ObjectiveTo evaluate the effect and safety of dezocine and sufentanil in intravenous analgesia for postoperative pain. Methods60 patients with ASA Ⅰ～Ⅲ,underwent general anaesthesia operation were divided into two groups randomly,with 30 cases for each group:dezocine 0.6mg/kg and sufentanil 0.6mg/kg was applied to PCIA in group A and B.PCIA was administered with subsequent bolus of 1 ml with lockout time 15 minutes and background infusion of 2ml/h.The analgesic effect was evaluated by VAS,BCS and Ramsay at 1、2、4、12、24、48 hours after operation.The changes of vital sign were also assessed. ResultsThere was no significant difference between two groups in analgesia effect(all P＞0.05)and adverse reaction incidence rate(P＞0.05). ConclusionThe effect of dezocine in intravenous analgesia for postoperative pain could be as satisfaction as that of sufentainyl.

Thyroid cancer is uncommon in children and adolescents. This article analyzed the current data and stated the treatment progress of the thyroid cancer in children and adolescents. Even though in the advanced stage at diagnosis, the prognosis is good for pediatric patients. Surgery is the treatment for pediatric thyroid cancer. Although there is no optimal surgery recommendation, most surgeons preferred total and (or) subtotal thyroidectomy. Hemi-thyroidectomy could also be considered in the low-risk patients with small unifocal tumors. We recommend routine central compartment clearance in pediatric thyroid cancers to reduce the local recurrence. Radioactive iodine therapy is also recommended in particular pediatric patients. Recurrences after treatment in childhood thyroid cancer may take place over a long period of time. Therefore, a life-long follow-up is mandatory.

Objective To study the clinical efficacy and plasma concentrations of tacrolimus in renal transplant patients. Methods Kidney transplant patients were randomly divided into experimental group and control group. Control group was treated with cyclosporin A, experimental group was treated with tacrolimus. Clinical efficacy of two groups was compared,and plasma concentrations of tacrolimus the experimental group were tested at different periods. Results Compared with the control group,experimental group D-BILI and the concentration of T-BILI significantly lower,rate of acute rejection and infection significantly reduced,the differences were statistically significant (P <0.05) ;At the same time,in the experimental group,blood concentration of FK506 in patients at different periods after surgery were different. Conclusions . Tacrolimus was expected to develop ithe main immunosuppressant, its blood concentration factors of further research would be beneficial for to provide a reasonable regimen the clinical organ transplant patients.

Objective: To investigate the extravasate sponging and hemostatic property of chitosan hemostatic sponge on the wound of otic vein of rabbit, and its healing effect on the scald of rabbit skin, for clinical application. Methods: Lacerating the otic vein of rabbit with bistoury and promptly pressing the wound with chitosan hemostatic sponge, gelatin sponge or gauze, respectively, the hemostatic effect was observed by uncovering each 30 seconds. Spreading chitosan hemostatic sponge, gelatin sponge or gauze, respectively, on the scalds of rabbit skin, the decrustation (pulling off scab) was observed within 10 days. Results: Comparing with the group of gelatin sponge, the group of chitosan hemostatic sponge showed significant differences in bleeding time and wound healing (P

Objective To evaluate the therapeutic effects,acute and late side-effects of cisplatin plus 5-fluorouracil (PF) schemed chronomodulated chemotherapy combined with concurrent intensitymodulated radiotherapy(IMRT) for nasopharyngeal carcinoma.Methods A total of 48 nasopharyngeal carcinoma patients treated with chronomodulated chemotherapy plus concurrent IMRT were retrospectively studied.The radiation doses prescribed to the gross target volume GTVnx of nasopharyngeal,to the positive neck lymphnodes GTVnd,to the clinical target volume CTV1,and to CTV2 were 73.92-77.88,69.96,60.06-66.00 and 50.96-56.00 Gy respectively.The Kaplan-Meier survival analysis was used to calculate the local-regional progression-free rate.The acute and late side-effects were graded according to RTOG radiation morbidity scoring criteria.Results The complete remission (CR) rate was 41.6％(20/48) ; the partial remission (PR) rate was 47.9％ (23/48) ; the stable disease (SD) rate was 4.2％(2/48) ; and the local tumor control rate was 89.6％.Most of the patients had grade 1 to 2 acute side effects and grade 0 to 1 late side-effects.No grade 4 acute and late toxicity was observed.1,2,4-year survival rates were 93.8％,79.2％ and 64.5％,respectively.The DVH analysis showed that IMRT improved the total dose and dose per-fraction to the target volume with considerable dose reduction of the normal structures at the same time.Conclusions PF chronomodulated chemotherapy plus concurrent intensity-modulated radiotherapy for NPC could improve therapeutic effects with satisfactory tolerance of the side effects.

OBJECTIVE: To verify the relationship between THI and VAS scores in patients with sudden hearing loss and tinnitus in a prospective study. METHOD: Forty-four patients classified their tinnitus according to VAS and THI before and after treatment, and both scores were compared through the Pearson's correlation coefficient test and Nonparametric tests. RESULT: There was a correlation between VAS and THI scores in patients with sudden hearing loss and tinnitus. Tinnitus assessment scores were significantly reduced after treatment. Decreasing of THI and VAS scores were not depended on frequency and loudness of tinnitus and severity of deafness, but therapeutic effect of sudden sensorineural hearing loss. CONCLUSION THI and VAS scores are useful for assessment of tinnitus in patients with sudden hearing loss and tinnitus.
Audiometry ; Deafness ; Hearing Loss, Sensorineural ; complications ; Hearing Loss, Sudden ; complications ; Humans ; Prospective Studies ; Tinnitus ; complications

