This review introduces the system, model, and method of the US ailitary medical logistic supply and support, analyzes the characteristics of the global sourcing and distribution, and highlights the information system development, cen-tral management, efficiency and effective improvement.By learning from the experience of the US Armed Forces, we can be helped to set up new systems and enhance the power of our military medical logistic support.

ObjectiveTo determine the influence of buspirone on sexual function and plasma prolactin in rehabilitative female major depressive patients.MethodsThe female major depressive patients,who had a total HAMD-17 less than 7,were living with a sexual partner and receiving SSRI antidepressant monotherapy for at least six months were recruited.Sexual dysfunction (SD) was assessed using the Arizona Sexual Experience Scale (ASEX).The patients with SD were treated with buspirone 15 ～ 30 mg by 4 weeks.Sexua function and blood samples were compared among the control,non-SD patients,and the SD patients before or after treating with buspirone.The clinical risk factor of SD was also investigated with correlation analysis.ResultsThe general incidence of SD in rehabilitative female major depressive patients was 33.3％.The improvement rate of SD was 60％ after the treatment of buspirone.The ASEX score and it 5 items were significantly decreased in the depressive patients after the treatment of buspirone (P ＜ 0.01 ).Prolactin in subjects treated with buspirone ( ( 20.38 ± 11.91 )ng/ml) was significantly higher than control ( ( 14.2 ± 12.15 ) ng/ml),but not higher than the period prior to treatment with buspirone ( ( 18.15 ±9.84) ng/ml).The ASEX score was significantly correlated the dose of fluoxetine( r=0.504,P=0.002) and paroxetine ( r=0.377,P=0.013).There was no significantly correlation between ASEX score and prolactin in the control,non-SD patients,and the patients before or after treating with buspirone.ConclusionBuspirone can release sexual dysfunction induced by SSRI antideptressant in the depressive patients.

Objective To investigate CT findings of polymyositis(PM) in musculus and the applied value of CT.Methods 20 cases of PM confirmed by pathology and undergone CT scan,including waist,back,gluteus thighs and calfs.Above of these gluteus,thighs and calfs were observed groupingly.The observed contents included :muscle density;muscle volume;changes of delecting myofascitis lesions;clear degree of musculature and thickness of subcutaneous fattiness.Results CT findings included amyotrophy in 15 groups;muscle density lower and muscle fat in 53 groups;thickened fascia in 18 groups;subcutaneous fat thickened in 23 groups and musculus indistinet in 3 groups.Conclusion CT can help display the degree and distribution of lesions,and the accurate localization for biopsies in myofascitis.

ObjectiveTo investigate the clinicopathological characteristics of nipple-areolar complex (NAC) involvement in patients with operable breast carcinoma and to determine the indications and risk factors of NAC-sparing modified radical mastectomy. Methods407 female patients with primary breast cancer were included in the study.Data like tumor position, tumor size, the distance from the tumor to the margin of areolar (D) were recorded.NAC sample in vitro was collected and routine pathological examination was performed.Statistical methods were employed to analyze the relation between the clinicopathological factors and NAC involvement.ResultsThe rate of NAC involvement was 13.27％ (54/407).NAC involvement had no statistically significant correlation with age or histological type, but had statistical correlation with tumor position, D value, tumor size, TNM stage, clinical manifestation of NAC, and status of axillary lymph nodes(P ＜ 0.05).ConclusionsTumor position, D value, tumor size, TNM stage, clinical manifestation of NAC and status of axillary lymph nodes are the major influential factors for NAC involvement.The indications of NAC-sparing modified mastectomy:1.in Ⅰ or Ⅱa TNM stage; 2.patients have strong will to preserve NAC or breast appearance; 3.noncentric tumor (D≥2 cm) ; 4.the maximum diameter of tumor should be less than 3 cm; 5.no abnormal manifestation like nipple discharge, eczematoid change or nipple inversion happened.6.no occult involvement in subareolar tissues was found by frozen pathology.

