OBJECTIVE:To provide suggestions and countermeasures for improving the accessibility of national essential medi-cines. METHODS:Based on the theoretical analysis,the questionnaire was designed for the pre-survey and formal survey on the experts from universities,enterprises,government agencies and non-governmental organizations,and analytic hierarchy process was used to analyze and discuss the valid questionnaire. RESULTS:Totally 35 question naires were sent out and 27 were effective-ly received with effective rate of 77.14%. The physicians and pharmacists’cognition of essential medicine system and essential medicine,and the reasonable degree of public bid prices of essential medicine,the fairness and impartiality of essential medicine bidding process were the key influential factors;the prescription,provision,reimbursement of essential medicine,and the financial compensation to primary public health care institutions that sell essential medicine by zero-slip were the secondary factors;primary health care institutions’monitoring on the use of essential medicine(such as prescription rate,etc.),the participation of social se-curity sector in bidding and purchasing of essential medicine,the reasonable degree of pricing of essential medicine,the monitoring of the price of essential medicine,and the compensation to manufacturers of essential medicine were the general factors. CONCLU-SIONS:The accessibility of essential medicine involves many stakeholders,whom impact from different levels. Therefore,all rele-vant stakeholders should be coordinated to gradually improve the accessibility of essential medicines.

Objective To find out early lesion of rentanl function in elderly patients with dipper essential hyperten-sion and morning blood pressure surge( MBPS) , and to find out the value of homocysteine( Hcy) with high-sensitiv-ity C reactive protein ( hs-CRP) in detecting early lesion of rentanl function in hypertensive patients. Methods Totally 168 elderly paritents with dipper essential hypertension were divided into MBPS group( observation group, n=73) and non-MBPS group (control group, n=95) according to the accompanying MBPS or not. The cystatin C ( Cys C) , urinary microcalbumin ( U-mAlb) ,urinary transferring( U-TRF) ,Hcy, hs-CRP,serum creatinine( SCr) , blood urea nitrogen(BUN), blood glucose(Glu),cholesterol(TCH),triglyceride(TG), high density lipoprotein cholesterol( HDL-C) and low density lipoprotein cholesterol( LDL-C) were tested. The differences in Cys C, Hcy, hs-CRP, the U-mAlb positive incidence and the U-TRF positive incidence between the two groups were analyzed. Results There were no statistical concernments in SCr, BUN, GLu, TCH, TG,HDL-C,and LDL-C between the two groups. The amplitude of variation in morning systolic pressure peak was higher in MBPS group than in non-MBPS group(P=0. 000). The obvious varieties in the Cys C, Hcy,and hs-CRP were higher in MBPS group than in non-MBPS group ( P=0. 000 ) . The U-mAlb positive incidence was higher in MBPS group than in non-MBPS group(χ2 =18. 014,P =0. 000). The U-TRF positive incidence was higher in MBPS group than in non-MBPS group(χ2 =19. 694,P=0. 000). Conclusion MBPS has a great effect on Cys C,U-mAlb,U-TRF,Hcy and hs-CRP. MBPS is apt to cause early lesion of rental function in elderly patients with dipper essential hypertension. And Hcy and hs-CRP can be used to diagnose the early renal insufficiency.

Various etiologies of hallux valgus and metatarsus primus varus have been reported, but still they are not conclusively established. Furthermore, between hallux valgus and metatarsus primus varus, the question is unanswered as to which is the cause and which is the result. To determine the primary cause and attribution of high heeled position to hallux valgus and metatarsus primus varus, we selected three different types of dancer. Traditional dancers wear cotton sox and strike the heels first to move, modern dancers walk or run and jump on naked feet, and ballerinas stand, walk or jump on their toes with hard wooden shoes, so the latter two types of dancers move with extremely high-heeled position. We analyzed the plain AP roentgenography of 84 feet for 16 ballerinas, 13 modern and 13 traditional dancers. The results were as follows : 1. First metatarsalgia was noted in 38% of modern dancers and 43% of ballerinas but none in traditional dancers. 2. The mean hallux valgus angle was 13.6°±2.7° in traditional dancers, 13.5°±3.8° in modern dancers, 18°±3.3° in ballerinas which are statistically significant between ballerinas and modern, traditional dancers(P < 0.01). 3. The mean intermetatarsal angle was 10.5°±1.4° in traditional dancers, 10.6°±1.1° in modern dancers, 10.8°±1.5° in ballerinas, and metatarsus primus varus angle was 17.6 °±5.1°, 18.3°±2.7°, 19.4°±3.6°, respectively, which were all statistically insignificant(P>0.01). Therefore, it is concluded that medio-lateral compression of shoes may be the principal contributor for the hallux valgus rather than high heel, and hallux valgus is the primary deformity.
Congenital Abnormalities ; Dancing ; Foot ; Hallux Valgus ; Hallux ; Heel ; Metatarsalgia ; Radiography ; Shoes ; Strikes, Employee ; Toes

