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The unclear connotation and fragmented governance of the multi-tiered medical security system pose challenges to its high-quality development.This article redefines the concept and connotation of the multi-tiered medical security system using holistic governance theory.It distinguishes the bottom layer,basic layer,and supplementary layer from the perspective of the essential attributes and direct functions of each system.Furthermore,from the perspective of holistic governance,the article analyzes the current reform practice and finds that fragmented management thinking,unclear positioning of sub-system functions,insufficient policy coordination,single participation subject,and lack of equal negotiation mechanisms are constraints on the overall effectiveness of the multi-tiered medical security system.Therefore,it is necessary to adopt systematic and targeted reform measures from the perspective of holistic governance to improve the system.
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Meta-analysis was conducted on the tetanus antibody protection rate of healthy population born after 1978 in China (data from Hong Kong, Macao and Taiwan was excluded, the same below). Search the data on China's tetanus antibody level which were published in China National Knowledge Infrastructure, Wanfang data, VIP, SinoMed database, PubMed and the Cochrane Library. The Chinese search keywords were "Tetanus Antitoxin", "Tetanus Antibody", "Healthy Population" and "Mainland China". English search terms include "tetanus antitoxin", "tetanus vaccine", "tetanus vaccine", "general population" and "mainland of China". The time limit for inclusion in literature research was 2010-2019. Stata software was used to conduct meta-analysis on the protection rate of tetanus antibody. A total of 24 articles were included. There was no obvious publication bias in the included articles. The total number of respondents was 23 530, the antibody protection rate was 49.5%-99.0%. A total of 20 817 people got effective antibody protection, which meant the antibody level reached and exceeded 0.1 IU/ml, and the combined protection rate was 78.6% (95: 75.0%-88.2%). The combined protection rates of antibody in 0-7 years old and 8-15 years old groups were 88.9% (95: 86.9%-91.0%) and 79.3% (95: 72.9%-86.2%) respectively. The combined protection rates of antibodies in 16-20 years old, 21-30 years old and 31-40 years old groups were 58.9% (95: 46.5%-71.2%), 47.7% (95: 16.8%-78.7%) and 63.8% (95:32.6%-95.1%) respectively. The combined protection rate of tetanus antibody for 0-15 years old people was 85.6% (95: 83.1%-88.1%), and the combined protection rate of antibody for 16-40 years old people was 52.9% (95: 39.3%-66.6%). With the increase of age, the protection rate of tetanus antibody among the healthy population aged 16-40 years in our country decreases. An individualized vaccination plan should be formulated according to the previous tetanus vaccination history and the tetanus antibody level when necessary.
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A case with breast schistosomiasis japonica was reported.
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Objective To analyze risk factors for delayed postpolypectomy bleeding (DPPB) of colorectal polyps. Methods We reviewed 1 098 patients (2 169 polyps) who accepted endoscopic polypectomy from July 2014 to July 2017. Evaluate the risk factors for DPPB. Results DPPB occurred in 18 (1.6%) cases. Univariate analysis revealed that history of hypertension (P = 0.007), polyp size ≥10 mm (P = 0.009), right hemicolon location (P = 0.015) and adenomatous polyp (P = 0.045) were risk factors for DPPB. Multivariate logistic regression analysis revealed that history of hypertension (P = 0.002, O(R) = 4.654, 95%CI: 1.755 ~ 12.343), polyp size ≥10 mm (P = 0.009, O(R) = 3.637, 95%CI: 1.390 ~ 9.517), location in the right hemicolon (P = 0.016, O(R) = 3.656, 95%CI:1.273 ~ 10.504) were independent risk factors for DPPB. Conclusion Patients with history of hypertension, polyp size ≥10 mm, polyp location in the right hemicolon are prone to DPPB. We should take effective measure to prevent DPPB.
