Objective To establish the quantitative evaluation system on the internal control of drug management, which could reflect the improvement and optimization of the internal control of drug management and be reference for the drug management in the hospital. Methods Brainstorm method was used to design a quantitative evaluation table. The methods of walking test, field inspection and comparative analysis were used to carry out the internal control design and execution effectiveness evaluation. Results Evaluation score increased from 36.50 points in 2015 to 43.75 points in 2021 when the full score was 50 points. The proportion of drug intotal income decreased from 37.97% in 2015 to 21.62% in 2021.The drug markup rate decreased from 14.38% to 0.96%, and the intensity of antibiotic DDDs decreased from 55.48 in 2018 to 39.30 in 2021. The proportion of essential drug prescriptions was higher than the national examination data. Conclusion The optimizing quantitative evaluation system on the internal control of drug management could improve the management specialization, the structure of income and payout and the level of rational drug use, promote the high-quality development of hospitals and safeguard the implementation of the Healthy China strategy.

Objective To observe the clinical effects of arthroscopic reconstruction for anterior cruciate ligament ( ACL ) tear using tension-relieving technique and enhanced recovery after surgery ( ERAS ) . Methods Between May 2014 and June 2016, 80 patients with ACL tear were randomly di-vided into 2 equal groups. The experimental group was treated with arthroscopic reconstruction using hamstring tendon autograft and tension-relieving technique followed by ERAS; the control group was treated with arthroscopic reconstruction using hamstring tendon autograft only followed by conventional postoperative re-covery. The 2 groups were compared in terms of knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC ( International Knee Documentation Committee ) , HSS ( Hospital for Special Surgery ) , and Lysholm scores at postoperative 3rd, 6th and 12th months. Results The 80 patients obtained an average follow-up of 12. 3 ± 1. 7 months. Arthroscopy one year postoperation revealed fine ACL growth without laxity or other complications in the experimental group. Joint stiffness appeared in one case at 2 months postoperation and ACL laxity was observed in 3 cases by arthroscopy at 12 months postoperation in the control group. The knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months in the experimental group were significantly better than those in the control group ( P <0. 05 ) . In both groups, the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months and the knee flexion angles at postoperative 2nd, 4th and 8th weeks were all significantly im-proved than the preoperative values ( P <0. 05 ) . Conclusion In arthroscopic reconstruction for ACL tear, tension-relieving technique combined with ERAS can promote functional recovery of the knee and reduce postoperative complications, facilitating early recovery of sports function.

Objective: To investigate the clinical value of endoscopic ultrasonography (EUS) and Multi-slice Spiral CT (MSCT) in the preoperativestaging of tumor(T) and lymph node (N) metastasis in patients with SiewertⅡand Ⅲ typeadenocarcinoma of esophagogastric junction(AEG). Methods: Clinical data of 145 Siewert Ⅱ and Ⅲ type AEG patientswithout preoperative chemoradiotherapy were retrospectively reviewed. Theyall received preoperative EUS and MSCT examination and underwent surgical resection, and the results of EUS and MSCT were compared with their postoperative pathologic staging. Results: The sensitivity, specificity, and accuracy of EUS for T stage in Siewert Ⅱ and Ⅲ type AEG were higher than those of MSCT. The total accuracy of EUS and MSCT were 90.3% and 63.5%, respectively, and the difference was statistically significant (χ²=29.52, P<0.01). The sensitivity of EUS for T1, T2 and T3 were 89.5%, 91.1% and 85.2%, respectively, which were significantly higher than 42.1%, 66.7% and 29.6% of MSCT (χ²=9.47, P<0.01 for T1; χ²=8.07, P<0.01 for T2; χ²=17.40, P<0.01 for T3). In addition, the total accuracy of EUS and MSCT for lymph node metastasis status of Siewert Ⅱ and Ⅲ type AEG were 75.9% and 64.8%, respectively, showing a statistically significant difference(χ²=4.23, P=0.04). The sensitivity of EUS for N1 and N2 were 82.1% and 79.2%, respectively, which were significantly higher than 53.6% and 60.4% of MSCT (χ²=5.24, P=0.02; χ²=4.48, P=0.03). There was no statistical significance for sensitivity of EUS and MSCT in N0 and N3 (P>0.05). Conclusion EUS diagnosis of T and N staging in Siewert Ⅱ/Ⅲ type AEG showed significantly greater performance than MSCT.

