The ongoing health reform is bringing reforms of public hospitals under spotlight in China, attracting growing attention onto its progress and roadblocks. Probing into the "three steps" of public hospital system reform in Wuxi, this article analyzed such a reform in the city. It described the measures and initial outcomes gained in such fields as the hospital trusteeship reform, the separation of hospital regulation from its administration, and the hospital board system. Citing the case of Wuxi No. 2 People's hospital as an example, the authors introduced the innovative efforts made in hospital internal mechanism, management innovation, medical service model, hospital connotation construction, and talents cultivation.

Objective To analyze the characteristics of newborns in occurrence of adverse outcomes that transferred from other hospitals during the past four years,in order to improve the province's perinatal survival quality and reduce mortality.Methods The clinical data of 255 cases in occurrence of adverse outcomes in transit during January 2008 to December 2011 were analyzed retrospectively.According chronologically 255 cases were divided into group A (124 cases,January 2008 to December 2009) and group B (131 cases,January 2010 to December 2011).We analyzed the basic data,perinatal factors and major diseases of the newborns,and compared the changes of related characteristics in different periods.Results Adverse outcomes in male patients were significantly higher than female patients (male:female 3.05:1,192:63) ; there were higher proportion of premature infants (73.3％,187/255) and cesarean section (49％,125/255).The major diseases were respiratory system diseases (71.4％,182/255),followed by circulatory system diseases (40.4％,103/255),and severe congenital abnormalities (26.3 ％,67/255).Group B compared with group A:(1) the proportion of hospitalization time ＜ 24 hours increased (73/131 vs 50/124,P ＜ 0.05) ; (2) the proportion of more than two referrals increased (41 / 131 vs 23/124,P ＜ 0.05) ; (3) the proportion of very low birth weight infants (including extremely low birth weight) increased significantly (75/131 vs 43/124,P ＜ 0.05) ; (4) the proportion of respiratory system diseased (131 / 131 vs 124/124),asphyxia (9/131 vs 22/124) and hypoxic ischemic encephalopathy (6/131 vs 16/124) decreased significantly (P ＜ 0.05) ;(5) the proportion of circulation system diseased (60/131 vs 31 / 124) and congenital developmental abnormalities (51/131 vs 23/124) increased significantly (P ＜ 0.05) ;(6) the application of mechanical ventilation (115/131 vs 88/124) and pulmonary surfactant (85/131 vs 52/124) increased significantly (P ＜ 0.05) ;(7) the usage of blood products decreased significantly (39/131 vs 53/124,P ＜ 0.05) ; (8) giving up treatment due to economic reasons reduced significantly (22/131 vs 37/124,P ＜ 0.05).Conclusion For the grassroots medical institutions,the choice of transport time and referral hospital may affect the incidence of adverse outcomes; the high rate of cesarean section may increase the incidence of adverse outcomes; the treatment capacity of extremely low and very low birth weight infants may directly affect the incidence of adverse outcomes ; the respiratory system diseases greatly impact on adverse outcomes,but the accompanied circulatory system diseases impact on adverse outcomes increased in recent years.

Objective To investigate the changes of serum protein fingerprint in patients with lung cancer with deep venous thrombosis.Methods Eighteen case patients with lung cancer were selected,including 8 case of lung cancers with thrombosis and 10 cases of lung cancers with no thrombosis.Surface enhanced laser desorption ionization protein-time of flight mass spectrometry (SELDI-TOF-MS) was used to analyze serum protein content of two groups in the same mass to charge ratios(M/Z),then drew the protein peaks that content difference was statistically significant.Results The M/Z of lung cancer with thrombus group and control group were 5911,1216,4187,1019,4293,the protein peaks had significant differences between the two group (43.81±7.74,6.37±5.02,2.97±0.35,35.96± 12.10,9.65±4.37;15.35± 12.69,2.06±0.37,4.67± 1.35,15.94±6.47,14.65±8.80;t =5.334,4.800,2.981,4.639,4.596;P＜ 0.05).Compared with the control group,the decrease of protein peak M/Z were 5911,1019,1216,and the increase of protein peak M/Z were 4293,4187 in the deep venous thrombosis group.Conclusion In the serum of patients with tumors SELDI profiles M/Z are 5911,4293,4187,1019,1216 of SELDI protein fingerprinting can be considered in patients with thrombosis of tumor specific markers.

