Objective The article introduced the application of the project schedule management in the con-struction of large-scale general hospital information system project and the important role that it played in the con -struction.Methods By the examples of the informationization construction of a new large -scale general hospital , this paper discussed the schedule management and control method in order to illustrate the fact role it played , inclu-ding the hospital information project activity definition , activity sequencing , resource estimation , time estimation, schedule planning and schedule control of the whole process .Results Through the effect seen above , we carried out the effective control of the project schedule and ensured the project goals on schedule .Conclusion Project schedule management is an important guarantee in informationization construction of large -scale general hospital , while impro-ving the management of large programs .

Conspecific organ transplantation provides the survival for the diseased patients at the later stage. The transplantation-induced emotional disorder, rejection, social and psychological burdens all affect the donor, recipients and their relatives, together with the involved medical staff regarding the physical and mental health. The differences of gender, age, cultural background, economic status, social and family roles, and religion beliefs may result in the varying psychological reactions. Therefore, it is recommended to conduct the psychological intervention for the population at each stage of the organ transplantation, as the transplantation technique increases.

Objective To investigate the incidence of vulvovaginal candidiasis(VVC)in the third trimester,and the effect on the of perinatal outcome.Methods Vaginal discharge samples of 300 gravida were examined and cultured for fungus.According to the clinical feature,the patients were divided into slight VVC group and heavy VVC group.The termination of pregnancy and perinatal outcome were recorded 42 days after delivery.Results The incidence of VVC was 34%.There was significantly higher prevalence of premature rupture of membrane(PROM),afterbirth adherence,premature labor,break of perinaeum when intrapartum,disruption of wound after intrapartum and infection of newborn in the group of heavy VVC,with significant difference as compared with non-VVC group (P＜0.01)but with no difference in puerperal infection(P＞0.05).Conclusion Heavy VVC is disadvantageousto the mothers and their babies in gravida,and the therapy of VVC in pregnant women should be conducted actively before and after delivery.

Objective To observe on the variance of serum IL-18 level and lymphocyte subpopulations in the patients with obese diabetic(T2DM).Methods The diabetic obese group contained 31 cases,the non-diabetic obese group contained 33 cases,healthy normal body weight group contained 23 cases,the blood glucose(FPG),insulin (FPI),blood total cholesterol(TC),triglyceride(TG),IL-18 and the cell population of lymphocyte subpopulations CD3+and CD4+、CD8+ in peripheral blood were determined,the insulin sensitivity index were calcnlated.Results Compared with the healthy normal body weight group,the blood fat,FPG,FPI,IL-18 of T2DM patients significantly increased,there were significant statistical difference(P ＜ 0.05 or P ＜ 0.01).The ISI significantly decreased(P ＜ 0.01).Compared with the non-diabetic obese group,the blood fat and IL-18 of T2DM patients significantly increased (P＜0.05).Compared with the diabetic obese group,the subpopulations cell population of CD3+、CD4+、CD8+ in the non-diabetic obese group significantly decreased,the ratio of CD4+/CD8+ significantly increased,there were significant statistical difference(P＜0.05 or P＜0.01)in the two groups comparison.Compared with the non-diabetic obese CD4+/CD8+ significantly increased(P＜0.05).Conclusion T2DM patients should prevent the hyperinsulinemia,control blood sugar,reduce insulin resistance,sustain normal lipid metabolism,boost immune function.

