Equity of the essential medicine system involves social justice,being important in health services availability equity.The essential medicine system,in practice in China,has to a certain extent improved the equity of health service availability,yet found with poor equity in the process due to differences in insurance,regional diversity,pricing of essential medicine,and poor implementation of the system at primary medical institutions.Such equity needs to be further improved in the future in such aspects,consistence of different insurance reimbursement percentages,further support to underdeveloped areas,encouragement of market competition,and better compliance of primary medical institutions in implementing the system.

OBJECTIVE To know of the application status of ?-lactamase inhibitor antibiotics in our hospital,promote the compliance of Guideline for application of antibiotics,and cut down the abusing or irrationally using of antibiotics.METHODS Retrospective cohort research was used to review the medical records of 1184 patients left our hospital.Based on the inspection results,to select following 98 inpatients to do prospective research and correct those problems found in the retrospective research.RESULTS There were 71 cases in the prospective research who had applied antibiotics,in which 23 cases had used ?-lactamase inhibitor antibiotics;20 cases with precautious application,18 cases underwent type Ⅰ operation and used antibiotics for 2 to 10 days;2 cases underwent type Ⅱ operation and used antibiotics for 5 to 6 days;2 cases underwent type Ⅲ operation;3 cases of internal medicine patients had been treated with ?-lactamase inhibitor antibiotics for 10 days,not selected by the type of bacteria and the result of drug sensitivity test,and no analysis records in the progress note.CONCLUSIONS In surgical departments,use antibiotics as preventive measurements even after clean operation which lack indications and choose over estimated level of ?-lactamase inhibitor antibiotics and combine medication for post-operation preventive medicine.When treating ordinary infections,Internal department had chose antibiotics which should be used for difficult diseases caused by resistant microbes.Most patients do not have undergone bacteria cultivation and drug sensitivity test before applying antibiotics.Therefore the management of antibiotics should be enhanced.

According to the registered product standards specification of medical devices, combined with the standard reviewing work, the common problems of standards during medical devices registration were analyzed and corresponding suggestions were proposed to standardize the standard of the registered product, accelerate the standardization and promote the industry standardized.
Device Approval ; Equipment and Supplies ; standards

Objective To study further the etiology of cerebral palsy(CP),and the clinical effects of early diagnoses and intervening treatments.Methods The causes,clinical typing and CT/MRI features of CP in 240 cases were analyzed.The patients with CP were treated with the drugs of trophic nerve,the channel pilot frequency,the laser transmission and the drugs penetrating skin by point combined with functional exercise attaining ect.Results Among 240 cases in the study,birth asphyxia was 44.6％ .The total effective rate was 87.1％ . Conclusion Most cases may be prevented by health care in perinatal period.The younger the age,the more satisfactory is the therapeutic effectiveness for treating CP.

OVX

Multislice Cr angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease.Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease.High diagnostic value has been achieved with multisfice CT angiography with use of 64-and more slice CT scanners.In addition,multislice CT angiography shows accurate detection and analysis of coronary calcium,characterization of coronary plaques,as well as prediction of the disease progression and major cardiac events.Thus,patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures.The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease;prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques.Limitations of multislice Cr angiography in coronary artery disease are also briefly discussed,and future directions are highlighted.

Objective To investigate the mechanisms of oxygen free radical/JNK signaling pathway on neuronal autophagy after subarachnoid hemorrhage(SAH) in rats.Methods 160 male Sprague-Dawley rats were randomly divided into four groups: sham group, SAH model group, low dose Edaravone group and high dose Edaravone group.The SAH model was established by autologous blood injection into cisterna magna twice, while the rats in the sham group were injected with isotonic saline(0.3mL/time).The high dose of edaravone group and low dose of edaravone group were given 5mg/kg or 10mg/kg of edaravone, respectively, once daily with tail intravenous injection after the models were established.The morphological changes of hippocampus neural cells were detected by light microscope.The malondialdehyde (MDA) level in brain tissue was determined with thiobarbituric acid.The changes of phosphorylated JNK and autophagic biomarkers (Beclin-1 and LC3-II)were detected by immunohistochemical method.The expressions of JNK mRNA,Beclin-1 mRNA and LC3 mRNA in hippocampus was detected by Real time-quantitative PCR.Results The necrotic nerve cells were seen in the hippocampus of SAH group in terms of nuclear dissolution, nuclear fragmentation or nuclear disappearance.Compared with Sham group, the level of MDA and the number of dead neurons, the expression of JNK mRNA, Beclin-1 mRNA and LC3-Ⅱ mRNA were increased in the SAH group (P<0.05).The survival rate of nerve cells in the SAH group was lower than that in the sham group.The immunoreactivity of phosphorylated JNK 、Beclin-1 and LC3-Ⅱ in the SAH group was enhanced than that in the sham group.However the damage of the morphological structure of nerve cells was relatively decreased in both doses groups.Compared with SAH group, the level of MDA and the expression of JNK mRNA in low dose Edaravone group and high dose Edaravone group were decreased.The expression of Beclin-1 mRNA and LC-3 mRNA was higher (P<0.05).Furthermore, the survival rates of nerve cells in both dosesgroups were higher than that in the SAH group (P<0.05).Meanwhile, the immunoreactivity of phosphorylated JNK in both doses groups was weakened than that in the SAH group.The mRNA expression of Beclin-1 and LC3-Ⅱ was increased(P<0.05).Conclusion Oxygen free radical played an important role in process of neuronloss by activating the JNK signaling pathway to regulate Beclin-1 and LC3-Ⅱ expression.

