Lung injury is a group of lung inflammation and fibrosis diseases which is caused by a variety of reasons.There is no specific and effective treatment for it.Late irreversible damage is an important factor that cause respiratory dysfunction even the death of patients.Therefore,finding a breakthrough in the treatment of lung injury is one of the research focuses.Mesenchymal stem cells (MSCs)can migrate to lung and participate in reconstruction of injured lung.MSCs can be obtained and cultivated easily,and has characteristics of strong plasticity and immune tolerance.

OBJECTIVE:To define the basic elements clinical pharmacists should possess in clinical treatment team.METHODS:The purpose of setting clinical pharmacists system was investigated.Different working scope and different professional requirements of clinical pharmacists and physicians were explored.The basic elements clinical pharmacists should possess in clinical treatment team were found out.RESULTS&CONCLUSION:Clinical pharmacist system of our country is a significant progress of the hospital clinical system.Clinical pharmacists in the clinical treatment team must have four basic elements:clinical responsibility,clinical action,clinical ability and clinical effect.Only in this way,could clinical pharmacists in the clinical treatment team become an irreplaceable part.

This paper reviews outpatient security policy of typical developed countries .It provides reference for outpatient security system in China .Analysts believe that the experience for Chinese reference should be acquired in the following ways:The pooling of outpatient service is an inevitable trend in the development of health insurance , which is in principle an integral part of payment and financing system; the implementation of outpatient community first diagnosis system should be adapted to the local conditions; the community first diagnosis system is a necessary condition for capitation , so it is closely related to compensation methods and the elaborate degree of outpatient treat -ment catalog;Outpatient services should be supervised and payment policies should be developed respectively .There are two supervision models about outpatient service:external supervision and self supervision , but the key is to focus on the management of outpatient doctors .External regulation should be consistent with the current regulatory approach of the situation and patients have to bear some responsibilities for outpatient treatment expenses in some proportions , but the payment cap line should not to be low .The implementation of certain preferential policies for vulnerable groups can be considered under the harmonized system to partially reduce their medical expenses .

Objective A meta-analysis of clinical trials of prehospital thrombolysis versus in-hospital thrombolysis or PCI for acute myocardia infarction (AMI). Method We collected the literature on prehospital thrombolysis for AMI published at home and abroad from January 1989 to April 2009. Recanalization rate of infarct-related arter, complication incidence and mortality ( ＜ 30 d) were regarded as result indicators. Software RevMan 4.2.8 was used to process meta-analysis. Results There were only 27 literatures selected. Prehospital thrombolysis was associated with higher recanalization rate of infarct-related arter[OR 2.67,95%CI(1.86 ～ 3.85);P ＜0.01] and lower mortality ( ＜ 30 d ) [OR 0.71,95%CI(0.64 ～ 0.78); P ＜ 0.01] than in-hospital thrombolysis. There was no significant difference in complications between them. Compared with PCI, prehospital thrombolysis was associated with higher complication incidence [OR 2.91,95% CI ( 1.26 ～ 3.80); P = O.005]. There was no significant statistical difference of mortality ( ＜30 d ),but the sensitivity analysis was not good. Conchusions The effect and prognosis of prehospital thrombolytic are superior to that of in-hospital thrombolysis,and the same with PCI,but prehospital thrombolytic has higher incidences of complications,and the sensitivity is not good.

Objective To learn about the mastery level of midwives and obstetric nurses about fetal monitoring knowledge.Methods 77 midwives and obstetric nurses attending a fetal monitoring education programme in Huaxi Second Hospital of Sichuan University were investigated by using a self-made questionnaire.Results Some respondents lacked of systematic training in fetal monitoring knowledge,and they could not accurately answer the purpose or contents of fetal monitoring,as well as the basic elements and related knowledge about fetal electronic monitoring.Most of the respondents focused on fetal monitoring in clinical practice,but neglected the corresponding frontier progresses.Conclusions The training and education on fetal monitoring knowledge should be strengthened to improve obstetric quality because of the unsatisfactory survey results in midwives and obstetric nurses.

