Equity of the essential medicine system involves social justice,being important in health services availability equity.The essential medicine system,in practice in China,has to a certain extent improved the equity of health service availability,yet found with poor equity in the process due to differences in insurance,regional diversity,pricing of essential medicine,and poor implementation of the system at primary medical institutions.Such equity needs to be further improved in the future in such aspects,consistence of different insurance reimbursement percentages,further support to underdeveloped areas,encouragement of market competition,and better compliance of primary medical institutions in implementing the system.

Objective To investigate the clinical features of stroke in young adults with infective endocarditis (IE).Methods This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients).Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases (11.7％) were complicated with stroke.Among them,21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation),9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0％ (35/35) vs 86.4％ (229/265),P =0.02;22.8％ (8/35) vs 6.4％ (17/265),P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95％ CI 1.626-15.072),and the OR of stroke for death was 8.387 (95％ CI 1.997-35.225),respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.

Objective To summarize the characteristics of neurological symptoms in patients with aortic dissection.Methods The clinical data including symptoms,signs,and imaging of 865 consecutive patients with aortic dissection were analyzed retrospectively.Results Neurological symptoms occurred in 225 cases (26.0％) with aortic dissection.The most common symptom was dizziness (56 cases,6.5％),followed by syncope (49,5.7％),single lower limb sensory disturbances(47,5.4％),single lower extremity weakness(27,3.1％),coma (22,2.5％),paraplegia (19,2.2％),headache (13,1.5％)and hemiplegia (9,1.0％).The first manifestation of five cases was the neurological symptoms,including syncope (2),dizziness(1)and headache (2).Patients with type A aortic dissection were more vulnerable to the neurological symptoms than those with type B aortic dissection (34.6％ vs 14.7％),and the symptoms with significantly higher occurrence were syncope,coma,hemiplegia,paraplegia and lower limb sensory disturbances.Conclusion Neurological symptoms are common in patients with aortic dissection,especially in those with type A aortic dissection.

Objective To analyze causes for complications after proximal femoral intramedullary nail treating unstable femoral intertrochanteric fractures in the elderly.Methods A total of 172 cases of unstable intertrochanteric fractures treated with proximal femoral intramedullary nail from December 2001 to May 2007 were reviewed upon postoperative complications to find out the causes for complications and discuss countermeasures.Results Of all, 149 cases were followed up for 6-42 months(mean 18. 5 months), which showed excellence rate of 89. 0% in aspect of functional recovery of the hip. Postoper-ative systemic complications occurred in 26 cases and local complications in 21.Condusions Proxi-real femoral intramedullary nail can be used in most elderly patients with unstable intertrochanteric frac-tures. A thorough evaluation of physiological function, treatment of preoperative comorbidities and aug-mentation of surgical technique are prerequisites for operation safety and decrease of complications.

DNA, as the material basis of all living cells, triggers innate immune responses through TLR9 and other cytosolic recognition receptors. In recent years, the research progress of TLR9 is mainly manifested by the following four aspects: (1) the determinants of TLR9 interacting with its ligands; (2) the mechanisms and the importance of TLR9 translocation from the endoplasmic reticulum to the endosome; (3) the roles of the endosomal acidification and maturation, and subsequent TLR9 cleavage in TLR9 signal transduction pathway; and (4) the possible mechanisms by which the organism distinguish self DNA from microbial DNA. Meanwhile, a series of experiments on TLR9 antagonists and TLR9 deficient mice confirmed the presence of TLR9-independent cytosolic DNA sensors. So far, three TLR9-independent DNA sensors have been found, and they are DAI, AIM2, and RNA polymerase Ⅲ.