Objective To explore the rule of central region lymph nodes metastasis in differentiated thyroid carcinoma (DTC) and the significance of central region lymph nodes neck dissection in surgical operation for DTC.Methods The clinical and pathological data of 122 lymph nodes in 109 patients (31 female and 78 male) with DTC undergoing neck lymph nodes ( central region lymph nodes included) dissection from Jan.2003 to Jun.2007 in our hospital were analyzed retrospectively.According to preoperative physical examination and imaging analysis,patients were divided into clinical cervical lymph nodes metastasis ( cN + ) group and clinical no cervical lymph nodes metastasis (cNO) group and compared respectively with their pathological data after surgery.Resuits Of the 122 lymph nodes,lymph node metastasis rate was significantly higher in region Ⅵ than in region Ⅱ,Ⅲ and Ⅳ.The difference had statistical significance (P ＜0.01 ).65.6％ (80/122) metastasis was in the central region.81.2％ (56/69) patients in cN + group and 45.3％ (24/53) patients in cN0 group had central region lymph nodes metastasis.Conclusions Central region lymph nodes metastasis is common for patients with DTC.Routine neck dissection in central region should be done in DTC operation.

Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87％ ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.

OBJECTIVESevere Epstein-Barr (EB) virus infection is potentially a devastating process that often leads to death encountered in pediatrics recently. Inappropriate control of EB virus replication may cause severe infection resulting in multiple organ dysfunction. However, little information is available on pulmonary complications associated with EB virus infection. The aim of the present study was to investigate severe EB virus (EBV) infection complicated with lung injury in pediatric intensive care unit (PICU), including clinical characteristics, laboratory or imaging feature and outcomes.

METHODA total of 45 children with severe EBV infection seen in PICU of Shanghai Children's Hospital between January 2011 and December 2014 were retrospectively reviewed. According to clinical characteristics and imaging feature, 45 children were divided into non-lung injury group (n =27), lung injury without pulmonary fibrosis group(n = 12) and pulmonary fibrosis group (n = 6).

RESULTIn totally 45 cases of severe EBV infection, 21 (46.7%) were male and 24 (53. 3%) were female, mean age was 2. 4 years; 18 cases were complicated with lung injury, including 8 male and 10 female, median age was 31. 2 months. All of 18 cases presented with fever and cough, 15 of them exhibited dyspnea,12 cases were complicated with gasping, and 6 cases with ARDS. Eight cases accepted mechanical ventilation for acute respiratory distress; 6 cases who developed pulmonary fibrosis had tachypnea, refractory hypoxemia and hypercapnia, severe pulmonary air leak. The average EBV-DNA level in peripheral blood was 4. 42 x 10(6) copies/ml (range: 3. 25 x 10(3) - 6.59 x 10(7) copies/ml). Anti-EBV antibodies were positive in 41 cases, 18 cases were positive (+) for VCA-IgM, 15 cases were VCA-IgG and EA-IgG (+), 8 cases VCA-IgM and VCA-IgG (+). The radiographic findings revealed pulmonary interstitial infiltrates in all 18 cases with lung injury, 4 cases with segmental consolidation and 2 cases showed pleural effusions. HRCT scanning found EBV associated fibrosis including multifocal patches and diffuse ground-glass attenuation in both lungs, reticular opacities and honeycombing changes were observed 4 weeks after illness onset. There were significant differences in respiratory failure, PICU stay (days), Pediatric risk of mortality III (PRISM III) and pediatric clinical illness score(PCIS), serum TNF-α, EBV-DNA levels, percentage of NK cells and CD4+/CD8+ T cell ratio among non-lung injury group, lung injury without pulmonary fibrosis group and pulmonary fibrosis group (X2 =27. 12, F = 85. 23, 78. 23, 88. 68, 323. 80, 7. 35, χ2 = 6. 71, 12. 15; all P < 0. 05). COX regression analysis revealed that EBV-DNA and serum TNF-α levels were correlated with pulmonary fibrosis significantly (OR = 3. 92, P = 0. 04; OR = 5. 95, P = 0. 01). The patients with EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH) had higher incidence of pulmonary fibrosis compared with non-EB-HLH (70% vs. 13%, χ2 = 4. 82, P = 0. 03). Of 18 cases, 8 cases died, including 3 cases with pulmonary fibrosis. The surviving cases with pulmonary fibrosis needed longer additional oxygen. Chest HRCT imaging of 3 cases with pulmonary fibrosis was improved at 6 months and oxygen therapy was discontinued at 18 months after discharge.

