13th Five-Year period is China's comprehensive completion of the decisive stage of a well-off society,when the development of public hospitals is facing great opportunities and challenges.Five development concepts introduced by the fifth Plenary Session of the 18th CPC Central Committee,offer guidance on public hospital reform and development.Among such concepts,innovation is leading the first power of hospital development;Coordination is the inherent requirements of the hospital' s sustainable and healthy development;Green is a necessary condition for the sustainable development of the hospital,and also an important reflection of the hospital development achievement;Opening is the only way for the rapid development of hospital;Sharing is the essential requirement of hospital development.Five development concepts shall guide the reform and development of Chinese public hospitals during the period of 13th Five-Year.

Objective To study the feasibility and safety of transumbilical single port laparoscopic cholecystectomy(LC).Methods We analyzed the clinical data of 52 cases of transumbilical single port LC done in our hospital from March 2009 to July 2009.Results Three cases were operated by usual LC becauseof stone embedded in gallbladder neck and exposure was difficult.In the other 49 cases(94.2%),transumbilical single port LC was successfully performed.Operating time was 39 to 108 min[mean(48?23 min)].There were no intraoperative complications.The patients were discharged from hospital in one to three days after operation,and resumed normal work in one week.Conclusions Compared with the routine LC,transumbilical single port LC is more feasible,has more micro-invasive advantages and with no visible abdominalscar.

Objective To detect the serum levels of angiogenic factors and inflammatory cytokines in patients w ith moyamoya disease and explore their roles in the pathogenesis of the disease. Methods The serum levels of vascular endothelial grow th factor (VEGF), angiopoietin -1 (Ang-1), interleukin-8 (IL-8), granulocyte colony stimulating factor (G -CSF), granulocyte-macrophage colony stimulating factor ( GM-CSF) and monocyte chemotactic protein 1 (MCP -1) in 56 patients w ith moyamoya disease and 26 healthy controls w ere measured by cytometric bead array. Results The serum levels of VEGF (2.81 ± 1.77 pg/ml vs.1.98 ±0.66 pg/ml; t = 3.081, P = 0.003 ) and IL-8 (0.89 ±0.69 pg/ml vs.0.63 ± 0.45 pg/ml; t'=2.0371, P < 0.05) in the moyamoya disease group w ere significantly higher than those in the healthy control group, and the serum level of Ang -1 in the moyamoya disease group w as significantly low er than that in the healthy control group (830.01 ±289.29 pg/ml vs.961.65 ±232.87 pg/ml; t =-2.032, P =0.045). Conclusions There are significant difference in serum levels of VEGF, Ang -1 and IL-8 betw een patients w ith moyamoya disease and healthy controls. The results indicate that angiogenic factors and inflammatory cytokines play some roles in the pathogenesis of moyamoya disease.

Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemodynamic and cardiac output in the elderly patients during induction of general anesthesia.Methods Ninety elderly patients(ASA Ⅰ ～ Ⅱ) undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group(group S),remifentanil group(group R) and fentanyl group(group F),30 patients in each group.Patients in group S,group R and group F received sufentanil 0.2μg/kg,remifentanil 2μg/kg and fentanyl 2μg/kg Ⅳ,respectively,using an blind method before intubation.SBP,DBP,MAP,HR,CO,CI and SVR were recorded before of anesthesia (T0),immediately after induction (T1),1,3 minutes after tracheal intubation (T2,T3).Changes of SBP and HR during observation were also recorded.Results The MAP and HR in three groups at T1 were significantly lower than those at T0 and decreased significantly in group R than those in group F and S(P ＜0.05).The MAP and HR in group F significantly increased at T1 than T0.The MAP and HR in group R were significantly decreased after tracheal intubation.Compared with the baseline,the MAP and HR in group S at T1,T2,remained unchanged.In group R,there were two patients whose HR were under 50 bpm.In group F,the MAP at T1,T2 were significantly higher than those at T.In group S,there were no significant changes in CO,CI,SVR which were all within normal range (P ＞ 0.05).Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.

Objective To develop an intelligent assist order system for parenteral nutrition and embed it into hospital information system,so as to facilitate rational prescription of parenteral nutrition.Methods Comprehensive database,knowledge base and control system of parenteral nutrition orders were set up based on production rule.An intelligent assist order system for parenteral nutrition was designed and developed.Individual energy demand of patients were calculated automatically and compared with doctors' orders of parenteral nutrition.Cation concentration was calculated automatically and controlled for the stability of all-in-one parenteral nutrition admixture.Results This system achieved successful and fast calculation of individual energy demand,over-standard warning of total energy,the ratios of carbohydrates to lipids and non-protein calories to nitrogen,ion concentration,and liquid volume.It also controlled the cation concentration,thus avoiding demulsification.Conclusions The intelligent assist order system for parenteral nutrition can solve the problems of energy calculation and ensure the stability of all-in-one parenteral nutrition admixture.As a result,it can improve the utilization of parenteral nutrition in hospital.

