Confronted with the complex and volatile situation of the medical market, hospitals must formulate long-term development strategies, enhance their core competitiveness, and secure or maintain an undefeatable position amidst competition. The paper discusses the strategic management of large hospitals from five dimensions: improving hospital leaders' strategic-thinking and decision-making skills, continuously implementing brand marketing strategies, adopting the ideas and methods of strategic cost management, constructing information-based hospitals, and creating vigorous and dynamic hospital culture. It argues that only by strengthening strategic management can the sustainable and concerted development of hospitals be promoted.

Objective To evaluate the effects of inhaled nitric oxide in the early period after extracardiac total cavopulmonary connection (ETCPC). Methods 32 patients after ETCPC were evaluated,of them 16 patients (experimental group) were administered with inhaled nitric oxide in the early postoperative period. Another 16 patients were as control. The cardiac index (CI), pulmonary vascular resistance(PVR), respiratory index(RI), pulmonary-left atrium pressure gradient(PLG), duration of ventilation, intensive care time, hydrothorax drainage and hospital stay were recorded. Results In experimental group, after inhaled NO, RI decreased from 2.61?0.32 to 1.41?0.21 (t=2.35,P

Objective: To observe the clinical effect of oral nutrition supplementation for maxillofacial tumor patients before operation. Methods: 60 patients who suffered from maxillofacial neoplasm were divided into two groups. In observation group, on basis of routine diet, oral nutrition supplements (Fortisip) had been added for 5～7 days before operation. In control group, only routine diet had been supplied. After operation, the two groups were all supplied with tube feeding. The blood routine test, plasma total protein, albumin, pre albumin and lymphocyte count were measured in all patients. Results: Every biochemical item reduced significantly after operation and no statistical significance was found between groups. But the absolute decreasing values had significant difference between the groups. Conclusions: Oral nutrition supplements (Fortisip) contains balanced nutrients and tastes well. It is safe and effective to use a nutritional supplement, being helpful to prevent malnutrition and to improve the immune function in perioperative period of patients with maxillofacial neoplasm.

Objective To investigate the expression of FOXP3 and CD25 in CD4+ T cells of peripheral blood from patients with early new-onset systemic lupus erythematosus(SLE) before and after treatment.Methods Forty-four early new-onset SLE patients including twenty-four with active disease (SLEDAI≥10), twenty with low active disease (SLEDAI

Objective:To investigate the expression of Foxp3 and CD25 on CD4+ T cells from patients with new-onset systemic lupus erythematosus(SLE)and assess their clinical significance.Methods:Twenty-one new-onset and untreated SLE patients including ten with active(SLEDAI≥10)and eleven with inactive disease(SLEDAI≤5)were enrolled in this study.Eleven age-and sex-matched healthy volunteers were also included as controls.Peripheral blood samples were collected and mononuclear cells isolated.The expression of CD25,Foxp3 and CD127 by CD4+ T cells was analyzed by flow cytometry(FACS).Proliferation assays were performed with the isolated CD4+CD25+ and/or CD4+CD25-T cells.Results:There was no significant difference in number of CD4+CD25+Foxp3+T cells in subjects with either active(1.91%-6.75%)or inactive(2.74%-7.01%)SLE compared to normal controls(2.11%-9.90%)(P=0.524 and P=0.794 respectively),Moreover,suppressive capacity of CD4+CD25+T cells in new-onset lupus patients was not impaired as measured by the capacity to inhibit proliferation of CD4+CD25-effector T cells(P=0.174,P=0.689).While CD4+CD25-Foxp3+T cells in both active(3.71%-10.94%)and inactive(2.97%-7.69%)patients with new-onset SLE were significantly more frequent than in normal controls(1.01%-3.62%)(P

