【Abstract】Objective To investigate the production and possible significance of plasma trypsinogen activation peptides (TAP) in rat experimental acute pancreatitis. Methods Ninety SD rats were randomly allocated to five groups: group EP with retrograde ductal infusion of 3%sodium taurocholate; group NP with retrograde ductal infusion of 5%sodium taurocholate; group TP with retrograde ductal infusion of 3%sodium taurocholate and ulinastatin(UTI) intravenous infusion half an hour later; group CP with 0.9% NS retrograde ductal infusion; group OP with sham operation. Animals in each group were killed 3h,6h and 24h after infusion. Plasma TAP was determined by EIA.The histological severity of the pancreas were assessed by Schmidt method. Results The pancreatic pathological changes in group NP was significantly severe than in group EP. At 3h and 6h after infusion, plasma TAP concentration of group NP (4.798±0.169)nmol/L and (3.999±0.299)nmol/L were significant higher than that of group EP(2.416±0.148)nmol/L and (3.356±0.211)nmol/L. At 6h after infusion plasma TAP concentration of group TP 〔(1.611±0.113)nmol/L〕 was significant lower than that of group EP(3.356±0.211)nmol/L. The difference of plasma TAP concentration between group EP and group NP appeared prior to the difference of the histopathological changes of pancreas between two groups. Conclusion Plasma TAP concentration is connected with the severity of sodium taurocholate-induced rat pancreatitis. Plasma TAP concentration may be used as a marker for early assessment of the severity of this experimental acute pancreatitis.
目的 检测Claudin-1蛋白在非小细胞肺癌（NSCLC）原发癌组织及其淋巴结转移癌组织中的表达，并探讨其与NSCLC各临床病理特征和预后的关系。 方法 利用组织芯片技术，采用免疫组织化学染色方法检测Claudin-1在1998年1月－2003年12月收集的279例NSCLC原发癌组织及其55例淋巴结转移癌组织、54例癌旁正常肺组织中的表达。运用SPSS 13.00统计软件对相关数据进行统计分析。 结果 Claudin-1在279例NSCLC原发癌组织和55例淋巴结转移癌组织中的阳性表达率分别为69.9%和50.9%，在鳞癌和腺癌中的阳性表达率分别为83.7%和55.7%，在高、中分化癌组和低分化癌组中的阳性表达率分别为78.6%和62.7%。Claudin-1在原发癌组织中的阳性表达率高于其淋巴结转移癌组织（P＜0.05）；在鳞癌中的阳性表达率高于腺癌（P＜0.05），且在高、中分化癌组中的阳性表达率高于低分化癌（P＜0.05）。Claudin-1阳性表达之NSCLC患者的生存率高于阴性表达者（P＜0.05）。 结论 Claudin-1在NSCLC中的表达与患者的组织学类型及病理分级有关，且Claudin-1是NSCLC侵袭、转移的抑制因子，并且可能是一个有用的预后因子。
Objective To explore the influencing factors of lymph node metastasis of Siewert Ⅱ/Ⅲ gastroesophageal junction adenocarcinoma (AEG) and its influence on prognosis of this kind of patients. Methods The clinical and pathological data of 49 patients with Siewert Ⅱ/Ⅲ AEG who admitted to Shiyan Hospital of Traditional Chinese from January 2010 to January 2013 were retrospectively analyzed. Univariate and multivariate analyses of factors affecting lymph node metastasis of AEG were performed by using a chi-square test and an unconditional logistic regression model; the effect of lymph node metastasis on the prognosis of patients with Siewert Ⅱ/Ⅲ AEG was performed by log-rank test. Results Multivariate unconditional logistic regression analysis showed that, tumor diameter (P=0.008), depth of invasion (P=0.019), vascular tumor thrombus (P=0.020), and degree of differentiation (P=0.017) were all influencing factors of lymph node metastasis. Patients with Siewert Ⅱ/Ⅲ AGE without lymph node metastasis had better survival than those with lymph node metastasis (P=0.005). Conclusion Tumor diameter, depth of invasion, degree of differentiation, and vascular tumor thrombus are independent risk factors for lymph node metastasis in patients with Siewert Ⅱ/Ⅲ AEG, and lymph node metastasis is associated with poor prognosis.
