Shanghai Medical Center for Children, jointly set up by the municipal government and the World Health Foundation of America, possesses advanced intelligence hospital buildings and medical facilities. The authors gave a detailed account of the centers practice in implementing reform with modern ideas of hospital management. Specific ways include: ①improving the overall quality by training all workers and staff of the management contingent; ②strengthening medical quality control via orienting medical service towards the needs of patients; ③conducting widespread international exchanges and cooperation with specialty development serving as the link; ④enriching hospital culture by strengthening the building of a spiritual civilization with special characteristics; ⑤setting up the centers development department so as to raise social charity funds for the advancement of the hospital; ⑥outsourcing logistic service so as to improve operating efficiency.

Objective To investigate the diagnostic significance of synchronous observation on bone marrow biopsy,bone marrow smear and peripheral blood smear in stubborn hematonosis.Methods Thirty-seven patients with difficult and complicated hematologic diseases were detected by peripheral blood smear,bone marrow smear and bone marrow biopsy.Those slides and smears were observed.Results The 37 cases with blood disease was diagnosed of aplastic anemia in 3 cases,5 cases of myelodysplastic syndrome,6 cases of primary myelofibrosis,13 cases of secondary myelofibrosis,7 cases of lymphoma with bone marrow infiltration and 3 cases of metastatic carcinoma of bone marrow.In the diagnosis of aplastic anemia,myelodysplastic syndrome,primary and secondary myelofibrosis,lymphoma and metastatic carcinoma of bone marrow diagnosis,bone marrow biopsy is superior to smear.Conclusion Bone marrow biopsy,bone marrow smear and peripheral blood smear synchronous observation can effectively increase the diagnostic rate,decrease misdiagnosis rate,and correctly identify the stage of the disease.

ObjectiveTo compare the characteristics of urinary function in the patients with spinal cord injury or stroke. MethodsThe urinary diaries of 40 patients with spinal cord injury and 43 patients with stroke during a week were analyzed. ResultsIn the group of spinal cord injury, the average frequency of incontinence was 11 times a day, the average incontinence volume was (180.6±21.4) ml, and the average residual urine volume was (257±86.5) ml, while in the group of stroke, it was 16 times a day（P>0.05）, (298.8±34.6) ml （P<0.01）, and (28.5±18.5) ml （P<0.01）, respectively. Ultrasonic inspection discovered that 12% patients appeared ureterectasia and hydronephrosis in group of spinal cord injury, but none in group of stroke. ConclusionThere is significant difference of urinary dysfunction between patients with spinal cord injury and stroke, which need different management to protect their upper urinary tract.

Objective To assess the expression pattern of protease-activated receptor 2 (PAR2) in human keratinocytes and to characterize its biological functions in the regulation of skin barrier.Methods Primary human keratinocytes and human N/TERT keratinocytes were used as the subject of this study.The expression and distribution of PAR2 in the keratinocytes were analyzed by using immunoflorescence staining and Western blot.Two different PAR2 agonists,trypsin and a PAR2-activating peptide (AP),as well as a PAR2-antagonistic peptide (H2N-FSLLRY-COOH) and a control peptide were used to induce the activation of PAR2 in the keratinocytes.Then,a fluorescence-based calcium mobilization assay was performed to evaluate the biological function of PAR2.Data were statistically analyzed by one-factor analysis of variance.Results Under normal culture conditions,PAR2 was weakly expressed in keratinocytes,and the expression was unaffected by culture medium composition or culture duration.Calcium mobilization was induced by trypsin of 50-250 nmol/L and the PAR2-activating peptide in a dose-and time-dependent pattern.The maximal activation of PAR2 was observed in keratinocytes treated with the PAR2 agonist HAN-SLIGKV-COOH of 75-250 μmol/L.The PAR2-antagonistic peptide (H2N-FSLLRY-COOH) obviously suppressed the increase in calcium mobilization induced by trypsin,while the control peptide PAR-RAP showed no inductive effect on the PAR2 activation based on the absence of calcium mobilization.The substrate-induced calcium release was complete within 250 seconds,and peaked at 50 seconds after the initial trypsin or PAR-AP stimulation.Moreover,the activation of PAR2 was accompanied by an increase in ERK phosphorylation and elicitation of MAPK signaling pathway in keratinocytes.Conclusions Human keratinocytes positively express PAR2,which can be activated by trypsin and PAR2-activating peptides,and the activation of PAR2 may influence the physiological function of keratinocytes by inducing intracellular calcium release.

