SWOT method was used to analyze the internal strengths,weaknesses,external opportunities and threats of Nanjing General Hospital of Nanjing Military Command,PLA. Based on the results,four development policy were put forward:developing the sections prepared for war; inducing invigorative system in human resource management; enhancing the value of nosocomial brand; strengthening of the audit about the medical cost accounting.

Currently all military hospitals attach great importance to the management of state-owned assets.However,there still exist some problems,such as weak management consciousness,irregular assets disposing and loose connections between management and accounting.The author ventures some measures to strengthen management consciousness,organization establishment,accounting procedures and monitoring mechanism.

0.05).The stimulative index(SI)tested by MTT in MLR at stimulator-to-reactor cell ratio 1∶1,1∶10,1∶20,1∶40 and 1∶80 was 2.7,4.1,3.1,2.5 and 1.6,respectively.The proliferation of T cells stimulated by DCs could be detected at all stimulator-to-reactor ratio.Conclusion DCs could be successfully induced from peripheral blood monocyte in the patients with colorectal cancer by AIM-V serum-free media or by traditional FBS-contained media.AIM-V is more suitable for clinical immunotherapy because it can avoid the risk of allergic reaction for clinical purpose.AIM-V might take the place of serum-contained media to culture DCs.According to the results of MLR,DCs could stimulate allogenetic T cells proliferation at all stimulator-to-effector ratio,furthmore the optimal ratio is 1∶10 .

Objective To investigate the effects of sevoflurane preconditioning on autophagy after traumatic brain injury (TBI) in rats and the role of C-Jun N-terminal kinase (JNK) signaling pathway.Methods Sixty adult male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into 4 groups (n =15 each) using a random number table:sham operation group (group S),group TBI,TBI + sevoflurane preconditioning group (group TBI + Sevo) and TBI + sevoflurane preconditioning + JNK inhibitor SP600125 group (group TBI + Sev + SP).TBI models were established using Feeney' s method.In TBI + Sev and TBI + Sev + SP groups,the rats inhaled 2.4％ sevoflurane for 30 min once a day for 4 concecutive days,and TBI was produced at 24 h after the end of sevoflurane preconditioning.In TBI + Sev + SP group,SP600125 (6 mg/kg) was injected intrapetitoneally at 30 min after TBI.Five rats were chosen at day 1,3,and 7 after TBI,and neurological deficit score (NDS) was measured.The rats were then sacrificed and brains were removed to measure brain water content,expression of LC3 lⅡ and Beclin-1 mRNA (using PCR),and expression of LC3 Ⅱ,Beclin-1,JNK and phosphorylated JNK (p-JNK) (by Western blot).Results Compared with group S,brain water content and NDS were significantly increased,and the expression of LC3 Ⅱ and Beclin-1 protein and mRNA,JNK,and p-JNK was up-regulated in the other three groups.Brain water content and NDS were significantly decreased,and the expression of LC3 Ⅱ and Beclin-1 protein and mRNA,JNK,and p-JNK was down-regulated in TBI + Sev and TBI + Sev + SP groups as compared with group TBI,and in TBI + Sev + SP group as compared with TBI + Sev group.Conclusion The mechanism by which sevoflurane preconditioning mitigates TBI is related to inhibiton of activation of JNK signaling pathway and decreased autophagy in rats.

Objective To evaluate the changes of endometrial microcirculation between pre-and postmenopause with magnetic resonance dynamic contrast-enhanced perfusion weighted imaging (MR DCE-PWI)and intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI).Methods Thirty-three patients with normal endometrium (premenopause in 21 and postmenopause in 12)confirmed by pathology underwent DCE-PWI,IVIM-DWI and conventional MRI.Quantitative parameters of DCE-PWI and IVIM-DWI in the endometrium were analyzed and compared between pre-and postmenopause groups.Results The DCE-PWI parameters were significantly higher in premenopause group than those in postmenopause one with significant differences in Ktrans (0.161±0.081)min-1 vs (0.097±0.054)min-1 , Kep (0.285±0.145)min-1 vs (0.184±0.119)min-1 and IAUC60 (20.854±10.695)mmol·kg-1 ·s vs (10.481±6.253)mmol·kg-1 ·s. No significant differences were found between the two groups in IVIM-DWI parameters including D,D* and f values.Conclusion DCE-PWI,rather than IVIM-DWI,can be used to quantitatively evaluate the changes of endometrial microcirculation between pre-and postmenopause.

