The new coming era has brought great challenge to present health service model, and the development of new science and technology had improved the reconstruction of medical system and model. With the guidance of evidence-based management and participation of model technology, this paper provides an explanation of the new health service model containing new health management, clinical medicine, chronic disease management and elder care which cover the whole life cycle, so as to implement the " Health China” strategy and develop a whole life cycle health service system for all residents with necessary, high quality, and affordable prevention, treatment, rehabilitation and health promotion.
目的:总结肝部分切除治疗肝胆管结石的临床经验。方法:回顾性分析91例肝胆管结石的定位诊断、手术方式、临床效果和手术并发症等情况。结果:术前行彩超检查91例（100％）、CT检查78例（85.7％）、MRI检查6例（5.5％）。术中发现合并胆管狭窄24例（26.4％），合并胆管癌2例（2.1％）。左外叶或左半肝切除71例（78.0％）、右叶各段切除18例（19.8％）、右半肝切除2例（2.2％）。术后并发症发生率19.8％，残石率18.7％。结论:彩超+CT对肝胆管结石的术前定位诊断基本能满足术前对手术方式的制定；以肝段叶切除为主的综合治疗方案是治疗肝胆管结石的有效手段；术中、术后彩超、纤维胆道镜的运用及术后针对患者具体情况的对症治疗措施可提高临床效果，减少并发症。
Objective To investigate the expression of aquaporin-1（AQP-1） on pleura in rats with carrageenan-induced pleural effusion and explore the role of AQP-1 in effusion formation.Methods Fifty-six healthy Wistar rats were randomly divided into a normal control group and 6 pleuritis groups（6，12，24，36，48 and 72 h groups respectively）.The rat model of inflammatory pleurisy was induced by injecting l-Carrageenan into the pleural cavity.The expression of AQP-1 on pleura was detected with immunohistochemistry.The mRNA and protein expression of AQP-1 on visceral pleura and parietal pleura were measured by RT-PCR and Western blot assay respectively.The volume of pleural effusions were measured.Results The volume of pleural effusion was 2.10±0.22，4.10±0.15，4.40±0.36，3.20±0.27，2.60±0.18，0.12±0.02 mL in the 6，12，24，36，48 and 72 h pleuritis groups respectively.AQP-1 were mainly expressed on visceral and parietal pleural mesothelial cells and capillary endothelial cells，and significantly increased in all pleuritic rats The mRNA and protein expression of AQP-1 on parietal pleura increased after 6 h and reached peak level at 24 h in pleuritic groups.The mRNA and protein expression of AQP-1 on visceral pleura increased after 12 h and reached peak level at 24 h in pleuritic groups.The expression of AQP-1 on parietal pleura at 12 h and 24 h in pleuritic groups was correlated positively with the volume of pleural effusion（r=0.857，r=0.846，all Plt;0.01）.The expression of AQP-1 on visceral pleura at 24 h in pleuritic groups was positively correlated with the volume of pleural effusion（r=0.725，Plt;0.05）.Conclusion The expression of AQP-1 on pleura were increased in rats with e carrageenan-induced pleural effusion.AQP-1 may play a role in pleural fluid transportation in pleural effusion.
Extrinsic allergic alveolitis is a general term for type Ⅲ or Ⅳ allergic pneumonia caused by repeated inhalation of various antigenic organic dusts and low molecular weight chemicals in susceptible people. The lesions involve alveolar, pulmonary interstitial, and airway. The main clinical manifestations are cough, expectoration, and dyspnea. Clinically, extrinsic allergic alveolitis is classified into acute, subacute, and chronic forms. Extrinsic allergic alveolitis has a great impact on the pulmonary function of patients. Timely treatment will improve clinical symptoms and inhibit the development of disease. The current treatment plan is mainly avoiding exposure to antigen, glucocorticoid therapy, immunosuppressive therapy, anti-fibrotic therapy, and lung transplantation.
