The human venous valve of the brachial,femoral and long saphenous veins wereexamined with light,transmission and scanning electron microscopy.The observationshows that the venous valve is composed of three functional layers covered withendothelium on both surfaces.A loosely structured layer is located underlying theendothelium.A network mainly containing randomly oriented elastic fibers was foundnear the side towards the lumen.To the side towards the venous wall,there is adense layer composed of eircumferentially and transversly oriented collagen bundles.Some smooth muscle cells extend from the wall of the vein to the base of thevenous valve.The elastic fibers and smooth muscle cells together with the collagenfibers contribute to the mechanical load-bearing performance of the valve and to thepassive closing and openning mechanism.In addition,the smooth muscle cells mightplay an active role in the normal functioning of the valve.The scanning and transmission electron microscopy of venous valve showdifferent arrangement of the endothelium.On the surface of the valve next to the wallof the vein,the endothelial cells are transversely arranged,while on the othersurface over which the current of blood flows,the cells are longitudinally arrangedin the direction of the current.These accord with the role of fluid mechanics.12 normal venous valves were tested by universal testing instrument (Instrontype 1122).The mean value of the maximum tension of the valve is 1 N.Theaverage value of the tensile ultimate strength is 10N/mm~2.

This paper introduced the design of medical quality management system on department level ,and its application and the effect in a large-scale hospital. Our practice demonstrated that this department-level quality management system with the PDCA cycle in the whole process of quality management ,can promote the medical quality management activities to be carried out in an organized ,regulated ,planed ,well checked and concluded manner .

Objective To investigate the outcomes of coronary artery bypass grafting(CABG) in insulin-treated diabetes mellitus(DM) patients with coronary artery disease(CAD) (age≤45 years old),and analyze the risk factors of major adverse cardiac and cerebrovascular events(MACCE) by logistic regression.Methods Data on 239 CAD patients combined with DM aged ≤45 who underwent CABG in our hospital were collected retrospectively from October 2007 to October 2016.There were 216 males and 23 females,the mean age was (42.15 ±2.59) years old.The mean LVEF was 0.59 ±0.09.43 patients (18.0％) had left main stenosis,and the average diseased vessel number was 3.20 ± 0.76.Results One patients (0.4％)in-hospital died of heart failure.Patients received (3.12 ±0.81) bypass grafts overall,12 patients (5.0％) were total artery revascularization.3 patients (1.3％) needed reoperation for bleeding and the perioperative atrial fibrillation rate was occured in 23 patients (9.6％).The follow-up rate was 95％ (226 cases),the median follow-up time was 5 years (1-9 years).8 patients (3.3％) died of all cause-mortality,and 183 patients (81.0％) were freedom from MACCE.The higher level of BMI、cholesterol and creatinine,LVEF ≤0.35,postoperative blood loss ≥ 1 000 ml and ventricular arrhythmia were the independent risk factors of MACCE.Conclusion CABG procedure in CAD patients under 45 years old accompanied DM is safety and reliable both in early and long-term outcomes.

OBJECTIVETo explore the present contamination status and profile of toxaphene in fish, chicken and meat samples in Pearl River Delta area.

METHODSTotally 60 independent samples including fish, chicken, meat were collected from Huizhou,Guangzhou,Dongguan,Jiangmen of Pearl River Delta area in Guangdong by purposive sampling from Oct 2010 to Jun 2011. Toxaphene monomer Parlar26, Parlar50 and Parlar62 levels in three various categories of foods were quantitatively and qualitatively analyzed referencing international authoritative standard methods by utilizing isotope dilution high-resolution gas chromatography/high-resolution double-focusing magnetic mass spectrometry (HRGC-HRMS). The levels of pollution and characteristics were compared.

RESULTSThe concentration of toxaphene median(M) in fish, chicken and meat were 12.87, 5.8 and 1.89 ng/kg (gross weight) , respectively and the difference was significant(H = 14.29, P = 0.001). The toxaphene level in seafish (M = 32.07 ng/kg) was significantly higher than that in freshwater fish (M = 10.63 ng/kg, Z = -2.52, P = 0.012). The profile analysis showed that Parlar50 and Parlar26 were the predominant characteristic monomers in fish, which contributed about 44% (9.91/22.60, ng/kg) and 39% (8.89/22.60, ng/kg) to total concentration, and Parlar62 and Parlar26 were the two predominant congeners in poultry products, the two congeners accounted for 42% (5.03/11.90, ng/kg) and 38% (4.58/11.90, ng/kg). Furthermore Parlar26 and Parlar62 made up about 57% (3.45/6.08, ng/kg) and 26% (1.58/6.08, ng/kg) of total concentration in livestock meat respectively.

CONCLUSIONToxaphene levels in all tested food samples are far lower than the limited standard stipulated by the European Food Safety Authority (EFSA) in 2002, which was 0.1 mg/kg. The congener characteristic difference in the three categories food indicated that the different enrichment ability in Toxaphene in different animal species.

Animals ; Chromatography, Gas ; Fishes ; Food Contamination ; Insecticides ; Meat ; Poultry ; Toxaphene

ObjectiveTo identify the key issues in emergency response to public health emergencies in the Yangtze River Delta region， and to provide a basis for the formulation of relevant policies. MethodLiterature on emergency response to public health emergencies in the Yangtze River Delta region was systematically reviewed and collected， and 18 main problems were identified after collecting and organizing the problems. A questionnaire survey and cluster analysis were used to identify the key issues. ResultsThe study of 18 major problems revealed that "insufficient reserve of emergency medical supplies"， "insufficient financial investment to meet the needs of emergency response"， "lack of a sound mechanism for the deployment of supplies， resulting in the untimely deployment of materials"， were the key issues of emergency response to public health emergencies in the Yangtze River Delta region. ConclusionFuture development of the emergency response system in the Yangtze River Delta region should focus on accelerating the integration process of the Yangtze River Delta， establishing and improving information systems， optimizing the material storage and deployment network， prioritizing the fund investment and utilization mechanism， and improving the effectiveness of public health emergency response.

Objective     To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods     Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group.  Results    There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group  (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85%(21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure.  Conclusion     CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.