The responsibility system of attending doctors plays a positive role in raising hospital efficiency and optimizing medical resources deployment.For the change in the subject of medical liabilities following the introduction of this system,medical management needs to shift from department management to doctor management instead.In the meantime,appropriate rules and regulations are needed to normalize the roles and behavior of the medical office,department heads,and attending doctors in medical activities.This will ensure the successful operation of this responsibility system,and generate ideal medical,economic and social outcomes.

AIM: To investigate the effect of sodium nitrite (SN) on lipopolysaccharide (LPS)-induced acute lung injury (ALI) and its underlying mechanism in mice. METHODS: All male Institute of Cancer Research (ICR) mice were randomly divided into five groups: Control group;LPS group;and SN 4.8 nmol/L, SN 48 nmol/L, SN 480 nmol/L (ip) groups. Lung wet weight/dry weight (W/D) ratio and permeability were detected. Neutrophil infiltration in bronchoalveolar lavage fluid (BALF) was measured by cel1 counting and morphological changes in lung tissues were assayed by hematoxylin-eosin staining. The 1evels of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) in lung were detected. Nitric oxide (NO) level and nitric oxide synthase (NOS) activity in lung were measured according to the specification. RESULTS: Compared to lung in LPS-induced ALI mice, at doses of 4.8 nmol/L and 48 nmol/L, not 480 nmol/L, SN markedly decreased the lung W/D ratio, total leukocyte number and neutrophil percentage in the BALF, lung permeability, and TNF-α/IL-10 ratio, in lung. SN at dose of 480 nmol/L markedly increased the lung NO level compared to control group. In addition, SN decreased the total NOS and inducible NOS (iNOS) activities compared to LPS-induced ALI mice. CONCLUSION: These results indicate that the protective effect of SN against LPS-induced ALI in mice is associated with the low dose SN-induced NO, as well as the subsequent decrease in iNOS activity and TNF-α/IL-10 ratio.

Objective: To develop a computer-aided cephalometric analysis system running under the environment of Windows 9X/NT and based on screen input of landmark and contour line. Methods: The analysis system was made with object-oriented method, the program was written with Visual Basic 6.0 and Access 8.0, and the data on the screen was converted. Results: Cephalometric landmark points and contour lines were input through computer screen, then analyzed (22 modes), superposed and managed statistically. The system showed the advantages of using popular hardware, good compatibility, easy expansion, friendly user interface, simple input of landmark points, artful input of cephalometric contour, intuition and diversification of superposition, deversification of statistic analysis, integrated information collection and convenient search. Conclusions: The system can be used in clinic and research.

Objective To investigate the value of early hematocrit (Hct) level in predicting early neurological deterioration (END) in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke within 24 h of onset were enrolled prospectively. They were divided into low Hct, normal Hct, and high Hct according to the quantile of the measured Hct. END was defined as an increase of ≥2 of the National Institute of Health Stroke Scale (NIHSS) score or ≥1 of the motor item score within 5 d after admission compared with the baseline. The vascular risk factors, clinical features, baseline NIHSS score, infarct size, and laboratory test variables were compared between the END group and the non -END group. Multivariate logistic regression analysis was used to identify the independent risk factors for END. Results A total of 216 patients with acute ischemic stroke were enrolled, including 128 males (59.26%). Their mean age was 67.40 ±14.12 years. Sixty-two patients (28.70%) experienced END. The normal ranges of Hct in male and female were 40.12%-46.35% and 38.32%-44.17%, respectively. Univariate analysis indicated that there were significantly differences in baseline NIHSS score ( P =0.001), fasting glucose (P =0.030), C reactive protein (CRP) (P =0.041), and the proportions of different Hct levels between the END group and the non-END group (P =0.023). The END incidences in patients with high -level Hct (40.0%) and low –level Hct (35.2%) were significantly higher than that in the normal Hct patients (20 .4%), but there was no significant difference between the high-level and low -level Hct patients ( P = 0.690). Multivariate logistic regression analysis showed that theigh-level Hct (odds ratio 2.460, 95% confidence interval 1.146-5.283; P =0.021) and the baseline NIHSS score (odds ratio 1.070, 95% confidence interval 1.014-1.129; P = 0.013) were the independent risk factors for END. Conclusion The elevated Hct in patients with acute ischemic stroke are susceptible to END.