Objective To compare the different features of contrast enhanced ultrasound(CEUS) and CT angiography (CTA) in abdominal aortic remodeling after thoracic endovascular aortic repair (TEVAR)of DeBakey type Ⅲ aortic dissection(AD),and to investigate the application value of CEUS in the follow-up of DeBakey type Ⅲ AD after TEVAR.Methods CEUS was performed in 28 patients with DeBakey type Ⅲ AD after TEVAR,in which 8 cases type Ⅲ a (simple type) were not involved of abdominal aorta,20 cases Ⅲ b(complex type) were involved in the abdominal aorta,all patients were performed CTA examination of aorta.The functional and morphological changes of abdominal aortic remodeling were observed by two methods in DeBakey type Ⅲ AD after TEVAR.Results There was no new rupture of the abdominal aorta in 8 cases type Ⅲ a AD,but 20 cases of type Ⅲ b AD showed the situation of ruptures,thrombosis,trues and falses lumen after 3 months of follow-up.CEUS was less than CTA in detecting the number of ruptures (P＜0.05),CEUS and CTA results were similar in the measurement of true and false lumen diameter (P＞0.05),but CEUS clearly showed the hemodynamic characteristics of abdominal aortic intimal tear,the size and position of rupture,moving blood flow of rupture,and true or false lumen,which provided more accurate data for the long term abdominal aortic remodeling of DeBakey type Ⅲ AD after TEVAR.Conclusions CEUS and aortic CTA can play a complementary role in DeBakey type Ⅲ AD after TEVAR of long-term follow-up,it is worth promoting.

Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation (NIPPV) and heated humidified high flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) among low-birth-weight premature infants.Method From May to December 2015,low-birth-weight premature infants with RDS who were born and treated in our hospital were randomly assigned into NIPPV group and HHHFNC group according to their initial ventilation mode.The incidence of initial treatment failure,the usage of pulmonary surfactant (PS),the parameters of respiratory support treatment and the incidence of complications were analyzed.Result A total of 70 cases with grade Ⅰ ～ llⅢ of RDS were included,including 33 males and 37 females.The birth weight ranged from 1 020 to 2 450 g,with a average of (1 845 ± 475) g.NIPPV and HHHFNC group each had 35 cases.No significant differences existed between the two group in the following items:the rate of mechanical intubation within 72 h (5.7％ vs.11.4％),use of PS (0％ vs.8.6％),incidence of severe apnea (11.4％ vs.14.3％),pneumonia (11.4％ vs.14.3％),the duration of invasive mechanical ventilation [76.3 (30.8,150.4) h vs.97.6 (56.2,142.6) h],non-invasive ventilation [65.0 (43.0,119.0) h vs.96.0 (65.0,134.0) h] and the duration of oxygen therapy [154.0 (47.0,340.0) h vs.148.0 (72.0,327.0) h,it was no (P ＞ 0.05).Also,no significant differences in the incidence of bronchopulmonary dysplasia,necrotizing enterocolitis,retinopathy of prematurity,patent ductus arteriosus,intra-ventricular hemorrhage,nose injury,pneumothorax between the two groups.Conclusion As an initial respiratory support for the treatment of low-birth-weight RDS preterm infants,HHHFNC has similar efficacy and safety with NIPPV,and further clinical research is needed.

Objective To evaluate the efficacy of routine extraluminal use of an Arndt endobronchial blocker (AEB) for one-lung ventilation (OLV) in infants.Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ infants,aged 6-36 months,weighing 5-18 kg,undergoing elective thoracoscopic surgery,were enrolled in the study.The loop of AEB was fastened to the front of the endotracheal tube (ETT),and the blocker was placed externally to the ETT.After induction of general anesthesia,the AEB's placement was facilitated through the use of a fibreoptic bronchoscope.Mean arterial pressure,heart rate,end-tidal pressure of carbon dioxide,oxygen saturation and airway pressure were recorded before AEB placement (T1),during AEB placement (T2),at the beginning of OLV (T3),at the beginning of two lung ventilation (T4) and at extubation (T5).The AEB placement time and successful placement and lung collapse time were recorded.The satisfaction with lung collapse,AEB shifting,hoarseness and development of intraoperative adverse cardiovascular events and hypoxemia and hypoventilation during OLV were recorded.Results Compared with the baseline at T1,no significant change was found in heart rate or mean arterial pressure at the other time points (P＞ 0.05),airway pressure was significantly increased at T2,3,and end-tidal pressure of carbon dioxide was increased at T4 (P＜0.05).The AEB placement time was (5.6± 1.2) min,the success rate of AEB placement 93％,the rate of satisfaction with lung collapse 83％,and the incidence of AEB shifting (only found in the pediatric patients in whom AEBs were placed on the right side) 13％.No intraoperative adverse cardiovascular events,hypoxemia or hypoventilation was observed in the pediatric patients in whom AEBs were successfully placed.Conclusion Routine extraluminal use of an AEB can provide a fast,safe and effective method for OLV in infants.

