In 2015 , policy reforms on centralized drug purchasing system have been released one by one , and the quality of medicines has been highly valued .Centralized drug purchasing system distinguishes different qualities of drugs mainly through bidding grouping , in order to achieve “uality priority”.However , there are yet some existing problems in group bidding policy at present , such as lack of a unified hierarchy , no scientific indicators and so on , which inevitably weaken the leading role of centralized purchasing policy over the quality of medicines .This paper , focuses on the study of group bidding , and the existing main problems are found through the statistical analysis of rel-evant policies introduced in different provinces .Finally, it explores some optimization strategies for “Group Bidding”which is of paramount importance .

OBJECTIVE We designed the overall layout,formulated the functional demand,and optimized the key design and operating parameters of a new-style asepsis clean ward.The new-style ward intends to provide a higher quality environment for patient infection control and all-around protection during treatment.METHODS We applied computational fluid dynamics(CFD)simulation to optimize the design scheme according to Chinese and international hospital design specifications.RESULTS The new-style asepsis ward reflected a new idea,new technology,high standards and created a comfortable and safe,high-quality environment for the treatment of patient.The Satisfaction of patients was more than 95% and workload of nurses was alleviated obviously.CONCLUSIONS The new-style asepsis ward can significantly control the endogenous infection of patients.

OBJECTIVE To compare the computational fluid dynamics(CFD) simulated results and field test data of the new-style asepsis ward.METHODS We used various equipments to test the asepsis ward and CFD software to simulate airflow of asepsis ward.RESULTS After calculating and comparing,we found the CFD simulation results agreed well with the tested data.Key design and operating parameters were up to the standard.The new-style of asepsis ward could improve the air quality and provide a comfortable environment for patient treatment and it was of great help to decrease the infection rate of patient.CONCLUSIONS The new-style asepsis ward can significantly control the endogenous infection of patients.

Objective To assess the result of aortic valve replacement(AVR) for patients of severe aortic stenosis(AS)with low transvalvular gradients(TVG) and severe left ventricular dysfunction,and try to identify the determinants of survival,functional status and change in left ventricular ejection fraction(LNEF) during follow-up.Methods From 2005 to 2011,35patients with aortic valve area(AVA) ＜ 1 cm2,LN EF ＜ 0.40 and mean TVG ＜ 30 mm Hg underwent AVR in our hospital.The average age of the patients was 58 yeats old,and 88.6％ of the patients were in New York Heart Association (NYHA) functional class Ⅲ/IV at admission to the hospital.The AVA was (0.70 ± 0.09) cm2,LVEF was 0.276 ± 0.020,TVG was (26.0 ± 2.3) mm Hg,and left ventricular end-diastolic diameter (LNEDD) was (6.3 ±0.4) cm respectively.35 prosthetic valves were implanted,including 20 mechanical prostheses and 15 biological prostheses with the mean sizs of (23 ± 1) mm.Concomitant procedures included mitral valvularplasty in 5.tricuspid valve repair in 3 and coronary artery bypass grafting in 4.Results The perioperative mortaiity was 8.6％.Follow-up period was 3 to 60 monthes.The survival rates were:1-year 78％,2-year 68％,5-year 60％.LVEF increased significantly to 0.358 ± 0.047 one week postoperatively (P =0.008) and 0.426 ± 0.031 six months later (P ＜ 0.01)).LNEDD decreased to (5.7 ± 0.4) cm one week later(P =0.062) and (5.3 ±0.3)cm 6 months postoperatiwely (P ＜ 0.01).NYHA functional class improved from 88.6％ in class Ⅲ/Ⅳ to 35％ (P ＜0.01).Compared with those who surviwd during follow-up,the patients who died during follow-up were older in the year of operation[(63 ± 10) vs (54 ± 11),P =0.017],their NYHA functional class was higher[(3.9 ±0.2) vs (2.9 ±0.3),P =0.003]and the LVEDD for them in one week postoperatively was larger[(6.0 ± 1.0) cm vs (5.5 ± 0.3) cm,P =0.031].Conclusion The left ventricle contractile reserve seems to play an essential role for surgery in patients of severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction.AVR can be performed for them with acceptable results.

Objective To identify small molecule inhibitors of APC-mutant colon cancer and provide lead compounds for targeted therapy of colon cancer. Methods APC-mutant colon cancer cell lines that stably express 7*Tcf-GFP/SV40-Cherry (7TGC) dual fluorescence reporter system was constructed for small-molecule inhibitor screening. Cell viability, colony formation, EdU incorporation, and xenograft tumor assay were used to evaluate the inhibitory effect of these inhibitors on APC-mutant colon cancer in vitro and in vivo. Western blot and co-immunoprecipitation assays were used to explore the molecular mechanism. Results Four small molecules that inhibited Wnt activity in APC-mutant colon cancer cells were discovered. Shikonin exhibited significant inhibition of cell viability and proliferation while inducing apoptosis of APC-mutant colon cancer cells. Xenograft tumor assay demonstrated that shikonin significantly reduced tumor growth in vivo. Furthermore, Western blot and co-immunoprecipitation assays revealed that shikonin markedly decreased β-catenin levels. Conclusion Shikonin effectively inhibits Wnt activity and suppresses tumor growth in APC-mutant colon cancer.

