OBJECTIVE:To put forward strategies to evolve the current drug bidding system.METHODS:The objective and efficacy of the drug bidding system was analyzed;and the reasons for the poor efficacy of the system were analyzed using the information asymmetry theory in economics,and the system was compared with its US counterpart.RESULTS & CONCLUSIONS:The drug bidding system in China should adopt such model in which the payers are chosen as agency and charge from the entrusting party.It is a systematic project to standardize drug circulation channels,reduce drug price and reduce the burden of patient,which can't be tackled by drug bidding system only.

Objective To investigate the effects of RDP1258 on survival of rat cardiac allograft. Methods RDP1258 was synthesized and the model of rat heart abdominal transplantation was established. Animals were divided into four groups. Group 1 received no immunosuppression. Group 2 received CsA alone. Group 3 received RDP1258 alone. Group 4 received RDP1258 and subtherapeutic CsA. In all cases RDP1258 was administrated intraperitoneally and CsA was gavaged. Light and electron microscopic examinations were taken . Transplanted hearts were monitored daily by direct palpation. Results The purity of synthesized RDP1258 was over 95 % and the molecular weight was in accord with theoretical value. The histology and the ultrastructure changed little in grafts in group 3 and group 4. Survival of rat cardiac allograft was significantly prolonged in group 4. Conclusions RDP1258 can suppress acute rejection. Perioperative administration of RDP1258 in combination with CsA can significantly prolong survival of rat cardiac allograft.

Objective To prepare dual-targeted microbubbles carrying both anti-CD34 monoclonal antibody and anti-ICAM-1 monoclonal antibody,to identify its basic characteristics,and to investigate its targeting performance in vitro.Methods ICAM-1-targeted microbubbles (MgIcAM-1),CD34-targeted microbubbles(MBcD34) and dual-targeted (with both monoclonal antibodies) microbubbles (MBD) were prepared by biotin-avidin bridging chemistry method.The targeted microbubbles were observed under light microscrope and characterized by a Mastersizer 3000,DFY software,laser confocal microscopy,and flow cytometry.The targeting specificity and attachment capability of dual-targeted microbubbles to endothelial progenitor cells (EPCs) and damaged human umbilical vein endothelial cells (HUVECs) were assessed in vitro.Results The morphous,diameter,surface potential,concentration,and the antibody-binding rates of microbubbles were not statistically significant in MBIcAM-1,MBCD34,and MBD (P ＞0.05).Echo intensity in MBD significantly increased compared with MBICAM1,MBCD34,and MBiotin (P ＜ 0.01).The targeting experiment in vitro showed that the attachment rate of MBD to EPCs and damaged HUVECs significantly increased compared with MBiotin (P ＜0.01),while no remarkable difference in attachment rate was found between MBD and MBcD34 in EPCs,and between MBD and MBIcAM-1 in damaged HUVECs (P ＞0.05).Conclusions Dual-targeted microbubbles carrying both anti-CD34 monoclonal antibody and anti-ICAM-1 monoclonal antibody are prepared successfully.The study in vitro has proved that the dual-targeted microbubbles can specifically bind to both EPCs and damaged HUVECs.

Following the blood pressure, pulse, breathing and body temperature, pain was identified as the fifth vital signs.Postoperative pain of the spine and spinal cord surgery was a neuropathic pain, it was severe and may affect multiple systems of the patients.Therefore, postoperative analgesia of spine and spinal cord surgery is very important.

Objective To access the diagnostic value of volume helical shuttle (VHS)technology of spectrum CT in detection of the pulmonary arteriovenous malformations (PAVM).Methods Thirteen patients with PAVM confirmed by surgery and clinical data underwent CT pulmonary artery angiography with VHS technology,which were regarded as group A.The consecutive images at four different phases were gotten Meanwhile,other thirty patients underwent conventional CT pulmonary artery angiography using bolus tracking scan,regarded as Group B.The enhancement degrees of the pulmonary trunk were measured,and the image quality was also subjectively assessed by two radiologists separately,which were compared between two groups.Results In group A,the proportion of optimal phase in each of the four phases was 15.38% (2/13),46.15% (6/13),30.77% (4/13)and 7.7% (1/13),respectively.The mean CT value in pulmonary trunk was (329.21±41.63)HU in group A and (281.74±49.83)HU in group B,exhibiting no difference (P =0.989). The percentage of enhancement degree of pulmonary trunk more than 300 HU in group A was more than that in group B (P=0.000).However, the image quality of the main pulmonary artery,lobar pulmonary artery or segmental pulmonary artery was not significantly different between two groups (P >0.05).There were no statistically differences in mean DLP between group A of (715.54±195.37)mGy/cm and group B of (558.36±186.81)mGy/cm (t=3.737,P=0.068).Conclusion Spectrum CT VHS with higher image quality and enhancement degree is superior to conventional CT scan,which can be used to reduce the influence of individual circulation difference on image quality.

