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    Editorial
    Commentary on study of monitoring and evaluation of deepening health care system reform
    MA Jin
    2011, 31 (2):  125. 
    doi: 10.3969/j.issn.1674-8115.2011.02.001

    Abstract ( 1283 )   PDF (3247KB) ( 1155 )  

    This paper describes the major methods of policy monitoring and evaluation, and then introduces the main modules of health system performance evaluation. Finally, the framework of the study on monitoring and evaluation of the current deepening health care system reform in China is explained.

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    Monographic report (Evaluation of medicaland health system reform)
    Study on evaluation indicators of medical security system reform
    LI Yan-ting, ZHAO Ming, DING Lei, et al
    2011, 31 (2):  128. 
    doi: 10.3969/j.issn.1674-8115.2011.02.002

    Abstract ( 2102 )   PDF (4664KB) ( 1552 )  

    Objective To build up evaluation indicator system of China's new health reform in medical security system, and establish evaluation standards fit to different time and areas. Methods Evaluation indicators of medical security system were set up from the government dimension, public dimension, internal management dimension and innovation and learning dimension using the model of Balanced Scorecard. Evaluation indicators were screened by Delphi consultation, and advice from experts on the evaluation standards was collected. Results Twelve indicators (coverage rate of medical insurance for urban residents, coverage rate of new rural cooperative medical insurance, coverage rate of medical insurance for retirees of bankrupt enterprises, coverage rate of medical insurance for migrant workers, coverage rate of medical insurance for low-income family, fee reduction level of new medical insurance for farmers, rate of poverty due to illness for farmers, rate of poverty due to illness for urban residents, growth rate of government grants for new rural cooperative medical insurance, growth rate of government grants for urban residents, balance rate of new rural cooperative medical insurance and compensation cycle of new rural cooperative medical insurance)and weight were determined, and advice was proposed. Conclusion The established evaluation indicator system of medical security system takes the four dimensions of government, public, internal management and innovation and learning into consideration, is fit to different time and areas, and bears high value of reference.

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    Study on evaluation indicator system of health service providing reform
    ZHAO Ming, LI Yan-ting, LU Lin, et al
    2011, 31 (2):  133. 
    doi: 10.3969/j.issn.1674-8115.2011.02.003

    Abstract ( 1912 )   PDF (5355KB) ( 1713 )  

    Objective To build up the evaluation indicator system of health service providing reform in China. Methods The evaluation indicator system of health service providing reform in China was established based on the evaluation frame of Balance Scorecard and the results of Delphi expert consultation and public questionnaire survey. Results According to the theory of Balanced Scorecard, the evaluation frame of health service providing reform was composed of government perspective, public perspective, hospital management perspective and hospital development perspective, and the evaluation indicators were determined. Expert consultation revealed that satisfaction in the examinations and treatment, prevalence of medical accidents, rate of sickbed turnover, number of sickbed per thousand population and number of medical staff per thousand population were indicators with higher weight. Public questionnaire survey indicated that qualification of medical staff, rate of annual growth of government investment, health network coverage, satisfaction in medical service from patients and prevalence of medical accidents were indicators with higher scores. Conclusion The evaluation indicator system of health service providing reform in China is preliminarily established, which mainly contains aspects of government investment in health service, construction of health facilities and cultivation of medical staff, and management of quality, efficiency and cost of health service.

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    Study on development of evaluation indicator system of public health service system
    DING Lei, LI Yan-ting, LU Lin, et al
    2011, 31 (2):  137. 
    doi: 10.3969/j.issn.1674-8115.2011.02.004

    Abstract ( 2255 )   PDF (3958KB) ( 1445 )  

    Objective To establish the effective evaluation indicator system of public health service system. Methods Based on government perspective, public perspective, internal business process perspective and innovation and development perspective of the Balanced Scorecard strategic management, pilot evaluation indicator system of public health service system was established, and Delphi expert consultation method was used to further screen the indicators. Results Based on the results of expert consultation, 13 indicators were determined, including the per capita public expenditures on health, rates of prenatal examination, hospital delivery and postnatal visit, the establishment of public health service package, rate of neonatal disease screening, rates of early detection and control of major infectious diseases (AIDS/TB), rates of diagnosis and control of chronic diseases such as hypertension, diabetes mellitus and mental disorders, rate of family health filing, rate of free health examinations for people aged more than 65 years, coverage of public health service facilities, rate of training for staff in public health institutions and primary health institutions, the implementation of public health talents cultivation, exposure of residents to health education materials per year and increase of salary of staff in high-risk post in disease prevention and control institutions. Conclusion The evaluation indicator system of public health service system has been established.

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    Study on evaluation indicator system of pharmaceutical supply system reform
    LU Lin, DING Lei, ZHAO Ming, et al
    2011, 31 (2):  141. 
    doi: 10.3969/j.issn.1674-8115.2011.02.005

    Abstract ( 1892 )   PDF (4387KB) ( 1488 )  

    Objective To establish evaluation indicators of pharmaceutical supply system in the new round of health care system reform. Methods Based on the four perspectives of Balanced Scorecard method, which were customer, financial, internal business process and learning and growth perspectives, pilot evaluation indicator system was established. Delphi method was used to further screen indicators. Results Fourteen evaluation indicators of pharmaceutical supply system reform were proposed. Conclusion The Balanced Scorecard method can be effectively used in the establishment of evaluation indicator system in the new round of health care system reform.