Objective To investigate the feasibility,safety and effect of gasless laparoscopic surgery used in patients at the second trimester.MethodsFrom Aug.2006 to Aug.2008,the data of 10 cases at gestational 15 - 24 weeks complicated by ovary benign tumors ( the diameters more than 5 cm) undergoing gasless laparoscopic surgery were studied retrospectively.Operation time,bleeding loss,period of hospitalization,the status of fetus and newborn babies,and peri-operative or postoperative complications were observed.ResultsAll 10 cases were treated by gasless laparoscopic surgery,including 4 cases with mature teratoma,5 cases with epithelial tumors and 1 case with ovarian endometrioma.The mean time of surgery was (30 ± 5) minutes,the mean bleeding in the surgery was (30 ± 8) ml,the mean period of in hospitalization was ( 6 ± 2 ) days.The blood gas ( pH:7.42 ± 0.11,7.41 ± 0.18,7.42 ± 0.12 ),blood pressure [ mean arterial pressure (MAP):(90.4 ± 3.1 ),(90.6 ± 0.7 ),( 89.7 ± 0.8) mm Hg( 1 mm Hg =0.133 kPa) ] and heart rates [ ( 84.0 ± 1.6),( 84.3 ± 1.7 ),( 82.7 ± 1.1 ) bpm ] in all cases at pre,peri and postoperative time did not show statistical difference ( P all ＞ 0.05 ).The fetal hearts were all in the normal range preoperative,intraoperative and postoperative time (P ＞ 0.05 ).No perioperative and postoperative complications were observed.All the cases underwent term delivery.Fetal weight and Apgar score did not show abnormality.ConclusionGasless laparoscopic surgery at the second trimester is feasible and safe to mother and fetus.

Objective To investigate the effects of rubella virus R16 infection on heat shock protein 70 (HSP70) and heat shock transcription factor 4 (HSF4) in the human embryonic lens epithelial cells in vitro. Methods The human embryonic lens epithelial cells were infected by rubella virus R16 for 3, 7 and 14 days respectively in vitro. Then the mRNA levels of HSP70 and HSF4 were measured by Real-time PCR assays, the HSP70 protein level was detected by Western blot assay, and the DNA sequence of HSF4 was also identified by DNA Sequencing. Results Both mRNA and protein levels of HSP70 were increased dramatically at 3 and 7 days after rubella virus R16 infection in vitro. But mRNA levels of HSF4 were decreased significantly. The DNA sequence of HSF4 had no change in the human embryonic lens epithelial cells at 14 d after rubella virus R16 infection. Conclusions Rubella virus R16 could directly induce the increased expression of HSP70 in the human embryonic lens epithelial cells infected by rubella virus R16 in vitro, which may prevent human embryonic lens epithelial cells from infecting with virus. The heat shock transcription factor may serve as a negative regulator at transcription level. However, the DNA sequence of HSF4 had no change in the human embryonic lens epithelial cells within 14 days after rubella virus R16 infection.

Objective: To investigate the effect of hyperlipemia on endothelial function and histomorphology of venous conduit in rabbits before grafting. Methods: Fifty adult male rabbits were randomly divided into 2 groups: one group was fed with normal diet (control group, n=25) and the other with high cholesterol diet (hyperlipemia group, n=25). The blood samples and cervical vein specimens were barvested before and 2, 4, 8 and 12 weeks after feeding. The serum levels of total cholesterol (TC), low density lipoproteins (LDL), triglycerides (TG), and high-density lipoproteins (HDL) were determined. The expression of endothelial NO synthase (eNOS) protein, the production of NO, and the histopathological changes (including the thickness of intima and media, the diameters of the veins, and the presence of lipid or plaque) in the vein specimens were examined. Results: Eight weeks after feeding, the serum levels of TC, LDL, TG, and HDL in hyperlipemia group were significantly higher than those in the control group (P<0.01). Obvious lipid plaques were formed in the carotid artery of rabbits in hyperlipemia group. The jugular veins of hyperlipemia rabbits had significantly lower eNOS expression and NO production (P<0.05). Endothelial denudation was noticed and the elastic fibers almost disappeared in hyperlipemia group; there were no foam cells and lipid plaques. Conclusion: Hyperlipemia may result in endothelium dysfunction and histomorphological change of venous conduit.

