Confronted with the complex and volatile situation of the medical market, hospitals must formulate long-term development strategies, enhance their core competitiveness, and secure or maintain an undefeatable position amidst competition. The paper discusses the strategic management of large hospitals from five dimensions: improving hospital leaders' strategic-thinking and decision-making skills, continuously implementing brand marketing strategies, adopting the ideas and methods of strategic cost management, constructing information-based hospitals, and creating vigorous and dynamic hospital culture. It argues that only by strengthening strategic management can the sustainable and concerted development of hospitals be promoted.

Objective To observe the effect of residual tumor after radiotherapy on survival rate of patients with nasopharyngeal carcinoma (NPC). Methods From Jan. 1989 to Dec. 1998, 108 of 304 NPC patients pathologically confirmed, had residual tumor after radical radiotherapy, of whom, 26, 68, 14 had residual lesion in the nasopharyngeal cavity alone, cervical lymph node alone, and nasopharyngeal cavity plus cervical lymph node. Results The overall 1 , 3 , 5 , and 10 year survival rates (OS) significantly decreased in the residual group. The highest OS was in the group with nasopharynx residual alone, and the lowest in nasopharynx plus residual lymph node group. The bigger the residual lesion, the lower the OS. Conclusions The overall survival rate decreases in patients with residual lesion after radiotherapy, especially in patients with both nasophrynx and regional lymph node residual. Tumor residual after radiotherapy can be a prognostic indicator for patients with NPC.

The paper described the framework for the hospital to compile its "12th Five-year Plan", including the introduction, status quo analysis, planned objectives, and implementation strategy.The introduction in which needs to pinpoint the strategic objectives of the hospital in five years; the status quo analysis to cover the strengths, weakness, and threats and opportunities faced by the hospital in terms of both internal and external conditions; the planned objectives need to clarify the vision,mission, general goals and targets; and the specific strategies in the end. A scientific and feasible development plan can only be compiled based on conditions of the hospital, scientific rules and framework.

Objective To explore the identification of the hypoxia regions within the primary foci and imaging time selection in 18F-fluoromisonidazole (FMISO) imaging on patients with nasopharyngeal carcinoma (NPC).Methods From July 2013 to July 2014,44 NPC patients (33 males,11 females,age range:18-74(53.45± 12.88) years) underwent 18 F-FMISO PET/CT imaging,including 3 cases with twice imaging (totally 47 case times).Inaging data were acquired and reconstructed 2 and 4 h after the injection of 18 F-FMISO.1s F-FMISO PET/CT images were merged with MRI images obtained 1 week before to construct fusion images.The boundary of primary tumor was determined based on MRI.Visual analysis was performed and SUVmax of posterior cervical muscles,NPC primary foci was measured by 2 observers respectively.The uptake ratio of primary tumor to muscle (TMR) was calculated.The identify consistency of hypoxic region between two observers were evaluated by Kappa test and intraclass correlation coefficient (ICC).The image contrast was evaluated by Wilcoxon paired rank sum test of TMR.Results PET images and MRI images of NPC primary foci were successfully fused.Positive non-NPC tissues were identified by MRI.The visual recognition of hypoxic regions of the two observers for 2 and 4 h imaging were highly consistent (Kappa =0.931 and 0.965,both P＜0.001).There was a high degree of consistency between the SUVmax of posterior cervicalmuscles and that of primary tumors.ICCs of posterior cervical muscles in 2 and 4 h were 0.896 (95％ CI:0.814-0.942) and 0.924 (95％ CI:0.865-0.958),respectively.ICCs of primary tumors in 2 and 4 h were 0.991 (95％ CI:0.985-0.995) and 0.998 (95％ CI:0.996-0.999),respectively.TMRs (M(P25,P75))in 2 and 4 h were 1.560 (1.341,3.015) and 1.675 (1.387,3.001) respectively in 24 positive case times,and the difference was statistically significant (z=-2.557,P＜0.05).Conclusions Using fusion images of 18F-FMISO PET and MRI,hypoxic tissues within NPC primary foci can be accurately identified.There is a high degree of consistency within the visual and quantitative analysis of two observers.The image contrast of 18F-FMISO PET at 4 h is superior to that at 2 h.

