OBJECTIVE:To provide reference of Clinical Research Coordinator(CRC)industry development in China. METH-ODS:By using the method of literature research combining with field survey research,the development status,training certifica-tion and working mode of CRC industry in Japan were summarized,and suggestions on the development of the CRC industry in China were proposed. RESULTS:Japanese CRC industry gradually matured,and staff tended to be stable,the standardized train-ing and certification system have been established,the services include the support on medical institutions,clinical trials,clinical researches and other multiple aspects. CRC industry in China should perfect the company system construction,carry out standard-ized training and certification examination, strengthen the hospitals' direct management of CRC, and expand the CRC services in clinical research. CONCLUSIONS:The experience of CRC industry development in Japan,including system construction,stan-dardized training and working mode,is a good example for China CRC industry to learn.

Echocardiography, Three-Dimensional ; methods ; trends

BACKGROUND: Selective posterior rhizotomy has been extensively acknowledged as an effective method of relieving lower limb spasticity in cerebral palsy. However, the postoperative complications such as reduced muscle strength and imbalance of the spine are of concern among surgeons and therapists. The combination of limited selective posterior rhizotomy (LSPR) with adductor tenotomy can decrease these complications without compromising the treatment effects.OBJECTIVE: To investigate the effects of combination therapy of LSPR with adductor tenotomy on lower limb spasticity, gait and movement of the patients.DESIGN: A self-controlled trial and observational follow-up taking children with cerebral palsy as the subjects.SETTING: Orthopedic Department of First Hospital Affiliated to Dalian Medical University.PARTICIPANTS: Thirty children patients with cerebral palsy treated in the Orthopedics Department of the First Affiliated Hospital of Jilin University from January 2001 to December 2002 were recruited in this trial. They presented scissors gait, flexed knee and tiptoeing of different degree. There were 18 cases of brisk tendon reflex and ankle clonus, and 15 cases of positive Babinski' s sign. All the patients had no immobile soft tissue contracture and could either accomplish walking and crouching independently or walk with arms on assistant devices.INTERVENTIONS: The patients received LSPR of L5 and S1 dorsal roots together with bilateral adductor tenotomy. Muscle tone and strength, knee and Achilles tendon reflexes, ankle clonus and pathologic signs were recorded before and after operation. X-ray examination on lumbar spine and pelvic was also taken for detection of deformity. The patients' movements were assessed according to their standing and walking postures, standing and crouching movements before operation and on follow-up. During follow-up all the mentioned indices were recorded by reference to the original case history, hospital reexamination and correspondence with the patients.MAIN OUTCOME MEASURES: The amelioration in lower limb spasticity and grading of lower limb()movements.RESULTS: During the follow-up for six months to three years(the mean of 11 months), the patients' lower limb spasticity was decreased by 2. 5 grades. The gait was also improved with disappeared scissors gait and tiptoeing, knee flexion was improved and the patients could walk with heels on the ground. All ankle clonus and pathologic reflexes disappeared. The brisk knee reflex in 12 patients became sluggish after operation. There was no decrease in lower limb strength or permanent hypesthesia. X-ray examination of lumbar spine and pelvic showed no deformity in 9 patients after over 2-year follow-up. The upper limb spasticity, salivation and aphasia in 8 patients were also ameliorated. The grading for postoperative standing, walking and crouching-standing alternation[(4.25±0.91), (3.92±0.65) and(4.02±0.74)] wasimproved(t=2.04-2.98, P ＜0.05-0.01).CONCLUSION: The combination of LSPR with adductor tenotomy can effectively ameliorate lower limb spasticity and movement with decreased operative damage.