Objective To determine the minimum alveolar concentration(MAC) of sevoflurane without body movement during laryngeal mask airway(LMA)intubation in premature infants less than 37 weeks of corrected gestational age undergoing total inhalation general anesthesia induction.Methods Twenty-one ASA Ⅰ or Ⅱ premature infants less than 37 weeks of corrected gestational age undergoing elective inhalation general anesthesia were enrolled in this study.At first,the general anesthesia induction was started by inhaling 6 ％ sevoflurane.After the premature infant lost consciousness,the end tidal sevoflurane concentration(ET-sev)was adjusted to the predetermined concentration and maintained stable for 15 min.After that,LMA was inserted.The up-anddown sequential allocation was used to determine MAC.The initial ETsev was 2 ％,which was increased or decreased by 1 gradient concentration in the next case according to the LMA insertion body movement response.The adjacent concentration gradient was 0.2％.The midpoint from th body movement response to non-body movement response was set as the balance point and the mean value of the concentrations of sevoflurane at all the balance points were calculated as MAC.Results The end tidal sevoflurane con centration without the body movement responses to LMA insertion was 1.71％.Conclusion The MAC of sevoflurane without the body movement responses to LMA insertion in premature infants less than 37 weeks of corrected gestational age is 1.71％,which is lower than that in the normal children and probably because imperfect central nervous system development in premature infants.

A review of the system background for the multi-institution physician practice in China,and an analysis for the specific constraints for physicians of public hospitals to embrace such a practice On this basis, the paper probed into the measures to encourage the physicians for doing so. The measures recommended include advanced design, improvement of the quality of care and safety mechanism,incentives mechanism, mandatory enforcement of medical liability insurance to minimize risk exposure of such a practice, aiming at advancement of this practice.

Objective:To explore the association between the CYP21A2 genotype and the virilization severity in girls with classic 21-hydroxylase deficiency (21-OHD), so as to further the understanding of virilization in females and provide guidance for prenatal diagnosis and genetic counseling. Methods:A total of 23 patients with two X chromosomes (46, XX) who were newly diagnosed with classic 21-OHD in Wuhan Children′s Hospital from August 2010 to March 2019 were included.These patients were divided into 3 groups according to the Prader grades of the degree of external genitalia masculinization.The 17-hydroxyprogesterone (17-OHP) level, androstenedione (AND) level, testosterone (T) level, dehydroepiandrosterone sulphate (DHEAS) level and genotypes were recorded.The gene mutations were divided into the Null group(the enzyme activity was completely impaired), group A(1% of the normal enzyme activity was retained), group B(2% of the normal enzyme activity was retained) and group C(20%-60% of the normal enzyme activity was retained). The correlation between the gene variation of different Prader grades and the corresponding gene groups were analyzed.Results:All 23 girls showed different degrees of external genitalia masculi-nization.There was a significant positive correlation between the Prader grades and the type of gene variation ( rs=0.696, P<0.001). The gene group A and Null group were highly matched with the Prader Ⅳ(the matching rate: 77.8%). Eighty percent of girls with Prader Ⅱ and Prader Ⅲ were classified as the gene group B. The testosterone le-vel of girls with Prader Ⅳ at first diagnosis was significantly higher than that of girls with Prader Ⅱ [4.6(4.0, 15.0)μg/L vs.0.63(0.40, 1.39)μg/L]( χ2=15.117, P<0.05). Conclusions:There is a significantly positive and strong correlation between the degree of external genitalia masculinization and the degree of deficiency of enzyme activity caused by gene variation in girls with typical 21-OHD.It can provide reference for both parents carrying CYP21A2 gene in prenatal diagnosis, genetic counseling and individualized diagnosis and treatment.

With the understanding of tumor metabolism, the process and mechanism of tumor metabolic reprogramming gradually attracted much attention in recent years.Oncogenes and tumor suppressor genes are constantly changing the pathway and flux of tumor metabolism in tumorigenesis to meet the needs of tumor growth and proliferation.The role of c-MYC, TP53, HIF-1αas well as the related signal pathways in tumor metabolic reprogramming would be discussed.

Objective To observe the effects of hyperventilation on jugular bulb pressure and optic nerve sheath diameter during RALRP. Methods Twenty patients undergoing elective RALRP were enrolled in this study. After hyperventilation of General anesthesia,we monitored and recorded changes of Heart rate(HR),mean arterial pressure (MAP),end-tidal carbon dioxide (ETCO2),arterial oxygen tension (PaO2),arterial carbon dioxide tension(PaCO2),peak airway pressure(PIP),JBP and ONSD in 5 minutes after intubation(T0),Trendelenberg posture in 15 minutes (T1),the established pneumoperitoneum in 30,60,90 minutes (T2,T3,T4) and termination of pneumoperitoneum in 15 minutes in supine position(T5)respectively. Results Compared with T0, JBP increased at T1 ~ T5(P < 0.05). ETCO2 and PaCO2 of T1 ~ T5 were lower than those of T0(P < 0.05)during hyperventilation. After establishment of Trendelenburg posture and pneumoperitoneum,PIP values increased at T1~T4 than that at T0 (P < 0.05),However,ONSD increased from T3 to T5 compared with T1 to T2 (P < 0.05). Conclusion Through over-ventilation,pneumoperitoneum and Trendelenburg posture,JBP and PIP can increase, and ONSD becomes wider evendually.