This paper reviewed and analyzed the management and performance of 43 key clinical pmjeets in recent ten years in Fudan University(the clinical part of original Shanghai Medical University).It was found that hardware equipments of clinic,the ability of disease prevention,diagnosis and treatment obviously improved,the talent training and personnel structure received outstanding outcome,the academic level of basic researches got obvious promotion,the preponderant disciplines established gradually and consolidated,and the center radiation effect showed preliminary success under the aid of key project fund.Constructing the key clinical projects should boost actively amalgamation of medicine and sciences and pay a great attention to develop the medicine auxiliary discipline to further enlarge the clinical research achievements and fully display the guidance function for the development of our country~clinical medicine discipline under the new situation.

Since the beginning of 973 plans and major scientific research programs,the ministry of science and technology has organized the implementation of a number of major projects under the principle guidance of top-level design,co-ordinate arrangements,advantage integration and dynamic adjustment.Prominent advance of technology and expansion of innovation capacity has become possible with the success of those major projects.As a dominant force of basic science research,universities took part in the designing and implementing of most of 973 major scientific research programs.In this paper,participating universities,such as Peking University,Tsinghua University,Fudan University,Zhejiang University,Shanghai Jiaotong University,University of Science and Technology of China,Nanjing University,were analyzed in their roles played in those projects,and the questions of how universities should make the adjustment to their planning and management to meet the requirements of future national research programs were discussed.

Objective To study the state of doctors' psychological capital in public hospitals,and to analyze the characteristics of such capital,so as to better leverage the capital as a hospital management tool.Methods A quantitative and qualitative research was made on the state of doctors＇ psychological capital.Results The doctors' task-oriented psychological capital scored 4.25,and guanxi-oriented psychological capital 4.41; “modesty and prudence”scored the highest in all dimensions of the doctors' psychological capital,“optimism and hope”lowest; the doctors with different genders,ages,seniority,and monthly average income have a difference in psychological capital.However,no significant difference was found with varying titles,hospital levels,and employment models.Conclusion The doctors were found with a strong psychological capital to cope with stress.Better psychological capital will raise quality of care in practice.

The clinicopathological data of 173 cases of inflammatory myofibroblastic tumor (IMT)were retrospectively analyzed.Among them 125 were males and 48 females with a mean age of 47.9 y (5-78 y).The lesions of 117 cases were located in lungs,41 cases in eyes,8 in ileocecum,2 in liver,2 in spleen,1 in abdominal wall,1 in maxillary sinus and 1 in face.The average diameter of lesions were 3.5 cm,ranging from 1.0 cm to 7.0 cm.The clinical manifestations were not specific,depending on the locations of tumor.The imaging examinations were helpful for diagnosis.The prcsence of slender-spindled myofibroblasts and proliferation of fibroblast cells,with infiltration of chronic inflammatory cells were the basic histopathological features of the disease.Combined with the histological characteristics and immunohistochemical staining IMT can be differentiated from other spindle cell tumors.Appropriate surgical resection is the main treatment for IMT.

Objective To investigate the infection prevention effect of prophylactic use of antibiotics for cancer inpatients with leukocyte count ≤ 1 × 109/L.Then to provide the basis for rational use of antibiotics.Methods It was retrospectively surveyed that the infection situation and prophylactic usage of antibiotics in the 426 cancer inpatients with leukocyte count ≤ 1 × 109/L caused by radiotherapy and chemotherapy.Results In the 426 inpatients,the infection rates of patients with and without prophylactic use of antibiotics were 11.0％ and 20.9％ respectively.The difference was statistically significant (x2 =6.815,P =0.009).The leukocyte count median values of patients with and without infection were 0.73 × 109/L and 0.77 × 109/L respectively.The difference had no statistical significance(Z =-1.257,P =0.209).The main infection sites were lower respiratory tract,upper respiratory tract and gastrointestinal tract with infection rates of 48％,12％ and 11％,respectively.The top five pathogens were Klebsiella pneumonia,Enterobacter cloacae,Escherichia coli,Enterobacter aerogenes and Staphylococcus aureus.The most use of antibiotics were cephalosporin.Conclusion When the leukocyte counts of cancer inpatients are less than or equal to 1 × 109/L induced by chemotherapy and radiotherapy,reasonable prophylactic use of antibiotics can reduce hospital infection rates.

