In order to enhance their core competitiveness,hospitals will deal with medical service suppliers,patients,counterpart hospitals and other stakeholders constantly.Such multiple value activities constitute a patient-oriented and hospital-centered value group.Hospitals have to constantly meet the demand of patients in the provision of medical services,and patients will be satisfied through their own participation in medical activities,thus realize the increase of their value.The pattern of mutual value creation between hospitals and patients forms the new hospital-patient relationship.It is an important condition for the hospitals to gain competitive advantages in the medical service provision through the two models of value maximization and organization minimization,and is also profitable for the formation of a harmonious relationship between doctors and patients.

Objective To investigate the etiology of early postoperative hyperbilirubinemia after liver transplantation.Methods The clinical data of 87 cases of liver transplantation and the etiology of early postoperative hyperbilirubinemia after liver transplantation were analyzed.Results The incidence of early postoperative hyperbilirubinemia after liver transplantation was(52.87 %).In 21 postoperative complications,17((80.95 %)) were associated with hyperbilirubinemia.The causes of hyperbilirubinemia were as follows in turn: ischemic-reperfusion injury(n=(25,28.73 %)),complications of(common) bile duct(n=23,(26.44 %));acute rejection(n=19,(21.84 %));others(n=13,(14.94 %)).(Conclusions) The early postoperative hyperbilirubinemia is the most common clinical manifestation in(patients) undergoing liver transplantation and can be taken as a reliable clinical mark for the postoperative complications and liver functions.The etiology of early postoperative hyperbilirubinemia after liver transplantation is very complicated.Early diagnosis and treatment is helpful to improve the survival of patients undergoing liver transplantation.

With the continuous economic development,the environment in which we live is undergoing change.Environmental pollution has greatly affected our physical and mental health.The occurrence of many diseases is derived from the environmental change.The health management of health problems caused by environmental pollution is of great significance in monitoring the impact of environmental pollution on people's health,timely detecting and preventing the occurrence of diseases,improving people's health,and building up a harmonious and healthy society.

Objectives To investigate the results of liver transplantation using steatosis liver donors in order to provide a scientific basis for the use of marginal donors.Methods From 2002 to 2011,80 of 407 were steatosis liver donors.There were 69 males and 11 females.Their age ranged from 20-54 years old.Sixteen donor livers with severe fatty liver and reperfusion injury were not used.The remaining 64 livers were divided into a S1 group (mild steatosis,n=22),a S2 group (moderate steatosis,n=25),and a S3 group (severe steatosis,n=17).A S0 group was used as a control (randomly selected fat-free liver,n=80).Results The occurrence rates of delayed graft function (DGF) in the S0,S1,S2,S3 groups were 5％,9.1％,20％,29.41％,respectively.Primary nonfunctioning occurred in 2 cases of the S3 group,which represented a 11.76％ of the S3 group (2/17),and 3.12％ of the total 64 cases (2/64).Conclusions Although the incidence rate of DGF was higher in the steatosis liver donor groups than the S0 group,there was no correlation in the mortality rate of the S1-S3 group within one year of transplantation.Attentions should be paid to the treatment of complications after steatosis liver transplantation.By minimizing ischemia-reperfusion injury,improving microcirculation,strengthening routine therapy and reducing the amount of immunosuppression,the same results could be achieved using steatosis donor liver and normal liver for transplantation.

Objective To evaluate the diagnostic yield and the etiological accuracy of double balloon endoscopy and capsule endoscopy in patients with.Methods Seventy-three patients with OGIB received double balloon endoscopy.The route of enteroscopy could be either via mouth or via anus.Negative result of initial route was required afterwards for another via mouth or via anus examination.Sixty-one patients with OGIB received capsule endoscopy.Results The overall diagnostic yield for double balloon enteroscopy was 94.5%,and for capsule endoscopy it was 81.8%.The etiological diagnostic accuracy of double-balloon enteroscopy was 80.8%,and for capsule endoscopy,50.0%.Double-balloon enteroscopy and capsule endoscopy were both well tolerated.Conclusion Double balloon enteroscopy is superior to capsule endoscopy in the diagnostic yield and the etiological diagnosis of obscure gastrointestinal bleeding.

Objective To explore the effect of rehabilitation training on learning and memorial ability and long-term potentiation (LTP) in hippocampal region CA3 in rats with cerebral infarction. Methods 30 male rats were randomly divide into model group, rehabilitation training group and normal group with 10 cases in each group. Photochemical method was used to induce hippocampal infarction. The performance of Y-maze test and moving-back with current stimulation experiment were recorded. The increase rate of population spike (PS) in hippocampal region CA3 and PS latent period were compared. Results The frequency of training of Y-maze test was less after rehabilitation training, the latent period of moving-back with current stimulation experiment prolonged, and the PS latent period was shortened. Conclusion Rehabilitation training may strengthen the LTP effect in hippocampal region CA3, and improve the learning efficiency

