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.

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.

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.

Administration, Cutaneous ; Adolescent ; Adult ; Analgesia ; methods ; Female ; Fentanyl ; administration & dosage ; Humans ; Male ; Pain, Postoperative ; prevention & control ; Tonsillectomy ; methods ; Young Adult

Tumor is a system-biology illness.Treatment of this intractable disease by any single medicine has not been realistic.In this review, we analyze the anti-tumor network of Tumor Necrosis Factor-related Apoptosis-indu-cing Ligand ( TRAIL ) by a system-biology technology and try to providecin individualized treatment strategy for TRAIL based therapy .

Objective To study the role of CT in the evaluation after patellar dislocation triple surgeries.Methods Retrospectively analysed the CT measurements of 60 recurrent patellar dislocation patients (61 knees),who had undergone patellar dislocation triple surgeries,within one month before and after procedures.The measurements included patellar tilt angle,lateral patellar displacement,trochlear con-gruence angle,Tibial Tuberosity-Trochlear Groove distance,Insall-Salvati Ratio and Caton-Deschamps Index.Moreover,the troch-lear dysplasia classifications of all patients were evaluated.In addtion,an analysis has also been completed for 40 (41 knees)of 60 patients who had second postoperative CT examinations as follow-up assessment 3 to 6 months after surgeries.Results All one-month postoperative measurements decreased obviously with statistical significance(P <0.05 ).Furthermore,one case of subluxa-tion,1 1 cases of abnormal Tibial Tuberosity-Trochlear Groove distance,13 cases of abnormal Insall-Salvati Ratio and 14 cases of Ca-ton-Deschamps Index abnormities were also observed.Besides that,it was also found that all patients had trochlear dysplasia and 5 cases were diagnosed with patellar subluxation or dislocation at the second postoperative follow-up assessment.Conclusion The patients with redislocation or risks for patellar instability can be detectecd by CT which provides objective evidence for postoperative evaluation and further treatments.

Objective To observe the efficacy of antiviral therapy of pegylated interferon (Peg-IFN) α-2a combined with ribavirin for patients with hepatitis C cirrhosis and hypersplenism underwent splenectomy or partial splenic embolization. Methods Thirty-eight patients with hepatitis C cirrhosis (genotype Ⅰ HCV infection) hypersplenism failed to the anti-viral therapy were performed splenectomy or partial splenic embolization to improving hypersplenism. After 3 months,Peg-IFNα-2a 90μg or 135 μg was given subcutaneously once weekly, plus ribavirin 600-1 000 mg/d orally for 1 year of the treatment. During the treatment, patients were followed at four-week intervals, and then followed-up every month until the 24th week after stopping. Liver function, blood routine, renal function, HCV RNA, and adverse reaction of medication were observed during treatment and the follow-up period. Results Splenic function of patients with hepatitis C cirrhosis and hypersplenism was improved after hypersplenism splenectomy or partial splenic embolization. The sustained virologic response (SVR) rate was 63.88%after giving Peg-IFNα-2a combined with ribavirin anti-viral treatment. Conclusion After splenectomy or partial splenic embolization, patients with hepatitis C cirrhosis and hypersplenism showed the better SVR at the treatment of Peg-IFNα-2a combined with ribavirin. The treatment could delay the progress of the hepatitis C cirrhosis and reduce the incidence of liver failure and liver cancer.

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 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.