Objective A systematic review of implementation outcomes of the essential medicine system in China to identify scientific evidences for a better system.Methods A systematic review is made to extract data from the research papers on outcomes of the essential medicine system,followed by an analysis and description of such data.Results Of the 87 papers included,most of them focused on primary care institutions,while four of them on residents or patients,and one of them on pharmaceutical enterprises.The study found the medical institutions with rising availability of essential drugs,lowered medicine costs,rising or dropping business volume,and apparent drop of out-of-pocket expenses for patients.These have encouraged rational drug use.Evidences in hand indicate expected outcomes from the essential medicine system.Conclusion Current researches on the system focus on primary care institutions in developed areas in China,lacking rigorous design.Studies of broader scale,further depth and more rigorous designs of the implementations of the system are recommended for evaluation of the impacts and outcomes of the system on various stakeholders of the policy.

Objective To identify the impact factors for community doctors with the essential medicine system in place,in support of mobilizing them and successful implementation of the essential medicine system in the community.Methods Based on the theory of ERG hierarchy of needs,the pathway analysis method was called into play to identify the three factors affecting community doctors,namely personal survival,interpersonal relations and self-development.Results Major factor of which is the interpersonal factor,with a score of 0.549,while the latter two factors do not directly affect the survival and development.The two however work on each other,and work on the interpersonal factor as well,with the impact coefficients of 0.320 and 0.402 respectively.Conclusion With the essential medicine system in place,the largest impact factor for community doctors'enthusiasm is the interpersonal one,involving the doctor-patient communications among others.This serving as the breakthrough point may improve the enthusiasm of the community doctors,paving the way for the system in the communities.

Objective To elucidate the roles of high mobility group box-1 protein (HMGB1) and myeloperoxidase (MPO) deficiency in evaluating coronary stenosis and the vulnerability of atherosclerotic plaques in patients with coronary heart disease.Methods Totally 50 patients with acute myocardial infarction (AMI),50 patients with unstable angina pectoris (UAP),50 patients with stable angina pectoris (SAP) and 30 patients without coronary heart disease underwent the study.Coronary arteriography (CAG) and intravascular ultrasound (IVUS) were performed to analyze coronary stenosis and plaque characteristics and then gensini score was calculated.Concentrations of HMGB1,MPO and hypersensitive C reactive protein (hsC-RP) were measured by means of enzymelinked-immonosorbent assay (ELISA).Results Concentrations of HMGB1,MPO and hsC-RP were significantly higher in AMI and UAP patients than in SAP paticnts (all P＜ 0.01).IVUS showed that 51.3 ％ (20/39) AMI patients,46.7％ (43/92) UAP patients had soft lipid-rich plaqucs,while 52.9％(46/87) SAP patients had fibrous plaques,only 17.2％(15/87) had soft plaques.AMI and UAP patients had larger plaque burden and vascular remodeling index than did the SAP patients (both P＜0.01).In AMI group,HMGB1 and MPO levels were correlated well with gensini score and remodeling index measured by IVUS,respectively(r=0.54,0.48,allP＜0.05),while in UAP group,HMGB1 and MPO levels were correlated well with gensini score and plaque burden measured by IVUS,respectively(r=0.43,0.56,all P＜0.05).Conclusions HMGB1 and MPO are positively correlated with coronary stenosis,which can be used to predict the severity of ACS.HMGB1 and MPO are associated closely with plaque vulnerability and rupture.

