Procurement constitutes a cornerstone of daily operations in public hospitals,involving medical equipment,medical materials,pharmaceuticals,infrastructure projects,office supplies,and service-oriented projects.The responsibility for procurement used to rest on various functional departments overseeing business management,a situation that often led to a lack of transparency and standardization due to decisions made by a single department or a few key cadres.To standardize procurement practices,the national policy has introduced a"procurement"and"management"separation model.In public hospitals,pro-curement includes two main aspects:"procurement"entails the actual execution of purchasing activities,including market re-search,price negotiation,tender document formulation,and contract signing;and"management"involves the preliminary re-search,budgeting and project initiation,installation and commissioning,inventory acceptance,maintenance quality control,and usage management of procured items.The separation of"procurement"and"management"is an important part of the procure-ment management unit in the modern hospital administration.This process-based division ensures the functional distinction be-tween procurement and management,fostering interdepartmental collaboration and mutual oversight,thereby mitigating procure-ment integrity while safeguarding procurement quality.

Objective:To analyze changes in energy metabolism and oxylipin metabolism in macrophages after stimulation by Mycobacterium marinum ( M. marinum) using targeted metabolomics, and to provide insights into the mechanisms underlying the immune defense by macrophages against M. marinum infections. Methods:Mouse bone marrow-derived macrophages were obtained from the bilateral femurs of mice, and cultured cells were divided into two groups: the active M. marinum group and the inactivated M. marinum group. Bacterial suspensions were prepared using M. marinum clinical isolates; the active M. marinum group was treated with live M. marinum suspensions for 12 hours, while the inactivated M. marinum group with inactivated M. marinum suspensions for 12 hours. Cell morphology was observed through microscopy, and cell length was measured. Cell lysates collected from both groups were subjected to liquid chromatography-tandem mass spectrometry analysis to detect energy and oxylipin metabolites. A t-test was utilized to compare the lengths of macrophages between the two groups, while principal component analysis and orthogonal partial least squares-discriminant analysis were conducted to identify differential metabolites. Results:Under the microscope, macrophages in the active M. marinum group formed more granuloma-like cell aggregates compared with those in the inactivated M. marinum group; the macrophages were significantly thinner and longer in the inactivated M. marinum group (439.52 ± 91.67 μm) than in the active M. marinum group (289.96 ± 70.11 μm, P < 0.001). Principal component analysis and orthogonal partial least squares-discriminant analysis of energy metabolism and oxylipin metabolism in macrophages demonstrated good separation between the two groups. As for the energy metabolism, a total of 12 differential metabolites were identified, with the amino acid metabolism showing the most significant changes. Specifically, there was a significant increase in the content of L-citrulline, while the content of L-leucine and serine decreased. As for the oxylipin metabolism, 20 differential metabolites were identified, with the arachidonic acid metabolism showing the most significant changes. Conclusions:Macrophages stimulated by live M. marinum exhibited altered amino acid metabolism and arachidonic acid metabolism compared with those stimulated by inactivated M. marinum, characterized by an increase in L-citrulline content, a decrease in L-leucine and serine levels, and alterations in arachidonic acid content.

