As China witnesses constant development of its market economy and gradual deepening of reform in its medical and health cause,the ability of domestic hospitals to adjust their operational management strategies in due course is crucially related to their survival and development amidst market competition.Hospital managers,while stressing quality and economic control,should attach special importance to the brand effect of their hospital and step up hospital brand building,the focus of which lies in patient satisfaction and loyalty and hospital popularity and reputation.Only in this way can they constantly create advantages,enhance core competitiveness and put their hospital in an invincible position amidst market competition.

The Eleventh Five-year Program period will be a very important period in the historical development of China;it will also be a key period for domestic hospitals to deepen reform and achieve steady growth.Doing a good job of the five years' work will be of great significance to promoting reform of the medical and health system,strengthening and developing the hard-won good situation,speeding up hospital construction and growth,and solving such problems facing the common citizens as "it is difficult and expensive to see a doctor".The authors offer suggestions and hope to arouse discussions as to how hospitals ought to formulate a Eleventh Five-year Program that will meet their own growth needs with the guidance of a scientific approach to development.

Objective To improve the diagnosis and treatment of epidemic cerebrospinal meningitis in children.Methods A retrospective review was performed and a total of 69 cases of children epidemic cerebrospinal meningitis were collected and classified into ordinary and fulminant epidemic cerebrospinal meningitis from 1999 to 2011.Disease prevalent season,age,clinical characteristics,laboratory examination,treatment,prognosis and risk factors were analyzed.Results The mean age(33 male and 36 female) was (6.85 ±5.12)years old,ranging from 56 days to 15 years old.A total of 60 cases began on January to May; 6 cases began on June to October; 3 cases began on November to December.All of the 42 cases of ordinary epidemic meningitis were recovered; 7 cases of fulminant epidemic meningitis(n =27) were dead.All of the patients had fever; 64 cases(92.75％) had Petechiae petechial skin; 36 cases(52.17％) had headache; 49 cases(71.01％) vomited; 65 cases(94.2％) had positive neck resistance; 15 cases(21.74％) had convulsion; 35 cases(50.72％) had drowsiness or coma; 32 cases (46.38％) had positive pathological signs and 24 cases (34.78％) had low blood pressure or shock.Blood tests revealed that 63.77％ of the patients leukocytes raised and 8.70％ of the patients reduced; 42.03％ of the patients platelet reduced; 55.07％ of the patients had electrolyte disturbance and 89.86％ of the patients had coagulation disorders,among which 46.38％ fibrinogen reduced.The rash printed piece and cerebrospinal fluid smear tests found that Gram-negative bacteria positive rate were 12.5％ and 19.35％ respectively; the positive rate in bacterial culture of cerebrospinal fluid and blood culture were 12.90％ and 7.25％ respectively.Drug sensitive test showed that penicillin and ceftriaxone were sensitive to bacteria.The differences of age,leukocyte and platelet counts,fibrinogen and altered mental status between ordinary and fluminant epidemic meningitis were significant (P ＜ 0.05).Conclusion The prevalent season is from January to May and the prevalent age is less than 5 years for children with epidemic cerebrospinal meningitis.Ceftriaxone or penicillin should be the preferred choice;age,lower leukocyte and platelet counts,lower fibrinogen and altered mental status should be used to predict the severity of the disease.

In recent years, the issue of liabilities in state-owned medical institutions in China has come to the attention of departments at different levels and has become one of the top concerns of various government departments and hospital administrators. Defining the appropriate scope of liabilities ratio for hospitals has become an urgent task in ensuring their unconventional and sustainable development from a high starting point and at a fast pace. On the basis of relevant financial theories and in light of the current situation of the domestic medical market and characteristics of state-owned hospitals, the paper makes a case study of the liabilities ratio of hospitals in a certain region so as to explore the appropriate scope of liabilities ratio and the scale of liabilities for hospitals.

Thanks to the three decades of reform and opening up,hospitals in China have made tremendous achievements in their development,yet facing new ehallenges as well.to address these challenges,there is an urgent need for these hospitals to further their reform under the guideline of the scientific concept of development.This will help them strengthen their hospital culture,quality control,technology,human resources development,and their leadership,in order to achieve a better and faster growth,better serving the role to build a harmonious socialist society.

