With the promoting of medicine and health system reform,it provided new requirement for the price management of medical consumbles.Based on the current statns of medical consumbles price management in China,it studied the mechanism of pricing and reimbursement of Japan and Australia.To implement the price management mode of Chinese medical consumables through optimizing China medical service item package charging,playing the function of evidence-based evaluation and economic evaluation and establishing the supervision system of medical consumable prices.

Objective:To study the potential effects of intensity modulated radiation therapy (IMRT) on clinical efficacy,oral mucosa reaction and immunological foundation;and to explore the effect of immunological changes on clinical efficacy and oral mucosa reaction in patients with nasopharyngeal carcinoma.Methods:A total of 200 patients with nasopharyngeal carcinoma,who came from First Department of Nasopharyngeal Radiotherapy,the First People's Hospital of Foshan from October 2008 to November 2011,were selected.The patients were treated with nasopharyngeal radiotherapy,and divided into an observation group and a control group (n=100 in each group).The control group underwent common conventional two-dimensional radiotherapy treatment,while the observation group underwent IMRT.The 5-year survival rates and recurrence rates were recorded at follow-up.After the radiotherapy,the oral mucosa in the patients were evaluated by the classification standard of acute radioactive mucositis by American Radiotherapy Oncology Group (RTOG),and the number of T lymphocyte subsets before and after treatment was detected.Results:There were significant difference in non-regional-recurrence survival rate,disease-free survival rate,local recurrence rate between the above 2 groups (all P＜0.05),but no significant difference in the distant metastasis-free survival rate (P＞0.05).The acute oral mucosa reactions of grade 1,2,3,4 in the control group were 8.00％,20.00％,12.00％,7.00％,respectively,and those were 7.00％,22.00％,15.00％,1.00％ respectively.There was no significant difference in the acute response of oral mucosa in grade 1,2 and 3 in the 2 groups (all P＞0.05),but there was significant difference in the grade 4 (P＜0.05).There were significantly difference in CD8+,CD4+/CD8+ and CD4+ T lymphocyte subsets before and after treatment in the above 2 groups (all P＜0.01);there were also significantly difference after treatment between the observation group and the control group (all P＜0.01).Conclusion:In the process of treatment in patients with nasopharyngeal carcinoma,the use of IMRT on the basis of chemotherapy is more effective than the conventional two-dimensional radiotherapy,which can reduce the proportion of grade 4 (severe) acute oral mucosa reaction.It may be related to the protective effect of IMRT on immune function in the patients.

Background Cilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently,cilostazol has been used for antiplatelet therapy after coronary bare metal stent implantation for thrombosis and restenosis prevention. This prospective randomized and double blind trial was designed to investigate the safety and efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis.Methods One hundred and twenty patients who underwent elective stent were randomly assigned to treatment group with cilostazol 200 mg/d (n = 60), clopidogrel 75 mg/d and aspirin 100 mg/d or to control group with clopidogrel treatment 75 mg/d (n = 60) and aspirin 100 mg/d. Follow-up coronary angiography was performed 6-9 months later.Results Nine months major adverse cardio-cerebral event (MACCE) were lower in treatment groups (P＜0.05).The quantitative coronary angiography (QCA) at 6 months follow-up showed that minimum lumen diameter(MLD) was higher in treatment group than that of control group [(2.14±0.52)mm vs (1.82 ±0.36)mm, P＜0.05].Late lumen loss (LL) [(0.82 ± 0.42)mm vs (1.31 ± 0.58)mm; P＜0.01 ], restenosis rate (RR) (14% vs 32%; P＜0.05)and target lesion revascularizaion (TLR) rate (5% vs 17%; P＜0.05) were lower in treatment group than in control group.Conclusion Cilostazol therapy is an effective regimen for prevention not only stent thrombosis but also RR and TLR through reducing MLD without the risk of increasing bleeding.

