Actins ; metabolism ; Dermatofibrosarcoma ; classification ; pathology ; Desmin ; metabolism ; Head and Neck Neoplasms ; metabolism ; pathology ; Histiocytoma, Benign Fibrous ; classification ; metabolism ; pathology ; Histiocytoma, Malignant Fibrous ; classification ; metabolism ; pathology ; Humans ; Oncogene Proteins, Fusion ; metabolism ; Skin Neoplasms ; metabolism ; pathology ; Vimentin ; metabolism ; Xanthomatosis ; pathology

To explore and discuss the challenge and solutions of medical ethics management in case of rapid development of medical research.Analyzed changes of the model,contents,and methods in modern medical research.Identified the significance of ethics review in medical research.Introduced some practices at Peking Union Medical College Hospital (PUMCH) in recent years.Ethical review is one of the key elements for quality of medical research. Management should be improved and strengthen for the protections of research subjects effectively in the case of rapid development of life science.

Objective To investigate the efficacy of emergency endoscopy for the treatment of patients with acute obstructive suppurative cholangitis(AOSC)and the difference compared with therapy of routine operation.Methods After ERCP were performed on 36 patients with AOSC,EST and/or ENBD were executed subsequently.To those asthenic patients complicated with diseases or tumors,ENBD was used to alleviate symptoms and then decided whether to take stones secondly or drain by ERBD.Biochemical indicators,physical sysmtoms and signs were monitored so as to compare with those of 32 patients with AOSC treated by routine operation.Results The clinical effect was satisfactory,and the relief of pain,incidence of complicated diseases,hospital stay,level of serum TBIL after treatment had significant difference between those in study group and in control group(all P＜0.05).Conclusion Endoscopic therapy is safe,easy and minimally invasive,which is suitable for the patients with AOSC.

Molecular targeted agents changed the therapeutic pattern on gastrointestinal stromal tumor (GIST).Imatinib of 400 mg/d is recommended to be the first line therapy for metastatic GIST.Escalation of imatinib dose or sunitinib could improve the overall survival of patients when the treatment with standard dose of imatinib failed.In addition,new targeted agents showed potential anti-tumor efficacy.Imatinib adjuvant therapy could improve the recurrence-free survival of GIST patients with median or high risk after complete tumor resection.Preoperative treatment with imatinib raises tumor resection rate,but whether it could provide survival benefit has not been proved.C-kit/PDGFRα gene mutation can predict the efficacy of imatinib and sunitinib,and it is helpful to screen out the GIST patients to receive imatinib adjuvant therapy.

Objective To evaluate the safety and effect of adefovir dipivoxil (ADV) on hepatitis B in HBeAgpositive patients.Methods 131 patients were divided into two groups randomly.Two groups were treated with ADV (10mg/d)and matrine (0.6g/d),respectively.The rate of HBV negative,the normalization rates of ALT,HBeAg loss and anfi-HBe seroconversion were evaluated respectively.Results After 12 weeks of treatment,the rate of HBV negative,the normalization rates of ALT,HBeAg loss and anti-HBe seroconversion of ADV were all significantly higher than those of matrine group(53.2％ vs 7.8％,36.0％ vs 8.7％,13.6％ vs 3.1％,6.2％ vs 0,respectively,x2 =56.32,23.18,all P ＜ 0.01).Conclusion The domestic ADV superior to matrine in HBeAg-positive patients.

It is an important turning point that early diagnosis and prompts initiation of adequate treatment improve the outcomes of primary or secondary hemophagocytic lymphohistiocytosis (HLH) which is a rare life-threatening syndrome.Even though the survival rate of the patients with HLH has been improved because of the immunochemotherapy or targeted immunotherapy based on new findings in the immunopathogenesis and the genetic defects,reducing the mortality will be main challenge for the pediatricians in pediatric intensive care unit.All of the clinical features are significant clues for the diagnosis,including continuing fever,specific liver dysfunction with coagulation abnormalities,pancytopenia,hypertriglyceridemia and hyperferritinemia.Defining patients' natural killer cells status during the different stages of sepsis and autoimmune diseases will be guiding innovative immunointerventions.

The new current versions of Hospital Finance System and Hospital Accounting System promote the reform of medicine accounting. It requires the method of the drugs cost accounting to change the retailing price accounting to the purchasing price accounting. It clearly defines individual valuation method, “first-in, first-out” method or weighted average method should be used to determine the actual cost of the materials based on the actual situation. It analyzes the problems of medical management and cost accounting, and proposes the practical solutions to strengthen the standard management of medicine and the medical cost accounting.

Objective To investigate the causes and preventive measures of subclavian venous catheter-related infections oc-curred in traumatic hemorrhagic shock patients .Methods 336 traumatic hemorrhagic shock patients indwelling subclavian vein catheter was included to explore the causes and treatment of catheter-related infections .The outcome was infect rate and strains dis-trubtion .Results Of 336 patients with subclavian vein catheterization average time was 4 .3 days ,including 27 cases of infection , and the infection rate was 8 .04% .All patients were discharged after active treatment ,with no deaths .Conclusion Traumatic hem-orrhagic shock patients with subclavian vein catheter are safe and effective .Risk factors for infection ,improve treatment and patient care ,shorten the time of catheter ,can effectively prevent catheter infections .

ObjectiveTo explore the effect of two puncture during epidural cavity of lumbar subarachnoid space block anesthesia( referred to as combined spinal-epidural anesthesia).MethodsClincal dato of 50 cases of application,two puncture method combined spinal-epidural anesthesia for abdominal hysterectomy Electrocardiogram,heart rate (HR),oxygen saturation,blood pressure (BP) changes were analyed were retrospectively analyzed.using modified Bromage scoring method to determine motor nerve block and the quality of anesthesia.Results50 cases were successfully completed operation,without changing the mode of anesthesia.Motor nerve block anesthesia and quality excellent rate was 100％,the abdominal and cervical muscle relaxation quality excellent rate was 100％,analgesia was completely.No difficulty in breathing,chest tightness,headache,intraoperative fluid infusion about 1500ml,operation time ( 135.0 ± 4.5 ) min.48 patients hemodynamic status ( SpO2,HR,BP) remained stable,2 patients after anesthesia 10min appeared a drop in blood pressure,intravenous injection ephedrine 10mg returned to normal.Postoperative patients were cured,no neurological complications after anesthesia.ConclusionTwo puncture lumbar epidural combined anesthesia applied to hysterectomy had good,anesthesia effect,less complications,should be worthy of promotion.

Fibrin related markers include several proteins and fragments developed in the conversion of fibrinogen to cross-linked fibrin and following degradation.FDP played as a more important role than conventional global coagulation test before application of D-dimer in clinical settings,moreover,combination of FDP and D-dimer improve the diagnostic of DIC greatly,and D-dimer has become an effective tool excluding venous thromboembolism besides the imaging.Whether basic or clinical research on soluble fibrin monomers and complexes were focused in an early stage,however,limited by diversity of analytes and nonstandardization,no full application was come into being.It is worthwhile to note that fibrin related markers release into plasma sequentially from initialization of fibrinogen activation to fibrinolysis.Thus,the combination of these index is useful to understand patient's condition (such as DIC),prognosis of VTE recurrence,and prophylaxes of post-operation thrombosis.