Objective Exploration of TSH, FT3, FT4 changes in critical condition prior to death.Methods 84 patients that were anti-tumor therapy acceptable and not associated with the treatment of thyroid disease in patients with terminal tumors. Age from 24 to 85-year-old, male 56, female 28. The use of SELDI technology (surface-enhanced laser description / ionization time-of-flight mass spectrometry protein chip technology) checks to M/Z for the 11 100 + H～11 900 + H peak of the cluster, divided into the positive group for critically ill patients with early warning protein (LGT) and the negative group for it. All patients were given TSH, FT3, FT4 inspection. The results were statistically analyzed. Results TSH, FT3, FT4 in the LGT positive group was significantly lower than in the negative LGT group. There was no correlation between TSH,FT3 and FT4 in the LGT positive group;In the negative LGT group FT3 and FT4 had a positive correlation,and FT3 and TSH no relevance. Conclusion Thyroid function is normal in the stage of cancer patients stable condition. Possible pituitary-hypothyroidism may occur as the disease advances to the end or before death.This may be an important factor causing the acceleration to the death of the patients. However, the cause and effect between this phenomenon and the early warning of protein fingerprint group(LGT) is still not clear. In critical condition checking thyroid function and render supplementary amount of thyroid hormone in accordance with the checking results may be beneficial.

There are many progresses in the therapy of MM with ASCT. ASCT improves the ratio of CR,EFS and OS,compared with conventional chemotherapy.Myeloma patients with renal failure or old age also can be candidate for ASCT.Tandem autologous transplantation improves the ratio of CR. Its impact to long-term EFS and OS still need to be judged.To improve conditional project,to choose suitable time,and- toselect consolidation schedule can boost therapeutic effect.

Follow-Up Studies ; Forearm ; Humans ; Infant, Newborn ; Male ; Melanoma ; congenital ; surgery ; Skin Neoplasms ; congenital ; surgery

Objective To evaluate clinical and radiographic outcomes associated with total hip arthroplasty (THA) using metal-on-metal prosthesis with large diameter femoral head.Methods From October 2007 to December 2007,41 patients (49 hips) underwent large diameter femoral head metal-on-metal THA in our hospital were involved in this study.Clinical outcomes measures were Harris score,hip range of motion and incidence of complications.Abduction angle and anteversion angle of cup were measured on radiological films.The radiolucent line and osteolysis around the prosthesis were also recorded.Results Thirty-nine patients (47 hips) were followed up at least 2 years.The average Harris hip score had improved from (43.8±13.1) points preoperatively to (92.0±5.4) points at final follow-up.All the patients had attained satisfactory results.No late complication happened.For the rang of motion at final follow-up:flexion of the hip had improved from 79.8° to 113.2°,abduction had improved from 20.9° to 40.2°,external rotation had improved from 12.0° to 30.8°.Radiological measurement showed the mean abduction angle of cup was 39.5°±4.9°,the mean anteversion angle of cup was 14.5°±2.1°.No radiolucent line and osteolysis were found after THA.Conclusion The short-term effects of THA using metal-on-metal prosthesis with large diameter femoral head is encouraging,especially for young patients.

In order to identify Peucedani Radix, Peucedani Decursivi Radix and their adulterants, the internal transcribed spacer 2 (ITS2) regions of Peucedani Radix, Peucedani Decursivi Radix and their adulterants were amplified and bidirectionally sequenced based on the Principles for Molecular Identification of Traditional Chinese Materia Medica Using DNA Barcoding, which has been promulgated by Chinese Pharmacopoeia Commission. Sequences were analyzed and assembled by Codon Code Aligner V3. 7.1. The relevant data were analyzed by MEGA 5. 0. Species identification analyses were performed by using the nearest distance methods and neighbor-joining (NJ) methods. The result showed that the ITS2 sequence lengths of Peucedani Radix were 229-230 bp and the average intra-specific genetic distances were 0.005. The ITS2 sequence lengths of Peucedani Decursivi Radix were 227 bp and the sequences contained no variation site. The average inter-specific K2P genetic distance of Peucedani Radix, Peucedani Decursivi Radix and their adulterants species were 0.044 and 0.065 respectively. The minimum inter-specific divergence is larger than the maximum intra-specific divergence of Peucedani Decursivi Radix. The nearest distance methods and NJ trees results indicated that Peucedani Radix, Peucedani Decursivi Radix and their adulterants species could be identification clearly. The ITS2 regions can stably and accurately distinguish Peucedani Radix, Peucedani Decursivi Radix and their adulterants.
Apiaceae ; classification ; genetics ; DNA Barcoding, Taxonomic ; methods ; DNA, Ribosomal Spacer ; Drug Contamination

