Combined with the development requirements of hospital medical disposable materials management and hospital information management,introduced a novel medical disposable materials management pattern which base on the enterprise resource planning chain supply systems.By optimizing purchasing procedure,inventory management,precision financial management,to realize the integrated management of the medical consumable materials affairs and financial affairs.

Objective:To explore the preoperative risk factors of laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis, and establish a nomogram model to predict the transition to laparotomy.Methods:A retrospective analysis of the clinical data of 309 patients undergoing surgery in Cangzhou People′s Hospital from January 1, 2015 to December 31, 2019, were divided into 290 cases in non-laparotomy group and 19 cases in laparotomy group whether they were transferred to laparotomy. Obtained independent predictors of transition to laparotomy through univariate analysis and multivariate logistic regression analysis, and used RStudio to establish a nomogram model to verify it.Results:The results of univariate analysis showed that the history of abdominal surgery, BMI, white blood cell, neutrophil ratio, ALP, serum total bilirubin, gallbladder wall thickness, common bile duct diameter, and lower common bile duct stone incarceration were relative risk factors of LC combined with LCBDE for conversion to laparotomy ( OR=0.195, 0.369, 0.287, 0.241, 0.237, 0.082, 0.166, 0.198, 0.190; 95% CI: 0.073-0.517, 0.114-1.195, 0.096-0.859, 0.085-0.682, 0.092-0.613, 0.023-0.287, 0.058-0.475, 0.073-0.537, 0.056-0.649). Multivariate logistic regression analysis showed that white blood cells>10×10 9/L, alkaline phosphatase>150 U/L, serum total bilirubin>17.1 umol/L, gallbladder Wall thickness> 4 mm, common bile duct diameter>12 mm, and lower common bile duct stone incarceration were independent predictors of LC combined with LCBDE for conversion to laparotomy ( OR=6.498, 3.656, 22.160, 5.762, 4.849, 7.916; 95% CI: 1.434-29.442, 1.095-12.203, 4.485-109.496, 1.491-22.262, 1.384-16.988, 1.366-45.884). The nomogram model was established based on independent predictors, and then bootstrap repeated sampling was used to internally verify the predictive model. The calibration curve found that the model was in good agreement, with a C-index of 0.924(95% CI: 0.857-0.990) and the area under the receiver operating characteristics curve was 0.924(95% CI: 0.855-0.992), indicating the high accuracy of the model. Conclusion:The nomogram model established based on the factors of lower common bile duct stone incarceration, gallbladder wall thickness, common bile duct diameter, common bile duct diameter, white blood cells, alkaline phosphatase, and serum total bilirubin has good ability to predict conversion to laparotomy of LC combined with LCBDE, and has high clinical application value.

Background and purpose:Despite the high remission rate in patients with multiple myeloma (MM) after the standard regimen, but often relapsed and resistant. It has been shown that modulation of cAMP can induce cell cycle arrest and apoptosis in a variety of tumor cells, which has become an interesting approach to cancer therapy. This study aimed to investigate possible effects of cyclic adenosine monophosphate (cAMP) analogue 8-(4-chlorophenylthio) adenosine 3’, 5’-cyclic monophosphate (8-CPT-cAMP) on multiple myeloma cells, provide direction to develop new drugs for the treatment of MM. Methods:The myeloma cell line U266 cells were treated with 8-CPT-cAMP of different concentrations. The proliferation of U266 cells was evaluated through cell counting kit (CCK-8) assay, lfow cytometry was used to analyze the changes of cell were distribution, apoptosis rate as well as mitochondrial transmem-brane potential (ΔΨm) in U266 cells before and after the treatment. Meanwhile, real-time quantitative polymerase chain reaction (RT-PCR) and Western blot assay were used to detect expression levels of apoptosis regulators including caspase-8, caspase-9, Bcl-2 and Bax genes in U266 cells before and after the treatment. Results:The U266 cells were treated 5 days with 8-CPT-cAMP of different concentration, it was shown that 8-CPT-cAMP could signiifcantly inhibit cell growth of U266 cells in a concentration and time dependent manner, the IC50 of 8-CPT-cAMP was reduced obvious prolonged reaction time, and reached to 58.52μmol/L in the iffth day. The cell cycle of U266 cells was stopped in G0/G1 stage as the progress of concentration. It was showed statistical signiifcant difference associated with the cellular proliferation inhibition rate and apoptosis rate in different concentration and control (P<0.05). Meanwhile, 8-CPT-cAMP could induce mitochondrial transmembrane potential collapse in U266 cells. Compared with control groups, the levels of Bcl-2 mRNA transcripts and protein in U266 cells were reduced in 8-CPT-cAMP treated groups (P<0.05), while the levels of caspase-9, Bax mRNA transcription and the expression of Bax protein were increased in treatment groups, but the caspase-8 mRNA had no statistical signiifcant difference with controls. Conclusion:8-CPT-cAMP can inhibit the proliferation and promote apoptosis of myeloma cells, which might be mediated by caspase via mitochondrial pathway.

