County hospitals function as comerstones in China's health system,as their sustainable development plays a key role for the ongoing health reform.Disciplines are the most primary functional units of a hospital,and their disciplinary culture characteristic of the county hospital' s disciplines and fitting their current development status are definitely the most important and fundamental factor for sustainable development of the discipline.Based on extensive research,authors identified no less than eight cultural elements,namely values of life,self-confidence,a comprehensive model of talent development,safety first,teamwork,communication,scientific pursuit and health management.This study aimed at providing thoughts for the current county hospital development.

Echinoderms are deuterostome, and occupy the top taxonomic position of invertebrates, where is the evolutionary linkage between invertebrates and vertebrates.This is a critical phylogenetic vantage point to infer both the early evolution of bilaterian immunity and the underpinnings of the vertebrate adaptive immune system.The available published literatures on echinoderm immunological mechanisms are compiled and discussed here to understand its evolution process and the hot spots or directions in future investigations.Echinoderms have an innate immune system like vertebrates but their adaptive attributes have not been observed.Its immune responses are based on coelomocytes activity working in parallel with a variety of humoral factors that react directly with invading pathogens.Comparative studies of immune functions in echinoderms have demonstrated that there is a complement system in echinoderms that appears to have alternative pathway and lectin pathway but lack classical pathway and terminal pathway.The sea urchin innate immune system has a number of large gene families.Further investigations are needed to understand the unknown immune-associated genes, proteins, immune signaling pathways and effector molecules, and to know the origin, the underlying mechanisms and evolution of innate immune system.

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.

This paper summarized the common medical ethical issues in clinical pharmacy service and analyzed them from the perspective of medical ethics.It put forward some countermeasures to solve these problems,such as helping clinical pharmacists to establish a patient-centered service mode,improving their occupation accomplish-ment,and avoiding moral issues and medical disputes caused by ethical issues under the premise of ensuring pa-tients' safety and rational use of drugs,and thus to comprehensively improve service level of clinical pharmacists.

Chlamydia psittaci is a causative agent of psittacosis,which can infect a wide range of hosts including birds and humans.However,information regarding C.psittaci infection in pigeons is scarce.In the present study,a total of 399 fecal samples from pigeons were collected from Jilin Province,northeastern China,between March and May 2015,and examined by nested PCR amplification of outer membrane protein A (ompA) gene.The overall Chlamydiosis prevalence was 5.01％ (21/399),with 3.19％ in Changchun City and 9.40％ in Jilin City.Furthermore,breed was the major risk factor associated with Chlamydia infection in pigeon,boiler pigeons had a prevalence of 7.49％,whereas no C.psittaci was detected in racing pigeons.Sequence analysis of the ompA gene revealed that all the identified isolates represented C.psittaci genotype B.Our results firstly indicated the presence of zoonotic C.psittaci in boiler pigeons in Jilin Province,northeastern China,and effective measures should be implemented to reduce the risk of C.psittaci transmission from pigeons to humans.

