OBJECTIVE:To consummate the flow sheet in drug storehouse management so as to improve the management efficiency.METHODS:5S management,visible management and demand-oriented management stated in lean management were applied in drug storehouse management.RESULTS:Due to the application of the methods in lean management,the storage capability of hospital drug storehouse was increased,medicine circulation was accelerated,and the work efficiency was enhanced.CONCLUSIONS:The application of lean management theory is conducive to the upgrading of scientific management as well as the enhancing of both efficiency and performance of hospital drug management.

OBJECTIVE:To explore the effects of early treatment with mouse nerve growth factor on the wound healing in aged patients with electric burn. METHODS:78 elderly patients with electric burn were divided into control group and observation group by random number table method,with 39 cases in each group. Control group was given routine method for electric burn, and observation group was additionally given Mouse nerve growth factor for injection 30 μg dissolved in 2 ml 0.9% Sodium chlo-ride injection within 24 h,im,qd,on the basis of control group. Treatment course of 2 groups lasted for 2 weeks. Clinical effica-cies of 2 groups were compared as well as VAS score before treatment,3,5,7 days after treatment. The survival rate of skin flaps and the rate of wound healing 3,5,7 days after treatment,the recovery of wound scar,the value of wound blood perfusion,the time of complete wound healing and the occurrence of ADR were also compared. RESULTS:The total effective rate of observation group(94.9%)was significantly higher than that of control group(66.7%),with statistical significance(P<0.05). 3,5,7 days after treatment,VAS score of observation group was significantly lower than that of control group,and the survival rate of skin flaps and the rate of wound healing were significantly higher than those of control group,with statistical significance(P<0.05). Af-ter treatment,VSS score of observation group was significantly lower than that of control group,while the value of wound blood perfusion was significantly higher than that of control group;the time of complete wound healing was significantly lower than that of control group,with statistical significance (P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Early treat-ment with mouse nerve growth factor for elderly patients with electric burns can effectively lower the VAS and VSS score,improve the survival rate of skin flaps and the rate of wound healing,increase the value of wound blood perfusion and shorten the time of complete wound healing with good clinical efficacy and safety.

Objective To discuss the clinical value of coronary artery imaging using 64-slice spiral CT in patient with atrial fibrillation.Methods The images of 31 patients with atrial fibrillation who underwent contrast-enhanced CT coronary angiography were evaluated.The presence of stenosis on each segment of coronary arteries was recorded and their degree of stenosis was measured using the vessel analysis software.Ten patients additionally underwent conventional coronary angiography.The results of conventional coronary angiography were compared with CT coronary angiography of the 10 patients.Results Image reconstruction was based on absolute timing.The image quality of 364 coronary vessel segments on the images from 31 patients was evaluated and defined as excellent,fine,moderate or poor.The image quality was excellent,fine,moderate and poor in 85,41,5,and 8 vessel segments respectively in patient group with heart rate between 47 beat per minent(bpm)and 69 bpm;and in 63,16,13,and 15 vessel segments respectively in patent group with heart rate between 70 bpm and 79 bpm;and in 46,25,23,and 24 vessel segments in patient group with heart rate between 80 bpm and 105 bpm.There was significant difference among the three patient groups(H=22.08,P＜0.01).Comparison was carried out between CT angiographic findings and conventional angiographic findings of the 125 segments of the coronary arteries in the 10 patients who underwent conventional coronary angiography.The sensitivity and specificity of CT angiography for diagnosing vessel with significant coronary stenosis(≥50% narrowing)was 85.0%(17/20)and 95.2%(100/105),respectively.Positive predictive value was 77.3%(17/22),and negative predictive value was 97.1%(100/103).Coronary CTA underestimated the lesions of 3 vessel segments and overestimated the lesions of 5 vessel segments.Conclusion Coronary artery imaging with 64-slice row CT had clinical value for patients with atrial fibrillation.

