Description of the significance of the team learning theory in building a learning hospital.Building a flat structure in a learning organization, catering to the inherent needs of the hospital and its staff in development, selection of training materials conductive to building common vision of the team, effective and interactive means of training, and team trainings that are objective-specific, level-specific, hatched and focused.All these practices maximize the effectiveness of team learning, bringing forth in the hospital desirable changes in concepts, behavior, culture and performance in the building of a learning hospital

Autoimmune pancreatitis (AIP)is a special type of chronic pancreatitis that originates from an autoimmune -mediated mecha-nism.AIP has unique radiological,serological,and histopathological features,often accompanied by peripancreatic lesions.AIP may be easily confused with pancreatic cancer and cholangiocarcinoma.It is necessary to diagnose AIP while integrating a variety of clinical indica-tors.Steroid therapy should be performed for patients diagnosed with AIP,and surgical treatment can be selected if necessary.

BACKGROUND:Manual reduction or traditional steel plate fixation is commonly used for repair of proximal humerus factures in older patients, because of poor stability, making these injuries prone to fracture malunion. While open reduction with steel plate fixation has a better outcome than closed reduction, the stability of internal fixation is stil less than satisfactory. Clinical studies have shown that minimal y invasive treatment with locking compression plates has presented good clinical results in terms of fixation stability, bone healing, and functional recovery. Therefore, we hypothesize that use of a locking compression plate wil provide better stability and that biocompatibility wil potentiate fracture healing and shoulder function recovery in older patients with proximal humerus fractures. OBJECTIVE:To observe the improvement of minimal y invasive treatment with locking compression plates in older patients with proximal humerus fractures. MEHTODS:This prospective, single-center, randomized control ed clinical trial wil be completed at the Department of Joint Surgery, Affiliated Hospital of Qinghai University in China. Eighty-two older patients with proximal humerus fractures wil be enrol ed and equivalently assigned to two groups. In the test group, patients wil undergo closed reduction via a lateral approach to the shoulder fol owed by locking compression plate fixation using a minimal y invasive technique, and those in the control group wil be subjected to closed reduction via a lateral approach to the shoulder fol owed by conventional steel plate fixation using a minimal y invasive technique. Al patients wil be fol owed up for 6 months. The primary outcome wil be recovery of shoulder function as indicated by clinical outcome scores according to the Neer classification system for proximal humeral fractures 6 months after surgery. The secondary outcomes wil include the operation time;intraoperative blood loss;postoperative hospital stay;fracture healing time;clinical outcome scores according to the Neer classification system 0.5, 1, and 3 months after surgery;visual analogue scale scores 1 and 3 days and 1 and 2 weeks after surgery to assess pain;scores of the Medical Outcomes Study 36-item short form health survey 0.5, 1, 3, and 6 months after surgery to assess quality of life;and X-ray examinations 0.5, 1, 3, and 6 months after surgery to assess fracture healing. The experiment was approved by the Ethics Committee of Affiliated Hospital of Qinghai University of China (approval No. QHY1005D). Participants were informed to the test content and treatment process, and signed informed consent. DISCUSSION:This study protocol represents an attempt to objectively choose appropriate methods for internal fixation of proximal humerus fractures in older patients by comparing locking compression plate and conventional steel plate fixation to improve shoulder function. TRIAL REGISTRATION:This trial was registered with the ClinicalTrials.gov identifier:NCT02784522;on 19 May 2016.

