Middle sized public hospitals are facing new challenges with the introduction of the new medical reform policies and the promotion of internet information economy.In order to adapt to the new social economy and policy,medium sized public hospitals should be reformed,be more active and find their own new position according to the new environment.The following work can be done to improve medium sized public hospitals' survival and development and to better meet the needs of the society:exploring their resources,building their regional medical associations,strengthening their construction of key disciplines,utilizing the advantages of internet and information system,and reforming their personnel divisions.

Objectives To evaluate the effectiveness of transcarotid artery chemotherapy for gliomas after surgery, and selection of drug, avenue of administration, and optional time for the therapy. Methods Beginning from 4 to 30 days after operation, Nimustine (ACNU, Japan) 2.5mg/kg was injected per carotid artery, once every week for three times as one course. A second course of treatment was given after an interval of 4 to 6 weeks. Results With the above regime, the effect was marked in 39 cases (18.8%), fairly effective in 44 cases (20.8%), only slightly effective in 59 cases (27.8%), no effect in 61 cases (28.8%), and failure in 5 cases (2.4%), the mean survival time was nearly 100 weeks. Conclusion Transcarotid artery chemotherapy for gliomas is helpful in prolonging survival period, with little side effects, easy to carry out, less expensive, and better accepted by the patients.

Objective To compare the anticoagulation effect of regional citrate and heparin in patients with sustained low-efficiency hemodialysis (SLED).Method This study was conducted in the teaching hospital of Sichuan University between November 2011 and January 2013.Sixty-three patients suffering from acute kidney injury or end-stage renal diseases (ESRD) were enrolled and further randomized to 2 groups:citrate and heparin anticoagulation treatment groups in SLED.SLED was conducted by Fresenius 4008sARrTplus dialyzer for 8 hours each session,and blood flow was set at 150 ml/min.Prothrombin time (PT),activated partial thromboplastin time (APTT) and platelet (PLT) count were analyzed.Result Sixty-three patients underwent 118 sessions of SLED.Among them,59 patients (93.7％) was discharged after treatment or converted to outpatient intermittent hemodialysis,and 4 patients died of multiple organ failure during hospitalization.Compared with that in the citrate group,both PT and APTT in heparin group was significantly higher [PT:(15.5 ± 2.0) s vs (12.3 ± 2.7) s,P ＜ 0.001 ; APTF:(56.0 ± 10.9) s vs (32.8 ± 6.1) s,P ＜ 0.001 ; respectively] at 2 h during SLED.However,the PT and APTT levels in heparin group decreased afterwards and were similar with those in the citrate groups at 5 h during treatment.There is no difference on PLT counts between these two groups after treatment.Conclusion The anticoagulation effect of regional citrate and heparin was similar in patients when receiving SLED.Regional citrate may be an alternative anticoagulant approach for the patients at high risk of bleeding who require the treatment of SLED.

OBJECTIVE To study the molecular cytogenetic alterations of transitional cell carcinoma of the urinary bladder with exfoliated cells by fluorescence in situ hybridization(FISH) analysis of chromosome-specific probes.METHODS FISH was performed using 3,7,9 and 17 of chromosome-specific probes to examine chromosome aberration of exfoliated cells in 50 urine samples from patients with transitional cell urinary bladder carcinoma.RESULTS The frequency of numerical aberration of chromosomes 3,7,9 and 17 was 28%,32%,56% and 38% in urinary exfoliated cells,respectively.Loss of chromosome 9 was the most common finding,but it was not correlated with pathological grade of cancer and stage of the disease.Abnormality of chromosomes 3,7 and 17 was associated with the clinical stage.CONCLUSIONS A number of chromosome aberrations are detected in transitional cell carcinoma of the urinary bladder by FISH technique which provides a basis for further understanding of its molecular pathogenesis.It is a rapid,accurate and very sensitive method and can be used in clinical diagnosis.

AIM: To construct a high-level expression system of recombinant human neuronal nitric oxide synthase (hnNOS) full-length enzyme in Escherichia coli. METHODS: The coding sequence of hnNOS full-length was firstly amplified by PCR, and then ligated into the expression vector pCWori+. The recombinant plasmid was transformed into Escherichia coli BL21 for high-level expression. After having been checked with Western blot, the enzyme was used for large-scale culture and purification. Finally, the property of the enzyme was determined by spectrophotometric method. RESULTS: The constructed expression system could give a yielding of 3 mg/L initial culture. CONCLUSION: The expression system constructed is fully sufficient to express the active human neuronal nitric oxide synthase.