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    Study on intermediate performance indicators of deepening medical and health system reform
    LI Yan-ting, ZHAO Ming, DING Lei, et al
    2011, 31 (2):  144. 
    doi: 10.3969/j.issn.1674-8115.2011.02.006

    Abstract ( 1897 )   PDF (4837KB) ( 1525 )  

    Objective To explain the set-up of the intermediate performance indicators in the whole evaluation indicator system of the deepening medical and health system reform. Methods Through literature review, the frame adopted by members of Organisation for Economic Cooperation and Development (OECD) in evaluating health system was referred, the related documents of the Central People's Government of China were studied, and the intermediate performance indicators were selected through Delphi method from the aspects of quality, efficiency and accessibility. Results Eight intermediate performance indicators and weight were determined. Conclusion Experts pay equal attention to quality, efficiency and accessibility of new health reform, while patients focus more on quality and costs.

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    Study on final performance indicators of deepening medical and health system reform
    LI Yan-ting, ZHAO Ming, DING Lei, et al
    2011, 31 (2):  149. 
    doi: 10.3969/j.issn.1674-8115.2011.02.007

    Abstract ( 1669 )   PDF (4417KB) ( 1349 )  

    Objective To explain the set-up of the final performance indicators in the whole evaluation indicator system of the deepening medical and health system reform. Methods Through literature review, the frame adopted by World Health Organization (WHO) and World Bank in evaluating health system was referred, the related documents of the Central People's Government of China were studied, and the final performance indicators were selected through Delphi method. Results Ten final performance indicators and weight were determined, and policy advice was proposed. Conclusion In the final performance indicators, experts focus more on the performance level and patients' satisfaction, and it is suggested that more importance should be attached to these two aspects to evaluate the final performance of new health reform.

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    Attention to medical and health system reform from Shanghai residents
    DING Lei, LU Lin, LI Yan-ting, et al
    2011, 31 (2):  153. 
    doi: 10.3969/j.issn.1674-8115.2011.02.008

    Abstract ( 2060 )   PDF (4621KB) ( 1561 )  

    Objective To investigate the attention from Shanghai residents on the medical and health system reform, and put forward suggestions on the medical and health system reform. Methods Multistage random sampling method was employed to investigate 1 600 residents with questionnaire survey. Results The issues most concerned by the investigated residents were rationality of drug use, qualification of training for medical staff, personal payment for medical expense and medical insurance coverage of urban residents. Conclusion The management of drug use should be enhanced, the distribution, composition and qualification of medical staff should be optimized, and the national essential drug system should be carried out to lower the personal payment for medical expense.

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    Original article (Basic research)
    Renoprotective effect of Bortezomib on adriamycin-induced nephropathy in rats
    ZHOU Qiao, LU Ying, ZHONG Fang, et al
    2011, 31 (2):  158. 
    doi: 10.3969/j.issn.1674-8115.2011.02.009

    Abstract ( 1846 )   PDF (12054KB) ( 2117 )  

    Objective To investigate the effect of Bortezomib on adriamycin-induced nephropathy in rats. Methods Sixteen male SD rats were randomly divided into normal control group (n=4) and adriamycin-induced nephropathy group (n=12). Four weeks after model establishment by intravenous injection of adriamycin, rats in adriamycin-induced nephropathy group were divided into model group, Bortezomib 30 μg/kg treatment group and Bortezomib 60 μg/kg treatment group, with 4 rats in each group. The blood and urine parameters including serum creatinine (SCr), blood urea nitrogen(BUN), albumin (Alb) and urinary albumin to creatinine ratio (ACR) in each group were detected. Eight weeks after model establishment, rats were sacrificed after blood sampling from heart, and renal tissues were obtained. The pathological changes of tubulointerstitium and glomerulus were observed with PAS and Masson staining, and the expression of α smooth muscle actin (α-SMA), collagen type Ⅰ (ColⅠ) and collagen type Ⅲ(Col Ⅲ)in renal tissues was detected by immunohistochemistry. Results Compared with normal control group, ACR in model group, Bortezomib 30 μg/kg treatment group and Bortezomib 60 μg/kg treatment group were significantly higher 2 weeks after model establishment. Eight weeks after model establishment, serum SCr, BUN and ACR were significantly lower, and Alb was significantly higher in Bortezomib 30 μg/kg treatment group and Bortezomib 60 μg/kg treatment group than in model group. For tubulointerstitium injury index, glomerulosclerosis score, percent of collagen deposition area and expression of α-SMA, ColⅠand Col Ⅲ in renal tissues, model group, Bortezomib 30 μg/kg treatment group and Bortezomib 60 μg/kg treatment group were significantly higher than normal control group, Bortezomib 30 μg/kg treatment group and Bortezomib 60 μg/kg treatment group were significantly lower than model group, and the treatment effect was most significant in Bortezomib 60 μg/kg treatment group. Conclusion Bortezomib could significantly ameliorate fibrosis of adriamycin-induced nephropathy, and prevent the progression of adriamycin-induced nephropathy in rats.

