The strategic cost management of the hospital means setting the cost management of the hospital in the realm of strategic management and analyzing the hospital and its cost behavior and structure from a strategic level so as to create advantages in competition, attain the goal of adapting the hospital to the continuously changing environment and facilitating stralegic management. Strategic cost management is characterized by a protracted, overaU, extensional and innovative nature and methods for it include value chain analysis, strategic positioning analysis, cost agent analysis and many others. Clarifying the goals of strategic cost management, selecting different strategies according to strategic cost information, perfecting the cost management of the hospital and enhancing cost awareness, and giving play to the functional role of economic management personnel are some of the prerequisites for the hospital to implement strategic cost management.

Objective To explore the indications of conservative treatment and to explore the laparotomy for children with abdominal trauma,so as to improve the diagnosis and treatment of abdominal injury in children.Methods This retrospective review included 89 children who had an abdominal trauma which was classified according to the injury situation.Results (1)Of 25 patients with hepatic injury,1 underwent surgery.Among the 48 patients with splenic injury,46 cases were treated successfully by conservative treatment,only 1 underwent splenectomy and another adopted splenic neoplasty.Fourteen patients suffered from gastrointestinal injury,and 4 of them underwent emergency laparotomy,however a delayed perforation of digestive tract occurred in 1 child when he was in hospital 4 days later.Eight cases of pancreatic trauma were treated successfully by conservative treatment,the same as 6 cases of renal and adrenal contusion.One child with uterus and bladder injury was atopted emergency surgical treatment.(2) Unlike adults,conservative management of hepatic and splenic injuries was successfully applied to the vast majority of children.Operative treatment ought to be carried out when hemodynamic stability could not be maintained despite a continuous intravenous fluids and blood transfusion,or when the total amount of blood transfusion exceeds 40 ml/kg.(3)CT was very useful for children with gastrointestinal injury,especially for one cannot stand for abdominal X-ray examination.Operative treatment ought to be carried out timely in those with pneumoperitoneum or abdominal distension.We should pay particular attention to the possibility of delayed perforation.(4)In general,pancreatic injury could be treated conservatively except the ones with pancreatic rupture.(5)Children with bladder and uterine injury often suffered from severe trauma,and needed to be operated timely.Conclusion Children with abdominal injury should be highly valued in primary hospital.Internal bleeding caused by substantial organ injury is the leading cause of death in children,and the delayed diagnosis and treatment of the injured cavity organs is another important cause of the death.Therefore,early accurate diagnosis,active treatment,comprehensive treatment of severe combined injuries and complications are the key to successful treatment of such patients.

Hepatic tumor-specific magnetic resonance (MR) enhancement with Gd-EOB-DTPA can detect and distinguish small hepatocellular carcinoma (HCC) with greater sensitivity than conventional magnetic resonance imaging and computed tomography.Hepatic tumor-specific MR enhancement with Gd-EOB-DTPA is more sensitive in detecting focal HCC,and more reliable in detecting lesions with a diameter smaller than 2cm.Gd-EOB-DTPA is excreted through the kidneys and biliary tract,and thus may provide more information about anatomic structures,demonstrate non-obstruction of the intra- and extrahepatic bile duct system,and provide information about hepatic function.

Objective:To investigate the relationship between hypercoagulable state and the activation of the NF- kappa B pathway,inflammatory/suppression cytokines in patients with osteoarthritis. Methods:56 patients with OA were divided into two groups according to random number table:XFC group ( 28 cases ) and glucosamine ( GS ) group ( 28 cases ) . Two groups were treated for 3 months. Nine healthy people are healthy control group ( NC) . Determining the expression levels of the index of the NF-κB signaling pathway (p50,p65,TAK1,IκBα) and TNF-α,IL-1,IL-10,platelet activating factor(PAF) in serum by enzyme-linked immunosorbent assay. Detected the level of the indicators and laboratory indexes related with coagulation,observed the changes between the two group, used OA symptoms integral scale, LequesneMG, SF-36 and vas to assess efficacy;and made a correlation analysis. Results: After treatment,FIB,D-D, PAF, PLT, p50, p65, TAK1, IL-1, TNF-α, hs-CRP, ESR, IgG, LequesneMG, symptom integral meter, and VAS integral were significantly higher,APTT,PT,PAF-AH,IL-10 and each dimension integral of SF-36 significantly decreased in 2 groups (P<0. 05). XFC group was better than the GS group in reducing the level of PLT,FIB,TNF-α,p65,TAK1,hs-CRP,ESR,symptom integral meter,and VAS integral and increasing PT,each dimension integral of SF-36, etc (P<0. 05,P<0. 01). The results of Pearson correlation analysis show that PLT,FIB,D-D,PAF had positive correlation with p50,p65,TAK1,IL-1,TNF-α,hs-CRP,ESR,IgG,Le-quesneMG,symptom integral meter,and VAS integral,and negative correlation with IL-10 and each dimension integral of SF-36 ( P<0. 05,P<0. 01). PT had positive correlation with IL-10,GH and PF,and negative correlation with p50,p65,TAK1,IL-1,TNF-α,hs-CRP,ESR,IgG,symptom integral meter,and VAS integral (P<0. 05,P<0. 01). Conclusion: XFC could inhibit the NF-κB signaling pathway, raise the level of IL-10, reduce the expression of IL-1, TNF-α, P50, p65, TAK1 and so on, and reduce the abnormal inflammatory immune response. So as to achieve the purpose of delaying and inhibiting the production of hypercoagulable state,reduce joint disease,relieve the symptoms of joint pain and stiffness,eventually improve the patient’s quality of life.

