Research advances in extrahepatic diseases associated with nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver diseases worldwide and covers a series of pathological manifestations from hepatic steatosis to inflammation, fibrosis, and even liver cirrhosis. NAFLD is associated with a wide range of extrahepatic diseases, including metabolic syndrome, cardiovascular disease, chronic kidney disease, endocrine diseases, obstructive sleep apnea-hypopnea syndrome, psoriasis, and skeleton-muscle diseases. The major causes of death in patients with NAFLD include cardiovascular disease, malignancies, and liver-related complications, suggesting that extrahepatic diseases associated with NAFLD should be taken seriously by clinicians. This article reviews the research advances in extrahepatic diseases associated with NAFLD, so as to provide ideas for clinical assessment and treatment.

The relationship between mild cognition impairment and components of metabolic syndrome in the elderly / 中华老年医学杂志

Objective:To explore the relationship between mild cognition impairment(MCI) and components of metabolic syndrome in the elderly.Methods:A total of 293 patients aged 65 years and older with an average age of (78.8 ± 7.5) years who met the inclusion criteria were included.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate cognitive function.The components of the metabolic syndrome were compared between the MCI and the normal cognitive function(NC) groups.Binary Logistic regression analysis was used to analyze the relationship between cognitive function and components of the metabolic syndrome.Results:The levels of body mass index(BMI)and tryglicerides(TG)were lower in the MCI group than in the NC group[BMI, (22.9±3.7)kg/m 2vs.(25.3±3.3)kg/m 2, t=3.124, P=0.002; TG, 1.2±0.6 mmol/L vs. 1.4±0.7 mmol/L, t=2.615, P=0.009]. The differences in proportions of hypertension and diabetes and in levels of fasting blood glucose and high-density lipoprotein cholesterol had no statistically significance between the MCI group and the NC group(all P>0.05). Binary multivariate Logistic regression analysis showed that after adjusting for age and education, BMI was independently associated with MCI, and as BMI increased, the risk of MCI decreased( OR=0.901, 95% CI: 0.838-0.968, P=0.004). In elderly men, after adjusting for age, education level and smoking history, TG was independently associated with MCI, and as TG increased, the risk of MCI decreased( OR=0.446, 95% CI: 0.249-0.874, P=0.017). While in elderly women, no independent correlation between TG and MCI was observed. Conclusions:BMI is independently associated with MCI.Screening for cognitive function among low-level BMI elderly is helpful to identify MCI.The relationship between TG and MCI is different between different genders, and different standards might be adopted for the management of TG in elderly MCI patients with different genders.

Analysis of death causes for patients aged 60 years and over at a level A tertiary hospital in Beijing / 中华老年医学杂志

Objective To investigate the death causes in recent years,the ranking of causes and changes in ranking in elderly patients at a level A tertiary hospital in Beijing,in order to provide suggestions and a basis for effective prevention and management of diseases,achieve better utilization of medical resources and improve quality of life in the elderly.Methods Death records of 3991 patients aged over 60 years in the People's Hospital of Peking University from January 2010 to October 2016 were collected and retrospectively analyzed with SPSS 20.0 by using descriptive statistics,the linear-by-linear association test and the Pearson correlation coefficient.Results In the past 7 years,the top four causes of death were diseases of the circulatory system(1074 cases,30.1 ％),the respiratory system(1074 cases,26.9 ％),tumors (927 cases,23.2 ％) and the digestive system (284 cases,7.1 ％).There was no significant difference in the ranking of death causes between males and females.Of the death causes,the mortality rate of respiratory diseases increased and the mortality rates of the circulatory system and tumors decreased year by year.Diseases of the circulatory system ranked first in the death causes from 2010-2013,and diseases of the respiratory system ranked first from 2014-2016.The primary death cause was different in different age groups,with cancer for the 60-74 years old group,diseases of the circulatory system for the 75-84 years old group,diseases of the circulatory system for the over 85 years old group.The leading causes for death were coronary heart disease for diseases of the circulatory system,pulmonary infections for diseases of the respiratory system and digestive system tumors for tumors.Conclusions In recent years,the primary death cause in elderly patients at our hospital is circulation system diseases.The mortality rate of respiratory diseases has increased year by year.Death causes vary in different age groups,suggesting it is necessary to provide different screening and prevention measures for the elderly at different ages.

