ObjectiveTo establish the reference intervals for ALT,AST,GGT and LDH among the Han nationality in Beijing.MethodsThe document C28-P3 issued by CLSI was a guideline about how to define,establish,and verify reference intervals in the clinical laboratory.IFCC had established multicenter enzymes reference intervals based on the guideline.Exclusion criteria were designed for screening candidate reference individual according to the document C28-P3 and the multicenter study's experience.Blood specimens were collected from 315 healthy individuals aged 20 to 60 years old,including 132 males and 183 females.Reference materials were used to ensure the accuracy of the test results of the four liver enzymes.The methods which used to test the four liver enzymes could be traced to the IFCC enzymes reference measure procedure,the reagent of ALT and AST included pyridoxal phosphate.Results There was statistically difference between males and females of the referenceranges forALT, ASTand GGT.Therefore,gender-specific reference intervals were established as ALT:8.2 -50.8 U/L (F),12.7 -71.8 U/L (M) ; AST:15.0 -36.7 U/L ( F),16.6 -51.1 U/L (M) ;GGT:9.0 -37.3 U/L (F),12.0 -50.9 U/L (M).For LDH,the reference interval was 127 -224 U/L,as no significant gender difference was found.ConclusionsThe reference intervals for the four liver enzymes based on the population of the Han nationality in Beijing are established.The upper reference limit for ALT in Beijing Han population is higher than that from other similar studies.

ObjectiveTo investigate the effect of acute normovolemic hemodilution (ANH) on the apoptosis in hippocampal cells induced by global cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy 50-60 day old male SD rats weighing 280-320 g were randomly divided into 3 groups ( n =12 each):group sham operation (group S); group global cerebral I/R (group I/R) and group ANH.Global cerebral I/R was produced by 4-vessel technique described by Pulsinelli et al.in groups I/R and ANH.ANH was carried out at 24 h after cauterization of bilateral vertebral arteries,before occlusion of bilateral carotid arteries.Blood was withdrawn from femoral artery until Hct was reduced to 30％ and equal volume of hydroxyethyl starch 130/0.4 sodium chloride was infused into femoral vein simultaneously.Bilateral carotid arteries were blocked for 5 min at 10 min after ANH.The rats were sacrificed at 24 h of reperfusion and their hippocampi were isolated.Apoptosis was detected by flow cytometry.The expression of Apaf-1 mRNA and caspase-3 mRNA was determined by RT-PCR.Results Global cerebral I/R significantly increased apoptosis index and up-regulated Apaf-1 mRNA and caspase-3 mRNA expression in group I/R as compared with group S.ANH significantly attenuated apoptosis and down-regulated Apaf-1 mRNA and caspase-3 mRNA expression in group ANH compared with group I/R.ConclusionANH can reduce hippocampal cell apoptosis induced by cerebral I/R through down-regulation of Apaf-1 and caspase-3 expression in hippocampus.

Objective:Combined with the development and application of the hospital's current scientific research fund management information system, this paper explores how to further improve the informatization of scientific research fund management.Methods:Through the analysis of the service condition of four information systems, this paper identifies and illustrates problems existed in the process of informatization of scientific research funds.Results:There are some problems in the information system of scientific research funds, such as the failure to realize the " full life cycle" informatization of scientific research funds management, the uneven quality of information system, and lack of top-level design of management team. Route-cause analysis is conducted.Conclusions:It is suggested that the top-level design of information management at the national level, the reform of internal control system in hospitals, the cultivation of inter-disciplinary talent, and the increase of publicity should be taken to improve the informatization management of scientific research funds and improve the efficiency of funds utilization.

