Many stakeholders are involved in the implementation of centralized drug procurement , namely government agencies ,drug bidding or procurement agencies ,pharmaceutical companies ,medical institutions ,doctors ,patients and health care institutions among others.The game falls into three stages.The first is that between government agencies or drug procurement agencies and medical institutions or doctors ;the second is that of price negotiations between the hospital and the winner pharmaceutical enterprise ; the third is that between doctors , patients and medical insurance agencies.Major setbacks found in the implementation of such a policy are as follows :disappearance of classic inexpensive drugs from the market ;rebates and commissions in the second bargainingphenomenon ;slow progress in the implementation of the purchase with quantity indication policy ;rapid rise of medical costs for national health insurance.Recommendations by the authors include optimization of the centralized drug procurement ;improvement of the public hospital performance appraisal system and talent evaluation system ;promotion of the purchase with quantity indication policy ;building of the game pattern of equal‐footing negotiation between hospitals and pharmaceutical companies ; and introduction of the payment management of medical insurance .

Objective To explore whether combination of Goremor vessel electroacupuncture and transplanted neural stem cells could promote the completely transected spinal cord tissue producting some nerve growth active substances. Methods Fourty-five adult rats were divided into normal group,control group,neural stem cells transplanted group(NSCs group),Goremor vessel electroacupunctural group(EC group) and Goremor vessel electroacupuncture plus NSCs transplanted group(EC+NSCs group).All animals(except for the normal group) were performed complete transection on T10 segment of spinal cord.The electroacupunctural treatment started at the fifth day after operation among EC group and EC+NSCs group.The sacrifice time of rats was the 14d and 28d after operation respectively.The cyclic adenosine-monophosphate(cAMP) radioimmunoassay and Western blotting test for levels of Neuroltrophin-3(NT-3),neurotrophic factor receptor——Trk and growth associated protein-43(GAP-43) were made in the tissue of injured spinal cord. Results 1.Fourteen days after operation,cAMP concentration at cranial segment and caudal segment of injured spinal cord segment was lower in all groups than that of normal group,except for EC group.cAMP concentration at injured segment was increased slightly in EC group and EC+NSCs group than that of normal group,Twenty-eight days after operation,cAMP concentration at cranial segment and caudal segment of injured spinal cord segment maintained a higher level in EC+NSCs group.cAMP concentration at injured segment was increased slightly in NSCs group and EC+NSCs group than normal group.2.The expression of NT-3,Trk and GAP-43 was more prominent in EC group and EC+NSCs group.Meanwhile,the expression of three proteins was lower in control group and NSCs group than that of EC group and EC+NSCs group.Conclusion Goremor vessel electroacupuncture may promote the injured spinal cord tissue producting cAMP.The combination of Goremor vessel electroacupuncture and transplanted neural stem cells may maintain higher cAMP concentration and tend to increase the concentration of NT-3,Trk and GAP-43 in injured spinal cord tissue.

Introduced in the paper are the connotation and current operations of the medical insurance negotiation mechanism.The authors also discussed obstacles blocking operations of the mechanism, including insufficient coordination capacity of the medical insurance institution over the negotiation, and lack of motivation of the institution for curbing costs and the contradiction against the profit pursuit of drug companies.Corresponding countermeasures and suggestions are put forward in the end, namely system reform for inter-governmental functions, enhancement of the capacity of both medical institutions and doctors against risks, and perfecting the restraint and incentive mechanism for medical institutions, aiming at smooth operation and optimization of the medical insurance negotiation mechanism.

This paperd probed four mistakes about teaching of Operational Research of Hygienic Management from different angles such as nature of courses,content of courses,academic goal and multimedia.By teaching example analysis,it put forward corresponding measures and suggestions on how to avoid these mistakes.

Hashimoto thyroiditis (HT) is the most common autoimmune disease of the thyroid. The thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) always increase greatly in the patients. Thyroid cancer is the most common malignant tumor in the endocrine system. And papillary thyroid carcinoma (PTC) is the most common pathological type of it. Recently, the coexistence of HT and PTC has shown an increased incidence. And these two diseases have many similarity in immunology, endocrine, genetics, implying the links between them. However the underlying mechinisms remain unclear. On the ground of the characteristics of epidemiology and histopathology, this article reviews and summarizes possible mechanism in many ways for the coexistence of these two disease, including precancerous lesion, cell proliferation and apoptosis disorder, immunology, endocrinology, genetics, etc.

OBJECTIVE: To explore the techniques for providing drug consultations to improve the pharmaceutical care level.METHODS: The drug consultation records of 601 ophthalmological outpatients in our hospital from Mar.2007 to Mar.2008 were analyzed retrospectively.RESULTS: 36.8% of the patients consulted from the clinical pharmacists about the administration of drugs versus 15.9% about the adverse drug reactions.CONCLUSION: The drug consultation service provided by pharmacists can promote rational drug use and enhance the therapeutic efficacy.

