Summarized in the paper are the experiences of Zhejiang University and its affiliated hospitals in developing medical consortiums based on two emphases of primary ends. The authors found that a sustainable ecosystem of medical services can be built upon quality resources of the university and its hospitals if the missions, components and roadmap are clarified.

Objective To investigate the effect of dexmedetomidine (DEX) on proliferation and differentiation of rat embryonic neural stem cells in vitro. Methods Embryonic neuraI stem cells of fetal SD rats were separated from rats with gestational age of 14-16 days , and underwent primary culture for nestin expression. Cells were divided into control group, low-dose DEX group, and high-dose DEX group, which were cultured with 0,1 and 10 ng/mL DEX respectively. Cell viability was detected by MTT assay;the proliferation rate was estimated by BrdU incorporation; the phosphorylation of ERK1/2 in the proliferation phases was detected by western blot; the differentiation of neuronal cells,astrocytes,oligodendrocyte and neural stem cells were assessed by immunocytochemistry of cell specific markers. Results More than 95% of the embryonic neural stem cells in primary culture were Nestin-positive. Cell viability , BrdU-positive cells and phosphorylation of ERK1/2 in low-dose DEX group increased significantly (P<0.05), and decreased significantly in high-dose DEX group compared with control group and low-dose DEX group (P < 0.05). NeuN-, GFAP- and MBP-positive cells increased (P < 0.05), while Nestin-positive cell decreased (P<0.05) in both low and high dose DEX group compared with control group. However, no significant difference was found in low and high dose DEX group (P > 0.05). Conclusions The proliferation of neuraI stem cells can be promoted by low-dose DEX and depressed by high-dose DEX , as well as regulated by DEX of the phosphorylation of ERK1/2. DEX induces neural stem cells non-selective differentiation.

AIM: To investigate the protective effect of ulinastatin on rats with hemorrhagic shock. METHODS: A prospective, controlled animal study was designed. The model of hemorrhagic shock in rats was produced by Chaudry method. After 60 min, rats were resuscitated by transfusion of shed blood and normal saline, but a half of them were treated with ulinastatin. At different time points after reperfusion, the levels of tumor necrosis factor-alpha (TNF-?), interleukin-6 (IL-6), malondialdehyde (MDA) and superoxide dismutase (SOD) in serum were detected. RESULTS: The levels of TNF-?, IL-6 and MDA significantly increased and the activity of SOD decreased. In the ulinastatin-treated groups, the blood pressure and heart rate were obviously improved; the levels of TNF-?, IL-6 and MDA significantly decreased and the activity of SOD had little change after hemorrhagic shock and reperfusion. CONCLUSION: Ulinastatin has a protection effect on rats with hemorrhagic shock by suppressing the production of inflammatory factors and reducing oxidative damage.

Objective To evaluate the efficacy and safety of standard percutaneous nephrolithot-omy (PCNL) for patients with deformity of spine. Methods Between Aug 2003 and May 2009, 35 patients of upper urinary tract calculi with scoliosis and kyphosis had undergone PCNL accessed by two steps dilation to 24F tract with ultrasound guidance. Clinical data were analyzed retrospectively. Results The pereutaneous renal access was successfully established in 35 patients under ultrasound guidance and immediate lithotripsy was performed. Prone position 9 units,lateral position 14 units,and other unconventional position 14 units. 34 (91.9 %) units were operated by single access and 3 (8.1%) by double in one session. The mean first accessing time was (8. 5±1.7)min, and stone management time was (39.3±14.6)min. The stone-free rate after the first operation was 86.5%, 2 kidneys ac-cepted another PCNL to remove the residual calculi, and the last stone-free rate was 91.9%. 2 cases needed transfusion. No injury of adjacent organs or urosepsis occurred. No severe complications oc-curred. Conclusions Standard PCNL for calculi in patients with deformity of spine accessed by two steps dilation to 24 F tract with ultrasound-guided puncture could be effective and safe. Special indi-vidual operative position and experienced clinical technique are needed.

