In order to orient medical service towards the needs of patients, put quality at the core of medical practice and take doctors as the axis, we started the deepening of the reform of the operational system of our hospital at the juncture when patients were allowed to select their doctors. Ways adopted include: creation of a sound environment of competition through management focused on personnel; promotion of the healthy development of the move of letting patients select their doctors via management focused on personnel; stimulation of doctors through dynamic competition based on management focused on personnel. The following good effects have been achieved. ①In the period lasting from January to June 2001, as compared with the same period of the previous year, the outpatient volume increased by 30 042 visits, the number of discharged cases increased by 1 275, and the consumption of health materials per hundred yuan of medical income dropped by 5.28%. ②Solutions were found to problems which had existed for a long time in the management of the hospital but which had failed to be solved, problems like engagement of people with senior professional titles on lower posts, improper relationship between senior, middle-aged and young personnel, and misunderstandings regarding management. ③A dynamic operational system was formed inside the hospital.

[Objective]A new type of external frame for the treatment of club foot in three dimensions was reported.The characteristics of this frame and Illizarov frame were compared.[Method]The new frame was consisted of 3 couples with 6 metal rods.The rods have lengthening or compressing force on foot in three dimensions respectively through 4 Kire wires in tibia,calcaneus and tarsals.Sixty-two cases with 85 club feet followed more than 12 months were treated by the frame since Fabruary 2004.[Result]According to Gaeceau standerd and clinical appearance,function of the feet after the treatment,40 feet were excellent,40 feet were good,5 feet were improved,no poor case.[Conclusion]The new type of external frame is safe,effective and reliable for the treatment of club foot in three dimensions.Compared to Illizarov frame,it is more simple,comfortable,cheep and easy to be managed.

[Objective]To explore the effect on spinal growth and devetopment at different month-age of immature rabbits with spinal fusion and fixation;and to explain the mechanism of crankshaft phenomenon after child scoliosis treatment.[Method]Twenty-four 6-weeks-old rabbits and 24 15-weeks-old rabbits were randomly divided into 2 groups.Various lengths of lumbar vertebral region were fused posteriorly and fixed with wires,and the Cobbs angle in the frontal and saglttal planes were measured after the surgery.[Result]The lumbar spine of each group became lordosis with different degree.It was most obvious in the group which were fused in 7 lumbar vertebraes at 6-month-week age.The multiple linear regression outcomes show significance among different month-age,different lengths of fusion region and the Cobbs angle.[Conclusion]In the imature rabbits,if their lumbar vertebrae were posteriorly fixed only may be appeared and getting serious gradually due to the potential growth of anterior spinal column.There has significant correlation among the degree of skelecton immature,fused segment length and spine lordosis.

Objective To evaluate effection of Milrinone in patients with pneumocardial disease at acute exacerbation stage .Methods Eighty-three patients were randomly divided into two groups , both in the same conventional therapy , the treatment group received 10mg of Milrinone dissolve in 250ml 5% glu-cose intravenous infusion , 1 second /day, 10 days for a course of treatment .Observation group were treated with 5%glucose infusion 250ml, 1 time /day.The arterial blood gas, echocardiography measurements with mean pulmonary artery pressure , left ventricular ejection fraction and clinical evaluation to improve cardiop-ulmonary function efficiently were compared before and after treatment .Results Arterial blood gas analy-sis, pulmonary artery pressure and left ventricular function were improved and comprehensive evaluation of the efficiency of cardiopulmonary function in treatment group were significantly better than the control group ( Pall<0.05).Conclusion There is satisfactory of Milrinone in acute exacerbation of chronic pulmonary heart disease .

