With the deepening of the national medical and health system reform,it is particularly important to establish the regional medical cooperative system with the large hospital as the core.The Affiliated Hospital of Xuzhou Medical University establishes interactive coordination relation with county-level hospitals through township hospitals in the cooperation model for collectivize operation,trusteeship and technical support,and it has accumulated some practical experience.The paper investigates and contrasts the core hospital and the member hospital development of the before and after the cooperative relationship,and sums up 6 key measures that the core hospital promoted the regional medical cooperative system construction,that is,improving the member hospital grade,strengthening talent development,support technology,specialty developments,hardware support and public project cooperation in order to provide references to promote the development of the regional medical cooperative system.

Objective To establish a method of quality control for compound Cornu cervi degelatinatum tablets. Methods Thin layer chromatography ( TLC ) was used for qualitative identification of Lonicerae Japonicae Caulis and Pyrola Herba in the preparations. High performance liquid chromatography was used to determine the content of loganin and chiratin in Lonicerae Japonicae Caulis and monotropein in Pyrola Herba. Results The TLC spots were clear and specific in the qualitative identification.HPLC determined the content. In the concentration range, monotropein, loganin and chiratin had a good linear relationship with peak area (r>0.999).The mean recovery was 97.2%, 98.4% and 96.0%;RSD was 1.4%, 0.8% and 0.8%. Conclusion The present study employs TLC for quality control and HPLC for quantity control. The methods are simple and accurate, have good reproducibility, and can effectively control the quality of compound Cornu cervi degelatinatum tablets.

Objective To study and evaluate the diagnostic and differencial diagnostic value of detection of human telomerase reverse transcriptase(hTERT) mRNA and telomerase activity in pancreatic juice of (pancreatic) cancer(PC) .Methods hTERT mRNA expression and telomerase activity in pancreatic juice in 24 cases of (pancreatic) cancer and 14 cases of chronic pancreatitis(CP) were detected and compared.Results Expression of hTERT mRNA was detected in 87 .5% (21/24) of PC cases and 21.4%(3/14) of CP cases(P

We studied the regulatory effects of the estragen receptorbeta (ERbeta) gene on the downstream estrogen signal transfection pathway in colon cancer cells and the possible mechanisms involved. A human ERbeta gene recombinant expression plasmid, pEGFP-C1-ERbeta, was constructed and transfected into the Caco-2 colon cancer cell line, a line with low ERbeta gene expression. The expression of ERbeta mRNA and protein was detected 72 h after transfection. RT-PCR was used to examine the expression levels of the progesterone recepror (PR) gene containing the classic estrogen response element (ERE), the C-fos oncogene containing the AP-1 site (a non-classical ER binding site), the epigenetic modifying genes, such as Dnmt1, Dnmt3a, Dnmt3b, and histone methyltransferase (HMT), and the human mismatch repair gene hMLH1. Methylation-specific PCR was used to detect the changes in the methylated sites of the CpG islands in the promoters of the ERbeta, PR, and C-fos genes. The results indicated that the human ERbeta gene recombinant expression plasmid pEGFP-C1-ERbeta was successfully constructed and transfected into Caco-2 cells. As compared with the control group, the mRNA and protein expression of ERbeta gene was increased significantly 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells. As compared with the control group, the mRNA expression of the PR, C-fos, Dnmt3a and Dnmt3b genes was increased significantly 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells, but the mRNA expression of the Dnmt1, HMT, and hMLH1 genes decreased significantly (P<0.05). As compared with the control group, different degrees of demethylation occurred in the promoters of the ERbeta, progesterone receptor (PR), and C-fos oncogene 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells. The methylation index of the estrogen signal transfection pathway in Caco-2 cells was decreased significantly following the expression restoration of ERbeta gene (P<0.05). It is concluded that the restoration or up-regulation of the ERbeta gene in Caco-2 cells may significantly activate the expression of the related target genes in the downstream estrogen signal transfection pathway and may result in the demethylation changes of the pathway. During the process, the expression level and activity of the epigenetic modifying genes and the human mismatch repair gene have changed simultaneously. The regulatory effect of the ERbeta gene on the estrogen signal transfection pathway to a certain extent partly involves demethylation.

Objective To evaluate laparoscopic resection of gastric stromal tumors. Methods Clinical data of 20 patients undergoing laparoscopic resection of gastric stromal tumors from June 2003 to October 2007 were retrospectively analyzed. Result Laparoscopic wedge resection was completed successfully in all 20 patients with a mean operating time of(60±34) min, and without major complications. The mean hospital stay was (6.0±2.6) days. During a follow-up period from 10 to 22 months there was no recurrence. Conclusions Laparoscopic wedge resection is safe, effective, and minimally invasive for treating gastric stromal tumors.

Objective To investigate the feasibility and effectiveness of laparoscopic splenoctomy (LS)in patients with idiopathic thrombocytopenic purpura(ITP). Methods Clinical data of 17 ITP cases undergoing LS between Augest 2003 and December 2006 were analyzed retrospectively. Remits LS was Successfully conducted in all 17 cases without converting to open surgery with an average intraoperative blood loss of 120 ml in each case.There was no postoperative bleeding,fistula and infection.The platelet count increased rapidly in one week.After stopping glucocorticoid treatment for one month.15 cases achieved complete response(88.2%)and 2 caSes had partial response(11.8%).Fbllow-up of 3～43 months found no recurrence. Conclusions Use of LS for ITP is safe,feasible and effective.

