OBJECTIVE:To investigate the characteristics and trends of illegal circulation of counterfeit drugs in China,and to put forward monitoring countermeasures. METHODS:In empirical study,3 typical cases of counterfeit drugs manufacturing and selling in China were analyzed (including Jiangsu Wuxi Internet transnational counterfeit drugs manufacturing and selling case, Shanghai Avastin eye drug case,Sichuan Dazhou counterfeit drugs case),to compare the sources of counterfeit drug and illegal cir-culation pathway,thus find out the monitoring problems. RESULTS & CONCLUSIONS:Main reasons for illegal circulation of counterfeit drugs in China are as follows as drug circulation regulation absence of foreign-funded medical institutions,the existence of hidden drug circulation monitoring holes in urban medical institutions,under-developed and weak ability of distinguishing talse drug information internet counterfeit drugs sales regulatory means. It is suggested to establish drug management norms for for-eign-funded medical institutions,improve drug circulation monitoring in primary medical institutions,establish pharmaceutical logis-tics(transportation)licensing system and strengthen online fake drug sale information monitoring and information publication.

BACKGROUND:Creation of a precise finite element model is an important basis for the finite element mechanical analysis of the spine. The reports on the precise finite element model are less.
OBJECTIVE:To create L 3-L 5 lumbar three-dimensional finite element model and validate this model with normal CT data.
METHODS:A 39-year-old male healthy volunteer with the height of 175 cm and weighted 65 kg was selected, then the L 3-L 5 lumbar spines were scanned with 16 row spiral CT to obtain 101 CT images with the thickness of 1.25 mm. Solid geometric model was established with Geomagic9.0 software, then determined the unit type,
divided the finite element mesh, and established the finite element model for loading and calculating.
RESULTS AND CONCLUSION:A L 3-L 5 lumbar three-dimensional finite element model was established. It
included 213 736 nodes and 799 779 elements. The ranges of motion of L 3-L 4 and L 4-L 5 segments of the model were consistent with cadaveric biomechanical testing results, verified the effectiveness of the model, so the
model could be used for experimental research.

Objective Summarize the clinical nursing keys and experiences for tranplantation of leg island flap. Methods Follow- up 111 patients with transplantation of leg island flap. Results There were 109 patients had accepted survival of island flap, their function of wounded limb were recoveried satisfactory by one- year follow up. There were 2 amputation patients because of disturbance of blood circulation of distal wounded limb. Conclusions Careful perioperative nursing and observation are the keys of survival for tranplantation of leg island flap. Proper rehabilitaiton education can guarantee the satisfactory prognosis.

Application of a number of philosophical ideas is instructive in eliminating the opposition on the doctors'right to inform and the patients right to being informed,building a harmonious relations between doctors and patients and correctly understanding and carrying out the informed consent.

Objective To evaluate the applicability of the simplified equation of MDRD to predict glomerular filtration rate(GFR)from serum creatinine in Chinese patients with chronic kidney disease(CKD),and refit the MDRD equation parameter estimates with Chinese patients data.Methods A total of 760 hospitalized CKD patients were investigated from 2002 to 2005.Patients'sex,age,height and body weight were recorded;plasma creatinine and ~ 99m Tc-GFR(standardized by body surface area)were measured in all patients;GFR was estimated with simplified equation of MDRD and Cockcroft-Gault;the accurancy of estimated GFR with MDRD and CG were compared with~ 99m Tc-GFR in different stage of CKD.Totally 670 patients were randomly selected as the training sample,the remaining 90 patients constituted the validation sample.We used stepwise multiple regression to refit the equation of MDRD and the regression models were developed by using the training sample.The refitting equation was then tested and compared with the other equation in the validation sample.Results (1)Both the MDRD and CG-GFR prediction equations seemd to systematically underestimate GFR,but the accurancy of MDRD equation was better than CG-GFR in stage Ⅰ~Ⅲ of CKD.(2)The bias of estimated GFR(MDRD or CG-GFR equation)with ~ 99m Tc-GFR was lower in stage Ⅰ~Ⅲ than in stage Ⅳ~Ⅴ of CKD.(3)Refitting of the MDRD equation parameter estimates to Chinese patients data set resulted in the following prediction equations:GFR=234.96?(Scr)~ -0.926 ?(Age)~ -0.280 ?0.828(Female).(4)Comparing with~ 99m Tc-GFR,the bias of estimated GFR calculated by the refitting MDRD equation was lower than that of estimated with MDRD or CG especially in the stage Ⅳ~Ⅴ of CKD in Chinese patients.Conclusion the simplified equation of MDRD can estimate GRF accurately,but the equation must be refitted in Chinese patients.

Objective To observe the effectiveness of Chinese herbal medicine plus movement therapy in treating upper limb spasticity in hemiplegic patients. Methods Sixty-six patients were divided randomly into two groups. Thirty-five patients in the therapy group were treated with Chinese herbal medicine and movement therapy, and 31 patients in the control group were treated with movement therapy alone. The modified Ashworth scale and sur- face electromyography were applied to evaluate spasticity. Results The total effectiveness rates were 94.3% in the therapy group and 64.5% in the control group. After treatment, the average integrated electromyogram (IEMG) val- ue in the therapy group was lower than that in the control group. The difference in IEMG values before and after treat- ment in the therapy group was significantly larger than in the control group. Conclusion Chinese herbal medicine plus movement therapy is more effective than movement therapy alone in relieving spasticity.

