This article makes a summary on the vascular access issues related to pediatric blood purification and progress,especially in view of the characteristics,principles of selection,maintenance and development direction of various vascular access in application of children patients.

External evaluation of large medical institutions is key to performance management in the medical sector,which is both a major means for the government to manage such institutions and a key guideline for their internal performance management. Based on a study on the pathways of such institutions in the UK,the USA and Japan in their external evaluation of performance,the paper summarized practices of Shanghai,Shenzhen,Zhenjiang and Beijing,in an attempt to offer references for building the external evaluation system for such institutions in China.

Objective To observe the clinical effects and complications of primary trigeminal neuralgia treatment with radiofrequency thermocoagulation on gasserian ganglion. Methods Under the guidance of C-arm or DSA and with Hartel method, we percutaneously punctured the oval foramen to gasserian ganglion and performed radiofrequency times. Results Pain was completed eliminated in 53 of the 56 patients, which was regarded as degree Ⅰ of clinical cure with the curativeness rate being 96.4%; 1 case was of degree Ⅱ; 1 case was of degree Ⅲ; 1 case had no effect. The rate of satisfactory effectiveness was 96.4% and the total rate of efficacy was 98.2%. No severe complications were observed. Conclusion Radiofrequency thermocoagulation is a safe and effective method to treat primary trigeminal neuralgia with few severe complications.

Objective To detect the expressions of enhancer of zeste homology 2 (EZH2) and signal transducer and activator of transcription 3 (STAT3) in gastric cancer tissues,and analyze the relationship between their expressions and clinicopathological factors and prognosis of patients.Methods The clinical data of 67 patients with gastric cancer who were admitted to the People's Hospital of Peking University from May 1999 to April 2000 were retrospectively analyzed.Gastric cancer tissues and adjacent normal tissues were harvested and fixed in 4％ formaldehyde,and then to make the tissue chips.The protein expressions of EZH2 and STAT3 were detected by immunohistochemical staining,and the relationship between the expressions of EZH2 and STAT3 and the prognosis of patients was analyzed.The correlation between the protein expressions of EZH2 and STAT3 in the gastric and colorectal tissues and the clinicopathological parameters was analyzed using the paired chi-square test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed by using the Logrank test.The relationship between the clinicopathological factors and the prognosis of patients was analyzed using the COX proportional hazard model.Results The positive protein expression rates of EZH2 and STAT3 in the gastric cancer tissues were 73.1％ (49/67) and 67.2％ (45/67),which were significantly higher than 32.8％ (22/67) and 37.3％ (25/67) in the adjacent normal tissues (x2=21.839,11.964,P ＜0.05).The protein expression of STAT3 was correlated with the age,TNM staging,lymph node metastatic status (x2=5.475,9.998,5.475,P ＜ 0.05).The protein expression of EZH2 was correlated with TNM staging and lymph node metastatic status (x2=11.573,5.902,P ＜ 0.05).The co-expression rate of EZH2 and STAT3 proteins was 73.1％ (49/67),EZH2 and STAT3 had the common expression trend (r =0.397,P ＜ 0.05).The co-expression rate of EZH2 and STAT3 was increased as the increase of TNM stages,and the co-expression of EZH2 and STAT3 in the gastric cancer tissue was correlated with the TNM stages (x2 =6.997,P ＜ 0.05).The 5-year survival rate of patients with low protein expression of EZH2 was significantly higher than those with high protein expression of EZH2 (x2=7.386,P ＜ 0.05).The 5-year survival rate of patients with low proteins expression of STAT3 was significantly higher than those with high proteins expression of STAT3 (x2=12.253,P ＜ 0.05).The 5-year survival rate of patients with low co-expression of EZH2 and STAT3 protein was significantly higher than those with high co-expression of EZH2 and STAT3 proteins (x2 =8.765,P ＜ 0.05).The results of univariate analysis showed that age,TNM staging,EZH2 and STAT3 expression,lymph node metastasis and distal metastasis were the factors influencing the survival of patients with gastric cancer (RR =2.136,3.452,3.179,8.341,11.773,6.873,P ＜0.05).The results of multivariate analysis showed that TNM staging and STAT3 expression were independent factors influencing the prognosis of patients with gastric cancer (RR =2.453,7.535,P ＜ 0.05).Conclusions There is significant correlation between EZH2 and STAT3 protein expressions in gastric cancer tissues,and co-expression of EZH2 and STAT3 is associated with the TNM staging and the prognosis of the patients with gastric cancer.