Objective To investigate the associations between levels of perioperative biochemical markers of the liver,kidney,lung and heart and death within 3 months postoperatively in the senile patients with femoral intertrochanteric fracture.Methods A retrospective study was conducted on the 153 senile patients with femoral intertrochanteric fracture who had been treated at Nanfang Hospital from January 2010 to January 2012.They were 71 men and 82 women,with an average age of 83.1 years.There were 70 stable and 83 unstable fractures.At preoperation (within 24 h after admission),and 24 h,25 to 48 h and 72 h postoperation,all the patients had blood examinations of biochemical markers of the liver [alanine aminotransaminase (ALT)],kidney (creatinine and urea nitrogen),lung (PaO2) and heart [brain natriuretic peptide (BNP)].The levels of biochemical markers at all time points and clinical data were compared between the living patients and those who died within 3 months postoperatively.Univariate and multivariate logistic regression analyses were conducted to estimate the independent risk factors for mortality within 3 months postoperatively.Results Of the 153 patients,32 (20.9％) died within 3 months postoperatively,including 10 men and 22 women.In the dead and surviving patients,there were respectively 25 and 17 cases who were rated as level Ⅲ or Ⅳ by ASA (American Society of Anesthesiologists).The levels of ALT,creatinine,urea nitrogen,and BNP increased to different extents while the level of PaO2 decreased postoperatively in both the dead and surviving patients.The differences between the dead and surviving patients were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed poor preoperative physical condition (ASA level Ⅲ or Ⅳ),increased creatinine level at 25 to 48 h postoperation,decreased PaO2 at 72 h postoperation,and increased BNP level at 24 h postoperation were independent risk factors for early mortality in senile patients with femoral intertrochanteric fracture.Conclusions Femoral intertrochanteric fracture in senile patients may lead to changes in the liver,kidney,lung and heart.Prompt and dynamic monitoring of the levels of PaO2,creatinine and BNP may provide timely prediction of the poor prognosis.

This paper reviews outpatient security policy of typical developed countries .It provides reference for outpatient security system in China .Analysts believe that the experience for Chinese reference should be acquired in the following ways:The pooling of outpatient service is an inevitable trend in the development of health insurance , which is in principle an integral part of payment and financing system; the implementation of outpatient community first diagnosis system should be adapted to the local conditions; the community first diagnosis system is a necessary condition for capitation , so it is closely related to compensation methods and the elaborate degree of outpatient treat -ment catalog;Outpatient services should be supervised and payment policies should be developed respectively .There are two supervision models about outpatient service:external supervision and self supervision , but the key is to focus on the management of outpatient doctors .External regulation should be consistent with the current regulatory approach of the situation and patients have to bear some responsibilities for outpatient treatment expenses in some proportions , but the payment cap line should not to be low .The implementation of certain preferential policies for vulnerable groups can be considered under the harmonized system to partially reduce their medical expenses .

Objective: To explore health resource allocation and optimization and evaluate the clinical departments efficiency in hospital. Methods: Taking a three level of first-class hospital in Beijing for example, the method of data envelopment analysis (DEA) was used for building a DEA model of clinical departments efficiency in hospital. Results: Based on the results of the DEA model, we drawn the technical efficiency and scale efficiency of the target clinical departments, obtained input redundancy rates and output deficiency rates of the non-effective decision-making units. Conclusion:By DEA evaluation results, the input redundancy and output deficiency of the target clinical departments are found. From the perspective of optimizing hospital resource allocation, measures to improve the hospital operational performance are proposed. There is important significance to improve the comprehensive competitiveness of the hospital.

砄bjective: To develop a computer aided cephalometric analysis system running under the environment of Windows 9X/NT and based on screen input of landmark and contour line. Methods: The analysis system was made with object oriented method, the program was written with Visual Basic 6.0 and Access 8.0, and the data on the screen was converted. Results: Cephalometric landmark points and contour lines were input through computer screen, then analyzed (22 modes), superposed and managed statistically. The system showed the advantages of using popular hardware, good compatibility, easy expansion, friendly user interface, simple input of landmark points, artful input of cephalometric contour, intuition and diversification of superposition, deversification of statistic analysis, integrated information collection and convenient search. Conclusions: The system can be used in clinic and research.

[Objective] To evaluate and describe CT findings in patients with pathologically confirmed retroperitoneal fibrosis. [Methods] CT findings in 8 patients (6 males, 2 females) pathologically confirmed retroperitoneal fibrosis were retrospectively reviewed and pertinent literature was discussed. [Results] Retroperitoneal fibrosis showed similar features in CT imaging: retroperitoneal irregular mass around abdominal aorta embedding adjacent tissue, with mild or moderate enhancement, unilateral or bibateral ureterectasis with hydronephrosis. [Conclusions] The pristine clinical manifestation of retroperitoneal fibrosis is occult and nonspecific. CT examination is a valuable approach to diagnose retroperitoneal fibrosis.

Objective To investigate the distribution and antibiotic resistance of the enteric pathogens in Shanxi province to guide the choice of antibacterials.Methods 798 cases of fecal samples from patients with diarrhea were treated in the outpatient and inpatient.The suspected pathogen was separated then PCR,biochemical test,serum agglutination tests were used for identification of suspected pathogen,and bacterial pathogens constitution and patho-genic characteristics were analyzed.Antimicrobial susceptibility testing was conducted by diskdiffusion method for the suspected pathogen with 6 antimicrobial agents.Results 81 strains isolated from 798 specimens were positive with 10.15% for pathogen detection.Diarrheagenic Escherichia coli was the first frequently pathogen,accounting for 46.91%,followed by Shigella,Salmonella and Aeromonas.Drug sensitivity monitoring showed that the most of the 81 strains had lower level of resistance to cefoitin,cefotaxime and ciorofloxacin,and higher level of resistance to tetra-cycline and nalidixic aid.Conclusion Diarrheagenic Escherichia coli,Shigella,Salmonella and Aeromonas are the major bacterial diarrheal pathogens in the hospital.Surveillance of antimicrobial resistance in these bacteria should be strengthened to provide reliable evidence for clinical anti infection treatment.