药品价格过高的原因分析及解决措施

一、我国药品流通过程分析 众所周知,药品价格主要高在流通环节.由于我国目前85%以上的药品是通过医院销售的,所以在分析我国药品流通成本时,也以医院这一销售渠道为主.流通成本主要由药品出厂后批发环节的流通成本、药品进入医院前后的公关成本、药品出厂后零售环节的流通成本三部分构成（见附图）.     

SARS流行期间公众心理状况调查

目的 探讨SARS流行期间公众心理健康状况，为心理干预提供依据。方法采用SCL-90量表，对2844名学生及城市社区居民和农村居民进行SARS流行期间的心理健康状况问卷调查。结果（1）SARS流行期间公众心理健康状况较全国常模差。（2）不同类群公众在SARS流行期间心态变化不尽相同，产生的心理卫生问题也不同。结论（1）SARS流行期间公众的心理危机问题值得关注。（2）SARS及其它公共卫生事件发生期间的心理危机干预非常必要，但要有针对性。     

Physicians for Rural America: The Role of Institutional Commitment Within Academic Medical Centers

CONTEXT: Prior study suggests that contextual characteristics of medical schools (e.g., state demographics, public vs private, NIH research effort) predict output of rural physicians without also considering the effects of the medical schools' own policies and programs. PURPOSE: This study examines medical school commitment to rural policies and programs and its relationship to contextual characteristics and rural physician output. METHODS: A survey of 122 U.S. allopathic medical schools provided data to construct a 32-item Rural Commitment Index for each medical school. Data for other characteristics were linked from published sources. Correlations, t tests, and multiple regression analysis were used to study the association between variables and percentage of medical school graduates (1988-1996) who were in rural primary care practice in 2000. FINDINGS: Among 90 medical schools (response rate, 73.8%), the Rural Commitment Index correlated with the percentage of the state population that is rural and whether the school is public or private, and it joined percentage state population rural, public vs private, and National Institutes of Health support in correlating with percentage of graduates in rural primary care. In a regression model that explained 48.4% of variation in the percentage of graduates in rural primary care, the Rural Commitment Index explained most variation, followed by percentage state population rural, public vs private, National Institutes of Health support, and the interaction between the Rural Commitment Index and public vs private. CONCLUSIONS: The findings support the proposition that observable institutional commitment affects rural physician output and provide justification for a definitive study to verify that a change in medical school commitment to rural medicine produces a change in rural physician output.     

护肾固精方治疗系膜增殖性肾炎临床研究

目的观察护肾固精方治疗系膜增殖性肾炎(Mesangial proliferative glomerulonephritis,MsPGN)的临床疗效。方法73例MsPGN患者分为治疗组和对照组。治疗组42例,以护肾固精方为基本方加激素或细胞毒性药物治疗;对照组31例,以激素或细胞毒性药物治疗为主。同时观察两组病例治疗前后的临床症状、体征,血、尿常规,24h尿蛋白定量,细胞免疫和体液免疫;血浆白蛋白、血脂;肾功能及血清β2-微球蛋白(β2-MG)、尿β2-MG、尿白蛋白(Alb)、尿球蛋白(IgG)等。结果治疗组完全缓解率为28.8%,总有效率为85.6%,显著高于对照组20.7%和61.3%,两组疗效比较有显著性差异(P<0.05);而且治疗组在改善临床症状、体征和肾功能及血清β2-MG、尿β2-MG、Alb、IgG,消除蛋白尿,升高血浆白蛋白,降低血脂,调节免疫功等方面均明显优于对照组(P<0.05或P<0.01)。结论护肾固精方对MsPGN患者有很好的临床治疗效果。     

中药材冲击摩擦超细气流粉碎方法研究

目的 :针对中药材粉碎特性 ,提出一种“中药材冲击摩擦超细气流粉碎”方法 ,该方法可有效解决现有中药材超细粉碎方法中关于超细粉碎效率的问题 ,特别是现有气流粉碎装置对不同物性的中药材粉碎适用性较差的缺点。方法 :将喷射气流的高速冲击粉碎作用和旋转靶的高速摩擦粉碎作用复合用于中药材的超细气流粉碎中 ,并经分级获得中药材超细粉体。结果 :通过几种典型中药材的超细粉碎实验表明 ,粉碎平均粒径分别为 2～12. 7μm。结论 :该方法具有适用性强、超细粉碎效率高的优点 ,是一种微米化中药材的有效制备手段。     

雷公藤多甙对大鼠胶原免疫性关节炎黏膜免疫的影响

目的:观察雷公藤多甙对于大鼠胶原免疫性关节炎黏膜免疫的影响.方法:Ⅱ型胶原与完全弗氏佐剂免疫大鼠,以雷公藤多甙治疗,观察大鼠黏膜免疫各项指标.结果:雷公藤多甙可以改善CIA大鼠病理改变,降低肠道PP结中CD4/CD8比值,对脾中T细胞亚群有调节作用,并可降低关节中致炎细胞因子的表达.结论:雷公藤多甙对CIA模型大鼠有抗炎和免疫抑制的作用.     