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Objective?To investigate the efficacy and safety of dental floss traction assisted technique in endoscopic submucosal dissection (ESD) of early rectal cancer and precancerous lesions.?Methods?57 patients recived ESD for early colorectal cancer and precancerous lesions from September 2014 to June 2017 were randomly divided into dental floss traction group (n = 28) and routine group (n = 29). To compare the average operation time, the amount of supplementary submucosal injection, and frequency of supplementary submucosal injection, complete resection rate, R0 resection rate, complications and follow-up results of the two groups.?Results?All 57 cases were treated with ESD successfully. The average operation time, the amount of supplementary submucosal injection and the frequency of injection were significantly less in the dental floss traction group than in the conventional group [(55.11 ± 10.44) vs (74.72 ± 14.47) min; (5.80 ± 1.80) vs (10.00 ± 5.70) ml; frequency (1.10 ± 0.90) vs (1.70 ± 0.90)]. The average operation time (P = 0.000), the amount of supplementary submucosal injection (P = 0.001) and the frequency of supplementary submucosal injection (P = 0.022) were significantly different between the two groups. The complete resection rate and R0 resection rate were 100.0% in both groups. There was no bleeding or perforation in the dental floss traction group, and 1 cases (3.4%) in the conventional group had delayed bleeding after operation, and 2 cases (6.9%) perforation occurred during the operation, and there was no significant difference between the two groups (P > 0.05). No recurrence was found in the two groups during follow-up period.?Conclusions?Dental floss traction assisted technique can significantly shorten the operation time of ESD, reduce the amount and frequency of supplementary submucosal injection and ensure good therapeutic effect for early colorectal cancer and precancerous lesions.
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α-Hederagenin (H), derived from Hedera nepalensis var.sinensis, is a pentacyclic oleane-type triterpenoid that exhibits clear cytotoxicity to different tumor cell lines.In this study,a series of novel C-28 derivatives of hederagenin (H) were designed and synthesized in attempt to develop potent tumor resistance reverse activities agents. Previous research showed that H6 displayed robust reverse activity for paclitaxel resistance in KBV cells. Importantly, Co-treatment of paclitaxel with H6 significantly reduced the tumor weight to 42%. Pleasingly, H6 enhanced the efficacy of paclitaxel against KBV cancer cell-derived xenograft tumors in nude mice.Mechanism studies had found that H6 activated permeability glycoprotein(P-gp)ATPase,reduced intracellular ATP levels and inhibited efflux of P-gp substrates,thus enhancing the antitumor activity of paclitaxel on KBV cells.Molecular docking analysis of homology P-gp and H6 then conducted using the Surflex-Dock module.H6 showed a high binding affinity docking score with a total score of 5.4148,much higher than that of H(0.1414).The nov-el C-28 derivatives of H was synthesized from H6 via three-step reaction. The reversal activity of all synthesized H derivatives were tested using the MTT assay.The results showed that the derivatives of nitrogen groups at C-28 displayed same even potent activity than parent compound H6.In addition,its underlying mechanism of action and in vivo activity are in explore.
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To measure particle size distribution of phenols in mainstream cigarette smoke aerosol,the particles of cigarette smoke aerosol were divided into 12 stages using single channel smoking machine coupled electrical low-pressure impactor (ELPI) and collected by 12 polyester films.The collected particles were weighted and then analyzed by ultra-high performance liquid chromatography-fluorescence detection (UPLC-FLD) to determine the 14 phenols in the different size particles.The results showed that the aerosols collecting method had good stability with relative standard deviation (RSD) of collected particles mass less than 10%.The analyzing results of 14 phenols by UPLC-FLD showed that the linear correlation coefficients(R2) were greater than 0.9959,with detection limits were less than 1.2 ng/cig and recoveries were 80.1%-115.0%.The distributions of 14 phenols with respect to smoke aerosol particle size were investigated.The results indicated that except 4-ethyl-2-methoxy-phenol not detected,the other 13 phenols were detected in mainstream cigarette smoke aerosol.The content of 13 phenols appeared increasing at first and then decreasing with increase of the particle size which distributed in a pattern similar to that of particle mass.All of 13 phenols were present in higher amounts in the medium size particles (0.261-0.722 μm) with peak content in particles 0.431 μm.The distribution of concentrations (ratio of content to particle mass) of 13 phenols in different size particles was different.The concentrations of phenol and mono-substituted phenol appeared to first increase and then decrease with increasing smoke aerosol particle size and were higher in medium size particles (0.261-0.772 μm).The concentrations of benzenediol and mono-substituted benzenediol were uniformly distributed in medium size particles (0.144-1.166 μm),and the concentration of disubstituted phenol was uniform throughout the particles of varying sizes.
