Objective: Through the analysis of the current situation of energy consumption and the energy management problems that hospital faced, elaborat the high demands of energy management in hospital effective logistics management, the saving mechanism of Energy Performance Contracting (EPC) is proposed. Methods: The process of introducing EPC to China and related concepts are described, and the main mode and implementation processes as well. Results: To explore the feasibility of the integration in energy-saving reformation and the mode of energy runing management what is the core to EPC, tell people what need to pay attention to in the implementation process, and provide scientific methods for energy management of efficiency operation and sustainable development in hospital. Conclusion:At last, pointing out that saving mechanism of EPC is suitable for hospitals and will bring significant saving benefit.

Objective To analyze patent applications by the top 20 hospitals in China in published papers and the advantages and disadvantages of patents owned by domestic hospitals so as to predict the development trends of their patents in the future.Methods Using data from China Patent Infonet,an analysis was made of the characteristics and technical features of the patents applied for by hospitals in the period 1985-2004,with a special focus on patent applications by the top 20 hospitals in published papers.Results It was found that in the 20-year period,patent applications by hospitals showed an upward tendency on the whole,with a marked rise in invention patents,a lack of proportion between patent applications and published papers,and a greater proportion of instruments and materials patents. Conclusion Domestic hospitals ought to give more attention to patent applications.

Objective To observe the clinical efficacy of electroacupuncture at different frequencies in treating post-stroke depression. Methods A hundred patients with post-stroke depression were randomized into treatment group 1, treatment group 2, treatment group 3, and a control group, 25 in each group. The treatment groups were intervened by electroacupuncture, while 2 Hz was adopted in treatment group 1, 50 Hz in treatment group 2, and 100 Hz in treatment group 3. The control group was intervened by oral administration of Sertraline Hydrochloride tablets. The Function Independent Measure (FIM) and Hamilton Depression (HAMD) scale were adopted for observation before and after intervention, and the clinical efficacies were compared. Results The FIM and HAMD scores were significantly changed after intervention in the four groups (P<0.05). After treatment, the FIM and HAMD scores in treatment group 1 were significantly different from that in treatment group 2 and 3 (P<0.05). The FIM score in treatment group 1 was significantly different from that in the control group (P<0.05). The total effective rate was 96.0%in treatment group 1, versus 92.0%in treatment group 2, 82.0%in treatment group 3, and 84.0%in the control group. The total effective rate in treatment group 1 was significantly different from that in the control group (P<0.05). Conclusions Electroacupuncture at 2 Hz, 50 Hz, and 100 Hz all can improve the activities of daily living and depression degree in patients with post-stroke depression, while 2 Hz ranks the top in comparing the therapeutic efficacy.

Objective To report the results of distally based lateral supramalleolar flap for the reconstruction of dorsal aspect of foot. Methods Twelve patients with soft tissue defects in the dorsal aspect of foot were treated with distally based lateral supramalleolar flap. The largest flap size was 9 cm? 6 cm, the smallest was 5 cm? 4 cm, with an average of 6 cm? 5 cm. Results The flap survived in all 12 patients. The color and texture of the flaps were nearly normal. Their appearance and function were satisfactory after 3 weeks to 24 months follow- up. Conclusion Distally based lateral supramalleolar flap is a reliable flap. The dissection is easy. The flap has a rich blood supply without sacrifice of major artery. It can be used reliably for the reconstruction of dorsal aspect of foot.

