The paper systematically elaborated the concept of corporate governance structure of public hospitals and theories in relation. In addition, it analyzed the status quo and problems existing in corporate governance structure of public hospitals in China, proposing the basic principles and the council model of corporate governance structure. The authors emphasized the following responsibilities and rights of the council, the president, and the board of supervisors in such a framework: 1) As the hospital's highest decision-maker, the council exercises the rights of ownership, playing a decisive role in hospital management; 2) the president is appointed and dismissed by the council, and authorized to run the hospital; 3) the supervisors are responsible for overseeing the council and senior management. In the end, this paper summarized the external environment required for building corporate governance structure of public hospitals.

ObjectiveTo explore the relationship between serum uric acid and prehypertension and the effects of age,obesity,fasting glucose and lipids in Chinese adults.Methods14,451 non-hypertensive cases from a community-based health examination survey in Xuzhou,Jiangsu province of China were enrolled in this study.Blood pressure,BMI,and determination of fasting glucose,lipids and serum uric acid were measured in all cases.ResultsThe odds ratios ( OR,95％ CI ) of prehypertension across increased serum uric acid after adjusting for age,sex were 1.0,1.20 ( 1.07 - 1.35 ),1.55 ( 1.36 - 1.76),1.82(1.60-2.09),2.33(2.03-2.67) (Pfor trend ＜0.01).The odds ratios were 1.0,1,04(0.92-1.18),1.21(1.06-1.38),1.26(1.09 - 1.45),1.36(1.17 - 1.58),( Pfor trend ＜0.01) after adjusting for age,sex,BMI,glucose,and lipids.In addition,fasting glucose significantly interacted with uric acid ( P for interaction ＜ 0.01 ).Conclusions Serum uric acid was associated with prehypertension,which might be an independent metabolic risk factor.Fasting glucose may reinforce the associations.

Objective To analyze the differentially expressed genes in esophageal squamons cell carcinoma (ESCC), para-cancerous tissue (PCT) and normal esophagus tissue (NET) using oligomicroarray and to identify the target genes related to the development and progression of esophageal carcinoma. Methods The total RNAs isolated from ESCC, PCT or NET using one step Trizol method were purified and reversely transcribed into cRNAs. The cRNAs were then fluorescence labeled and hybridized with Agilent oligomicroarray (21 074 probes). The fluorescence intensity features were detected by Agilent scanner and quantified by feature extraction software. The selected candidate genes were confirmed by real time real time fluorescent quantitative RT-PCR immunohistochemistry andWestern blotting.Results ① The oligomicroarray demonstrated that there were 38 up-regulated genes and 61 down-regulated genes. ② The real time fluorescent quantitative RT-PCR revealed that five genes (CTHRC1, INHBA, SPP1 ,LUM, HRK)were more differentially expressed in up-regulated genes. Of which, CTHRC1 displayed more disparity.③ Immunohistochemistry examination showed that the higher expression of CTHRC1 (56.5 %, 26/46) was observed in ESCC. There was significantly difference in expression of CTHRC1 between patients with or without lymph node metastasis (P<0.05). ④ CTHRC1 protein was expressed in both TE-13 and Eca-109 cell lines. Conclusion CTHRC1 is probably one of the most significant biomolecules in ESCC.

Objective To explore the effect of minimally invasive surgery in patients with multiple fractured ribs complicated with traumatic diaphragmatic hernia. Methods Clinical data of 48 patients with multiple fractured ribs complicated with traumatic diaphragmatic hernia from January 2010 to January 2016 were retrospective analyzed. All the patients were divided into control group and observation group according to the operation method, 24 cases in each. Patients in control group were treated with thoracotomy, while patients in observation group were treated by video-assisted thoracic surgery. Results The incision length, operative time, blood loss, postoperative thoracic drainage time and hospital stay in the observation group were significantly lower than that in control group, and the difference was statistically significant (P < 0.05). Patients with fractured ribs of the two groups were cured after bandage fixation and the observation group were treated with no conversion to thoracotomy. Clinical efficiency of the two groups were 91.67% and 79.16% and the overall complication rate was 8.32% and 37.48% respectively, the difference is statistically significant (P < 0.05). Conclusion The video-assisted thoracic surgery in treatment of multiple fractured ribs complicated with traumatic diaphragmatic hernia has advantages of less trauma and blood loss during operation, shorter operation time, faster postoperative recovery, and better curative effect, lower incidence of complications. It can be further promoted and used in clinical.

