The authors probed systematically into the delicacy management measures adopted by the hospital in its internal mechanism reform, innovative medical service model, human resource optimization, and its performance appraisal system reform. Discussions in the paper include such topics as flat management for hospitals,intensification,centralization and integration in diagnose and treatment, as well as vertical nursing management, and the outsourced logistic services. The methods and paths to achieve these goals are summarized as “preciseness, accuracy, carefulness, and strictness”.

Objective To investigate the relationship between cognitive function and emotional status in functional constipation patients.Methods Thirty-five functional constipation patients (the functional constipation group) and 24 healthy controls (the HCs) were enrolled in an event-related potential (ERP),behavior and electroeneephalogram study while performing an oddball auditory task.Response time,accuracy,latency and P300 amplitude were compared between the two groups.The Hamilton depression rating scale (HAMD-17),Hamilton anxiety scale (HAMA),symptom check list-90 (SCL-90) and Eysenck personality questionnaire (EPQ) were administered prior to the oddball task.Results The average HAMD-17,HAM A and SCL-90 (the somatization,obsessive-compulsive disorder,depression,anxiety and psychosis dimensions) scores of the functional constipation group differed significantly from those of the HCs.The intro-extraversion and neurosis dimensions of the EPQ were also significantly different.There was no significant difference in response time or latency between the two groups.The ERP results showed that the P300 amplitudes at the F3 and F7 sites were significantly different between the functional constipation group and the HCs.But there was no significant difference in P300 latencies at F3 or F7 between the two groups.Conclusions The findings suggest that patients with functional constipation are more susceptible to depression and anxiety,as well as somatization,obsessive-compulsive tendencies and other neurotic personality characteristics.Patients may employ psychological defense mechanisms to avoid the depression and anxiety.The ERP results imply there may be the implicit cognitive dysfunction with emotion in patients with functional constipation.

The ongoing health reform is bringing reforms of public hospitals under spotlight in China, attracting growing attention onto its progress and roadblocks. Probing into the "three steps" of public hospital system reform in Wuxi, this article analyzed such a reform in the city. It described the measures and initial outcomes gained in such fields as the hospital trusteeship reform, the separation of hospital regulation from its administration, and the hospital board system. Citing the case of Wuxi No. 2 People's hospital as an example, the authors introduced the innovative efforts made in hospital internal mechanism, management innovation, medical service model, hospital connotation construction, and talents cultivation.

Objective To investigate the expression level of miRNA-146a (miR-146a) in retinal pigment epithelial (RPE) cells aging and age-related macular degeneration (AMD),and discuss its regulation mechanism of AMD by repressing VEGF-A.Methods The expressions of miR-146 and VEGF-A were examined by qRT-PCR in RPE cells in mice aged 2 months,8 months,12 months,18 months or 24 months,and in RPE cells from 75 years old AMD patients.The protein level of VEGF-A was also detected by Western Blotting.Finally,the effects of overexpression of miR-146a in APRE-19 cell line on expression of VEGF-A was checked.Results MiR-146 was up-regulated to 8 times or 24 times at 18 months or 24 months aged mice,and the expression of VEGFA was down-regulated in aging RPE from 1.5 times to 0.8 times.However,the expression of miR-146 decreased to 14.5 times and VEGF-A increased in RPE cells of AMD.In cultured cells,overexpression of miR-146a inhibited the expression of VEGF-A.Conclusion Up-regulation of miR-146a in aging RPE cells and its down-regulation in AMD suggest a potential of miR-146a as molecular marker.MiR-146a overexpression inhibits the expression of VEGF-A,supporting a potential clinical treatment of miR-146 in AMD.

Objective To study the early clinical outcome of patients undergone minimally invasive direct coronary bypass(MIDCAB) surgery,and the mid-term patency of left internal mammary artery(LIMA)-left anterior descending(LAD) anastomosis.Methods From Jannuary 2007 to May 2014,47 cases underwent MIDCAB surgery in our department,with 35 males and 12 females,aged 48-76 years,with the average of (62.9 ± 8.1) years old.Types of LAD lesions were as followed:1 case was ostial total obstruction,28 severe stenosis at proximal segment,10 long and severe stenosis,3 calcified lesion with severe stenosis,5 myocardial bridge.All patients had symptomatic angina,typical myocardial ischemia could be detected by electrocardiogram for all patients with myocardial bridge.Comorbidities included:hypertension 38 cases,27 diabetes mellitus,3 COPD and 3 chronic kidney disease.Results All surgery went well without transfer to mid-sternotomy.LIMA harvest time was 38-53 minutes,mean LIMA flow rate was(22 ± 6) ml/min after anastomosis.Surgery duration was 117-143 minutes,blood loss was less than 100 ml for each operation.No blood transfusion was required.Tracheal intubation time was 4-16 hours,ICU stay time was 22-45 hours,hospital stay time was 6-10 days.There was no peri-operative death,either no myocardial infarction or cerebral vessel accident.During follow-up,all LIMA-LAD appeared to be patent by coronary CT angiography.Conclusion High patency rate of LIMA-LAD anastomosis could also be obtained during MIDCAB surgery.It was reserved as a safe and effective surgery for well-selected patients.