[Objective ] To investigate the improvement of the surgical treatment effect on cerebral palsy with spastic diplegia by performing modified surgeries since 2004. [Method ] Twenty-three cases of severe cerebral palsy with spastic diplegia were operated, 14 male, 9 female; age 3 ～ 12 years; the average age of 5.7 years; their main symptoms were unable to stand and walk independently, with severe hypermyotonia of both lower extremities, and a scissoring type of gait when standing, hip and knee flexing contracture, ankle and foot equinovarus. Physical examination: there was hypermyotonia of the iliopsoas, adductor musculus, hamstrings, triceps surae, anterior and posterior tibial muscle, flexor pollicis longus and flexor digitorum longus. The muscle tone was 3 ～4 grade according to Ashworth criterion. Treatment: The intramuscular tenotomy, fascial division or sliding elongation were performed, to lengthen the tendon of the joint flexion contracture, the lateral half of anterior tibial muscle tendon was transferred laterally to balance the muscle force at the foot. Finally, both lower extremities were fixed by a new designed external frame, to straigthen the articular genu, keep both ankles and feet in neutral position, both lower extremities abducting 30°, and to correct all joint deformities. Family rehabilitation programs started after the external frame was removed 6 weeks later. [Result] All cases were followed up in 1 ～3 years with the average 2. 2 years. The results were evaluated as excellent, good and ineffective, according to correction of the joint deformities, the ability to stand and walk, and parent's satisfaction to the treatment. Of them 21 cases were excellent, 2 cases good, and no ineffective case. [ Conclusion ] For the severe cerebral palsy with spastic diplegia in children, reasonable release of the tight tendons of the multi-joint flexion contracture, balance of muscle force at the foot, correction of all deformities and fixation of the lower extremities with the new external frame, and long term of family rehabilitation after the surgery, are more effective treatment.

Objective To treat femur fracture in neonates using a new homemade harness designed and observe the effec of this harness. Methods Designed a new harness used in femur fracture in neonates,and used this harness in 7(8 femur fracture)csses,including 6 boys(7 femur fracture)and 1 girl,the age from 1 day to 12 days(average 4.7 days).Those cases included proximal thirds(2 cases)and middle thirds(6 cases)of femur fracture.The angle of fracture was from 44°to 83°(average 62.4°)before treatment. Results The angle of fracture was from 0°to 22°(average 14.0°)after treatment using the harness.Hespitalization was from 2 to 3 days.There were no skin sloughing or harness breaking off.All cases were followed up 6 to 36 months(average 21.3 months).All femur fracture healed in good alignment with leg-length discrepancy＜1 cm.Movement of hip and knee was normal. Conclusions The harness is a better method to treat femur fracture of the proximal and middle thirds in neonates.Advantages of it include simply operation,minimal hospitalization,minimal cost,and easy nursing.

AIM: To study the effect of Liuwei Dihuang Wan (LWDHW) on the expression of immune-associated genes in the aged rats using cDNA microarray. METHODS: Forty 20-months-old rats were divided into two groups equally. One group was treated with LWDHW for 5 weeks,another was untreated as control. Some biochemical assays were used to confirm the physiological differences between two groups. The mRNA from the spleens of twenty 4-months-old young rats were extracted and divided equally into two parts. Each part was conjoined with mRNA from drug treated aged rats and that from untreated control aged rats,respectively,and two experimental combinations for reverse transcription and cDNA microarray were formed. By comparing two groups of data from two combinations,the effects of LWDHW on the expression of the associated genes were evaluated. RESULTS: 13 down-regulated genes and one up-regulated gene were identified in the untreated control old rats,whose expression did not change obviously in treated old rats compared with young rats. The expressions of another two sequence were up-regulated distinctly in treated old rats compared with young rats. CONCLUSIONS: 16 immune-associated genes expressions were affected markedly by LWDHW. It will be helpful for understanding the molecular mechanism of LWDHW in ageing.