Correlation between nonalcoholic fatty liver disease fibrosis score and unstable plaques of carotid in elderly patients with nonalcoholic fatty liver disease / 中华老年医学杂志

Objective To investigate the correlation between nonalcoholic fatty liver disease (NAFLD)fibrosis score(NFS)and unstable plaques of carotid in elderly NAFLD patients.Methods The clinical and carotid plaques data of 191 elderly(≥ 60 years old)admitted into our department between July 2016 and January 2018 were retrospectively collected.With NFS 0.676 as a cut-off point,the patients were divided into a liver fibrosis group(NFS ≥0.676,n=65)and a non-liver fibrosis group (NFS＜0.676,n=126).Based on quartiles of NFS,the patients were divided into four groups..the Q1 group(NFS＜-0.865,n=48),the Q2 group(0.865≤NFS＜0.100,n=48),the Q3 group(0.1≤ NFS＜ 1.070,n=47),the Q4 group (NFS≥ 1.070,n =48).The correlation of NFS with the property of carotid plaques was analyzed.Results The detection rate of unstable carotid plaques was increased along with the increase of NFS(F--8.573,P =0.004).The detection rate of unstable carotidplaques was higher in the liver fibrosis group than in the non-liver fibrosis group(78.5％ or 51/65 vs.60.3 ％ or 76/126,x2 =5.883,P--0.015).Multiple logistic regression analysis showed that liver fibrosis(NFS≥0.676)was independently correlated with unstable carotid plaques(β=0.816,95％CI:.1.110～4.607,OR=2.261,P=0.025)after adjusting for possible confounding factors including age,gender,diabetes mellit us,hypertension,total cholesterol,triglyceride,high-density lipoprotein,lowdensity lipoprotein.Conclusions NFS is correlated with unstable carotid plaques in elderly NAFLD patients,and the higher NFS is the independent risk factor for unstable carotid plaques for elderly NAFLD patients with NFS higher than 0.676.We should pay more attention to the evaluation of unstable carotid plaques.

Correlation between nonalcoholic fatty liver disease fibrosis score and unstable plaques of carotid in elderly patients with nonalcoholic fatty liver disease / 中华老年医学杂志

Objective@#To investigate the correlation between nonalcoholic fatty liver disease(NAFLD)fibrosis score(NFS)and unstable plaques of carotid in elderly NAFLD patients.@*Methods@#The clinical and carotid plaques data of 191 elderly(≥60 years old)admitted into our department between July 2016 and January 2018 were retrospectively collected.With NFS 0.676 as a cut-off point, the patients were divided into a liver fibrosis group(NFS ≥0.676, n=65)and a non-liver fibrosis group(NFS<0.676, n=126). Based on quartiles of NFS, the patients were divided into four groups: the Q1 group(NFS<-0.865, n=48), the Q2 group(-0.865≤NFS<0.100, n=48), the Q3 group(0.1≤NFS<1.070, n=47), the Q4 group(NFS≥1.070, n=48). The correlation of NFS with the property of carotid plaques was analyzed.@*Results@#The detection rate of unstable carotid plaques was increased along with the increase of NFS(F=8.573, P=0.004). The detection rate of unstable carotid plaques was higher in the liver fibrosis group than in the non-liver fibrosis group(78.5% or 51/65 vs.60.3% or 76/126, χ2=5.883, P=0.015). Multiple logistic regression analysis showed that liver fibrosis(NFS≥0.676)was independently correlated with unstable carotid plaques(β=0.816, 95%CI: 1.110~4.607, OR=2.261, P=0.025)after adjusting for possible confounding factors including age, gender, diabetes mellitus, hypertension, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein.@*Conclusions@#NFS is correlated with unstable carotid plaques in elderly NAFLD patients, and the higher NFS is the independent risk factor for unstable carotid plaques for elderly NAFLD patients with NFS higher than 0.676.We should pay more attention to the evaluation of unstable carotid plaques.