Objective To investigate the effects of different BIS values on postoperative cogni-tive dysfunction (POCD)and S100βprotein(S100β)in the early stage of postoperation.Methods Fifty patients who were scheduled for selective abdominal surgery under general anesthesia (male 34 cases, female 1 6 cases,aged 65 to 75 years,ASA Ⅰ or Ⅱ)were randomly divided into two groups:light anesthesia group (group L,n =25,BIS value was maintained at 50 to 59)and deep anesthesia group (group D,n =25,BIS value was maintained at 30 to 39).BP,HR,SpO 2 ,ECG,PET CO 2 ,inhaled anes-thetic concentration and BIS values were recorded on time points of 5 minutes after the patients ente-ring the operating room (T0 ),before endotracheal (T1 ),intubation (T2 ),incision (T3 ),two hours after incision (T4 ),three hours after incision (T5 )and at the end of surgery (T6 ).The procedure du-ration,anesthesia time,dosages of propofol,fentanyl,midazolam and VAS scores on 1 d after sur-gery were also recorded.Blood samples were collected on time points of 10 min before anesthesia,im-mediately after surgery and 24,48 h after operation.S100β concentration were detected.Mini-mental State Examination (MMSE)score and Trail Making Test (TMT)completion time were recorded on 1 d before surgery and 1,3,7 d after surgery.Results BIS value of group D were lower than group L on T2 ,T3 and T4 .The propofol dosage of group D was significantly greater than that in group L (P <0.05 ).The concentration of serum S100βincreased significantly immediate and 48 h after operation in both groups compared with 10 min before anesthesia(P < 0.05).It was still higher 24 hours after op-eration than before anesthesia.But there was no statistic difference.Compared with the end of surger-y,the concentration of serum S100βin two groups on 24 h after surgery were significantly decreased (P < 0.05 ).The concentration of serum S100β in group L on the end of surgery and 24 h after surgery were higher than that in group D significantly (P <0.05).Compared with 1 d before surgery, postoperative 1 d MMSE scores in two groups and postoperative 3 d MMSE score in group L de-creased significantly (P <0.01).Compared with postoperative 3 d,postoperative 7 d MMSE score in group L increased significantly (P <0.01).Postoperative 1,3 d MMSE score in group D were signifi-cantly higher than group L (P <0.05).Compared with 1 d before surgery,TMT completion time in two groups on 1 d after surgery were significantly prolonged (P <0.01 ).Compared with 1 d after surgery,TMT completion time in two groups on 3 d after surgery were significantly shortened (P <0.01).Compared with 3 d after surgery,TMT completion time in group L on 7 d after surgery was significantly shortened (P <0.01 ).TMT completion time in group D on 1,3 d postoperative were significantly shorter than group L (P <0.05).POCD incidence of group D on 1 d after surgery was lower than that in group L (P < 0.05).Conclusion Different depth of anesthesia can ensure hemo-dynamic balance in old patients during surgery and after surgery.When BIS value was maintained at 30 to 39,it had lower S100βprotein levels,lower incidence of early POCD and a lesser degree of post-operative cognitive dysfunction.

Objective To prepare a novel extravascular human epithelial growth factor receptor 2 (HER2)-targeted polylactic-co-glycolic acid (PLGA)-COOH ultrasound contrast agent with liquid perfluorocarbons(PFH-PLGA-tra),and to observe it's general properties and it's effects on ultrasound imaging in vitro.Methods Polymeric nanocapsules of liquid perfluorocarbons were prepared by the single emulsion technique and conjugated with trastuzumab monoclonal antibody by EDC/NHS.The general characteristics were observed.The conjugation was demonstrated by immunofluorescence and the targeting performance of the agent was checked in human MCF-7 cells line in vitro.The encapsulation of liquid fluorocarbons was detected by heating in vitro.The effects on ultrasound imaging were observed in vitro.Results The mean diameter of agents was (261 ± 28)nm.The targeted nanocapsules were positive in immunofluorescence.In the targeted study,it was shown that a number of targeted nanocapsules conjugated with MCF-7 cells in vitro.Droplet-to-bubble transition experiment in vitro showed that there were no nano/microbubbles formed by heating in control groups at 80℃,while there were a lot of nano/microbubbles appeared in nanocapsules formulations at 80 ℃.The agents presented a good ultrasound imaging in vitro.Conclusions The HER2-targeted polymeric nanocapsules of liquid perfluorocarbons are successfully prepared,which may become a novel extravascular targeted ultrasound contrast agents.

