As a successful mode of hospital reform, the hospital group offers the key to the solution of some major problems hindering the development of hospitals. The objective of setting up a hospital group is to better realize the strategic goals of the hospitals. While hospital groups have different types and formation patterns, the key to success lies in the operating mechanism and management standards. Organizational and cultural building is of great significance to the long-term development of hospital groups.

Objective To provide clinical experience in the treatment and prevention of complicated acute cardiac tamponade in the course of heart interventional therapy. Methods To analyse the clinical features of patients with acute cardiac tamponade and to investigate the possible underlying mechanism. Results Twenty-one cases experienced acute cardiac tamponade when undergoing heart interventional therapy. Among all the 21 patients with acute cardiac tamponade, 11 occurred from percutaneous coronary interention(PCI) ,6 from the radiofrequency catheter ablation , 1 from the closure of atrial rspetal with amplaty closure service, 1 from the percutaeous balloon mitral valvuloplasty ( PBMV), 2 from temporary pacemaker implantation. Eighteen patients were successfully rescued left no serious sequelae. Three cased died, including two PCI-related death and one temporary-pacemaker-installation-related death. Conclusion Any heart interventional operation is at the risk to cause acute cardiac tamponade. Early identification and appropriate treatment is the key to successful rescue.

Objective To compare the efficacies of the treatment of sternal fracture with wire fixation and the titanium sternal fixation system. Methods Thirty patients with sternal fracture from May 2003 to July 2009 were followed up. Among them,there were 20 patients with wire fixation (wire fixation group), 10 patients with the titanium sternal fixation system (titanium sternal fixation system group). The conditions before, during and after operation,complications and effects were compared to evaluate the effieaeies of titanium sternal fixation system. Results The operative time of titanium sternal fixation system group and wire fixation group were (67.0 ± 7.9) min and (90.0 ± 8.6) min, the blood loss were (11.0 ± 5.4) ml and (48.0 ± 8.4)ml,the duration of drainage were (0.5 ± 0.4) days and (1.9 ± 0.7) days,the amount of drainage were (1.9 ± 1.3) ml and (19.0 ± 4.6) ml, the average hospitalized days were (2.3 ± 0.5) days and (6.9 ± 0.9) days, the duration of pain were (1.5 ± 0.5) days and (3.8 ± 1.1) days, there were all significant difference between two groups (P < 0.05). The rates of wound infection, delayed union or nonunion, re-fracture,plate fracture or plate shift of wire fixation group were 5% (1/20) ,5% (1/20) ,5% (1/20), 10% (2/20). But the rates of titanium sternal fixation system group were 0, there were all significant difference between two groups (P < 0.05). Conclusion The treatment of sternal fracture with titanium sternal fixation system is a simple and stable fixation,high bone union rate and few complications,especially for the sternal fracture.

Objective To establish a method for qualitative identification of polymorphs in pharmaceutical solid preparations of active pharmaceutical ingredients ( API ) . Methods We obtained the powder diffraction patterns of the polymorphic drug substance like nimodipine and roxithromycin in solid preparation material and completed quantitative identification for polymorphs by the quantitative detection and using PXRD technology, deduction calculation through the powder X-ray diffraction and comparing with standard diagram. Results Through the analysis of nimodipine and roxithromycin which came from 27 batches of solid preparations from 11 different manufacturers, and comparing to the standard patterns of pure polymorphs, the quantitative identification of different crystalline states of API in pharmaceutical preparations had been established. Conclusion The qualitative detection method for polymorphs of API in pharmaceutical preparations by powder X-ray diffraction has wide applicability and high accuracy, which can be used to identify the polymorphism of API in solid preparation,and also used to control the quality of solid preparations commonly as a qualitative analysis method.

Objective To study polymorphism of the free radical scavenger edaravone and to find the one which has good advantages to the clinical medication. Methods Preparation of four forms of edaravone through kinds of physical or chemical methods. These polymorphs were characterized by single crystal X-ray diffraction method (SXRD), powder X-ray diffraction method (PXRD), differential scanning calorimetry method (DSC), infrared spectrum method (IR) and melting point method (MP);a variety of influence factors experiment were used to research the stability of polymorphs. Solid edaravone in different forms were orally administered to SD rats respectively, the plasma concentration of the drug was determined by HPLC, and the pharmacokinetic characteristic of different forms was compared according to the HPLC results. Results Four forms(form A, form B, form C, form D) and the preparation of pure crystal forms were obtained by crystal screening technology. These polymorphs were identified by PXRD, DSC and IR. The edaravone polymorphs have an influence on the stability and pharmacokinetic. Conclusion Edaravone research provideds a variety of crystal material composition, preparation methods, stability, solubility and pharmacokinetic characteristic, and form A has been proved of good advantage one. This research provides data and technology support for choice of preponderant pharmaceutical polymorphs and drug quality standard improvement.

