The lean financial management, which emphasizes lean, scientific and systematic ways, uses modern financial information system platform to conduct a comprehensive budget management through centralized fund management. It discusses and analyzes on the effective method and measurement of constructing lean financial management system in public hospitals.

Objective To investigate the influences of age and sex on the expression of serum antinuclear antibody (ANA) and its titer level.Methods The serum ANA in 993 people aged 60 years and over were detected and titer of positive serum were analyzed. They were divided into different groups according to age and sex. Two hundred healthy cases aged less than 60 years were collected as control group. Results The serum ANA positive rate was increased with age and it was significantly higher in people aged 60 years and over than aged less than 60 years (29. 1% vs. 14.0%, x2=5. 074, P=0. 025). The serum ANA positive rates were 24.1%, 30. 5% and 33.6% in people aged 60-69 group, aged 70-79 group and aged above 80 group. Among people aged 60 years and over, the positive rate was 35.8% in female group, which was higher than in male group (22. 4%) (x2= 21. 179, P=0. 05). The titre levels of the positive samples were increased with age. In control group, the samples with 1 : 100 titre was 57.1% among the positive samples, which was higher than in the elderly group (36. 3%). And in control group, the samples with 1 : 3200 titre was 0 among the positive samples, which was lower than in the elderly people group (7.6%). The ANA preliminary screening in people aged 60 years and over showed that the titre level was less than 1 : 320-1: 1000 in female and less than 1 : 100-1: 320 in male. Its specificity could be up to about 90%. Conclusions The serum ANA positive rate in people aged 60 years and over is affected by age and sex. The positive rate is higher in female than in male and it is increased with age. It suggests that 1 : 320 to 1 : 1000 could be taken as ANA preliminary screening critical value in female and 1 : 100 to 1 : 320 in male.

Electrical status epilepticus in sleep (ESES) indicates a special electroencephalographic pattern showing sleep-induced continuous paroxysmal discharges of spike-wave complexes.ESES can be seen in a series of epileptic syndromes in children characterized by seizures,ESES and cognitive impairment,including epilepsy with continuous spikes and waves during slow sleep,Landau Kleffner syndrome,typical and atypical benign childhood epilepsy with centro-temporal spikes.Though the mechanism generating ESES remains elusive,great advances in several aspects,such as genetic studies (GRIN2A,copy number variations,ect.),high-frequency oscillations and brain networks have been achieved.Treatment for ESES related disorders should focus on both epileptic seizures and ESES,and the introduction of appropriate antiepileptic drugs or other strategies like hormone therapy should be considered to furthest eliminate epileptic seizures and protect cognitive function.

Vitamin B6 related epilepsy is a group of epileptic diseases,seizures in which could not be con-trolled by antiepileptic drugs,but could be controlled or obviously improved by vitamin B6 .It comprises of pyridoxine dependent epilepsy and pyridoxine responsive epilepsy predominantly,and the latter includes vitamin B6 responsive in-fantile spasms,pyridox(am)ine -5′-phosphate oxidase (PNPO)deficiency,hyperphosphatasia mental retardation syndrome (Mabry syndrome)and so on.The clinical presentations of the diseases above are nonspecific,manifesting as refractory seizures onset in neonatal or infantile period,which need to be distinguished from other diseases such as new-born hypoxic ischemic encephalopathy,Ohtahara syndrome and non -ketotic hyperglycinemia.Pyridoxine dependent epilepsy,PNPO deficiency and Mabry syndrome have relative specific biomarkers and known disease -causing genes, which are helpful for diagnosis.It is suggested that pyridoxine or pyridoxal phosphate should be tried first for all patients started seizures early (including all infantile spasms patients),avoiding missing these diseases.And once diagnosed,vi-tamin B6 should be maintained long -term or all the life according to the detailed disease.

Epileptic encephalopathies are an epileptic condition characterized by epileptiform abnormalities associated with progressive cerebral dysfunction.These syndromes include early myoclonic encephalopathy and Ohtahara syndrome in the neonatal period,West syndrome and Dravet syndrome in infancy,myoclonic status in nonprogressive encephalopathies,and Lennox-Gastaut syndrome,Landau-Kleffner syndrome,and epilepsy with continuous spike waves during slow wave sleep in childhood and adolescences.Other epileptic syndromes such as migrating partial seizures in infancy and severe epilepsy with multiple independent spike foci may be reasonably added.In this paper,an overview of epileptic encephalopathies including clinical features,etiology,electroencephalogram characteristics,treatment and prognosis are provided.

