As China witnesses constant development of its market economy and gradual deepening of reform in its medical and health cause,the ability of domestic hospitals to adjust their operational management strategies in due course is crucially related to their survival and development amidst market competition.Hospital managers,while stressing quality and economic control,should attach special importance to the brand effect of their hospital and step up hospital brand building,the focus of which lies in patient satisfaction and loyalty and hospital popularity and reputation.Only in this way can they constantly create advantages,enhance core competitiveness and put their hospital in an invincible position amidst market competition.

The Eleventh Five-year Program period will be a very important period in the historical development of China;it will also be a key period for domestic hospitals to deepen reform and achieve steady growth.Doing a good job of the five years' work will be of great significance to promoting reform of the medical and health system,strengthening and developing the hard-won good situation,speeding up hospital construction and growth,and solving such problems facing the common citizens as "it is difficult and expensive to see a doctor".The authors offer suggestions and hope to arouse discussions as to how hospitals ought to formulate a Eleventh Five-year Program that will meet their own growth needs with the guidance of a scientific approach to development.

Objective To observe the effect of atmospheric pollution on workers'α1-antitrypsin concentrationb in petrochemical enterprises.Methods During health examination,the workers were indivded into 3 groups according tO the length of job experience.Ⅰ group(<10 years)included 291 cases,aged 22-35 years old,Ⅱ group(10-20 years)included 634 cases,aged 33-45 years old,and Ⅲgroup(>20 years)included 427 cases,aged 44-55 years old.The normal control were individed int different group according to the status of petrochemical workers.,all the serum samples were detected on automatic biochemical analyzer,α1-antitrypsin levels were analyzed between the different groups.Results In group Ⅰ,the α1-AT concentration was 2.58±0.38 g/L(P>0.05)without significant difference compared with control.In group Ⅱ and Ⅲ,the concentration α1-AT were 2.02±0.43 g/L and 1.72±0.41 g/L respectively with significant differences compared with control.And the significant difference existed among the three groups of petrochemical workers..But the sigficant difference did not exist between different group of control people.Conclusion During the process of oil refining,the plants exhausted the polluted gas of nitrogen dioxide,olefins,alkanes,alcohols,carbonyl and other harmful substances,it influenced theα-AT levels of body.It is a good suggestion to decreas the petrochemical pollution,and to monitor the serum concentration of α-AT content among petrochemical workers,it might to reduce the incidence of lung disease of great significance.

One of the most problems is the diagnosis of the borderline lesion and/or borderline tumor to pathologists. It is necessary to make the correct diagnosis of the gastrointestinal borderline lesion and/or borderline tumor and correlative lesion such as gastrointestinal stromal tumors, gastrointestinal lymphoid proliferation and MALT lymphoma, IPSID, gastrointestinal adenoma and appendix carcinoid.[

Adult ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Spinal Fractures ; surgery ; Surgical Wound Infection ; therapy

Animals ; Biomarkers ; Hexanes ; poisoning ; toxicity ; Humans ; Neurotoxicity Syndromes ; etiology

Objective To investigate the safety,efficacy and effects of emergent percutaneous coronary intervention (PCI) in patients from Second Affiliated Hospital,Medical College,Zhejiang University with cardiogenic shock (CS) complicating acute myocardial infarction (AMI).Method Twenty-seven patients with CS complicating with AMI were treated by PCI with intraaortic balloon counterpulsation (IABP) support.The change of hemodynamics before and after IABP and PCI,the characteristics of PCI,the mortality during hospitalization, the major adverse cardiac events (MACE) and left ventricular ejection fraction at 30-day follow-up were observed.Results The hemodynamics were significantly improved after IABP.No patients died during PCI.Two patients died after PCI and the total mortality was 7.4% in hospital.During the period of 30-day follow-up, one patient died of heart failure.The left ventricular ejection fraction greatly improved at 30 days after PCI. Conclusions The data suggested that the use of IABP during PCI in patients with CS complicating AMI was safe, decreased mortality and improved prognosis.

