医院职能部门管理成本核算和控制的难点及对策

医院职能部门是医院运营中不可缺少的部门。据资料统计,我国医院管理成本约占总成本的20％～30％因此做好医院职能部门管理成本的核算和控制具有重要意义。     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

Objective To compare the effects of Celsior (CS) solution vs University of Wisconsin (UW) solution on preservation of non-heart- beating donor (NHBD) livers in rats. Methods The healthy male SD rats were taken as donors and recipients. The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 10 min to induce ischemia as a NHBD model. After flushed with the cold CS or UW solution, NHBD livers were stored at 4℃ for 8 h or 16 h. Then they were transplanted using the two-cuff technique with arterial reconstruction. Accordingly, the recipients were divided into four groups: CS 8 h, UW 8 h, CS 16 h and UW 16 h groups. The bile discharge, liver enzymes (ALT and AST), ET-1, IL-1 and TNF-alpha levels in serum at 1, 3, and 6 h after reperfusion were measured. Histopathological examination was carried out by HE staining, and the 7-day survival rate was observed. Results As compared with a homogenous appearance in the NHBD livers perfused with CS solution, the NHBD livers perfused with UW solution showed a heterogenous appearance, with more or less mottling. In the CS 8 h group there were more bile discharge at 1 h, lower ALT and AST levels at 1, 3 and 6 h, and lower serum ET-1, IL-1 and TNF-alpha ? levels at 1 and 3 h after reperfusion than the UW 8 h group (P<0.05). Histopathological examination showed a well-preserved hepatic architecture, milder portal congestion and inflammatory infiltration in CS 8 h group as compared with UW 8 h group. The 7-day survival rate in CS 8 h and UW 8 h groups was 58.3% and 25.0% respectively (P<0.05). There were no significant differences in bile discharge, ALT, AST, ET-1, IL-1 and TNF-alpha ? levels at different time points between CS 16 h and UW 16 h groups (P>0.05), and histopathological examination showed no much difference in the tissue damage between two groups; all recipients died within 3 days (P>0.05). Conclusion CS was more effective than UW in preserving NHBD livers after 8 h of cold storage, which may be due to the better perfusion of CS and inhibition of Kupffer cells, but it had better preserve NHBD livers with CS no more than 16 h.     

TOPSIS法在临床科室医疗质量综合评价中的应用

TOPSIS法是系统工程中有限方案多且目标决策分析常用的一种决策方法…。它将原始数据进行归一化处理,清除了不同指标量纲的影响,排序结果直观、可靠。本研究应用TOPSIS法对我院2012年医院临床科室的医疗质量进行综合评价,旨在从多方位对各病区的工作进行分析,综合评价,以宏观掌握医院各临床科室全年医疗任务完成情况。     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

Objective To compare the effects of Celsior (CS) solution vs University of Wisconsin (UW) solution on preservation of non-heart- beating donor (NHBD) livers in rats. Methods The healthy male SD rats were taken as donors and recipients. The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 10 min to induce ischemia as a NHBD model. After flushed with the cold CS or UW solution, NHBD livers were stored at 4℃ for 8 h or 16 h. Then they were transplanted using the two-cuff technique with arterial reconstruction. Accordingly, the recipients were divided into four groups: CS 8 h, UW 8 h, CS 16 h and UW 16 h groups. The bile discharge, liver enzymes (ALT and AST), ET-1, IL-1 and TNF-alpha levels in serum at 1, 3, and 6 h after reperfusion were measured. Histopathological examination was carried out by HE staining, and the 7-day survival rate was observed. Results As compared with a homogenous appearance in the NHBD livers perfused with CS solution, the NHBD livers perfused with UW solution showed a heterogenous appearance, with more or less mottling. In the CS 8 h group there were more bile discharge at 1 h, lower ALT and AST levels at 1, 3 and 6 h, and lower serum ET-1, IL-1 and TNF-alpha ? levels at 1 and 3 h after reperfusion than the UW 8 h group (P<0.05). Histopathological examination showed a well-preserved hepatic architecture, milder portal congestion and inflammatory infiltration in CS 8 h group as compared with UW 8 h group. The 7-day survival rate in CS 8 h and UW 8 h groups was 58.3% and 25.0% respectively (P<0.05). There were no significant differences in bile discharge, ALT, AST, ET-1, IL-1 and TNF-alpha ? levels at different time points between CS 16 h and UW 16 h groups (P>0.05), and histopathological examination showed no much difference in the tissue damage between two groups; all recipients died within 3 days (P>0.05). Conclusion CS was more effective than UW in preserving NHBD livers after 8 h of cold storage, which may be due to the better perfusion of CS and inhibition of Kupffer cells, but it had better preserve NHBD livers with CS no more than 16 h.     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

