OBJECTIVE:To put forward policy suggestions on the selection and revision of National Essential Drug List (NEDL) in China. METHODS: The selection principles, criteria and procedures of WHO Model List of Essential Medicines and Australia’s Pharmaceutical Benefits Scheme Directory which was commonly regarded as Essential Drug List of Australia were analyzed to provide reference for the selection and revision of NEDL in China. RESULTS & CONCLUSION: The selection and revision of NEDL which were strongly supported by related policies demand active participation of all social sectors, open and transparent working procedures, scientific and operational methods for selection and revision, authoritative monitoring and aftereffect evaluation system.

Objective To investigate the prevalence and charateristics of carotid atherosclerosis among healthy middle-aged people of community. Methods Totally 1930 subjects aged 50 years and above were selected randomly from 10027 participants recruited during Phase 3 of the Guangzhou Biobank Cohort Study (GBCS).Common carotid artery intima-media thickness (CCA-IMT) and carotid plaques (CP) were measured by B-mode ultrasonography using ALT HDI 3000 mainframe with a high-resolution. Results The prevalences of CCA-IMT and CP in men were higher than women [41.5％(400/963)vs.16.2 (157/967),34.1％ (328/967) vs.13.8％ (133/967),both P＜0.001].The prevalence of CCA-1MT was higher with age increasing in either men or women in groups of 50-yrs,60-yrs and 70-79 yrs (all P＜0.001).The most of CP was cankerous spot (37.8％),secondly hard spot (24.9％),soft spot (22.1％) and the prevalence of flat spot was lowest (15.2％).The number of CP was not significantly different between the left and right side (51.0％ and 49.0％).The most common location of CP was bifurcations of carotid arteries (61.7 ％),next the common carotid artery (21.0％) and internal carotid artery (ICA) was lowest (17.3 ％).The prevalence of CP was 44.4％ (83/87) in women aged 50- yrs,it was higher than that in men 20.9％ (108/517).However,the prevalence of CP was 79.1％ (409/517) in men aged more than 60 yrs,higher than that in women (55.6％). Conclusions The carotid atherosclerosis is commonly encountered disease in the male elderly,and the most of CP was cankerous spot in bifurcations of carotid arteries

Objective To explore the operative procedure and perioperative management of gastric cancer with liver cirrhosis.Methods Clinical data of 28 cases of gastric cancer with liver cirrhosis who were surgically treated in our hospital during the last seven years were retrospectively analyzed.Preoperatively,a detailed examination,and improvement of their nutritional status,liver function,and prothrombin time were aggressively made,and the possibility of tumor removal was estimated.Seven patients underwent radical proximal subtotal gastrectomy,and 4 of these cases underwent splenectomy and pericardial devascularizaion simultaneously.Five cases underwent total gastrectomy,and 3 of them had splenectomy and pericardial devascularizaion simultaneously.Twelve patients underwent radical distal subtotal gastrectomy,and 5 of these cases had splenectomy and suture of pericardial varices simultaneously.Four patients had palliative distal subtotal gastrectomy.The support of liver function and intense monitoring and management of complications were carried out postoperatively.Results Varying degrees of ascites occurred in all the 28 patients postoperatively,and other complications such as early liver coma occurred in five patients,extensive wound bleeding in three patients,left subdiaphragmatic abscess in one patient and wound infection in two patients.The morbidity rate was 100%(28/28).However,all the complications were recovered by non-surgical treatment.There were no perioperative deaths in this series.Conclusions Gastric cancer patients with liver cirrhosis are at a significant risk of developing postoperative complications.The surgical procedure should the "individual" principle based on liver function,history of upper gastrointestinal bleeding and the location of gastric carcinoma.Good hepatic reserve and perioperative care,meticulous hemostasis during operation,and prevention and treatment of postoperative complications are the likely determinants of operative prognosis.

Objective To evaluate the efficacy and safety of recombinant human brain natriuretic peptide (rh-BNP) combined with levosimendan on acute myocardial infarction complicated by heart failure.Methods Patients who suffered from anterior wall acute myocardial infarction (AMI) with heart failure (KillipⅡ ～ Ⅲ) within 12 to 24 hours after the onset of chest pain were randomized into two groups: the control group (n=30, receiving dobutamine and/or cedilanid) and the experimental group (n=30, receiving rh-BNP combined with levosimendan).The hemodynamics, parameters of laboratory tests and adverse events were observed before and after treatment.Results The experimental group showed that the respiratory rate (RR), heart rate (HR), systolic blood pressure (SBP), arterial blood gas oxygen saturation (SaO2), cardiac index (CI), extravascular lung water index (EVLWI) were significantly different between 2 h and sequential time points after treatment and pre-treatment (allP＜0.05).The control group showed that RR, HR, SaO2, CI, EVLWI were significantly different between 6 h and sequential time points after treatment and pre-treatment (P＜0.05 for all).There were significant differences in RR, HR, SBP, SaO2, CI, EVLWI at 2 h and 6 h after treatment between the two groups (P＜0.05 for all).Parameters of RR, HR, CI, EVLWI at 72 h after treatment had differences between the experimental group and controls.Patients in the experimental group presented larger urine volume, lower level of plasma NT-pro BNP, higher left ventricular ejection fraction (LVEF) and shorter length of stay in CCU as compared with patients in the control group (P＜0.05 for all).In adverse events monitoring in hepatic parameters, electrolyte level and coagulation function before and after treatment, there was no significant difference between the two groups.Conclusions Compared with the conventional treatment, the combination therapy with rh-BNP and levosimendon can improve the hemodynamics, increase the urine volume, decrease the level of plasma NT-proBNP and elevate LVEF significantly, so as to improve the clinical symptoms and shorten the hospital stay in patients with acute myocardial infarction complicated by heart failure.

