SWOT-PEST model was used to analyze the internal advantages and disadvantages,external,opportunities and challenges of tertiary public pediatric hospitals.Based on stakeholder theory,through the literature review method,policy analysis method,combined with the actual work,and summarize its main role and demands.Put forward the development strategy of three-level public pediatric specialty hospital.Through the analysis of interest demands of stakeholders of tertiary public pediat-ric specialty hospitals,the overall development is good at present,but there are still problems that need to be solved urgently.From the perspective of internal and external stakeholders,the optimization strategy involving multiple levels,multiple angles and multiple subjects is proposed to promote the comprehensive development of tertiary public pediatric specialty hospitals.

Objective To develop a method for the determination of ketamine analogues in hair samples by liquid chromatography quadrupole linear ion trap mass spectrometry(QTRAP LC-MS/MS).Methods 20 mg of washed and dried hair was added to 1 mL extracting solution and then prepared using an ultrasonic extraction with frozen pulverization method.After centrifugation and purification with membrane,the supernatant was separated in a ACQUITY UPLC? HSS T3 column with gradient elution,finally tested with multiple reaction monitoring for the detection of 10 ketamine analogues.The above method was applied for quantitative analysis of ethylfluamine,F-norketamine and tiletamine in 20 positive samples.Results When the concentration ranged from 0.01 to 2.00 ng/mg,there was good linearity for 10 ketamine analogues with the correlation coefficients over 0.99.The recoveries ranged from 89.1％to 106.1％,and the matrix effects were between 88.3％and 106.0％.Among the 20 positive samples,the contents of ethylfluamine,F-norketamine and tiletamine in hair ranged between 0.02～8.35 ng/mg,0.01～0.94 ng/mg and 0.02～10.93 ng/mg,respectively.Their mean values were 1.59 ng/mg,0.28 ng/mg and 2.69 ng/mg.Their medians were 0.40 ng/mg,0.19 ng/mg and 2.11 ng/mg.Conclusion The established method was simple,efficient,reliable and suitable for the determination of ketamine analogues in hair.The data provided reference for the drug control and forensic science practice.

Objective To investigate the clinical effect of digital subtraction angiography(DSA)-guided foam sclerotherapy on lower limb varicose veins.Methods The relevant data of patients with lower limb varicose veins treated by DSA-guided foam sclerotherapy were analyzed retrospectively.At the same time,the safety and efficacy were compared before and after operation according to clinical etiology anatomy pathophysiology(CEAP)and clinical symptoms.Results Among the 278 affected limbs treated,2(0.72％)had neurological complications during treatment,8(2.88％)had chest tightness or cough during treatment,7(2.52％)had thrombophlebitis after treatment,and 28(10.07％)had hyperpigmentation after treatment.No serious complications such as skin necrosis,deep vein thrombosis(DVT)or pulmonary embolism(PE)occurred.There were 48 cases of grade C1 and 201 cases of grade C2 before treat-ment,while 244 cases of grade C0 and 26 cases of grade C1 after treatment,and the differences were statistically significant(P＜0.05).Conclusion DSA-guided foam sclerotherapy on lower limb varicose veins is a safe and effective minimally invasive treatment with high technical success rate.

Objective To investigate the VATS lobectomy and lymph node dissection impact on lung function and the survival rate in patients with different pathological types of lung cancer.Methods One hundred and twenty five cases of lung cancer patients underwent laparoscopic lobectomy and mediastinal lymph node dis-section as research subjects from June 2009 to September 2011 in our hospital.The patients were divided into pa-thology group( AG) ,squamous cell carcinoma( SG) and large cell carcinoma group( LG) according to the type of cancer.The clinical effects were observed before and after surgery,lung function and survival rate.Results LG Group in operative time,blood loss and postoperative chest tube drainage were higher than SG group AG group( P<0.05);AG group blood loss,postoperative chest tube drainage,blood transfusion after surgery and postoperative recovery times were higher than the SG group(P<0.05);LG group was higher than AG group(P<0.05)in terms of FVC%;LG Group,AG group in FVC%,FEF50%,FEF75%respects SG group were significantly differ-ent(P<0.05);18-month survival rate of patients in each group after the first follow up results of less than 12 months(P<0.05).SG group at 12,18-month survival rates were higher than AG group and LG group(P<0.05).Conclusion Laparoscopic lobectomy combined treatment of pathological lymph node dissection in pa-tients with different types of lung cancer,large cell carcinoma surgery operative time,blood loss and postoperative chest tube drainaged are higher than adenocarcinoma,squamous cell carcinoma;squamous cell survival and physi-cal evaluation of patients are higher than the other groups.