Objective To study the effects of diacerein and its metabolite rhein on plasma inflammatory cytokine level and expression of perirenal adipose tissue chemerin in type 2 diabetes mellitus (T2DM) rats and its role in regulating glucose and lipid metabolism.Methods We randomly divided 56 SD male rats into 5 groups: normal control group (Group A), T2DM group (Group B), pioglitazone group (Group C), diacerein group (Group D), and pioglitazone+diacerein group (Group E).Group A was fed with ordinary feed whereas the other groups were fed with high-fat diet.At the end of week 8, rats in Groups B, C, D and E were injected intraperitoneally with 30mg/kg of STZ solution to create the model.Those in Group A were injected with the same volume of sterile sodium citrate solution.OGTT examination was taken to screen the model rats at the end of week 10.The successful mode was chosen according to OGTT result.Then Group C was treated with pioglitazone 10mg/(kg·d) orally, Group D with diacerein 50mg/(kg·d), Group E with pioglitazone 10mg/(kg·d)+diacerein 50mg/(kg·d), and Group A and B were given the same volume of normal saline.The intervention lasted 4 weeks.At the end of experiment weeks 10 and 14, FBG, FINS, TC, TG, LDL-C, IL-1β, IL-6, and TNF-α were detected in the fasting rats with free access to water.After blood sample was taken at the end of week 14, all rats were killed and theperirenal adipose tissue was isolated, the expression of chemerin in perirenal adipose tissue was detected by Western blotting.Results At the end of week 10, FBG, FINS, TG, TC, LDL-C, IL-1β, IL-6, and TNF-α were higher in Groups B, C, D and E than in Group A while HDL-C was lower (all P<0.01).At the end of week 14, TC, TG, and LDL-C were lower in Groups C, D and E than in Group B but higher than Group A while HDL-C was lower than in Group A (all P<0.05).Group E had greater changes in glucose and lipid metabolism and inflammatory cytokine level than Groups C and D (P<0.05).Western blotting results showed that the expression of chemerin in perirenal adipose tissue increased higher in Group B than in Groups A, C, D and E (P<0.05).The expression of chemerin were also higher in Groups C and D than in Groups A and E (P<0.05), but there was no significant difference between Groups A and E.Conclusion Diacerein can regulate the metabolism of glucose and lipid, improve insulin resistance by reducing the expression of chemerin and the level of inflammatory cytokines.

