Since the State Council approved and issued the law of The People's Republic of China Government Procurement Regulations(Draft),from the perspective of internal control,regarding internal control environment,risk assessment and evaluation,internal control supervision and other elements,it explored and analyzed the existing problems and improvement measurement for government procurement business in public hospitals,summarized the highlights and deficiencies to provide enlightenment for improving internal control level of public hospitals.

Substituting the value-added tax for business tax was one of the main content of the current implementation of structural tax cutting.As the policy fully implemented,it put forward how to strengthen the management of public hospital in tax and accounting cohesion measures around the public hospital tax changes and the resulting effects.

Sancai and Zhonghe are important parts of Chinese traditional culture. Their enriched connotation continues to influence Chinese ancient science and the development of TCM. Sancai-Zhonghe-TCM is a complex relationship, and this article focused on the relationship among the three. This article pointed out that the Zhongheand Sky and Earth form Sancai; Zhonghe and human corresponding reflects the overall concept of TCM, and is further enrichment of the unique theoretical system of TCM between man and universe correspondence. Zhonghe and qi corresponding has an important influence on the TCM essence, qi and spirit theory, supplemented by charts to describe.

Objective To study the value of the temporary vena cava filter in the prevention of ectopic embolism formation in cases with thrombolytic therapy of venous thrombosis.Methods Of 11 patients, 10 suffured from venous thrombosis of lower limb and 1 from thrombosis of right internal jugular vein with persistent truncus arteriosus were treated by inserting permanent or temporary vena cava filter via median vein. Results In all 11 case control of symptoms followed this treatment occurred 7 to 15 days, thrombi were completely or partly dissoluted, the blood vessels recanalized, and finally removed the temporary vena cava filter. There were no complication and ectopic emboli related to thrombolytic therapy. Conclusions Our observation indicated that temporary vena cava filter insertion is safe and effective to prevent ectopic embolism in thrombolytic therapy of venous thrombosis.

Object To study the chemical constituents of Hibiscus mutabilis L.Methods Isolation and purification were carried out on silica gel, or polyamide column chromatography etc. Constituents were identified and structurally elucidated by physicochemical properties and spectral analysis.Results Ten compounds were obtained, nine of them were determined as tetracosanoic acid (Ⅰ), ?-sitosterol (Ⅱ), daucosterol (Ⅲ), salicylic acid (Ⅳ), emodin (Ⅴ), rutin (Ⅵ), kaempferol-3-O-?-rutinoside (Ⅶ), kaempferol-3-O-?-robinobinoside (Ⅷ) and kaempferol-3-O-?-D-(6-E-p-hydroxycinnamoyl)-glucopyranoside (Ⅸ).Conclusion All compounds are isolated from the plant for the frist time except Ⅱ and Ⅵ.

Neuropsychiatric systemic lupus erythematosus (NP-SLE) is more common in young woman but not yet in people over 75 years old.We report a case of NP-SLE in an old woman,who complained of tremor,hypermyotonia and gatism.The lab examinations showed strong positive (1∶3200) ANA,decreased levels of CH50,C3,C4,WBC,RBC,PLT,anti-ds-DNA(+),anti-Sm(+),SSA(+),PO(+),RO-52(+),urine blood (+) and protein (+).The proteins,MBPand IgGin CSF were increased.Head MRI scan showed many demyelination in bilateral intra ventricular and multiple patchy irregular long T1 and T2 signal under right parietal subcortical.The patient was immediately given methylprednisolone hormone therapy,combined with gamma globulin and hydroxychloroquine.After 4 days of treatment,most symptoms such as tremor and hypermyotonia disappeared.Laboratory tests showed that all immune markers changed better in three weeks.The patient was discharged in 4 weeks.it must be identified with cerebrovascular disease,Parkinson's disease and other common diseases in elderly people.It can be improved if the diagnosis and treatment of NP-SLE is immediately and the illness is well controlled.

Objective To investigate the prevalence of fatigue in AS and its relationship with other clinical and functional parameters used for the evaluation of disease activity. Methods The fatigue was assessed in 73 patients with active AS using a single-item fatigue question of BASDAI. The correlation between fatigue and the clinical parameters of disease including the Bath AS disease activity index(BASDAI), Bath AS functional index (BASFI), Bath AS metrology index(BASMI), night pain, spinal inflammation, patient's global assessment(PGA) and enthesis index(EI) were determined. Results A total of 73 patients with ankylosing spondylitis were recruited. The prevalence of fatigue was 90.4% and the fatigue score of 68.5% patients was higher than 5. After controlled for the possible confounding factors such as age, gender, age and disease duration, it was found that fatigue was highly correlated with disease activity, pain and functional disability, BASMI,physical health and mental health. Conclusion Fatigue is an important symptom in AS. Fatigue can be measured with a single-item fatigue question of BASDAI.

