OBJECTIVE:To understand the situation of essential medicines and promote their rational use in our hospital. METHODS:The prescription variety and cost percentages of essential medicines in outpatient department in the two halves years of 2013 in our hospital(eye and ENT specialized hospitals)were compared;the medicines with forefront prescription kind percent-ages in eye and ENT departments were sorted and rankings in 4 quarters were compared. RESULTS:After the approval of the Na-tional Essential Medicine List(2012 edition),compared with the first half year of 2013,prescription variety and cost percentages of essential medicines in outpatient department in the second half year were significantly increased (P<0.01). Prescription variety and cost percentages of essential medicines in eye department in the second half year were significantly increased(P<0.01),in the top 20 prescription variety,totally 2 kinds were contained by the list 2012 edition and 3 were contained by the supplementary list of Shanghai(2012 edition). Compared with the first half year of 2013,prescription variety and cost percentages of essential medi-cines in ENT department in the second half year were significantly decreased(P<0.01),the cost percentage was significantly in-creased(P<0.01),in the top 20 prescription variety,totally 2 kinds were contained by the list 2012 edition and 3 were contained by the supplementary list of Shanghai (2012 edition). CONCLUSIONS:The prescription variety and cost percentages of essential medicines in our hospital show increase trend. Nevertheless,the non-essential medicines are still dominant and further improvement of essential medicines is still needed. Medicine variety and dosage forms of eye in ENT department are insufficient concluded in Es-sential Medicine List. Further adjustment of Essential Medicine List still needs more consideration for the medication characteristics in specialized hospital.

Objective To establish a framework of indexes for assessing the composite results in TCM hospitals so as to promote their development. Methods Such methods and techniques as literature review, descriptive study, Delphi expert consultation, step analysis, composite index, weighted rank sum ratio, and correlation analysis as used by Kendall and others were adopted. Results The current situation regarding the allocation and utilization of health resources in a certain city was found out and a framework of indexes for assessing the composite results in TCM hospitals and the demarcation line for dividing the results into grades were defined. Conclusion The development of TCM hospitals in the city has reached a certain scale, the feature of TCM specialties forms a new growth point, and the framework of indexes for the assessment of composite results in TCM hospitals needs constant perfection.

ObjectiveTo explore the effect of CQI on the teaching of physical diagnostics.MethodsThe theory and practice of CQI are discussed in accordance with specific conditions of the teaching of physical diagnostics.ResultsThe level of the teaching of physical diagnostics can be raised by applying CQI.ConclusionThere will be broad prospects in the application of CQI to quality teaching of physical diagnostics.

Objective: To study the pharmacological action and clinical curative effect of Linglongqingre microenema. Methods: The actions of relieving fever and calming hypnotism. anti convulsions of Linglongqingre Microenema on rabbit, mouse and rat were observed. Also children's fever illess was treated to judge preliminary curative effect. Results: Linglongqingre Microenema has obvious action of relieving fever, more effective than Chaihu injection, as same as Antipyrine (80mg/kg) on subcutaneous injection. It was used to treat children's feverillness on 38 cases, markedly effective rate 60.53%, total effective rate 86.84%. Among them body temperature of one third case fell over 1.5?C in two hours. Conclusion: Linglongqingre microenema is a new quick effective pharmaceutical preparation which is suitable for emergency treatment of traditional Chinese medicine

[Objective]To compare and contrast the dosimetry between Tomo planning and BrainLab planning for lung metasta-ses in stereotactic body radiation therapy(SBRT).[Methods]Four Patients with one,two,three and four metastases were selected. The PTV is 2.89 ± 1.15 cm3. Two plannings with total dose of 50 Gy to cover 95% of PTV ,5 Gy/Fraction and 10 fractions were designed using Tomo planning system and BrainLab planning system respectively. The DVH curves of spinal cord ,both lungs and normal tissue were compared. The conformity index andhomogeneityindex were analyzed as well.[Results]The homogeneity index (HI)and conformity index(CI)of the targets in Tomo planning system were 1.0314 ± 0.0700 and 0.687 ± 0.075,respectively. In BrainLab planning system the HI and CI of the targets were 1.0764 ± 0.1241 and 0.571 ± 0.042,respectively. To HI the P value in T test was less than 0.01 and the HI was better in Tomo than BrainLab and so was CI. The dose to spinal cord was higher in BrainLab planning system than that in Tomo. The dose to nomal tissue and both lungs were not different in the two planning systems and V20 of lung is as small as 10%.[Conclusions]For small volume lung metastases which longest diameter were less than 4 cm,the tomotherapy should be better choice.

