The effective guarantee of the supply of low-price medicine in common use is of great significance for the protection of public health, the safeguard of social equality and the smooth progress of new healthcare reform. On the basis of the governance tools theory, the paper focuses on an analysis of approaches to combine and optimize the diverse utilization of governance tools in order to integrate the means of supply of the low-price medicine in com-mon use. In other words, the paper utilizes the ‘Voluntary-Directive-Mixed’ governance tools framework to provide possible solutions for the supply of low-price medicine in common use, namely, the locations of the voluntary tools ( household and community, volunteers, and market) , the directive tools ( government command-control regulation, establishment of public enterprises, and direct provision) , and the mixed tools ( information disclosure and advice, subsidies, auctions of property rights, tax and user charge) . Lastly the paper proposes specific policy suggestions in four aspects to confirm the total strategy of guaranteeing the supply of low-price medicine in common use:clever use of price leverage, improvements to procurement methods, establishment of an information disclosure system for medi-cine price, and a confirmation of government subsidies and industrial policy strategies.

Sepsis is still a leading cause of death in infants and children.It is the result of multiple organ dysfunction syndrome caused by infection.For sepsis,early diagnosis is very important.Biomarkers (procalcitonin,C-reactive protein,pro-inflammatory cytokines,white blood cell count,neutrophil count,left shift and CD64) during the response to infection can be used for early diagnosis.In addition,continuously monitoring these biomarkers can be used for evaluating severity of illness,monitoring of treatment responses and predicting outcome.

Objective To measure the blood levels of mercury and arsenic of mother and umbilical cord, and analyze the relationship between these levels and outcome of pregnancy and complications. To explore the influential factors in order to guide a good birth and good care in pregnancy and lying-in women.Methods A total of 400 cases who were hospitalized in Xinhua hospital from March 2009 to August 2009 were included in this study. The blood levels of arsenic of mother and umbilical cord were determined by microwave digestion method and inductively coupled plasma emission mass spectroscopy method ( ICP-MS),while mercury determination was made using flame atomic absorption spectrophotometer (AAS). In addition, pregnant women were required to fill the questionnaire including their living environments, life styles,diet habits and etc. Results The newborn cord blood levels of mercury and arsenic were positively related to those of their mothers( r =0.88,0.91 respectively, P ＜0.05). The adverse pregnancy rates and complications rates in blood elevated mercury and arsenic groups were significantly higher than in the normal groups( x2 =7.07, 9. 94 respectively, P ＜ 0.01 ). Multiple regression analysis showed that the newborn blood mercury levels were significantly correlated to sea-fish eating, fruits supplement and ventilation during pregnancy. The former was a risk factor( Wald χ2 =8.28, P ＜0.01 ) and the later two were protective factors( Wald χ2 = 9.02, 6.05 respectively, P ＜ 0.05 ). Multiple regression analysis also showed that the newborn blood arsenic levels were significantly correlated to eating canned food, using cosmetics and education degree. Eating canned food and using cosmetics were risk factors(Wald χ2 =7.35, 10.38 respectively,P ＜ 0.05 ) while high education degree was protective factor( Wald χ2 = 8.87, P ＜ 0.05 ). Conclusion The newborn cord blood levels of mercury and arsenic were related to those of their mothers, environmental factors and health care during pregnancy. Health education and care during pregnancy were effective approaches for preventing mercury and arsenic poisoning.

Objective To investigate the effect of curcumin on tumor necrosis factor-alpha (TNF-α)-in-duced expression and release of monocyte chemoattractant protein-1 (MCP-1) in rat astrocytes.Methods The primary astrocytes were prepared from the cerebral cortex of 5 neonatal Sprague-Dawley rats and cultured.The cultured cells were identified by immunofluorescence staining with glial fibrillary acid protein.The cells were then divided into 6 groups (n =15 each):control group (group C),TNF-α group (group T),TNF-α+ different concentrations of curcumin groups (Cur5,Cur10 and Cur20 groups),and TNF-α+ solvent control group (D group).TNF-α with the final concentration of 20 ng/ml was added and the cells were incubated for 2h in T group.In Cur5,Cur10 and Cur20 groups,curcumin with the final concentrations of 5,10 and 20μmol/L was added,respectively,the cells were incubated for 24h and then the culture medium was abandoned,TNF-α with the final concentration of 20 ng/ml was added and the cells were then incubated for another 2h.In group D,dimethyl sulfoxide with the final concentration of 1 μl/ml was added,the cells were then incubated for 24h,then TNF-α with the final concentration of 20 ng/ml was added and the cells were incubated for another 2h.After treatment in each group,the expression of MCP-1 was determined by immunohistochemistry and the release of MCP-1 was determined by ELISA.Results Compared with group C,the expression and release of MCP-1 was significantly increased in the other five groups (P ＜ 0.05).Compared with group T,the expression and release of MCP-1 was significantly decreased in group Cur20 (P ＜ 0.05),and no significant changes in the expression and release of MCP-1 were found in Cur5,Cur10 and D groups (P ＞ 0.05).Compared with group Cur5,the expression and release of MCP1 was significantly decreased in group Cur20 (P ＜ 0.05),and no significant change in the expression and release of MCP-1 was found in group Cur10 (P ＞ 0.05).Conclusion Curcumin can inhibit TNF-α-induced expression and release of MCP-1 in rat astrocytes and the effect is dose-related and may be one of the mechanisms of curcumin-induced reduction of neurophathic pain.