Injury monitoring is an important approach for injury control and is an important part of comprehensive disease monitoring. With the development of medical digitalization, an intelligent injury monitoring system has been created in Yinzhou District, Ningbo City, Zhejiang Province using artificial intelligence techniques based on Ningbo Municipal Health Information Platform and has been applied across the district since 2019. The manual card-reporting mode has been transformed to intelligent card-reporting mode in this system, which achieves functions of epidemiological analyses of the monitoring data, early warning of high-incidence injuries, classified management of injury and quality control of report cards. Nearly 300 thousand cards have been automatically reported since the system was online available since November 2022, and the epidemiological characteristics of injury were preliminarily understood, which provide data supports to early earning and interventions of injury. The intelligent injury monitoring system greatly improves the injury monitoring efficiency and card-reporting quality, and saves a large number of manpower and material resources, which provides a powerful technical support to widespread injury monitoring.

AIM:To explore the changes of plasma levels of soluble vascular endothelial growth factor receptor 2 ( sVEGFR2) and superoxide dismutase ( SOD) in hypertensive patients and hypertensive diabetic patients.METHODS:In this cross-sectional study, 88 cases were enrolled, which were divided into hypertensive group (n=31), hypertensive diabetic group ( n=31 ) and control group ( n=26 ) .Blood pressure was obtained from each participant with mercury sphygmomanometer.The levels of sVEGFR2 and SOD were measured by ELISA.Meanwhile, the levels of plasma glucose, glycosylated hemoglobin A1c ( GHbA1c) and lipid profile were detected.RESULTS:The levels of total cholesterol ( TC) and body mass index (BMI) were significantly higher in hypertensive group than those in control group (P<0.05).The levels of TC, low-density lipoprotein cholesterol ( LDL-C) , triglyceride ( TG) , BMI, waist circumference were significantly higher in hypertensive diabetic group than those in control group (P<0.05).The plasma levels of sVEGFR2 and SOD in both hypertensive diabetic group and hypertensive group were significantly decreased compared with control group ( P<0.05), while the mean plasma levels of sVEGFR2 and SOD in hypertensive diabetic group were significantly decreased compared to the hypertensive group ( P<0.05 ) .A significantly positive correlation between sVEGFR2 and SOD in the whole study population (P<0.05) was observed.CONCLUSION: The plasma level of sVEGFR2 is decreased in both hypertensive and hypertensive diabetic patients, and more significantly decreased in hypertensive diabetic patients.De-creased SOD level may be associated with to the reduction of sVEGFR2.

OBJECTIVETo observe the heart damage in 10 patients with acute fluoroacetamide poisoning.

METHODSMonitoring serum activities of myocardial enzymes [creatine kinase (CK), asparate aminotransferase (AST), lactate dehydrogenase(LDH) and hydroxybutyrate dehydrogenase(HBDH)] and recording ECG on these 10 patients were performed during the period of their hospitalization. In the mean while, 24 hour dynamic ECG were also recorded and analysed using GP7000L Holter.

RESULTS(1) Urinary fluorine ion concentrations were increased in 9 patients before therapy and in all these 10 patients during therapeutic period. (2) The activities of serum CK in 2 patients and that of serum HBDH in one patient were increased before therapy. However, the serum activities of one or more than one myocardial enzymes were increased in all these 10 patients during therapeutic period. (3) Four patients had abnormal change of ECG before therapy and 5 patients during therapeutic period. (4) 24 hour dynamic ECG records showed that there were heart electrical alternans in 9 patients. One patient had wandering pacemaker and 6 patients had arythmia.

CONCLUSIONFluoroacetamide may cause obvious heart damage, and also heart electrical alternation.