OBJECTIVE: Through the analysis of coagulation convention and blood routine parameters of sudden hearing loss (SHL) patients, further prove the correlation of sudden deafness and the the inner ear microcirculation, to guide clinical diagnosis and treatment. METHOD: Select 424 patients (448 ears) with sudden deafness in our department to SHL group. According to hearing curve is classified into low intermediate frequency descent group, high frequency drop and full frequency group, and drawing 244 cases in the same period of hospitalization deviated septum, vocal cord polyp patients as control group. All patients' coagulation detection, D-dimer, blood leukocytes, neutrophils and platelet count percentages were analyzed. Then a meaningful factor multivariate Logistic regression analysis was made. RESULT: There was a statistically significant difference between the two groups' prothrombin time, international normalized ratio, activated partial thromboplastin time, thrombin time measurement, fibrinogen, D-dimer, platelet count, white blood cell, neutrophil ratio(P<0.05); Logistic regression analysis showed that the prothrombin, thrombin time measurement, fibrinogen, D-dimer, neutrophil incidence of sudden hearing loss associated risk factors. CONCLUSION SHL in patients with coagulation dysfunction may be involved in the occurrence of SHL development mechanism, and there is a correlation of the SHL and the dysfunction of inner ear microcirculation.
Blood Coagulation Disorders ; complications ; Ear, Inner ; blood supply ; Fibrin Fibrinogen Degradation Products ; analysis ; Fibrinogen ; Hearing Loss, Sudden ; blood ; complications ; Humans ; Incidence ; Risk Factors

Objective To evaluate the application value of BODE and the relationship between BODE index and life quality in patients with chronic obstructive pulmonary disease (COPD) in rural China. Methods A total of 26 rural patients with stable COPD were enrolled. BODE index and it's four components including body mass index ( BMI ), airflow obstruction ( FEV1 % ), dyspnea ( MMRC ) and exercise capacity ( 6MWD ) were calculated. St. Georgeps Respiratory Questionnaire (SGRQ) were used to evaluate health-related quality of life of these patients. Results The BODE index was significantly correlated with the SGRQ total score , symptom ,activity and impact score ( r = 0. 674,0. 430,0. 460,0. 495 respectively, Ps ＜ 0. 05 ). GOLD grade was only significantly correlated with the SGRQ total score and active score( r =0. 447,0. 418 ,Ps ＜0. 05 ). Stepwise liner multiple regression analysis showed that activity score of SGRRQ was an influence factor of BODE index. 6MWD of BODE index( t = - 2. 397, P = 0. 025 ) and MMRC ( t = 2. 257, P = 0. 034 ) were independently correlated with activity scores of SGRQ . Conclusion BODE index and life quality had significant relationship. 6MWD and MMRC of BODE index were the most powerful influence factors of life quality in rural COPD patients.

ObjectiveTo investigate current status and demand of continous general practice (GP) education in Shanghai.Methods Two hundred and twenty general practitioners from 10 community health service centers of Shanghai underwent a questionnaire survey.Chi-square test was used for data analysis.ResultsThe effective response rate was 96.57％(212/220).About 87 percent of the participants considered continous GP education was helpful.Nearly 55 percent of the participants were satisfied withcurrentcontinousGP education.Unsatisfaction withcontinuing GP education,wishto reparticipate continous GP education,expected method and content of training were partly related to professional title and age.Ninety-seven percent of the participants thought the assessment of continuous GP education should include clinical practical capability evaluation.Conclusion The present continous GP education in Shanghai is not matched with GP's demand.Continous GP education should meet different needs of general practioners in different ways.

Acetylcysteine ; analogs & derivatives ; urine ; Adolescent ; Adult ; Deoxyguanosine ; analogs & derivatives ; urine ; Female ; Furans ; urine ; Humans ; Hydrocarbons, Aromatic ; analysis ; Male ; Occupational Exposure ; analysis ; Young Adult

Thanks to the three decades of reform and opening up,hospitals in China have made tremendous achievements in their development,yet facing new ehallenges as well.to address these challenges,there is an urgent need for these hospitals to further their reform under the guideline of the scientific concept of development.This will help them strengthen their hospital culture,quality control,technology,human resources development,and their leadership,in order to achieve a better and faster growth,better serving the role to build a harmonious socialist society.