Objective To investigate CT findings in gastric stromal tumors(GST).Methods Both plain and enhanced spiral CT findings in 46 cases with gastric stromal tumor were retrospectively analyzed.In all patients,diagnosis was confirmed with immunohistochemical markers.CT features were retrospectively studied and summarized.Statistical analysis of the shape,growth pattern,necrosis and enhancement patterns was performed with X2 test in 43 cases with single gastric stromal tumor.Results Of the 46 GST patients,43 patients had single GST and multiple GST was detected in 3 cases.In the 43 cases with single GST,tumors were found in the gastric body in 24 cases,gastric fundus in 16 cases,and in the gastric antrum in 3 cases.GST mostly grow along the vertical plane of gastric wall,with a large size but local attachment.The tumor size was less than 5era in diameter in 14 cases.Of them,ten cases had a regular shape,10 cases showed homogeneous enhancement,and 4 cases exhibited central necrosis,7 tumors showed intra-luminal growth and 5 tumors showed extra-luminal growth,while the other 2 cases involved both intra and extra lumina.Twenty-nine cases had tumors larger than 5cm in diameter.Of them,24 cases had irregular shape,27 cases showed inhomogeneous enhancement,24 cases had central necrosis,5 tumors showed intra-luminal growth and 9 tumors showed extra-luminal growth,while 15 cases involved both intra and extra lumina.The tumor size of GST closely was related to the shape,growth pattern,necrosis and the inhomogeneous enhancement patterns of the GST(P<0.05).The enhancement of the tumor was more intense in venous phase and delayed phase.Five cases showed septal enhancement,4 tumors exhibited marked enhancement in arterial phase with up to 60 HU.Conclusions CT can precisely display the location,shape and size of gastric stromal tumors.It is very helpful to provide useful information for early diagnosis and evaluation.

Objective To prepare the folate receptor-targeted and paclitaxel-loaded ultrasound contrast agent (folate-poly(lactide-co-glycolide)-paclitaxel,FOL-PLGA-PTX) and to investigate its targeting and imaging performance in vitro.Methods Paclitaxel-loaded PLGA-COOH micmcapsules with a core of liquid perfluorocarbon (PLGA-PTX) were prepared using single emulsion technique and then conjugated with folate by carbodiimide method.The size,surface potential,entrapment efficiency and drug loading efficiency were measured by Malvern laser detector and HPLC.The connectivity condition of PLGA-PTX with folate and the binding rate of fluorescent antibody were detected by immunofluorescence staining and flow cytometry.The targeting performance of FOL-PLGA-PTX was checked after co-incubated with human SKOV3cell lines in vitro and compared with that of non-targeted group and free folic acid intervention group.In vitro experiments were performed to explore the effects of FOL-PLGA-PTX on the enhancement of ultrasound imaging after irradiation by high intensity focused ultrasound (HIFU).Two-sample t test and one-way analysis of variance were used to analyze data.Results The average diameter of FOL-PLGA-PTX was (244.43 ±13.32) nm,with the drug entrapment efficiency of (86.23 ± 1.23)％ and loading amount of (8.62±0.12)％.The binding rate of folate was as high as (98.49± 1.28)％.The connection rate of FOL-PLGAPTX on SKOV3 cells was higher than that of non-targeted group ((84.32±4.25) ％ vs (16.45±2.89) ％; F289.45,t=10.654,P＜0.01) and the free folic acid intervention group ((36.33±3.23)％; t=8.923,P＜0.01).During in vitro ultrasound imaging,the average grey scale of FOL-PLGA-PTX before HIFU irradiation was significantly lower than that after HIFU irradiation (39.32±3.64 vs 126.44±7.15 ; t =4.829,P＜0.01).Conclusion FOL-PLGA-PTX has been prepared successfully,with high entrapment efficiency and much drug loading,which can target to SKOV3 cells specifically and effectively in vitro,and enhance the ultrasound imaging greatly after HIFU irradiation.

