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OBJECTIVE To analyze the current situation of pediatric drug use under centralized drug procurement， and to provide reference for the subsequent design of pediatric drug centralized procurement rules. METHODS The comparative analysis method was used to analyze the problems in the centralized procurement， clinical use and supply of pediatric drugs from the aspects of centralized procurement selection results and actual use of pediatric drugs， price difference and online prices of pediatric drugs. The solutions were put forward to optimize the centralized procurement and pricing rules of pediatric drugs. RESULTS & CONCLUSIONS The demands for pediatric drugs in China were increasing， but the supply of marketed pediatric drugs was insufficient （including insufficient coverage of disease fields， insufficient varieties， insufficient suitable dosage forms for children， insufficient specifications for children， etc.）， and the development of pediatric drugs was relatively difficult. After merging the dosage forms of centralized procurement according to the medical insurance list， some suitable dosage forms and specifications for children couldn’t be selected， resulting in a shortage of clinical pediatric medication. Relevant enterprises’ enthusiasm for developing and producing pediatric drugs and participating in online competitions had decreased. There was also the problem of underpricing of pediatric drugs under the drug price difference ratio rule. It is recommended that when conducting centralized drug procurement， special drugs for children should be grouped separately for centralized procurement based on attributes and the population covered by the indications. The specifications of suitable pediatric drugs that were not selected are converted into the agreed purchase quantity of medical institutions in a certain proportion. It is necessary to further optimize the pricing rules for pediatric specialized drugs， ensure a certain profit margin for such drugs， increase the willingness of production enterprises to research， develop and supply drugs， and thus ensure the use and supply of pediatric drugs.
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Hierarchical medical system empowers the current healthcare reform on the medical supply side in China, a key to resolving the contradictions in the healthcare sector. This study analyzed the necessity and obstacles for such a system with synergy between hospitals, insurance and pharmacy, putting forward suggestions for building a scientific and rational hierarchical system.
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This paper introduced the measures to construct the hierarchical medical system in Yichang city. The authors identified problems found and proposed the city to take the following countermeasures. Such steps included service capacity building at primary level, motivating primary medical workers, attracting patients to primary care, and improving policies of hierarchical medical system.
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Objective To study the changes of PI3K/Akt/GSK3β signaling pathway during resuscitation with neck cooling in order to explore the relationship between the protective effect of neck cooling and the phosphorylation of PI3K/Akt and GSK3β.Methods Thirty rabbits were randomly(random number) divided into five groups, and models of cadiac arrest were induced by ventricular fibrillation(VF, the positive electrode in the right ventricle and negative pole on the apex of heart) for 4 min.In sham group,a electrode was placed into right ventricle without electric current conducted, and CA was not induced.The rabbits were sacrificed and specimens were taken at 24 hours after modeling.In normothermia treat group(NT group),resuscitation was carried out to restoration of spontaneous circulation(ROSC),and the rabbits were sacrificed and specimens were taken at 24 hours after modeling.In intra-arrest therapeutic hypothermia group (IATH group), rapid neck cooling was initiated at the same time with CPR,and the target brain temperature was set at 34 ℃ maintained for 4 hours after ROSC.Rabbits were sacrificed and specimens were taken at 24 hours after modeling.In recovery period cooling + LY294002 group(PATH+LY294002 group), LY294002 was injected intra-ventricularly at 20 minutes before resuscitation.Rapid neck cooling was started at the same time with CPR,and the target brain temperature was set at 34 ℃ maintained for 4 hours after ROSC.The rabbits were sacrificed and specimens were taken at 24 hours after modeling.In post-arrest therapeutic hypothermia group (PATH group), rapid neck cooling was begun after CPR for 1 hour,and the target brain temperature was set at 34 ℃ maintained for 4 hours after ROSC.The rabbits were sacrificed and specimens were taken at 24 hours after modeling.Animals were sacrificed by using overdose anesthetic drug.Western blot was used to detect the level of Akt p-Akt GSK-3β p-GSK-3β (ser9) protein, and TUNEL was used to observe apoptosis of tissues in each group.Multiple comparisons were performed with one-way analysis of variance (ANOVA).Results Compared with Sham group, Akt (Thr-308) phosphorylation (P-AKT) and P-GSK-3β levels in the brain neuron cytoplasm in 24 hours after CPR resuscitation in NT group was significantly reduced, and showed a gradual reduction trend (P<0.05);the P-AKT and P-GSK-3β levels in the brain neuron cytoplasm in 24 hours after CPR resuscitation in IATH group were significantly enhanced compared with NT group (P<0.05);the levels of these two kinds of protein at one hour after resuscitation in PATH group were significantly enhanced compared with NT group (P<0.05), but lower in IATH group.Intra-ventricularly injection of LY294002 made the effect of hypothermia lost, indicating that LY294002 inhibited the phosphorylation of Akt.Apoptosis cells were significantly reduced in IATH group and normothermia theatment group compared with PATH group and LY294002 group(P<0.05).Conclusions Neck cooling can reduce apoptosis in rabbit brain cells after recovery, and the protective effect on brain is best in intra-arrest therapeutic hypothermia group.LY294002 specifically block the PI3K/Akt pathway, and the protective effect of cooling on the brain can be abolished,indicating hypothermia protects the neurological function via activation of PI3K/Akt pathway.Neck cooling protects the neurological function by activating PI3K/Akt/GSK-3β, promoting the Akt activation, and increasing the expression of P-GSK3β.Specific Akt inhibitor LY294002 inhibits Akt phosphorylation of brain tissue recovery and further inhibit the phosphorylation of GSK-3β, thus abolishing protective effect of cooling on neurological function.
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The paper focuses on the (Primary Diagnosis at Grassroots Level,PDGL),and the current pilot situation and consequence of PDGL,analyzes the problems during the progresses,and dissects the conflicts of interest among the relative stakeholders.At last,the paper provides the corresponding countermeasures to the future development of PDGL.
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Objective To investigate the long-term effect of direct percutaneous coronary intervention (PCI) on left ventricular remodeling in patients aged ≥75 years with acute myocardial infarction (AMI).Methods 108 cases of patients with acute myocardial infarction were collected into the study.Direct PCI were completed in patients in PCI group within 12 hours of onset.Patients in non-PCI group received conventional conservative treatment with drugs.Patients were followed up for 0.5-8.0 years,and cardiac function (NYHA) and the detected ultrasonic cardiogram were evaluated during follow-up.Results The 106 patients received follow-up.Two female patients who were not treated with PCI died during follow-up,one patient died of sudden cardiac death and another patient died of severe pneumonia.Compared with non-PCI group,direct PCI group showed that cardiac function (NYHA) grade was lower(t=3.17,P＜0.05),the end-systolic and end-diastolic volume of left ventricle were less(t=3.50、3.90,all P＜0.01),the left ventricular ejection fraction was increased (t=2.00,P＜0.05),the ventricular wall motion index was smaller (t=2.96,P＜0.01).E/A ratio was higher,E wave deceleration time was shorter,and left ventricular mass index was smaller (t=4.04,4.29,4.70,respectively,all P＜0.01),the left ventricular long and short axis diameter were decreased (t=2.30,t=5.53,P＜0.05 or 0.01),and Spherical index was increased (t=2.97,P＜0.01).Conclusions Direct PCI treatment improves chronic ventricular remodeling in elderly patients with AMI and contributes to long-term improvement in cardiac function.
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The establishment of basic medical service system is the premise to realize that everyone will have access to basic healthcare rights. This study puts forward the basic medical services concept according to the evolution of basic medical services connotation and status quo of research at domestic and abroad. Based on the four basic characteristics’ “necessity, fairness, accessibility and efficiency”, the paper studies the connotation and governmen-tal responsibilities, and provides policy references for practical work in the future.
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Objectives:To formulate the specific basic medical services package that adapts to China’s health-care situations. Methods:With the optional items which are covered by medical insurance and the medical services price regulation in 2012 , the 2 phase and 5 steps experts consultation methods were applied according to the princi-ples of meeting characteristics and the floor level of basic medical services. Results:1343 items are included in the basic medical service package and finally 713 items in the supplementary package. Discussion and suggestion: The screening strategy combining medical insurance system ensures the chosen items’ economical efficiency. The basic medical service providers are not just restricted in primary medical institutions. The government responsibility should be highlighted and the basic medical insurance system should be developed to be the main financial subsidy re-sources.
