Objective To study the effect of early rehabilitation on dysphagia in the patients with acute stroke. Methods 126 patients with acute stroke were divided into 2 groups: rehabilitation group (n=63) and control group (n=63). The rehabilitation group was trained with the swallowing function immediately after inhospital. They were evaluated with the drinking water test before and a month after treatment. Results The swallowing function improved in the rehabilitation group (P<0.01), and the incidence of aspiration pneumonitis decreased (P<0.01) compared with those in the control group. Conclusion Early rehabilitation of dysphagia in the patients of acute stroke can improve the function of swallowing, and reduce the incidence of aspiration pneumonitis.

BACKGROUND: The meniscus has limited ability in repairing itself after being injured. However, tissue engineering provides a new way to meniscus repair after injury. Bone marrow mesenchymal stem cells (BMSCs), which possess the potential of multi-directional differentiations, can be ideal seed cells in meniscus tissue engineering. OBJECTIVE: To investigate the feasibility of differentiation of in vitro cultured porcine BMSCs into fibrochondrocyte phenotypes in inductive medium. METHODS: BMSCs were isolated with whole bone marrow culture method. Then, BMSCs of the third passage were digested and incubated in a medium containing transforming growth factor-β1, insulin-like growth factor-Ⅰ, dexamethasone and ascorbic acid in a 24-well plate at a density of 2.0×10~4/cm~2 in the experimental group. While in the control group, the DMEM-LG complete culture medium containing no inductive factor were used instead. At day 7, 14 and 21 after induction respectively, Toluidine blue staining and immunocytochemical staining were performed to detect differentiation. MAIN OUTCOME MEASURES: ①Population double time (PDT) of BMSCs; ②Morphological changes of BMSCs under light microscope;③Proteoglycan expression;④Collagen type Ⅰ and type Ⅱ expression. RESULTS AND CONCLUSION: ① The PDT of the second passage BMSCs was 2 days, which was the shortest. The PDT prolonged relatively after the fourth passage, which were 5 to 9 days. ② The BMSCs changed from a spindle-like appearance into a polygonal shape after induction. ③ In the experimental group, toluidine blue staining resulted in hyacinthine-stained cytoplasm and the blue was even deeper in the area where cells were dense; The degree of staining increased with the increasing induction time. While in the control group, only nucleus of BMSCs were stained blue. ④ Collagen type Ⅰ immunocytochemical staining was positive in both the experimental and the control group and there was no difference of significance between various induction time. No collagen type Ⅱwas seen expressed in the control group, while in the experimental group it was seen to be expressed steadily after 14 days of induction. It is indicated tlat BMSCs can be induced to synthesize fibrochondrocyte-characterized extracellular matrixes in vitro, which suggests that BMSCs are available as seed cells in meniscus tissue engineering.

To assess the advantage, disadvantage and feasibility of small thoracotomy incision for intrathoracic operations. In 124 patients minimal thoracotomy incisions (MT) were made for infrathoracic surgery from July 1999 to June 2001. The operative approaches consisted of posterolateral incisions in 82 cases, axillary incisions in 17 cases, and anterolateral incision in 25 cases. The operations included 46 lobectomies, 8 pneumonectomies, 27 wedge resections, 13 mediastinum tumor resections, 13 bullae ligations with pleurodeses, 2 esophagectomy and esophagogastric anastomosis, 1 total gastrectomy and esophagojejunostomy, 9 explorations, and 5 other operations. There was no mortality or serious complication in this group. The patients had a faster recovery with less postoperative pain and better cosmetic result. Minimal thoracotomy incisions are safe and feasible approaches for intrathoracic surgery and worth recommending.

Objective To analyze the immunophenotyping characteristics of myeloid leukemia in transgenic mouse.Methods According to differential antigen expression profile on various hematopoietic lineages,flow cytometric analysis of bone marrow sample was performed on 5 myeloid leukemia mice and 10 healthy BL6 mice.Cell cycle analysis was further performed to assess cell proliferation.Results Expressions of Mac-1+ Gr-1+ and c-Kit+ in bone marrow cells in transgenic leukemia mice were(72.6±6.5)% and (20.5±4.8)%,and it were significantly higher than those in normal mice[(52.8±4.8)% and(2.1±0.3)%](t=6.66,12.66,P＜0.01).And expressions of B220+,CD3+,CD41+ and Ter119+ in leukemia mice were(2.7±1.1)%,(1.2±0.3)%,(1.2±0.6)% and(2.8±1.1)%,respectively.It were significantly lower than those in normal mice[(20.2±2.1)%.(6.6±1.3)%,(4.7±1.1)% and(10.6±1.2)%](t=-17.63,-8.69,-6.30,-12.28,P＜0.01).The percentages of S phase and G2/M phase in leukemia mice were(25.7±4.2)% and(21.1±4.2)%,respectively.It were significantly increased as compared with normal mice[(11.8±2.1)% and(8.9±1.8)%](t=8.59,7.98,P＜0.01).Conclusions Immunophenotyping of myeloid leukemia in transgenic mouse was characterized by hish expression of myeloid specific marker(Mac-1 and Gr-1)and hematopoietic stem/progenitors cells specific marker(c-Kit),and by low expression of B-lymphoid specific marker(B220),T-lymphoid(CD3),megakaryocyte(CD41)and Erythroid(Ter119).

