Objective To explore the lean management model for the application of National Natural Science Foundation of China (NSFC).Methods Under the framework of lean management,Peking University Third Hospital (PUTH) tapped potential through the earlier stage survey and policy guidance,focused on improving efficiency based on discipline and talent,curriculum service were also provided to bolster application quality.This paper reviewed the NSFC application situation of PUTH in 2014 2016 and compared with 2011-2013,summarized the management experience.Results All the indexes increased significantly during 2014-2016,also achieved a breakthrough in talent projects.Compared with 2011 2013,the application number of 2014-2016 increased by 34.8％,meanwhile,both the support number and amount of NSFC increased 44.2％ and 111.6 ％ respectively.We also achieved 71.8％ growth and added 5 experts in high end talent projects.Conclusions The lean management significantly improves the management efficiency,and we hope to make reference to other clinical hospitals in promoting basic research management.

BACKGROUND: The characteristics of cervical anatomy and pedicle screw, operational specification, and individual screw implantation are the key factors of a successful implantation treatment.OBJECTIVE: This study was designed to investigate the cervical pedicle screw and host response as well as the recovery of spinal nerve functions during the surgery and follow-up period of cervical spine fracture-dislocation.DESIGN: A case analysis.SETTING: Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Lianning Province, China.PARTICIPANTS: A total of 41 patients with cervical spine fracture-dislocation, who have complete follow-up data, were admitted to the Department of Orthopaedics, General Hospital of Shenyang Military Area Command of Chinese PLA between February 2002 and February 2006. Of the included patients, 18 were complicated by spinal cord injury (according to Frankel classification system, 6 were graded as A, 1 as B, 4 as C, and 7 as D.METHODS: Forty-one patients with cervical spine fracture-dislocation were treated by implanting a screw through the cervical pedicle and fixing it. Prior to surgery, all patients were subjected to X-ray, CT and MRI examinations. According to measurements, each cervical pedicle screw was individually implanted. The entire surgery was accomplished by Xiang Liang-bi, chief physician, whose qualification corresponds to the responsibilities.MAIN OUTCOME MEASURES: Material and host response during and after screw implantation as well as in the follow-up period. Recovery of spinal nerve function after screw implantation.RESULTS: All patients were followed up for 6-12 months and all incisions were healed primarily. Material and host response during the process of screw implantation: A total of 218 screws were implanted. After initial implantation, 12 screws were loosened, and such a phenomenon disappeared in 11 screws by adjusting inserting point and inserting direction or/and increasing screw diameter or length. The remaining 1 screw was stabilized by increasing the fixed segments. After drilling, poles of 10 screws bled much and treated by hemostasis. C1-2 venous plexus hemorrhage was caused in 3 patients and stopped by compression, and Apofix internal fixation was used in 1 of 3 patients due to unclear surgical visual field. Material and host response after surgery and during the follow-up: A total of 218 screws were inserted. Of the 218 screws, 196 were in correct position, and 22 were deviated to different degrees. Deviation of 1 screw caused injury to nerve root and that of another screw led to injury to blood vessel. Thirty-eight patients acquired satisfactory reduction and bone union. Three patients presented with symptoms of nerve root irritation due to incomplete reduction in the old fracture-dislocation. Among the 3 patients, 1 was subjected to anterior approach due to screw removed, and neither injury to vertebral artery, spinal cord, and nerve root nor internal fixation destroy was found in any other patients. Recovery of spinal nerve function after implantation: Among the 18 patients complicated with spinal cord injury, 6 patients, who were assessed as grade A spinal cord injury, did not exhibit improvement in spinal cord function, while the remaining 12 presented with 1 or 2 grades of improvement.CONCLUSION: There is a lower probability for biocompatibility reaction, and spinal nerve function recovers better after implantation of cervical pedicle screw. So implantation of a cervical pedicle screw system is an effective and relatively safe method for treatment of cervical spine fracture-dislocation.

