Clinical study on 3D printing technology in percutaneous nephrolithotripsy for complicated renal calculi / 中华泌尿外科杂志

Objective:To explore the clinical application value of 3D printing technology in percutaneous nephrolithotomy(PCNL) to complex renal calculi.Methods:The clinical data of 41 patients with complex renal calculi from May 2018 to October 2019, in the First Affiliated Hospital of Xiamen University and Xiang'an District of the First Affiliated Hospital of Xiamen University were retrospectively analyzed. There were 19 cases underwent PCNL after 3D printing (3D printing group), and 22 cases during the same period did not undergo 3D printing before operation (control group). Before operation, the two groups underwent CT plain scan enhanced examination. In 3D printing group, 3D printing technology was used to obtain 3D renal models, then 3D renal models were used for preoperative design and simulation of surgical puncture and preoperative conversation.The control group only underwent PCNL after routine examination.The ages of the patients in 3D printing group and control group were (42.9±2.5) vs. (41.3±2.9) years old, male/female ratio 11/8 vs. 12/10, body mass index (22.4±1.1) vs. (23.2±1.4) kg/m 2, serum creatinine (42.9±2.5) vs. (78.2±4.5) μmol/L, stone size (5.0±1.2) vs. (5.2±1.3) cm, the CT values of the stones was (930±210) vs.(950±200) HU. The difference of above parameters was not statistically significant ( P>0.05). The following indexes were compared between the two groups: score of questionnaire on satisfaction of preoperative conversation, and datas about operation and postopetation. Results:All the operations were successfully completed. The time of locating the target calyces in 3D printing group and control group was (3.3±1.3) vs. (5.3±3.1) min, and the coincidence of puncture calices was 94.7% (18/19) vs. 54.5%(12/22), and the stone removal rate of the 3D printing group was 78.9% (17/19) vs. 36.4% (8/22), 3D printing group was better than the control group in these respects( P < 0.05). However, there were no significant differences in postoperative complications [21.0% (4/19) vs. 13.6% (3/22)], multi-channel[89.4% (17/19) vs. 86.4% (19/22)], operation time [(121.8±20.2) vs. (132.1±18.5) min], time of hospitalization [(7.6±1.3) vs. (8.0±1.8)d] and time of extubation for renal fistula [(3.8±1.7)vs. (4.5±2.0 )d] (all P > 0.05). During preoperative conversation between the 3D printing group and the control group , the time spent on signing the consent [(17.0±3.9) vs.(21.0±3.3) min], the degree of understanding of the stone condition [(2.5±0.6)vs.(2.0±1.2) points], the degree of understanding of the PCNL surgical process and complications [(2.6±0.6) vs.(1.8±1.3) points] and the degree of satisfaction with the doctor’s preoperative conversation effects [(2.4±0.9) vs.(1.7±1.6) points]were significantly different in comparisons ( P<0.05). Conclusions:3D printing technology can be used in PCNL to directly display the internal anatomical relationship of renal calculi, guide accurate preoperative designing, help improve the operation efficiency and stone clearance rate, and can also be used as a mold in preoperative conversation to improve communication efficiency.

Clinical application of contrast-enhanced ultrasound in inflammatory hepatocellular adenoma / 中华超声影像学杂志

Objective:To investigate the contrast-enhanced ultrasound (CEUS) features of inflammatory hepatocellular adenoma (I-HCA).Methods:The contrast-enhanced ultrasound features I-HCA of 28 cases from April 2009 to November 2019 in Zhongshan Hospital, Fudan University were retrospectively analyzed, including arterial phase enhancement pattern, the homogeneity of enhancement, subcapsular enhancement, and the internal perfusion defect. All I-HCA lesions were divided into >5 cm group( n=9) and ≤5 cm group( n=19), the CEUS features between the two groups were compared. Results:All I-HCA lesions were hyper-enhanced in the arterial phase, among which 39.3% (11/28) showed diffuse filling, 39.3%(11/28) showed centripetal filling, and 21.4%(6/28) showed centrifugal filling pattern. Twenty-five percent (7/28) of I-HCAs showed heterogeneous enhancement, 10.7% (3/28) revealed unenhanced areas within the lesions. Subcapsular vessels were observed in 67.7 (21/31) of I-HCA lesions. Heterogeneous enhancement and unenhanced areas were more frequently detected in lesions >5 cm ( P=0.020, 0.026, respectively), while there was no difference in the enhancement pattern and subcapsular vessels between the two groups ( P>0.05). Inportal venous phase, 42.9%(12/28) of I-HCAs showed hypo-enhancement, and 57.1%(16/28) of lesions showed washout in late phase. According to "hyper-enhancement in arterial phase, sustained hyper- or iso-enhancement in portal venous and late phase" by CEUS, the diagnostic accuracy of benign lesion was 42.9%(12/28). According to any of hyper-enhancement pattern in arterial phase, subcapsular vascular enhancement, and sustained hyper- or iso-enhancement in portal venous and late phase, the diagnostic accuracy of I-HCA was 71.4% (20/28). Conclusions:CEUS is valuable in the diagnosis of inflammatory hepatocellular adenoma.

