In the recent years,our country have made great developement on the reform about the nation health curative system,consummating the health curative market mechanism and conversion on the conception about health.If legionary hospital want to make a good place in the future competition about curative market,they must do more things.To do this,they must get away from the bad factors in the conducting system for current market and use good factors to achieve more markets in the competition.In order to actualize the business,we must consummate the system about curative service management.

To evaluate the effect of rosiglitazone on the Angiotensin Ⅱreceptor 1(AT1) and explore its mechanisms of lowering the blood pressure and protecting the organs. The spontaneously hypertensive rats(SHR) 24(SHR)rats were divided into 2 groups:12 were given rosiglitazone,12 were in the control gronp without any treatment. The duration of observation was 8 weeks. The tail blood pressure was measured indirectly.The in situ hybridization and the immunohistochemical methods were used to estimate the expression of the AT1 mRNA and AT1 receptors of heart.In rosiglitazone group,the blood pressure was reduced significantly,and the expressions of AT1 mRNA and AT1 receptor of heart were inhibited.The effect of rosiglitazone on the expressions of AT1 mRNA and AT1 receptor might be one of the reasons why insulin sensilizers reduce the blood pressure and prevent the organ injuries of hypertension.

Objective To evaluate the safety and efficacy of nephron sparing surgery (NSS) for renal angiomyolipoma (RAML). Methods Thirty-nine patients of RAML were underwent NSS. Tumor enucleation was done in 23, partial nephrectomy in 16, and selective arterial embolization in 2. Results The average diameter of enucleated tumor was 5.8 cm(from 3.0 to 14.0 cm), the average of blood loss was 190 ml(from 75 to 800 ml),none of the patients developed hemorrhage or urinary fistula. The average follow-up of 38 patients was 48 months(from 1 to 120 months). Postoperative serum level of creatinine was stable, no patients had a local recurrence. Conclusions NSS can be performed with satisfactory result in RAML. Effective control of hemorrhage and conservancy of renal function are the key points.

Purpose To investigate the clinicopathologic features and prognostic factors of apocrine carcinoma ( AC) of breast. Meth-od Clinical data of 70 ACs and 283 invasive carcinomas, not otherwise specified were collected. Differences between the prognostic outcomes of the two groups were compared, and the relationship between clinicopathological characteristics and prognosis was also ana-lyzed. Results The mean age of the patients with AC (56. 17 ± 12. 41 years) was older than those with invasive carcinoma not other-wise specified (52. 77 ± 11. 07 years) (P=0. 039). The patients with AC had a lower frequency of axillary nodal metastasis, a lower frequency of ER and PR positivity comparing to invasive carcinoma not otherwise specified ( P<0. 05 ) . No significant differences in the overall survival (P=0. 221) and disease-free survival (P=0. 378) periods of the two groups were observed. Kaplan-Meier surviv-al analysis showed tumor size, lymph node metastasis, pathological stage, lymph node tissue infiltration were related with prognosis of patients with AC ( P<0. 05 ) . In multivariate analysis, lymph node metastasis was associated with a worse prognosis ( P<0. 05 ) . Conclusions Although AC and invasive carcinoma not otherwise specified have different clinicopathologic characteristics, the prog-noses of patients with these diseases are similar. Lymph node metastasis could be used as an independent factor for predicting the prog-nosis of patients with AC, early diagnosis and early treatment is the key to improve its prognosis.

Objective To study the factors influencing outcome of acute arterial embolism in extremity.Method From Aug 1997 to Nov 2001, we have accomplished treatment in 41 cases of acute arterial embolism in extremity with Fogarty catheter.Result Among 41 cases,26 cases were succeeded in leg salvage,8 cases were subject to amputation and 7 cases were dead finally.Conclusions Durationand degree of ischemia in extremity,embolectomy completeness in the case of introoperation,reperfusive injury and myonephropathic-metabolic syndrome,Primary diseases and general conditions are main influencing factors in treatment of acute arterial embolism.