Objective To evaluate the clinical results of total laparoscopic hepatectomy for hepatolithiasis. Methods The clinical data of 72 patients with intrahepatic lithiasis receiving total laparoscopic hepatectomy in our hospital from July 2005 to April 2009 were retrospectively analyzed. Results The mean age of the 72 patients was (43. 8±21.7) yrs (16-65 yrs). For laparoscopic hepatectomy, it was anatomical left liver resection in 34 patients, anatomical resection of left lateral liver in 19 and resection of S6 in 16. The operative duration was (262.5± 115.5)min (125-320 min). The median intraoperative blood loss was 150 ml (50-400 ml). The occurring rate of postoperative complications was 12.50 %. Complications included bile duct infection in 8 patients, bile leakage in 6, gastroparesis in 1,postoperative early inflammatory ileus in 1 and subcapsular fluid collection of liver in 1. All the complications were cured by non-surgical means. Conclusion In the era of minimally invasive surgery, total laparoscopic hepatectomy has gradually become the prominent treatment for hepatolithiasis.

Objective To explore prevention of cyclosporine A (CsA) combined with Cobalt protoporphyrin (CoPP) against murine graft versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods C57BL/6 (H-2Kb) mice were used as donors and BALB/c (H-2Kd) mice as recipients,which were randomly divided into 4 groups.The mice in total body irradiation group (TBI group) were lethally irradiated and injected intravenously with PBS; The mice in Allo-HSCT group (BS group) were lethally irradiated and injected intravenously with bone marrow cells and spleen cells; The mice in CsA intervention group (CsA group) were injected with CsA intraperitoneally after allo-HSCT; The mice in CsA combine with CoPP intervention group (combination group) received both CsA and CoPP intraperitoneally after alloHSCT.Recipients were monitored for condition,survival rate and weight.The liver,small intestine and skin in the recipients were gained and pathological changes of GVHD were assessed.The kidney was stained with Masson staining dye to observe the tissue fibrosis.The expression levels of renal HO-1 mRNA in the recipients were detected.Results In contrast to BS and CsA groups,GVHD degree in combination group was mild,with less reduction and quick recovery of weight.On the day 30 after HSCT,survival rate in BS group was 36.8％,and that in combination group and CsA group was 69.6％ and 53.5％ respectively (P＜0.05).In comparison with BS and CsA groups,pathological changes in combination group were mild,cellular edema and degeneration degree of the liver,small intestine and skin were slight,and few necrosis and infiltrated inflammatory cells were observed.Tubulointerstitial fibrosis hardly occurred in combination group,but it occurred in CsA group abundantly.As compared with BS group,the expression levels of HO-1 mRNA was increased in combination group,while decreased in CsA group (P＜0.05).Conclusion CsA combined with CoPP enhanced the protective effect of CsA against GVHD,moreover,CoPP could alleviate the side effects of CsA,which might be related with up-regulation of the expression levels of HO-1.

Objective To make a rapid dose estimation for a patient exposed locally to high dose radiation exposure in early stage of 5.7 192Ir source accident in Nanjing.Methods Based on source parameters,exposure pattern,and time duration,the doses were estimated using MCNP simulations with the aid of the proper East Asia adult male voxel phantom and main physiological parameters of the exposed patient.Result Absorbed doses to 16 organs or tissues were estimated to be in the range 0.03 to 9.16 Gy.Also,the iso-dose curves for the skin of legs showed clearly the dose difference between right and left legs.Absorbed doses to patient's testicles and prostrate,about 9.16 Gy,were higher than those to other organs or tissues.The skin of both legs was exposed locally to high dose radiation exposure,for which the estimated doses were in agreement with the results obtained from infrared thermal imaging.Conclusions Monte Carlo simulation technique and common software can be used for dose estimation in early stage of radiation accidents effectively with integrating proper models.

Objective To use three different methods in attempt to estimate the biological dose of the patient partially exposed to 192Ir source at5.7 accident in Nanjing,so as to provide dosimetric information for clinical remedy of exposed patients in the emergency of a nuclear accident.Methods Peripheral blood samples were collected on days 5 after exposure.The biological dose was estimated by the yields of dicentrics plus rings ( dic + r),cytokinesis-block micronuclei (CBMN) assay and nucleoplasmic bridge plus FHC (NPB + FHC).The homogeneity of radiation exposure was examined by Poisson distribution of dicentrics.Results By using three different methods,the whole body equivalent dose was dic + r estimated to be 1.51 Gy (95％ CI 1.40-1.61),1.47 Gy (95％ CI 1.36-1.60) by CBMN and 1.30 Gy (95％ CI 1.00-1.60) by NPB + FHC,respectively.A non-poisson distribution was also detected,suggesting partial body radiation exposure.Conclusions The estimated whole body equivalent dose ot a non-uniform radiation exposure was consistent with clinical diagnosis,suggesting that the yields ofdic + r,CBMN,as well as NPB + FHC,are efficient approaches to the estimation of biological doses.