Objective To evaluate the effect of EMS through ureteroscope per urethra for the treatment of infant bladder and urethral stone with acute urinary retention. Methods Ten cases (9 boys, 1 girl)of infant bladder and urethral stone with acute urinary retention were treated by EMS through ureteroscope per urethra. Mean age of the patients was 9 months. Two cases suffered from bladder stones while the other 8 cases suffered from urethral stones. The size of stones varied from 0.5-1.1 cm with the average of 0.8 cm. All 10 cases underwent EMS through ureteroseope per ure-thra after general anaesthesia by using ketamine in vein. Wolf F8/9. 8 ureteroscope was used and mo-nitored by television. The EMS probe of ultrasound lithotripsy was sticked through operating passway of ureteroscope to shatter and eliminate bladder and urethral stone. During operation, 50-- 100 ml li-quid pressure was retained in the urinary bladder. The pressure of perfusion pump varied between 160 and 210 kPa(average, 180 kPa). The energy of ultrasound lithotripsy was 40%--60% with a ratio of 30%--70%. F8 type of 2 cavity aerocyst urethral catheter was indwelled after operation. Results The average operation time was 25 min. Urethral stones were rinsed into bladder. Stones were elimi-nated at one time by ureteroscope. Urethral catheters were removed after the patients revived from anesthesia and smooth urination was seen immediately after operation. No retained calculus in the bladder and urethra was found by B ultrasound 3 days later. Conclusions Low urinary obstruction could be relieved immediately after EMS through ureteroscope per urethra in patients of infant bladder and urethral stone with acute urinary retention. This operation is safe, high-efficient with less lesion, and would be the first option for the patients of infant bladder and urethral stone with acute urinary re-tention.

Objective To investigate the clinical application of ureteroseope in the treatment of infant renal calculus with acute post-renal failure. Methods Thirteen cases of infant renal calculus with acute post-renal failure included 11 males and 2 females aging from 5 months to 1 years with a mean age of 9 months. Five cases showed bilateral renal calculi with hydronephrosis, 3 cases showed one side renal calculus with eontralateral uretal calculus incarceration, 3 cases showed bilateral uretal calculus incarceration, 2 cases showed bilateral renal calculi and hydronephrosis with urinary calculi. Anuria appeared in 11 cases for 1-3 d while oliguria appeared in 2 cases for 5-10 d. BUN and SCr were higher than normal level in all cases. Hyperuricemia was found in 8 cases, hyperkaliemia was found in 9 cases, pH values in urine of all infants were less than 6. 5(mean, 5. 5). Radiopague stone was not found in all cases by KUB. Hydronephrosis was found in 13 cases, and the diameter of hydro-nephrosis in 9 cases was more than 2.5 cm by B ultrasound. All cases were diagnosed as urinary stones with the diameter from 0.5 to 1.5 cm by CT. All cases were inserted with double J stents un-der ureteroscope for internal drainage, crushing, rinsing and eliminating stones. Results Hyperdi-uresis emerged within 24 h after operation in 13 patients. The duration of hyperdiuresis was from 24 h to 72 h. Urine volume revived gradually 48-96 h after operation while BUN and SCr revived 1-5 dafter operation. Serum uric acid revived 1-7 d after operation in 8 cases of hyperuricacidemia. Serum potassium revived 1-3 d after operation in 9 cases of hyperpotassaemia. Double J tubes were detained for 2-4 weeks. Renal calculus in 10 cases were found by B ultrasound to be discharged and conse-quently double J tubes were pulled out. Renal calculi in 2 cases became smaller and lighter. Conclu-sions For infant renal calculus with acute post-renal failure, upper urinary obstruction could be re-lieved immediately with revived urination and improved renal function by dissolution and crushing of calculus, and the placement of double J tube for internal drainage under ureteroscope. This operation is safe, high-efficient with less lesion, and would be the first option to relieve obstruction for infant re-nal calculus with acute post-renal failure.

