OBJECTIVE:To explore the feasible program of independent financing for essential medicines. METHODS:Based on the comprehensiveness of national essential medicine system and the value chain of while essential medicines,the feasibility of independent financing to supplying,application and payment was analyzed,and finally the feasible program of independent financ-ing for essential medicines was put forward. RESULTS & CONCLUSIONS:Making full use of financial subsidies,individual con-tribution and medical insurance balance fund,with appropriate supplementary financing can establish the compensation fund. The unified compensation fund is used for providing financial support for fixed-point production of scarce essential medicines;compen-sating production enterprises supplying essential medicines;compensating medical institutions equipped with essential drugs;provid-ing“secondary compensation”to patients purchasing essential medicines. Complete system of financing,supplying,application and payment for medicines should be further designed after“medicine separation”.

OBJECTIVE:To research the effect of price change on pharmaceutical enterprises in China to improve the assess-ment of drug pricing. METHODS:Market share,competitive products’price and substitutes of the elasticity of drug price were an-alyzed to receive the effect of price change on pharmaceutical enterprises. RESULTS:The market share of homogeneous drugs for a same disease had positive correlation with price change,that is to say,if raised the price,its market share was on the rise;in terms of the effects on the price of competitive products and substitutes,the drug price change in an enterprise had a positive effect on the price of competitive products and substitutes. CONCLUSIONS:Price change of drugs has effect on market share and the price of competitive products and substitutes. Therefore,according to the price index,the enterprise can predict the market share and the price of competitive products and substitutes to assess the effect of drug quotation on the enterprise itself and external envi-ronment.

OBJECTIVE:To provide reference for the price management of medicines in Chinese mainland by inquiring into rel-ative management in Hong Kong. METHODS:Based on the steps of price management and the value chain of medicines in Hong Kong,the management mechanism of medicine pricing,circulation and compensation were researched. RESULTS & CONCLU-SIONS:The prices of the medicines in Hong Kong are mainly determined by the tender between Hospital Authority and the pharma-ceutical suppliers. In circulation,medicine payer as main body in bidding and purchase conducthigh qualitybidding andmasspurchase,and price remained the same in public hospital. On the basis of the purchase price,the price that actually paid by pa-tients is the result of government compensation. Chinese mainland can draw lessons from such drug bidding mode in Hong Kong which will lead health care department to act as the main body in bidding,weaken the relationship between the hospitals and the drug dealers or manufacturers,and expand the government's financial investment in public medical institutions to improve reim-bursement.

OBJECTIVE:To explore price management mechanism of medical service in Macau of China,and to provide refer-ence for the formulation of price management mechanism of medical service in the mainland area of China. METHODS:From two key links of pricing and compensation,price management mechanism of medical service in Macau was introduced. RESULTS &CONCLUSIONS:In respect of pricing,Macau Health Bureau as pricing subject set up guide price for public health institutions by marginal cost pricing,which focused on technology value and labor value of medical staff,and graded pricing for health institu-tions at various levels. In respect of compensation,compensation subjects included government,social security funds,charitable or-ganization,etc. The government provided fixed-rate compensation for citizen by allocating funds for public health institutions,so as to improve compensation level for primary health institutions. The social security funds extended sick benefit to insured patients, and compensated patients at fixed rate. Charitable organization subsidized private health institutions to reduce medical service price. Finally,actual price has been formulated through pricing and compensation links,and the experience is worthy of learning by the mainland of China.

OBJECTIVE:To provide reference for improving the rational drug use of China. METHODS:By referring to In-dia,South Africa and Argentina's policy in this regard,the rational drug policy rules and supporting measures in the national drug policy of these states were analyzed and summarized to put forward related policies for China. RESULTS & CONCLUSIONS:Pro-moting the rational drug use required multi-angle managements towards the supply-side,the demand-side as well as third-party, and relevant supporting measures needed to be improved. Firstly,the managements on the supply-side is particularly important,in-cluding measures such as strengthening prescription management,formulating and implementing the standard treatment guidelines, intensifing the functions of pharmacists,establishing serious irrational drug use and specific diseases medication management sys-tem;then,the demand-side needs the investigation and feedback about the patients with drug use to eliminate irrational drug use, and through the internet and other media to raise public awareness of the medicine information as well;besides,the third-party needs to establish a non-profit organization to regulate pharmaceutical advertisements,and increase information about rational drug use;finally,improving the rational drug policy also needs to improve needs to promote the separation of medicine,reform Medi-care payment and other supporting measures.

