OBJECTIVE:To provide reference for improving the policies and countermeasures for national essential medicines. METHODS:The existing problems of medicine distribution under essential medicine system were analyzed and countermeasures were put forward. RESULTS:Due to the regional economic environment and industry development level differences,local policy had conflict with national laws and regulations,lacking of systembasis in regulatory process and drug centralized bidding and pur-chasing department weakened responsibility in terms of administrative supervision when performing national essential medicine sys-tem;distribution distribution capability had weakened,distribution enterprise internal management was not standard,the essential medicine storage and distribution process quality showed safety hidden risks in terms of marketization. It is suggested to establish and improve the national essential medicine system overall implementation programs and regional implementation programs,inte-grate medicine distribution market,explore and establish modernized pharmaceutical logistics system,intensify supervision and management of distribution,support distvibution transformation development to reduce social risk and further improve bidding and purchasing mechanism to reduce distribution costs. CONCLUSIONS:The existing problems in distribution can be gradually solved only by further promoting the medical and health system and improving the national essential medicine system.

Gastrointestinal stromal tumors (GISTs) are common mesenchymal neoplasms in the gastrointestinal tract.The results of computed tomography play important roles in the diagnosis,treatment planning and follow up of GISTs. From August 2007 to January 2012,28 patients with GISTs were admitted to the Henan Provincial People's Hospital. Sixteen tumors showed extra-luminal growth,4 showed intra-luminal growth,7 involved both intra- and extra-luminal growth,and 1 showed extra-gastrointestinal growth.After administration of contrast media,9 tumors demonstrated homogeneous enhancement,18 showed heterogeneous enhancement and 1 showed non-obvious enhancement.The enhancement of tumors in arterial and venous phase was 20 Hu higher than that in plain scan.Angiogenesis was displayed in 6 tumors,and feeding arteries were observed in 3 tumors.

Objective To analyze the perioperative complications and prognosis of surgical treatment of pancreatic ductal stones.Methods 60 patients diagnosed to have pancreatic ductal stones and were admitted into our hospital from January 2009 and December 2014 were enrolled into this retrospective study.There were 47 males and 13 females.The average age was (44.1 ± 12.0).Results All patients underwent surgical operation and there was no perioperative death.Perioperative complications occurred in 7 patients (11.7％), including pancreatic fistula in 4 patients, delayed gastric emptying in 1 patient, abdominal infection in 1 patient, anastomotic bleeding in 1 patient.Eight patients developed elevated amylase levels.The fasting time was 3.4 ± 1.2 days and the hospital stay was 10.0 ±4.0 days.The follow-up rate was 88.3％ (53/60), at a mean follow-up of 27 months.In 51 patients who presented with abdominal pain, 43 patients (84.3％) had complete pain relief and 7 patients (13.7％) had partial pain relief.In 14 patients with preoperative diabetes mellitus, 1 patient had improvement and 2 patients recovered from diabetes.Two additional patients were diagnosed to have diabetes two years after the operation.Of the 2 patients who were shown to have pancreatic cancer on histopathological study, 1 patient was lost to follow-up while another patient died at 27 months after the operation.The patients diagnosed to have epithelial dysplasia were followed-up and none developed pancreatic cancer.Conclusions The relationship between chronic pancreatitis and pancreatic ductal stones was very close.Chronic pancreatitis also caused exocrine and endocrine dysfunction.Surgical operation plays an important role in symptomatic relief and in delaying pancreatic dysfunction.

Objective To explore the imaging characteristics of seminomas and nonseminomatous germ cell tumors (NSGCT) and its pathological foundation. Methods CT and MR imaging manifestations in 25 cases of testicular germ cell tumors proved by pathological examinations were analyzed retrospectively. All tumors were divided into seminomas group (12 cases) and NSGCT group (13 cases). In the seminomas group, 5 cases were examined by CT and 4 of those also had contrast enhanced CT. Seven cases had MRI and 4 of those had dynamic enhanced MRI. In the NSGCT group, 5 were examined by plain CT in which two were by contrast enhanced CT, eight were by MRI in which 4 were by dynamic enhanced MRI. CT or MRI characteristics (morphology, density or intensity, enhancement) in both groups were analyzed by Fisher test. Results Histological examination revealed 25 intratesticular lesions. In 12 seminomas, 10 showed a nodular/lobulated shape, 5 showed a mixed density or intensity. In 13 NSGCT, only one lesion showed a lobular shape, 11 showed a mixed density or intensity. Seven seminomas showed a low signal on T2WI on MRI while only two NSGCT showed this sign. In four lesions underwent dynamic MRI scanning, 3 showed fibrous septum enhancement while no lesions in NSGCT showed this sign. The occurrence rate of the above imaging characteristics in both group was significantly different (P<0.05). Conclusion Seminomas and NSGCT may have their own CT and MRI characteristics, which may be of great value for differential diagnosis .

