Objective To observe the relationship between carotid artery elasticity and ultrasonic classification of carotid plaques in elderly patients,and to provide the clinical basis for clinical treatment and prevention of atheroselerosis.Methods 682 elderly patients undergoing health physical examination were randomly selected in our hospital from February 2010 to February 2012.Clinical data were surveyed by using questionnaire method.Carotid artery color Doppler ultrasound detection and brachial-ankle pulse wave velocity (PWV) were measured and analyzed.The relationship between carotid artery elasticity and ultrasonic classification of carotid plaques in elderly patients were evaluated.Results A total of 186 cases with carotid atherosclerotic plaques (CAP) were found in 682 cases,accounting for 27.3％,among whom there were 123 patients (18.0％) with hard plaques and 63 patients (9.2％) with soft plaques.Patients with CAP were divided into hard plaque group and soft plaque group.There were significant differences in carotid intima media thickness (IMT) among carotid plaque grade 1 versus 2 versus 3[(0.8±0.2)mm,(0.88±0.23)mm,(0.97±0.17) mm,respectively,P＜0.05].There was a positive correlation between PWV and carotid plaque grade in the hard plaque group (r＝0.30,P＜0.05),but not in soft plaque group.Conclusions Arterial elasticity is an index for vascular disease,and is closely related to the severity of carotid atherosclerosis,which can be used as one of predictive indexes for carotid atherosclerosis.

Confronted with the complex and volatile situation of the medical market, hospitals must formulate long-term development strategies, enhance their core competitiveness, and secure or maintain an undefeatable position amidst competition. The paper discusses the strategic management of large hospitals from five dimensions: improving hospital leaders' strategic-thinking and decision-making skills, continuously implementing brand marketing strategies, adopting the ideas and methods of strategic cost management, constructing information-based hospitals, and creating vigorous and dynamic hospital culture. It argues that only by strengthening strategic management can the sustainable and concerted development of hospitals be promoted.

ObjectiveTo explore the effect of CQI on the teaching of physical diagnostics.MethodsThe theory and practice of CQI are discussed in accordance with specific conditions of the teaching of physical diagnostics.ResultsThe level of the teaching of physical diagnostics can be raised by applying CQI.ConclusionThere will be broad prospects in the application of CQI to quality teaching of physical diagnostics.

Objective To investigate the clinical efficacy of warming and unblocking acupuncture in treating scapulocostal syndrome.Method Eighty patients with scapulocostal syndrome meeting the inclusion criteria were allocated by simple randomization to warming and unblocking acupuncture and conventional acupuncturegroups, 40 cases each.The warming and unblocking acupuncture group received warming and unblocking acupuncture at points Tianzong(SI11), Jianjing(GB21)and Dazhui(GV14)on the affected side and affected chest Huatuo jiaji(Ex-B2)points and uniform reinforcing-reducing acupuncture at points Quchi(LI11), Hegu(LI4)and Waiguan(TE5).The conventional acupuncture group received uniform reinforcing-reducing acupuncture at the same points as those in the warming and unblocking acupuncture group after arrival of qi.Both groupswere treated once every other day, 10 days as a course, for a total of one course.Pain severity was assessed using the Pain Visual Analogue Scale(VAS) in the two groups of patients before and after treatment.Theclinical therapeutic effects were evaluated by follow-up at one month after the completion of treatment.Result The total efficacy rate was 95.0% (38/40) in the warming andunblocking acupuncture group and 80.0% (32/40) in the conventional acupuncture group; there was a statistically significant difference (P<0.05).The PainVisual Analogue Scale(VAS) score was significantly lower in the two groups of patients after treatment than before treatment; there was a statistically significant difference (P<0.05).The VAS score was decreased more in the warming and unblocking acupuncture group after treatment and at the follow-up one month after the completion of treatment (P<0.05).Conclusion Warming and unblocking acupuncture has clinically a better therapeutic effect onscapulocostal syndrome.

Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 cases in the laparoscopic repair group (LR group) and 53 cases in the open repair group (OR group) respectively. Operative time, intraoperative blood loss,postoperative pain at 1 d and 3 d.time to first flatus and resumption of diet, time to drainage removal,surgical site infections (wound infection and intra-abdominal abscess),systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[(32.7 ±25.6) ml], lower postoperative pain at 3 d[(2.8 ±1.5) scores], earlier time to first flatus [ (25.8 ± 20.1) h] and resumption of diet [ (2.7 ±2.1) d ], shorter time to drainage removal [(2.0±1.5) d], less wound infection (0) and shorter hospital stay[(4.8 ±2.3) d] than those in OR group [(53.2±30.0) ml, (36.9±27.9) h, (3.7±2.0) scores, (3.6±2.3) d,(2.9±2.2) d,9.4%(5/53), (6.6±4.0) d](P< 0.01 or <0.05). There were no significant differences in operative time,postoperative pain at 1 d, incidence of intra-abdominal abscess and systemic complications between the two groups. There were no suture-site leakage, reoperation and death in two groups. Conclusions Laparoscopic omental patch repair for perforated peptic ulcer is safe and efficacious. It has significant advantages over open approach with respects of less postoperative pain,earlier return of bowel function,less wound infection and shorter hospital stay.