Objective Identifying the factors of psychological pressure from medical disputes on clinical doctors and possible solutions. Methods Self-rating Anxiety Scale (SAS) and the Occupational Stress Indicator (OSI) were called into play, to study 52 clinical doctors in a tertiary hospital in a city, who had encountered medical disputes in recent two years. In parallel, 63 clinical doctors without such disputes and 50 non-clinical workers were randomly selected as the control group for questionnaires. Results Clinical doctors with such an experience were commonly found to be anxious, and their SAS score (58. 27±11.38)averaged higher than those in the control group. Doctor-patient relationship, legal liabilities and clinical positions were found to be positively correlated to psychological pressure of clinical doctors. Conclusions Medical disputes tend to add to psychological pressure of the doctors. Clinical doctors deserve psychological counseling and training and improvement of their working conditions.

Focal adhesion kinase (FAK), a type of protein tyrosine kinase in the cytoplasm, is highly expressed in many types of malignant tumors. FAK is named as such because of its close relationship with the cell adhesion function. Recent studies show that FAK is expressed in many tumor cells and has a definite relationship with cancer progress, metastasis, and prognosis. Accordingly, FAK has become one of the new tumor therapeutic targets that will bring new methods for tumor therapy.

TheInner Canon of Huangdi originated from moral.In the aspect of knowledge, it advocatesthat the doctor should not teach bandits, selecting and teaching, upright character, open but not narrow;In terms of career pursuit, it advocatesthat the doctor should adopt and frequently ask, work hard and to be a good doctor;In the as-pect of ethics, it advocatesthatdoctor should cherish life, be meticulous;In terms of professional belief, it advocat-esthatdoctor should learn from the ancient, firmly believe that science, opposing superstition; TheInner Canon of Huangdi advocate consummate medical skillthe noble medical ethics, with far-reaching influence, become the ori-gin of Chinese medical ethics thought germinal, future generations of today′s high-quality professional talents of Chinese medicine has a very important guiding significance.

Objective:To explore the correlation between homocysteine (Hcy) level and left ventricular diastolic func‐tion in patients with hypertension .Methods :A total of 121 enrolled patients with essential hypertension received plasma Hcy ,routine biochemical measurement and echocardiography examination .With Hcy=10 mmol/L as the di‐viding line ,patients were divided into H hypertension group (high Hcy group ,n=65) and hypertension with normal level group (normal Hcy group ,n=56) .Correlation between plasma Hcy level and left ventricular diastolic function was analyzed .Results:(1) H hypertension accounted for 53.7% ,male proportion in H hypertension group was sig‐nificantly higher than that of normal Hcy group (67.7% vs .37.5% , P<0.01);(2) Compared with normal Hcy group ,there were significant rise in left atrial diameter [LAD ,(34.4 ± 3.3) mm vs .(37.6 ± 5.4) mm] ,left ven‐tricular mass [LVM ,(183.5 ± 37.0) g vs .(205.6 ± 53.1) g] ,left ventricular mass index [LVMI ,(111.1 ± 19.2) g/m2 vs .(121.2 ± 31.8) g/m2 ] and transmitral early diastolic peak flow velocity/peak velocity of early diastolic mi‐tral annular motion [E/Em ,(8.4 ± 2.6) vs .(15.3 ± 7.4)] in H hypertension group ,P<0.05 or <0.01 ;(3) Pear‐son correlation analysis indicated that Hcy was positively correlated with LAD ,left ventricular end‐diastolic dimen‐sion (LVEDd) ,E/Em ,LVM and LVMI (r=0.247~0.620 , P<0.05 or <0.01);multi‐factor linear gradual re‐gression analysis found that plasma Hcy level ,was influencing factors for E/Em (P=0.529 ,t=7.599 ,P<0.05) . Conclusion:There is a significant positive correlation between plasma homocysteine level and left ventricular diastolic function insufficiency in patients with hypertension .More attention is required for detection of plasma homocysteine level in clinic .

Non-responding pneumonia describes the situation, in which an inadequate clinical response is present de-spite antibiotic treatment. The incidence of treatment failure in community acquired pneumonia (CAP) can range up to 31%. At present, the diagnosis and treatment of this kind of disease remain a great challenge to CAP. For this reason, several stud-ies have attempted to establish risk factors and new strategies for the treatment of non-responding pneumonia. This article re-views the progress of the pathogeny and treatment of non-responding CAP.