In this paper, a systematical and retrospective review was made on how the drug purchasing system of Chinese healthcare institutions has evolved from decentralized purchasing to centralized purchasing based on four stages as budding stage, initial stage, adjustment stage and deepening stage. In each stage, the working characteris-tics, achievements and problems have been analyzed. Targeting at the problems and challenges confronted with cur-rent drug purchasing, recommendations was made to reform and improve public hospitals’ centralized purchasing sys-tem, such as persisting centralized purchasing online at provincial level, sticking to “four favorable” principles, breaking through the mechanism of compensating medical cost with drug-selling profits, promoting coordinated inter-action reforms in healthcare insurances, distribution and pricing, strengthening comprehensive services and supervi-sion, etc.

Objective To investigate the expression and distribution of Kv1.6 in rat hippocampus after status epilepticus (SE) induced by lithium and pilocarpine to explore the relationship between Kv1.6 and epileptogenesis.Methods Forty-eight healthy male Sprague-Dawley rats were randomly divided into experiment group and control group.The rats in each group were randomly assigned into 6-hour,1-day,2-day and 3-day subgroups (n =6).Electroencephalography (EEG) of rats in both groups were recorded to show the electrical activity of the rat brains.Nissel staining was performed to investigate the pathological changes,and immunohistochemistry and Western blotting were applied to analyze the expression and distribution of Kv1.6.Results (1) The EEG of rats in control group showed α wave with uniform amplitude,while the EEG in rats subjected to pilocarpine injection showed slow waves and spike waves with irregular amplitude and rhythm.Sustained spike waves were observed during SE.(2) Nissl staining showed that 6 hours after SE,the neural morphology of hippocampi in experiment group was as the same to that in control group.There was no change in neuronal morphology and numbers.However,1 day after SE,the structure of hippocampi was discrete and the number of neurons was decreased.Two and 3 days after SE,the number of neurons in hippocampi decreased further.Swelling and deformation of neurons were seen.Nissl bodies emerged,decreased or even disappeared.(3) There was no statistically significant difference in the expression of Kv1.6 in CA3 and CA1 areas between experiment group and control group 6 hours after SE (all P＞0.05).One day,2 days and 3 days post SE,the expression of Kv1.6 in CA3 area (0.117 ±0.040,0.135 ±0.029,0.112 ±0.050) decreased obviously compared to control group (0.192±0.054,0.201 ± 0.062,0.184 ±0.042;t---3.861,3.745,5.579,all P ＜0.05);and the expression of Kv1.6 in CA1 area (0.114 ± 0.02,0.082 ± 0.031,0.106 ± 0.043) decreased significantly compared to control group (0.165±0.036,0.187 ±0.025,0.172 ±0.052;t=3.221,6.360,3.645,all P＜0.05).The expression of Kv1.6 did not show statistically significant difference in DG area between experiment group and control group at all time points examined (P ＞ 0.05).The Western blotting showed the same trend.Conclusion The decreased expression of Kv1.6 may play a role in the epileptogenesis.

Objective: To compare the efficacy of conventional radiotherapy and three dimensional conformal radiotherapy (3D-CRT) for malignant glioma retrospectively. Methods: From January 1997 to May 2007, 152 patients with malignant glioma received postoperative radiotherapy at our hospital. Patients were classified into two groups according to the radiotherapy techniques. Group A (n=85) received conventional whole brain or subtotal brain irradiation at 36.40 Gy followed by a boost of 20 Gy to the tumor bed. Group B (3 D-CRT group, n = 67) were given 50-54 Gy of irradiation in the clinical target volume (CTV) and 60 Gy of irradita-tion in the gross tumor volume (GTV). GTV was defined as the high signal area on T2 weighted FLAIR MRI image, and CTV was defined as GTV plus a 2-cm margin. The fraction dose for both conventional chemotherapy and 3D-CRT was 2.0 Gy/fx, once a day, five times per week. The efficacies of both ratiotherapy were compared and the failure mode was analyzed. Results: The 3-year overall survival rates were 22.9% and 31.9% in group A and group B, respectively (χ2 = 1.01, P = 0.31). Incidence of increased intracra-nial pressure were 47.1% and 31.3% in group A and group B, respectively(χ2 = 3.95, P = 0.04). All the tumor recurrence was detected within the range of GTV and CTV in 45 patients in group B. Conclusion: 3D-CRT reduces the incidence of radiation-induced high intracranial pressure of malignant glioma patients compared with conventional radiotherapy. The irradiation volume including the high signal area on T2 FLAIR MR imaging plus a 2-cm margin is feasible in 3D-CRT.