OBJECTIVETo investigate the clinical features and prognosis factors of α-fetoprotein (AFP) positive gastric cancer patients.

METHODSClinical data of 512 gastric cancer patients undergoing surgery from January 2003 to December 2008 in the General Surgery Department, the First Affiliated Hospital, Dalian Medical University were collected. According to serum AFP level, patients were divided into AFP positive group and AFP negative group. Clinical data and survival time were compared between the two groups. Effect of positive AFP on prognosis was evaluate.

RESULTSThere were 50 AFP positive patients and the ratio was 9.8%. As compared to AFP negative group, AFP positive group had a higher incidence of vascular tumor invasion [12.0%(6/50) vs. 3.7%(17/462), χ(2)=7.28, P<0.05] and liver metastasis [36.0%(18/50) vs. 2.6%(12/462), χ(2)=4.20, P<0.01]. The median survival time of AFP positive and negative groups was 30 months and 42 months, the 5-year survival rate was 20.8% and 27.5%, respectively(P<0.05). Univariate analysis showed that AFP level, tumor size, tumor infiltration, lymphatic metastasis, pathological stage, liver metastasis and vascular tumor invasion were risk factors influencing the prognosis of AFP positive gastric cancer(P<0.05). Cox analysis showed that the independent prognostic factors included tumor infiltration (HR=1.464, 95% CI: 1.068-2.007, P=0.018), lymphatic metastasis (HR=1.136, 95% CI: 1.011-1.275, P=0.032) and liver metastasis (HR=4.116, 95% CI: 2.610-6.489, P=0.000), but not AFP level(P>0.05).

CONCLUSIONGastric cancer patients with positive serum AFP usually present vascular tumor invasion and liver metastasis, but AFP level is not the independent prognostic factor.

Objective:To explore the surgical treatment of lateral condylar fracture of the humerus combined with lateral dislocation of the elbow in adults.Methods:A retrospective study was conducted to analyze the 8 patients who had been treated at Department of Orthopaedic Trauma, Zhengzhou Orthopaedic Hospital for lateral condylar fracture of the humerus combined with lateral dislocation of the elbow from June 2020 to June 2023. There were 3 males and 5 females, with an age of (50.1±12.3) years. All the lateral condylar fractures of the humerus combined with lateral dislocations were treated by open reduction and internal fixation after swelling subsided. Flexion and extension of the elbow and rotation of the forearm were recorded at the last follow-up. Mayo elbow function score (MEPS) was used to evaluate the functional recovery of the elbow.Results:Elbow dislocation was corrected in 2 patients after rectification, but the elbow subluxation still existed because the displacement of the humeral lateral condyle was not reduced. The elbow dislocation still existed in 6 patients because it was difficult to maintain the correction of the dislocation after manual reduction. Follow-ups were conducted for 12.0 (12.0, 18.8) months. At the last follow-up, the flexion-extension was 85.6°±20.3°, rotation 133.1°±24.0°, and MEPS (91.9±8.0) points. The joint stability was significantly improved in the 8 patients compared with that before operation. Obvious pain was reported in none of the patients, and their joint limitation was acceptable.Conclusions:In adults, lateral condylar fracture of the humerus combined with lateral dislocation of the elbow is rare in clinic. Surgical treatment of the condition can achieve satisfactory clinical outcomes, but elbow dysfunction and limited rotation of the forearm may occur in the affected limb.