Objective To investigate the infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation.Methods Retrospectively analyzed the clinical data of 170 patients who underwent liver transplantation in Beijing Chaoyang Hospital,Capital Medical University between January 2011 and April 2016.The incidence,pathogenic characteristics,distribution and drug resistance of methicillin resistant Staphylococcus aureus were analyzed.Results In this research,the methicillin resistant Staphylococcus aureus infection occurred in 23 cases after liver transplantation,and the incidence rate was 13.53％ (23/170).There were 27 strains of pathogens had been isolated,and 74.07％ (20/27) of pathogens were isolated from peritoneal drainage fluid.The most common methicillin resistant Staphylococcus aureus were Staphylococcus haemolyticus,Staphylococcus epidermidis and Staphylococcus hominis,accounting for 29.63％ (8/27),22.22％ (6/27) and 14.81％ (4/27).Drug sensitivity results indicated that the methicillin resistant Staphylococcus aureus were completely resistant to Penicillin,Oxacillin and Methicillin antibiotics.And the pathogens were extensively drug-resistant to Ciprofloxacin,Levofloxacin and Moxifloxacin,the resistance rates were 63％ (15/24),63％ (15/24) and 58％ (14/24).But the pathogens were sensitive to Teicoplanin,Vancomycin and Linezolid,and there have not been detected drug-resistant bacteria.Conclusions The infection of methicillin resistant Staphylococcus aureus is one of the most common pathogens after liver transplantation.Routine prophylactic antibiotics are not useful for the treatment,however,Teicoplanin,Vancomycin and Linezolid can be used as the first choice of treatment.

Objective To explore the effect of anterior decompression plus posterior intradural release in treatment of old thoracolumbar fractures with paraparesis. Methods A total of 22 patients with old thoracolumbar fractures with paraparesis were admitted to our hospital since January 2004 to Jan-uary 2008. Before admission, all patients were treated with decompression and internal fixation with pos-terior pedicle system, with bony compression to the spinal cord found through CT scanning and intact spi-nal cord found by MRI but without obvious neurofunction recovery. Of all, 20 patients were kept with the original posterior fixation except for two patients that were fixed with Z-plate after removal of posterior hardware. Autologous bone grafts from iliac were utilized in all patients. Intradural release was done 3-6 months after anterior decompression. Results Of all, 19 patients were followed up for 17-49 months (average 28 months). Twenty patients obtained varied recovery of neurofunction after anterior decompres-sion, with ASIA motor scores increasing from average 59.4 points before decompression to 71.3 after de-compression. The followed-up patients won further recovery after secondary posterior intradural release, with ASIA motor scores further increasing to average 80.6 points. Conclusion For patients with old thoracolumbar fractures combined with paraparesis, the release of intradural sear and fibrocompression is also important besides anterior decompression.

Objective To study the relationship between advanced liver fibrosis and peripheral neuropathy in patients with type 2 diabetes mellitus (DPN). Methods A total of 173 patients (89 men and 84 women) with type 2 diabetes who hos?pitalized in Tianjin Third Central Hospital within nearly three years (2013.02-2015.02) were divided into three groups ac?cording to non-alcoholic fatty liver disease (NAFLD) fibrosis score:group A (NFS≤-1.455), group B (-1.455

Objective:To explore the influence of fatty liver donor on the prognosis of benign liver disease liver transplantation.Methods:The clinical data of 229 recipients and donors who underwent liver transplantation at Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2015 to December 2019 due to benign liver diseases were retrospectively analyzed. According to the degree of fatty degeneration of the donor liver, the patients were divided into non-fatty liver group( n=168), mild-medium fatty liver group( n=43), and severe fatty liver group( n=18). First, the overall prognosis after liver transplantation was analyzed, the general data of the donor and recipient were compared, and the perioperative complications of the three groups were compared. Finally, survival analysis was performed to compare the long-term prognosis of the three groups. Measurement data with the normal distribution were represented as ( Mean± SD), comparisons among groups were analyzed using t test. Comparisons of counting data between groups were analyzed using chi-square test. The theoretical frequency was less than 1. Fisher exact probability method was used, and variance analysis was used for the comparison among the multiple groups. Results:The overall 1-year, 3-year, and 5-year survival rates of the patients were 86.9%, 70.7%, 70.7%, respectively, and the average survival time was 53.1 months. The general data of donors and recipients were not significantly different among the three groups. The probability of perioperative transplanted liver failure, delayed liver function recovery, and acute kidney injury in recipients with severe fatty liver was significantly higher than that of mild to moderate fatty liver group and non-fatty liver group ( P<0.05). The results of survival analysis showed that the 1-year, 3-year, and 5-year survival rates of the non-fatty liver group were 90.5%, 71.7%, 71.7%, the mild-moderate group were 88.4%, 76.7%, 64.0% and the severe fatty liver group were 61.1%, 49.4%, 49.4%, the survival rate of patients with severe fatty liver was significantly lower than that of the other two groups ( P<0.05). Conclusion:Donor weight-grade steatosis leads to a higher incidence of transplanted liver failure, delayed liver function recovery, acute kidney injury, and worse long-term prognosis.

OBJECTIVE To find the differences in QOL between patients treated with total laryngectomy with voice rehabilitation or without voice rehabilitation and subtotal laryngectomy, to analysis the factors affecting QOL of patients after laryngectomy by HNQOL. METHODS With HNQOL,a survey was conducted in patients treated with total laryngectomy (30cases) with voice rehabilitation, 30 cases without voice rehabilitation, and 30 cases treated with subtotal laryngectomy for laryngeal cancer. We discuss changes of QOL with time went by,and analysis the factors affecting QOL of patients after laryngectomy. RESULTS There is no difference between patients treated with total laryngectomy with .voice rehabilitation and the one treated with subtotal laryngectomy in their quality of life, however, there is difference between patients treated with total laryngectomy without voice rehabilitation and the one treated with subtotal laryngectomy. CONCLUSION Through voice rehabilitation ,we could advance quality of life of the patients treated with total laryngectomy. Through the integration of psychological, clinical and social intervention, the quality of life of patients may have an overall improvement.

Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of (50±12) years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali-zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no typeⅠendoleak; complications included pulmonary infection (n=1), strokes (n=1), reversible abnormal renal function (n=6) and retrograde aortic arch dissection (n=1). No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.