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    Vasodilation effect of propofol on isolated rat thoracic aorta rings
    WEN Xiang-yu, CUI Yong-yao, JIANG Wei, et al
    2011, 31 (2):  165. 
    doi: 10.3969/j.issn.1674-8115.2011.02.010

    Abstract ( 1499 )   PDF (4684KB) ( 1484 )  

    Objective To investigate the effect of propofol on isolated rat thoracic aorta rings, and explore the possible mechanism. Methods Vascular rings were randomly divided into endothelium-intact group and endothelium-denuded group, and each group was then divided into 5 subgroups: 10-6 mol/L norepinephrine (NA) group (n=6), 10-6 mol/L NA+propofol group (n=6), 10-6 mol/L NA+0.18% intralipid group (n=6), 10-6 mol/L NA+10-4 mol/L propofol group(n=6), 10-5 mol/L glibenclamide+10-6 mol/L NA+propofol group (n=6), 10-4 mol/L L-NAME +10-6 mol/L NA+propofol group (n=6) (this subgroup was not included in endothelial-denuded group). On the basis of maximal vasoconstriction evoked by NA (10-6 mol/L), propofol was added in progressively increasing cumulative concentrations(10-6, 5×10-6, 10-5, 5×10-5 and 10-4  mol/L)at a 15 minute interval, and the effect of propofol on artery was observed as vascular tone changed. Results Propofol induced vasorelaxation at a concentration-dependent manner, and the effect was most significant in endothelium-intact group, with the vasodilation extent of (11.28±1.51)%,(25.23±4.03)%,(44.08±4.49)%,(66.28±4.83)% and (74.59±4.78)%,respectively, which were significantly different from those in endothelium-denuded group with same management (P<0.01). Propofol-induced vasodilation was inhibited by L-NAME (10-4 mol/L), a nitric oxide synthase inhibitor (P<0.01), and was also suppressed by glibenclamide, a specific inhibitor of KATP channels in endothelium-intact aorta. In addition, the vasodilation induced by 10-6 mol/L and 5×10-6 mol/L propofol was reversed by glibenclamide. Conclusion Propofol causes vasodilation of isolated thoracic aorta rings in rats in endothelium-dependent and concentration-dependent manners,and nitric oxide and KATP channels can mediate drug-induced vasodilation.

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    Methodological study on filtering and segmentation of three-dimensional echocardiographic images by virtual endoscopy
    XUE Hai-hong, CHEN Bin-jin, SUN Kun, et al
    2011, 31 (2):  169. 
    doi: 10.3969/j.issn.1674-8115.2011.02.011

    Abstract ( 1643 )   PDF (5013KB) ( 1324 )  

    Objective To assess filtering and segmentation of three-dimensional echocardiographic images by virtual endoscopy. Methods Filtering and segmentation were performed for three-dimensional echocardiographic images of 30 children. Three-dimensional echocardiographic heart models were reconstructed by four different methods: ray-casting algorithm, ray-casting algorithm (gradient threshold ranged 3-19), ray-casting algorithm (gradient threshold ranged 3-6)and ray-casting algorithm (visualization after filtering and classification, gradient threshold ranged 3-6). Visualization results were compared. Results Ray-casting algorithm with visualization after filtering and classification performed better than the other methods, and the visible heart models showed precisely anatomy structure and spatial relationship including mitral valve, tricuspid valve and atrial septal defect. Conclusion Filtering and classification is helpful for visualization of three-dimensional echocardiographic virtual endoscopy.

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    Mechanism of ring-enhancement by contrast-enhanced ultrasound in testicular torsion
    LIU Zhen-hua, CHEN Lin, ZHAN Wei-wei, et al
    2011, 31 (2):  173. 
    doi: 10.3969/j.issn.1674-8115.2011.02.012

    Abstract ( 1973 )   PDF (6397KB) ( 1583 )  

    Objective To explore the mechanisms of ring-enhancement by contrast-enhanced ultrasound in testicular torsion. Methods Eighteen rabbits were randomly divided into control group, intravaginal testicular torsion group and extravaginal testicular torsion group (n=6). Appropriate amount of ultrasonic couplants were injected within or outside tunica vaginalis in intravaginal testicular torsion group and extravaginal testicular torsion group, and contrast-enhanced ultrasound was performed. Results Ring-enhancement was found in intravaginal testicular torsion group and extravaginal testicular torsion group, while no ring-enhancement was found in control group. Ring-enhancement in intravaginal testicular torsion group was significantly stronger than that in extravaginal testicular torsion group. In intravaginal testicular torsion group, tunica vaginalis was more strongly enhanced than scrotal sac and muscles. In extravaginal testicular torsion group, scrotal sac and muscles were slightly enhanced, while tunica vaginalis was not enhanced. Conclusion Ringenhancement by contrast-enhanced ultrasound in testicular torsion mainly comes from tunica vaginalis and partly from scrotal sac and muscles, and the extent of ring-enhancement may help in the differential diagnosis of intravaginal testicular torsion and extravaginal testicular torsion.

