Objective:To analyze the pros and cons of the US strategic national stockpile ( SNS) from the per-spective of the supply chain and to put forward suitable recommendations for China’s national emergency medicine system. Methods:Literature review and a comprehensive analysis have been utilized to understand the SNS supply chain model and its differences from the Chinese model. Results:From the perspective of the supply chain, the Unit-ed State’s storage of emergency medicine consists of the forward placement of push packages, managed inventory and purchase contracts. The deployment of logistics for emergency medicine must gain approval from the federal government’s “local-state-nation” system, and be conducted at a different time. To transmit information, a large da-tabase, simulation software, and a technical advisory response unit have been established to manage information flow to distribute medicine accurately and promptly. Conclusion:Given the experiences of supply chain management in the US SNS system, it is critical for China to improve the supply chain system of emergency medicine, define the institu-tions and responsibilities within the supply chain, establish disaster relief reserve of emergency medicine and adopt fourth-party logistics for emergency medicine in order to make the China’s emergency preparedness more systemized, standardized, and information-based.

OBJECTIVE: To explore the diagnosis, treatment and surgical approaches of parapharyngeal space tumors. METHOD: This retrospective study consisted of 112 patients with parapharyngeal space tumors underwent surgeries. The data included clinical symptoms and signs, pathological types, imaging examinations, surgical approaches and postoperative complications. RESULT: Computerized tomography (CT), magnetic resonance imaging (MRD and digital subtraction angiography (DSA) made clear the tumor size, localization and its relation to adjacent structures. The postoperative histopathology varied and showed benign in 98 cases consisting of salivary gland tumors (52 cases), neurogenic tumors(33 cases) and other types (13 cases). During the 3 years follow-up period, local recurrence appeared in 3 patients with salivary pleomorphic adenoma and 1 patient with neurofibromatosis. These recurrent tumor cases were cured with second surgery. In 14 patients with malignant tumors reported, 8 cases survived for 5 years, 2 cases (1 adenoid cystic carcinoma and 1 carcinoma in pleornorphic adenoma) recurred in the two and a half years cured with second surgery affiliated radiation therapy through 3 years follow-up time and the rest were followed up 1 to 3 years without recurrence. Peripheral facial paralysis was observed in 25 patients, and 3 patients experienced hypoglossal nerve palsy. Only 1 patient encountered vagus nerve injury, and 2 patients appeared Horner's syndrome, and 4 patients endured Frey syndrome. Gills leakage was discovered in 3 cases and cavity infection was noted in 1 patient. CONCLUSION CT, MRI and DSA were important in the diagnosis and differential diagnosis of parapharyngeal space tumors. The key to successful treatment is knowing the anatomy of the parapharyngeal space, preoperative assessment and appropriate surgical approach.
Adenoma, Pleomorphic ; complications ; Carcinoma, Adenoid Cystic ; complications ; Diagnosis, Differential ; Facial Paralysis ; complications ; Horner Syndrome ; complications ; Humans ; Magnetic Resonance Imaging ; Neoplasm Recurrence, Local ; Pharyngeal Neoplasms ; diagnosis ; therapy ; Pharynx ; pathology ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Salivary Gland Neoplasms ; complications ; Tomography, X-Ray Computed

With the development of biological techniques,the study on the pathogenesis of disease-causing genes of congenital cataracts has substantial progress.Some positive results of screen of mutation gene in congenital cataract family has been reported,but the report of negative result is rate.ObjectiveThe present study attempts to screen the mutation of CRYAA,CRYAB,CRYA1/A3,CRYBB2,CRYGC and CRYGD gene in a Chinese family with autosomal dominant congenital cataract. MethodsThe periphery blood samples were exacted from 8 patients of 4 generations of with congenital cataract in this family.The complete coding region and intron spliced sites of CRYAA,CRYAB,CRYA1/A3,CRYBB2,CRYGC and CRYGD were amplified with polymerase chain reaction (PCR),and the products of PCR were directly sequenced.The control blood samples were from 10 normal subjects.This study followed the Declaration of Helsinki.Written informed consent was obtained from all of the patients.ResultsThe patients were found in each generation in this family and the mode of inheritance was in accordance with the characteristic of autosomal dominant inheritance.The sequence of amplified genetic fragments of CRYAA,CRYAB,CRYA1/A3,CRYBB2,CRYGC and CRYGD genes were inaccordance with those of normal subjects and GeneBank.No any mutation loci was found in all of the patients of this family.ConclusionCRYAA,CRYAB,CRYA1/A3,CRYBB2,CRYGC and CRYGD genes is not the causing-disease genes in this family.