Objective:To explore the strategies for reduction of irreducible intertrochanteric fractures according to our self-designed new classifications.Methods:A retrospectively study was conducted to analyze the data of 124 patients with irreducible intertrochanteric fracture who had been admitted to Department of Minimally Invasive Orthopaedics, Zhengzhou Orthopaedics Hospital from January 2019 to December 2021. There were 56 males and 68 females with a mean age of (76.8±13.2) years. According to the displacement pattern of the proximal head-neck fragment of the fracture, the irreducible intertrochanteric fractures of the femur were classified into 3 types. In type 1 (rotational type) of 65 cases, there were 24 cases of subtype 1.1 (the lesser trochanter attached to the distal fracture fragment), 8 cases of subtype 1.2 (the lesser trochanter attached to the proximal fracture fragment), and 33 cases of subtype 1.3 (the lesser trochanter floating). In type 2 (locked type) of 18 cases, there were 13 cases of subtype 2.1 (lesser trochanter floating), no case of subtype 2.2 (the lesser trochanter attached to the proximal fracture fragment), and 5 cases of subtype 2.3 (the lesser trochanter attached to the distal fracture fragment). In type 3 (reverse trochanter type) there were 41 cases. Under the guidance of our new classification, the patients were treated by fixation with intramedullary nails after reduction with corresponding techniques (like prying, clamping, pulling, and temporary fixation with Kirschner wires). Operation time, intraoperative blood loss, fracture reduction quality and Harris hip score at the last follow-up were recorded.Results:The operation time was (53.0±20.7) min and blood loss (132.1±81.3) mL in this cohort. According to the criteria proposed by Chang and Kim et al., the quality of fracture reduction was evaluated as excellent in 101 cases, as good in 17 cases, as fair in 4 cases, and as poor in 2 cases, resulting in an excellent and good rate of 95.2% (118/124). All the 124 patients were followed up for an average of (12.4±3.7) months. First-stage fracture union was achieved in 120 patients, and fracture union was achieved in 2 patients of type 3 with breakage of the main nail only after replacement of the intramedullary nail. The mean healing time for the 122 patients was (5.1±1.4) months. In addition, hemiarthroplasty was performed in 2 patients of type 1.3 whose femoral head had been cut by a head nail. Postoperatively, urinary tract infection occurred in 5 cases but responded to appropriate symptomatic treatment. The Harris hip score was (94.2±5.4) points at the last follow-up, and 103 cases were excellent, 17 cases good, and 4 cases poor, giving an excellent and good rate of 96.8% (120/124).Conclusion:It is easy to understand and master the new classification of irreducible intertrochanteric fractures based on the displacement of the proximal head and neck bone which can directly and effectively guide the intraoperative reduction, leading to satisfactory reduction and fixation.

Objective To present the initial practice of a novel procedure for the surgical treatment of inguinal hernia-"lateral approach single-incision laparoscopic totally extraperitoneal(L-SILTEP)repair"in certain specific situations.Methods The clinical data of 110 inguinal hernia patients who underwent L-SILTEP in the First Affiliated Hospital of Ningbo University,Shanghai General Hospital affiliated to Shanghai Jiao Tong University School of Medicine,and Shanghai East Hospital affiliated to Tongji University from June 2021 to March 2024 were collected retrospectively.Patients' demographics,surgical details,length of hospital stay,and postoperative outcomes were analyzed respectively.Results All surgeries were completed successfully and there was no conversion.The median surgical time was 55(41.25,70)mins and the intraoperative blood loss was 5(2,10)mL.In surgery,inferior epigastric artery injury occurred in 5 cases(4.5%)and spermatic cord injury occurred in 1 case(0.9%).The mean visual analog scale(VAS)scores pain assessment at 6,24,and 48 h after surgery were 3.0±0.8,1.9±0.7 and 1.1±0.4,respectively.The duration of hospital stay was(3.3±0.7)days.The most common postoperative complication was seroma,which occurred in 9 cases(8.2%).Additionally,extraperitoneal hematoma occurred in 1 case(0.9%)and scrotum effusion in 1 case(0.9%).Conclusions Generally,L-SILTEP is safe,feasible and effective.However,due to its advanced technique-demand,the application of L-SILTEP should be patient-specific and surgeon-specific.The successful implementation of this surgical procedure necessitates extensive training and meticulous attention to the surgical details.

OBJECTIVE: To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures. METHODS: The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up. RESULTS: All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5). CONCLUSION Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.
Male ; Female ; Humans ; Adult ; Bone Wires ; Clavicle/injuries* ; Suture Anchors ; Blood Loss, Surgical ; Retrospective Studies ; Fractures, Bone/surgery* ; Fracture Fixation, Internal ; Ligaments, Articular/surgery* ; Postoperative Complications ; Treatment Outcome