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Aim Tostudytheprotectiveeffectsofin-hibition of neuronal nitric oxide synthase ( nNOS ) in methamphetamine ( METH ) induced neurotoxicity via oxidativestressinjuryinrats.Methods Ratmodelsof acute METH poisoning with/without 7 nitroindazole (7-NI) pretreatment were built to evaluate the protec-tive effects on the changes of ethology, nNOS, nitro-proteins, dopamine ( DA ) and apoptosis in rat stria-tum.Results ThenNOSexpression,nitroproteinex-pression and apoptosis increased significantly in the METH group( P0. 05 ) . Stereotyped behavior increased significantly in the METH group and the 7-NI combined group compared with the 7-NI group and the control group(P<0. 01). Conclusions 7-NIshowssignificantprotectiveeffects against the alterations of DA level, nNOS expression, nitroprotein expression and apoptosis in rat striatum caused by acute METH poisoning. However, there is no obvious protective effect on METH-induced stereo-typed behavior.
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Objective To observe the effect of icarrin on proliferation and differentiation of rat osteoblasts cultured in vitro as well as the expressions of bone morphogenetic protein-2 (BMP-2) and Osterix in rat osteoblast.Methods Calvarial osteoblasts were obtained from newborn (＜ 24 h) SD rats by trypsin-collagenase digestion.The culture medium with different icarrin concentrations and the second generation osteoblasts were mixed.The mRNA expressions of BMP-2,Osterix,ALP,and Col Ⅰ were detected by semiquantative RT-PCR.Then the second generation osteoblasts were cultured in the medium containing icariin (10 ng/ml) with or without BMP-2 antibody.After48 h,RT-PCR was used to estimate the mRNA expression of Osterix.Results In comparison with the control group,the mRNA expressions of BMP-2,Osterix,ALP,Col Ⅰ were increased in a dose-dependent manner (P＜0.05) with a maximal effect at the concentration of 10 ng/ml.The mRNA expression of Osterix treated with the mixture of icarrin and BMP-2 antibody was significant decreased(P＜0.05),and compared with the group of icarrin,however,the difference between the BMP-2 group and the mixture group was not statistically significant (P ＞ 0.05).Conclusions Icarrin stimulates proliferation and differentiation of cultured osteoblast in vitro by increasing the mRNA expression of ALP and Col Ⅰ.Icarrin could stimulate Osterix gene expression by enchancing BMP-2 gene expression,finally,it could induce bone formation and prevent and/or treat osteoporosis.
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Objective To investigate the effect and safety of long-term use of atorvastatin on carotid atherosclerosis in advanced elderly patients.Methods Totally 61 elderly patients with carotid atherosclerosis were permitted into study.They were treated with atorvastatin (20 mg/d) and followed-up for five years.The carotid atherosclerosis parameter and the serum levels of TC,TG,LDL-C,HDL-C,fasting blood glucose (FBG),ALT,AST,STB,CB,Bun,Cr and creatine kinase (CK) were measured before and 5 years after treatment.Results During fellow-up,2 patients died of severe pneumonia and 1 patient died of operation complications of intestinal obstruction,with mortality rate of 4.9％.2 patients (3.4％) gave up treatment because of muscle-related side-effect.Data was collected in 56 patients achieving study end.There was significant decrease in LDL-C (P＜0.05) and increase in HDL-C (P＜0.05),but there was no change in serum levels of TC,TG,FBG,ALT,AST,STB,CB,BUN,Cr and CK (P＜0.05) after 5 years.The total area of carotid atherosclerosis plaque was reduced [(0.63±0.41)cm2 vs.(1.07±0.67)cm2,P＜0.05] and echo of carotid atherosclerosis plaque was enhanced (2.67±0.52 vs.1.53±0.44,P＜0.01),but carotid intima-media thickness(IMT) appeared no change after five years.Conclusions Atorvastatin is safe in the treatment of advanced elderly patients,it can make carotid atherosclerosis plaque smaller and stable after long-term treatment.
