Based on the theory of organizational performance appraisal and the needs of developing China's hospital performance assessment system, the paper proposed the concept and emphasized the significance of establishing a comparative hospital performance assessment system in China. By sharing identical experiences from overseas, the paper also advocates that as China is building its comparative hospital performance assessment framework, it is imperative to verify the comparability of hospital performance assessment indicators, build a quality-centered comparative model for hospital performance assessment, and a three-tier comparative model to cover hospitals, departments and posts. These efforts will further improve China's performance assessment system.

Objective To investigate the effect of hyperbaric oxygen ( HBO) preconditioning on activation of plasma protein C in a rat model of asphyxial cardiac arrest?resuscitation. Methods A total of 105 adult male Sprague?Dawley rats, aged 70-90 days, weighing 260-320 g, were randomly divided into 3 groups: cardiac arrest group ( group CA, n=5) , cardiac arrest?resuscitation group ( group CA∕R, n=50) , and hyperbaric oxygen preconditioning group ( group H, n=50 ) . Cardiac arrest was induced by campling the endotracheal tube at the end of expiration. The animals underwent HBO preconditioning once a day for 3 consecutive days before cardiac arrest was induced in group H. The rats were placed in the HBO chamber, 10 min later the pressure was increased at a constant rate until the hyperbaric oxygen reached 2 atmosphere absolute, and maintained at this level for 45 min, after the oxygen concentration>95%, and then the pressure was decreased at a constant rate ( within 20 min) until the normal pressure was reached. The rats underwent no resuscitation in group CA. Five rats were selected from CA∕R and H groups at 3, 6, 12 and 24 h after restoration of spontaneous circulation, and at 30 min of cardiac arrest in group CA, and blood samples were taken from the abdominal aorta for determination of the plasma activated protein C ( APC) concentrations. The time from asphyxia to cardiac arrest, time for spontaneous regular cardiac rhythm, and successful resuscitation were recorded. Results Compared with group CA, the plasma APC concentrations were significantly decreased at each time point after restoration of spontaneous circulation in CA∕R and H groups ( P<0.05) . Compared with group CA∕R, the time from asphyxia to cardiac arrest was significantly prolonged, the time for spontaneous regular cardiac rhythm was shortened, the success rate of resuscitation was increased, and the plasma APC concentrations were increased at each time point after restoration of spontaneous circulation in group H ( P<0. 05 ) . Conclusion HBO preconditioning can promote activation of plasma protein C after resuscitation in a rat model of asphyxial cardiac arrest, and is helpful in improving hypercoagulation.

Objective To establish the norm of occupational stress on the nurse in China. Methods Used stratified random cluster sampling,a total of 3091 nurses in 21 from China' s eastern,central and western parts of three regional hospitals, hospital were tested by Chinese nurse stressor scale (CNNS). Results ①The total norms for the CNNS and each factor are established. ②Descriptive statistics for CNSS for different regions samples, different working year' s samples,different marital status samples,different titles samples,different age's samples, different education background samples and different work nature samples were modulated. Conclusion The norm established can basically represent the occupational stress on nurses in China.

The clinical data and routine biochemical parameters of 64 maintenance hemodialysis (MHD)patients and 20 controls were analyzed in the study.Serum cystatin C levels were detected by latex particle enhalice inununo-turbidimetry:and the cardial structure and function were assessed by echocardiography.As MHD time extended,the levels of semm cystatin C increased gradually,accompanied with high incidence of left ventricular hypertrophy(LVH).The LVH-positive patients had higher systolic blood pressure and left veHtricular mass index,and had higher serum cystatin C than tllose in LVH-negative patients.The serum cystatin C levels were positively correlated with left yentricular mass index(r=0.633,P<0.01)and systolic blood pressure(r:0.397,P<0.01).The results suggest that serum cystatin levels may be an influencing factor for long-term cardiacvascular complication in MHD patients.