Objective To explore the effects of pelvic nerves denervation (PND) on the expression of transit potential receptor vanilloid 1 (TRPV1) in distal colonic mucosa of rats.Methods The experimental study was conducted.One hundred and eight adult male rats were randomly divided into the control group,sham operation group and PND group:(1) 36 rats in the control group remained untreated and were fed regularly;(2) 36 in the sham operation group received open exclusion for 15 minutes,and then sew up the incision;(3) 36 in the PND group received laparotomy with pelvic nerve transection before abdominal closure.The expression of TRPV1 protein in distal colonic mucosa was respectively detected by Western blot at postoperative day 1,3 and 7.Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) was used to detect the mRNA level of TRPV1 in the distal colonic mucosa.Measurement data with normal distribution were represented as (x)±s.Repeated measurement data were analyzed by repeated measures ANOVA.Comparisons at the same time intervals among the 3 groups were analyzed using one-way ANOVA.Pairwise comparison was done by the independent samples t test.Results (1) The results of immunohistochemical staining:the average density of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 was respectively 0.180±0.016,0.179±0.015 and 0.183±0.026 in the control group,with no statistically significant difference (F=0.088,P＞0.05).The average density of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 was respectively 0.132±0.017,0.160±0.023 and 0.173±0.020 in the sham operation group,with a statistically significant difference (F=8.699,P＜0.05).The average density of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 was respectively 0.057± 0.009,0.122±0.016 and 0.180± 0.016 in the PND group,with a statistically significant difference (F =113.315,P ＜ 0.05).There were statistically significant differences in the average density of TRPV1 at postoperative day 1 and 3 among the 3 groups (F =108.960,15.218,P＜ 0.05),while significant differences were respectively detected between the control group and the sham operation group or the PND group at postoperative day 1 (t =5.025,15.979,P＜0.05),and a significant difference was also detected between the sham operation group and the PND group (t =9.590,P＜0.05).There was no statistically significant difference in the average density of TRPV1 between the control group and the sham operation group at postoperative day 3 (t =1.670,P＞0.05),while significant differences were respectively detected between the control group and the PND group and between the sham operation group and the PND group (t=6.543,3.361,P＜0.05).There was no statistically significant difference in the average density of TRPV1 at postoperative day 7 among the 3 groups (F=0.518,P＞0.05).(2) The results of Western blot:the relative expressions of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 1.02±0.13,1.00±0.15 and 1.00±0.10 in the control group,with no statistically significant difference (F=0.084,P＞0.05).The relative expressions of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 0.51±0.13,0.93±0.14 and 1.01±0.16 in the sham operation group,with a statistically significant difference (F =20.930,P＜0.05).The relative expressions of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 0.30±0.10,0.70±0.10 and 1.07±0.16 in the PND group,with a statistically significant difference (F=61.441,P＜0.05).There were statistically significant differences in the relative expressions of TRPV1 at postoperative day 1 and 3 among the 3 group (F=58.014,8.841,P＜0.05),while significant differences were respectively detected between the control group and the sham operation group or the PND group at postoperative day 1 (t =6.677,11.145,P＜0.05),and significant difference was also detected between the sham operation group and the PND group (t =3.287,P＜ 0.05).There was no statistically significant difference in the relative expressions of TRPV1 between the control group and the sham operation group at postoperative day 3 (t =0.798,P＞0.05),while significant differences were respectively detected between the control group and the PND group and between the sham operation group and the PND group (t=4.127,3.398,P＜0.05).There was no statistically significant difference in the relative expressions of TRPV1 at postoperative day 7 among the 3 group (F=0.428,P＞0.05).(3) The results of RTqPCR:the mRNA levels of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 1.00±0.15,1.10±0.21 and 1.09±0.18 in the control group,with no statistically significant difference (F=0.489,P＞0.05).The mRNA levels of TRPV1 in distal colonic mueosa at postoperative day 1,3 and 7 were respectively 0.58±0.12,0.99±0.19 and 1.13±0.23 in the shan operation group,with a statistically significant difference (F=13.964,P＜0.05).The mRNA levels of TRPV1 in distal colonic mucosa at postoperative day 1,3 and 7 were respectively 0.31±0.10,0.67±0.12 and 1.09±0.19 in the PND group,with a statistically significant difference (F=44.642,P＜0.05).There were statistically significant differences in the mRNA levels of TRPV1 at postoperative day 1 and 3 among the 3 group (F=44.653,9.700,P＜0.05),while significant differences were respectively detected between the control group and the sham operation group or the PND group at postoperative day 1 (t=5.233,9.264,P＜0.05),and significant difference was also detected between the sham operation group and the PND group (t=4.127,P＜0.05).There was no significant difference in the mRNA levels of TRPV1 between the control group and the sham operation group at postoperative day 3 (t =0.995,P＞0.05),while significant differences were respectively detected between the control group and the PND group and between the sham operation group and the PND group (t =4.411,3.505,P＜0.05).There was no statistically significant difference in the mRNA levels of TRPV1 at postoperative day 7 among the 3 group (F=0.099,P＞0.05).Conclusion The expression of TRPV 1 in distal colonic mucosa of rats is significantly down-regulated after pelvic nerves denervation,however,it is gradually recovered with passage of time,which is consistent with the trend of gradual recovery of colonic transit function after pelvic nerve injury.