Objective:To analyze the structure of supply and demand, the distribution status of essential drugs and low-cost drugs and the influencing factors in the distribution, and provide strategies and suggestions. Methods:The literature research, Delphi method, sampling survey and the other methods were used to analyze the effects of distribution pattern on the drug distribution in Henan, and then optimization measures were studied systematically. Results:The distribution mode of centralized purchasing drugs was the major influen-cing factor in the drug distribution rate and enthusiasm. Conclusion:The distribution of centralized purchasing drugs should stick to the principles of essential drugs priority and reasonable use in order to enhance the distribution enthusiasm of manufacturers. The distribution should base on the two-way choice distribution mode and combine with the mode of centralized distribution and independent choice, mean-while, the information technology should be improved to optimize dynamic management of distribution and promote the effectiveness of drug delivery.

[Objective]To study the dynamic changes of the VEGF and BMP-2 genes expressions inside the necrotic femoral head of rabbits.[Method]Made rabbit model of femoral head necrosis(FHN) with the method of twice intravenous injection with low dosage lipo polysaccharide(LPS)(10 ?g/kg body weight,at a time interval of 24 hours.)and 3 times intramuscular injection with methylprednisolone(MPS)(20mg/kg body weight,at a time interval of 24 hours.().)Immunohistochemistry,in situ hybridization and extract total RNA for real-time quantitative PCR were performed and successfully designed the suitable probes and primerswas used to detect the dynamic changes of the VEGF and BMP-2 genes expressions inside the femoral head of rabbits.[Result]The expressions of the VEGF and BMP-2 genes in group B(model group)at the 4,8,12 th and 16 th week were negative and real-time quantitative PCR showed that the level of the VEGF and BMP-2 mRNA genes expressions were obviously lower than that of control group.[Conclusion]The VEGF and BMP-2 genes expressions are inhibited in FNH model induced by LPS and MPS.

Objective Carry out the reform of the online learning mode of prehospital training for refresher doctors , and evaluate the effect of reform in Peking Union Medical College Hospital .Methods An exploration was carried out on the refresher doctors prehospital training mode from traditional classroom teaching to online learning , Estab-lished the online learning system .Evaluated the effect of online learning by the way of questionnaire investigation andreexaminationamong289refresherdoctors.Results 289refresherdoctorshavecompletedthestructuredon-line courses of prehospital training , and the average pass rate of the first test was 42.2%.The questionnaire and retest was conducted , A total of 262 doctors completed the work , The recovery rate was 90.7%, and the average pass rate of retest was 74.9%, showing improvement by 32.7%.Conclusions Online learning mode is an effec-tive tool for knowledge dissemination , and has a better learning effect .

Objective:To compare the efficacy and safety between cryoablation(Cryo)and radiofrequency (RF)ablation in patients with atrioventricular nodal reentrant tachycardia(AVNRT). Methods: A total of 83 patients with AVNRT underwent electrophysiological treatment in our hospital from October 2006 to March 2009 were studied. Patients were divided into two groups according to their own choices. Cryo group (n=41) and RF group (n=42). The clinical characteristics,success rate,procedural time and ablative time were compared between two groups. Results:The procedural time and ablative time in Cryo group was significantly longer than those in RF group (119.14±40.16 min vs.85.86±28.24 min,P=0.001; 1118.91±620.62 s vs.370.97±279.23 s,P<0.001). The acute success rate was achieved in 40/41(97.6%)patients in Cryo group,and 42/42(100.0%) in RF group. Transient AV-block was encountered in 6 (15%) patients in the Cryo group and 5 (11.9%) in RF group (P=0.681). There was no complete atrial-ventricular(AV)conduction block at the end of procedures. There was no recurrence of AVNRT in either Cryo group nor in RF group during 11.6±5.5 months of follow up period.Conclusion:Cryoablation was as effective and safe as RF ablation for AVNRT. Cryo-energy was one kind of alternative ablation energy for AVNRT.