CONCLUSIONEB virus infection complicated with lung injury had higher incidence of respiratory failure, pulmonary fibrosis with a fatal outcome. EBV-DNA and serum TNF-α level were found to be statistically significant indicators of pulmonary fibrosis. Pulmonary fibrosis associated with severe EB virus infection may be reversible.

Antibodies, Viral ; blood ; CD4-CD8 Ratio ; Child, Preschool ; China ; DNA, Viral ; blood ; Epstein-Barr Virus Infections ; pathology ; Female ; Herpesvirus 4, Human ; Humans ; Intensive Care Units, Pediatric ; Killer Cells, Natural ; Lung Injury ; virology ; Lymphohistiocytosis, Hemophagocytic ; pathology ; virology ; Male ; Pulmonary Fibrosis ; pathology ; virology ; Retrospective Studies ; Tumor Necrosis Factor-alpha ; blood

Objective To evaluate the value of noninvasive monitoring of pulmonary arterial pressure in the children with severe pneumonia and respiratory failure.Methods A prospective study was adopted to investigate 69 patients who suffered from severe pneumonia and respiratory failure in Pediatric Intensive Care Unit in Shanghai Children's Hospital from June 2013 to December 2013 were involved in this study,except for heart disease.The pulmonary arterial pressure (PAP) and cardiac function were monitored by using bedside color doppler ultrasound cardiogram,such as PAP,cardiac index (CI),left ventricle ejection fraction(LEFT),and heart early diastolic filling velocity maximum/heart late diastolic filling velocity maximum (E/A ratio).They were divided into 2 groups according to PAP,one group as pulmonary arterial pressure normal group,the other group as pulmonary arterial hypertension(PAH) group,and the impact of the PAP on the prognosis and mechanical ventilation was assessed.Milrinone[0.5 μg/(kg · min)] were given the patients who were combined with pulmonary hypertension,and the PAP and cardiac function before using Milrinone and 24 h,48 h and 72 h after giving medicine was observed.Results Among 69 cases,40 cases were male and 29 cases were female,age ranging from 2 months to 12 years old,and the weight range was (14.3 ± 8.9) kg.The pediatric critical illness score(PICS) was 70.5 ± 9.6,and the pediatric risk of score m ortality Ⅲ was 13.5 ± 5.0.Among 69 cases,46 cases had pulmonary arterial hypertension,38 cases of them experienced mechanical ventilation,and 9 cases died.Among 23 cases who had no pulmonary arterial hypertension,only 8 cases experienced mechanical ventilation.There was a significant difference in the mechanical ventilation rate and mortality between two groups(x2 =15.78,P ＜0.0l ; x2 =5.18,P ＜ 0.05).The mechanical ventilation time was longer in pulmonary arterial hypertension group (t =3.89,P ＜0.01).PAP was (58.23 ±5.44) mmHg(1 mmHg =0.133 kPa),(49.10 ±4.69) mmHg,(42.53 ±4.54)mmHg and(35.63 ±4.78) mmHg respectively before and after using Milrinone 24 h,48 h and 72 h in 46 cases with pulmonary arterial hypertension,and the pressure decreased significantly after using medicine (F =67.11,P ＜ 0.01).There was no significant difference in CI,LVEF and E/A(all P ＞0.05).However,9 cases of them did not show any response to Milrinone,and in the end they couldn't live without mechanical ventilation,they died.Conclusions Noninvasive pulmonary arterial pressure monitoring could be beneficial in judging patient's condition and assessing prognosis of children with severe pneumonia and respiratory failure,and milrinone could decrease PAP.

