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.

Objective To investigate the clinical character of axillary node involvement(ANI) in breast carcinoma and provide a theory evidence for breast-conserving therapy. Methods 200 cases of breast cancer from 2000 to 2005 in our hospital were analyzed and were divided into two groups according to the states of ANI or not. The datas about its tumor size,course of disease,axillary lymph node palpared were regiscered. Results When the tumor size 5cm,ANI decreased 26.8% ,when the tumor surgery inside the three months the ANI were 57.1 %. Conclusion Lower ANI rate is related with that the tumor small,after discovered and surgery at once,the axillary lymph node non-palpated and the tumor resected at outpatient department.

Objective To explore the effects of automobil exhaust on immune adherence function of erythrocytes in mice Methods The male Kunming mice were exposed to gasoline fueled engine exhausts 20 minutes per day continouusly for 20 days After the whole exposure,the ratio of spleen to body weight and total count of erythrocytes in peripheral blood of mice were observed The immune adherence function of erythrocytes was determined by complement sensitized yeast cell hemagglutination test in mice Results The ratio of spleen to body weight [(4.84?0.53)mg/g] and total count of erythrocytes [(5 83?10 12?0 25?10 12)/L] of mice exposed to automobil exhausts were significantly lower than those of control group [(5 55?0 68)mg/kg,(7 71?10 12?0 29?10 12)/L] respectively The positive rate of blood coagulation of exposure group (12 5%) was significantly lower than that of control group (82 5%) at blood coagulation titer of 1∶8,? 2=39 2,P

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.

Advances in the understanding of cancer at the molecular level have led to much progress in the development of anti-cancer agents. Among the newly invented medications for targeted cancer therapy, protein kinase inhibitors target intracellular molecules crucial in signaling pathways for cancer cell survival, proliferation, and disease progression. The Raf serine/threonine kinases are pivotal molecules within the Raf/mitogen extracellular kinase (MEK)/extracellular signal-related kinase (ERK) signaling pathway. The exact function of Raf in normal human cells is not yet understood; however, preclinical and clinical researches have shown that over expression of Raf gene or overreaction of Raf kinase isoforms have critical roles in many types of solid tumors, including renal cell carcinoma, hepatocellular carcinoma, melanoma, and non-small cell lung cancer (NSCLC). Sorafenib is the first oral, multi-kinase inhibitor that targets the Raf kinases. It also has a broad spectrum activity against other receptor tyrosine kinases associated with vascular endothelial growth factor receptors and platelet-derived growth factor receptors. Sorafenib was recently approved by FDA for use in advanced renal cell cancer, and is currently undergoing active investigation in the treatment of other types of malignancies, such as melanoma, liver cancer, prostate cancer, and NSCLC. In this review, we will illustrate the role of Raf in both normal and malignant cells, the mechanism of sorafenib in the treatment of renal cell carcinoma, as well as clinical data that support its use and further investigation in advanced renal cell carcinoma, melanoma, and other tumor types.

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.

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.

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.

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.