Competition in the medical market in future will be the competition of core competence. Confronted with the increasing integration of the domestic and foreign medical markets, hospitals in our country will have no other strategic alternative but to devote major efforts to enhancing their core competence. After defining the concept of core competence of hospitals, the authors make an analysis of the features and elements of core competence of hospitals and put forward measures for enhancing the core competence of hospitals.

OBJECTIVE:To establish a rapid,sensitive,accurate and stable method for the determination of voriconazole in human plasma in order to monitor clinical use of voriconazole. METHODS:HPLC-UV detection method was applied using carba-mazepine as internal standard. Plasma samples were treated with acetonitrile protein precipitation. The determination was performed on Phecda C18 column with 20 mmol/L monopotassium phosphate buffer solution (pH 6.0)-acetonitrile (50∶50,V/V) as mobile phase at flow rate of 1 ml/min. The column temperature was 40℃ and detection wavelength was 255 nm. The injection volume was 50 μl. RESULTS:The retention time of voriconazole and internal standard were 8.34 and 6.24 min. The linear range of voricon-azole in plasma were 0.10-20.00 μg/ml(r=0.999 5). The lowest limit of quantitation was 0.05 μg/ml. Intra-day and inter-day RSD were below 1.57% and 1.45%,respectively. The extraction recovery of low,medium and high concentrations were between 81.40%to 128.29%. CONCLUSIONS:The method is simple and accurate for therapeutic drug monitoring(TDM)of voriconazole.

Objective To investigate the routine ultrasound and contrast-enhanced ultrasound (CEUS) features of hepatic nodules in Budd-Chiari syndrome(BCS) after portacaval anastomosis.Methods Routine ultrasonography and CEUS were performed in 18 BCS patients with hepatic nodules after portacaval anastomosis.Results Appearance after portosystemic anastomosis,multiplicity,small size,presence of peripheral rim and hypervascularization were important ultrasound imaging features of hepatic regenerative nodules in patients with BCS.Nodules showedquick wash-in and slow wash-out pattern in CEUS.Sixteen cases showed center-to-periphery enhancement pattern in arterial phase and hyper-enhancement in portal phase and late phase.Two cases showed periphery-to-center enhancement pattern in arterial phase and periphery enhancement in portal phase and late phase.Conclusions Hepatic regenerative have different features on routine ultrasound and CEUS in patients with BCS after portacaval anastomosis,which are useful for differential diagnosis.

OBJECTIVE:To investigate the role of clinical pharmacists in the therapy for acute exacerbation of chronic obstruc-tive pulmonary diseases (AECOPD) complicated with pulmonary infection. METHODS:Clinical pharmacists participated in the therapy for a case of acute exacerbation of AECOPD complicated with pulmonary infection. According to the patients’signs,assis-tant examination and disease condition,clinical pharmacists provided suggestions,i.e. Piperacillin sodium and sulbactam sodium for injection (4∶1) 5.0 g,ivgtt,q12 h,for anti-infective treatment;Bisacodyl enteric-coated tablet 5 mg,po,qd,for promoting defecation;Clostridium butyricum viable bacteria tablet 20 mg,po,tid,for regulating gastrointestinal flora;Pinaverium bromide tablet 50 mg,po,tid,for regulating gastrointestinal smooth muscle tension;Shexiang baoxin pills 22.5 mg,po,tid,instead of flu-id infusion for protecting heart,and isosorbide 5-mononitrate 20 mg,po,tid,for preventing angina pectoris;Cefminox capsule 100 mg,po,tid,for anti-infective treatment;fluconazol 0.4 g,ivgtt,qd,for antifungal treatment,and Bacillus licheniformis 500 mg,po, tid,for preventing alteration of intestinal flora. RESULTS:The physicians adopted clinical pharmacist’s suggestions. No ADR was found during treatment,and the patients transferred to ordinary ward after the disease condition had been controlled. CONCLU-SIONS:The participating of clinical pharmacists in pharmaceutical care can promote rational drug use in the clinic and guarantee the safety of drug use.

A total of 160 elderly patients with Ⅰ -Ⅲ essential hypertension were enrolled in the study and examined with high-frequency color Doppler ultrasonography (America ATL Company HDI3500 type color ultrasonoscope). Common carotid artery (CCA), internal carotid artery and external carotid artery (ECA) were detected, including carotid artery intima-media thickness (CAIMT) and hemodynamic index. At the same time, 110 healthy elders were taken as contrast group. With the increased degree of hypertension, CAIMT was gradually enhanced and the most obviously in patients of grade Ⅲ hypertension. There were significant differences in grade Ⅲ, Ⅱ, Ⅰ and contrast group (P