Objective To investigate the role of antigen-processing machinery (APM) component defects in HLA class Ⅰ antigen down-regulation in laryngeal squamous cell carcinoma (SCC) and to assess the clinical significance of these defects. Methods Fifty-one formalin-fixed,paraffin-embedded SCC specimens were examined for the expressions of APM component transporter associated with antigen processing (TAP1) and low molecular weight polypeptide (LMP-7) and HLA class Ⅰ antigen by immunohistochemistry.Results HLA class Ⅰ antigens,TAP-1 and LMP-7 expressions were downregulated in 56.9％ (29/51),39.2 ％ (20/51) and 45.1％ (23/51) of the tested specimens respectively,whereas HLA class Ⅰ antigens,TAP-1 and LMP-7 expressions lost in 21.6 ％ ( 11/51 ),33.3％ ( 17/51 )and 27.5 ％ ( 14/51 ) of the tested specimens respectively.TAP-1 and LMP-7 expressions were significantly correlated with HLA class Ⅰ antigen expression (r =0.460,P < 0.05 and r =0.685,P < 0.05,respectively).HLA class Ⅰ antigens down-regulation was significantly correlated with T stage( x2 =8.61,P ＜ 0.05).Both TAP-1 and LMP-7 down-regulations were significantly correlated with T stage ( x2 valueswere 9.72 and 8.97 respectively,P ＜ 0.05 ) and TNM stage( x2 values were 9.18 and 7.70 respectively,P ＜0.05 ).TAP-1,LMP-7 and HLA class Ⅰ antigen down-regulations were significantly associated with reduced patients' overall survival ( P ＜ 0.05 ) and disease-free survival ( P ＜ 0.05 ).Multivariate analysis showed lymph node metastasis,recurrence and HLA class I antigen down-regulation were unfavorable prognostic factors(P ＜ 0.05).Conclusions Down-regulated expressions of HLA class Ⅰ antigen and APM component TAP-1 and LMP-7 occur frequently in laryngeal squamouss cell carcinoma,by which cancer cells could avoid immune surveillance,while HLA class Ⅰ antigen down-regulation is a major contributing factor to tumour progression and mortality.

Objective To evaluate the in vivo antibacterial effect of cefathiamidinein against mouse septicemia.Methods Experimental model of mouse septicemia was established by intraperitoneally injection with 0.5 mL minimum lethal dose (MLD) bacteria.The 0.2 mL different concentrations of drugs were injected through caudal vein.Cefathiamidine,cefazolin and ampicillin adopted two methods of dose regimen,which are single-dose and two-dose;while,both ceftriaxone and levofloxacin adopted single-dose.The survival time of the infected mouse was monitored for 1-7 d.The 50％,95％ effective doses(ED50,ED95) were determined by the Bi-level integrated system synthesis (BLISS) method.The antibacterial activities between cefiazine and control drugs were compared.In vivo protection experiments were carned out on 3 standard strains and 7 pathogenic strains isolated through single dose.Results The cefathiamidine had good antibacterial activity in vivo against Streptococcus pneumonia and Enterococcus faecalis.The ED50 of single-dose was between 1.43-1.71 mg · kg-1,which was significantly superior to cefazolin and was similar to levofloxacin.According to the results of two -dose regimen,the ED50 values of cefathiamidine against Sreptococcus pneumonia,Staphylococcus aureus and Haemophilus influenza significantly declined,which were between 0.78-14.78 mg · kg-1.However,with regard to Enterococcus faecalis,the ED50 value of two-dose increased compared to that of single-dose,which could be related to the fact that low plasma concentration affected protective effects in vivo.Conclusion Cefathiamidine had a better antibacteria effect in vivo against gram-positive bacteria,especially Streptococcus pneumonia and Enterococcus faecalis.Through the comparison between single-dose and two-dose,it is more reasonable to adopt two-dose or multiple-dose of cefathiamidine with regard to most strains.