The State Key Specialized Scientific Projects bring the unprecedented opportunity for the development of variety disciplines and provide the critical timing for the improvement of science and technology of university. Meanwhile, it presents new challenges to develop the frontier of sciences and to promote cooperation and cross of different disciplines. Through the process of the programs, we will expect to train and find team leaders and outstanding scientists. This paper presented the brief outline how the researchers from the Departments of Infectious Disease and School of Pharmacy in Fudan University collaborated in a cross-discipline manner and integrated the research resources based on the objectives of the research programs. During the application, they reorganized research teams, combined the overlapping research fields to focus the direction of research fields according to the national and research needs. In the process of their application, they finally promoted the capacities for their competition and innovation which were undoubted to help us to establish headship/main forces in the fields of infectious disease precaution and devolvement of new clinical medicine in the future.

Objective To investigate the adhesion mechanism of Lactobacillus acidophilus FN001外to Peyer's patches. Methods Adhesion of L. acidophilus FN001 to mice Peyer's patches was studied in vitro using a fluorescent quantization method. The nature of adhesion mediator was studied by the effects of physical, chemical and enzymatic pre-treatments of the bacteria on their adhesion and effect of sugars on in- hibition of adhesion. The presence of lectin-like proteins in the cell surface was determined by hemagglutina- tion. Effect of L. acidophilus FN001 on inhibition of adhesion of pathogens to Peyer's patches was also stud- ied. Results The adhesion of L. acidophilus FN001 was strongly inhibited in the presence of D-mannose and methyl-ct-D-mannoside. Pretreatment of L. acidophilus FN001 with pepsin and trypsin decreased the ad- hesive capacity indicating that cell surface proteins are involved in adhesion to Peyer's patches. L. acidophi- lus FN001 could agglutinate rabbit red cell in mannose specific manner and protease pretreatment could de-crease hemagglutinin, suggesting that L. acidophilus FN001 has mannose specific lectin (s). In adherence inhibition assay, L. acidophilus NF001 could significantly inhibit adhesion of E. coli ATCC25922 to Peyer's patches when L. acidophilus NF001 were applied to Peyer's patches first or at the same time with pathogen. Conclusion It was concluded that a mannose-specific protein mediated adhesion of L. acidophilus FN001 to the Peyer's patches, and L. acidophilus FN001 could inhibit adhesion of pathogen with similar lectins speci- ficity to Peyer's patches.

Objective To evaluate the dose distribution of target volume and normal tissues in forward intensity modulated radiotherapy (fIMRT) and inverse intensity modulated radiotherapy (iIMRT) modes for breast cancer after radical mastectomy.Methods Both fIMRT and iIMRT plans were developed for 10 patients with breast cancer after radical mastectomy.On each patient's CT images the supraclavicular area, chest wall, and internal mammary area were delineated.The prescription dose was 50 Gyin 25fractions.In the fIMRT plan X-ray irradiation at the dose of 6 MV was adopted for the supraclavicular and the chest wall areas and electron irradiation at the dose of 9 - 12 MeV was adopted for the internal mammary area, and the doses of cold and hot spots were adjusted according to the fitting doses of these 3 regions.In the iIMRT plan the supraclavicular area, chest wall, and internal mammary area were taken asa whole target, 6 MV X-rays was used, and inverse optimal design was performed.The dose distribution oftarget volume and normal tissues, conformal index (CI) , and heterogeneous index (HI) , and acceleratormonitor unit (MU) were analyzed using dose-volume histogram (DVH)for the two intensity modulated modes.Results The maximum dose of PTV of the iIMRT plan was significantly lower than that of the fIMRT plan(t = -3.23,P ＜0.05), the minimum dose and V95% of PTV of the iIMRT were significantly higher than those of the fIMRT plan(t = 4.08, -2.69, both P ＜0.05).The CI level of the iIMRT plan was significantly higher than that of the fIMRT plan and the HI level of the iIMRT plan was significantly lower than that of the fIMRT plan (t = -3.13, 2.74, both P ＜0.05).There were not significant differences in V10, V20, V25, V30, and Dmean of the ipsilateral lung between these 2 groups.However, the V15 of ipsilateral lung of the iIMRT group was significantly lower by 4.2% than that of the fIMRT group (t= 3.2, P ＜ 0.05).There were not significant differences in the mean dose (Dmean) and V30 of heart, and Dmean of contralateral lung and contralateral breast between these 2 groups.Conclusions Compared with fIMRT, the iIMRT plan results in more PTV coverage, higher conformity index, and more homogeneous dose distribution, with lower dose upon the lung at the affected side, and better protection of the contralateral lung, heart, and breast.