Objective:Objectives The aim of the study is to evaluate the mechanical performance, safety and efficacy of the novel robotic-assistant flexible ureteroscopy system (Ra-fURS) under in vitro and in vivo environments.Methods:Combing with commercial flexible ureteroscopes, the novel Ra-fURS was used for the in vitro test and animal model operation in October 2020. The study included three sections. ①Basic mechanical performance assessment: including endoscope motion control (dual deflection, axial rotation and forward/backward distance), reaction time and fiber regulation. ②Simulated surgery in ex-vivo 3D-printing renal collecting system model: including completion rate and time of calyxes exploration, directional movement and laser fragmentation [gypsum models (0.5×0.5×0.5 cm) were used to stimulate kidney stones]. ③Intrarenal surgeries in animal models (two 5-month female Yorkshire white pigs). In total, 32 surgeries was performed (8 surgeons × 2 pigs × 2 kidneys/pig). In vivo assessments were carried out including: ①consuming time for Ra-fURS installation and offloading; ②completion rate and time of calyxes exploration; ③comfort score (ranging from 0-10) as compared to the manual f-URS, which was corresponding to each Ra-fURS surgery. In simulated surgery and animal surgery sections, 8 surgeons were enrolled in the study (group A 4 without flexible ureteroscopy experience; group B: 4 highly experienced), and results were compared between two groups.Results:Under the Ra-fURS control, the flexible ureteroscope movement in three degrees of freedom (forward / backward: + 11 to -11 cm, axial rotation + 225°to -225°; active duel-flection: + 270°to -270°, as well as the laser fiber regulation + 2.5 to -2.5 cm). In simulated surgery tests, both groups achieved 100% completion rate of calyxes exploration, and there were no statistical differences in the time of the calyxes exploration between group A and group B (116.0±8.0)s vs.(110.3±15.4)s( P>0.05). Time-consumption for laser fragmentation of group B was shorter than that of group A (525.8±58.5)s vs. (780.5±141.2)s( P<0.01). In animal surgery, the installation time of Ra-fURS gradually shortened within the first 7 cases was(234.0±43.0)s, and became comparable in the later 8-32 cases was(149.3±8.0)s. The average uninstall time was (43.9 ±5.9)s and was relatively stable. There were 51 renal calyxes in two pigs. It was higher for the completion rate of calyxes exploration in group B than in group A [(95.5±9.1)% vs. (59.1±9.1)%, P<0.05], and the exploration time was also statistically variant between the two groups group A and group B[(274.8±34.6)s vs.(127.3±18.2)s, P<0.05]. For all the operators, the comfort scores were favorable to the Ra-fURS as compared to the manual f-URS (8.9±0.3 vs. 5.9±1.1, P<0.05). Conclusions:This preliminary study demonstrated that the novel Ra-fURS was capable of controlling flexible ureteroscope to perform retrograde intrarenal surgery and fragmenting stones with laser. Besides, other features, including easy installation, stable performance and comfortable manipulating environment, made it easy to use in clinical application.

Objective To evaluate the prognostic value of prognostic nutritional index (PNI) in gastric cancer patients with peritoneal metastasis.Methods 287 gastric cancer patients with peritoneal metastasis were enrolled from Jan 2010 to Dec 2016.Results Compared with PNI ＞ 45,patients in PNI≤45 group were elder [(59 ± 11) vs.(54 ± 11),t =3.734,P =0.000],lower albumin [(35 ± 4) g/L vs.(42 ± 4)g/L,t =15.988,P =0.003)],lower plasm hemoglobin concentration [(110 ± 22)g/L vs.(129 ±24) g/L,t =6.245,P =0.000),higher platelet count/lymphocyte count ratio [PLR,(210 ± 89) vs.(150 ± 66),t =6.547,P =0.000],higher neutrophil count/lymphocyte count ratio [NLR,(3.7 ± 2.9)vs.(2.4 ± 1.2),t =4.628,P =0.000],lower percentage of pallative gastrectomy (45.5％ to 58.5％,x2 =4.45,P =0.035).Logistic regression analysis showed that age ＞ 58-years,NLR ＞ 2.87,PLR ＞ 170,hemoglobin ≤ 130 g/L,local organ infiltration were risk factors leading to low-PNI (all P ＜ 0.05).The median survival time for all patients was 8.7 months.Univariate analysis revealed that,PNI ＞ 45,serum albumin ＞ 40 g/L,no ascites,lower-grade of peritoneal metastasis,pallative gastrectomy,postoperation chemotherapy were positively associated with better prognosis (all P ＜ 0.05).Multivariate analysis demonstarted that,PNI (HR =0.717,P =0.039).Grade of peritoneal metastasis (HR =1.206,P =0.044),pallative gastrectomy (HR =1.529,P =0.001) were independent prognostic risk factors for the patients with peritoneal metastasis.Conclusion PNI are both predictors of nutrition assessment and of prognosis for gastric cancer patients with peritoneal metastasis.