OBJECTIVE: The role of different local flaps in small external nasal skin defect reconstruction was discussed. METHOD: Forty-two cases of the small size nasal defects (diameter < 2 cm) were repaired with local external nose flap (includes the dorsal nasal flap, nasolabial flap and bilobed flap). The clinical and follow-up data were analyzed of patients with small external nasal skin defects, who accepted different local flaps reconstruction. Dorsal nasal flap, nasolabial flaps (includes island flap, slid flap and axial flap) and bilobed flap were tailored to reconstruct different external nasal defect. Twenty-seven patients were male and fifteen patients were female, the patients' age ranged from 28 to 74 years, the median age was 61 years. Thirty-eight cases resulted from resection of skin malignant tumor and four cases were benign lesions. The diameter of defects was 1-2 cm. The defects were reconstructed by single-stage dorsal nasal flap in 7 cases. There were 30 cases of caudolateral nasal defects were reconstructed by nasolabial flap, single-stage island nasolabial flap in 7 cases, axial flap in 18 cases and slid flap in 5 cases. Superior lateral defects were reconstructed by single-stage bilobed flap in 5 cases. RESULT: All defects were repaired successfully. All tissue flaps survived and had not necrosis. There was no tumor recurrence during 3 months to 2 years follow-up. CONCLUSION The dorsal nasal flap, nasolabial flap and bilobed flap can be used safely and effectively to repair the small external nasal defect and have satisfactory curative effect.
Adult ; Aged ; Dermatologic Surgical Procedures ; methods ; Face ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nose ; pathology ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin ; pathology ; Surgical Flaps

Objective To determine the contributions of main chemical compositions of extracts of Eucalyptus camaldulensis represented by GC/MS elute peaks to the molluscicidal activities,and explore a shortcut of looking for the effective components from natural products. Methods E. camaldulensis leaves were collected consecutively in 12 months at the same place,extracted with dichloromethane,analyzed by GC/MS,and their LC50(s)of molluscicidal activities were tested according to the method rec-ommended by WHO. The correlation of the main components in 12 extracts and their molluscicidal activities were analyzed by the grey relative correlation analysis model with software GTMS 3.0. Result All the dichloromethane extracts of eucalyptus leaves showed excellent molluscicidal activities with the highest LC50 of 0.257mg/L and 0.242mg/L for the samples in June and July and the lowest LC50 of 6.802 mg/L and 5.406 mg/L in December and January respectively. The structures of 16 main chemical compo-nents were elucidated by GC/MS and NIST Mass Spectral Library,most of which were monoterpenes and sesquiterpenoids. The gray correlation coefficients with activity were all over 0.5,the first five over 0.9 were 4,4,8-Trimethyltricyclo[6.3.1.0(1,5)]do-decane-2,9-diol,(-)-Spathulenol,a structural isomer of(-)-Spathulenol,Eucalyptol and Ledol. Conclusion The most main in-gredients in the dichloromethane extracts of E. camaldulensis leaves show good correlations with the molluscicidal activity,which suggests that the molluscicidal role is synergistically played by the multiple components together.

Objective To observe the effect of Danshen in the treatment of severe hand-foot-and-mouth disease and investigate its mechanism.Methods One hundred and forty cases of children with severe hand foot and mouth diseases who hospitalized the intensive care unit were enrolled in the study from February 2012 to July 2014.The children were randomly divided into a control group and an observation group,with 70 cases in each group.The control group was given antiviral to reduce the intracranial pressure and intravenous immunoglobulin and the observation group was given Danshen in addition to the control group.The levels of neuron specific enolase (NSE)、S-100βprotein、TNF-α and IL-6 were detected at admission and checked again seven days after treatment.The changes of the above indicators and the clinical curative effect were compared before and after therapy.Results The total effective rate of the control group and the observation group was 80.0% and 92.9% respectively,showing statistical significance(P<0.05). After treatment, observation group of serum NSE (9.42 ± 2.56μg/Lvs. 11.71 ± 3.21μg/L,t=2.159), S-100β (177.34 ± 87.28 ng/Lvs. 286.14 ± 159.69 ng/L, t=2.315), TNF-α (15.98 ± 4.35 ng/Lvs. 23.17 ± 4.80 ng/L, t=4.297), IL-6 (41.72 ± 6.64 ng/Lvs. 52.05 ± 9.33 ng/L,t=3.492) , the level of were lower than those in the control group(P<0.05 orP<0.01). In the observation group, serum. The fever clearance time、the disappearance time of rash and the hospitalization time in the observation group (3.55 ± 1.02 d vs.4.55 ± 1.09 d, 7.14 ± 1.04 d) were shorter than those in the control group (4.46 ± 0.97 d vs.5.88 ± 1.44 d, 8.68 ± 1.06 d;t=5.409, 6.161, 8.677 respectively, P<0.01).Conclusions On the basis of conventional therapy,Danshen can effectively alleviate the systemic inflammatory response in children with severe hand foot and mouth diseases, reduce brain damage and improve the clinical efficacy.

