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    Editorial
    Commentary on health system research
    MA Jin
    2013, 33 (6):  703. 
    doi: 10.3969/j.issn.1674-8115.2013.06.001

    Abstract ( 791 )   PDF (319KB) ( 1129 )  

    Health system research is conducted from the view of system, focuses on the evidence, and aims to improve the health output and promote the health care delivery. Health system reform, in order to improve the performance of health system, should lay emphasis on the systematic thinking and collaboration relationship. Only when every subsystem operates concordantly and efficiently can the whole health system ultimately provide higher efficient health services with lower investment, and satisfy the health demands of all the people. The article systematically makes a comment on the definition and significance, systematic thinking, main research problems and progress of health system research.

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    Monographic report (Health system research)
    Analysis of main policy of health system reform in China
    HOU Jia-le, MA Jin
    2013, 33 (6):  707. 
    doi: 10.3969/j.issn.1674-8115.2013.06.002

    Abstract ( 1100 )   PDF (396KB) ( 978 )  

    Objective To analyse the main policy of health system reform in China in recent years, and explore the development path in future. Methods The methods of literature review and policy analysis were employed to study the main policy of health system reform in China in recent years. Results Government pricing played a dominating role, which was the fundamental cause for the ineffectiveness of price mechanism. The findings from 16 pilot cities indicated that the reform of public hospitals had not made a significant breakthrough. Conclusion It would be a practical way to establish the mechanism of medicine price formation to solve the current problem, and the key to reform of public hospitals lies in the socialization of medical resources.

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    Analysis of salary distribution system in public hospitals
    REN Yi-jiong, JI Qing-ying
    2013, 33 (6):  712. 
    doi: 10.3969/j.issn.1674-8115.2013.06.003

    Abstract ( 931 )   PDF (369KB) ( 967 )  

    Objective To analyse the challenge in reform of salary distribution system in public hospitals, and put forward suggestions. Methods Annuals released by the Ministry of Health and National Bureau of Statistics of China were retrieved, the incomes and expenditures of hospitals between 2003 and 2010 were analysed, and the salary increase of staff in public hospitals was compared with that in other institutions. On-site survey on workload of medical staff in 18 municipal hospitals in Shanghai was also conducted. Results The input of government in public hospitals was less than 10%, which was significantly lower than the salary expenditures (>26%), and the income of drugs still accounted for 45% of the total income of hospitals. The performance-based pay system and workload evaluation proposed in medical reform posed significant influence on current salary distribution system, which would result in shortage by 3.26% to 7.38%. The data of workload were hard to obtain, and the standard was hard to determine. Conclusion Both opportunities and challenges exist in current salary distribution system in public hospitals, and hospital management should be enhanced to balance between current salary distribution system and performance-based pay system.

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    Research of working status of medical staff in pilot hospital of public hospital reform in Beijing
    TAO Jing-jing, GAO Xing, YUAN Su-wei, et al
    2013, 33 (6):  717. 
    doi: 10.3969/j.issn.1674-8115.2013.06.004

    Abstract ( 1001 )   PDF (473KB) ( 1114 )  

    Objective To investigate the working status of medical staff with the public hospital reform in Beijing, and evaluate the effect of reform on behaviors, recognition and attitudes of medical staff. Methods The research scheme and scale designed by the third party was employed to conduct an anonymous questionnaire survey among 400 medical staff of two tertiary comprehensive hospitals in Beijing (one pilot hospital of public hospital reform and one non-pilot hospital), and analyse the differences in workload, income and satisfaction among different hospitals and medical staff on different posts. A total of 382 valid questionnaires were recovered, data input was conducted with EpiData3.0, and statistical analysis was carried out with SPSS 17.0 software. Results The medical staff worked 9 h per day, and 73.3% considered the current workload was high in the pilot hospital, while the medical staff worked 7.5 h per day, and 65.0% considered the current workload was high in the non-pilot hospital. The average monthly income of the pilot hospital was 9 386.0 yuan, which was significantly higher than that of the non-pilot hospital (5 956.2 yuan)(P<0.05). Almost half of the medical staff in two hospitals thought the respect from patients was moderate. The overall working satisfaction was not high, and the medical staff (especially nurses) in the pilot hospital was more satisfied with the performance assessment system. Conclusion The advance of health system reform increases workload of medical staff, and most of the medical staff are overworked. The income of medical staff increases to some extent over the previous year, but still does not meet the expectation. The dynamic management of nursing post in the pilot hospital gets the approval from nurses, and can be implemented to the other posts.