Objective:To investigate the effects of tert-butyl hydroperoxide (TBH) on the expression of second mitochondria-derived activator of caspase (Smac) and X-linked inhibitor of apoptosis (XIAP) in mitochondrial pathway after cerebral ischemia/reperfusion injury in rats.Methods:From March to December in 2019, 45 healthy male Sprague-Dawley rats were randomly divided into sham-operation, model and TBH groups. Rat models of cerebral ischemia/reperfusion injury were established by ligation of the left carotid artery. Rat neurological function was evaluated to exclude the rats that failed in cerebral ischemia/reperfusion injury induction. Ten rats were left in each group. At 0.5 and 12 hours after cerebral ischemia/reperfusion injury, rats in the TBH group were treated by intragastric administration of 12.5 mg/kg TBH and those in the sham-operation and model groups were identically treated by intragastric administration of equal volume of 0.9% sodium chloride injection. After 24 hours of reperfusion, rat neurological function was assessed in each group. Then the rats were killed and the brains were harvested. Apoptosis of nerve cells was detected by terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) assay. The levels of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the brain tissue were detected by enzyme-linked immunosorbent assay. XIAP- and Smac-positive cell count and protein expression were determined by immunohistochemical staining and western blot assay, respectively.Results:Rat neurological function score in the TBH group was significantly lower than that in the model group [(1.36 ± 0.49) points vs. (3.73 ± 0.97) points, t = 6.896, P < 0.001]. In the TBH group, a large number of apoptotic nerve cells were found in the ischemic cerebral cortex, but the number of apoptotic nerve cells in the TBH group was significantly smaller than that in the model group. In the model group, SOD level was significantly lower, MDA, TNF-α and IL-1β levels were significantly higher compared with the sham-operation group [SOD: (51.94 ± 3.46) U/mg vs. (70.68 ± 2.67) U/mg, t = 13.560, P < 0.001; MDA: (5.69 ± 0.78) nmol/mg vs. (1.20 ± 0.96) nmol/mg, t = 11.479, P < 0.001; TNF-α: (89.36 ± 9.84) pg/mg vs. (40.53 ± 4.35) pg/mg, t = 14.353, P < 0.001; IL-1β: (41.35 ± 6.79) pg/mg vs. (17.22 ± 2.31) pg/mg, t = 10.639, P < 0.001]. In the TBH group, SOD level was significantly higher, MDA, TNF-α and IL-1β levels were significantly lower compared with the model group [SOD: (51.94 ± 3.46) U/mg vs. (68.84 ± 5.03) U/mg, t = 8.754, P < 0.001; MDA: (5.69 ± 0.78) nmol/mg vs. (2.46 ± 0.48) nmol/mg, t = 11.153, P < 0.001; TNF-α: (89.36 ± 9.84) pg/mg vs. (57.64 ± 6.22) pg/mg, t = 8.617, P < 0.001; IL-1β: (41.35 ± 6.79) pg/mg vs. (23.84 ± 5.48) pg/mg, t = 6.346, P < 0.001]. XIAP- and Smac-positive cell count and protein expression in the model group were significantly greater than those in the sham-operation group [XIAP-positive cell count: (22.63 ± 4.37) vs. (12.39 ± 3.18), t = 5.992, P < 0.001, Smac-positive cell count: (47.58 ± 6.94) vs. (5.64 ± 1.35), t = 18.759, P < 0.001; XIAP protein expression: (0.53 ± 0.08) vs. (0.24 ± 0.05), t = 9.721, P < 0.001; Smac protein expression: (0.92 ± 0.15) > ( 0.36 ± 0.05), t = 11.200, P < 0.001 ]. In the TBH group, XIAP-positive cell count and XIAP protein expression were significantly higher and Smac-positive cell count and Smac protein expression were significantly lower compared with the model group [XIAP-positive cell count: (36.78 ± 5.26) vs. (22.63 ± 4.37), t = 6.543, P < 0.001, Smac-positive cell count: (31.74 ± 4.26) vs. (47.58 ± 6.94), t = 6.151, P < 0.001; XIAP protein expression: (0.79 ± 0.10) vs. (0.53 ± 0.08), t = 6.420, P < 0.001, Smac protein expression: (0.70 ± 0.09) vs. (0.92 ± 0.15), t = 3.977, P < 0.001]. Conclusion:TBH can effectively reduce neuronal apoptosis, oxidative stress and inflammatory reaction after cerebral ischemia/reperfusion injury, which may be related to the regulation of XIAP and Smac signaling pathways.