Objective To explore the reparative effect of bactericidal/permeability-increasing protein(BPI) on the damaged mucosa of rats with otitis media with effusion (OME),and state the pathogenesis of OME.Methods Wistar rats(40 ears) were randomly divided into six groups:normal control group (n=4),BPI control group(n=4),eustachian tube obstruction (ETO) group (n=8),lipopolysaccharide (LPS) injection group (n=8),ETO+LPS group (n=8),ETO+LPS+BPI group (n=8).The experimental OME model was made through eustachian tube obstruction and LPS injection.The rats were killed after 1,2 and 4 weeks and the changes of mucosa of middle ear were observed under light and scanning electron microscope.Results The rats in normal control group and BPI control group had the normal mucosa in the tympanic orifice of the eustachian tube.It consisted of pseudostratified ciliated cubical or columnar epithelium which contained an abundant number of ciliated cells and a few goblet cells,these were the mucociliary clearance system of the middle ear.The hypotympanum consisted of thin,squamous epithelium with few microvillus.Middle ear mucosa was obviouly thickened in LPS injection,ETO and ETO+LPS groups.An increase in goblet cells and a decrease in ciliated cells were observed in the tympanic orifice of the eustachian tube.The epithelial layer in the hypotympanum had become more pseudostratified ciliated cubical epithelium.In ETO+LPS+BPI group,there was thin squamous epithelium in the hypotympanum near normal,which was not thickened and contained few microvillus. Conclusion LPS and ETO can result in the occurrence and protracted courses of OME by mimosa's inflammatory reaction which can reduce the activity of ciliary cells and weaken the function of mucociliary clearance system.BPI could bind avidly to LPS,reduce inflammatory reaction,and break the inflammatory cycle and reestablish an effective mucocillary clearance system.The results suggest that BPI treatment is a potential effective drug for prevention and therapy of chronic OME.

Objective To investigate the effect of propofol and fentanyl on inflammatory response to tissue injury in children undergoing open heart surgery with CPB and the possible mechanism. Methods Twenty HYHA class Ⅱ - Ⅲ children with congenital heart disease, aged 10 month-12yr, undergoing elective open heart surgery were randomly divided into two groups: group F in which anesthesia was maintained with high dose fentanyl (50-80?g? kg-1 ) and group FP in which anesthesia was maintained with propofol infusion (20mg?kg-1?h-1 ) and intermittent iv boluses of fentanyl (

Henoch-Scholein purpura(HSP)is a common systemic vasculitis of the small vessel in children,with a variety of clinical manifestations.The main diagnostic criteria include palpable skin purpura.Patients who have gastrointestinal tract as the main symptoms suffer clinically abdominal pain and gastrointestinal bleeding,they are easily misdiagnosed before skin purpura,the rate of misdiagnosis can be as high as 87.5%,and the main treatment is early application-oriented glucocorticoids.This review include etiopathogenisis,pathogenesis,pathology,clinical manifestations,auxiliary examination and treatment about gastrointestinal manifestations in HSP.

AIM:To disscus the clinical effect of the silicone tube implantation under the guidance of memory wire in the treatment of lacrimal canaliculus.
METHODS:One hundred and fifteen cases (115 eyes ) of traumatic canalicular laceration were treated by canaliculoplasty from September 2012 to June 2014. Finding the end of lacrimal canaliculus under microscope, guided by memory wire which was probed in lacrimal passage to the nasal cavity, intubating double-passage silicone tube as a support and end-to-end anastomosis. The condition of epiphora and irrigation of lacrimal passage were observed after extubation.
RESULTS: All 115 cases were experienced successful operation. All patients were followed up for 6mo ~ 1a (mean 9. 3mo) after extubation. Lacrimal passage was unobstructed in 96 cases 96 eyes(83. 5%), stricture in 13 cases 13 eyes (11. 3%), and blocked in 6 cases 6 eyes (5. 2%).
CONCLUSION:Double-passage silicone tube guided by memory wire may be an optional technique in the treatment of traumatic lacrimal duct laceration, which is a feasible, minimally - invasive, safe and effective method.