Neurofeedback (NF) technology based on electroencephalogram (EEG) data or functional magnetic resonance imaging (fMRI) has been widely studied and applied. In contrast, functional near infrared spectroscopy (fNIRS) has become a new technique in NF research in recent years. fNIRS is a neuroimaging technology based on hemodynamics, which has the advantages of low cost, good portability and high spatial resolution, and is more suitable for use in natural environments. At present, there is a lack of comprehensive review on fNIRS-NF technology (fNIRS-NF) in China. In order to provide a reference for the research of fNIRS-NF technology, this paper first describes the principle, key technologies and applications of fNIRS-NF, and focuses on the application of fNIRS-NF. Finally, the future development trend of fNIRS-NF is prospected and summarized. In conclusion, this paper summarizes fNIRS-NF technology and its application, and concludes that fNIRS-NF technology has potential practicability in neurological diseases and related fields. fNIRS can be used as a good method for NF training. This paper is expected to provide reference information for the development of fNIRS-NF technology.
Neurofeedback/methods* ; Spectroscopy, Near-Infrared/methods* ; Brain/diagnostic imaging* ; Magnetic Resonance Imaging ; Technology

OBJECTIVETo summarize the clinical features, pathology and surgical treatment experiences in the patients with aortic paravalvular abscess by infective endocarditis.

METHODSThe study consisted of a retrospective analysis of 29 cases with aortic paravalvular abscess by infective endocarditis underwent surgical treatment between January 2001 and June 2013. Among the 29 patients, 22 were male and 7 were female, and the mean age was (37 ± 16) years (range from 11 to 63 years). The primary cardiac disease was congenital aortic valve malformation in 16 patients. There were 15 patients with a history of severe heart failure. Of 29 cases, 8 abscess cavities, 13 pseudoaneurysms and 6 fistulas were found, and complete aortoventricular discontinuity was present in 5 patients with serious infections. Of them, the abscess was above the annulus in 14 patients and below the annulus in 10 patients, and simultaneously involved the annulus above and below in 5 patients. 19 patients were culture positive either positive preoperative blood cultures or positive cultures of surgical specimens, including 9 patients with Staphylococcus infection. The paravalvular defect was repaired by patch in 19 cases, and by local closure in 10 cases. The valvular annulus was reconstructed simultaneously in 16 patients. Aortic valve replacement was performed in 26 patients, and Bentall procedure in 2 patients, including 23 with prosthetic mechanical valve and 5 with biological valve.

RESULTSOf the total 29 patients, 28 patients were recovered, and 1 patient was died of sepsis. During 3 months to 13 years postoperative follow-up (average 4.5 years), one was died of non-cardiac cause, and no patient had recurrent endocarditis and paravalvular leakage.

CONCLUSIONSAortic paravalvular abscess by infective endocarditis is not uncommon, prone to heart failure. According to the different pathological manifestations, the appropriate surgical approach and strategy can achieve satisfactory outcomes.

Abscess ; surgery ; Adolescent ; Adult ; Aortic Valve ; surgery ; Child ; Endocarditis, Bacterial ; complications ; surgery ; Female ; Heart Defects, Congenital ; complications ; surgery ; Heart Valve Diseases ; complications ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the role of left atrial appendage (LAA) closure for cerebral ischemic stroke prevention following mitral valve replacement.

METHODSRetrospective data on 860 consecutive adult patients undergoing mitral valve replacement between January 2008 and January 2013 were analyzed. There were 414 male and 446 female patients, with a mean age of (53 ± 12) years. The patients were divided into two groups according to whether the left atrial appendage was closed during operation: LAA closure group (n = 521) and non-LAA closure group (n = 339).Early mortality, postoperative cerebral ischemic stroke and the risk factors for cerebral ischemic stroke were assessed. Multivariate analysis was performed using logistic regression analysis.

RESULTSCompared with non-LAA closure group, LAA closure group had higher proportion of female gender, higher percentage of patients with cardiac insufficiency, pulmonary hypertension and left atrial thrombus, higher incidence of mechanical valve implantation and concurrent tricuspid surgery, and larger preoperative diameter of left atrium, but lower proportion of hypertension and patients undergoing coronary artery bypass surgery, and shorter aorta cross clamping time (χ² = 6.807 to 122.576, t = -2.818 and 3.756, all P < 0.05). There were no differences in exploratory thoracotomy for bleeding and in-hospital mortality between the two groups. Postoperative cerebral ischemic stroke occurred in 12 patients (1.4%). The incidence of cerebral ischemic stroke in LAA closure group was significantly lower than in non-LAA closure group (0.6% vs.2.7%, χ² = 6.452, P = 0.011).Logistic regression analysis showed that LAA closure was a significant protective factor for postoperative cerebral ischemic stroke (OR = 0.189, 95% CI: 0.039 to 0.902, P = 0.037) while history of cerebrovascular disease (OR = 4.326, 95% CI:1.074 to 17.418, P = 0.039) and preoperative diameter of left atrium (OR = 1.509, 95% CI: 1.022 to 1.098, P = 0.002) being the independent risk factors for postoperative cerebral ischemic stroke. The subgroup analysis showed that, for atrial fibrillation patients, LAA closure was a strong protective factor (OR = 0.064, 95% CI: 0.006 to 0.705, P = 0.025), but LAA closure was not a significant predictive factor (OR = 1.902, 95% CI: 0.171 to 21.191, P = 0.601) in non-atrial fibrillation patients.

CONCLUSIONConcurrent LAA closure during mitral valve replacement is safe and effective to reduce the early postoperative risk of cerebral ischemic stroke in atrial fibrillation patients.

Adult ; Aged ; Atrial Appendage ; surgery ; Atrial Fibrillation ; Brain Ischemia ; complications ; prevention & control ; Coronary Artery Bypass ; Female ; Heart Valve Prosthesis Implantation ; Hospital Mortality ; Humans ; Incidence ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; surgery ; Nervous System Diseases ; Retrospective Studies ; Risk Factors ; Stroke ; prevention & control ; Thrombosis