Objective To study the clinical features of large-artery atherosclerosis cerebral infarction and perforating artery disease type cerebral infarction.Methods Ninety cases of large-artery atherosclerosis cerebral infarction were set as the observation group and 90 cases of perforating artery disease type cerebral infarction as the control group.The general data and clinical characteristics were performed the comparative analysis.Results The drinking and smoking rates in the observation group were 43.33 ％ and 54.44 ％ respectively,which were in turn higher than 27.78 ％ and 25.56 ％in the control group;the occurrence rates of complicating coronary heart disease and lipid metabolism abnormality in the observation group were 45.56 ％and 58.89 ％respectively,which were in turn higher than 21.11 ％ and 37.78 ％in the control group;while the occurrence rate of complicating diabetes mellitus in the control group was 65.56 ％,which was higher than 42.22％ in the observation group,the differences were statistically significant(P＜0.05).Plasma oxidized low density lipoprotein and circulating endothelial cell count in the observation group were (687 ± 169)g/L and(9.0 ±1.7) × 106/L respectively,which were significantly higher than the normal level in the control group,the level of nitric oxide in the observation group was(77.4±21.1)mol/L,which was lower than that in the control group.The differences between the two groups were statistically significant(P＜0.05).Conclusion The onset factors of large artery atherosclerosis cerebral infarction have larger relation with drinking,smoking,complicating coronary heart disease and lipid metabolism abnormality,while perforating artery disease type cerebral infarction is more related with diabetes.

With the development of all kinds of new simulative training equipment,the way of medico's clinic skill training method will change radically.Their clinic skill will be greatly improved.This article analyzed the necessities and imminence of setting up the clinic skill training center,and discussed how to manage it.At last we discussed how to build the clinic skill training center in the large comprehensive hospitals.

Objective To evaluate the safety of conscious venous anesthesia with fentanyl and propofol in elderly patients over 70 during gastrointestinal endoscopy. Methods Clinical data of 826 elderly patients over 70, who underwent gastrointestinal endoscopy with venous anesthesia, were retrospectively analyzed. The patients were divided into 2 groups according to their ages, with 618 patients aging from 70 to 80 in group A, in which 342 received endoscopy and 276 underwent colonoscopy, and 208 patients older than 80 in group B, in which 112 underwent endoscopy and 96 had colonoscopy. Another cohort of 600 patients younger than 70, who underwent venous anesthetic endoscopy during the same time period, was randomly selected as the control group, in which 400 patients received endoscopy and 200 had colonoscopy. Blood pressure, heart rate, peripheral oxygen saturation (SpO2) and adverse reaction were monitored in each patient during the procedure and compared among different groups. Results No procedure-related perforation or sedation-related mortality was observed, and no procedure was terminated clue to sedation complication. The average dosages of propofol used in procedure of endoscopy in groups A, B and control were 54.22±21.36 mg, 40.22±12.46 mg, and 86.44±34.26 mg, respectively. The average dosages of propofol in colonoscopy were 82.56±40.64 mg, 45.36±15.44 mg and 102.23±46.32 mg, respectively. With same procedure, there was no significant difference in heart rate and blood pressure among different groups, nor was there any difference in these variables before and after the procedure in each group (P>0.05). Sedation exerted more influence on SpO<,2> in elderly patients. A total of 18 cases in groups A and B experienced SpO<,2> <90%, which was mainly due to aspiration of saliva and relieved by oxygen inhalation. Conclusion Under appropriate monitor, it is safe and feasible to give conscious sedation to elderly patients over 70 during gastroimestinal endoscopy.

To support the ongoing health reform in China,Chongqing municipal government made the decision in 2008 "Building Healthy Chongqing" ,and pinpointed for the first time regional development as a key goal.In line with this situation,the hospital proposed such hypothesis changes as from "disease hypothesis to "health hypothesis",from "illness oriented" to "capability oriented",and from "shaping development" to "adaptive development",as well as from one-sided efforts of medical staff to minimize casualty to joint efforts with patients to safeguard life and health.Focusing on these four strategic shifts,the hospital works in developing its "technical attraction,service capacity,innovation capacity,and emergency assurance capability,and management soft power",aiming at building a sustainable hospital in its development.