Objective:To evaluate the efficacy and safety of using platelet-rich plasma (PRP) eyedrops for the treatment of moderate to severe dry eye disease (DED).Methods:A total of 395 patients (790 eyes) with moderate to severe DED diagnosed and treated in the Armed Police Liaoning Corps Hospital and the PLA 967 Hospital from March 2018 to October 2019 were collected. Random number table method was used to divide into autologous PRP treatment group (196 cases, 392 eyes) treated with autologous PRP and control group (199 cases, 398 eyes) treated with artificial tears. The changes of subjective symptoms of DED, Schirmer test (ST), corneal fluorescein staining (CFS) and Ocular Surface Disease Index (OSDI) before and after treatment were observed in both groups.Results:After 1 course of treatment, the ST values of both groups increased, which was statistically significant compared with before treatment ( P<0.05). After treatment, the OSDI and CFS scores of the two groups were reduced. The difference in OSDI and CFS scores of the PRP treatment group before and after treatment was statistically significant ( P<0.05), and there was no statistically significant difference in the control group before and after treatment ( P>0.05). After treatment, the OSDI and CFS scores of the PRP treatment group were lower than those of the control group [(16.8 ± 18.7) scores vs. (43.2 ± 14.5) scores, (0.21 ± 0.53) scores vs. (1.62 ± 0.69) scores], the differences were statistically significant ( P<0.05). After one course of treatment, the total effective rate of the autologous PRP treatment group was higher than that of the control group [80.1% (157/196) vs. 51.76% (103/196)], the difference was statistically significant ( P<0.05). Conclusions:Autologous PRP can treat patients with moderate-to-severe autologous PRP treatment group, which can greatly improve patients' eye discomfort and other symptoms.

Objective:To explore the correlation between oxidative stress markers malondialdehyde(MDA), superoxide dismutase(SOD), magnetic resonance burden and vascular cognitive impairment in patients with ischemic cerebrovascular disease (CSVD).Methods:Totally 300 patients with ischemic cerebral small vessel diseases who were admitted to the Department of Neurology, North China University of Science and Technology Affiliated Hospital were selected as the research subjects, and 60 healthy outpatients in the same period were selected as the control group.According to the results of mini mental state examination(MMSE), patients with ischemic cerebral small vessel diseases were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (101 cases), moderate cognitive impairment group (58 cases ) and severe cognitive impairment group (35 cases) according to Montreal cognitive assessment (MoCA). MDA and SOD were determined by double antibody sandwich method and the results were compared and analyzed.Results:(1) Compared with the control group(MDA: (8.40±1.81)μmol/L, SOD: (112.73±83.48)U/ml), the level of MDA increased while the level of SOD decreased significantly in normal group(MDA: (8.46±2.05)μmol/L, SOD: (108.90±88.72)U/ml) and cognitive impairment group(MDA: (12.19±7.02)μmol/L, SOD: (62.64±20.34)U/ml). Compared with the cognitive normal group, the level of SOD decreased significantly and MDA increased significantly in cognitive impairment group, the differences were statistically significant (all P<0.05). Compared with the normal cognitive group (1.18±1.10), the cognitive impairment group (1.93±1.05) had a higher MRI burden score ( P<0.05). (2)Multivariate analysis showed that the decrease of plasma SOD level( β=-0.024, OR=0.977, 95% CI=0.961-0.992)and the increase of plasma MDA level( β=0.110, OR=1.117, 95% CI=1.005-1.241)and the MRI overall burden( β=0.453, OR=1.573, 95% CI=1.011-2.446)were independent protective factors of vascular cognitive impairment in patients with ischemic CSVD.(3) Compared with mild cognitive impairment group(MDA: (9.79±5.79)μmol/L, SOD: (81.64±58.09)U/ml, MRI overall burdern (1.69±0.99)), the level of SOD decreased significantly and the level of MDA and the MRI overall burden increased significantly in moderate cognitive impairment group and severe cognitive impairment group(MDA: (7.95±2.44)μmol/L, SOD: (76.13±46.00)U/ml, MRI overall burden: (1.78±0.86)), (MDA: (11.16±6.68)μmol/L, SOD: (63.49±20.04)U/ml, MRI overall burden: (2.89±1.02). Compared with the moderate cognitive impairment group, the level of SOD decreased significantly and the level of MDA and the MRI overall burden increased significantly in the severe cognitive impairment group (all P<0.05). Conclusion:Increased plasma MDA level, MRI burden score and decreased SOD level in patients with CSVD are all risk factors for the occurrence of cognitive impairment.It is suggested that oxidative stress injury and cerebral small vessel lesions may be involved in the occurrence and development of cognitive impairment of CSVD from multiple aspects.

