Objective: To analyze the problems of large medical equipment allocation in our country, put forward the method and basis of scientific configuration. Methods: The current situation of large medical equipment allocation was analyzed by the methods of literature, statistics and analysis, in order to understand the operating costs and benefits and provide a scientific configuration tool when bringing in medical technology. Results: The configuration of large medical equipment has some problems, such as the uneven distribution of medical resources, equipment shortage, blind purchase of high-end equipment, low localization rate and so on. These problems will directly lead to the unreasonable allocation and the waste of medical resources. Conclusion:The configuration of large medical equipment must comply with the relevant provisions of the state by the HTA and other scientific methods, so as to improve the level of investment decision-making. It will make the use of medical resources efficiently and reasonably.

Objective To assess the safety and effectiveness of laparoscopically total extraperitoneal (TEP) repair using two mesh cross and overlap without stapler technique and to discuss the cause of main complications. Methods In this study 243 cases of inguinal hernia were randomly divided into two groups. One group underwent two meshes cross and overlap no fixation TEP, the other underwent a single mesh stapling fixation TEP. The average postoperative follow-up was ( 28 ± 6 ) months. For comparing the effect of the two approaches, statistical analysis including the χ2 test and Student's t test was carried out where appropriate. A p value of less than 0. 05 was considered statistically significant. Results The recurrence rate for the mesh no fixation group ( 1.9% ) did not increase when compared to mesh fixation group( 2. 9% ) ( P ＞ 0. 05 ). The overall postoperative complication rate or individual complication rate was not significantly different between the two groups. Conclusions Laparoscopically total extraperitonealrepair(TEP) using two mesh cross and overlap no fixation technique is safe and reliable.

OBJECTIVE: To report on a novel KIR3DL3 allele identified in a southern Han Chinese individual. METHODS: Peripheral blood sample was collected from a voluntary blood donor with inconclusive result by KIR3DL3 sequence-based typing (SBT). Total mRNA was extracted and subjected to reverse transcription to obtain KIR3DL3 cDNA, which was then amplified by PCR with a pair of KIR3DL3-specific primers. The product was subjected to cDNA cloning and sequencing. RESULTS: cDNA cloning and sequencing have identified a wide-type KIR3DL3*00802 allele and a novel KIR3DL3*064 allele. The latter differed from KIR3DL3*00601 by a missense variant at codon 374[c.1184 C>T (p.Thr374Ile)] in exon 9. The novel KIR3DL3 allele has been officially assigned by the KIR subcommittee of World Health Organization Nomenclature Committee for factors of HLA system. CONCLUSION cDNA cloning and sequencing may be used to distinguish inconclusive results in KIR3DL3 SBT in order to identify novel KIR alleles.

OBJECTIVETo observe the impacts on anesthetic dosage and postoperative pain under general anesthesia assisted by auricular-plaster therapy.

METHODSOne hundred and twenty cases of gynecological laparoscopic surgery were randomized into three groups, 40 cases in each one. In auricular point group A, the magnetic beads were stick on the auricular points which were Shenmen (TF4), Lung (fei, CO14), Spleen (pi,CO13), Stomach (wei, CO4), Large Intestine (dachang, CO7), Adrenal (shenshangxian, TG2 (P)), Endocrine (neifenmi, CO18), Uterus and Pelvic Cavity(penqiang, TF5) etc. In auricular point group B, the magnetic beads were stick on the preauricular points and the corresponding retroauricular points of the ears. In a placebo group, the plasters of the same appearance were stick on the corresponding auricular points of the ears. The anesthetic method was same in three groups and the anesthesia effect were assessed and compared among the three groups.

RESULTSIn surgery, the dosage of sufentanil, the narcotic analgesic was (22.08 +/- 7.11) microg in auricular point group A and was (20.19 +/- 7.21) microg in auricular point group B, which were reduced as compared with (26.13 +/- 9.04) microg in the placebo group (both P < 0.05). The difference in the dosage of propofol, the anesthetic was not significant statistically among three groups (P > 0.05). On the 1st day after surgery, the score of pain visual analogue scale (VAS) was (1.77 +/- 1.65) in auricular point group A and was (1.80 +/- 1.96) in auricular point group B, which were reduced as compared with (2.62 +/- 1.46) in the placebo group (both P < 0.05). Before surgery, the serum beta-endorphin (beta-EP) was (198.8 +/- 124.1) pg/mL in auricular point group A and was (207.2 +/-102.7) pg/mL in auricular point group B, which were higher apparently as compared with (143.6 +/- 87.1) pg/mL in the placebo group (both P < 0.05). The differences in the above indices were not significant statistically between the two auricular point groups.

