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.

In recent years,there has been increasing evidence that microcirculatory disturbance,including vasoconstriction,shunting,inad-equate perfusion,increased blood viscosity,and coagulation,is closely associated with the pathogenesis of acute pancreatitis (AP).These processes may be exacerbated by ischaemia-reperfusion injury and the generation of oxygen radicals.The anatomical features of pancreatic microcirculation,the pathophysiological mechanism of pancreatic microcirculation disturbance and related inflammatory mediators,and pro-gress in the treatment of microcirculatory disturbance in AP are reviewed.It is suggested that the pancreatic and systemic microcirculation may play a key role in the development and progression of AP.

Felty syndrome is a rare disorder that involves rheumatoid arthritis,a swollen spleen,de-creased white blood cell count,and repeated infections.This article analyze the clinical characters of this disease.

Acute pancreatitis happens rapidly and leads to patient's condition changing swiftly.Acute pancreatitis may be complicated by acute lung injury (ALI) and acute respiratory distress syndrome (ARDS),or even multiple organ dysfunction syndrome,and the mortality rate has been high.The mechanism of acute pancreatitis with complications of ALI and ARDS is intricate.It involves the uncontrolled inflammatory response,the damage and apoptosis of cell,the role of trypsin,the imbalance of coagulation and fibrinolysis,etc.These respects interrelate with each other,forming a complex network.Further study of mechanism of acute pancreatitis complicated with ALI and ARDS will supply more new target for clinical diagnosis and treatment.

Objective: To observe the characteristic changes of specific immunological function of serum endo toxin level,spleen lymphocyte human leukocyte antigen(locus) DR(HLA-DR),limphopolesis and positive expression of caspase-3 in rats with sepsis and the effect of Xuebijing injection(血必净注射液) on their immunological function.Methods: Sepsis model was produced by cecal ligation and puncture(CLP).Seventytwo male SD rats were randomly divided into four groups: sham operation,model,levofloxacin and Xuebijing injection.Blood samples were taken from the vein in the abdominal cavity at 3,24 and 72 hours after the models were established, afterwards the rats were sacrificed and their spleens were taken out.Matrix development process was employed to examine the level of serum endotoxin,FACS flow cytometer was used to examine the expression level of HLA-DR,immunohistochemistry method was applied to examine the positive expression of caspase-3 in spleen,and the method of methyl thiazolyl tetrazolium(MTT) was employed to examine the lymphopoiesis.Results: The levels of serum endotoxin,lymphopoiesis and caspase-3 positive expression index in model group were obviously elevated than those of sham operation group,and percentage of HLA-DR was markedly lowered(all P

Kidney transplantation has become the optimal treatment for end-stage renal disease. However, the demand for kidney exceeds the available supply. In last years, living-related kidney transplantation has progressively increased because of the less rejection, the higher achievement ratio and so on. From 2007 to 2008 ,our hospital succeed in 196 living-related kidney transplantation based on the previous work.

Objective To study the present situation of misdiagnosed acute pancreatitis(AP)in China and to im prove the identification of AP.Methods One hundred and forty.four documents of Chinese-language cases studies involving the misdiagnosis of AP published from 1988 to 2007 were identified by searching in the China National Knowledge Infrastructure(CNKI).Retrospective study of misdiagnosed diseases,clinical manifestations,risk fac tors and accessory examinations etc,Was made in 1098 patients with AP.Results(1)The patients related to the departments of internal medicine,surgery,obstetrics and gynecology,and pediatrics and so on.The misdiagnosed diseases were over 63 kinds.The first five places successively were:cholelithiasis combined with biliary infection (182 times),acute gastroenteritis(158 times),coronary heart disease(108 times),acute appendicitis(102 times),and intestinal obstruction(90 times).(2)Abdominal pain(878 cases)is the main manifestation in AP, and the first five regions of abdominal pain successively were:upper-middle abdomen(434 cases),whole abdomen (220 cases),right lower quadrant(79 cases),right upper quadrant(74 cases),left upper quadrant(71 cases). (3)Cholecystolithiasis(145 cases)was the first risk factor,and followed the order of fat meal(106 cases)＞chronic cholecystitis(72 eases)＞alcohol(67 times).(4)The number of cases diagnosed by operation was the most,up to 378;others successively were serum and urine amylase examinations(35 1 CtLSe8)and abdominal CT scan(135 cases),and abdominal ultrasound imaging(59 cases).Conclusions(1)The main causes of misdiag nasis were superficial understanding of predisposing condition,lack of correct analysis on clinical manifestations, and mistakes in the analysis Oil the accessory examinations.(2)Although amylase in serum or urine has limitation in diagnosis,it still Was the main method of diagnosis;and it Was necessary to be examined by abdominal CT or sur gical exploration for patients who were highly suspected as having AP but could not be diagnosed.

