Introduced in the paper are the background,mode and development course of Taizhou Enze Medical Center (Group),with special focus on the concrete measures of its group management,including the reconstruction of human resource,finance,property,information,professional skills and knowledge resources.It also made recommendations based on its practice and experience.

Objective To evaluate the diagnosis and micro-invasive treatment of ureteral obstruction after complete cystectomy. Methods All the 12 patients (primary diseases:10 cases of bladder tumor,1 of small bladder of tuberculosis,1 of radiocystitis;post-operative ureteral obstruction:9 cases of anastomotic stenosis,3 of supra-anastomotic obstruction) underwent MRI and experienced nephroscopic monitoring for diagnosis.Eleven patients underwent surgical treatment.Of them,6 cases received ureter nickel-titanium alloy trestle;4 cases (6 sides),ureter trestle,and 1,ureterocystostomy. Results All the 12 cases were correctly diagnosed.Of them 11 were followed up for 3 months to 5 years.IVU showed normal renal function and complete resolution of hydronephrosis of the diseased kidneys in 9 cases and relief of hydronephrosis in 2.Cr and BUN were normal in all the cases.Only one case of bladder cancer died of lung metastasis. Conclusions Pelviureteroradiography under MRI or nephroscopic monitoring is the most valuable method of examination for ureteral obstruction after complete cystectomy.Surgical ureter trestle and nickel-titanium alloy ureter trestle are simple,micro-invasive and effective for paitens with such post-operative obstruction.

The key to clinical paths administration lies in the optimization of the key processes and sectors in medical service, which will achieve an integration that is based on patients and span departments to cover all medical service sectors and processes. The clinical path practice was introduced into the hospital in 2005, and the clinical paths have been put into practice for over 20,000 cases/occasions by the end of 2009, scoring satisfactory social and economic outcomes as of now. For the purposes of speeding up the clinical path practice for expected outcomes in optimizing key medical service processes, we have got the following eight experiences and lessons: (1) Build shared demands; (2)Establish a powerful leadership; (3) Develop and promote visions; (4) Eliminate resistance and pool the forces; (5) Keep on the efforts and focus on details; (6) Reward involvements; (7) Recruit and develop key operators within the hospital; (8) Systemize and supervise the experiences of implementation.Promotion of clinical paths is a renovation in management with its inherent rules. Adoption of appropriate technical strategies and cultural strategies will upgrade the quality and acceptance of clinical path implementation.

Objective To evaluate the therapeutic effects of combined recombinant human IL-11(rhIL-11) and recombinant human G-CSF (rhG-CSF) on the neutron-irradiated dogs. Methods 18 male beagle dogs were divided into radiation control group (C, n=7), symptomatic treatment group (S, n=4), and combination therapy group (T, n=7). All dogs were exposed to total body 2Gy 90% neutron radiation. From the first day after radiation, the animals of group T received rhG-CSF 10?g/(kg?d) and rhIL-11 50?g/(kg?d) subeutaneously for 14d and 21d respectively. The cell counts of peripheral blood and CFU-GM of bone marrow were carried out. Results All animals of group S and T survived, however, the survival rate of group C was only 57%. The cellcounts of T group peripheral blood cells (white blood cell at any time point , the platelet and red blood cell of recovery phase) were higher than that of C or S group. The count of T group bone marrow CFU-GM was 6 fold higher than that of group C or S on day 1, and still 1.75, 1.46 fold higher than that group C or S, respectively, on day 33. Conclusion the combination therapy of rhIL-11 and rhG-CSF significantly raised the white cell and platelet counts in ARS dogs induced by neutron irradiation by accelerating the recovery of bone marrow hematopoietic function.

Objective To evaluate the effect of rhIL-11 on radiation injury to the intestinal epithelium and cells cycle of intestinal epithelial cell in mice irradiated with 3.5 Gy neutron. Methods The morphology of the small intestinal epithelium, crypt cells necrosis, and cell proliferation were observed of the epithelial cells of the irradiated mice. Cell cycle of the epithelial cells of the small intestine of the mice was examined by flow cytometry. Results rhIL-11 pretreatment before and treatment after irradiation could accelerate the repair of small intestinal mucosa in irradiated mice. G 2/M block which occurred in the irradiated small intestinal epithelial cells and the rhIL-11 treatment might significantly increased the proportion of cells at S phase. Conclusion rhIL-11 could significantly exert a preventive effect on the small intestine against radiation injury in neutron irradiated mice, with an impact on cell cycle of the intestinal epithelial cells.