?AIM:To investigate the causes and characteristics of retinal detachment after vitrectomy.?METHODS: Retrospective analysis of patients in our hospital in recent 4a who underwent primary, standard, three -port pars plana vitrectomy ( PPV ) . Retinal detachment occurred in 24 eyes ( 23 cases ) , 24-67 years old, average 49.0±12.0 years old.There were male in 17 cases, female in 6 cases, 6 right eyes, 18 left eyes.?RESULTS:Eighteen (75%) eyes without any symptoms were found during a routine check, 6 eyes ( 25%) with decreased visual acuity or in front of shadow.It took 1-223d from PPV to retinal detachment, average 40.7 ± 54.2d, of which retinal detachment occurred in 10 (42%) eyes within 1wk, 14 (58%) eyes within 1mo.The direct cause of retinal detachment was new retinal break ( a total of 27 holes ) in 19 eyes, proliferative vitreoretinopathy ( PVR) in 4 eyes, 1 eyes with primary hole not closed.All retinal detachment were ultimately completely reset.?CONCLUSION: The occurrence of new retinal breaks is the main cause of retinal detachment after vitrectomy, attention should be paid to the early postoperative peripheral retinal examination;after a timely surgery, the retina can be reset.

Objective To study the inhibitory effects of angelica A_3 active fraction (A_3) inflammation and up-regulation of cyclooxygenase-2 (Cox-2) expression of rat uterus induced by lipopolysaccharides (LPS). Methods The anti-inflammatory effects of A_3 were investigated in rats using the carrageenin-induced paw swelling model and in mice using dimethylbenzene-induced ear edema model; RT-PCR and Western blotting were used to analyze Cox-2 mRNA and the protein expression levels. Results A_3 (1, 5, and 10 mg/kg) dose-dependently inhibited dimethylbenzene-induced ear edema in mice and paw swelling in rats by ig administration. LPS 1 ?g/mL could significantly increase the level of Cox-2 mRNA and protein expression. A_3(10—320 mg/L) could concentration-dependently inhibit Cox-2 mRNA and protein over-expression stimulated by LPS. Conclusion A_3 possesses better anti-inflammatory effects than angelica oil, which maybe relates to its inhibitory effects on Cox-2 overexpression.

Objective To ascertain the gross α/β levels in drinking water in Inner Mongolia and to estimate the annual effective dose to the local residents from radionuclides in drinking water.Methods A total of 768 water samples were collected from 101 counties distributed over 12 cities of Inner Mongolia.Low background α/β measuring instrument was used to measure the radioactivity level;On this basis,use EPA Federal Guidance Report 11 universal method to estimate the annual effective dose to the local residents via intake of radionuclides from drinking water.Results The gross α radioactivity range was 0.016-1.003 Bq/L for tap water,O.016-0.975 Bq/L for factory water,0.017-1.544 Bq/L for river water,0.120-0.672 Bq/L for lake water,0.016-0.492 Bq/L for reservoir water,0.016-1.139 Bq/L for well water,0.032-3.156 Bq/L for spring water,respectively.The gross β radioactivity range was 0.030-0.828 Bq/L for tap water,0.031-0.571 Bq/L for factory water,0.066-0.873 Bq/L for river water,0.169-2.268 Bq/L for lake water,0.046-0.519 Bq/L for reservoir water,0.071-0.526 Bq/L for well water,0.087-1.063 Bq/L for spring water,respectively.Conclusions In Inner Mongolia,the gross α/β mean value in tap water is less than the World Health Organization-recommended value and the average annual effective dose from tap water is also less than the WHO-recommended value O.1 mSv/a.The gross α/β radioactivity from the other water samples is also within the range of the nationwide average.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Lung Neoplasms ; genetics ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide ; Receptor, EphB4 ; genetics