Objective To characterize clinical feature, frequency of isolation and antimicrobial susceptibility of pathogens isolated from patients with nosocomial bloodstream infections in Huashan Hospital, Fudan University from 1995 to 2004. Methods The clinical data of all patients who were diagnosed with nosocomial bloodstream infections based on national diagnostic criteria of nosocomial bloodstream infections were retrospectively analyzed. The pathogens were routinely isolated and identified. Susceptibilities against antimicrobial agents were determined by Kirby-Bauer methods and analyzed by WHONET 5.0 software. Results During the 10-year study period, a total of 395 patients were diagnosed with nosocomid bloodstream infection with 435 strains isolated from blood specimen.Gram positive bacteria, Gram negative bacilli and fungi, accounted for 47.4%, 45.1 % and 7.6%,respectively. Coagulase-negative Staphylococci (21.4%), S. aures (17.9%), E.coli (13.6%), K. pneumoniae (10.8%), Candidaspp (7.4%), Enterococci (6.0%), Pseudomonasspp (6.0%) and Acinetobacter spp (3.7%) were frequently identified isolates. S. aures and coagulase-negative Staphylococci resistant to methicillin were 62.8% and 87.1%, respectively. The susceptibilities of cefotaxime and ceftazidime against E. coli and K. preumonine were 46%-78% and 27.7%-40.4%, respectively. Conclusions The Gram positive cocci are slightly more prevalent than Gram negative bacilli in nosocomial bloodstream infections and resistance to the first line antibiotics is common among all pathogens isolated. Candida spp is the fifth leading cause of nosocomial bloodstream infections.

Objective To study the postmortem distribution of Bromadiolone and its metabolite-Benzylideneacetone in dogs and provide an experimental evidence for the sampling of Bromadiolone poisoning cases. Methods The dogs were given 2LD50 and 4LD50 Bromadiolone by intragastric administration. Anatomy was conducted immediately after death and samples of body fluids and viscera (heart blood; peripheral blood, bile, urine, heart, liver, spleen, lung, kidney, brain, urinary bladder, left leg muscle, stomach, stomach contents, pancreas) were collected and detected after the dogs poisoning death. The Bromadiolon and its metabolite-Benzylideneacetone contents in samples were analyzed by GC/MS. Results Hemorrhagic symptoms came out at 3d after Bromadiolone delivery and deaths occurred at (178.40±20.94)h after intoxication. The postmortem distribution of Bromadiolon and its metabolite-Benzylideneacetone in dogs was as following: 2LD50 Bromadiolon: bile>urine, liver, heart, kidney>heart blood, peripheral blood, spleen, lung and so on. Benzylideneacetone: the content in bile, urine, heart blood, peripheral blood, lung, stomach contents are higher. 4LD50 Bromadiolon: bile, urine>liver, peripheral blood>heart blood, stomach contents and others. Benzylideneacetone:contents in bile, urine and lung are higher. Conclusion The postmortem distribution of Bromadiolon and its metabolite-Benzylideneacetone in dogs is uneven, contents in bile, urine, liver, heart blood and peripheral blood are higher, whichare suggested for forensic toxicological analysis in Bromadiolon poisonig case.

