OBJECTIVE:To standardize hospital purchasing management for medicinal material. METHODS:The separation of the four powers,including plan,purchase,supply,and payment,was practiced on the basis of centralized purchasing medicinal material in our hospital. SWOT method was used to analyze the strengths,weaknesses,opportunities and threats of the model;im-provement measures were formulated;finally the effects of the model were evaluated. RESULTS:This model played an active role in the professional advantage of purchasing management,made up for the lack of management system and manpower shortage dis-advantage;adapted to policies to seize the opportunities for improvement,reduced the threat of standard deletion and purchasing cost,and promoted reasonable consumption of medicinal materials. And then the purchasing cost of our hospital was reduced after system procedure improvement,fine management of medicinal material and professional level improvement,medicine ratio fell from 42% in 2010 to 37% in 2014;logistics support became stable and standard,and the level of medicinal material supply was improved. CONCLUSIONS:The purchasing model for medicinal material under separation of the four powers provides the refer-ence for the correct course of the standardized,normalized and modernized hospital purchasing management.

Objective To assess the relationship between position of incisor and soft tissues changes in class Ⅲ malocclusion cases after orthodontic treatment.Methods All 26 patients in this study were diagnosed as skeletal class Ⅲ malocclusion.The lateral X-ray cephalometric films taken at the beginning and the end of the treatment were analyzed for position of incisor and soft tissues changes.Statistical analysis Waft performed using SAS v8.0 software.Resuits There was correlation between the labial inelination of upper and lower incisors and the soft tissue profile.Conclusion Soft tissue will be harmonious by the labial inclination increase of the upper incisor teeth and reduction of the lower incisor teeth.

During the mission of Peace friendship-2015, between September 2015 and January 2016,the Chinese Navy hospital ship respectively participated in the Harmony-2015joint military exercise in Malaysia and with the local military of Polynesia and Barbados .The article summarized the relevant background of the joint military exercise and the main practices in various stages .This article also suggests that the emergency platform be moved forward , the function of the triage area be expanded, basic life support(BLS),advanced cardiovascular life support (ACLS),and advanced trauma life support(ATLS) training programs be introduced, the training model and the test system be innovated , and realistic traumatic conditions be designed in order to guarantee the success of the joint exercise .

Objective To prepare a new bone-targeting drug of epirubicin-oxidized dextran-alendronate compound,and investigate the compound's bone targeting effect.Methods Based on Schiff base theory,we synthesized a new bone-targeted drug delivery system:epirubicin-oxidized dextran-alendronate compound.The physicochemical character was evaluated through ultra-violet (UV) spectroscopy,infrared (IR) spectroscopy and nuclear magnetic resonance (1H-NMR) spectroscopy.The character of affinity to bone in vitro was evaluated through HA absorbing test and the affinity to bone in vivo was evaluated by fluorescence microscopy.Drug distribution in different organs and different time point were investigated through liquid chromatograph.Results There were typical physicochemical characters of dextran,oxidized dextran,Dex-ALN compound,EPI-Dex-ALN compound through UV spectroscopy,IR spectroscopy and 1H-NMR spectroscopy,showed successful preparation of the bone targeting drug.HA binding rates were 86.13％,13.91％ in epirubicin-oxidized dextran-alendronate compound and epirubicin groups respectively through HA absorbing test in vitro.Luminescence microscope showed luminescence located in cortical bone,cancellous bone of metaphysic,no luminescence was found in bone marrow in affinity to bone in vivo.Compared by EPI group,IOD value of fluorescence in EPI-Dex-ALN group was 2.7 times.In HPLC drug concentration test,we detected drug concentration in different organs during the period of 10 min,1 h,2 h,24 h,48 h after injection in EPI,EPI-Dex-ALN compound group.The maximum concentration was at 2 h,and tissue distribute was different in different organs; there was statistical difference during the period of 10 min,1 h,2 h,24h,no statistical difference during the period of 48 h after injection in bone tissue between EPI group and EPI-Dex-ALN compound group.Conclusion We successfully synthesized a new bone-targeting drug delivery system,which showed better bone affinity in vivo and in vitro,and had powerful targeting function.

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum

Objective To investigate the effect of recipient's pre-transplant triglyceride (TG) abnormalities on early graft function (EGF) after kidney transplantation.Methods According to the inclusion and exclusion criteria,154 identified living-kidney transplant recipients in the 309 Hospital of Chinese PLA from Jan.2011 to Dec.2014 were enrolled in present study,including 124 males and 30 females,and aged of 31.9 ± 8.4 years.The cohort was divided into two groups:TG normal group (0.40＜TG≤1.70mmol/L,n=107) and TG abnormalities group (TG＞l.70mmol/L or require lipid lowering therapy,n=47).The incidences of poor early graft renal function (PEGF),slow graft function (SGF) and delayed graft function (DGF) were compared between the two groups,and then the serum creatinine (Scr) levels were compared among the patients showing immediate graft function (IGF) at 3rd,7th and 30th day after transplantation.The ROC curve was drawn up taking TG as diagnosis index to explore the optimal cut-offvalue for predicting PEGF,SGF and DGF after transplantation.Results Compared with the TG normal group,the TG abnormalities group showed significantly higher incidence of PEGF and DGF (P＜0.05).Among the IGF patients,the TG abnormalities group showed higher Scr level at the 7th and 30th day after transplantation (P＜0.05).The area under ROC curve (AUC) reflected TG levels for PEGF,SGF and DGF were 0.774,0.704 and 0.818,respectively (P＜0.05).The optimal cut-offvalues were all 1.37mmol/L.Conclusions Recipients with abnormal pre-transplant TG level may have worse EGF after renal transplantation.The risk of developing PEGF,S GF and D GF tends to emerge when pre-transplant TG level is higher than 1.37mmol/L.