Objective:To explore the expression of indoleamine 2, 3-dioxygenase 1(IDO-1), lymphocyte-activation gene 3 (LAG-3) and T cell immunoglobulin domain and mucin domain-containing molecule 3 (TIM-3) in differentiated thyroid cancer (DTC), and the value of them on prognosis.Methods:From May 2014 to November 2015, 119 DTC patients (33 males, 86 females, media age: 42 years) who underwent surgical treatment in Shanghai Sixth People′s Hospital were retrospectively analyzed. The expressions of IDO-1, LAG-3 and TIM-3 in the specimens were analyzed by immunohistochemistry and the expression differences between cancer tissues and normal tissues were analyzed by χ2 test. The correlation of IDO-1, LAG-3 and TIM-3 with clinical characteristics were analyzed using logistic regression analysis. The patients were followed up for 5 years, and the relationships of the progression-free survival (PFS) rate with the expressions of the three immune checkpoints were analyzed by Kaplan-Meier method, log-rank test and Cox proportional hazard models. Results:The overall 5-year PFS rate for 119 DTC patients (median follow-up time: 55(2-66) months) was 76.47%(91/119). The positive expression rates of LAG-3 and TIM-3 in cancer tissues were 21.85%(26/119) and 78.15%(93/119) respectively, which were significantly higher than those in normal thyroid tissues (7.34%(8/109) and 62.39%(68/109); χ2 values: 9.43, 6.81, both P<0.05). While the positive expression rate of IDO-1 was 70.59%(84/119) in cancer tissues, which did not show a significant difference from that in normal thyroid tissues (64.22%(70/109); χ2=1.05, P>0.05). Factors associated with the positive expression of LAG-3 included tumors with a single lesion (odds ratio ( OR)=0.248, 95% CI: 0.086-0.716, P=0.010). Log-rank test ( χ2=4.96, P=0.026) and multivariate Cox regression analysis (hazard ratio ( HR)=2.239, 95% CI: 1.013-4.592, P=0.046) suggested that LAG-3 positive expression was an independent risk factor of PFS. The same analysis of TIM-3 found no clinicopathological factors related to TIM-3 positive expression ( OR: 0.309-3.084, all P>0.05) and no association between TIM-3 positive expression and PFS ( χ2=0.008, P=0.929). Conclusion:The expressions of LAG-3 and TIM-3 are significantly increased in DTC tissues, and the higher expression of LAG-3 is associated with the worse prognosis, suggesting that LAG-3 may be a potential target for immunotherapy in DTC patients.

