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 Investigating the relationship between the incidence of Primary Acute Cerebral Infarction (PACI) and seasonal variation to employ measures to prevent PACI with climate change. Methods A retrospective analysis of patients diagnosed with PACI between 2009 and 2013 in the department of Neurology of Second hospital of Tian Jin Medi-cal University (n=1 198 patients) was carried out. Combined with the general clinical data, we analyzed seasonal, monthly and weekly variation among PACI incidents. Results The incidence of PACI increases over years between 2009 to 2013 (P ＜ 0.01). Significant difference of incidents of PACI was observed between each season (P=0.047). Incidence of PACI peaked in winter(30.33 ± 9.63/month), while bottomed in spring(21.83 ± 5.36/month). Significant difference of incidents of PACI was also observed between each months(P=0.010). The monthly incidence was highest in January and February (33.25 ± 9.62/month)and lowest in March and April(20.75 ± 4.89/month). The seasonal variation was only found in the pa-tients who are complicated with pulmonary infection (P＜0.01) regardless of the presence or absence of other risk factors, such as smoking, drinking ,hypertension, coronary heart disease, and diabetes mellitus. The weekly variation of PACI was on-ly significant in patients younger than 65 years old(P=0.043). The peak incidence among a week was Monday(17.86%),and incidence bottomed on Friday (13.36%). Conclusion Our study revealed that the incidence of PACI increase over year be-tween 2009 to 2013 and it shew a characteristic variation with respect to season, month and week. Based on these results, we can formulate prevention measures accordingly.

Objective To discuss whether Saccharomyces boulardii sachets can improve the eradication rate and reduce some untoward effects of gastrointestinal tract when adding in the Helicobacter pylori (Hp) standard quadruple therapy.Methods 249 cases infected with Hp were randomly divided into control group(124 cases) and treatment group (125 cases).The control group was treated with standard quadruple therapy:colloidal bismuth pectin capsules,100 mg,tid,po;furazolidone tablets,0.1 g,bid,po;amoxil capsule,1 g,bid,po;rabeprazole sodium enteric-coated capsules,20 mg,qd,po.The treatment group was treated with Saccharomyces boulardii sachets(0.25 g,bid,po)besides.Both groups were treated for 4 weeks.Evaluate the effect of Hp eradication rate by using the method of intent of treatment (ITT) analysis and consistent scenario set (PP)analysis.Results According to the ITT analysis,the eradication rate of control group was 89.52%,and that of treatment group was 96.00%.According to the PP analysis,the eradication rate of control group was 90.00%,and the rate of treatment group was 97.39%.Both analysis results showed the eradication rate of Hp in treatment group was significantly higher than control group(P<0.05).As for reducing the untoward effects such as nausea,inappetence,diarrhea,astriction and erythra,control group was obviously lower than treatment group (P<0.05).Conclusion Compared with standard quadruple therapy only,adding Saccharomyces boulardii sachets can significantly improve the eradication rate of Hp and obviously reduce the untoward effects such as nausea,inappetence,diarrhea,astriction and erythra.It is worth to be generalized and applied in clinical practice.

Objective:To evaluate 131I adjuvant therapy in B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E mutant patients with non-distant metastatic papillary thyroid cancer (PTC). Methods:From January 2008 to January 2019, a total of 181 PTC patients (65 males, 116 females, age: (38.9±11.8) years) with non-distant metastases from Peking Union Medical College Hospital were retrospectively enrolled. All patients received only one time 131I therapy with complete clinicopathological information, data of follow-up (median time: 63 months) and assessment of response to therapy. Patients were divided into mutant and wild type group in terms of BRAF V600E status or ablation group (1.1 GBq) and adjuvant therapy group (3.7-5.5 GBq) in terms of different 131I dosage. Clinicopathological features and the response to therapy were compared between different groups by using independent-sample t test, Mann-Whitney U test and χ2 test. Results:The levels of preablative stimulated thyroglobulin (ps-Tg) in the BRAF V600E mutant type group ( n=150) was significantly higher than that in the wild type group ( n=31; 6.32(0.90, 8.70) vs 3.92(0.40, 4.40) μg/L; z=-2.413, P=0.016), however, there were no significant differences in other clinicopathological characteristics (including age, sex, tumor size, multifocality, capsule invasion and N staging) between the two groups ( t=-0.663, z=-1.151, χ2 values: 0.003-1.491, all P>0.05) and the therapeutic response was also not different between the two groups( χ2=1.094, P=0.778). Of 81 patients who received 131I adjuvant therapy, the ps-Tg level of BRAF V600E mutant type group ( n=69) was higher than that of the wild type group( n=12; 8.70(1.30, 11.80) vs 3.40(0.30, 4.50) μg/L; z=-2.194, P=0.028), while the therapeutic response was not different between the two groups ( χ2=1.792, P=0.617). Compared with BRAF V600E mutant patients received 131I ablation ( n=81), BRAF V600E mutant patients received 131I adjuvant therapy ( n=69) had larger tumors (1.52(0.95, 2.00) vs 1.21(0.60, 1.50) cm; z=-2.728, P=0.006), more advanced N staging ( χ2=11.460, P=0.003) and higher ps-Tg level (8.70(1.30, 11.80) vs 4.34(0.50, 5.30) μg/L; z=-3.314, P=0.001), but the therapeutic response was not different between the two groups ( χ2=6.478, P=0.091). Conclusion:131I adjuvant therapy may improve the longer-term response to therapy in BRAF V600E mutant PTC patients with lager tumors, more advanced N staging and higher ps-Tg level.

