With the progress of gastrointestinal stromal tumor(GIST), to prevent GIST's recurrence and metastasis is still a hot topic. The pre-operative pathological diagnosis of GIST is difficult to be made, and the biopsy has the chance to cause metastasis. Standard operative procedure is the key point to prevent GIST's recurrence and metastasis, which includes en-bloc resection, enough margin and so on. For the recurrence/metastasis GIST, the reoperation can be performed, but the effective therapy is to use the molecular targeted drug:imatinib.

The treatment of gastrointestinal stromal tumors (GIST) has been revolutionized by the molecular targeted therapy, but we still emphasize the importance of how to use surgical principle and skill to treat GIST. In this review, we describe the experience in the treatment of GIST located in esophagus, gastrointestinalinal tract and colorectum. During operation, the surgeon shouldi resect the tumor completely. If the tumor can not to be resected completely, treatment should be managed by imatinib mesylate(Gleevec). Because GISTs seldom appear lymph metastases, it is not necessary to perform lymph node dissection.

Summarized in the paper are the practices and experiences of hospitals across China,in their optimization of medical resources under the Healthcare Improvement Initiative to meet medical needs.Namely rationally allocating medical resources to strengthen emergency rescue,introducing new technologies to improve procedures and efficiency,introducing day surgery and day-care units,and innovating resource sharing among others.The author also recommended on further optimization of medical resources.

Objective:To compare the changing trends and differences of bed numbers,doctor numbers and medical service utilization in the US.and China so as to provide polity implication for the health care reform in China from the supply side.Methods:The data of beds,doctors,hospitalization and outpatient service utilization from the website of OECD and CDC of the United States as well as Chinese Statistical Yearbook of Health and Family Planning were used to describe the trends.Results:The beds per 1000 people in China had exceeded that of the US,while the doctors per 1 000 people in China was less than the US.Both the two countries had yearly increasing trend of outpatient visits.However,the hospitalization was decreasing in the US,while the growth rate of hospitalization was even higher than the outpatient visits in China.Conclusion:The decrease of bed amount and the increase of outpatient amount were the main changing trend of medical resources and service utilization in the US.The imbalanced structure of medical resource supply in China resulted the overuse of hospitalization services.In the supply side reform of medical reform in China,it suggested to promote the cooperation of medical insurance,drug and health care,adjusted the reform thought from resource amount into the promotion of service quality,changed the health management system from disease centered into health centered.

Objective To investigate the clinical and imaging features of aortic dissection(AD) with damage in nervous system.Methods The clinical data were retrospectively analyzed in 14 cases of AD with damage in nervous system.Results 13 patients(92.9%) were over age 40.All cases were acute onset and 9 cases had history of hypertensive disease.During onset,the blood pressure was elevated in 9 cases,decreased in 3 cases and could not be measured in 2 cases.The clinical manifestations of patients presented severe pectoralgia in 5 cases,chest-back complaint in 4 cases,bellyache,lumbago with emesia in 2 cases,shock in 2 cases.The appearances of nervous system:circumgyration in 5 cases,conscious disturbance in 4 cases,hemiparalysis in 2 cases,barylalia in one case,paraplegina in 2 cases and hypesthesia in 3 cases(meta-body in 1 case,below T 4 or T6 in 2 cases).The breast and abdominal part CT and CTA of all cases showed clearly the true and false lumens,the position of intimal slit(according Debakeys,2 cases were typeⅠ,7 cases were typeⅡ,5 cases were type Ⅲ) and mural thrombosis.The breast and abdominal part MRI in 8 cases could show conspicuous true and false lumens.The true lumen was presented flow and inane signals but the false lumen was presented higher signals in T1 and T2 WI.Conclusions The clinical manifestations of AD with damage in nervous system are main the ischemic impaired symptoms and signs of brain and spinal cord.Both CT and MRI can show the false lumen and vascular intimal slit of AD.

This study was aimed to evaluate the number of acute exacerbation of chronic obstructive pulmonary disease (COPD) and quality of life with family pulmonary rehabilitation exercise. Randomized controlled method 584 was used in the study. The COPD patients in the stability drug treatment were divided into the treatment group and control group. The treatment group A was given health education and pulmonary rehabilitation training in the family. And the treatment group B was given health education and treatment of pulmonary rehabilitation training in the family with acupoint application therapy. Health education was given in the control group. Changes on the number of acute exacerbation of COPD and quality of life were observed. The intervention time was one year. The results showed that patients after one-year pulmonary rehabilitation exercise in the family, the acute exacerbation (AECOPD) times of treatment group A and group B were obviously decreased (P < 0.01) compared to pre-treatment. The OR value was (0.79, 2.02) and (0.59, 2.11), respectively. The quality of life of treatment group A and group B was obviously improved (P < 0.05). The OR value was (3.39, 10.11) and (4.23, 9.57), respectively. Compared to the control group, the quality of life in treatment group B was obviously improved (P < 0.05). The OR value was (0.59, 7.78). It was concluded that the pulmonary rehabilitation exercise in the family can decrease the number of AECOPD and improve the quality of life of patients, reduce the risk of COPD patients in the future. This method is worth popularizing in the clinical and community practice.