Objective To investigate the effects of acute oxidative stress induced by H2O2 on expression of senescence marker protein30 (SMP30) and morphology,survival rate of human lens epithelial cells (HLECs).Methods HLECs were treated with H2O2(0 μmol · L-1,100 μmol · L-1,200 μmol · L-1,300 μmol · L-1) for 24 hours,the acute oxidative stress models were established,the changes of cell morphology was observed,and MTT was used to analyze the cells state,the expressions of SMP30 were measured by Western blot.Results The cell density decreased,morphological changed and viability of cells significant decreased in 100 μmol · L-1 and 200 μmol ·L-1 treated group,the large and round cells appeared,the cell body stretched with unclear boundary.With the H2O2 concentration increased,the viability of cells were gradually decreased in treated group,there were statistical differences compared with 0 μmol · L-1 treated group (all P ＜ 0.05).The relative expression of SMP30 in control group and 100 μmol · L-1 and 200 μmol · L-1 treated group were 0.273 ±0.055,0.464 ± 0.058,0.442 ± 0.050,respectively.There were significant differences between 100 μmol · L-1,200 μmol · L-1 treated group and control group (all P ＜ 0.05),and there was no statistical difference between 100 μmol · L-1 and 200 μmol · L-1 treated group (P ＞ 0.05).Conclusion SMP30 is up-regulated in HLECs under acute oxidative stress induced by H2O2,the cell morphology is changed,the viability of cells is decreased,and SMP30 may be involved in the process of acute oxidative stress in HLECs.

In the process of building a high level resident standardized training base, the competency training of the management staff is an important mission.The connotation of management staff`s competency is divided into three levels: knowledge competence, work competence and problem-solving competency.The training of management staff`s competency needs to be decomposed and analyzed on three levels of competency, and to be implemented according to the specific training process.

Objective To study effects of salmon calcitonin and Heng Gu bone healing reagent on vertebral osteoporotic fracture(OPF).Methods From Nov.2007 to Dec.2009,82 cases of vertebral OPF were treated.These cases were randomly divided into treatment group and control group.The treatment group(42 cascs)were treated with salmon calcitonin and Heng Gu bone healing reagent.The control group(40 cases)received salmon calcitonin only.Pain relief of the 2 groups wag compared.Results Before treatment,the 82 patients were scored 6-9 points by visual analogue scales(VAS)and pain scores of the 2 groups were similar (P>0.05).3 days,5 days,8 days and 15 days after treatment,VAS scores of the 2 groups were significantly different(P<0.01).Compared to the control group,the treatment group had pain relief in shorter time and their bone mineral density Was better showed by the 3-month-later review.Conclusion The combination therapy of salmon calcitonin and Heng Gu bone healing reagent in treating vertebral OPF has better effect of pain relief and bone formation,which is a safe and effective method.

Objective To evaluate the reliability of objective structured clinical examination based on standardized patients in clinical skill test for medical students.Methods To analyze the scores of 8 stations OSCE by applying multivariate generalizability theory.Results The relative G coefficient of the 8 stations OSCE was 0.886, and the absolute G coefficient was 0.883.Conclusions Multivariate generalizability theory is an objective and scientific method to evaluate the OSCE stations, and the analysis results facilitate to improvement the practice interms of quality and efficacy.

A total of 40 patients with COPD (excluding those with correlated/relevant diseases)were measured for inflammation parameters of erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) after hospital admission and some coagulation/fibrinolysis parameters including D-dimer,thrombinantithrombin (TAT),prothrombin fragment 1 + 2,(tissue plasminogen activator) tPA,plasminogen activator inhibitor 1 (PAI-1),von Willebrand factor (von WF),endothelin receptor A,thromboxane B2,P-selectin and pulmonary arterial pressure (PAP) by ultrasonic cardiography after the settling of the symptons of acute period.All patients were then divided into 2 groups according to PAP [＜ 40 mm Hg (1 mmHg=0.133 kPa) (n=24),＞40 mm Hg (n=16)].The values of CRP and ESRin the group with PAP ＞ 40 mm Hg were significantly higher than those in another group (P =0.044 and P =0.002respectively) while tPA was lower (P =0.04).A moderate positive correlation existed between tPA and TXB2 (r =0.547).Moreover,a highly positive correlation was found between TXB2 and PAl-1 (r =0.929).The results indicated that the COPD patients with pulmonary arterial hypertension (PAH) tend to have a higher level of inflammation,and their fibrinolysis becomes impaired leading to a prothrombotic state.

Quantities of teaching-helping activities are present in among hospitals because of gap in education quali-ty.Effectiveness of those helping activities depends on establishment of a scientific teaching -helping system.Teach-ing-helping system among hospitals is based on the establishment of teaching system of hospital , scientific and scheduled helping process management , and a clear claim of effectiveness .Peking Union Medical College Hospital reviewed its teaching-helping activities and developed a theoretical model of effectiveness of teaching -helping among hospitals .