Objective To study the supportive personnel system reform for implementing the essential medicine system in Guangxi,as well as its impacts on the township hospitals and problems so incurred.Methods Deans (and/or vice deans)and financial staff of 24 townships hospitals were interviewed,while 80％ of medical staff of health centers in 8 counties were subject to a questionnaire survey,to evaluate impacts of the essential medicine system on township hospitals.Results As shown in the outcomes,44.02％of those surveyed were less enthusiastic after the new system was put in place,township health center doctors found their average salary decreased(P=0.027),and the rewarding salary failed to distinguish differences among posts,which all worsened the brain drain of these doctors.Conclusion The new personnel system is found with setbacks of poor incentive mechanism and poor operability.Thus further improvement should be made in scientific measurement of the gaps found in the performance-based pay,and the implementation of thetwo-way flow of medical personnel policy.

Objective:To establish an HPLC method to determine the contents of ephedrine hydrochloride, (R, S)-goitrin, lae-trile,chlorogenic acid,licorice glycosides and glycyrrhizic acid in Xiao'er Kechuanling granule.Methods:The chromatography condi-tions were as follows:an Agilent Eclipse XDB-C18(250 mm×4.6 mm,5 μm) column was used,and acetonitrile-0.1% phosphoric acid was applied as the mobile phase. The flow rate was 1.0 ml·min-1with gradient elution. The wavelength was 207 nm for ephed-rine hydrochloride and laetrile,237 nm for glycyrrhizic acid,licorice glycosides and chlorogenic acid and 245 nm for (R,S)-goitrin. Results:The linear range of ephedrine hydrochloride was 2.423-96.920 μg·ml-1(r =0.999 2), and the average recovery was 100.1% (RSD=0.30%,n=6). The linear range of (R, S) -goitrin was 1.920-76.798 μg·ml-1(r=0.999 9), and the average recovery was 99.86% (RSD=1.14%,n=6). The linear range of chlorogenic acid was 2.396-92.891 μg·ml-1(r=0.999 9),and the average recovery was 98.57% (RSD =0. 75%,n =6). The linear range of amygdalin was 1.982-79.279 μg·ml-1(r =0.999 8),and the average recovery was 99.67% (RSD=0.59%,n=6). The linear range of glycyrrhizin was 2.136-85.440 μg· ml-1(r=0.999 9),and the average recovery was 98.57% (RSD=0.69%,n=6). The linear range of glycyrrhizic acid was 2.432-97.260μg·ml-1(r=0.999 9),and the average recovery was 98.57% (RSD=0.11%,n=6). Conclusion: The method is accu-rate and reliable,which can be used for the quality control of Xiao'er Kechuanling granule.

Objective:To establish an atomic absorption spectrophotometric method for the determination of 6 heavy elements in-cluding lead,cadmium,mercury, arsenic, copper and chromium in iron filings and ferric ammonium citrate in order to control the quality and ensure people's daily medicine safety.Methods:The determination method for lead,cadmium,chromium,copper,arse-nic and mercury was a graphite furnace method, a graphite furnace method, a graphite furnace method, a flame method, a hydride method and a cold steam absorption method,respectively. Results:The concentration of lead within the range of 0-50 ng·ml-1had a good linear relationship with the absorbance(r=0.999 8),and the average recovery was 98.9%(RSD=2.3%,n=6). The concen-tration of cadmium within the range of 0-4 ng·ml-1had a good linear relationship with the absorbance(r=0.999 1),and the average recovery was 90.5%(RSD=1.5%,n=6). The concentration of chromium within the range of 0-50 ng·ml-1had a good linear rela-tionship with the absorbance(r=0.999 7),and the average recovery was 96.1%(RSD=1.1%,n=6). The concentration of copper within the range of 0-800 ng·ml-1had a ood linear relationship with the absorbance (r=0.999 9), and the average recovery was 97.5%(RSD=1.2%,n=6). The concentration of arsenic within the range of 0-16 ng·ml-1had a good linear relationship with the absorbance (r=0.999 0),and the average recovery was 93.4%(RSD =1.1%, n =6). The concentration of mercury within the range of 0-18 ng·ml-1had a good linear relationship with the absorbance(r=0.999 2),and the average recovery was 93.2%(RSD=3.8%,n=6). Conclusion:The method with good repeatability is accurate,which can be used for the quality control of iron filings and ferric ammonium citrate.