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The integration reform of medical service system in counties and towns had been an important way to sink the county health resources and to enhance the primary medical service ability.By summarizing the reform of the policy and the practical experience,it summarized the current diversification of integrated reform as decentralized help management,centralized agreement hosting,loose "medical union" integration and close "medical union" integration.After analyzing the challenges faced the integration reform,it proposed the need to establish a close "medical union",optimize the functions of government services and establish the modem hospital management system.
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<p><b>OBJECTIVE</b>To investigate the prevalence of adenoviruses (AdV) and their genotypes in infants and young children with diarrhea.</p><p><b>METHODS</b>A total of 380 children with diarrhea aged less than 3 years were enrolled. The genomic DNA was extracted from stool and PCR was used to detect AdV. Clone sequencing and genotyping were performed for DNA in AdV-positive specimens.</p><p><b>RESULTS</b>AdV was detected in 24 out of 380 specimens, and the detection rate was 6.3% (24/380). A majority of children with positive AdV were aged 2-3 years. The viral sequence analysis of positive specimens showed that the detection rates of enteric AdV41 and non-enteric AdV were 4.2% (16/380) and 2.1% (8/380), respectively, and among the children with non-enteric AdV, there were 2 with AdV1, 2 with AdV2, 1 with AdV7, 2 with AdV12, and 1 with AdV31.</p><p><b>CONCLUSIONS</b>Diarrhea caused by AdV is commonly seen in children aged 2-3 years, and AdV41 is the major predominant strain.</p>
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Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Adenoviridae , Clasificación , Genética , Diarrea , Virología , GenotipoRESUMEN
This study examined the effect of CD24 on anoikis of ovarian cancer cells. The expression of CD24 was detected by RT-PCR and Western blotting in ovarian cancer cells with high metastatic potential (HO-8910PM cells) and low metastatic potential (A2780 cells). Cell viability and cell proliferation were detected by MTT assay in suspension culture and adhesion culture. Soft agar culture was used to observe the colony formation. Anoikis was flow cytometrically detected. The results showed that the expression levels of CD24 mRNA and protein were significantly higher in HO-8910PM cells than in A2780 cells (P<0.01). In the suspension culture and soft agar culture, the HO-8910PM cells formed larger and more colonies (35.33 ± 5.51 vs. 16.67 ± 4.04; P<0.01), and showed a stronger resistance to anoikis than A2780 cells did (cell apoptosis rate: 5.93% ± 2 .38% vs. 16.32% ± 2.00%; P<0.01). After treated with CD24 monoclonal antibodies, the number of colony formed in HO-8910PM and A2780 cells was significantly decreased (9.33 ± 2.52 and 8.00 ± 2.00, respectively), and the anoikis rate of the two cell lines was also markedly increased (23.11% ± 2.87% and 28.36% ± 2.29%, respectively). Our study suggested that CD24 may play an important role in the development of anoikis resistance and CD24 can be used as a new therapeutic target to induce anoikis and inhibit metastasis in ovarian cancer.