Objective To study the differentiation of bone marrow mesenchymal stem cells in artery tissue under different calcification environments.Methods We made a vascular calcification model using warfarin,vitamin K1 and vitamin D3.After the model was successfully made,we took artery tissue of normal SD rat arteries and calcified arteries co-cultured with MSC,which were divided into three groups.The normal group included normal artery tissue with MSC; calcified inducers group included calcified inducers (dexamethasone with β-glycerophosphate and ascorbic acid),normal arterial tissue and MSC; calcification group included calcified artery tissue and MSC.Each group was cultured for 3 weeks.On the 10th day of the experiment,osteoprotegerin (OPG) protein secretion was detected by ELISA.After three weeks,changes of cell morphology were observed using inverted microscope,and total protein content and alkaline phosphatase (ALP) activity were detected by ELISA.In additional,the Ror2 (receptor tyrosine kinase-like orphan receptor 2) mRNA expression was detected by using RT-PCR method.Results MSC in calcification group spontaneously proliferated and differentiated to osteoblast-like cells.Compared with normal group,calcification group showed that the total protein content,ALP activity of bone metabolism markers,OPG were significantly elevated,while Ror2 mRNA expression was significantly decreased.MSCs in calcified inducers group did not differentiate to osteoblast-like cells,and the total protein content and OPG were increased,while ALP activity had no significant difference as compared with the normal group.However,Ror2 mRNA expression was lower in calcified inducers group than in normal group,while was higher than that in calcification group.Conclusions MSCs proliferate into bone-like differentiation in vascular calcification environment and aggravate the vascular calcification.And in normal vascular with calcified inducers environment,MSCs proliferate into smooth muscle cell differentiation and rehabilitate the vascular calcification.These phenomenons may be related to the Ror2 expression in artery.

Abdominal Pain ; etiology ; Child ; Female ; Humans ; Ovarian Cysts ; complications ; Torsion Abnormality

Objective To assess the clinical efficacy of vitrectomy with intravitreal ranibizumab (IVR) at different injection time for proliferative diabeticretinopathy (PDR).Methods This was a prospective,comparative,and randomized study.Ninety-seven eyes of 97 patients were enrolled and randomly assigned to three different treatment groups:30 eyes (30 patients) in the preoperative IVR group,32 eyes (32 patients) in the intraoperative IVR group and 35 eyes (35 patients) in the no IVR injection group.The best corrected visual acuity (BCVA) (F=0.18) and the grading of vitreous hemorrhage (x2 =1.39) before surgery did not differ significantly among the 3 groups,respectively (P ＞ 0.05).All eyes enrolled underwent conventional 23-gauge pars plana vitrectomy (PPV).The preoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection 3 to 7 days before PPV,intraoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection at the end of PPV and non-drug injection group received PPV only.Postoperative BCVA,fundus color photography,optical coherence tomography examination was performed in all eyes at 1 week and 1,3,6,9,12 months after surgery.Early RVH was defined as RVH occurred within 1 week to 1 month postoperatively;while late RVH was defined as RVH occurred 1 month later after the operation.Results The mean BCVA were all improved among the 3 groups compared with the preoperative vision at 1 month after operation.At the beginning of 3 months after surgery,the average BCVA of the preoperative injection group and the intraoperative injection group tended to stable;while 3 eyes in the non-drug injection group began to decreased.There was no significant difference in average BCVA at 1,3 and 12 months of follow-up periods among the 3 groups (F=1.42,1.17,0.26;P＞0.05).The incidences of early RVH were 16.7％,9.4％,28.6％ in the preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =5.12,P＜0.05).The incidence of early RVH in the intraoperative injection group reduced compared to preoperative injection group and non-drug injection group (x2 =4.04,4.93;P＜0.05).The incidences of late RVH were 13.3％,9.4％,14.3％ in preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =0.47,P＞0.05).The average centeral foveal thickness (CFT) decreased among the 3 groups in different degrees at 1 month when compared with that of 1 week after operation and the decreasing was statistically significant (F=59.50,P＜0.05).A subgroup pairwise analysis showed no significant difference of decreasing CFT in preoperative injection group compared with that of intraoperative injection group (t=0.23,P＞0.05).The average CFT of the 3 groups had different degrees of thickening at 3,6,9,12 months after surgery,and the increasingof CFT among the 3 groups were not differ significantly (F=2.92,2.86,3.07,3.12;P＞0.05).Conclusions The adjunctive use of IVR can reduce the incidence of early postoperative RVH in vitrectomy for PDR,decrease in macular thickness and obtain favorable visual recovery.The effect of preoperative IVR injection was slightly better than that of the intraoperative IVR injection.