目的 比较Celsior(CS)液与UW液对大鼠无心跳供者(NHBD)供肝的保存效果.方法 选取健康雄性SD大鼠作为肝移植的供、受者.通过阻断大鼠主动脉和膈上下腔静脉10 min的方法,制备和获取NHBD供肝,并采用不同的器官保存液灌注和冷保存供肝.随机将受者分为4组.CS8 h组:受者采用经CS液灌注和冷保存8 h的供肝移植;UW8 h组:受者采用经UW液灌注和冷保存8 h的供肝移植;CS16 h组:受者采用经CS液灌注和冷保存16 h的供肝移植;UW16 h组:受者采用经UW液灌注和冷保存16 h的供肝移植.受者门静脉开放前、开放后1、3及6 h,取各组受者的静脉血检测血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、内皮素1(ET-1)、白细胞介素1(IL-1)及肿瘤坏死因子α(TNF-α)水平;观察和比较各组受者的胆汁生成量、移植肝组织病理学改变及术后7 d内的存活率.结果 NHBD供肝经UW液灌注后呈"花斑"状,肝叶边缘灌注不良,经CS液灌注后肝叶边缘灌注良好.CS8 h组和UW8 h组受者的胆汁生成量分别为(0.21±0.01)ml和(0.10±0.02)ml(P<0.05).门静脉开放后1、3及6 h,CS8 h组受者的血清ALT及AST水平明显低于UW8 h组(P<0.05),门静脉开放后1、3h,CS8 h组受者的血清ET-1、IL-1及TNF-α水平均明显低于UW8 h组(P<0.05);CS8 h组受者移植肝肝窦扩张、门静脉充血及炎症细胞浸润等病理学改变明显轻于UW8 h组,CS8 h组和UW8 h组受者术后7 d的存活率分别为58.3%和25.0%(P<0.05).CS16 h组和UW16 h组受者各时点的胆汁分泌量、血清ALT、AST、ET-1、IL-1及TNF-α水平的比较,差异均无统计学意义(P>0.05),两组受者均在术后3 d内死亡,两组受者移植肝组织病理学改变无明显差异.结论 CS液对大鼠NHBD供肝的保存效果优于UW液,这可能与UW液较CS液粘稠及CS液能够减少枯否细胞的激活有关;NHBD供肝的冷保存时间不宜超过16 h.     

艾滋病流行的动态研究

艾滋病 (AIDS)由艾滋病病毒 (HIV)感染引起的一种传染病。自 1 981年美国首次报道艾滋病以来 ,艾滋病已在全球广泛流行 ,至 1 998年底全球报道的艾滋病患者 2 0 0百万例 ,估计HIV感染人数为 3 340万人 ,目前全球每天 1 6 0 0 0人感染艾滋病病毒。由于艾滋病的病死率高 ,又无有效的疫苗及能治愈的药物 ,给人们心理造成了极大的恐慌 ,给健康带来了严重的影响 ,因本病传播广泛 ,流行迅速 ,不但造成经济损失 ,还严重阻碍社会发展 ,已成为各国政府十分关注的社会问题[1 ] 。现将艾滋病的流行动态简述如下。1　艾滋病的流行趋势艾滋病正在全球…     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

Objective To compare the effects of Celsior (CS) solution vs University of Wisconsin (UW) solution on preservation of non-heart- beating donor (NHBD) livers in rats. Methods The healthy male SD rats were taken as donors and recipients. The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 10 min to induce ischemia as a NHBD model. After flushed with the cold CS or UW solution, NHBD livers were stored at 4℃ for 8 h or 16 h. Then they were transplanted using the two-cuff technique with arterial reconstruction. Accordingly, the recipients were divided into four groups: CS 8 h, UW 8 h, CS 16 h and UW 16 h groups. The bile discharge, liver enzymes (ALT and AST), ET-1, IL-1 and TNF-alpha levels in serum at 1, 3, and 6 h after reperfusion were measured. Histopathological examination was carried out by HE staining, and the 7-day survival rate was observed. Results As compared with a homogenous appearance in the NHBD livers perfused with CS solution, the NHBD livers perfused with UW solution showed a heterogenous appearance, with more or less mottling. In the CS 8 h group there were more bile discharge at 1 h, lower ALT and AST levels at 1, 3 and 6 h, and lower serum ET-1, IL-1 and TNF-alpha ? levels at 1 and 3 h after reperfusion than the UW 8 h group (P<0.05). Histopathological examination showed a well-preserved hepatic architecture, milder portal congestion and inflammatory infiltration in CS 8 h group as compared with UW 8 h group. The 7-day survival rate in CS 8 h and UW 8 h groups was 58.3% and 25.0% respectively (P<0.05). There were no significant differences in bile discharge, ALT, AST, ET-1, IL-1 and TNF-alpha ? levels at different time points between CS 16 h and UW 16 h groups (P>0.05), and histopathological examination showed no much difference in the tissue damage between two groups; all recipients died within 3 days (P>0.05). Conclusion CS was more effective than UW in preserving NHBD livers after 8 h of cold storage, which may be due to the better perfusion of CS and inhibition of Kupffer cells, but it had better preserve NHBD livers with CS no more than 16 h.     

