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 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 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

plus stented elephant trunk implantation (Bentall+Sun′s surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ②5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery;2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26 ± 10) weeks. (3)Maternal and fetal outcomes:20 patients survived after treatment (83%,20/24) and 4 patients died (17%,4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant;3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4 ± 1.7) years. So far the infants′ development was good.Conclusions Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.

In this mini review,some research advance on Marinomonas from domestic and overseas was briefly summarized,mainly including of its classification、ecological distribution、functional genes and bioactive molecules.Furthermore,some suggestion and perspectives for further studies on Marinomonas were also proposed.

[Abstract ] Objective The role of serum Pygo2 expression in children with non-alcoholic fatty liver disease(NAFLD) in the disease process and whether it can be used to evaluate the degree of liver fibrosis still remain unknown .The article aimed to detect Pygo 2 expression in the peripheral blood of children with NAFLD and ana-lyze its relationship with traditional serum hepatic fibrosis index in or-der to evaluate the clinical significance of Pygo 2 measurement in chil-dren with NAFLD . Methods We enrolled 120 cases of childhood obesity and 18 healthy controls in Anhui Provincial Hospital and the First Affiliated Hospital of Nanjing Medical University from September 2014 to February 2016.The cases of childhood obesity were di-vided into simple obesity group ( n=44, no diffuse fatty liver under liver ultrasound detection ) , NAFL group ( n=35, diffuse fatty liver with normal liver function under liver ultrasound detection ) and NASH group ( n=41, diffuse fatty liver with abnormal liver function under liver ultrasound detection ) .The peripheral serum was collected from all patients and healthy controls .ELISA was used to detect serum Pygo2 expression and radioimmunoassay was used to detect the serum hyaluronia acid (HA), procollagen type Ⅲ(PCⅢ), pro-collagen type Ⅳ(CⅣ) and laminin(LN) levels.Finally the serum ALT and γ-GT levels were measured with totally automatic enzymat-ic method. Results Pygo2 expression in NAFL group [52.1(12.3)μg/L] and NASH group[78.3(50.0)μg/L] increased signifi-cantly compared with simple obesity group [43.2(18.7)μg/L](P<0.05).Pygo2 expression in NASH group increased significantly compared with control group [41.7(16.8)μg/L] and NAFL group (P<0.001).The serum hepatic fribrosis and inflammation markers ( HA, PC, ALT, C III and IV gamma-GT) levels gradually increased in the obese children .There were statistically positive correla-tions between serum Pygo2 and HA, PCⅢ, CⅣ, ALT or γ-GT (P<0.001).In particular, more significant positive correlations were found between serum Pygo2 and HA, CⅣor γ-GT (r=0.708, P<0.001;r=0.589, P<0.001;r=0.674, P<0.05). Conclusion The degree of liver fibrosis worsens with the increase of Pygo 2 expression and Pygo 2 is in remarkable correlation with conventional he-patic fibrosis serum makers ( HA, C IV) orγ-GT, which shows Pygo 2 expression can be taken as the clinical evaluation index of liver fibrosis in children with NAFLD .

Objective To investigate the clinical treatment of infective endocarditis with vegetations in pregnant women and the outcomes of the gestation. Methods Nine cases of pregnant women diagnosed as infective endocarditis with vegetations in Beijing Anzhen Hospital, Capital Medical University from January 2001 to October 2015 were enrolled in retrospective analysis. Consultations were held by doctors from department of obstetrics, anesthesiology, cardiology, cardial surgery and extracorporeal circulation to decide the individualized treatment plan for the 9 cases of pregnant women after admissions. Clinical treatments including general treatment, anti-infection treatment, cardiac surgery, and termination of pregnancy surgery were completed through collaboration among related departments. The clinical characters, therapeutic regimens, maternal and neonatal outcomes of the 9 cases were analyzed. Results (1)Clinical characters: the ages of the 9 cases of pregnant women were from 25 to 36 years old. The onset gestational ages were from 19 to 36 weeks. Clinical symptoms: fever, cough, sputum and progressive anemia were the main symptoms. Patients had cyanosis of lips, could not lie on the back or even be orthopnea, when heart failure happened. Heart murmur was audible and splenomegaly was touched in physical examination. Blood cultures were positive. Basic heart disease types: 7 cases of congenital heart diseases included 2 cases of aortic insufficiency, 1 case of mitral insufficiency, 1 case of patent ductus arteriosus, 1 case of right ventricular outflow tract stenosis and 2 cases of ventricular septal defect.Two cases of rheumatic heart diseases included 1 case of mitral stenosis, 1 case of mitral stenosis after artificial disc changed and jammed. According to endocardial vegetations attached position there were 3 cases of mitral valve vegetations, 2 cases of pulmonary valve vegetations, 3 cases of aortic vegetations and 1 case of right ventricular outflow tract neoplasm. Preoperative heart function classification:1 case of levelⅡ, 3 cases of levelⅢ, 5 cases of levelⅣ.(2)Treatments:general treatment included oxygen uptake, rest in bed, cardiac strengthen and diuretic therapy, etc. Combined and adequate antibiotics were applied in anti-infection treatment according to drug sensitive test. Nine cases of pregnant women were all performed surgical treatment of heart diseases and removal of the endocardial vegetations. Caesarean sections were performed for 2 cases in second trimester and for 7 cases in last trimester. Cardiac surgery and caesarean section were operated in 6 cases at the same time among 22-34 weeks of pregnancy. Cardiac surgery were respectively operated in 2 cases 11 days and 32 days after the caesarean section at 33, 37 weeks of pregnancy. While Cardiac surgery was operated (at 26 weeks of pregnancy) before the caesarean section (at 37 weeks of pregnancy) in another 1 case. (3) Maternal and neonatal outcomes:7 cases of pregnant women were rescued successfully, while 2 cases of pregnant women were death. Postoperative heart function classification: 1 case of level Ⅰ, 2 cases of levelⅡ, 4 cases of levelⅢand 2 cases of levelⅥ. Neonatal survivals were 6 cases including 2case of full-term infants, 4 cases of preterm infants. Stillbirth or neonatal death were 3 cases, which included 2 cases performed caesarean section in second trimester and 1 case of very low weight infant who was given up treatment by family because of severe asphyxia. Followed up periods were from 1 to 7 years with an average time of (2.0 ± 1.6) years. Infants and young children grew and developed well during the period of follow up. Conclusions The risk is extremely high of pregnancy with infective endocarditis with vegetations. But there is still a way to save the maternal and neonatal life by using a multidisciplinary collaboration formulation and implementation of individualized treatment plan and selecting the appropriate time for heart surgery and the termination of pregnancy.

