ObjectiveTo study the application of lean management in operation processing of central sterile supply department(CSSD)in order to promote its efficiency and quality improvement.MethodsFrom collecting international and domestic related literatures of lean thoughts, lean medical management, summarizing and introducing the application of lean management in medical domain, discussing the implementation of lean management in CSSD.ResultsThe implementation of lean management was ensured to be successful through establishing value stream mapping, mobile operation, waste elimination, obtaining support of top management, reforming of organization construction, placing personal and technological operation.ConclusionsThe flow of operation can be improved, the business model will be re-build and the efficiency and quality of CSSD can be improved by establishing the value stream mapping in CSSD and using the information technology.

Objective:To study the transdermal permeability of Psoralen (Pro) and Isopsoralen (Isopro). Methods:V C two compartment was adopted to research the permeability deferences between Pso and Isopso in nude mouse skin in vitro, and investigated the effect of penetration enhancers, such as EtOH, azone and glycerol on the permeability of them. Results: Pso and Isopso are suitable compounds for transdermal delivery system and the permeability coeffient of Isopso is larger than that of Pso. 10% EtOH-1% Azone greatly increased the permeability coefficient. Conclusion: The results can offer reference for Psoralea corylifolia TDS.

Object To study the degree of deacetylation of chitosan and its residual amount left over in the clarified products when chitosan was used as a clarificant. Methods The free amino group in the deacetylated chitosan was determined by linear titration. Results The degree of deacetylation of chitosan was found to be about 80%. The residual amounts left over in the clarified products were lower than 10 -4 . Conclusion The results suggested that it is feasible to use chitosan as a clarificant for refining water extract of TCM.

Objective: To study the effects of clarificant chitosan on contents of zinc,manganese,calcium and heavy metal lead in the water extraction liquid of chinese herbal medicines. Methods: The contents of these elements were determined by atomic absorption spectrophotometry.Results: The results indicated that the chitosan clarification could raise the transfer rate of some inorganic elements such as zinc,manganese and calcium as compared with water extraction and alcohol precipitation method,And it could also reduce the amount of heavy metal lead.Conclusion: chitosan as a clarificant is promising in the field of refining water extraction liquid of chinese herbal medicines.

Objective To investigate the effects of sodium aescinate(SA)on oxidative stress and pulmonary function during acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods One hundred and twenty patients with COPD were randomly divided into two groups:the control group(n =60) and the treatment group(n =60).All patients were treated with routine anti-infection,oxygen inhalation,relieving phlegm and anti-asthma The treatment group took SA in addition to the routine beteropathy.The changes of serum SOD,MDA,GSH-Px,T-AOC,pulmonary functions and 6 minute walk distance(6MWD) were detected before and after two-week treatment in patients of the two groups to compare with 60 healthy subjects.Results The total effective rate in the treatment group was 91.67％,while 76.67％ in the control group.The difference was statistically significant(x2 =5.065,P ＜0.05).Serum MDA level in both groups were comparatively higher than the healthy controls(9.25±1.55) μmol/L vs.(9.74±1.50) μmol/L vs.(2.06±0.29) μmol/L,P ＜0.001),while the levels of SOD,GSH-Px and T-AOC were lower than the healthy controls[SOD:(91.14±9.54) kU/L vs.(90.61±8.01) kU/L vs.(116.63±6.57) kU/L; GSH-Px:(139.38±36.56) U vs.(137.57±34.19) U/L vs.(189.34±35.54) U/L; T-AOC:(6.48±1.15) kU/L vs.(6.39±1.13) kU/L vs.(13.34±1.23)kU/L;P < 0.001].After treatment,all indexes of the two groups were obviously ameliorated in comparison with before treatment(P ＜ 0.001),but the level of MDA[(4.56±1.39) μmol/L]in the treatment group decreased more greatly than in the control groups(P ＜ 0.001).The levels of SOD[(103.85±7.07) kU/L],GSH-Px[(169.65±34.51) U/L],T-AOC[(10.52±1.09) KU/L],forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)[(60.49±6.11)％],FEVI％[(76.62±6.35)％]and 6MWD [(394.83±10.11)m]increased considerably more than those in the control group(P ＜ 0.001).Conclusion Oxidative stress might be involved in the course of acute exacerbation of COPD.Sodium aeseinate can improve the pulmonary functions by ameliorating the oxidative stress during acute exacerbation in patients with COPD.

Objective To explore the effect of inflammation and autoimmunity in peripartum cardiomyopathy(PPCM). MethodsA total of82 PPCM patients and 100 normal delivery patients were randomly selected and conducted epidemiological survey.High-sensitivity Creaction protein(hs-CRP),troponin I,human antimyocardial antibody IgG(AMA-IgG),Coxsackie B virus IgG(CBV-IgG)and adenovirus antibody IgG(ADV-IgG)were detected with ELISA. ResultsCompared with control group,PPCM patients had older age,higher pressure,higher proportion of cesarean section and infection.The levels of serum hs-CRP,cTNI,and leucocyte were markedly higher in PPCM patients compared with control.The positive proportion of AMA-IgG and CBV-IgG was significantly increased(P<0.01)in PPCM patients compared with the control.Logistic regression showed that infection(OR=2.87,95%CI 1.15-5.24),increased hs-CRP(OR=1.86,95%CI 1.08-4.02)and positive AMA-IgG(OR=2.68,95%CI 1.19-4.85)were independent risk factors for PPCM. ConclusionsInflammation and autoimmunity play an important role in peripartum cardiomyopathy.

