目的：探討彩色多普勒超聲在心臟手術中的應用價值。方法：在14例心臟病手術中，于心臟修復完成后經心外膜超聲檢查。結果：一例先天性心臟病室間隔缺損修補片周少量殘余漏；一例風濕性心臟病二尖瓣、主動脈瓣置換術后，主動脈瓣下少量返流；因不構成血流動力學的改變，未行二次修復。結論：可即時、準確地為外科醫生提供相關信息，評價手術效果。
目的 提高對囊性纖維化的認識。 方法 2011年11月收治1例自幼有臨床表現的囊性纖維化患者，回顧其診斷及治療經過，復習相關文獻總結其臨床特征、診療進展及預后評價。 結果 囊性纖維化起病年齡較早，患者自幼年起即反復出現肺、消化道、肝臟等多系統病變，最終導致多器官功能衰竭。 結論 應提高對囊性纖維化的識別度，對于發病年齡過早、反復發作的嚴重支氣管擴張，伴隨生長發育延遲、肝硬化等臨床征象應注意對囊性纖維化的篩查。
Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.
ObjectiveTo research prognostic prediction value of serum γ-glutamyltransferase-to-prealbumin ratio (GPR) for patients with hepatocellular carcinoma (HCC) after radical resection. MethodsThe clinical data of HCC patients undergoing radical resection from January 2013 to November 2021 were analyzed retrospectively. The optimal critical value of GPR was determined by receiver operating characteristic (ROC) curve. The patients were allocated into the low GPR group (GPR was the optimal critical value or less) and the high GPR group (GPR was greater than the optimal critical value). The differences of clinicopathologic characteristics were compared between the two groups. The overall survival (OS) and relapse-free survival (RFS) were analyzed by the Kaplan-Meier survival curve and compared by the log-rank test between the two groups. The risk factors affecting the OS and RFS of patients with HCC were analyzed by univariate and multivariate Cox regression, and the predictive value of GPR on the OS was evaluated by ROC curve. ResultsA total of 216 eligible HCC patients were gathered. The optimal critical value of GPR was 0.29, 93 cases were in the low GPR group and 123 cases were in the high GPR group. Compared with the low GPR group, the proportions of the patients with preoperative alanine aminotransferase >50 U/L, albumin <40 g/L, total bilirubin ≥34.2 μmol/L, tumor size >5 cm, multiple tumor lesions, stage Ⅲ of China liver cancer staging (CNLC), and major hepatectomy (liver segment resection was 3 or more) were higher in the high GPR group (P<0.05). The Kaplan-Meier survival curve showed that the OS and RFS of the low GPR group were better than those of the high GPR group (χ2=14.356, P＜0.001; χ2=7.963, P=0.005). Cox regression multivariate analysis showed that the preoperative alpha-fetoprotein (AFP) ≥400 μg/L, GPR >0.29, stage Ⅲ of CNLC, and operation time (more than 3 h) were the risk factors for OS and RFS of HCC patients (P<0.05). The area under the ROC curve of GPR alone and it in combination with risk factors (preoperative AFP and CNLC stage, respectively) and in combination with the above three indicators to predict the OS of patients with HCC were 0.636, 0.712, 0.696, and 0.737, respectively. ConclusionFrom the results of this study, GPR is associated with the postoperative survival of patients with HCC after radical resection, and GPR in combination with preoperative AFP and CNLC stage has a certain predictive value for the OS.
Objective To understand the status of needs, demands and utilization of health services of urban and rural residents in Chongqing, so as to provide references for the evaluation of health services status and policy making and regulating. Methods The data from family health questionnaire of health service survey in Western China in 2008 were descriptively analyzed. Results The two-week prevalence rate was 216.9‰ and the two-week hospital visit rate was 211.5‰. The sick people who did not seek medical care accounted for 56.2% among the sick population. The chronic disease prevalence rate was 226.4‰. The annual hospitalization rate was 77.1‰. Conclusion During the past five-year from 2003 to 2008, the needs of health services in Chongqing have had no big change, but the chronic disease prevalence rate has been in uptrend, and the utilization has obviously increased. And the economic factor is still the major cause for impeding residents to seek medical care. So it’s necessary to strengthen the construction of primary health care institutions, to improve the level of health insurance system, and to decrease the disparity in urban and rural areas.