OBJECTIVE To investigate the protective effect of total alkaloids of Rhizoma Corydalis (TARC) on experimental gastric mucosal lesions in rats. METHODS Gastric mucosal lesions were induced in rats by injecting acetic acid under gastric mucosal. From the 2nd day post the preparation of the rat model, cimetidine 400 mg · kg-1 or TARC 20, 40 and 80 mg · kg-1 was ig delivered for 15 d in different groups. Two days after the last delivery, gastric juice volume and total acidity were measured. Histopathology of stomach tissues was observed by HE staining. The area of gastric ulcer area was measured and the ulcer index and ulcer inhibitory rate were calculated. The expression of epidermal growth factor (EGF) and EGF receptor (EGFR) was detected by immunohistochemical staining. RESULTS Comparing with shame group, the eare of gastric ulcer and ulcer index were increased signifi?cantly in the model group(P<0.01), suggesting that the model rats were prepared properly. Compared with the model group, the ulcer area in rats of cimetidine and TARC 80 mg·kg-1 groups was decreased by 39.9%and 23.7%,respectively. The ulcer index was decreased by 52.3%and 30.5%,respectively. There was no significant difference between the cimetidine group and TARC 80 mg · kg-1 group, in the ulcer area or index. Compared with model group, EGF protein expression of cimetidine and TARC 40 and 80 mg · kg-1 groups was increased by 81.8%,24.2%and 57.6%,respectively while EGFR protein expression was increased by 45.9%,16.2%and 29.7%,respectively(P<0.05,P<0.01). Deciduous and necrotic gastric mucosal and a large amount of inflmmatory cells infiltration were observed in model group, and gastric mucosal lesions were improved in cimetidine and TARC 40 and 80 mg · kg-1 groups. CONCLUSION TARC has protective effect on gastric mucosal lesions in rats. The mechanism may be related to the increase of EGF and EGFR protein expression.

Objective To investigate the risk factors for intracranial infection after external ventricular drainage and provide basis for preventing and controlling the drainage-associated intracranial infection. Metheds the clinical data from three hundred sixty-seven cases of ventricular hemorrhage patients were retrospectively analyzed, using Logis?tic regression to screen risk factors of intracranial infection after external ventricular drainage. Results There were 29 cases with intracranial infection and infection rate was 8.19%, 8.04% and 7.32% at ventricle drainage tube indwelling 1-week group, 2-week group and 3 week-group, respectively. Glasgow coma score (GCS) [OR= 2. 569 CI (1.792 3.378) %, P< 0.05), urokinase perfusion (OR= 2.897, 95%CI (1.297 5.061), P< 0.05), cerebrospinal fluid sampling (OR= 3.399, 95%CI (2.705 4.175), P< 0.01] and comorbidities [OR= 3.751, 95%CI (2.032 5.371), P< 0.01] were risk factors for ventricle drainage operation. Conclusion Ventricle drainage tube indwelling 3 weeks is safe. Less use of urokinase perfusion and cerebrospinal fluid sampling and active treatment of comorbidities diseases can reduce the intra?cranial infection incidence of external ventricular drainage after Intraventricular hemorrhage .

