The paper gives an account of the four systems that are currently used for evaluating hospital quality in America, viz. America's Best Hospitals, Solucient 100 Top Hospitals, International Quality Indicator Project, and the Joint Commission on Accreditation of Healthcare Organizations. The "America's Best Hospitals" methodology takes into account three factors, infrastructure, process and outcome. Hospitals are first ranked in specialties, then the index of hospital quality is calculated by means of weighted indexes, and after that the best hospitals are selected according to the specialty rankings and the number of the hospitals. The "Solucient 100 Top Hospitals" methodology selects 100 top hospitals among hospitals of the same size on the basis of hospital quality and safety indexes. The evaluation indexes include eight items, such as index of risk-adjusted mortality rates, index of complications, and disease severity-adjusted average length of hospital stay. The methodologies of "International Quality Indicator Project" and "the Joint Commission on Accreditation of Healthcare Organizations" are used in many countries to evaluate clinical efficiency and enjoy high reputation in monitoring and promoting medical quality.

Objective To establish the optimal section planes for observing ventricular septal defect(VSD) by real-time three dimensional echocardiography(RT-3DE).Methods In 6 pig hearts with different types of VSD, after high pressural perfusion with coupling reagent, two dimensional, dual plane and RT-3DE were performed with different section planes, estimating with half quantificational visional grade:4 marks,very clear;3 marks,clear;2 marks,not clear enough; 1 marks,not clear. Results Observation by RT-3DE, en-face view of atrial-ventricular(S2a) and en-face view of left ventricular septum(L1a) provided relatively ideal section planes in sub-arterial ventricular septal defect, S2a and en-face view of right ventricular septum(L2a) provided relatively ideal section planes in perimembranous and muscular VSD. Conclusions S2a reflects relatively ideal section plane in sub-arterial, perimembranous and muscular VSD.

Objective To observe the learning and memory ability,oxidative stress,apoptosis morphological changes in the hippocampus,and to explore the effects of hyperuricemia on cognitive function.Methods 51 healthy male SD rats were randomly divided into three groups (17 in each group):Blank group,Distilled water group and Hyperuricemia group.Using the lavage methods of yeast extract combined with ethambntol to establish hyperuricemic model.Morris water maze test was used to measure the learning and memory ability.The levels of MDA,GSH-Px,ASAFR,SOD were measured through chemical colorimetry.Hippocampus morphology structures were observed under the HE staining light microscopy to detect the apoptosis of hippocampus cone cell with TUNEL.Results The average escaped latency and passing platform times of Blank group had no significant difference compared with those of Distilled water group and Hyperuricemia group (all P＞ 0.05).GSH-Px,ASAFR,SOD of Hyperuricemia group ((83.70 ± 5.47) nmol/mg,(606.03±46.61) U/L and (55.05 ± 2.11) units/mg) were increased compared with those of Blank group ((67.28±8.37) nmol/mg,(473.84 ± 57.64) U/L,(45.79 ± 2.05) units/mg) and Distilled water group ((71.96±9.47) nmol/mg,(505.97 ± 47.19) U/L,(46.24 ± 3.65) units/mg) (all P＜ 0.05).Compared with Blank group ((3.19±1.14) μmol/L) and Distilled water group ((3.16±1.43) μmol/L),the MDA of Hyperuricemia group ((1.74±0.45) μmol/L) was significantly decreased (all P＜ 0.05).Form and structures of hippocampal neurons of each group were basically normal under the HE staining light microscopy.Compared with Blank group (CA1:(3.59±0.63) ％,CA3:(5.54± 0.78) ％) and Distilled water group (CA1:(3.25±0.97) ％,CA3:(5.96± 0.82) ％),the hippocampal cells of Hyperuricemia group (CA1:(4.04± 0.78) ％,CA3:(5.95±0.80) ％) also had no statistical differences (P＞0.05).Conclusion Hyperuricemia has antioxidant effect on hippocampal neurons and has no effect on cognitive function and hippocampal neural morphology in rats.