Objective To study the rehabilitation effect of Bellidifolin for injuried sciatic nerve,and to explore whether ciliary neurotro-phic factor ( CNTF) is involved in this mechanism. Methods The right sciatic nerver of 225 male wistar rats was cut and sewed under mi-croscopy. Rats were devided into 5 groups,as control group,Bellidifolin 25 mg group,50 mg group、75 mg group and Mecobalamin group. The control group were injected sodium chloride,other groups were injected different dose of Bellidifolin and Mecobalamin. 1,3 and 5 weeks later, the motor nerve conduction velocity( MNVC) and gastrocnemius muscle cross-sectional area were detected,CNTF positive area were analysed by immunohistochemical method. Results There were differences among bellidifolin groups,control group and mecobalamin group in Nerve conduction velocity. Within Bellidifolin groups,50 mg group compared with 25 mg and 75 mg groups,there were statistically differences( P=0. 025). Three weeks after operation,gastrocnemius muscle cross-sectional area of control group,mecobalaming grop and Bellidifolin 25 mg group,50 mg group,and 75 mg group were(455. 06 ± 29. 38),(679. 03 ± 81. 48),(465. 31 ± 71. 55),(670. 24 ± 91. 26) and (669. 28 ± 78. 54) respectively,compared with control group and Bellidifolin 25 mg group,others had a significant difference(P<0. 05). CNTF expres-sion showed billidifolin 50 mg group are higher than others(P<0. 05). Conclusion Bellidifolin can improve the rehabilitation of injured sciatic nerve. CNTF is involved in this mechnism.

Objective To study whether bellidifolin has rehabilitation effect on injured sciatic nerve rats,and whether ciliary neurotrophic factor (CNTF) is involved in this mechanism.Methods 225 male wistar rats were made to be sciatic nerve injured models,with right sciatic nerve being cut and sewed under microscopy,left sciatic being sham.Rats were randomly divided into control group,bellidifolin 25 mg,50 mg,75 mg groups and mecobalamin group,with 45 rats in each group.Rats in control group were just injected sodium chloride,others were intra-peritonealiy injected different doses of bellidifolin and mecobalamin after operation.Results Three weeks after operation,SFl of control group,mecobalaming group,bellidifolin 25 mg,50 mg and 75 mg group were-84.35± 4.87,-45.20±2.30,-70.42±4.21,-57.73±3.46 and-64.38±4.38 respectively.Compared with control group,others showed significant differences (P＜0.05).There were statistically differences between bellidifolin groups and mecobalaming group(P＜0.05).Within bellidifolin groups,50 mg group showed difference compared with 25 mg and 75 rg groups(P=0.031).TSW results also showed differences among bellidifolin groups,control group and mecobalaming group.There were statistical differences among bellidifolin groups(P＜0.05).Each groups with immunohistochemistry analysis,CNTF expression showed statistically differences among bellidifolin 50 mg group and 25 mg,70 rg groups,Bellidifolin 50 mg group was higher than others(P＜0.05).Conclusion Bellidifolin can promote the recovery of injured sciatic nerve,especially the concentration of 50 mg bellidifolin,and CNTF is involved in the rehablitation process.

Objective To investigate Danhong in improving the movement function of reperfused rat after stroke. Methods Rats to make middle cerebral artery occlusion model,after 24 hours of reperfusion were divided into control group,high dose and low dose of Danhong groups and Venorruton group randomly. Rats in Control group were injected saline. High and low dose group were injected DanHong according to their weight,high dose as 14. 4 mg/kg,low dose as 3. 6 mg/kg. Venorruton group were injected Venorruton as 0. 04 g/kg. The infarcted square of rat brain was measured,the rats were tested with walking wood bar and two fore limb grasp strength. Results Rat infarcted squre in 24 hours and 3 days,control groups is the biggest,compared with others,there are statistically difference(P<0. 05). Score in each group of walking wood bar in 3rd days are (1. 30 ± 0. 91),(3. 78 ± 1. 72),(4. 18 ± 2. 05),(4. 63 ± 2. 45). Compared between control and other druge groups,there are statistically differnec(P<0. 05). There are statistically differences between control and other groups in two fore limb grasp testing(P<0. 05). Conclusion Danhong has the same effect which can improve the movement function to stroke rat as Venorruton.