Application Analysis of Tranexamic Acid in the Orthopedic Inpatients from 4 Third-grade Class-A Hospitals in Chongqing / 中国药房

OBJECTIVE：To investig ate the application and trend o f tranexamic acid in the orthopedic inpatient ，and to provide reference for rational drug use. METHODS ：The consumption of tranexamic acid ，the distribution of orthopedics diseases using tranexamic acid and route of administration were analyzed in 3 sub-departments （joint surgery department ，spinal surgery department，orthopedic trauma department ）from 4 third-grade class-A hospitals of Chongqing during 2017 to 2020. RESULTS ： The total consumption of tranexamic acid used in orthopaedic department had increased year by year in the past 4 years，with increase of 6.2％-52.2％，and the consumption of tranexamic acid in various departments also increased year by year ；from 2017 to 􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂􀤂 书辅料标明情况及风险控制建议 [J].中国药师，2018，21 中华中医药杂志，2018，33（6）：2225-2229. （18）：2020-2022. [10] 孟菲，李学林.中成药说明书中规格项存在的问题与探 [ 7 ] 国家药典委员会.中华人民共和国药典：二部[S]. 2010年 讨[J].当代医学，2015，21（12）：14-15. 版.北京：中国医药科技出版社，2010：1014. [11] 国家食品药品监督管理局 .中成药规格表述技术指导原 [ 8 ] 孟菲，李学林.中成药说明书中功能主治项表述方法的探 则：征求意见稿 [EB/OL].（2017-10-11）[2020-12-20]. 讨[J].中医药临床杂志，2015，27（1）：111-112. https：//www.nmpa.gov.cn/xxgk/zhqyj/zhqyjyp/20171011- [ 9 ] 田硕，郭晖，苗明三.中成药说明书完善的思考及实践[J]. 151401184.html. [12] 王裴芳.我国中成药说明书中老年人用药项的调查分 Δ基金项目：重庆市科技计划项目-技术预见与制度创新项目（No. 析[J].中国药房，2015，26（29）：4055-4057. cstc2018jsyj-zdcxX0052）；重庆市社会科学规划项目（No.2019QNGL31） [13] 林志健，周伟龙，张冰，等.中成药说明书中儿童用药信息 ＊硕士研究生 。研究方向 ：社会医学 、卫生事业管理 。电话： 023-68485178。E-mail：351389583@qq.com 的修订完善思考 [J].药物流行病学杂志 ，2018，27（4）： # 通信作者：教授，硕士生导师，硕士。研究方向：医事法学、卫生 244-248. 政策、卫生事业管理。电话：023-68485178。E-mail：puchuan68@sina. （收稿日期：2021-01-07 修回日期：2021-05-26） com （编辑：罗 瑞） ·1622· China Pharmacy 2021Vol. 32 No. 13 中国药房 2021年第32卷第13期 2019，joint surgery department accounted for the largest prop ortion（59.2％ ，53.5％ ，47.2％）to use tranexamic acid ，and orthopedic trauma department accounted for the largest proportion （39.2％）in 2020. On the whole ，top 4 orthopedic diseases in the list of the consumption of tranexamic acid were joint replacement （25.5％-29.6％），hip fracture （19.3％-23.6％），diaphysis fracture （13.5％-18.6％）and pelvic and acetabular fracture （8.2％-14.0％）. The route of administration for tranexamic acid in spinal surgery department ，joint surgery department and orthopedic trauma department was mainly intravenous application every year （accounting for 55.1％-81.0％，46.9％-77.1％，49.3％-73.3％，44.9％-71.5％）. CONCLUSIONS ：The consumption of tranexamic acid in orthopedic inpatients is increased year by year ，and is dominated by joint surgery department and orthopedic trauma department. The route of tranexamic acid is still mainly intravenous administration ，which is safe and reliable.