Objective To evaluate the efficacy and safety of direct renal chemolysis with alkaline drug through ureteral catheter or nephrostomy tube for the treatment of infantile renal calculus resul-ted from melamine. Methods Fifteen infants of acute post-renal failure resulted from bilateral renal calculi were treated. The age of the infants was 5--12 months(average, 9 months). Stone size varied from 0.4 to 1.5 cm (average, 0.8 cm). They were all fed on milk powder polluted with melamine for a long time and diagnosed with acute post-renal failure based on the imaging and chemical examination. Double-J stents insertion by ureteroscope was performed on 13 infants and direct renal chemolysis with alkaline drng(5% NaHCO3,20 ml)through ureteral catheter was performed during operation. Percuta-neous nephrostomy was performed on 2 infants to remove the obstruction of upper urinary tract and di-rect renal chemolysis with alkaline drug(1.4% NaHCO3, continuous perfusion by gravity) through ne-phrostomy tube was performed intermittently after operation. Results Direct renal chemolysis was performed successfully on the 15 infants. The urine volume recovered in 2--5 d, blood urea nitrogen and serum creatinine recovered in 2--3 d postoperatively. During the operation of the infants treated by direct renal chemolysis with 5%NaHCO3 throuth ureteral catheter, a large number of limous fluid spurted from ureterostoma. According to CT examination 2 weeks after operation, the stone frag-ments were removed thoroughly in 13 infants, the diameter of the stone lessened more than 50% in 2 infants. Conclusion Direct renal chemolysis with alkaline drug for eliminating infantile renal cal-culus resulted from melamine is sale and effective.

Objective To evaluate the technique and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) for renal calculi in pediatric patients. Methods From April 2009 to December 2009, 12 pediatric patients (8 males and 4 females) with renal calculi were treated by MPCNL. The age ranged from 18 to 53 months (mean 32 months). All the 12 cases were diagnosed by KUB+IVU, ultrasonography and CT. The stone had average diameter of 1. 3 cm (ranged from 1. 0 to 1. 8 cm). Seven cases had simple renal pelvis stone and 5 cases had multiple renal calyx stone. UPJ stricture was not found in this series. General anaesthesia was applied. Renal transfixion pin was punctured to select renal calices by monitoring with ultrasonography. 12 - 16 F percutaneous renal access was successfully established in all cases and calculi were fragmented by pneumatic lithotripter. Results The average operative time of MPCNL was 74 min. Phase Ⅰ lithotripsy was underwent in all patients. The phase Ⅰ stone-free rate was 67%(8/12). One cases accepted second MPCNL. The calculus clearance rate reached 75%(9/12). Three cases had residual calculi ranged from 2 to 4 mm. One of whom had ESWL 2 weeks postoperatively. All cases were followed up for 1 - 7 months, all cases were in stone free status. Conclusion Regarding the advantages of less bleeding, high clearance rate, and shorter hospital stay, MPCNL is an effective and safe treatment option for renal calculi in pediatric patients.

BACKGROUND:Conflicting data have been reported regarding the expression of retinol-binding protein 4 in non-alcoholic fatty liver disease. OBJECTIVE:To evaluate the impact of dietary interventionversus metformin treatment on expression of retinol-binding protein 4 in rats with non-alcoholic fatty liver disease. METHODS: Fifty male Sprague-Dawley rats were randomized to six groups, including two normal control groups (rats were kiled after 8 and 16 weeks of normal diet), two HFD groups (rats were kiled after 8 and 16 weeks of high-fat diet), one dietary intervention group (rats were kiled after 8 weeks of high-fat diet and 8 weeks of normal diet) and one metformin treatment group (rats were kiled after 8 weeks of high-fat diet and 8 weeks of high-fat diet and metformin treatment). The levels of retinol-binding protein 4 in serum and biochemical indexes were detected through enzyme-linked immunosorbent assay. The expression of retinol-binding protein 4 mRNA in liver tissues was measuredvia western blot analysis, immunohistochemistry and RT-PCR. RESULTS AND CONCLUSION:Non-alcoholic fatty liver disease models were successfuly established by high-fat diet. Liver tissues of high-fat diet fed rats showed progressing non-alcoholic fatty liver disease histology, from non-alcoholic fatty liver to non-alcoholic steatohepatitis. Dietary intervention increased retinol-binding protein 4 expression in liver tissue as wel as improving liver enzyme, dyslipidemia and insulin resistance, and aleviated impaired liver histology. Metformin treatment only aleviated hepatic steatosis caused by high-fat diet. The results indicated that retinol-binding protein 4 expression might play a role in the pathogenesis of non-alcoholic fatty liver disease. Metformin treatment can aleviate non-alcoholic fatty liver disease histology,dietary intervention should be the fundamental treatment.

