With the continuous progress and development of the medical and health industry, drug procurement has gradually attracted more attention, and the drug bidding and procurement model in China is in a stage of gradual improvement. In this article, the historical evolution of drug centralized bidding and procurement policy in China is briefly introduced. By analyzing the current drug centralized bidding and procurement policy implemented in China, issues such as difficulty reasonably determining “quantity” in quantity procurement, lack of drug effective supervision of procurement policy, incomplete drug catalog procurement, and out-of-network procurement were found. Some possible feasible suggestions are also put forward, aiming at providing reference and ideas for further improvement of drug centralized bidding and procurement policy under the new situation, so as to ensure safety of drugs and benefit the people.
目的 探讨maspin和p53在乳腺癌中的表达及其临床意义。方法 选取河北省盐山县人民医院及天津市第五中心医院共96例乳腺癌标本及25例正常乳腺组织标本，采用免疫组织化学方法检测maspin和p53的表达情况，分析其与乳腺癌患者临床病理特征间的关系及二者的相关性。结果 96例乳腺癌标本中，maspin表达阳性率为44.79% （43/96），明显低于其在正常乳腺组织中的表达 〔72.00% （18/25），χ2=5.873 8，P=0.015 4〕；p53表达阳性率为61.46% （59/96），明显高于其在正常乳腺组织中的表达 〔8.00% （2/25）， χ2=20.586 9，P=0.000 0〕。maspin和p53阳性表达均与肿瘤TNM分期和淋巴结转移有关（P＜0.05），而均与患者年龄、肿瘤大小、组织学类型及组织学分级无关（P＞0.05），且maspin阳性表达与p53阳性表达呈负相关（rs=-0.447，P=0.000）。结论 maspin和p53在乳腺癌演进过程中扮演重要角色，提示二者可作为预测乳腺癌生物学行为及预后的参考指标，并为乳腺癌的治疗提供了新的研究靶点。
ObjectiveTo investigate clinical outcomes and safety of minimally invasive left atrial myxoma (LAM) resection via right anterolateral minithoracotomy (ALMT). MethodsClinical data of 9 patients who underwent minimally invasive LAM resection via right ALMT in the Affiliated Hospital of Luzhou Medical College from January 2011 to October 2013 were retrospectively analyzed. There were 2 male and 7 female patients with their age of 37-62 (51±9) years. The operation was performed through a small (4-6 cm) right ALMT incision. Femoral artery and vein and superior vein were cannulated to establish cardiopulmonary bypass (CPB). Transthoracic clamp was used for ascending aortic clamping. Antegrade cold blood cardioplegia was infused for myocardial protection. LAM was resected through right atriotomy trans-septal approach. ResultsAll the operations were successfully performed without in-hospital death. Operation time was 210-310(260±33) minutes, aortic cross-clamping time was 23-50(37±9) minutes, CPB time was 60-87(71±9) minutes, postoperative mechanical ventilation time was 6-14(9.0±2.5) hours, and length of ICU stay was 17-26(20±3) hours. Postoperative mediastinum drainage was 100-650(376±190) ml. Mean length of right ALMT was 4.5-6.0 (5.3±0.6) cm. All the patients were followed up for 1 to 30 months,and echocardiography showed no LAM recurrence. ConclusionMinimally invasive LAM resection via right ALMT is safe and feasible with satisfactory clinical outcomes.
ObjectiveTo analyze clinical outcomes of mitral valvuloplasty (MVP) via right anterolateral minithoracotomy. MethodsClinical data of 23 patients with valvular heart disease who underwent minimally invasive MVP via right anterolateral minithoracotomy from January 2011 to February 2013 in the Department of Cardiothoracic Surgery in our hospital were retrospectively analyzed. There were 8 males and 15 females with mean age of 41±10 years. The procedure was performed through a small (4-6 cm) incision via right anterolateral minithoracotomy. Cardiopulmonary bypass (CPB) was established via femoral artery and vein cannulation. Transthoracic clamp was used for ascending aortic clamping. Cold blood cardioplegia was delivered after aortic cross-clamping. Left atrial drainage was established through right superior pulmonary vein. MVP was performed through the atrial septal approach,and tricuspid valvuloplasty was performed for tricuspid regurgitation if necessary. ResultsAll the operations were successfully performed without in-hospital death. Operation duration was 160-290 (229±37) minutes. Aortic cross-clamping time was 40-121 (67±19) minutes. CPB duration was 60-136 (87±21) minutes. Postoperative mechanical ventilation time was 6-47 (16±11) hours. The length of intensive care unit stay was 19-60 (30±12) hours. Postoperative chest drainage was 80-780 (320±184) ml. Postoperative color Doppler echocardiography showed that left ventricular ejection fraction was 49%-65% (56.0%±4.8%). There were 5 patients with trivial mitrial valve regurgitation and 6 patients with mild tricuspid valve regurgitation. Postoperative mean length of the right thoracic incision was 3.9-6.0 (5.3±0.7) cm. The patients were followed up for 1-24 months. The result of echocardiography showed no modern to severe valve regurgitation. ConclusionMinimally invasive MVP via right anterolateral minithoracotomy is safe and feasible with satisfactory cosmetic and clinical results.
