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.

Objective To investigate the prevalence of impaired glucose-insulin metabolism in obstructive sleep apnea hypopnea syndrome (OSAHS); to examine the relation between severity of OSAHS and impaired glucose metabolism; and to evaluate the effectiveness of continuous positive airway pressure (CPAP) on impaired glucose metabolism.Methods A total of 214 patients who were free of diabetes at baseline underwent both nocturnal polysomnography (PSG),and 2-h oral glucose-tolerance test,insulin and hemoglobin Alc test.CPAP treatment for glucose-insulin metabolism ( + ) was given to OSAHS group after informed consent had been obtained.Results Eighty-eight patients and 17 patients with impaired glucoseinsulin metabolism were found in OSAHS group and the control group respectively.Impaired glucose-insulin metabolism was present in 54.3% of OSAHS group and 32.7% of control group.Logistic regression analysis showed a significant positive correlation with OSAHS ( AHI ≥ 10 times/h ) and impaired glucose-insulin metabolism in all patients (OR = 2.440,95% CI 1.201-4.958 ).Plasma glucose level changes had no significant differences between before and after CPAP treatment (P ＞ 0.05 ).ConclusionOSAHS is associated with a high frequency of impaired glucose metabolism.The relationship between OSAHS and impaired glucose metabolism is independent of obesity.Longest apnea time (LAT) and AHI are important contributors to impaired glucose metabolism in OSAHS patients.Short-term CPAP therapy has no significant improvement on glucose metabolism in patients with OSAHS.

Objective To investigate the correlation between PaCO2 and cerebral blood flow (CBF), cerebral metabolism of oxygen (CMRO2), glucose (CMRglu) and lactate (CMRlact) and intracranial pressure during intracranial surgery. Methods Twenty ASA Ⅰ - Ⅱ patients (6 male, 6 female), aged between 26-54yr, weighing (65 ? 11) kg scheduled for elective intracranial surgery were studied. The patients were unpremedicated. Before general anesthesia radial artery was cannulated and a catheter was inserted into internal jugular vein and advanced cranially until jugular bulb. Lumber puncture was performed at L3-4 and a catheter was inserted into subarachnoid space for 3 cm, for pressure monitoring and CSF sampling. Anesthesia was induced with diazepam 10mg, fentanyl 3-4?g?kg-1, propofol 2mg?kg-1 and vecuronium 0.08mg?kg-1 iv. The patients were mechanically ventilated with a mixture of oxygen and argon (O2 : argon = 3 : 1) after tracheal intubation. Anesthesia was maintained with sevoflurane and intermittent iv boluses of vecuronium. Arterial and cerebral venous blood gases, glucose and lactate levels, CBF, ICP and CSF level of lactate were determined before anesthesia when patients were awake(Ⅰ) and during anesthesia when PETCO2 = 40, 30, 20 mm Hg (Ⅱ,Ⅲ,Ⅳ). CBF was measured by modified Kety-Schmidt inert gas saturation technique with argon. CMRO2 and CMRglu were calculated based on the difference in their arterial -cerebral venous blood levels. Results At PETCO2 20mm Hg (Ⅳ) CBF decreased by 57.75% and CMRO2 by 58.70% as compared with the baseline; CMRglu decreased by 46.93% as compared with the baseline. There was no significant change in lactate level, jugular venous blood O2 saturation and pH. ICP decreased from (22.14 ? 7.88)mm Hg( Ⅰ) to (17.57?5.03)mm Hg( Ⅱ ),(13.43?4.89)mm Hg(Ⅲ) and (10.00? 2.31)mm Hg(Ⅳ) and the differences were significant. All measurements were done when MAP and HR were stable. PET CO2 was (10? 2) mm Hg lower than PaCO2 . Conclusions Cerebral blood flow, cerebral oxygen and glucose metabolism and intracranial pressure change with changes in PET CO2 . Cerebral vascular reactivity to CO2 is not impaired by 1.3 MAC sevoflurane. Mild hypocapnia is necessary during neurosurgery.

Objective To investigate the expressions of COX-2 and p53 in human colorectal carcinoma and their correlations with clinicopathological features of colorectal carcinoma. Methods The expressions of COX-2 and p53 were determined by immunohistochemical staining in 72 surgical specimens of colorectal carcinoma and 21 normal mucosal tissues. Results The positive rates of COX-2 and p53 in colorectal carcinoma were 70.8 % and 62.5 %, respectively. The differences between carcinoma group and normal tissues group were statistically significant(P

Objective To investigate the different expression pattern of Src-homology2 domain phosphatase (SHP)-1 and SHP-2 in human papiilomavirus (HPV)6/11 infected condyloma acuminatum (CA) and the significance of the difference. Methods HPV6/11 related CA cases were diagnosed by in situ hybridization. The expression and distribution of SHP-1 and SHP-2 were examined by SP immunohistochemistry technique in skin samples from 40 HPV 6/11 positive CA cases and 20 healthy control (foreskins). Results The positive rates of SHP-1 and SHP-2 were 80% and 85% respectively in CA, which were significantly higher than those in healthy control cases (only 35% and 30%, respectively, X2=11.87,P<0.01; X2 =18. 15,P<0. 01) . The SHP-1 and/or SHP-2 positive cells in CA skin lesions were mainly distributed in prickle layer, showing as brown yellow, with the positive staining located in cytoplasm. Contrastively, the SHP-1 and/or SHP-2 positive cells in healthy controls were rare and mainly distributed in basal layer, showing as pale yellow with the positive staining located in cytoplasm. There was no significant correlation between the expression of SHP-1 and SHP-2 in CA( rs = 1.0, P>0.05 ). Conclusion The expressions of SHP-1 and SHP-2 increase in HPV6/11 positive CA, which suggest that with the infection of HPV6/11, SHP-1 and SHP-2 may play a regulatory role in the proliferation of keratinocytes.