Objectives To describe background, measures and impacts of building essential healthcare system in the developed and developing countries aboard. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. The resources we searched included electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develop an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result 166 studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objectives, many studies (160 articles) aimed to describe strategies, while few studies(6 articles) were to evaluate effectiveness of strategies. Most of studies evaluating effectiveness were cross-sectionnary data, Except one time cohort study with intervention. Conclusions Strategies to implement essential healthcare system varies in the different country because of diversity of political, culture and economic background and different goals. The experience in transition countries gives us more high lights.
It is the key for evidence-base decision to gain the high quality evidences. As a valuable method,systematic review has been widely used in medical areas with the improvement of the method, but it cannot be useddirectly in health policy field, because the characters of the health policy such as research topics, methods and objectives.The Center for Health Management and Policy of Shandong University has made some researches which focus on themethod under the support from the Alliance for Health Policy and Systems Research (WHO) from 2006. We haveexplored the two-stage systematic review method of health policy researches and applied it into reality. The purpose of thisarticle is to introduce the key technical of this method, which include quality assessment of the literatures, analysis andintegrated approaches. We also put forward the work which needs to be continued in the future.
Objective To describe the criteria and procedure for defining an essential healthcare package in the developed and developing countries. Method Search words were chosen by both health policy experts and search coordinators after discussion and pilot. We searched electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develope an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result One hundred and sixty-six studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objective,160 articles aimed to describe strategies, 6 articles aimed to evaluate effectiveness of strategies.Five studies evaluating effectiveness were cross-sectionnary data, and one study was time series. Conclusion An appropriate package should be defined according to both technique criteria and social welfare criteria, considering each country’s healthcare system and market structure, characteristics of the demander and provider, capacity of government’s regulation. The experience in transition countries gives us more high lights.
Objectives To describe the range of strategies for expanding health insurance coverage for vulnerable population and how the authors have assessed these strategies. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. What was searched included 28 electronic databases, 12 websites of health institutions, 3 grey literature databases and search engine Google. Any report of implemented strategies to expand health insurance coverage for vulnerable population was included. Pre-designed data extraction form was used for collecting strategies and study methods of the included studies. Then the extracted information was analyzed and described. Results A total of 86 studies were included, most of which were the ones in the U.S. and the main targeted population was children. In terms of the study objective, 61 studies aimed to describe strategies and 25 ones are to evaluate effectiveness of the strategies. All strategies could be categorized into 6 groups based on the theoretical framework: changing eligibility criteria of health insurance, increasing awareness, making premium affordable, innovating enrollment approaches, improving health care delivery and strengthening management capacity. Most of the studies evaluating effectiveness were retrospective analysis of longitude data, and there were also two experimental studies. Conclusions The U.S. and other developed countries have implemented a great many strategies for expanding insurance coverage, while few strategies and related studies are found in developing countries. However, developing countries can learn from the developed countries in extending health insurance coverage. The 25 included studies evaluating strategies need further systematic reviews to assess the effectiveness of these strategies.
Objectives Through a systematic review, to summarize and describe various health security mechanisms of protecting financial risk from illness in low and middle income countries (LMICs), and to analyze causes that lead to different effects in financial risk protecting. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. Twenty-four electronic databases, websites of 11 health institutions, and the search engine Google were searched. Any original study to evaluate the role of financial protection of health security mechanism in LMICs was included. Pre-designed data extraction form was used for collecting strategies and study method of included studies, and extracted information was analyzed and described. Results Fifty-two studies were included, and 56 specific health security mechanisms were categorized into 6: community-based health insurance, social health insurance, health sector reform, subsidy, user fee, and new rural cooperative medical scheme (NRCMS) in China. Forty-two mechanisms had positive effect in financial protection, 6 were negative, 5 had no effect and the effect of the other 2 was unclear. Conclusion Mechanisms that produced positive effect can be summarized as: setting up of co-payment rate, design of benefit packages, providing free care for vulnerable population, delivering primary health care directly in remote area, and Chinese NRCMS. Mechanisms to protect the poor from financial risk of illness include: government provides health insurance, providing free care and setting up different co-payment rate according to income. The failure of health security mechanisms can be ascribed the deviation from its original goal of health security mechanism design, due to various inner or external causes.