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Objective To study the antimicrobial susceptiblity,clinical and bacteriological characteristics of enterobacter cloacae infection in ICU. Methods 83 cases of ICU infected with enterobacter cloacae were analyzed retrospectively. Results The elderly, hypoproteinemia,invasive operation,long-term hospitalization and the abuse of broad-spectrum antibiotics were the risk factors of infection with enterobacter cloacae. Besides highly sensitive to imipenem, the bacterium was resistant to most antibiotics, many of whose drug resistance ratio is over 50%. Conclusion The patients in ICU should be avoided the long-term abuse of broad-spectrum antibiotics and invasive operation.Bacterial culture and antibiotic susceptibility test should be carried out promptly. They could reduce the incidence of enterobacter cloacae infection.
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Objective To analyse the relationship between cytochrome C release and the opening degree of the permeability transition pore (PTP) during in post cardiopulmonary resuscitation(CPR) rats. Method Adult male Sprague Dawley (SD)rats were randomly (random number ) divided into a surgical sham group (no CA/CPR) ( n = 8) and CA/CPR group ( n = 48). Animals in CA/CPR group was induced by asphyxiation and icecold 0.5 mmol/L KCI and killed by decapitation and processed for isolation of brain cortex mitochondria at 3 h,6 h,12 h,24 h,48 h,72 h after restoration of spontaneous circulation (ROSC). MPTP opening degree was based on the absorbance changes of the mitochondrial suspension at 540 nm. Western blot analysed the release of CytC from mitochondrial to cytoplast. Results Neural cells MPTP always remained opening post ROSC. The opening degree of MPTP was not reaching the peak instantly. While its' change depended on time: remaining low level within 6 h post ROSC,then rapidly opening, till 12 h reaching the largest degree,and at 24 h post ROSC slightly shrunken. All these suggested that mitochondria started to shink. While at 48 h the opening degree largen again, shrunken once more at 72 h,but not reaching the normal level ( P ＜ 0.05 or P ＜ 0.01). Cytochrome C could not be detected in the cytosol in the earlier phases of the sham-operated brain samples but appeared in the mitochondria.The amount of cytochrome C released was proportional after restoration of spontaneous circulation 3 h and 24 h,failed to detect the enzyme in the mitochondria fraction. Conclusions We draw the conclusion MPTP plays a key role in neurocyte apoptosis after CA/CPR, which leads to mitochondria release CytC.
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Objective To determine the level of adiponectin (APN) in serum and induced sputum of patients with chronic obstructive pulmonary disease both during acute exacerbation (AECOPD) and silent stage, and investigate APN' s role as a marker of inflammation in the pathogenesis of COPD. Method From October 2008 to October 2009,30 male AECOPD patients in the emergency department, 30 male silent COPD patients in the department of respiratory diseases and 30 healthy nonsmoking male volunteers were included. All subjects' serum and induced sputum were collected, and they were all of normal weight(BMI range of 18.5～ 24.9 kg/m2). Patients were excluded if they suffered from severe bronchial asthma, bronchiectasis or autoimmune disease. The number of cells in induced sputum was counted and the cell type was classified. The concentrations of APN, IL-8, IL-6 and TNF-α in both serum and sputum were measured by using ELISA, and their pulmonary function was tested. The different groups were compared among them by using the t -tests, ANOVA analysis or nonparametric analysis, the relation between variables was assessed by using the Pearson or Spearman correlation test. Results The concentrations of APN in both serum and induced sputum of AECOPD patients were significantly higher than those in the silent COPD patients and the control subjects ( P ＜ 0.01 ). The concentrations of APN in the silent COPD patients were significantly higher than those in the control subjects ( P ＜ 0. 01 ). There were significant relationships between the concentrations of APN in serum and induced sputum and the levels of IL-8 and TNF-α in AECOPD patients ( r = 0.739, 0. 734,0.852 and 0. 857, respectively, P ＜ 0. 05) and in silent COPD patients ( r = 0.751,0.659, 0.707 and 0.867, respectively, P ＜0.05). There was significant relation betweenship between APN and neutrophil in induced sputum of AECOPD patients (r = 0.439, P ＜ 0.05). Conclusions APN was involved in the process of systemic and airway inflammation of COPD, and it was related with IL-8 and TNF-α. APN can be used as a new inflammation marker for COPD.