ObjectivesTo systematically review the concept, definition, development, operation mechanism, function, efficacy, advantages and challenges of pharmacy benefit management (PBM), in order to provide evidence for its introduction and application in China.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and CBM databases were searched to collect literatures on researches, policies, and applications related to PBM from January 1st, 2000 to January 1st, 2017. Two researchers independently screened literatures, extracted data and used the AHRQ evaluation list to evaluate the quality of the observational studies, then qualitative method was used to review literature.ResultsA total of 12 researches were included. The results showed that PBMs had played an important role in negotiation discounts with drug manufacturers, supervising drug circulation and doctors' prescription behaviors, delivering health management services for patients, prescription payments with highly information-oriented systems, etc., which, as a result, could reduce the medication burden of patients with superior diseases management.ConclusionsChina's attempt to adopt a PBM model must take full account of practical conditions, which involves health management system, pharmaceutical market environment and social culture. It cannot merely emulate the PBM model of the United States. With consideration of local conditions, China can explore a suitable path for its own PBM model.
【摘要】 目的 觀察低溫等離子射頻治療阻塞性睡眠呼吸暫停低通氣綜合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）合并變應性鼻炎的療效。 方法 對2010年1－5月收治的42例OSAHS合并變應性鼻炎患者，采用低溫等離子射頻雙下鼻甲減容、鼻腔內蝶腭神經及篩前神經末梢阻滯，并配合鼻中隔成形等手術。使用Epworth嗜睡評分量表（epworth sleepiness scale， ESS）和視覺模擬評分法（visual analogue scale，VAS）對治療前及治療3個月后的總體感受評分。 結果 ESS評分與VAS評分均符合正態分布，手術前、后ESS評分[（14.22±4.21）分，（6.78±4.12）分]與VAS評分[（8.34±2.72）分，（3.96±1.02）分]差異有統計學意義（Plt;0.05）。 結論 低溫等離子射頻治療OSAHS合并變應性鼻炎療效較好。【Abstract】 Objective To observe the clinical effect of treatment by low-temperature plasma radio frequency on obstructive sleep apnea-hypopnea syndrome (OSAHS) complicated with allergic rhinitis. Methods A total of 42 patients with OSAHS complicated with allergic rhinitis between January 2010 and May 2010 were chosen. All of the patients were treated by low-temperature plasma radio frequency nerve block, concha nasalis inferior ablation and other operations such as nasal septal construction. The nerve terminals of sphenopalatine nerve and anterior ethmoid nerve were blocked by ablation. Epworth sleepiness scale (ESS) and visual analogue scale (VAS) were used to estimate the curative effects. Results The results of ESS and VAS were consistent with gaussian distribution. There were statistical significant difference between the scores of pre-and post-operation (Plt;0.05). Conclusion The low-temperature plasma radio frequency treatment for OSAHS complicated with allergic rhinitis is easy，safe and efficient.
【摘要】 目的 探討胰腺癌早期診斷的要點及誤診因素。 方法 回顧性分析2009年7月8日收治的1例以腹脹、嘔吐為主要表現的胰腺癌患者。 結果 患者經及時剖腹探查確診為胰腺癌并行手術切除。 結論 胰腺癌起病隱匿，其早期誤診率高，進行胰腺癌的早期診斷、避免誤診是提高預后的重點和難點。【Abstract】 Objective To explore the main points of early diagnosis of pancreatic cancer and its misdiagnosis factors. Methods The clinical data of one patient with pancreatic cancer on the 8th July, 2009 was retrospectively analyzed. The chief complaints included abdominal distension and vomiting. Results By exploratory surgery in time,the patient was diagnosed as pancreatic cancer and underwent the resection. Conclusion The onset of pancreatic cancer is very insidious,usually with a high misdiagnosis rate. How to make the right early diagnosis and to avoid misdiagnosis are the focal points of improving the prognosis.
目的 研究人喉表皮癌細胞系Hep-2中乳腺癌易感基因1（BRCAl）、P53結合蛋白1（53BP1）和DNA損傷檢測點介質1（MDC1）的表達及臨床意義。 方法 采用逆轉錄聚合酶鏈式反應檢測BRCA1、53BP1、MDC1在喉癌細胞系Hep-2中mRNA的表達，同時用免疫印跡法檢測蛋白的表達。 結果 在所檢測的人喉癌細胞系Hep-2中BACR1、53BP1、MDC1在基因與蛋白兩個水平均有表達。 結論 BRCA1、53BP1、MDC1可能在喉癌的發生發展中有一定作用。