Outsourcing hospital rear service is an inevitable result of the deepening of hospital reform and each hospital has its own ways of promoting the move. The authors give an account of the measures adopted in their hospital: ①detennining which part of the rear service was to be outsourced first; ②selecting the organizations for cooperation; ③clarifying the obligations of each party and drawing up working standards; ④amplifying necessary rules and regulations; and ⑤strengthening organization and management. Marked effects have been obtained as a result of about half a year's practice: ①optimization of the contingent of temporary workers which has rid the hospital of the worries behind; ②promotion of the change of concepts on the part of the staff which has led to an intensification of the sense of urgency and the awareness of competition; ③improvement of the quality of the rear service; and ④economy of funds.

To study the effect of high altitude on the expression of transforming growth factor beta 1 (TGF ?1) during the healing process of radius fracture, a rat radius fracture model was established at a high altitude. The expression of TGF ?1 in callus was detected using of immunohistochemistry method. It was found that the expression of TGF ?1 in the rats of high altitude group were decreased significantly compared with the low altitude group, especially high altitude might affect the on day 3 and week 3 ( P

Objective: To discuss the influence of the dialysate conductivity of Several of the most common situation,and the method of disposition. Methods:To analyze the composition of each ion in the dialysate, the content of various components;The role of dialysate in the treatment process. Results:Affect the dialysate conductivity will directly affect the quality of dialysis and the safety of dialysis, it must be strictly monitored. Conclusion:In the daily inspection work, we should grasp the key and requirements about dialysate conductivity.

Objective: To optimize the decolorization technology of activated carbon for the plant pigment in Bletilla striata polysaccharide.Methods: Using L 9 (3 4) orthogonal test with activated carbon as the decolorizer, the amount of activated carbon, decolorization temperature, decolorization liquid pH and decolorization time were investigated.The decolorization rate and polysaccharide retention rate were investigated.The decolorization rate and polysaccharide retention rate were taken as the indices.Results: The optimum decolorization technology was as follows: the amount of activated carbon was 1.0%, the decolorization temperature was 40 ℃, the pH value was 5 and the decolorization time was 30 min.Under those conditions, the decolorization rate of Bletilla striata polysaccharide was 91.3% and the retention rate of polysaccharide was 80.6%.Conclusion: The selected decolorization technology of activated carbon can make Bletilla striata polysaccharide get the best decolorizing effect.

Objective To detect the expression of type Ⅰ interferon in monocyte-derived dendritic cells(MoDCs)after Toll like receptor(TLR)3 triggered in patients with chronic hepatitis B(CHB),and to evaluate immune responses of CHB patients and its roles in the mechanisms of persistent infection of hepatitis B virus(HBV)and chronicity of hepatitis.Methods Peripheral blood mononuclear cells(PBMCs)were isolated and purified using magnetic beads(plasma was saved simultaneously)from 26 CHB patients and 18 healthy volunteers(HV).Dendritic cells(DCs)were induced and proliferated in a culture medium with recombinant human granulocyte macrophage colony stimulating factor(rhGM-CSF)and recombinant human interleukin(rhIL-4).EX3s were stimulated with Poly Ⅰ:C and the supernatants were collected at 0 h and 24 h after stimulation.Type Ⅰ interferon(IFN-α and IFN-β)in plasma and supernatants were examined by enzyme linked immunosorbent assay (ELISA).Results The levels of type Ⅰ interferon in plasma were not significantly different in groups of HV and CH B.IFN-α and IFN-β expressions in supernatants before Poly Ⅰ:C stimulation were(80.00±16.15)ng/L,(36.39±13.90)ng/L in CHB group and(76.76±15.90)ng/L,(37.14±13.68)ng/L in HV group,respectively.And there were no statistical differences between two groups(t=1.651,t=0.178;both P＞0.05).IFN-α expressions in supernatants at 24 h after stimulation in two groups were both higher than those before stimulation(at 0 h),but there were no statistical differences(t=1.534,t=1.243;both P＞0.05).IFN-β expressions in supernatants at 24 h after stimulation in HV group was(54.57±16.80)ng/L,which was significantly higher than that at 0 h(37.14±13.68)ng/L(t=4.061,P＜0.05).However,there was no significant difference at 24 h than tht at 0 h in CHB group(t=1.796,P＞0.05).At 24 h after stimulation.IFN-β level was(54.57±16.80)ng/L in HV group,which was significantly higher than that[(41.64±12.57)ng/L]in CHB group(t=2.921,P＜0.05).Conclusions Functions of MoDCs from CHB patients are impaired and MoDCs could not express type Ⅰ interferon normally.Expression of type Ⅰ interferon after TLR3 triggered in CHB patients is mainly IFN-β.