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    Construction of eukaryotic expression vector and microRNA expression plasmid of NELL2 gene and their biological effects in vitro
    ZHOU Sha-sha, LI Pin
    2011, 31 (2):  177. 
    doi: 10.3969/j.issn.1674-8115.2011.02.013

    Abstract ( 2074 )   PDF (5817KB) ( 1452 )  

    Objective To construct the microRNA (miRNA) expression plasmid (p-NELL2-miRNA) of eukaryotic expression vector of rat NELL2 gene (pcDNA3.1(-)-NELL2), and investigate its in vitro effect on expression of NELL2 mRNA. Methods Total RNA was extracted from hypothalamus of SD rats, specific primers were designed, cDNA of NELL2 gene was amplified by RT-PCR, and recombinant plasmid pcDNA3.1(-)-NELL2 was obtained after cloning of objective fragment to expression vector pcDNA3.1(-) with T vector. Four pairs of pre-miRNA sequences were designed for NELL2 gene, and were cloned to pcDNA6.2-GW/EmGFP-miRNA expression vector by T4 ligase for the construction of expression plasmid (p-NELL2-miRNA1-4). Human embryonic kidney 293 cells (HEK293) were co-transfected with p-NELL2-miRNA1-4 and pcDNA3.1(-)-NELL2 (p-NELL2-miRNA1-4 treatment group), and the expression of NELL2 mRNA was detected by Real-Time PCR 48 h after transfection. Cells transfected with pcDNA3.1(-)-NELL2 were served as positive control group, and those co-transfected with pcDNA3.1(-)-NELL2 and negative control expression plasmid pre-miRNA-neg as negative control group. Results Enzyme digestion and sequencing revealed that the sizes of fragments of recombinant plasmid pcDNA3.1(-)-NELL2 and expression plasmid p-NELL2-miRNA were in line with those of anticipation, with correct cloned sequences. Real-Time PCR indicated that the expression of NELL2 mRNA in treatment group was significantly lower than that in positive control group and negative control group (P<0.05 or P<0.01). Conclusion The eukaryotic expression vector of NELL2 gene and microRNA expression plasmid have been successfully constructed, and microRNA expression plasmid has specific inhibitory effect on expression of NELL2 mRNA of HEK293 cells.

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    Effects of sevoflurane on spatial learning and memory in mice
    XU Min, LU Zhi-jun, ZHANG Fu-jun
    2011, 31 (2):  182. 
    doi: 10.3969/j.issn.1674-8115.2011.02.014

    Abstract ( 1883 )   PDF (5444KB) ( 1734 )  

    Objective To observe the effects of sevoflurane anesthesia on spatial learning and memory in mice. Methods Twentyfour C57BL/6 mice were divided into anesthesia group and control group (n=12). Since the following day, Morris water maze was performed on mice in both groups, including 4 trail days and 1 probe day. Latency, distance and average swimming velocity were recorded during trail days. Times across the platform, time during platform quadrant and time percent during platform quadrant were recorded on probe day. The data were statistically analyzed. Results From trail day 2-4, latencies of mice in anesthesia group were significantly shorter than those in control group (P<0.05). On trail day 2, distance of mice in anesthesia group was also significantly shorter than that of control group (P<0.05). On probe day, time during platform quadrant and time percent during platform quadrant in anesthesia group were significantly longer than those in control group (P<0.05). Conclusion Sevoflurane anesthesia improves not only learning ability but also spatial memory in mice.

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    Mechanism of apoptosis induced by Resveratrol |in human gastric cancer HGC27 cells
    YANG Hong-mei, XING Ying, ZHENG Mei-zhen
    2011, 31 (2):  187. 
    doi: 10.3969/j.issn.1674-8115.2011.02.015

    Abstract ( 1713 )   PDF (4244KB) ( 1384 )  

    Objective To investigate the relationship between the expression of VEGF and MMP-9 in PTEN and p-Akt signaling pathway of resveratrol affecting gastric cancer HGC27 cells. Methods The effects of resveratrol on growth inhibition rate and cell cycle of HGC27 cells were examined by CCK-8 test and flow cytometry, respectively. The effects of resveratrol on apoptosis-related PTEN and p-Akt gene in HGC27 cells were detected by Western blotting, and the contents of VEGF and MMP-9 protein in HGC27 cells before and after resveratrol treatment were determined by ELISA. Results The growth inhibition rate of HGC27 cells by resveratrol treatment was concentration- and time-dependent (P<0.05). Forty-eight hours after resveratrol treatment, cell cycle analysis indicated that the percent of HGC27 cells with DNA synthesis (S phase) significantly decreased, which exhibited a negative correlation with dosage (r=-0.930, P=0.007). There was a positive relationship between the relative expression of PTEN and Res concentration (r=0.951,P=0.04), while there was a negative relationship between the relative expression of p-Akt, VEGF and MMP-9 and Res concentration (r=-0.969,P=0.03;r=-0.894,P=0.02;r=-0.881,P=0.01). Conclusion Resveratrol could inhibit the proliferation and induce apoptosis of human gastric cancer HGC27 cells, which may be related to the expression up-regulation of PTEN and phosphorylation inhibition of Akt. Resveratrol could also regulate the expression of VEGF and MMP-9 to inhibit the proliferation and apoptosis of HGC27 cells.