CONCLUSIONThe auricular-plaster therapy reduces the dosage of anesthetic, alleviates postoperative pain and acts on tranquilization and analgesia. The effect is not intensified apparently in the treatment for the magnetic beads sticking on both preauricular points and the corresponding retroauricular points of the ears.

Acupuncture Analgesia ; Acupuncture, Ear ; Adult ; Aged ; Anesthesia, General ; Anesthetics ; administration & dosage ; Female ; Gynecologic Surgical Procedures ; Humans ; Intraoperative Period ; Laparoscopy ; Middle Aged ; Pain Management ; Young Adult

Objective:To investigate clinicopathological and magnetic resonance imaging (MRI) characteristics of pediatric cardiac tumors.Methods:The clinical, pathological and MRI data of 7 patients with pediatric cardiac tumors confirmed by pathological examination in Children's Hospital of Chongqing Medical University from February 2012 to December 2016 were retrospectively analyzed.Results:There were 3 males and 4 females with first diagnosis age ranging from 1 month to 3 years. As for clinical presentation, most cases were featured with cardiac murmur and enlarged cardiac boundary; only 1 case had acute cerebral infarction, and 1 case did not show any abnormal performance. Pathological findings showed that 6 cases of benign tumors (including 2 cases of fibroma, 1 case of rhabdomyoma, 1 case of myxoma, 1 case of lipoma and 1 case of hemangioma), 1 case of malignant tumor (primitive neuroectodermal tumor of pericardium). MRI results showed that the signal intensity of malignant tumor was higher than that of normal myocardium in each sequence; significant differences were found in benign tumors; first-pass perfusion, cardiac cine image and late gadolinium enhancement were the most obvious.Conclusions:The clinical presentations of pediatric cardiac neoplasms are atypical. Each tumor type has pathognomonic pathological features. MRI has great advantages in the diagnosis and differential diagnosis of cardiac tumors especially for benign tumors.

Objective To investigate the clinical value of abnormal course of fetal superior mesenteric arteries (SMA) detected by ultrasound during the first trimester (11-13+6 weeks) in predicting congenital diaphragmatic hernia (CDH). Methods This study enrolled women who underwent fetal nuchal translucency (NT) screening during the first trimester in Central Hospital of Panyu District from March to December 2017. Low-speed high-definition flow imaging was used to observe the course of fetal SMA, and it was regarded as abnormal when the angle between SMA and abdominal aorta >90°. Once abnormal course of the SMA was suspected, the position of fetal thoracic cavity and abdominal organs would be scanned carefully. Furthermore, ultrasound examinations would be repeated at 16-18, 20-24, 28-32 and 37-40 weeks of gestation. Fetus diagnosed as CDH by ultrasound would be scheduled for MRI or autopsy to confirm the diagnosis. Pregnancy outcomes of all cases were followed up by telephone. Descriptive statistical analysis was used in this study. Results A total of 6 899 gravidas (6 964 fetuses) underwent NT scan during the first trimester were enrolled and the SMA of all fetuses were successfully displayed. Three cases with abnormal course of the SMA were identified. Two of them were diagnosed with left CDH at 17+ and 23+ weeks of gestation, which was confirmed by autopsy after termination of pregnancy, and the other one terminated pregnancy in first trimester due to a large omphalocele. Among the 6 961 fetuses with normal SMA, the pregnancy outcomes of 6 120 were successfully followed up, only one of which was found to have left CDH at 32 gestational weeks by ultrasound examination, and was later confirmed by neonatal MRI after delivery. No other fetal CDH was detected. Conclusions Abnormal course of the SMA identified in early pregnancy may be a simple and effective indicator for CDH that allow early intervention and treatment.