BACKGROUND:As a more common method in the orthopedic field, the method of intra-articular injection drugs has distinct curative effects, but there are some complications. In a certain extent, this method caters to the psychological fear of surgery, and can serve as a kind of conservative treatment. But some experts believed that because of the limit of sterile conditions, intra-articular injection of drugs wil increase the risk of intra-articular infection and they opposed this method.
OBJECTIVE:To review the efficacy and adverse reactions of intra-articular injection drugs in recent years, and explain clinical applications of intra-articular injection drugs in orthopedics.
METHODS:A computer-based search was conducted in PubMed and Wanfang database for articles related to the application of intra-articular injection drugs in orthopedics published between January 2007 and December 2013. The English and Chinese key words were“intra-articular, injection, orthopaedics, tranexamic acid, hyaluronic acid, corticosteroid, drugs”. Data were checked in the first trial, old articles and repetitive studies were excluded. The relevant 43 articles accorded with inclusion criteria were reviewed.
RESULTS AND CONCLUSION:In orthopedics, the method of intra-articular injection drugs is simple, economic and effective, but at the same time, there are some side effects. Tranexamic acid by intra-articular injection can significantly reduce blood loss after total joint replacement, is safety and economic. Intra-articular injection joint lubricant can reduce internal friction of joints and improve the adhesion of joint cavity, can be used as a good conservative treatment for osteoarthritis. Intra-articular injection hormone drugs can treat inflammatory arthritis, and short-term curative effect is obvious, but due to large long-term side effects, the method is not recommended now. Intra-articular injection of analgesic drugs and other drugs have both advantages complications. The efficacy of intra-articular injection drugs in orthopedics is obvious;meanwhile, this method has some complications. Orthopedic surgeons should select related drugs by indications. We stil need to further make reasonable regimen with intra-articular injection drugs in future large-scale study.

In order to find out appropriate model to best disseminate laparoscopy for colorectal cancer clinical advanced technologies,it is necessary to establish a whole set of training system,which included selecting training site,intensive training,operation observation,advanced study at home and abroad,technical support,etc..Evaluation was based on operation time,hemorrhage in surgery,other injuries in surgery,conversion to open surgery and the ratio of in situ relapse in one year post surgery.These five indexes were compared between the training group and the control group with the gradually stable trend of learning curve as standard.Without previous laparoscopic surgery experience,the training group required 13.8±0.75,14±0.89,10.2±0.74,16.4±0.49 and 20.4±0.49 cases,respectively,to achieve expected proficiency,and the control group required 28.6± 1.69,29.2±1.16,27.8 ± 0.74,22.8 ± 0.40 and 25.4± 1.03 cases,respectively.The learning time required 13.4± 1.02 months on average for the training group and 27.8±2.13 months for the control group.In conclusion,the training system achieved obvious superiority to the controls to achieve expected skills and proficiency in laparoscopy for colorectal cancer.

BACKGROUND:Tranexamic acid has been more and more used in reducing bleeding after joint replacement, but its usage method and dosage remain controversial, and become a hot focus in recent years. OBJECTIVE:To investigate the efficacy of intra-articular injection of tranexamic acid on postoperative blood loss and limb circumference changes in patients who received unilateral total knee arthroplasty. METHODS:From March to October 2013, clinical data of 90 patients undergoing primary unilateral total knee arthroplasty were randomized to the tranexamic acid group and the control group, including 19 males and 71 females. The 30 patients in the tranexamic acid group received 50 mL of 3%tranexamic acid dilute solution inside knee joint after capsule closure, and 60 patients in the control group received the same volume of physiological saline. No significant difference in age, height, body mass index, anticoagulation, the type of prosthesis, tourniquet time and preoperative diagnosis was detected between the two groups (P>0.05). The amounts of intraoperative and postoperative blood loss and blood transfusion, postoperative drainage volume, the preoperative and postoperative limb circumference 10 cm above the operated knee were recorded. Routine blood test was reviewed after the surgery. RESULTS AND CONCLUSION:There were no significant differences in total blood loss, postoperative drainage volume and limb circumference changes between tranexamic acid and control groups (P>0.05). The amount of postoperative hidden blood loss was significantly less in the tranexamic acid group than in the control group (t=-2.683, P<0.05). These data suggested that the intra-articular injection of tranexamic acid intraoperatively in patients receiving total knee arthroplasty could significantly reduce the amounts of postoperative hidden blood loss, and did not affect the postoperative limb circumference changes.

OBJECTIVETo observe the effects on post-stroke depression treated with acupuncture at the acu points based on ziwuliuzhu (the midnight-noon ebb-flow theory).

