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.

Great improvement has been made in the 5-year survival of patients with osteosarcoma due to application of novel chemo-agent and progression in surgical techniques. However, the treatment outcome of osteosarcoma was bottlenecked by drug resistance and immuno-escape mechanism. Recent studies showed that some osteosarcoma cells possess the characteristic of tumor stem cells: capable of self-renewal and extensive proliferation. Meanwhile, SP cells, isolated from osteosarcoma cells, have high expression of ABCG2 and can form tumor in NOD/SCID mice, indicating that the drug resistance of osteosarcoma cells might be related to SP cells. Studies on the biomarkers of tumor stem cells and decrease of ABCG2 expression may contribute to the treatment outcome of osteosarcoma. Moreover, research on active and passive immunotherapy and Src protein tyrosine-kinase targeted therapy may provide new pathways for treatment of osteosarcoma.

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.

OBJECTIVE:To explore the effects of dual-phase insulin aspart with different dosing regimens on the related indica-tors of type 2 diabetic (T2DM) patients with poor glycemic control. METHODS:70 T2DM patients with poor glycemic control were randomly divided into group A and group B. All patients were given metformin and stopped other antidiabetic drugs;based on it,group A was additionally given Dual-phase insulin aspart injection,0.5 U/(kg·d),in the morning and evening before a meal by subcutaneous injection;group B was given Dual-phase insulin aspart injection,0.5 U/(kg·d),once before lunch time for 6-10 U and other twice in the morning and evening before a meal by subcutaneous injection. Both groups were treated for 12 weeks. Glu-cose control rate,glucose control time,and glucose indicators,daily fluctuations of glucose before and after treatment and incidenc-es of hypoglycemia and adverse reactions in 2 groups were observed. RESULTS:Glucose control rate in group B was significantly higher than group A,glucose control time was significantly shorter than group A,incidence of hypoglycemia was significantly low-er than group A(P<0.05). After treatment,glucose indicators and daily fluctuations of glucose in 2 groups were significantly lower than before,and group B was lower than group A(P<0.05). There were no obvious adverse reactions during treatment. CONCLU-SIONS:Conpared with 2 times a day,Dual-phase insulin aspart with 3 times a day for administration can effectively improve the glucose control rate and glucose levels in the treatment of T2DM patients with poor glycemic control,with good safety.

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.

BACKGROUND:Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients,the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradualy increasing,especialy in strongly predisposal children.Therefore,exploring the risk factors of delayed healing orpost-operative recurrence in pediatric patients after spinal tuberculosis surgery,wil have significance in the prevention and treatment of tuberculosis.OBJECTIVE:To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis,and evaluate the efficacy of individualized re-operation.METHODS:From June 1998 to June 2013,clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively,and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence.The patient's age,gender,nutritional condition,lesion debridement,history of chemotherapy and internal fixation,complicated spinal lesion,scope of lesions,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications were analyzed by Logistic regression analysis.The risk factors of delayed healing or post-operative recurrence were analyzed.After re-operation,erythrocyte sedimentation rate,C-reactive protein and imaging studies were detected.RESULTS AND CONCLUSION:After surgery,29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation.The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20％and the re-operation rate was 8.3％.Logistic regression analysis showed that,nutritional condition,history of chemotherapy,lesion debridement,and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P＜0.05).While patient's age,gender,history of internal fixation,complicated spinal lesion,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P ＞0.05).Individualized re-operation can achieve good outcomes.Experimental findings indicate that,the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex,enhancing the nutrition,complete debridement of lesions,and receiving chemotherapy can effectively decrease the incidence.According to the initial surgery and patient's conditions,individualized re-operation is the key to the success.