OBJECTIVETo determine the effect of type I transmembrane protein (IRE1alpha) deletions on the cell cycle of human periodontal ligament fibroblasts (hPDLFs) cells.

METHODSBased on the IRE1alpha deletions, a full-length model was successfully constructed. Moreover, overlapping polymerase chain reaction mutagenesis facilitated the establishment of two deletion mutants of IREla (pD-Kinase, pD-Rnase). The full-length model and two mutant eukaryotic expression vectors were transfected into hPDLFs cells. Western blot analysis was performed to identify the expression in the cells. The changes in the cell cycle of hPDLFS cells were detected by flow cytometry (FCM).

RESULTSThe two deletion mutants of IRE1alpha with eukaryotic expression vectors were successfully constructed and correctly expressed in hPDLFs cells based on Western blot analysis. Under stress conditions, the FCM assay showed that cell percentage of S phases increased, whereas that of G1 phases decreased in the IRE1alpha group (P < 0.05) compared with the control group of tunicamycin (TM) treatment. Moreover, the cell percentage of the S phases decreased, whereas that of the G1 phases increased in the D-Rnase group (P < 0.05) compared with the control. The deletion mutant D-Kinase had no influence on hPDLFS cell proliferation and cycle (P>0.05).

CONCLUSIONUnder stress conditions, IRE1alpha can improve the cell cycle of hPDLFs cells from the G1 to the S phase. The deletion mutant D-Rnase cause hPDLFs cell growth arrest at the G1 phase, whereas deletion mutant D-Kinase has no significant effect.

Objective To investigate the feasibility and safety of autologous tumor tissue lysate loading den-dritic cells(DC) for the treatment of hepatocellular carcinoma (HCC). Methods The monocytes-derived DC were induced and antigen loaded with tumor tissue lysate to produce DC vaccine. Vaccination and clinical observation were conducted in 12 HCC patients for 41 times. Results The average output of DC was 1.69×107(1.69×107±9.44×106>) from 90 ml peripheral blood. 63.41% (26/41)patients appeared to develop delayed-type hypersensitivity after intradermal injection. After an average of 9 months follow up, 1 patient out of 4 recurrence and metastasis pa- tients survived for 17 months. The other three patients progressed. Out of 8 patients undergoing immunotherapy post- operatively,6 patients had no signs of recurrence and the others were found to have liver rceurrence and progression. Conclusion DC based immunotherapy is safe and feasible,with no side effects,which can be applied in the immu- notherapy strategy of HCC patients.

Objective To evaluate the clinical application of implantation of totally implantable venous access port (TIVAP) via the internal jugular vein (IJV) guided by ultrasonography in infants.Methods The clinical data of 446 sick infants,who received TIVAP at the Affiliated Shanghai Children's Medical Center,School of Medicine,Shanghai Jiaotong University,China (single center) during the period from January 2009 to July 2016,were retrospectively analyzed.The time spent on surgery,the success rate of first puncturing of IJV and the incidence of puncture-related complications were recorded,and the results were compared between traditional IJV blind puncture group and ultrasound-guided IJV puncture group.Results Of the 446 sick infants,traditional IJV blind puncture was employed in 265 and ultrasound-guided IJV puncture was adopted in 181.In traditional IJV blind puncture group,the mean time spent on surgery was 7.6 min,the success rate of first puncturing of IJV was 75.85％ (201/265),and the incidence of puncturerelated complications was 5.66％ (15/265).In ultrasound-guided IJV puncture group,the mean time spent on surgery was 4.2 min,the success rate of first puncturing of IJV was 97.24％(176/181),and the incidence of puncture-related complications was 1.70％ (3/181).Conclusion For the performance of TIVAP implantation in sick infants,the use of ultrasound-guided IJV puncture technique can shorten the operation time,improve the success rate of first puncturing,and reduce the incidence of puncture-related complications.Therefore,ultrasound-guided IJV puncture is a safe,effective,simple and feasible technique.This technique is worthy of clinical promotion.