Objective To investigate whether the donor's glomerular filtration rate (GFR) to recipient's weight ratio (Dg/Rw) is a useful tool to predict early clinical outcome in living-related do-nor transplantation.Methods A total number of 108 living donor transplant recipients in the Chinese Military 309th Hospital from Jan.2014 to July 2015 were enrolled in this study.The patients who had multi-organ transplantation or developed grafts rejection,delayed graft function,hydronephrosis or renal vascular stenosis were excluded.The 90 qualified recipients were divided into G1 group (Dg/Rw ≤0.81),G2 group (Dg/Rw 0.81～1.11),and G3 group (Dg/Rw≥1.12).We respectively analyzed the relationship between recipient's serum creatinine Scr and Dg/Rw at 3-,7-,30-day and 1 year after transplantation.Results Scr at 3-,7-,30-day and 1 year after transplantation had linear correlation with Dg/Rw.As compared with G1 and G2 groups,Scr level was significantly reduced in G3 group at different time points (P＜0.05).Conclusion Dg/Rw has a negative relationship with Scr level after renal transplantation.Pre-transplant Dg/Rw is a potential index to predict the early clinical outcome in living-related donor transplantation.

Objective To investigate the correlation between de nove anti-endothelial cell antibodies (AECA) and adverse events after renal transplantation and the effect of transplanted renal function within six months after operation.Methods The expression of AECA in serum of 85 renal transplant recipients was detected by indirect immunofluorescence assay (ⅡF) before and 1 day,3 days,7 days,15 days and 1 month after renal transplantation.The patients were divided into double positive group (AECA positive before and after surgery),single positive group (postoperative de nove AECA positive) and negative group (preoperative and postoperative AECA negative) according to AECA test results.The occurrence of adverse events in each group such as DGF,rejection,infection and so on,as well as the serum creatinine levels were recorded at each time point within six months.Results Of the 85 recipients,29 were positive for AECA,including 19 in the double positive group,10 in the single positive group,and 56 in the negative group.The incidence of rejection in single positive group (30％) was higher than that in the rest two groups (5.3％ for double positive group,and 17.9％ for negative group),but there was no statistically significant difference (P =0.21).The incidence of DGF in the single positive group,double positive group and negative group was 70.0％,26.3 ％ and 32.1 ％ respectively.The positive rate of the single positive group was significantly higher than that of the rest two groups (P =0.04),and the duration of DGF was significantly longer in the single positive group than that of the rest two groups (P＜0.01).The incidence of infection in the single positive group,double positive group and negative group was 20.0％,21.1％ and 8.9％respectively,and there was no significant difference among the three groups (P =0.31).As compared with the double positive group and the negative group,the serum creatinine level was significantly increased in the single positive group at 1st week,1st month,3rd month and 6th month after operation (P =0.02,P =0.04,P =0.04 and P =0.02 respectively).Conclusion Postoperative AECA can increase the risk of DGF,prolong the duration of DGF,and affect the recovery of renal function within 6 months after renal transplantation.

The clinical data of 9 patients with huge adrenal tumors (≥6 cm) undergoing retroperitoneal laparoscopic adrenalectomy between February 2015 and September 2016 were retrospectively analyzed.There were 2 males and 7 females aged 29-65 years.The tumors were detected due to investigation of paroxysmal hypertension in 4 cases, and during the health check-up in 5 cases.The lesions were located on the right side in 4 cases, on the left side in 4 cases and bilaterally in 1 case.The operations were all successful, there was no case transferring to open surgery.The average operation time was 70 min (50-100 min),mean bleeding volum was 100 ml(50-200 ml).The postoperative diagnosis: 4 cases of pheochromocytoma, 2 cases of cortical adenoma, 2 cases of neurilemmoma and 1 case of neuroinoma.The average follow-up time was 13.5 months (6-24 months) and no recurrence was found.

NS2 is a nonstructural protein of Periplaneta fuliginosa densovirus(PfDNV) with a molecular mass of 30 kD,whose function is not yet clearly understood. In order to study the expression,subcellular distribution and the function of NS2 protein,the coding region of NS2 was amplified from the hindgut tissue of cockroaches infected with PfDNV by RT-PCR and then the recombinant prokaryotic expression vector pET28a-NS2 was constructed. The recombinant plasmid was transformed into E. coli BL21(DE3) to express the 6?His fusion protein in the bacteria. After purification,the fusion protein was injected into New Zealand rabbits to prepare polyclonal antibody. The specificity of the anti-NS2 antibody was successfullyproved by western blotting on the eukaryotic expressed products of NS2 protein.Meanwhile,the full sequence of ns2 gene was also cloned into the eukaryotic expression vector pAC. The recombinant plasmid pAC-NS2 was then transfected into Schneider line 2(S2) cells to express NS2 protein in the insect cells. The subcellular localization of NS2 in the insect cells was then investigated by indirect immunofluorescence technique using the anti-NS2 polyclonal antiserum. The confocal laser scanning microscope observation showed that NS2 protein was located primarily in the cytoplasm with some punctate nuclear staining.