In order to lower the purchasing prices of drugs, prevent unhealthy tendencies that might arise in the process of drug circulation in the hospital, and reduce the financial burdens of patients, our hospital started from March 1997 the practice of purchasing drugs through open tender. The measures adopted include: ①establishment of a leading group in charge of drug purchases and a drug purchasing group; ②formulation and earnest implementation of the system of purchasing drugs through open tender, making “five checks”; ③standardization of the scope of routine drugs used in the hospital; and ④adherence to the system of examination and approval by the Drug Management Committee when introduction of new drugs is being considered. Since the adoption of the system of purchasing drugs through tender, the purc hasing prices of drugs have on the average dropped 14.7% and the drug expenses for single entity diseases have been lowered.

Objective To explore relationship between the changes of mononuclear cells (MNCS) apoptosis and the levels of inflammatory cytokines and adhesion molecules in patients with systemic lupus erythematosus(SLE). Methods The apoptotic rates of MNCS in 32 patients with SLE and 10 healthy subjects were detected with flow cytometry, and the plasma levels of inflammatory cytokines(IL-8, IL-6,TNF-? and NO) and adhesion molecules(P-Sel, ICAM-1) were assayed with ELISA. Results The percentage of MNCS apoptosis in the patients with active stage of SLE was obviously higher than that in healthy subjects and patients with remission stage of SLE, and there was no significant difference in the percentage of MNCS apoptosis between healthy subjects and patients with remission stage of SLE. The levels of plasma IL-8, TNF-?, IL-6, NO, P-sel and ICAM-1 in patients with active stage of SLE were significantly higher than those in healthy subjects and the patients with remission stage of SLE, and were positively correlated with the percentage of MNCS apoptosis and the severity of SLE.There was no significant difference in the levels of plasma inflammatory cytokines and adhesion molecules between patients with remission stage of SLE and healthy subjects. Conclusion The apoptotic rate of MNCS increased in the patients with active SLE, and was closely associated with the severity and efficacy of SLE. The high expressions of inflammatory cytokines and adhesion molecules may be the reason of MNCS apoptotic increase. Appropriately regulating the expression of cytokines and adhesion molecules, and moderately controlling the apoptosis of MNCS may improve the prognosis of SLE.

OBJECTIVE:To evaluate the role of PDCA cycle management on standardizing clinical use of atomization inhala-tion drug. METHODS:Using a retrospective method,300 medical records of atomization inhalation drug use were collected from our hospital during Jan.-Dec. in 2013(non-intervention group),200 medical records collected during Apr.-Jun. in 2014(one cycle intervention group),and 180 medical records collected during Oct.-Dec. in 2014(two rounds of cycle intervention group). The use of atomization inhalation drugs was compared before and after the application of PDCA cycle management. Before and after two cy-cle intervention,4 types of medical staff were investigated on cognition of the related knowledge of atomization inhalation drugs, as physicians,pharmacists,nurses and mechanic. RESULTS:After two rounds of PDCA cycle management and intervention,the proportion of unsuitable route of administration of antibiotics,long acting glucocorticoid,non-atomization inhalation dosage form of resolving phlegm drugs,protease decreased from 54.0%,62.0%,59.7%,44.7% before intervention to 0.6%,1.1%,15.0%, 1.1% after intervention;those phenomena had not been found,such as unsuitable route of administration of TCM injection and non-atomization dosage form of theophyllines,unsuitable atomization frequence,unsuitable indication,drug mixture for preventing and controlling symptom,etc. The proportion of medical staffs being familiar with medical device,drug classification,drug selec-tion for prerention and treatment and the proportion of hospital drug stock to 93.4%,86.7%,92.4%,96.2% after intervention from 38.0%,79.0%,49.0%,39.5%before intervention. CONCLUSIONS:The application of PDCA cycle management can effec-tively regulate the use of atomization inhalation drugs in our hospital;the method can be promoted and applied.