METHODSNinety-three patients were randomized into a comprehensive group, a ziwuliuzhu group and a prozac group, 31 cases in each group. In the ziwuliuzhu group, acupuncture was applied to the acupoints based on ziwuliuzhu, once a day, 5 times in a week. In the prozac group, fluoxertine hydrochloride (prozac) was prescribed for oral administration, once a day, 20 mg each time. In the comprehensive group, acupuncture based on ziwuliuzhu combined with the oral administration of prozac were adopted and the treatment frequency was the same as the ziwuliuzhu group and the prozac group. The 4-week treatment was taken as one session in the three groups and 6 sessions were required totally. The clinical efficacy and the Hamilton depression rating scale (HAMD) score and the adverse reaction were compared among the 3 groups.

RESULTSThe total effective rate was 96.8% (30/31) in the comprehensive group, better than 83.9% (26/31) in the ziwuliuzhu group and 80. 6% (25/31) in the prozac group (both P<0.05). In 4, 12 and 24 weeks of treatment, HAMD score was lower significantly than that before the treatment in the three groups (all P<0.05), and the score in the comprehensive group at each time point after treatment was lower than the other two groups (all P<0.05). In 4 and 12 weeks of treatment, there were not different significantly between the ziwuliuzhu group and the prozac group (both P>0.05). In 24 weeks of treatment, HAMD score in the ziwuliuzhu group was lower than that in the prozac group (P<0.05). For the adverse reaction, there were 2 cases in the comprehensive group, 6 cases in the prozac group and 0 case in the ziwzuliuzhu group.

CONCLUSIONThe comprehensive therapy of acupuncture at the acupoints based on ziwuliuzhu and oral administration of prozac is superior to either the simple oral administration of prozac or the ziwuliuzhu acu-puncture in terms of clinical efficacy and the improvements in depressive state. Regarding the clinical efficacy, the impact of simple ziwuliuzhu acupuncture is not different significantly as compared with the simple oral administration of prozac, but it is better than the simple oral administration of prozac in terms of the long-term HAMD score and safety.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Aged, 80 and over ; Depression ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome

Objective To discuss the value of serum thymidine kinase 1 and DNA ploidy for the diagnosis of patients with acute myeloid lecukemia.Methods Determined TK1 and DI in 20 healthy people,6 patients with benign proliferate in hematological system and 66 patients with acute myeloid lecukemia by chemiluminescence detection technique and flow cytometry.Nonparametric comparisons among three group were done by rank sum test.ROC curve was used to determine the AUC and the diagnosis value serum thymidine kinase 1 and DNA.Results As showed by peripheral blood results,the TK1 (x2 =36.877,P＜0.001) and DI (x2=4.040,P＜0.05) had statistically difference among healthy people group,patients with benign proliferate in hematological system group and AML group.The normal control group compared with the AML group,TK1 (Z=-6.073,P＜0.001)and DI (Z=-2.012,P =0.044) had statistically difference;The normal control group compared with the benign proliferate patients,TK1 (Z=-1.234,P =0.169) and DI (Z=-1.084,P =0.278) had no statistically difference.The benign proliferate patients and that with AML patients,TK1 (Z=2.177,P=0.036) had statistically difference,but DI (Z=-1.801,P=0.061) had no statistically difference.The TK1 and DI area under the ROC curve were 0.950 (P＜0.001) and 0.638 (P=0.063),best cut-off were 1.73 pmol/L and 0.98,sensitivity were 0.95,0.78,and specifity were 0.88,0.39.Conclusion Serum TK1 and DI is a important diagnostic marker of early for AML patients,TK1 have a better diagnostic performance than DI significantly.

Objective This study simulated clinical implant surgery using squeeze technique by establishing a rational animal model.We investigated the microscope image in order to observe the agglutination of the cancellous bone after being compressed.Methods The cancellous bone in condyles of dog femur had been chosen as the experimental position,the implant holes were prepared using squeeze technique according to different compressing extent(0,0.6,1.2,2.0mm),and then the corresponding implants were inserted into them.After different healing periods(1 week,2 weeks,4 weeks,12 weeks),the mongerl dogs were sacrificed and the hard tissue slices were made,then the architecture of the cancellous bone was observed using microscope.Results The architecture of the cancellous bone was changed obviously by squeeze technique in 1 week,2 weeks and 4 weeks hard tissue slices.After being compressed,the bone trabecula around implants was compact.Conclusion The clinical implant surgery using squeeze technique helps improve peri-implant bone density,which is good for obtaining primary stabilities of implants.