180 U/L.CK-MB raised in only 5 cases(15.6%),and the highest was 28 U/L.Of the 218 MPP patients,only the 5 patients(2.3%) with raised CK-MB levels could be diagnosed as myocardial damage complicated with MPP.Conclusions The abnormal ECG is more important than myocardial zymogram in the diagnosis of myocardial damage complicated with MPP.Only higher level of certain myocardial zymogram without abnormal ECG can not be diagnosed as myocardial damage if lack of clinic and other objective evidences for myocardial damage.In watching out for myocardial damage,excessive examinations and treatments shall be avoided if possible.

ObjectiveTo explore the diagnostic value of plasma (1, 3)-β-D-glucan test (G test) in diagnosis of invasive fungal infections (IFI) and the influence of albumin on G test.Methods A prospective observational study was conducted. 267 patients admitted to medical intensive care unit (MICU) of Dalian Municipal Central Hospital from January 21st, 2012 to October 31st, 2014 were enrolled. According to IFI guideline, the patients were divided into without IFI group (n= 35), possible IFI group (n = 70), hypotheticle IFI group (n = 145) and proven IFI group (n = 17). G test was examined routinely using microbiology kinetic rapid reader MB-80.The different threshold values were calculated on G test. The difference among G tests, fungal culture and clinical diagnosis were compared. The results of G test ahead of and post albumin administration in each group were compared, and the value of G test for diagnosis of IFI during albumin infusion was evaluated.Results When the cut-off value was 20 ng/L for IFI diagnosis, higher sensitivity (79.8%), specificity (87.9%), and Youden index (67.7%) were found. The positive rates of G test, fungal culture and clinical diagnosis of IFI were 57.7% (154/267), 60.7% (162/267) and 54.3%(145/267) respectively, without showing significant differences (allP> 0.05). The result of G test (ng/L) was not obviously changed after albumin administration compared with that before in without IFI, possible IFI, hypotheticle IFI, and proven IFI groups (without IFI group: 11.25±2.33 vs. 10.99±1.07,t= -1.723,P= 0.085; possible IFI group: 53.14±5.53 vs. 49.22±8.11,t= -0.395,P= 0.693; hypotheticle IFI group: 90.30±9.38 vs. 85.41±10.11, t= 710.500,P= 0.860; proven IFI group: 100.98±19.24 vs. 103.21±17.66,t= 653.000,P= 0.449). Prior to the administration of albumin, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index were 79.8%, 87.9%, 45.6%, 96.7%, 67.7%, respectively. However, after the administration of albumin, they were 81.5%, 85.7%, 44.8%, 96.5%, and 67.2%, respectively, without significant difference.Conclusions G test is method for early diagnosis of IFI. The sensitivity and specificity are higher with 20 ng/L as the critical value. The result of G test is not interfered by albumin administration.

This article,in view of the research status and development tendency of hospital core competence,introduced the index selection process and constructed the evaluation index system of core competence.This system comprises 3 level-1 indexes (social reputation,hospital health resources and development potential)and 9 level-2 indexes,with recommendations on improvements of the existing system.

In this paper,based on theoretical analysis,the concept of hospital core competence is redefined,combined with the needs of hospital's development in medical service market,the connotation is also clearly definition,and the characteri stics is summarized.Meanwhile,on the basis of all above,this paper has carried on a thorough discussion about the construction of Chinese hospital core competence.

Hepatocyte transplantation may be a viable alternative treatment to liver transplantation for acute/chronic liver failure and metabolic liver disorders. Hepatocyte transplantation is an effective treatment to support liver function around liver transplantation due to its relatively easy manipulation and mild wound. In recent two decades, hepatocyte transplantation have been applied in clinical treatment and showed some effect in acute/chronic liver failure and metabolic liver disorders. Here, we sum up the status of clinical hepatocyte transplantation, discuss its value in clinical application and some challenges need to resolve.

OBJECTIVE: To analyze the research literatures related to bioartificial liver, and to make a conclusion concerning the development of bio-artificial liver.DATA SOURCES: Using bioartificial liver, liver cell, hepatocyte culture and bioreactor as search terms, searching Ovid, Springer Link database, and China National Knowledge Infrastructure, Vip Information database and Wanfang Date (1990.09-2008.09). Literatures search was limited to English and Chinese languages.DATA SELECTION: Researches regarding liver cells of bioartificial liver, reactors and auxiliary equipment was included, and the studies about immune and animal infection studies of bioartificial liver were excluded.MAIN OUTCOME MEASURES: ①The source, quantity and culturing of bio-artificial liver hepatocytes. ②Bioreactor type, nature and type of films. ③Composition of oxygen and temperature control devices of bioartificial liver.RESULTS: Totally 3898 documents seized initially in the searching by computer, according to inclusion and exclusion criteria, 29 were analyzed. Bioartificial liver was a hybrid device in which can culture hepatocytes in vitro, when the patient's blood flows through the device, material exchange with the cultured hepatocytes through semi-permeable membrane or direct contacting can take place, which can perform the same roles of detoxification, synthesis, biological transformation and other functions as real liver cells, so as to achieve the purpose of support and treatment. Bioartificial liver can also be involved in metabolism of the three major nutritive substances, as well as secretion of hepatocyte growth promo ting substances. So it is an effective alternative to the real liver as the function of detoxification and synthesis, and can fills the essential gap between the transplantation and acute liver failure.CONCLUSION: Although the bioartificial liver research has made significant progress, it still faces the problems such as limited liver cells sources, long-term maintenance of liver cell activity and function, and further optimization of the reactor design.