Objective To explore the appropriate approach of delivery after cesarean section of Uyghur women in primary hospitals in Xinjiang Uyghur Autonomous Region.Methods A total of 5 154 women delivered in Luopu County People Hospital,Hetian Prefecture,Xinjiang Uyghur Autonomous Region from January 2011 to December 2012.Among them,178 Uyghur women had cesarean section history.The interval between the previous cesarean section and this delivery varied from 1 year to 17 years.The number of cases attempting vaginal labor and the indications of the previous cesarean section were recorded.The indications for the second cesarean section were analyzed.The gestational weeks at delivery,blood loss in 2 hours after delivery,neonatal birth weight,newborn asphyxia,the rate of postpartum fever (≥38 ℃) and hospitalization days were compared between the two approaches of delivery.Results (1) Among the 178 cases,119 cases attempted vaginal labor,the rate of attempting vaginal labor was 66.9％ (119/178).A total of 113 cases succeeded in vaginal delivery (the vaginal delivery group),with the successful rate of attempting vaginal delivery of 95.0％ (113/1 19),and the successful rate of vaginal delivery was 63.5％ (113/178).For those 119 women succeeded in vaginal delivery,the indications of the previous cesarean sections were as following:pregnancy complications (68.1％,81/119),macrosomia(5.0％,6/119),dystocia (14.3％,17/119),pregnancies complicated with other diseases(5.0％,6/119) and cesarean section on maternal request(7.6％,9/119).(2) 15 cases in the cesarean section group had postpartum hemorrhage,with the incidence of 13.3％(15/113).The mean total labor time was (507± 182) minutes.6 cases attempting vaginal delivery failed and turned to cesarean section.(3) 59 cases received the second cesarean section (the cesarean section group).The rate of second cesarean section was 33.1％ (59/178).The indications of the second cesarean section were as following:contracted pelvis (5％,3/59),pregnancy complications (42％,25/59),macrosomia (20％,12/59),short interval between the two cesarean sections(≤2 years); (12％,7/59) and cesarean section on maternal request (20％,12/59).(4) Gestational weeks at delivery,rates of newborn asphyxia in the vaginal delivery and cesarean section groups showed no significant statistical difference (P＞0.05).In the vaginal delivery group,the average blood loss in 2 hours after delivery was (259±213) ml,the rate of postpartum fever was 10.6％,the mean fetal birth weight was (3 272±477)g and the mean hospitalization was (1.8±1.6) d.In the cesarean section group,they were (400±320)ml,54.2％,(3 539±500)g and (8.7±2.2)d,respectively.There was significant statistical difference (P＜0.01) between the two groups.Conclusions Vaginal delivery after cesarean section could be attemped in Uyghur pregnant women in Xinjiang primary hospitals,if doctors could choose the indications strictly and monitor closely.These could increase the success rate and safety of vaginal delivery and therefor reduce the cesarean section rate.

OBJECTIVE To establish a simple and stable animal model with abdominal infection due to drug-resistant bacteria.METHODS Forty healthy rabbit were infected by Klebsiella pneumoniae ATCC700603,and divided into three test groups:A1(bacterial dose 8?109CFU/kg),A2(bacterial dose 16?109 CFU/kg) and A3(bacterial dose 24?109 CFU/kg).Normal control group B was established at the same time.Vital signs,white blood cell count(WBC),blood and abdominal irrigating solution cultures and strain identification were observed at 12,24,48,72 and 96h after infection.Patho-samples were obtained after being executed.RESULTS The body temperature,WBC,heart rate(HR) and respiratory rate(R) in group A3 were significantly higher than groups A1 and B,after rabbits having being infected 12-24 hours.And it continued for 96 hours(P

Transforming growth factor-β (TGF-β) is a multifunctional protein and regulates a wide variety of cellular bio-effects,such as proliferation,differentiation,migration and apoptosis.Studies have proven that TGF-β is one of the important cytokines that promote fibrosis,and it is confirmed to be closely related to the progression of tumor.Smad signaling is the major pathway in which TGF-β fulfills its functions.These years,it has been found that E3 ubiquitin ligases Arkadia can enhance the biological effect of TGF-β signal transduction pathway through Smad signaling pathway.Therefore,it is increasingly attracting public attention.This study will summarize the effects of Arkadia on TGF-β/Smad signal transduction pathway.