The relationship between hyperlactatemia and metabolic acidosis, which may involve shock resuscitation,homoiostasis, and nutritional support, remains a hot topic. On one hand, increased production of lac-tate due to anaerobic glycolysis during tissue hypoperfusion can aggravate metabolic acidosis; on the other hand,the utilization of lactate at organ and cell levels may lower blood lactate level, and thus alleviate metabolic acidosis.The ultimate blood lactate level depends on the balance of these two action mechanisms.

Hitherto, it is reported that caspase family includes 14 members at least, which play important roles in executing cell apoptosis. Experimental studies have proved that caspases are expressed and activated in the injured skin and during skin wound healing, which suggests that cell apoptosis induced by caspases may occur. Further investigation on the roles that caspases play in the injured skin and during skin wound healing may offer a new way for the clinical treatment of the skin wound and the medico-legal wound age determination. The article reviews the biologic characters of caspases and the advances in the studies on the caspases in the skin wound and wound healing. It is suggested that caspases exert significant parts during skin wound healing, which are worthy of further investigation.

Objective To evaluate the influence of different antigen retrieval methods and pH values of fixatives on immunostaining of incised wound skin.Methods 3d-post-incision mouse skin were sampled and fixed in 4% formalin buffered with PBS at pH 5.0,6.0,7.0,8.0 and 9.0.The deparaffinized sections were treated 0.01mmol citrate buffuer(pH 6.0)in high pressure cooker or by microwave heating,or with pepsin,trypsin or microwave+pepsin.Thereafter,immunostainings of caspase-3,caspase-6,caspase-7,IL-8,and IL-10 were evaluated by immunohistochemical SABC method with ratio of immunostaining-positive cells,respectively.Results The immunostaining-positive cell ratios in sections treated by heating retrieval was higher than by proteinase treatment.The positive cell ratio was slightly higher by high pressure than by microwave heating.Sections were more easier peeled off during high pressure treatment than during micrwave heating.Sections treated with pepsin were fallen off easier than with trypsin digestion.The highest positive cell ratio was detected in sections by microwave+trypsin treatment without section peeling off among all antigen treatment methods.The best result was obtained in sections fixed in buffered formalin at pH 7.0 and 8.0.Conclusion The best immunostaining result may be obtained in mouse incised wound sections fixed in buffered formalin at pH 7.0 and 8.0 with microwave+trypsin treatment.

Objective To investigate the expressions of caspase-6,-7 during skin wound healing and the applicability of the time-dependent expressions of caspase-6,-7 to determination of the wound age.Method The expressions of caspase-6,-7 were studied in skin incised wound in mice by immunohistochemical SABC method,and the non-incised mouse skin was used as control.Results Expressions of caspase-6,-7 were detectable in polymorphonuclear cells (PMNs) in the wound specimens aged 6h. In the wound specimens aged from 12h to 24h after injury, caspase-6,-7 were identified in a large number of infiltrating PMNs and part of mononuclear cells (MNCs). Afterwards, the MNCs and fibroblastic cells (FBCs) accounted for the most part of the caspase-6,-7-positive cells. Morphometrically, the ratios of the number of the caspase-6,-7-stained PMNs, MNCs and FBCs to total number of the cells in the wounds were evaluated and calculated. The ratios of the caspase-6,-7-positive cells were low in the wound specimens aged from 0h to 3h, and maximized in the wound specimens aged 3 day. Thereafter, the ratios decreased and minimized in the specimens aged 14 day.Conclusion The results suggest that caspase-6,-7 were expressed in neutrophils, macrophages and fibroblasts during healing process of skin incised wound in mice. Caspase-6,-7 may be used as a marker for the wound age determination.

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 understand websites of public hospitals in China.Methods Website search and appraisal were called into play to analyze the percentage and present conditions of websites built by public hospitals in Shanghai,Hubei Province and Gansu Province.Rusults The study found websites in less than 55％ of the public hospitals in these three areas.Those websites in operation provide instant information on hospitals and medical services,yet their online service functions are less satisfactory and website levels vary sharply.Conclusion The authors recommend the Chinese government encourage public hospitals to build websites and enhance their online services.

Objective:To evaluate the physiologic work of breathing (WOBphy)as parameter of respiratory weaning and extubation. Method: Patient work of breathing (WOBt) and imposed work of breathing (WOBimp) were measured. WOBphy was obtained with WOBt minuting WOBimp. In the patients who did not meet conventional respiratory weaning parameters ,if WOBphy

s of enteral nutrition depends on the primary diseases and duration of nutmition support.Nasoenteral tube placement is safe and effective.Percutaneons endoscopic gastrostomy and needle catheter jejunostomy are the alternative approaches.

Data monitoring of No.1 Military Medical Project is very important for the accuracy of information system data. It's supposed that the statistics staff monitor the data in the network. That is, the data in daily and monthly medial reports should be checked and the checking software should be applied to the examination of the data on the first page of the case history to verify their logicality and nonvacancy.

Objective To investigate the effect of microbubble-enhanced non-focused ultrasound on liver uhrastructure during the treatment of hepatic trauma.Methods The model of hepatic trauma was established in 18 healthy New Zealand rabbits.The subjects were divided into trauma group,ultrasound group and ultrasound-microbubble group according to the random number table,with 6 rabbits each.Thicker region of the left hepatic lobe was treated by custom-made non-focused ultrasound for 5 min.Peak intensity (PI) was used to evaluate the blood reperfusion of the target region after treatment.Liver specimens were performed transmission electron microscope examination immediately and 24 h after treatment to analyze ultrastructure changes.Results PI ratio in ultrasound-microbubble group (15.1 ± 2.6) was significantly lower than that in trauma group (23.1 ± 1.1) and ultrasound group (23.4 ± 1.3) (P ＜ 0.05).But the difference between trauma and ultrasound groups was insignificant (P ＞ 0.05).Compared with trauma and ultrasound groups immediately after treatment,hepatic cells in ultrasoundmicrobubble group had obvious edema,sinusoids thinned,organelles arranged in disorder,mitochondrial edema was present,endothelia cells of interlobular hepatic artery,interlobular vein and bile canaliculi in the portal area damaged,and microvilli of bile canaliculi disappeared.Hepatic cells showed morphology of apoptosis 24 h after treatment.Conclusion Microbubble-enhanced non-focused ultrasound can be used to make rapid hemostasis by decreasing the blood perfusion,but it causes certain damage to the ultrastructure of hepatic cells and may induce apoptosis in the radiation zone and neighboring cells.