Expert Concensus on Triune Personalized Treatment of Pelvic Tumor Based on Three-Dimensional Printing / 医用生物力学

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Mannan-binding lectin regulates Treg/Th17 cell balance in mice with Candida albicans infection / 中华微生物学和免疫学杂志

Objective To investigate the regulation of Treg/Th17 axis by mannan-binding lectin (MBL) in mice with Candida albicans ( C. albicans ) infection. -ethods MBL gene-knockdown (MBL-/-) C57BL/6 mice and wild-type (WT) C57BL/6 mice were divided into four groups. C. albicans strains (2×107 CFU) were injected intraperitoneally into the mice of infection groups. Paraffin sections of mouse liver and kidney tissues were prepared on 3 d. Histopathological changes were observed with hematox-ylin and eosin ( HE) and Periodic acid-Schiff ( PAS) staining. Flow cytometry was performed to analyze Th17 and Treg cells in mice on 7 d. The levels of IL-10 and IL-17A were measured by ELISA. CD4+T cells were obtained from spleen cells by magnetic sorting. Expression of Foxp3 and RORγt at mRNA and protein levels were detected by qRT-PCR and Western blot, respectively. Results The mouse model of C. albicans infection was established successfully. After infection, the MBL-/- mice had higher percentages of Th17 cells, but lower percentages of Treg cells than the WT mice. ELISA results showed that compared with the WT mice with C. albicans infection, the MBL-/- mice had significantly increased IL-17A and decreased IL-10 after infection. Moreover, the expression of RORγt at both mRNA and protein levels was up-regula-ted, while that of Foxp3 was down-regulated in the MBL-/- mice than in the WT mice following infection. Conclusions MBL regulates the immune balance of Treg/Th17 cells in mice infected with C. albicans through promoting the differentiation of CD4+ T cells into Treg cell subsets and inhibiting the differentiation into Th17 cell subsets.

The value of combination of micro-flow imaging and color Doppler flow imaging in the detection of vascular in hepatic tumors / 中华超声影像学杂志

Objective To evaluate the value in the diagnosis of focal nodular hyperplasia( FNH) by combining micro-flow imaging ( MFI) and color Doppler flow imaging ( CDFI) . Methods A total of 32 patients with 32 FNH lesions were enrolled in this study . Each patient underwent CDFI ,MFI ,and contrast-enhanced ultrasonography ( CEUS ) examinations . The differences in the grade and characteristic distribution of blood flow in FNH were compared between CDFI and MFI . The results were further compared with CEUS . Results There was a significant difference between MFI and CDFI in detecting the blood flow in FNH . Twenty-six cases (81 .3％ ) were detected with blood flow of grade Ⅱ and Ⅲ by MFI , however , 18 cases ( 56 .3％ ) were detected of grade Ⅱ and Ⅲ by CDFI ( P = 0 .000) . A total of 12 (37 .5％ ) lesions were correctly showed spoke-wheel arterial flow peculiar by CDFI ,whereas the number increased to 23(71 .9％ ) in combination with MFI( P = 0 .013) . Conclusions In combination with MFI , CDFI can reveal more blood flow and detect more sensitively in FNH ,which helps to diagnose FNH . To a certain degree ,it can be applied to reduce the use of CEUS .

Review and analysis of the treatment of polycentric osteosarcoma in China / 中华骨科杂志

