Japan has accumulated much mature experience in hospital management, which is worthy of being drawn upon by hospital managers in China. By means of an account of the model of ward rounds by doctors at three levels, the system of academic previews and the system of regular meetings for copying down and reading medical papers in foreign languages in Japanese hospitals and in light of the situation of domestic hospital management, the paper discusses measures for improving the system of ward rounds and scientific research management. The goal is to enhance the medical expertise levels, scientific research capabilities and foreign languages proficiency of medical workers in China so as to deliver better medical and healthcare services to the broad masses of the people.

Objective To assess the long term effects of combined oral contraceptive pills use on the mean of serum TG, TC, HDL C, LDL C, ApoA1, ApoB and Lp(a). Methods The study was carried out in 446 women grouped as combined norethisterone containing ethinylestradiol (EE) 35 ?g and norethisterone 625 ?g; combined 18 metayl norethisterone (norgestrel) containing EE 30 ?g and 18 metayl norethisterone 300 ?g for using 5～25 years, and control subjects wearing IUD for the corresponding period. The three groups were similar in age, body mass index (BMI), continued period of contraceptives use and income. Results The data showed that changes of varying degree of lipid and lipoprotein parameters were obvious in women of long term taking low dose combined norethisterone and norgestrel, compared with the control. The mean of TG, HDL C, ApoA1 were significantly increased simultaneously ( P

BACKGROUND: It has been reported that bioactivity is found to be favored by the co-operative behavior of silanol (Si-OH)or Ti-OH etc. groups on the material surface and the involved calcium ions. To confirm the hypothesis that a new family of organic-inorganic hybrid materials, which incorporate gelatin chains covalently into Si-O-Ti network, is synthesized through sol-gel procedure.OBJECTIVE: To synthesize a hybrid of gelatin and CaO-SiO2-TiO2 system which is used for bone repairing, and observe its structure and bioactivity.DESIGN: Randomized control observation.SETTING; the laboratory, School of Material Science and Engineering, Shaanxi University of Science and Technology. MATERIALS: Gelatin (Sinopharm Chemical Reagent Co., Ltd), titanic acid isopropyl ester (Gu'an Hengye Fine Chemicals Co., Ltd), γ-glycidoxy propyl trimethoxy silane (Jingzhou Jianghan Fine Chemicals Co., Ltd), calcium nitrate (Tianjin Bodi Chemicals Co., Ltd)METHODS: The experiment was carried out in the laboratory, School of Materials Sciences and Engineering, Shaanxi University of Science and Technology between April and August in 2006. A new type of bioactive organic-inorganic hybrid was synthesized through sol-gel processing starting from gelatin, γ-(2,3-glycidoxypropyl)trimethoxysilane (GPSM),Tetraisopropyltitanate (TiPT) and calcium nitrate. ①Structure of the hybrid: The structures of the products were investigated with Fourier transformed infrared (FT-IR) diffusive reflection spectroscope, X-ray diffraction (XRD) instrument and scanning electron microscope (SEM) respectively.②Bioactivity: The products Ti15Ca0 and Ti15Ca20 were soaked in a stimulated body fluid (SBF) to evaluate the morphology of the surfaces by SEM and thin-film XRD. MAIN OUTCOME MEASURES: The structure and bioactivity of the hybrid.RESULTS: ①The hybrid was completely amorphous and its surface was almost homogenous, which implied the covalent bonding between the organic component and inorganic component. FT-IR spectra result verified the occurrence of Si-OH group and Si-O-Ti bond, as well as the addition of TiPT supplied Si-O-Ti bond. ②There were lots of apatite crystallines formed on the surface of hybrid Ti15Ca20 after soaked in SBF for 7 days, which confirmed their in vitro bioactivity. These apatite particles were similar to the bioglass and other bioactive materials in the patterns. CONCLUSION: A new type of organic-inorganic hybrid material, which incorporates gelatin chains covalently into Si-O-Ti network, is synthesized through sol-gel procedure. There are lots of apatite and brushite crystals formed on the surface of the product Ti15Ca2O after soaking in SBF for 7 days, which obviously proves the bioactivity of the hybrid.