BACKGROUND: Recently,Illizarov external frame is commonly used to treat adult talipes equinovarus.However,its application is limited in infant and child due to amount of components,large volume and heavy weight. OBJECTIVE: A new three-dimensional external mini-frame was designed to observe its therapentical effects for congenital talipes equinovarus in infants. DESIGN,TIME AND SETTING: Retraspectively analysis of the therapentical effects of the three-dimensional external mini-frame for congenital talipes equinovarus in infants at the Department of Pediatric Orthopedics,Third Hospital of Hebei Medical University between January 2004 and June 2007. PARTICIPANTS: 106 infants (130 feet) with congenital talipes equinovarus,76 males and 30 females aged 1.6 years (range 0.5-3 years),including 80 left feet and 50 right feet,24 cases bilateral feet and 82 cases unilateral feet. Eighty-one cases underwent orthosis or cost treatment but were not cured; 10 cases underwent surgery in other hospitals but all failed,the other cases were not given any treatment. The new three-dimensional external mini-frame was designed by the authors and produced by Hebei Hengshui Kangda. METHODS: According to the age,degree of deformity,being operated or not and pathological changeS of the foot,different treatment methods were applied: Corrcetion and fixation of the foot directly with the new external mini-frame; Limited soft tissue release,followed by corrcetion and fixation of the foot with the mini-frame; Corrcetion and fixation of the foot with the mini-frame after more soft tissue realse on interior posterior foot; Corrcetion and fixation of the foot with the mini-frame after soft tissue release,tendon transfer and restore of muscle force balance. The postoperative external fixation lasted for about 3 mouths. MAIN OUTCOME MEASURES: Evaluatoin of therapentical effects according to Garceau standards. RESULTS: All cases were followed up for 2.5 years (range 0.5-3.5 years). Eighty-six cases (94 feet) were excellent: the foot looked near normal,the calcar pedis was erect,with plantigrade foot in walking,the range of the joint motion in foot was near normal. Seventeen cases (32 feet) were good: the foot deformity improved obviously,but a light adduction was remained in the forefoot,with plantigrade foot in walking,the range of joint motion in foot was good. Three cases (4 feet) were effective: the forefoot adduct lightly,with lightly calcaneus varus,the motion of foot was limitted partly. CONCLUSION: The new 3D external mini-frame shows favorable effects for congenital talipes equinovarus in infants.

Objective:To understand the characteristics and practice of standardized training for resident in psychiatric department,providing a reference for other hospitals in the similar situation.Methods:Using qualitative method,in-depth interview and focus group interview were carried out with clinical teaching and teaching management experts of a tertiary hospital,to understand the characteristics,practice,and deficiencies of resident doctors standardized training for psychiatrists.Results:Focusing on clinical operation,psychotherapy,and communication capability were the major characteristics of resident doctors' standardized training for psychiatrists in this hospital.Though this hospital did positive trials on guarantee system improvement,outpatient and inpatient training combination,and training content expansion,it was not perfect enough in united training and training pattern.Conclusions:The psychiatry resident's standardized training for psychiatrists should establish complete standards of performance for united training,strengthen training mechanism and training mode,and make full use of modem distance education resources to further improve quality of the psychiatric residency training.

Objective To investigate the feasibility of using low volume of low concentration isotonic contrast medium for 320 row coronary CT angiography.Methods 64 patients whose heart rate 70 beats per minute or less,normal cardiac rhythm,BMI≤24 kg/m2 were scanned using a 320 row dynamic volume CT with the tube voltage of 100 kVp and injection of contrast medium with a concentration 270 mg I/mL.Prospective ECG gating technique and adaptive iterative dose reduction algorithm reconstruction were used.In group A,22 patients were injected 50 mL contrast medium by a rate of 5.0 mL/s.In group B,21 patients were injected with the dosage of contrast medium calculated by 0.7 mL/kg and injection rate was 4.5 mL/s.In group C,21 patients were injected with the dosage of contrast medium calculated by 0.6 mL/kg and the injection rate was 4.0 mL/s.The attenuation value,signal-to-noise(SNR),con-trast-to-noise ratio(CNR),image quality and iodine intake between three groups were compared using One-Way ANOVA .Results There was no significantly statistical difference of age,sex ratio,BMI,heart rate between the three groups (P >0.05).However,the dosage of the contrast agent and different injection time had statistical significance (P <0.05).The attenuation value from group A to group B and then to group C was on the decline,the CT value of group A was obviously higher than that of group B and group C,and the differences were statistically significant (P <0.05),and there was no significantly statistical difference between the group B and group C (P >0.05).The image quality,SNR and CNR in three groups did not have significant difference (P >0.05).The total iodine and iodine injection rate were lowest in group C.Conclusion In 320 row coronary CT angiography with 100 kVp tube voltage and iterative reconstruction algorithm,the patients whose heart rate 70 beats per minute or less,BMI≤24 kg/m2 injected the low concentration of contrast medium by 0.6 mL/kg dose injection can give a good image quality which can meet the diagnostic requirement.Mean-while,it can also reduce the iodine intake and the risk of contrast induced nephrology (CIN).