Background The suppression of retinal angiogenesis is one of primary treatment targets for retinal vascular diseases,so seeking the intervention targets of retinal neovascularization is a hot research.Studies showed that insulin-like growth factor 1 (IGF-1) can promote the growth and restrain the apoptosis of vascular endothelial cells.However,whether IGF-1 is an intervention target for the treatment of retinal vascular diseases is unelucidated.Objective This study was to address the effects of IGF-1 on the migration,apoptosis and capillary tube formation of human retinal vascular endothelial cells (HRECs) and mechanism.Methods HRECs were cultured in vitro,and the cells in the exponential phase were prepared for subsequent experiments.The expression of IGF-1R mRNA in the cells was examined using reverse transcriptase PCR assay.Different concentrations of IGF-1 were added in the medium based on the difference of tests.The relative free-cell area difference (△S) after test was measured by Photoshop CS4 software and compared among 0,10 and 200 ng/ml IGF-1 groups 12 and 24 hours after cell scratching,respectively.The cell apoptotic rate was assayed by flow cytometry and compared between 0 ng/ml IGF-1 group and 1 000 ng/ml IGF-1 group,and the number of capillary tubes was examined by Matrigel test and assessed among 0,10,100 and 200 ng/ml IGF-1 groups 24 hours after addition of IGF-1.The expressions of platelet derived growth factor (PDGF)-BB mRNA and caspase-3 mRNA in the cells of the 0,500 and 1 000 ng/ml IGF-1 groups were detected by real-time fluorescence quantitative PCR after adding IGF-1 for 6 hours.Results Cultured cells grew well and attached 90％ confluence 2-3 days after incubation,and IGF-1R mRNA was positively expressed in the cells.In 12 and 24 hours after scratching,the relative migrating area of the cells was gradually reduced with the increase of IGF-1 contents.The △S was (4.83 ± 0.61) × 105 μm2 in the 200 ng/ml IGF-1 group,which was significantly larger than (3.28±0.64) ×105 μm2 in the 0 ng/ml IGF-1 group 24 hours after stretching (t=-3.707,P=0.021).The apoptotic rate in the 0 ng/ml IGF-1 group and 1 000 ng/ml IGF-1 group was (18.77±2.37) ％ and (12.05 ±0.88) ％,with a significant difference between them (t =2.869,P =0.046).The number of intact tubes was significantly increased in the 200 ng/ml IGF-1 group compared with the 0 ng/ml IGF-1 group ([20.33±2.83]/well vs.[17.94± 1.96]/well;t =-2.940,P =0.042).Compared with 0 ng/ml IGF-1 group,the relative expression level of PDGF-BB mRNA was elevated and that caspase-3 mRNA was evidently reduced in the 1 000 ng/ml IGF-1 group (t=-3.489,P =0.025;t =7.287,P =0.002).Conclusions IGF-1 can promote the migration and angiogenesis of HRECs and inhibit the apoptosis of HRECs.These effects of IGF-1 probably are associated with the up-regulation of PDGF-BB and down-regulation of caspase-3 in the cells.

Objective To investigate the toxicity of lidocaine solid lipid nanoparticles (SLNs) in human neurons.Methods Lidocaine-loaded SLNs were prepared using high pressure homogenization.SHSY5Y cells were cultured in vitro and inoculated on 96-well plates (100 μl/well) at a density of 5× 105 cells/ml.SH-SY5Y cells were randomized into 10 groups (n =30 each) using a random number table:control group (group C), different concentrations of lidocaine groups (L1-4 groups), different concentrations of lidocaine SLN groups (L-SLN1-4 groups), and blank SLN group (group SLN).The cells were cultured routinely in group C.The cells were incubated with the culture medium containing lidocaine with the final concentrations of 1.000％, 0.500％, 0.250％ and 0.125％ in L1-4 groups, respectively.In LSLN1-4 groups, the cells were incubated with the culture medium containing lidocaine SLNs with the final concentrations of 1.000％, 0.500％, 0.250％ and 0.125％ in L1-4 groups, respectively.Before incubation (at the corresponding time points in group C), and at 1, 12 and 24 h of culture or incubation (T0-3) , 6 wells in each group were selected for measurement of the cell survival rate (using methyl thiazolyl tetrazolium assay).The cell morphology was examined with optical microscope at T3.Results Compared with that at T0, the cell survival rate was significantly decreased at each time point in L1-4 and L-SLN1,2 groups, at T2,3 in L-SLN3 group, and at T3 in L-SLN4 group (P＜0.05) , and no significant change was found in SLN and C groups (P＞0.05).The cell survival rate was significantly lower at T2,3 in L1-4 and L-SLN1-3 groups, and at T3 in group L-SLN4 than that at T1, and at T3 in L1-4 and L-SLN1-4 groups than that at T2 (P＜0.05).Compared with group C, the cell survival rate was significantly decreased at each time point in L1-4 and L-SLN1,2 groups, at T2,3 in group L-SLN3, and at T3 in group L-SLN4 (P＜0.05) , and no significant change was found in group SLN (P＞0.05).Compared with group L-SLN at the corresponding concentration, the cell survival rate was significantly decreased at each time point in group L1-4 (P＜0.05).Conclusion Lidocaine SLNs have toxic effect on human neurons, but the effect is weaker than that caused by Iidocaine solution.