Pancreatic cancer is a highly malignant neoplasm with dismal prognosis. The risk of recurrence and metastasis remains high even for patients who have undergone radical dissection. Therefore, adjuvant therapy after "curative" resection is crucial. However, consensus on the optimal management of pancreatic cancer after surgery has not been reached. Both chemotherapy and concurrent chemoradiation therapy have been advocated. Yet, based upon the results of published phase Ⅲ trials, the consensus and standard strategy of adjuvant treatment after pancreatic cancer surgery is still undo" debate. According to the results of GITSG and RTOG trials, the mainstream in North American is adjuvant chemoradiation. However, based on the results of ESPAC-1 and CONKO-001 studies, the oncologists in Europe usually recommend chemotherapy alone. Furthermore, the superiority of gemcitabine over 5-FU in the adjuvant setting is largely unclear. This article reviewed the main results of the clinical trials in the field of adjuvant treatment of pancreatic cancer.From the authors' view, both the standard dosage of gemcitabine (CONCO-001) and chemoradiation (RTOG-9704) after resection of pancreatic cancer could be considered as candidates for adjuvant strategy. However, the optimal therapy will have to be determined by trials with larger number of patients.

Objective To study the present situation of misdiagnosed acute pancreatitis(AP)in China and to im prove the identification of AP.Methods One hundred and forty.four documents of Chinese-language cases studies involving the misdiagnosis of AP published from 1988 to 2007 were identified by searching in the China National Knowledge Infrastructure(CNKI).Retrospective study of misdiagnosed diseases,clinical manifestations,risk fac tors and accessory examinations etc,Was made in 1098 patients with AP.Results(1)The patients related to the departments of internal medicine,surgery,obstetrics and gynecology,and pediatrics and so on.The misdiagnosed diseases were over 63 kinds.The first five places successively were:cholelithiasis combined with biliary infection (182 times),acute gastroenteritis(158 times),coronary heart disease(108 times),acute appendicitis(102 times),and intestinal obstruction(90 times).(2)Abdominal pain(878 cases)is the main manifestation in AP, and the first five regions of abdominal pain successively were:upper-middle abdomen(434 cases),whole abdomen (220 cases),right lower quadrant(79 cases),right upper quadrant(74 cases),left upper quadrant(71 cases). (3)Cholecystolithiasis(145 cases)was the first risk factor,and followed the order of fat meal(106 cases)＞chronic cholecystitis(72 eases)＞alcohol(67 times).(4)The number of cases diagnosed by operation was the most,up to 378;others successively were serum and urine amylase examinations(35 1 CtLSe8)and abdominal CT scan(135 cases),and abdominal ultrasound imaging(59 cases).Conclusions(1)The main causes of misdiag nasis were superficial understanding of predisposing condition,lack of correct analysis on clinical manifestations, and mistakes in the analysis Oil the accessory examinations.(2)Although amylase in serum or urine has limitation in diagnosis,it still Was the main method of diagnosis;and it Was necessary to be examined by abdominal CT or sur gical exploration for patients who were highly suspected as having AP but could not be diagnosed.

Objective: To observe the characteristic changes of specific immunological function of serum endo toxin level,spleen lymphocyte human leukocyte antigen(locus) DR(HLA-DR),limphopolesis and positive expression of caspase-3 in rats with sepsis and the effect of Xuebijing injection(血必净注射液) on their immunological function.Methods: Sepsis model was produced by cecal ligation and puncture(CLP).Seventytwo male SD rats were randomly divided into four groups: sham operation,model,levofloxacin and Xuebijing injection.Blood samples were taken from the vein in the abdominal cavity at 3,24 and 72 hours after the models were established, afterwards the rats were sacrificed and their spleens were taken out.Matrix development process was employed to examine the level of serum endotoxin,FACS flow cytometer was used to examine the expression level of HLA-DR,immunohistochemistry method was applied to examine the positive expression of caspase-3 in spleen,and the method of methyl thiazolyl tetrazolium(MTT) was employed to examine the lymphopoiesis.Results: The levels of serum endotoxin,lymphopoiesis and caspase-3 positive expression index in model group were obviously elevated than those of sham operation group,and percentage of HLA-DR was markedly lowered(all P

OBJECTIVE To establish a simple and stable animal model with abdominal infection due to drug-resistant bacteria.METHODS Forty healthy rabbit were infected by Klebsiella pneumoniae ATCC700603,and divided into three test groups:A1(bacterial dose 8?109CFU/kg),A2(bacterial dose 16?109 CFU/kg) and A3(bacterial dose 24?109 CFU/kg).Normal control group B was established at the same time.Vital signs,white blood cell count(WBC),blood and abdominal irrigating solution cultures and strain identification were observed at 12,24,48,72 and 96h after infection.Patho-samples were obtained after being executed.RESULTS The body temperature,WBC,heart rate(HR) and respiratory rate(R) in group A3 were significantly higher than groups A1 and B,after rabbits having being infected 12-24 hours.And it continued for 96 hours(P

Objective To improve scientific research capacity and disciplines development,we performed grading system to specialize and quantize the management in Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Methods With assistance of forum survey related to 20 clinical and technical departments in hospital,we assessed the status of disciplines development,designed assessment criteria,and revised relevant regulations in grading system.Results The implementation of grading system promoted scientific achievements,academic communications and human resource development in hospital as relative to their pre-implemental controls.Conclusions The implementation of grading system facilitates scientific research and improves disciplines development.