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    Survey of satisfaction of outpatients in pilot hospitals of public hospital reform in Beijing
    LIU Wen-wei, YUAN Su-wei, CAO Jian-tao, et al
    2013, 33 (6):  724. 
    doi: 10.3969/j.issn.1674-8115.2013.06.005

    Abstract ( 993 )   PDF (444KB) ( 1028 )  

    Objective To investigate the satisfaction of outpatients in pilot hospitals of public hospital reform in Beijing, and put forward strategies. Methods Questionnaires survey of satisfaction was conducted in 400 outpatients randomly selected from two pilot hospitals of public hospital reform in Beijing, and the data were statistically analysed. Results The general satisfaction of outpatients in these two hospitals was relatively higher, and the total scores were 4.33 and 3.97 respectively. The outpatients were more satisfied with the hospital environment, service attitude and service delivery, and were less satisfied with the medical cost. The correlation analysis revealed that medical cost, service attitude and technical level had higher levels of correlation with the overall satisfaction. Conclusion In the next step of public hospital reform in Beijing, more attention should be paid in relief of burden of outpatients, including reducing the waiting time and medical cost through reform of appointment service and payment mechanism.

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    Survey on satisfaction of inpatients in pilot public hospital of reform in Beijing
    YUAN Su-wei, GAO Xing, LIU Wen-wei, et al
    2013, 33 (6):  729. 
    doi: 10.3969/j.issn.1674-8115.2013.06.006

    Abstract ( 857 )   PDF (430KB) ( 1088 )  

    Objective To evaluate the effectiveness of reform on public hospital in Beijing by inpatients. Methods Two hundred inpatients were selected from one pilot hospital of reform (with global budget and diagnosis related groups payment reform) and non-pilot hospital (without payment reform) respectively, and the satisfaction of inpatients with reform measures was surveyed with questionnaires. Results There was no significant difference in demographic characteristics between two hospitals (P>0.05). The total score of satisfaction of pilot hospital (4.64±0.24) was significantly higher than that of non-pilot hospital (4.40±0.28)(P<0.01). Among 5 first-level indicators, the scores of hospital environment, health service providing and medical auxiliary service in polit hospital were significantly higher than those in non-pilot hospital (P<0.01). There was no significant difference in the satisfaction rate between pilot hospital (93.18%) and non-pilot hospital (90.98%)(P>0.05). The satisfaction rate of health service providing was the lowest among 5 indicators in these two hospitals, and were 84.00% and 79.58% respectively (P>0.05). The satisfaction rate of medical auxiliary service in pilot hospital (97.04%) was significantly higher than that in non-pilot hospital (87.83%)(P<0.01). Among 20 second-level indicators, except for the indicators of waiting time for admission, admission procedures, explanation of admission reason by doctor, attitude of medical technician and doctor's response to the demand of patients, the scores of satisfaction of the other 15 indicators in pilot hospital were significantly higher than those in non-pilot hospital (P<0.01). Moreover, inpatients were most satisfied with the service attitude of nurses, and were most dissatisfied with the health care cost. Convenience of bill query, satisfaction of hospital environment and food quality of hospital were second-level indicators that significantly correlated with the total satisfaction score of inpatients. Conclusion The satisfaction of inpatients in pilot hospital is relatively higher. Further efforts should be made to push forward global budget and diagnosis related groups payment reform in Beijing in order to control the medical expenditure and improve the satisfaction of inpatients.