Objective:To evaluate the protection of small bowel and bladder by Contoura carbon fiber belly board in patients with rectal cancer undergoing postoperative radiotherapy and the position deviation during radiotherapy. Methods: This study enrolled 45 consecutive patients with rectal cancer who had undergone prior surgery. Twenty patients who applied the belly board were defined as group A, and the other 25 patients were defined as group B. All the patients received threE-dimensional conformal radiation therapy(3D-CRT), and the prescriptive radiation dosage of 95% of planning target volume (PTV) was 50 Gy/25 times. Patients in group A underwent two sets of CT scans as follows: group A1, prone alone; group A2, prone with the use of the belly board. The radiation dosage and radiated volume in PTV, small bowel, and bladder were observed by dosE-volume histograms. Ten patients were selected randomly from group A and group B, respectively. Their position deviation during radiotherapy was measured by double exposure field verification system. The acute radiation reactions of all patients were observed and recorded during radiotherapy. Results: No significant difference was found in the total PTV and total volume of small bowel and bladder and mean irradiation dosage to PTV between groups A1 and A2. The mean irradiation dosage to the small bowel and bladder, the volume of small bowel irradiated at 10%-100% dose levels, and the volume of bladder irradiated at 30%-100% dose levels, were significantly decreased in group A2. The difference was significant. Compared with group B, the right-left and superior-inferior position deviations were significantly reduced in group A. The difference was significant (P<0.05). The anterior-posterior position deviation was also reduced, but the difference was not significant (P=0.705). The incidence of grade 3 or more adverse reactions were 15% (3/20) in group A and no patient broke off or stopped treatment; the incidence of grade 3 or more adverse reactions was 24% (6/25) in group B, and two patients broke off the treatment because of severe adverse reaction. One patient terminated the treatment. Conclusions: The Contoura carbon fiber belly board can reduce the irradiation dosage and volume of small bowel and bladder in patients with rectal cancer undergoing postoperative radiotherapy. The position deviation has better reproducibility and the acute radiation reactions are tolerable. It is worthy of application in clinic.

Objective:To explore the efficacy of elective nodal irradiation (ENI) and involved field irradiation (IFI) combined with chemotherapy in treatment of esophageal cancer.Methods:A total of 104 patients with esophageal cancer in Affiliated Hospital of Jiangnan University from May 2018 to May 2020 were selected as subjects for prospective study. All patients were randomly divided into observation group and control group by lottery method with 52 cases in each group. The target volume of observation group was delineated with IFI, and the control group was delineated with ENI. The curative effects, the levels of serum tumor markers [carbohydrate antigen 50 (CA50), squamous cell carcinoma (SCC) and carcinoembryonic antigen (CEA)] before and after treatment, the 1-year overall survival (OS) rate, the incidence of adverse reactions and the scores of various dimensions of health survey summary (SF-36) after treatment were compared between the two groups.Results:The total effective rate in the observation group was 90.38% (47/52), the total effective rate in the control group was 84.62% (44/52), and the difference was not statistically significant ( χ2 = 0.79, P =0.374). There was no statistical difference in CA50, CEA, SCC levels between the two groups before and after treatment (all P > 0.05). After treatment, the CA50, CEA and SCC levels in the two groups were lower than those before treatment, and the differences were statistically significant (all P < 0.05). The 1-year OS rate of the observation group was 94.23%, the control group was 90.38%, and the difference in OS between the two groups was not statistically significant ( χ2 = 0.54, P = 0.462). The incidence of acute radiation esophagitis in the observation group was lower than that in the control group, and the difference was statistically significant ( P < 0.001). There was no statistical difference between the two groups in SF-36 scale scores of physical functioning, role-physical, bodily pain, mental health, vitality, social functioning, role-emotional, and general health after treatment (all P > 0.05). Conclusions:Both ENI and IFI are effective treatments for patients with esophageal cancer. There is no significant difference in the quality of life of patients between the two delineation methods, but the incidence of acute radiation esophagitis is lower in patients with IFI regimen.