Objective To analyze the role of paroxysmal nocturnal hemoglobinuria (PNH) clones in children with acquired aplastic anemia (AA). Methods The relationship between the existence of PNH clones and clinical features in children with AA was retrospectively analyzed. The influence of PNH clones on the efficacy of combined immunosuppressive therapy (IST) of anti-thymocyte globuline (ATG) and cyclosporine A (CSA) was also observed. In addition, multiple factor analysis was used to analyze the main factors affecting the efficacy of AA. Results One hundred and forty-eight children with AA were enrolled, including 74 cases (50%) of granulocyte PNH clones positive, 68 cases (45.9%) of monocyte PNH clones positive, and 93 cases (62.8%) of total PNH clones (granulocytes and / or monocytes) positive. In 49 children having both granulocytes and monocytes PNH clones, the clone size of monocytes and granulocytes was 0.7% (0.4%-1.5%) and 0.2% (0.1%-0.7%), respectively, and the difference was significant (P<0.001) and there was a significantly positive correlation between them (r=0.65, P<0.001). According to the different PNH positive clones (monocytes, granulocytes, total), children were divide into three groups. And there were no differences in gender, age, concurrent infection, white blood cell count, hemoglobin concentration, platelet count, neutrophil absolute count, reticulocyte percentage in different PNH clones positive and negative groups (P>0.05). The group with monocytes PNH clones positive had a positive effect on the efficacy of IST (P=0.02). Multiple factor logistic regression analysis showed that the concentrations of hemoglobin and the positive PNH clones of monocytes were the main factors affecting the efficacy (P<0.05). Conclusions The high concentration of hemoglobin and the positive PNH clones of monocytes contribute the better effect of IST in children with AA.

Objective This study investigated the nurses'pressure of PDA usage , analyzed its related factors, in order to provide the basis for extensive use of PDA , and to accelerate the process of nursing informatics .Methods Using convenience sampling method , 117 nurses of Beijing tertiary hospitals were surveyed.Results The mean score of pressure of nurses using PDA was (2.96 ±0.68), at a medium level of pressure .More than 70%of the nurses used PDA for six months or more , and 57 .3%of them used PDA well , and 41.9% of them liked to work using PDA.When first using PDA, 45.3% of nurses felt pressure.At present, 40 nurses (34.2%) showed relieving the pressure of PDA usage .Nurses of different ages, different working years , different computer skills level , liking to use PDA and proficiency in using PDA , showed statistically significant differences ( t =-2.329, -2.264,2.390,5.363,7.699, respectively;P <0.05). Conclusions We need to concern about the pressure of nurses using PDA in working , to further strengthen their awareness of the initiative , to carry out relevant training , to expand the range of applications and functions of PDA in clinical nursing work , and then to promote the development of nursing information .

Objective To develop a intelligentized delirium assessment system based on the Confusion Assessment Model for Intensive Care Unit ( CAM-ICU ) and test its usability among nurses in the ICU . Methods Through convenient sampling , investigators selected 68 ICU nurses from 3 hospitals in Beijing to participate in this study .Participants tried the new intelligentized system before they filled in the evaluation form named as "Usability analysis of the intelligentized CAM-ICU delirium assessment system interface evaluation questionnaire"which was adapted from the framework of "Technology Acceptance Model".Results Among the 68 ICU nurses, 51.5% had received delirium assessment training prior to the study , 79.4% had cared for delirious patient and 70.6% had actually identified delirious symptoms among the patients they cared in the past.The average score for the items in the questionnaire ranged from 3.4 to 4.0.The scores among nurses who had received delirium assessment training before the study had significant difference compared to the ones who did not (P<0.05).They had perceived that the design of the system was satisfactory , and they were willing to use this system in delirium assessment , and expressed that it could improve their ability in assessing delirium therefore promoted the overall quality nursing care of patients (χ2 =6.28,P =0.012).Conclusions The design of the intelligentized CAM-ICU delirium assessment system is simple to use and easy to operate , especially among those who have had knowledge related to delirium assessment prior to the study .It reflects that this system is useful in identification of delirious patient and can improve the accuracy of delirium diagnosis in the ICU.