Objective Sharing and exploring the efficient development of scientific research management with peers in large tertiary general hospital.Methods This article took the whole process management of scientific research in our hospital during the past five years as example,analyzed and elaborated the quality control and related safeguarding measures.Results According to the comparison between 2012 and 2016,the number of SCI papers published,the number of National Natural Science Funding and other important indicators all have been increased significantly in our hospital.Conclusions The implementation of the whole process quality control management and security measures of scientific research helps hospital to achieve initial and efficient development in research management.

Objective Through analyzing and summarizing the experiences and reflections during the construction of regional medical scientific research alliance,to explore the ultimate goal and ideal model of such work.Methods Literature review,as well as working experience summary and analysis.Results The purpose of setting up regional medical scientific research alliance lies in shared regional medical scientific research data information,using the two-way transformation model of laboratory and clinical research to support the medical service of primary health care in local hospitals,at the same time,promoting the construction and development of regional medical alliance.The ideal model is to make good use of the regional clini cal scientific research data sharing platform and related information sharing platform to promote the collaborative development of regional medical scientific research.Conclusions The ultimate goal of collaborative development of scientific research is to establish "an information map of regional scientific research resources",the map can be used for scientific research project cooperation,resource allocation,integration of scientific research forces and training of talent echelon,thereby comprehensively improve the regional research capacity.

Objective To achieve the hospital's scientific research objectives during the 13th five-year plan period,we designed to know about the potential NSFC application capacity and existed problems in our hospital.Methods Using "Questionnaire Star" network investigation platform to design questionnaire and conduct data analysis.Results Respondents are divided into two groups,one was who intend to apply in next three years while the other would not.it is found that there are obvious differences between the publication of SCI,as well as the previous research project application and conducting experiences.Conclusions In order to improve the rate of NSFC application,the hospital scientific management workers can consider doing the following:Improve the number of SCI papers published from the perspective of helping to encourage and forcing pressure.Strive for financial support from all parties and build a central experimental platform to create conditions for basic experiments for clinical medical workers.Regular and in time training for NSFC application.Some pressure when necessary to promote the extension of low-level study.Pay more attention to the incentives of research performance at the department level.

Objective From the perspective of the application of Beijing Tongzhou district science and technology project,we can grasp the present situation,existing problems and opportunities of the hospital.Methods Taking the information of the application declared by Beijing Luhe Hospital in 2017 as the research object,using the Excel,statistical analysis of the applicants'age,professional title,degree and departments distribution;summing up the common problems of the expert feedback.Results The study found that the 144 subjects participated in the declaration had been laying particular stress on each of the five areas,including:research category,applicants‘ age,professional title,degree and department.Conclusions Based on the data of the application,we have made a preliminary discussion about the overall planning and management measures of the future hospital scientific research.

Objective To observe the effects of maternal high fat diet (MHFD) during pregnancy and lactation on intestinal barrier function in offspring mice.Methods C57BL/6 pregnant mice were divided into high fat diet (MHFD) group and normal diet group (MND) randomly and were given high fat diet and normal diet during pregnancy (3 weeks) and lactation (3 weeks) respectively.Both groups of offspring mice were naturally given and bodyweight of pups was monitored at birth and weekly.After weaning,the intestinal permeability of offspring mice was detected by fluorescein isothiocyanate conjugated-dextran method (FITC-D).Immunofluorescence was used to detect the expression of ZO-1 in intestinal tissues.HE staining was used to assess the villus length and crypt depth.The intestinal cell proliferation (expression of Ki-67) and Mucin 2 (MUC2) were assessed by immunohistochemistry.PAS staining was used to evaluate the goblet cells.The expression of inflammatory cytokines including IL-1β,IL-6,and TNF-α in intestinal tissue were measured by real-time PCR.Results At the age of 2 and 3 weeks,the offspring in MHFD group were significantly heavier than those in MND group.HE staining showed no obvious microscopic inflammation in both groups of 3 weeks old offspring mice,however,the relative expression levels of IL-1β (1.95±0.53 vs.1.13±0.15;t =3.65,P=0.005),IL-6 (1.40±0.71 vs.0.73±0.17;t=2.72,P=0.04),and TNF-α (1.63±0.53 vs.1.04±0.12;t=2.64,P=0.02) mRNA were significantly higher in the MHFD group.Compared with the 3 weeks old offspring mice in MND group,MHFD significantly increased the permeability of intestine and decreased the expression of ZO-1 in membrane.The number of Ki-67 positive cells (18.00±4.74 vs.24.60±4.17;t =3.31,P=0.004) in each villus,goblet cells (14.70±2.91 vs.28.10±4.95;t =7.38,P＜0.001) and MUC2 positive cells (20.60± 3.13 vs.30.00±3.33;t=6.50,P＜0.001) in each crypt were significantly lower than those in MND group.Conclusion Maternal high fat diet in early life of offspring mice can induce intestinal low grade inflammation and lead to the disruption of intestinal mucosal barrier in offspring mice,which may be involved in the progeny diseases.