Objective To investigate the changes of monoamine neurotransmitters of the brain in two tat models of morphine dependence,and to explore the effects of sinomenine on morphine dependence.Methods A physical dependent rat model was established with morphine at a gradually increasing dosage and the withdrawal syndrome was scored after naloxone precipitation.The conditioned place preference(CPP)in rats induced by morphine was used to investigate psychic dependence in rots.Contents of norepinephrine(NE),dopamine(DA)and serotonin(5-HT)in hypothalamus of rats were assayed with a fluorescent method.Results 1.In naloxone precipitated withdrawal test of in morphine-dependent rats,after morphine withdrawal,the rats presented marked with drawal symptoms and signs,their withdrawal scores were significantly increased,and the levels of NE and 5-HT in hypothalamus of the rats were significantly increased than the control group Ⅰ(7.07±1.406μg/g wet tissue and 1.15±0.346 μg/g wet tissue,respectively,P<0.01),but the content of DA was markedly reduced than the control group Ⅰ(0.28±0.121 μg/g wet tissue,P<0.05).2.In CPP model,morphine caused a marked place preference in rats and the levels of DA and 5-HT in hypothalamus were significantly increased than the control group Ⅱ(1.13±0.359 μg/g wet tissue and 1.23±0.343μg wet tissue,respectively,P<0.01),but the content of NE was not significantly changed(3.28±1.098 μg/g wet tissue,P>0.05).Sinomenine could significantly inhibit the withdrawal syndrome and development of CPP induced by morphine in rats,and could suppress the rising of monoamine neurotransmitters of the brain in two morphine dependent models in rats.Conclusion In the physical dependent model induced by morphine in rats,the rising of NE and 5-HT in the rat brain were significant,but in CPP model induced by morphine in rats,the levels of DA in the rat brain were enhanced predominately.Sinomenine could inhibit the withdrawal syndrome and development of CPP in rats,and regulate and improve the function of monoamine nerve system.

The prognosis is very poor for the patients with advanced esophageal cancer proved by explored operation.There was not concurrent for the value of radiotherapy after explored operation.A series of 104 patients with explored operation alone and 155 patients with radiotherapy before or after explored operation were analyzed to evaluation the value of postoperetive radiotherapy. The results showed: (1) Postoperative radiotherapy was effective for the patients with advanced esophageal cancer after explored operation.The average survival/mean survival and 1～5 years survival were higher in the patients with postoperative radiotherapy than in those of operation alone. (2) ≥6000cGy groupe was better than

As the development of technology in Neonatal Intensive Care Unit,the neurology outcome of premature has become a critical issue for their future life quality.Early electroencephalogram (EEG) test is a noninvasive and convenient method to monitor brain function.Nowadays,EEG monitoring has been used to evaluate the maturity of background activity,to detect subclinical seizures and to predict future neurological outcomes.The guideline of American clinical neurophysiology society in 2011,and the guideline of French clinical neurophysiology society in 2015 have made recommendations for the indication,timing and duration of EEG monitoring.Interpret EEG needs both skill and experience,it is hard for clinicians to master the skill in a short time.Hence,despite the advantages of EEG monitoring,the application of EEG among premature is limited.The amplitude-integrated EEG and other quantitative EEG monitoring method have become the latest research hotspot for evaluation of preterm brain function.In order to improve the recognition of EEG in the area of preterm neurologic evaluation,now the latest researches are reviewed.

Neurohypophyses of six adult rats were observed under electron microscope toinvestigate the morphological features of pituicytes and their possible functionalsignificance.The results of morphological observation showed that the pituicytesmay be divided into 4 types,the two of which,astral pituicytes and ependymalpituicytes,obviously resemble to the neurogliocytes of central nervous system intheir morphological features.The third,dark pituicytes,was rich in mitochondria.Little was known about secretory pituicytes other than their presumable secretoryfunction suggested by the secretory granules present in their cytoplasm.The interstitial cisternae were the sites where the neurosecretory activities carriedon.The dilations of nerve fiber around the interstitial cisternae were rich in vesi-cles.It was substantiated that the pituicytes can participate in supporting andnourishing the nerve fibers,removing cell debris and may also serve a function oftransferring excitation,because of the presence of gap junction between pituicytes andynapselike contact between pituicyte and the nerve fiber.

Objective To discuss the clinical features of primary epididymal rhabdomyosarcoma and review the diagnostic and therapeutic advances. Methods One 16-yesr-old male presented with right scro-turn swelling mass for 4 months. Physical examination revealed an ovoid and solid mass of 4.5×3.5×3.0 cn in right scrotum. The mass was hard and its surface was smooth without tenderness. Transillumination test was negative. There was no palpable inguinal lymph node. Pre-operative diagnosis was inflammatory nodule of right epididymis. Results Right epididymectomy was performed under caudal anesthesia une-ventfully. The pathological study showed that the neoplasm was composed of small round shape ceils with small and anachromasis nucleus. The immunohistochemical study showed that these cells were positive for myoglobin, aetin and desmin, but negative for smooth muscle actin. Electron microscopy showed that paral-leling thin filaments were found with no asrcomere-like structure in the intracytoplasm. The pathologic diag-nosis was right epydidymal rhabdomyosarcoma. The patient refused further therapy. A mass was found with rapid growth accompanied with pain in the right scrotum 2 months after the first operation and was clinically diagnosed as tumor recurrence. This patient had then undergone right radical orchiectomy. Frozen section analysis revealed negative surgical margin. The pathologic diagnosis was embryonal rhabdomyosarcoma re-currence. Patient underwent subsequent chemotherapy with ifosfamide, etoposide and vincristine. After one year follow-up, he was generally well without evidence of recurrence. Conculsions Primary embryonal rhabdomyosarcoma is a rare tumor with aggressive growth patterns. The diagnosis depends on the pathologi-cal examination because the clinical presentation is not specific. Combination therapy with radical orchiecto-my, chemotherapy and radiotherapy provides patients an excellent long-term prognosis.