Objective:To explore the feasibility of smart phone real-time picture exchange-assisted telecytopathology for rapid on-site evaluation (tele-ROSE), and the role of tele-ROSE in improving the diagnostic efficiency of endoscopic physicians.Methods:Data of patients who underwent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) from April 2020 to May 2021 in Qilu Hospital of Shandong University were retrospectively collected. Patients who didn't receive ROSE from April 2020 to October 2020 were enrolled in the non-ROSE group, and those who underwent ROSE from November 2020 to May 2021 were enrolled in the ROSE group, of which endosonographers used WeChat on the smartphone to send ROSE images to cytopathologists from November 2020 to March 2021 were the mobile phone group, and those whose ROSE results independently diagnosed by trained endosonographers from April 2021 to May 2021 were the self-ROSE group. Basic information, ROSE results, postoperative pathology and follow-up were compared, and the diagnostic effectiveness of tele-ROSE was analyzed.Results:A total of 188 cases were included, of which 179 cases (95.2%) were solid pancreatic lesions and 9 (4.8%) were enterocoelia lesions. There was no significant difference in the puncture time among the non-ROSE, mobile phone and self-ROSE groups [3 (3, 4) VS 3 (3, 4) VS 3 (2, 4), H=1.320, P=0.517]. With the final diagnosis as the golden standard, the sensitivity, the specificity, the accuracy, the positive predictive value, the negative predictive value and Kappa value of the non-ROSE group were 80.6% (58/72), 89.5% (17/19), 82.4% (75/91), 96.7% (58/60), 54.8% (17/31), and 0.6 respectively. The corresponding indices in the ROSE group were 97.4% (74/76), 100.0% (21/21), 97.9% (95/97), 100.0% (74/74), 91.3% (21/23), and 0.9 respectively, those of the mobile phone group were 95.2% (40/42), 100.0% (10/10), 96.2% (50/52), 100.0% (40/40), 83.3% (10/12), and 0.9 respcetively, and those of the self-ROSE group were 100.0% (34/34), 100.0% (11/11), 100.0% (45/45), 100.0% (34/34), 100.0% (11/11), and 1.0 respectively. The sensitivity ( P=0.002), the accuracy ( P=0.001) and the negative predictive value ( P=0.009) of the ROSE group were significantly higher than those of the non-ROSE group, and there was no significant difference in other diagnostic efficacy indices ( P>0.05). There was no significant difference between the mobile phone group and the self-ROSE group in diagnostic efficacy ( P>0.05). Conclusion:Instant smartphone-assisted tele-ROSE through WeChat can well meet the needs of pathologists and endoscopic physicians. After the application of tele-ROSE training, the diagnostic accuracy of endoscopic physicians is equivalent to that of cytopathologist, which helps to obtain more sufficient specimens under endoscopy and improve the diagnostic accuracy of EUS-FNA.

This article reviews the importance of assessing quality of life related to nasal symptoms in patients after endonasal skull base surgery and assessment tools. This article introduces the assessment tools from the development background, applicable population, assessment content, application status, so as to provide a reference for medical and nursing staff to choose appropriate assessment tools. At the same time, this article provides ideas for the development of nasal symptom assessment tools for patients after endonasal skull base surgery in China.

Objective:To explore the application value of artificial intelligence-assisted diagnosis system for TBS report in cervical cancer screening.Methods:A total of 16 317 clinical samples and related data of cervical liquid-based thin-layer cell smears, which were obtained from July 2020 to September 2020, were collected from Southern Hospital, Guangzhou Huayin Medical Inspection Center, Shenzhen Bao′an People′s Hospital(Group) and Changsha Yuan′an Biotechnology Co., Ltd. The TBS report artificial intelligence-assisted diagnosis system of cervical liquid-based thin-layer cytology jointly developed by Southern Medical University and Guangzhou F. Q. PATHOTECH Co., Ltd. based on deep learning convolution neural network was used to diagnose all clinical samples. The sensitivity,specificity and accuracy of both artificial intelligence-assisted diagnosis system and cytologists using artificial intelligence-assisted diagnosis system were analyzed based on the evaluation standard(2014 TBS). The time spent by the two methods was also compared.Results:The sensitivity of artificial intelligence-assisted diagnosis system in predicting cervical intraepithelial lesions and other lesions (including endometrial cells detected in women over 45 years old and infectious lesions) under different production methods, different cytoplasmic staining and different scanning instruments was 92.90% and 83.55% respectively, and the specificity of negative samples was 87.02%, while that of cytologists using artificial intelligence-assisted diagnosis system was 99.34%, 97.79% and 99.10%, respectively. Moreover, cytologists using artificial intelligence-assisted diagnosis system could save about 6 times of reading time than manual.Conclusions:Artificial intelligence-assisted diagnosis system for TBS report of cervical liquid-based thin-layer cytology has the advantages of high sensitivity, high specificity and strong generalization. Cytologists can significantly improve the accuracy and work efficiency of reading smears by using artificial intelligence-assisted diagnosis system.

