OBJECTIVE:To provide reference for implementation of national essential drug system in various medical institutions.METHODS:The effect of national essential drug system on medical institutions was analyzed.RESULTS:The implementation of national essential drug system has various impacts on medical institutions in different levels,especially on primary medical institution,non-public medical institiution and military medical institution.CONCLUSION:Medical institutions were suggested to analysis the effect and put forward related countermeasures to cater to the changes and challenges of medical market and improve simultaneous development of social effect and economic effect.

The liver is the most common site of colorectal cancer metastasis(CRLM). The importance of how to treat CRLM has attracted attention from doctors world wide and specific academic organization and expect consensus has been established. Relative principals of treatment of CRLM also developed in China, for example, guideline of diagnosis and treatment of colorectal cancer liver metastasis(draft) and standard for diagnosis and treatment of colorectal cancer, which were established in 2008 and 2010, respectively. However, we found that the Chinese doctors still understand these treatment policies inadequately, and easily produce deviation on the treatment progress. Based on the problems of current CRLM treatment, we have some thoughts or suggestions as follows: (1)Promoting the core conception of CRLM treatment actively: surgery is the only method to achieve possible cure of the CRLM. (2) Evaluating the status of new adjuvant chemotherapy for CRLM dialectically. (3)Paying attention to multi-disciplinary team(MDT): MDT is the scientific treatment foundation of CRLM. (4)Changing the treatment conception of primary tumor of CRLM: radical resection of primary tumor is essential for the resectable CRLM.(5)Emphasizing the surgical treatment of CRLM combined with lung metastasis. (6)Do not neglect the safety of patients, when we emphasize the surgery is the optimal treatment of CRLM. These guides of treatment of CRLM will improve the outcomes of CRLM around the world, but we still need pay attention to above mentioned points in order to insure the standardization and scientification of CRLM therapy.
China ; Colorectal Neoplasms ; pathology ; therapy ; Combined Modality Therapy ; Humans ; Liver Neoplasms ; secondary ; therapy

Objective To investigate the value of laparoscopic operations for the diagnosis and treatment of acute or chronic pelvic inflammatory diseases (PID). Methods A series of 83 patients with PID diagnosed and treated by laparoscopic technique from January 1999 to December 2003 were retrospectively analyzed. Results Conversions to open surgery were required in 2 patients because of serious pelvic adhesions. No complications were observed. The diagnostic accordance rate before and after the surgery was 63.9% (53/83): 74.3% (26/35) in patients with acute PID and 56.2% (27/48) in patients with chronic PID. Among 35 patients with acute PID, the duration of operation was 20~75 min (mean, 44.7 min) and the postoperative hospital stay was 3~12 d (mean, 6.2 d). Postoperative pyrexia occurred in 28 patients, whose temperatures returned to normal within 5 days. The blood routine examination results were restored to normal levels in 26 patients at 2 days after operation. Out of 48 patients with chronic PID, the length of operation was 20~130 min (mean, 75 min) and the postoperative hospital stay, 2~8 d (mean, 5.5 d). Postoperative pyrexia occurred in 5 patients and a complete recovery of temperature was observed within 3 days. The blood routine examinations revealed normal findings in 42 patients at 2 days after operation. Follow-up checkups for 3 months in all the patients found no relapse. Conclusions Prompt application of laparoscopic operations is of importance in increasing diagnostic accuracy, improving curative efficacy, and preventing possible complications.

Objective To investigate effects of laparoscopy in the early diagnosis of atypical tubal pregnancy.Methods We retrospectively studied clinical records of 36 cases of "probable tubal pregnancy" from January 2003 to May 2005 in this hospital.All the patients were given transvaginal ultrasonography and serum ?-human chorionic gonadotropin examinations.Then laparoscopy was performed to clarify the diagnosis.The accordance rate before and after the laparoscopy was evaluated. Results After laparoscopy,26 patients were confirmed as having ectopic pregnancy(oviduct,25 patients;ovary,1 patient) and 3 patients were excluded for having ectopic pregnancy,the confirmative diagnosis rate being 80.5%(29/36).The diagnosis could not be identified with certainty in 7 patients,2 of whom were cured with radix trichosanthis and 5 of whom were afterwards clinically diagnosed as having tubal pregnancy(1 patient) or intrauterine early pregnancy(4 patients).Conclusions Laparoscopic management at proper time is the best choice in the diagnosis of ectopic pregnancy,especially in early-stage or atypical cases.

Partial hepatectomy (PH) is widely used and the preferred method for the surgical treatment of hepatocellular carcinoma,and liver regeneration is directly related to the prognosis of the patients after the operation.Therefore,the specific mechanism and cytokines related to liver regeneration have become a hot topic in recent years.Currently,there is a wide variation of reported gene expressions and signal transduction pathways in the literature,but the mechanism and interactions are still unclear,especially for postoperative liver regeneration with hepatitis or cirrhosis.This review summarizes current research on the liver regeneration process,the mechanism of liver regeneration after partial hepatectomy,and the different mechanisms of hepatocirrhosis.