Objective: To explore the effect of health education and supportive therapy on neuroses. Methods: Fifty six subjects were assigned into two groups according to the sequence of hospitalization. Both groups received the same drug treatment, average dosage: in experiment group fluoxetine 20～30mg/d (9 cases), Amitriptyline 75～150mg/d(8 case), Alprazolam 1.6～ 2.8mg/d(13 cases), received the health education and supportive therapy for 38 to 60 days in addition to drug treatment. In control group, fluoxetine 20～30mg/d(11 case), Amitriptyline 75～200mg/d(5 cases), Alprazolam 1.2～2.8mg/d(10 cases) were used. The Symptom Checklist 90 was used for assessment before and after treatment and cure rate was evaluated by clinical standard at discharge in both groups. Results: Cure rate was higher in the experimental group (94%) than control group (71%, P<0.05). The total score of the Symptom Checklist 90 and main factors were lower in the experimental group than the control group (P<0.01). Conclussion: Early health education and supportive therapy can improve the treatment outcome of patients with neuroses.

Objective To evaluate the clinical significance of phural effusion and/or ascites and their prognostic role in patients with acute pancreatitis.Methods The clinical data of 312 patients with acute pancreatitis were collected and analyzed retrospectively.Results Pieural effusion was found in 47 patients and ascites in 18.of 47 cases with pleural effusion,there were 31 cases(65.9%)of severe pancreatitis(P＜0.01)and 27 cases (57.4%)complicated by pseudocyst(P＜0.01).Among 18 cases with ascites,there were 14 cases(77.7%)of severe pancreatitis(P＜0.01).6 cases with pleural effusion and/or ascites died of multiple organs failure.Conclusion Pleural effusion and/or aseites is closely associated with severe pancreatitis.

Objective To explore carotid atherosclerosis and its relative factors of maintenance peritoneal dialysis patients. Methods The general clinical conditions,hematobiochemical parameters and color ultrasound parameters of 27 maintenance peritoneal dialysis patients and 24 controll patients were collecled. General clinical conditions included body weight, height and BMI. Hematobiochemical paremeters included Hb, Alb, LP (a), TC, TG, HDL-C,LDL-C, CRP, plasma fibrinogen, C3, Apo-A 1, Apo-B, LP (a). Color ultrasound parameters included plaque incidence rate,thickness of vascularendothelium(IMT). Results Compared with the controll group,maintenance peritoneal dialysis patients: plaque incidence rate, thickness of vascularendothelium (IMT) increased significantly, Age, TC, TG,LDL-C,LP (a), dialysis time increased significantly in plaque-positive group(all p ＜ 0. 05), while Hb, Alb andPAB decreased significantly (all P ＜ 0.0 5) , CRP increased significantly (P ＜ 0.0 1) . Conclusions In maintenance peritoneal dialysis group,CRP,LP(a) had positive relationship with C-IMT. CRP had negative relationship with ALb. CRP had not relationship with age and dialysis time. There were relationships among malnutrition,inflammation and atherosclerosis in maintenance peritoneal dialysis patients. Interdiction of the relationship may played a very important role in ameliorating the prognosis of the maintenance peritoneal patients.

Syncope is a common pediatric emergency event,which can be caused by various metabolic disorders different from other illness. The major metabolic anomalies include hypoglycemia, hyperventilation,electrolytes imbalance,hypoxemia and others, in which hypoglycemia is caused by hyperinsulinemia,pituitary and adrenal disease, diabetes, ketotic hypoglycemia, inherited metabolic disorders of sugar, organic acids and amino-acids,etc. This article introduced the common metabolic anomalies and their causes,diagnosis and therapy.

This paper studied the usage and impact of the theory in hospital development.Based on such,special manifestations behind the marginal diminishing effect are taken into consideration to grasp particular demands and requirements of health,and to look for a positive role and a progressive increase of the marginal utility.Furthermore,the explorations in hospitals,such as technical innovations,structure optimizations and management breakthroughs,as well as the experimental and practical construction of micro-economic administrative mechanism in clinical departments were discussed in the text.It has been demonstrated in practice that the practice has a significant effect on the prevention of marginal diminishing utility and an essential reference on hospital transformational development.

To discover factors affecting the inpatient’ actual reimbursement rate of urban resident basic medical insurance ( URBMI ) . Methods: Using the method of correlation analysis and multiple stepwise regression modeling to identify the influencing factors. Results: The per capita funding criteria, rate of inpatient out of pocket payment over resident annual per capita disposable income and per capita hospitalization rate have significant effect on the actual reimbursement rate of URBMI. Conclusion: It is needed to establish a sustainable steady financing mechanisms for URBMI, improve the evaluation system of reimbursement policy and gradually raise the level of actual reimbursement.