By analyzing the crisis of survival in 2 hospitals, the authors argue that reform of the hospital property right system may be a way out. However, in the process of the reform, hospitals may face some problems. One problem is how to ensure the steady transition and sustained development of a hospital if the whole of it is sold out to an enterprise run by the local people. Another problem is how to safeguard the status, salary and welfare of the staff. To ensure the success of the reform, the following measures need to be taken: ①strengthening leadership, seeking unity of thinking, and clarifying the guiding ideology; ②formulating rigorous and detailed plans so as to guarantee a steady transition; ③making proper arrangements for the placement of the staff after the change of the property right system so as to ensure the ideological stability of the staff.

Objective To observe the changes in levels of plasma leukocyte cell-derived chemnotaxin 2 (LECT2) in patients with newly diagnosed type 2 diabetes (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD),and to investigate the clinical significance.Methods A total of 137 subjects were enrolled in the study,including 50 patients with newly diagnosed T2DM complicated with NAFLD,47 patients with newly diagnosed T2DM with non-NAFLD and 40 healthy subjects.The level of plasma LECT2 was determined by ELISA.Anthropometric data and other biochemical indicators were measured in three groups.The body mass index (BMI) and waist-to-hip ratio (WHR) were calculated.Insulin resistance and pancreas β-cell function were determined by homeostasis model assessment (HOMA-IR,HOMA-％β).Results Plasma concentration of LECT2 in patients with newly diagnosed T2DM complicated with non-NAFLD was higher than that in type 2 diabetic patients with non-NAFLD [(32.95 ± 10.11 vs 29.08 ± 7.54) ng/mL,P ＜ 0.01].Plasma LECT2 levels in both groups were significantly higher than that in normal control group [(22.38 ± 4.40) ng/mL,P ＜ 0.01].Plasma LECT2 level was positively correlated with BMI,FPG,FINS,C peptide,HbA1c,GGT,TG and HOMA-IR,while negatively with HDL-C and HOMA-％ β (all P ＜ 0.01).Multivariate regression analysis showed that levels of BMI,FPG and HDL-C were important factors affecting plasma LECT2 level.Conclusions Plasma LECT2 concentration significantly elevates in patients with newly diagnosed T2DM complicated with non-NAFLD.Plasma level of LECT2 is closely correlated with insulin resistance and glycolipid metabolism.LECT2 may play an important role in the patho genesis of insulin resistance and T2DM.

Objective To investigate the effects of AGEs-RAGE on the apoptosis of GLUTag cells and explore the possiblc mechanism.Methods GLUTag cells treated with 0、100、200、300μg/ml of AGEs for 24h were examined for gene and protein expression of RAGE using RT-PCR and western blotting,respectively.GLUTag cells were randomly divided into four groups:control,200μg/ml AGEs,AGEs+siRNA-RAGE and AGEs+apocynin.The protein expression of p22phox、p47phox 、Bcl-2、Bax in the cells were detected with western blotting.The reactive oxygen species (ROS) levels were examined using 2'7'-dichlorodihydroflur-rescein diacetate (DCFH-DA) and the apoptosis of L cells were tested by AnnexinV-FITC/PI.Results AGEs increased thc cxpression of RAGE in a dose dependent manner.Treatment with AGEs induced a significant increase in the expression of p22phox,p47phoxand the activity of ROS,caused up-regulation of Bax and down-regulation of Bcl-2,which enhanced the apoptosis of GLUTag cells.Apocynin,the inhibitor of NADPH oxidase,prevented those responses and the effects caused by AGEs were abolished by inhibition of RAGE activity with siRNA.Conclusion AGEs positively regulate the exprcssion of NADPH oxidase-derived ROS and its down-steam signaling pathway p53/Bax by targeting RAGE,leading to the apoptosis of GLUTag cells.

Objective To compare the EEG complexity between rats under awaking and differ-ent depth of anesthesia via analyzing sample entropy and fractal dimension.Methods Sixteen SD rats were intraperitoneally injected with urethane twice,first with 500 mg/kg and second with 800 mg/kg one hour later.The scalp EEG was collected in stage of awaking (W),light anesthesia (LA)and heavy anesthesia (HA).The sample entropy (SampEn)and fractal dimension (FD)were computed by MATLAB.The characteristic values were denoised by linear dynamic system method during the whole process.Results The value of SampEn and FD gradually dropped from awaking to heavy anes-thesia.The SampEn and FD in W was significantly higher than the value in LA or in HA (P <0.05). The SampEn and FD in HA was significantly lower than that in LA (P < 0.05 ).Conclusion The SampEn and FD of EEG could be used to monitor the depth of anesthesia.