Correlation between the triglyeceride and glucose index and nonalcoholic fatty liver disease in elderly patients / 中华老年医学杂志

Objectives To investigate the correlation between the triglyceride and glucose (TyG) index and nonalcoholic fatty liver disease (NAFLD) and to evaluate the predictive value of TyG for NAFLD.Methods This retrospective study included 279 individuals aged 60 or over (115 with NAFLD and 164 without NAFLD).Clinical data including height and weight (for body mass index,BMI),presence of diabetes mellitus,lipid-regulating medications,glucose-lowering medications,alanine aminotransferase (ALT),aspartate transaminase (AST),gamma-glutamyltransferase (GGT),albumin,fasting plasma glucose (FPG),serum lipid profiles,serum uric acid,glycosylated hemoglobin,and serum creatinine were collected and analyzed.The TyG index was calculated according to FPG and fasting serum trig[ycerides.Binary logistic regression was carried out to determine the correlation between TyG and NAFLD.Receiver operating characteristic (ROC) curve analysis was used to test the predictive value of TyG and TyG combined with ALT and BMI for NAFLD.Results According to the quartiles of TyG,the subjects were divided into four groups:Q1 (TyG≤ 7.40)、Q2 (TyG≤ 7.80)、Q3(TyG≤＜≤8.31)、Q4(TyG≤8.13).The rates of NAFLD were 16.2％ in Q1,29.6％ in Q2,53.7％ in Q3,and 65.3％ in Q4 (P ＜0.0001).Logistic regression showed that TyG was independently associated with NAFLD;Compared with Group Q1,the adjusted odds ratios (ORs) and 95％ confidence intervals (CIs) for NAFLD of Q2,Q3,and Q4 were 1.677 (95％ CI:0.641-4.384),3.279 (95％ CI:1.285-8.364),and 5.447 (95％ CI:2.172-13.658),respectively.The ROC analysis indicated that the area under the ROC curve (AUC) was 0.730 (95％ CI:0.67-0.79) and that,with the cut-off point at 7.78,the largest Youden's index value was 0.402,with a sensitivity of 74.6％ and a specificity of 65.6％ for NAFLD.When combining TyG with BMI and ALT,the AUC could reach 0.822 (95％ CI:0.771-0.872).Conclusions TyG is correlated with NAFLD in the elderly.Besides,TyG combined with BMI and ALT is effective to predict NAFLD in the elderly.

Analysis of risk factors and clinical features in elderly patients with nonalcoholic fatty liver disease combined with mild cognitive impairment / 中国综合临床

Objective To investigate the risk factors for NAFLD patients with mild cognitive impairment ( MCI) in elderly through comparing the clinical features among elderly NAFLD patients with MCI. Methods A total of one hundred and sixteen elderly patients with NAFLD were enrolled in this study and were divided into MCI group (37 cases) and non-MCI group (79 cases). The clinical data including medical history of myocardial infarction,diabetes mellitus,hypertension,medications,blood pressure,BMI,liver function, kidney parameters,glucose metabolism, serum lipid profile, vitamin D, NAFLD fibrosis score, HOMA-IR and carotid plaques were analyzed and compared. Results Compared with non-MCI group,the age,AST/ALT ratio, serum creatinine,NAFLD fibrosis score,serum uric acid of MCI group were significantly higher ((80. 5±7. 4) years vs.(72.5±8.0)years,t＝5.87,P＜0.001; (1.33±0.51) vs. (1.09±0.30),t＝2.599, P＝0.012;(100.86±78.02) μmol/L vs. (78.12±22.12) μmol/L,t＝2.402, P＝0.018; (0.73±1.01) vs. (0.03 ±1. 17),t＝3. 132,P＝0. 002; (382. 95±79. 61) μmol/L vs (349. 99±79. 18) μmol/L,t＝2. 086,P＝0. 039), while serum γ-glutamyl transpeptidase (γ-GT),diastolic blood pressure (DBP),estimated glomerular filtration rate (eGFR) of MCI group were significantly lower than those in the non-MCI group (22. 00(17. 00,26. 00) U/L vs. 28. 00(19. 00,39. 50) U/L,Z＝－3. 038,P＝0. 002;(69. 30±6. 78) mmHg vs. (74. 30±9. 45)mmHg,t＝－3.252, P＝0.002; (62.60±17.78)(ml/min×1.73 m2) vs. (79.41±16.95)(ml/min×1.73 m2),t＝－4. 900,P＜0. 001). Detection rates of carotid unstable plaques and high BMI in MCI group were higher than those in the non-MCI group (83. 78%(31/37) vs. 64. 56%(51/79),χ2＝4. 496, P＝0. 034)(83. 78%(31/37) vs. 60. 76%(48/79),χ2＝6. 149, P＝0. 013) . There were no significantly differences between the two groups in history of myocardial infarction,diabetes mellitus,hypertension,usage rates of antiplatelet drugs and statins. Logistic regression showed that age (regression coefficient＝0. 166,OR＝1. 181,95%CI 1. 078－1. 293,P＜0. 001), high BMI (regression coefficient＝1. 942,OR＝6. 974,95%CI 1. 466－33. 176,P＝0. 015),diastolic blood pressure ( regression coefficient＝ －0. 099, OR＝ 0. 905, 95%CI 0. 828－0. 990, P＝ 0. 029 ), γ-GT (regression coefficient＝－0. 094,OR＝0. 910,95%CI 0. 852－0. 972,P＝0. 005), serum uric acid (regression coefficient＝－0. 009,OR＝1. 009,95%CI 1. 000－1. 017,P＝0. 039) and low density lipoprotein cholesterol ( LDL-C) (regression coefficient＝0. 898,OR＝2. 454,95%CI 1. 029－5. 854,P＝0. 043) were related to elderly NAFLD patients with MCI. Conclusion The high BMI,diastolic blood pressure,serum uric acid,low density lipoprotein are related to MCI in elderly patients with NAFLD. For elderly patients with NAFLD,these indicators may be used to assess the risk of MCI and to locate high-risk groups at an early stage.

