OBJECTIVE: To evaluate the status quo and the tendency of utilization of antihypertensives in our hospital. METHODS: The consumptions of antihypertensives from 2001 to 2004 were analyzed statistically with Microsoft Excel 2000. RESULTS: The use of antihypertensives assumed an increased tendency, of which, about 90% were included in the catalog of the Drugs of National Basic Hospitalization Insurance. Calcium antagonists, diuretics, ACEI and ?-receptor blocking agents were the basic clinical drugs. Usage of angiotensin;angiotensin Ⅱ receptor blocking agents increased to a large degree year by year. CONCLUSION: The utilization structure of antihypertensives in our hospital is basically reasonable. Developing compound antihypertensive that of excellent quality and reasonable price is of great significance in the management of hypertension and its complications.

Objective:To survey and evaluate the situation of present clinic use of antidiabetic drugs,estimate their consuming trend and discuss the rational methods in applying antidiabetic drugs.Method:The drug purchasing data during the years of 2002 to 2006 in hospitals were compared,and statistically analyzed with Microsoft Excel.Result:Ac- counting approximately 52%-72% in total antidiabetie DDDS,sulfonylureas and bigunides were most commonly used.In- sulin and?-Glycosidase inhibitors also took more than 25%-35% share in total DDDs.Some other new drugs and tradi- tional Chinese medicine were less than 10% in total DDDs.The first line of antidiabetic drugs included mefformin,gliclas- ide,acarbose,glipizide and insulin.Conclusion:Clinical application of antidiabetic drugs was reasonable in Nanjing dis- trict.The cost of diabetes patient is the main factor which will influence the application of antidiabetic drugs normatively and continuously.

OBJECTIVE:To discuss the correlation between Interntion Normalized Ratio(INR)with concentration of warfarin enantiomer and dose density after cardiac valve replacement. METHODS:The plasma concentration of R-warfarin or S-warfarin, dose of unit weight and INR of 176 patients with anticoagulation after cardiac valve replacement in each time point were moni-tored,and the correlation of INR and warfarin plasma concentration or dose was observed. RESULTS:Doses of all patients in 24-288 h were significantly higher than 0 h,the differences were statistically significant(P<0.001),the dose was fluctuated within a certain range after 96 h,and compared with 96 h,there were no significant differences(P>0.05). Average plasma concentration of R-warfarin or S-warfarin had consistent trend,plasma concentration of enantiomers was fluctuated within a certain range after 108 h,there were no significant differences(P>0.05). Compared with 0 h,there was no significant difference when INR was 12 h (P>0.05),it increased significantly in 36 h and had been increasing,then fluctuated within a certain range after 108 h,compared with 108 h,there were no significant differences(P>0.05). The correlation coefficient between INR and unit weight dose of warfa-rin in 60 h>36 h>12 h,it showed correlation(P<0.001). There was certain correlation between plasma concentration of warfarin and dose density in 12,36 and 60 h. CONCLUSIONS:The correlation between plasma concentration of warfarin and unit weight dose is stronger than the correlation between INR and unit weight dose. When combined with other coagulation,it may help to man-age warfarin dose.

OBJECTIVE: To established an HPLC method for the determination of main component and related substances in amlodipine maleate dispersible tablets. METHODS: The separation was performed on a Lichrospher C18 column. The mobile phase consisted of methanol-0.03 mol?L-1 potassium dihydrogen phosphate (70 ∶ 30) at the flow rate of 1 mL?min-1. The detection wavelength was set at 237 nm and column temperature was 30 ℃. RESULTS: The linear range of amlodipine maleate were 31.94～127.75 ?g?mL-1 (r=0.999 8, n=5). The average recovery was 99.5% (RSD=0.39%, n=9). The contents of related substance were all lower than 0.38%. CONCLUSION: The method is simple, rapid, accurate and specific for the quality control of amlodipine maleate dispersible tablets.

OBJECTIVE:To study the time-concentration curves of single dose of ambroxol hydrochloride orally integrating tablets in healthy volunteers and to evaluate its bioequivalence.METHODS:A single oral dose of 90mg ambroxol hydrochloride orally dissolving tablets and 90 mg ambroxol hydrochloride tablets were given to 18 healthy volunteers by a randomized crossover design.The concentrations of ambroxol hydrochloride in plasma were determined by HPLC.RESULTS:The main pharmacokinetic parameters of the test and references preparations of ambroxol hydrochloride were as follows:Cmax were(169.58?39.43)ng?mL-1 and(170.28?43.26)ng?mL-1;tmax were(1.6?0.5)h and(2.2?0.6)h;t1/2 were(6.77?2.04)h and(6.50?1.27)h;AUC0～24 were(1 131.26?289.36)ng?h?mL-1 and(1 191.54?270.17)ng?h?mL-1;AUC0～∞ were(1 215.27?306.56)ng?h?mL-1 and(1 281.44?291.51)ng?h?mL-1,respectively.The relative bioavailability of the test preparation was(95.5?15.6)%.CONCLUSION:The result demonstrated that the two preparatioins were bioequivalent in absorption degree,suggesting the rapid release characteristics of the preparation.

