Objective:To conduct a systematic review on the implementation effects of National Essential Medi-cine System ( NEMS) since the new health care reform and provide some suggestions to further improve the NEMS. Methods:Databases and relevant international organization reports were searched to collect studies related to the im-plementation of NEMS in China. The database search occurred from January 2009 to December 2014. Results:A to-tal of 1 292 studies were finally included, encompassing 1,277 Chinese papers, 12 English papers, and 3 WHO/HAI reports. A lot of researches have been done on NEMS, but the techniques of NEMS evaluation are not perfect. The sample representativeness is poor, and the longitudinal follow-up studies of the microscopic view is insufficient. . Evi-dence-based evaluation research using big data has just started. Conclusions: The research on NEMS should be strengthened. The NEMS evaluation should not only be based on national conditions, but it should also be in combi-nation with an international, multidimensional evaluation framework in terms of availability, affordability and rational drug use, so as to provide evidences to perfect the NEMS.

ObjectiveTo investigate the mechanisms of N-acetylcysteine protection against liver injury caused by biliary tract obstruction in rats. MethodsSeventy-two Wistar rats were divided randomly into the following three groups: (1) Rats received choledochus ligationon and N-acetylcysteine by intraperitoneal injection (DBL+NAC); (2) Rats received choledochus ligationon only; (3) sham operation. Six rats were killed each time after 1 d, 3 d, 5 d and7 d and their liver function was tested by TBA-40FR Automatic Chemistry Analyzer. In addition, NO production was detected by Griess Reagent System. ResultsWhen the period of biliary duct obstruction is extended, serum AST,ALT,TBIL, DBIL, NO and TNF-α increase but the increase in serum ALT,AST,NO and TNF-α(P＜0. 05) is more prominent in group DBL than group DBL+NAC at any given time. Conclusions N-acetylcysteine can effectively protect against liver injury in rats with obstructive jaundice, and this may be achieved through down-regulation of TNF-α and NO in hepatocytes.

Objective To detect different animal erythrocyte hemolysins titer,and compare the application of these hemolysins in immunological experimental teaching,for selecting the better method of preparing high titer hemolysin for experimental teaching of medical immunology.Methods A total of 40 experiment rabbits were divided into 4 groups in this study,and immunized by sheep red blood cell(SRBC) and porcine red blood cell(PRBC) through different immunization procedures to prepare the hemolysin,detect and compare these 4 groups hemolysins titer by the complement hemolysis test.Results Rabbit Anti-SRBC in the group A was 1∶4 800,rabbit Anti-PRBC in the group B was 1∶1 200,rabbit Anti-SRBC in the group C was 1∶1 000,rabbit Anti-PRBC in the group D was 1∶200.Conclusion The hemolysin titer of the rabbit Anti-PRBC was lower than that of the rabbit Anti-SRBC by the same immunization procedures,and the immunization procedure by intradermal multi-point and auricular vein injection is the better method of preparing high titer hemolysin,so PRBC could replace SRBC as antigen,and immunize the rabbits for preparing hemolysin,which could be used in experimental teaching of medical immunology.

OBJECTIVE:To evaluate the availability and equipment of antidiabetic drugs in public hospitals from Shaanxi prov-ince. METHODS:Using a standardized methodology developed by WHO and Health Action International,the availability and equipping rate of the most common oral antidiabitic drugs were investigated and evaluated in public hospitals of Shaanxi province. RESULTS:The availability and equipping rate of tertiary hospitals and secondary hospitals were all higher than those of community health service centers. Among generic drugs,the availability of metformin was the highest (94.4%),and those of glibenclamide and repaglinide were the lowest(5.6%). Among original drugs,the availability of acarbose was the highest(68.1%). The equip-ping rate of original drugs was higher than that of generic drugs. The equipping rate of generic drugs(25.0%)was higher than that of original drugs(12.5%)in community health service center,but the equipping rates of generic drugs and original drugs were in low level. CONCLUSIONS:General hospitals (especially tertiary hospitals) have high equipping rate of original antidiabetic drugs,the community health services have low availability and equipping rate. Comprehensive measures should be taken to im-prove the availability of drugs in primary medical institutions and ensure drug use of chronic disease patients in primary hospitals.

OBJECTIVETo improve the treatment for severe open tibia-fibular fracture.

