With the growing comprehensive national strength and international position,the international exchanges in medical health care field become actively and frequently,in which the medical associations play a proactive and facilitating role.The importance of foreign affairs of medical associations emerges.The management of foreign affairs is an important area of management.The foreign affairs must be in compliance with national policy to guide,regulate and dispose issues and problems.The management of foreign affairs of medical associations is one of the tasks of civil diplomacy and is also key component of civil diplomacy of Chinese characteristics which serves for national holistic diplomacy policy.The author is a project manager dealing with foreign affairs in Chinese Medical Association (CMA).Therefore,the author plans to analyze current international exchanges of CMA so as to explore certain enlightenments for peers.The paper is written based on international exchanges practice by CMA and analysis of typical cases,so as to raises some thoughts about how to improve the work of management of foreign affairs of medical associations.

Src family kinase (SFK) highly expresses in many types of cancers,broadly adjusting their malignant behaviors.Paclitaxel is a widely used chemical agent.However,because of constant resistance,the effect of paclitaxel has been greatly attenuated.The present review summaries the recent research progress of the structure and adjustment of SFK and the molecular mechanism of paclitaxel resistance,as well as the regulation of SFK on paclitaxel resistance,in order to provide new references and evidences upon the paclitaxel-based tumor therapy.

Objective To observe the relationship between early lactate clearance and APACHEⅡ in critically ill patients. Methods In 121 critically ill patients,APACHE Ⅱ and lactate clearance rate were recorded. According to APACHE Ⅱ score,all patients were divided into≤10 score group, (11 ～20) score group,(21 ～30) score group and ＞ 30 score group, then compared the level of the early lactate clearance rate. The early lactate clearance rate were also compared between survival group and death group. Then the relationship between early lactate clearance and APACHE Ⅱ were analyzed. Results In( 11 ～20) score group,the early lactate clearance rate was lower than those in ≤ 10 score group, but the difference was not significant ( P ＞ 0. 05 ). The early lactate clearance rate in (21 ～ 30) score group ( 18. 35 ± 10. 01 ) % was lower than those in ( 11 ～ 20) score group (27.35 ± 10. 22) % ( t = 3.481, P ＜ 0. 01 ),in ＞ 30 score group( 11.98 ± 9. 93 )% those was lower compared with (21 ～30) score group( t = 2. 968, P ＜ 0. 01 ). In death group, APACHE Ⅱ score(28. 1 ± 6. 7 ) was higher than that in survival group ( 18. 8 ± 8. 4) ( t = 3. 030, P ＜0. 01 ), the early lactate clearance rate was lower ( t = 3. 619, P ＜ 0. 01 ). APACHE Ⅱ score correlated well with the mean level of the early lactate clearance rate ( r = - 0. 641, P ＜ 0. 01 ). Conclusion The lactate clearance rate was the good fator on evaluation of condition and prognosis in the critically ill patients.

Integrating Post-Abortion family planning services into existing abortion services in hospital settings in China (INPAC) Project under European Union Framework 7 is an international cooperative study underwent by 7 Sino-European research institutions and non-profit organizations.By learning experiences and integrating the methods of tree-like hierarchical management, whole process management and fine management, the Chinese Medical Association explored a characteristic management method of international cooperative study suitable for non-profit organization, which effectively facilitated project management and financial management and stimulated the disciplinary development and talents building.