OBJECTIVE:To evaluate the effect of ambroxol on plasma concentration and pharmacokinetic parameters of roxithromycin when healthy volunteers received roxithromycin and ambroxol. METHODS: In double-period cross-over experiment, 24 healthy male volunteers received roxithromycin tablets or roxithromycin tablets combined with ambroxol tablets. Serial venous blood samples were collected at different time points after drug administration. Plasma concentrations of roxithromycin were measured by LC-MS. The pharmacokinetic parameters of roxithromycin were calculated and analyzed by variance analysis. Drug interaction was detected by 90% confidence interval. RESULTS: Main pharmacokinetic parameters of roxithromycin tablets and drug combination were as follows: tmax(1.67?0.32)h vs. (1.67?0.41)h; Cmax(10.26?2.82) mg?L-1 vs. (10.86?3.19) mg?L-1; AUC0～72(110.19?35.18) mg?h?L-1 vs. (113.42?38.72)mg?h?L-1; AUC0～∞(111.70?36.23) mg?h?L-1 vs. (115.04?39.98) mg?h?L-1. CONCLUSION:? Ambroxol has no effect on the plasma concentration and pharmacokinetics of roxithromycin in healthy volunteers.

Objective To evaluate the clinical curative effect and safety of the stapled transanal rectal resection (STARR) in treatment rectocele. Methods Ninety-two cases suffering from rectocele were treated with rectal inferior extremity half circum mucosectomy by PPH stapler. The operative time, operation effect,complication and recurrence rate were studied. Results All cases were operated successfully. The mean operation time was (25 ±8)min,The totol effective rate was 100% ,postoperative complication included inferior abdomen discomfort and pain (32 cases,34. 7%),urinary retention(9 cases,9. 8%) ,anal anus pain(5 cases, 5. 4%) and bleeding(3 cases,3. 3%). The average length of postoperative stay was 1-5 days (average[2. 2 ±0. 9]days). The follow-up period ranged from 4 to 40 months and no recurrence was observed. Conclusion The stapled transanal rectal resection (STARR) has several advantages,such as safety,rapid recovery,good recent therapeutic effect and lower recurrence in treating rectocele.

Objective To investigate the clinical efficacy of endovascular treatment for iliac vein compression syndrome (IVCS) in 112 cases. Methods From September 2011 to June 2015, 112 cases of IVCS (Cockett syndrome) were treated in our hospital with endovascular methods .The case numbers of different CEAP ( clinical etiological anatomical pathophysical ) classifications were C2 (45 cases), C3 (23 cases), C4 (19 cases), C5 (11 cases) and C6 (14 cases).All the cases were diagnosed by venography .The operations started from puncturing the ipsilateral veins .The stenotic degree and compressed intensity of iliac vein were evaluated by the minimum diameter with low pressure balloon .And then a stent was placed into after percutaneous transluminal angioplasty ( PTA) when residual stenosis was more than 50%.The occlusive segment was dilated by 8 mm diameter balloon firstly , and catheter directed thrombolysis treatment was applied if thrombus was detected .The PTA and stenting were performed when the thrombus was completely removed .The improvement of clinical symptoms was observed after operation and the patients were followed up by ultrasound and venograghy . Results Nine cases were given PTA only , and the other 103 cases underwent stent placement . Postoperative venography showed collateral vessels were disappeared in 22 cases, obviously decreased in 56 cases and mildly decreased in 34 cases.The average difference of swelling leg ’s circle was diminished from (2.56 ±0.88) cm pre-operation to (0.93 ±0.71) cm post-operation, while the average area of skin ulcer was diminished from (6.34 ±3.78) cm2 pre-operation to (2.13 ±1.88) cm2 post-operation, all of which were statistically significant (t =20.24 and 7.19,P=0.000).A total of 86 cases were successfully followed up during a period from 2 months to 45 months (average, 19.2 months).The patency rate of treated iliac vein 12 months after operation was 76.2%in the PTA group, and in the PTA with stenting group was 96.7%, 88.6%, and 86.1%, respectively, at 12, 24, and 36 months after operation, in which a statistical significance was detected (log-rank χ2 =30.32, P=0.000).The patency rate in diameter ≥16 mm group was 95.2%and 95.2%, respectively, at 12 and 24 months after operation, while in diameter <16 mm group was 97.0%and 93.3%, respectively, in which no statistical significance was detected (log-rankχ2 =0.39, P=0.532).Thrombotic complication was found in 2 cases during the follow-up period , including 1 case of iliac vein thrombosis at 1 month and 1 case of thrombus in contralateral leg 8 months later .According to the results of venography in 78 cases at 12 months after operation , restenosis was found in 5 out of 6 cases in the PTA group, and the patency rate in the stent placement group was 95.8%(69/72).No stent migration was found . Conclusion Comfortable clinical results were obtained after endovascular therapy for iliac vein compression syndrome , and the application of stenting could increase the middle and long term patency rate of treated vessels .

Objective To investigate the clinical characteristics and differences among Uygur and Han patients with simple severe preeclampsia and their first-degree relatives. Methods To analysis the 100 cases with simple severe preeclampsia among Uygur and Han patients and their first-degree relatives. Results The age and gestational age between Uygur and Han group, there was no significant difference (P>0. 05). Average production time, women with preeclampsia history and BMI of Uygur group were higher than the Han group(P < 0. 05). Antenatal examination times of Uygur group was lower than the Han group(P < 0. 05). Hypertension, cardiovascular and cerebrovascular disease prevalence rate of mother in the Uygur group were higher than their father(P < 0. 05). The comparison of parents in Han and Uygur group were no statistically significant difference (P>0. 05). Conclusion During pregnancy, the Uygur should pay more attention to improve diet structure, control body weight, and strengthen their pregnancy health care, so that the disease can be early diagnosed and treated, reducing or avoiding therapeutic preterm labor.