OBJECTIVE: To compare the efficacy and safety of doxorubicin with epirubicin in patients with metastatic breast cancer (MBC) by systematic review and Meta-analysis to provide reference for clinicians. METHODS: Randomized controlled trials (RCTs) that compared the efficacy, safety, or both, of doxorubicin with epirubicin in treatment of metastatic breast cancer were collected from the Cochrane library, PubMed, Embase, CNKI, CBM and Wanfang database using the following terms: doxorubicin, epirubicin, breast cancer, randomized controlled trials. In addition, the reference lists of relevant trials or reviews were screened. Trials that provided sufficient data on objective response rate (ORR) and/or overall survival (OS) were considered eligible for inclusion. Studies were assessed for quality. A fixed-effect model was used for Meta-analysis unless there was significant between-study heterogeneity. Meta-analysis was performed by Revman 5.3 software, with results expressed as odds ratio (OR), 95% confidence interval (CI) and P value. The other parameters were summarized by descriptive analysis. RESULTS: A total of 1221 patients from six RCTs were included for final analysis, with 614 patients in the doxorubicin group and 607 patients in the epirubicin group. The median OS was 549 d for the doxorubicin group and 480 d for the epirubicin group. The pooled risk ratio (RR) suggested that there was not statistically significant difference in the ORRs between the doxorubicin (general type and liposomal type) group and the epirubicin group for the treatment of MBC [for doxorubicin vs epirubicin, RR=1.12, 95% CI (0.99, 1.26), P=0.07; for liposomal doxorubicin vs epirubicin, RR=1.24, 95% CI (0.94, 1.62), P=0.12]; and for general doxorubicin vs epirubicin RR=1.09, 95% CI (0.96, 1.24), P=0.12); Descriptive analysis of safety showed that doxorubicin had similar incidences of hematologic toxicity and alopecia to epirubicin but was superior to epirubicin in aspect of cardiac toxicity. There was no significant heterogeneity among the included studies in most of the Meta-analyses. CONCLUSION: Epirubicin and doxorubicin are equally effective and the safety profile of the former is at least not worse than the latter in the first-line treatment of patients with metastatic breast cancer. But compared to doxorubicin, epirubicin might be a better choice for MBC patients especially those with cardiac diseases.

Objective To observe the effects of Dl-3-n-butylphthalide ( NBP) on the mitochondria infarction, size of myocardial infarction and myocardial apoptosis after acute myocardial ischemia in rats. Methods 92 male SD rats were divided into sham operation group (8 rats) , model group (21 rats) , and low-dose NBP group (21 rats) , medium-dose NBP group (21 rats) , high-dose NBP group (21 rats) . The model and NBP groups were made into MI model by ligation of the left anterior descending ( LAD) coronary artery, but not in sham-operated group. Model group and NBP group were taken heart specimens after coronary artery ligation. Cardiomyocyte apoptosis was ana-lyzed by TUNEL in each group. Size of MI was analyzed by TTC staining in sham-operated group, model group and high-dose NBP group. Electron perspective microscopy was applicated in observing mitochondria infarction in model group and high-dose NBP group after myocardial infarction. The expressions of Bcl-2 protein and Bax protein were detected by Western blot. Results Compared with model group, butylphthalide significantly increased expression of Bcl-2 protein ( P <0.05 ) and the ratio of Bcl-2/Bax ( P <0.05 ) , inhibited mitochondria infarction ( P <0.05 ) , reduced myocardial infarct size ( P<0.01 ) and cardiomyocyte apoptosis ( P<0.05 ) . Conclusion Bu-tylphthalide significantly inhibits myocardial infarction by increasing expression of Bcl-2 protein and the ratio of Bcl-2/Bax and decreasing mitochondria infarction, reducing myocardial infarct size and cardiomyocyte apoptosis in rats during the acute myocardial ischemia process.

Objective To study the effect of zVADfmk(a Caspase inhibitor) on Caspase-3 activation and neuronal apoptosis after intracerebral hemorrhage (ICH) in rats.Methods ICH model was made by stereotactic infusing 50?l autologous blood into the caudate nucleus. zVADfmk was given via intraventricular injection. TUNEL staining and immunohistochemitry method were used to detect the expression of apoptosis and Caspase-3 in cerebral tissues at different time point.Results After ICH, Caspase-3 and TUNEL positive cells increased obviously in the perihematomal brain edema zone compared with the pseudo-operation group ( P

Objective To investigate the associations of IL-6(rs6949149,rs1800796 and rs10499563) and IL-6R(rs2228145) single nucleotide polymorphisms(SNP) with the risk of gastric cancer in Chinese Han population of Xuyi,Huai'an.Methods A total of 400 patients with gastric cancer and 400 healthy controls were enrolled in this case-control study.The genotypes of the four SNPs were detected by the Mass-Array technology.The associations between the IL-5/IL-6R SNPs and the risk of gastric cancer were analyzed by Logistic regression model.Results There was a significant difference in the distribution of the IL-6 rs1800796 genotypes between the patients with gastric cancer and healthy controls(x2 =6.213,P =0.045).The IL-6 rs1800796 GG genotype was associated with a increased risk of gastric cancer(adjusted OR =1.27,95 ％ CI:1.15-3.20,x2 =6.326,P =0.012).Subgroup analysis showed that the associations between the IL-6 rs1800796 GG genotype and the risk of gastric cancer were obvious in the female(adjusted OR =3.99,95％ CI:1.36-11.71,x2 =6.358,P =0.012) and the patients with H.pylori infection(adjusted OR =2.20,95％ CI:1.08-4.45,x2 =4.770,P =0.029).Conclusion The IL-6 rs1800796 GG geuotype is associated with the risk of gastric cancer,especially in the female and the patients with H.pylori infection.