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Femenino , Humanos , Anoicis , Antígeno CD24 , Genética , Metabolismo , Línea Celular Tumoral , Proliferación Celular , Supervivencia Celular , Resistencia a Antineoplásicos , Neoplasias Ováricas , Genética , MetabolismoRESUMEN
This study examined the effect of CD24 on anoikis of ovarian cancer cells. The expression of CD24 was detected by RT-PCR and Western blotting in ovarian cancer cells with high metastatic potential (HO-8910PM cells) and low metastatic potential (A2780 cells). Cell viability and cell proliferation were detected by MTT assay in suspension culture and adhesion culture. Soft agar culture was used to observe the colony formation. Anoikis was flow cytometrically detected. The results showed that the expression levels of CD24 mRNA and protein were significantly higher in HO-8910PM cells than in A2780 cells (P<0.01). In the suspension culture and soft agar culture, the HO-8910PM cells formed larger and more colonies (35.33±5.51 vs. 16.67±4.04; P<0.01), and showed a stronger resistance to anoikis than A2780 cells did (cell apoptosis rate: 5.93%±2.38% vs. 16.32%±2.00%; P<0.01). After treated with CD24 monoclonal antibodies, the number of colony formed in HO-8910PM and A2780 cells was significantly decreased (9.33±2.52 and 8.00±2.00, respectively), and the anoikis rate of the two cell lines was also markedly increased (23.11%±2.87% and 28.36%±2.29%, respectively). Our study suggested that CD24 may play an important role in the development of anoikis resistance and CD24 can be used as a new therapeutic target to induce anoikis and inhibit metastasis in ovarian cancer.
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The aim of this study was to investigate the effect of meisoindigo on Wnt signal pathway in K562 cells and HL-60 cells and its possible regulatory mechanism. RT-PCR and Western blot assay were used to detect the expression of GSK-3beta and its downstream associated genes as well as proteins expression respectively. The results showed that the meisoindigo could inhibit the phosphorylation of GSK-3beta and decreased beta-catenin and c-myc genes expression in HL-60 cells, but did not significantly affect the two gene expression in K562 cells. Meisoindigo slightly increased the expression of GSK-3beta protein in HL-60 cells, obviously decreased the expression of p-GSK-3beta and c-MYC proteins in K562 cells and HL-60 cells, while meisoindigo did not affect the expression of beta-catenin in K562 cells significantly, but could decrease the expression of beta-catenin in HL-60 cells. It is concluded that the meisoindigo can affect the Wnt signal pathway through inhibiting the GSK-3beta expression and down-regulating the beta-catenin and c-MYC protein expression, which play an important role in the treatment for chronic myeloid leukemia.
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Humanos , Glucógeno Sintasa Quinasa 3 , Metabolismo , Glucógeno Sintasa Quinasa 3 beta , Células HL-60 , Indoles , Farmacología , Células K562 , Proteínas Proto-Oncogénicas c-myc , Metabolismo , Transducción de Señal , Proteínas Wnt , Metabolismo , beta Catenina , MetabolismoRESUMEN
Objective To evaluate the clinical value of color doppler flow image (CDFI) and three-dimension color power angiography(3D-CPA) in the diagnosis of thyroid nodules. Methods A total of 62 pathologically confirmed thyroid nodules of 30 patients were analyzed. All the patients underwent ultrasound examination and operation in the Second Affiliated Hospital of Harbin Medical University between January, 2008 and May, 2009. Both CDFI and 3D-CPA were performed before the operation. All the nodules were divided into three groups including nodular goiters, thyroid adenomas and thyroid cancers according to the pathological results. The hemodynamic features and the vascular morphology characteristics of nodules in different groups were compared. Results 3D-CPA showed that blood vessels of nodular goiters commonly distributed surrounding the mass and the inner vessels were thin and regular, thyroid adenomas were bulb-shaped and netted structure, and malignant thyroid nodules displayed distorted and irregular distributed vessels. Peak systolic velocity (PSV)of the three groups were (39.43±11.17a), (46.39±12.98) and (65.17±9.23)cm/s, respectively. Resistance index(RI) of the three groups were (0.32±0.08), (0.41±0.06) and (0.69±0.07)cm/s, respectively. Both PSV and RI in malignant thyroid nodules were higher than in nodular goiters and in thyroid adenomas and the difference were statistical significant (all P < 0.05). The blood flow grade of malignant nodules was also higher in malignant nodules than in other two groups(χ2 = 17.11, 12.79, 23.05, 15.41, P< 0.01). Conclusions CDFI and 3D-CPA could visually demonstrate the characteristic and distribution of the inner and outer blood vessels, display the vessels structures, and they are benefit the differential diagnosis of thyroid nodules.