Intercourse between heart and kidney and harmonization of fire and water are important concepts in TCM.At present,discussions about them are not clear,but confused.This paper concludes the concepts and meanings about intercourse between heart and kidney and harmonization of water and fire,based on opinions of ancient theories of yin and yang,and five elements.It also expounds the differences and relations about harmonization of yin and yang,harmonization of water and fire,and intercourse between heart and kidney,and puts forward that the concept of intercourse between heart and kidney should be divided into aspect in two parts which are in broad sense and in narrow sense.In broad sense,it indicates kidney qi and heart qi interacts in all aspects;in narrow sense,it indicates the intercourse between heart fire and kidney water.The pathway,the time and other meanings about intercourse between heart and kidney are also reviewed in this article.

Objective To investigate the current status of nurses′ work performance and job involvement, and to analyze the impact of nurses′job involvement on work performance. Methods Self-made questionnaires were used to investigate 309 nurses in a 3A military hospital in Beijing. The military hospital is in a high standardization level, which may be properly representative of both military hospitals and 3A hospitals. Results The total score of nurses′work performance was 192.04 ± 31.25. The total score of nurses′ job involvement was 55.48 ± 9.94. The multiple regression analysis showed that the nurses′ work performance would be influenced by staff type, vigor and absorption. Conclusions The nurses′work performance and job involvement were at a high level. Managers should take methods to keep a high level of nurses′job involvement, which may improve work performance.

Objective To investigate the effect of thrombin and hemoglobin on aquaporin (AQP) and the correlation between AQP and hydrocephalus.Methods Eighty-four clean grade healthy male SD rats were randomly divided into 3 groups:a control group,a thrombin group,and a hemoglobin group using the random number table method.A hydrocephalus model was induced by injecting isotonic saline (0.3 ml),thrombin (0.3 ml[10,U/ml]) and hemoglobin (0.3 ml[150 mg/ml]),respectively into the cisterna magna.According to the deficiency and complement way,each group maintained 24 rats.The relative area of the lateral ventricles,the expression of AQP1 and AQP4,and the correlation between AQP and the area of the lateral ventricles were observed at 1,3,7,and 14 d after molding.Results (1) Compared with the control group,both the thrombin group and hemoglobin group showed hydrocephalus at 1 ,3 ,7 and 14 d,and they were most obvious at 1 day (6.94±0.19% and 6.58±0.15% vs.3.40±0.13%,6.06±0.12% and 5.79±0.09% vs.3.55±0.15%,5.80±0.13% and 5.58±0.08% vs.3.78±0.18%,5.66±0.14% and 5.47±0.13% vs.3.52±0.18 %,respectively).There were significant differences (all P<0.01).(2) The increase of AQP1 was mainly in the basal membrane and apical membrane of ventricular choroid plexus epithelial cells,and the increase of AQP4 was mainly in the ependymal cell of ventricle.The relative expression levels of AQP1 and AQP4 at 1,3,7,and 14 d in the control group were 1.09±0.07 and 1.30±0.15,0.91±0.06 and 1.18±0.12,1.33±0.17 and 1.16±0.08,1.22±0.11 and 1.00±0.10,respectively;the thrombin group were 4.40±0.14 and 3.69±0.11,3.88±0.11 and 3.17±0.07,3.55±0.07 and 2.86±0.13,and 3.36±0.07 and 2.70±0.07,respectively,the hemoglobin group were 4.24±0.07 and 3.55±0.10,3.77±0.08 and 3.04±0.09,3.46±0.07 and 2.76±0.08,and 3.31±0.10 and 2.62±0.08,respectively;the relative expression levels of AQP1 and AQP4 of the thrombin group and hemoglobin group at each time point were significantly higher than those of the control group.There were significant differences among the groups (all P<0.01).There were no significant differences in the relative expression levels of AQP1 and AQP4 mRNAs in the hemoglobin group at each time point (P>0.05);in the thrombin group and hemoglobin group,compared with those at 1 d,the expression levels of AQP1 and AQP4 at 3,7,and 14 d were significantly decreased (all P<0.01);compared with those at 3 d,AQP1 was decreased significantly at 7 and 14 d (P<0.05).The differences were statistically significant (P<0.05).(3) The relative expression levels of AQP1 (r=0.983,P<0.01) and AQP4 (r=0.987,P<0.01) in the thrombin group at each time point were positively correlated with the contralateral ventricular area;and the relative expression levels of AQP1 (r=0.964,P<0.01) and AQP4 (r=0.962,P<0.01) in the hemoglobin group at each time point were positively correlated with the contralateral ventricular area Conclusions After injecting thrombin and hemoglobin into subarachnoid space,it could cause the increased expression levels of AQP1 and AQP4 of ventricles and their surrounding areas.Thrombin and hemoglobin may be the important mediating factors of hydrocephalus after subarachnoid hemorrhage.

Objective To investigate the relationship between the delivery gestational age, birth weight and fidgety movement. Methods 81 infants in fidgety movement phase were divided into preterm group and full-term group according to their delivery gestational age, into <2500 g group and ≥2500 g group according to their birth weight. The number of different kinds of General Movements (GMs) was compared.The correlation between birth weight, delivery of gestational age and GMs was analysed. Results The number of fidgety movement was more in the full-term group than in the preterm group (P=0.001), while the number of absence of fidgety movement was significantly less (P=0.003). The number of fidgety movement was more in the ≥2500 g group than in the <2500 g group (P=0.001), the number of absence of fidget movement was significantly less (P=0.003). The GMs was correlated with birth weight and delivery gestational age. Conclusion Premature and low birth weight are the risk factors for abnormal fidgety movement.