The paper gives a detailed description of the main features of American medical services,the characteristics of American hospitals,the responsibilities of hospital presidents and the problems faced by them.In addition,it introduces the macro-management of American hospitals and the existing problems.

Objective To investigate the relationship between myeloid-derived suppressor cell ( MDSC) levels and immune function and hepatitis B virus DNA ( HBV-DNA) replication level in patients with hepatitis B. Methods 96 patients with hepatitis B were included in the study.40 normal persons who received physical examina-tion in the hospital during the same period were included as the control group.The content of MDSC was detected by flow cytometry and HBV-DNA level was detected by real-time fluorescence quantitative PCR technique.Statistical analysis was performed.Results The content of MDCS in hepatitis B group (8.77 ±3.69)%was significantly high-er than (1.64 ±1.26)%in the control group (t=16.80,P<0.05).The content of MDCS in HBsAg positive group (11.29 ±3.39)%was significantly higher than (4.71 ±2.88)%in HBsAg negative group (t=10.76,P<0.05). The proportions of HBA DNA<103 IU/mL,103 -104 IU/mL and 105 -106 IU/mL in HBsAg positive group(0.00%, 0.00%,9.09%) were significantly lower than those in HBsAg negative group (54.05%,22.97%,20.27%),while the proportion of HBA DNA>107 IU/mL ( 90.91%) was significantly higher than that in HBsAg negative group (2.70%)(P<0.05).The content of MDSC in HBV DNA positive group[(10.82 ±3.26)%] was significantly higher than that in HBV DNA negative group[(5.84 ±2.16)%](t=8.42,P<0.05).Spearman's correlation analy-sis showed that the level of MDCS expression was positively correlated with the level of DNA replication (r=0.769, P<0.05).Conclusion The increased level of MDSC content can cause the immune suppression and is positively correlated with the degree of HBV DNA replication.

0.05); and more 5 years,length of service also between doctors. There were 98.3% of medical staffs being aware of health care law for six-step hand-washing and hand hygiene 97.8% being aware of hand hygiene compliance and 86.7% obtained knowledge after proper training,but most of them did not know the relationship between hand hygiene and hospital infection. CONCLUSIONS A good hand hygiene compliance need not only a reliable and convenient environment,but also training,inspection,supervision and management.

OBJECTIVE: To observe the effects of combined application of Radix Salviae Miltiorrhizae injection and dopamine injection on peritoneal dialysis patients.METHODS: By self-control method,the peritoneal dialysis solution of 22 patients with ambulant continued peritoneal dialysis was added with 20 mg dopamine injection and 12 mL Radix Salviae Miltiorrhizae injection for dialysis of 14 days.The D/P values of urea nitrogen(UN) and creatinine(Cr),week's peritoneal UN clearance index(KT/V),the clearance rate of Cr(Ccr),week's total KT/V,Ccr,reabsorption rate of glucose and the net amount of 24 hours' ultrafiltration were recorded before and after medication.RESULTS: The addition of dopamine injection and Radix Salviae Miltiorrhizae injection to the peritoneal dialysis solution resulted in significant higher values in week's peritoneal KT/V,Ccr and week's total KT/V,Ccr and the net amount of 24 hours' ultrafiltration as compared with before medication(P

Objective: To establish the assay of berberine hydrochloride for Sanhuang Tablets (Radix et Rhizoma Rhei, Extractum Scutellariae and berberine hydrochloride). Methods:The HPLC with a KF C 18 column (250mm?4.6mm,10?m) was used. Acetonitrile-0.05 mol?L -1 triethylamine buffer solution (adjusted pH to 3.0 with conc. H 3PO 4) (35∶65) was used as mobile phase. The flow rate was 1.0mL?min -1 , and the detection wavelength was at 347nm. Results: The method has a good linear dependuce. The average recovery of loading sample was 98.21% with RSD 1.01%. ( n =9). Conclusion: The method is convenient for a good resolution and can be used for the quality control of Sanhuang Tablets.