Objective To investigate the association between different number of inferomedial screws (0-3 screws) and their efficacy in locking plate of proximal humerus fractures.Methods Data of 90 patients who had undergone locking plate for proximal humerus fracture between January 2007 and December 2012 were retrospectively analyzed.They were divided into four groups according to the number of inferomedial screws.In the NS (no-screw support) group,36 patients did not have inferomedial screws for mechanical support of the inferomedial region of the proximal humerus; in the OS (one-screw support) group,23 patients had the reconstruction by insertion of only one inferomedial screw; there were 19 patients in the TS (two-screw support) group and 12 in the ThS (three-screw support) group.There were no significant differences among 4 groups in sex,fracture type and age.The Constant scores of the shoulder function,changes in humeral head height at the latest follow-up,incidence of complications and time for fracture healing among the 4 groups were collected.Results The follow-ups for the patients ranged from 12 to 56 months (mean,21.4 months).At the latest follow-up,the ThS,TS,OS and NS groups had a mean Constant score of 76.7 (SD,11.6),74.1 (SD,7.4),66.8 (SD,10.7),65.8 (SD,10.2),respectively; the mean change in humeral head height were 1.4 (SD,1.0) mm,2.9 (SD,1.2) mm,5.3(SD,3.2) mm and 6.7(SD,3.3) mm,respectively.There were no significant differences between the ThS and TS groups in Constant score,and Constant scores in ThS and TS groups were significantly higher than those in OS and NS groups.However,the loss in humeral head height in the ThS group was significantly less than those in the TS,OS and NS groups,and the loss in humeral head height in TS group was significantly less than those in the OS and NS groups.There were no significant differences among 4 groups in time for fracture healing and incidence of complications.Conclusion Locking plate in general do not appear to be a panacea for proximal humerus fractures especially in cases of medial comminution or bone defects because of the malreduction of the medial cortical bone.However,medial support with two or three inferomedial screws being meticulously placed in the inferomedial region may enhance the mechanical stability of medial column support and allow for better maintenance of reduction.

Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and laparoscopic cholecystectomy(LC)for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients(P＜0.05).Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.

Objective To study the preventive effect of biliary duct injury(BDI)of three-dimensional spiral CT cholangiography(SCTC)before laparoscopic cholecystectomy(LC).Methods A retrospective analysis was carried out for 30 patients suffering from cholelithiasts concurrent with choledocholithiasis from July 2007 to June 2009.EAndoscopic sphincterotomy(EST),then three-dimensional SCTC was carried out through endoscop-ic nasobiliary drainage(ENBD)before IX,and the preventive effect of BDI was evaluated.Results The visibility of intra-hepatic bile duct,the hepatic bile duct and the common bile duct were 100% the visibility of chol-ecyst bile duct was 73% ,and three-dimensional SCTC can tell the position of cholecyst duct,BDI was not happened in all these patients.Conclusion Three-dimensional SCTC before LC can decrease the possibility of BDI.

ObjectiveTo study the preoperative evaluation of three-dimensional spiral CTcholangiography(SCTC) in patients with bile duct obstruction.MethodsA retrospective analysis was performed for 60patients with bile duct obstruction from May 2008 to April 2011,who were treated with endoscopic retrograde cholangiopancreatography( ERCP),then SCTC was performed through endoscopic nasobiliary drainage( EN-BD) tube,and the bile duct tree image of SCTC of bile duct obstruction was evaluated.ResultsIn 60 cases of bile duct obstruction who performed three-dimensional SCTC,the left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,cholecyst bile duct was visible in 80％ patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enters into the common bile duct.ConclusionThree-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values in judging the structure of the bile duct tree and the shape of cholecyst bile duct during operation.

Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy.Methods A retrospective analysis was performed for 60 patients with cholelithiasts concurrent with choledocholithiasis from May 2009 to April 2012,which were treated with endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST),and endoscopic nasobiliary drainage (ENBD),then three-dimensional spiral CT cholangiography(SCTC) was performed through endoscopic nasobiliary drainage (ENBD) tube,and the bile duct tree image of SCTC was evaluated,then laparoscopic cholecystectomy (LC) was carried out.Results Sixty cases were performed three-dimensional SCTC.The left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,and cholecyst bile duct was visible in 75％patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enteres into the common bile duct.Conclusion Three-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values to judge the structure of the bile duct tree and the configuration of cholecyst bile duct during operation,which can decrease the possibility of bile duct injure.

Objective To explore the clinical effect of treatment for cholecystolithiasis and calculus of com-mon bile with duodenoscope and laparoscope. Methods 48 cases of patients with cholecystolithiasis and calculus of common bile duct were analysed, of whom 30 cases were treated by traditional operation, and 18 cases were treated by duodenoscope and laparoscope. The operation time, stay-in-hospital time after operation, the gastrointestinal function recovery time after operation, the degree of pain were compared. Results The cost of duodenoscope and laparoscope was higher than that of traditional operation group, but the other parameters were better ( P < 0.05 ). Conclusion Treating cholecystolithiasis and calculus of common bile duct with duodenoscope and laparoscope is safe, less traumatic and the patients may recover faster than routine treatment.