Objective To assess the effectiveness and safety of thalidomide for treating multiple myeloma in China. Methods Randomized controlled trials (RCTs) of thalidomide for multiple myeloma were collected from CNKI (1979 to 2008), CBMdisc (1979 to 2008), and VIP (1989 to 2008) databases. Other relevant journals were also handsearched. The methodological quality of the included studies was evaluated, and data analyses were performed using the Cochrane Collaboration’s software RevMan 4.3. Results A total of 9 RCTs involving 324 patients were included. As for the total effective rate and complete remission rate, significant differences were found between thalidomide + MP vs. MP alone (RR=1.34, 95%CI 1.05 to 1.70; RR=1.77, 95%CI 1.26 to 2.49) and thalidomide + VAD vs. VAD alone (RR=1.45, 95%CI 1.20 to 1.75; RR=1.73, 95%CI 1.25 to 2.39). Conclusion According to the domestic evidence, treatment for multiple myeloma with thalidomide can improve the total effective rate and the complete remission rate. However, more high–quality, large-sample, randomized, double-blind, controlled trials are required.
ObjectiveTo compare early postoperative outcomes of Chinese patients undergoing off-pump coronary artery bypass grafting (OPCAB) with or without preoperative discontinuation of aspirin. MethodsClinical data of 354 patients who underwent elective OPCAB in Department of Cardiac Surgery, People's Hospital of Peking University from 2011 to 2012 were retrospectively analyzed. There were 132 patients during year 2011 who discontinued aspirin more than 5 days before OPCAB and were defined as a discontinuation group, including 93 males and 39 females with their age of 36-83 (61.70±8.74) years. There were 222 patients during year 2012 who continued aspirin treatment before OPCAB and were defined as an aspirin group, including 162 males and 60 females with their age of 37-82 (63.26±8.94) years. Postoperative chest drainage, incidence of reexploration for bleeding, in-hospital morbidity and mortality were compared between the 2 groups. Serum cardiac troponin I (cTnI) levels during 4-6 hours, 12-18 hours and 24-48 hours after OPCAB were also compared. ResultsPreoperative clinical characters were not statistically different between the 2 groups (P>0.05). Average number of grafts in the discontinuation group was significantly smaller than that in the aspirin group (3.00±0.89 vs. 3.43±0.93, P=0.001). There was no significant difference in postoperative chest drainage (1 063.75±511.50 ml vs. 1 131.35±460.13 ml, P=0.201), incidence of reexploration for bleeding(0 case vs. 1 case, P=1.000), perioperative myocardial infarction(2 cases vs. 1 case, P=0.647), postoperative acute renal failure(4 cases vs. 7 cases, P=1.000), stroke(1 case vs. 4 cases, P=0.726), mechanical ventilation time(41.46±85.50 hours vs. 52.07±143.59 hours, P=0.441), length of ICU stay(81.46±116.90 hours vs. 79.07±136.43 hours, P=0.867), or in-hospital mortality(0.8% vs. 0.9%, P=1.000)between the 2 groups. Serum cTnI levels during 4-6 hours after OPCAB were not statistically different between the 2 groups (P=0.506). Serum cTnI levels during 12-18 hours and 24-48 hours after OPCAB were statistically different between the 2 groups (P=0.002 and P=0.000). The percentages of patients with cTnI level higher than 4.0 ng/ml during 12-18 hours and 24-48 hours after OPCAB in the aspirin group were significantly lower than those in the discontinuation group (5.4% vs. 16.7%, P=0.001;5.9% vs. 17.4%, P=0.000). ConclusionOPCAB without preoperative discontinuation of aspirin does not increase the risk of postoperative bleeding, in-hospital morbidity or mortality, but can decrease postoperative myocardial injury of Chinese patients undergoing OPCAB.
ObjectiveTo evaluate the safety of a less traumatic surgical approach in minimally invasive direct coronary artery bypass (MIDCAB). MethodsWe retrospectively analyzed the clinical data of 70 patients underwent MIDCAB via left anterior small thoracotomy between May 2012 and August 2013. There were 60 male and 10 female patients with a mean age of 56.8±9.2 years (ranged 44-76 years), with single vessel disease (left anterior descending artery) in 42 patients,and double or three vessels disease in 28 patients (include left main vessel disease). ResultsThe procedure were successfully completed in all 70 patients. No operation-related death or complication occurred. The extubation time was 4-16 (9.7±5.2) hours. The ICU time was 10-24(20.8±10.8)hours. They were followed up for 1-14 months. No deaths or angina or myocardial infarction occurred. Postoperative coronary angiography in 17 patients found no restenosis. ConclusionMIDCAB via left anterior small thoracotomy can be performed safely by using the new left internal mammary artery (LIMA) harvesting system.
In the context of actively coping with aging, China has introduced a series of health care integration policies. Using the advocacy coalition framework theory, this paper aims to analyze the process of health care integration policy changes in China from three dimensions: policy beliefs, external events and policy learning. The policy subsystem of health care integration in China includes two coalitions: top-down cascade promotion and bottom-up absorption and radiation. External events and policy learning triggered policy change, where policy learning included endogenous learning within the coalition and exogenous learning between the coalitions. A policy impasse occurs when the two advocacy coalitions are at odds, and policy brokers and professional forums can get rid of the policy impasse. In the process of policy change in China’s health care integration, the two major advocacy coalitions have reached a certain consensus. It is recommended to alleviate the problems in the integration of health care by strengthening the external factors in the change of health care policy, enhancing the policy learning in the change of health care policy, and making full use of the information resources in the change of health care policy, so as to promote the high-quality development of the integration of health care.