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    Original article (Clinical research)
    Outcomes of impacted mandibular third molar extraction with different tooth separation techniques
    DONG Jian-hui, ZHU Ya-qin
    2011, 31 (2):  191. 
    doi: 10.3969/j.issn.1674-8115.2011.02.016

    Abstract ( 1638 )   PDF (3373KB) ( 1504 )  

    Objective To observe and compare the outcomes of impacted mandibular third molar extraction with different tooth separation techniques. Methods One hundred and fifty low and medial impacted mandibular third molars in 150 patients were selected, and were extracted with traditional hammer and chisel technique (n=50), hammer and chisel+“T” typed tooth separation technique (n=50) and turbine+“T” typed tooth separation technique (n=50), respectively. The incidences of postoperative reactions (regional swelling and pain) and complications were compared among groups. Results The incidence of severe postoperative regional swelling in patients treated with turbine+“T” typed tooth separation technique was significantly lower than that in those treated with traditional hammer and chisel technique (16% vs 34%, P<0.05). The incidences of postoperative Ⅲ degree pain in patients with traditional hammer and chisel technique, hammer and chisel+“T” typed tooth separation technique and turbine+“T” typed tooth separation technique were 36%, 20% and 4%, respectively, and there were significant differences among patients treated with different techniques (P<0.05). The incidences of postoperative complications such as numbness of lower lip, extraction of lorum together with dental root and fever in patients treated with hammer and chisel+“T” typed tooth separation technique and turbine+“T” typed tooth separation technique were significantly lower than those in patients treated with traditional hammer and chisel technique (P<0.05). Conclusion Compared with traditional hammer and chisel technique, turbine+“T” typed tooth separation technique works better in extraction of impacted mandibular third molars with less postoperative reactions and complications.

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    Evaluation of left ventricular remodeling and function by quantitative real-time three-dimensional echocardiography in patients with acute myocardial infarction
    ZHENG Li, HUANG Guo-qian, WANG Cheng
    2011, 31 (2):  194. 
    doi: 10.3969/j.issn.1674-8115.2011.02.017

    Abstract ( 1786 )   PDF (5039KB) ( 1330 )  

    Objective To investigate the application of quantitive real-time three-dimensional echocardiography (RT-3DE) in evaluation of left ventricular remodeling and function in patients with acute myocardial infarction(AMI). Methods Thirtyfive patients with AMI (AMI group) were divided into 3 subgroups according to the results of coronary angiography. In subgroup A (n=9), left anterior descending artery was not involved; in subgroup B (n=9), only left anterior descending artery was involved; and in subgroup C (n=17), left anterior descending artery was involved in multi-vessel disease. Besides, 29 healthy subjects were served as normal controls. Left ventricular volume and left ventricular function were measured by two-dimensional echocardiography (2DE) biplane Simpson's method and RT-3DE. Results There was no significant difference between the findings of RT-3DE and those of Simpson's methods in normal control group (P>0.05). In AMI group, LVEDV and LVESV measured by Simpson's method were lower than those measured by RT3DE, while EF measured by Simpson's method was higher than that measured by RT-3DE (P<0.05). There was no significant difference between the findings of RT-3DE and those of Simpson's methods in subgroup A and subgroup B (P>0.05). In subgroup C, LVEDV and LVESV measured by Simpson's method were lower than those measured by RT-3DE, while EF measured by Simpson's method was higher than that measured by RT-3DE (P<0.01). LVEDV and LVESV in subgroup C were significantly higher than those in subgroup A and subgroup B measured by RT-3DE, while EF in subgroup C was significantly lower than that in subgroup A and subgroup B measured by RT-3DE (P<0.01). Conclusion RT-3DE allows non-invasive, accurate and quantitative evaluation of left ventricular remodeling and function in patients with AMI, and it is of clinical significance for those with severe and extensive coronary artery disease, such as multi-vessel coronary disease with left anterior descending artery involved.

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    Case-control study on influencing factors of metabolic syndrome in children
    DING Hui-ping, DING Qian, ZHANG Fu-dong, et al
    2011, 31 (2):  198. 
    doi: 10.3969/j.issn.1674-8115.2011.02.018

    Abstract ( 1667 )   PDF (5384KB) ( 1439 )  

    Objective To investigate the prevalences of metabolic syndrome (MS) and MS components in children with normal weight, overweight and obesity, and to explore the relationship between MS and family factors, eating behaviors and diet factors. Methods A total of 1 707 children from one primary school of Luwan District and one primary school of Baoshan District in Shanghai were selected, and 364 children with overweight and obesity were screened. Ninety-four venous blood samples were available from these 364 children, and overweight group (n=34) and obesity group (n=60) were divided. Besides, control group of children with normal weight was established (n=120). With case-control method, the influencing factors of MS were analysed by questionnaire survey, physical examinations, blood pressure and blood biochemical marker measurement. Results The prevalences of overweight and obesity in 1 707 children were 12.8% and 9.1%, respectively. Both the overweight rate and obesity rate in boys were significantly higher than those in girls (P=0.000). Both the overweight rate and obesity rate of children in Luwan District were significantly higher than those of children in Baoshan District (P=0.000). By Cook diagnostic criteria, the prevalences of MS in control group, overweight group and obesity group were 0.8%, 2.9% and 6.7%, respectively. In children of obesity group, the prevalences of abdominal obesity, hypertension, high triglyceride and low high density lipoprotein-cholesterol were 76.7%, 46.7%, 11.7% and 6.7%, respectively, and those with one, two and three MS components accounted for 51.7%, 35.0% and 6.7%, respectively. Multivariate analysis revealed that protein, calcium, vitamin C and vitamin E were protective factors of MS components, while parental obesity, taking food too fast, big appetite and cooking by grandparents were risk factors of MS components. Conclusion The prevalence of MS is high among investigated children. Family factors, eating behaviors and diet factors are related to MS components.