Objective To compare the clinical outcomes of arthroscopy-assisted Tightrope technique and clavicular hook plating for the treatment of acromioclavicular joint dislocation of Rockwood Type Ⅲ in aduhs.Methods The clinical data were reviewed of the 60 patients who had been treated for acromioclavicular joint dislocation of Rockwood Type Ⅲ from January 2012 to December 2015 at Department of Orthopedics,Jinhua Municipal Central Hospital.Their age ranged from 34 to 62 years (mean,40 years).Injury was at the left side in 28 cases and at the right in 32 ones.They were randomly assigned to receive treatment either using arthroscopy-assisted Tightrope technique (group A,30 cases) or using clavicular hook plate (group B,30 cases).The 2 groups were compared in terms of incision length,operation time,blood loss,visual analogue scale (VAS) and Constant-Murley shoulder function scores at postoperative 3 and 12 months.Results The 2 groups were compatible because there were no significant between-group differences in gender,age,injury laterality,Rockwood fracture typing or injury cause (P ＞ 0.05).All the patients were followed up for a mean of 10 months (from 6 to 12 months).Primary incision healing was achieved in both groups with no neural lesion.The incision length in group A (3.4 ± 0.6 cm) was significantly shorter than that in group B (8.8 ± 1.8 cm),and the blood loss in the former (40.0 ± 8.2 mL) significantly less than that in the latter (70.9 ± 9.8 mL) (P ＜ 0.05).The VAS scores and Constant-Murley shoulder function scores at postoperative 3 and 12 months in group A (respectively:2.2±1.1 and 1.1 ±0.9 points;85.5±2.1 and 98.0±3.1points) were significantly better than those in group B (respectively:3.2 ± 1.8 and 2.1 ± 1.2 points;75.0 ±4.1 and 85.1 ±2.9 points) (P ＜ 0.05).There were no obvious complications during the follow-up period in either group.Conclusions Although both arthroscopy-assisted Tightrope technique and clavicular hook plating can relieve shoulder pain in the adult patients with acromioclavicular joint dislocation of Rockwood Type Ⅲ,the former shows advantages of a smaller incision,less bleeding,lower VAS scores,and reduced pain and financial cost for the patients due to no trouble of implant removal.

Cerebral infarction, with high incidence, high mortality, high disability and high recurrence rates, can impose a serious burden on families and society. After cerebral infarction occurrence, neurons, as the fundamental structures of the central nervous system, are unable to renew or multiply after death; hence, full recovery from neurological impairments following cerebral infarction is challenging. With stem cell and genetic recombination advancements, cellular replacement therapy after cerebral infarction progresses, which helps clinical transformation and application. In this paper, the basic researches of cellular replacement therapy after cerebral infarction are reviewed from 3 aspects: endogenous nerve regeneration, exogenous stem cell transplantation, and in situ somatic cell trans-differentiation into neurons, in order to provide references for cerebral infarction treatment

【Objective】 To determine the reference range of thromboelastogram(TEG) and establish a TEG feature for local population by measuring TEG parameters in healthy adults in Shenzhen comparing the difference between gender and age, and analyzing the reference data provided by reagent manufacturer. 【Methods】 A total of 916 healthy adults, aged between 19 to 59, who did their regular health checks in our hospital from September 2020 to August 2021 were selected. The TEG(from Lepu Medical Technology Co., Ltd.) was performed, and the clot reaction time(R), clot formation time(K), coagulation angle(α-Angle), maximum amplitude(MA), coagulation index(CI), fibrinolysis index LY30 and the estimated percent lysis (EPL) were analyzed. 【Results】 The reference ranges of TEG parameters, including R, K, α-Angle, MA, CI, LY30 and EPL, of 916 healthy adults from Shenzhen were 3.25~8.19 min, 0.66~3.18min, 47.70~76.56deg, 50.05~72.91mm, -4.3~3.4, 0~2.2% and 0~3%, respectively. The value of α-Angle, CI, K, LY30, MA and R didn’t all meet the given range provided by the manufacturer; some were exceeding and some inferior to. A total of 227 out of 916 individuals presented abnormal results, relative to the references, in at least one parameter, and 78 were diagnosed of abnormal coagulation based on the given reference range, with a specificity of 75.2%. 【Conclusion】 The reference range of TEG parameters of Shenzhen locals is significantly different from that provided by manufacturers. And it is imperative for local TEG laboratories to establish their own reference ranges according to age and gender groups based on local population characteristics.

Chloroquine (CQ) phosphate has been suggested to be clinically effective in the treatment of coronavirus disease 2019 (COVID-19). To develop a physiologically-based pharmacokinetic (PBPK) model for predicting tissue distribution of CQ and apply it to optimize dosage regimens, a PBPK model, with parameterization of drug distribution extrapolated from animal data, was developed to predict human tissue distribution of CQ. The physiological characteristics of time-dependent accumulation was mimicked through an active transport mechanism. Several dosing regimens were proposed based on PBPK simulation combined with known clinical exposure-response relationships. The model was also validated by clinical data from Chinese patients with COVID-19. The novel PBPK model allows in-depth description of the pharmacokinetics of CQ in several key organs (lung, heart, liver, and kidney), and was applied to design dosing strategies in patients with acute COVID-19 (Day 1: 750 mg BID, Days 2-5: 500 mg BID, CQ phosphate), patients with moderate COVID-19 (Day 1: 750 mg and 500 mg, Days 2-3: 500 mg BID, Days 4-5: 250 mg BID, CQ phosphate), and other vulnerable populations (.., renal and hepatic impairment and elderly patients, Days 1-5: 250 mg BID, CQ phosphate). A PBPK model of CQ was successfully developed to optimize dosage regimens for patients with COVID-19.