Objective To explore the effect of invigorating splcen and kidney methods on the pregnancy outcome of the intrauterine insemination (IUI) in infertile men with asthenospermia.Methods a total of 78 male infertility patients with spleen and kidney deficiency type were collected,all cases were randomly allocated into three groups,group A using methods of invigorating spleen and kidney,group B using Antioxidant therapy,and group C as the blank group.There are 26 cases in each group.One course of treatment lasts for 12 weeks.Before and after treatment,the changes of sperm quality index were analyzed by computer assisted sperm analysis (CASA) and sperm morphology.The pregnaucy outcome after IUI was followed up.Results After the treatment,sperm motility and sperm forward movement (PR) difference before and after treatment in group A with was statistically significant (P ＜ 0.05).The differences between patients with semen volume,sperm concentration,sperm morphology and sperm motility parameters before and after treatment in three groups were not statistically significant (P ＞ 0.05).Clinical pregnancy rate and cumulative pregnancy rate and the live birth rate in group A were higher than that of group B and group C,but the difference was not statistically significant (P ＞ 0.05).Conclusion Invigorating spleen and kidney method can improve the sperm motility and forward movement speed of the type of patients for the treatment of male infertility patients with asthenospermia,and it is helpful to improve the pregnancy outcome of the IUI.

Objective To investigate the protective effects of Ulinastatin on intestinal barrier damaged after cardiopulmonary resuscitation (CPR) in rats in order to illustrate the possible mechanism.Methods Twenty-one male SD rats were divided into three groups randomly (random number) including control group (sham group, n =7), cardiopulmonary resuscitation group (CPR group, n =7) and ulinastatin group (UTI group, n =7).The rats were anesthetized with pentobarbital sodium (45-60 mg/kg) by intraperitoneal injection.The rats of sham group were only treated with endotracheal intubation.Ulinastatin (100 000 U/kg) were injected via caudal vein 2 hours prior to CPR, and cardiac arrest was made in rats and cardiopulmonary resuscitation was carried out in the UTI group, while equivalent volume of sterile saline was used instead in the CPR group.Blood and ileum samples were obtained at 48 hour after restoration of spontaneous circulation (ROSC).The levels of tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β) were assayed by ELISA (enzyme-linked immunosorbent assay), the protein levels of caspase-3 were determined by western blot, the intestinal mucosa were stained by terminaldeoxynucleoitidyl transferase mediated nick end labeling (TUNEL) and ileac mucosa were observed under transmission electron microscope.Data were processed with SPSS 17.0 software.Results The plasma levels of TNF-α and IL-1β were dramatically higher in CPR group than those in other two groups (CPR vs.sham, P ＜ 0.01;CPR vs.UTI, P ＜ 0.05).Moreover, the tight junctions between cells obviously broadened and loosened in the CPR group were found under electron microscope, however, this phenomenon was not obvious in the UTI group.A large number of apoptotic cells were observed by TUNEL assay in the CPR group, but a small number of apoptotic cells were observed in the UTI group.The protein levels of caspase-3 in the UTI group were higher than those in sham group, but lower than those in CPR group (both P ＜ 0.05).Conclusions Ulinastatin has protective effects on the intestinal barrier damaged after cardiopulmonary resuscitation in rats by decreasing the proinflammatory mediators in the blood, reducing the expression of caspase-3and then reducing the numbers of apoptotic intestinal cells.

Aim To discuss the effectsof extract from fermented buckwheat flower and leaf(EFBFL) on myocardial injury in spontaneously obese type Ⅱ diabetic db/db mice and its mechanism.Methods 9-week-old male db/db mice were randomly divided into high level EFBFL dose group(EFBFL-H, 0.1 g·kg-1), low level EFBFL dose group(EFBFL-L, 0.05 g·kg-1),metformin hydrochloridecontrol group, model control group, and normal control group, with 10 mice in each group.All groups were treated with 8 wks of drugs by gastric perfusion.The random blood glucose(RBG) was tested respectively at the end of 2nd, 4th, 6th, and 8th wk.Finally, the levels of creatine kinase(CK) creatine kinase MB(CK-MB), andadvanced glycosylation endproducts(AGEs) were detected after 8 wks.The morphological changes of myocardium were observed under light microscope by HE staining, and the ultrastructure of myocardium was observed under electron microscope.Immunohistochemical method and Western blot were used to detect myocardial tissue glucose transporter-4(Glut-4).Results EFBFLcould repress patho-proceeding of myocardial fibrosis efficiently, and significantly decrease the level of blood glucose, CK,CK-MB, and AGEs in db/db mice.Meanwhile, it could increase the expression of Glut-4 in myocardial tissues of mice.Conclusions EFBFL can prevent myocardial injury in spontaneously obese type Ⅱ diabetic db/db mice.The possible mechanism may be related to lowering the level of blood glucose and serum AGEs and up-regulating Glut4of cardiac muscle.