Objective To investigate the therapeutic effect and safety of endoscopic submucosal dissection (ESD) for upper gastrointestinal neuroendocrine neoplasms.Methods A total of 19 lesions diagnosed as neuroendocrine neoplasm were treated by ESD.Pathological diagnosis was performed.Adverse eventss were recorded.Patients were followed up for recurrence and metastasis.Results Lesions,0.4-1.5 cm (mean 0.9 cm) in diameter,were all resected at one ESD procedure.The operation time was 15-50 min (mean 20 min).No mass bleeding or perforation occurred.18 cases were histologically diagnosed as neuroendocrine tumors,with 16 as G1 and 2 as G2.One lesion was confirmed as G3 neuroendocrine carcinoma and the patient was referred for extensive surgery.All resected samples were free of residual tumor cell in the lateral and basal margins.Postoperative bleeding occurred in one case and was controlled endoscopically.No recurrence was detected during a mean follow-up of 28 months.Conclusion ESD,as a novel procedure for the treatment of the upper gastrointestinal neuroendocrine neoplasm,is safe and efficacious in clinic.

Objective To explore the CT and pathological features of renal epithelioid angiomyolipoma (EAML). Methods Clinical data and CT images from ten cases with EAML proved by surgery and pathology were retrospectively analyzed. All cases were performed with plain and contrast enhanced CT scans. Results CT features: higher pre-contrasted density than kidney, bulging from kidney,absent of fat, markedly heterogeneous enhancement ( quick wash-in and slow wash-out), big size without lobular sign, complete capsule with clear margin and mild necrostic area. Pathological features: diffuse sheets of epithelioid cells were found under microscopy with immunohistochemistrical findings including positivity for HMB-45 and negativity for EMA. Conclusion Some specific CT features, which is correlated well with the pathological findings, provide helpful information in the primary diagnosis of EAML.

Objective To explore the pathological and imaging features of epithelioid angiomyolipoma(EAML). Methods A 47-year-old man presented with dull pain in left upper abdomen for 1 year admitted to hospital.Accompanied with several enlarged lymph nodes,a mass with the largest diameter of 28 cm in the left kidney was inhomogeneously enhanced on CT.The left kidney and the mass were radically resected with regional lymph node dissection after general anaesthesia. Results During the operation,a well-circumscribed,encapsulated mass with several paraaortic lymph nodes was found on the upper-middle left kidney.The gross cut surface showed fleshy texture with regions of necrosis.Microscopically and immunohistochemistrically,diffuse sheets of epithelioid cells were found with positivity for HMB-45 and negativity for EMA.CT features included higher pre-contrasted density,absent fat,enhanced mode of quick wash-in and slow wash-out.There was neither metastasis nor recurrence during the 1 year follow-up. Conclusion EAML with malignant potency is a rare tumor of mesenchymal tissue presenting with some specific radiopathological features and a good prognosis.

Objective To respectively analyze the results and complications of hip arthroplasty for failed intertrochanteric hip fractures treating with internal fixation.Methods From July 2004 to June 2006,32 patients(24 males and 8 females)were treated with hip arthroplasty after the failed internal fixation of intertrochanteric fractures.The mean age was 71 years(range,57-81 years)at the time of the hip arthroplasty.The average interval from fracture to arthroplasty was 40 months(range,5-70 months).Fifteen patients had been treated with sliding hip screw,10 with intramedullary nail,5 with plate and screws,2 with multiple screws.The failure modes were nonunion in 8 patients,implant cut out from the femoral head in 9,avascular necrosis of the femoral head in 7,and traumatic arthritis in 8 patients.Cemented stems were used in 12 hips,and uncemented stems in 20 hips.Standard prostheses were used in 25,long-stem prostheses in 7.Results Twenty-eight patients were followed up for a minimum of 4 years after the hip arthroplasty,with the mean period of 5 years(range,4-6 yeas).For these 28 patients,the average preoperative Harris Hip Score was 37(range,32-45),and 88(range,84-95)at the latest follow-up.The average acetabular inclination was 44°(range,42°-48°).No loosing was found in cotyloid components.Nine of 10 cemented femoral components had cementation rated as grade C,and 1 as grade A.Three had heterotopic bone six months postoperatively,and 2 were Brooker type Ⅱ,one was type Ⅲ.Conclusion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient.