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    Analysis of job satisfaction and determinants among medical staff of a county hospital in Guangxi
    HOU Jia-le, KONG Wei, WU Yan-ming, et al
    2013, 33 (6):  735. 
    doi: 10.3969/j.issn.1674-8115.2013.06.007

    Abstract ( 609 )   PDF (392KB) ( 939 )  

    Objective To investigate the job satisfaction of medical staff in a county hospital of Guangxi, and analyse the determinants. Methods A total of 250 medical staff were randomly selected from Wuming County Hospital in Guangxi for survey on job satisfaction. The questionnaire included the basic characteristics such as gender, age, occupational category, professional title, education, duration of working, annual income and training status, and the evaluation on job satisfaction concerned with occupational category, working condition, medical equipment, income, performance evaluation system, promotion opportunity, opportunity for training, effect of measures, doctor-patient relationship and social status. Descriptive analysis, t test, variance analysis and non-conditional Logistic regression were performed to investigate the job satisfaction of medical staff and explore the determinants. Results The job satisfaction of medical staff was 2.80, and the satisfaction rate was 65.0%. Doctor, nurse and medical technician were negative factors of job satisfaction, doctors and medical technicians were significantly different from other groups, and those with training were significantly different from the group without training. Conclusion The medical staff in the county hospital are not satisfied with the income, doctor-patient relationship and social status. It is advised to take effective measures to improve the income, doctor-patient relationship and social status of medical staff.

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    Analysis of satisfaction and determinants among out-patients of a county hospital in Guangxi
    HOU Jia-le, KONG Wei, WU Yan-ming, et al
    2013, 33 (6):  740. 
    doi: 10.3969/j.issn.1674-8115.2013.06.008

    Abstract ( 712 )   PDF (386KB) ( 805 )  

    Objective To investigate the satisfaction and determinants among out-patients of a county hospital in Guangxi. Methods A total of 450 out-patients were randomly selected from Wuming County People's Hospital of Guangxi for the survey on satisfaction. The questionnaire included basic characteristics such as gender, age, household, work status, education, income and insurance, and the evaluation on satisfaction concerned with convenience, waiting time, environment, equipment, technical level, attitude of medical staff, communication with medical staff, therapeutic effect and medical cost. Descriptive analysis, t test, variance analysis and non-conditional Logistic regression were performed to investigate the satisfaction of out-patients and explore the determinants. Results The satisfaction of outpatients was 3.74, and the satisfaction rate was 96.3%. Age<60, employment, unemployment, secondary school education, urban basic health insurance were negative factors of satisfaction of out-patients. Urban and unemployed populations were significantly different from other groups (P<0.05). Conclusion The satisfaction of out-patients with the medical service in the county hospital is relatively higher as a whole, but the satisfaction with waiting time and medical cost is lower. The hospital should take effective measures to reduce the waiting time of out-patients based on characteristics of different departments, and decrease the operation cost with philosophy of cost accounting and information technology.

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    Analysis of hospital expenditure and influencing factors of patients with acute myocardial infarction
    GU Qian, MA Jin, LI Na, et al
    2013, 33 (6):  746. 
    doi: 10.3969/j.issn.1674-8115.2013.06.009

    Abstract ( 911 )   PDF (340KB) ( 1271 )  