Celsior液与UW液对无心跳大鼠供肝保存效果的比较

Objective To compare the effects of Celsior (CS) solution vs University of Wisconsin (UW) solution on preservation of non-heart- beating donor (NHBD) livers in rats. Methods The healthy male SD rats were taken as donors and recipients. The thoracic descending aorta and supradiaphragmatic inferior vena cava were cross-clamped for 10 min to induce ischemia as a NHBD model. After flushed with the cold CS or UW solution, NHBD livers were stored at 4℃ for 8 h or 16 h. Then they were transplanted using the two-cuff technique with arterial reconstruction. Accordingly, the recipients were divided into four groups: CS 8 h, UW 8 h, CS 16 h and UW 16 h groups. The bile discharge, liver enzymes (ALT and AST), ET-1, IL-1 and TNF-alpha levels in serum at 1, 3, and 6 h after reperfusion were measured. Histopathological examination was carried out by HE staining, and the 7-day survival rate was observed. Results As compared with a homogenous appearance in the NHBD livers perfused with CS solution, the NHBD livers perfused with UW solution showed a heterogenous appearance, with more or less mottling. In the CS 8 h group there were more bile discharge at 1 h, lower ALT and AST levels at 1, 3 and 6 h, and lower serum ET-1, IL-1 and TNF-alpha ? levels at 1 and 3 h after reperfusion than the UW 8 h group (P<0.05). Histopathological examination showed a well-preserved hepatic architecture, milder portal congestion and inflammatory infiltration in CS 8 h group as compared with UW 8 h group. The 7-day survival rate in CS 8 h and UW 8 h groups was 58.3% and 25.0% respectively (P<0.05). There were no significant differences in bile discharge, ALT, AST, ET-1, IL-1 and TNF-alpha ? levels at different time points between CS 16 h and UW 16 h groups (P>0.05), and histopathological examination showed no much difference in the tissue damage between two groups; all recipients died within 3 days (P>0.05). Conclusion CS was more effective than UW in preserving NHBD livers after 8 h of cold storage, which may be due to the better perfusion of CS and inhibition of Kupffer cells, but it had better preserve NHBD livers with CS no more than 16 h.     

结肠癌实质细胞长标签基因表达系列分析文库的建立及应用

目的:应用长标签基因表达系列分析(long serial analysis of gene expression,LongSAGE)技术定量分析结肠癌实质细胞转录组,并筛选肿瘤相关基因.方法:应用激光捕获显微切割(laser capture microdissection,LCM)、RNA提取和线性扩增方法得到结肠癌实质细胞及其相应正常结肠上皮细胞的反义RNA(antisense RNA,aRNA)样品,构建LongSAGE文库;然后应用SAGE2000软件对所得序列文本进行分析,筛选肿瘤相关基因;最后采用RT-PCR方法验证该差异表达基因.结果: 结肠癌细胞LongSAGE文库标签体总数为50 542个,识别出基因总数为16 497个.正常结肠细胞LongSAGE文库标签体总数为50 124个,识别出基因总数为16 417个.LongSAGE文库筛选出结肠癌差异表达基因705个(P＜0.05).转化生长因子β诱导基因(transforming growth factor β-induced gene,TGFBI)为LongSAGE文库筛选出的结肠癌相关基因,RT-PCR检测验证了其在结肠癌组织标本中表达上调.结论:LCM-LongSAGE是对结肠癌实质细胞进行定量转录组研究的可行流程.     

某区体系部队10年传染病情况分析

为掌握部队传染病病谱及发病情况变迁,为防治工作提供依据,我们对1991年1月～2000年12月住院的体系部队传染病病例进行了回顾性分析.