of serum SP-A, MDA and TNF-α were significantly lower at the end of operation in group E than in group C (P ＜ 0.05). Conclusion Edaravone pretreatment can reduce the lung injury during OLV through inhibiting oxidative response and inflammatory response in patients.

This study was aimed to optimize the extraction process of resveratrol by central composite design (CCD) and response surface method (RSM), based on the result of single factor experiment. Resveratrol was extracted from Polygonum cuspidatum by water bath extraction of organic solvent. And content of resveratrol was taken as index in the investigation of solvent concentration effect, extraction time and solvent content on extraction process. The results showed that the optimum condition was 12.7 times amount of 72.0% ethanol and extract for 2 times under the temperature of 50℃, 1.1 h for each time; the average deviation between the maximum theoretical value and measured value was 0.83%. It was concluded that this extraction process was highly predictive, which provided experimental evidence for the industrial production of P. cuspidatum extraction.

Objective To evaluate the efficacy of visual analog scale international prostate symptom score (VAS-IPSS) in patients with benign prostate hyperplasia (BPH).Methods Three hundred and ninety patients with BPH were recruited to participate in this study and were randomly assigned to one of two groups:the standard IPSS group and the VAS-IPSS group.In each group,sub-groups were further divided to non-interpretation arm (A) and interpretation arm ( B),based on the availability of medical professionals to interpret patientsˊ VAS-IPSS score.In the same way,the similar sub-groups were established in VAS-IPSS group with non-interpretation arm (C) and interpretation arm (D).All the patients were required to fill out the same questionnaires at first consultation and second consultation with an interval of two weeks.Eventually,all the data were collected and analyzed.Results The ICC index was as follows for arms A through D:0.87 (95％CI0.72-0.94); 0.88 (95％CI0.74-0.95); 0.82 (95％CI0.59-0.92); 0.97(95％ CI 0.93-0.99).The optimal prediction factor for arm A was frequency (F =14.70,P =0.010)and the sub-optimal was nocturia ( F =12.10,P =0.000) and urgency ( F =11.80,P =0.000).The optimal prediction factor for arm B was nocturia ( F =6.02,P =0.000 ) and the sub-optimal was urinary incontinence ( F =5.79,P =0.008 ).The optimal prediction factor for arm C was nocturia ( F =30.98,P =0.000) and the sub-optimal was urinary incontinence ( F =22.42,P =0.000).The optimal prediction factor for arm D was nocturia ( F =20.20,P =0.000) and the sub-optimal was urinary incontinence ( F =18.00,P =0.000) and weak urine steam (F =15.30,P =0.000).Conclusions VAS-IPSS is more stable than the standard IPSS.The questionnaire explanation to patients is helpful for improving the VASIPSS stability.

Objective To evaluate the effects of gender and age on median-effective target plasma concentration(EC50)of propofol administered by target controlled infusion(TCI)causing respiratory depression.Methods Eighty ASA Ⅰ or Ⅱ patients aged 40-79 yr,with body mass index 18-25 kg/m2.undergoing general anesthesia were divided into 4 groups(n=20 each):1 middle-aged male group(MA);Ⅱ middle-aged female group(FA);Ⅲold male group(MO) and Ⅳo ld female group(FO).No premedication was administered.Propofol Was administered by TCI for 15 min,using TCI system incorporating Marsh pharmacokinetic model.EC50 Was determined by up-end-down sequential trial.The target plasma concentration(Cr)was set at 3.1μg/ml in the first Patient in each group.Each time Cr increased/decreased by 10%in the next patient depending on whether or not the respiratory depression occurred.Respiratory depression was defined as RR<8 bpm,Vr≤5 ml/kg,end-tidal PCO2≥50 mm Hg,SaO2≤94%and/or apnea≥15s.Results The EC50 and 95%confidence interval of propofol TCI causing respiratory depression were 6.40(6.09-6.72)μg/ml in group MA,5.93(5.54-6.34)μg/ml group FA,4.58(4.32-4.91)μg/ml in group MO and 4.37(4.14-4.61)μg/ml in group FO.EC50 was significantly lower in group FO than in group FA and in group MO than in group MA,but there Was no significant difference in EC50 between group MA and group FA or between group MO and FO. Conclusion The potency of propofol given by TCI causing respiratory depression is increased in the old patients as compared with the middle-aged patients and is not related to sex.