Objective Recent studies have shown that inflammatory cytokines are involved in the occurrence and development of diabetes mellitus .The article aimed to investigate the effects of anti-inflammatory drug--diacerein on hepatic PPAR-γand GLUT-2 protein expression and its role in the regulation of glucose and lipid metabolism in rats with type 2 diabetes mellitus ( T2DM) . Methods 55 male SD rats were randomly divided into 4 groups:normal control group (n=10), T2DM group (n=15), pioglitazone intervention group(n=15), and diacerein treatment group(n=15) .Rats in normal control group were fed with normal diet , the other 3 groups were fed with high fat diet .At the end of 8th experi-ment week, rats in 3 groups fed with high fat diet were treated with intraperitoneal injection of 30mg/kg streptozotocin ( STZ) solution, while rats in normal control group were injected with the same volume of sterile sodium citrate solution .At the end of 10th week, OGTT modeling rats were screened .Rats in pioglitazone intervention group were treated with 10 mg/kg pioglitazone by intragastric administra-tion, rats in diacerein group was treated with 50mg/kg diacerein by intragastric administration , and rats in normal control group and T2DM group were given the same volume of normal saline .The intervention lasted 4 weeks.At the end of 8th, 10th and 14th week, the blood examination of glycolipid , FINS, IL-1βand liver function indexes was done on fasting rats .Fourteenth weeks later , after getting blood samples , all rats were sacrificed and liver tissues were isolated .Western blot was applied in the detection of PPAR γand immu-nohistochemistry was applied to detect GLUT-2 protein in livers. Results At the end of 8th week, the FBG level in pioglitazone in-tervention group increased compared with normal control group ( P<0.05) , and the levels of TC , TG, FINS, LDL-C, ALT, AST, IL-1βin the other 3 groups increased significantly compared with normal control group (P<0.05).At the end of 10th week, in comparison with normal control group , the levels of FBG , FINS, TC, TG, LDL-C, ALT, AST and IL-1βincreased significantly ( P<0.05) , while the levels of HDL-C and ISI decreased significantly (P<0.01).Moreover, the levels of FINS, TC, TG, LDL-C, ALT, AST and IL-1βat 10th weekend increased significantly compared with those at 8th weekend(P<0.05).At the end of 14th week, the FBG levels in T2DM group, pioglitazone intervention group and diacerein treatment group were higher than that of normal control group (P<0.01), while compared with T2DM group, the FBG level in pioglitazone intervention group decreased and the levels of HbA 1c, TC, TG, LDL-C and ALT in pioglitazone intervention group and diacerein treatment group decreased ( P<0.05) along with the increased ISI and HDL-C levels ( P<0.05) .Compared with the results at 10th weekend , the levels of FBG , HbA1c, LDL-C, ALT, AST in T2DM group in-creased (P<0.05) while the levels of HbA1c, TC, ALT, AST and IL-1βin pioglitazone intervention group and diacerein treatment group decreased significantly at 14th weekend(P<0.01).The expression level of PPAR-γin pioglitazone intervention group (0.91± 0.03) was significantly higher than normal control group (0.82±0.15), T2DM group(0.75±0.28) and diacerein treatment group (0.83± 0.34) ( P<0.01) , and no significant difference was found between diacerein treatment group and normal control group( P>0 .05) show-ing higher levels compared with T 2DM group ( P<0.01).At 14th weekend, the GLUT-2 expression levels in normal control group (0.209±0.023), pioglitazone intervention group (0.226±0.017) and diacerein treatment group (0.232±0.012) were higher than that of T2DM group (0.173±0.009,P<0.01);and the GLUT-2 expression levels in pioglitazone intervention group and diacerein treatment group were higher than that of normal control group (P<0.05).The expression level of liver PPAR-γwas in positive correlation with those of GLUT-2 protein, HDL-C, FINS, ISI ( r=0.815, 0.780, 0.747, P<0.01) and in negative correlation with those of FBG , HbA1c, TC, TG, AST, ALT, IL-1β(r=-0.465,-5.716,-0.615,-0.675,-0.617,-0.521,-4.827, P<0.05). Conclusion Diacerein can enhance liver PPAR-γand GLUT-2 expression levels and reduce the levels of IL-1β, HbA1c and blood lipid, thus im-prove insulin resistance in T 2DM rats.

Objective To investigate the relationship between interleukin-18(IL-18)and the pathogenesis of type 2 diabetes melli-tus.Methods 72 healthy Sprague-Dawlay male rats were randomly divided into four groups, NC group,NCS group,HF group and HFS group.At the end of the 8th week,NCS group and HFS group were injected with STZ(25mg/kg)into abdominal cavity.At the end of the 10th week,diabetic rats were screened by oral glucose tolerance test(OGTT).The blood sample was collected when the rats were killed at the end of the 14th and 20th week.The levels of serum IL-18,IL-6 and tumor necrosis factor-α(TNF-α)were assayed with ELISA.Results Most rats in HFS group were achieved the diagnostic standard of diabetic rat, and their insulin sensitivity index(ISI)were decreased.At the end of the 14th week and 20th week,the levels of serum IL-18,IL-6 and TNF-α in HFS group were significantly higher than those in NC group(P＜0.01).In HFS group,the levels of serum IL-18,IL-6 and TNF-α at the end of the 20th week were higher than those at the end of the 14th week,but it had no statistic significance(P＞0.05).Pearson linear correlation analysis showed that the level of serum IL-18 in HFS group was positive correlated with FBG,IL-6,and TNF-α(r=0.90,P＜0.01 or r≥0.73,P＜0.05),and negative correlated with ISI(r=-0.86,P＜0.01).Condusions Our results show that IL-18 is related with the pathogenesis of type 2 diabetes mellitus and chronic inflammation plays an important role in the development of type 2 diabetos mellitus.

