The main intention of this paper is to propose suggestions for optimizing China 's high-value medical consumables centralized procurement .In this paper , we have analyzed the developed countries 'best practices in high-value medical consumables procurement from the perspectives of procurement principle ( s), key procurement bodies, procurement patterns, supervision, and management.The results of our analysis show that “Value for mon-ey” is the core principle in procurement and hospital route , national/regional centralized route ( s) , and group pur-chase organization ( GPO) route are four primary procurement patterns in foreign countries .Procurement management is optimized through improving product coding system and encouraging health technology assessment ( HTA) and clin-ical practitioners'involvement in procurement decision-making.In that perspective, it's been suggested that China's high-value medical consumables centralized procurement could be improved from three aspects:referring partial HTA indicators so as to enhance tender evaluation and realize value-based purchasing;establishing a standard and unified coding system for medical devices;introducing GPO route and make market surveillance mechanism into full play .

BCR/ABL negative classical myeloproliferative neoplasms including three diseases,namely polycythemia veta,essential thrombocythemia and primary myelofibrosis.Progresses have been made in the study of these dieases in children following the development of that in adult,especially the research of molecular pathogenesis.Differences exist in clinical and molecular characteristics between children and adult BCR/ABL negative classical myeloproliferative neoplasms.There are specific characteristics in the diagnoses and treatment of childhood myeloproliferative neoplasms.This paper reviews the characteristics of childhood BCR/ABL negative classical myeloproliferative neoplasms in clinical and molecular features,diagnoses and treatment.

Objective To investigate the clinical efficacy and safety of kidney stones minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy.Methods 397 cases patients with kidney stones were randomly divided into the control group and the experimental group,the control group were treated with the extracorporeal shock wave lithotripsy treatment,and the later group were treated with holmium laser lithotripsy for percutaneous nephrolithotomy.Results The experimental group of taking the net rate was 97.48％,and the time of taking the net rate was 87.15 ％,higher than those of the control group(x2 =14.72,24.78,all P ＜ 0.05).Compared with the control group,the shortened operation time,(t =2.36,P ＜ 0.05),the reducing amount of bleeding (t =3.27,P ＜ 0.05),the shortened length of stay hospital (t =1.28,P ＜ 0.05),low complication rate (x2 =17.06,P ＜ 0.05) took place in the experimental group.Conclusion Minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy treatment of kidney stones is safe and effective,fewer complications,faster recovery,which is worthy of promotion.

Background:Nonvariceal vascular upper gastrointestinal bleeding is a special type of nonvariceal upper gastrointestinal bleeding (NVUGIB) with serious disease course and high mortality rate, which should be paid more attention by clinicians.Aims:To explore the etiological factors and therapeutic strategies of vascular NVUGIB for improving the diagnosis and treatment of the disease.Methods:Clinical data of 111 cases of vascular NVUGIB admitted from Jan.2012 to Dec.2016 at Daping Hospital, the Third Military Medical University were retrospectively analyzed.All cases were diagnosed by gastroscopy, abdominal CT or angiography.Results:One hundred and five patients underwent a gastroscopy within 24 hours of hospital admission.The major causes of bleeding were peptic ulcer involving blood vessels (62.2%) and vascular malformation (22.5%);other causes included Dieulafoy disease, gastrointestinal stromal tumor, malignant tumor, intra-abdominal infection, trauma and gastric angiotelectasis.Seventy-eight patients (70.3%) received endoscopic hemostasis, 19 received conservative medical therapy only, 13 were treated by interventional embolization and 5 underwent surgical operation.Hemostasis was achieved in 96.4% of the patients (107 cases);in four deceased, 3 were failures of endoscopic and interventional therapies.Conclusions:Peptic ulcer and vascular malformation are the major causes of vascular NVUGIB.Endoscopic therapy has generally been recommended as the first-line treatment, however, interventional embolization or surgical operation should be used directly if necessary.

