By analyzing relevant documents of procurement of drugs with target quantity in Shanghai, com-bined with onsite investigations and interviews, this paper summarizes the practice of procurement of drugs with target quantity in Shanghai from six aspects, namely the basic situation of centralized procurement, pilot scope and variety of procurement of drugs with target quantity, business qualification and certification, determination of successful bid-der, drug distribution, and drug payment settlement. This paper argues that Shanghai has successfully implemented the policy of procurement of drugs with target quantity, by scientifically establishing a comprehensive evaluation index of quality, setting up private drug procurement accounts, prepaying drug procurement loans and strengthening plat-form services and regulatory capabilities, in order to effectively guarantee the operation of procurement of drugs with target quantity. From this case study of Shanghai, it can draw the following implications that in order to successfully achieve procurement of drugs with target quantity mechanism, setting up functional departments of unified authority is the most important guarantee, and using technical means and platform building is the basic conditions. Therefore, the setting up of economic and technical bidding should focus on the individual properties of generic drugs, and the pro-moting of tripartite system reform will help to further expand the scope of procurement of drugs with target quantity.

Objective To study the triterpene saponins from Gynostemma pentaphyllum with antitumor activities.Methods The 75% EtOH extract of G.pentaphyllum was used for isolation by silica gel column chromatography and preparative HPLC.The structures of pure compounds isolated were identified by the spectral analysis and chemical evidence.Results Two compounds were isolated and identified as 23(S)-3β,20ξ,21ξ-trihydroxy-19-oxo-21,23-epoxydammar-24-ene 3-O-α-L-rhanmopyranosyl(1→2)-[β-D-xylopyranosyl(1→β)]-β-D-arabinopyranoside(1)and23(S)-21(R)-O-n-butyl-3β,20ξ-dihydroxy-21,23-epoxydammar-24-ene 3-O-α-L-rhamnopyranosyl(1→2)-[β-D-xylo-pyranosyl(1→3)]-β-D-arabinopyrannside(2).Conclusion Compound 2 is a new triterpene saponin with moderate antitumor activities against the HL-60,Colon205,and Du145 cell lines.

OBJECTIVE:To provide reference for the establishment of a system of expired medicine recycling in China. METHODS:The experience of developed countries with respect to the system of expired medicine recycling was summed up,and the existing problems about the recycling of expired medicines in China were considered to make suggestions to the establishment of a system of medicine recycling in China. RESULTS & CONCLUSIONS:Generally,the developed countries such as Britain, France,Germany and America treat expired medicines as hazardous wastes in the Environmental Protection Law,Waste Disposal Law and other laws,and have basically standardized the recycling of expired medicines. The projects of recycling expired medi-cines in those countries are usually funded by their governments or enterprises of manufacturing or selling medicines,where the medicines were recycled at designated places or on a regular basis or by post,executed by pharmacists and pharmacies,and then disposed on the basis of classification or burned and buried at dumps. However,currently there are no laws and regulations and spe-cial funds for medicine recycling in China,leading to people’s lacking of enthusiasm to recycle the expired medicines. It is suggest-ed that China should take such measures as soon as possible,including establishing and improving the laws and regulations of ex-pired medicine recycling,distinguishing the reasonably determination and disposition of different types of expired medicines,accel-erating the reform of the medical insurance payment system,giving full play to the pharmacist’s role of medication guidance,and fully increasing information transparency.

Objective To evaluate the efficacy and toxicities of gemcitabine plus oxaliplatin with R-GemOx or without (GemOx) rituximab regimen in the treatment of relapsed or refractory diffuse large B-cell lymphoma in elderly patients.Methods A total of 39 patients with relapsed or refractory diffuse large B-cell lymphoma received R-GemOx or GemOx chemotherapy.There were 16 patients in R-GemOx and 23 patients in GemOx group.Patients in both groups received gemcitabine 1000 mg/m2,d1,at land 8 day and oxaliplatin 130 mg/m2,d1 at lday.Patients in R-GemOx additionally received rituximab 375 mg/m2.Every 21-28 days was 1 cycle.The toxicities were evaluated after 1 cycle of chemotherapy.The efficacy was evaluated after 2 cycles of chemotherapy.Results In R-GemOx group,the total response rate was 62.5％,and the clinical benefit rate was 87.5％.In GemOx group,the total response rate was 47.8％,and the clinical benefit rate was 73.9％ There was no significant differences between the two groups.There was a significant difference in the median time-to-progression (TTP) between R-GemOx group (6.4 months) and GemOx group (5.0 months) (P ＜ 0.05).The major toxicities were marrow suppression and gastrointestinal reaction,which had no significant differences between the two groups.Conclusions R-GemOx and GemOx regimen are effective and safe for the elderly patients with relapsed or refractory diffuse large B-cell lymphoma(DLBCL).But the patients with relapsed/refractory DLBCL treated with R-GemOx had a longer median time-to-progression than with GemOx regimen.