Objective To explore the impact of IL-10 gene polymorphisms on the outcome in HLA matched sibling hematopoietic stem cell transplantation (HSCT).Methods PCR-sequencespecific primer (PCR-SSP) assay was used to analyze the SNP of IL-10 in 77 recipient and donor pairs:-1082 A/G,-819 T/C,-592 C/A.Results IL-10 ATA/ATA (1082,-819,-592) genotype in recipients significantly decreased the incidence of grade Ⅱ-Ⅳ acute graft vursus-host disease (aGVHD) (6.1％ vs.25.0 ％,P＜0.05),reduced 5-year transplant-related mortality (TRM) (10.7 ％± 5.9％ vs.29.7％ ± 5.2％,P＜0.05) and increased disease free survival (DFS) (81.8％ ± 6.7％ vs.56.8％ ± 7.5％,P＜0.05).With regard to the donor genotype,the incidence of grade Ⅱ-Ⅳ aGVHD,extensive chronic GVHD,5-year TRM and DFS had no signicant difference between IL-10 ATA/ATA and non ATA/ATA subgroup.Multivariable analysis also revealed that IL-10 non-ATA/ATA genotype in recipients and high-risk status of disease were two independent risk factors for DFS (HR =2.911,P =0.029; HR =2.686,P =0.027).Conclusion In HLA-matched sibling HSCT,the presence of recipient IL-10 ATA/ATA significantly decreased the incidence of grade Ⅱ-Ⅳ aGVHD and TRM,and increased DFS.

Objective: To investigate the clinical characteristics and outcomes of Maisonneuve fractures. Methods: Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days). Results: Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21). Conclusion The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.

Objective: To evaluate the outcomes and prognostic factors of patients with refractory and relapsed acute myeloid leukemia (AML) who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The overall survival (OS) , disease free survival (DFS) , acute and chronic graft-versus-host disease (GVHD) , relapse rate (RR) , transplantation related mortality (TRM) and their related risk factors were analyzed retrospectively. Results: All the patients (median age 35 years, range 6 to 58) received myeloablative conditioning regimens. All patients had successful engraftment, and the median time of neutrophils engraftment was 14 days (range 9 to 25) . Of the patients who survived more than 100 days, the accumulative incidence of grade Ⅱ-Ⅳ acute GVHD and chronic GVHD (cGVHD) were 27.3% (95%CI 18.9%-36.3%) , 33.9% (95%CI 24.6%-43.5%) , respectively. Meanwhile, the accumulative incidence of extensive cGVHD was 9.3% (95%CI 4.5%-16.1%) . The 3-year OS, DFS, RR, and TRM was 45.0% (95%CI 34.6%-55.4%) , 45.0% (95%CI 34.8%-55.2%) , 36.6% (95%CI 26.9%-46.4%) and 19.7% (95%CI 12.4%-28.3%) respectively. Multivariate analysis revealed four independent risk factors: non remission status before transplantation[P=0.009, HR=2.21 (95%CI 1.22-4.04) ], WBC at diagnosis>50×10⁹/L[P=0.024, HR=2.11 (95%CI 1.11-4.02) ], donor age>35 years [P=0.031, HR=1.96 (95%CI 1.06-3.60) ]and without cGVHD[P=0.008, HR=0.38 (95%CI 0.18-0.78) ]. According to the risk factors before transplantation (non remission status, WBC at diagnosis>50×10⁹/L, donor age>35 years) , we then defined three subgroups with striking different OS at 3 years: no adverse factor (75.0%) ; one adverse factor (46.9%) ; two or three adverse factors (15.4%) (χ²=26.873, P<0.001) . Conclusion Allo-HSCT is a promising and safe choice for patients with refractory and relapsed AML and relapse is the major cause of the transplantation failure. Disease status before transplantation, donor age, WBC at diagnosis and cGVHD are confirmed as prognostic factors for these patients who received allo-HSCT.