Association between Helicobacter pylori infection and allergic diseases / 中国综合临床

Objective The association between Helicobacter pylori(H.pylori) infection and allergic diseases was controversial.The aim of this study was to investigate the association between H.pylori infection and allergic diseases.Methods A questionnaire survey regarding the general health condition and allergic diseases was carried out in patients who had taken gastroscopy at People's Hospital of Peking University from September 2015 to April 2016.H.pylori infection was detected by the H.pylori antibody,rapid urease test and gastric mucosa pathology.Results There were 1 034 patients were enrolled in this study.The rate of H.pylori infection was 20.5%(212/1 034).The frequencies of contact dermatitis,urticaria,food/drug allergy,allergic rhinitis,bronchial asthma were 6.9%(71/1 034),15.5%(160/1 034),18.0%(186/1 034),20.8%(215/1 034) and 3.4%(35/1 034),respectively.The rate of the food/drug allergy was significantly lower in the H.pylori-positive group than in the H.pylori-negative group(11.8 %(25/212) vs.19.6%(161/822),χ2=6.940,P=0.008).The risk of food/drug allergy in H.pylori-positive group was 0.611(95% CI:0.386-0.966,P=0.035) in the multivariate analysis.When the patients were divided into age-dependent groups,the rate of the food/drug allergy was significantly lower in the H.pylori-positive group than in the H.pylori-negative group(10.9 %(11/101) vs.20.6%(101/490),χ2=5.152,P=0.023) in those patients ≥50 years old.There were not statistically significant differences on contact dermatitis,urticaria,eczema,asthma and allergic rhinitis between helicobacter pylori positive group and negative group(P>0.05).Conclusion H.pylori infection may be a protective factor in food/drug allergy and the protective effect enhanced by infection time.

Research of the Evaluation Model of Hospital Beds Utilization Efficiency Based on the Single Bed Work Efficiency / 中国医院管理

Objective To investigate the application and feasibility of the single bed work efficiency in the evaluation of hospital beds efficiency,to establish the hospital beds efficiency evaluation model,in order to provide the basis for scientific and effective utilization and evaluation of beds.Methods Proposing the concept of single bed work efficiency,establishing a new evaluation model of bed efficiency,and analyzing the utilization of hospital beds in 2015.Results Single bed work efficiency is supenor to other indexes in evaluating the Utilization efficiency of hospital beds,and the new bed efficiency evaluation model is more objective and accurate.Conclusion The evaluation model of hospital beds utilization efficiency based on the single bed work efficiency is more comparable and operable,which can be widely used in hos pital delicacy management.

DRGs-based improvement of hospital service quality control and efficiency / 中华医院管理杂志

The authors probed into the application and feasibility of DRGs in improving the efficiency and quality of hospital medical services,in order to establish a lean management mode based on DRGs.DRGs are seen as different from other means of management,with such evaluation of medical services being more comparable and operable,and the evaluation results more trustworthy.Application of such practice can obviously improve the efficiency and quality of medical services,making it widely applicable to hospital′s lean management.

