Objective To analyze the characteristics of adrenal metastasis from renal cell carcinoma (RCC),and explore the principles to deal with the ipsilateral adrenal gland during radical nepbrectomy.Methods The data of adrenal metastasis in 19 patients with RCC from January 2003 to December 2012 was retrospectively analyzed,including 8 cases with ipsilateral adrenal metastasis,5 with contralateral adrenal metastasis,and 6 with bilateral adrenal metastasis,respectively.The relationship between RCC location,diameter,TNM stage and adrenal metastases was evaluated,and the clinical features of adrenal metastasis were summarized.Results Diameters of RCC ranged from 1.6 cm to 12.6 cm in the 19 cases,and the average diameter was 6.3 cm.The mean diameter of primary RCC,metastasized to the ipsilateral,contralateral and bilateral adrenal gland,was 5.6,6.5 and 7.1 cm,respectively.Among the 9 patients whose primary RCC located in the upper pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,3,3,respectively.Of the 7 patients with RCC located in the middle and lower pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,2,2,respectively.Three patients with diffused RCC in the whole kidney occurred ipsilateral adrenal metastases.RCC and adrenal metastasis were simultaneously found in 9 patients,with the average diameter of the primary RCC of 7.4 cm and the clinical stage of T2b-4N0-1 M1.Adrenal metastasis were found in 10 patients during the postoperative follow-up,with the average diameter of the primary RCC of 5.3 cm and the clinical stage of T1a-4N0M0.Nine patients underwent surgery,8 received non-surgical treatment,and 2 had no treatment.Fourteen patients had an average follow-up of 31.9 months,with 1,3 and 5-year survival rates of 84.2％,26.3％ and 15.8％,respectively.Conclusions Adrenal metastasis from RCC may be associated with the diameter and TNM of the primary tumor,regardless of the location.For the patients with normal adrenal gland observed in pre-operative imaging,ipsilateral adrenalectomy is not recommended.

Objective To investigate the clinical characteristics of tuberous sclerosis-associated huge renal angiomyolipoma,and to summarize the experiences of diagnosis and treatment.Methods The clinical data of 9 patients with tuberous sclerosis-associated huge renal angiomyolipoma treated in Peking Union Medical College Hospital from January 2009 to June 2014 was analyzed retrospectively,including 4 males and 5 females.The age at onset and diagnosis of tuberous sclerosis was 0 to 7 years (mean 2.3 years) and 2 to 30 years (mean 19.6 years),respectively,and the diagnosis age of renal angiomyolipoma was 14 to 35 years (mean 25.2 years).In the 9 patients,8 cases had facial angiofibromas,7 cases had hypomelanotic macules,6 cases had ungual fibromas and epilepsy,and 5 cases had family history.All the patients underwent abdominal ultrasound examination,CT scan and serum creatinine testing,and 3 cases received renal dynamic imaging to assess renal lesions and functional status.Results Imaging examinations showed typical renal angiomyolipomas,which were bilateral and multiple lesions with the maximum diameter greater than 10 cm in every patient,and with 2 patients had a history of acute retroperitoneal hemorrhage.The levels of serum creatinine were normal in all patients,and 3 patients had unilateral glomerular filtration rate of 44.4-99.1 ml/min (mean 62.9 ml/min).One patient underwent unilateral partial nephrectomy,2 patients underwent selective renal artery embolization,1 received blood transfusion due to acute bleeding,1 received rapamycin treatment,and 4 patients underwent close follow-up.Conclusions Tuberous sclerosis-associated renal angiomyolipomas are often bilateral and multiple.Increase of the lesion diameter may only enhance the risk of bleeding with small effect on renal function.Therapeutically,close follow-up and mTOR inhibitor are the preferred treatment options,surgery or selective renal arterial embolization is used only for the possible malignancy,acute bleeding or patients with high risk of bleeding.

Objective To discuss the characteristics of pulmonary function in children patients with positive bronchodilating response using impulse oscillation system(IOS) and provide the evidence for clinical diagnosis and performing IOS.Methods Seventy children patients with bronchodilating response using IOS were recruited randomly for this study.Forty children patients with positive bronchodilating response were regarded as positive group and the other thirty children patients with negative bronchodilating response were regarded as negative group.The IOS parameters,for example,total respiratory impedance (Z5),respiratory resistance at 5 Hz(R5),reactance at 5 Hz(X5),peripheral respiratory resistance(Rp) in the two groups were analyzed.Results Z5,R5,X5 of the positive group [(123.45 ± 24.75)％,(120.09 ± 25.40)％,(138.62 ± 33.48)％] were higher than those of the negative group [(103.89 ± 16.30)％,(102.67 ± 18.16)％,(111.85 ± 14.93)％].There were significantly different between the two groups (P ＜ 0.05).Moreover,Rp ≥ 19.89 cmH2O/ (L·s)(1 cmH2O =0.098 kPa) in the positive group was 50.00％(20/40),which was higher than that in the negative group[23.33％(7/30)].There was significant difference between the two groups(P＜ 0.05).Conclusions The impedance of children patients with positive bronchodilating response using IOS is significantly increased,especially X5.When IOS parameters ≥ 100％,especially X5 ≥ 100％,which suggest that perform the bronchodilation test in order to decrease the rate of missed diagnosis of asthma.