Objective To investigate the diagnostic and prognostic value of serum soluble CD163 (sCD163 )and the positive rate of membrane -bound CD163 (mCD163 )in peripheral blood mononuclear cells (PBMC)in children with infection -associated hemophagocytic syndrome (IAHS).Methods Between July 2012 and June 2016,26 pediatric patients with IAHS (IAHS group)and 28 pediatric patients with sepsis(sepsis group)admitted to Children′s Hospital Affiliated to Shanghai Jiaotong University were selected,and 20 healthy children were taken as healthy control group. Sandwich enzyme linked immunosorbent assay was used to detect serum sCD163 .The population of circulating mCD163 positive monocytes was determined by using flow cytometry.Receiver operating characteristic (ROC)curves were used to evaluate the diagnostic and prognostic values of sCD163 and mCD163 in children with IAHS compared with the diagnos-tic and prognostic values of plasma ferritin,and so on.Results The serum levels of sCD163 in patients of IAHS group, sepsis group and healthy control group were (1264 ±538)mg/L,(862 ±332)mg/L,(610 ±316)mg/L,respective-ly.And the population of mCD163 -positive PBMC in patients of IAHS group,sepsis group and healthy control group was (88.3 ±9.7)%,(68.5 ±18.3)%,(28.9 ±5.2)%,respectively.Both serum sCD163 and the population of mCD163 -positive PBMC were significantly higher in IAHS group compared with those of sepsis group (t =2.031 ,P =0.048;t =3.191 ,P =0.002,respectively).The serum sCD163 and population of mCD163 -positive PBMC in sepsis group were higher than controls (t =3.848,P =0.002;t =4.049,P =0.000,respectively).Moreover,the areas under the ROC curve (AUC)for the mCD163 ,sCD163 ,were 0.853(P =0.013),0.762(P =0.004),0.755(P =0.049),respec-tively.mCD163 at a cutoff of 83.7% had a high diagnosis sensitivity (81 .8%)and specificity (72.4%).The optimal cutoff values of sCD163 and ferritin for predicting IAHS was 888 mg/L (sensitivity 66.7% and specificity 63.3%)and 2880 μg/L (sensitivity 80.0% and specificity 54.5%).In addition,the serum level of sCD163 and the population of mCD163 -positive PBMCs were significantly increased in acute phase and decreased in recovery phase[(1553 ±542) mg/L vs.(866 ±92)mg/L,(91 .0 ±6.4)% vs.(79.0 ±4.6)%,t =2.450,χ2 =3.419,P =0.036,0.007]in IAHS group.Furthermore,subgroup analysis indicated that the serum level of sCD163 and the population of mCD163 -positive PBMCs were significantly higher in dead patients than those in survived patients [(1748.91 ±518.17)mg/L vs. (909.69 ±171 .35)mg/L,t =3.070,P =0.011 ;(93.50 ±8.42)% vs.(77.30 ±3.28)%,χ2 =3.005,P =0.024, respectively].Conclusion Serum sCD163 and the population of mCD163 -positive PMSCs are specific and validity bio-markers for early diagnosis of IAHS,which also are associated with treatment response assessment and prognostic analy-sis in IAHS.

Objective To investigta e the efficayc of bedside plasma exchange( PE) combined con-tinuous veno-venous hemodiafiltration ( CVVHDF ) in childer n with critical hemo lty ic uremic syndrome ( HUS) .Method s Eight patients with HUS from Pediatric Intensive Care Unit of Shanghai Ch ildren′s Hos-pitalw ere included in the present stuyd .The seveir ty of children was gar ded accordni g to peid atric critiac l ill-ness soc re and pediatric riks ofs core mortalityⅢ.Four of them received continuuo s blood purification treat-me nt.Meanwhile,the clinical manifestation and outcom e of HUS weer analyzed.Results Eight children with HUS weer ni itially trae ted with diuretic and blood transfusion for 12-24 hours.Four ac ses who deteriora-ted aggressively were ep rofr med PE and CVVHDF.Plasauto iQ21 and Prisma flex wereu sed with Pir sma TPE 2000 membrna e plasma separator and AN69 M60 membrane filter respectively.All the 4 patients with critical HUS survived after bedside continuous blood purification treatment.Clinical symptoms and serum bio-chemistry were improved sing ificantly as follows.The average levels of serum creatinine and lactate dehydro-genase decreased obviously(318μmol/L vs.162μmol/L;1 963 U/L vs.407 U/L,respectively).In addi-tion,platelet count increased significantly(40 ×109/L vs.97 ×109/L) .Eventually,symptoms disappeared in these 4 patients.Conclusion The combined therapy of PE and CVVHDF in HUS could stabilize fluid acid-base equilibrium,prevent hemolysis and improve the renal function.