    Objective To investigate the variation trend of hospital expenditure and its constitution in patients with acute myocardial infarction (AMI), and explore the influencing factors. Methods The information of home page of medical records of 1 880 patients with AMI hospitalized in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2007 and August 2012 was retrospectively analysed. The data of hospital expenditure were discounted by the consumer price indices based on 2012. Univariate analysis and multiple regression analysis were conducted to identify the main influencing factors of hospital expenditure. Results The hospital expenditure of patients with AMI exhibited a rising trend in general, and was mainly constituted by surgery fee (63.52%), medicine fee (17.57%) and examination fee (13.16%). The treatment charge and nursing charge ranked the lowest, which accounted for 0.34% and 0.38% respectively. The multiple regression analysis revealed that the times of admission, length of stay, ICU stay during hospitalization, surgery procedure and prognosis significantly affected the hospital expenditure (P<0.05). The partial regression coefficients indicated that length of stay had the greatest influence on hospital expenditure (b6=0.41), followed by surgery procedure (b8=0.35). The more times patients got into hospital, the less was the hospital expenditure (b4=-0.09). Patients who died in hospital cost more than the survival ones (b13=-0.08). Conclusion The control of hospital expenditure in patients with AMI is not favorable as a whole, which is embodied by the irrational constitution of hospital expenditure and underestimation of labor value of medical staff. The length of stay and surgery procedure were the main influencing factors of hospital expenditure. In the health care reform, more efforts should be made to regulate the behavior of doctors, shorten the average length of stay, so as to improve the efficiency of health resource utilization.

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    Agreement of appropriateness evaluation protocol of admission and hospital days in department of gynecology and department of neurology
    TAO Jing-jing, LUO Cheng-zu, MA Jin
    2013, 33 (6):  751. 
    doi: 10.3969/j.issn.1674-8115.2013.06.010

    Abstract ( 738 )   PDF (265KB) ( 1042 )  

    Objective To investigate the agreement of appropriateness evaluation protocol (AEP) of admission and hospital days in department of gynecology and department of neurology. Methods The clinical data of 50 patients hospitalized in department of gynecology and 50 patients in department of neurology in Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine were randomly selected, and the appropriateness of admission and hospital days was retrospectively evaluated by two nurses based on AEP. The inter-rater agreement of two nurses and Cohen's Kappa (κ) were calculated, and the agreement of AEP of admission and hospital days was determined. Meanwhile, the concept of “overrides” was introduced to increase the flexibility of AEP. Results After deletion of the incomplete data, 43 medical records from each department entered the statistical analysis. For the agreement of AEP-based judgment towards admission appropriateness, the overall agreement rate was 90.70%, and κ was 0.59. For the inter-rater agreement of AEP-based judgment towards hospital days appropriateness, the overall agreement rate was 77.52%, and κ was 0.54. After introduction of “overrides”, the inter-rater overall agreement rate was 81.65%, and  κ was 0.61. Conclusion Original AEP yields good agreement in assessment of the appropriateness of inpatient services in department of gynecology and department of neurology.

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    Research progress of unnecessary hospitalization
    TAO Jing-jing, MA Jin
    2013, 33 (6):  754. 
    doi: 10.3969/j.issn.1674-8115.2013.06.011

    Abstract ( 848 )   PDF (359KB) ( 1070 )  

    The presence of unnecessary hospitalization has aggravated the economic burden of patients, decreased the utilization efficiency of health resources, and reduced the supply efficiency of medical services. This paper undertakes the systemic review of relevant literatures on unnecessary hospitalization, and recognizes that the existing studies in China generally consider the hospital stay that can not provide material benefits to patients or achieve the expected results is unnecessary. On the other hand, the concept of unnecessary hospitalization is much wider in the foreign researches, considering in-patient stay with low cost-effectiveness is also unnecessary, and unnecessary hospitalization incorporates the low-effective and ineffective parts in the in-patient services. According to the estimation, the extent of latent economic burden resulting from unnecessary hospitalization is 10% to 15% of the government budget expenditure on health care. Facing the existence of overuse and underuse of health care, it should be a focus to conduct the unnecessary hospitalization research and reduce unnecessary services without compromising the quality of inpatient services, in order to further improve the provision efficiency of medical services, optimize the medical resource allocation structure, and finally widen the equity and accessibility of health care.

