The 2012 version of international guidelines for management of severe sepsis and septic shock got re-revised on the basis of the 2008 version.For pediatric severe sepsis,the 2012 version enforces initial resuscitation;develops detailed ant-infection measures;stresses isotonic crystalloid fluid resuscitation and the use of albumin,hetastarch is no longer recommended ;reduces the value of early use of dopamine,and clears the use of corticosteroids indications and the use of blood products;mechanical ventilation is recommended to use lung protective ventilation strategy; standardizes sedation and analgesia applications; clears the level of blood glucose control;others include blood purification,nutrition,stress ulcer prevention recommendations.

ObjectiveTo explore the effects of propofol combined with remifentanil in different ratios for intravenous anesthesia. Methods63 patients were randomly divided into three groups,each group 21 cases,different target plasma concentration of propofol and remifentanil were dosed for every group.Hemodynamic parameters such as MAP,HR were recorded at different time.so as to stop time for the zero time of local anesthetic.The extubation time,the quality and time of awakening were compared as well. ResultsThe MAP and HR value of all patients after induction of general anesthesia were lower than that before intubation,which showed significant difference(all P＜0.05),and the MAP and HR value of all patients after intubation reseal and decannulation showed significant difference compared with that before intubation reseal.The resurgence time and decannulation time of group A were the shortest,and the postoperative detubation revive quality score was also the best when compared with that of group B and C. ConclusionThe target plasma concentration of propofol(2.5mg/L)and remifentanil(μg/L)was the best.With the increasing of target plasma concentration of remifentanil and the decreasing of target plasma concentration of propofol,the resurgence time,decannulation time and the postoperative detubation revive quality score were improved gradually.

Mesenchymal stem cells is another adult stem cells in bone marrow apart from hematopoietic stem cells.Because of their strong self-renewal capacity and the potential of multi-lineage differentiation.mesenehymal stem cells are used more and more in the treatment of malignant diseases,such as hematological malignant diseases and extensively applied in regenerative medicine and tissue engineering.However,the exact role of mesenehymal stem cells on tumor is not completely clear.This review is about the impact of mesenchymal stem cells on tumor growth and the related mechanism.

OBJECTIVE:To provide references for drug pricing and drug administration for Chinese government.METHODS:The drug pricing and administration policies in UK were expounded and the effects of which were analyzed and evaluated,based on which some suggestions were put forward with the consideration of the specific condition of our country.RESULTS&CONCLUSIONS:The rules of market economy should be obeyed and market monitoring should be carried out in China.The non-governmental organizations should play a key role in the support and service for national drug supervision and administration.The drug prices should be controlled according to category so as to make the formula process of drug price policy scientific.The government-set price and the market price monitoring mechanism should be established and the legal system of drug price management should be established as soon as possible.

Because cardiomyocytes have extremely low capacity to cell proliferation, cell transplantation has recently attracted muchattention as a new method to improve the damaged heart function and structure. Cellular cardiomyoplasty refers to the implantation ofdifferent kinds of cells besides autologous cardiomyocytes into the myocardium to reinforce its structure and function. Presently, fetaland neonatal cardiomyocytes, hematopoietic stem cells, bone marrow mesenchymal stem cells, skeletal myoblasts, endothelial stem cells, hepatic stem cells and neural stem cells have been used to repair the damaged heart in animal experiment. This article overviewstype, outcome, advantage, disadvantage, and problems of seed cells used for cellular cardiomyoplasty.

The etiology of acute pancreatitis in children is infection,drugs,trauma,or anatomic abnormalities.Acute pancreatitis is less frequent in children than in adults,but recent studies indicate that an increasing incidence in the pediatric population.Limited data of severe acute pancreatitis(SAP) remains.Abdominal pain and vomiting are important early symptoms.Also children may initially present with shock,followed by symptoms of multiple organ dysfunction.To date,there is no pediatric prognostic severity scoring system that is available to practice.The prognostic severity tool with 3 variables includes lipase,albumin,and WBC within 24 hours of admission may be applied to predict pediatric SAP.Continuous renal replacement therapy can effectively reduce systemic inflammatory response,improve the organ function and maintain the fluid balance,may be a new potential therapy in children with SAP.

OBJECTIVE:To evaluate the application of cost-utility analysis in health area of China in recent year. METH-ODS:From CNKI,Wanfang and VIP database,settingcost utilityorcost-utilityastitleorkeyword,related literatures were retrieved during Jan. 2011-Dec. 2015,with subject field ofmedical science and technologyin CNKI,medical sciencein Wanfang database,clinical medicineChinese medicinepreclinical medicinepreventive medicine hygieneorpharmacyin VIP. The comprehensive evaluation involved research design,research perspective,cost measurement,utility index and measure-ment method,cost-utility analysis index,discount and sensitivity analysis. RESULTS:A total of 31 literatures meeting inclusion cri-teria were selected,including 12 prospective studies,9 retrospective studies,9 Markov model studies,1 mixed study. Thirteen lit-eratures worked in medical institutions. Seven literatures explicitly mentioned research perspective;most literatures only measured direct cost(19 literatures)and adopted QALY as utility index(27 literatures). Twenty eight literatures described measurement meth-od of utility index(direct measurement,indirect measurement or literature method)in detail. More than half(16 literatures)analyzed cost-utility by using cost-utility ratio(CUR);7 literatures adopted incremental cost-utility ratio(ICUR)and 6 literatures adopted both CUR and ICUR. Five literatures used the threshold of ICUR. Eleven literatures described discount,and the majority was Markov mod-el study. Sensitivity analysis was conducted in 16 literatures,among which 11 literatures adopted single factor analysis. The most com-monly involved influential factor was cost,followed by utility value and discount rate. CONCLUSIONS:Cost-utility analysis has been widely used in China,but the quality and normalization of studies have much room for improvement. Learning more experiences from international researches can help to promote the quality of domestic studies,guide the practice of clinical rational use of drugs and sup-port the government decision-making process and medical insurance payment in the future.

The performance status(PS)≥2 patients with non-small cell lung cancer(NSCLC) are short of effective management.The phase Ⅱ/Ⅲ clinical trails of target therapy of anti EFGR of VEGFR have already got promise results.This article expatiates the actuality and development of the chemotherapy and novel target therapy for the PS≥2 patients with NSCLC.

OBJECTIVE: To provide valuable reference for China in formulating and evolving pricing policy on patent drugs.METHODS: The current pricing policy on patent drugs in Sweden and its outcome were analyzed,and then its implication for Chinese medical & health market were summarized.RESULTS & CONCLUSIONS: We suggest that market information should be taken into full consideration and drugs price supervision system should be established in making pricing policy so as to avoid information asymmetry in pricing game and ensure effective utilization of social medical insurance resources.

OBJECTIVE: To evaluate the pricing policy on the patent drugs in UK.METHODS: The current pricing policy on patent drugs in UK and the outcome of the policy were analyzed and its characteristics and applicable condition were summarized.RESULTS & CONCLUSIONS: Current pricing policy on patent drugs in UK provided incentives for the research & development as well as innovation of drugs and it helped to keep UK's pharmaceutical industries in the global leading level.However,there is no mechanism within it to take explicit account of therapeutic value of drugs.Also,it provides weak incentives to invest in the most cost-effective yet clinically demanded drugs and it has limited effect on price control of drugs.