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    Expression of PTEN, HIF-1&alpha|and NDRG1 in endometrioid carcinoma and their correlations
    FENG Zhen-zhong, CHEN Jia-wei, YANG Zhao-rui, et al
    2011, 31 (2):  203. 
    doi: 10.3969/j.issn.1674-8115.2011.02.019

    Abstract ( 1695 )   PDF (6456KB) ( 1493 )  

    Objective To investigate the role of aberrant expression of PTEN, HIF-1α and NDRG1 protein in the pathogenesis and progression of endometrioid carcinoma. Methods Tissue microarray and immunohistochemical staining were employed to detect the expression of PTEN, HIF-1α and NDRG1 in tissues of type I endometrial carcinoma (n=124) and atypical hyperplasia (n=28) and normal endometrial tissues (n=35). The relationship among the markers, as well as their correlations with clinicopathological features were evaluated. Results The expression of PTEN, HIF-1α and NDRG1 in tissues of endometrioid carcinoma was 29.8%, 61.3% and 52.4%, respectively, and was significantly different from that in tissues of atypical hyperplasia and normal endometrial tissues (P<0.01). The downregulation of expression of PTEN and overexpression of NDRG1 were significantly related to the tumor differentiation (P<0.05), and the expression of HIF-1α protein was significantly related to the tumor differentiation, myometrial invasion and lymph node metastasis (P<0.05). The expression of PTEN was negatively related to that of HIF-1α and NDRG1 in tissues of endometrioid carcinoma (r=-0.314, P<0.01, r=-0.296, P=0.001), and the expression of HIF-1α protein was positively related to that of NDRG1 (r=0.237, P=0.008). Conclusion The absence of PTEN may upregulate the expression of HIF-1α and NDRG1 protein, which may be involved in the pathogenesis and progression of endometrioid carcinoma, and the combined detection of these markers is of great value in the prediction of tumor behavior and prognosis.

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    Effects of different applications of statins on ICAM-1, VCAM-1 and MCP-1 in patients with coronary heart diseases
    LIANG Wei, WU Chun-fang, YANG Hui, et al
    2011, 31 (2):  208. 
    doi: 10.3969/j.issn.1674-8115.2011.02.020

    Abstract ( 1835 )   PDF (4984KB) ( 1779 )  

    Objective To investigate the effects of different applications of statins on intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and monocyte chemoattractant protein-1 (MCP-1) in patients with coronary heart diseases. Methods Forty-two patients with coronary heart disease (coronary artery stenosis between 50% and 70%) without stent implantation were divided into monotherapy group (n=19) and combined therapy group (n=23). Patients in monotherapy group were treated with 20 mg atorvastatin from the first week to the fourth week, and were managed with 50 mg atorvastatin from the fifth week to the twelfth week. Patients in combined therapy group were treated with 5 mg atorvastatin+10 mg ezetimibe from the first week to the fourth week, and were managed with 10 mg atorvastatin+10 mg ezetimibe from the fifth week to the twelfth week. Blood samples were collected before treatment and 4 weeks and 12 weeks after treatment, and blood lipid, liver and renal function and concentrations of creatine kinase, ICAM-1, VCAM-1 and MCP-1 were measured. Results The concentrations of TC and LDL-C in monotherapy group and combined therapy group significantly decreased 4 weeks after treatment, and the concentrations of TC and LDL-C 12 weeks after treatment were significantly lower than those before treatment (decreased by 37.82% and 38.26%, respectively)(P<0.01). However, there was no significant difference between these two groups (P>0.05). There was no significant increase in liver and renal function and concentration of creatine kinase after treatment in these two groups. Twelve weeks after treatment, the concentrations of ICAM-1, VCAM-1 and MCP-1 in monotherapy group were significantly lower than those before treatment, and there were significant differences between monotherapy group and combined therapy group (P<0.05). Conclusion Monotherapy with larger dose of statins may be superior to combined therapy with smaller dose of statins and ezetimibe in plaque stabilization in patients with coronary heart diseases.

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    Expression and significance of FAK and FAKpY397 in squamous cell carcinoma of larynx
    GAO Shang, DONG Pin, LI Da-wei, et al
    2011, 31 (2):  212. 
    doi: 10.3969/j.issn.1674-8115.2011.02.021

    Abstract ( 1753 )   PDF (4854KB) ( 1643 )  

    Objective To detect the expression and clinicopathological significance of focal adhesion kinase (FAK) and phosphorylation of focal adhesion kinase tyrosine 397 (FAKpY397) in human squamous cell carcinoma of larynx. Methods The expression of FAK and FAKpY397 in tissues of squamous cell carcinoma of larynx (n=57) and normal laryngeal tissues (n=10) was detected by immunohistochemistry. Results The positive expression of FAK and FAKpY397 was 66.7% and 84.4%, respectively in tissues of squamous cell carcinoma of larynx, and was significantly different from that of normal laryngeal tissues (P<0.01). The expression of FAK and FAKpY397 was correlated with the clinical stage and lymph node metastasis (P<0.05), but was not related to the age of patients, tumor size and degree of differentiation of carcinoma cells. Conclusion There is high expression of FAK and FAKpY397 in tissues of squamous cell carcinoma of larynx, which may be related to the invasion and metastasis of squamous cell carcinoma of larynx.