Objective To investigate the clinical and imaging features of von Hippel-Lindau disease to raise awareness of the disease. Methods The clinical and imaging data of a case of VHL patient were analyzed retrospectively and discussed with relative literature review. The patient was a 50-year-old man, who was admitted with the chief complaints of painless gross hematuria and blurred vision for 5 months. Imaging data and ophthalmoscopy examination showed bilateral multiple renal tumors, renal cysts, pancreatic cysts, hepatic cysts and retinal angioma in his right eye. He suffered a surgical operation for his cerebellar hemangioblastoma 12 years ago without family history. Results The patient underwent nephron- sparing surgery (NSS) in the left kidney. Five renal tumors were removed, and the largest tumor was 3.5 cm× 3.5 cm. Postoperative oral administration of Sorafenib agents was applied. Followed up for 4 months, the renal function was normal and the right kidney tumor reduced. Pathology confirmed the diagnosis of multiple renal clear cell carcinoma. Conclusions VHL disease is a familial autosomal dominant hereditary syndrome, with the performance of hemangioblastorna in central nervous system, visceral tumors and multiple visceral cysts. Comprehensive imaging examination plays a major role in both the diagnosis and the follow-up of VHL disease.

Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic tuberculosis.Methods The study was retrospective,from September 2009 to September 2012,38 patients who underwent EBUS-TBNA were finally diagnosed of thoracic tuberculosis,with enlarged hilar or mediastinal Iymph nodes on chest enhanced computed tomography(≥ 1.0 cm).Patients in whom EBUS TBNA was nondiagnostic subsequently underwent surgical biopsy.All the patients had a minimum of 6 months clinical and radiologic follow-up.Results EBUS-TBNA was performed on a total of 88 lymph node stations in 38 patients.Of the enlarged lymph nodes,60(68.18％) were located in the mediastinal region and the remaining 28 (31.82 ％) around the hilum or interlobar area.Of the 38 patients,EBUS-TBNA achieved definitive diagnosis in 34 patients(89.47％).EBUS was well tolerated by all of the patients with no complications.Conclusion EBUS-TBNA is a safe procedure with a high yield for the diagnoses of thoracic tuberculosis.

Objective To analyze the effect of cervical.curvature and intervertebral height on the surgical outcome of posterior decompression in patients with multi-level cervical spondylotic myelopathy.Method A total of 50 patients with multi-segment cervical spondylotic myelopathy (≥ 3 segments),treated with posterior decompression from June 2006 to January 2009 were retrospectively analyzed.Twenty six patients underwent cervical omni-posterior decompression and lateral mass screw internal fixation (group A); 24patients underwent expansive open-door laminoplasty (group B).The effects of changing of cervical curvature and intervertebral height on JOA score and VAS score were analyzed.Results All patients were followed up for 8 months to 4 years (average,24 ±5.5 months).There were statistical differences of cervical curvature angles between preoperative and 3 days postoperatively in group A,while no statistical differences in group B.There were no statistical differences of cervical curvature angles between 3 days,6 months and 3 years postoperatively in group A,while there were differences in group B After further analysis of the loss of cervical curvature and intervertebral height,the result showed that JOA score and VAS score in the low-loss group were better than those in the high-loss group.Conclusion Lateral mass screw internal fixation after cervical omni-posterior decompression had many advantages such as reducing the change of cervical curvature,the loss of intervertebral height and incidence of cervical axial symptoms.