Objective To compare the clinical effects between the two-level ladder ultrafiltration and sequential dialysis for hemodialysis patients with excessive water retention.Methods According to our hospital standard,23 patients with water retention during treatment with dialysis from January 2010 to September 2011 were selected.And they conducted a total of 198 dialysis.Both the two-level of high-level segment and sequential ultrafiltration step dialysis were set for 1 hour.Ultrafiltration accounted for one-third of the total,and the remaining two-thirds of the amount of ultrafiltration was completed in the remaining time.The blood pressure,ultrafiltration volume completed,plasma osmotic pressure,detection of vascular access pressure,and other observed indicators during dialysis were compared.Results The occurrence of hypotension and muscle spasms in two-level ladder ultrafiltration was slightly more than that in sequential dialysis,ultrafiltration volume completed actually in two-level ladder ultrafiltration was a little less than sequential dialysis.However,the difference was not statistically significant ( P ＞ 0.05 ).It took more time during sequential dialysis simple ultrafiltration,occasionally dialysis fluid stopped flowing and dialyzer and the trail tube lack of incubation,and some patients could not adapt to it.Amount of heparin( [7.48 ± 1.73 ] mg/h vs[6.25 ± 1.36] mg/h,t =5.374,P ＜ 0.01 ),venous pressure ( [ 128.62 ± 10.53 ] mm Hg vs [ 96.35 ± 11.84 ] mm Hg,t =20.166,P ＜ 0.01 ),trausmembrane pressure( [ 236.84 ± 23.65 ] mm Hg vs [ 175.94 ± 24.72] mm Hg,t =17.516,P ＜ 0.01 ) were significantly higher than those in the high level of ultrafiltration period.Mean arterial pressure ( MAP ) ( [ 100.48 ± 5.78 ] mm Hg vs [ 102.54 ± 5.39 ] mm Hg,t =2.571,P ＜ 0.05 ) and plasma osmotic pressure ( [ 311.42 ± 7.36] mOsm/( kg · H2O ) vs [ 3 1 7.31 ± 6.89 ] mOsm/( kg · H2O ),t =5.774,P ＜ 0.01 ) in high level period were significantly lower than those in the singal ultrafiltration period,and the MAP difference was higher than that in the singal ultrafiltration period ( [ 11.46 ± 6.53 ] mm Hg vs [ 9.42 ± 5.46 ] mm Hg,t =2.385,P ＜ 0.05 ).There is less symptomatic hypotension and other adverse reactions.Conclusion Two dialysis ultrafiltration method can both be used for patients with excessive water retention,they can reduce the ultrafiltraion complications and achieve ultrafiltration targets.Two-level ladder ultrafiltration with dialysis and ultra.filtration unity is more likely to be adopted by the clinic.

OBJECTIVE:To provide theoretic support for medicine affordability evaluation in China by studying medicine af-fordability evaluation methods. METHODS:Through introducing the concept and evaluation methods of affordability,the evalua-tion steps of“catastrophic expenditure”and“medicine affordability”in medicine affordability evaluation methods were interpreted systematically. RESULTS & CONCLUSIONS:The catastrophic expenditure and impoverishing effect methods can measure med-icine affordability,but they both have limitations. Catastrophic expenditure evaluation method cannot measure the consequences of a catastrophic expenditure to the family,and ignore the reduction of family income after the occurrence of diseases. Impoverishing effect evaluation method cannot pay attention to originally poor population. These two evaluation methods complement each other, and can more objectively reflect the ability of patients bearing medical expenses,which can provide scientific references for poli-cies of enhancing medicine pricing and reimbursement system.