Taking the curriculum integration of skin diseases as an example, this paper summarizes the skin diseases with high incidence in the army such as acne, tinea pedis, warts, folliculitis, corns and calluses, sunburns, etc. The results have been applied to the integration of the skin disease curriculum in Air Force Medical University. During the course integration process, we integrated the courses of dermatology, plastic surgery and burn surgery together, and simplified the teaching content according to the "organ-system" orientation and features of military medical university. In the teaching process, the PBL teaching method was used to guide the students to discuss with the problems. At the end of the course, the students were assessed by tests, and the satisfaction evaluation were carried out. The results showed that the application of high incidence of skin diseases in the army in curriculum integration can help improve the teaching effect and the satisfaction of students, which will provide a certain reference for the curriculum integration reform of military medical universities.

Objective:To compare the short-term efficacy of Billroth Ⅱ+Braun anasto-mosis versus Roux-en-Y anastomosis in totally three-dimensional (3D) laparoscopic distal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 140 patients with gastric cancer who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2020 were collected. There were 105 males and 35 females, aged from 23 to 84 years, with a median age of 55 years. Of the 140 patients, 54 patients undergoing totally 3D laparoscopic distal gastrectomy with Billroth Ⅱ+Braun anastomosis were allocated into Billroth Ⅱ+Braun group, and 86 patients undergoing totally 3D laparoscopic distal gastrectomy with Roux-en-Y anastomosis were allocated into Roux-en-Y group, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect remnant gastritis and its severity, bile reflux, reflux esophagitis in the postoperative 3 months up to April 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations: 140 patients underwent totally 3D laparoscopic distal gastrectomy. The operation time, cases with volume of intraoperative blood loss <50 mL, 50 to 200 mL or >200 mL, the number of lymph node dissected were (233±39)minutes,15, 35, 4, 30±13 for the Billroth Ⅱ +Braun group , respectively, versus (240±52)minutes,25, 51, 10, 27±10 for the Roux-en-Y group, showing no significant difference between the two groups ( t=0.856， χ2=0.774， t=1.518， P>0.05). (2) Postoperative situations: cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, cases with postoperative severe complications, duration of postoperative hospital stay, surgery cost and total hospitalization cost of the Billroth Ⅱ+Braun group were 38, (3.5±0.8)days,4, 1, 0, 0, 5, 1, (9.0±5.0)days, (3.8±1.2)×10 4 yuan and (9.7±2.1)×10 4 yuan, respectively. The above indicators of the Roux-en-Y group were 59, (3.7±1.0)days, 9, 1, 0, 1, 11, 2, (9.0±4.0)days, (4.3±1.0)×10 4 yuan and (9.2±2.1)×10 4 yuan, respectively. There was a significant difference in the surgery cost between the two groups ( t=2.453, P<0.05), while there was no significant difference in cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, duration of postoperative hospital stay or total hospitalization cost between the two groups ( χ2=0.049, t=?1.339, Z=0.000, χ2=0.409, t=0.197, 1.383, P>0.05). There was also no significant difference in cases with postoperative severe complications between the two groups ( P>0.05).(3) Follow-up: 134 of 140 patients received the follow-up, including 52 cases in the Billroth Ⅱ+Braun group and 82 cases in the Roux-en-Y group. Results of follow-up within postoperative 3 months showed that the incidence rates of remnant gastritis, bile reflux, reflux esophagitis were 61.5%(32/52), 38.5%(20/52), 26.9%(14/52) for the Billroth Ⅱ+Braun group, respectively, versus 41.5%(34/82), 22.0%(18/82), 12.2%(10/82) for the Roux-en-Y group, showing significant differences between the two groups ( χ2=5.131, 4.270, 4.695, P<0.05). Cases with grade 0,Ⅰ,Ⅱ, Ⅲ, Ⅳ residual food were 42, 3, 5, 2,0 for the Billroth Ⅱ+Braun group, versus 67, 9, 1, 5,0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?0.156, P>0.05). Cases with minimal lesion, grade A, grade B gastritis (severity of gastritis) were 6, 5, 3 for the Billroth Ⅱ+Braun group, versus 8, 2, 0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?1.468, P>0.05). Conclusions:It is safe and feasible to operate Billroth Ⅱ+Braun or Roux-en-Y anastomosis in totally 3D laparoscopic distal gastrectomy. Billroth Ⅱ+Braun anastomosis can reduce the surgical cost. Roux-en-Y anastomosis has advantages in reducing the incidence of reflux esophagitis, bile reflux and reflux gastritis.