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<p><b>OBJECTIVE</b>To investigate the health care status of female workers exposed to occupational hazards in Haidian district of Beijing and improve the labor protection of female workers.</p><p><b>METHODS</b>A questionnaire provided by National Center for Women and Children's Health of Chinese CDC was used in the survey conducted to collect information about health care status of female workers in 141 factories with occupational hazards including chemical poisons and physical factors (noise, libration, microwave, high frequency and low temperature).</p><p><b>RESULTS</b>141 factories were investigated, including 53 state-owned enterprises, 21 collective enterprises, 46 joint-stock enterprises, and 21 non-public enterprises. 12 251 female workers were surveyed, 10.19% (1249/12 251) of whom were exposed to occupational hazards. Of 141 factories studied, 16.31% (23/141) had no labor protection management organization.27.66% (39/141) did not provide pre-employment physical examination service to female workers.48.94% (69/141) didn't establish labor protection system for female workers in menstrual period. While, 21.28% (30/141) of the studied institutes deducted some salaries in the pregnancy, and 32.62% (46/141) deducted their wages during the puerperal period. 2.13% (3/141) arranged female workers in the posts which are forbidden by law (continuous heavy work load operation).9.93% (14/141) arranged pregnant female workers on the post forbidden by law.31.91% (45/141) and 33.33% (47/141) would deduct the time of prenatal medical examination and lactation from their working hours, respectively.39.01% (55/141) didn't afford the cost of fertility. 68.09% (96/141) had annual gynecological examination.45 factories were collected occupational examination reports, accounted for 31.91% (45/141). No female workers were found suffering from occupational disease. Of the 1865 occupational hazard factor monitoring points in 34 factories, there were 155 monitoring points, which were all noise monitoring points, did not meet the standard.</p><p><b>CONCLUSION</b>The current health-care status of female workers is not optimistic. It is necessary to consistently improve health care legislations, establish coordinated management mechanism and strengthen the publicity of policy to protect female workers.</p>
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Femenino , Humanos , China , Epidemiología , Enfermedades Profesionales , Epidemiología , Exposición Profesional , Salud Laboral , Encuestas y Cuestionarios , Servicios de Salud para Mujeres , Evaluación de Capacidad de Trabajo , Lugar de TrabajoRESUMEN
<p><b>OBJECTIVE</b>By means of Delphi method and expert panel consultations, to choose suitable indicators and improve the score table for classifying the hygienic condition of hotels so that it can be widely used at nationwide.</p><p><b>METHODS</b>A two-round Delphi consultation was held to choose suitable indicators among 78 experts from 18 provinces, municipalities and autonomous regions. The suitable indicators were selected according to the importance recognized by experts.</p><p><b>RESULTS</b>The average length of service in public health of the experts was (21.08 +/- 5.78) years and the average coefficient of experts' authorities C(r) was 0.89 +/- 0.07. The response rates of the two-round consultation were 98.72% (77/78) and 100.00% (77/77). The average feedback time were (8.49 +/- 4.48) d, (5.86 +/- 2.28) d, and the difference between two rounds was statistically significant (t = 4.60, P < 0.01). Kendall's coefficient were 0.26 (chi(2) = 723.63, P < 0.01), 0.32 (chi(2) = 635.65, P < 0.01) and opinions among experts became consistent. The score table for the hygienic quantifying and classification of hotels was composed of three first-class indicators (hygienic management, hygienic facilities and hygienic practices) and 36 second-class indicators. The weight coefficients of the three first-class indicators were 0.35, 0.34, 0.31.</p><p><b>CONCLUSION</b>Delphi method might be used in a large-scale consultation among experts and be propitious to improve the score table for the hygienic quantifying and classification.</p>
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Técnica Delphi , Vivienda , Clasificación , Estándares de Referencia , Higiene , Evaluación de Resultado en la Atención de Salud , Administración en Salud Pública , MétodosRESUMEN