By studying the academia criterion of the first hospital affiliated of wenzhou medical univertisy full-time graduate,result display that part of the graduate student academic criterion consciousness is faint,lack of academic criterion related knowledge,academic anomie behavior sometimes appear,Supervisor is partly absent from academic criterion guide.Aiming at this situation,University should strengthen the education of Supervisor,improve the system of rewards and punishment,purify academic atmosphere,promote graduate degree of academic criterion.

Objective To investigate the association of C3435T genetic polymorphism of MDR1 gene with paliperidone plasma concentration in the patients with schizophrenia by detecting the paliperidone plasma concentration change and C 3435T genetic pol‐ymorphism of MDR1 gene during medication process .Methods The paliperidone plasma concentration in 61 patients with schizo‐phrenia was detected by adopting the liquid chromatography tandem mass spectrometry at the end of 1 ,2 ,4 ,6 weeks after medica‐tion .Meanwhile C3435T MDR1 genotype was determined by adopting the LDR‐PCR method .The paliperidone plasma concentra‐tions in the patients with different genotypes and different alleles were compared .Results Among 61 patients with schizophrenia , CC ,CT and TT genotypes accounted for 24 .59% (15/61) ,63 .30% (38/61) and 13 .11% (8/61) respectively ,in which the propor‐tion of heterozygote CT was significantly higher than that of homozygote CC and TT (P<0 .05) .The proportion of C and T allele were 55 .74% and 44 .26% respectively(P<0 .05) .The paliperidone plasma concentration at 4 detection time points in the patients with TT genotype at 4 time points was significantly higher than that in the patientis with CC genotype ,and paliperidone plasma concentration only at the end of 1 week in TT genotype was significantly higher than that in CT genotype ,CT genotype was higher than CC genotype (P<0 .05) .The paliperidone plasma concentration at 4 detection time points in the patients of T allele was higher than that in the patients with C allele ,but statistically significant difference was only found at the end of 1 week (P<0 .05) .Conclu‐sion The C3435T genetic polymorphism of MDR1 gene has certain relationship with paliperidone plasma concentration in the pa‐tients with schizophrenia .

Objective To discuss the effect of comprehensive intervention on the quality of life of esophageal cancer patients receiving radiotherapy.Methods 100 patients with esophageal carcinoma treated with radiotherapy for the first timewere selected between October 2012 and December 2014 in Nantong Tumor Hospital in Jiangsu Province and randomly divided into control group and observation group (n =50 in each group) with a random number table.In the control group,routine dietary instruction,fluid infusion support and symptomatic intervention were used;comprehensive intervention was added in the observation group.Scores of core quality of life questionnaire (QLQ-C30) and nutritional indexesbefore and after radiotherapy in the two groups were compared.Results There were no statistically significant differences in QLQ-C30 scores and nutritional indexes between the two groups before radiotherapy (all P＞0.05).After radiotherapy,the physical [(75.6 ±13.1) vs.(63.8 ± 12.4)] and emotional function [(61.9 ± 14.3) vs.(52.5 ± 13.7)],fatigue [(36.6 ± 13.2) vs.(45.8±15.0)],pain [(34.8±16.1) vs.(44.3±17.0)],insomnia [(49.2±15.7) vs.(57.2±14.3)],loss of appetite [(50.2 ± 16.2) vs.(59.0 ± 15.8)],nausea and vomiting [(21.5 ± 10.3) vs.(29.9 ±11.3)],general health status [(68.8 ± 13.4) vs.(58.2 ± 12.8)] inthe observation group were significantly better than in the control group (all P ＜0.05).Innutritional status,body weight [(59.3 ± 8.5) kg vs.(54.4 ± 7.3) kg],body mass index [(21.9 ±2.1) kg/m2 vs.(18.4 ±2.8) kg/m2],hemoglobin [(125.9 ± 8.9) g/Lvs.(107.3±9.5) g/L],albumin [(35.1±6.9) g/Lvs.(29.0±5.3) g/L],and prealbumin [(213.54 ±37.47) mg/L vs.(174.56 ±36.26) mg/L] in the observation group were all higher than thosein the control group after radiotherapy (all P ＜ 0.01).Conclusion Comprehensive intervention for esophageal cancer patients receiving radiotherapymay improve nutritional status,reduce esophagitis,thirsty,fatigue,loss of appetite and other symptoms,improve the quality of life,ensure the completion of radiotherapy.