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    Original article (Basic research)
    Detection of transfection efficiency of hepatocyte-targeting Gal-Bu in rat liver cells
    WANG Yu-qiang, SHENG Jing, CHEN Shu-yan, et al
    2013, 33 (6):  759. 
    doi: 10.3969/j.issn.1674-8115.2013.06.012

    Abstract ( 1113 )   PDF (342KB) ( 1172 )  

    Objective To evaluate the transfection efficiency of hepatocyte-targeting galactosylated polyethylenimine derivative Gal-Bu in rat liver cells (BRL-3A). Methods Gal-Bu was synthesized through chemical modification of PEI-Bu with galactose residue. The pDNA condensation ability of the polymer was evaluated by agarose gel electrophoresis, MTT assay was employed to detect the cytotoxicity of the polymer in BRL-3A cells, luciferase plasmid was used as the reporter gene to determine the transfection efficiency of Gal-Bu in BRL-3A cells, and competition assay of galactose was performed to investigate the hepatocyte-targeting property of Gal-Bu. Results Gel retardation assay showed complete condensation of pDNA at weight ratio >15. At concentrations ranging from 5 to 100 μg/mL, cytotoxicity of Gal-Bu and PEI 25 000 increased with the concentrations. Gal-Bu exhibited lower cytotoxicity than PEI 25 000 at the same concentration (P<0.01). The polymer performed the highest transfection efficiency at weight ratio of 50, which was 5.6 times of PEI 25 000 (P<0.01) and was close to Lipofectamine 2000. Competition assay of galactose revealed that the transfection efficiency of Gal-Bu was significantly decreased in the presence of 100 mmol/L galactose (P<0.01), whereas this phenomenon was not observed on the transfection efficiency of PEI-Bu (P>0.05). Conclusion Gal-Bu is a non-viral hepatocyte-targeting gene carrier with lower cytotoxicity and enhanced transfection efficiency, which would be a promising candidate in hepatocyte-targeting gene therapy.

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    Influence of fresh and short-term cultured islet transplantation on survival of transplanted islets
    TANG Cheng-jia, DU Cheng-you, LIU Ding-zhi, et al
    2013, 33 (6):  763. 
    doi: 10.3969/j.issn.1674-8115.2013.06.013

    Abstract ( 896 )   PDF (946KB) ( 1171 )  

    Objective To investigate the influence of fresh and short-term cultured islets on revascularization and function of transplanted islets in mice. Methods Pancreatic islets of donors were obtained from C57 mice by digestion of collagenase P solution and Ficoll 400 density gradient centrifugation. The diabetic C57 mice undergoing syngenetic islet transplantation under renal capsule were randomly divided into three groups, with 10 mice in each group. Mice in group A were transplanted with fresh islets, and those in group B and group C were transplanted with islets with culture of 1 d and 3 d respectively. The changes of blood glucose in diabetic mice after transplantation were observed. The transplanted islets were obtained 14 d after transplantation, HE staining was conducted, immunohistochemical staining of insulin and CD31 was performed, and the microvascular density was calculated. Results The blood glucose of mice was lower than 11.0 mmol/L within 3 d after islet transplantation in three groups. The blood glucose of mice in group A maintained less than 11.0 mmol/L on the 14th day after transplantation, while the blood glucose in group B and group C continued to rise 3 d after transplantation, and was significantly higher than that in group A since then (P<0.05). Immunohistochemical staining of insulin demonstrated that there were a large number of insulin positive cells in cell masses in group A, whereas insulin positive cells were seldomly found in group B and group C. Immunohistochemical staining of CD31 demonstrated a large number of cells positively stained by CD31 under the renal capsule in group A, while there were fewer positive cells in group B and group C. The microvascular density in islets in group A was significantly higher than those in group B and group C (P<0.05). Conclusion Fresh islet transplantation is better than short-term cultured islet transplantation in improving the revascularization and survival of transplanted islets in mice.