Objective To discuss the safety of endoscopic sphincterotomy (EST) in treatment of choledocholithiasis in patients over 80 years.Methods From 2005 to 2007,893 patients with choledocholithiasis were divided into group A (n= 148,aged over 80 years) and group B (n=745,aged below 60 years).The clinical data,complications and EST successful rate were retrospectively reviewed between two groups.Results ① The important chronic concomitant diseases were significantly higher in group A than those in group B ( 29.3 % vs 8.1 % ,P＜0.01).② The EST successful rate in group A and B was 95.6% and 96.5%,respectively ( P＞0.05).③ Sixteen patients in group A had complications including 13 caused by EST itself,3 related with EST and one died of aspiration pneumonia.While in group B,41 complications were caused by EST itself and no EST related complications.There was a statistically difference in EST related complications between two groups (P < 0.01 ).In complications caused by EST itself,there was no difference between two groups (P 0.05 ).④ The average hospital stay was ( 7.2 ± 2.2) days in group A and (5.1 ± 1.4) days in group B with no significant difference (P 0.05),Conclusion The EST is safe and effective in treatment of patients over 80 years.

Objective To investigate the safety of endoscopic suhmucosal dissection (ESD) in elderly patients with lesions of gastroesophageal mucosa. Methods Thirty-six elderly patients with flat elevation lesion of gastroesophageal mucosa were studied from July 2007 to May 2008. There were 14 cases with dysplasia, 9 cases with early carcinoma and 13 cases with leiomyoma confirmed by pathologic biopsy and endoscopic ultrasonography. All the patients were treated under consciousness condition, and the focus of lesion were completely resected with improved hook knife, IT knife and electrocoagulation or electro-cutting technique. The wound surface was managed with noradrenaline added in ice physiological saline, argon beam coagulator and metal clips. After operation, they were treated by abrosia, acid suppression and mucosa protection. The conditions of wound healing and residual lesions were reexamined four weeks after operation. Results Among the 36 patients (19 males and 17 females), there were 29 patients(80.6%) with complete focus ablation by ESD and 7 patients (19.4%) with resection by snare. Three cases (8.3%) of perforation occurred during operation and the perforations were treated with metal clips. After inserting stomach tube for fasting and anti-infection treatment for 5-7 days, all the three cases were recovered. One case(2.8%)had hematemesis 2 hours after operation and bleeding was stopped by endoscopic metal clip. Conclusions ESD is a safe and effective therapeutic tool in elderly patients with lesions of gastroesophageal mucosa.

PurposeTo explore the relationship between expression of apoptosis-modulating proteins and chemotherapeutic efficacy in acute leukemia. MethodsImmunocytochemical method was used to detect the expression of Bcl-2、Bcl-XL、Bax and Bak in 36 cases of acute leukemia including previously untreated/ drug-sensitive group and refractory/relapse group. ResultsThe average positive cell rates of Bcl-2 and Bcl-XL in refractory/relapse group were (41.68 ± 14.39) % and (35.96 ± 9.95 ) %, while the rates in previously untreated/drug-sensitive group were (15.64 ± 8.51 )% and (12.91 ± 8.63 )%. Statistical analysis showed the average positive cell rates of Bcl-2 and Bcl-XL in refractory/relapse group were higher than those in previously untreated/drug-sensitive group (P ＜ 0.01 ). There was no significant difference in average positive cell rates of Bax and Bak between refractory/relapse group (25.28 ± 15.49) %, (15.53 ± 10.64) % and previously untreated/drug-sensitive group (21.55 ± 12.58)%, (13.23 ± 8.36)%. The Logistic regression of expression of Bd-2 、Bcl-XL、Bax and Bak to complete remission rate (CR) of 36 cases of acute leukemia showed that Bcl-XL was the most risk factor in reducing the CR.ConclusionsBcl-2 and Bcl-XL might play important roles in multi-drug resistance of acute leukemia and Bcl-XL was more important than Bcl-2.

Objective:To explore the expression of B7-1,B7-2 and B7-H1 on tumor-infiltrating dendritic cells(TIDC) and on splenic dendritic cells(SDC),and to investigate TIDC-mediated and SDC-mediated T-cell function after blocking B7-H1 expression in these dendritic cells.Methods: The TIDCs and SDCs were isolated from tumor-bearing mice using anti-mouse CD11c magnetic beads.The expression of B7-1,B7-2 and B7-H1 on TIDC and SDC was analyzed using flow cytometer.T cells were co-cultured with TIDCs or SDCs for the mixed lymphocyte reaction(MLR),and monoclonal antibodies to B7-H1 or the isotype control antibodies were added to the MLR cultures.T-cell proliferation was assessed using XTT method and the secretion of IL-10 was detected using ELISA.Results: B7-1 and B7-2 positive TIDCs were significantly less than SDCs(P0.05).T-cell proliferation stimulated by TIDCs was weaker than that stimulated by SDCs;T cells produced more IL-10 after TIDCs stimulation than after SDCs stimulation(P