Objective To explore the clinical significance of detecting platelet parameters in the diagnosis and efficacy-evaluation of adult severe primary immune thrombocytopenia (ITP). Methods Thirty-four adult patients with primary ITP admitted in our hospital served as observa-tion group while another 30 healthy people undergoing physical examination as control group. Platelet parameters on both groups before treatment and in observation group 3and 7 days after treatment were observed.Results Before treatment,observation group was evidently lower in platelet count (PLT)and plateletocrit (PCT)and obviously higher in mean platelet volume (MPV) than control group (P <0.05),but there was no significant difference in platelet distributive width (PDW)(P >0.05).Compared with treatment before,PLT,PCT,MPV increased more markedly 3 d after treatment while PLT,PCT,PDW increased significantly 7 days after treatment in obser-vation group (P <0.05).Conclusion Platelet parameters have important clinical significance in e-valuating the progression and efficacy of adult patients with severe primary ITP.

Objective To explore the clinical significance of detecting platelet parameters in the diagnosis and efficacy-evaluation of adult severe primary immune thrombocytopenia (ITP). Methods Thirty-four adult patients with primary ITP admitted in our hospital served as observa-tion group while another 30 healthy people undergoing physical examination as control group. Platelet parameters on both groups before treatment and in observation group 3and 7 days after treatment were observed.Results Before treatment,observation group was evidently lower in platelet count (PLT)and plateletocrit (PCT)and obviously higher in mean platelet volume (MPV) than control group (P <0.05),but there was no significant difference in platelet distributive width (PDW)(P >0.05).Compared with treatment before,PLT,PCT,MPV increased more markedly 3 d after treatment while PLT,PCT,PDW increased significantly 7 days after treatment in obser-vation group (P <0.05).Conclusion Platelet parameters have important clinical significance in e-valuating the progression and efficacy of adult patients with severe primary ITP.

Background: Changes in thyrotropin receptor antibody (TRAb) levels are associated with the clinical outcomes of Graves’ hyperthyroidism. However, the effects of the patterns of TRAb changes on patient prognosis according to the treatment duration of antithyroid drugs (ATDs) are not well established. Methods: In this retrospective cohort study, 1,235 patients with Graves’ hyperthyroidism who were treated with ATDs for more than 12 months were included. Patients were divided into two groups according to treatment duration: group 1 (12–24 months) and group 2 (>24 months). Risk prediction models comprising age, sex, and either TRAb levels at ATD withdrawal (model A) or patterns of TRAb changes (model B) were compared. Results: The median treatment duration in groups 1 (n=667, 54%) and 2 (n=568, 46%) was 17.3 and 37.1 months, respectively. The recurrence rate was significantly higher in group 2 (47.9%) than in group 1 (41.4%, P=0.025). Group 2 had significantly more goiter, thyroid eye disease, and fluctuating and smoldering type of TRAb pattern compared with group 1 (all P<0.001). The patterns of TRAb changes were an independent risk factor for recurrence after adjusting for other confounding factors in all patients, except in group 1. Integrated discrimination improvement and net reclassification improvement analyses showed that model B performed better than model A in all patients, except in group 1. Conclusion The dynamic risk model, including the patterns of TRAb changes, was more suitable for predicting prognosis in patients with Graves’ hyperthyroidism who underwent longer ATD treatment duration.