Objective:To identify pathogenicity of the potential splicing variants in two Chinese Han patients with osteogenesis imperfecta.Methods:Genomic DNA was extracted using the conventional phenol-chloroform method; whole exome sequencing (WES) was used to analysis the disease-related variants in the two probands; Minigene assay was used to identify pathogenicity of the variants found in the patients' genome that possibly affect RNA splicing.Results:Two potential splicing variants, c.858+1_858+5delGTAAG in intron 12 of COL1A1 and c.1405-7C>T in intron 24 of COL1A2, were found in proband 1 and proband 2, respectively. In addition, a missense mutation, c.2972G>T (p.G991V) in exon 45 of COL1A2, was detected in proband 2. Minigene assay revealed that the variant in proband 1 caused the skipping of exon 12, while the variant in proband 2 did not lead to aberrant splicing. G199 of the COL1A2 in proband 2 was a highly conserved amino acid site, and the results suggested that c.2972G>T (p.G991V) may be the real pathogenic variant by the means of bioinformatics analysis.Conclusion:The variant c.858+1_858+5delGTAAG in COL1A1 was a causative variant that led to OI in proband 1, while the missense variant c.2972G>T (p.G991V) in COL1A2 was the cause of OI in proband 2, instead of the variant c.1405-7C>T. Minigene assay for potential splicing variants detected by WES could not only validate the pathogenicity of the candidate variants and enrich the mutation spectrum of OI, but also lay the foundation for patients' prenatal diagnosis and subsequent mechanism research.

Objective Meningovascular syphilis is the intima inflammation of blood vessels caused by the syphilitic infec-tion, which is associated with the occurrence of ischemic stroke.The study analyzed the clinical, imaging features and prognosis for meningovascular syphilis so as to improve its diagnosis and treatment. Methods 14 patients diagnosed with meningovascular syphilis were collected prospectively from December 2007 to March 2015 in the neurological department of Jinling Hospital.The patients were followed for a period of 21.5(range 10.2~37.9)months,and the prognosis were evaluated. Results Patients with meningovascular syphilis presented with dizziness, hemiplegia, hemidysesthesia and cognitive decline.Lesions showed multiple, scattered on MR ima-ging, intracranial vascular stenosis was seen in the CTA/MRA, and the laboratory examination had characteristic changes.With a large dose and sufficient courses of penicillin treatment, meningovascular syphilis may hopefully get predominant effects.78.57%patients got good prognosis(modified Rankin Scale ,mRS≤2)at 3 months and 85.71% patients got goodlong-term prognosis(mRS≤2). Conclusion Meningovascular syphilis was usually presented as acute onset, lacks the specific clinical and neuroimaging manifesta-tions.Most patients has favourable prognosis after treatment of syphilis with full course of penicillin.

Objective To observe the changes and clinical significance of procalcitonin(PCT) level in children with bacterial pneumonia.Methods The levels of PCT,hs-CRP and WBC were detected in 31 pneumonia children pre and post antibiotic treatment,and the changes were observed.Results The PCT levels of the 31 patients were all increased before treatment.After cured,PCT level of 28 cases returned to normal.But in the 28 normal cases,WBC level increased in 10 cases(35.7％),and hs-CRP level elevated in 4 cases(14.3％).In the other 3 cases,the PCT levels decreased from 5.69ng/mL,1.25ng/mL and 0.83ng/mL at admission to 0.51ng/mL,0.55ng/mL and 0.52ng/mL,respectively.And in these 3 cases,there was one case with the levels of WBC and hs-CRP respectively ascended,in which WBC level descended from 13.1 × 109/L to 12.1 × 109/L and hs-CRP level reduced from 20.92mg/L to 7.38mg/L.Conclusion The sensitivity of the index PCT is the highest at the accurate time phase of bacterial pneumonia,which can guide the reasonable use of antibiotics.