Objective To develop a new methodology of prenatal sonography scoring to assess and dignose clubfoot.Methods Thirty-one fetuses suspected clubfoot(50 foots) and 62 normal fetuses(124 foots) were scanned with both 2D and 3D sonography,and were divided into normal feet group and clubfeet group.Our scoring system was made according to the Pirani-scoring for children,while considering the morphology of mid-foot and hind-foot of infants.The doctors would give final diagnosis for all fetuses after delivery or induced labor,and analyse the correlations among the abnormal signs,sonographic score and the clinical outcomes.Results The curve lat border,the medial crease,the empty heel and the post crease can be observed in the 3D reconstruction images.These four abnormal signs had close correlations with the clinical results.Conclusions The new prenatal clubfeet scoring system by 3D sonography is a promising methodology with clinical values.

The effects and the mechanism of insulin treatment on intracellular lipid metabolism in liver of diabetic rats were evaluated. Type 2 diabetic rats were induced by injecting the streptozotocin (25 mg/kg) and fat rich food. According to the results of oral glucose tolerance test (OGTT) and glucose-induced insulin secretion test (IRT), the rats were divided into two groups: untreated group (UT) and insulin-treated group (IT). Normal rats (NC) served as controls. The treatment with either Humulin N (4--6 U/kg every day), or saline lasted for 4 weeks. Body weight, OGTT, IRT, blood lipids, intracellular lipids in liver, hepatic fatty acid oxidation and the activity of fatty acid synthase (FAS) were detected. The change of liver histology was observed. The insulin sensitivity index (ISI) was applied to assess the status of insulin resistance. The results showed that as compared with NC group, the plasma and hepatic intracellular Triglyceride (TG), total cholesterol (TC) and free fatty acids (FFAs) were increased significantly in UT group (P < 0.05), and lipid droplets could be seen dispersedly in the liver specimens, the hepatic fatty acid oxidation was increased markedly (P < 0.05), while the fatty acid synthase activity decreased (P < 0.05). Insulin treatment resulted in a further accumulation of lipids in liver by 55.7%, 19.87% and 22.2% increase in TG, TC, FFAs respectively. The size of hepatocytes was enlarged and the cells were filled with fat drops. Plasma lipids showed little decrease and still significantly higher than those in NC group after the insulin treatment. Meanwhile, insulin treatment was companied by 20% decrease in the rate of fatty acid oxidation and 31% increase in hepatic FAS activity compared to UT group. It was concluded that treatment with insulin on type 2 diabetic rat increases hepatic intracellular lipid accumulation by inhibiting hepatic fatty acid oxidation and activating FAS.

Objective To explore the feasibility of coelocentesis in prenatal diagnosis.Methods Coelocentesis were applied on 58 women scheduled for at 6～12 weeks of gestation,and fetal heart rate before the procedure and 1,5,30 minutes afterwards and hemorrhage of amnionic cyst was observed.Y gene of sex-determining region was detected by polymerase chain reaction,and compared with chorionic villi sample.Results The total achievement ratio of coelocentesis was 96.6% of all cases in five minutes.The coelomic fluid was successfully aspirated at first attempt in 93.2% at 7～10 week's gestation,25.0% at 6～7weeks and 50.0% at 10 ~ 12 weeks.There was no significant difference in FHR between before coelocentesis and afterwards (P＞0.05).The detection accurate rate of SRY was 91.1%,all female fetus were matched with those observation by chorionic villi sampling,and only 5 male fetus were not matched,the accurate rate was 80.8%.Conclusion Coclocentesis has the advantage of simple procedure,safe and high feasibility.The optimal time of coclocentesis is in the 7th to 10th week of gestation.

Objective To evaluate the ultrasonic feature and clinical significance of persistent left superior vena cava(PLSVC)in fetal life.Methods Fetal echocardiography was performed in 3368 fetuses.Thirty-one fetuses of PLSVC were confirmed.Results The dilated coronary sinus was observed in 30 of 31 fetuses.Congenital heart defects were presented in 14 of these cases,and extracardiac anomalies were presented in 6 fetuses.Both congenital heart defects and extracardiac anomalies were observed in 4 fetuses.Conclusions PLSVC is always associated with congenital heart defects.The prognosis Of affected fetuses largely depends on whether or not the PLSVC is associated with a congenital heart defect.Prenatal diagnosis of PLSVC can help US plan perinatal counseling and ameliorate the postnatal course.

Mutations P459H and R483W detected in CYP21A2 gene in two Chinese patients with simple virilizing 21-hydroxylase deficiency were studied.Plasmid vectors containing P459H and R483W were constructed and transfected into COS-7 cells.The converting rate of progesterone to 11-desoxycortisone was calculated.P459H reduce 21-hydroxylase activity to 6.8%,while the residual enzyme activity of R483W was only 2.9%.