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 explore the expression of tyrosine phosphatase containing c-Src homology SH2 (SHP-2) in condyloma acuminatum. Methods Phosphorylated tyrosine and SHP-2 were detected in skin lesions of 30 patients with condyloma acuminatum, tumor tissues of 13 cases of cervical cancer and normal foreskin tissues of 11 normal controls by SP immunohistochemical stain. Results In the foreskin tissue, the phosphorylated tyrosine and SHP-2 were mainly expressed on the nuclei of kerotinocytes adjacent to the basal layer, and the number of cells with positive expression was not so many. In condyloma acuminatum, the positive cells arranged in patches, phosphorylated tyrosine and SHP-2 distributed in the cytoplasm. In cervical cancer, the expression of phosphorylated tyrosine and SHP-2 were mainly in the cytoplasm, diffusely distributed, and not in the nuclei. The positive expression rates of phosphorylated tyrosine and SHP-2 in condyloma acuminatum and cervical cancer were 96.67% (29/30) and 100% (13/13), respectively. However the cytoplasm of normal foreskin showed negative expression(0/11). Conclusions There is an aberrant activation of phosphorylated tyrosine and SHP-2 in condyloma acuminatum and cervical cancer. SHP-2 may play an important role in the carcinogenesis.

Objective To summarize our experience of laparoscopic surgery for complex choledochal cysts (type Ⅳ-A). Methods The clinical data of 65 children of choledochal cyst undergoing laparoscopic choledochal cyst resection were retrospectively reviewed from 2002 to 2009 in our institute.Among those type Ⅳ-A cyst was found in 16 patients. Hepaticojejunostomy was performed using a Roux-en-Y jejunal loop after extrahepatic cyst excision and ductoplasty. Results Laparoscopic procedures were successfully performed in 16 patients with type Ⅳ-A cysts. The stenotic segment was splited or excised and a wide hepaticojejunostomy was completed at the porta hepatis in 8 patients with a stricture extending to the level of common hepatic duct. The constrictive confluence of the bilateral hepatic duct was incised and the bi-ductal cystojejunostomy was achieved at the bifurcation in 4 cases. A septum was found at the orifice of right hepatic duct and was excised through the hilar stoma in 2 cases. A downstream stricture of the left hepatic duct was incised from the hilum to the dilated segment along the lateral wall in 2 patients, so that a long intrahepatic cystojejunostomy was completed in an oblique course. Postoperative complications developed in 2 cases including temporary bile leakage in one case and anastomotic stricture in another. The intrahepatic cysts were remarkably reduced in size during the follow-up. Conclusions With the magnified laparoscopic view, the radical resection of extrahepatic cyst and correction of the intrahepatic bile ductal stenosis can be easily performed. Laparoscopic hepaticojejunostomy and/or intrahepatic cystojejunostomy is effective and safe for children with type Ⅳ-A choledochal cysts.

Objective To study the anatomy of splenic hilum blood vessels in order to thread ligature(endoligature)instead of using stapler during the process of laparoscopic splenectomy and to evaluate the prelimnary clinical results.Methods 41 children patients underwent laparoscopic splenectomy with this technique(endoligature)for various hematologic and autoimmune disorders,including 25 cases of hereditary spherocytosis,13 idiopathic thrombocytopenia purpura,and 3 hypersplenic granulocytopenia.The anatomy of splenic pedicle,the adjacent relation between splenic vessel and pancreas were detected by color Doppler ultrasonography preoperatively.The above-mentioned parameters were compared with that found intraoperatively.Results The relationships of splenic vessel and pancreas was of type Ⅰ in 24 cases and type Ⅱ in 17.In 31 cases,the major splenic blood vessels were ramified into branches 2 cm away from the hilum and in 10 it was within 2 cm as detected by preoperative ultrasonography.These characters were largerly identified by laparoscopic laparotomy,and in all the 41 cases laparoscopic splenectomy was successfully accomplished using this endoligature instead of vasculature stapler.There was no serious complication.The mean operating time was(114 ±31)min,the estimated blood loss was(51 ±23)ml.Conclusions Ultrasonography could identify the anatomic type of splenic vessel,and its relation with the pancreas.Endoligature in the management of splenic pedicles during laparoscopic splenectomy is safe and reliable.

Objective To study the correlation of cleft lip and palate transmembrane 1 like(CLPTM1L)expression and radiosensitivity of lung cancer cells.Methods Thiazolyl blue tetrazolium bromide(MTT) and cell colony formation assays were used to determine cell growth and survival.Western Blot assay was employed to measure protein expression.Results The results demonstrated a negative correlation between the CLPTM1L expression level and radiosensitivity of lung cancer cells.A lower radiosensitivity in lung cancer cells containing high level of CLPTM1L expression,and vice versa.Enforced expression of CLPTM1L resulted in a significant reduction of radiosensitivity in lung cancer cells irradiated with γ-rays.On the contrary,a marked elevation of radiosensitivity was observed in lung cancer cells transfected with CLPTM1L siRNA.Conclusions CLPTM1L may be a novel target gene in mediating radiosensitivity of lung cancer cells.