ObjectiveTo provide policy suggestions concerning the distribution of health resources between urban and rural areas and management and education of diabetes, this study depicted the current status of access to healthcare and analyzed its determinants among Chinese diabetic patients.MethodsMultivariate ordinal logistic regression and multivariate binary logistic regression were employed to analyze the effects of socioeconomic status and urban-rural disparities on health access.ResultsMultivariate results suggested that urban patients were more likely to conduct more blood glucose tests (P<0.000 1) and receive more self-care suggestions from physicians (P=0.02). After controlling all other covariates, patients graduated from secondary schools and those with vocational school degrees or above were 1.61 and 2.44 times more possible to take more blood glucose tests.Conclusions There exists significant urban-rural disparities of access to healthcare among Chinese diabetic patients. Education may be a key factor of access to healthcare among Chinese diabetic patients. It’s highly recommended to implement education programs on diabetes management in rural areas, where the education status and demographic factors should be considered. The distribution of health resource in rural areas requires more policy and governmental support.
The operation mode of scientific research incentive mechanism in West China Hospital of Sichuan University is closely connecting individual needs with organizational objectives, and coordinating and adjusting again through communication and feedback. It can play an incentive role continuously and actively promotes the development of hospital scientific research. But the incentive mode, research funding management, research output rate, strengthening of effective communication and other aspects need to be constantly optimized and improved. Based on Porter Lawler’s comprehensive incentive theory, this paper explores and summarizes the operation mode of scientific research incentive mechanism in West China Hospital of Sichuan University. Finally, the paper puts forward suggestions, which aims to provide reference for the construction of scientific research incentive mechanism in large general hospitals.
Most immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICIs) resulted from excessive immune response against normal organs. The severity, timing, and organs affected by these events were often unpredictable. Adverse reactions could cause treatment delays or interruptions, in rare cases, pose a life-threatening risk. The mechanisms underlying irAE involved immune cell dysregulation, imbalances in inflammatory factor expression, alterations in autoantibodies and complement activation, even dysbiosis of intestinal microorganisms. However, the mechanisms of irAE occurrence might differ slightly among organs due to variations in their structures and the functions of resident immune cells. Future research should focus on the development of targeted drugs for the prevention or treatment of irAE based on the mechanisms by which irAE occurs in different organs. A deeper understanding of the mechanisms underlying irAE occurrence would aid clinicians in effectively utilizing ICIs and provide valuable guidance for their clinical application.
ObjectiveTo analyze the changing trend of cancer burden in China from 2005 to 2020, so as to provide reference for the formulation of cancer prevention and control strategies. MethodBased on the report “National and subnational trends in cancer burden in China, 2005–20”, the overall changes in cancer deaths in China by gender, age, urban and rural areas, and different regions of the country were analyzed. Results① Among the whole population, the number of cancer-related deaths and years of life lost (YLLs) in China increased by 21.6% and 5.0% respectively, and the top third leading cause of cancer-related deaths ranked by mortality rate were tracheal, bronchus, and lung cancer, liver cancer, and stomach cancer. ② In different gender groups, for the males, the top five leading cause of cancer-related deaths by mortality rate remained unchanged from 2005 to 2020, they were tracheal, bronchus, and lung cancer, liver cancer, stomach cancer, oesophageal cancer, and colon and rectum cancer. The average annual percent change (AAPC) of the age-standardized mortality rate (ASMR) increased in 4 of the leading 10 cancers, followed by prostate cancer (1.70 per 100 000), pancreatic cancer (0.95 per 100 000), lymphoma (0.33 per 100 000), and colon and rectum cancer (0.31 per 100 000). For the females, the tracheal, bronchus, and lung cancer remained the first leading cancer from 2005 to 2020, the second to the fifth leading cancers by mortality rate showed evident changes, with the liver cancer moving from the third to the second position, the stomach cancer moving from the second to the third position, the colon and rectum cancers moving from the fifth to the fourth position, and the breast cancer moving from the sixth to the fifth position, the pancreatic cancer moving from the ninth to the eighth position. Among the top 10 cancers, only the pancreatic cancer had an increase in AAPC of ASMR (0.67 per 100 000). ③ Among different age groups, the cancer-related mortality in young people (18–44 years old) and middle-aged people (45–59 years old) was much lower than that of the elderly (over 60 years old). ④ The mortality and YLL rates due to cancer in rural areas were higher than those in urban areas for both sexes. The cancer mortality rates of 11 provinces or regions such as Anhui were higher than those the national average value. The mortality, ASMR, YLL rates, and age-standardized YLL rates of all cancer types in Guangxi Zhuang Autonomous Region, Hebei, Xinjiang Uygur Autonomous Region, Henan, and Qinghai decreased in the males and which in Jiangsu, Henan, Guangxi Zhuang Autonomous Region, Xinjiang Uygur Autonomous Region, and Shanghai in the females also decreased. The ASMR of the colon and rectum cancer and pancreatic cancer increased significantly in some provinces or regions.ConclusionsFrom 2005 to 2020, there are rising trends in the number of cancer-related deaths and YLLs in China, and there are differences in the gender, age, urban and rural, and regional distribution of cancer burden. The prevention and control situation is grim, there is an urgent need for a comprehensive cancer prevention and control strategy to deal with the changing cancer burden in China.
