Confronted with the reality of being pushed onto the medical market, hospitals must be discreet in developing its strategies and conducting management. It is imperative for them to be guided by the needs of patients and stress business benefits; to attach importance to all matters, big or small, and adopt the low cost expansion strategy; to try to develop high tech and proper techniques and improve the environment; to strengthen cost accounting, improve service quality, expand the channels of the medical market and try to gain an increasingly bigger share; to make a good job of the four major techniques, viz. the rescue of emergency and critical cases, the intervention therapy, minimally invasive operations and organ transplantation, and to improve the technological level and medical quality. At the same time, hospitals ought to pay attention to organizational reform, management of cadres and talents and the relationship between development and stability.

The authors first describe the concept and connotation, origin and functions of clinical pathways and then give an account of the selection of disease groups or cases in clinical pathways and the formulation of means and procedures. They argue that in the implementation of clinical pathways, reform of the manner of hospital payment is the driving force, transformation of physicians idea of service is the key, and coordination and cooperation between various departments is the guarantee.

At present implementation of cost accounting is necessary for hospitals to strengthen operational management, rationally allocate medical resources, adapt to competitions on the medical market, perfect the excitation mechanism, and standardize medical management. Cost accounting in Chaoyang Hospital has transformed from an imperfect stage lasting from 1997 to 1999 to a fairly perfect stage dating from 2000. As a result of the implementation of cost accounting, the awareness of costs and effects on the part of the entire staff in the hospital has been enhanced, competition for equipment, space, manpower, etc. among the various departments has been restrained, and the outcome of the hospital has been markedly improved.

Objective To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal, ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation, there were 2 cases of right native renal pelvic cancer, 1 case of right native renal (pelvic) and ureter cancer and 2 cases of right ureter cancer respectively. The transplanted kidney was in the same iliac fossa side of the tumor. All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Result Five operations were completed successfully. The operative time was 180 to 280 min, and the blood loss was 50 to 200 ml. The recovery of intestinal function after operation was 12 to 36 h. The urine output was 1 500 to 4 000 per day. Postoperative serum creatinine was still normal. The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney. The procedure is safe and less invasive, which provides a good protection of transplanted (kidney).

Objective To investigate the expression of CD158b in NK cells after allogeneic kidney transplantation.Methods In 62 patients with allogeneic kidney transplantation, blood samples were collected on the day before operation, first, 7th day after operation, the moment the graft (reco)-(vered) and the acute rejection occurred. The expression of CD158b was detected in peripheral blood NK cells. The ratio of CD3~-CD16/56~+CD158b~+ was measured.Results There were 38 patients without acute rejection during the whole transplantation period. The ratio of CD3~-CD16/56~+ cells and CD3~-CD16/56~+CD158b~+ cells were stable before and after the transplantation. Twenty-four patients experienced acute rejection post-transplantation. The ratio of CD3~-CD16/56~+ cells was increased significantly after acute rejection, the ratio of CD3~-CD16/56~+CD158b~+ cells decreased significantly, and the percentage of CD3~-CD16/56~+CD158b~+ cells of total NK cells decreased significantly.Conclusion There are not too much factors interfering with the expression of CD158b in NK cells, and the ratio of CD3~-CD16/56~+CD158b~+ cells had already decreased significantly before the clinical diagnosis of (acute) rejection. Monitoring of CD158b in NK cells is more accurate and sensitive for the evaluation of immune state.

Objective To investigate the changes of gut barrier function under glucocorticoid, so as to understand the reasons of gut-derived infection and bacteria infection.Methods Fifty-six Wistar rats were divided into control and methylprednisolone (Mep, 100 mg/kg, i.p., once every day) groups, and there were four time points in each group (0, 3, 5, 7 day). At each time point the rats were subjected to general anaesthesia and blood, mesenteric lymph nodes, enteric content and ileal tissue were obtained for determination of serum D-lactic, DAO, intestinal microecosystem, apoptosis index of mesenteric lymph nodes and bacterial culture. Results At the latter three time points, compared with control group, serum D-lactic and DAO, and apoptosis index of mesenteric lymph nodes in MeP group were significantly increased (P 0.05) from the day 3 after administration,the positive rate of organs bacterial culture in MeP groups at the No7 day is much higher than that in control group(P

Objective To present 3 cases of MFH of the urinary system. Methods Two cases of renal MFH and one case of bladder MFH were retrospectively analysed. Results The diagnosis was established on pathological examination and immunohistochemistry. Two patients died 4～7 months affer operation , while the other patient has been well for 30 months. Conclusions It is difficult to differentiate it from primary renal and bladder neoplasm.Immunohistochemistry is helpful to distinguish it from carcinoma,renal sarcoma and renal parental cell carcinoma.

100 ml). Conclusions The increase of residual urine is the consequence of the decreased detrusor contractility whereas BOO has no significant effect on the residual urine.

Objective To evaluate the relation between blood level of tacrolimus and AUC after renal transplantation. Methods Blood assay of FK506 was conducted at 0～12 h after oral administration,the study was carried out in 60 renal transplantation or pancreas kidney transplantation patients.AUC was computed according to the blood FK506 levels.Regression analysis was used to study the relation between AUC and Cx. Results The blood FK506 levels 0～12 h after renal transplantation were different from those after pancreas kidney transplantation.In renal transplantation patients,the correlation between C 2 and AUC ( r 2=0.89) has been better than C 0 and AUC ( r 2= 0.74 ).In some renal transplantation patients with hepatopathy and in some pancreas kidney transplantation patients,the corretation between C 2 and AUC ( r 2=0.91) has been similar to that of C 0 and AUC ( r 2=0.90). Conclusions The equation AUC=7?C 2 could be applied in renal transplantation patients free of hepatopathy whereas,in renal transplantation patients with hepatopathy and in pancreas kidney transplantation patients,it is better to assess C 1～4 in the early stage of FK506 administration and suitable equation selected to compute AUC.

Objective To investigate and evaluate a novel fluorotyping procedure for HLA-DRB1 locus. Methods On the basis of low resolutation SSP technique,the fluorogenic probe was used to establish the fluorotyping procedure of HLA-DRB1 which was carried out for 46 samples. Results The fluorotyping has been successful for all the 46 samples and was completely coincident to the SSP results.As compared to the serological typing of DR locus,the coincidence rate was 66.3%(61/92) whereas the coincidence rate of both the 2 specific genes was 43.5%(20/46). Conclusions Fluorotyping is accurate,sensitive,reproducible,depends less on manual manipulation and eliminates the problems related to contamination.