Objective To evaluate the effect of low dose fentanyl on target plasma concentration (CP) of propofol (P) given by target controlled infusion (TCI) required to prevent response to proseal laryngeal mask insertion in 50% of patients (EC50). Methods Forty-six ASA Ⅰor Ⅱ patients aged 20-50 yr with body mass index ≤ 30 kg/m2 undergoing elective gynecological laparoscopy were randomly divided into 2 groups (n=23each):propofol group (P) and propofol-fentanyl group (PF). Anesthesia was induced with TCI of propofol. The initial Cp of propofol TCI was set at 2.5 μg/ml in group PF and 4 μg/ml in group P. Following equilibration between plasma and effect site concentration of propofol, fentanyl 1 μg/kg (in group PF) or normal saline (in group P) was injected iv. Laryngeal mask airway (LMA) was inserted at 3.5 min after fentanyl administration. EC50 was determined by up-and-down sequential trial. The ratio of Cp between the two consecutive patients was 1.2 in group P and 1.1 in group PF. LMA insertion response was defined as nausea, bucking and/or body movement during insertion. "Probit method was used to calculate the Echo and 95 % confidence interval required to prevent LMA insertion response. Results The EC50 and 95 % confidence interval of propofol given by TCI required to prevent LMA insertion response was 4.68 (4.20-5.21)μg/ml in group P and 2.63 (2.45-2.83) μg/ml in group PF. There was significant difference between the 2 groups. Conclusion Fentanyl 1 μg/kg iv can significantly reduce the Cp of propofol TCI required to prevent LMA insertion response.

OBJECTIVE:To provide basic industrial research and development recommendations for the supply-side structural reform in drug distribution in China. METHODS:Structure-conduct-performance(SCP)analysis paradigm from Harvard was used for in-depth study of market structure,business conduct and business performance in China since 2010. RESULTS:Since 2010, drug distribution industry in China had shown the scale of decline in the growth rate,low market concentration,increased barriers to entry,the leading of state-owned capital,etc. Though corporate mergers and acquisitions and public financing expanded the scale,management information,third-party logistics,Internet+and pharmacy alliance business model flourished,the industry op-erating performance was poor,state-owned enterprises showed poor performance. CONCLUSIONS:The transformation and upgrad-ing of the industry business model should be promoted by targetedly accelerating the supply-side structural reforms in the drug distri-bution industry,encouraging corporate finance mergers,breaking local protectionism,developing cooperative pharmacies and phar-maceutical third-party logistics alliances and leveraging the Internet.

Objective To study role of MDC/CCI22-CCR4 axis in mouse milky spots with peritoneal carcinomatosis of gastric cancer. Methods We examined the expression of CCR4 in 615 Mouse gastric cancer cell (MFC) lines by RT-PCR and Western-blot; Peritoneal metastasis model on the 615mouse was established by intraperitoneal injection of 0.2 ml MFC cells(1×104 cells). Dil fluorescence was used to observe the transfer process and section of MFC. Immunohistochemistry was conducted to detect the expression of CCR4 and CCL22 in omental milky spot; the structure of Milky spot was observed by scanning electron microscopy. Mice were randomly divided into 2 groups, namely, the saline control group (received saline) and MFC group. The concentration of CCL22 in ascitic fluid was measured in the 615 mice injected MFC after 6,8,10 days and in the saline group. Results MFC first metastasizes to the milky spot on the omentum, the expression of CCR4 and CCL22 were observered in the milky spot. The surface layer cells in milky spot consisted of discontinuous mesothelial cells and mainly macrophages and lymphocytes. The average value of CCL22 was 43 pg/ml and 364 pg/ml respectively in saline control group and MFC group.Conclusions MDC/CCL22-CCR4 axis plays an important role in the development of peritoneal carcinomatosis in mouse gastric cancer.

Objective To study the role of MDC/CCL22-CCR4 axis in milky spots in peritoneal carcinomatosis of gastric cancer.Methods We examined the expression of CCR4 in 5 gastric cancer cell lines by RT-PCR and Western-blot.Cell growth rate of BGC-823 cell lines before and after incubated with CCL22 was detemined by MTT assay.The effects of CCL22 on invasion of BGC-823 cells into Matrigel were measured using Transwell test.Immunohistochemistry was conducted to detect the expression of CCR4.Results CCR4 mRNA and protein expression were detected in all 5 human gastric cancer cell lines:CCL22had a direct promotive effect on BGC-823 cell prolifetation and invasion.There was CCR4 expression in Stomach neoplasms.The expression of CCR4 in primary tumor was correlated with tumor pathological differentiation(P<0.05),but not with age of patients,gender,location of tumor,tumor size,tumor stage,lymph node metastasis(P>0.05).Conclusions The MDC/CCL22-CCR4 axis may be one of the mechanism of peritoneal metastasis in milky spot in gastric cancer.

OBJECTIVE:To provide reference for improving licensed pharmacist qualification system and the legislation of Li-censed Pharmacist Law in China. METHODS:The implementation of licensed pharmacist system in China was introduced;based on the experience of licensed assistant physician system in China and pharmacy technician qualification system in USA,the necessi-ty and feasibility of setting up licensed assistant pharmacist were interpreted. RESULTS&CONCLUSIONS:At present,it is neces-sary to draw lessons from licensed assistant physician system in China and pharmacy technician qualification system in USA and set up licensed assistant pharmacist because of the shortage of licensed pharmacist,low threshold of qualification admittance,non-stan-dard licensed qualification of primary(assistant)pharmacy technician,absence of Licensed Pharmacist Law. It is recommended to promote the legislation of Licensed Pharmacist Law through clearing the definition and responsibility of licensed assistant pharma-cist,confirming examination scope and the threshold of qualification admittance,etc.