Objective:To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications.Methods:Case control study.Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed.According to postoperative complications (bile leakage, gastrointestinal anastomotic fistula, bleeding, incision dehiscence, cholangitis, abdominal infection, pancreatitis, and lymphatic fistula), these children were divided into the complication group (group A) and non-complication group (group B). Age, laboratory indicators[preoperative white blood cell (WBC) count, hemoglobin, glutamic pyruvic transaminase, prealbumin, and postoperative albumin], and clinical factors, such as operation method, operation time, intraoperative blood loss, cyst type, cyst diameter, hepatic duct diameter, abdominal operation history, biliary sludge and calculus, hepatic duct anatomic variation, and pancreaticobiliary maljunction were statistically analyzed between the two groups.The t-test was performed for normal distribution of the measurement data, and the non-parametric rank sum test for non-normal distribution.Multivariate analysis was made using Logistic regression. Results:Among the 124 children, 25(20.16%) had complications, and 99(79.84%) had no complications.Bile leakage occurred in 14 children (11.29%), of whom 7 received operation again and 7 received conservative treatment.Gastrointestinal anastomotic fistula occurred in 2 children (1.61%), of whom 1 was re-operated and 1 was cured conservatively.One child (0.81%) was complicated with bleeding and cured by re-operation.Two children (1.61%) were complicated with incision dehiscence, of whom 1 was cured by re-operation and 1 was cured by conservative treatment.Cholangitis in 2 children (1.61%), abdominal infection in 2 children (1.61%), pancreatitis in 1 child (0.81%), and lymphatic fistula in 1 child (0.81%) were all conservatively cured.No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0.05). Blood loss volume and cyst diameter were significantly different between the two groups (all P<0.05). Postoperative albumin[(27.84±4.62) g/L vs.(32.45±3.72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups ( t=5.254, P<0.05). Logistic multivariate regression analysis suggested that preoperative anemia ( OR=7.922, 95% CI: 1.468-42.757) and biliary sludge and calculus ( OR=1.295, 95% CI: 1.075-4.359) were independent risk factors for postoperative complications; postoperative albumin ( OR=0.055, 95% CI: 0.012-0.244) was a protective factor for postoperative complications, and the differences were statistically significant (all P<0.05). Conclusions:The larger the cyst diameter, the more the intraoperative bleeding, and the higher the risk of operation.Treating anemia before operation, clearing sludge in the hepatic duct during operation, reducing bleeding, and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children.

ObjectiveTo explore the effectiveness and potential mechanism of Shugan Jianpi Granules （疏肝健脾颗粒） combined with Chushi Zhiyang Ointment （除湿止痒软膏） in the treatment of atopic dermatitis with sleep disturbance of liver constraint and spleen deficiency syndrome. MethodsSixty-six patients with atopic dermatitis combined with sleep disturbance of liver constraint and spleen deficiency syndrome were randomly divided into 33 cases each in the treatment group and the control group. Both groups were treated with Chushi Zhiyang Ointment for external use. The treatment group additionally received Shugan Jianpi Granules orally， one dose per day； and the control group received cetirizine hydrochloride tablets orally， 10mg per day， taken before bedtime. Both groups were under the treatment for 4 weeks. Clinical effectiveness was evaluated after treatment， and the SCORing Atopic Dermatitis （SCORAD） index， pruritus visual analog scale （VAS） score， Insomnia Severity Index （ISI） score， and Pittsburgh Sleep Quality Index （PSQI） score were recorded before and after treatment， and serum levels of melatonin （MLT）， interleukin-4 （IL-4）， interleukin-6 （IL-6）， interleukin-13 （IL-13）， and tumor necrosis factor-α （TNF-α） were measured. The patients were also tested for blood routine， liver function and kidney function before and after treatment， and the occurrence of adverse events was also observed. ResultsThe total effective rate in the treatment group （90.63%， 29/32） was significantly higher than that in the control group （66.67%， 20/30， P＜0.05）. After the interventions， the scores for SCORAD， VAS， ISI， and PSQI， as well as the levels of IL-4， IL-6， IL-13， and TNF-α， were significantly reduced in both groups. In contrast， the MLT levels in treatment group significantly elevated compared to that before treatment （P＜0.05）. Comparing between the two groups after treatment， the scores of SCORAD， ISI， PSQI， and VAS， as well as the levels of serum IL-4 and IL-13 in the treatment group were significantly lower than those in the control group， while the MLT levels were markedly higher than that in the control group （P＜0.05 or P＜0.01）. There was no obvious abnormality in blood routine， liver function and kidney function in both groups when compared before and after treatment. The incidence rate of adverse reactions was 9.38% （3/32） in the treatment group and 13.33% （4/30） in the control group， and the difference between groups showed no statistical difference （P＞0.05）. ConclusionOn the basis of topical application of Chushi Zhiyang Ointment， the combined application of Shugan Jianpi Granules can significantly alleviate the degree of skin lesions and itching， and improve the quality of sleep in atopic dermatitis patients with sleep disturbance of liver constraint and spleen deficiency syndrome， and its mechanism may be related to regulating the immune balance， reducing the secretion of inflammatory factors， and elevating the level of MLT.