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Objective To study the effects of Shen-fuinjection onthe activity of β-adrenoreceptor in SD rats with cardiopulmonary resuscitation. Method The exprimerit was done at emergency medical lab of Shanghai Changzheng hospital.Cardiac arrest was induced thngh asphyxiation(succinylcholine)and ice-cold 0.5 mol/L KCI in rats,and resuscitation began at five minutes after cardiac orrest.In this experiment,seventy-two male SD rats were randomizly divided into 9 groups:control group(sham group),routine treatment(O.5 h,2 h,4 h,6 h) groups.and Shen-fu treatment(O.5 h,2 h,4 h,6 h),and each group had 8 rats.Rats of Shen-fh treatment groups were injected with shen-fu(20 mL/kg,20 mL/h)during CPR.3H-prazosln Wag used to determine the activity of β-adrenoreceptor in myocyte. The data of the statistic analysiswere presentedin the for mofmeaj14-standard(4-5)deviation.One-way ANOVA was used for muhig Toup comparison,and t-test for comprarison between two groups.Results[3-adrenoreeeptor reached peak at0.5 h after CPR(247.81±8.91)fmol/mg,reached the lowest level at 4 h(104.17 4-13.87)fmol/mg,and returned to the normal level at 6 h(178.53±10.42)fmol/mg.In the eady period.-adrenorecepter activity in control group[O.5 h:(259.91-4-18.09)finol/mJ was similar to that in Shenfu treatment groups(P>O.05).In the late phase,adrenoreeeptor activity in the Shen-fu treatment groups[2 h:(173.04±18.77)fmol/mg,4 h:(148.72±13.88)finoL/mg]was significantly hi#er than that in the control groups(P<0.05).Conclusiom After CPR, ceplor activity firstly rises and then declines,and Shenfu injection Call significantly increase adrenoreceptor activity of mrs in the later period after CPR.
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Objective To investigate the apoptosis of renal tubule epithelium after cardiopulmonary resuscitation(CPR)in rats and its possible mechanism.Methods Cardiac arrest was induced by asphyxiation(succinylcholine)and ice-cold 0.5 mol/l KCL in rats,and resuscitation started at 5 minutes after arrest.Forty-eight male SD rats were randomly divided into 6 groups:sham(control group);after cardiopulmonary resuscitation rats were allowed to reperfuse spontaneously for 3 hours,6 hours,12 hours,24 hours and 48 hours(n=8,per group).The apoptosis of renal tubule epithelium was assessed by TUNEL.Fas and Bcl-2 protein expression were observed using immunocytochemistry in every group.Results The apoptosis of renal tubule epithelium was singnificantly increased at 3 hours after resuscitation and peaked at 24 hours(P
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Objective To study the changes of neuron specific enolase(NSE) and S100? protein levels in serum after cardiopulmonary resuscitation(CPR) in rats,and and to evaluate their significance on early diagnosis of brain injury. Methods Caridiac arrest model was induced by asphyxiation with ice-cold 0.5 mol KCl in rats,and resuscitation 5 minutes after arrest.Fifty male Sprague Dawley rats were randomly divided into 5 groups : sham control group (n=10) and 4 routine treatment group (experimental group) (n=10,per group) . The blood samples were taken from rats at 6 , 12 , 24 , 48 hours after restoration of spontaneous circulation(ROSC).NSE and S100? measured by enzyme-linked immunosorbent assay were compared between each experimental group,serum from sham control animals was also analyzed. Results Both NSE and S100? were significantly increased in serum after ROSC when compared to sham controls(P
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Objective To investigate the effects of hypotonic sodium chloride hetastarh 40 injection(HSCH)on the expression of PMN Fas following hemorrhagic shock,and to explore the effective role and mechanisms of HSCH on hemorrhagic shock.Methods Modified Wiggers canine hemorrhagic shock model was used.Expression of Fas in PMN was measured by flow cytometry.Results The levels of PMN Fas expression during hemorrhagic shock were significantly lower than those in control group(P