Objective To study the pharmacokinetics and detection window of clozapine and its metabolites in human blood, so as to provide experimental basis for forensic cases of identification of clozapine poisoning. Methods 29 Taiyuan Han people's elbow venous blood was collected after given oral administration of 12.5mg clozapine at different time point, in which clozapine and its metabolites were extracted with solid phase extraction (SPE) and determined by HPLC-MS-MS. The qualitative analysis was based on retention time and MRM ions. The quantitative analysis was based on an internal standard method and calibration curve. Using the 3p97 pharmacokinetic software, pharmacokinetic equation of clozapine in the blood were imitated from the C-T data, and pharmacokinetic parameters were calculated. Results The pharmacokinetics of clozapine met a two compartment open model with a first kinetics absorption. The Tmax of clozapine(CLP), demethylclozapine(DMCLP), N-oxidation-clozapine(NO-CLP) respectively were 2.96±1.32h, 8.65±3.00h, 9.31±26.38h; The Cmax of CLP, DMCLP, NO-CLP respectively were 34.68±9.32ng/mL, 11.16±4.15ng/mL, 9.62±13.88ng/mL;The t1/2 of CLP, DMCLP, NO-CLP respectively were 17.02±23.63h, 27.06±12.58h, 41.27±29.75h; The detection window of CLP, DMCLP, NO-CLP respectively were 81.72±26.19h, 93.21±29.40h and 19.93±14.62h. Conclusion The pharmacokinetics of clozapine in blood of Han people is consistent with two compartment open model with a first kinetics absorption. The pharmacokinetics model and parameters of clozapine can provide expirimental basis for forensic identification of clozapine poisoning cases.

OBJECTIVE: To improve the outcome of treatment in patients with craniocerebral firearm wound. METHODS: Prospectively and retrospectively reviewed a series of 93 patients presented to the Xi-Jing Hospital of Fourth Military Medical University with a diagnosis of craniocerebral firearm wound during a period of 27 years from July 1970 to July 1997. All the patients had acute craniocerebral firearm wound. Of these, it consisted of 81 males (87.1%) and 12 females (12.9%) ranging from 3 months to 58 years in age (median 24.6 years). The lesion included 16 tangential wounds, 58 tubular wounds and 19 through-and-through wounds. The cases were urgent and in serious and unstable condition. All the patients underwent surgical intervention and aggressive perioperative management in the neurosurgical intensive care, including resuscitative protocols. RESULTS: After emergency treatment and operation, 9 cases died (9.7%). Follow-up studies at three months postoperative showed that 56 cases (66.7%) had made good recovery. Rates of moderate disability, severe disability or vegetative state in this series were 19.0%, 10.7% and 3.6%, respectively. Long term follow-up studies (median 5.5 years) found that 42 (50.0%) were capable of resuming their occupation. CONCLUSIONS: Craniocerebral firearm wounds are often severe, needing urgent treatment for the patients. Timely, proper and thorough initial debridement are crucial for avoiding rapid neurological deterioration.

Objective: To investigate the clinical and histological features, diagnosis and differential diagnosis of myofibroma/myofibromatosis. Methods: The clinical data and pathology features of nine cases of myofibroma/myofibromatosis were collected from August 2011 to November 2016 in Affiliated Drum Tower Hospital, Nanjing University Medical School and Children′s Hospital of Nanjing Medical University. Immunohistochemistry(IHC), PDGFRB molecular analysis and ETV6-NTRK3 gene fusion were performed and relevant literature reviewed. Results: There were 7 males and 2 females, with age ranging from 3 days to 18 years (mean 5 years). The tumors were located in head and neck (eight cases) and trunk (one case). Clinically, the tumors presented as freely movable nodules. Microscopically, they appeared biphasic with alternating light- and dark-staining areas. The light-staining area consisted mainly of plump myoid spindle cells with eosinophilic cytoplasm arranged in nodules, short fascicles, or whorls.The dark-staining area was composed of round or polygonal cells with slightly hyperchromatic nuclei or small spindle cells arranged around a distinct hemangiopericytoma-like vascular pattern. IHC showed the tumor cells in the light-staining area were strongly positive for vimentin and SMA, while cells in dark-staining area were strongly positive for vimentin, and weakly for SMA. Tumor cells were negative for desmin, S-100 protein, h-Caldesmon, CD34 and STAT6. Analysis of PDGFRB mutations was performed in seven cases. Two cases showed 12 exon point mutation c. 1681 c>T(p.R561C), one case showed 14 exon point mutation c. 1998C>G (p.N666K). ETV6-NTRK3 gene fusion was not detected by fluorescence in situ hybridization in four patients under three years old. All cases were followed for 6 to 68 months, with two recurrences. Conclusions Myofibroma/myofibromatosis is an uncommon benign myofibroblastic tumor of infancy and childhood. The tumor can appear biphasic, and may show PDGFRB point mutation which is of potential diagnostic value.