Objective To evaluate the effects of reduced glutathione (GSH) on contractile and diastolic functions of the thoracic aorta of rats with obstructive jaundice.Methods Twenty-four adult male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 4 groups (n =6 each) using a random number table:sham operation group (group S),GSH group,bile duct ligation group (group BDL),and GSH + bile duct ligation group (group GSH + BDL).In GSH and GSH + BDL groups,GSH 300 mg/kg was infused via stomach everyday for 7 consecutive days,while the equal volume of normal saline was given in the other two groups.The common bile duct was ligated in the animals on 1 d after the end of intragastric administration in GSH and GSH + BDL groups.In GSH and GSH + BDL groups,after the model was established,GSH 300 mg/kg was infused via stomach everyday for 7 consecutive days,while the equal volume of normal saline was given in the other two groups.On 7th day after the model was extablished,blood samples were collected for determination of the levels of serum total bilirubin (TB),alanine aminotransferase (ALT) and aspartate aminotransferase (AST),tumor necrosis factor-alpha (TNF-α),interleukin-lβ (IL-1β) and 3-nitrotyrosine (3-NT),malondialdehyde (MDA),nitric oxide (NO) and GSH.The thoracic aortic rings were obtained and perfused with different concentrations of norepinephrine (NE),acetylcholine (Ach) and sodium nitroprusside (SNP).The maximum contraction and dilatation of aortic rings were recorded and the percentage was calculated.Some thoracic aortic rings were obtained again and perfused with different concentrations of NE after removal of the endothelium or after being perfused with L-NAME (nitricoxide synthase inhibitor).The maximum contraction of aortic rings was recorded and the percentage was calculated.Results Compared with group S,the serum levels of TB,ALT,AST,TNF-α,IL-1β,MDA,3-NT,NO and GSH were significantly increased in group BDL,and the serum levels of TB,ALT,AST,MDA,GSH and NO were increased in group BDL + GSH,the percentage of the maximum contraction amplitude of aortic rings in response to NE was decreased,and the percentage of the maximum dilatation amplitude of aortic rings in response to Ach and SNP were decreased in groups BDL and BDL + GSH,and no significant changes were found in the parameters mentioned above in group GSH.Compared with group BDL,the serum levels of TB,ALT,AST,TNF-α,IL-1β,MDA,3-NT and NO were significantly decreased,the level of GSH was increased,the percentage of the maximum contraction amplitude of aortic rings in response to NE was increased,the percentage of the maximum dilatation amplitude of aortic rings in response to Ach was increased,and no significant change was found in the percentage of the maximum dilatation amplitude of aortic rings in response to SNP in group BDL + GSH.Compared with the aortic rings from which the endothelium was removed or which were perfused with L-NAME in group BDL,no significant change was found in the percentage of the maximum contraction amplitude of aortic rings after removal of the endothelium or after being perfused with L-NAME in response to NE in group BDL + GSH.Conclusion GSH can improve the contractile and diastolic functions of thoracic aorta of rats with obstructive jaundice and this effect depends on the vascular endothelium.

Objective:To analyze the pay for performance related costs and provide suggestions for further stud-y. Methods:Empirical literatures from inside the country and overseas were collected with a systematic review. Costs were summarized on the basis of three drivers ( performance appraisal, performance improvement and incentive per-formance) . Results:A total of 141 papers, 47 in Chinese and 94 in English were enrolled. Most papers in Chinese were subjected on healthcare facilities while the English ones emphasized on hospitals. Pay for performance may lead to the healthcare service costs, regulation costs and the resources allocation related costs reduction. In addition to these visible costs, a large amount of others hidden from different hospital management levels were also due to pay for performance. Conclusions:(1) Differences in costs could be found from home and overseas experience which per-haps resulted from the pay for performance, the supporting measures and the policy development. (2) More attention should be paid to the quantification researches on the health facilities’ hidden costs. (3) Most available researches fo-cus on pay for performance cost-effectiveness from the society and service purchase but not the providers’ perspective and the hidden costs were also ignored.

With the support of World Bank ( WB ) and UK Department for International Development ( DFID) , China Rural Health Project ( hereinafter referred as Health XI Project) began to introduce the idea of performance management to 40 counties in 8 provinces in 2008 . The project implemented cyclic performance manage-ment strategies, including performance planning, performance communication, performance evaluation and perform-ance improvement. With the continuous improvement of performance as the goal, the project attempted to establish incentive mechanisms based on the performance of health care services. After five years of pilots in 40 counties, it has achieved good results in the aspects of improving the quality and efficiency of health care services, motivating the enthusiasm of health care managers and workers, etc. Moreover, it has successfully built several advanced counties with exemplary performance management and accumulated some experience, which provides reference and demonstra-tion for implementing performance management in other areas. The key experiences of implementing performance management of rural primary health care include taking health care quality as the core of performance, appropriately combining economic and non-economic incentives, encouraging personnel participation in performance management in order to ensure the sustainability of performance improvement, and effectively applying the ideology of systematic per-formance management in order to effectively enhance the management level of hospitals. The paper also puts forward some policy suggestions based on emerging issues during implementation of performance management.

This study aimed at comparing the United States, Britain, Australia, the Netherlands and China’s national performance evaluation, and sum up the experience to provide a theoretical basis for the China’s development of hospital performance evaluation system. The study found that China needs to consider the patient's perspective, to establish a fixed third-party performance evaluation agencies, establish an effective incentive mechanism and feedback mechanism and combine a variety of assessment methods in the development of hospital performance evaluation index system.