Objective: To explore sarcoplasmic reticulum ryanodine receptor2 (RyR 2) expression and calcium releasing function in chronic heart failure (CHF) rabbits and to study the impact of long term valsartan treatment in relevant animals. Methods: HF model was established by volume overloading with pressure overloading in experimental rabbits. 27 rabbits were divided into 3 groups: Sham group, HF group and HF+valsartan group. n=9 in each group and the animals were treated for 7 weeks. Left ventricular structure, hemodynamic parameters, expression and functional changes of myocardiocyte sarcoplasmic reticulum RyR 2 were observed and compared among different groups. Results: Compared with Sham group, HF group had increased left ventricular mess index (LVMI), left ventricular end diastolic pressure (LVEDP) and decreased left ventricular shortening fraction, LVEF, all P<0.05. Compared with HF group, HF+valsartan group showed decreased LVMI, LVEDP and increased left ventricular shortening fraction, LVEF, all P<0.05. Sarcoplasmic reticulum RyR 2 expression and calcium releasing function were lower in HF group than Sham group, P<0.05; while they were both higher in HF+valsartan group than HF group, P<0.05. Conclusion: Long term application of valsartan could improve the cardiac function which might be related to increased myocardial sarcoplasmic reticulum RyR 2 expression and calcium releasing function in experimental CHF rabbits.

Objective To investigate the effect of early adequate enteral nutrition (EN) on diaphragmatic thickness and prognosis of mechanical ventilation (MV) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by ultrasound. Methods Sixty-two MV patients with AECOPD and feasible to receive early EN were admitted to the Department of Intensive Care Unit (ICU) of Wenling Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from April 2017 to March 2018, and they were divided into an observation group and a control group according to random number table, 31 cases in each group. Besides conventional treatment, both groups started EN (EN) within 2 days, in the observation group, the EN was adequately treated, and the target calories were gradually reached within 3 days; in the control group, nourishing feeding was given, and the target calories were gradually reached after 7 days. Ultrasound was used to measure the diaphragmatic end-expiratory muscle thickness (DTee) and end-inspiratory muscle thickness (DTei) before and after treatment for 3 days, 7 days, and the diaphragmatic thickening fraction (DTF) were calculated; in addition, the MV time, ICU time of stay, 14-day success rate of off-line and incidence of ventilator associated pneumonia (VAP) were compared between the two groups. Results There were no statistical significant differences in the comparisons of age, arterial blood gas analysis and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score etc general status, and the parameters of DTee, DTei and DTF between the two groups before treatment (all P > 0.05). No statistical significant differences in DTee were found after treatment for 3 days, 7 days and after off-line in the comparisons between the two groups (mm: 3 days was 2.69±0.12 vs. 2.68±0.15, 7 days was 2.70±0.14 vs. 2.70±0.13, off-line was 2.71±0.15 vs. 2.70±0.10, all P > 0.05); while the DTei of the two groups were decreased after treatment for 3 days of treatment, the difference between the two groups being not statistically significant (mm: 3.27±0.13 vs. 3.26±0.12, P > 0.05), but the levels of DTei in the two groups were significantly increased after treatment for 7 days and after off-line, the differences between the two groups being statistically significant (7 days: 27.26±5.25 vs. 28.74±6.39, off-line: 34.19±4.78 vs. 30.10±2.90, both P < 0.01). There was no significant difference in MV time and ICU time of stay between the two groups [MV time (days): 7.8±1.0 vs. 8.5±1.2, ICU time of stay (days): 11.4±2.6 vs. 12.1±2.8, both P > 0.05], the 14-day success rate of off-line and incidence of VAP were similar in the two groups, and the difference were not statistically significant [14-day success rate off-line: 77.42% (24/31) vs. 70.98% (22/31), incidence of VAP: 6.45% (2/31) vs. 9.68% (3/31), both P > 0.05]. Conclusion The early adequate EN therapy can improve diaphragmatic function and prognosis in MV patients with AECOPD.