Objective To assess the value of central venous-to-arterial carbon dioxide difference [ P( cv-a) CO2 ] in evaluation of disease severity and prognosis in patients with septic shock.Methods There were 45 consecutive resuscitated septic shock patients from April 2009 to October 2010 included immediately after their admission into our ICU.The patients were divided into low P(cv-a) CO2 group and high P(cv-a) CO2 group according to a threshold of 6 mm Hg ( 1 mm Hg=0.133 kPa).All patients were treated by early goal directed therapy (EGDT).The parameters of hemodynamics,lactate clearance rate,the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ ) score,the sequential organ failure assessment (SOFA)score,6 h rate of EGDT achievement,the ICU mortality and 28 days in-hospital mortality were recorded for all patients.Results There were 30 patients in the low P(cv-a) CO2 group,and 15 in the high P(cv-a)CO2group.There were no significant differences between low P(cv-a) CO2 and high P(cv-a) CO2 patients in age,APACHE Ⅱ score and SOFA score (all P ＞ 0.05 ).Compared with the high P(cv-a)CO2 group,the low P(cv-a) CO2 group had higher cardiac index ( CI ) and 24 h CI,higher delivery O2 ( DO2 ) and 24 h DO2,higher central venous oxygen saturation ( ScvO2 ) [ (74 ± 9) ％ vs (67 ± 8) ％ ],lower lactate [ ( 3.4 ± 2.1 )mmol/L vs (5.7 ± 4.5 ) mmol/L] and higher △SOFA score [ (0.7 ± 1.8 ) vs ( - 0.4 ± 1.1 ) ],lower 24 h SOFA score [ (7.8 ± 2.0) vs (9.8 ± 2.0 ) ],higher 6 h rate of EGDT achievement ( 83.3％ vs 53.3 ％ )(P ＜ 0.05 ),however,there were no differences in 28 days mortality and ICU mortality between the two groups ( P ＞ 0.05 ).Conclusion P(cv-a) CO2 might be an indicator for predicting the severity of patients with septic shock and evaluating tissue perfusion.

Objective To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality of patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI).Methods Randomized controlled trials (RCTs) of IABP compared with non-IABP control in AMI patients, from January 1970 to May 2015, were searched from MEDLINE, Embase and Web of Science.The data were analyzed with software RevMan 5.0.Results Five RCTs involving 1 450 AMI patients, including 722 treated with IABP (IABP group) and 728 without IABP (non-IABP group), were included for analysis.Compared with non-IABP group, IABP did not significantly decrease the hospital mortality or 30-day mortality (OR=0.92, 95%CI: 0.69-1.25,P=0.61).According to the timing of IABP before or after PCI, it was further divided into IABP-before-PCI subgroup and IABP-after-PCI subgroup.Compared with non-IABP group, the 30-day mortality was not decreased in IABP-before-PCI subgroup or in IABP-after-PCI subgroup (OR=0.64, 95%CI: 0.23-1.78,P=0.39;OR=1.25, 95%CI: 0.42-3.77,P=0.69, respectively).According to complicating with cardiogenic shock (CS) or not, patients were divided to AMI with CS subgroup and AMI with no-CS subgroup;the hospital or 30-day mortality were not significantly decreased in both subgroups (OR=0.96, 95%CI: 0.70-1.32,P=0.80;OR=0.68, 95%CI: 0.28-1.70,P=0.27, respectively).Conclusion IABP does not decrease the 30-day mortality of AMI patients treated with PCI.

Objective To investigate the protective function of panax notoginseng saponins(PNS) on grafted liver during ischemia-reperfusion in rat with orthotopic liver transplantation.Methods After establishing rat orthotopic liver transplantation model,the rats were randomly divided into three groups:the experimental group(P),the control group(N),and sham operation group(S).The levels of serum ALT and AST were(determined),the hepatic pathohistological changes were observed,the expression of caspase-3 and TNF-? were examined by immunohistochemistry,and the apoptotic hepatocytes in grafted liver were detected by TUNEL method.Results The levels of ALT,AST,and the expression of caspase-3 and TNF-?,and apoptotic cells in grafted liver were significantly higher in the control group than that in the experimental group.(Conclusions) PNS can protect the grafted liver from injury during ischemia-reperfusion in rat orthotopic liver transplantation.

PurposeTo investigate the correlation between iodine concentration and clinical severity of acute pancreatitis (AP) through the quantitative evaluation with dual-energy spectral computed tomography (DESCT), so as to find out an effective imaging technology in the evaluation of clinical severity of AP.Materials and Methods Sixty patients with AP confirmed clinically (AP group) and 30 patients with normal pancreas (control group) were retrospectively analyzed. All the patients underwent enhanced CT scan in the spectral imaging mode. Iodine concentration and normalized iodine concentration (NIC) were respectively measured during arterial phase and portal phase in the material-decomposition images by using a spectral imaging viewer (GSI Viewer). Results Iodine concentration and NIC were significantly higher in the control group than in the AP group (P<0.05,P<0.001). In the AP group, according to Ranson grading, 24 patients were in the mild grade, 20 patients were moderate, and 16 patients were severe. Iodine concentration and NIC decreased along with the increase of their Ranson grade. There were significant difference in iodine concentration and NIC among the three subgroups (iodine concentration on arterial phase:F=8.776,P<0.01; iodine concentration on portal phase:F=4.019,P<0.05; NIC on arterial phase:F=12.700,P<0.001; NIC on portal phase:F=8.732,P<0.01). Iodine concentration and NIC on arterial and portal phases in the mild grade group were both significantly higher than those in the moderate grade group (P<0.05); however, iodine concentration on arterial and portal phases, and NIC on arterial phase in the severe grade group were significantly lower than those in the moderate grade group (P<0.05).Conclusion DESCT can analyze hemodynamic changes in AP quantitatively, which is of great value in evaluating changes in AP of each grade.