Survey on the Current Status of Job Satisfaction of Clinical Medical Staff and Research on Coping Strategies / 中华医学科研管理杂志

Objective To explore the current status of job satisfaction of clinical medical staff and factors that influence the job satisfaction,and to put forward coping strategies and suggestions for improving the job satisfaction of clinical medical staff,so as to maintain workforce stability.Methods The paper will investigate the job satisfaction of clinical medical staff by sending questionnaires to all doctors and nurses working in a hospital,and use descriptive analysis and T test statistic method to analyze the current status of job satisfaction of questionnaire receivers as well as different dimensions of job satisfaction among different population groups.Results More than 85％ of questionnaire receivers think that the job they are doing is at higher risk.Over 80％ feel stressed out by their jobs.Less than 35％ are satisfied with their occupations,social status,working status,job security,and promotion opportunities.Less than 15％ feel respected by their jobs.Conclusions Generally,questionnaire receivers' job satisfaction is low.Heavy workload and poor quality of life are leading factors that contribute to their low job satisfaction.In this sense,we should adopt various measures to give attention to these key population groups.

Exploration on a New Mode of training aid on healthcare talents of Western China by first class hospital / 中华医学科研管理杂志

Objective To promote professional training aid on healthcare talents in western China,this paper aims to explore methods and to evaluate the effectiveness of a new training system for underprivileged medical professionals from hospitals of western China.Methods Questionnaires and interviews were conducted to 115 trainees and their employers took part in the Counterpart Support Project.A retrospective analysis was done to evaluate key indicators of the trainees' professional competence.Results More than 90％ of the trainees have seen great improvement on basic healthcare knowledge,clinical skills,and diagnosis and treatment practice.About 80％ the participating hospitals have enjoyed varied degrees of growth in outpatient visits,surgical volume,number of inpatient and operational efficiency.(Increase level from 0％ to 50％) Conclusions Within the frist 3 years of implementation,this new model has been proven effective to enhance participants' overall professional competence,and by tapping into the significant resource of first class hospitals,this model will help greatly promoting the development of healthcare talents in Western China.

A study on the anesthesiologist deployment at tertiary hospitals / 中华医院管理杂志

Objective To learn the current anesthesiologists deployment at the hospital,and to figure out how to measure anesthesiologists deployment.Methods Existing data and expert consultation were used to obtain various indicators,and the current anesthesiologists deployment was analyzed,calculating with the formula the needed number of anesthesiologists.Results Despite the rising demand and resource utilization,anesthesiologists were found in obvious shortage at the hospital.The number of anesthesiologists needed was calculated as 101.4,with a vacancy of 11.4.Conclusion The national health authorities were recommended to revise the standard of anesthesiologists deployment at hospitals.

Comparison of efficacy of different treatment regimens on H.Pylori Eradication / 中国综合临床

Objective To compare the efficacy in radical cure of H.Pylori (Hp) by different proton pump inhibitor (PPI)-based treatment regimens.Methods One thousand two hundred and three H.Pyloriinfected patients diagnosed by both endoscopic pathology and a rapid urease test were enrolled in this study.Reviewed 13 C-urea breath test at the end of Hp eradication treatment for more than 4 weeks,and retrospective analyzed the different effect of Hp eradication regimens.All patients were given treatment regimens,which including PPI (esomeprazole azole,bella,esomeprazole,pantoprazole omeprazole,2 times/d) plus antimicrobial for 7,10,14 d.According to antimicrobial,patients were divided into A,B,C,D,E group.Patientss in group A(421 cases) were given amoxicillin 1.0 g,2 times/d,clarithromycin 0.5 g,2 times/d;In group B (49cases) were given amoxicillin 1.0 g,2 times/d,levofloxacin 0.2 g,2 times/d;In group C(69 cases) were given amoxicillin 1.0 g,2 times/d,metronidazole 0.4 g,2 times/d;In group D(559 cases) were given clarithromycin 0.5 g/d,2 times/d,levofloxacin 0.2 g,2 times/d and in group E(105 cases) were clarithromycin 0.5 g,2times/d,metronidazole 0.4 g,2 times/d.Bismuth were colloidal bismuth pectin 200 mg,2 times/d.Results The radical cure rate of Hp was 84.04％ (453/539) in the group treated by regimens with Amoxicillin,and significant higher than that of without Amoxicillin (69.12％ (459/664),x2 =36.104,P =0.000),and the radical cure rate of Hp was 14.92％.The Hp radical cure rate of quadruple therapy was 76.85％ (767/998),while triple therapy was 70.73％ (145/205).However,no significant difference between these two regimens was found(x2 =3.476,P =0.062).The Hp radical cure rates of 14-,10-and 7-day course therapies were 84.28％ (134/159),75.79％ (579/764),71.07％ (199/280) respectively,and there was significant different among the three groups (x2 =9.644,P =0.008).There was significant increases trend in the 14-day therapy group comparing to 10-and 7-day regimen groups (x2 =5.399,11.719,P =0.020,0.001 respectively),while no significant difference was shown between the 10-and 7-day therapy groups(x2 =2.398,P =0.121).The radical cure rates were 84.80％ (357/421),81.63％ (40/49),81.16％ (56/69),69.95％ (391/559),64.76％(68/105) respectively in A,B,C,D and E groups,and there was significant difference among the groups (x2 =37.999,P =0.000).Conclusion Radical cure therapy of Hp should be PPI-based.A 14-day triple or quadruple treatment regimen with combination of Amoxicillin and clarithromycin is suggested as a first-line therapy.It is worth to clinically popularize such regimens in the light of the superior efficacy.

