Objective To provide the evidence on the selection and related policies of essential medicine for policy-makers through systematic review of the National Essential Medicine List(NEML) around the world. Method We systematically searched the official websites of the health authorities, like the departments of health and pharmaceutical administrations. We selected the published NEML. Two reviewers independently selected literature and extracted data. We analyzed the time of NEML published and updated, NEML committees, selection criteria, medicine category, number of medicines, and medicine information in NEML and standard treatment guidelines (STGs) as well. Results Thirty-six NEMLs from 25 countries were included with 34 in English and 2 in Chinese. From 1982 to 2009, Twenty-five countries developed their NEMLs respectively. They were updated from four months to eight years. The NEML committee members came from central government, ministry of health, pharmaceutical administrations, ministry of public health, ministry of education, essential medicine division, etc. The committees were composed of clinical specialists, health officials, pharmacists (pharmacologists), medicine educators, economist, statisticians, epidemiologist and experts from WHO/UNICEF, etc. Most of the countries took the WHO’s concept of essential medicine and selection criteria as standard. The applications of essential medicine were reviewed by considering the following aspects: safety, effectiveness, economic characteristics, the main disease burden, rational use of drug and supply. The medicines in NEMLs of 25 countries varied from 103 to 2 033, and the median is 447. The Anatomical Therapeutic Chemical (ATC) classification was used to classify the medicines in NEMLs of 12 countries. The drug information was provided, including generic name, dosage, form of medication and administration route as well. The STGs or formularies covered from 73 to 167 common diseases, including the diagnosis, treatments, rational use of drug, contraindications, adverse effects, etc. Conclusions The NEMLs in 25 countries have shown great differences because of the variation of the social and economic developments, disease burdens and the developments of health care systems in different countries. We can learn from the experience of other countries, like Australia and South Africa, in the selection and use of essential medicines, STGs and related policies. We should develop the national essential medicine system for policy making and administration, especially the national essential medicine list for common diseases base on the high quality evidence, the local disease burden as well as specific demands in different areas.
ObjectiveTo investigate the value of diffusion weighted imaging (DWI) combined with three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma. MethodsFrom July 2009 to March 2011, DWI examination was performed in 37 patients with hilar cholangiocarcinoma, which was compared with 3D-VIBE sequences. The morphological characteristics and distribution were analyzed for metastatic and nonmetastatic lymph nodes. Signal intensity (SI) was measured on DWI images and apparent diffusion coefficient (ADC) was calculated for each lymph node. The SI of lymph nodes (SILN） and liver (SIliver) were also measured and the ratio of SI was calculated. The ADC and the ratio of SI were compared between metastatic and nonmetastatic lymph nodes. ResultsThere were fifty-nine groups of lymph nodes in 37 patients with hilar cholangiocarcinoma, fifty-one groups were revealed in both DWI and 3D-VIBE sequences, and eight groups were only demonstrated in one sequence (P=0.070). The short diameters were (1.05±0.42) cm and (0.78±0.22) cm on 3D-VIBE images for metastatic and nonmetastatic lymph nodes, respectively (P=0.030). The ADC value in metastatic lymph nodes was (1.64±0.3)×10-3 mm2/s, which was significantly lower than that in nonmetastatic lymph nodes 〔(2.28±0.79)×10-3 mm2/s〕 on DWI images (P=0.033). There were no significant differences in SILN/SIliver between metastatic and nonmetastatic lymph nodes on images of portal venous phase and 3 min delayed contrast-enhanced phase. ConclusionsDifferences of ADC and short diameter can provide valuable information to differentiate metastatic lymph nodes with nonmetastatic lymph nodes. When combined with 3D-VIBE sequence, DWI is more effective in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma.
ObjectiveTo investigate the effect of attenuated expression of neuraminidase 3 (NEU3) via RNA interference on the proliferation and apoptosis in human osteosarcoma MG-63 cells.MethodsMG-63 cells were immunostained to observe the expression of NEU3. The cells were then divided into 5 groups: MG-63 cells in normal control group (group A) were not treated; MG-63 cells in 30, 50, and 100 nmol/L NEU3 RNA interference groups (groups B, C, and D) were transfected with 30, 50, and 100 nmol/L of NEU3 small interfering RNA (siRNA); negative control group (group E), MG-63 cells were transfected with different species negative siRNA (actin siRNA of mice, 50 nmol/L). The expression level of NEU3 mRNA was measured with real-time fluorescence quantitative PCR (qPCR). The proliferation of the cells was measured by cell counting kit 8 (CCK-8). The cell apoptosis rate was detected by flowcytometry (FCM). The expressions of cell apoptosis related proteins (Ras and Bcl-2) were detected by Western blot assay.ResultsNEU3 expressed in the cytoplasm of MG-63 cells under fluorescence microscope. The qPCR results showed that NEU3 mRNA levels were significantly lower in groups B, C, D than that in groups A and E (P<0.05) after 24 hours of transfection; meanwhile, with the increase of siRNA concentration, NEU3 mRNA levels were significantly decreased (P<0.05). The CCK-8 results showed that with the increase of siRNA concentration, the survival rate of MG-63 cells was significantly suppressed (P<0.05) and the apoptosis rate of MG-63 cells was significantly accelerated (P<0.05) after 48 hours of transfection. FCM results showed that after 24 hours of transfection, the number of live MG-63 cells decreased as that of the dead cells increased in groups B, C, D, and showing significant differences between 3 groups (P<0.05). While the apoptosis rate in groups B, C, and D showed significant difference when compared with that of group A (P<0.05); and when compared with group E, the apoptosis rate in groups C and D were significantly reduced (P<0.05), but there was no significant difference between groups B and E (P>0.05). The results of Western bolt assay showed that the protein levels of Ras and Bcl-2 in groups B and C were not significantly different from groups A and E (P>0.05), while the protein levels of Ras and Bcl-2 were significantly decreased in group D (P<0.05).ConclusionAttenuated expression of NEU3 could inhibit the survival of MG-63 cells and accelerate its apoptosis. The results suggest that NEU3 could be a possible target for treating osteosarcoma.