Objective To evaluate the effect of sleep dysfunction on sedation induced by propofol in the patients undergoing radical mastectomy.Methods One hundred breast cancer patients,aged 25-60 yr,with body mass index of 19-23 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective modified radical mastectomy,were randomly divided into 2 groups according to sleep quality.The patients with global Pittsburgh Sleep Quality Index (PSQI) score ≤7 served as regular sleep quality group (Ⅰ group,n =59).The patients with global PSQI score ＞ 7 served as sleep dysfunction group (group Ⅱ,n =41).Anesthesia was induced with propofol given by target-controlled infusion (target plasma concentration of 3.5 μg/ml),and then with remifentanil 4 μg/kg and rocuronium 0.6 mg/kg after loss of consciousness.The consumption of propofol at loss of consciousness was recorded.Results Compared with group Ⅰ,the consumption of propofol at loss of consciousness was significantly decreased in group Ⅱ.Conclusion Sleep dysfunction can enhance propofol-induced sedation in the patients undergoing radical mastectomy.

Purpose To evaluate the clinical value of triple-rule-out (TRO) computed tomographic angiography using adaptive prospective ECG triggering for chest pain patients.Materials and Methods Sixty patients with chest pain were prospectively collected and randomly divided into group A and group B:group A (n=30) performed prospectively gated axial scan and group B (n=30) performed retrospectively gated helical scan.The vascular density,noise and muscle density of the vessels including aorta,pulmonary artery,coronary artery between the two groups were measured and analyzed.The vascular density/noise ratio,contrast noise ratio and effective dose (ED) between the two groups were calculated.The image quality and scanning radiation dose were compared between the two groups.Results There was no significant difference in the image quality of aorta,pulmonary artery and coronary artery between group A and group B (P＞0.05).The ED in group A was lower than that in group B [(5.90±2.10) mSv vs (11.31 ± 2.12) mSv,P＜0.01].Conclusion The technique of TRO computed tomographic angiography triggered by adaptive prospective ECG can significantly reduce the radiation dose while ensuring image quality.

Objective To evaluate the effects of different doses of dexmedetomidine on stress responses of the hypertensive patients undergoing thoracic surgery and find the uptimal infusion rate of dexmedetomidine in decreasing stress responses.Methods Sixty hypertensive patients of both sexes,aged 45-64 yr,weighing 65-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 4 groups (n =15 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).In D1,D2 and D3 groups,dexmedetomidine 0.2,0.3 and 0.4 μg · kg 1 · h 1 were intravenously infused until 30 min before the end of surgery,respectively,starting from 15 min before induction of anesthesia.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration of dexmedetomidine (T0),at 1 min after endotracheal intubation (T1),at skin incision (T2) and immediately after extubation (T3),venous blood samples were collected for determination of epinephrine and norepinephrine concentrations in plasma (using high-performance liquid chronatography) and blood glucose concentrations.The development of adverse effects such as bradycardia,hypotension and respiratory depression was recorded.Results Compared with group C,epinephrine and norepinephrine concentrations in plasma and blood glucose concentrations were significantly decreased at T1-3 in D1,D2 and D3 groups,the incidence of bradycardia and hypotension was significantly increased in group D3 (P＜0.05),and no significant change was found in the incidence of bradycardia or hypotension in D1 and D2 groups (P＞0.05).There were no significant differences in epinephrine and norepinephrine and concentrations in plasma and blood glucose concentrations at each time point between group D1,group D2 and group D3 (P ＞ 0.05).Conclusion The optimal infusion rates of dexmedetoinidine are 0.2 and 0.3μg · kg-1 · h-1 in decreasing stress responses of the hypertensive patients undergoing thoracic surgery.

Objective To investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.