Study of clinical features of acute pancreatitis during pregnancy / 中国综合临床

Objective To investigate the clinical features of acute pancreatitis during pregnancy,including etiology,clinical manifestation,treatment and prognosis,in order to provided the clinical experience to prevent and treat the acute pancreatitis.Methods Retrospective analyse the clinical information of 11 patients with acute pancreatitis during pregnancy in the People's Hospital Affiliated to Peking University from January 1990 to December 2012.Results The age rage of patients was 25-34 years old.Of them,mild acute pancreatitis(MAP) was 5 cases (45.5％),while severe acute pancreatitis (SAP) were 6 cases (54.5％).Pathogenic data showed that 2 cases (18.2％) were biliary pancreatitis,7 cases (63.6％) were with hyperlipidemia,1 case(9.1％) was gallstone pancreatitis with hyperlipidemia,and 1 case (9.1％) did not find a clear cause.Five cases occurred during second trimester(45.5％),and 6 cases occurred during third trimester (54.5％) as well as no maternal death was seen.Four cases of fetal delivery were at term (36.4％),5 cases of premature delivery(45.4％),2 cases of death (18.2％),and all born infants were alive.Conclusion Acute pancreatitis during pregnancy mainly relates to biliary diseases and hyperlipidemia,and mostly occurred during third trimester.Acute pancreatitis during pregnancy can lead to premature birth,still birth.Early diagnosis and therapy are important for acute pancreatitis during pregnancy.

Preliminary analysis of association between stomach cracks under gastroscopy and h.pylori infection and its pathological significance / 中国综合临床

Objective To investigate the clinical significance of gastric cracks by investigating the relationship between stomach cracks under gastroscopy and H.pylori infection as well as its pathological manifestation,in order to improve the detection rate of H.pylori.Methods Gastroscopy patients were enrolled as our subjects excluding those with tumors,major diseases and under 18 years old.Mucosal biopsies were obtained from the lesser curvature of antrum and the greater curvature of body in each patient,then by HE staining,pathological and HP examination.The information including the pathological diagnosis,HP antibody,rapid urease test,endoscopic diagnosis and endoscopic gastric body cracking phenomenon were collected from all patient.H.pylori positivity was defined as a patient who showed two or more positive results in the Rapid Urea's Test,pathohistological examination and H.pylori antibody detection.Results (1) 437 patients with gastroscopy were included between December 2009 and December 2011,among whom 210 were male and 227 were female.There were 32 cases with gastric ulcer,59 cases with duodenal ulcer,51 cases with duodenitis,62 cases with reflux esophagitis,and 276 cases with chronic gastritis.(2) H.pylori distribution in stoma of all patients:160 of 437 patients(36.61％) are H.pylori positive,of which 68.75％ (110/160) was found H.pylori positive in both of gastric antrum and body,25.63％ (41/160) was H.pylori positive only in antrum,and 3.13％ (5/160) was H.pylori positive only in the body of stomach.(3)Relationship between the presence of cracks in gastric body and H.pylori infection:the H.pylori positivity was 62.58％ (97/155) and 22.34％ (63/282) respectively in the group with or without the presence of cracks in body.Cracks in gastric body examined by gastroscopy was related to H.pylori infection(x2 =69.788,P =0.000).(4) Relationship between the presence of cracks in gastric body and patho-histology:the presence of cracks in gastric body was related with severity of gastric inflammation by Wilcoxon rank sum test (P ＜ 0.0001),while there was no relationship between gastric body cracks and atrophy,intestinal metaplasia and atypical hyperplasia(P ＞ 0.05).(5) Relationship between the presence of cracks in gastric body and diseases:the presence of cracks in body was related with duodenitis,bile reflux under gastroscopy while there was no difference among in gastric body and gastric ulcer,esophagitis and chronic gastritis in terms of cracking appearance (P ＞ 0.05).Conclusion Our finding showed that cracking appearance in the gastric body is related with severity of inflammation in gastric mucosa bile reflux and duodenitis,suggesting that it can be one of the gastroscopic manifestations of more severe gastritis.