Objective To explore the MRI features of patients with multiple system atrophy (MSA) and Parkinson's disease (PD) for providing early evidence in differential diagnosis. Methods The MRI features of 24 patients with MSA, 30 patients with PD and 30 healthy people as controls were retrospectively analyzed. Abnormal intensity in MRI included the hot-cross bun sign and the slitlike changes. The atrophies of brain included cerebellar, middle cerebellar peduncles, medulla oblongata and pon. Cerebral ventricle dilatation included fourth ventricle and cisterna pontis. The midbrain area, pons area and middle cerebellar peduncles width were measured. Results All patients with MSA had at least one of the features observed on MR images, and there were some differences in the subtypes of MSA. The high sensitive features were the atrophies of middle cerebellar peduncles (79.2%), the atrophies of pons (79.2%) and the hot-cross bun sign (75.0%). The parameters with high specificity and high positive predictive value were hot-cross bun sign (both 100%), the slit-like sign (both 100%), the atrophies of middle cerebellar peduncles (93.3% and 90.1%), and the atrophies of pons (96.7% and 95.0%). MSA group had the statistically significantly decreased values of pons area, midbrain area and middle cerebellar peduncles width [(288. 7±75. 4) mm2, (127.8±25.8) mm2 and (10. 7±2.8) mm, respectively], as compared with PD group [(477. 5 ± 54. 3) mm2, (145.9±21.6) mm2 and (16.2±1.3) mm, respectively] and healthy group [(454. 5±36. 8) mm2 , (146.4±17.4) mm2 and (16.7±1.2) mm, respectively] (all P ＜0. 05). Conclusions The routine MRI is helpful in differential diagnosis between MSA and PD and has some values in diagnosing the subtypes of MSA.

OBJECTIVE To investigate the trends of susceptibility of Enterobacter cloacae isolates to antimicrobial agents from Shandong provincial nosocomial infection surveillance system. METHODS The data from Shandong provincial nosocomial infection surveillance system from Aug 2001 to Jul 2004 were summarized and analyzed.(RESULTS) In the period of study from Aug 2002 to Jul 2004,231 strains of E.cloacae were collected.The (sputum),(urine) and wounds were major specimens,and accounted for 55.41%, 10.82% and 9.96% from total(specimens),respectively.The resistant rates of E.cloacae isolates to antimicrobials,except imipenem,increased to some extend.CONCLUSIONS Antimicrobial resistance of clinical isolates of E.cloacae threatens the success of(infectious) disease treatment.It is very important to promote the rational use of antimicrobial agents for control of resistance and to take effective measures for the prevention of infections.

OBJECTIVE To investigate the distribution and bacterial resistance of nosocomial infection.METHODS The data of 45 hospitals from Shandong Provincial Nosocomial Surveillance System from Jan 2003 to Dec 2005 were analyzed.RESULTS Of total 5 626 isolates strains from the nosocomial infection cases,G-bacilli,G+ cocci and fungi accounted for 58.27%,25.84% and 15.89%,respectively.The ampicillin-resistant rate of commonly encountered G-bacilli was above 89%.There were 72.98% of E.coli resistant to ciprofloxacin.The rates of resistance of S.aureus and coagulase negative Staphylococcus to penicillin,ampicillin and erythromycin were all above 80%;the lincomycin-resistant rate of S.aureus increased gradually to 86.64%.CONCLUSIONS Drug resistance of the nosocomial infective bacteria is a serous problem.Surveillance of bacterial resistance should be strengthened.

OBJECTIVE To investigate the relationship of nosocomial infection with use of antimicrobial agents.METHODS A retrospective study of 171 cases admitted from Nov 2004 to Apr 2005 in a general hospital.RESULTS Sixteen thrush cases all were found to have prior use of antimicrobial agents with average time about(12.5?8.10) days.Twenty six out of 57 surgical cases had wound infection,all used antimicrobial agents preoperatively.Inadequate use of antimicrobial agents manifested as prolonged use or over frequent drug change or improper combined use of drugs etc.CONCLUSIONS Protracted use of antimicrobial agents may be related with development of thrush.Rational use of antimicrobial agents is to be emphysized.