The drug and medical consumables management center in Wuhu features the operational mechanism separating the decision-making power of drug purchasing,the executive power and the supervision power.This practice terminates the interest chain previously found between medicine suppliers with hospitals,pharmacies and doctors,creating the Wuhu Model of drug and medical service separation at public hospitals.The drug zero-profit policy reshapes the drug supply system and the existing compensation mechanism of public hospitals,further defining the Wuhu Model.This model is paving the way for the same reform to be carried out nationwide.

The separation of drug and medical service is key to alleviating the social problem of high medical expenses,and the top thing to do is to cut off the profit link found in the drugs purchase and sales interests chain.Pharmacies of the hospital are found to play a crucial role in this chain,as they not only take part in the decision-making of drug purchase but also directly purchase and dispense drugs.Wuhu has established the Medicine and Medical Consumables Management Center,which directly regulates the pharmacies and detach them from this chain,weakening their rent-seeking power.Practices of this reform found the pharmacies no longer playing a dominant role in drug purchase/dispensation on one hand,and yet less incentives of the pharmacies due to management by the Center on the other,resulting in poorer pharmaceutical management of the hospital as a result.In this consideration,pharmacies have experienced a detachment and return process from their hospital in the reform of drug and medical service separation in Wuhu.Experiences prove the correct way out is to guide the pharmacies to upgrade from logistics in drug supply to innovated services,thus better serving hospital management.

Objective To explore the clinical effect of adenovirus dipivoxil combined with Anluohuaxian pill in the treatment of chronic hepatitis B cirrhosis .Methods 98 patients with chronic hepatitis B liver cirrhosis were randomly divided into the two groups .49 cases in the control group were treated with adenovirus dipivoxil ,and 49 ca-ses in the observation group were given adenovirus dipivoxil combined with Anluohuaxian pill .The clinical effect of two groups was observed .Results The total effective rate of the observation group was 92.9%,which was significant-ly higher than 69.4% of the control group (χ2 =9.37,P<0.05).Before treatment,the alanine aminotransferase (ALT),hyaluronic acid (HA) and albumin/globulin (A/G) between the observation group and the control group had no significant differences (t=0.213 1,1.212 2,0.403 2,all P>0.05).After treatment,the ALT,HA and A/G of the two groups were significantly improved compared with those before treatment ,the improvement of the observation group was better than control group ,the difference was statistically significant ( t=11.302 1,9.012 1,7.312 4,all P<0.05).Conclusion In clinical practice,adenovirus dipivoxil combined with Anluohuaxian pill in the treatment of patients with chronic hepatitis B cirrhosis has good therapeutic effect ,it can improve the clinical symptoms and pa-tients'liver function ,so as to improve the liver detoxification function and the clinical treatment effect ,which worthy of clinical application and promotion .

Objective To investigate the clinical features of pregnancy complicated severe hepatitis and summarize experience in diagnosis and treatment so as to decrease maternal mortality.Methods Forty-two cases of pregnant women with severe hepatitis in the hospital were retrospectively analyzed.According to the outcome,all subjects were divided into death group(27 cased) and survival group(15 cases).Clinical data including viral markers,clinical manifestations,blood biochemistry,clinical treatment and pregnancy outcomes were recorded.Results (1) Pathogen examination showed that the major infection was hepatitis B virus (HBV),accounting for 64.29％ (27/42).(2) The first symptoms was gastrointestinal symptoms,accounting for 73.81％ (31/42).(3) The level of serum albumin,cholesterin (CH) and cholinesterase (CHE) in survival group were (29.91 ± 6.78) g/L,(2.80 ± 1.02) μmol/L and (5 399.4 ± 1 096.5) U/L respectively,significantly higher than that in death group((25.14 ± 7.36) g/L,(1.73 ± 0.77) μmol/L,(3423.6 ± 1102.7) U/L respectively).The serum creatinine(SCr) and prothrombin time (PT) levels in survival group were (83.06 ± 47.23) μ mol/L,(18.98 ± 6.72) s,lower than that in death group ((231.54 ± 58.90) μmol/L,(44.16 ± 5.38) s).The differences were statistically significant (t =2.07,3.84,5.57,8.37,13.29 ; P ＜ 0.05 or P ＜ 0.001).(4) The mortality rate of patients who chose pregnancy termination was 31.58％ (6/19),lower than the overall average mortality rate 64.29％ (27/42) and the difference was statistically significant (x2 =5.636,P =0.018).Conclusion HBV infection is the main reason for pregnant women with severe hepatitis.Gastrointestinal symptoms is the main symptom.Serum albumin,SCr,PT,serum CH and CHE can be regarded as prognostic indicators of the disease.Active comprehensive treatment and timely pregnancy termination can reduce maternal mortality.

Female ; Hemangioma ; therapy ; Humans ; Infant, Newborn ; Syndrome ; Thrombocytopenia ; therapy

The Cooperative medical system,like the insurance,has the adverse selection,this article points out the concept of adverse selection,and raises some efficient way to control the adverse selection.

