Hospital construction is essentially disciplinary construction and personnel development. Improving the quality of department heads in an all round way and bringing into full play their potential and enthusiasm will be of great significance in promoting disciplinary and hospital construction and development. To give play to the role of department heads, it is imperative to enhance their quality, bring into full play their potential and enthusiasm, and appropriately handle relationships with them. Only by doing so can marked achievements be made in hospital construction and development.

Objective To compare the clinical efficacy of seretide (50 μg/500 μg salmeterol/fluticasone propionate) with seretide (50 μg/250 μg salmeterol/fluticasone propionate) in single inhaler in the treatment of patients with stable status moderate to severe chronic obstructive pulmonary disease (COPD)Methods Sixty patients with COPD were randomly divided into the treatment and the control groups.Baseline treatments were similar in all patients,patients in the treatment group received seretide (50 μg/500 μg) while the control group received seretide (50 μg/250 μg) inhalation once every 12 hours for 24 weeks Before and after the therapeutic course,tests for lung function in patients of the two groups were conducted and compared with each other.Clinical symptoms and physical signs were graded by questionnaire.Results There was no significant difference on indexes of lung function between the two groups at baseline (P ＞ 0.05).After treatment,the score of clinical symptoms and signs in the treatment group was lower than that in the control group ((4.0 ± 0.5) vs.(4.8 ± 0.3),t =2.63,P ＜ 0.05).Six minutes walking distance was longer in the treatment group than that in the control group ((451.6±22.9) meter vs.(401.2 ±25.4) meter,t =2.51,P ＜0.05).The levels of forced exhaled gas volume 1 (FEV1),FEV1/forced vital capacity (FVC) and FEV1/pred in the treatment group were higher than those in the control group ([FEV1:(2.18 ± 0.38) L vs.(1.78 ± 0.45) L;FEV1/pred:(63.19 ±9.08)％ vs.(57.19 ±9.25)％; FEV1/FVC％:(73.8 ±5.6)％ vs.(67.3 ± 11.5)％ ;P ＜ 0.05).Conclnsion High dosage of seretide had better effect in the treatment of stable moderate and severe COPD,and can obviously improve patients' lung function,clinical symptoms and quality of life.

Objective Many studies have proved that the ABCD 2 score can be used to predict early stroke risk after transient ischemic attack ( TIA) , but few reports are seen on its predictive value for early stroke risk after TIA in different types of circulation . This article aimed to evaluate the ABCD 2 score in predicting early stroke risk following anterior or posterior circulation TIA . Methods Patients with definitely diagnosed TIA consecutively included in Nanjing Stroke Registration System from September 2011 to December 2012 were classified into anterior and posterior circulation TIAs .Various risk factors were collected and a 90-day follow-up was conduc-ted.The ABCD2 score was obtained from each patient and its predictive value assessed using the receiver operating characteristic curve. Results A total of 204 patients were analyzed in the study , including 59 (28.9%) females, 143 with anterior and 61 with posterior circulation TIA, aged 63.7 ±11.2 years.There were no statistically significant differences in the incidence rate of stroke within 90 days between the anterior and posterior circulation TIAs (11.2% vs 9.8%, P=0.776).The mean ABCD2 score was re-markably higher in the anterior than in the posterior circulation TIA (3.7 ±1.5 vs 2.5 ±1.3, P<0.001).The area under the curve (AUC) in predicting stroke risk was 0.711 for the former (95%CI:0.575-0.847, P=0.006) and 0.555 for the latter (0.298-0.820, P=0.637). Conclusion The ABCD2 score can predict early stroke risk in anterior but not in posterior circulation TIA .

Objective:This study investigates the clinical effect of bodyγ-knife combined with radiosensitizer and/or hyperthermia. for the recurrence of soft tissue sarcoma. Methods:Sixty-three patients with recurrent soft tissue sarcoma from January 2012 to March 2014 were treated by bodyγ-knife combined with radiosensitizer and/or hyperthermia. The patients were exposed to radiation dose levels of 4-5.5 Gy/fraction (10-13 fractions) with total doses of 44-55 Gy and 55%-70%isodose, including 95%PTV. The radiosensitizer, sodium glycodidazolum (CMNa), was administered to all patients at 1.00-1.50 g V.D qod at 5-6 fractions 0-3 h before bodyγ-knife treat-ment. Hyperthermia for 30 patients was delivered during the bodyγ-knife treatment with two fractions/week for a total of six frac-tions. Results:The total response rate was 77.7%three months after the treatment. The one and two year local control rates were 78.8%and 63.6%, respectively, while the survival rates of patients treated with bodyγ-knife with radiosensitizer at one and two years were 75.7%and 63.6%, respectively. The local control rates at one and two years were 83.6%and 70.0%, respectively, while the surviv-al rates at one and two years for bodyγ-knife combined with radiosensitizer and hyperthermia treatments were 80.0%and 63.3%, re-spectively. Serious complications of radiotherapy were not observed. Conclusion:Bodyγ-knife combined with radiosensitizer and/or hyperthermia is effective for recurrent soft tissue sarcoma.