Objective:By demonstrating the performance, experience and practical value of the original " science and technology evaluation" of Fuwai Hospital, it is expected to build the brand of " Fuwai innovative service for science and technology evaluation" and provide a wider social service.Methods:The four-in-one " science and technology evaluation and service system" , which is composed of " standardized local data-base" , " Fuwai Spider Net Map and Spider Track Map evaluation method" , " hierarchy three-level index system" , and " intellectual science and technology evaluation and service system" , is established for efficient evaluation of science and technology.Results:The " science and technology evaluation and service system" has run with benefit in Fuwai Hospital for years.With the multi-factor evaluating feature, it solves the drawbacks of traditional evaluating system, thus improving accuracy of evaluation and helping implementation of national policies.If the system is extended to other hospitals, it would advocate the feature and strength of Fuwai science and technology evaluation system as well as provide pluralistic reference and advice for decision-making departments.Conclusions:Science and technology evaluation is such a systemic work, with all issues of different levels along the whole evaluating process to be considered.Drawbacks exist in the traditional method which depends on a single final score.By the practice of Fuwai Hospital, the innovative " four in one" evaluation system has been validated to be more scientific.

Objective To study the effect of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differential diagnosis of hydronephrosis and pyonephrosis.Methods From March 2015 to October 2017,50 patients with renal stone and highly suspected infectious hydronephrosis underwent renal DW-MRI,and clinical materials were collected and analyzed retrospectively.Seventeen male and 33 female patients were enrolled with a mean age of (49.40 ±-10.51) years.The median maximum diameter of renal stone was 30.30 (17.38,56.01) mm and hydronephrosis was 46.39 (34.33,56.55) mm.No pyonephrosis was diagnosed by preoperative ultrasound or CT,while 29 cases of hydronephrosis and 21 cases of pyonephrosis were reported by preoperative DW-MRI.Final diagnoses of hydronephrosis and pyonephrosis were made according to whether the pelvic urine drainage was purulent or not during the surgery.DW-MRI reports and characteristics of DW images were analyzed retrospectively.Apparent diffusion coefficient (ADC) was calculated and ADC map constructed,which was compared between the two groups.Receiver operating characteristic curve (ROC) was drawn to analyze the area under curve (AUC) and the optimal cutoff of ADC value,with sensitivity and specificity.Results Thirty-three patients of hydronephrosis and 17 pyonephrosis were confirmed intraoperatively.The overall accuracy of diagnosis using DW-MRI was 84.00％ (42/50),with sensitivity of 88.24％ (15/17) and specificity of 81.82％ (27/33).Among 30 patients who underwent CT scan in our hospital,mean CT value of 18 hydronephrosis was (7.03 ± 3.26)HU and that of 12 pyonephrosis was (8.67 ± 3.52) HU,with no statistical significance (P ＞ 0.05).On DW image,when b ≥ 500 s/mm2,hydronephrosis signal intensity was lowered apparently,whereas pyonephrosis signal intensity was intensified.On ADC map,hydronephrosis appeared as hyperintensity,whereas pyonephrosis appeared as hypointensity.The mean ADC value of pyonephrosis group was lower than hydronephrosis group [(1.53 ±0.58) × 10-3 mm2/s vs.(2.86 ±0.56) × 10-3 mm2/s,p ＜0.01].ROC analysis revealed that AUC =0.92 (95％ CI 0.80-0.98),and the cut-off value of ADC for pyonephrosis diagnosis was 1.39 × 10-3 mm2/s,of which the sensitivity and specificity was 94.12％ and 84.85％ respectively.Conclusions Signal of pyonephrosis was enhanced on DW image,while decreased on ADC image.The ADC value of pyonephrosis was much lower than that of hydronephrosis,with which the differential diagnosis between pyonephrosis and hydronephrosis could be made efficiently.