Objective To assess the relationship between pregnancy associated plasma protein-A (PAPP-A)and culprit coronary plaque morphology in patients with unstable angina(UA).Methods Sixtyeight UA patients undergoing diagnostic coronary angiography and intravascular ultrasound were included in this study.A sandwich enzyme-linked immunosorbent assay technique was used to assay the circulating PAPP-A.Plaque characteristics of culprit lesion were analyzed for UA patients with various PAPP-A levels.Results PAPP-A level was significantly higher in high-risk UA than in non-high-risk UA[(19.9±20.1)mIU/L vs.(6.9 ±5.7)mIU/L,P=0.002].Optimal threshold of PAPP-A to prediet high-risk UA was determined as 11.0 mIU/L with a sensitivity of 78.6%and a specificity of 77.5%.Patients with higher PAPP-A level(≥11.0 mIU/L)was associated with larger external elastic membrane cross-sectional area,plaque area and more plaque burden compared with patients with lower PAPP-A Ievel(all P<0.01).Positive remodeling,attenuated plaque and plaque rupture were significantly more often in patients with higher PAPP-A than in patients with lower PAPP-A level(all P<0.01).PAPP-A≥11.0 mIU/L(OR=5.921,P=0.014)and attenuated plaque(OR=7.541,P=0.038)were independent risk predictors for high-risk UA.Conclusions PAPP-A was associated with instability of culprit plaque in UA patients.PAPP-A≥11.0 mIU/L and attenuated plaque were independent predictors for high-risk UA.

Objective To analyze the risk factors related to in-hospital bleeding for patients with acute coronary syndrome (ACS).Methods Clinical and therapeutic data of 3807 patients who were registered with acute coronary syndrome in SINO-GRACE in China from March 2001 to December 2007 were reviewed.A total of 57 patients were grouped to bleeding group and 234 out of the remaining 3750 patients without bleeding were randomly chosen and served as non-bleeding group.Hemorrhage-related factors were screened and compared between the two groups.Unitary logistic regression analysis was performed to detect the possible factors related to hemorrhage.Factors with P ＜ 0.1 were further analyzed by stepwise regression method and multivariate conditional logistic regression analyses.Results (1) Age,history of coronary artery bypass graft (CABG),previous hemorrhage,renal failure and heart failure as well incidence of acute coronary syndrome were significantly higher in bleeding group than in non-bleeding group (all P ≤0.05).Patients were more often treated with clopidogrel and glycoprotein (GP) Ⅱ b/Ⅲ a receptor antagonist in bleeding group than in non-bleeding group.(2) Single factor logistic regression analysis showed that age ＞70 years,history of previous bleeding,renal failure,heart failure,clopidogrel and GP Ⅱ b/Ⅲ a receptor antagonists use,non-ST-segment elevation myocardial infarction,inferior wall,lateral myocardial infarction,CABG were risk factors for bleeding (all P ＜ 0.05).(3) Multivariate logistic regression analysis showed that history of renal failure (OR =19.77,95％ CI 4.38-89.18,P ＜ 0.01) and clopidogrel (OR =19.77,95％ CI 4.38-89.18,P ＜ 0.01) and GP Ⅱ b/Ⅲ a receptor antagonist (OR =343.57,95％ CI 40.39-999.99,P ＜ 0.01) use were the independent risk factors for bleeding.Conclusion Our results show that renal failure history and clopidogrel and GP Ⅱ b/Ⅲ a receptor antagonist use are independent risk factors for in-hospital bleeding in patients with acute coronary syndrome.

Objective To evaluate the accuracy of quantitative coronary angiography ( QCA ) assessment on target lesion and reference vessel in patients with diabetes mellitus with intravascular ultrasound (IVUS) measurements as golden standard. Methods QCA and IVUS were performed in 52 diabetes mellitus patients [35 males, mean age (62.3 ±7. 1)years]. Regression equation was ascertained with the IVUS derived plaque burden as dependent and QCA derived vessel stenosis as independent variable. The measurement results derived from the two modalities on proximal and distal reference vessels were compared. Result The regression equation (constant = 0. 8286, P = 0. 001) of plaque burden and vessel stenosis derived from two modalities were significantly correlated ( r = 0. 691, P < 0. 001 ) but QCA overestimated the stenosis severity (57. 9% ± 15. 5% vs. 53. 5% ± 12. 9% , P <0. 01 ). Target vessels negative remodeling index in these patient was 0. 87 ±0.23. QCA significantly underestimated the proximal and distal reference segments vessel diameters [ ( 0. 81 ± 0. 24 ) mm, ( 0. 64 ± 0. 17 ) mm, all P < 0. 05 ] as compared to IVUS results. Conclusion Due to the significant negative vessel remodeling, QCA overestimated the stenosis severity and underestimated the reference segments vessel diameters in patients with diabetes mellitus.