Objective To investigate the clinical effect of ropivacaine hydrochloride at 0.25%, 0.375% and 0.5% concentration for lower limb nerve block anesthesia.Methods75 cases of lower extremity nerve block anesthesia from Ningbo Zhenhai District Hospital of traditional Chinese Medicine from September 2014 to February 2015 were enrolled in the course of the study, they were divided into three groups: group 0.25%, the equivalent number of 0.375% and 0.5% groups, and three groups of patients were made with a concentration of 0.25%, 0.375%, 0.5% ropivacaine hydrochloride for lower extremity nerve block anesthesia;the clinical data of three groups were analyzed retrospectively, observation of three groups of patients with lower limb nerve block effect.ResultsThe results showed that 0.25% groups of patients in the motor block time was (36.8±5.9) minutes, motor block in patients with a total of 7 cases, with nerve block in patients with a total of 11 cases.0.375% groups of patients in the motor block time was (23.1±4.3) minutes, motor block in patients with a total of 14 cases, with nerve block in patients with a total of 18 cases.0.5% groups of patients in the motor block time was (20.6±5.7) minutes, motor block in patients with a total of 16 cases, with nerve block in patients with a total of 18 cases.Available block time of 0.375% groups of more than 0.5% groups, less than 0.25% groups;0.375% motor block group was 56.0%, higher than the 0.25% group, lower than the 0.5% group;the 0.375% group and 0.5% group of nerve block ratio is same, higher than the 0.25% group, the difference was statistically significant (P<0.05).ConclusionThe effect of anesthesia using concentration of 0.375% ropivacaine hydrochloride is relatively good, can reduce the dosage of anesthetic drugs, but also ensure the anesthetic effect, meet the clinical requirement, this method will be applied to.

Objective:To explore the implicit attitude and explicit attitude toward death of college students,and the relationship between the two kinds of attitude.Methods:Totally 65 college studems participated in this study.The Single Category Implicit Association Test (SC-IAT,including cognition,affection and behavior) was used to exam the implicit attitude toward death of undergraduate students.The Death Attitude Profile-Revised (DAP-R,including five dimensions,i.e.,fear of death,death avoidance,death acceptance,escape acceptance,and neutral acceptance) was used to measure the explicit attitude.Results:Data of the SC-IAT indicated that the differences between the mean reaction time of the incompatible task and compatible in all three dimensions and the total SC-IAT were significant (Ps ＜0.01),and both the D scores of the total SC-IAT and three dimensions were larger than zero.The mean score of neutral acceptance was the highest in the five factors of SC-IAT.Relationships between the implicit effect of SC-IAT and the Mean scores of the DAP-R's five factors were not significant(Ps ＞ 0.05).Conclusion:The implicit attitude toward death of college students is negative,the explicit attitude toward death of college students is neutral.The implicit and explicit attitude toward death of college students is incongruent,and they are relatively independent.

Objective To know the correlation about PetCO_2 and PaCO_2, the meanings of PetCO_2monitoring in respiratory failure patients with mechanical ventilation, and then summarize the related nurs-ing points. Methods Divided 112 patients in ICU into the A group(58 eases) and the B group(54 cas-es) according to their station of hemodynamics. Mechanical ventilation were used in both the two groups,PetCO_2 and PaCO_2 were monitored at the same time, and then observed the correlation of PetCO_2 and Pa-CO_2 in both the two groups. Results There was a significant corrlation in the A group about PetCO_2 and PaCO_2, while the correlation in the B group was not significant. Conclusions PetCO_2 and PaCO_2 had sat-isfactory corrlation in patients with stable hemedynamies, PetCO_2 monitoring can take place of PaCO_2 in these patients with its sensitive, atraumatic, consecutive and convient merits.

