The medicine for military use only is an essential material for medical support. The United States of America is one of the earliest countries which has used special medicine to protect the military personnel from injuries and diseases. The current situation of service support in the military of USA is introduced and the challenges facing the development, product, supply and use of the special medicine in USA are analyzed,for reference by our army.

OBJECTIVE:To construct the evaluation index system for the effects of rational drug use policy in the military hos-pital. METHODS:Based on methods like literature analysis,expert consultation,modified Delphi method,analytic hierarchy pro-cess(AHP),the evaluation index system was constructed and the weight of indicators was calculated. The feasibility of the index system was verified by experimental evaluation. Through comparing drug use level between military patients and local insurance for medical care,the effects of rational drug use policy were evaluated in military hospital. RESULTS & CONCLUSIONS:The index system includes 3 first-level indexes as rationality,accessibility,economics,10 second-level indexes and 20 third-level indexes. The results of the experimental evaluation in 176 military hospitals show that the economic indexes scoring rate is lower than the reasonable indexes and the availability indexes,and the difference value are 3.12%and 4.06%;the first-level indexes average scor-ing rate of divisional hospital is higher than that of regimental hospital,and the difference value is 21.6%. The index system solves the problems of false data,incomplete evaluation,inadequate check,improves informatization level of evaluation,and realizes long-term dynamic monitoring and remote evaluation.

Objective To investigate the relationship between expression of mucin1 (MUC1) and tumor invasion in pituitary adenomas.Methods The expression of MUC1 was detected by immunohistochemical analysis in 26 tissues of invasive pituitary adenoma and 29 of non-invasive pituitary adenoma.Results The expression of MUC1 in invasive pituitary adenomas tissues was 76.92 ％ (20/26).It was weakly positive or negative in non-invasive pituitary adenoma tissues,and the positive rate was 27.57 ％ (8/29).There was significant difference in two groups (x2 =13.35,P ＜ 0.01).The expression of MUC1 in functional pituitary adenomas was 44.82 ％ (13/35) and was 75.00 ％ (15/20) in non-functional pituitary adenomas.There were no significant difference in two groups (x2 =6.13,P ＞ 0.01).Conclusions Over-expression and aberrant localization of MUC1 in invasive pituitary adenoma may act as distinguishing diagnostic markers of invasive pituitary adenoma.MUC1 might be as the target of immunotherapy of invasive pituitary adenoma.

Objective To investigate the expression of FRAT1 and β-catenin in human brain glioma,analyze the correlation between the expression and clinical pathological grades and the correlation of the two genes.Methods FRAT1 and β-catenin were detected by immunohistochemistry in 84 human brain glioma tissues and 6 human normal brain tissues.Results 66.7 ％ (56/84) and 77.4 ％ (65/84) of human brain glioma tissues expressed FRAT1 and β-catenin protein,whereas no FRAT1 and β-catenin protein expression was detected in human normal brain tissues.The expression levels of FRAT1 and ββ-catenin increased markedly with the ascending of pathologic grade of tumor specimens (r =0.55,P ＜ 0.01,r =0.70,P ＜ 0.01),there was a positive correlation between FRAT1 and β-catenin (r =0.77,P ＜ 0.01).Conclusion FRAT1 and β-catenin over-expression maybe closely related with occurrence and development of human brain gliomas.The results provide important supplements for the research of Wnt/β-catenin pathway.Meanwhile,FRAT1 may act as a valuable biomarker for molecular diagnosis of glioma and a potential target for gene therapy of glioma.

OBJECTIVETo evaluate the effect of portal hypertension on prognosis in patients with decompensated liver cirrhosis.

METHODSThe clinical data of decompensated cirrhosis patients in our hospital, between 2003 and 2006, were retrospected and followed up. Model for end-stage liver disease (MELD) score and Child-Turcotte-Pugh (CTP) classification was calculated using the standard formula. Kaplan-Meier survival analysis was used to compare the mortality in subgroups ranked by the syndromes. Cox proportional hazards regression was used to evaluate the effect of the syndromes on prognosis.

RESULTSA cohort of 322 patients was admitted in this study at the end of the follow-up. The mortality of variceal bleeding, hepatic encephalopathy, a large volume ascites, spontaneous bacterial peritonitis, the type I and type II hepatorenal syndrome was 45.9%, 79.4%, 66.7%, 100%, 100% and 84.6% respectively. On the whole, the occurrence of all the syndromes was correlated with CTP classification and MELD score. Kaplan-Meier survival analysis showed that all of these syndromes, except for low to medium volume of ascites, significantly affected the survival rate (P<0.01). In Cox regression analysis, all the syndromes were the independent predictors of prognosis, the regression coefficient values of hepatic encephalopathy, spontaneous bacterial peritonitis, type I and type II hepatorenal syndrome, variceal bleeding and ascites were 0.973, 0.928, 0.935, 0.866, 0.464 and 0.369 respectively.

