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.
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.
Objective To identify the N6-methyladenosine (m6A)-related characteristic genes analyzed by gene clustering and immune cell infiltration in myocardial ischemia-reperfusion injury (MI/RI) after cardiopulmonary bypass through machine learning. Methods The differential genes associated with m6A methylation were screened by the dataset GSE132176 in GEO, the samples of the dataset were clustered based on the differential gene expression profile, and the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the differential genes of the m6A cluster after clustering were performed to determine the gene function of the m6A cluster. R software was used to determine the better models in machine learning of support vector machine (SVM) model and random forest (RF) model, which were used to screen m6A-related characteristic genes in MI/RI, and construct characteristic gene nomogram to predict the incidence of disease. R software was used to analyze the correlation between characteristic genes and immune cells, and the online website was used to build a characteristic gene regulatory network. Results In this dataset, a total of 5 m6A-related differential genes were screened, and the gene expression profiles were divided into two clusters for cluster analysis. The enrichment analysis of m6A clusters showed that these genes were mainly involved in regulating monocytes differentiation, response to lipopolysaccharides, response to bacteria-derived molecules, cellular response to decreased oxygen levels, DNA transcription factor binding, DNA-binding transcription activator activity, RNA polymerase Ⅱ specificity, NOD-like receptor signaling pathway, fluid shear stress and atherosclerosis, tumor necrosis factor signaling pathway, interleukin-17 signaling pathway. The RF model was determined by R software as the better model, which determined that METTL3, YTHDF1, RBM15B and METTL14 were characteristic genes of MI/RI, and mast cells, type 1 helper lymphocytes (Th1), type 17 helper lymphocytes (Th17), and macrophages were found to be associated with MI/RI after cardiopulmonary bypass in immune cell infiltration. Conclusion The four characteristic genes METTL3, YTHDF1, RBM15B and METTL14 are obtained by machine learning, while cluster analysis and immune cell infiltration analysis can better reveal the pathophysiological process of MI/RI.
Objective To investigate the safe distance of upper gastric cancer by pokemon protein. Methods In 60 cases of upper gastric cancer， specimens were get from tumors’ tissue and every 0.5 cm from the proximal of tumor margin beginning at the 1.0 cm to distal. Western blot method was used to test the expression of pokemon protein. Results There were 38 cases （63.3%） positively expressed pokemon protein. Compared with the center of tumor， the positive expression rates of pokemon protein at every sites of 2.5-5.0 cm from margin were lower （P＜0.003）， but didn’t signi-ficantly differed at every sites of 1.0-2.0 cm from margin （P≥0.003）. When the incisal margin distance of more than 3.5 cm of both sides， the positive expression rate of pokemon protein were 0. There were no significant difference between the corresponding sites of the upper resection margin and lower resection margin （P＞0.05）. Conclusions The results show that 3.5 cm may be the molecular margin basing on the positive expression of pokemon protein in the surgical margin of upper gastric cancer， which may have guiding significance to the surgical margin.
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.
Objective To investigate the expression of growth hormone receptor (GHR) in human gastric cancer tissue. Methods The GHR was detected in samples of the human gastric cancer (57 cases) and the distal normal tissues (57 cases) by immunohistochemistry technique. Results The GHR expression positive rate was 80.7%(46/57) in the human gastric cancer tissues and 70.2%(40/57) in the distal normal tissues. There was no statistic difference between the human gastric cancer tissues and the distal normal tissues (Pgt;0.05). There were also no statistic differences among the gastric cancer tissues of different differentiation, different tissue type, different gender and different age ranges (Pgt;0.05). Conclusion It is similar that the expression of GHR between the human gastric cancer tissues and the distal normal tissues.
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.
ObjectiveTo compare and evaluate the discrimination, validity, and reliability of different data envelopment analysis (DEA) models for measuring the effectiveness of models by selecting different input and output indicators of the model.MethodsData from health statistical reports and pilot program of diagnosis-related groups of tertiary hospitals in Hubei Province from 2017 to 2018 were used to analyze the discrimination, content and structure validity, and reliability of the models. Six DEA models were established by enriching the details of input and output on the basis of the input and output indicators of the conventional DEA model of hospitals.ResultsFrom the view of discrimination, the results of all models were left-skewed, the cost-efficiency model had the lowest left-skewed degree (skewness coefficient: -0.14) and was the flattest (kurtosis coefficient: -1.02). From the view of structure validity, the results of the cost-efficiency model were positively correlated with total weights, outpatient visits, and inpatient visits (r=0.328, 0.329, 0.315; P<0.05). From the perspective of content validity, the interpretation of model was more consistent with theory of production after revision of input and output indicators. From the view of reliability, the cost efficiency model had the largest correlation coefficient between the data of 2017 and 2018 (r=0.880, P<0.05).ConclusionsAfter refining the input and output indicators of the DEA model, the discrimination, validity, and reliability of the model are higher, and the results are more reasonable. Using indicators such as discrimination, validity, and reliability can measure the effectiveness of the DEA model, and then optimize the model by selecting different input and output indicators.