Objective To evaluate the efficacy of discriminant function analysis for pericolic infiltration in colorectal cancer on enhanced 64-slice spiral CT and to improve the diagnostic accuracy and specificity of pericolic infiltration. Methods Dynamic enhanced 64-slice spiral CT was performed in 49 colorectal cancer patients (49 masses in total) before surgery. One or two slices were selected for each mass, with a total of 96 slices. The 96 slices were classified into two groups (pericolic infiltration or nonpericolic infiltration group) according to pathological data. Discriminant analysis was performed on the CT values between the mass and the corresponding pericolic tissue 5 mm from the mass at different time points as follows; 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, and 75 s. The discriminant function was calculated, and the pericolic infiltration determined by discriminant function and CT morphology were compared with the pathological results. The CT values in pericolic and non-pericolic infiltration groups at different enhancement time points were assessed using analysis of variance. Results The mean CT values ranged from (43. 6 ±7. 8) HU to (52. 3 ±0. 8) HU in the pericolic infiltration group, and ranged from (100.4±20.3)HU to(116.2±21.4)HU in the non.perieolic infiltration group.At 20 s and 40 s,the mean CT vshle8 were(43.6±27.8)HU and(50.9±27.8)HU in the perleolic infiltration group, (102.0±16.9)HU and(116.2 ±21.4)HU in the non-perieolic infiltration group,respectively.The mean CT value in the pericolic infiltration group was significantly lower than that in the non-pericolic infiltration group at all contrast enhancement time points(F=6.278,P<0.01).A diseriminant function Was obtained as follows:D=-3.450+0.023Xl±0.017X2-0.00lX12-0.001X22+0.002X1×X2. Based on the CT morphology of colorectal cancer,69 slices were identified correctly and 27 slices were fulsely interpreted.the sensitivity.speeificity and accuracy for perieolic infiltration determination were 82.5%,64.3%and 71.9%.respectively.Based on diseriminant function,85 slices were identified correctly and 11 slices were falsely interpreted.the sensitivity,specificity and accuracy were 85.0%.91.1%and 88.5%,respectively.Conclusion The discriminant function with dynamic enhanced 64-slice spiral CT can improve the diagnostic accuracy and specificity of perieolic infiltration in eolorectal cancer patients.

Objective To investigate the effect of pathophysiology case-based learning(CBL)method on scores of pediatrics.Methods Undergraduates from 2005 grade at Chengde medical college were divided into two groups:experimental group(n=138,CBL method)and control group(n=136,conventional teaching method).The scores of pediatrics between the two groups were compared.The pediatrics test paper was divided into two types:type B,which was tightly connected with the pathophysiology knowledge and type F,which had less connection with pathophysiology knowledge.The accuracy rates of both groups were compared.Correlation analysis on scores between pathophysiology and internal medicine,surgery,pediatrics,obstetircs and gynaecology was made.Results No significant difference in total scores of pediatrics was observed between the two groups(P＞0.05);total accuracy rate of experimental group was higher than that of control group(P＞0.05);similar total accuracy rates of type F test paper were observed in both groups(P＞0.05);positive correlations in scores between pathophysiology and internal medicine,surgery,pediatrics,obstetircs and gynaecology were found.Conclusions Satisfactory long-term effect are received by applying pathophysiological CBL model since it can promote the application of pathophysiological knowledge in pediatrics,however,no apparent effect on students'clinical ability can be obtained from the mere application of CBL in pathophysiology course.

Objective To apply the optical coherence tomography(OCT) to detect the characteristics of coronary artery plaque and to investigate its correlation with levels of serum matrix metalloproteinase 7(MMP 7),MMP9 and MMP12.Methods The patients undergoing coronary arterial angiography for diagnosing coronary arterial lesions in the cardiology department of our hospital from October 2014 to March 2016 were collected and included into the research subjects.The subjects were divided into the stable plaque group and unstable plaque group based on the results of OCT scanning.The neovascularization characteristics such as the fibrous cap thickness of plaque,angle of lipid pool,macrophage infiltration and plaque cracks were detected by using OCT.ELISA was used to measure serum MMP7,MMP9 and MMP12 levels.Results (1) The fibrous cap thickness in the stable plaque group was more than that in the unstable plaque group(P＜0.01);the lipid pool angle,microphage infiltration,intima erosion and plaque cracks in the unstable plaque group were more than those in the stable plaque group(P＜0.05).(2) The MMP7 and MMP9 levels in the unstable plaque group were higher than those in the stable plaque group and control group(P＜0.05).(3) The fibrous cap thickness had significantly negative correlation with serum MMP9 level(r=-0.336,P=0.034);the MMP7 and MMP9 levels in the microphage infiltration group were higher than those in the non-microphage infiltration group(P＜0.05);the MMP9 level in the intima erosion group was higher than that in the non-intima erosion group(P＜0.01).Conclusion OCT can detect and find unstable plaque and the serum levels of MMP7 and MMP9 are significantly elevated in the patients with unstable plaque,which can be used as an important basis for predicting unstable plaque and guiding the treatment decisions.