Objective To investigate the efficacy and safety of tranexamic acid on bleeding in rheumatoid arthritis (RA) patients undergoing total hip arthroplasty (THA). Methods A retrospective study was performed in 197 RA patients (Steinbrock?er III-IV) following primary unilateral THA from June 2012 to June 2014. The patients were divided to three groups based on the regimen of tranexamic acid:68 patients received a single intravenous dosage of 15 mg/kg tranexamic acid 20 min prior to opera?tion (single dose group);74 patients received an intravenous dosage of 15 mg/kg preoperatively and a second dosage of 10 mg/kg 3 hours postoperatively (repeated dose group);the other 55 patients didn't receive tranexamic acid (control group). The primary out?comes were total blood loss, transfusion rate, the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). The sec?ondary outcomes were postoperative drainage, hemoglobin (Hb) drop on third day postoperatively and other wound related compli?cations. Results There was less total blood loss (816.80 ± 245.09 ml vs 975.15 ± 216.33 ml vs 1 295.68 ± 263.85 ml), drainage (221.60 ± 70.05 ml vs 337.20 ± 113.10 ml vs 479.74 ± 120.66 ml), transfusion requirement (5.41%vs 10.29%vs 25.45%) and Hb drop (2.71±0.74 g/dl vs 3.18±0.62 g/dl vs 3.83±0.70 g/dl) in experimental group when compared with control group. And the effect was better in repeated dose group, with less total blood loss (816.80 ± 245.09 ml), less transfusion requirement (5.41%) and less postoperative drainage (221.60±70.05 ml). No episode of DVT or PE occurred in either group. There were 8 wound complications in single dose group, 6 in repeated group, and 8 in control group, and there were no statistically difference. Conclusion Intrave?nous administration of tranexamic acid was effective and safe on decreasing blood loss and transfusion requirement in RA patients following THA. Compared with a single dosage of tranexamic acid preoperatively, a second dosage of tranexamic acid 3 hours post?operatively was recommended.

Background and purpose:The role of urine N-telopeptides of type Ⅰ collagen(uNTX) and serum bone spesifi c alkaline phosphatase(sBAP)was confi rmed in osseous metastasis of solid tumors. The aim of this article was to study their role in multiple myeloma (MM). Methods:Thirty eight MM patients (22 new diagnosed, 12 relapsed or refractory, 4 plateau patients ) were examined. Ten age-matched healthy volunteers were used as controls. Urine and serum samples were taken from all patients and controls before therapy, after 3 months and 6 months chemotherapy. Urine samples of NTX, serum samples of BAP were measured with enzyme-linked immunosorbent assays (ELISA). Results:Urine NTX concentrations were signifi cantly higher in newly diagnosed and relapsed or refractory patients than that in plateau patients and controls. Serum BAP concentrations were signifi cantly lower than that in plateau patients and controls. In newly diagnosed patients, urine NTX values were signifi cantly higher in stage Ⅲ disease than in stage Ⅰ/Ⅱdisease, serum BAP values were signifi cantly higher in stage Ⅰ/Ⅱ disease than stage Ⅲ disease. At the third month, urine NTX were signifi cantly lower and serum BAP were signifi cantly higher as well as at the sixth month. But osteolytic lesions in X–ray had no change at the sixth month. Conclusions:Bone turnover markers uNTX, sBAP and bone destruction are closely interrelated in multiple myeloma, they change much earlier than X-ray. They are useful in monitoring progression and the therapeutic effect of myeloma.