Objective To observe the liver protection of Ginsenoside Rg1 and Oxymatrine and research its mechanisms.Methods Nonalcoholic fatty liver disease(NAFLD) model was induced by high-fat diet and hepatic fibrosis(HF) model was caused by CCl4 in rats. Protection effects of Ginsenoside Rg1, Oxymatrine and the combination were obsrved.ResultsBoth Rg1 and OMT significantly reduced serum total cholesterol(TC), triglyceride(TG), alanine aminotransferase(ALT) and aspartate amino transferase (AST) levels of NAFLD rats[Rg1 group (2.76±0.22) mmol/L,(1.24±0.17) mmol/L,(112.39±12.91)U/L, (195.16±12.99) U/L; OMT group (2.35±0.19) mmol/L,(1.09±0.09) mmol/L,(90.57±10.25) U/L, (186.45±13.14) U/L,P<0.05 or 0.01],elevated liver PPARα mRNA and PPARγ mRNA[Rg1 group: (0.64± 0.05),(0.77±0.07);OMT group(0.67±0.07),(0.73±0.06),P<0.05 or 0.01] and alleviated the degree of fatty liver. The effects of the combination group[(1.87±0.21) mmol/L, (0.77±0.10) mmol/L,(58.78± 8.87)U/L,(149.78±11.27)U/L,(0.81±0.09),(0.89±0.05) ] was better than single treatment group (P<0.05 or 0.01). Both Rg1 and OMT significantly reduced the serum ALT, AST levels and liver methane dicarboxylic aldehyde(MDA)content[Rg1 group: (46.75±5.11) U/L,(147.53±7.31) U/L,(5.54±1.06) nmol/g; OMT group:(148.24±4.32) U/L, (93.90±14.22) U/L,(5.85±0.91) nmol/g,P<0.01] in HF model[Rg1 group: (146.75±5.11) U/L,(147.53±7.31)U/L,(5.54±1.06)nmol/g; OMT group:(148.24±4.32) U/L,(93.90±14.22) U/L,(5.85±0.91) nmol/g,P<0.01], enhanced liver SOD activity[Rg1 group:(91.61±9.26) U/mg prot; OM group: (86.19±8.51) U/mg prot,P<0.01] and reduced the semi-quantitative score [Rg1 group:(2.7±0.4); OMT group:(2.9±0.5),P<0.05 or 0.01], the effect of the combination group[(92.21±4.36) U/L,(52.08±7.56) U/L,(3.68±0.54) nmol/g,(99.67±13.13) U/mg prot, (1.2±0.4)] was better than single treatment group.Conclusion Ginsenoside Rg1 and Oxymatrine had synergic of liver protection and the synergic regulation of liver PPARα, PPARγ and antioxidant effect, which should be the potential mechanisms.

Objective To investigate the efficacy of disodium pamidronate in treatment of bone metastasis cancer .Methods 50 cases of bone metastasis cancer were divided into control group and experimental group according to different medication, 25 cases in each group.Control group was treated by chemotherapy, experimental group was treated on the basis of control group with disodium pamidronate 45 mg+0.9%sodium chloride solution 500 mL, intravenous drip.Pain maintenance time, patient pain grading and serum NTx levels were compared after treatment.ResuIts Compared with control group,pain maintenance time of experimental group was longer(P <0.05),pain level overall score was lower,NTx was lower(P <0.05). ConcIusion Disodium pamidronate can inhibit bone metastasis cancer patients with the degree of pain, reduce the levels of serum NTx.