Objective To analyze the diagnostic process of a rare case of acute myeloid leukemia with minimal differentiation undergoing a lineage switch to mixed phenotype acute leukemia, NOS-rare types,and to investigate its difference from other acute myeloid leukemia and mixed phenotype acute leukemia. Methods Following tests were performed on the patient with switched mixed phenotype acute leukemia and three control leukemia patients ( including two acute myeloid leukemia with minimal differentiation and one mixed phenotype acute leukemia ). Cell morphology was analyzed by bone marrow smear and related cell chemical staining. Immunophenotyping of bone marrow was performed by flow cytometry ( FCM ). G-banding technique was used for karyotype analysis and RT-PCR was used for fusion gene detection. All the laboratory data of the switched patient were compared to that of three control patients in order to reveal the characteristics of such a rare phenotype switch in acute leukemia. Results Before switching, the morphology of acute myeloid leukemia with minimal differentiation demonstrated 0.82 blasts occurring in bone marrow, distinct nucleoli and absence of Auer rods. Blast cells expressed hematopoieticassociated antigens ( CD38, HLA-DR ), myeloid antigens ( CD13, CD56, CD11b ) and CD7. And these blasts were negative for MPO, CD33, CD15, CD79, CD19, CD22, cytoplasmic CD3, CD4 and CD8. After switching, 0. 42 blasts were found in bone marrow, showed eosinophilia and presence of basophile. Blast cells expressed hematopoietic-associated antigens ( CD38, HLA-DR ), myeloid antigens ( MPO, CD13 ),lymphoid antigens ( CD19, CD79a ,cytoplasmic CD3, and CD7 ). The control group showed typical morphology and immunophenotyping. No abnormal karyotype and fusion gene were detected. Conclusions It is a rare and complicated case that acute myeloid leukemia with minimal differentiation switched to mixed phenotype acute leukemia, NOS-rare types. The laboratory features, especially the change of immunophenotyping play an important role in the diagnosis.

Objective To investigate the effect of matrine on migration, proliferation and apoptosis of hepatic stellate cell (HSC) induced by PDGF in vitro. Methods HSC line was incubated separately with matrine in different concentration of 0.25 and 0.5 mg/ml, cell proliferation was assessed by MTT assay. Apoptosis was tested by TUNEL in situ assay. The migration ability of HSCs was observed with Transwell chamber assay. Results The cell migration rate and absorbance value of the groups with 0.25 mg/ml and 0.5 mg/ml matrine were significantly lower than those of the control group, as well as in PDGF groups. But there was no difference in rates of cell apoptosis among three groups. Conclusion Matrine can inhibit HSC migration, proliferation and induce apoptosis of HSC, which might be one of the mechanisms that matrine counteracts against liver fibrosis. But there was no effect of matrine on HSC apoptosis induced by PDGF.

The authors give an account of the changes in both internal and external environments that hospitals confront in the new century, emphasizing that it is imperative for hospital managers to manage their hospitals with new concepts and means so as to meet the needs of the times. The paper is focused on 10 ways of management, namely, knowledge management, human resources management, operational management, efficiency and benefit management, new medical quality content management, fuzzy management, information management, image management, humanistic management, and hospital culture management.

With the development of the times and the constant change of the forms of labor, it is imperative to explore the value of labor and principle of distribution of medical workers. The authors first describe a number of relevant concepts, including instruments of labor, forms of labor, value of labor, and human resources. Then they analyze the value of labor of medical workers and their administrators, including the features and forms of the creation of value by medical workers and their administrators. Finally, they expound the importance of deepening reform in the distribution system of medical institutions. By analyzing the theoretical basis for readjusting the distribution mechanism, they put forward the principles of giving expression to the creation of the value of labor in readjusting the distribution system and taking efficiency, capital and production factors into account in distribution and offer suggestions respectively for the reform of the distribution system in profit and non profit medical institutions.

Firstly the authors expound the management attribute of hospital management ethics, clarifying the connotation of hospital management ethics, the basic issues in the study of hospital management ethics, and the eight functions, tasks and goals of hospital management ethics. Secondly they discuss the relationship between hospital management and hospital management ethics. Thirdly they offer a preliminary account of the application of hospital management ethics in hospital management: ①illustrating via a diagram the application of hospital management ethics in hospital decision-making; ②presenting ways of judging “good” and “evil” activities in the hospital; and ③describing the application of hospital management ethics to the monitoring and assessment of medical programs. Finally they propose some methods for cultivating the capability of the entire staff of the hospital to fulfill the obligations of moral excellence.