Objective To investigate the expression of caveolin-1 in the sera of esophageal cancer patients , and the possibility of caveolin-1 to be the tumor marker of an esophageal cancer .Methods ⑴Western blot was used to detect the expression of caveolin-1 in esophageal cancer cell EC 109 and EC9706;⑵The sera were collected from 43 esophageal cancer patients , 30 benign esophageal lesions, and 50 healthy control men.Enzyme linked immunosorbent assay (ELISA) was used to detect caveolin-1 in serum.Results⑴Western blot showed that caveolin-1 was detected in two types of esophageal cancer cell lines .The level of caveolin-1 in the poor dif-ferentiated EC109 cell line was mush higher than in the well differentiated EC 9706 cell line ( t =3.08 , P =0.035 ) .⑵ ELISA re-vealed that the median level of serum caveolin-1 in 43 esophageal cancers (0.104 ng/ml) was significantly higher than 30 benign e-sophageal lesions (0.075 ng/ml) or 50 healthy control men (0.081 ng/ml) (χ2 =23.16, P =0.001).Conclusions Caveolin-1 may be the tumor marker of an esophageal cancer as its level in esophageal patients was higher than in benign esophageal lesions pa -tients or healthy control men .

Objective To evaluate the adaption,effectiveness,dose,complication of the treatment for cranio pharygiomas with gamma knife surgery.Methods Gamma knife surgery was performed in 41 patients.Patients with mixed solid and cystic tumors were treated with stereotaxic aspiration while six cases were treated with divergence surgery prior to gamma knife therapy.The central dose ranges from 17.1 ～40 Gy(29.6Gy in average).The patients were treated at 30%～50% equal dose curve with 6 ～14Gy of tumormargin dose(9.5Gy in average).The exposure dose of the optic nerve and optic tract is less than 10Gy.Results Of twenty-nine patients who were followed up from 6 to 100 months,sixteen had disappeared or decreased tumor,six had unchanged,two was performed craniotomy one year or three years after gamma knife surgery,and the remaining five were dead one year to three years.The tumor control rate was 75.9%(22/29).Conclusion The treatment of stereotaxic radiation with single and high dose is sensitive to most of the solid craniopharyngioma,and the treatment of stereotaxic resection combined with gamma knife surgery may be feasible for the recurrent mixed solid and cystic craniopharyngioma.

AIM: To observe the early changes of local cerebral blood supply in dogs during the acute vertebral artery stenosis by 99 TcmECD cerebral blood flow perfusion imaging(CBFPI).METHODS: Twenty-four dogs were randomized into groups of normal controls(A),moderate stenosis(B),severe stenosis(C) and arterial occlusion(D),with 6 in each group.Group A were free from any intervention,but Group B,C and D were undergone ligation of the right vertebral arteries by the extent of 50%～69%(Group B),70%～99%(Group C) or 100%(Group D).The imaging agents were injected intravenously 0.5-1 h after ligation and the single photon emission computed tomography(SPECT) was performed after 1 h.RESULTS: CBFPI examination of the early changes of cerebral blood supply during the acute vertebral artery stenosis by visualization showed that the sensitivity was 33.3%,83.3% and 100% in Group B,C and D,respectively,with an average sensitivity of 72.2%,while semi-quantitative assessment suggested that the sensitivity was 50%,100% and 100% in the three groups,respectively,with an average sensitivity of 83.3%.When examining the activity ratio for regions of interest(ROI) by semi-quantitative 99 Tcm-ECD CBFPI,the findings suggested that Group D and C decreased significantly(exception in cerebellum in Group C),but Group B had no evident changes,as compared with Group A.By comparison of the groups of B-C,B-D and C-D,differences were observed in the right temporal lobes,whereas the changes in left temporal lobes were seen in Group B-C or B-D.The changes were seen in occipital lobes when groups of B and D were compared,but with no differences in cerebellum.CONCLUSION: The degree of stenosis in vertebral arteries may involve varied regions,the temporal lobe is susceptive,followed by occipital lobe,while cerebellum is somewhat resistant from the involvement.