Objective:To analyze the safety and effectiveness of application of modified double-lumen microcatheter in the measurement of fractional flow reserve(FFR) in coronary bifurcation lesions.Methods:Total of 28 patients with coronary bifurcation lesions in two centers were divided into two groups:conventional technique group(CON) and novel technique group(NOV). The fluoroscopy time, contrast dye usage and FFR-related complications of the two groups were analyzed retrospectively.Results:There were 16 cases in CON group and 12 cases in NOV group. The median time required fluoroscopy in NOV group was significantly less than that in CON group; additionally, lesser amounts of contrast dye were used in NOV group (both P<0.05). The NOV group procedures were successfully accomplished in all cases without complications, such as damage of the pressure sensor, SB spasm or dissection. However, The CON group failed in three patients, including two who experienced coronary artery spasms( P>0.05). Conclusions:Limited experience suggests that the application of modified double-lumen microcatheter in the jailed SB FFR measurement after MV stenting is a safe and technically feasible approach.

We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
Animals ; Chromoblastomycosis ; Humans ; Laser Therapy ; Lasers, Solid-State ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Terbinafine ; Treatment Outcome

Objective: To understand the changes of serum transient receptor potential channel 1(TRPC1) in patients with vascular depression. Methods: 58 patients with vascular depression, 49 patients with major depressive disorder and 38 healthy controls were recruited.The TRPC1 of all subjects were detected by ELISA.Patients with vascular depression and patients with primary depression were scaled by HAMD-17.The level of TRPC1 was contrasted in different ages groups and in different nosogenesis (cerebral infarction, ischemic cerebrovascular disease, old cerebral hemorrhage, cerebral microbleeds, vascular risk factors, etc.) of vascular depression.The relationship between TRPC1 level and severity of depressive symptoms was further analyzed. Results: (1)The level of TRPC1 of serum((643.76±118.43)pg/ml) was decreased in patients with vascular depression compared with that in healthy controls ((712.48± 98.75) pg/ml). The level of TRPC1 in patients with vascular depression over 60 years ((601.43±113.55)pg/ml)was lower than that in patients with major depressive disorder over 60 years ((626.32±125.46)pg/ml) and healthy controls over 60 years((721.84± 99.62)pg/ml) .(2) Among the various causes of vascular depression, the level of TRPC1 in patients with cerebral infarction, ischemic cerebrovascular disease and cerebral microbleeds was significantly lower (P<0.05). (3) The levels of TRPC1 in the patients with vascular depression (r=-0.962, P<0.05) and patients with major depressive disorder (r=-0.674, P<0.05) were negatively correlated with HAMD-17 score. Conclusion The level of TRPC1 is lower in patients with vascular depression, which is more obvious in patients with cerebral infarction, ischemic cerebrovascular disease, and cerebral microhaemorrhage.The lower the level of TRPC1, the more severe the depression.The neuroprotective effect of TRPC1 is reduced in patients with vascular depression.The TRPC1 can be used as a biomarker for vascular depression.

Objective: To observe the clinical effect of acupuncture Yingxiang point in the treatment of hiccups. Methods: 120 cases with hiccups were selected, and they were randomly divided into treatment group and control group according to the digital table, 60 cases in each group.The control group was given conventional acupoint acupuncture.The treatment group received acupuncture internal Yingxiang acupuncture point.The total effective rate and effective time of treatment were observed. Results: The total effective rate of the treatment group was 100.0%, which of the control group was 96.7%, the difference between the two groups was not statistically significant (P>0.05). The effective time between the two groups had statistically significant difference (χ²=10.75, P=0.00). Conclusion Acupuncture Yingxiang point in the treatment of hiccups can enhance the treatment effect and shorten treatment time.

Objective To evaluate the feasibility of needle-based confocal laser endomicroscopy (nCLE) for imaging of intra-abdominal tissues and organs in rabbit models in vivo. Methods The nCLE miniprobe was inserted through the 19-gauge needle into various intra-abdominal tissues and organs[omentum majus, liver, pancreas and psoas major (skeletal muscle)]. The nCLE images were acquired and real-time sequences of respective locations were recorded. Finally, nCLE image characteristics were compared with histopathologic findings. Results nCLE was successfully performed in intra-abdominal tissues and organs of five rabbit models. The microscopic structures of cells, glands and microvessels in the omentum majus, liver, pancreas and psoas major ( skeletal muscle) were visualized clearly, respectively. Characteristics of various intra-abdominal tissues and organs were displayed on nCLE images, which were correlated well with histological findings. Conclusion Imaging of intra-abdominal tissues and organs with nCLE in vivo is feasible in future clinical practice.