Objective To investigate the correlation between serum glutamate levels and post-stroke depression (PSD). Methods The consecutive patients with acute ischemic stroke were enroled. At 3 month after onset, the PSD diagnosis was conducted according to the American Diagnostic and Statistical Manual of Mental Disorders (4th Edition) somatic disease caused mood disorder and Hamilton depression scale (HAMD) was used to evaluate the severity of depressive symptoms in patients with PSD. The demographics and baseline clinical data were compared and analyzed in the PSD group and the non-PSD group. Results A total of 177 patients were enroled in the study, including 55 in the PSD group and 122 in the non-PSD group. The age (64. 4 ± 7. 8 years vs. 60. 1 ± 11. 1 years; t = - 2. 575, P = 0. 012), NIHSS scores (median and interquartile: 6 [5 - 8] vs. 3 [2 - 5 ]; Z = - 5. 463, P = 0. 002 ), serum homocysteine (16. 9 ± 4. 9 μmol/L vs. 14. 3 ± 3. 9 μmol/L; t = - 3. 929, P = 0. 001 ), high-sensitivity C-reactive protein (1. 0 [0. 8 - 1. 7] mg/L vs. 0. 4 [0. 7 - 1. 3] mg/L; Z = - 3. 439, P = 0. 002 ), glutamate levels (279 [205 - 345] μmol/L vs. 161 [110 - 209] μmol/L; Z = - 6. 172, P = 0. 001 ), as wel as the proportion of women (50. 9% vs. 34. 4% ; χ2 = 4. 308, P = 0. 038) in the PSD group were significantly higher than those in the non-PSD group, while the education level was significantly lower than that in the non-PSD group (χ2 = 9. 679, P = 0. 003). Spearman correlation analysis showed that serum glutamate levels were significant positive correlated with HAMD scores ( r = 0. 491, P < 0. 001 ). Multivariate logistic regression analysis showed that the increased serum glutamate level (odd ratio 1. 016, 95% confidence interval 1. 010 - 1. 023; P = 0. 002) was an independent risk factor for PSD in patients with acute ischemic stroke. Conclusions The increased serum glutamate level may be an independent risk factor for PSD.

Objective To study the influence factors and prevention measures of complication of laparoscopic uter?ine surgery. Methods Patient who underwent laparoscopic uterine surgery were collected (n=415) and divided into hyster?ectomy group (n=310) and myomectomy group (n=105). Intraoperative and postoperative complications such as gastrointesti?nal injury, urinary injury and bleeding were recorded and compared between these two groups. Base on their uterine size, pa?tients were divided into Group A (uterine volume ≤300 cm3), Group B (300 cm3 0.05). The inci?dence of intraoperative or postoperative bleeding was 1.93%(8/415) and incidence of gastrointestinal damage or urinary inju?ry rate was 0.96%(8/415). The incidence of complications in group C was 20.0%(8/40) which is higher than that in group A (2.8%;5/179) and group B (5.1%;10/196). P<0.01 in all cases. The difference between group A and group B was not signif?icant (P>0.05). The incidence in pelvic adhesions group is higher than that in the group without pelvic adhesions [8.3%(15/180) vs 3.4%(8/235), P<0.05]. Conclusion The incidence of complications in laparoscopic myomectomy was higher than that in laparoscopic hysterectomy. When patients were without pelvic adhesions or with uterine volume< 600 cm3, laparo?scopic surgery present least complication.