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BACKGROUND: Intestinal tract factors, especially intestinal ischemiareperfusion, can induce the injury of remote organ. Chinese herb, rhubarb,can clear oxygen free radical to promote the proliferation of beaker cell in intestinal mucous membrane, inhibit excessive multiplication of bacterium and endotoxin absorption in the intestinal tract, activate blood circulation and remove blood stasis, improve microcirculation and other ways to protect intestinal mucous membrane barrier, so as to prevent and treat pulmonary injury.OBJECTIVE: To observe the preventing and treating effect of rhubarb on intestinal ischemia/reperfusion-induced pulmonary injury and the effect of rhubarb on tumor necrosis factor and phospholipase A2 (PLA2).DESIGN: A randomized controlled observation.SETTING: Department of Emergency, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.MATERIALS: This experiment was carried out in the Second Military Medical University of Chinese PLA from February to July 2003. Totally 80SD rats were selected and randomly divided into intestinal ischemia/reperfusion group (n=24), sham operation group (n=46), treatment group (n=24) and normal saline group (n=16).METHODS: In the intestinal ischemia-reperfusion group, rats were fasted before operation. They were anesthetized and given a median abdominal incision. Superior mesenteric artery was isolated and occluded by vascular clamp without wound, and then the incision was sutured; 45 minutes later,vascular clamp was taken out to recover blood supply. For the treatment group, modeling was the same as that in the intestinal ischemia/reperfusion group, 600 mg/kg suspension of rhubarb extract was gastrointestinally perfused into the rats 30 minutes before recovering blood supply. For the normal saline group, modeling was the same as that in the intestinal ischemia/reperfusion group; same dosage of normal saline was gastrointestinally perfused into the rats 30 minutes before recovering blood supply. For the sham operation group, occlusion of superior mesenteric artery was omitted. Taking pathological change and 125I-labeled bovine serum albumin pulmonary uptake index as the index to evaluate pulmonary injury, TNF content and serum of pulmonary tissue and PLA2 activity of lung and intestinal tissue of animals in each group were measured respectively at different time points.MAIN OUTCOME MEASURES: 125I labeled bovine bovine serum albumin uptake index, tumor necrosis factor content of blood and pulmonary tissue, and PLA2 activity of serum, lung and intestinal tissue RESULTS: ① Pathological and morphological change of pulmonary tissue: There was no obvious abnormality in the sham operation group; In the intestinal ischemia-reperfusion group, 6 hours later, pulmonary interstitial edema, neutrophile infiltration appeared and alveolar edema was also found, and there were a little haemorrhage and exudation of fibrin. Only mild pulmonary interstitial edema and a small quantity of neutrophiles were found in the treatment group. ② Ultramicro-pathological change of pulmonary tissue: There was no obvious change in the sham operation group. In the intestinal ishcemia/reperfusion group, 6 hours later, pulmonary capillary endothelial cells were swelled and neutrophilic granulocyte leaked into pulmonary stroma and alveolar space. There were no above changes in the treatment group. ③ Change of tumor necrosis factor of pulmonary tissue in the sham operation group or treatment group (reperfusion for 30 minutes) was significantly lower than that in the intestinal ischemiareperfusion group (reperfusion for 30 minutes) (0.235±0.114,1.374±0.550,16.315±4.587,P ＜ 0.01). ④125I-BSA pulmonary uptake index in the treatment group was significantly lower than that in the intestinal ischemiareperfusion group and normal saline group (P ＜ 0.01), without significant difference in comparison with sham operation group (P ＞ 0.05).CONCLUSION: Early application of rhubarb is helpful to prevent and treat lung injury following small intestine ischemic reperfusion, so as to inhibit tissue disease course to deve1op multiple organ dysfunction syndrome,which might be implemented through inhibiting the release of TNF and PLA2 and other media.
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It is increasingly important and imminent that bilingual teaching in emergency medicine is carried out and promoted in Chinese medical universities,with the internationalization of education.This teaching has been implemented in 8-year students of the Faculty of Medicine in our university this year.The desired results have been achieved.We conclude that some links,such as choice of teaching materials,teaching staff levels and raising students'enthusiasm,should be strengthened to improve the quality of teaching.