ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.
目的：探討彩色多普勒超聲在心臟手術中的應用價值。方法：在14例心臟病手術中，于心臟修復完成后經心外膜超聲檢查。結果：一例先天性心臟病室間隔缺損修補片周少量殘余漏；一例風濕性心臟病二尖瓣、主動脈瓣置換術后，主動脈瓣下少量返流；因不構成血流動力學的改變，未行二次修復。結論：可即時、準確地為外科醫生提供相關信息，評價手術效果。
Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
目的 提高對囊性纖維化的認識。 方法 2011年11月收治1例自幼有臨床表現的囊性纖維化患者，回顧其診斷及治療經過，復習相關文獻總結其臨床特征、診療進展及預后評價。 結果 囊性纖維化起病年齡較早，患者自幼年起即反復出現肺、消化道、肝臟等多系統病變，最終導致多器官功能衰竭。 結論 應提高對囊性纖維化的識別度，對于發病年齡過早、反復發作的嚴重支氣管擴張，伴隨生長發育延遲、肝硬化等臨床征象應注意對囊性纖維化的篩查。
Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). MethodsPatients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.
Bone tissue engineering is considered as one of the most promising way to treat large segmental bone defect. When constructing bone tissue engineering graft in vitro, suitable bioreactor is usually used to incubate cell-scaffold complex under perfusion to obtain bone tissue engineering graft with good repair efficiency. However, the theoretical model for growth rate of single cell (especially for stem cell) during this process still has many defects. The difference between stem cells and terminally differentiated cells is always ignored. Based on our previous studies, this study used self-made perfusion apparatus to apply different modes and strengths of fluid shear stress (FSS) to the cells seeded on scaffolds. The effects of FSS on the proliferation and osteogenic differentiation of mesenchymal stem cells (MSCs) were investigated. The regression analysis model of the effect of FSS on the single-cell growth rate of MSCs was further established. The results showed that 0.022 5 Pa oscillatory shear stress had stronger ability to promote proliferation and osteogenic differentiation of MSCs, and the growth rate of a single MSC cell under FSS was modified. This study is expected to provide theoretical guidance for optimizing the perfusion culture condition of bone tissue engineering grafts in vitro.
【摘要】 目的 探討胰腺癌早期診斷的要點及誤診因素。 方法 回顧性分析2009年7月8日收治的1例以腹脹、嘔吐為主要表現的胰腺癌患者。 結果 患者經及時剖腹探查確診為胰腺癌并行手術切除。 結論 胰腺癌起病隱匿，其早期誤診率高，進行胰腺癌的早期診斷、避免誤診是提高預后的重點和難點。【Abstract】 Objective To explore the main points of early diagnosis of pancreatic cancer and its misdiagnosis factors. Methods The clinical data of one patient with pancreatic cancer on the 8th July, 2009 was retrospectively analyzed. The chief complaints included abdominal distension and vomiting. Results By exploratory surgery in time,the patient was diagnosed as pancreatic cancer and underwent the resection. Conclusion The onset of pancreatic cancer is very insidious,usually with a high misdiagnosis rate. How to make the right early diagnosis and to avoid misdiagnosis are the focal points of improving the prognosis.
Objective To analyze the dynamic efficiency of township hospitals. Methods Based on the DEA-Malmquist index, this research analyzed the change of the total factor productivity indices and the decomposition items of 281 township hospitals in Hunan province with panel data from 2000 to 2008. Results Among 281 township hospitals, less than half increased their scale efficiency, while more than half increased their total factor productivity, technology, whole efficiency and technical efficiency. Increasing technology and whole efficiency was the best way to improve total factor productivity. Besides, increasing technical efficiency and scale efficiency was the best way to improve whole efficiency. Conclusions The improvement of scale efficiency is key to developing the central township hospitals, while the improvement of technology is the key to developing general township hospitals.
目的 研究人喉表皮癌細胞系Hep-2中乳腺癌易感基因1（BRCAl）、P53結合蛋白1（53BP1）和DNA損傷檢測點介質1（MDC1）的表達及臨床意義。 方法 采用逆轉錄聚合酶鏈式反應檢測BRCA1、53BP1、MDC1在喉癌細胞系Hep-2中mRNA的表達，同時用免疫印跡法檢測蛋白的表達。 結果 在所檢測的人喉癌細胞系Hep-2中BACR1、53BP1、MDC1在基因與蛋白兩個水平均有表達。 結論 BRCA1、53BP1、MDC1可能在喉癌的發生發展中有一定作用。
ObjectivesTo systematically review the concept, definition, development, operation mechanism, function, efficacy, advantages and challenges of pharmacy benefit management (PBM), in order to provide evidence for its introduction and application in China.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and CBM databases were searched to collect literatures on researches, policies, and applications related to PBM from January 1st, 2000 to January 1st, 2017. Two researchers independently screened literatures, extracted data and used the AHRQ evaluation list to evaluate the quality of the observational studies, then qualitative method was used to review literature.ResultsA total of 12 researches were included. The results showed that PBMs had played an important role in negotiation discounts with drug manufacturers, supervising drug circulation and doctors' prescription behaviors, delivering health management services for patients, prescription payments with highly information-oriented systems, etc., which, as a result, could reduce the medication burden of patients with superior diseases management.ConclusionsChina's attempt to adopt a PBM model must take full account of practical conditions, which involves health management system, pharmaceutical market environment and social culture. It cannot merely emulate the PBM model of the United States. With consideration of local conditions, China can explore a suitable path for its own PBM model.