Objective The effect of Asperosaponin Ⅵ(ASAⅥ)on adipocyte differentiation and the involvement of Wnt signal pathway was investigated. Methods The murine bone marrow stromal cell line ST-2 were divided into 6 groups:control group, adipocyte differentiation group, and 4 different doses of ASAⅥgroups. Control group was exposed to the vehicle, adipocyte differentiation group was exposed to adipogenic reagent, and those 4 ASAⅥgroups were treated with different concentration(10-7, 10-6, 10-5, 10-4 mol/L)of ASAⅥafter adipocyte differentiation induction. 5 days later, oil red O staining was performed to calculate adipocyte rate. Then mRNA transcription levels of PPARγ, FABP4 genes andβ-catenin that were Wnt/β-catenin signaling pathway proteins were examined by FQ-PCR. Then Wnt pathway inhibitor DKK1 was supplemented into ST-2 cells treated with 10-4 mol/L ASAⅥfor 5 days. After that FQ-PCR was used to detect whether tran?scription levels of PPARγ, FABP4 andβ-catenin in ST-2 cells were changed. Results Compared with adipocyte differenti?ation group 10-5 mol/L and 10-4 mol/L ASAⅥtreatments greatly down-regulated the number of lipid droplets and markedly inhibited transcription levels of adipocyte characterization transcription factors included PPARγ, FABP4 while up-regulat?ed transcription level ofβ-catenin in ST-2 cells. DKK1 can reverse the inhibitory effect of ASAⅥon adipocyte differentia?tion in ST-2 adipocyte. The transcription levels of PPARγand FABP4 were up-regulated significantly while transcription level ofβ-catenin was inhibited. Conclusion ASAⅥblocks adipocyte differentiation in ST-2 cells which might be medi?ated through activating Wnt/β-catenin signaling pathway.

Aim To study the influence of PD on the activity of PKC(protein kinase C) of VSMC during ischemia and hypoxia.Methods The hypoxia model was made by drawing off the oxygen of an enclosed acryl glass box and ischemia model was made by low sugar culture medium. Then the activity of PKC was measured by ?-scintillation counting instrument.Results It was found that the activity of PKC of cytoplasm in VSMC in ischemia and hypoxia situation increased (vs normal group P0.05 ).Conclusion PD can reverse the PKC activities induced by ischemia and hypoxia. It may be one of the mechanisms of PD to have antishock effect.

Objective To investigate the treatment of the complications of puncture lapsus after the percutaneous vertebroplasty (PVP) for osteoporotic fractures.Methods From December 2011 to November 2014,3 female patients with postoperative complications of PVP which were treated for osteoporotic fractures,aged from 71 to 82 years (average,78 years old) were involved.Each of them performed a revision surgery in our hospital.One of them was performed with PVP of the 12th thoracic vertebral due to the osteoporotic thoracic vertebral compression fracture.However,bone cement was leaked into spinal canal after PVP,and the patient suffered from left abdominal constriction and impaired of sensation in left inguinal region.She underwent anterior approach of decompression,cement removal and internal fixation one year after the first operation.The second case was performed with PVP of the 1st lumbar vertebral due to the osteoporotic lumbar vertebral compression fracture.In this case,bone cement was leaked into spinal canal after PVP,and the patient suffered from abdominal and lower extremity pain,paralysis,and hypoesthesia of lower limbs.This patient was treated with posterior approach of decompression,cement removal and internal fixation.The third case was performed with the 12th thoracic vertebral PVP due to the osteoporotic thoracic vertebral compression fracture.Subdural hemorrhage happened after PVP,and the patient suffered from paralysis and sensory loss of the two lower limbs.This patient was treated with posterior approach of laminotomy,hemostasis in the spinal canal and evacuation of hematoma.We performed a follow up from 21 to 29 months (average,24.7 months),to observe the recovery of the patients.Results one case' s abdominal constriction eliminated and the inguinal region pain improved after the revision surgery,and there's no internal fixation loosening with the follow-up of 21 months.The other case's abdominal and lower limb pain relieved,the lower limb muscle strength recovered to grade 4,and the tactile of lower limb recovered to normal after the revision surgery.There' s no internal fixation loosening with the follow-up of 29 months.One case of patients with slightly recovered of lower extremity muscle strength and feeling after surgery,and remained lower limb pain,died two years after the surgery.Conclusion Complications of spinal cord compression after percutaneous vertebroplasty (PVP) for osteoporotic fractures can get good outcomes by using appropriate revision surgeries,although revision surgery is difficult and risky.

Objective:The objective of this study was to evaluate the relationship between the adequacy of nutritional therapy and prognosis in trauma patients.Methods:217 trauma patients were included.The nutritional therapy interventions were divided into three groups:low energy therapy (＜50％),moderate energy therapy (50％ ～ 80％),high energy therapy (＞ 80％).General data,hospitalstay,ICU stay,infectious complications and mortality were compared among groups.Results:The protein intake of high energy group was higher than the other two groups (P ＜0.01).High energy therapy was associated with reduced mortality and decreased length of hospital stay.Kaplan-Meier survival analysis indicated that high energy therapy had a significantly higher 60 days cumulative survival rate compared with other groups.Conclusion:High energy therapy is more effective and associated with improved mortality and decreased length of stay.

OBJECTIVETo investigate the clinical effect of Halo-vest head ring in the treatment of replantation of total scalp avulsion.

METHODSWe treated 11 cases of total scalp avulsion with the anastomosis of arteriovenous vessels and Halo-vest head ring from December 2006 to February 2015.

RESULTSOne patient's replanted scalp got necrosis because of serious contusion which was healed without hair growth after free skin graft and dressing. All the scalp flaps in the other 10 patients survived. After 3-96 months follow-up, the wound completely healed, the scalp and hair grew well with satisfactory appearance.

CONCLUSIONSThe use of Halo-vest head ring for replantation of total scalp avulsion can effectively improve the survival rate and survival area.

Anastomosis, Surgical ; methods ; Bandages ; Graft Survival ; Humans ; Lacerations ; surgery ; Necrosis ; etiology ; Prostheses and Implants ; Replantation ; methods ; Scalp ; injuries ; pathology ; surgery ; Skin Transplantation ; methods ; Surgical Flaps