Objective To analyze the advancement and trends of English literature on elderly integrated care, and provide a reference for related research and practice in China. Methods Web of Science database was searched for English literature on elderly integrated care published between 1977 and 2000, and then CiteSpace software was applied to analyze and graphically present the articles to understand the chronological development, publishing institutions, research hotspots, key articles and so on. Results A total of 1177 English research papers on elderly integrated care were included. The yearly quantity of articles increased significantly since 2016. More than 100 articles had origin in the Unite State of America, the Netherland, the United Kingdom, and Canada, respectively; the organizations of those researches were mainly single programs, and the research fields were relatively scattered. The high-frequency keywords of these articles were health care, quality of life, primary care, home care, community, chronic disease, long term care, mental health, etc, and the burst terms were long term care, case management, quality of life, community, rehabilitation, telehealth, all inclusive care, etc. According to the centrality of co-citation clustering, the top one article was World Report on Ageing and Health published by the World Health Organization. Conclusions Elderly integrated care has been paid increasing international attention. In recent years, integrated care, transitional care, case management and telecare have become research hotspots. With the key policies of people-centred and integrated health services, primary care, and community-level interventions, typical countries have developed basic models of elderly integrated care. The above theories and experiences can provide references for the practice of elderly integrated care in China.
ObjectiveTo investigate the expression of heat shock proteins 90α(HSP90α) in human hepatocellular carcinoma and the relationship between its expression and biologic behavior of tumor and prognosis. MethodsUsing the immunohistochemical SP method, HSP90α expression was detected in liver tissue from 10 normal individuals, 40 patients with hepatocellular carcinoma(HCC) and adjacent noncancerous liver tissues. ResultsThe positive expression rate of HSP90α was 10.0%,52.5%,72.5% in normal liver tissues,adjacent noncancerous liver tissues,hepatocellular carcinous tissues respectively. A significantly higher distribution of HSP90α positive expression in HCC tissues compared with adjacent noncancerous liver tissues and normal liver tissues was obtained （P＜0.05）. The positive expression of HSP90α in HCC was correlated with clinical stage, tumor differentiation, serosal condition and lymph node metastasis （P＜0.05）, but not to tumor number （P＞0.05）. It was also correlated with prognosis of HCC. The mean tumorfree survival of patients with HSP90α negative expression was 38.6 months while that of HSP90α positive expression was 25.5 months （P＜0.05）. ConclusionHSP90α is overexpressed in human hepatocellular carcinoma. HSP90α could be used as an indicator to judge the clinical stage, tumor differentiation, serosal condition, lymph node metastasis and prognosis of HCC.
Objective To investigate the relationship between pancreatic cancer and pancreatic duct stone and the clinical features, diagnosis, treatment of pancreatic duct stone with pancreatic cancer. MethodsThe clinical data of 10 patients suffering pancreatic duct stone with pancreatic cancer, admitted to our hospital from March 1992 to September 2007， were retrospectively analyzed. ResultsThe major symptom was abdominal pain (8/10) in pancreatolithiasis with pancreatic cancer and there were few characteristic symptoms. The positive percentages ofdiagnosis of this disease with B ultrasonography, CT and ERCP wererespectively 4/10, 6/10 and 5/5. The percentage of preoperative final diagnosis was 7/10, meanwhile there were 2 patients who were diagnosed during the operation and 1 patient with missed diagnosis. Surgical treatment was received by all of the patients. Pancreatoduodenectomy was performed in 8 patients. Pancreolithotomy plus pancreaticojejunostomy were performed in 1 patient because of misdiagnosis, while biopsy was only done in the last one. ConclusionCombination of multiple examinations can improve the accuracy of diagnosis of this disease. However, the preoperative diagnosis is not completely believable, and it is necessary to perform the pathological examination during operation. Pancreatoduodenectomy should be used as the first choice for pancreatic duct stone with pancreatic cancer.
ObjectiveTo measure the operational efficiency and explore the phenomenon of the economy of scale in secondary public general hospitals of China for improving the health service efficiency.MethodsFrom February to August 2019, the data set of two input indicators (the number of employees and actual open beds) and two output indicators (the numbers of outpatients and discharges) in 511 secondary general hospitals of Shandong, Anhui, Shanxi, Hubei and Hainan provinces in 2018 were collected for data envelopment analysis. The analysis processes were three folds: First, the technical efficiency, pure technical efficiency, scale efficiency and scale compensation status of the sample hospitals were calculated respectively. Second, the comparative analysis of efficiency value and scale compensation status was carried out in 5 groups according to the bed scale. Finally, the input and output projection analysis was carried out on the ineffective decision making units.ResultsThe medians of technical efficiencies, pure technical efficiencies, and scale efficiencies of the 511 secondary general hospitals were 0.472, 0.531, and 0.909, respectively. In the 511 hospitals, 493 hospitals (96.5%) were in ineffective state, of which 321 hospitals (62.8%) were in the state of decreasing return to scale. The staff redundancy of the group with beds >100 and ≤300 was 23.86%, and its service quantity could be increased by 39.37%.ConclusionsThe overall operating efficiencies are inefficiency in secondary general hospitals of China and the optimal scale of actual open beds is between 300 and 500 beds from the perspective of scale efficiency.