Objective To study whether 3D computerized pre?operative planning is accuracy and reliability in CroweⅣtype developmental dysplasia of the hip (DDH) patients undergoing total hip arthroplasty (THA). Methods Between September 2009 and February 2011, 20 CroweⅣtype DDH patients (20 hips) were included in this study. The 3D pre?operative planning was performed using Mimics software to predict the acetabular component size, acetabular component abduction angle, hip rota?tion center position, the acetabular component coverage and number of patients received structural bone graft. The results were compared with traditional acetate templating technique and post?operative results. Results 70%(14/20) components were pre?dicted exactly and 30%(6/20) components were predicted with one size using 3D computerized planning, comparing with 25%(5/20) components were exactly, 45%(9/20) components were with one size and 30%(6/20) were with two size or more using conven?tional acetate templating technique. Statistically analysis revealed that 3D planning was more accuracy than templating technique regarding acetabular component prediction (t=-4.66, P=0.00). There was no significant difference between the 3D computerized planned acetabular component abduction angle (3D plan 41.10°±4.87°, postoperative 44.98°±10.83°, t=0.88, P=0.42), hip rota?tion center distance (horizontal distance:3D plan 77.51 ± 7.78 mm, postoperative 79.85 ± 8.61 mm, t=-1.95, P=0.11;vertical dis?tance:3D plan 42.79±8.22 mm, postoperative 44.98±10.83 mm, t=-1.27, P=0.26), acetabular component host coverage (3D plan 77.73%± 10.51%, postoperative 78.98%± 10.24%, t=-1.84, P=0.09), and that found post?operatively. Five patients were consid?ered to need structural bone graft according to 3D computerized planning, which was highly coincident with the intraoperative find?ings in all five cases. Conclusion 3D computerized pre?operative planning using Mimics software is an accurate and reliable technique in treating CroweⅣtype DDH patients undergoing THA.

Objective To evaluate mid?term clinical outcomes associated with total hip arthroplasty using metal?on?met?al prosthesis with large diameter femoral head. Methods From March 2007 to December 2009, 153 patients (177 hips) with ad?vanced hip diseases undergoing large diameter femoral head metal?on?metal total hip arthroplasty in our hospital were retrospec?tively analyzed in this study. Clinical physical examination and radiographic examination were used to evaluate hip function and the incidence of complications (implant loosening and inflammatory pseudotumor);ICP?MS method was used to determine serum cobalt ion and chromium ion levels and compare with normal values;revision was set as the prosthesis endpoint to evaluate the five year survival rate of implant. Results A total of 145 patients (169 hips) were followed up for average 72.4 months (67-80 months), the follow?up rate was 94.8% (145/153). For the involved patients, 85 were male (104 hips), 60 were female (65 hips);age 20-78 years old, average 49.3±12.6 years old. All patients received ASRTM?XL large femoral head metal?on?metal to?tal hip arthroplasty operation. At the end of follow?up, the average Harris hip score improved from 44.2±12.6 points preopera?tively to 91.5±5.7 points. A total of 8 patients received revision, 3 for acetabular implant spinout?out and 5 for hip inflammato?ry pseudotumor. The prosthetic survival rate 5 years after operation was 95.3% (161/169) for revision. Serum cobalt (2.89 μg/L) and chromium (3.31 μg/L) ion levels were significantly increased compared with normal value (<0.5 μg/L). Conclusion For the fixation and friction interface disadvantages, acetabular implant spinout?out and inflammatory pseudotumor might occur for patient receiving large femoral head metal?on?metal THA. The mid?term prosthetic survival rate was also low, with metal ion levels increased significantly. For primary THA, large femoral head metal?on?metal prosthesis cannot be the first choice.