OBJECTIVE:To provide references for the controlling of reimbursement of medicare drug expenditure in urban employees in China.METHODS:Referenced experiences were summed up from classified drug reimbursement acts in other countries and areas stated in the literature review.RESULTS&CONCLUSION:It is a common international policy to clas?sify drugs by quality and adopt different reimbursement ratio;most of the countries and areas would exclude the reimburse?ments of over-the-counter drugs;the purpose of classified drug payment and reimbursement was to increase the users'payment thereby to lessen the burden of the authorities on the expenditure of social medicare drugs;concerning the controlling of drug expenditure,measures only taken from the aspects of price setting,ratio of reimbursement and quantity of drug con?sumption can that be effective;analysis about advantages and disadvantages should be considered in the making of the re?forming policies about establishing pharmaceutical reference prices and setting up prescription fee and etc.

Objective To evaluate the efficacy and safety of intravenous thrombolysiswith urokinase combined with emergency interventional therapy acute myocardial infarction(AMI).Methods 128 patients with AMI were randomized to thrombolysis plus PCI group and primary PCI group,the patency rate of infarct related artery(IRA) before intervention,the procedural success rate,the incidence of bleeding complications and acute ischemic events during hospitalization and the left ventricular ejection function(LVEF) measured by echocardiography before discharge were compared.Results The IRA patency rate in the thombolysis plus PCI group(65.7%) was significantly higher than that in the primary PCI group(24.3%)(P

Objective ToinvestigatethefeasibilityofspectralvirtualnonGcontrast(VNC)takingtheplaceoftruenonGcontrast (TNC)inthyroiddiseases.Methods CTimagesof30patientswiththyroiddiseasewerecollected,includingTNC,spectraldualGphase contrastandconventionaldelayedcontrastimaging.36lesionswithcorrespondingsurgeryandpathologicalconditionswereselected forretrospectiveanalysis.Theradiationdose,imagequality,meanCTvalues,SNRanddiagnosticefficacybetweenTNCand VNC werecompared.Results Theeffectivedose(ED)andtotaldoseGlengthproduct(DLP)ofthespectraldualGphasecontrastscanswere bothsignificantlylowerthanthoseofTNCincombinationwithconventionaldualGphasecontrast(P＜0.05).Thesubjectivequality scoreofVNCwasslightlylowerthanthatofTNC (P＜0.05),howeveritwasacceptableforradiologistwithascoreabove3.The SNRofVNCimageswassignificantlylowerthanthatofTNC (P＜0.05).The meanCTvaluesofVNCimageswerelowerthan thoseofTNCimagesbutwithoutasignificantdifference(P＞0.05).TheabilityofVNCtodelineatenecrosis,calcification,andlymph nodemetastasisinthelesionwasconsistentwithTNC (k＞0.75).Conclusion TheimagequalityofVNCissatisfiedinthediagnosis ofthyroiddiseases.VNChassimilardiagnosticefficacytoTNCwitheffectivelyreducdingradiationdose,whichisapromisingclinical application.

Objective To summarize the safety and efficacy of Sunitinib in the treatment of metastatic renal clear cell carcinoma. Methods Fifteen patients with clear cell metastatic RCC were treated with Sunitinib,with 11 males and 4 females,aged from 26 to 74 years with median age of 55 years.Thirteen cases of 15 were T3 to T4 stage,and 8 cases underwent radical nephrectomy,while 5 other cases underwent renal biopsy with the pathological diagnosis of renal cancer.The other two cases (one man and one woman)with the solitary kidney renal cell carcinoma ( stage T1a) and renal insufficiency,were diagnosed as metastatic renal cell carcinoma by biopsy.Sunitinib monotherapy was administered by the regimen of 6 weeks per cycle with daily oral Sunitinib 4 weeks,followed by 2 weeks off ( from 1 - 10 cycles).Response was evaluated by RECIST.Renal tumor was 9.52 ± 3.3 cm in diameter at baseline,and the assessment of metastases included retroperitoneal lymph nodes (6 cases),mediastinal lymph nodes (3 cases),brain (2 cases),lung (6 cases),bone (2 cases) and liver (2 cases).Karnofsky score,tumor changes,adverse events and the survival of each patient was assessed and recorded. Results The follow-up duration was from 1.5 - 15months,with median follow-up of 6 months,and tumor response was evaluated by RECIST.Seven of 15 patients (46.7％) treated with Sunitinib achieved partial responses (PR),7 patients (46.7％) demonstrated stable disease (SD),and 1 patient (6.7％) developed progressive disease (PD) during the follow-up.Objective Response Rate (ORR) was 46.7％,PR + SD was 93.3％,6 months PFS was 93.3％,and median PFS was 12 months,respectively.Renal tumor was 8.7 ± 4.0 cm in diameter after therapy.Two PR patients with the obvious effectiveness had experienced progressed hypertension,and one cases with hypertension that could be controlled below 140/90 mm Hg ( 1 mm Hg =0.133 kPa) by a single drug before treatment,showed increased blood pressure ( ＞ 160/105 mm Hg) following the second cycles treatment,who were administered increased dosage and combination therapy.The other case without history of hypertension,showed high blood pressure ( ＞ 150/100 mm Hg) in the third cycle,and could be controlled well by antihypertensive drugs.Fortunately,the tumor of these two cases reduced obviously by more than 50％. 1/2 adverse reactions of 12 cases:yellowing of the skin and yellow sweat ( 12 cases,80％ ),fatigue ( 12 cases,80％ ),4 cases of hypothyroidism (26.7％),bilirubin and triglyceride levels elevated in 7case (46.7％); Four cases showed 3/4 degree adverse events with the emergence of gastrointestinal bleeding in one case secondary to platelets reduction (6.7％).Three cases (20％) showed serious fatigue,nausea,vomiting and severe hand-foot skin reaction. Conclusions Sunitinib is recommended for the treatment of metastatic renal clear cell carcinoma with good efficacy and safety.