樱桃花青素对佐剂性关节炎大鼠自由基和炎症因子的影响

目的:观察樱桃花青素对佐剂性关节炎(AA)大鼠自由基和抗氧化功能以及炎症因子的影响.方法:将50只SD雄性大鼠随机分为5组即正常组、模型组、樱桃花青素高、中、低剂量组.对足爪肿胀进行测量,在光镜下观察各组组织形态学变化,用比色法检测了动物外周全血的谷胱甘肽过氧化物酶(GSH-PX)活性、血清超氧化物酶(SOD)活性、血清丙二醛(MDA)含量以及血清总抗氧化能力(T-AOC).用ELISA检测血清中TNF-α含量,用放射免疫法检测了足爪PGE2含量.结果:模型组和正常组相比GSH-PX,SOD活性和T-AOC能力下降,血清MDA含量升高,血清中TNF-α和足爪PGE2含量升高.樱桃花青素组能升高GSH-PX,SOD和T-AOC活力,降低血清MDA,TNF-α以及足爪PGE2含量.光镜下组织形态观察表明樱桃花青素各组能不同程度减轻滑膜增生,减少炎细胞浸润.结论:樱桃花青素能增强AA抗氧化能力,并能降低炎症细胞因子PGE2和TNF-α,从而减轻AA模型的关节炎损伤.     

Calreticulin binding and other biological activities of survival peptide Y-P30 including effects of systemic treatment of rats

Neuron survival-promoting peptide Y-P30, purified from oxidatively stressed neural cell lines, inhibits the appearance of microglia and rescues neurons 1 week after direct application to lesions of the rat cerebral cortex (7). Y-P30 affinity matrices treated with solubilized membranes from a variety of cell lines including human neuroblastoma SY5Y, mouse hippocampal cells HN 33.1, and human promonocytes HL-60, as well as with cerebral cortex tissue from both humans and rats, showed highly specific binding to calreticulin, a ubiquitous calcium binding protein that may be critical for integrin function. Treatment of cultures with 0.1 nM Y-P30 stabilized all these cell types whether differentiated or not, while 1 microM peptide also inhibited the morphological differentiation of the HL-60 cells into macrophages. Western analysis of the medium of SY5Y cell cultures suggested Y-P30-stimulated release of calreticulin, a result consistent with its other biological activities. Likewise, single dose systemic application of Y-P30 in unoperated rats and in rats with cerebral cortex lesions produced significant reductions in cerebral cortex membrane-associated calreticulin. Both direct and intravenous treatment with peptide also reduced cortical neuron atrophy 4 days after these lesions but only direct application consistently inhibited the appearance of ED-1(+) monocyte derivatives. We suggest that in vitro and in vivo mechanisms of Y-P30 effects are similar and involve the targeting of calreticulin. The results also suggest that some of these activities are apparent in the cerebral cortex after systemic application of this peptide.     

维生素C、维生素E、硒与镉联合作用对LLC-PK1细胞脂质过氧化的影响

[目的]研究氯化镉(CACl2)及其分别与维生素C(VitC)、维生素E(VitE)、硒联合作用对猪肾近曲小管上皮(LLC—PKl)细胞增殖、脂质过氧化及抗氧化酶的影响。[方法]实验设对照组、镉组、镉 Vitc组、镉 VitE组和镉 硒组。以四甲基偶氮唑盐(MTT)比色法检测LIE—PK,细胞活力的变化，黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)活力，以催化还原性谷胱甘肽(GSH)速度表示谷胱甘肽过氧化物酶(GSH—Px)的活力，硫代巴比妥酸法(TBA)测定丙二醛(MDA)含量。[结果]不同浓度cdcl2(0—100μmol／L)作用于LIE—PK1细胞12h，细胞存活率随CAC12浓度升高而下降，呈剂量一反应关系；VitC 镉组、vitE 镉组、硒 镉组分别与单独加镉组相比均可显著提高LIE—PK,细胞存活率；10—40pmol／L(ktCl2作用LLC—PK，细胞12h后的培养液上清MDA含量明显增加，与对照组相比差别有显著性。同时，CuZn-SOD、Mn-SOD、GSH—Px活力较对照组相比显著性升高；硒 镉组细胞培养液上清MDA含量与镉组相比有显著性下降。[结论]镉对LIE—PKl细胞增殖有明显的抑制作用；镉可引起LIE．PK1细胞脂质过氧化，是导致肾细胞毒性机制之一；硒对镉引起的ILC—PK。细胞的脂质过氧化有一定的拮抗作用。     

毛细管胶束电泳法测定血浆异丙酚方法的研究

目的　采用毛细管胶束电泳法测定血浆中异丙酚血药浓度。　方法　探讨样品预处理方法、缓冲液种类、波长、SDS浓度、pH值、工作电压、柱温对分离的影响 ,筛选后的最佳方案为 5 0mmol/L硼砂 -2 0mmol/L硼酸 -2 5mmol /LSDS -3 %甲醇 (pH =9.3 ) ,分离电压 2 0KV ,柱温 2 0℃ ,检测波长 2 72nm ,压力进样 2 0 psi× 10S。　 结果　异丙酚、百里酚能得到令人满意的分离。　结论　本方法可使异丙酚血药浓度的测定时间缩短 ,方法简便、快速、灵敏、干扰少 ,是测定异丙酚血药浓度的理想方法之一。