Objective To discuss the security and reliability of preoperative thoracoscopic pericardial exploratory and to evaluate of the surgical indications.Methods Video full-assisted thoracoscopic pericardioscopy has been implemented in 41 central type lung cancer cases before radical resection.Results Video assisted pericardioscopy group underwent thoracotomy lung resection with procession of intrapericardial pulmonary artery in 8 cases (partial pericardial resection in 2 cases),with pulmonary vein in 10 cases,and out-pericardial lung resection in 9 cases.Spiral CT projections were consistent with surgery was only 65.8 ％.The average time of explorationa was (23±10) min.Conclusion Except for widely used in pulmonary wedge resection and lobectomy,video-assisted thoracoscopic pericardial exploration can improve resection rate and survival rate in central type lung cancer patients which can reduce the need for exploratory thoracotomy.

Objective:To observe the changes of lactate clearance rate (LCR) and serum polyligandosan-1 (SDC-1) in patients with septic shock complicated with acute respiratory distress syndrome (ARDS) and to evaluate its prognostic value.Methods:Patients with septic shock and ARDS who were admitted to the Respiratory Intensive Care Unit (RICU) of Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 2021 to April 2022 were selected as subjects. The patients were divided into the survival group and death group according to their 28-day survival status. General clinical data and related indicators of patients in the two groups were collected and compared. The related factors influencing the 28-day death of patients with septic shock and ARDS were screened, and receiver operating characteristic (ROC) curve was drawn to evaluate the individual and combined forecast value of LCR and SDC-1 for the prognosis of patients with septic shock and ARDS.Results:Compared with the survival group, sequential organ failure score (SOFA) and acute physiology and chronic health status score Ⅱ(APACHE Ⅱ) at admission to RICU, the levels of 24 h Lac, 6 h SDC-1, 24 h SDC-1 and 72 h SDC-1 in the death group increased significantly (all P< 0.05), and the levels of 6 h LCR, 24 h LCR, 6 h OI, 24 h OI and 72 h OI significantly decreased (all P<0.05). Spearman correlation analysis showed that SDC-1 at 6 h, 24 h and 72 h was significantly negatively correlated with OI at corresponding time points (all P<0.05), and LCR at 6 h and 24 h was significantly positively correlated with OI at corresponding time points (all P<0.05). Multivariate Logistic regression analysis showed that SOFA score, 24 h LCR, 24 h SDC-1 and 72 h SDC-1 were the risk factors of 28-d death in patients with septic shock and ARDS (all P<0.05). The areas under ROC curve of each related factor were SOFA score, 24 h LCR, 24 h SDC-1 and 72 h SDC-1, which could predict the prognosis (all P<0.05). 24 h LCR combined with 24 h SDC-1 had the maximum area under the curve (AUC=0.805, 95% CI: 0.691-0.920, with a sensitivity of 75.0% and a specificity of 74.4%). Conclusions:24 h LCR, 24 h SDC-1 and 72 h SDC-1 are the risk factors of the 28-day death of patients with septic shock and ARDS. 24 h LCR combined with 24 h SDC-1 can improve the test efficiency compared with the single indicator.

This paper expounds the connotation and origin of the Kenang theory,as well as its correlation with chronic obstructive pulmonary disease(COPD),and focuses on the pathogenesis and treatment of COPD based on the Kenang theory.The Kenang theory emphasizes the importance of the pathological products of phlegm and stasis,and holds that the deficiency of primordial qi and the dis-order of qi activity can lead to the intermingling of phlegm and blood,which is highly similar to the etiology and pathogenesis of COPD.The treatment should be guided by the Kenang theory,eliminating phlegm and promoting blood circulation,and its basic treat-ment principles is to treat phlegm and blood stasis together.Meanwhile,the regulation of qi activity should be paid attention to help e-liminate phlegm and promote blood circulation,and the spleen and kidney should be strengthened to nourish primordial qi and consoli-date the root,providing new ideas for the clinical treatment of COPD.