Objective ToinvestigatethecorrelationandthediagnosticefficiencyofquantitativeDCE-MRIparametersandADC valueinhistopathologicalgradeinpatients withinvasiveductalbreastcancer.Methods The DCE-MRIquantitativeparameters (Ktrans,KepandVe),semiquantitativeparameters(W-in,W-outandTTP)andtheADCvaluewereanalyzedandcomparedaccording bydifferenthistopathologicalgradein90invasiveductalbreastcancerpatients.Results ThemeanvalueofKtrans washigheringradeⅢgroupthanthatingradeⅡgroup,andthemeanvalueofADCwasloweringradeⅢgroupthanthatingradeⅡgroup.Thedifferenceswere statisticallysignificant(P<0.05),butthecorrelationswereweak(|r|<0.30).TherewerenostatisticallysignificantdifferencesamongKep, Ve,W-in,W-out,TTPingradeⅡandgradeⅢ (P>0.05).TheAUCofKtrans,ADCandKtranscombinedwithADCwere0.647,0.685 and0.749,respectively.Conclusion TheDCE-MRIquantitativeparametersKtransandADCvaluehavecorrelationswithhistopathologicalgradeof invasiveductalbreastcancer.HigherKtransandlowerADCvalueindicatehigherhistologicalgrade,andKtranscombinedwithADCcould improvethediagnosticefficiency.

Objective: To explore the value of dynamic contrast-enhanced MRI (DCE-MRI) based radiomics model in predicting the pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) of breast cancer. Methods: In this retrospective study, 91 patients who had received NAC and had pathological response results were collected in Meizhou people′s hospital from January 2016 to August 2018. A primary cohort consisted of 63 patients and an independent validation cohort consisted of 28 patients. The patients were divided into pCR group of 23 cases and non-pathological complete response (Non-pCR) group of 68 cases. All the patients underwent dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before NAC. A list of radiomics features were extracted using the A.K software and the corresponding radiomics signature was constructed. Logistic regression was used to develop the prediction model. The predictive ability of the model was tested by using the area under the curve (AUC) of ROC analysis. Results: The discrimination performance of radiomics signature yielded a AUC of 0.750 in the primary dataset and a AUC of 0.789 in the validation dataset. The model that incorporated estrogen receptor (ER), progesterone receptor (PR) and radiomics features was developed, and had an AUC of 0.859 in the primary dataset and an AUC of 0.905 in the validation dataset. Conclusion The radiomics predictive model, which integrated with the DCE-MRI based radiomics signature, ER and PR, can be used as a promising and applicable adjunct approach for predicting the pCR to NAC of breast cancer.

Epimedii folium is a commonly used Traditional Chinese Medicine (TCM) for warming the kidney and strengthening the yang qi. It has androgen-estrogen-like effect. It can not only directly act on sexual organs to regulate hormone levels, but also exert sex-hormone-like effect through hypothalamus-pituitary-gonadal axis. Its regulation of hormone levels is similar to that of plant hormones. At present, Epimedii folium is commonly used with other TCMs to treat diseases caused by sex-hormone deficiency, such as male spermatopenia, asthenospermia, benign prostatic hyperplasia, functional erectile dysfunction, female premature ovarian failure, perimenopausal syndrome, dysfunctional infertility during ovulation, hyperandrogenemia of PCOS patients, etc.

Objective To explore the predictive value of the enhanced CT imaging-based radiomics model and the clinical model for the serosal invasion in advanced gastric cancer.Methods The data were collected from 351 patients with advanced gastric cancer who underwent abdominal enhanced CT examination within 2 weeks before surgery,and the patients were randomly divided into a training group(n=247)and a validation group(n=104)in a ratio of 7:3.The 3190 radiomics features which were extracted from the arterial and venous phase CT images using A.K software were dimensionally reduced for constructing a radiomics model.The pathological features between serosal invasion positive and negative groups were compared,and the significant features were used to establish a clinical model.The model's performance was evaluated using receiver operating characteristic curve.Results In the training and validation groups,N staging and M staging were different in serosal invasion positive and negative groups(P<0.05).A total of 14 radiomic features were ultimately selected from the arterial and venous phase images.In the validation group,the diagnostic efficacy of the radiomic model for predicting serosal invasion in advanced gastric cancer was higher than that of the clinical model based on the combination of N staging and M staging(AUC:0.854 vs 0.793).Conclusion Both the radiomics model based on the enhanced CT imaging and the clinical model based on the combination of N staging and M staging can successfully predict serosal invasion in advanced gastric cancer,but the former performs better.