Objective To compare the efficacy and safety of thrombolysis and anticoagulant therapy for post-traumatic acute submassive pulmonary embolism (PE) in middle-aged and elderly patients.Methods Totally 45 patients with post-traumatic acute submassive pulmonary embolism in our hospital were selected.Patients were divided into thrombolysis group (n =22) and anticoagulation group (n=23) according to their conditions.Symptoms and signs,blood gas analysis,D-dimer,echocardiography,CT pulmonary angiography (CTPA) were performed before and after thrombolysis or anticoagulant therapy.Results There were no significant differences in clinical curative rate between thrombolysis group and anticoagulation group [95.5％ (21/22) vs.91.3％ (21/23),x2 =0.32,P＞0.05],and no case was found dead in both two groups.There was a significant difference in hemorrhage rate between thrombolysis group and anticoagulation group [27.3％ vs.4.3％,x2 =4.53,P ＜ 0.05].At 24 hours after thrombolysis or anticoagulant therapy,the improvement rate of dyspnea,PaO2 level was significantly higher and the pulmonary arterial pressure was significantly lower in thrombolysis group than in anticoagulation group [45.5％ (10/22) vs.17.4％ (4/23),(80.4±8.1) mm Hg vs.(73.6±9.3) mm Hg,(51.2±6.2) mm Hgvs.(60.3±5.7) mm Hg,respectively,all P＜0.05],and there were no statistical significances at other time points between the two groups.Conclusions The clinical curative rate and fatality rate are similar in thrombolysis group versus anticoagulation group.Hemorrhage rate is higher in thrombolysis group than in anticoagulation group.Thrombolysis can relieve dyspnea rapidly,reduce pulmonary artery pressure and make the embolized blood vessels recanalized.Patients with low bleeding risk in a critical condition are suggested to take thrombolysis therapy,while patients with high bleeding risk in a light condition are suggested to take anticoagulant therapy.

(0.05)).Conclusions RT3DE planimetry of MVA before and after PBMV is feasible and accurate.It provides a new quantitative way for MVA following up after PBMV.

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) with scissors knife in difficult cases.Methods A total of 36 sessions of ESD in 34 patients were performed from May 2010 to May 2012 with application of new scissors knife.The complications and followup outcomes were recorded.Results All lesions were removed successfully with an en bloc resection rate at 91.7％.Delayed bleeding occurred in 2 patients (5.6％),and both of them were cured sucessfully with endoscopy.No perforation happened and the average hospitalization time was 5 days.Follow-up endoscopy performed 6 or 12 months after ESD in 6 patients revealed no recurrence or residual lesions.Other patients are under follow-up now.Conclusion The scissors knife is easy to manipulate,which can ensure the safety and efficiency of ESD.

Objective To build the county level hospital nursing assistance need indicator system in Jiangxi province.Methods Literature review,qualitative research method and Delphi expert consultation method were adopted to build the county level hospital nursing assistance need indicator system.The indicator system was revised through trial test.Results Two rounds of expert consultation showed that expert authority degree coefficients were 0.79,0.83; Coordination coefficient(Kendall's W) was 0.11～0.16; content experts consistency coefficient was 0.78,reliability Cronbach's α coefficient was 0.85.Through expert advice and pre-examinaion,the county level hospital nursing assistance need indicator system was built,consisting of 3 level Ⅰ indicators,8 level Ⅱ indicators,43 level ⅠⅡ indicators,including assistance contents,assistance ways and assistance time.Conclusions This study established the county level hospital nursing assistance need indicator system with better scientific and feasible characteristics.It can provide experience and guidance for the relevance and effectiveness of the implementation of follow-up care aid work.

Objective To investigate the effects of rehabilitation and exercise training on endothelial func- tion and collateral circulation in patients with coronary heart disease(CHD)who underwent PCI.Methods Sixty- three cases were divided into three groups:group A undertook rehabilitation protocol with three stages,group B with additional extracorporeal counterpulsation in addition to the intervention of group A,group C acted as control.The Bruce submaximal treadmill,coronary angiography and Doppler were conducted for evaluation of the functional per- formance,lateral branching and endothelium function.Results(1)The value of RPP and RPE of groups A and B were significantly higher than those of the control group as quantified by exercise test alter the third stage of rehabilita- tion(P

Atmosphere ; chemistry ; Chromatography, High Pressure Liquid ; Polycyclic Aromatic Hydrocarbons ; analysis ; Sensitivity and Specificity

Objective :To explore the feasibility and clinical value of real time three‐dimensional transesophageal echo‐cardiography (RT‐3D TEE) in diagnosis of congenital heart valvular disease (CHVD).Methods :A total of 135 CH‐VD patients treated in our hospital were selected .All patients received surgery ,and transthoracic echocardiography (TTE) and RT‐3D TEE inspection successively within 7d before surgery .Heart valve lesion condition was observed , and diagnostic results of two methods and surgical outcome were compared and analyzed .Results :RT‐3D TEE could display the morphological structure ,lesion degree and peripheral blood flow of heart valves in CHVD patients in a multi‐angle ,stereoscopic and clear way .It could find heart valve disease which is difficult to be identified by TTE , and corrected the diagnostic deviation .With surgical results as the gold standard ,diagnostic coincidence rate of RT‐3D TEE was significantly higher than that of TTE (97. 04% vs.91. 11%, P＝0.039).CHVD diagnosed by RT‐3D TEE and TTE possessed a intermediate consistency (Kappa＝0.477 , P＝0. 001).Conclusion :RT‐3D TEE can pro‐vide more imaging information for the diagnosis of CHVD ,which can be used as an effective supplement for preop‐erative TTE examination .