Objective:To evaluate the effect of hierarchical diagnosis and treatment model of childhood bronchial asthma in Shanghai Pudong New Area.Methods:According to the principle of proximity, children aged 6 months-17 years who were diagnosed with bronchial asthma at Shanghai Children′s Medical Center from July 2016 to May 2017 were divided into two cohorts: the specialized hospital group and the community hospital group.Twelve months of treatment and follow-up were conducted.The asthma control level, Childhood Asthma Control Test (C-ACT) score, medication adherence and health economic indicators were collected.Results:A total of 524 children were included for data analysis and divided into the specialized hospital group (300 cases) and the community hospital group (224 cases). According to the Global Initiative for Asthma(GINA) criteria, there was no statistical difference in monthly asthma control level between the two groups (all P>0.05). In the 12 th month, the well-controlled rate of the specialized hospital group increased by 12.4% ( P<0.01), and that of the community hospital group increased by 22.9% ( P= 0.015). According to the C-ACT criteria, there was no statistical difference in the monthly well-controlled rate between the two groups (all P>0.05), and the rate maintained an upward trend.The rates of patients with good compliance in the specialized hospital group and the community hospital group at the 12 th month of hierarchical diagnosis and treatment were 78.3%(235/300 cases) and 75.0%(168/224 cases), respectively, and the difference was not statistically significant ( P=0.370). After 12 months of hierarchical diagnosis and treatment, the number of asthma attacks were 1.0 and 2.0 ( P=0.269), and the hospitalization rates for asthma were 3.0%(9/300 cases) and 4.9%(11/224 cases), respectively in the specialized hospital group and the community hospital group, and the diffe-rence was not statistically significant ( P=0.259); the number of respiratory infections in the specialized hospital group (2.0 times) was lower than that in the community hospital group (3.0 times), and the total cost of treatment in the community hospital group (2 471.5 Yuan) was lower than that in the specialized hospital group (3 445.5 Yuan), and the difference was statistically significant ( Z=-3.308, -3.336, all P<0.01). Twelve months after hierarchical diagnosis and treatment, the number of asthma attacks, the number of respiratory infections and the hospitalization rate for asthma in the two groups were all lower than those in the first 12 months of hierarchical diagnosis and treatment, and the difference was statistically significant (all P<0.01). Conclusions:Hierarchical diagnosis and treatment model of childhood asthma in Shanghai Pudong New Area can improve asthma control level, C-ACT score and asthma medication adherence, and enhance health economic benefits, thus it′s an effective way to manage childhood asthma.

Objective According to the clinical medicinal crystal form———form γ of levonorgestrel, to establish the quantitative analysis method for levonorgestrel form γ by powder X-ray diffraction (PXRD) . Methods Firstly, single crystal X-ray diffractometry and powder X-ray diffractometry were used to confirm that the prepared levonorgestrel form γ was 100％ polymorphic purity, which provided a standard sample for quantitative analysis by single peak method; then, the standard samples of different quality levonorgestrel form γ for powder X-ray diffraction were weighed, the peak intensity values of characteristic diffraction peaks d = 6.4 , d = 6. 1  and d = 5. 6  of form γ as quantitative parameters selected, a linear relationship between the peak intensity value and the quality of form γ was established; finally, the content of levonorgestrel form γ was quantitatively analyzed. Results The peak intensity values of characteristic diffraction peaks d = 6.4 , d = 6.1  and d = 5.6  of levonorgestrel form γ and the quality showed a good linear relationship.In the range of form γ masses of 5 mg to 50 mg, the regression linear equations wereY = 459.59X+5 536.5, R2 = 0.993 0, Y = 430.03X+6 867.6, R2 = 0.990 5,Y = 615.95X+ 6 209.5, R2 = 0.990 8,respectively. Conclusion The method is simple, rapid, accurate and reliable, it can be used as quality control method for levonorgestrel polymorphs.