Objective To investigate the clinical significance of human telomerase RNA component (hTR) and human telomerase reverse transcriptase(hTERT) mRNA expression in cutaneous squamous cell carcinoma(SCC) and Bowen′s disease(BD). Methods Expressions of hTR and hTERT mRNA were detected by in situ hybridization technique in 30 cases of cutaneous SCC and 30 cases of BD. Results Weak expressions of hTR and hTERT mRNA were observed in BD, with positivity rates of 23.33% and 16.67%, respectively. Expressions of hTR and hTERT mRNA were found in 86.67% and 93.33%, respectively, in cutaneous SCC. hTR and hTERT mRNA were positive in 82.35% and 88.24%, respectively, of stage I and II of cutaneous SCC, without strong positive signals in those patients. hTR and hTERT mRNA were positive in 92.31% and 100%, respectively, of stage III and IV of cutaneous SCC, with strong positivity rates of 69.23% and 76.92% in those patients. Expressions of hTR and hTERT mRNA in skin tumors were gradually increased which positively linked with phenotypic progression and degree of dysplasia. Conclusion The strong expression of hTR and hTERT mRNA in the skin tumor suggest the presence of cutaneous squamous cell carcinoma.

The infection of HBV may cause acute and chronic hepatitis B,and potentially lead to hepatocirrhosis and liver cancer.As a defense mechanism of organism to resist external infection,RNA interference(RNAi) has become a powerful tool for us to study its effects on antiviral infection and gene therapy in recent years.In this article we summarize the mechanisms of RNA interference and the progress on anti-HBV infection studies by RNAi.

Objective To observe the therapeutic effect of segmental scleral buckling and vitrectomy with/without lensectomy on the retinopathy of prematurity (ROP) stage 4a,4b and 5.Methods One hundred and thirty-four ROP infants (181 eyes) diagnosed as stage 4a,4b and 5,and performed with segmental scleral buckling or vitreous with/without lensectomy were retrospectively analyzed.The operated 4a-,4b-and 5-stage eyes were 40,51 and 90 eyes.The operational method depended on the location and severity of fibrovascular membrane.Of 181 eyes,segmental scleral buckling was referred for 37 eyes which include 23 eyes with 4a stage and 14 eyes with 4b stage;vitrectomy was referred for 50 eyes which include 14 eyes with 4a stage,29 eyes with 4b stage and 7 eyes with 5 stage;vitrectomy with lensectomy was referred for 94 eyes which include 3 eyes with 4a stage,8 eyes with 4b stage and 83 eyes with 5 stage.The effect was classified as success,improved and failure.Failure includes lost eye.Follow-up for 4a,4b and 5 stage patients are 34,31 and 29 months respectively.Results Segmental scleral buckling was referred for 37 eyes,success in 23 eyes (62.16％),improved in 11 eyes (29.73 ％),failure in 3 eyes (8.11 ％).Vitrectomy was referred for 50 eyes,and success in 20 eyes (40.00％),improved in 22 eyes (44.00％),and failure in 8 eyes (16.00％).In the total of 94 eyes underwent vitrectomy with lensectomy,20 eyes was success (21.28％),improved in 17 eyes (18.08％),failure in 57 eyes (60.64％).In 40 stage 4a eyes,33 successes (82.50％),6 improved (15.00％) and 1 failure (2.50％).In 51 stage4b eyes,11 successes (21.57％),30 improved (58.82％) and 10 failures (19.61％).For 90 stage 5 eyes,14 successes (17.50％),19 improved (23.75％) and 57 failures (71.25％).The therapeutic effect of segmental scleral buckling for stage 4a was better than that for stage 5 (x2 =6.707,P=0.035).The difference of therapeutic effect of vitrectomy for different stage was significant (x2=21.010,P =0.000);stage 4a was the best;stage 4b was the second,stage 5 was the worst.The therapeutic effect of vitrectomy with lensectomy for stage 5 was worse than that for stage 4a and 4b (x2=16.066,P=0.003).Conclusion The surgery patterns of ROP was determined based on the disease severity,the surgery effects of stage 4a and 4b were better than stage 5,which had nothing to do with the surgical procedures.

Objective To investigate the patients′cell morphology characteristics in peripheral blood and bone marrow with the reduce of leukocyte,hemoglobin and platelet in peripheral blood,and analyze the common cause.Methods From June 2005 to Feb-ruary 2011,222 patients with pancytopenia treated in the hospital were enrolled in the study,whose peripheral blood and bone mar-row smears were stained by Wright,combined with histochemical staining and the clinical data of patients,the disease types were analyzed.Results In the 222 patients with pancytopenia,patients with hematopoietic system disease accounted for 84.65% (188/222),non-hematopoietic system disease accounted for 15.35%(34/222),the difference was statistically significant(P <0.05 ).In 150 patients whose peripheral blood smears were obseved,58% patients obtained positive results.Conclusion The diseases of hem-atopoietic system are the common cause of pancytopenia,but can not ignore the non-hematopoietic system diseases.Peripheral blood smear has a high value in the diagnosis of these diseases.

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012.