Radiofrequency ablation(RFA) is a local and minimally-invasive therapy.In recent years,RFA has been increasingly practiced in the clinical treatment of bone tumors.RFA is very safe and effective in relieving pain caused by inoperable metastatic bone lesions and in reinforcing the ablated vertebra when combined with bone cement injection,which is helpful in preventing pathologic fracture.RFA offers an ideal and effective alternative for patients with inoperable metastatic bone tumors.

Objective To explore current situation of hospital outpatient injection room infection and to discusse relevant countermeasures of infection control .Methods A retrospective analysis was conducted in 245 patients admitted and got infected in our hospital outpatient department injection room from October 2012‐to October 2013 .By analyzing its infection type ,treatment time ,age ,etc .,and in winter and items ,air ,medical staff hand in spring and summer and fall of hospital respectively we understand the hospital infection and the seasonal relationship ,the related factors of hospital infection ,and develop targeted and effective inter‐vention measures .Results The outpatient injection room infection were mainly occurred in respiratory system and digestive sys‐tem ,the occurrence rates were 54 .29% (133/245) ,25 .31% (62/245) ,respectively .The infection rate of treatment time> 7 d (2 .74% ) apparently higher than < 7 d (1 .09% ) (χ2 = 56 .246 ,P= 0 .000) .The infection rate of people whose age over 40 (1 .91% )apparently higher than age < 40 (1 .13% ) (χ2 = 12 .316 ,P= 0 .000) .The qualified rate of atmosphere in Winter and Spring (68 .46% ) was significantly lower than summer and autumn (89 .23% ) (P<0 .05) ,the qualified rates of surfaces and hands of medical staffs (84 .62% ,82 .31% ) were significantly higher than summer and autumn(63 .08% ,66 .15% ) .Conclusion The out‐patient injection room infections were related to a variety of factors ,we could carry on the comprehensive analysis and formulate specific interventions to reduce hospital infection .

Objective To investigate the incidence of subclinical hypothyroidism (SCH) during the third trimester of pregnancy and its effects on pregnancy outcomes and neonatal hypothyroidism.Methods A total of 10 695 women in the third trimester of pregnancy (28-42 weeks of gestation) who labored from January 1,to December 31,2012 in Changzhou Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University were enrolled.The levels of thyroid stimulating hormone (TSH),free thyroxine (FT4) and thyroid peroxidase antibody (TPOAb) of the mothers were quantified by electrochemical immunoassay.The time-resolved fluorescence immunoassay was used to detect neonatal thyroid hormone levels.Using t test or x2test,the incidence of adverse pregnancy outcomes was compared between SCH group and euthyroid group and between SCH women with positive (n=40) or negative TPOAb (n=176).Results The incidence of SCH was 2.02％ (216/10 695) and the positive rate of TPOAb in SCH women was 18.5％ (40/216).No neonatal thyroid dysfunction was found.According to the age matched,222 cases were randomly selected as controls from 7 757 euthyroid women.Compared with the controls,SCH women had a higher incidence of premature rupture of membranes [28.7％ (62/216) vs 14.9％ (33/222),x2=12.34],anemia [11.6％ (25/216) vs 4.1％ (9/222),x2=8.65],pregnancy-induced hypertension [9.7％ (21/216) vs 4.5％ (10/222),x2=4.53],premature labor [8.8％ (19/216) vs 3.6％ (8/222),x2=5.10] and intrahepatic cholestasis of pregnancy [8.3％(18/216) vs 2.3％ (5/222),x2=8.14] (all P＜0.05).The overall incidence of adverse pregnancy outcomes was also higher in SCH group than in the controls [69.4％ (150/216) vs 49.5％ (110/222),x2=17.96,P＜0.01].The incidence of fetal growth restriction and still birth in SCH mothers with positive TPOAb was higher than in those with negative TPOAb [7.5％ (3/40) vs 0.0％ (0/176),x2=13.32,P＜0.01; 2.5％ (1/40) vs 0.0％ (0/176),x2=4.40,P＜0.05],but there was no significant difference in the overall incidence of adverse pregnancy outcomes compared with TPOAb-negative mothers [65.0％ (26/40) vs 70.5％ (124/176),x2=0.46,P=0.50].Conclusions SCH diagnosed in the third trimester may lead to adverse pregnancy outcomes.Early screening for thyroid dysfunction is necessary.