In this paper, the SWOT analysis method is used to find out the internal strength, weakness, exterior opportunities and threats of the present medical devices' procurements in hospitals and some strategic considerations are suggested as "one direction, two expansions, three changes and four countermeasures".
Cost Savings ; Equipment and Supplies, Hospital ; economics ; Group Purchasing ; economics ; organization & administration ; Humans ; Marketing of Health Services ; methods ; Purchasing, Hospital ; organization & administration ; Quality Control

OBJECTIVE:To explore the multi-component,multi-target,multi-channel mechanism of Tibetan medicine Ptero-cephalus hookeri in the treatment of rheumatoid arthritis (RA). METHODS:The selected target compounds (10 chemical struc-tures of P. hookeri)were imported and stored by related software;target prediction and filtering were conducted by PharmMapper and DrugBank databases. The pathways of targets were acquired and analyzed by MAS 3.0 database. Finally P. hookeriactive com-ponent-targeting-pathwaynetwork was constructed by Cytoscape 3.4.0 software. RESULTS:The target information obtained in the PharmMapper database were compared with that of the DrugBank database for inflammation-related drugs,26 potential targets for the treatment of RA were obtained,in which MAPK14,RXRA,ALB,PDE4D,VDR may be the main potential target gene group in the treatment of RA. 57 functional pathways were obtained after 26 functional targets were annotated by pathway. In addition to 27 RA-related pathways,30 other pathways such as endocrine regulation and immune were involved. CONCLUSIONS:Base on the study of network pharmacology,P. hookeri plays the role in the treatment of RA by acting on inflammation,immune,endo-crine and related targets and pathways.

Objective To investigate the effect of video -assisted thoracoscopic surgery (VATS)and conventional thoracotomy in treatment of thoracic esophagus cancer,to provide the reference for clinical.Methods 90 cases of thoracic esophageal cancer in our hospital from January 2012 to January 2015 were chosen as the research subjects.They were randomly divided into observation group(application of VATS treatment)and the control group (application of traditional open chest surgery).The quantity difference,chest drainage,hospitalization time,complica-tions,recovery conditions and other indicators of bleeding were compared in the two groups.Results The operation time of the observation group[(267.6 ±76.5)min]was shorter than that of the control group[(324.4 ±87.6)min]. The amount of intraoperative bleeding[(235.3 ±79.5)mL],drainage volume[(327.5 ±95.2)mL]of the observation group were less than the control group[(398.2 ±98.3)mL and (752.6 ±156.4)mL].Postoperative hospitalization time[(12.2 ±3.2)d]of the observation group was shorter than the control group[(15.8 ±4.4)d].The differences were statistically significant (t =3.276,8.644,15.575,4.439,all P <0.05).There were no significant differences between two groups in recurrence and metastasis rate,mortality rate and total survival rate (χ2 =0.123,0.212, 0.212,all P >0.05).The complication rate of the observation group was lower than that of the control group,the difference was statistically significant (χ2 =4.865,P <0.05).Conclusion In the treatment of thoracic esophageal carcinoma,VATS and conventional thoracotomy surgery has good effect,and VATS has small injury,less complication.

Objective To study the effect of public hospitals vertical integration on scale economy in Shanghai. MethodsA total of 401 samples of 67 hospitals from 1999 to 2004 in Shanghai were collected.Median regression was performed to estimate the multi-output cost function and marginal cost of discharge patients,and scale economies were calculated.Results The independent variables Beds,W,X1,X23,Region,Level,Y03,and Y04 were all predictors of cost.Conclusion Both integrated tertiary and secondary hospitals had scale economy before and after integration.Integration enhanced the output and improved the efficiency of integrated secondary hospitals.To some extent,patients were dispersed to secondary hospitals.

Objective To explore the differences in health care quality,scale,output,efficiency,cost and financial condition between freestanding secondary hospitals and system-affiliated secondary hospitals in Shanghai,and analyse the determinants of hospital integration. Methods Eleven upper secondary hospitals in Shanghai integrated between 2000 and 2004 were selected,and another 40 secondary hospitals (including 30 upper secondary hospitals and 10 middle secondary hospitals) without integration were served as controls. Using related data of 1999,Mann-Whitney U test was performed to analyse the differences between these two groups,and Logistic regression analysis was conducted to explore the determinants of hospital integration. Results There were significant differences in health care quality,scale,and output between these two groups (P0.05). It was revealed by Logistic regression analysis that health care quality,scale,output,and financial condition were determinants of integration. Conclusion System-affiliated secondary hospitals have advantages over freestanding hospitals in health care quality,scale,output and financial condition,and those with better health care quality,larger scale,larger output and better financial condition are more likely to be integrated by tertiary hospitals.

In this article,we presented the rationale and calculation procedures of a propensity score weighting method,with its application in epidemiological studies.The rationale for propensity score weighting method is similar to those for traditional standardization methods.Propensity score is used to estimate the weight for each individual.As the propensity score serves the function of observed covariates,the propensity score weighting can balance the distribution of the observed covariates between the comparison groups.There are two weighting methods according to the target standard populations:the Inverse probability of treatment weighting(IPTW)and the Standardized mortality ratio weighting(SMRW).Results of the example show that the distribution of the covariates tended to be consistent after weighting,and the IPTW and SMRW methods showed similar effect estimates.Propensity score weighting method can effectively balance the distribution of the confounding factors between the compared groups in non-randomized controlled trials.