Objective To analyze the efficacy and safety of losartan in the treatment of massive proteinuria in kidney transplant recipients.Methods All of the 82 patients were randomized in two groups:losartan group and control group(amlodipine group).Both of the groups were divided into two different subsets according to blood pressure control Twenty-four-hour proteinuria,serum creatinine,blood pressure and adverse effects were observed.Results Losartan and amlodipine had the similar effects on blood pressure control The 24-h proteinuria in losartan group at the end of the study was significantly lower than that at the baseline,and there was significant difference between the losartan blood pressure control subset and the losartan blood pressure un-control subseL The effective rate and significant effective rate in losartan group for massive proteinuria were higher than in control group.Conclusion T Losartan can be effectively and safely used for the treatment of massive proteinuria in renal transplant recipients independent of blood pressure.

Objective To investigate the changes of protein and energy intakes and the z-score of weight for age in appropriate for gestational age (AGA) and small for gestational age (SGA) preterm infants with gestational age less than 34 weeks. Methods The data from 314 hospitalized premature infants ( 268 cases of AGA and 46 cases of SGA) during January 2012 to December 2014 were retrospectively collected. The intakes of protein and energy and the changes of weight within 2 weeks after birth were compared. Results Compared with AGA group, the hospital stays, durations of parenteral and enteral nutrition and total enteral nutrition, and time to achieve full dose feeding were signiifcantly longer in SGA group (P?

Objective The application of nano-carbon tracer technique in radical antegrade modular pancreatosplenectomy (RAMPS) to treat malignant tumors of pancreatic body and tail.To investigate whether radical anterograde modulization of pancreatic body and tail combined with nano-carbon tracer technique is more beneficial to the prognosis of patients.Methods From January 2014 to September 2018,a retrospective analysis was performed in 48 patients in Linyi Central Hospital,all patients underwent RAMPS,all of whom were pathologically proved to be pancreatic carcinoma of the body and tail.Based on whether the nano-carbon lymph node tracer was performed during the operation,the patients were divided into two groups:nano-carbon group (nano-carbon lymph node tracing) and conventional operation group (no nano-carbon lymph node tracer).The differences between the two groups were analyzed,including operative time,intraoperative blood loss,postoperative complications (pancreatic fistula),postoperative hospitalization time,postoperative pathological lymph node status (number of dissection,number of positive lymph nodes,the positive rate of lymph node black staining in nano-carbon group) and survival time after operation.The measurement data were expressed as mean ± standard deviation (Mean ± SD),t-test were used for comparison among groups;Chi-square test was used for comparison of counting data,and Kaplan-Meier test was used for comparison of survival rate.Results There was no significant difference in the time of operation [(4.45 ± 0.59) h vs (4.41 ±0.65) h],the amount of blood lost during operation [(447.39 ± 109.51) ml vs (434.8 ± 76.38) ml] and the time of hospitalization after operation [(16.52 ± 4.12) d vs (16.56 ±2.92) d] between the two groups (P＞0.05).There were 1 case of pancreatic fistula in the nano-carbon group and 2 cases of pancreatic fistula in the convertional operation group,but the difference was not statistically significant (P =0.55).The number of lymph nodes dissected and positive lymph nodes in nano-carbon group were significantly higher than those in conventional operation group [(18.26 ± 2.49) vs (12.16 ± 2.19);(5.52 ± 1.50) vs (3.32 ± 0.85).The difference was statistically significant (P ＜ 0.05).The positive rate of lymph nodes in black stained lymph nodes (38.10％,96/252) was significantly higher than that in non-stained lymph nodes (18.45％,31/168),and the difference was statistically significant (P ＜ 0.05).The average survival time in the nano-carbon group [(25.48 ± 11.74) months] was significantly longer than that in the conventional operation group [(15.80 ± 11.64) months],and the difference was statistically significant (P ＜ 0.05).Conclusions It is safe,effective and feasible to treat malignant tumors of pancreatic body and tail by RAMPS combined with nano-carbon tracer technique.The positive rate of lymph node dissection and the detection rate of total lymph nodes are increased,and the prognosis of patients is improved,to improve the survival time of patients after operation is improved.