Objective To analyze antimalarial assosiated retinopathy detected by different methods with of modern ocular fundus examination, and explore screening strategy and the diagnosis of hydroxych-loroquine assosiatedretinopathy according to clinical experience and international guidelines. Methods Full fundus examination was performed in two patients with antimalarial retinopathy. The related literature were reviewed. Results Two patients had bull's eyes maculopathy and abnormal visual fields. Conclusion Clin-icians' alertness to hydroxychloroquine related retinopathy may improve early diagnosis of hydroxychloroquine toxicity. New objective tests are more sensitive than visual fields examination. Visible bull's-eye maculopathy is a late change, and the goal of screening is to recognize toxicity at early stage.

Objective To compare the clinical effect of drug-eluting stents implantation or pure balloon expansion for the treatment of patients with knee artery lesions. Methods Sixty-eight patients with knee artery lesions were randomly and voluntarily divided into the control group( n=34 )and observation group( n=34 ) . The patients in the control group were given balloon expansion treatment,while in observation group were implanted drug-eluting stents besides balloon expansion. Pathological changes of skin temperature,percutaneous oxygen partial pressure( TcPO2 ),ankle brachial index( ABI),and the recurrence rate of patients before and after treatment for 6 months and 12 months were recorded and compared. Results After 6 months treatment,TcPO2 and ABI in observation group were(35. 4 ± 4. 5)mmHg and 0. 85 ± 0. 04,significantly higher than that in control group(( 28. 2 ± 3. 5 ) mmHg and 0. 62 ± 0. 03 ),and the differences were statistically significant( t=2. 535,2. 185;P﹤0. 05). At 12 months after treatment,skin temperature,TcPO2,ABI in observation group were(32. 4 ± 4. 3)℃,(34. 3 ± 4. 2)mmHg and 0. 80 ± 0. 04,significantly higher than that of the control group ((28. 6 ± 3. 7)℃,(26. 4 ± 3. 6)mmHg,0. 53 ± 0. 02;t =2. 354,2. 648,2. 064;P ﹤0. 05). Meanwhile,the recurrence rate was 5. 9% in observation group,significantly lower than that of the control group( 32. 4%;χ2=8. 463,P﹤0. 05). Conclusion The clinical effect of drug-eluting stents implantation in treatment of patients with knee artery lesions is superior to that of balloon expansion.

With new acupuncture and moxibustion as the study object, based on the basic composition of acupuncture-moxibustion theory, from 3 aspects of meridian-acupoint theory, acupuncture-moxibustion method theory and acupuncture-moxibustion treatment theory, under the background of western medicine, ZHU Lian's different opinions on theory and method of acupuncture and moxibustion were discussed. It was believed by ZHU Lian that the distribution of 14-meridians was approximately identical to that of nerves, so with modern neuroanatomy knowledge to understand the meaning of acupoint; the acupuncture function could be explained from the angle of neurophysiology. Clinical diagnosis and treatment method could be established by modern classification methods of diseases. ZHU Lian's cognition that was different from traditional theory and method of acupuncture and moxibustion was combined with updated physiology and anatomy knowledge at that time, and was involved with Pavlov's advanced nerve theory, so she firstly put forward the opinion that acupuncture therapy can't work without the involvement of cerebral cortex.
Acupuncture Points ; Acupuncture Therapy ; history ; psychology ; Books ; history ; China ; History, 20th Century ; History, 21st Century ; Humans ; Knowledge ; Medicine ; Moxibustion ; history ; psychology

