An exploration was made on the content and methodology of supply chain management of a hospital in line with the fifth edition JCI standard.By means of enhanced management of supply chain procurement,tracking validation,risk management and indicators monitoring,the speed and certainty of relevant processes are improved,with hospital operation effectiveness and efficiency enhanced.

Objective To study the spatial change of transverse arch in the metatarsal head during a normal walking cycle, demonstrate the significance of transverse arch in normal walking and the relationship with hallux valgus. Methods A modeling gait cycle was obtained under the C- armed machine, the coronal spatial change of the transverse arch of the metatarsal head were recorded using video tape. On computer work station, the images from video tape were transformed to mpeg files. A model of the transverse arch was created for the analysis of the relationship between the transverse arch index Q and sinking time; between Q and I andⅡ intermetatarsal angle;Ⅰ andⅣ intermetatarsal angle; sinking time and body mass. Results There was a transverse arch formed by the 5 metatarsal heads. In normal walking, during standing phase to toe- off phase, the 2 and 3 metatarsal heads approach the ground resulting in sinking of the transverse arch. The transverse arch index had an adverse relationship with the hallux valgus angle. The time of the transverse arch sinking decrease accompanying with the transverse index Q. Conclusion The transverse arch of metatarsals played an important role during normal gait cycle. During normal walking, when the center of pressure moved forward, the force acting on the 2 and 3 metatarsal was increasing. So, the metatarsal heads drop down resulting in sinking of the transverse arch of the metatarsal head. In hallux valgus patients, the time of transverse arch sinking was earlier than normal and duration was longer. The total force acting on the 2 and (or) 3 metatarsal increased, which may caused disorder of forefoot.

[Objective]To study the foot radiographs of rheumatoid arthritis(RA),evaluate the relationship between foot deformity and disease duration,the relationship between flat foot and forefoot deformities in RA,thus to improve understanding of the progression of deformity and provide more appropriate treatment. [Method]Anteroposterior and lateral weight-bearing radiographs were obtained for 112 feet of patients with RA and 104 feet of patients without RA.The hallux valgus angle,the first intermetatarsals angle,the top angle of the medial longitudinal arch,the anterior angle of the medial longitudinal arch,the relative height of the talus were measured.One-Way ANOVA were used to evaluate the difference between two groups,and partial correlations were used to analyze the relationship between the foot deformities and disease duration by control the age,the relationship between flat foot and forefoot deformity by control the age was also analyzed.[Result]The hallux valgus angle was 24.2?14.3 in RA group and 13.2?5.3 in control group,the first intermetatarsals angle was 9.6?5.9 in RA group and was 7.6?4.4 in control group,the top angle of the medial longitudinal arch was 129.4?6.6 in RA group and 124.4?5.2 in control group,the anterior angle of the medial longitudinal arch was14.5?3.0 in RA group and 16.2?4.5 in control group,the relative height of the talus was 0.184?0.024 in RA group and was 0.191?0.032 in control group,there was significant difference between two groups except the anterior angle of the medial longitudinal arch.With the increase of disease duration,the top angle of the medial longitudinal arch,increased in RA group(P

Objective To evaluate factors which maintain the stability of the ankle, and discuss indications for trans-syndesmotic fixation. Methods 12 freshly-frozen cadaver legs amputated below the knee were collected and divided into 2 groups. An ankle fracture model of unconstrained pronation-external rotation was then designed. Group A simulated the injury combined with medial malleolus fracture, and Group B the injury combined with deltoid tear. Ligaments were cut off sequentially to simulate the increasing severity of the injury. Fuji super low-pressure sensitive films and displacement transducers were used to measure the contact area of the tibiotalar articular surface and the width of the syndesmosis. The data were analyzed with SPSS to analyze the relationship of ligament injury and ankle stability. Results In Group A, the articular contact area and the syndesmotic width after section of the deltoid were significantly different from those before the section (P