CONCLUSIONSThe portal hypertensive syndromes have significant effect on the prognosis of the patients with decompensated cirrhosis, hepatic encephalopathy is the worst one.

Adult ; Aged ; Esophageal and Gastric Varices ; epidemiology ; etiology ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; epidemiology ; etiology ; Hepatic Encephalopathy ; epidemiology ; etiology ; Hepatorenal Syndrome ; epidemiology ; etiology ; Humans ; Hypertension, Portal ; complications ; epidemiology ; Liver Cirrhosis ; complications ; mortality ; pathology ; Male ; Middle Aged ; Models, Statistical ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Survival Analysis

Objective:To investigate the changes in peripheral blood and liver-infiltrating natural killer-like B (NKB) cells in patients with primary hepatocellular carcinoma (HCC), and to assess the influence of IL-18 on NKB cells in vitro and the underlying mechanism. Methods:Forty-three HCC patients and 21 normal controls (NC) were enrolled in the study. Peripheral blood samples were collected to isolate plasma and peripheral blood mononuclear cells (PBMC). Intrahepatic lymphocytes (IHL) were isolated from tumor tissues and para-tumor tissues obtained from 16 HCC patients who received surgery. IL-12, IL-18 and IL-18 binding protein (IL-18BP) levels in plasma were measured by enzyme linked immunosorbent assay. The percentages of CD3 -NKp46 + CD19 + NKB cells and IL-18 + NKB cells in PBMC and IHL were analyzed by flow cytometry. Changes in the percentages of NKB cells and IL-18 + NKB cells were measured after stimulating PBMC and IHL with recombinant human IL-18 (1 ng/ml and 10 ng/ml). Changes in IL-18BP levels in the culture supernatants and phosphorylated nuclear factor-κB (NF-κB) in NKB cells were also assessed. Student′s t test, one-way analysis of variance or LSD-t test was used for statistical analysis. Results:There was no significant difference in plasma IL-12 level between HCC patients and NC ( P=0.245). Compared with NC, HCC patients had decreased IL-18 level in plasma [(224.3±58.89) pg/ml vs (327.0±52.27) pg/ml, P<0.000 1], but increased IL-18BP level [(4.421±0.97) ng/ml vs (0.92±0.18) ng/ml, P<0.000 1]. The percentages of peripheral blood NKB cells and IL-18 + NKB cells were lower in HCC patients than in NC [(2.68±1.23)% vs (8.88±2.95)% and (54.42±12.60)% vs (69.74±12.65)%, both P<0.000 1]. The percentage of NKB cells in IHL was reduced in tumor tissues as compared with that in para-tumor tissues [(2.89±0.86)% vs (4.66±1.17)%, P<0.000 1]. Moreover, the percentage of IL-18 + NKB cell was also down-regulated in tumor tissues as compared with that in para-tumor tissues [(51.50±13.18)% vs (62.13±9.24)%, P=0.013]. Recombinant human IL-18 stimulation reduced the IL-18BP level in the culture supernatants ( P<0.05). IL-18 stimulation at 1 ng/ml did not affect NKB cell percentage, IL-18 + NKB cell percentage or NF-κB phosphorylation in NKB cells from PBMC or IHL ( P>0.05), while 10 ng/ml of IL-18 not only elevated NKB cell percentage and IL-18+ NKB cell percentage, but also promoted NF-κB phosphorylation in NKB cells ( P<0.01). Conclusions:In vitro stimulation with high concentration of IL-18 might promote NF-κB phosphorylation by inhibition of IL-18BP expression. This process might play a positive feedback role to induce the activation of NKB cells and IL-18 secretion.

OBJECTIVETo report the operative technique and clinical results of the neurocutaneous vascular axial flap with perforating vessels as its pedicle.

METHODSAn axial skin flap was designed along the axis of small paraneural vessels that was close to a concomitant cutaneous nerve. The cutaneous perforating branches of major arteries were used as the pedicle, which provided a rotation arc for the flap to cover the defects in the distal site of extremities. 43 neurocutaneous vascular axial flaps were transferred, including 13 sural neurocutaneous axial flaps (30 cm x 12 cm to 16 cm x 8 cm) supplied by perforating branches of the peroneal vessel; 9 saphenous neurocutaneous axial flaps (15 cm x 8 cm to 5 cm x 4 cm) with posterior tibial perforators as the pedicle; 8 posterior antebrachial neurocutaneous axial flaps (16 cm x 6 cm to 10 cm x 4 cm) based on the dorsal branch of the anterior interossea vessel and 13 reversed neurocutaneous axial flaps (6.0 cm x 3.5 cm to 2.5 cm x 1.5 cm) on the dorsal hand pedicled with the perforators at the interdigital web space.