Objective: To summarize the initial experience of flexible ureteroscopy combined with thulium laser for the treatment of high-risk upper urinary tract urothelial carcinoma (UTUC) in patients with solitary kidney or renal insufficiency. Methods: A retrospective analysis was performed in 5 cases of UTUC with solitary kidney or renal insufficiency treated via flexible ureteroscopy combined with thulium laser from May 2016 to November 2018. Patients consisted of 4 cases of left side tumor, 1 case of right side tumor, with median age of 73 years old(ranging 53-87 years old). Among the 5 cases, 3 were solitary kidney with renal pelvis tumors, 2 cases were renal insufficiency accompanied with proximal ureter or renal pelvis tumor. All the patients had tumors large than 2 cm in diameter. The creatine in 3 cases with solitary kidney was 102, 128, 143μmol/L, respectively. The creatine in 2 cases with renal insufficiency was 281, 179μmol/L, respectively. Variable hydronephrosis was noticed in all paients. The cytological examination could reveal tumor cells in all cases. During the operation, part of tumor tissues were resected for pathological examination and the remaining visible tumor tissue was all ablated and vaporized. As there was no obvious residual tumor tissue, double J stent was retained. Patients were regularly reexamined after surgery. Results: Of the 5 cases, 4 patients were successfully performed, while intraoperative bleeding occurred in 1 case. The operation was suspended after indwelling double J stent. Then, the renal artery interventional embolism was performed after ineffective conservative treatment, and the bleeding was well controlled. One month later, the patient was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again. The pathology of all cases was high-grade invasive urinary epithelial carcinoma. Patients were followed up with regular imaging and endoscopic examination. The median follow-up period was 19 (4-26) months, during which 4 cases had local recurrence, one patient died of non-tumor factors. No recurrence of urothelial carcinoma occurred in the bladder during follow-up, the overall recurrence rate was 80%, and the median recurrence time was 6 (1-24) months. Patients with recurrence was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again. Conclusions Flexible ureteroscopy combined with thulium laser is an alternative treatment for high-risk upper urinary tract urothelial carcinoma in patients with solitary kidney or renal insufficiency, while with high tumor recurrence rate. Therefore, a stringent imaging and endoscopic follow-up should carry out postoperatively.

Objective:To compare the ability of platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in evaluating the prognosis of patients with TNM stageⅠto Ⅲ gastric cancer.Methods:From May 2001 to December 2013, the clinicopathological data of 645 patients with gastric cancer treated at Harbin Medical University Cancer Hospital were retrospectively analyzed. Chi-square test was used to analyze the differences between NLR, and PLR and clinicopathological characteristics of patients. Kaplan-Meier method and log-rank test were performed to compare the overall survival of patients. Cox proportional hazards regression model was performed to analyze the prognosis of gastric cancer patients. The ability of NLR and PLR to evaluate the prognosis of gastric cancer was compared by receiver operating characteristic curve.Results:The cutoff values of PLR and NLR were 141.50 and 1.94, respectively. PLR was associated with gender, resection method, maximum diameter of tumor, whether chemotherapy, T-stage, N-stage, TNM stage, tumor location, white blood cell, hemoglobin, albumin, and whether total gastrectomy ( χ2=9.224, 10.577, 28.825, 6.831, 29.059, 28.637, 30.748, 18.023, 24.320, 77.274, 9.021 and 10.745, all P<0.05). NLR were associated with resection method, maximum diameter of tumor, T-stage, N-stage and TNM stage, white blood cell, hemoglobin and albumin ( χ2=14.563, 12.092, 22.697, 44.735, 34.151, 7.949, 9.611 and 7.498, all P<0.05). The results of multivariate analysis showed that resection method, whether chemotherapy, T-stage, N-stage, PLR and whether total gastrectomy were all independent risk factors for gastric cancer patients ( χ2=23.653, 22.023, 16.697, 24.038, 4.110 and 22.364, all P<0.05). The five-year cumulative survival rate of the patients with PLR<141.50 was higher than that of patients with PLR≥141.50 (55.4% vs. 30.5%), and the difference was statistically significant ( χ2=47.968, P<0.01). The AUC value of PLR in prognostic evaluation of gastric cancer was 0.629, which was higher than that of NLR (0.596, P<0.01). Conclusion:PLR is better than NLR in the prognostic evaluation of gastric cancer patients.

At present, the routine specialized training for primary pediatricians (focusing on theoretical learning of public subjects) cannot meet the needs of primary pediatricians. In order to promote the development of children's medical care at the grassroots level and improve the quality, medical and clinical research abilities of regional pediatric medical personnel, the Children's Hospital of Chongqing Medical University has designed and built a "hierarchical training model for improving the professional ability of pediatricians" from the aspects of training objectives, training contents, training methods, construction and evaluation of training programs, and quality control. In addition, the 8-month "Pediatric Professional Basic Training" and the 9-month "Pediatric Professional Ability Improvement Training" were respectively carried out in Xianyang Children's Hospital. In the "Professional Basic Training", 88 trainees were comprehensively evaluated after training, 53 of whom were qualified or above. In the "Ability Improvement Training", 26 of the 29 students actually participated in the evaluation and reached the qualified level or above. Learners provided feedbacks that they have effectively improved their own knowledge structure, expanded their clinical diagnosis and treatment thinking and clinical research ideas, and provided some guidance for clinical work.