Objective To assess the perioperative hidden blood loss in aged patients with femoral intertrochanteric fracture.Methods Clinical data of 243 patients (111 males and 132 females) with intertrochanteric fracture admitted from 2009 September to 2015 September were retrospectively reviewed.Two hundred and seventeen patients aged 60-98 years received surgical treatment and 26 patients aged 62-91 years received conservative treatment (non-surgical group).In surgical group,17 cases were operated within 1 d after fracture,71 within 3 d,73 within 7 d,31 within 14 d,and 25 cases were operated after 14 d.Hidden blood loss was evaluated and blood routine was tested.Results The hidden blood loss was (340 ± 216) ml in non-surgical patients,(602 ± 216) ml in patients operated after 14 d,(671 ± 327) ml in patients operated 8-14,(596 ± 362) ml in patients operated 4-7 d,and (505 ± 119) ml in patients operated 2-3 d,(498 ± 244) ml in patients operated within 1 d;there was significant difference among groups (F =14.758,P =0.001).The hemoglobin level in non-surgical group was (121.8 ± 17.6) g/Lwithin 1 d after fracture,(101.1 ±23.3) g/L on 1-3 d,(91.5 ±31.9) g/L on4-7 d,(92.2 ±31.6) g/L on 8-14 d,and (108.3 ± 22.4) g/L after 14 d;there was statistically significant among groups (F =12.457,P =0.001).Conclusions Hemoglobin level in elderly patients with femoral intertrochanteric fracture is dynamically changed,and reaches the lowest point within 1-2 weeks after injury;and operation is an important factor of hidden blood loss in femoral intertrochanteric fracture patients.

Objective To investigate the therapeutic efficacy and side effects of arsenic trioxide (As2O3) with ATRA on newly-diagnosed patients with acute promyelocytic leukemia (APL). Methods 35 patients of newly-diagnosed APL received As2O3 with ATRA treatment. The therapeutic effects were compared with As2O3 treatment on 33 patients. The dose were adjusted according with As2O3 0.16 mg·kg-2·d-1 and ATRA 25 mg·m-2·d-1 until complete remission (CR). The CR rate, period to CR, the incidence of early death and side effects were observed in two groups. Results There was no significant difference in CR rate, in which 94.3 % for As2O3 with ATRA group and 90.9 % for As2O3 group (P >0.05). Significant difference was observed in the period to CR, in which the medium time to CR was 26.1 days for As2O3 with ATRA group and 30.5 days for As2O3 group (P <0.05). No significant differences was detected in APL associated syndrome, the occurrence of cytoxic responses and the incidence of early death. The death rate was higher in high WBC group than that in middle and low WBC group, with statistical difference (P <0.05), but there was no obvious difference between lower WBC and middle WBC group (P >0.05). Conclusion The treatment combined with As2O3 and ATRA could lessen the time of reaching CR. The WBC count > 10×l09/L was one of the main causes of therapy associated death and the APL differentiation syndrome should be detected and given attention immediately.

Objective To explore patients′ cognitive status and influence factors of intravenous transfusion demerits in health alliance community,and to provide evidence for related health education. Methods A total of 589 patients who had received infusions in six health alliance communities outpatients were investigated by questionnaire to get to know their knowledge about infusion.Results The overall average score of intravenous transfusion KAP among health alliance outpatients was (7.21±2.10) with only 93 patients (15.8%) getting full score. Logistic multi-factor regression analysis showed that gender,degree of education,occupation,health education on infusion were the influencing factors of intravenous transfusion KAP.Conclusions Intravenous transfusion related KAP of community patients remains to be improved. More attention should be focused on male patients,patients with lower literacy level,non-government institutions,and those who are lack of transfusion related health education.

( CPR ) skills of community nurses in the regional health alliance and its influencing factors . Methods Nosocomial CPR first-aid skills of 104 in-service nurses from 6 community hospitals in the regional health alliance using a convenience sampling method were investigated .Results The score of the CPR skill examination of community nurses in the health alliance was (75.6 ±11.3), which was lower than the score of nurses in the leading hospital .The subjects with the three lowest accuracy were:the technique and the items of the bag safety inspection of the bag valve mask (8.7%, 10.6%), the CE method to hold the mask (15.4%). The multiple linear regression test showed that community nurses′education , working age , weather they had attended related training were influencing factors of the nosocomial CPR skill score of community nurses in the health alliance .Conclusions Nosocomial CPR skills of community nurses in the regional health alliance need improving .The leading hospital in the health alliance should fully integrate resources and strengthen the first -aid skill training of community nurses in the regional health alliance in order to ensure medical safety in the community.