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    Optimization design of bioinspired functionally graded interface layer of all ceramic restoration
    CUI Chang, SUN Jian, SUN Fang
    2013, 33 (6):  768. 
    doi: 10.3969/j.issn.1674-8115.2013.06.014

    Abstract ( 609 )   PDF (998KB) ( 995 )  

    Objective To explore the optimization design of bioinspired functionally graded interface layer of all ceramic restoration. Methods Three dimensional planar finite element model of bilayered ceramic/bioinspired functionally graded layer/cement/dentine was established. Experiment groupⅠ (Zirconia as the core material) and experiment group Ⅱ(Diene acid aluminum as the core material) were divided according to different core materials, and three dimensional finite element analysis was performed. The optimization analysis of graded change of elastic modulus of bioinspired functionally graded layer was conducted by first order optimization method. Besides, the three dimensional planar finite element model of bilayered ceramic/cement/dentine was served as control. Results For experiment groupⅠ, the stress uniformly distributed in bioinspired functionally graded layer with the maximum principal stress value of 23.0186 MPa, and a smooth stress transition from bioinspired functionally graded layer to cement was found. As for control group of experiment groupⅠ, stress concentration was found at the sub-surface of the core with the maximum principal stress value of 100.25 MPa. For experiment group Ⅱ, the stress uniformly distributed in bioinspired functionally graded layer with the maximum principal stress value of 15.9 665 MPa, and a smooth stress transition from bioinspired functionally graded layer to cement was found. As for control group of experiment group Ⅱ, stress concentration was found at the sub-surface of the core with the maximum principal stress value of 73.884 MPa. The optimization curves of elastic modulus gradient change of bioinspired functionally graded layer of experiment groupⅠ and experiment group Ⅱ were obtained. Conclusion The existence of bioinspired functionally graded layer can significantly reduce the stress concentration at the sub-surface of the core, and there exists optimization of elastic modulus graded change in bioinspired functionally graded layer.

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    Wear properties of dental alloy materials against tooth hard tissues
    CHEN Jie, XIN Xian-zhen, WEI Bin
    2013, 33 (6):  773. 
    doi: 10.3969/j.issn.1674-8115.2013.06.015

    Abstract ( 668 )   PDF (877KB) ( 981 )  

    Objective To wear common dental alloy materials against tooth hard tissues, and compare the vertical substance loss of enamel and dentin. Methods Four dental alloy materials (soft Co-Cr alloy, gold alloy 55.6%, Co-Cr alloy and titanium alloy) were selected, and were worn against human in vitro enamel and dentin specimens with paired grouping procedures. The vertical substance loss of enamel and dentin was quantified as wear depth, and was statistically analysed. The worn surface areas were observed by stereo microscope. Results The values of wear depth of enamel specimens against soft Co-Cr alloy, gold alloy 55.6%, Co-Cr alloy and titanium alloy were (54.37±6.91) μm, (24.77±4.49) μm, (127.74±16.25) μm and (57.79±7.39) μm respectively, and those of dentin specimens were (167.76±18.23) μm, (44.32±9.21) μm, (171.39±20.79) μm and (86.04±11.49) μm respectively. Statistical analysis revealed that the vertical substance loss of tooth tissues in wear against gold alloy 55.6% was significantly less than that in wear against soft Co-Cr alloy (P<0.000 1), and the vertical substance loss of tooth tissues in wear against titanium alloy was significantly less than that in wear against Co-Cr alloy (P<0.000 1). Conclusion In common fixed dental prostheses materials, gold alloy 55.6% wears less than soft Co-Cr alloy against tooth hard tissues. In common movable dental prostheses materials, titanium alloy wears less than Co-Cr alloy against tooth hard tissues.