Aim To study and compare the pharmaco-kinetic parameters of roxithromycin under normoxic and hypoxic rats. Methods A highly effective and rapid ultra-performance liquid chromatography with tandem mass spectrometry ( UPLC-MS/MS) method with posi-tive electrospray ionization source was successfully de-veloped and validated for quantification of roxithromy-cin in rat plasma. Sprague-Dawley rats were randomly divided into the hypoxia and normoxic groups. Each rat obtained a single dose of roxithromycin with 10 mg · kg-1 via intragastric administration. The pharmacoki-netic parameter comparison between normoxic and hy-poxic groups was calculated by SPSS software using in-dependent sample t test method. Results The main pharmacokinetic parameters of roxithromycin between the normoxic and hypoxic rats were:the AUC(0-t) 7 576 and 3 761 μg·h·L-1 , MRT(0-t) 5. 6 and 7. 7 h, T1/2 3. 4 h and 3. 9 h, CL 1. 5 and 3. 0 L · h-1 · kg-2 , tmax3. 1 and 3. 4 h, Cmax 1 116 and 372 μg·L-1 , re-spectively. The levels of Cmax and AUC of roxithromy-cin in hypoxic rats were statistically lower than those in normoxic rats. Conclusion The exposure level of rox-ithromycin in hypoxic rats markedly decreased. Our re-sults may provide an important experimental basis to adjust the dosage for roxithromycin in hypoxic clinical practice.

Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.

The Chinese Pharmacopoeia is the legal technical standard which should be followed during the research, production, use, and administration of drugs. At present, the new edition of the Chinese Pharmacopoeia is planned to be promulgated and implemented. This article summarizes and analyzes the main characteristics and the content of updates and amendments of the Chinese Pharmacopoeia 2025 Edition(Volume Ⅰ), to provide a reference for the correct understanding and accurate implementation the new edition of the pharmacopoeia.

Objective Acute type B aortic dissection (ATBAD) is a life-threatening condition.Open surgical (OS) repair with a prosthetic graft has been a conventional treatment for ATBAD.Thoracic endovascular aortic repair (TEVAR),as a less invasive and potentially safer technique,has been used increasingly in recent decade.Evidence to support the use of TEVARin these patients is needed.This meta-analysis was to assess the efficacy of TEVAR versus conventional OS in patients with ATBAD.Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2010,Issue 4),MEDLINE,EMBASE,CINAHL,Web of Science 、OpenSIGLE 、National Technical Information Service(NTIS) 、CNKI 、Chinese Biomedicine Database 、VIP、WanFang Data for clinical trials and additional sources for published and unpublished trials until 1/18/2011.Controlled trials in which patients with ATBAD were assigned to TEVAR or OS repair were included.The authors extracted independently the following information using a specifically designed data collection form for individual trial included:first author and the year of publication,study population,interventions used (TEVAR or OS repair) and outcomes (short-term mortality,short-term complications,long-term complications and long-term mortality rates).Data were extracted on the relevant methodological domains to minimize the bias in the analysis with use of the Cochrane methods for bias assessment and Grading of Recommendations Assessments Development and Evaluation (GRADE)methods.For each outcome,GRADE criteria and Cochrane Bias evaluation were used to evaluate the quality of the evidence with regard to inconsistency (heterogeneity),indirectness,imprecision,and other potential sources of bias,such as publication and reporting bias.Revman5.0 and GRAED profiler 3.2.2 software were used to analyze the data.Results Five trials (318 participants) were included in the analysis.The five studies were limited by lack of allocation concealment and blindness,and the studies were small.The evidence quality determined with the GRADE approach for 30-day mortality was poor and for other variables was very poor.As compared with ATBAD,TEVAR associated with a significantly reduced short-term mortality,M-H fixed odds ratio 0.19,95％ CI [0.09,0.39],P＜0.001.However,TEVAR could not improve the postoperative outcomes such as complications or long-term mortality,M-H random odds ratio 1.40,95％ CI[0.24,8.18].Conclusion TEVAR can be weakly recommended as an alternative for the treatment of ATBAD in selected cases and may not be used as a general option in place of surgery based on the current evidences.

ObjectiveTo compare the clinical characteristics of ischemic colitis (IC) and ulcerative colitis (UC).MethodsThe data of 43 IC patients and 36 UC patients diagnosed from January 2008 to June 2011 were compared on the clinical and endoscopic characteristics.ResultsThere were statistical differences in terms of gender,age,course of disease and underlying diseases between the two groups( P ＜0.05 ).IC was more frequently seen in aged women with cardiovascular diseases,and with short course of disease (29/43,67.0％).IC group showed higher CRP and lower PLT level than did UC group (P ＜ 0.05 ).IC mostly involved sigmoid colon,with localized lesions of vertical or irregular ulcer which cured more quick and characterized with mucosal inflammation,while UC mainly originated from rectum and involved the whole intestinal wall,manifested with scattered spot ulcer,cryptitis and abscess.Conclusion Age,disease course,underlying diseases,serum CRP level,endoscopic and pathological characteristics are all factors to consider for differential diagnosis of IC and UC.