Objective To study the effects of preconditioning treadmill exercise on excitatory amino vacid changes in rats after the cerebral infarction and the protective effects against cerebral isehemia brain injury. Methods Thirty Sprague-Dawley rats were used in this study. Twenty-five rats were subject to an operation to establish the animal model of middle cerebral artery occlusion and divided into a isehemia group, an 1-week ex- ercise group (trained in the 4th week) , a 2-week exercise group (trained in the 3rd and 4th weeks) and a 4- week exercise group (trained for 4 weeks) , while the remaining 5 rats were subject to sham operation, and served as the controls. After 4 weeks of experiment, all the the rats were fixed on stereotactie apparatus for the brain microdialysis of the striatum. Then the focal middle cerebral artery ischemia and reperfusion were made with thread oeclussion in rats and microdialysis technique was used to collect extraeellular fluid in each period of pre-ischemia, ischemia (40, 80 and 120 min), and reperfusion (40, 80, 120, 160, 200 and 240 min) to detect the changes of the excitatory amino acid. At the same time the infarction volume was also measured at 24 hours after ischemia-reperfusion of the brain. Results The difference between any two groups was significant with regard to the volume of cerebral infarction (P < 0.05). Two weeks and four weeks of the preconditioning treadmill exercise couled significantly reduce concentration of Glu excessively released due to the ischemia (P < 0.01). Conclusion At least two weeks of preconditioning treadmill exercise can inhibit the excessive release of the important excitatory amino acid neurotransmitter glutamate, to some extent, in the process of the subse- quent ischemic brain injury and during reperfusion, which might be one of the protective mechanisms of move- ment against the early isehemie brain injury.

In order to promote the integration between disciplines, the convergence between basic course and clinical teaching, increasing students ability including the active learning and life-long learning ability, finding problem and solving problem ability, teamwork spirit and so on. After nearly 3 years preparation, Hebei Medical University successfully carried out the PBL teaching in Seven-year Clinical Medicine Science. Combining with the teaching activities, formative assessment was carried out, and PBL teaching website was established. The reform has already achieved initial results, got good responds from teachers and students. Through the study, it has been confirmed that the PBL teaching method in Hebei Medical University is effective and worthy to reference.

Objective: To explore the application value of pulmonary ultrasound for the treatment of severe acute respiratory distress syndrome in children with extracorporeal membrane oxygenation(ECMO). Methods: Seven children with severe acute respiratory distress syndrome (ARDS) who were treated with ECMO in the PICU ward of Hunan Children Hospital from August 2018 to March 2019 underwent pulmonary ultrasound before treated with ECMO, after each bronchoscopy and lavage, before ECMO withdrawal, and within 24 hours after ECMO withdrawal. Performance of pulmonary ultrasound and clinical data were retrospectively reviewed. Results: Seven patients treated with ECMO for 11.5(3-27)days, and 1 patient underwent ECMO transport. Six (86.7%) patients were successfully weaned from ECMO, and 1 (14.2%) patient failed to exit ECMO successfully. Four(57.1%) patients were discharged from hospital, and 3(42.8%) patients eventually died. In various diagnostic signs of pulmonary ultrasound were detected in 7 patients, including pulmonary edema (7 cases), lung consolidation (5 cases), followed by pleural effusion (4 cases), atelectasis (3 cases) and pneumothorax (3 cases). Pulmonary ultrasound showed that the lungs were re-expanded and suggested that the child could attempt to evacuate the ECMO. Conclusions Pulmonary ultrasound can comprehensively evaluate the various lung lesions in children with ECMO treatment, and can dynamically monitor the process of lung recruitment in real time, providing a reference for guiding the evacuation of ECMO.