Objective To investigate the predictive value of the baseline ,week 1 and week 2 model for end‐stage liver disease (MELD) scores ,MELD‐Na scores and MELDNa scores for 3‐month mortality in hepatitis B virus (HBV) related acute‐on‐chronic liver failure (ACLF) patients .Methods Fifty‐three eligible HBV‐related ACLF patients who received initial treatment in People′s Hospital of Deyang City , Sichuan Province from January 2014 to January 2015 were enrolled in this retrospective clinical follow‐up study .Patients were divided into death group and survival group according to the prognosis after 3 months of treatment .Biochemical data and complications were collected .t test was used to compare the means between two groups and χ2 test was used to compare categorical data .Accuracy of scoring models in predicting mortality within 3 months was performed by area under receiver operating characteristic curve (AUC) .Results Of the fifty‐three patients ,twenty‐one HBV‐related ACLF patients died in 3‐month , while thirty‐two patients survived .The AUC of MELD scores ,MELD‐Na scores and MELDNa scores at the baseline in predicting 3‐month mortality were 0 .548 (95% CI:0 .406 -0 .685 , P= 0 .555) ,0 .502 (95% CI:0 .362-0 .643 ,P=0 .978) and 0 .523 (95% CI:0 .381-0 .662 ,P=0 .778) ,respectively .The AUC increased gradually at the first and the second week .At the second week ,the AUC of MELD scores ,MELD‐Na scores and MELDNa scores were 0 .881 (95% CI:0 .762 -0 .953 ,P<0 .01) ,0 .878 (95% CI:0 .759-0 .951 ,P<0 .01) and 0 .897 (95% CI:0 .783 -0 .963 ,P<0 .01) ,respectively .The AUC of the second week was higher than those of the baseline and the first week (both P<0 .05) .The sensitivity ,specificity ,positive predictive value (PPV) ,and accuracy at the second week were best when the cut off was 26 for MELD ,29 for MELD‐Na and 29 for MELDNa , and were higher than the corresponding values of the baseline and the first week .Conclusions The predictive values of MELD scores ,MELD‐Na scores and MELDNa scores at the second week are superior to the baseline and the first week for 3‐month mortality in HBV‐related ACLF patients ,while the predictive values at the baseline could be poor .

The evaluation indexes are selected from the aspects of hospital behavior and user behavior based on the relevant theories on influence and the transmission characteristics of Wechat,with the data so acquired processed with the principal component analysis.In the end,the expression of evaluation was applied to the evaluation and analysis of the influence of the hospital Wechat.

Hyperbaric oxygen (HBO) therapy is the inhalation of 100％ oxygen at a pressure higher than one atmosphere absolute (ATA),and has been used as an auxiliary therapy for various skin diseases.It has been proved that HBO can increase the oxygen content in skin tissues,accelerate aerobic metabolism of skin,promote epithelial regeneration and wound healing,relieve adverse stimuli on peripheral nerves and sensors in the skin,inhibit apoptosis of neurons,enhance the function of regulatory T cells,alleviate inflammation,and mobilize vascular stem/progenitor cells (SPCs) from the bone marrow to peripheral blood and ulcer tissues.At present,HBO has been widely applied in the auxiliary treatment of psoriasis,atopic dermatitis,postberpetic neuralgia,chronic refractory cutaneous ulcer,pyoderma gangrenosum,fungal infection,vascular embolization after cosmetic facial filling,and some other skin diseases.

Objective To investigate the clinical significance of plasma presepsin levels in patients with sepsis. Methods 92 patients who were admitted to the ICU of the affiliated hospital of Jiangsu University from October 2011 to March 2013 and 30 age-matched healthy controls were enrolled in this study. The patients were divided into three groups: sepsis, SIRS, and control. Plasma presepsin and serum procalcitonin (PCT) were measured, APACHEⅡscore were calculated at enrollment, and ROC curve was used to analyze the performance index for the diagnosis of sepsis. Results Serum levels of presepsin, PCT and APACHEⅡscore were significantly higher in the death group than in the SIRS group and the control group (P<0.01). Serum levels of presepsin and PCT were higher in the sepsis group than in the SIRS group and the control group (P<0.05). There was no significant statistical difference between the SIRS group and the sepsis group in the APACHEⅡ score (detailed in table 1). Level of plasma presepsin was significantly correlated with serum PCT (r = 0.82); plasma presepsin level was related with the APACHEⅡ score (r = 0.69). The area under the curve (AUC) of presepsin was 0.908 (95%CI 0.848~0.967), greater than the AUC of PCT 0.862 (95%CI 0.787~0.937). The cutoff value of presepsin for discrimination of bacterial and nonbacterial infectious diseases was determined to be 629 pg/mL, of which the clinical sensitivity and specificity were 68.6% and 90%, respectively; when the cutoff value of PCT was 1.98 ng/mL, the clinical sensitivity and specificity were 92%and 65%. Conclusions Level of presepsin increases in patients with sepsis, and an elevated presepsin may suggest the severity of sepsis.