RESULTS42 flaps survived completely. One flap underwent venous congestion with necrosis on the distal one fourth of the flap. The color and texture of the flaps were good. The appearance and functional results were satisfactory as revealed by follow-up for 6 to 24 months.

CONCLUSIONSThe modified operation combines the advantages of both the perforator flap and the neurocutaneous axial flap, enlarges the size of the flap and extends the scope of reconstruction. The flap is characterized with delicate designation, easy dissection and reliable blood supply. It is a good method in repairing the skin defects of the extremities.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin ; blood supply ; innervation ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Young Adult

The computer-aided design was used to simulate the docking of PDGF receptor with known active compounds, and the active groups that can bind to key sites were identified by analyzing the key amino acid residue fragments that exerted active effects on the target proteins. The natural product oleanolic acid was used as the parent, and the active group was introduced into the 2-position, and the C-28 carboxyl group was esterified and amidated. A series of oleanolic acid analogues targeting PDGF receptor inhibitors were designed and synthesized. Their structures were confirmed by MS and NMR. Through MTT assay, SGC-7901 and A549 cells were selected for preliminary in vitro anti-tumor activity screening. PDGF receptor protein inhibition test was performed on I₃ and Ⅱ₅ by FPIA. The activity tests showed that I₃ and Ⅱ₅, compared with the positive control drug, had stronger inhibition. FPIA test showed that Ⅱ₅ and PDGF receptor protein had good binding ability. The newly synthesized oleanolic acid analogues have significantly higher antitumor activity than the parent compound and deserve further study.

OBJECTIVE: To explore the predictive value of preoperative enhanced CT combined with des-γ-carboxy-prothrombin(DCP) level for microvascular invasion(MVI) of hepatocellular carcinoma(HCC).METHODS: The clinicaldata of 105 cases of HCC diagnosed by pathology after surgical resection from January 1,2016 to March 1,2019 in thethe Affiliated Hospital of Southwest Medical University were analyzed retrospectively. According to the pathologicalresults,they were divided into two groups: experimental group(with MVI): 30 cases,control group(without MVI): 75 cases,using univariate and multivariate logistic regression analysis to predict influencing factors of MVI in HCC. Thereceiver working curve(ROC curve)was used to evaluate the predictive value of DCP combined with enhanced CT forMVI in HCC.RESULTS: Univariate analysis showed that serum DCP level(t=4.667,P<0.001),tumor size(t=9.427,P<0.001),capsule type(χ~2=18.456,P<0.001) and pathological type(χ~2=11.914,P=0.003) were risk factors for MVI in HCC,with statistically significant differences(P<0.05). Multivariate logistic regression analysis showed that tumor size(OR=12.610,P=0.001),capsule type(OR=14.363,P=0.008) and serum DCP level(OR=19.254,P=0.014)were independentrisk factors of MVI in HCC,with statistically significant differences(P<0.05). ROC curve analysis showed that thesensitivity,specificity and area under the curve(AUC) of serum DCP and enhanced CT model for predicting MVI in HCCwere 90.0%,74.7% and 0.856,respectively.CONCLUSION: Preoperative serum DCP level combined with enhanced CThelps predict MVI in HCC.

Objective: To investigate the clinical and pathologic features, diagnosis and differential diagnosis of congenital hemangioma (CH). Methods: Forty cases of CH were diagnosed from January 2017 to December 2020 in Henan Provincial People's Hospital. The clinical and pathological and immunohistochemical data were analyzed, with review of literature. Results: There were 24 male and 16 female patients. The lesions were located in the head, neck (11 cases), limbs (14 cases), and trunk (15 cases). The clinical manifestations were congenital painless plaques or masses, the larger ones protruded on the skin surface, mostly dusky purple or bright red, with surrounding white halos. Under low magnification, the tumor was lobular and well demarcated, composed of neo-microvascular lumen of different sizes. The vascular endothelial cells were cuboidal or hobnail in appearance, forming stellar drainage vessels within the lobules. Extra-medullary hematopoiesis was seen in one case of rapidly involuting CH; there were different number of tortuous and dilated vascular lumen between the lobular structures, and some non-involuting CH cases were vascular malformations, which were devoid of lobulated structures. Immunohistochemistry showed that endothelial cells were strongly positive for CD31, CD34 and ERG, while D2-40 and GLUT-1 were negative. Conclusions: CH is a benign congenital vascular tumor with characteristic lobulated growth and abnormal blood vessels in the stroma. Pathological diagnosis often needs to be differentiated from infantile hemangioma, pyogenic granuloma, kaposiform hemangioendothelioma and vascular malformation.
Endothelial Cells/pathology* ; Female ; Hemangioendothelioma/pathology* ; Hemangioma/pathology* ; Humans ; Kasabach-Merritt Syndrome/pathology* ; Male ; Sarcoma, Kaposi/pathology* ; Skin Neoplasms/pathology*