Objective To observe the effect of sodium butyrate on the invasion and migration of human salivary gland ade‐noid cystic carcinoma cell line ACC‐2 in vitro and to investigate the underlying mechanisms .Methods The cultured ACC‐2 cells were treated with different concentrations of sodium butyrate for 24 h ,and detected the viability rate of the cells by methyl thiazolyl tetrazolium(MTT) assay ;the drug′s influence on invasion and migration on ACC‐2 were detected by Transwell experiment ,while the protein and mRNA expression of HMGB1 and TLR4 explored by Western‐blot and RT‐PCR assay ;the relationship between TLR4 expression and HMGB1 was investigated .Results Compared with control group ,0 .625 ,1 .250 ,2 .500 ,5 .000 ,10 .000 mmol/L groups of sodium butyrate inhibited the proliferation of ACC‐2 cells(P<0 .05);the influence of sodium butyrate on the in‐vasion of ACC‐2 cells of all groups had no significant difference(P>0 .05);only 2 .500 ,5 .000 and 10 .000 mmol/L groups inhibited ACC‐2 cells migration and down‐regulated the protein and mRNA of HMGB1 and TLR4(P<0 .05) .Correlation analysis showed a positive correlation between the TLR4 protein and HMGB1 protein(r=0 .810 ,P<0 .05) .Conclusion Sodium butyrate could inhib‐it ACC‐2 cells proliferation and high concentration gropes inhibit ACC‐2 cells migration ,while reducing HMGB1 and TLR4 mRNA and protein expression ,suggesting that NaB might inhibite ACC‐2 cells migration through down‐regulated the mRNA and protein expression .

Objective To establish a mouse model of circulating tumor cells (CTCs) by applying mouse hepatoma Hapa 1-6 cells.Methods 108 healthy male C57BL/6 mice were randomly divided into 3 groups according to their body weights.Hepa 1-6 cell suspension was intravenously injected to each mouse in the three groups at a concentration of 1×106,5×106 and 1×107/mL,0.2 mL per mouse,respectively.Blood samples were collected from the mice on the 1st,5th,9th,13th,17th and 21st days after tumor cell injection.The number,ratio and relative inhibition rate of CTCs were calculated in 20,000 nucleated cells.The mortality of mice was recorded.②80 male C57BL/6 mice were averaged into 2 groups according to their body weight: control and sorafenib tosylate groups.0.2 mL of Hepa 1-6 single cell suspension was injected to each mouse through the caudal vein at a concentration of 5×106/mL.The mice were gavaged with sorafenib tosylate (50 mg/kg) for 21 days and blood samples were collected at the 3rd,8th,15th,and 21st days for CTC assessment.Results For the 1×106/mL group,the CTC inhibition rate was 25.1%,18.1%,8.9%,4.4%,2.9% and 0.3% on the 1st,5th,9th,13th,17th and 21st days,respectively,and all the mice were alive.For the 5×106/mL group,the CTC inhibition rate was 40.4%,35.4%,15.4%,9.0%,6.6% and 4.1% on the 1st,5th,9th,13th,17th and 21st days,respectively,and all the mice were alive.For the 1×107/mL group,the CTC inhibition rate was 39.1% and 33.5% on the 1st and 5th days,respectively.Some mice died immediately after intravenous injection and all mice died within 7 days.②The relative clearance of CTCs was-7.5%,4.6%,55.3% and-94.5% on the 3rd,8th,15th and 21st days of sorafenib tosylate administration.Compared with the control group,there were significant differences among the three groups (P<0.05 or P<0.01).Conclusions A mouse model of circulating hepatoma cells has been established by intravenous injection of 0.2 mL of 5×106/mL mouse Hepa 1-6 cell suspension.This mouse model can be used for screening and evaluation of drugs for circulating tumor cell inhibition.

Objective To evaluate the changes in the right ventricular systolic and diastolic function during the early period after cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG).Methods Eighteen ASA physical status Ⅱ or Ⅲ patients of both sexes,with coronary heart disease (NYHA Ⅱ or Ⅲ),aged 50-80 yr,weighing 51-96 kg,with left ventricular ejection fraction≥50％,scheduled for elective CABG under CPB,were enrolled in this study.Before splitting of sternum and at 5 min after termination of CPB,the parameters of hemodynamics,cardiac output (CO)and variables of right ventricular function (using transesophageal echocardiography) including tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (RVFAC),tricuspid annular peak velocity during isovolumic contraction (IVV),peak velocity during ejection phases (St),early diastolic peak velocity (Et),late diastolic peak velocity (At),E/Et ratio and Et/At ratio were recorded.Results Compared with the baseline value before splitting of sternum,TAPSE,IVV,St,RVFAC,CO,E,Et and At were significantly increased,and no significant change was found in the parameters of hemodynamics and E/Et and Et/At ratios at 5 min after termination of CPB.Conclusion For the patients undergoing CABG,the right ventricular systolic function is significantly enhanced,and there is no obvious improvement in the right ventricular diastolic function during the early period after CPB.