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    Changes in prevalences of COPD within 5 years in people aged no less than 60 years in Shanghai urban area
    GONG Yi, SHI Guo-chao, WAN Huan-ying, et al
    2011, 31 (2):  216. 
    doi: 10.3969/j.issn.1674-8115.2011.02.022

    Abstract ( 1732 )   PDF (5507KB) ( 1871 )  

    Objective To investigate the changes in prevalences of chronic obstructive pulmonary disease (COPD) in people aged no less than 60 years in Shanghai urban area, and explore the causes. Methods Epidemiological investigations of prevalences of COPD, lung function and high risk factors were conducted in 767 people aged no less than 60 years in 4 communities of Shanghai urban area between 2008 and 2009, and the data were compared with those obtain from 333 people between 2003 to 2004. Results The data of 710 people investigated between 2008 and 2009 were effective, with the overall prevalence of COPD being 14.61%, which was 8.3% higher than that obtained between 2003 and 2004. It was revealed by investigations between 2008 and 2009 that smoking, age, gender and childhood pulmonary infection were high risk factors of COPD. Both FEV1 and FVC decreased with age increase in people with COPD and those without COPD, and there was no significant difference in the absolute value of decrease with age increase between people with COPD and those without COPD (P>0.05). Conclusion The prevalence of COPD between 2008 and 2009 is significantly higher than that between 2003 and 2004 in people aged no less than 60 years in Shanghai urban area. Smoking, age and childhood pulmonary infection are the main risk factors of COPD. One of the reasons leading to the increase of prevalence of COPD may be the aging of population.

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    Emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach
    LIU Ming, KAN Wu-sheng, LI Peng, et al
    2011, 31 (2):  221. 
    doi: 10.3969/j.issn.1674-8115.2011.02.023

    Abstract ( 1490 )   PDF (6683KB) ( 1642 )  

    Objective To evaluate the operative method and clinical outcomes of the emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach. Methods Thirty-six patients with distal tibial open fracture combined with fibula fracture underwent emergency treatment. After emergency debridement, all patients were treated with plate fixation of fibular and limited internal fixation of tibia through single lateral approach, as well as spanankle external fixation when necessary. The original open wounds were closed by direct suture or in situ skin graft after fracture fixation. The injured limbs were stabilized with plaster external fixation. Results Patients were followed up for 8 to 36 months (20 months in average). Thirty-four patients (94.4%) experienced fracture healing, with healing time of 3 to 18 months (5.8 months in average), and delayed union occurred in 5 patients (13.9%). Nonunion occurred in 2 patients (5.6%). Postoperative skin necrosis occurred in 14 patients(38.9%), among whom 2(5.6%) experienced wound infection. According to American Orthopedic Foot and Ankle Society clinical rating scales, the total excellent and good rate was 80.6%. Conclusion Emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach is contributive to fracture reduction and fixation, and can promote the healing of fractures.

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    Original article (Preventive medicine)
    Effects of maternal exposure to Di (2-ethylhexyl) phthalate during mid- to late pregnancy on pregnancy outcome and offspring development
    DING Yu, GAO Yu, SHI Rong, et al
    2011, 31 (2):  225. 
    doi: 10.3969/j.issn.1674-8115.2011.02.024

    Abstract ( 1587 )   PDF (4468KB) ( 1516 )  

    Objective To investigate the effects of maternal exposure to Di (2-ethylhexyl) phthalate (DEHP) during mid- to late pregnancy on pregnancy outcome and offspring development. Methods Fifty pregnant Wistar rats were randomly assigned to 1 mg/kg DEHP treatment group, 250 mg/kg DEHP treatment group, 750 mg/kg DEHP treatment group, 1 000 mg/kg DEHP treatment group and control group (n=10) on pregnancy day 12. Treatment groups were managed with 1 mg/kg, 250 mg/kg, 750 mg/kg and 1 000 mg/kg DEHP through day 17, respectively, and control group were administered with corn oil. The effects of DEHP on behavior, body weight, pregnancy outcome and organ coefficient of pregnant rats, and the effects of DEHP on body weight of offsprings and on vaginal orifice of female offsprings were observed. Results The weight gain of rats in DEHP treatment groups were not affected during exposure period (P>0.05). There was no significant difference in average viable litter size between each treatment group and control group (P>0.05), and no fetal malformation and stillbirth was observed. Twenty-two days after delivery, there was no significant difference in organ coefficient of uterus, ovary, liver, spleen, kidney, thymus, hypothalamus, brain and adrenal gland between treatment groups and control group (P>0.05). There was no significant difference in weight gain of offsprings from day 1 to day 22 after birth between each treatment group and control group (P>0.05). Sixty-six days after birth, 62.5% of female offsprings of 750 mg/kg DEHP treatment group and 81.25% of female offsprings of 1 000 mg/kg DEHP treatment group developed vaginal atresia, while no such abnormality occurred in the other groups. Conclusion Maternal exposure to 750 mg/kg and 1000 mg/kg DEHP during mid- to late pregnancy may not cause significant maternal toxicity, while high incidence of vaginal atresia in adult offsprings can be observed.