Objective To study the impact and mechanism of continuous venovenous hemofiltration (CVVH) in different uhrafihration rates on plasma cytokines in porcine endotoxemic shock. Methods Eighteen anesthetized mechanically ventilated pigs weighing 21-34 kg were randomly divided into three groups. In control group (n=6), the pigs received a 15.7 μg/kg endotoxin (E.coli 0111:84) infusion. In CVVH group (n=6) and high volume hemofihration (HVHF) group (n=6), the pigs received CVVH after the endotoxin infusion for 24 hours with an was taken before endotoxin infusion and at 0, 1, 6, 12, 24 h during CVVH. The plasma levels of TNF-α, IL-6, IL-10 and IL-18 were tested by ELISA. Results The survival time in control group was (15.4±5.2) h,CVVH group was (21.4±7.1) h,HVHF group was (22.4±6.7) h. The survival time in CVVH and HVHF group was significantly longer than that of control group (P< 0.05 ). Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP) and cardiac output (CO) showed no significant differences among three groups. Plasma BUN and Ser increased gradually after the establishment of porcine endotoxemic shock model. BUN and Scr of CVVH and HVHF group were lower compared to control group (P<0.05), but there was no significant difference between CVVH and HVHF group (P>0.05). Plasma TNF-α and IL-6 peaked at T1, IL-10 peaked at TO, then they declined gradually. While IL-18 increased at TO and did not change after TO. A significant decrease of plasma IL-10 level was observed at T6, T12 and T24 in CVVH group compared with control group (P<0.05). HVHF group accomplished a greater decrease in plasma TNF-α (T6) and IL-10 (T6, T12, T24) levels compared with control group and CVVH group (P< 0.05). The levels of IL-6 and IL-18 showed no significant differences among three groups. There was a negative correlation between IL-6 and survival time (P<0.05). Conclusions HVHF and CVVH can prolong the survival time of porcine endotoxemic shock. IL-10 can be removed effectively with CVVH and HVHF. HVHF can also remove TNF-α effectively. CVVH and HVHF treatment can both remove BUN and Scr effectively. IL-6 is a powerful independent predictive factor for survival time of porcine endotoxemic shock.

BACKGROUND: Bone morphogenetic protein (BMP) and its derived scaffold or vector here been widely used in experiment and gradually applied in the clinic. However, the tracing method challenges the therapeutic effect, The discovery and application of enhanced green fluorescent protein (EGFP) can solve this problem.OBJECTIVE: To construct the bicistronic eukaryotic vector pIRES2-EGFP-hBMP-2 and to observe its expression in human embryo kidney (HEK) 293 cells.METHODS: hMBP-2 gene was extracted from human osteosarcoma by RT-PCR and inserted into PMD18-T vector. Following the DNA sequence verification, it was then sub-cloned into the eukaryotic vector pIRES2-EGFP. After restriction enzyme analysis the pIRES2-EGFP-BMP-2 was transfected into HEK 293 cells. Then its expression was observed using fluorescence microscopy and Western blot.RESULTS AND CONCLUSION: hBMP-2 gene was amplified and the eukaryotic vector plRES2-EGFP-hBMP-2 was constructed successfully. At 48 hours after tranfection of pIRES2-EGFP-hBMP-2 into HEK 239 cells, approximately 30% of cells emitted green fluorescence under a fluorescence microscope. Western blot results demonstrated that there was a specific BMP strap at Mr46×10s side, which indicated that the target gene could be expressed in constructed pIRES2-EGFP-hBMP-2 vector.

Objective To investigate the effect of different concentrations of arsenic trioxide (As2O3,ATO) on neurokinin A (NKA) in renal tissue of BXSB mice and explore its clinical value.Methods Fifty BXSB mice (twelve weeks old and weighted 23～26 g) were randomly divided into control group,systemic lupus erythematosus (SLE) group,and therapeutic group of three different concentrations of ATO.All biochemical indicators were analyzed before and after treatment.The pathology of renal tissue was examined by immunohistochemistry.The concentration of NKA in renal tissues was detected by ELISA and the concentration of NKA mRNA was detected by RT-PCR.Results The concentration of NKA in SLE group in renal tissue (299±26) pg/g was significantly higher than that of normal control group (122±7) pg/g (P＜0.05).The concentration of NKA in the SLE group in renal tissue was significantly higher than that of three different concentrations of ATO in low-dose group (151±14) pg/g,moderate--dose group (147±9) pg/g and in highdose group (155±14) pg/g (P＜0.05).No difference was found between three different dosages of ATO treatment groups and normal control groups (P＞0.05).There were no significant differences among three different dosages of ATO treatment group (P＞0.05).The side effects in low-dose group were significantly lower than those of moderate and high-dosage groups (P＜0.05).Conclustion NKA concentration expressed in the renal tissues in the SLE group is higher than that in the control group.Decreasing the concentrations of NKA mRNA in renal tissues may be one of the important mechanisms of ATO in treating SLE.Low-dosage ATO is safe and effective to treat SLE and has therapeutic potentials.