Objective Hypertension is a leading modifiable risk factor for cardiovascular disease .However , a lot of hyper-tension patients hold inactive attitudes to hypertension treatment .The purpose of this study was to investigate the relationship between previous treatment of hypertension and stroke severity in acute ischemic stroke . Methods We retrospectively analyzed the clinical data of 653 in-hospital ischemic stroke patients with hypertension between January 2011 and December 2014 .According to the National Institutes of Health Stroke Scale (NIHSS) at admission, the stroke patients were divided into a mild group (NIHSS≤3) and a severe group (NIHSS >3) and, based on their history of hypertension treatment , allocated to a regular treatment, an irregular treatment, a non-treatment , and an unawareness group .We studied the relationship of previous hypertension treatment with stroke severity by Spearman correlation analysis and identified the potential factors associated with stroke severity by multivariate logistic regression anal-ysis. Results Previous treatment of hypertension was positively correlated with stroke severity (r=0.146, P=0.000 2).Compared with the patients of the regular treatment group , those in the irregular treatment group (OR: 2.21; 95%CI:1.39 -3.52; P =0.001), non-treatment group ( OR: 2.18; 95%CI: 1.41 -3.36; P =0.0004) and unawareness group (OR:1.80;95%CI:1.12-2.88; P=0.015) tended to have more severe stroke. Conclusion Previous treatment of hypertension is closely related to the severity of ischemic stroke .

Objective To evaluate the effect of curcumin on the inflammatory responses in the hippocampus during global cerebral ischemia-reperfusion (I/R) injury in hypertensive rats.Methods Forty-eight SPF male Wistar-Kyoto rats,aged 8 weeks,weighing 180-200 g,were randomly divided into 2 groups (n =24 each) using a random number table:sham operation group (W-Sham group) and I/R group (W-I/R group).Seventy-two SPF male spontaneously hypertensive rats,aged 8 weeks,weighing 180-200 g,were randomly divided into 3 groups (n =24 each) using a random number table:sham operation group (S-Sham group),I/R group (S-I/R group),and curcumin group (S-Cur group).Global cerebral ischemia was induced by 4-vessel occlusion method (10 min of transient global ischemia followed by reperfusion).Curcumin 100 mg/kg was injected intraperitoneally at 30 min of reperfusion in S-Cur group,and corn oil 5 ml/kg was injected intraperitoneally at 30 min of reperfusion in the other groups.The ability of learning and memory was tested by step-down test at 7 days of reperfusion.Rats were sacrificed at 3 h and 1,3 and 7 days of reperfusion (T1-4) and the hippocampi were removed.The morphological changes of pyramidal cells in hippocampal CA1 area were observed by HE staining.The mean density of pyramidal cells in hippocampal CA1 area was quantified by Nissl staining.The contents of interleukin-lβ (IL-1β),tumor necrosis factor-alpha (TNF-α) and IL-10 in the hippocampus were determined by ELISA.Results Compared with W-Sham group,the ability of learning and memory was significantly decreased,the mean density of pyramidal cells in hippocampal CA1 area was decreased,the contents of IL-1β at T1-3,TNF-α at T1,and IL-10 at T2 were increased,and the contents of IL-10 were decreased at T1,3,4 in W-I/R group,and no significant changes were found in the parameters mentioned above in S-Sham group.Compared with W-I/R group,the ability of learning and memory was significantly decreased,the contents of IL-1β at T1,3 and IL-10 at T2 were decreased,the content of TNF-α was increased at T1,no significant change was found in the mean density of pyramidal cells in hippocampal CA1 area,and the damage to pyramidal cells in hippocampal CA1 area was severe in S-I/R group.Compared with S-I/R group,the ability of learning and memory was significantly increased,the mean density of pyramidal cells in hippocampal CA1 area was increased,the contents of IL-1β at T2,3 and TNF-α at T1-4 were increased,and the content of IL-10 was increased at T2,and the damage to pyramidal cells in hippocampal CA1 area was reduced in S-Cur group.Conclusion Inhibition of inflammatory responses in the hippocampus may be involved in the mechanism by which curcumin reduces global cerebral I/R injury in hypertensive rats.

Objective To identify the pathogen distribution and antibiotics resistance of blood stream infection(BSI) in the pediatric surgery intensive care unit(PSICU).Methods The clinical data of 138 pediatric patients diagnosed with BSI from January 2011 to December 2015 were collected in PSICU,and the distribution of pathogens and drug resistance were retrospectively analyzed.Results The incidence of BSI was 3.88‰(138/35.524)in the five years,the majority of the BSI cases occurred under one year old,and the mortality was 13.77%(19/138).A total of 179 strains were isolated from blood samples of 138 patients,of which gram-positive bacteria,gram-negative bacteria and fungi accounted for 60.89%(109/179),22.91%(41/179)and 16.20%(29/179)respectively.The most common gram-positive bacteria was coagulase-negative staphylococcus (84/179,46.93%).The predominant gram-negative bacteria were Acinetobacter baumannii(15/179,8.38%),Klebsiella pneumonia(12/179,6.70%) and Escherichia coli(6/179,3.35%).The rate of carbapenems-resistant Acinetobacter baumannii increased continuously in the study period.Non-albicans Candida was the most common fungi (14/179,7.82%).The resistance rate of multi-drug resistant strains to carbapenems significantly increased.Conclusion The incidence of BSI in PSICU increases,and the mortality in children younger than one year is high.Better understanding of distribution of BSI pathogen could provide more effective antibiotic prescription.