Objective To evaluate the clinical toxicity and efficacy of S-1 combined with γ-ray body stereotactic radiation therapy in treatment of locally advanced pancreatic cancer.Methods Forty-five patients with locally advanced pancreatic cancer were randomly divided into two groups.The combination group received γ-ray stereotactic body radiation therapy which was given isodose curve of 50 ％-60 ％,tumor encircling dose of 3.0-4.5 Gy per fraction depended on dimension of tumors,9-12 fractions.Combined with S-1 40 mg/m2,2 times/d,for consecutive twenty-one days for four courses.The control group was given γ-ray stereotactic body radiation therapy only.Toxicities and effects were evaluated according to the criteria of WHO and RTOG.Results The CR rates in combination group and control group were 30.4 ％ (7/23) and 13.6 ％ (3/22),the response rates were 91.3 ％ (21/23) and 63.6 ％ (14/22) (x2 =4.980,P =0.026).The rates of gastrointestinal tract side reaction in combination group and control group were 82.6 ％ and 68.2 ％ (x2 =1.267,P =0.260),myelosuppression in combination group and control group were 78.3 ％ and 63.6 ％ (x2 =1.171,P =0.279).The rate of Ⅲ-Ⅳ grade myelosuppression in combination group were higher than that in control group (x2 =4.874,P =0.027).The median progression-free survival (PFS) rates of two groups were 8 months and 6 months respectively (x2 =1.357,P ＞ 0.05),the median survival period were 17 months and 14 months (x2 =1.017,P ＞ 0.05),1 year survival rates were 60.9 ％ and 54.5 ％ respectively (x2 =0.184,P ＞ 0.05).Conclusions S-1 combined with body gamma system treatment can improve local control rate and effective rate for inoperable patients with local advanced pancreatic carcinoma,and the adverse reactions are well tolerated.This method can be used as locally advanced pancreatic cancer chemoradiation safe and effective choice.

Objective To explore effect of different postures for PICC intubation through basilic vein in very low birth weight infants. Methods Eighty infants from Oct. 2013 to Sep. 2014 with PICC via basilic vein were set as the control group in which traditional method of preventing catheter displacement was applied, another 80 cases from Oct. 2014 to Sep. 2015 were divided to the observation group. And improved method was applied in the experiment group besides the traditional method. The ectopic occurrence rates of the two groups were compared. Result The ectopic rate of PICC catheters in the observation group was significantly lower than that of the control group (P<0.05). Conclusion When the catheter tip reaches the shoulder of the very low birth weight infants, the method of raising their upper limbs slightly to the head can reduce the ectopic incidence of catheters and thereby improve the success rate of PICC intubation.

BACKGROUND:In recent years, the number of cases of anterior cruciate ligament reconstruction with remnant preservation is increased year by year, but its clinical results, especialy effects on improving proprioceptive recovery after reconstruction, are stil controversial. OBJECTIVE: To compare the clinical effects of arthroscopic anterior cruciate ligament reconstruction with or without remnant preservation. METHODS:Totaly 146 patients undergoing arthroscopic anterior cruciate ligament reconstruction were randomly divided into two groups; preserving-remnant group and removing-remnant group. Autologous hamstring tendons were selected. Evaluation of knee mobility, Lysholm score, IKDC scores and knee stability was performed before and 6, 12 months after reconstruction. Proprioception was recorded before and 3, 6 and 12 months after reconstruction. The comparative analysis was carried out on these data between the group and between affected and healthy limbs. RESULTS AND CONCLUSION:114 patients were folowed up for over 12 months, including 61 in the preserving-remnant group and 53 in the removing-remnant group. There were significantly statistical improvements in knee mobility, Lysholm score, IKDC score and knee stability at 6 and 12 months after reconstruction in the two groups (P < 0.01), and the Lysholm score, IKDC score and knee stability were better in the removing-remnant group than the removing-remnant group at 6 months after reconstruction (P > 0.05). The knee proprioception was significantly improved at 3, 6 and 12 months after reconstruction in the two groups (P < 0.01), and it was also better in the removing-remnant group than the removing-remnant group at 3 and 6 months after reconstruction (P < 0.05). These findings indicate that the anterior cruciate ligament reconstruction with remnant preservation is beneficial to the recovery of postoperative proprioception and knee function.