Acute Disease ; Alanine Transaminase ; blood ; Creatine Kinase ; blood ; Electrocardiography ; drug effects ; Fluoroacetates ; poisoning ; Heart ; drug effects ; Humans ; Hydroxybutyrate Dehydrogenase ; blood ; L-Lactate Dehydrogenase ; blood

Objective: To examine the correlation between frailty and lifestyle factors among middle-aged and elderly populations, so as to provide insights into the management of frailty among middle-aged and elderly populations. Methods : Middle-aged and elderly residents at ages of 45 ot 69 years were recruited using the convenient sampling method from seven townships in Changxing County of Zhejiang Province from 2019 to 2020. The demographic characteristics and lifestyle factors were collected using questionnaires, and the frailty was measured using the Chinese version of Tilburg Frailty Indicator ( TFI ). Factors affecting frailty were identified among middle-aged and elderly populations using the multivariable logistic regression model. Results: A total of 7 170 residents were surveyed, including 2 780 males ( 38.77% ) and 4 390 females ( 61.23% ), which had a median age of 56 (interquartile range, 10) years. The median frailty score was 2 (interquartile range, 3 ) among the study subjects, and the median frailty score was 2 ( interquartile range, 2 ) among residents at ages of 45 to 59 years, and 2 (interquartile range, 3) among residents at ages of 60 to 69 years. The overall detection of frailty was 16.07%, and the detection of frailty was 13.52% among subjects at ages of 45 to 59 years and 21.01% among subjects at ages of 60 to 69 years. Multivariable logistic regression analysis identified physical activity ( OR=0.826, 95%CI: 0.719-0.949 ) and sleep quality ( OR: 3.376-11.493, 95%CI: 2.907-15.808 ) as factors affecting frailty among middle-aged and elderly residents. Following age stratification, physical activity ( OR=0.817, 95%CI: 0.681-0.981 ) and sleep quality ( OR: 3.076-11.566, 95%CI: 2.518-18.216 ) as factors affecting frailty among subjects at ages of 45 to 59 years, while sleep quality ( OR: 3.777-11.827, 95%CI: 3.002-18.547 ) significantly correlated with frailty among residents at ages of 60 to 69 years. Conclusion Physical activity and sleep quality are associated with the risk of frailty among middle-aged and elderly populations.

AIM: To explore the effect of hydrogen sulfide on the senescence of human umbilical vein endothe -lial cells (HUVECs) induced by high glucose.METHODS: Senescence model was established by treating HUVECs with33 mmol/L glucose for 48 h.The parameters were detected to demonstrate the effect of hydrogen sulfide on senescence andthe mechanism involved was also investigated .RESULTS: In the cells treated with high glucose, the proliferation was attenuatedwith a higher number of senescence -associated β-galactosidase (SA-β-Gal) positive cells, and plasminogen activatorinhibitor 1 (PAI-1) protein expression, malondialdehyde (MDA) production and NF-κB p65 activity were increasedsignificantly, but the expression of superoxide dismutase 1 (SOD1) was decreased.However, the cell number and SOD1expression were increased, and the number of SA-β-Gal positive cells, PAI-1 protein expression, MDA production and theactivity of NF-κB p65 were decreased after sodium hydrosulfide (100 and 200 μmol/L) treatment.CONCLUSION: Exogenoushydrogen sulfide prevents HUVECs against high glucose -induced senescence by suppressing oxidative stress and NF -κB p65 activity.

Objective:To understand the incentive effect and influencing factors of the current economic incentive policy for medical alliances in Longhua District of Shenzhen(the alliance for short) on doctors′ willingness to work at primary medical institutions(the primary for short) from the perspective of mental account, and to explore the economic incentive effect of different economic incentive distribution methods on doctors′ willingness to work at the primary.Methods:The questionnaire was designed based on mental account theory. Random sampling was made in November 2019 for a questionnaire survey among doctors in two district-level medical institutions of the alliance in Longhua District of Shenzhen. The purpose was to analyze their inclination to work at the primary and their selection preferences for economic incentive distribution methods under the current economic incentive policy. The data were analyzed by descriptive analysis, and the influencing factors of doctors′ willingness to work at the primary were analyzed by χ2 test and binary logistic regression. Results:A total of 254 valid questionnaires were collected with an effective recovery rate of 90.7%. Among the respondents, 189(74.4%) were willing to work at the primary, 168(66.1%) chose to receive the economic incentives specifically for working at the primary, and 148 people(58.3%) hoped to receive such economic incentives immediately. Education background, self-rated economic income level of doctors and different payment methods of economic incentive for working at the primary had significant effects on their willingness to work at the primary( P<0.05). Conclusions:The current economic incentive policy of the alliance can meet the demands for economic incentives in terms of doctors′ material accounts, and doctors′ overall inclination to work at the primary was strong. If the amount of economic incentives is constant, doctors preferred to receive the economic incentives specifically, mainly affected by income accounts and additional income accounts. In addition, education and self-assessment of economic income level were important factors affecting the willingness of doctors to work at the primary, which may be affected by mental accounts other than material accounts.