Objectives To investigate the clinical and pathological characters , treatment of patients with Angioimmunoblastic T cell lymphoma(AITL). Methods From 1997 to 2004, 14 patients with AITL were reviewed retrospectively in our hospital. Results The most common symptoms at the presentation included general lymphadenopathy. 9 patients had fever. 3 patients had autoimmune hemolytic anemia.The histopathologic characteristics of AITL was generalized as:the damage of normal structure of lymphonodus,the proliferation of immunoblastic cell and arborescent supervascularization. All immunophenotyping were T cell type.14 patients were with ProMACE-CytaBOM regimen.The overall response rate was 57% and CR 3 cases, PR 5 cases. Median survival times was 25 months. 2-year survival was 60 %. Conclusions The most cases with AITL runs an aggressive course.The disease may progress rapidly and have unfavorable prognosis. Therefore further studies are repuired to improve the outcome.

Objective To explore the clinical features of female recurrent major depression(MD) patients with and without suicidal ideation.Methods 301 female recurrent major depression patients were interviewed by specially trained interviewers using computer evaluation system and divided into suicidal ideation group and non-suicidal ideation group according to suicidal ideation.The comparisons between the two groups were investigated on items of demographic, clinical data, assessment of psychopathology, Eysenck neuroticism questionnaire, stressful life events.Results 66.4％ of MD patients have suicidal ideation.Compared with non-suicidal ideation group, there were more total number of MD symptoms (8.58±0.77, OR=2.476, P=1.154× 10-9) and melancholia symptoms (6.74±1.07, OR=1.546, P=0.001) and it was more common in the factors of less appetite (OR=2.201, P=0.011), lose weight (OR=2.030, P=0.004), early morning awakening (OR=1.774, P=0.045), worthless (OR =2.352, P=0.014), impaired decision-making (OR=2.044, P=0.018), hopelessness (OR=7.130, P=6.651 × 10-9) ,helpless (OR=2.046, P=0.049) in suicidal ideation group.Also in suicidal ideation group the scores of neuroticism dimension (OR=1.631, P=0.024) were higher, and they were more suffered from stressful life events (OR=1.302, P=0.008).Binary logistic regression analysis indicated that total number of MD symptoms (OR=4.840, P=1.154×10-8) ,stressful life events (OR=1.392, P=0.014) and hopelessness (OR=3.528, P=0.008)were significantly associated with suicidal ideation.Conclusion Specific clinical features are associated with suicidal ideation among female patients of recurrent depression disorder.Hopelessness, stressful life events are risk factors of suicide ideation in female recurrent major depression patients.Integrated clinical assessment should be taken for recurrent major depression patients with suicidal ideation.

Objective To explore the clinical features of female diagnosed recurrent major depression (MD) comorbidity with general anxiety disorder (GAD).Methods 301 females patients with recurrent major depression were interviewed by specially trained interviewers with using computer evaluation system and divided into comorbidity group and non-comorbidity group according to whether comorbid MD with GAD or without GAD.The comparison between the two groups included items of demographic,clinical data,assessment of psychopathology,Eysenck neuroticism questionnaire (EPQ),stressful life events,parental bonding instrument.Results 25.2％ of patients of MD coexistence GAD.There was no significant difference in sociodemographic data between the two groups.Significant differences among total number of depression symptoms(OR=1.439,95％ CI =1.049-1.975,P =0.024),duration of illness(OR=1.253,95％ CI =1.010-1.475,P=0.048),psychomotor agitation(OR=2.031,95％ CI =1.123-3.676,P=0.019),suicidal thought(OR=2.228,95％ CI =1.010-4.912,P=0.047),anxiety(OR =5.547,95％ CI =1.935-15.896,P=0.001),irritable(OR=1.956,95％ CI =1.081-3.542,P=0.027) were identified between the two group.In the comorbidity group,the score of nenroticism dimention derived from EPQ was also higher(OR=2.287,95％ CI =1.674-3.124,P=2.287× 10-7) than that of non-comorbidity group.There was no significant difference of stressful life events between two groups(OR=1.118,95％ CI =0.913-1.368,P=0.280).Conclusion This study suggests the phenomena that female patients of recurrent depression disorder comorbidity with general anxiety disorders is common in clinical.The patients comorbid MD and GAD have more symptoms,neuroticism and be worse in severity.

The authors analyzed the status quo of the indicators, outcomes and uses,methodology, procedures and technologies of the variations management of clinical pathways in China the abroad. The outputs of the study point to the following assignments in such a management, such as further identification of the contents of such variations, and further clarification of variation analysis indicators.