OBJECTIVE: To investigate the differential gene expression profiles in patients with blood stasis syndrome by oligonucleotide microarray technique. METHODS: Sixteen patients with blood stasis syndrome were divided into patients with coronary heart disease (CAD) (n=8) and non-CAD patients (n=8) by using coronary angiography. The sex- and age-matched eight healthy persons were enrolled as control group. Venous bloods were collected for extracting RNA. Test-3 chip was first employed to examine the quality of samples. Then the samples were hybridized with Affymetrix U133 Plus 2.0 array to compare the gene expression profiles among the three groups. Gene-array scanner and gene chip operating software were applied to screen hybridization signals and analyze gene expression respectively. Based on the comparison of the three groups of samples, the differential genes related with blood stasis syndrome were analyzed by Gene Ontology (GO) and pathway, and confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Forty-eight differential genes were found being associated with blood stasis syndrome, including 26 up-regulated genes and 22 down-regulated genes. Five of the forty-eight genes (10.4%) were related to inflammatory reaction and immune response through the GO analysis. In the pathway analysis, five of ten significant pathways were referred to inflammation and immune response. The results of real-time RT-PCR proved the accuracy of the gene chip. CONCLUSION: Inflammatory- and immune-related genes have a remarkable predominance in blood stasis syndrome gene expression profiles, which may explain the function of inflammation and immune response in the occurrence and development of blood stasis syndrome.

OBJECTIVE:To systematically review the clinical efficacy and safety of sirolimus(SRL)versus tacrolimus(Tac) for anti-rejection after renal transplantation,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,Medline,Science Direct,Cochrane library,CJFD,VIP and Wanfang Database,randomized controlled tri-als(RCT)about SRL(test group)versus Tac(control group)for anti-rejection after renal transplantation were collected. Meta-anal-ysis was performed by using RevMan 5.2 software after data extraction and quality evaluation. RESULTS:Totally 5 RCTs were in-cluded,involving 594 patients. Results of Meta-analysis showed,there was no significant difference in the incidence of acute rejec-tions [RR=1.26,95%CI(0.82,1.93),P=0.30],graft loss rate [RR=0.91,95%CI(0.32,2.55),P=0.85] and mortality rate [RR=0.87,95%CI(0.34,2.22),P=0.77] in 2 groups;while the infection rate in test group was significantly lower than control group, the difference was statistically significant [RR=0.13,95%CI(0.04,0.40),P<0.001]. CONCLUSIONS:Compared with Tac,SRL has the same anti-rejection effect after renal transplantation,not changed graft loss rate and mortality rate,but reduced the infection rate with higher safety.

Objective To study the diagnosis and treatment of mesenteric diseases,and to enhance the understanding.Methods The clinical and histopathological data of 114 cases of mesenteric diseases were retrospectively analyzed.Results The percentage of mesenteric diseases was 0.06% of all inpatients during the same period;the causes were as follows,inflammation (53.5%),tumor (33.3%),lesion of vessels (8.8%) and others (4.4%).The lesion sites were mostly in the mesentery of small intestine (64.0%).The confirming diagnostic methods were exploratory laparotomy,laparoscopy,fine needle aspiration biopsy and ultrasonography.The therapeutic strategies were cause-oriented,but the prognosis of those with unknown causes was poor.Conclusion Mesenteric diseases are clinically rare,and the prognosis of some of the types is unfavourable.