Objective To explore the application value of pulmonary ultrasound for the treatment of severe acute respiratory distress syndrome in children with extracorporeal membrane oxygenation( ECM O ) . Methods Seven children with severe acute respiratory distress syndrome ( ARDS ) w ho were treated with ECM O in the PICU ward of Hunan Children Hospital from August 2018 to M arch 2019 underwent pulmonary ultrasound before treated with ECM O , after each bronchoscopy and lavage , before ECM O withdrawal ,and within 24 hours after ECM O withdrawal . Performance of pulmonary ultrasound and clinical data were retrospectively reviewed . Results Seven patients treated with ECM O for 11 .5( 3－27) days ,and 1 patient underwent ECM O transport . Six ( 86 .7% ) patients were successfully weaned from ECM O ,and 1 ( 14 .2% ) patient failed to exit ECM O successfully . Four( 57 .1% ) patients were discharged from hospital , and 3( 42 .8% ) patients eventually died . In various diagnostic signs of pulmonary ultrasound were detected in 7 patients ,including pulmonary edema ( 7 cases ) ,lung consolidation ( 5 cases ) ,followed by pleural effusion ( 4 cases) ,atelectasis ( 3 cases) and pneumothorax ( 3 cases ) . Pulmonary ultrasound showed that the lungs were re‐expanded and suggested that the child could attempt to evacuate the ECM O . Conclusions Pulmonary ultrasound can comprehensively evaluate the various lung lesions in children with ECM O treatment ,and can dynamically monitor the process of lung recruitment in real time ,providing a reference for guiding the evacuation of ECM O .

Objective To observe the abdominal ultrasonic manifestations of children with Langerhans cells histiocytosis (LCH).Methods Imaging features of histopathologically proved LCH in 28 children were retrospectively analyzed.Results Among 28 eases,multi system involvement was found in 25 cases,while only liver and bile duct involvement were detected in 3 cases.Different degrees of enlarged liver,inhomogeneous echo of liver parenchyma,scattered or diffuse hypoechoic regions were found in all 28 cases.Uneven thickening and echo enhancement of the bile duct wall,as well as local expansion or stricture of bile duct cavity were found in 13 cases.Splenomegaly was found in 17 cases,swelling of the pancreas was found in 5 cases,varying degrees of ascites were found in 13 cases,and hepatic hilar lymphadenectasis were found in 14 cases.Conclusion There are specific ultrasonographic manifestations of LCH in children,which may be helpful to improving diagnostic accuracy of LCH.

Objective:To analyze the characteristics of ultrasound in children with myocardial hypertrophy and to understand the etiology.Methods:From December 2016 to December 2019 in our hospital, 44 cases of children with ventricular septum and left ventricular posterior wall thickness Z value >2 were retrospectively analyzed.Results:There were 10 cases of hereditary myocardial hypertrophy (22.7%), 6 cases of hypertrophic cardiomyopathy showed asymmetric myocardial hypertrophy, the hypertrophy mainly concentrated in the apex, anterior septum and posterior septum, and the thickened myocardial fibers were disorderly arranged, the myocardial echo was disorderly and uneven; 2 cases had family history but did not do gene detection; 2 cases of glycogen storage disease type Ⅱ showed symmetrical myocardial hypertrophy, enhanced and dense myocardial echo, and progressive myocardial hypertrophy, 1 case was misdiagnosed as hypertrophic cardiomyopathy; 1 case of primary carnitine deficiency showed symmetric hypertrophy of myocardium with dense and uniform echo, which was misdiagnosed as hypertrophic cardiomyopathy for the first time; 1 case was clinically diagnosed as myocardial amyloidosis, symmetric hypertrophy of myocardium, dense and uniform echo, with unique signs of " ground glass degeneration" and granular strong echo. There were 29 cases (65.9%) with acquired myocardial hypertrophy, including 14 cases caused by aortic disease, 1 case with Williams syndrome, showing myocardial thickening mainly with ventricular septum thickening, but without abnormal myocardial echo; 12 cases were mothers with abnormal glucose metabolism during pregnancy, with thickening of interventricular septum and posterior wall of left ventricle without abnormal myocardial echo; 2 cases of renal hypertension showed concentric myocardial hypertrophy. The remaining 5 cases (11.4%) are unknown.Conclusions:The causes of myocardial hypertrophy are complex and diverse. Comprehensive analysis of imaging characteristics and clinical results should be used to identify the cause of the disease as early as possible and take timely intervention to the cause to save the child's life and improve the quality of life.