After The Medical Institution Management Regulations was enacted by the State Council in 1994, 26 Chinese provinces and municipalities have enacted the local legislation of medical institution management.These local legislations make a full use of the space of legislation which the host law gives, reasonably determined the health administrative departments'management responsibilities at all levels, detailed the responsibility division for examina-tion and approval, and defined the medical institution practice behavior requirement.The local legislation has played a positive role for the rational medical resources allocation and standardized the local medical institutions practice or-der.But as time goes by and reform deeply, the weakness of these legislations has emerged.This is seen for the fact that they have not been repaired for many years, blindly repeat host law, heavily rely on the regulations with poor sta-bility , do not keep the pace with the system design times, violate the license law, and pay attention to the administra-tive examination and approval instead of the occupational behavior management.This paper makes full investigation on the existing relevant medical institution management laws, regulations and policies.Through the analysis of advan-tages and disadvantages of provincial legislations, some thinking on the medical institutions management is put for-ward.

Objective To explore the clinical manifestation and therapeutic effect of children's oral mucosa factitious ulcer.It aims to improve the diagnosis and therapy level of such ulcer.Method 36 cases with children's ulcer symptoms and mental attitudes were observed.Tothlcases and were divided into 3 groups.Group 1:Take medicine(Inosine Pill 0.2,Vitamin B6 Pill 10 mg)3 times a day;use EGF spray for some part,together with psyehotherapy for 1 month.Group 2:Adopt orthodontics to correct factitious habit and use psychotherapy.Group 3:Group 1+Group 2.Trackingrandomly for 1 month,3 months,half a year,1 year,check the therapeutic and ulcer healing-up progress by further consultation.Result According to 36 cases,boys are more vulnerable to such disease.They tend to bite cheek,tongue,lips.Ulcer used to happen on tongue brim mucosa,quantity 1～3,size 0.2～1.8 cm,irregular appearance,white keratosis surrounding,priority therapy is to correct factitious habit.15 cases(41.67%)healed,9 cases(25.00%)showed good result,10 cases(27.57%)were efficacious,2 cases(2.78%)ineffective.The thempeutic effect of Group 3 is much better than Group 1 and Group 2.Conclusion The diagnostic importance of such disease is factitious habit.Correct factitious habit and psychotherapy are the important therapeutic methods.This disease can be the oral manifestation of children's Attention Deficit Hyperactivity Disorder.

Objective To explore the clinical features of lissencephaly and the detection ofLISI gene.MethodsThe characteristic of clinical features, laboratory examination and gene detection in one case of lissencephaly was retrospectively analyzed. Meanwhile, the related literatures were reviewed.ResultsA 5-month-old female child diagnosed with epilepsy 20 days ago was hospitalized for convulsive seizure more than 30 times in 3 days. The manifestations were eyes staring, and turning upward, cyanosis of lips and face, froth at the mouth, extremities rigidity and loss of consciousness, and the symptoms can spontaneously remitted in 2-3 minutes. Laboratory examination showed that peripheral blood white cell count was 13.67×109/L, hemoglobin 108 g/L, red blood cell count 3.90×1012/L, lymphocyte 10.26×109/L; maocardial enzyme and hepatic and renal function were normal; blood ammonia was 23 μmol/L and lactic acid 2.11 mmol/L. Long-range video EEG showed highly arrhythmia, and frequent partial epilepsy, and sometimes secondary generalized epilepsy. Head MRI showed lissencephaly. The child was treated with oral administration of Keppra 27 mg/(kg·day), Topiramate 6.5 mg/(kg·day), currently no seizure. The detection ofLIS1 gene found that heterozygous mutation of c.232delG, which lead to protein shift mutation (p.E78NfsX25). No mutation was found in her parents.ConclusionsChild with lissencephaly may combine with epilepsy which may cause by mutation inLIS1 gene. And there was no information about point mutation of c.232delG inLIS1 gene being reported at home and abroad so far.