Objective To investigate the clinical features and prognosis of the patients with renal cell carcinoma and venous tumor thrombus.Methods Fifty-six patients with renal cell carcinoma and venous tumor thrombus were selected as our subjects,who underwent radical nephrectomy and thrombectomy in the Second Hospital of Tianjin Medical University from June 2002 to May 2014.There were 28 patients with stage Ⅰ tumor thrombus,l5with stage Ⅱtumor thrombus,9 with stage Ⅲ tumor thrombus and 4 with stage Ⅳtumor thrombus.All patients underwent renal tumor resection and embolectomy,and were follow-up.Results Of all the patients,46 were male and 10 were female with a mean age of 61.7(age ranging from 42 to 83).Twenty-four were presented on the left kidney and 32 were right.The clinical features were as follows:The tumor size was 2.5 to 14 cm in diameter(mean:6.2 cm),there were 21 cases with low back pain,18 cases with hematuria,lcases with abdominal.Pathological results showed that 39 with clear cell carcinoma,9 with papillary cell carcinoma,3 with chromophobe cell carcinoma,1 with low-differentiated cell carcinoma and 1 with undifferentiated cell carcinoma,3 with sarcomatoid differentiation.Forty-three patients were followed up,and the median follow up period was 20.4 months (2-90 months).The median survival time for the patients was 47 months and the 5 year overall survival was 45.2％.The survival time of the patients with early tumor thrombus(below hepaticvein) was (55.3 ± 4.9) month,significantly longer than that of the patients with advanced tumor thrombus (above hepaticvein) ((24.8 ± 5.3) months,P =0.047).Conclusion Patients with renal cell carcinoma and venous tumor thrombus are characterized with high malignancy and poor prognosis.Surgical operations are effective therapies for the patients.Long term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor.

Objective:To find a feasible method to stimulate tumor-draining lymph node(TDLN) cells in clinic.Methods:CTL activity of TDLN cells induced by different stimulus (IL-2 group, IL-2+autologous tumor antigen group, IL-2+GM-CSF+IL-4+autologous tumor antigen group) was measured by the method of maximal LDH enzyme release. The mechanisms were explored by observation in morphology and detection of the CD83 positive rate of TDLN cells.Results:The level of growth of TDLN cells induced by (IL-2+GM-CSF+IL-4+autologous tumor antigen) was significantly higher than TDLN cells induced by IL-2 and (IL-2+autologous tumor antigen)(P

Objective To observe the effect of MAP4K4 targeted shRNA on biological characteristics such as proliferation,invasiveness,and apoptosis in human bladder cancer cell.Methods Differentially expressed genes was screened out through cDNA microarray analysis in 5 pairs of fresh-frozen muscle-invasive bladder cancer(MIBC) and adjacent normal tissue obtained from radical cystectomy.Combining the results of genechip and literature review,MAP4K4 was picked up for further analysis.To verify the result of microarray analysis,16 pairs of fresh muscle-invasive bladder cancer (MIBC) and adjacent tissues were assessed for the expression of MAP4K4 mRNA and protein through RT-PCR,qRT-PCR and Western-blot.T24 cell line was stably trasfected with MAP4K4 targeted shRNA and control shRNA,respectively.The effects of MAP4K4 silencing on proliferation,invasiveness and apoptosis of T24 cells transfected with MAP4K4 targeted shRNA and control shRNA were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),transwell and flowcytometry (FCM) assay.Results MAP4K4 was overexpressed in muscle invasive bladder cancer than in normal tissue.Down regulation of MAP4K4 expression decreased bladder cancer cell proliferation(MAP4K4-targeted versus control,P＜0.001),invasiveness(MAP4K4-targeted versus control,P=0.004)and promoted cell apoptosis(MAP4K4-targeted versus control,P=0.023).Conclusions MAP4K4 is overexpressed in muscle invasive bladder cancer than in normal tissue.Down-regulation of MAP4K4 expression inhibits the invasive ability of bladder cancer.Therefore,MAP4K4 might be a potential therapeutic target for bladder cancer.