METHODSFrom 1994 to 2000, 146 patients with severe open tibia-fibular fracture were treated. According to Gustilo classification, all patients were of type III. Among them, 96 patients belonged to III A, 36 III B, and 18 III C. One hundred and eight patients were male and 38 female, aged from 11 to 68 years, with an average of 31. All patients were treated with unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire). Thirty patients were treated with secondary flap operation. Among them, 19 patients received pedicle gastrocnemius muscle flaps, 9 free vastus lateralis muscle flaps, and 2 free latissimus dorsi muscle flaps.

RESULTSThree patients of type IIIB were subjected to amputation because of advanced age and associated cerebral or thoraco-abdominal injury. Five patients of type III C had amputation because of insufficient postoperative blood supply and necrosis. The rupture of other 138 patients was well reduced, and firmly fixed. They were followed up for 6 months-6 years, with an average of 2.5 years. The average time of fracture-union was 27 weeks, and the average time for removal of fixtors was 28 weeks. The motion of knee joint ranged from 0 to 120 degree in 110 patients; from 0 to 100 degrees in 25, and from 0 to 90 degrees. The motion of ankle joint was approximately normal.

CONCLUSIONSFor patients with severe open tibia-fibular fracture, comprehensive analysis should be made for preservation of the wounded limb or amputation as for elderly patients with vessel-nerve injury or with cerebral- thoracoabdominal injury, emergency amputation should be done. Unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire) for severe open tibia-fibular fracture is advantageous for a simple and reliable fixation. It is less traumatic.

Adolescent ; Adult ; Aged ; Child ; External Fixators ; Female ; Fibula ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

Objective:To evaluate the knowledge, attitudes and practices ( KAP) on National Essential Medi-cine System among pharmacists from secondary public hospitals in Shaanxi province. Methods: The quantitative re-search of KAP questionnaire is used, and the content of questionnaire includes personal information, knowledge, atti-tudes and practices. Results: A total of 520 copies of questionnaires were distributed and 82. 3% were effective. Respondents’ overall knowledge and attitudes are at the middle level;the main way to obtain knowledge is via training and meeting;respondents’ education level and frequency of participating in training have a significant impact on their level of knowledge;the degree of attention paid by hospitals has yet to be strengthened; and respondents are mostly concerned about the supply and distribution of essential drugs. Conclusion: In order to improve the awareness and recognition levels of pharmacists on the implementation of National Essential Medicine System in secondary public hospitals, the government should take the relevant measures, including introducing the high educated persons into secondary public hospitals, organizing related training programs and standardizing the daily monitoring of essential drugs in secondary public hospitals, etc.

OBJECTIVE To investigate and analyze the use of acetaminophen in primary medical institutions of Shaanxi province， and to provide evidence for promoting the standardized and rational use of acetaminophen. METHODS According to the method of cluster stratified random sampling， all prescriptions of acetaminophen issued by primary medical institutions in one district and one county （or two districts） were randomly selected from 10 provincial cities of Shaanxi province from 2020 to 2023； the existing clinical diagnoses were classified by using the International Classification of Diseases （ICD） code， and the drug information of collected prescriptions was analyzed descriptively. SPSS 25.0 software was used for single-factor analysis and Logistic regression analysis to find out the key factors affecting the duration of medication ＞10 d. RESULTS A total of 7 375 valid prescriptions for acetaminophen were collected in this study. The patients who used acetaminophen were mainly female （52.11%） and aged 19-64 （66.73%）. Based on the ICD code， the disease categories most involved in the use of acetaminophen were musculoskeletal system， connective tissue diseases or symptoms and signs （43.48%）； the top 3 clinical diagnoses were joint disease （25.59%）， fracture （9.95%）， and toothache （8.58%）. Among the 7 175 prescriptions with clear drug usage and dosage， 3 366 were in line with the recommendation of acetaminophen instruction， and 5.63% of the prescriptions exceeded the maximum dose limit of acetaminophen 2.0 g/d. There were 4 051 prescriptions exceeding the conventional limit of treatment duration （7 d）， and 1 336 prescriptions exceeding the limit of treatment duration （10 d）. The main factors affecting the duration of drug treatment ＞10 d were the region and type of medical institutions， the gender and age of patients， and the phenomenon of the duration of drug treatment ＞10 d was common in the primary medical institutions from southern Shaanxi， township health centers， the elderly and female patients. CONCLUSIONS There are some unreasonable clinical applications of acetaminophen in primary medical institutions of Shaanxi province， which are mainly manifested in inappropriate usage and dosage， unsuitable clinical diagnosis and drug duration. The region， type of medical institution， age and gender of patients will affect the duration of this drug prescription.