Objective:To study the effects of FLASH irradiation (FLASH-RT) and conventional irradiation (CONV-RT) on gene expression profile in mouse liver, in order to provide theoretical basis of the potential mechanism of FLASH-RT.Methods:A total of 11 C57BL/6J male mice were divided into healthy control group (Ctrl group), CONV-RT group and FLASH-RT group according to random number table method. Mouse abdomen was treated with 12 Gy CONV-RT or FLASH-RT. Then the mice were killed by neck removal, and the liver tissues were collected to extract total RNA for transcriptome sequencing (RNA-Seq) that was then analyzed by bio-informatics analysis to investigate the changes of gene expression profiles. The mRNA expression levels of Stat1, Irf9 and Rela were verified by quantitative real-time PCR assay.Results:1 762 differentially expressed genes (DEGs) were identified in group FLASH-RT vs. CONV-RT. Among them, 660 genes were up-regulated and 1 102 genes were down-regulated. 1 918 DEGs were identified in groups FLASH-RT vs. Ctrl. Among them, 728 genes were up-regulated and 1 190 genes were down-regulated. 1 569 DEGs were identified in group CONV-RT vs. Ctrl. Among them, 1 046 genes were up-regulated and 523 genes were down-regulated. According to Gene Ontology (GO) analysis, these DEGs from groups FLASH-RT vs. CONV-RT were involved in various functions including defense response to virus, other organisms in cell components, adenylyltransferase activity in molecular function activity. These DEGs from group FLASH-RT vs. Ctrl were involved in various functions including defense response to other oranisms, endoplasmic reticulum chaperone complex, double-stranded RNA binding and so on. These DEGs from group FLASH-RT vs. CONV-RT were involved in several Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways including influenza A, Herpes simplex infection and so on. These DEGs from group FLASH-RT vs. Ctrl were involved in several KEGG pathways including influenza A, NOD-like receptor signaling pathway. Stat1 was likely to be activated by FLASH radiation. The quantitative real-time PCR assay showed that FLASH-RT obviously increased the mRNA expressions of Stat1, Irf9 and Rela ( t=6.62, 2.11, 1.67, P<0.05). Conclusions:FLASH-RT and CONV-RT could alter gene expression profiles in mouse liver tissues, and these DEGs are involved in multiple radiobiological functional pathways. In comparison with CONV-RT, FLASH-RT induces a low level of liver injury, which may due to hypoxia radiation resistance.