Analysis of influencing factors for standardized resident training / 中华医院管理杂志

Objective To identify the influencing factors for the quality and efficiency of standardized resident training in order to scientifically select and train qualified resident physicians.MethodsThe exam passing rate served as the indicator to measure the quality of training; the year(s) used to pass the exam the indicator to measure the efficiency,while such methods as descriptive study,chi-square test,logistic regression,rank sum test and stratified analysis were used for data analysis and processing. ResultsThe exam passing rate of research postgraduates is lower than clinical postgraduates,the year(s) needed to pass the exam of research postgraduates is longer than clinical postgraduates. Conclusion Clinical postgraduates deserve higher priority in selecting clinicians.Research-based postgraduates shifted to clinical work require a longer training time.

A comprehensive appraisal system for clinicians in professional title review / 中华医学科研管理杂志

Objective To investigate the effectiveness of the comprehensive quantitative　assessment system in the review of senior clinical titles so as to set up a comprehensive appraisal　system for clinicians.Methods A retrospective analysis was made to compare the objective parameters　for performance appraisal of the applicants for senior titles before and after the adoption of the　comprehensive quantitative assessment system,namely,between 2003 to 2006 and 2007 to 2010.Results The parameters were improved in aspects of clinical practice,education and research.And　the average age of applicants was lowered.Conclusion The new assessment system works well for　clinician appraisal,and produces a positive guiding effect of the senior title review on hospital　development.Suggestions are also made to solve the existing problems and to improve the system.

Employment of 360-degree evaluation and performance report evaluation / 中华医院管理杂志

Objective To search for a scientific and feasible system for performance appraisal of hospital management staff, and enhance the level of hospital management. Methods The 360-degree evaluation and improved performance report evaluation are called into play to examine such staff. Examiners include the superiors, peers (heads of clinical and technical departments and those of administrative departments), inferiors and others (representatives of the faculty congress and staff congress). Results Outcomes of the two evaluation methods found 8 of the top ten as overlapping, and 8 of the bottom ten as overlapping as well. 80% overlapping between the two prove the results as highly similar, and a relativity analysis found the general results of the two methods as highly consistent. Conclusion United applic of the two methods can effectively examine the management staff and improve their management capabilities.

Expression and clinical significance of T regulatory cells in patients with gastric cancer / 中华普通外科杂志

Objective To investigate the proportion changes of the CD4 + CD25 + T cells and CD8 + CD28 - T cells in the peripheral blood of gastric cancer patients. Methods The proportions of CD4 + CD25 + T cells and CD8 + CD28 - T cells in the peripheral blood of gastric cancer patients were determined by flow cytometry. 30 patients with gastric cancer and 30 patients with chronic gastritis were enrolled in this study. Results Compared with the chronic gastritis controls, the proportion of the CD4 + CD25 + T cells in the peripheral blood of patients with gastric cancer (8.7%±1.3%) was not significantly changed. But the proportion of the CD8 + CD28 - T cell in the peripheral blood of patients with gastric cancer (30.3%±3.3%) was significantly higher than that of control group (20.3%±2.7%), P<0.05. There was no significant association between the proportions of T regulatory cells and the lymphomatic metastasis of gastric cancer. No relation was found between the proportions of T regulatory cells and pathological types of gastric cancer. Conclusion CD8 + CD28 - T ceils in peripheral blood may be of some value in the progression of gastric cancer.