Objective To explore the short to long term surgical outcomes and treatment experiences of esophageal atresia（EA）.Methods The clinical data of EA inpatients in our hospital from 2006 to 2009 were reviewed retrospectively.The birth weight,main associated anomalies,details of management,complications and outcomes were discussed.Main risk factors were evaluated with major prognostic classification systems.Results Totally 48 consecutive infants with EA were identified from 2006 to 2009,male 33（69%）,female 15（31%）.Mean birth weight was 2 668 g（range 1 700 g to 3 800 g）.All received primary operation.Complications included pneumonia,anastomotic leakage（16%）,tracheoesophageal fistula,incision sepsis（11%）,delayed tracheoesophageal fistula（7%）,stricture（10%）,and gastroesophageal reflux（GER）（67%）.Mortality was 12.5%,mainly due to severe pneumonia and complex cardiac anomalies.Conclusion Most patients with esophageal atresia could be cured after primary operation with excellent outcomes.The main factors for mortality were complex cardiac anomalies,aspiration and pneumonia.The main mid-term complications were GER and stricture.

BACKGROUND:Some studies have shown that hyperlipidemia can lead to osteoporosis in rats, and exercise can increase the bone mineral density of rats. But the effect of short-time exercise on the bone mineral density of hyperlipdemia induced osteoporosis male rats is unclear yet.
OBJECTIVE:To investigate the effect of short-time middle-load treadmil exercise on the bone mineral density of hyperlipidemia male rats.
METHODS:Twenty-six male Sprague Dawley rats were randomly divided into three groups:control group (n=8), hyperlipidemia group (n=9) and exercise intervention group (n=9). The rats in the control group were fed with normal diet, and the rats in the other two groups were fed with high-fat diet and lasted for 4 weeks to establish the hyperlipidemia models. The rats in the exercise intervention group received treadmil exercise 5 days per week for 4 weeks according to the fol owing schedule:15 m/min for 15 minutes in the 1st week, 15 m/min for 20 minutes in the 2nd week, and then 20 m/min for 20 minutes in the last 2 weeks. Slope grade of the treadmil was adjusted at 0°. At the end of experiment, the rats were sacrificed, and the bone mineral density of the right femur, the morphological change of tibia, the level of plasma alkaline phosphates and calcium content were examined.
RESULTS AND CONCLUSION:Compared with the control group, the distal femur bone mineral density in hyperlipidemia group was significantly decreased (P<0.05);histological analysis of the proximal tibia showed thinning and loss of bony trabeculae arrangement, the gap was widened, and a large amount of fat cel s infiltration or integration into vacuoles in the marrow was observed, the plasma alkaline phosphates was significantly increased (P<0.01). Compared with the hyperlipidemia group, distal femur bone mineral density in the exercise intervention group was increased (P<0.05). After adjust body weight, the whole femur bone mineral density was significantly greater in exercise intervention group compared to hyperlipidemia group (P<0.05). The histological analysis of the proximal tibia showed that the spaces of bone trabeculae decreased and the structure of bone trabeculae compacted, the alkaline phosphates activities were increased (P<0.01). There were no significant differences in serum calcium and phosphates levels between groups. The results show that short-time middle-load treadmil exercise can increase the bone mineral density of hyperlipidemia male rats.

Objective To determine the correlation between serum asymmetric dimethylarginine (ADMA) and non-spoon-shaped blood pressure of non-dialysis chronic kidney disease (CKD) patients,also to observe the impact of the serum ADMA level on the structure and function of left ventricle.Methods One hundred and twenty cases of non-dialysis CKD patients underwent 24-hour ambulatory blood pressure monitoring were divided into three groups:CKD1-2,CKD3,CKD 4-5.Serum ADMA concentration was measured using liquid chromatograph and other clnical data such as uric acid (UA),left ventricular mass index (LVMI),24 h urine protein,and high-sensitivity C-reactive protein (hs-CRP) were collected for further statistical analysis.Results (1) With the decline of renal function,ADMA concentration was increased,from CKD 1-2 (1.70±0.48) μmol/L rose to CKD 4-5(4.46±1.56) μmol/L (P ＜ 0.05).(2)There were 42 cases of CKD patients with hypertension and 78 cases of CKD patients with normal blood pressure.The serum ADMA levels in hypertension group was significantly higher than those in non-hypertensive group [(3.53±1.70) μmol/L vs (2.01±0.65) μmol/L,P ＜ 0.05].(3)There were 50 cases of non-spoon-shaped normotensive CKD patients and 28 cases of spoon-shaped normotensive CKD patients.Serum ADMA level and LVMI in non-spoon-shaped group were significantly higher than that in spoon-shaped group when kidney functions appeared to be equal (P ＜ 0.05).(4)Serum ADMA level was positively correlated with UA(r=0.352,P ＜ 0.01),LVMI (r =0.345,P＜ 0.05),24 h urine protein(r =0.200,P ＜ 0.05),and high-sensitivity C-reactive protein (r =0.309,P ＜ 0.01),but negatively correlated with the left ventricular ejection fraction (LVEF)(r =-0.329,P ＜ 0.01) and estimated glomerular filtration rate (eGFR)(r =-0.011,P ＜ 0.01).Multiple regression results showed that eGFR,UA,LVMI,hs-CRP,24 h urine protein were associated with ADMA level.The regression equation was Y =1.991-0.011 × [eGFR] + 0.002 × [UA] + 0.008 × [LVMI] + 0.036 ×[hs-CRP]-0.084× [24 h urinary protein].Conclusions Serum ADMA level begins to increase in early stage CKD and it progressively increases with the decline of renal function,also the non-spoonshaped blood pressure ratio and the left ventricular damage increase.Kidney function,urine protein and microinflammatory state may impact on the serum ADMA level.