Objective To investigate the prostecdtive efficacy of one-stage bone grafting in man-aging chronic osteomyelitis after debridement.Methods From March 1999 to May 2003, 79 patients with chronic osteomyelitis including 28 patients with nonunion underwent one-stage autogenous bone graft-ing, allografts or mixed bone grafting after debridement in Nanjing General Hospital of Nanjing Military Command.All patients were followed up for a mean period of 77 months (60-111 months).Results Six patients (8%) , including two with autogenous bone grafting, three with allografts and one with mixed bone grafting, were confirmed with recurrence of infection, with no statistical difference among three methods of bone grafting.Of 28 patients with nonunion, 23 patients with autogenous bone grafting and two with allografting obtained union, the other three patients with mixed bone grafting obtained union in two patients but resulted in recurrence of infection with nonunion in one, with cure rate of 96% (27/28).Conclusions One-stage bone grafting after debridement for infection and bone union can reach cure rate of over 90%.The recurrence of infection mostly occurs within the first year after operation, with stable long-term curative effect.

Objective To investigate the effects of interleukin-18 ( IL-18 ) on M cells of intestinal mucosa in acute pancreatitis (AP) in rats. Methods Seventy SD rats were divided into seven groups: AP 6 hour group, 12 hour group, 24 hour group, IL-18 6 hour group, 12 hour group, 24 hour group, and control group at random. The models of AP were established. Serum, pancreatic tissue, and ileal mucosa were harvested. Serum amylase, glutamate pyruvate transaminse, total bilirubin, endotoxin, IL-27, and TNF-α were detected. Pathologic changes of pancreatic tissue and ileal mucosa were observed. The protein with reverse transcription-polymease chain reaction (RT-PCR). Results The level of serum TNF-α increased obviously in IL-18 6 hour group, 12 hour group, and AP group. The level of serum IL-27 increased in IL-18 6 hour group and AP group and back to normal in IL-18 24 hour group. The in IL-18 group than AP group (P < 0. 05 ). Conclusions IL-18 may affect M cells function and play important roles in intestinal barrier in acute pancreatitis.

Objective To assess the cardiovascular structure and function in children with confirmed primary hypertension,and to explore the impact of hypertension and related risk factors on cardiovascular structure and function of children.Methods Parameters related to cardiac structure,vascular structure and function were measured in 213 hypertensive children,who were confirmed upon repeated measurements on separate occasions.A total of 197 healthy children were recruited as controls.Results 1) In hypertensive children,left ventricular end-diastolic diameter (LVEDd),left ventricular end-systolic diameter (LVESd),left ventricular mass (LVM),left ventricular mass index (LVMI),left ventricular posterior wall thickness (LVPT) and interventricular septal thickness (IVST) were all significantly higher than their counterparts (P＜0.05).No statistical differences were found in carotid intima-media thickness (cIMT),relative wall thickness (RWT) and brachial ankle pulse wave velocity (ba-PWV).2) Compared with controls,LVEDd,LVESd,LVM,LVMI were all significantly higher in hypertensive children (P＜0.05),regardless of age group or weight-status.No statistical differences were found in ccIMT and RWT,while ba-PWV was statistically higher in controls among children aged 6-12 years.3) Data from multiple linear regression analysis noticed that LVMI was associated with age,sex,BMI and hypertension while RWT was associated with age and BMI.Conclusion In children with primary hypertension,changes of vascular structure and function were not shown but left ventricular remodeling and early changes of function had been developed in children under 12 years old.

Objective To discuss the application of blending learning based on MOOC in Histology and Embryology, so as to improve students' learning effectiveness. Methods Nursing undergraduates in class one of 2017 grade were randomly selected as experimental group (n=47) , and nursing undergraduates in class two as control group (n=48), with blending learning and traditional teaching model adopted, respec-tively. SPSS 19.0 was applied to processing the data and T test were used to compare the results of the final exam of this course and the evaluation scale of students' independent learning ability in two groups. Results The experimental scores [(24.22±5.08) vs. (18.49±4.65)], paper test scores [(52.37±6.24) vs. (47.15± 5.99)], and total score [(76.61±7.22) vs. (62.83±7.36)], which shows the scores of experimental group were statistically higher than those of the control group. According to the evaluation scale of students' inde-pendent learning ability, the self-learning ability of the experimental group was better than that of the control group, with significant differences (P<0.05). Conclusion Blending learning can be applied to the teaching of Histology and Embryology, which can effectively improve learning quality, with satisfactory teaching effects to both teachers and students.