Objective To investigate the clinical and epidemiological characteristics of osteosarcoma in China and analyze the incidence and clinical treatment of osteosarcoma.Methods The clinical data of 1 593 patients with osteosarcoma in 7 bone cancer treatment centers from January 2000 to February 2017 were analyzed.We retrieved large samples of documents in the database,extracted the relevant data and compared the data with this study.SPSS 13 software was used for statistical analysis and each factor was tested by x2.Results Of 1 593 patients,984 were males and 609 were females.The ratio of male to female was 1.62∶ 1.The average age was 23.2 years (range from 3-80 years).The peak age of onset was 11-20 years (52.4％).There were 217 elderly patients (＞ 40 years old).The tumors occurred in 1 524 limbs and 69 in axial bone.The most common sites of disease were distal femur 706 cases,proximal tibia 375 cases,distal humerus 117 cases and others 395 cases.There were 1 154 cases (71％) around the knee joint.The axial bone included 18 cases of spine,49 cases of pelvis and 2 cases of rib.Preoperative biopsy was performed in 1 111 cases and incisional biopsy in 280 cases.Preoperative diagnosis could be made in 1 345 cases (84.4％ of all patients,accounting for 96.7％ of biopsy patients).There were 79 cases with metastasis at first visit,accounting for 5％.Preoperative chemotherapy was performed in 1 185 cases (74.4％).With the DIA preoperative chemotherapy 271 cases,DIA+MTX 251 cases,AP 149 cases.220 cases of tumor cell necrosis rate was evaluated after operationaccording to the Huvos classification.There were78 cases of grade Ⅰ,105 cases of Ⅱ grade,35 cases of Ⅲ and 2 cases of grade Ⅳ.There were 1 299 cases undergoingpostoperative chemotherapy (81.5％),1 306 patients undergoinglimb salvage surgery (82％).Thespecific operation with prosthetic replacement is the most common (911 cases,69.8％).The postoperative chemotherapy included DIA+MTX regimen 471 cases,DIA regimen 266 cases and AP regimen 98 cases.Before and after the operation,379 cases were treated with the same chemotherapy regimen and 666 cases were changed.A total of 18 large sample documents were retrieved in Chinese data base (5 684 cases).The sex ratio,age range,peak incidence and location of the disease were similar to those of this study.The average age was 1-2 years old younger.The percentage of lung metastases associated with initial visits washigher.The rate of preoperative and postoperative chemotherapy and limb salvage waslowand the rate of tumor necrosis wasbetter after chemotherapy.A total of 22 large sample literatures were searched in foreign database (12 850 cases).The ratio of men and women is 1.30∶1 and the proportion of women is higher than the domestic data.The average age was 1-2 years older.The ratio of the knee joint was lower.The percentage of lung metastases associated with initial visits washigher.The rate of preoperative and postoperative chemotherapy and limb salvage were similar to that of this study and the rate of tumor necrosis was better after chemotherapy.Conclusion The general situation of the incidence of osteosarcoma (sex,age,location of the disease) is not significantly different from the previous reports both at home and abroad.In the treatment,preoperative and postoperative chemotherapy rate and limb salvage surgery rate have improved significantly compared with the past.The chemotherapy program from the coexistence of various programs,gradually to the DIA+MTX and DIA program as the mainstream program.

Outcome of patients with osteosarcoma after recurrence and analysis of factors affecting the long-term survival——A long-term follow-up study of recurrent patients by multicenter / 中华骨科杂志

Objective To investigate the outcome and affecting factors of patients with osteosarcoma after recurrence.Methods Retrospective analysis was used to analyze the achieved data and prognosis-related factors of 72 patients with extremity osteosarcoma after recurrence from June 2000 to September 2012 through multicenter joint treatment.37 males and 35 females were included.The overall age was 7 to 61 years old (average age22.2 years old).Classification based on the tumor recurrent parts:42 cases (58.3％) on femur,18 cases (25％) on tibia,7 cases (9.7％) on humerus and 5 cases (6.9％) on fibula.Classification based on metastases:14 cases of simple recurrence (19.4％),58 cases (80.6％) of recurrence with metastasis:29 cases (40.3％) of recurrence occurred first,9 cases (12.5％) of metastasis occurred firstly,20 cases (27.8％) of simultaneous recurrence with metastasis;12/14 patients (16.7％) of simple recurrence had long-term survival,but 2 died (2.8％).Six of 58 patients (8.3％) of recurrence with metastasis had long-term survival but 52 died (72.2％).Results The overall 10-year postrelapse survival rate of the 72 patients was 25％.Kaplan-Meier univariate analysis revealed that postrelapse survival was significantly influenced by the continued treatment after recurrence and the number of postoperative chemotherapy,but it was not significantlyinfluenced by age,gender and the number of preoperative chemotherapy.Multivariate analysis revealed that the continued treatment after recurrence and the number of postoperative chemotherapy were independent prognostic factors (P=0.002,P=0.007).At the same time,according to the survival curve grouped by different indicators,the number of chemotherapy after recurrence has no significant effect on TFS.However,the continued treatment after recurrence has obvious statistical significance on improving TFS and OS of patients (P=0.026,P=0.002).Conclusion Resection and standard postoperative chemotherapy had significant effects on the postrelapse survival in patients with osteosarcoma.There are good prospects for further multimodal therapy and multicenter cooperation for osteosarcoma after recurrence.