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Objective To analyze the VP1-VP4 genetic region of enterovirus 71 ( EV71 ) strains isolated from children with severe or mild hand, foot and mouth disease ( HFMD) in Shenzhen in 2012. Methods EV71 strains were isolated from five children with mild HFMD and five children with severe HFMD in Shenzhen in 2012.Reverse transcription-polymerase chain reaction ( RT-PCR) method was used to amplify the sequence of VP1-VP4 genes of EV71 strains.The sequences of the amplified products were analyzed by comparing with those of the EV71 reference strains ( A, B and C genotypes) published in Gen-Bank using nucleotide alignment, amino acid alignment and phylogenetic tree analysis.Results The homo-geneity between the EV71 strains isolated from severe and mild cases was 95.1%-98.2% in nucleotides and 99.2%-100% in amino acids.The VP1-VP4 nucleotide sequences of 5 strains isolated from severe cases and 5 strains from mild cases in Shenzhen shared 87.9%-97.8% homologies in nucleotides and 97.3%-99.9% homologies in amino acids with the genotype C EV71 reference strain.The EV71 strains isolated from children in Shenzhen were highly similar with the EV71 strain (FJ439769) isolated in Fuyang in 2008 and the one isolated in Jingdezhen in 2011 (JQ806378, C4a subtype) in nucleotide sequences.Mutations at the residue 31 in the VP1 region ( N→D ) were detected in 3 strains isolated from children with severe HFMD.Conclusion All of the 10 EV71 strains isolated in Shenzhen in 2012 belonged to the sub-genotype C4a.The mutation ( aa31 N→D) in the VP1 region of EV71 might be related to the different clinical mani-festations of HFMD cases in Shenzhen area.

Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.

Objective To study needs of training of trainers(ToT)in mini-clinical evaluation exercise(mini-CEX)and its effectiveness.Methods One hundred and fourteen doctors involved in TOT for mini-CEX were interviewed with questionnaire before and after training for their satisfaction of training and fifty of them scored the training videos.Results Before the training.39%(44/114)of doctors involved in TOT knew mini-CEX and 97%(111/114)of them hoped to know how to carry out mini-CEX thronsh training.When the training finished,30%(34/114)tO 55%(63/114)of them could completely understand seven items of examinations of mini-CEX.Fifty doctors involved in TOT scored the training videos after the training.There was signifieant difference in scores between TOT and standard scoring on training video 1 for teaching of coronary heart disease and video 2 for teaching of hematochezia(P<0.05).No significant difference Was found in scores between TOT and standard scoring on the video 3 for teaching of abdomihal pain(P>0.05).as well as those between TOT with five or less years experience and those with more than five years experience(P>0.05).Conclusions Currently,doctors involved in TOT have more demands on mini-CEX.However,effectiveness of short-course training for mini-CEX is not satisfactory,and pattern of its training should be improved further.

Thirty four residents of general practice and 11 students of junior college to undergraduate program were evaluated with the mini-clinical evaluation exercise (mini-CEX) when they were rotated to community clinics or the ward of general practice in Zhongshan Hospital from September 2009 to February 2010. The reliability and validity of mini-CEX for rotation examination in general practice training was assessed. Forty five trainees and 9 clinical faculty members completed 81 mini-CEX evaluations. The Cronbach's alpha coefficient was 0. 932. Criterion-related validity for mini-CEX overall competence with the end examination of rotation was O.53 ( P ＜ 0.001 ). The results indicate that mini-CEX may be an appropriate evaluation tool for rotation examination in general practice training.

Objective: To explore the relationship between left coronary plaque character with the bifurcation angle and diameter by 256-slice CT angiography (CTA). Methods: A total of 387 consecutive patients who received CTA in our hospital were retrospectively studied. There were 102 patients with normal image including 60 male and 42 female at the mean age of (52.10 ± 9.65) years and 285 patients with left coronary plaque including 166 male and 119 female at the mean age of (55.65 ± 10.40) years. All patients were divided into 4 groups according to the plaque condition, Normal group,n=102 patients without plaque, Non-calciifcation group,n=137, Calciifcation group,n=79 and Mixed group,n=69. The patients with non-calciifcation plaque included 73 of mild stenosis and 57 of moderate to severe stenosis in proximal LDA. Left coronary bifurcation angle, proximal diameter and area were measured by multi-planar reconstruction (MPR) and the maximum density projection (MIP) techniques to analyze the relationship between the above indexes and plaque position, character, degree of local stenosis. Results: Left coronary bifurcation angle, the proximal diameter, area in LDA and LCX in 3 plaque groups were all larger than those in Normal group,P<0.05. In Non-calciifcation group, the above indexes were similar between the patients with mild stenosis and moderate to severe stenosis,P>0.05, while in patients with moderate to severe stenosis, the bifurcation angle and diameter were larger in male than those in female patients,P<0.05. Conclusion: 256-slice CTA could objectively evaluate left coronary bifurcation angle, stenosis degree and plaque character, which are valuable for coronary artery disease prevention, diagnosis and treatment in clinical practice.