Objective To compare short-term therapeutic outcomes and the safety of percutane-ous radiofrequency ablation (PRFA) with left single lung ventilation (LSLV) for liver cancer of the hepatic dome (LCHD) and that of PRFA for right liver carcinoma in favorable location. Methods Thirty one patients with hepatocellular carcinoma (belonging to LCHD) receiving PRFA with LSLV (Group LCHD) between January 2006 and January 2009 in our hospital were selected, and 45 control patients with right lobe HCC ≥1 cm away from the liver capsule, gallbladder, and main portal bran-ches were also included. One month after PRFA, residual tumors were followed up with contrast en-hanced CT and alpha fetal protein and PRFA was repeated in the presence of residual foci. Tumor-free survival time was defined as the duration from complete ablation to diagnosed local tumor progression.The Mann-Whitney test was used to compare age, tumor diameter, and average number of punctures between LCHD patients and controls. A χ2 test was used for comparison of the incidence of complica-tions and incomplete tumor ablation rate. The Kaplan-Meier's method was used for calculation of local tumor-free survival rate compared with a log-rank test. Results The incidence of right shoulder pain was significantly higher in LCHD patients than in controls (87. 1% vs 11. 1%, P<0. 01). LCHD pa-tients showed no difference from controls in the average number of punctures (2. 8±. 5 vs 3. 2±. 5,P>0. 05). Meanwhile, there was no difference between the 2 groups in average duration of treatment and hospitalization, and the complete tumor ablation rate at first PRFA. No differences were observed in the 1-, 2- and 3-year local tumor-free survival rates between LCHD patients (85. 5% , 65. 8% , and 36. 4% ,respectively) and controls (87.7%, 62. 3% , and 34.0% , respectively). Conclusion PRFA with LSLV for LCHD seems to promise comparable short-term outcomes and safety to PRFA for right liver carcinoma of fa-vorable location and should be preferred as one of the therapeutic options for LCHD patients with tumor di-ameters≤5 cm regardless of its unique location.

Objective To assess the therapeutic efficacy and safety of CT-guided percutaneous radiofrequency ablation(PRFA) for hepatocellular carcinoma in the bare area (HCCBA). Methods During the period from April 2000 to June 2009, 26 patients with HCCBA were treated with CTguided PRFA, and 26 other HCC patients were selected as controls, whose lesions were located in the right lobe ≥1.0 cm away from the liver capsule, gallbladder, and main portal branches. One month after PRFA, the residual tumors of each patient were examined by contrast-enhanced CT and alpha-fetoprotein test, and repeated PRFA was undertaken if residual was present. Tumor-free survival was defined as the duration from complete ablation to diagnosed local recurrence. The 2-independent-samples t-test was used to compare tumor diameter between HCCBA patients and controls. The MannWhitney U test was used to compare patient's age, etiologies of liver disease, liver function status,number of needle punctures and the value of AFP. A χ2 test was used for comparison of the complete tumor ablation rate and the cumulative local tumor-free survival rate. Results No significant difference was observed in the incidence of complication between the HCCBA patients and the controls (26. 9% vs 19.2%,P＞0.05). There were no differences between the two groups in the number of needle punctures and the complete tumor ablation rate at first PRFA. Furthermore, no differences were observed in the cumulative 1-,3- and 5-year local tumor-free survival rates between HCCBA patients (88. 5%, 46.2% and 19. 2% respectively) and patients in the control group (92.3%, 53.8% and 15.4% respectively). Conclusion CT-guided PRFA is effective and safe for HCCBA and could be preferred as one therapeutic option for HCCBA.

Bile duct injury caused by abdominal trauma, usually accompanied with injuries of other abdominal organs, is rarely seen. For the reason of its complexity and often delayed diagnosis and treatment, bile duct injury usually leads to severe complications such as abdominal infection. This paper reports a group of 10 cases of bile duct injury treated in our center in the recent decade.

Objective To evaluate the appearance of CT in patients with severe acute respiratory syndrome (SARS) in the recovery phase, and to study the correlation of CT findings with pulmonary function.Methods From June to August in 2003, 100 patient with confirmed SARS accepted examination in our hospital. Among them, 91 patients (39 men, 52 women, mean age 36.4 years, age range 19- 66 years) received CT examination and pulmonary function test on the same day. The interval between SARS onset and the examination ranged from 52 to 125 days (mean 87.4 days). CT appearances of pulmonary parenchymal abnormalities including distribution and extent of involvement were quantitatively analyzed, and four levels on CT scan including the aortic arch, the tracheal carina, the pulmonary venous confluence, and the dome of right diaphragm were selected to score the lesions. The correlation of CT scores with the results of pulmonary function tests was studied.Results Of the 91 cases, 47 patients had normal CT appearance in the recovery phase, whereas the other 44 patients still had parenchymal abnormalities, including residual ground-glass opacification and reticular shadow. CT visual score had correlation with DLco% ( r =-0.618, P