Objectives To describe the esthetic acceptance to dental fluorosis in the rural residents of eastern Guangdong Province and to explore whether the Dean's criteria is still suitable for modern society. Methods A survey was conducted in eastern areas of Guangdong Province in 1 237 cases of 9～17 and 35～44 years old rural residents who drank well water containing 0.1～2.5 mg/L of fluoride. Clinical examination and questionnaire investigation were performed to record dental fluorosis and the severity of perceived appearance of their teeth. Results While the study subjects perceived the appearance of their teeth as " no problem", the community fluorosis index (CFI) was 0.5 and prevalence rate of dental fluorosis was 10.1 %. While perceived "a little bit bad" and "bad" and "very bad", the CFI and prevalence rate would be 0.9 and 33.7 %, 1.3 and 75.8 % and 1.7 and 98.2 % respectively. Conclusion The acceptance to the severity was basically in accordance with Dean's criteria. The Dean's criteria about dental fluorosis is still suitable for rural areas of eastern Guangdong Province and therefore it can be used in setting criteria of fluoride concentration in drinking water in these areas.

Objective To summarize the clinical experience of laparoscopic radical resection of colorectal carcinoma.Methods Clinical data of 13 cases of colorectal carcinoma treated by laparoscopic radical resection from November 2002 to April 2006 in this department were retrospectively analyzed.There were 10 cases of colon cancer(Duke's A,4 cases;Duke's B,6 cases) and 3 cases of rectal cancer(all Duke's A).Results According to the size of the tumor,the 13 patients were treated with either laparoscopic-assisted operation(10 cases) or hand-assisted laparoscopic surgery(3 cases).All the operations were performed successfully.No conversions to open surgery were needed and no mortality occurred.Follow-up checkups for 1~36 months(mean,17 months) showed no recurrence.Conclusions In patients with colorectal carcinoma,the selection of laparoscopic-assisted procedure or hand-assisted laparoscopic surgery can not only provide the operative safety and effectiveness,but also enable the operation minimally invasive.

Objective To report the medium-term follow-up results for deep venous thrombosis(DVT) after total knee arthroplasty(TKA).Methods Between July 2003 and March 2004,55 patients(63 knees)who had had TKA were followed up for DVT.In follow-ups 1 to 2 weeks after TKA,their clinic symptoms,Doppler ultrasonograms and venograms were analyzed.In the following out-patient follow-ups done at every six months,we observed their clinic symptoms and Doppler uhrasonograms for the operated lower extremity.Venography was done only for those who had severe DVT symptoms.Results The venography one week after TKA conformed that DVT occurred in 34 patients(41 knees,61.8%).Two weeks after operation,DVT vanished in 12 cases,but deterio- rated to the proximal part in two cases.The follow-ups averaged 36.6 months(range,32 to 40 months).The results at five time points showed that the incidence of DVT did no decrease with lapse of time(P＞0.05).Conclusion No matter whether DVT occurs in the perioperative period,incidence of DVT in the medium term varies little.

Objective To investingate the effect of survivin shRNA on chemotherapy resistance in GBC-SD cells. Methods They were divided into three groups of GBC-SD, GBC-SD/EGFP and GBC-SD/survivin. MTT assay was used to detect cell viability in the 3groups. mRNA and protein of survivin were tested by RT-PCR and Western blot. Then the cells were treated with proper construction DDP. The cell survival rate and IC_(50) were determined with MTT, cell apoptosis detected by FACS and the alteration of nucleus observed by TUNEL. Meanwhile, caspase-3 activity was determined using the colorimetric method. Results Cell viability was reduced remarkably in GBC-SD/survivin and survivin expression was decreased obviously. After being treated with DDP, cell survival rate and IC_(50) were decreased obviously in GBC-SD/survivin, apoptotic rate elevated remarkably compared with other groups. There were brownly nucleuses in three groups. Caspase-3 activity increased first and then decreased, but it exceeded in GBC-SD/survivin than that in other two groups. Conclusion The survivin shRNA can down-regulate the expression of survivin in GBC-SD cells remarkably and improve the sensibility to chemotherapy.

Objective To evaluate the accuracy of multi-detector spiral CT (MSCT) semiautomated volumetric measurement of right lobes and its value in living donor liver transplantation (LDLT). Methods Fifty-six donors underwent four phases MSCT. Pre-operative liver volumes of two measurements [IQQA(R)-liver semi-automated (Vs) and manual volume (Vm) measurements] in portal vein phase were compared with intra-operative measurement (Vio) by means of water displacement. Results Correlation analysis and Bland-Altman tests were used for statistical analysis.Results Pre-operative measurements of grafts resulted in a mean Vs, Vm, Vio of (818. 60 ± 161.43)cm3 , (880. 16 ± 169. 92) cm3 and (669. 84 ± 141.37) cm3 respectively. All corresponding pre-and intra-operative data were correlated significantly with each other. There was a good correlation between Vs and Vio(r= 0. 778, P＜0. 05), so did Vm and Vio(r= 0. 746, P＜0. 05). The equations of linear regression were Vio = Vs × 0. 681 + 112. 26, and Vio = Vm × 0. 620 + 123. 81 respectively. Exact 95 % CIs and the extent of concordance were 121.57-175. 95 cm3, -354. 135-56. 62 cm3 for semiautomated measurements, and 180. 09-240. 56 cm3 , - 438. 66-18. 01 cm3 for manual measurements,respectively. Conclusion Semi-automated method for the volumetric measurements of the right liver lobes in LDLT is more accurate than the manual method.