Objective To report a case of toxic epidermal necrolysis associated with geotrichosis due to Geotrichum silvicola. Methods The exudates from the body surface, blood and urine of the patient were examined by microscopy and simultaneously inoculated onto the Sabouraud dextrose agar (SDA) medium. The isolate was examined by microscopy, PCR which amplified the D1/D2 domain of 26S rDNA, and gene sequencing. Homologous sequences were searched in the GenBank/EMBL/DDBJ/PD nucleotide sequence library, and the genetic relationship was analyzed with the genealogical tree. Results Microscopy of pus from the abscess on the dorsa of left hand revealed a lot of spores and a few hyphae, which were not observed in the blood or urine specimens. Meanwhile, whitish colonies were grown in all the three successive cultures of blood and urine specimens, rather than the exudates on the body surface. After itraconazole and garlicin were administered for one week, both microscopic exam and fungus culture were negative. Microscopic exam of the isolate showed arthrospores arranged in chains, budding spores and a few of hyphae. It was found that there was a one-base difference between our isolate (Hebei-1) and the isolate from kerion -like eruptions (Changzheng-1), and a four-base difference between our isolate and the reference Geotrichum silvicola strain as well, in the D1/D2 domain of 26S rDNA. This isolate was identified to be most close to Changzheng-1 in the phylogenetic tree. Conclusion The patient with toxic epidermal necrolysis is associated with geotrichosis due to Geotrichum silvicola.

Objective To explore the types and drug resistance of pathogens in patients with type Ⅰ incision surgical site infection in orthopedics department.Methods Patients with type Ⅰ incision surgical site infection in orthopedics department at Peking University Third Hospital from January 2005 to December 2013 were retrospectively collected.Clinical characteristics of patients,distribution and drug resistance of pathogens were analyzed.Results A total of 58.2 thousands patients with type Ⅰ incision surgical site were hospitalized from January 2005 to December 2013 in orthopedics department,and among them 442 patients had infection in the type Ⅰ incision surgical site.The infection rate was 0.8％.Infection was mainly observed in elderly patients.The most common diseases were lumbar canal stenosis (21.7％),cervical spondylosis (20.6％) and lumbar intervertebral disc herniation (14.0％).A total of 453 pathogenic strains were detected,of which 52.9％ were gram-positive bacteria,45.5％ were gramnegative bacteria and 1.6 ％ were fungi.The common pathogens were Staphylococcus aureus (25.2 ％),Staphylococcus epidermidis (14.1 ％),Escherichia coli (11.5 ％),Enterobacter cloacae (7.3 ％),Pseudomonas aeruginosa (6.2 ％) and Acinetobacter baumannii (6.0 ％).The percentage of Meticillinresistant Staphylococcus aureus (MRSA) was 23.7％ and the percentage of Meticillin-resistant Staphylococcus epidermidis (MRSE) was 43.8％.Vancomycin or linezolid-resistant Staphylococcus aureus or Staphylococcus epidermidis were not detected.Proportion of extended-spectrum beta-lactamases (ESBL) producing strains in Escherichia coli was 53.8％,and proportion of ESBL-producing strains in Klebesiella pneumonia was 50.0％.The resistance rates to impenem and meropenem of the three different species in Enterobacteriaceae,including Escherichia coli,Enterobacter cloacae and Klebsiella pneumonia,were 0.Resistance rates of Pseudomonas aeruginosa to cefoperazone-sulbactam,piperacillin-tazobactam were less than 10 ％.Resistance rate of Acinetobacter baumannii to minocyline was 11.1％ and resistance rates of it to other drugs were more than 20％.Conclusions The rate of type Ⅰ incision surgical site infection in orthopedics department is low.Gram-positive and gram-negative bacteria each account for half of the pathogens.The proportion of resistant pathogens is high and empirical treatment is needed to cover these pathogens.