Objective To investigate the epidemiologic characteristics of patients with severe acute pancreatitis (SAP) and the effects of its complications on prognoses in past 7 years in the north area of Guizhou province. Methods Data of 209 patients with SAP admitted to the Department of Critical Care Medicine of Affiliated Hospital of Zunyi Medical College from January 2009 to January2016 were retrospectively analyzed, and they were divided into a survival group (178 cases) and a death group (31 cases) according to the prognosis. The gender, age, diagnosis (primary and recurrent), the length of stay in hospital, the levels of creatinine and total bilirubin (TBil), the time of blood purification, hematocrit (HCT) level on the first day after admission, pathogenesis, complications [infection, pseudocyst, intra-peritoneal hemorrhage, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), abdominal compartment syndrome (ACS), pancreatic encephalopathy, multiple organ dysfunction syndrome (MODS)], sequential organ failure (SOFA) score (maximum SOFA score during hospital stay), application of hormones, surgical interference, etc. related factors were compared, the SAP epidemiological characteristics, factors affecting prognosis and the effect of complications on prognosis in intensive care unit (ICU) were analyzed in the two groups.Results Of the 209 patients 98 cases were diagnosed biliary pancreatitis accounting for the majority (46.9%), hyperlipidemic pancreatitis 76 cases (36.3%), alcoholic pancreatitis 6 cases (2.8%) and idiopathic pancreatitis29 cases (13.9%). The age (years: 47.1±13.5 vs. 53.2±12.0), creatinine (μmol/L: 109.4±100.3 vs. 335.7±222.4), the ration of intra-peritoneal hemorrhage [4.5% (8) vs. 38.7% (12)], ARF [1.1% (2) vs. 54.8% (17)], ACS [1.1% (2) vs. 9.7% (3)], MODS [18.5% (33) vs. 74.2% (23)] and SOFA score (3.3±2.4 vs. 10.5±5.4), percentage of patients using hormones [5.6% (10) vs. 29.0% (9)] were significantly lowered (allP < 0.05) and the time of blood purification was shortened (days: 1.95±1.97 vs. 4.81±5.84) in survival group than those in death group; while the gender, diagnosis, the length of stay in hospital, TBil, HCT on the first day after admission, pathogenesis, complications (infection, pseudocyst, ARDS and pancreatic encephalopathy) and surgical treatment situation were compared between the two groups, no statistical significant differences were seen (allP > 0.05). Logistic regression analysis showed that creatinine > 300μmol/L [odds ratio (OR) was 2.651, 95% confidence interval (95%CI) was 1.459-3.935,P = 0.017], intra-peritoneal hemorrhage (OR was 5.231, 95%CI was 3.517-7.159,P = 0.000), ARF (OR was 3.731, 95%CI was 2.641-4.857,P = 0.000), ACS (OR was 2.517, 95%CI was 1.003-3.098,P = 0.000), use of hormone (OR was 1.012, 95%CI was 0.825-2.051,P = 0.000) and SOFA score (OR was 3.179, 95%CI was 2.630-6.021 andP = 0.000), MODS (OR was 4.716, 95%CI was 2.086-7.902 andP = 0.031) were the risk factors having critical effects on the prognosis of thedisease, The higher the creatinine level, the worse the prognosis. The mortality of ARF was very high reaching 89.5%; the mortalities of patients with complications as intra-peritoneal haemorrhage, ACS, MODS, pancreatic encephalopathy, AKI, infection, pancreatic pseudocyst and ARDS were as follows: 60.0%, 60.0%, 41.1%, 33.3%, 32.1%, 23.1%, 17.7%, 13.1% respectively.Conclusion Biliary disease andhyperlipidemia are the major causes of SAP in north area of Guizhou province, creatinine > 300μmol/L, intra-peritoneal hemorrhage, ARF, ACS, SOFA score, use of hormones are the independent risk factors leading to poor outcome in patients with SAP and the use of hormones cannot ameliorate the disease situation.