Objective To observe the change of sino-atrial nodal tissue structure and ectopic pacing function after xenogenic sino-atrial nodal tissue transplanted into left ventricular wall, so as to provide new ideas for the treatment of sick sinus syndrome and severe atrioventricular block. Methods Seventy healthy rabbits were selected, male or female, and weighing 1.5-2.0 kg. Of them, 42 were used as reci pient animals and randomly divided into sham operation group, warm ischemia transplantation group, and cold ischemia transplantation group (n=14), the other 28 were used as donors of warm ischemia and cold ischemia transplantation groups, which were sibl ing of the recipients. In recipients, a 6-mm-long and about 2-mm-deep incision was made in the vascular sparse area of left ventricular free wall near the apex. In sham operation group, the incision was sutrued directly by 7-0 Prolene suture; in cold ischemia transplantation group, after the aortic roots cross-clamping, 4 ℃ cold crystalloid perfusion fluid infusion to cardiac arrest, then sinoatrial node were cut 5 mm × 3 mm for transplantation; in warm ischemia transplantation group, the same size of the sinus node tissue was captured for transplantation. After 1, 2, 3, and 4 weeks, 3 rabbits of each group were harvested to make bradycardia by stimulating bilateral vagus nerve and the cardiac electrical activity was observed; the transplanted sinus node histology and ultrastructural changes were observed. Results Thirty-six recipient rabbits survived (12 rabbits each group). At 1, 2, 3, and 4 weeks after bilateral vagus nerve stimulation, the cardiac electrical activity in each group was significantly slower, and showed sinus bradycardia. Four weeks after operation the heart rates of sham operation group, warm ischemia, and cold ischemia transplantation group were (81.17 ± 5.67), (82.42 ± 7.97), and (80.83 ± 6.95) beats/ minute, respectively; showing no significant difference among groups (P gt; 0.05). And no ectopic rhythm of ventricular pacing occurred. Sino-atrial nodal tissue survived in 6 of warm ischemic transplantation group and in 8 of cold ischemia transplantation group; showing no significant difference between two groups (P gt; 0.05). Two adjacent sinoatrial node cells, vacuole-l ike structure in the cytoplasm, a few scattered muscle microfilaments, and gap junctions between adjacent cells were found in transplanted sinus node. Conclusion The allograft sinus node can survive, but can not play a role in ectopic pacing.
ObjectiveThrough comparing the efficacy of levosimendan with dopamine for severe valvular disease patients with atrial fibrillation surgery to explore the efficacy and safety of levosimendan used in cardiac surgery. MethodsWe allocated 48 severe valvular disease patients with atrial fibrillation surgery into a dopamine group (24 patients with 15 males and 9 females at age of 55.0 ± 17.4 years) and a levosimendan group (24 patients with 18 males and 6 females at age of 52.3 ± 16.2 years) by random digital table in the Affiliated Hospital of Luzhou Medical College between February and June 2014. The effects of the two groups were compared. ResultsHospitalization time (18.7±8.6 d vs 20.6±7.5 d, t=11.52, P=0.02) and the incidence of acute kidney injury(1/24 vs 5/24, χ2=25.30, P=0.01) in the levosimendan group were lower than those in the dopamine group. There was no statistical difference between the two groups in other early clinical outcomes. At each postoperative time point, there was no statistical difference in creatine kinase isoenzyme (CK-MB) between the two groups. While 6 to 48 hours after operation, there were significant differences in cardiac troponin (cTnI) and brain natriuretic peptide(BNP) level between the two groups (P < 0.05). Five days after operation, the left ventricular ejection fraction(LVEF) in the levosimendan group was higher than that in the dopamine group with statistical difference. ConclusionLevosimendan used for severe valvular disease with atrial fibrillation surgery is safe and effective, and has certain myocardial protection and renal protection effect, while its mechanism still needs further study.