Objective: To explore the changes of protein expression and activity of calcium/calmodulin-dependent protein kinase-II (CaMK-II) in myocardium nucleus and sarcoplasmic reticulum in experimental rabbits with heart failure (HF).
Methods: A total of 16 rabbits were divided into 2 groups: Sham group and HF group, the HF model was established by volume overload plus pressure overload.n=8 in each group and all animals were treated for 7 weeks. Left ventricular structure, hemodynamic parameters and protein expression and activity of CaMK-II in myocardium nucleus and sarcoplasmic reticulum were examined and compared between 2 groups.
Results: Compared with Sham group, HF group presented increased left ventricular mass index (LVMI) (1.32 ± 0.06) g/kg vs (3.61 ± 0.09) g/kg, LVEDP (-1.50 ± 0.50) mmHg vs (23.00 ± 2.37) mmHg, allP<0.05; while decreased left ventricular shorten fraction (37.83 ± 3.58) % vs (17.38 ± 3.13) % and LVEF (71.92 ± 4.56) % vs (38.50 ± 6.07) %, allP<0.05. The protein expression and activity of CaMK-II were both higher in HF group than Sham group, allP<0.05.
Conclusion: Increased protein expression and activity of CaMK-II in myocardium nucleus and sarcoplasmic reticulum might be one of the mechanisms for HF occurrence in experimental rabbits.

Objective To compare the efficacy and safety of two concurrent chemoradiotherapy regimens between paclitaxel plus fluorouracil( TF) and cisplatin plus fluorouracil ( PF) in the treatment of locally advanced esophageal squamous carcinoma. Methods 103 patients with locally advanced esophagus carcinoma were treated in Affiliated Hospital of Jiangnan University from December 2014 to February 2016, and randomly assigned to either study group ( TF ) or control group ( PF ) according to random number table, of which 52 patients in the TF group while 51 patients in the PF group. The primary outcome was overall survival(OS), and secondary outcomes include progression-free survival(PFS), local progression-free survival( LPFS) and side effects. Results The 1-year OS for TF group was 76. 9％ versus 74. 5％ for PF group( P>0. 05 ) , and the 2-year OS for TF group was 59. 6％ versus 56. 9％ for PF group ( P >0. 05). The 1-year LPFS for TF group and PF group were 71. 2％ and 66. 7％ respectively(P>0. 05), and the 2-year LPFS for TF group and PF group were 61. 5％ and 58. 8％ respectively(P>0. 05). The 1-year PFS for TF group was 63. 5％ versus 62. 7％ for PF group ( P>0. 05 ) , and the 2-year PFS for TF group was 51. 9％ versus 39. 2％ for PF group ( P>0. 05 ) . The incidence rate of serious ( grade 3- 4 ) leukopenia for TF group was 36. 5％ versus 17. 6％ for PF group(χ2 =4. 642, P<0. 05). The incidence rate of serious (grade 3-4) acute radiation pneumonitis was 15. 4％ in the TF group, higher than that in the PF group with the rate of 3. 9％(χ2 =3. 859, P<0. 05), while the incidence rate of severe nausea and vomiting for PF group was 17. 6％ versus 1. 9％ for TF group(χ2 =7. 262, P <0. 05). The difference between the two groups was statistically significant. Conclusions Patients who were treated with two concurrent chemoradiotherapy regimens showed no difference in OS, PFS and LPFS. The regimen on the basis of Paclitaxel has higher risk of adverse effects incidence rates of hematological toxicity and acute radiation pneumonitis, while digestive system toxicity must be concerned when concurrent chemoradiotherapy is performed on the basis of cisplatin plus fluorouracil.