Objective To elucidate the expression of Toll-like receptor 3 (TLR3) on dendritic cells(DCs) in patients with chronic hepatitis B (CHB), and to explore the correlation between hepatitis B virus (HBV) persistent infection and TLR3 expression. Methods Sixty CHB patients (CHB group) and 20 healthy controls (control group) were enrolled. The peripheral blood mononuclear cells (PBMCs) were isolated and CD14~+ monocytes were sorted by immunomagnetic beads. Immature DCs (imDC) were induced and proliferated in vitro and mature DCs (mDC) were obtained after the poly I:C stimulation. The expression of intracellular TLR3 mRNA was detected by real-time polymerase chain reaction (PCR), and surface markers [CD80 and human leucocyte antigen (HLA)-DR] were determined by flow cytometry after 48 h of stimulation. The comparison of quantitative data was done using t test. The qualitative data were compared using chi-square test.Results The mean fluorescence intensities (MFI) of intracellular TLR3 of imDC before poly I:C stimulation in CHB group and control group were 1212.05 ± 250.80 and 1192.95 ± 301.40,respectively, which were not significantly different (t = 0. 280, P>0. 05). While after stimulation,those were 1352.98± 313.67 and 1593. 00± 349. 65, respectively, the latter was significantly higher than the former (t = 2. 880, P<0. 05). The levels of TLR3 mRNA inside mDCs in both groups were increased after poly I:C stimulation, which were 0. 1204 ±0.0267 and 0. 1780 ± 0.0664, respectively in CHB group and control group, and that in control group was significantly higher (t = 3. 909, P<0.05). Furtherly, patients in CHB group were divided into HBeAg(+ ) and HBeAg( -) subgroups.After stimulation, the MFI and mRNA of TLR3 inside mDC were greatly elevated in both subgroups,but there were no difference between these two subgroups (t = 0. 366, P>0. 05). Conclusions The intracellular expressions of TLR3 in mDC in CHB group and control group are obviously increased after the poly I:C stimulation, but the increased level in CHB group is lower than that in control group. The results suggest that the insufficiency of TLR3 synthesis may be related to the HBVpersistent infection.

BACKGROUND:The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. ＜br> OBJECTIVE:To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. ＜br> METHODS:A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three ＜br> groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. ＜br> RESULTS AND CONCLUSION:After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction (P＜0.05). Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups (P＜0.05). The operation time showed no significant differences among three groups. The rate of complications was 11%in the group of percutaneous locking compression plate, and 27%in the groups of interlocking intramedul ary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to smal injury, good biomechanical stability, and no influence on blood supply at fracture end;interlocking intramedul ary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen careful y due to great dissection, great influence on blood supply and high complication rate.

Objective:To study the effect of artificial gastric juice on the dissolution of schizandrin A to provide the parameters for the best extraction method of Schisandra chinensis. Methods:Schisandra chinensis was respectively extracted by artificial gastric juice and water. Schizandrin A in the extracts was determined by HPLC, and the dissolution of schizandrin A in artificial gastric juice and water was studied and compared. Results:At 60 min, schizandrin A dissolution was 0. 483% in artificial gastric juice, and 0. 362%in water. Conclusion:The dissolution of schizandrin A in artificial gastric juice is 33. 4% higher than that in water, suggesting artifi-cial gastric juice can significantly improve the dissolution of schisandrin A.

Objective:To observe the clinical efficacy and safety of compound Bletilla Striata cream in the treatment of patients with second degree hand rhagadia. Methods: Totally 146 patients with second degree hand rhagadia were randomly divided into the treatment group and the control group with 73 cases in each. The treatment group was treated with compound Bletilla Striata cream, while the control group was treated with urea ointment. The treatment course was 10 days. The time of paln disappearance, keratoder-ma softening and rhagadia healing were compared between the two groups, and the efficacy and adverse drug reactions of the two groups were also observed and compared. Results:After the first treatment course, the curative rate of the treatment group was 94. 5%, which was higher than that of the control group (82. 2%) with statistical significance (P<0. 05). The total effective rate of the two groups was both 100% without statistical significance (P>0. 05). The time of keratoderma softening and rhagadia healing in the treatment group was significant shorter than that in the control group (P<0. 05), while the time of paln disappearance showed no significant difference between the two groups(P>0. 05). Conclusion: Compound Bletilla Striata cream in the treatment of second degree hand rhagadia is effective and safe, which shows good prospect for clinical application.

Objective To describe the clinical feature ,therapeutic approach and prognosis of histoplasmosis for improving clinicians’ awareness of this disease .Methods The clinical data of 7 cases of histoplasmosis treated in Shanghai Huashan Hospital from 2001 to 2014 were reviewed retrospectively .Relevant reports about histoplasmosis from 2001 to 2014 in Chinese mainland were comprehensively reviewed .Results The major clinical manifestations of progressive disseminated histoplasmosis included fever ,hepatosplenomegaly ,lymphadenopathy ,and pancytopenia .Skin lesions and pancytopenia were more common in the patients complicated with HIV/AIDS .The patients with local infection were lack of systemic symptoms or signs . Histological examination found Histoplasmacapsulatum in macrophages in bone marrow or biopsy tissues .Amphotericin B was used most frequently to treat histoplasmosis .Itraconazole was appropriate in mild patients .Conclusions Histoplasmosis is caused by H .capsulatum .The golden standard of diagnosis is any culture positive for H .capsulatum .Antifungal treatments such as amphotericin B and itraconazole are very important .