Objective To compare the dosimetric differences of three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and volumetric modulated arc radiotherapy(V-MAT) for external beam partial breast irradiation.Methods Twelve patients with breast cancer receiving breast-conserving surgery and external beam partial breast irradiation were enrolled.Three different techniques including 3D-CRT,IMRT and V-MAT were designed for each patient.The dosimetry in the target,the dose to the organs at risk(OAR),the MU and delivery time were compared.Results All three plans met the clinical requirement. 3D-CRT showed the worst conformity in target. V-MAT provided the lowest target coverage and homogeneity in target.3D-CRT plans showed the lowest values for the V5,V10,mean dose and the highest values for V30 in the ipsilateral lung.No statistically significant differences were observed in V20 of the ipsilateral lung among three plans.V-MAT showed the lowest values in ipsilateral normal breast volume 15,20 and 25 Gy post-irradiation.For V5,the mean and max dose in heart,the mean dose in contralateral lung and the mean,max dose in thyroid,IMRT and 3D-CRT showed the highest and lowest value respectively(z =-2.94 - -2.09,P ＜ 0.05 ).The MUs in 3D-CRT,IMRT and V-MAT were 417.6 ± 34.4,772.8 ± 54.4 and 631.0 ± 109.0,respectively (z =- 2.93, - 2.76,-2.93,P ＜ 0.05 ). V-MAT significantly reduced the delivery time. Conclusions V-MAT shows significant advantages in reducing the dose in the ipsilateral normal breast and the delivery time compared with 3D-CRT and IMRT.

Objective To detect the expression of delta-like ligand 4 (DLL4) and its relation with the angiogenesis in pancreatic cancer.Methods SP immunohistochemistry method was used to detect the expression of DLL4 in pancreatic cancer and para-cancerous tissue.The microvessel density (MVD) was calculated with CD34 staining for microvessel endothelium and the correlation between expression of DLL4,MVD and clinicopathological parameters of pancreatic carcinoma was investigated.Results The expression of DLL4 in pancreatic cancer was significantly higher than that in para-cancerous normal pancreatic tissue (68.3％ vs 20％,P ＜0.01 ).The over-expression of DLL4 in pancreatic cancer was positively related to the differentiation degree,TNM staging,metastasis and invasion (P ＜0.05),but not related to the location,tumor size and histological types.The MVD in pancreatic cancer tissues was significantly higher than that in para-cancerous normal tissues (34.9 ± 13.2 vs 18.9 ±2.2,P ＜0.01).MVD was correlated with the differentiation degree,TNM staging,metastasis and invasion (P ＜0.05 ),but not with the tumor size and location,histological types.MVD in pancreatic cancer expressing DLL4 was significantly higher than that in pancreatic cancer not expressing DLL4 ( 38.8± 10.7vs 29.0 ± 15.2,P =0.038 ),and the expression of DLL4 and MVD were positively correlated ( r =0.669,P ＜ 0.05 ).Conclusions DLL4 expression may play an important role in pancreatic carcinogenesis by promoting angiogenesis and may be associated with tumor invasion and metastasis.