BACKGROUND: Decreasing of absorption of zinc from small intestine can induce dermatitis, alopecia, growth and developmental disorder and so on. It is not very clear that how to keep homeostasis when there is low zinc concentration. The discoveries of zinc transporters and relative researches provide new study direction.OBJECTIVE: To study the effect of different zinc concentration on the expressions of divalent metal transporter 1 (DMT1) and human zinc-regulated transporter (ZRT), iron-regulated transporter (IRT)-like protein (ZIP) 4mRNA, and analyze the potential pathway of absorption of zinc from small intestine in low zinc concentration.DESIGN: Blank-controlled experiment.SETTING: Department of Military Hygiene, Navy Faculty, Second Military Medical University of Chinese PLA.MATERIALS: The experiment was accomplished in Department of Military Hygiene, Navy Faculty of Second Military Medical University of Chinese PLA between October 2004 and May 2005. Materials were human colon adenocarcinoma cells Caco2 that were purchased from Shanghai Institute of Cell of Chinese Academy of Sciences.Time-dependent effect: The expression of DMT1 and ZIP4 mRNA was detected with reverse transcription-polymerase chain reaction (RT-PCR) at 0,dependent effect: The expression of DMT1 and ZIP4 mRNA were measured after the 0, 2.5, 5, 7.5 and 10 μmol/L TPEN exposure, respectively, by RT-PCR.MAIN OUTCOME MEASURES: Time-and dose-dependent effect of zinc on the expression of DMT1 and ZIP4 mRNA in Caco2 cells.RESULTS: ①Time-dependent effect: Compared with 0 hour, the expression of DMT1 mRNA obviously increased at 6, 8 and 10 hours (P ＜ 0.05 ), but there was no significant change at 2 and 4 hours. The expression of ZIP4 mRNA markedly increased in all timing, and ZIP4 mRNA level at the 6th hour reached the peak with the prolongation of low zinc duration,which was 2.1 times ofthat at 0 hour. ②Dose-dependent effect: The expression of DMT1 mRNA distinctly increased at the concentration of 7.5 and 10 μmol/L TPEN exposure as compared with that of the control group (P ＜ 0.05), but there was no significant change at 2.5 and 5 μmol/L. The ZIP4 mRNA expression increased with the increasing of the concentration of TPEN, the expression of ZIP4 mRNA was 2.7 times of that at 0 μmol/L. CONCLUSION: Zinc can regulate the expression of DMT1 and ZIP4 mRNA in Caco2 cells, and there is time-and dose-dependent effect. But the mRNA expression of ZIP4 is more sensitive and prompt than DMT1. Cells can upregulate the expression of DMT1 and ZIP4 mRNA to keep the homeostasis in low zinc condition.

Objective To understand the characteristics of molecular epidemiology of enterovirus 71(EV71) in children with hand, foot and mouth disease (HFMD) in Shanghai area during the first half year of 2009. Methods Seventy-three throat swabs and 38 stool samples were collected from 95 hospitalized children with clinical diagnosis of HFMD in Children's Hospital of Fudan University during April to May 2009. TaqMan real-time reverse transcription-polymerase chain reaction (RT-PCR) and nest RT-PCR were used to detect EV71 VP1, followed by gene sequencing analysis. Results Six of the 73 throat swabs were EV71 positive with the detection rate of 8.2%. In the 38 stool samples, 24 were EV71 positive with the detection rate of 63.2%. Twenty-eight nested RT-PCR positive samples were sequenced and the genetic analysis showed that 27 were C4 subtype,which were absolute dominant strain and the other one was C2 subtype. The isolated strain from a fatal case was C4 subtype and there was no obvious mutation found in VP1 region. Conclusions EV71 is an important pathogen in HFMD children in Shanghai area during April to May 2009. C4 subtype strains are absolutely dominant, and accompanied by epidemic strains of subtype C2.

Objective To explore the effects of batroxobin on the microcirculation of patients with severe acute pancreatitis (SAP). Methods A total of 38 patients with SAP were randomly divided into group A (21 cases) and group B (17 cases). Patients in group A were treated with routine method andpatients in greup B were treated with routine method plus batroxobin injection. Another 18 normal individuals were used as control. The levels of plasma endothelin (ET), thromboxane B_2 (TXB_2) and 6-keto-PGF_(1α)were measured by radioimmunoassay. At the same time, the ratio of TXB_2/6-keto-PGF_(1α) was observed. The Balthazar CT and APACHE Ⅱ scores were monitored and compared between group A and group B. Results The levels of plasma 6-keto-PGF_(1α) were significantly higher while the levels of plasma ET, TXB_2 and the ratio of TXB_2/6-keto-PGF_(1α) were significantly lower in group B at 6 days after admission [(129.3 ± 12.9) ng/L, (93.8 ± 9.9) ng/L, (254.4 ± 24.9) ng/L and 1.83 ± 0.31]as compared with those in group B on admission [(98.9 ± 10.7) ng/L, (140.3 ± 13.1) ng/L, (311.4 ± 31.5) ng/L and 3.16 ± 0.54]and group A at 6 days after admission [(108.2 ± 11.6) ng/L, (120.3 ± 11.4) ng/L, (308.5 ± 31.1) ng/L and 2.84 ± 0.43](P < 0.05). The Balthazar CT and APACHE Ⅱ scores in group B at 6 days after admission were significantly lower than those in group B on admission and group A at 6 days after admission (P< 0.05 or < 0.01). Conclusion Batroxobin is an effective way to improve the microcirculation in SAP.