BACKGROUND:At present, there was lack of reports on the efficacy of thoracolumbar tuberculosis complicated with severe kyphosis (>90°). Choice of surgical treatment is necessary for patients with severe spinal tuberculosis kyphosis, affected heart and lung function and neurological disorders. OBJECTIVE:To retrospectively analyze the repair effect of I-stage posterior osteotomy orthopedic fixation and II-stage anterior debridement interbody bone grafting fusion in repair of patients with thoracolumbar tuberculosis complicated with severe kyphosis. METHODS:Total y 53 patients with spinal tuberculosis complicated with severe kyphosis were enrol ed. Patients underwent posterior osteotomy orthopedic fixation in the first stage, and underwent anterior debridement interbody bone grafting fusion in the second stage. X-ray, CT, MRI and other imaging examinations were conducted before and after the treatment. Erythrocyte sedimentation rate, C-reactive protein, pain visual analog scale scores, kyphosis and ASIA spinal cord injury classification before and after the treatment were compared and analyzed for clinical evaluation of efficacy. RESULTS AND CONCLUSION:Al patients had a successful surgery. The operative time was 290 (195-420) minutes, and the intra-operative amount of blood loss was 1800 (1 100-3 300) mL, the average number of fixed segments were 11.8 (9-16). Al these 53 patients were fol owed up for 26-28 months. The erythrocyte sedimentation rate and C-reactive protein of patients after treatment gradual y recovered to normal, and recovered to normal levels at the final fol ow-up. The mean correction of sagittal Cobb angle was 77.92°, the correction rate reached to 74.6%at the final fol ow-up. Til the final fol ow-up, the average loss of corrective angle was 1.35°. The lower back pain and limitation of function obtained varying degrees of al eviating after treatment. The visual analog scale scores in the final fol ow-up were significantly lower than those before treatment (t=19.219, P<0.001). ASIA spinal cord injury scores gradual y increased. Patients recovered the ability to live and work in varying degrees. These results suggest that I-stage posterior osteotomy orthopedic fixation combined with II-stage anterior debridement interbody bone graft fusion is an effective methods for repair of thoracolumbar tuberculosis complicated with severe kyphosis. The lesions of patients with thoracolumbar tuberculosis complicated with severe kyphosis who were enrol ed in this study involve multiple vertebral body, long bone defect, and often need long segmental al ograft bone grafting, with long-time of bone grafting fusion, therefore, zygapophyseal bone grafting fusion should be conducted to increase the stability of posterior bone grafting.

BACKGROUND:There are no systematic and coherent studies on the mitochondrial apoptotic pathway of fluoride-induced osteoblast apoptosis, and the specific pathways to induce apoptosis in osteoblasts by fluorine are stil unclear. OBJECTIVE:To explore the possible pathways of apoptosis in osteoblasts induced by fluoride and its molecular characteristics. METHODS:A fluorosis model of human osteosarcoma cel line Saos-2 was establishedin vitro. After in vitro culture, the cels were treated with sodium fluoride at different concentrations (0, 5, 10, 20, 40, 80 mg/L). Flow cytometry was used to inspect the mitochondrial membrane potential at 24 hours after intervention; 84 apoptosis-related genes were detected by PCR Array; parts of the differentialy expressed genes were verified by western blot method. RESULTS AND CONCLUSION: When the concentrations of sodium fluoride were 20, 40 and 80 mg/L, the mitochondrial membrane potentials in osteoblasts were 27.0%, 28.8%, 38.6%, respectively (alP < 0.05). PCR array found 13 genes upregulated and 15 genes down-regulated. Immunoblotting results showed Bim, Caspase 9, Caspase 14, BCL2, BAX expressions enhanced with increasing doses of sodium fluoride; Caspase 3 expression was decreased at the concentration of 5 mg/L, but increased gradualy at over 10 mg/L. Caspase 7 expression had no significant difference. The expression of Caspase 10 decreased with the increasing doses of sodium fluoride. These findings indicate that fluoride may induce apoptosis in osteoblasts through the mitochondrial pathway (including the endoplasmic reticulum stress pathway) and death receptor pathway.

0.05).The cytological false negative rate was 23.58% for LSIL,17.57% for high squamous intraepithelial lesion(HSIL),0.00% for squamous cell cancer(SCC),and 50.00% for adeno-carcinoma(AC);the false positive rate was 14.29% for LSIL and 3.85% for HSIL.Conclusion Liquid-based cytology test is an effective method for the screening of cervical cancer and precancerous lesion.The high-quality cervical cell specimen is important to ensure the diagnosis accuracy.

Objective To investigate the role and mechanism of signal transducer and activator of transcription 4 (STAT4) in homocysteine (Hcy)-induced proliferation,migration and senescence of human aorta smooth muscle cells (VSMCs).Methods After VSMCs were incubated with Hcy (0-0.50 mmol/L) for various time periods,a CCK-8 assay was performed to determine proliferation activity.Modified Boyden chamber system (Transwell apparatus) was used to examine migration ability.A SA-β-gal staining kit was used to determine senescence status.Western blotting was performed to examine the expressions of STAT4 and phosphorylated STAT4 (p-STAT4) proteins,and ELISA was performed to examine MCP-1 expression.Results Hcy (from 0.05 mmol/L) significantly increased the proliferation of VSMCs (P ＜ 0.05).Hcy (from 0.10 mmol/L) significantly increased the migration of VSMCs (P ＜ 0.05).Hcy promoted the senescence of VSMC in a concentration-dependent manner,and significantly increased VSMC senescence when the concentration of Hcy reached 0.10 mmol/L (P ＜ 0.05).Hcy (from 0.10 mmol/L) treatment significantly increased the expression of p-STAT4 (P ＜ 0.05) and MCP-1 (P ＜ 0.05).Conclusions Hcy increases the proliferation,migration and senescence of VSMCs,probably by the activation of STAT4 pathway.