Enhancement characteristics of liver focal nodular hyperplasia ( less than 3 cm ) by contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To analyze the typical contrast-enhanced ultrasound ( CEUS ) enhancement characteristics of hepatic focal nodular hyperplasia ( FNH) within 3 cm ,and to discuss the diagnostic value of CEUS in small FNH lesions . Methods Forty-eight cases of FNH were retrospectively studied . All lesions were confirmed histopathologically after surgical resection . CEUS examinations with SonoVue were performed to characterize the enhancement patterns of lesions in 5 minutes . The whole wash in and wash out enhancement procedure of lesions were recorded and analyzed . Results All FNH lesions displayed a rapid hyper-enhancement in arterial phase by CEUS ,39 lesions of which showed spring-like enhancement ;8 lesions showed spoke-like enhancement ;1 lesion showed dendritic enhancement . 6 .3% (3/48) of the lesions showed central scar ,and feeding arteries was found in 52 .1% (25/48) lesions . According to echogenicity shift of the lesions in various phases ,20 .8% (10/48) FNH showed fast-in and slow-out" ,64 .6% (31/48) showed fast-in and synchronous-out" ,and 14 .6% (7/48) showed fast-in and fast-out" . According to fast-in and synchronous-out" or fast-in and slow-out" by CEUS ,the accuracy rate of benignity reached 85 .4% (41/48) . According to any of the spring-like enhancement ,spoke-like enhancement ,central scars or feeding arteries ,the accuracy rate of diagnosis of FNH within 3 cm reached 97 .9% (47/48) ,and 81 .3%(39/48) of which were diagnosed through spring-like enhancement . Conclusions CEUS is helpful in diagnosis of FNH within 3 cm by showing various characteristic enhancement patterns ,and spring-like enhancement is the most important sign in diagnosis of FNH less than 3 cm . CEUS has high diagnostic value for FN H less than 3 cm .

Effects of mannan-binding lectin on differentiation of Th17 cells / 中华微生物学和免疫学杂志

Objective To investigate the effects of mannan-binding lectin ( MBL) on the differen-tiation of Th17 cells (T helper cell 17, Th17). Methods CD4+T cells were separated in vitro from fresh human cord blood by MACS ( magnetic-activated cell sorting ) separator. Anti-CD3 monoclonal antibody ( McAb) and anti-CD28 McAb were used to stimulate CD4+T cells with IL-6 and TGF-β1 as inducers. Then, these cells were treated with ( MBL group) or without ( control group) different concentrations of MBL. Percentages of Th17 cells in different groups were detected by fluorescence-activated cell sorting( FACS) after 72 hours of culturing. Quantitative real-time PCR ( Q-PCR) was used to analyze the expres-sion of RORγt ( retinoid-related orphan receptor-γ-t) at mRNA level in both control and MBL groups. En-zyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IL-17A in supernatants of cell culture from different groups. FACS was used to detect the percentages of Th17 cells in MBL-/-and wild type ( WT) mice. Results MBL could significantly reduce the percentage of Th17 cells after 72 hours of culturing as compared with the control group. Moreover, MBL could significantly down-regulate the expres-sion of RORγt at mRNA level and decrease the expression of IL-17A. Results of animal experiments showed that the percentages of CD4+RORγt+Th17 cells in MBL-/- mice were significantly higher than those in WT mice. Conclusion MBL can inhibit the differentiation of CD4+T cells to Th17 cells, which is induced by IL-6 and TGF-β1.

Effects of mannan-binding lectin on differentiation of Th17 cells / 中华微生物学和免疫学杂志

Objective To investigate the effects of mannan-binding lectin ( MBL) on the differen-tiation of Th17 cells (T helper cell 17, Th17). Methods CD4+T cells were separated in vitro from fresh human cord blood by MACS ( magnetic-activated cell sorting ) separator. Anti-CD3 monoclonal antibody ( McAb) and anti-CD28 McAb were used to stimulate CD4+T cells with IL-6 and TGF-β1 as inducers. Then, these cells were treated with ( MBL group) or without ( control group) different concentrations of MBL. Percentages of Th17 cells in different groups were detected by fluorescence-activated cell sorting( FACS) after 72 hours of culturing. Quantitative real-time PCR ( Q-PCR) was used to analyze the expres-sion of RORγt ( retinoid-related orphan receptor-γ-t) at mRNA level in both control and MBL groups. En-zyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IL-17A in supernatants of cell culture from different groups. FACS was used to detect the percentages of Th17 cells in MBL-/-and wild type ( WT) mice. Results MBL could significantly reduce the percentage of Th17 cells after 72 hours of culturing as compared with the control group. Moreover, MBL could significantly down-regulate the expres-sion of RORγt at mRNA level and decrease the expression of IL-17A. Results of animal experiments showed that the percentages of CD4+RORγt+Th17 cells in MBL-/- mice were significantly higher than those in WT mice. Conclusion MBL can inhibit the differentiation of CD4+T cells to Th17 cells, which is induced by IL-6 and TGF-β1.