Objective:To observe the changes in coagulation parameters, peripheral blood cytokines, NF-kappa B signaling pathway protein, laboratory indexes in Sjogren′s syndrome ( SS ) patients, thus to explore the mechanism of hypercoagulable state. Methods:60 patients with SS and 20 healthy persons were randomly selected as the study group and the control group;Automatic coagulation analyzer was used to detect the value of coagulation parameters [ activated partial thromboplastin time ( APTT) ,prothrombin time ( PT) , plasma fibrinogen ( FIB ) , prothrombin time ( TT ) , D-dimer ( DD ) ]; ELISA method was performed to observe the expression of related cytokines(IL-1β,TNF-α,IL-10) and NF-κB signaling pathway proteins (p65,p50,IκBα); Westergren method was used to determine erythrocyte sedimentation rate ( ESR) ,and automatic biochemical analyzer to examine immune protein( IgG,IgA, IgM,GLO) and high sensitivity C-reactive protein (hs-CRP). Results: Blood coagulation parameters in 60 patients with SS were at least one abnormal for 46 cases,accounting for 76. 7% of the subjects. Among them,the abnormal rate of D-D was the highest,followed by FIB,APTT,PT,TT. Compared with the control group,D-D,FIB were significantly increased in SS patients,and TT,PT,APTT was not found obviously different. In addition,IL-1β,TNF-α,P50,P65,IκBα and inflammatory indexes like ESR,hs-CRP,IGg,GLO,ESSDAI, corneal staining score increased while the salivary flow rate,tear film break-up time and IL-10 decreased significantly( P<0. 05 or P<0. 01). Correlation analysis showed that the coagulation parameters FIB were positively correlated with the salivary flow rate,TNF-α, P50,P65,ESR,hs-CRP,while negatively correlated with IL-10,that TT was negatively correlated with TNF-α;that D-D was positively correlated with TNF-α, IL-1β, P65, ESR, hs-CRP, ESSDAI and corneal staining score, while negatively correlated with IL-10. Conclusion: SS patients generally have hypercoagulable state, and may be associated with the imbalance of cytokines, abnormal activation NF-kappa B signaling pathway,which mediates vascular endothelial cell damage,causing coagulation/fibrinolytic system dis-orders.

At present, microbe surface display system mainly involves phage surface display system, bacte- rial surface display system, yeast surface display system and virus surface display system. Baculovirus sur- face display system is a new type of eukaryote surface display system which developed based on deeply un- derstanding of construction and function of virus genome in recent years. Through fused expression with vi- ral capsid or membrane proteins exogenous peptides can be displayed on the surface of the virus and formed hedgehog-shape "fake virus". Baculovirus surface display system was characterized by safeness and high performance, furthermore, this system can complete post-translation processing and modification of protein to enhance the bioactivity of exogenous product. Combined with the author’s experimental work, this paper briefly introduces the mechanism and traits of this system and summarizes the newest research development on its application in the field of monoclonal antibody preparation, new-type vaccine development, genes transduction and genes therapy. It is believed that the system above may show extensive application through further improvement and optimization.

Objective To investigate the dose-effect relationship of donor antigenic specificity CD4~+ CD25~+ Treg cells prolonging the survival of rat kidney allograft.Methods Sixty allograft kid- ney transplantation animal models were established with SD rats as donors and Wistar rats as recipi- ents.CD4~+ CD25~+ T cells were sorted from Wistar rats'spleens by way of MACS and the phenotypes of donor antigenic specificity were induced in vitro.According to the quantities of prepared CD4~+ CD25~+ T cells injected through tail vein in kidney transplantation,models were divided into four ex- perimental groups:2?10~5(group I),5?10~5(groupⅡ),1?10~6(groupⅢ),2?10~6(groupⅣ).The models which had no injection served as control group(n=12).The survival of the transplanted kid- ney was observed.The levels of blood serum creatinine were determined and the histopathological changes in the transplanted kidney were observed at day 4,9 and 15.The results of histopathology were evaluated according to the standard of Banff Schema and the semi-quantitative scores were gained by way of Watanabe.The reaction indexes of receptor spleen cells to the donor antigens were tested by way of MTT at day 15.Results The mean survival time of transplanted kidneys was the highest in groupⅢ[(31.4?4.6)days]and lowest in the control group[(11.7?6.2)days].There was signif- icant difference between groupⅢand control group in levels of serum cre'atinine(P