Objective: To investigate the overall incidence and age distribution of upper digestive tract cancer in Cixian county, and to provide a reliable basis of prevention and treatment for upper gastrointestinal cancer. Methods: Collected annual incidence rate among 2003-2012 from Cixian cancer registry and abstracted all incidence rate of upper digestive tract cancer. The age-standardized incidence rate by Chinese standard population (ASR China) was calculated using the national population composition of 2000. The age-standardized incidence rate by world standard population (ASR world) was calculated using the world population composition of 1964 of Segi's. The annual average change (APC) was used to estimate the growth rate of the last two years in comparision with the first two years, which was calculated by Joinpoint regression model. The data was divided into two sections (from 2003 to 2007, and from 2008 to 2012), and the rate difference of different age group was calculated. Results: The crude incidence rate of the digestive tract cancer from 2003 to 2012 was 165.36/100 000 (10 309/6 234 346), which dropped from 170.75/10 100 000 (1 029/602 638) of 2003 to 146.02/100 000 of 2012 (936/640 991).The PC and APC of the crude incidence rate of upper gastrointestinal cancer were-12.96%, and-1.54% (95%CI:-3.22%-0.07%), respectively. The PC and APC of ASR China were-10.83%, and-1.30% (95%CI: 2.54%-0.03%), respectively. The PC and APC of ASR world were-9.82%, and-1.13% (95%CI:-2.20%--0.03%), respectively. The incidence of upper gastrointestinal cancer decreased. The incidence rate of 2003-2007 and 2008-2012 were 171.55/100 000 (5 239/3 048 593), and 159.41/10 000 (5 070/3 180 514), respectively and the rate difference was-12.15/100 000. The decrease of rate difference of 70 to 74 years old was the most (-340.32/100 000) and the increase of rate difference over the age of 85 was the most (447.21/100 000). Conclusion From 2003 to 2012, the crude incidence of upper digestive tract cancer in Cixian showed a decreasing trend, and the 70-74 years old age group shows the most obvious decline

Objective To study the effects of tacrolimus(Tac) concentrations on the number of NK cells and receptor expression in peripheral blood of renal transplantation receptors.Methods A total of 60 first-time kidney transplantation recipients in our institute from Dec.2007 to July 2009 were followed up.Tac maintenance immunosuppressive therapy was given to all recipients.The recipients were divided into low-concentration Tac group (6.84 + 1.72μg/L,n =30) and highconcentration Tac group ( 11.88 + 2.59 μg/L,n =30) according to concentrations of Tac.Twenty healthy volunteers served as controls.Before and 6 months after operation,concentrations of Tac were analyzed by using micro particle immunoassay chemiluminescent method.NK cells and their receptors (CD85j,CD158d,CD94 and NKG2D) were detected by using flow cytometry.The concentrations of soluble HLA-G5 were detected by using ELISA.Results The number of NK cells in lowconcentration Tac group and high-concentration of Tac group preoperatively was significantly reduced as compared with control group (P ＜ 0.05 ). The percentage and number of NK cells in low concentration Tac group and high-concentration Tac group at 6th month after operation were significantly reduced as compared with control group (P＜0.05).The number of NK cells in lowconcentration Tac group was significantly greater than in high-concentration Tac group (P＜ 0.05).There was no significant differende in the expression of CD85j,CD158,CD94 and NKG2D before operation between two groups(P＞0.05).The expression of CD85j and CD158d in two groups was increased,but that of CD94 and NKG2D was decreased at 6th month post-transplantation as comapred with that preoperation.In low-concentration Tac group,the expression of CD85j and CD158d was increased as compared with that in high-concentration Tac group (P＜0.05 ).Spearman correlation analysis revealed that the CD85j and CD158d expression had a positive correlation with sHLA-G5(P＜0.01 ),but the NKG2D had a negative correlation with sHLA-G5(P＜0.01 ).Conclusion There was correlation between the concentrations of Tac and NK cells count and NK receptors. Low concentrations of Tac can safely and effectively protect kidney function.The number of NK cells andtheir inhibitor receptors are increased in the recipients with low concentration of Tac.