Adult ; Aged ; China ; epidemiology ; Female ; Gold ; Humans ; Male ; Middle Aged ; Mining ; Silicosis ; mortality ; Young Adult

Objective To evaluate characteristic clinical and imaging findings of pancreatic neuroendocrine tumors (NET) in dual-phase contrast enhancement MSCT.Methods The dual-phase contrast enhancement MSCT images of 23 lesions in 20 patients with histologically confirmed pancreatic NET were studied retrospectively.Their clinical presentations,imaging characters as well as the intensities of lesions and normal pancreas in each phase were measured,and the following indices were calculated.First,the absolute enhancement of lesions,including the increasing of CT value of the maximum enhancement area within a tumor in arterial phase,that was named A1 in short,and that of the minimum enhancement area was labeled as A2.The same ROI measured increasing CT values in portal venous phase was labeled as V1 and V2 respectively.Secondly,the relatively enhancement indices comparing with the normal pancreas in the same patient within the same phase were calculated.This included the differences between the maximum,as well as the minimum,enhancement areas of tumors and the normal pancreas in arterial phase,which was named as AP1 and AP2 respectively,and those differences in portal venous phase,which were labeled as VP1 and VP2 respectively.All of the tumors were graded as G1 to G3 according to the WHO classification in 2010.A Kruskal Wallis test were performed to compare differences of tumor diameters and the enhancement indices.The change trend of enhancement indices varying with pathology grading were described.Fisher exact test was used to find differences of clinical and imaging characters.Results Twenty-three lesions in 20 patients included 13 lesions in grade 1 (G1),8 in G2,and 2 in G3.Among the 10 patients with G1 NET,7 of them had no endocrine symptoms,while the other 3 had endocrine symptoms.Six of them had no abdominal pain,while 4 of them complained of it.All of the 10 patients with G1 NET had no hepatic metastasis.Among 8 patients with G2 NET,4 of them were with endocrine abnormality,and the other 4 were not.Five of them complained of abdominal pain while the other 3 did not.Six of them had no hepatic metastasis,and 2 of them had.Both of the 2 patients with NET in G3 did not have any endocrine abnormality,and one of them complained abdominal pain.Both of them were with hepatic metastasis.There was no difference between groups that whether or not endocrine syndrome and abdominal pain was presented (x2 =2.238,0.713,P =0.318,1.000),while hepatic metastasis was of significant differences (x2 =9.516,P =0.003).Tumor location,distinct outline,necrosis and/or calcification were not significantly different.Tumor enhancement showed a probable trend of decrease in group of higher grade.A1 decreased from (126.4 ± 45.7)HU to (38.7± 8.5)HU (x2 =7.254,P=0.027),A2 decreased from (94.1 ±31.1)HU to (22.8 ± 14.0) HU (x2 =7.323,P =0.026) and AP1 dropped from 80.6 HU(-21.8 — 169.7 HU) to -36.7 HU(-41.6—-31.7 HU) (x2 =6.778,P =0.034).All of the indices mentioned above were of significant difference and the other indices showed no significant difference (P ＞ 0.05).Conclusions Quantitative assessment of their enhancement patterns may provide useful information to preoperative grading of pancreatic NET,and tumors in a higher grade may show poorer enhancement.

ObjectiveTo evaluate the effects of thoracic and lumbar epidural block on the depth of propofol sedation.MethodsForty-five ASA Ⅰ or Ⅱ patients with stomach cancer ( n =15) or colorectal cancer ( n =30) aged 20-64 yr weighing 46-79 kg with body height 151-179 cm undergoing elective radical operation were enrolled in this study.The 30 patients with colorectal cancer were randomly divided into 2 groups ( n =15 each):group control (group Ⅰ ) and group lumbar epidural group(group Ⅱ ).The 15 patients with stomach cancer received thoracic epidural block (group Ⅲ ).Epidural block was performed at L2.3 interspace in groups Ⅰ and Ⅱ and at T9.10 interspace in group Ⅲ.After a test dose of 3 ml 1.5％ lidocaine,a bolus of 1.5％ lidocaine 12 ml (in groupsⅡ and Ⅲ ) or 12 ml of normal saline (in group Ⅰ ) was injected into epidural space.Target-controlled infusion(TCI) of propofol was started at 12 min after epidural lidocaine.Target plasma concentration of propofol was set at 4 μg/ml.Fentanyl 4 μg/kg was injected iv as soon as the patients lost consciousness.Tracheal intubation was facilitated with vecuronium 0.1 ng/kg.The patients were mechanically ventilated.Radial artery was cannulated for direct BP monitoring and blood sampling.BIS value was monitored (Aspect Medical System).The number of spinal sequent affected in the subarachnoid epidural anesthesia was counted before propofol TCI.Arterial blood sampies were collected at 2,3,4 and 5 min of propofol TCI for determination of plasma concentration of propofol ( by HPLC).BIS value and plasma concentration of propofol calculated by TCI pump were recorded at 2,3,4 and 5 min of propofol TCI.ResultsThe BIS values were significantly lower in groups Ⅱ and Ⅲ than in group Ⅰ and in group Ⅲ than in group Ⅱ.There was no significant difference in plasma propofol concentration measured by HPLC and plasma concentration of propofol calculated by TCI pump.ConclusionThe efficacy of thoracic epidural block enhancing propofol sedation is higher than that of lumbar epidural block.