Objective To analyze the effect of antimicrobial enema liquid to explore different bacterial infection patients with chronic pelvic inflammatory disease by clearing away heat and promoting diuresis, detumescence,promoting blood circulation and relieving pain, and to investigate the influence of antimicrobial enema liquid applicated in rectal on endovaginal microecologics.Methods Seventy-one cases of chronic pelvic inflammatorydisease patients were selected as the research objects in Obstetrics and Gynecology Hospital Affiliated to Fudan University from March 2011 to January 2012.The bacterial culture of cervical secretions in patients with chronic pelvic inflammatory disease(excluding the vulva and vaginitis) was swab by cotton swab, then bacterial culture and bacterial vaginal infection Wulian analysis were conducted.The minimal inhibitory concentration(MIC) and minimum bactericidal concentration(MBC) of the common pathogenic bacteria were determined by using the flat dish two times dilution method according to the different kinds of pathogenic bacteria.Wulian analysis bacterial vaginal infection was reviewed after patients received the same kind of enema rectal administration.Results Main pathogenic bacteria in 71 cases of patients with chronic pelvic inflammatory disease were enterococcus faecalis of 12.5％ (4/71), beta hemolytic streptococcus of 31.25％ (10/17), escherichia coli of 34.38％ (11/71), Staphylococcus aureus of 28.13％ (9/71), mlicrococcus scarlatinae of 6.25％ (2/71), bacillus typhosus of 6.25％ (2/71), Shigella of 3.13％ (1/71), staphylococcus epidermidis of 3.13％ (1/71), klebsiella pneumoniae of 3.13％ (1/71) and pseudomonas aeruginosa of 3.13％ (1/71) .Chronic pelvic inflammatory disease enema on enterococcus faecalis, beta hemolytic streptococcus, escherichia coli, staphylococcus aureus and antibacterial activity was obvious, the minimum inhibitory concentration (MIC) were the original drug concentration of 1/32,1/32,1/16, 1/16, the minimum bactericidal concentration(MBC) respectively as raw material concentrations of 1/16, 1/8, 1/8, 1/8;has certain antibacterial activity against streptococcus pyogenes, typhoid salmonella, shigella flexneri, the MIC were the original drug concentrations of 1/8,1/8,1/4,the MBC were the original drug concentrations of 1/8,1/4,1/4.In vitro antibacterial activity on pseudomonas aeruginosa, coagulase negative staphylococci was not obvious.There were statistically significant differences in PH activity abnormality rate (67.61％ vs 36.62％), positive rate of catalase (66.20％ vs 29.58％), leukocyte esterase (56.33％ vs 29.58％), neuraminidase (53.52％ vs 25.35％), proline aminopeptidase (57.75％ vs 32.39％) and glucosaminidase(52.11％ vs 22.55％) after enema liquid applicated in rectal, and the difference was significant(P＜0.5).Conclusion The use of clearing away heat and promoting diuresis, detumescence, Huoxue Zhitong enema on chronic pelvic inflammatory disease pathogenic bacteria have certain inhibition, especially enterococcus faecalis infection.The drug has efficient on chronic pelvic inflammatory disease and endovaginal microecologics.

AIM: To study the correlation between the drug effects and serum HPLC fingerprint from active compositions of Radix paeoniae alba and Radix et Rhizowa Glycyrrhizae. METHODS: Orthogonal design of L_9(3~4) of the different combinations of three active compositions of paeoniflorin,glycyrrhiza flavoues and Glycyrrhizic acid were prepared,antalgic pharmacological experiments of mice were carried out.The fingerprints of the serum were tested by HPLC method and different chromatographic peaks were obtained.Correlation analysis was applied to interelationship between the area of each peaks and the pharmacologic data. RESULTS: Correlation coefficients were different between pear areas and analgetic coffec. CONCLUSION: This study provides a significant try of investigating the compatibility of composite herbal medicines.

Objective:To compare the clinical and imaging characteristics between central nervous system vasculitis(CNSV)and mitochondrial encephalomyopathy(ME),so as to analyze the differential diagnosis of the two disorders.Methods:Clinical data on seven patients with CNSV and five with ME were retrospectively analyzed.The clinical manifestations,laboratory parameters,imaging features and histological characteristics were compared to screen for the evidence of their differential diagnosis.Results:The MRI results of both CNSV patients and ME patients(MELAS type)showed a multi-lesion pattern.The symptoms of CNSV patients included headache,limbs weakness,and erythrocyte sedimentation rate(ESR)increase.The symptoms of MELAS patients included epilepsy and increased serum lactic acid.The electroencephalographic manifestations of both diseases were abnormal:CNSV patients mainly had diffused lesions accompanied with limited alterations;ME patients had evidence of epileptic discharge,which was consistent with the clinical symptoms.Conclusion:Clinical manifestations of CNSV and ME patients are more valuable than imaging findings in the diagnosis of the two diseases.CNSV is characterized by vascular disorders and inflammatory reactions;ME is characterized by abnormal energy metabolism and severe damage of gray matter.The final diagnosis should depend on laboratory and histological examinations.

Objective To evaluate the laparoscopic repair for indirect inguinal hernia in children. Methods A total of 72 children with unilateral and 25 children with bilateral indirect inguinal hernia underwent laparoscopic high ligation of the sac. In operation a self-made needle introduced subperitoneally was used to pass a ligature circumferentially around the internal ring. Results All the operations were successfully completed. The average operating time was 10 min in unilateral hernias and 16 min in bilateral hernias. The postoperative hospital stay was 1 day. No surgical complications occurred. Follow-up for 2~60 months (mean, 31 months) in 70 children found no recurrence. Conclusions Laparoscopic repair for indirect inguinal hernia in children is safe, feasible and minimally invasive, offering a low complication and recurrence rate and a quick postoperative recovery.