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 To investigate the clinical manifestations,pathological features,treatment and prognosis of nongesta-tional choriocarcinomas.Methods The clinicopathological data in 4 cases of nongestational choriocarcinoma were retrospectively analyzed and the relevant literatures were reviewed.Results All 4 patients had no confirmed diagnosis at first visit to hospital.All patients received the operative therapy and postoperative bleomycin,etoposide and cis-platinum (BEP)regimen chemotherapy.The followed up lasted for 3-32 months.One case died at postoperative 26 months due to pulmonary metastasis;one case was loss of follow up;two cases had relatively favorable condition.Conclusion Nongestational choriocarcinoma is a rare and highly invasive trophoblastic neoplasm,and is prone for early distant metastasis.The treatment is recommended to adopt operation combined with postoperative combined chemotherapy of multiple drugs.

Objective To analyse the incidence, clinical features, histopathology and clinicopathological correlation in different age group of 524 cases with IgA nephropathy(IgAN) retrospectively. Methods 524 cases of IgA nephropathy were divided into three groups according to their age, and the clinical and renal pathological features were analyzed. Results In children group(≤15 years), the incidence of recurrent gross hematuria was 47. 2% and renal impairment 4. 6%. Malignant hypertension as first presentation associated with serious renal impairment occured in 3. 8% patients of youth and adult group (16 - 49 years). Higher incidence of nephrotic syndrome and acute renal failure was found in elder group (50 - 69 years). Conclusions The incidence Of IgAN in children and elder population is increased, especially in the children. They need a further follow-up. For elder patients considered as IgAN, a renal biopsy seems to be necessary. While youths and adults still account for the most part of IgAN patients.

Objective To discuss the relationship between disease progress with the change of cell im munological function as well as the effect of immunological function in severe a cute respiratory syndrome. Methods Retrospective study was designed to analyze the relationship of disease progres s with the change of immunological function. According to the disease outcomes, the patients are divided into two groups: died group and survival group. The dif feren ce of immunological function in groups was performed statistics analysis. Results Immunological function (CD3 +, CD4 +, CD8 +) descended to the lowest level in period of fastigium in SARS patient, and then recovery quickly. Comparison of died grou p and survival group was found that Immunological function (CD3 +T, CD4 +T, CD 8 +T) were lower in period of fastigium and recovery in died group than in survival g roup(P

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 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.

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.

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.