OBJECTIVE:To provide reference for formulating the policy of promoting the popularization and application of es-sential medicines in second grade or third grade medical institutions. METHODS:Drug purchase and warehousing data was collect-ed from 31 second grade or third grade medicinal institutions in Nanjing during Jan. 2012-Dec. 2015. Excel 2010 and SPSS 20.0 software were used to summarize and analyze statistically the purchase amount of allocation quantity of essential medicines. RE-SULTS:The proportion of essential medicine purchase amount in total medicine purchase amount during 2012-2015 were 18.33%, 18.56%,17.19%,17.53% in 31 medicinal institutions (calledthe ratio of essential medicine purchase amountfor short);the proportion of national essential medicine purchase amount in essential medicine purchase amount(calledthe ratio of essential medi-cine purchase amountfor short)were 31.14%,29.40%,25.69%,25.79%,respectively. The number of generic names for allocat-ed essential medicines were 189.84,205.58,210.26,206.65,respectively. The ratio of essential medicine purchase amount and the ratio of essential medicine purchase amount in 2014 were decreased significantly,compared to in 2013(P<0.05). The number of generic names for allocated essential medicines in 2013 was increased significantly,compared to in 2012 (P<0.05). The ratio of essential medicine purchase amount in second grade medical institutions was significantly higher than third grade medical institu-tions,the ratio of essential medicine purchase amount in general hospital was significantly higher than special hospital;the number of generic names for allocated essential medicines was significantly higher than TCM hospital and special hospital;the ratio of es-sential medicine purchase amount in second grade medical institutions with community health service center in subjection to them was significantly higher than those without community health service center in subjection to them;there was statistical significance (P<0.05). There was negative correlation between the ratio of essential medicine purchase and total purchase amount of medicine in general hospitals(P<0.05). There was positive correlation between the number of generic name of allocated essential medicines and the number of generic name of all medicines in 31 medical institutions(P<0.05). CONCLUSIONS:The ratio of essential med-icine purchase amount and national essential medicine purchase amount,the numbers of generic names of essential medicines were very different and low in these hospitals during 2012-2015. Just one or two had met the requirements of the Jiangsu provincial health and family planning commission. The grade,type,medicine purchase and allocation scale,administering community health service center all influence the purchase and allocation of essential medicines.

Objective To explore the abilities and personal qualities that medical undergraduates need for their future clinical work, and develop their competency model. Methods The self-made ques-tionnaire survey on medical undergraduates' competencies was conducted among the 1326 medical under-graduates in a medical university by using the cluster sampling method, and the 1099 effective question-naires were collected with effective rates of 82.88%. The exploratory factor analysis was used to analyze the internal structure of competency item and to build the competency model. The rating method was used to calculate the weight of each competency item. Results The overall Cronbach's alpha coefficient of the competency questionnaire was 0.965, and the coefficient of each dimension was above 0.832. The KMO statistic value was 0.970, and the probability associated with Bartlett test statistic was P=0.000, showing that the questionnaire has high reliability and validity. The competency model of medical undergraduates covers six aspects, namely, craftsmanship, personal qualities, professional learning, interpersonal communication, psychological adaptation and the pursuit of excellence, which contain 49 factors. The cumulative variance contribution rate was 54.729%. The weights of these six aspects in the model were 0.204 4, 0.202 1, 0.175 3, 0.158 8, 0.137 6 and 0.121 8 respectively. Conclusion The competency model of undergraduate medi-cal students has a certain scientific and practical value, which can provide new evaluation methods and ideas for medical education objectives, quality assurance, teaching evaluation, medical personnel selection and training.

Objective To build a multi‐level hierarchical structure model of the influencing factors for hierarchical medical system ,to identify the role relationship between all the factors and transmission pathways ,and to recommend on developing China′s hierarchical medical system . Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system .On such basis ,16 influencing factors were identified by three health policy experts ,which affect operations of the current system .Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops .Results There exist among the 16 factors a 3‐level hierarchical structureand two conduction loops .The factor directly limiting the hierarchical medical system is two‐way referral,and most internal core drivers arehuman resources development and governance mechanism.By means of self‐growth and external constraints ,they exert their influence on the operation of hierarchical medical system .Conclusions There are interactive hierarchical effects among the factors ,merging into three node elements of functional role,inter‐entity relationshipand patient participation.

Objective To investigate the early clinical characteristics and radiographic changes in confirmed Novel coronavirus pneumonia (NCP) and excluded NCP patients. Methods Twenty-four patients with suspected NCP admitted to Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and Jinshan Branch Hospital between January and February, 2020 were chosen as our research subjects. Early clinical features and radiographic changes were analyzed in 10 patients of confirmed NCP and 14 patients of excluded NCP. Results In the early stage, all 24 suspected patients were mild, and had normal blood gas analysis. Of 10 diagnosed patients, 50% were male. All the 10 patients had fever and fatigue, with body temperature between 37.5℃ and 38.5℃. Only 1 patient had dry cough. 2 patients had no clear epidemiological exposure history, the other 8 had a clear epidemiological exposure, with a possible incubation period of 1-10 days. From CT imaging, lesions were characterized as ground glass shadow ( n =9), which could be unilateral ( n =1) or bilateral ( n =9), and were mainly close to the pleura ( n =9), with nodule shadow ( n =1) and without focal necrosis, and could combined with pleural effusion ( n =1. Among patients excluded NCP, all 14 patients had a clear history of epidemic exposure, with an onset time of 1 to 13 days. 12 patients had fever , including 4 with temperature > 38.5°C, 8 with temperature 37.3-38.5°C, and 2 without fever. All patients had fatigue , 7 patients had dry cough and 2 patients had chest pain. From CT imaging, ground glass shadow appeared in 4 patients , lesions were unilateral in 10 patients and bilateral in 4 patients , and the lesions were relatively sporadic, without necrosis or pleural effusion. Conclusion 1．Not all patients with NCP have a direct history of epidemiology exposure, some patients may be infected unknowingly. 2. According to CT imaging, NCP seems to have no special manifestations different from other viral pneumonia. 3. NCP is more common among middle-aged people.