Objective To study the effect of local mild hypothermia on the expression of matrix metallopro- teinases-2/9 (MMP-2/9) and brain edema in experimental intracerebral hemorrhage (ICH) in rat. Methods One hundred and forty-five Wistar rats were randomly divided into a normothermia sham-operation (NSO) group ( n = 15 ), a normothermia intracerebral hemorrhage (NICH) group (n = 75 ) and a mild hypotbermia intracerebral hemor- rhage (MHICH) group (n = 75). Autologous arterial blood was stereotaxically injected into the right caudate nucleus of the rats of the NICH and MHICH groups to make intracerebral hemorrhage model. The rats in the MHICH group were then subjected to 4 hours of local mild hypothermia, while those in the NICH group were under the room temper- ature. The brain water content, permeability of brain-blood barrier (BBB) and expressions of MMP-2/9 were meas- ured by immunohistochemistry method at 6 h, 24 h, 72 h, 5 d and 7 d after operation. Results In NICH group, the brain water content, permeability of BBB and expression of MMP-9 all began to increase at 6 h and peaked at 3 d after injection of blood and still higher than the NSO group at 7 d. The expression of MMP-2 only began to increase little at 24 h and peaked at 5 d after operation and remained highly expressed at 7 d. In the MHICH group, the chan- ges of brain water content, permeability of BBB and expression of MMP-9 were similar to those of the NICH group, but the extent of changes was significantly lower at the every time point. In NICH group and MHICH group, MMP-9 expression was positively correlated with both the brain water content and the permeability of BBB, but MMP-2 ex- pression was not correlated with them. Conclusion Mild hypothermia might protect BBB against injury caused by ICH and relieve brain edema and inflammation reaction through inhibiting the expression of MMP-2/9.

Background Cellular autophagy is a non-apoptosis death form of tumor tissue.Research determined that arsenie trioxide (As2O3) leads to apoptosis of tumor cells.But whether As2O3 induce autophagy of SO-Rb50 cells or not is unclear.Objective This study was to assess the effects of As2O3 on autophagy of SO-Rb50 cells.Methods As2O3 with the concentration of 0,0.5,1.0,2.0,4.0 μmol/L was used to treat the SO-Rb50 cell line for 48 hours,and the growth and proliferation of SO-Rb50 cells were detected using MTT assay (A570).pGFP-LC3,a marker of autophagy,was constructed to transfer SO-Rb50 cells,and the cells were then divided into RPMI-1640 culture group (untreated group),As2O3 + RPMI-1640 culture group (As2O3 treated group) and rapamycin culture group (positive control group).Autophagy of SO-Rb50 cells was examined by laser confocal microscope and monodansylcadaverine (MDC) influorescence staining,respectively,48 hours following cell culture.Ultrastructural features of autophagy were examined with transmission electron microscope (TEM).The percentage of autophagy positive cells in different concentrations of As2O3 treated groups was calculated with flow cytometer.Results The A570 values of SO-Rb50 cells were 2.194±0.066,1.841 ±0.213,1.035±0.046,0.374±0.042 and 0.167±0.019 in 0,0.5,1.0,2.0,4.0 μmol/L As2O3 treated groups,with a significant difference among these 5 groups(F=547.636,P＜0.05),and those of 0.5,1.0,2.0,4.0 μmol/L As2O3 treated groups were significantly reduced in comparison with untreated group (P =0.000).The positive granular spots for GFP-LC3 chimeric protein were seen to aggregate in autophagic vacuoles in the As2O3 treated group and positive control group,but diffuse cytoplasmic signal for GFP-LC3 was found in the untreated group.Normal ultrastructure of SO-Rb50 cells was exhibited in the untreated group,and many double-membrane-like bound vesicles and autlysosomes were documented in the As2O3 treated group and positive control group under the TEM.A lots of MDC fluorescence granule were found in the As2O3 treated group and positive control group rather than the untreated group.Flow cytometry showed that the percentages of SO-Rb50 cells were 0,15.6％,42.7％,57.9％,79.5％ and 89.0％ in the 0,0.5,1.0,2.0,4.0 μmol/L As2O3 groups and positive control group,respectively,showing a As2O3 concentration-dependent increase.Conclusions As2O3 can induce the autophagy of SO-Rb50 cells and inhibit the proliferation of SO-Rb50 cells.Autophagic response of SO-Rb50 cells appears prior to the nuclear change after exposed to As2O3.The degree of autophagy of SO-Rb50 cells is associated with As2O3 dose.

This article introduced the neuromuscular activation characteristics of patients with chronic ankle instability during dif-ferent movement patterns, and explained the reasons of deficits of neuromuscular control in lower extremity muscle ac-tivity, kinetics, and kinematics, which aimed at further clarifying the mechanism of chronic ankle instability, and provid-ing theoretical basis for its rehabilitation training.

Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.