OBJECTIVE:To investigate the influence of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on hemodynamics,stress reaction and anesthesia effects of pediatric hernia surgery. METHODS:Eight-six children underwent hernia surgery in Hubei Provincial Third People's Hospital from May 2011 to Sept. 2015 were selected as subjects and divided into tri-al group and control group according to random number table,with 43 cases in each group. Trial group was given Tirofiban hydro-chloride for injection 0.4 μg/(kg·min),ivgtt,Cisatracurium besilate for injection 0.1 mg/kg+Fentanyl citrate injection 1.0 μg/kg,iv, for anesthesia induction;given 2%-3% sevoflurane inhalation for anesthesia maintenance,and additionally given fentanyl citrate 0.5 μg/kg,iv if necessary. Control group was given Propofol emulsion injection 3 mg/kg+atracurium 0.1 mg/kg+ fentanyl citrate 1.0μg/kg,iv for anesthesia induction;given micro pump injection of propofol 3 mg/(kg·h)for anesthesia maintenance,and additional-ly given fentanyl citrate 0.5 μg/kg,iv if necessary. The onset time of anesthesia,hemodynamic parameters (SBP,DBP,HR), stress reaction indexes(NE,E,R),recovery situation and the occurrence of ADR were observed in 2 groups. RESULTS:The on-set time of anesthesia in trial group was(3.82±0.45)min,significantly shorter than control group(5.13±0.74)min,with statisti-cal significance(P<0.05). Before anesthesia induction,there was no statistical significance in SBP,DBP,HR,the serum levels of NE,E and R between 2 groups(P>0.05). The levels of SBP,DBP,HR of 2 groups at incision,5 min after incision,10 min after incision were significantly higher than before anesthesia,with statistical significance(P<0.05). Above indexes of trial group at incision,5 min after incision were significantly lower than control group,with statistical significance (P<0.05). At incision, the serum levels of NE,E and R in 2 groups were increased significantly compared to before anesthesia induction,but the trial group was significantly lower than the control group,with statistical significance (P<0.05). The postoperative eye opening time, awake time and orientation recovery time of trial group were significantly shorter than control group,while the PAED score was sig-nificantly lower than control group,with statistical significance(P<0.05). The incidence of ADR in trial group(0)was significant-ly lower than control group (11.6%),with statistical significance (P<0.05). CONCLUSIONS:Sevoflurane inhalation anesthesia has less effect than propofol intravenous anesthesia on hemodynamic indexes and is helpful to relieve stress reaction and promote postoperative revival with good safety.

1 ?mol/L,24 h); (3) With the development of neoplastic transformation, the resistance to terminal differentiation induced by some promoter increased till the promoter became mitogenic. Conclusion: The development of transfected cells provides a powerful and convenient model for detecting potential tumor promoters and research on the mechanisms of promotion tumor.

In recent years,with the rapid development of minimally invasive spine surgery,lumbar disc herniation of minimally invasive treatment is an important progress.The operative injury is small,the duration is short and the effect is satisfactory.Correct recognition of microinvasive surgery,strictly grasp of its indication and perfect operative techniques are the keys to get good therapeutic efficacy.In this review,various methods of minimally invasive techniques and their clinical applications are summarized.

Objective To investigate the status of urogenital Ureaplasma urealyticum (Uu) infection and their drug tolerance in our area,so as to guide rational administration for the clinic.Methods Mycoplasma culture and drug susceptibility test were performed for 771 patients with urogenital infaction. The culture,identification and drug resistance of mycoplasma were carried out with one complex mycoplasma kit.Results The positive rate of Uu was 49.9%. The proportional percentage of males was 12.5% and the Uu positive rate was 22.3%,for females,the proportional percentage and Uu positive rate was 87.5% and 60.6% respectively. The population aged 21-40 was susceptible to Uu infection. The most sensitive antibioties to Uu was clindamycin (95.12%),followed by doxycycline (87.57%) and roxithromycin (86.24%).Conclusion The difference of Uu drug sensitivty was significant in different areas. So it is necessary to select antibioties by drug sensitivity. Clindamycin,doxycycline and roxithromycin may are used as preferred antibioties in treating Uu infection in our area. The drug-resistance status of spectinomycin and lincomycin was serious.

Objective To observe the clinical efficacy of Bushen-Yiqi-Huayu capsule in the treatment of vascular dementia.Methods 58 cases who diagnosed with vascular dementia,Chinese Traditional Medicine fine for the gas deficiency and blood stasis,Tanzu patients were randomly divided into two groups:observation group with 30 patients(oral Bushen-Yiqi-Huayu capsule); control group with 28 cases (oral Piracetam tablet),Treatment course three-months. Results The total effective rate was 86.7 percent,compared with the control group (total effective rate 60.8%), and the difference was significant (P