Medical model is the product of medical practice and crystallization of the essence of medicine and insights of life based on human being's fights against diseases for ages.Medical practice and medical model change fundamentally with the changing needs of human.being for health,having undergone for example from biomedical model to biopsychosocial(BPS)model.Thanks to perspectives of Epistemology and practice theory,the medical model is nourishing itself with BPS theories and methodologies for sustainable development,helping human being to better understand health and life multi-dimensionally.In such a model,individual hospitals will shift from focusing on disease care to provision of wholesome and sustained health services,while hospital systems will shift from coordination to resources reallocation and vertical integration.Thus the hospitals will gain new perspectives and broader horizon for development in the future.

ObjectiveTo explore the effects of steroids for hyperthyroidism management during the perioperative period. Methods198 cases were analyzed in terms of the perioperative use of steroids such as dexamethasone for hyperthyroidism. ResultsFT3 and FT4 decreased gradually to the nomal level after use of dexamethasone. 15 cases had hypokalemic limb paralysis, 2 cases had hyperthyroidism crises, 9 cases had transient numbness of mouth, lip and limb, and the rest resumed normal. ConclusionsThe use of steroids such as dexamethasone for hyperthyroidism can shorten the preoperative preparation time, improve the success rate, and reduce postoperative complications.

To investigate the effect of transfection of adenovirus mediated vascular endothelial growth factor B (VEGF B) gene transfer on the proliferation of endothelial cells. We constructed a replication deficient recombinant adenovirus vector coding for human VEGF B, and detected its gene transcription and expression in Ad. VEGF B infected rat arotic endothelial cells (RAECs) with RT PCR and western blat. The effect of Ad.VEGF B on RAECs prolifeation was examined by MTT assay on days 1, 2, 3, 5, 7 after infection. RAECs were successfully infected with high efficiency and expressed a special protein that is immunoreactive to anti VEGF B monoclonal antibody. This protein could be detected in the culture medium. The proliferation assay of RAECs infected with VEGF B expressing adenovirus revealed a significant increase in cell number over control. These results implied that the use of VEGF B expressing recombinant adenovirus may induce angiogenesis, which might be potential in vivo gene therapy for ischemic heart disease.

Objective To investigate the highly-recognized job evaluation factors among the doctors from tertiary general hospitals and to establish a doctor-oriented job evaluation factor system for general hospitals followed with the reliability and validity analyses.Methods A questionnaire about the highly-recognized 23 job evaluation factors was launched among 791 doctors by the stratified sampling from six tertiary general hospitals in Beijing,and the factors were from a job evaluation model of tertiary general hospitals.Initial factor solutions were obtained by the principal components analysis of all evaluation factors and the main factors whose eigenvalues were over one were extracted as evaluation dimensions. Factor loadings were attained through Varimax and the factor whose factor loading was lower than 0.5 was eliminated.A reliability analysis by calculating Cronbachαcoefficient and a validity analysis with structural equation modeling were sequentially conducted on the job evaluation factor system.Results A doctor-oriented job evaluation factor system for general hospitals including 22 factors subject to 3 dimensions was established while the factor of job relevance was removed. The internal consistency coefficients of the dimensions were greater than 0.8 according to the calculation of Cronbachα, which showed a nice reliability. Several main indexes for evaluating the model fitting were all close to 0.9,which indicated a fair structural validity. Conclusion A doctor-oriented job evaluation factor system for general hospitals is established with fair reliability and validity,which could provide more references to the job evaluation of the doctors in tertiary general hospitals.

By means of literature review,expert interviews and experts sorting,the authors identified three approaches of medical humanities care,and applied them to three clinical departments of top ten incidence of medical disputes of the hospital in 2012.These departments have similar number of beds,and covered both internal medicine and surgery departments.The purposes of the study are to evaluate the effects of medical humanities care measures in clinical departments,and to make relevant thoughts and suggestions.

Using the method of semi -structure interviews to pre-interview 6 experts and officially interview10 experts , then the record of the interview was compiled into the paper .Using the grounded theory method to encode material of the interview , a summary was made for each case base on data collation and analysis .This paper ana-lyzed the humanities concern the connotation of the application in the construction of a harmonious doctor -patient relationship and the specific measures .On the basis of the application of humanistic care in the construction of a harmonious doctor -patient relationship , significance and limitation is discussed .

The paper covered the self-assessment practices of the hospital in the new round of accreditation.These include principles of Promoting hospital development and reform,and Balancing accreditation and development,Emphasizing Quality,Safety,Service,Management,and Performance,Centering on patients,and Focusing on Quality of Care and Medical Care Performance.The hospital adopted such means as enhancing hospital internal development,building the hospital-department twotier management responsibility system,upgrading quality of care and safety,and promoting sustainable development.The self-assessment has improved and tested the construction of quality control system of the hospital,while a better system further supports the accreditation of the hospital on the other hand.