Intraductal papillary mucinous neoplasm (IPMN) is a kind of epithelial neoplasms of mucin-producing cells arising in the main duct and/or branch ducts of the pancreas,and it is one of the precancerous lesions of the pancreatic cancer.With the development of pathology and radiology,the diagnostic rate of IPMN has been gradually increased and given a new understanding on the pathological characteristics,clinical diagnosis and treatment of IPMN.This review overviewed the classification,diagnosis,management and prognosis of IPMN,aiming to deepen the understanding of IPMN and improve the level of diagnosis and treatment.

Objective To explore the application of subdermal vascular network skin graft in severed finger reunion with small area skin defects.Methods Modified subdermal vascular network,which was inversion thin and middle thick,was used to repair defect of severed finger reunion without exposure of blood vessel.There were 10 patients and 14 fingers,including 7 patients and 10 fingers injured in the dorsal sid with 5 fingers' extensor tendon exposed,and 3 patients and 4 fingers injured in the palmar side with 2 patients' flexor tendon exposed.The defect area was ranged from 1.0 cm × 0.8 cm to 3.0 cm × 1.5 cm.Results In 6 larger subdermal vascular network,skin's edge became blue and blister appeared in the middle.The others was good with skin texture and aspect.Conclusions Modified subdermal vascular network skin graft is safe and effective choose to solve severed finger reunion with smnall area skin defects.

Objective To explore the clinical effect of transjugular intrahepatic portosystemic shunt (TIPS) and percutaneous transhepatic variceal embolization (PTVE) on the treatment of cirrhosis with esophageal gastric varices bleeding. Methods The data of 61 patients of liver cirrhosis combined with esophageal gastric varices bleeding who underwent the interventional treatment were included in the retrospective analysis. Patients were divided into two groups, PTVE treatment group (n=42), and TIPS treatment group (n=19). The success rate of clinical treatment, the rebleeding rate, the alleviation of varicose veins, the incidence of hepatic encephalopathy, survival rate and liver function parameters were compared between two groups. Results Two groups of surgery were successful. The portal vein pressure decreased obviously in TIPS group. The rebleeding rate was higher in PTVE group (78.6%) than that in TIPS group (63.2%). The total alleviation rate of esophageal gastric varices was significantly lower in PTVE group (50.0%) than that in TIPS group (89.5%, P<0.05). The incidence rates of hepatic encephalopathy were 14.3% and 26.3% for PTVE group and TIPS group respectively. The two-year cumulative survival rates of PTVE group and TIPS group were 95.2% and 89.5% respectively, and there was no statistically significant difference between two groups. After surgery, the liver function parameters were not significantly different from those determined before the treatment in PTVE group. At 1 month and 3 months after TIPS, the liver functions were declined obviously. At 6 and 12 months after the treatment, the liver functions were not significantly different from those determined before the treatment in PTVE group. Conclusion The surgery of TIPS is safe and ideal interventional treatment for cirrhosis with esophageal gastric varices bleeding, which has the lower rebleeding rate, better esophageal gastric varices alleviation rate and long term less influence in liver function.

Background and purpose:Cancer is a common disease. Multidisciplinary approach is the best model for cancer treatment. Cancer staging is the basis for diagnosis, treatments and prediction of prognosis.The survey is to give an overview of the current application of cancer multidisciplinary approach and UICC or other international cancer staging in mainland China. We made inquiries to our Chinese oncologists’ experience of using these staging and share their comments and recommendations. For those cancers common in China, Chinese oncologists and academic societies should provide more information of staging, therapies, outcome, prognostic predictors of prognosis, etc. to make international stage systems, like UICC or AJCC, a more appropriate, accurate and acceptable guide to individual patients’ staging and treatment, to predict outcome and to facilitate clinical trials better. Methods: This survey was done from 2012 to 2013 by questionnaires. The questions were answered for 10 major cancers in China (liver cancer, esophageal cancer, nasopharyngeal carcinoma, lung carcinoma, breast cancer, gastric cancer, colorectal cancer, gynecologic cancer, prostate cancer and lymphoma). Thirty-three questionnaires have been answered by national wide hospitals including provincial cancer hospitals, district cancer hospitals and departments of oncology in general hospitals. We also site visited 7 grade B hospitals. Results:Multidisciplinary approach is not widely used in the hospitals. UICC or AJCC stages have been widely used for 10 cancers, but for cancers that were uncommon in the West;while common in China (nasopharyngeal carcinoma, liver cancer) the staging proposed by Chinese society have also been used to replace UICC/AJCC. Conclusion:We suggest a wild implementation of multidisciplinary approach. For those cancers common in China Chinese oncologists and academic societies should provide more information of staging, therapies, outcome, prognostic predictors of prognosis etc. to make international stage systems, like UICC or AJCC, a more appropriate, accurate and acceptable guide to individual patients’ staging and treatments, to predict outcome and to facilitate clinical trials better.