The effects of pharmaceutical service fee policy on the county-level public hospitals:A case study of five counties( districts) in Chongqing / 中国卫生政策研究

It is an important content for breaking the mechanism ofdrug-supplement-medicine that the com-pensation system of drug zero price rate should be improved in public hospitals. In this paper, we collect random sampling survey data of the implementation of zero-difference drug sales before and after which is performed in People's hospital and Traditional Chinese Medicine hospital in five counties( districts) of Chongqing city. Based on the data, the status and effects of pharmaceutical service Fee policy on the county-level public hospitals in Chongqing was evaluated by combining quantitative description with qualitative analysis in the research methods. The study shows that the compensation policy design of pharmaceutical service fee is reasonable in Chongqing city and its posi-tive effect is obvious. It has also an obvious effect on the reduction of the average outpatient and hospitalization drug expense;but it's not conducive to arouse the enthusiasm of public hospital deepening reform of the initiative because the actual compensation rate of pharmaceutical service fee is low, and the public hospital comprehensive compensa-tion mechanism and operation mechanism reform are lagging behind.

Discussion on the Causes and Treatment Strategies of Artificially High Drug Prices / 中国药房

OBJECTIVE:To discuss the causes and related treatment strategies of artificially high drug prices. METHODS:The causes of artificially high drug prices were analyzed from drug price formation,distribution and trading,drug use in medical institutions and other aspects,in order to sort out the overall plan and treatment strategies of artificially high drug prices. RESULTS& CONCLUSIONS:Artificially high drug prices are resulted from not sound pricing mechanism,numerous circulation links,im-perfect procurement system,“drug maintaining medicine”mechanism of medical institutions and other factors. It is suggested to solve artificially high drug prices from perfecting drug market price formation mechanism,promoting circulation reform,improving centralized purchasing trading mechanism;at the same time,accelerating the reform of medicare payment system,deepening the re-form of public medical institutions operating mechanism and perfecting supervision laws and regulations so as to gradually improve the drug price administration system and realize reasonable drug pricing.

Thinking of Deepening National Essential Medicine System Reform / 中国药房

OBJECTIVE:To provide reference for improving the national essential medicine system and satisfy the needs of ra-tional use from the public METHODS:The current situation and existing problems in the national essential system were described by literature research and comparative analysis,and recommendations were presented. RESULTS:The implementation of essential medicine system has certain effects in China,but there still remains some problems,involving too much variety of essential medi-cines,high price and others,and limitation of the use of medicine and distribution in primary medical institutions. CONCLU-SIONS:Government should further simplify the essential medicine lists,reduce prices,strengthen policy support for primary medi-cal institutions,deepen the national essential medicine system and protect the public's rational drug use.

The anatomy and clinical application of sural blood vessel combined with free skin flap / 中华骨科杂志

Objective To study the anatomical characteristics of sural blood vessel, and to explore the clinical effect of sural blood vessel combined with free skin flap in repairing large tissue defect of calf. Methods 10 fresh adult cadavers were col-lected for experimental studies. Chose 8 cadavers randomly and ligate the sural medial vessel (4 cases) or sural lateral vessel (4 cases) of one limb, leaving the contralateral limb un-ligated as control. Angiography was performed to observe the blood supply of the gastrocnemius muscle after the ligation of the sural medial vessel or sural lateral vessel. For the remaining 2 cadavers, the ori-gin, diameter, and location of the communicating branch of the gastrocnemius muscle were observed by macroscopic anatomy and vascular cast. The data of 19 patients with large tissue defect of calf from October 2006 to September 2013 were analyzed retro-spectively for clinical research. There were 11 males and 8 females aged from 10-40 years (mean, 32 years). 12 patients took sural medial blood vessels as recipient vessels, and 7 patients took sural lateral blood vessels. 6 patients were grafted with free chest na-vel flaps, 8 with anterolateral thigh flap, 2 with lateral thoracic flap, and 3 with latissimus dorsi flap. The areas of wound surface were ranging from 5 cm×10 cm-8 cm×37 cm. The areas of the flap dissected were ranging from 7 cm×10 cm-10 cm×30 cm. Re-sults The study found that the blood supply of gastrocnemius muscle of the calf was multifocal, and was mainly by sural artery. When the blood supply of sural artery was cut off from one side, the gastrocnemius muscle could be supplied by the communicat-ing branches between medial and lateral head of gastrocnemius muscle and the communicating branches of soleus muscle. The communicating branches were at constant anatomical locations, with larger diameter and rich branches. All the 19 cases of free skin flip transplantation were survived. Healing time of wound was ranging from 13-29 d, among which 11 cases were primary healing, and 8 were secondary healing. The follow-up duration was ranging from 12-24 months. The flaps could endure friction of certain degree. No sensory dysfunction was reported. For the cases that split thick skin graft or split-thickness thin skin flap taken from abdomen or huckle were autografted to cover the donor site, primary healing was all gained. Conclusion The sural blood vessels are deeply located in the gastrocnemius muscle at constant anatomical locations, with a long pedicle and a large diameter, and are easy to be dissected, thus they are suited for anastomosis. Sural vessel combined with free skin flip provides a new treat-ment option for the repair of large tissue defect of calf.