Objective To investigate the immune tolerance in animal models of primary biliary cirrhosis (PBC) by determining the cell proliferation and activation induced cell death (AICD).Methods C57BL/6 mice were injected with 5 mg/kg of polyI:C to develope PBC models. The lymphocytes and CD4~+ T cells were separated from spleens and livers 16 weeks later and were stimulated by M2, conA and anti-CD3 for cell proliferation and AICD. Expression of apoptosis related genes and proteins were detected by real time polymerase chain reaction (PCR) and Western blotting, respectively. Results ① The lymphocyte proliferation was 0.1988 ± 0.0111 in blank controls and 0. 2068±0. 0115 in PBS treated mice with no significant difference (P>0.05). However, an abundant lymphocyte proliferation was found in PBC mice (0. 358 ± 0. 022), which was higher than that in controls and PBS treated mice. The proliferation of lymphocyte from liver was greater than that from spleen in PBC mice (P<0.01). ② The apoptotic rate in blank controls (74.70%±4.58%) and PBS treated mice (74.20%±4.44%) was higher than that in PBC mice (44.85%±6.47%,P<0.01),but no difference was found between blank controls and PBS treated mice (P>0.05). Furthermore, the apoptosis rate of T cells from livers were significantly lower than that from spleens in PBC mice (P<0.01). ③ The expressions of FasL and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in PBC mice were lower than those in PBS treated mice (P<0. 01), but there was no change in expression of Fas was found. ④ The expression of Fas-associated death domain-like interleukin-1-β-converting enzyme-inhibitory protein (FLIP_L) in PBC mice was higher than that in blank controls. Moreover, the expression of FLIP_L in livers was higher than that in spleens in PBC mice (P<0. 01). Conclusios The elevated expression of FLIP_L may inhibit AICD. Besides, the decreased expressions of FasL and TRAIL may also help in the enhancement of the anti-apoptotic ability in lymphocytes and in the aggravation of portal area inflammation.

OBJECTIVETo investigate the cause of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy.

METHODSColor Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy in 1 patient postoperatively and to examine the anatomic relationship between the gallbladder bed and branches of the middle hepatic vein in 91 patients preoperatively.

RESULTSThere is a major branch of middle hepatic vein extended close to the gallbladder bed. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 14 of 91 patients (15.4%). The mean distance between the closest point of the middle hepatic vein and the gallbladder bed is 5.0 +/- 4.6 mm, the mean diameter of this point is 3.2 +/- 1.1 mm.

CONCLUSIONSPatients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound.

Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Hepatic Veins ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; Risk Factors ; Ultrasonography, Doppler, Color

Endocrine therapy is one of the standard treatment options for breast cancer which plays an important role in treating patients with estrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) negative breast cancer.However,some patients develop resistance during therapy due to factors such as tumor heterogeneity,which is particularly acute in the treatment of advanced breast cancer.Based on aiming at a rational and effective treatment,some clinical trials recently have demonstrated that compared to endocrine therapy alone,cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy can significantly improve the prognosis of ER-positive,HER2-negative advanced breast cancer.Its main products are Palbociclib,Ribociclib and Abemaciclib.This review mainly focuses on the mechanism and related clinical trials of CDK4/6 inhibitor inhibitors in ER-positive,HER2-negative advanced breast cancer.

Objective:To explore the efficacy of percutaneous osteoplasty (POP) combined with 131I therapy in patients with bone metastases from differentiated thyroid carcinoma (DTC) and assess the survival. Methods:From Januray 2008 to January 2020, 29 DTC patients with bone metastases (16 males, 13 females, age range: 24-64 years) who received POP combined with 131I therapy in Shanghai Sixth People′s Hospital were retrospectively analyzed. Clinical data and characteristics of patients were analyzed. The efficacy and prognosis were evaluated based on the changes of serum thyroglobulin (Tg) and relieving condition of bone pain after the combined treatment. χ2 test was used to determine the association between clinical characteristics and efficacy, and Kaplan-Meier analysis was used to estimate the overall survival (OS) rate. Results:The biochemical response rate of serum Tg was 68.97% (20/29) after the combined treatment. For the influence on changes of serum Tg, whether or not combined with non-osseous distant metastasis, and cumulative dose of 131I treatment(≥22.2 vs <22.2 GBq) were statistically significant ( χ2 values: 5.448 and 4.371, both P<0.05). The rate of bone pain relief was 65.52%(19/29). Age (≥55 vs <55 years) and the cumulative dose of 131I treatment had statistically influences on bone relief ( χ2 values: 7.486 and 5.154, both P<0.05). The 5-years OS rate of patients was 87.68%, while the 10-years OS rate was 65.76%. Conclusion:POP combined with 131I therapy is effective on relieving the pain, reducing the serum Tg to some extent, and improving the long-term survival of DTC patients with bone metastasis.