Objective To observe the changes of mononuclear cell (MNCs) apoptosis and the level of inflammatory cytokines and adhesion molecules in patients with systemic lupus erythematosus (SLE) and to study the relationship between them. Methods The apoptosis of MNCs in 22 patients with SLE at the active stage and 10 patients with SLE at remission and 10 healthy controls were determined with flow cytometry. The inflammatory cytokines and the adhesion molecules were tested with ELISA method. Results The percentage of MNCs apoptosis in the patients with SLE at the active stage was significantly lower than that of healthy con- trols and the patients with SLE at remission. There was no significance difference of MNCs apoptosis between healthy controls and patients with SLE at remission. The levels of IL- 8, TNF-?, IL- 6 , NO, P- sel and ICAM- 1 in patients with SLE at the active stage were significantly higher than that of healthy controls and the pa- tients with SLE at remission, and the increased levels of inflammatory cytokines and adhesion molecules in ac- tive SLE patients were negatively correlated to the percentage of MNCs apoptosis and positively correlated to the severity of SLE. Conclusion The data demonstrates that there is a promote apoptotic process of MNCs in active SLE. The high expression of inflammatory cytokines and adhesion molecules may play an important role of promoting MNCs apoptosis which reduces the functional life span of MNCs. For this reason, modulating the expression of cytokines and adhesion molecules and moderately controlling the apoptosis of MNCs may be a new therapeutic target for SLE treatment.

Objective To evaluate the feasibility and efficacy of suspended method in scar hidden technology in laparoscopic appendec-tomy ( LA) . Methods 27 patients underwent scar hidden laparoscopic appendectomy with the aid of suspended method. Silver probe was pierced abdominal cavity,bended into a hook shape and fixed appendix,then underwent appendectomy. Results 27 patients finished surgery successfully,the operative time was 25~100 min ( mean, 45 min) ,the blood loss during operation was 10~50 mL ( mean,20 mL) ,the hos-pital stay was 3~8 d ( mean,4 d) . Conclusion Scar hidden technology in laparoscopic appendectomy with the aid of suspended method is safe,feasible and further improves the cosmic result.

Objective: To investigate the findings of coronary artery angiography in coronary artery disease patients with diabetes mellitus. Methods: The angiographic fingings of 153 coronary artery disease patients from 1995 to 1997 were reviewed. Among them, 33 were diabetic,23 were impaired glucose tolerance(IGT) and 97 were nondiabetic patients. Results: The age, sex, hypertension, hypercholesterolemia, smoking and the rate of myocardial infarction were the same among 3 groups. But the 2 vessel and 3 vessel disease were more frequent in diabetic group(66.7% ,30.3%) than in nondiabetic group (26.8%,19 6%). Two vessel disease were more frequent in diabetic group(66.7%) than in IGT group (13.1%). Single vessel disease were less frequent in diabetic group(3.0%) than in IGT group(52.2%)and nondiabetic group(53.6%)( P

BACKGROUND: The proximal tibia is the second common site for primary bony sarcomas,which lacks adequate soft tissue coverage.Resection and reconstruction by any technique leave the reconstructed area in a subcutaneous position.This has been a major source of necrosis of skin and infections.OBJECTIVE: To observe the effect of gastrocnemius muscle transfer to obtain soft-tissue coverage and extensor mechanism reconstruction for limb-sparing resection of the proximal tibia with endoprosthetic reconstruction.METHODS: From January 2001 to June 2008,27 patients with osteosarcoma of the proximal tibia confirmed by biopsy were selected.All the tumours were assigned to stage IIB based on Enneking's classical staging system.Neoadjuvant chemotherapy(Bacci,IOR/OS-N4)was utilized for the patients.All the patients adopted limb-sparing surgery,i.e.resection of proximal tibia with endoprosthetic reconstruction.A gastrocnemius flap was utilized to improve implant coverage and enhance the patellar tendon repair.MSTS was used to measure the functional status of patients with a sarcoma in the leg.RESULTS AND CONCLUSION: The follow-up was averagely 53.1 months.Of 27 patients,2 cases(7%)died of lung metastasis within 2 years,1(4%)suffered from amputation due to infection and underwent amputation.The others developed no complications or recurrence.The MSTS score was averagely 25.1 points.Results show that resection with endoprosthetic reconstruction utilizing a gastrocnemius muscle flap for osteosarcoma of the proximal tibia is reliable and predictable in combination with neoadjuvant chemotherapy.