Objective To investigate the effect of abnormal lipid metabolism in the pathogenesis of preeclampsia.Methods Thirty women with severe preeclampsia who delivered by cesarean section in the International Peace Maternity & Child Health Hospital from November 1,2011 to June 30,2012,were included as the study group.Thirty normal pregnant women delivered during the same period by cesarean section were included as the control group.The mRNA levels of lipoprotein lipase (LPL) and endothelial lipase (EL) in the placentas were quantified by real-time polymerase chain reaction.The expression of LPL/EL protein was detected by Western-blot assay and the distribution on the placenta was determined by immunohistochemical staining.The maternal serum level of lipid markers was detected by automatic biochemical analyzer.Difference between the two groups was compared with t-test or rank-sum test.Results (1) The triglyceride (TG) concentration [(3.35±0.80) mmol/L vs (2.75± 0.92) mmol/L,t =3.082,P=0.003] and atherosclerosis index (AI) (2.76±0.46 vs 2.47±0.34,t=3.066,P=0.003) increased in the study group compared with the control group,while the concentration of high-density lipoprotein-cholestrol (HDL-c) decreased[(1.64 ± 0.34) mmol/L vs (1.85 ± 0.22) mmol/L,t=-3.157,P =0.003].(2) The median level of LPL mRNA expression in placenta of the study group was higher than that of the control [1.26 (0.46-1.58) vs 0.52 (0.34-0.84),Z=-2.587,P=0.010],whereas the expression of EL mRNA was lower [0.65 (0.48-0.76) vs 1.32 (0.94-1.62),Z=-4.154,P=0.000].(3) Immunohistochemical analysis showed that the placenta EL and LPL located in cytoplasm of syncytiotrophoblast cells at the materno-placental interface and of endothelial cells at the feto-placental interface.(4) Compared with the control group,the median level of LPL protein expression in placenta inthe study group increased [0.68(0.46-0.83) vs 0.31(0.15-0.55),Z=3.335,P=0.001],and the expression of EL protein decreased [0.13 (0.11 0.16) vs 0.70(0.56 0.81),Z=-5.711,P=0.000].The expression of LPL protein was negatively correlated with that of EL protein (r=-0.501,P=0.000).Conclusions Abnormal lipid metabolism contributes to the pathogenesis of severe preeclampsia.

This study aimed to evaluate emerging trends of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) among 290 former blood donor HIV-1 infected patients in Hubei,China,from 2004 to 2006,all of whom had received anti-HIV-1 therapy.The presence of NRTI- and NNRTI-associated mutations were established by sequencing; genotypic and predicted phenotypic drug resistance were evaluated using HIVdb Program version 5.0.1 (http://hivdb.stanford.edu/pages/algs/HIVdb.html).Genotypic drug resistance analysis showed significant increases in percentages of patients carrying HIV-1 strains with M41L,T215Y/F,D67N,K103N,G190A/S,Y181C/F or L210W mutations.Of the variants' predicted phenotypic drug resistance,highly significant increases were detected in percentages of patients carrying HIV-1 with high resistance to zidovudine (AZT) or stavudine (D4T) in NRTIs,and to delavirdine (DLV),efavirenz (EFV) or nevirapine (NVP) in NNRTIs; intermediate resistance to abacavir (ABC),AZT,D4/T,didanosine (DDI) or tenofovir disoproxil fumarate (TDF) in NRTIs,and to etravirine (ETR) in NNRTIs; and low and potential low resistance to lamivudine (3TC),ABC,emtricitabine (FTC) or TDF in NRTIs,and to ETR in NNRTIs.

Objective To study the clinical effects of different surgical treatments for laryngotracheal steno-sis .Methods The clinical data of 56 patients with laryngotracheal stenosis from July 2006 to July 2014 were ana-lyzed .Of all 56 cases ,7 cases were children ,49 cases were aducts ;9 cases underwent CO2 laser resection ,5 cases underwent temperature controlled radiofrequency ablation and 5 cases received laryngeal mold under self -retaining laryngoscope ,6 cases received Keel placement after laryngofissure ,23 cases received T -shape tube implantation af-ter laryngoplasty or tracheoplasty and 8 cases underwent end-to -end tracheal anastomosis after cervical tracheoto-my .Results All the patients had been followed up for 6 months to 2 years postoperatively .Thirty nine cases of 56 were cured after single-operation ,and 10 of 56 were cured after repeated operations .No one suffered from laryn-gotracheal stenosis again .Five cases failed and survived with tracheal tube .2 cases lost to follow -up .No people die or had complications .Among all cases ,5 cases with laryngeal mold and 8 cases with tracheal anastomosis were cured after single-operation .Among 9 cases with lasere scar removal surgery ,5 cases were cured after an operation ,3 cases were cured after two operations ,1 case failed because of laryngeal cancer recurrence .Among 5 case with tem-perature controlled radiofrequency ablation ,3 cases were cured afrter an operation ,1 case was cured after two opera-tions ,1 case had no effect .Among 6 cases with keel place -ment ,4 cases were cured after one operation ,1 case was cured after two operations ,1 case had no effect .Among 23 cases with T -shape tube implantation ,14 cases were cured after an operstion ,5 cases were cured after two and more operations ,2 cases had no effects and 2 cases were lost .Conclusion In order to improve the therapeutic effects of laryngotracheal stenosis ,the treatment strategy should be personalized according to the degree of stenosis ,the position of stemtis ,and the impairment of laryngotra-cheal framework .