ObjectiveTo explore whether preoperative coronary angiography could increase the incidence of postoperative acute kidney injury for patients with valve replacement. MethodsA total of 638 patients underwent routine cardiac valve replacement in our hospital from January 2013 through September 2015. There were 118 patients with preoperative coronary angiography (a coronary angiography group), and 520 patients without coronary angiography (a non-coronary angiography group). Serum creatinine (Scr), urea nitrogen(Bun), brain natriuretic peptide (BNP), creatine kinase myocardial band (CK-MB), cardiac troponin I (cTnI) values were recorded at 4 time points:before surgery (T0), after surgery 12 h (T1), 24 h (T2), 48 h (T3). The number of patients with acute kidney injury at the time of 48 hours after surgery was recorded. ResultsScr values (91.6±37.7 μmol/L vs. 81.0±27.4 μmol/L, 84.9±23.6 μmol/L vs. 73.5±25.3 μmol/L) increased in the patients who did not undergo coronary angiography at the time of 24 hours and 48 hours after cardiac surgery compared with the patients with coronary angiography with statistical differences. While there was no statistical difference in the incidence of acute kidney injury between the two groups. The cardiac enzymes had no statistical difference between the two groups. ConclusionPreoperative coronary angiography does not increase the probability of postoperative acute kidney injury.
Objective To study the influence of ischemia-reperfusion on the expression of the hyperpolarization activated cycl icnucleotide gated cation channel 4 (HCN4) and to discuss the mechanism of functional disturbance of sinoatrial node tissue (SANT) after ischemia reperfusion injury (IRI). Methods Eighty five healthy adult rabbits, weighing 2-3 kg, were randomly divided into 3 groups: control group [a suture passed under the root section of right coronary artery (RCA) without l igation, n=5], experimental group A (occluding the root section of RCA for 30 minutes, then loosening the root 2,4, 8 and 16 hours, n=10), experimental group B (occluding the root section of RCA for 1 hour, then loosening the root 2, 4,8 and 16 hours, n=10). At the end of the reperfusion, the SANT was cut off to do histopathological, transmission electronmicroscopical and immunohistochemical examinations and semi-quantitative analysis. Results The result of HE stainingshowed that patho-injure of sinoatrial node cell (SANC) happened in experimental groups A and B after 2 hours of reperfusion, the longer the reperfusion time was, the more serious patho-injure of SANC was after 4 and 8 hours of reperfusion, SANC reached peak of damage after 8 to 16 hours of reperfusion; patho-injure of SANC was more serious in experimental group B than in experimental group A at the same reperfusion time. Immunohistochemical staining showed that the expression of HCN4 located in cellular membrane and cytoplasm in the central area of SANC and gradually decreased from the center to borderl ine. The integral absorbance values of HCN4 expression in the control group (397.40 ± 34.11) was significantly higher than those in the experimental group A (306.20 ± 35.77, 216.60 ± 18.59, 155.40 ± 19.11 and 135.00 ± 12.30) and in the experimental group B (253.70 ± 35.66, 138.70 ± 13.28, 79.10 ± 9.60 and 69.20 ± 8.42) after 2, 4, 8 and 16 hours of reperfusion (P lt; 0.05). With reperfusion time, the expression of HCN4 of SANC decreased, which was lowest after 8 hours of reperfusion; showing significant difference among 2, 4 and 8 hours after reperfusion (P lt; 0.05) and no significant difference between 8 and 16 hours after reperfusion (P gt; 0.05). At the same reperfusion time, the expression of HCN4 was higher in the experimental group A than in the experimental group B. The result of transmission electron microscope showed that ultramicrostructure of SANC was damaged after reperfusion in experimental groups A and B. The longer the reperfusion time was, the more serious ultramicrostructure damage of SANC was, and reached the peak of damage after 8 hours of reperfusion. Ultramicrostructure of SANC was not different between 8 and 16 hours of reperfusion. At the same reperfusion time, the ultramicrostructure damage of SANC was moreserious in experimental group B than in experimental group A. Conclusion IRI is harmful to the morphous and structure ofSANC, and effects the expression of HCN4 of SANC, which is concerned with functional disturbance and arrhythmia.