Executive function is an important advanced cognitive process, and it is the function that integrates different cognitive processes to achieve one's aim. Updating is an important component of executive function. According to the classifications of Miyake & Colletee on executive function, two study paradigms on memory updating are discussed: n-back paradigm & running memory paradigm. A new study method called latent variable analysis and new studies of cognitive neuroscience on memory updating are introduced. Issues on ethics and morality in research on cognitive experiment of psychology are briefly demonstrated to explore appropriate direction for research of executive function in future.

Objective:To summarize the application of hospital electronic medical record system and implementation experience, for the scientific and reasonable construction of digital hospital provides design scheme. Methods: The electronic medical record to the patient as the center including the establishment of hospital medical records, doctor's orders, all kinds of inspection, inspection reports and other information. Results: The uniform ultimate implementation of electronic health record standard, electronic data from medical records and medical information barrier-free exchange, realize the integration and sharing of electronic medical records information inside the hospital. Conclusion: The electronic medical record system to improve the clinical efficiency in hospital application, provide auxiliary functions for clinical decision making.

Objective To compare the effects of the two kinds of crystalloid solutions on glycometabolism in type 2 diabetic patients during the operation for the sclestion of the most suitable crystalloid solution. Methods In the forty scheduled gastrointestinal operation patients,there were twenty (D-group) type 2 diabetic patients and the others (N-group) were non-diabetic patients. Each of the two groups were randomly divided into two groups according to infusing different crystalloid solutions: lactated Ringer’s solution (L group), Plasma Lyte A (A group).So the patients were divided into D-L group,D-A group,N-Lgroup,N-A group.The blood glucose concentration,the blood lactate concentration and artery blood gas analysis before operation (T0) and at the end of operation(T1)were measured . Results The blood glucose concentrations had significant increase at the end of operations,and the blood glucose concentrations of D group were higher than that of N group at T0 and T1.The lactate concentrations before operation were normal in all the patients, but the lactate concentrations were over the normal limits after infusing lactated Ringer’s solution and remained normal after infusing Plasma Lyte A.The lactate concentrations had significant increase in the other three groups except N-A group. Conclusion Plasma Lyte A is the more safe and efficient crystalloid solution for diabetic patients during the operation.

Objective:To study the mesiodistal teeth size and the relationship between upper and lower teeth dimension of normal occlusion from Han Chinese in Xi'an. Methods: 52 males and 55 females with normal occlusion were selected. The mesiodistal width of each tooth was measured using a vernier gauge caliper. Statistical analysis was performed. Results: For the 107 cases with normal occlusion, the mean and standard deviation of the teeth size were calculated. There were significant differences between males and females in maxillary incisors, canines, first molar and mandibular canines, premolars. The normal range was obtained for the anterior and overall tooth size ratio(anterior ratio:78.32?3.01 overall ratio:91.10?2.27); and the regression equation that was used to quantify the tooth size discrepancies was expressed according to the significant correlation between the upper and lower tooth (r anterior=0.754, rtotal=0.851). Conclusion: There is a relationship between upper and lower teeth dimension. Sex difference should be considered when tooth size was used in clinic.

Objective The purpose of this study was to evaluate the use of tracheo-oesophageal vioce prostheses after total laryngectomy.Methods Between 1995 and 1999,18 male patients ,Aged from 42 to 68,average 54.6,used Blom-singer voice prostheses after total laryngectomy.10 cases were glottic style,8 cases were subglottic style.12 patients received stage I,6 patients received stage Ⅱ voice reconstruction surgery. Results All cases were followed-up from 3 to 5 years. The success rate was 77.8%(14/18). The time with prostheses ranged from 8 to 19 months(average 12months). All failures were stage Ⅱ surgey .Conclusion Stage I voice reconstruction surgery can be performed in all total laryngectomy patients. But the indications of stage Ⅱ voice reconstruction surgery should be controlled strictly. More attention should be paid to the training of voice rehabilitation after total laryngectomy. The tracheo-oesophageal voice prostheses is an effective method to improve the life quality of the patients.