<p><b>OBJECTIVE</b>To investigate the association of TGF beta1 and AT1R gene polymorphisms with hereditary susceptibility and clinical phenotype of HBV-induced liver cirrhosis.</p><p><b>METHODS</b>Peripheral blood samples were collected from 102 patients with HBV-induced liver cirrhosis and 106 healthy blood donors. The polymorphisms of the promoter site -509C/T of TGF beta1 and 1166A/C of AT1R gene were determined by PCR-RFLP.</p><p><b>RESULTS</b>The frequency of the homozygote CC of -509C/T of TGF beta1 gene in the group of liver cirrhosis was higher than that the control group (P<0.05); and the frequency rate of homozygote CC was higher in group C than in group A and group B of liver cirrhosis (P<0.05), but there was no significant difference in allele frequency among these group (P>0.05). There was no significant difference in genotypes and allele frequency of AT1R gene 1166A/C between the liver cirrhosis group and the control group (P>0.05).</p><p><b>CONCLUSION</b>The polymorphism of the promoter site -509C/T of TGF beta1 gene is associated with hereditary susceptibility to liver cirrhosis and severity of HBV-induced liver cirrhosis; the polymorphism of AT1R gene 1166A/C is not associated with hereditary susceptibility to HBV-induced liver cirrhosis.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alelos , Estudios de Casos y Controles , Predisposición Genética a la Enfermedad , Genotipo , Hepatitis B , Genética , Cirrosis Hepática , Genética , Virología , Fenotipo , Polimorfismo Genético , Receptor de Angiotensina Tipo 1 , Genética , Factor de Crecimiento Transformador beta1 , GenéticaRESUMEN
<p><b>OBJECTIVE</b>To understand the distribution of chronic disease related behavior and lifestyle in adults from Beijing.</p><p><b>METHODS</b>16,658 adult residents from Beijing city were randomly selected with stratified multi-stage cluster sampling method in 2005. Each participant was invited to receive a set of standardized questionnaire, physical examinations and laboratory tests.</p><p><b>RESULTS</b>In the adults living in Beijing, 33.2% were overweight and 16.4% were obesive. The current smoking rate was 26.2% and the regular smoking rate was 21.4%. 57.7% of the male and 4.6% of the female adults were current smokers. In male adults, 64.3% drank alcoholic beverage at least once per month while 16.1% drank almost everyday, 16.5% drank more alcohol than moderate, and 18.5% were binge drinkers. 46.0% of Beijing adults were in lack of active physical exercise. Unhealthy dietary habits such as:excess consumption of sodium or oil, lower intake of vegetable, milk and soybean productions, skipping breakfast, fond of salted vegetable and fried food intake, as well as eating snacks etc. were quite commonly seen in the adults from Beijing. In addition, most of the risk factors had a higher prevalence in the suburban areas and population at working-age.</p><p><b>CONCLUSION</b>The prevalence rate of chronic risk factors was still high in adults of Beijing. Effective interventions should be carried out to prevent further worsening of the situation, especially in the suburban areas and people at working-age.</p>
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Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Distribución por Edad , Consumo de Bebidas Alcohólicas , Epidemiología , China , Epidemiología , Enfermedad Crónica , Epidemiología , Conducta Alimentaria , Conductas Relacionadas con la Salud , Estilo de Vida , Obesidad , Epidemiología , Sobrepeso , Epidemiología , Fumar , Epidemiología , Encuestas y CuestionariosRESUMEN
Objective To evaluate therapeutic ERCP in the treatment and preventing the recurrence of acute biliary pancreatitis(ABP).Methods One hundred and seventeen patients of ABP were randomly divided into two groups,ERCP treatment group(n=49)and non-ERCP control group(n=68).Changes of clinical symptoms and laboratory indexes were recorded accordingly.Follow-up study was for all the patients. Results Of the 117 with ABP,99 cases were mild(MABP)and 18 ones were severe(SABP).The days of relief of abdominal pains,normalization of hepatic function indexes and hospitalization were significantly shorter in ERCP treatment group than that in control group.The complications related to endoscopic therapy were not found.All patients had got followed-up visits for average 20(range 5-37)months(94.0%).The re- currence rate in the ERCP group 0(0/46)were significantly lower than that in the control group 46.8%(29/ 62)(P