Clinical study on application of gastrocnemius blood vessles in transplatation of free flaps for repairing infected skin defects of seriously injured legs / 中华显微外科杂志

Objective To evaluate clinical application of the gastrocnemius blood vessles as recevier ones to anastomose with free flaps. Methods From June 2005 to July 2011,twenty adult lower limbs were infused with red glue to observe the origin,streching,branches and communication with other blood vessles of the gastrocnemius blood vessles and to measure their outer diameters and pedicle length. Operations were also simulated on these specimens to make the above chacracters of the vessles clear further.CT images of 16 fresh adult lower limbs were got to observe the effects of obstruction of one side of the gastrocnemius blood vessels to the blood supply of the gastrocnemius muscles. Fifty-two free flaps were transplanted to legs with large defects of skin and soft tissues where the gastrocnemius blood vessles were anastomosed with the flaps to supply artery blood and receive vein blood. Results The main blood vessles of the gastrocnemius muscles were medial and lateral gastrocnemius blood vessles. They both origined from the popliteal arteries and communicated with other blood vessles. The pedicles of the medial gastrocnemius blood vessles were 8.0 -13.8 cm in length which averaged 11.1 cm and their outer diameters were (1.8 ± 0.3) mm when they entered the muscles. The pedicles of the medial gastrocnemius blood vessles were 5.4 - 12.3 cm in length which averaged 8.8 cm.The outer diameters of the two accompanying veins were (1.8 ± 0.3)mm when they entered the muscles.When one gastrocnemius blood vessle were obstructed,the gastrocnemius muscles could got enough blood supply by co mmunicating branches between the obstructed vessle and other blood vessles.All the 52 free flaps survived. Through one to two-years follow-up, the defects cured with no infection and the knees' motions were normal. Conclusions With a long pedicle and wide diameter,the medial or lateral gastrocnemius blood vessle can be a reliable alternative used in free flap transplautation for repairing large defects of skin and soft tissues of seriously injured legs with no other choice of blood vessles, which causes unobvious effects to the blood supply of the legs and can simplify the free flap transplantation.

Proximal humerus reconstruction with endoprostheses and polypropylene mesh / 中华骨科杂志

Objective To investigate the surgical technique,postoperative function and dislocation incidence of proximal humerus reconstruction with metallic endoprostheses and polypropylene knitted nonabsorbable mesh after proximal humeral tumor resection.Methods Twenty patients with proximal humeral tumor were retrospectively reviewed.They were performed proximal humerus reconstruction with proximal humeral prosthesis and polypropylene knitted non-absorbable mesh from February 2006 to January 2009.There were 5 women and 7 men with a mean age of 38 years(range,21-55 years)at the time of surgery,and giant cell tumor in 9 patients(including Campanacci Ⅱ for 3,Campanacci Ⅲ for 6),osteosarcoma in 1(Enneking ⅡB).and chondrosarcoma in 2 (Enneking ⅡA).The operative time,blood loss,and shoulder movement postoperation were analysed.According to the assessment system by MSTS,the function of limb after surgery was assessed.Results Patients were followed clinically and radiographically for a minimum of 24 months (mean,35 months;range,24-52 months).The mean operative time was 172 min(range,150-200min).The mean blood loss was 254 ml (range,150-500 ml).There were no shoulder dislocations at final follow-up.The mean shoulder flexion was 41°(range,20°-60°)and mean shoulder abduction was 42°(range,20°-70°).The mean postoperative functional assessment score of the limb was 66%(range,53%-77%).None of the Datients had a wound infection,traction neuropraxia or died after the surgical procedure.Conclnsion The data suggests that the use of a polypropylene knitted non-absorbable mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment after tumor resection.