Objective To analyze the clinicopathological characteristics and prognosis of different subtypes of breast cancer patients with bone metastasis.Methods For this study, we recruited 300 primary breast cancer patients with bone metastasis treated at the Department of Oncology, the First Affiliated Hospital of Xi`an Jiaotong University, between September 1, 2007 and September 1, 2011.We also retrospectively analyzed their clinical and follow-up data.Results The percentage of Luminal A, Luminal B, human epidermal growth factor receptor-2 (HER-2) overexpression and triple negative subtypes in all the bone metastatic breast cancer patients was 59.0％, 16.0％, 13.7％ and 11.3％, respectively.Age, tumor size and histologic grade significantly differed among the four subtypes (P<0.05).However, there were no significant differences in menopausal status, lymph node metastasis, histological type or lymphovascular invasion among different subtypes (P>0.05).The median survival time of Luminal A breast cancer patients with bone metastasis was 28.6 months, longer than Luminal B (26.9 months), HER-2 overexpression (20.9 months) and triple negative breast cancer patients (12.0 months) with bone metastasis.The overall survival significantly differed among the patients with four subtypes of breast cancer.Conclusion Different subtypes of breast cancer patients with bone metastasis have different clinical characteristics and prognosis.Luminal A breast cancer patients with bone metastasis have better prognosis whereas triple negative subtype has poorer prognosis.

Objective:To investigate the effect of miR-106a on osteoarthritis.Methods:Twenty-four S-D female rats were randomly divided into three groupsaccording to the random number table: the sham operation group, the osteoarthritis (OA) group and the miR-106a mimic group. Eightweeks after operation, all rats were killed and articular cartilage was separated from the medial tibial plateau of each rat. Histopathology was used to observe the morphological changes and denatured quantity of chondrocytes, the level of inflamm-atory cytokines [interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-β 1], the expression of apoptosis receptor p65, DR6 protein and the expression of mir-106a RNA. The mean between groups was compared by one-way analysis of variance (ANOVA), and the least significant difference (LSD)- t test was used for the comparison between the two groups. Results:Histopathological staining results showed that the articular surface and synovium of rats in the sham operation group were intact, the chondrocytes were arranged horizontally, and the articular cartilage edge was smooth.In the OA group, the articular cartilage edge was seriously damaged and the arrangement of chondrocytes was disordered.In the miR-106a simulation group, the cartilage structure tended to be normal, occasionally uneven, and the articular cartilage surface was not smooth. Compared with sham operation group, the expression of miR-106a in OA group was significantly decreased ( F=918.02, P<0.01); the expression of inflammatory mediators (IL-1, IL-6, TNF-β) in OA group was also signifi-cantly increased ( F=41 914.86, P<0.01; F=64 85.16, P<0.01; F=8 873.31, P<0.01). The expression levels of DR6 and p65 in OA group were higher ( F=2 319.338, P<0.01; F=1 253.882, P<0.01). Compared with OA group, the levels of inflammatory mediators (IL-1, IL-6, TNF-β) in miR-106a mimetic group were significantly decreased (1.270±0.020, 6.040±0.170, 5.690±0.080), and the expressions of DR6 and p65 were decreased (1.53±0.09, 0.41±0.04). Conclusion:miR-106a can reduce the inflammatory changes and the degeneration of chondrocytes in osteoarthritis rats.

Objective To investigate the effects of cognitive interventions (CIs) in the context of communi- ty based rehabilitation (CBR) on cognitive deficits (CDs) in stroke patients.Methods Ninety-two stoke patients with CDs were randomly divided into a CI group and a control group.All patients were treated with conventional CBR.In addition,the patients in the CI group were also treated with special intervention therapy.The patients in both groups were assessed with the neurological and cognitive status examination (NCSE) for cognitive functioning, the FCA for motor function and the BI for their ability in the activities of daily living.Results The NCSE,FCA and BI scores in the cognitive intervention group after treatment were significantly higher than those before treatment and also significantly higher than those in the control group after treatment.Conclusion CIs can not only improve CDs,but also enhance recovery of motor function and ADL.

Objective To investigate the prevalence, etiology, rehabilitation demands and service condition of hearing disorders based on the whole population in Jilin Province, China. Methods Using the probability proportion to size (PPS) sampling, 9246 (93.3%) out of 9909 residents sampled form 36 counties were targeted for investigation from August, 2014 to January, 2015, followed the WHO Ear and Hearing Disorders Survey Protocol. The hearing loss and disability were classified as WHO recommended and Classification and Grading Criteria of Disability (GB/T 26341-2010). Results The standardized prevalence of hearing loss and disability was 16.41%and 4.78%, re-spectively. Age, sex, residence, occupation and marriage status, education level and household income were significantly associated with hearing loss prevalence, while nationality was not. The main etiologies included non-infectious disease (47.33%), ear disease (14.17%), un-known causation (13.89%), and noise (8.59%). Among all people with hearing loss, those who accepted intervention service accounted for 11.02%. Among all people with hearing disability, those who used hearing aids accounted for 5.58%, and 0.67%used artificial cochlea. Con-clusion Demographics and socioeconomic factors are significantly associated with the prevalence of hearing loss. The main etiology con-tains non-infectious disease, ear disease and noise. Both the rate of service utilization among people with hearing loss and the rate of adopt-ing hearing aids among people with hearing disability are low. It is needed to do more in prevention and rehabilitation of hearing impairment.