BACKGROUND: Raman spectrum, compared with conventional detection technologies, is a rapid, non-invasive and label-free optical method. Its application has become an issue of concern in biomedical research. However, further studies are warranted to optimize the acquisition condition of Raman spectra from different stem cells. OBJECTIVE: To explore the effect of the wavelength of laser and the groove frequency of gratings to obtain the optimized parameter combination for Raman spectrum collection in human stem cells. METHODS: Using human mesenchymal stem cells as samples, the effects of different laser wavelengths (532, 38,785 nm) and different grating groove frequency (600, 1200, 1800 gr/mm) on Raman spectra were compared respectively. Then the different combinations of the wavelength and groove frequency were used and compared in terms of the spectra resolution and acquisition time, and the best acquisition condition was selected and applied in a comparison study on the Raman spectra from human mesenchymal stem cells and human embryonic stem cells. RESULTS AND CONCLUSION: The wavelengths of lasers and groove frequencies of gratings showed compound impacts on both the spikes at different wavenumbers and the ratio between spikes; the combination of 785 nm and 1200 gr/mm was confirmed to be the best spectrum features for human mesenchymal stem cells. The comparison of Raman spectra from human mesenchymal stem cells and human embryonic stem cells implies that the embryonic stem cells contain higher nucleic acids than the mesenchymal stem cells, while the mesenchymal stem cells appear to contain more proteins and lipids.

Objective To obsOrvO thO diffOrOnt manifOstations and diffOrOncOs of pOlvic laparoscopy in primary and sOcondary infOrtility patiOnts, and to clarify thO application of hystOroscopy combinOd with laparoscopy in thO diag-nosis and trOatmOnt of infOrtility.Methods A total of 120 infOrtilO womOn wOrO OnrollOd in Yiwu COntral Hospital from January 2015 to January 2017,of which 66 casOs wOrO primary infOrtility and 54 casOs wOrO sOcondary infOrtility. ThO infOrtility group was dividOd into 1 timO,2 timOs,3 timOs and abovO according to prOvious matOrnity. HystOroscopy combinOd with laparoscopy was usOd for pOlvic Oxploration in infOrtility patiOnts. ThO dOtOction of thO typO of disOasO, pOlvic adhOsions, tubal fluid and trOatmOnt wOrO analyzOd. Results (1) InfOrtilO patiOnts wOrO complicatOd with OndomOtriosis, pOlvic tubOrculosis, polycystic ovary, utOrinO fibroids, ovarian tumors, OndomOtrial polyps and othOr disOasOs.(2)ThOrO wOrO 94 casOs of pOlvic adhOsions(78.3% ),50 casOs of primary infOrtility(75.8% ),and 44 casOs in SOcondary infOrtility group(81.5% ).(3) Primary infOrtility adhOsion ratio of 75.8% ,sOcondary infOrtility adhO-sion ratio of 81.5% , thO proportion of adhOsions in matOrnal 1 timO patiOnts was 80.6% ,thO proportion of adhOsions in prOgnant womOn with 2 timOs was 83.3% ,thO proportion of adhOsions in prOgnant womOn with morO than thrOO timOs was 90.0% , and thO mOdian adhOsion ratO was 36.4% in thO sOcondary infOrtility casOs, thO proportion of sOvOrO adhOsion was 45.5%.(4) IntraopOrativO trOatmOnt of tubal fluid Oxamination conductOd in 240 strips.ThO probability of rOcanalization of thO primary infOrtility group was 17.78% ,and thO probability of rOcanalization was 18.75%.Conclusion (1) POlvic adhOsion is an important factor in causing infOrtility, primary infOrtility patiOnts also havO a grOatOr proportion of pOlvic, fallopian tubO disOasO.(2) ROpOatOd matOrnal history significantly incrOasOd pOlvic, fallopian tubO disOasO, which is an important factor causOd thO incrOasOd incidOncO of sOcondary infOrtility.