Effect of Tongmai Liquid on ET,IL-1 8 and M-CSF in patients with coronary heart disease / 中成药

AIM:To observe the effect ofTongmai Liquid on endothelin(ET),interlenkin-18(IL-18),macrophage colony stimulating factor(M-CSF)in patients with coronary heart disease(CHD).METHODS:Eighty patients with coronary heart disease accompanied by heart and spleen qi deficiency and qi stagnanty+phlegm stasis and were randomly assigned into test group and control groups.Forty patients in test group were treated with Tongmai Liquid,30 mL,thrice per day,Forty patients in control group were treated with Shexiang Baoxin Pills,2 pills every time,thrice per day.The therapeutic course for both groups was 30 days.The blood-serum ET,IL-18 and M-CSF had been tested before and after the treatment.RESULTS:The levels of blood-serum ET,IL-18 and MCSF in the two groups decreased significantly after treatment(P＜0.05).There's significant difference in two groups'blood-serum of ET(P＜0.05),There're no significant diffference in two groups'blood-serum level IL-18 and of M-CSF(P＞0.05).CONCLUSION:Tongmai Liquid may decrease blood-serum level of ET,IL-18 and M-CSF in patients with coronary heart disease without side effect.

Gastrocnemius muscle transfer for soft-tissue coverage and extensor mechanism reconstruction for limb-sparing resection of the proximal tibia / 中国组织工程研究

BACKGROUND: The proximal tibia is the second common site for primary bony sarcomas,which lacks adequate soft tissue coverage.Resection and reconstruction by any technique leave the reconstructed area in a subcutaneous position.This has been a major source of necrosis of skin and infections.OBJECTIVE: To observe the effect of gastrocnemius muscle transfer to obtain soft-tissue coverage and extensor mechanism reconstruction for limb-sparing resection of the proximal tibia with endoprosthetic reconstruction.METHODS: From January 2001 to June 2008,27 patients with osteosarcoma of the proximal tibia confirmed by biopsy were selected.All the tumours were assigned to stage IIB based on Enneking's classical staging system.Neoadjuvant chemotherapy(Bacci,IOR/OS-N4)was utilized for the patients.All the patients adopted limb-sparing surgery,i.e.resection of proximal tibia with endoprosthetic reconstruction.A gastrocnemius flap was utilized to improve implant coverage and enhance the patellar tendon repair.MSTS was used to measure the functional status of patients with a sarcoma in the leg.RESULTS AND CONCLUSION: The follow-up was averagely 53.1 months.Of 27 patients,2 cases(7%)died of lung metastasis within 2 years,1(4%)suffered from amputation due to infection and underwent amputation.The others developed no complications or recurrence.The MSTS score was averagely 25.1 points.Results show that resection with endoprosthetic reconstruction utilizing a gastrocnemius muscle flap for osteosarcoma of the proximal tibia is reliable and predictable in combination with neoadjuvant chemotherapy.

Biological significance of vW factor expression at fracture site in fracture healing / 中华创伤杂志

Objective To primarily study the possible biological significance of yon Willebrand factor (vWF) expression at the fracture site in the mechanism of fracture healing. Methods A total of 28 male SD rats were selected to set up femoral fracture models. Then, tissue samples from fracture site were randomly taken at days 2, 3, 5, 7, 10, 14 and 21 after establishment of the models, with 4 rats at each time point, vWF expression at fracture site and the relationship of vWF expression with osteoblasts and chondroblasts were observed by using computer image analysis system. The biological significance of vWF expression at fracture site in mechanism of fracture healing were analysed based on the results of vWF expression of in vitro cultured rat osteoblasts. Results The expression of vWF at every time point was positive and distributed disproportionally irregular at bone trabecula and soft tissue of the fracture site. vWF expressed positively in the extracellular matrix around the chondroblasts. Conclusions During the course of fracture healing, there may be vWF-platelet activation pathway that can regulate differentiation and proliferation of local osteoblasts and chondrocytes and activate platelets secreting growth factors such as PDGF, IGF-1, EGF and TGF-a, as creates a sound microenvironment for fracture healing.