Objective To investigate the effects of trimetazidine on renal function in patients with shock.Methods A prospective randomized controlled double-blind study was conducted.128 patients with shock admitted to intensive care unit (ICU) of Guangzhou Red Cross Hospital from April 2011 to April 2013 were enrolled and randomly divided into control group and trimetazidine treatment group,each n＝64.All patients received anti-shock treatment,while the patients in trimetazidine group received trimetazidine treatment (20 mg orally,tid) for 7 days,and patients in control group received placebo (10 mL of sterile water for injection,tid) for 7 days.The urinary output,serum creatinine (SCr),blood urea nitrogen (BUN),cystatin C,and creatinine clearance (CCr) reflecting renal function were recorded in both groups,and the values were compared before treatment,48 hours after treatment,and 1 week after the treatment.At the same time,dynamic mean arterial pressure (MAP) was monitored,and 48-hour and 1-week mortality rates were recorded.Results There was no significant difference in results in all the renal function parameters before the treatment between two groups.The levels of SCr,BUN,cystatin C were gradually decreased after treatment in both groups,but CCr and MAP were gradually increased.Compared with the control group,cystatin C at 48 hours after treatment was significantly decreased,while CCr was significantly increased in treatment group [cystatin C (mg/L):0.85 ± 0.81 vs.1.01 ± 0.91,t=2.562,P=0.017; CCr (mL/s):0.93 ± 0.64 vs.0.69 ± 0.40,t=2.155,P=0.033].SCr and BUN at 1 week after treatment were significantly decreased in treatment group [SCr (lμmol/L):94.23 ± 88.31 vs.104.99 ± 98.37,t=2.921,P=0.003 ; BUN (mmol/L):9.46 ± 8.24 vs.11.87 ± 8.65,t=2.611,P=0.010].Urine output per hour and MAP was improved after treatment in both groups,and no significant difference was found between treatment group and control group [urine output (mL):48 hours after treatment 55.67 ± 31.43 vs.45.34 ± 11.79,t =0.934,P=0.323 ; 1 week after treatment 71.67 ± 37.23 vs.75.35 ± 22.88,t=1.280,P=0.210; MAP (mmHg,1 mmHg=0.133 kPa):48 hours after treatment 72.13 ± 33.24 vs.69.28 ± 39.98,t=1.408,P=0.179; 1 week after treatment 71.44 ± 21.98 vs.72.32 ± 31.11,t =1.184,P =0.252].Mortality rate in treatment group was lowered compared with control group,however no statistical significance was found [48 hours after treatment:31.2％ (20/64) vs.32.8％ (21/64),x2=0.084,P=0.785; 1 week after treatment:32.8％ (21/64) vs.35.9％ (23/64),x2=2.084,P=0.173].Conclusions Trimetazidine can improve renal function in patients with shock.

Objective To evaluate the effects of isoflurane anesthesia on NR1 expression and neuronal apoptosis in the hippocampus and cortex of adult rats .Methods Thirty-six adult male Sprague-Dawley rats , weighing 250-280 g ,were randomly assigned into 3 groups using a random number table :control group (group C , n=6 ) ,O2 inhalation group (group O , n=6 ) and isoflurane anesthesia group (group I , n=24 ) .The rats were exposed to 2% isoflurane (group I) ,to pure oxygen (group O) ,or to air (group C) for 2 h .At 2 h ,and 1 ,7 and 14 days after the rats were awake (T1-4 ) ,Morris water maze test was performed .The rats were then sacrificed and brains were removed for isolation of the hippocampus and cortex .NR1 expression was detected using SABC immuno-histochemical technique and neuronal apoptosis was determined using TUNEL .Results Compared with group C , the escape latency at T2 and total swimming distance at T1 ,2 were significantly prolonged , and the expression of NR1 in hippocampi was down-regulated at T1 ,2 in group I ,and the expression of NR1 in the cortex was down-regulated in O and I groups ( P<0.05) .There was no significant difference in the apoptosis index between the three groups ( P> 0.05 ) .Conclusion Isoflurane anesthesia can decrease the cognitive function transiently ,which is related to inhibition of up-regulation of NR1 expression in the hippocampi ,but not related to neuronal apoptosis in adult rats .