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    Original article (Public health administration)
    Study on managerial talent's competency model of community health service in Shanghai
    CAI Yu-yang, ZHANG Jun-wen, LI Ji, et al
    2011, 31 (2):  229. 
    doi: 10.3969/j.issn.1674-8115.2011.02.025

    Abstract ( 1658 )   PDF (5248KB) ( 1534 )  

    Objective To construct the managerial talent's competency model of community health service in Shanghai. Methods McClelland's Competency Dictionary was referred, questionnaire survey was conducted among 250 medical staff of 19 community health service centers in Shanghai, expert consultation was carried out in 14 experts, typical competency data of managerial talents of community health service were obtained, and managerial talent's competency model of community health service was established. Results The managerial talent's competency model of community health service in Shanghai contained two sub-models, which were for promotion and for employment, respectively. There were 6 character clusters, 16 characteristic items, 33 evaluation dimensions and 35 typical behavior descriptions in managerial talent's competency model of community health service-for promotion, and there were 6 character clusters, 10 characteristic items, 25 evaluation dimensions and 25 typical behavior descriptions in managerial talent's competency model of community health service-for employment. Conclusion The managerial talent's competency model of community health service in Shanghai is constructed, which may serve as objective criteria for the evaluation of managerial talent's competency of community health service.

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    Review
    Group psychotherapy for diabetes education
    CAI Yi-ting, WANG Li-hua, LIU Wei
    2011, 31 (2):  234. 
    doi: 10.3969/j.issn.1674-8115.2011.02.026

    Abstract ( 1531 )   PDF (4707KB) ( 1453 )  

    Diabetes education plays an important role in diabetes management. At present, the forms of diabetes education are various, and the contents are rich in china, while there is much room for exploration. However, some other countries have developed definite standards for diabetes education. The long-term compliance of patients after receiving diabetes education needs to be improved. Diabetes education with patient-centered group psychotherapy might help patients get rid of fear and worry about diabetes by interaction between members, and improve lifestyle and compliance.

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    Value of neural stem cells in treatment of cerebral ischemic diseases
    ZHOU Qiu-meng, ZHONG Jun
    2011, 31 (2):  238. 
    doi: 10.3969/j.issn.1674-8115.2011.02.027

    Abstract ( 1451 )   PDF (5206KB) ( 1773 )  

    Because the central nerve system is susceptible to ischemia and hypoxia, the treatment of cerebral ischemic diseases has been regarded as a hard task. Nowadays, numerous studies have demonstrated that neural stem cells have potential capability of proliferation and differentiation following injury. Accordingly, cerebral neurons might not be the terminally differentiated cells, which may bring a new therapy to the cerebral ischemic diseases. The value of neural stem cells in the treatment of cerebral ischemic diseases is reviewed in this paper.

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    Research progress of relationship between Toll like receptor 4 and sepsis
    SHEN Ting, BAI Jian-wen
    2011, 31 (2):  243. 
    doi: 10.3969/j.issn.1674-8115.2011.02.028

    Abstract ( 1687 )   PDF (4852KB) ( 1569 )  

    Toll like receptors (TLRs) is a family of pattern recognizing receptors, which may lead to the release of inflammatory cytokines by inducing the cellular signal transduction system, and play an important role in recognizing pathogen and initiating inflammatory response. TLR4 is the major receptor recognizing gram-negative bacteria cell wall components including lipopolysaccharide, and the TLR4/CD14 signaling pathway is the most important way in inflammation reaction induced by lipopolysaccharide, which plays a key role in the pathogenesis of sepsis. The genetic polymorphism of TLR4 is associated with the individual susceptibility to sepsis, which provides important reference for the diagnosis and treatment of diseases.

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    Optimization of evaluating indices of coronary heart diseases by treadmill exercise test
    GUAN Ze-hong, ZHOU Shan-hong, HONG Jie-xin
    2011, 31 (2):  248. 
    doi: 10.3969/j.issn.1674-8115.2011.02.029

    Abstract ( 1935 )   PDF (6081KB) ( 1712 )  

    This paper analyses the positive criteria and diagnostic value of different indices of treadmill exercise test (TET). TET is a way of diagnosing coronary heart diseases(CHD) and estimating CHD patients' exercise tolerance. The principle of TET is that exercise can increase the load of heart, which leads to increased demand for oxygen of myocardium, and when the load meets the trigger point, which means overloading the ability of supplying blood of coronary artery, myocardial ischemia occurs, which can be revealed by electrocardiogram (ECG). The indices of TET mainly focus on the change of ST segment, especially on the depression of ST segment. In recent years, the other physiological changes caused by exercise have been studied to learn the relationship between these changes and CHD, such as the changes of QRS, blood pressure and heart rate recovery loop. TET has become an important approach of diagnosing CHD and estimating prognosis and therapeutic effect.

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