Objective To evaluate the efficacy of splenectomy plus selective pericardial devascularization under endoscope in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism so as to explore the minimally in-vasive and safer surgical treatment. Methods A secure splenectomy was performed with laparoscope and its supporting devices, and at the same time,the ligation of the left gastric vein and the ligation of esophageal vein perforating vertically into the esopha-gus were also performed in 14 advanced schistosomiasis patients with portal hypertension and hypersplenism. Results Among the 14 patients,the splenic artery was separated and clipped before the treatment of splenic pedicle. One patient was of conversion to open laparotomy for the splenic vein rupture bleeding in the separation. There was no death. Conclusion The operation of sple-nectomy plus selective pericardial devascularization under endoscope is effective,truly minimally invasive,and safe in the treat-ment of advanced schistosomiasis patients with portal hypertension and hypersplenism.

Purpose To exp1ore the c1inicopatho1ogica1 features,diagnosis and differentia1 diagnosis of mu1ti1ocu1ar cystic rena1 ce11 carcinoma( MCRCC). Methods 18 cases of MCRCC were reported by microscopy,immunohistochemistry,differentia1 diagnosis and were fo11owed-up. Results A11 patients were adu1ts inc1uding twe1ve ma1es and six fema1es who aged from 26 to 68 years(mean 55. 6 years). Imaging studies revea1ed a po1ycystic mass,with c1ear boundary. Gross1y,the cut surface of the tumors had more cysts of va-rying sizes,containing serous or b1oody f1uid. Microscopica11y,the cyst wa11s of tumors were often covered with a few simp1e c1ear ce11s,stratified epithe1ium or devoid of epithe1ium. The septa contained aggregates of epithe1ia1 ce11s with transparent cytop1asm which showed gradeⅠ nuc1ear features,these characteristics were diagnostic c1ues of MCRCC. Immunohistochemica11y the c1ear ce11 was positive for CD10,vimentin,EMA and Ki-67 showed 1ow pro1iferative activity. 18 case were fo11owed up,mean fo11ow-up 43 months, no case recurred or with metastasis. Conclusion MCRCC is a rare histo1ogica1 subtype of rena1 ce11 carcinoma with more favorab1e prognosis. It shou1d be distinguished from cystic change of c1ear ce11 rena1 carcinoma and cysts of kidney 1esion.

Objective To explore a medical insurance model for rare diseases and orphan drugs applicable in China.Methods Eleven rare diseases from six disease systems and thirty-five orphan drugs covered were pinpointed for comparative analysis of their present coverage in various medical insurance systems in China.Results The coverage of 35 orphan drugs in the national essential drug list(2009)and the national essential drug list(2012)is 0 and 37.1％ respectively; the coverage in the national essential insurance medicine list is 54.3％ (19 types),and the average coverage in the medicine list for the New Rural Cooperative Medical Insurance Scheme is 33.6％.The study found insufficient rare diseases included in the Basic Medical Insurance Schemes in general.Conclusion The coverage of basic medical insurance for rare disease patients is low in China.In this regard,such measures should be taken to mitigate the economic burden for these patients,namely expanding the coverage of reimbursement list of orphan drugs,building the special reimbursement system of rare diseases and orphan drugs and improving the medical rescue system for rare diseases in China and their medical care level.

Objective To explore the value of joint detection of serum cystatin C (Cys C) ,retinol‐binding protein(RBP) ,urea ni‐trogen(BUN) and creatinine(Cr) in early diagnosis of nephropathy .Methods A total of 230 cases of inpatients with nephropathy form April 2013 to June 2014 were collected and divided into diabetic nephropathy group (130 cases)and hypertensive nephropathy group(100 cases) .Other 200 healthy individuals were collected as healthy control group .The serum levels of Cys C ,RBP ,BUN and Cr were detected by using the Hitachi 7180 automatic biochemistry analyzer .Results Compared with the healthy control group ,the sertum levels of Cys C ,RBP ,BUN and Cr were significantly increased in the diabetic nephropathy group ,and the serum levels of Cys C and RBP were significantly increased in hypertensive nephropathy group ,there were statistically significant differences (P<0 .05);while no statistically significant differences in serum levels of BUN and Cr were found between the hypertensive nephropathy group and healthy control group(P>0 .05) .Positive rates(81 .9% ) of the four indicators in the two nephropathy groups were high‐er than those in the healthy control group ,and the positive rate of joint detection of the four indicators was higher than single detec‐tion in patients with nephropathy .Conclusion Serum RBP and Cys C are sensitive indicators for early renal damage ,and combined with BUN and Cr could increase sensitivity of early diagnosis of nephropathy ,which has significant clinical value .