Objective To explore the role of Cyclin B1 and Cyclin D1 on Barrett esophagus,Barrett's esophagus mixed with atypical dysplasia and esophageal adenocarcinoma.Methods Cyclin B1 and Cyclin D1 were examined with immunohistochemistry.76 esophageal tissues of patients werB collected,including severe reflux esophagitis(RE,25 cases),Barrett esophagus(BE,35 cases),Barrett esophagus mixed with atypical dysplasia(DY,8 cases),esophageal carcinoma(CA,8 cases).Ten cases with normal esophageal mucosa were examined as the control. Results Cyclin B1 and Cyclin D1 were high expression in the specimens of the BE,DY and CA groups and very low expression in the control and RE group.Statistieal difference Was showed(P<0.01).Expression of Cyclin D1 was increasing gradually from the tissues of intestinal metaplasia,atypical dysplasia to adenocarcinoma(50.04 vs 67.94 vs 74.31).There Was significant difference among these three groups(P<0.01).Conclusion Cyclin B1 and Cyclin D1 as markers of tumour development could evaluate the risk from Barrett esophagus to adenocarcinoma.Perhaps it is the earlv event in the development of esophageal carcinoma.

Objective To study the characteristic of salvianolic acid(SA) binding to bovine serum albumin(BSA) and the structure-performance relationship.Methods The interactions between BSA and four natural SA(SAⅠ,rosmaric acid;SAⅡ,lithosperic acid;SAⅢ,salvianolic acid A;and SAⅣ,salvianolic acid B) were investigated by fluorescence and ultraviolet spectroscopy.Results The intrinsic fluorescence of BSA was quenched by SA via forming SA-BSA complexes and non-radiation energy transfer.The parameters of SA-BSA binding process,such as the static apparent association constant KA,the number of binding site n,the efficiency of energy transfer E,the spatial distance r were obtained,and the thermodynamic constants ?G,?H,and ?S were calculated.Conclusion The results indicate that SAⅢ bounds to BSA mainly through a hydrophobic force and the other three SA-BSA interactions are mainly driven by hydrogen bond and Van der Waals' force.Y,a comprehensive binding parameter constructing from the equation Y=lg (KA?E?n/r),could be used to reflect the interaction extent of SA-BSA system.The Y value changes with the number of free phenolic hydroxyl and molecule volume and decreases in the order of SAⅢ→SAⅣ→SAⅡ→SAⅠ.The results from correlation analysis indicate that it could be possible to estimate SA-BSA binding extent from hydrophobic parameter clogP and topo-polar surface area per unit of molecular weight tPSA/Mr of SA molecule.

Aim To study the protective effects of dipfluzine against the whole cerebral ischemia and reperfusion injury and its mechanisms.Methods Four-vessel occlusion method was used to make the cerebral ischemia-reperfusion model.In early period of reperfusion,several including LDH,MDA,SOD and brain water content were tested.And in the late period of reperfusion,the delayed neuronal death and amnesia induced by reperfusion were studied.Results The contents of brain water and MDA were increased,and the activities of SOD and LDH were decreased after ischemia and reperfusion injury.The hippocampal structure and memory of rats were also destroyed in the delayed neuronal death.Dip reversed the changes obviously.It had antagonistic effect on brain edema and lipid oxidation,it also protected the neurons of hippocampal CA1 regions from ischemia injury.Conclusion Dip had protective effects on the early stage of reperfusion injury,and delayed neuronal death after the whole cerebral ischemia and reperfusion,which were possibly due to the antagonistic effect on lipid peroxidation.

AIM To establish an Endothelin 1 induced focal cerebral ischemia and reperfusion model. METHODS Endothelin 1(ET 1), a potent vasoconstrictor, was injected near the middle cerebral artery to induce reduction in cerebral blood flow and ischemic neuronal damage. The changes of cerebral blood flow in striatum were characterised using hydrogen clearance technique. The neurologic scores were performed and the infarct volume was identified by TTC staining at 6 h and 24 h after ET 1 application, respectively. RESULTS ET 1 induced a dose dependent reduction of cerebral blood flow in striatum and the CBF at 10 min after ET 1 injection were the lowerest. CBF at 10 min post injection was (27 1?2 9)% in group 300 pmol, (12 7?2 1) % in group 360 pmol, (11 9?1 8)% in group 400 pmol and (9 5?1 6)% in group 500 pmol , respectively. Neurologic score showed that ET 1 could induce variable grade neurologic deficit. The infarct volume were increased with the increment of ET 1 concentration and showed a close correlation, which were (3 9?0 3)% in group 300 pmol, (7 4?0 5)% in group 360 pmol, (11 3?1 3)% in group 400 pmol, and (16 2?1 8)% in group 500 pmol respectively, r =0 992 6 ( P