OBJECTIVETo provide guidance for the high-dose methotrexate (HD-MTX) treatment of pediatric acute lymphoblastic leukemia (ALL), and to understand the impact of SLCO1B1c.521T>C (rs4149056) variant on methotrexate (MTX) pharmacokinetics and clinical outcome in children with ALL.

METHODEighty-two children with ALL in Division of Hematology of Wuhan Children's Hospital from January 2008 to February 2013 were enrolled. All patients were genotyped for rs4149056 single nucleotide polymorphism (SNP) into wild-type group (TT genotype) and variant group (TC/CC genotype). According to the ALL-BFM 2000 protocol, all patients received intravenous infusion of MTX every ten days at 3 to 5 g/m(2). Leucovorin rescue was performed after 36 hours of the MTX administration and its dose was adjusted according to the MTX plasma concentration at 48 hours. The concentrations of MTX and its metabolite at 24, 48 and 72 h were determined by high performance liquid chromatography with solid phase extraction. Population pharmacokinetic parameters were estimated by the NLME software. The pharmacokinetics, toxicity and leucovorin rescue was compared. The relapse rate within 5 years and event-free survival were followed up.

RESULTEighty-two pediatric patients were classified into two groups: variant group including 20 TC genotype carriers and one CC genotype carrier, wild-type group included 61 patients with TT genotype. Compared with wild-type group, plasma concentration of MTX at 48 and 72 h increased significantly [48 h: (1.00±1.41) vs.(0.34±0.17) µmol/L, t=2.131, P=0.046; 72 h: (0.31±0.26) vs.(0.08±0.04) µmol/L; t=3.995, P=0.001]. Area under the concentration time curve (AUC48-∝) of MTX significantly increased in variant group [(23.18±19.91) vs.(5.66±2.01) h·µmol/L] (t=4.025, P=0.001). Time above the MTX safety threshold (TC>0.1 µmol/L) increased significantly in variant group [(95.3±22.0) vs.(67.1±7.5) h, t=5.880, P<0.001]. Rescue dosage of leucovorin in variant group was higher than that in wild-type group [(312.7±287.8) vs.(140.6±27.5) mg/m2, t=2.614, P=0.017]. The children carrying rs4149056 C allele suffered from a higher frequency of serious adverse effect [gastrointestinal toxicity: 33% (7/21) vs. 5% (3/61);hepatic toxicity: 24% (5/21) vs. 2% (1/61)]. The difference was statistically significant (χ2=9.275, 8.289, all P<0.05). Hospital stay of variant group was significantly longer than that of wild-type [(4.95±1.43) vs. (4.05±0.22) d, t=2.881, P=0.009]. The relapse rate within 5 years of variant group and wild-type group were 9% (2/21) and 13% (8/61), respectively. There were no significant differences in the event-free survival between the two groups (χ2=0.001, P=0.971).

CONCLUSIONThe SLCO1B1 c.521T>C variant was an important determinant of MTX pharmacokinetics. An appropriate leucovorin dose raise in variant group was beneficial to reducing the serious toxicity and did not affect the long-term clinical outcome.

Alleles ; Antineoplastic Combined Chemotherapy Protocols ; Asparaginase ; Child ; Daunorubicin ; Disease-Free Survival ; Genotype ; Humans ; Leucovorin ; administration & dosage ; Methotrexate ; administration & dosage ; pharmacokinetics ; Organic Anion Transporters ; genetics ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; genetics ; Prednisone ; Solute Carrier Organic Anion Transporter Family Member 1b1 ; Treatment Outcome ; Vincristine