【摘要】 目的 了解成都市社区居民脑卒中的流行病学特征，为脑卒中预防、干预提供科学依据。 方法 采用整群随机抽样方法抽取成都市2个社区。对132 303人采用前瞻性的热追踪，搜集社区中脑卒中发病及死亡人群。 结果 2008年脑卒中发病率、死亡率分别为217.68/10万、49.13/10万，2009年发病率、死亡率分别为239.60/10万、41.57/10万，2008年—2009年标化发病率216.01/10万，标化死亡率43.61/10万。缺血性脑卒中患者构成比最高，占半数以上。发病率随年龄增长而增高（χ2=1 095.11，Plt;0.001），男女发病率差异无统计学意义（χ2=2.367，P=0.124）。 结论 成都市社区居民发病率与我国平均水平相当，死亡率略低于我国平均水平。【Abstract】 Objective To explore the epidemiologic features of cerebral apoplexy in community of Chengdu, and to provide references for intervention and prevention of cerebral apoplexy. Methods Two communitis in Chengdu were selected by randomized cluster sampling method. The morbidity and mortality in 132 303 people were calculated by prospective tracing. Results The annual incidence was 217.68 per 100 000, and the annual mortality was 49.13 per 100 000 in 2008. The annual incidence was 239.60 per 100 000, and the annual mortality was 41.57 per 100 000 in 2009. The age-standardized incidence was 216.01 per 100 000, and the age-standardized mortality was 43.61 per 100 000 in the two years. Ischemic cerebral apoplexy exceeded half of all and had a highest constituent ratio. The incidence Increased with the age (χ2=1 095.11, Plt;0.001), while there was no significant difference between the male and female (χ2=2.367, P=0.124). Conclusion The incidence of cerebral apoplexy in Chengdu City is similar to the average incidence of our country, and the mortality is lower than that of the average mortality.
目的:探讨西南地区雌激素受体α（estrogen receptor α，ERα）基因多态性与原性肝癌关系。方法:选择西南地区100名原发性肝癌患者为实验组，100名非肝病人群作为对照组。应用分子生物学的方法分析PvuⅡ，XbaⅠ限制性片段长度多态性（restriction fragment length polymorphism，RFLP）。同时对人雌激素受体基因上游的短串联重复序列（short tandem repeat，STR）进行纯化、克隆和序列分析，观察ERα基因多态性基因型在实验组与对照组中的基因型分布。结果:PvuⅡ和XbaⅠ限制性片段长度多态性在两组中均呈多态性分布。病例组TA13等位基因频率高于对照组，差异有显著性，TA15等位基因频率低于对照组，差异有显著性。结论:ERα基因多态性与原性肝癌有关，X等位基因可能是其危险因素，P等位基因可能是其保护因素，TA13等位基因可能是其危险因素，TA15等位基因可能是其保护因素。