Objective To compare the value of intravascular ultrasound (IVUS) and assess the value of quantitative coronary angiography ( QCA) and 64 multi-detector computed tomography ( MDCT) on unstable anginas (UAP) risk stratification. Method A total of 61 UAP patients (low risk; 17, middle risk; 33 and high risk; 11) were recruited, 71 vessels were examined by MDCT, QCA and IVUS. Plaque characteristics (soft, fibrous, calcified and mixed plaques) and plaque burden at minimum area ( ≤50% , 51%-74% and ≥75%) were detected, calculated and analyzed. Results derived from various detection methods were compared. Results Plaque burden detection by QCA was comparable to IVUS results for low and middle risk UAP ( r = 0. 768 and r = 0. 721, respectively; all P < 0. 01 ) but not for high risk UAP ( 67% ± 14% vs. 75% ± 16% , P < 0. 01) due to significant positive vessel remodeling ( remodeling index = 1.21±0.31). The high negative predict value of MDCT for stenosed coronary vessels(87. 8%-96. 3%) was valuable for exclusion of coronary heart disease but MDCT was not able to identify fibrous cap( kappa = 0. 235) and lipid core ( kappa = 0. 245 ) . Extent of remodeling index, external elastic membrane area, minimum lumen area, plaque burden, plaque rupture and thrombosis increased in proportion to increasing risks of UAP patients. Conclusions QCA is a suitable tool for assessing UAP patients with low and middle vessel stenosis but underestimated the stenosis degree in UAP patients with high vessel stenosis. MDCT is valuable for exclusion vessel disease but not useful for identifying soft and fibrous plaque. Soft plaque with positive remodeling index and minimum lumen area <4 mm~2 derived from IVUS could correctly identify UAP patients with high degree of vessel stenosis.

Objective Novel stents loaded with antibody against CD105 were analyzed for their potential to limit coronary neointima formation and to accelerate endothelialization by attracting activated endothelial cell. Methods Thirty Stents coated with antibody against CD105, thirty unloaded polymer, and thirty bare metal stents were deployed in 90 coronary arteries of 30 minipigs. Oral aspirin (300 mg before operation and 100 mg post operation) and clopidogrel (300 mg before operation and 75 mg post operation) were orally administrated. Coronary artery quantitative analysis was completed by coronary arteriography,the vascular endothelium changes were observed under scanning electron microscope and the vascular morphological changes were observed under light microscope 7 and 14 days after operation. Results Complete procedural and angiographic success was achieved in all 30 minipigs. There were no major adverse cardiac and cerebrovascular events. At 7 days, there was no difference for mean neointimal area and percent rea stenosis among various groups. At 14 days, endothelialization scores were significantly higher in the CD10S antibody-loaded stents and bare metal stents group than in sirolimus-eluting stents group (1.78 ± 0.49, 1. 50±0. 67 vs. 1. 08±0. 29, all P < 0. 05 ), mean percent area stenosis in the CD105 antibody-loaded stents, sirolimus-eluting stents group were less than that in bare metal stents group [ (23. 8± 4) % , (24. 2±2)% vs. (38.0 ±3)% , all P <0.05] ,mean angiographic late luminal loss in the CD105 antibody-loaded stents, sirolimus-eluting stents group were less than that in bare metal stents group [ (0. 29±0. 28) mm, (0. 28±0. 02) mm vs. (0.41±0. 01) mm, all P < 0. 05 ]. There was no difference for mean percent area stenosis in the CD105 antibody-loaded stents and sirolimus-eluting stents group. The mean neointimal area in the CD105 antibody-loaded stents,and sirolimus-elutingstents group were less than that in bare metal stents group [(0.88±0.08) mm2, (0. 89 ±0. 12mm)2 vs. ( 1. 00 ±0. 14) mm2 , all P<0.05] and there was no difference for the mean neointimal area in the CD105 antibody-loaded stents and sirolimus-eluting stents group. At 7 and 14 days, there was no difference for the injury score and the inflammation score among various groups, scanning electron microscopy evidenced enhanced endothelial coverage on CD105 antibody-loaded stents compared to sirolimus-eluting stents group. Conclusion Stent coated with antibody against CD105 could effectively reduce in-stent restenosis and accelerate endothelialization in th eminipigs.