Objective: To assess the effectiveness of interventions on patient trust Methods: A system review was conducted through searching 11 relevant databases, such as Cochrane Library, EMBASE, PsycINFO, CINAHL, PubMed, Web of Science, SinoMed, CNKI, WANFANG. The randomized controlled trials (RCTs) were screened from 1539 original studies according to inclusion and exclusion criteria Meta-analysis was used to evaluate and interpret the interventions. Results: Ten RCTs were included in the review. It was concluded from meta-analysis that no significant difference could be found between controlled and intervention groups by increasing doctors'abilities(SMD = -0.05, 95％ CI: -0.22 -0.12); while the other two interventions, doctor's information disclosure as well as patient education and nursing intervention, significantly enhanced patient trust (SMD = 0.13, 95％ CI: 0.06 - 0.21; SMD = 0.60, 95％ CI: 0.29 - 0.90). Conclusion: Doctor's information disclosure, patient education and nursing intervention are effective in increasing patients'trust, while intervention of doctor's ability promotion seems not so remarkable.

Three cases of swimming pool granuloma are reported.Case 1:a 40-year-old female presented with a 2-month history of nodules and plaques on the right hand and forearm.She was a tropical fish salesperson but denied trauma history.Skin examination revealed multiple irregularly sized,dark-red nodules and plaques on the joints of right fingers,wrist,and elbow,as well as multiple subcutaneous nodules simulating strings of beads on the right upper limb.Case 2:a 48-year-old female presented with a 2-month history of nodules and plaques on the left hand and forearm.There was a history of trauma due to tropical fish tank and filter cleaning.Physical examination showed multiple deep purple plaques and painless subcutaneous nodules scattered on the left hand,wrist,and upper limb.Case 3:a 39-year-old male presented with a 3-month history of nodules on the fingers of both hands.There was no history of trauma,but he was a tropical aquarist.Skin examination revealed multiple soybean-sized dark-red nodules on the extensor aspect of interphalangeal joints of both hands.Fungal examinations yielded negative results in the 3 cases,while histopathology revealed infectious granuloma with a mixed inflammatory cell infiltrate.All of the cases showed positive results in purified protein derivative (PPD)skin test.Mycobacterium marinum was isolated from the lesional tissue of Case 1 and 2,but not from Case 3.All the patients were diagnosed with swimming pool granuloma,and given anti-atypical mycobacterial therapy including oral rifampin and clarithromycin.The lesions disappeared after 1 to 3 months of treatment,with the treatment course varying from 2 to 5 months.No recurrence was observed during a 3- to 12-month follow-up.

Objective:To study the effects of rolling blood pump parameters and blood concentration on hemolysis during extracorporeal circulation.Methods:According to the extracorporeal hemolysis experiment standard, an extracorporeal circulation experimental device was built to analyze the influences of circulation time (0 ~ 90 min), blood flow rate (1~4 L/min), and blood volume fraction (60%, 70%) on the hemolysis of blood samples in the circulatory system. The results of hemolysis were analyzed using first-order linear regression.Results:The longer the blood pump circulation time, the greater the hemolysis rate; the higher the blood flow rate, the greater the hemolysis rate. When the flow rate is 1 and 2 L/min, the hemolysis rate curve has an inflection point that changes with time, i.e. when the circulation time exceeds 30 min, the slope of the hemolysis rate curve suddenly increases. However, when the flow rate is 3 and 4 L/min, the hemolysis mutation phenomenon is not obvious. Compared to the blood sample with blood volume fraction of 70%, a blood sample with a blood volume fraction of 60% is less prone to hemolysis.Conclusions:The longer the blood pump circulation time and the higher the blood flow rate, the more easily the red blood cells are destroyed, i.e. the hemolysis rate is directly proportional to the circulation time and blood flow rate. When the circulation time increases to a certain degree, an inflection point appears in the hemolysis rate curve, and the hemolysis trend will be significantly enhanced.

Teaching competition is an effective way for college and university teachers to improve their teaching skills. Based on the teaching practice and experience in medical parasitology,this paper discusses several key issues in teaching competition including topics,teaching designs and teaching methods. It provides references for the teachers in department of parasitology of universities and colleges to improve the quality of classroom teaching.