Objective To investigate the effects of hypoxia-inducible factor (HIF)-1α on glycolysis of human esophageal squamous carcinoma cells and the possible mechanism.Methods TE13 and Eca109 cells were cultured under normal oxygen (20％O2) and hypoxia (1％O2) conditions.The hypoxia was duration 6 hours,12 hours,24 hours and 48 hours.HIF-1α gene was stable silented by RNA interference method and TE13/small interfering HIF cells and Eca109/siHIF cells were obtained.The cell culture condition and time was same as TE13 and Eca109 cells.The changes of HIF-1α expression were detected by Western-blot.The changes of lactic acid concentration in cell culture supernatant were determined by Spectrophotometry.The changes of glucose transporter-1 (GLUT-1) and lactic dehydrogenase A (LDHA) expression at mRNA level were examined by realtime polymerase chain reaction.The changes of GLUT-1 and LDHA expression at protein level were tested by Western blot.Using t or t' test to analyze the effects of hypoxia duration on HIF-1αexpression at protein level.One-way ANOVA was applied for the difference analysis between the groups.Results In TE13 and Eca109 cells,the HIF-1α expression significantly increased under hypoxia condition and reached the peak at 12 hour (t=6.11,8.31; both P＜0.05).The lactic acid secretion of TE13/siHIF cells and Eca109/siHIF cells was (1.24±0.33) and (1.28±0.37) mmol/L,which significantly decreased when compared with TE13 and Eca109 cells [(3.25±1.34) and (4.91±1.69) mmol/L,t=2.53,3.59,both P＜0.05].The lactic acid secretion of TE13 and Eca109 cells significantly increased after hypoxia [(6.48±1.73) and (8.02± 1.95) mmol/L,t=2.715,2.050,both P＜0.05].There was no significant lactic acid secretion in TE13/siHIF cells and Eca109/siHIF cells after hypoxia (P ＞ 0.05).The expressions of GLUT-1 and LDHA at mRNA level were significantly suppressed in TE13/siHIF cells and Eca109/siHIF cells (normal oxygen:t=6.98,3.92,7.25,3.67,all P＜0.05).The expression of GLUT-1 at protein level remarkably weaked (normal oxygen:t=4.57、16.56,hypoxia:t=6.19、6.09,all P＜0.05),while the expression of LDHA at protein level slightly decreased (P＞0.05).Conclusions The level of glycolysis can be lowered by suppression HIF-1α expression in human esophageal squamous carcinoma cells.The pathway may be involved in the suppression of GLUT-1 and LDHA expression.Except for HIF-1α,there may be other regulating factors in LDHA protein expression at same time.

Objective To analyze the diagnostic methods of Achilles tendon rupture by MRI.Methods All 16 cases with Achilles tendon rupture were examined with sagital T 1,2 WI and axial T 1WI imaging.4 cases were appended Gd-DTPA enhancement.6 cases were followed up with MRI after 6～8 weeks.Results MRI appearance of Achilles tendon rupture represented Achilles tendon thickening,decrescent ratio of wide/vertical survey,hyperintensity in tendon,discontinuous fibrous bundle,fluid collected around tendon comparing with of normal Achilles tendon.Conclusion MRI is an valuable tool for the diagnosis of Achilles tendon rupture.

Objective To compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction.Methods This retrospective study investigated patients treated for malignant gastric outlet obstruction from January 2007 to January 2014 in the first affiliated hospital of Nanjing Medical University.Endoscopic stenting was placed in 29 patients and surgical gastrojejunostomy was performed in 42 patients.The outcomes assessed included diet scores,time to diet,length of hospital stay,treatments fees and complications.Results Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome with significant higher GOOSS score compared with that before treatment (P ＜0.05),but score improves faster in stenting group.Clinical success for endoscopic stenting and surgical gastrojejunostomy was 96.6％ and 92.9％ respectively,and technical success was 100％ for both of them.Endoscopic stenting group was found to have lower early complication rate(3.4％ VS 23.8％,P ＜0.05),higher late complication rate(24.1％ VS 6.9％,P ＜0.05),less time to diet,hospital stay and treatment fees(all P value ＜ 0.05)than surgical gastrojejunostomy group.The major complication after endoscopic stenting is re-obstruction while it is infection and leak of anastomotic site for surgical group.There were no significant differences in complication between two groups (27.6％ VS 11.9％,P ＞ 0.05).Conclusion Both endoscopic stenting and surgical gastrojejunostomy can relieve patients' syndrome effectively and safely,but endoscopic stenting improves GOOSS scores more rapid with less time to diet,less early complication rate and easy-dealing late complications,also it needs less hospital stay and fees.It's a better choice for patients with less survival expectation.

Objective To establish RNase L gene knockout HEK 293 cell lines using CRISPR/Cas9 system.Methods Small guide RNA ( sgRNA) sequences of human RNase L were designed and sgRNAs were inserted into pCas-Guide and pCas-guide RNA(gRNA) vectors were obtained.The donor DNA sequences of the homologous arm were designed for RNase L knockout .In the presence of the right homologous arm , the resistance gene of hygromycin B and the left homologous arm as templates of homology-directed repair , the donor DNA template was amplified by overlopping PCR and cloned into the pBackZero-T expression vector and pBackZero-T-RNase LK vector was obtained .The pCas-gRNA vector and pBackZero-T-RNase LK vector were co-transfected into HEK293 cells to establish the stable expression cell line of RNase L gene knockout .Cells were cultured with hygromycin B , while Western blotting and DNA sequencing were used to analyze the gene of RNase L knockout from genome .Results and Conclusion The pCas-gRNA vector and pBackZero-T-RNase LK vector were successfully constructed.Five RNase L gene knockout HEK293 cell lines were generated,contributing to the study of the biological function and molecular mechanism of RNase L .