Objective To evaluate the influence of different hemoperfusion (HP) intensities on prognosis in patients with acute paraquat (PQ) poisoning. Methods The data of patients with acute PQ poisoning admitted to Department of Emergency of Shengjing Hospital Affiliated to China Medical University from January 2012 to February 2016 were retrospectively analyzed. Patients satisfied the following criteria were enrolled in the study: adult patients, ingestion PQ within 12 hours and receiving HP treatment within 24 hours. Depending on the intensity of HP, patients were divided into lower intensity HP group (LHP, defined as receiving HP for less than 2 hours, 1 column) and higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients were divided into three groups, i.e. small dose (< 20 mL), medium dose (20-40 mL), and high dose (> 40 mL) poisoning groups on the basis of PQ ingestion volume. The baseline data of patients after hospital admission and arterial partial pressure of oxygen (PaO2), white blood cell (WBC), proportion of neutrophils (NEUT), alanine aminotransferase (ALT), total bilirubin (TBil), MB isoenzyme of creatine kinase (CK-MB), blood urea nitrogen (BUN) and serum creatinine (SCr) on the 4th day after hospital admission were compared, and 28-day mortality was followed up. Multiple logistic regression model was used to evaluate the characteristics of the dead patients within 28 days. The predictive value of each indicator for death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC). Results ① LHP group consisted 67 patients of 144 patients included with 24 in small dose group, 27 in medium dose group and 16 in high dose group. HHP group consisted of 77 patients with 28 in small dose group, 29 in medium dose group and 20 in high dose group. There were no significant differences in age, ingestion dose, time from poisoning to gastric lavage, and the time from the admission to HP between different intensities groups. ② Compared with LHP group, 28-day mortality in HHP group was significantly lowered (46.8% vs. 70.1%, χ2 = 8.032, P = 0.005). The patients receiving HHP in medium and small doses groups had lower 28-day mortality compared with those receiving LHP (41.4% vs. 74.1%, χ2 = 4.841, P = 0.017; 21.4% vs. 50.0%, χ2 = 4.661, P = 0.043). But there was no significant difference in 28-day mortality in high dose group between HHP and LHP (90.0% vs. 93.8%, χ2 = 0.000, P = 1.000). ③ The survival time of 12 patients with high dose poisoning was less than 72 hours, which were excluded for statistical analysis. Compared with LHP, the indexes of medium and small dose groups were obviously improved after HHP for 4 days. ④ Compared with survival group, PQ ingestion dose in non-survival group was increased, time from poisoning to gastric lavage and the time from the admission to HP were prolonged, and lower patients receiving HHP. ⑤ It was indicated by multiple logistic regression model that PQ ingestion dose [medium dose: odds ratio (OR) = 0.018, 95% confidence interval (95%CI) = 0.004-0.085, P < 0.001; high dose: OR = 0.075, 95%CI = 0.018-0.322, P < 0.001], time from poisoning to gastric lavage over 120 minutes (OR = 0.146, 95%CI = 0.045-0.470, P = 0.001), time from admission to HP over 4 hours (OR = 0.108, 95%CI = 0.029-0.395, P = 0.001), and LHP selection (OR = 0.363, 95%CI = 0.142-0.930, P = 0.035) were risk factors for the death at 28 days in patients with acute PQ poisoning. ⑥ It was shown by ROC curve that area under ROC curve (AUC) of PQ ingestion dose was 0.804 (95%CI = 0.723-0.885); when the cut-off value was 5.50 mL, the sensitivity was 94.0%, and the specificity was 65.6%. The AUC of time from poisoning to gastric lavage was 0.702 (95%CI = 0.617-0.786); when the cut-off value was 85.00 minutes, the sensitivity was 48.2%, and the specificity was 83.6%. AUC of time from the admission to HP was 0.719 (95%CI = 0.636-0.801); when the cut-off value was 3.50 hours, the sensitivity was 59.0%, and the specificity was 78.7%. Conclusions PQ ingestion dose, time from poisoning to gastric lavage, and time from the admission to HP are valuable factors for prognosis of the patients. HHP can improve the prognosis of patients with ingestion PQ less than 40 mL as early as possible, but for high dose group patients there was no much effect.

Endometriosis ; therapy ; Female ; Humans ; Infertility, Female ; therapy ; Medicine, Chinese Traditional ; Phytotherapy ; methods