Objective:To evaluate arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors in the treatment of tibial eminence fracture.Methods:The 23 patients were retrospectively analyzed who had been treated at Department of Orthopedics, Beiing Shunyi District Hospital for tibial eminence fractures by arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors from October 2015 to December 2019. They were 15 males and 8 females, aged from 12 to 55 years (average, 35.5 years). All the injuries were unilateral (14 right and 9 left sides). According to the modified Meyers-McKeever classification, 2 cases belonged to type Ⅱ, 18 cases to type Ⅲ and 3 cases to type Ⅳ. Range of motion of the knee, Lysholm and International Knee Documentation Committee (IKDC) scores were observed before surgery, 1 month and 12 months after surgery. The anterior tibial slope angle (ATSA) on CT was measured preoperatively and 1 month after surgery for evaluation of fracture reduction.Results:All the 23 patients were followed up for an average of 23 months (from 12 to 52 months). Postoperatively, limited knee movement was observed in 2 patients and non-anatomic reduction in one patient. At 1 month and 12 months after operation, the Lysholm scores (61.4 ± 3.5 and 90.4 ± 4.3) and IKDC scores (69.6 ± 4.2 and 88.5 ± 3.0) were significantly improved compared with the preoperative values (45.4 ± 6.8 and 49.6 ± 3.9, respectively) ( P<0.05). ATSA was significantly restored from preoperative 4.2° ± 5.7° to -11.7° ± 2.9° at 1 month after operation ( P<0.05). Conclusion:In the treatment of tibial eminence fracture, arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors can achieve anatomical reduction and firm fixation, leading to satisfactory surgical outcomes.

Objective:To compare the clinical efficacy and safety of nalmefene hydrochloride injections and Naofukang injections in the treatment of the patients with severe head injury. Methods:Totally 60 cases of patients with severe head injury were randomly divided into the observation group and the control group. The two groups were all given the conventional therapy, such as dehydration, expansion and anti-infective therapy. On the basis of the conventional therapy, the observation group was treated with nalmefene hydro-chloride injections, 0. 4-0. 6 mg in 0. 9% sodium chloride injections, ivd, qd, while the control group was given Naofukang injections, 4-9 g in 5% or 10% glucose injections, ivd, qd. The treatment course was 2 weeks. After the 3-day treatment, the heart rhythm, the incidence of respiratory abnormalities and intracranial pressure were compared between the two groups. After the 10-day treatment, the total efficacy and complications in the two groups were also recorded and compared. Results:After the 3-day treatment, the incidence of abnormal heart rhythm and respiratory abnormalities in the observation group were significantly lower than that in the control group (P<0. 05), the intracranial pressure in the observation group was better than that in the control group (P<0. 05). After the 10-day treatment, the total effective rate of the observation group was 93. 3%, which was much higher than that in the control group ( P<0. 05). After the treatment, the incidence of respiratory infections, acid-base unbalance and upper gastrointestinal bleeding in the ob-servation group was significantly lower than that in the control group (P <0.05). Conclusion: The clinical efficacy of nalmefene hydrochloride injections in the treatment of patients with severe traumatic brain injury is significant with promising safety, which is bet-ter than that of Naofukang injections.

Objective To evaluate the effects of dexmedetomidine on the development of perioperative cardiovascular events in elderly patients.Methods Forty-eight patients of both sexes,aged 65-85 yr,with body mass index of 19.5-25.3 kg/m2,of American Society Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective abdomninal or lower limb surgery under general anesthesia,were divided into 2 groups (n =24 each) using a random number table:general anesthesia group (group G) and dexmedetomidine plus general anesthesia group (group D).In group D,dexmedetomidine was intravenously infused in a loading dose of 0.25 μg/kg over 10 min and then continuously infused at 0.2 μg · kg-1 · h-1 until 30 min before the end of surgery.The equal volume of normal saline was intravenously infused instead in group G.At 1 day before surgery and 1 and 2 days after surgery,dynamic electrocardiogram was used to monitor heart rate variability including standard deviation of normal-to-normal intervals,standard deviation of the average 5-min normal-to-normal intervals,and root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals.The development of intraoperative cardiovascular events and requirement for vasoactive drugs were recorded,and the development of cardiovascular events within 2 days after surgery was also recorded.Results Compared with group G,standard deviation of normal-to-normal intervals and standard deviation of the average 5-min normal-to-normal intervals at 1 and 2 days after surgery and root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals at 2 days after surgery were significantly increased,the total incidence of intraoperative cardiovascular events and requirement for vasoactive drugs were decreased,and the total incidence of cardiovascular events within 2 days after surgery was decreased in group D (P ＜0.05).Conclusion Dexmedetomidine can reduce the development of perioperative cardiovascular events in elderly patients.