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    Sorafenib inhibits growth of human renal cell carcinoma xenografted in nude mice
    WANG Lei, ZHOU Pei-jun, XU Da, et al
    2013, 33 (6):  776. 
    doi: 10.3969/j.issn.1674-8115.2013.06.016

    Abstract ( 746 )   PDF (740KB) ( 1301 )  

    Objective To establish the xenogenous implant model of human renal cell carcinoma in nude mice, and observe the inhibition effect of different doses of sorafenib on the growth of tumor. Methods Tumor-bearing nude mouse models were developed by subcutaneous implantation of Caki-1 cells into BALB/c mice, and were evaluated by small animal fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) one week after implantation. Eighteen tumor-bearing mice were randomly divided into control group, low-dose sorafenib group and high-dose sorafenib group, with 6 mice in each group. Thirty-five days after Caki-1 implantation, mice were sacrificed, the body weight of mice and volumes and weight of tumors were measured, and the histological changes of tumors were observed. Another three similar groups were set up, with 5 mice in each group, and the survival of nude mice were compared in the expected observation duration of 100 d. Results The uptake of 18F-FDG in tumor tissues was significantly higher than that in normal tissues. Compared with control group, the tumor growth in lowdose sorafenib group and high-dose sorafenib group was significantly inhibited, and there were significant differences in the volumes and weight of tumors among groups (P<0.05). The body weight of nude mice in high-dose sorafenib group was significantly lower than that in control group and lowdose sorafenib group (P<0.05). The survival of nude mice in low-dose sorafenib group and high-dose sorafenib group was significantly higher than that in control group (P<0.05). Conclusion Small animal 18F-FDG PET/CT can be used in evaluation of growth of renal carcinoma cells in host, and sorafenib can significantly inhibit the growth of renal carcinoma cells in xenogenous implant model of human renal cell carcinoma in nude mice.

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    Cyclic fatigue of casting clasps in cobalt chromium alloy, titanium alloy and high cobalt chromium molybdenum alloy
    JIA Shuang, WANG De-fang, YE Rong-rong, et al
    2013, 33 (6):  782. 
    doi: 10.3969/j.issn.1674-8115.2013.06.017

    Abstract ( 1085 )   PDF (643KB) ( 1086 )  

    Objective To investigate the cyclic fatigue of casting clasps in cobalt chromium alloy, titanium alloy and high cobalt chromium molybdenum alloy. Methods The cyclic fatigue of three kinds of casting clasps in alloy materials of cobalt chromium alloy, titanium alloy and high cobalt chromium molybdenum alloy on the butments with two pour concave depth (0.25 mm and 0.50 mm) for simulation of clinical use for five years was examined, and the enclasp force before and after cyclic fatigue was tested. Results The statistical analysis of enclasp force test before and after cyclic fatigue of three kinds of casting clasps revealed that with the same pour concave depth, the enclasp force of casting clasps in titanium alloy was the lowest, that in high cobalt chromium molybdenum alloy was the highest, and there were significant differences among three kinds of casting clasps (P<0.05). With the same alloy materials, the enclasp force of pour concave depth of 0.50 mm was significantly higher than that of pour concave depth of 0.25 mm (P<0.05). Conclusion The fatigue restraint ability of high cobalt chromium molybdenum alloy is superior to titanium alloy and cobalt chromium alloy, and the fatigue restraint ability of titanium alloy is the lowest.

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    Effect of morphine, sufentanil and dezocine on contraction and motor function of intestinal smooth muscle in rats
    BIAN Xiao-cui, ZHOU Ren-long, WEN Da-xiang, et al
    2013, 33 (6):  786. 
    doi: 10.3969/j.issn.1674-8115.2013.06.018

    Abstract ( 862 )   PDF (365KB) ( 1127 )  

    Objective To investigate the effect of morphine, sufentanil and dezocine on contraction and motor function of intestinal smooth muscle in rats. Methods Isolated small intestine of rats was prepared, and were treated with different concentrations of morphine (5 mg/L, 10 mg/L and 30 mg/L), sufentanil (20 μg/L, 40 μg/L and 120 μg/L) and  dezocine (1.7 mg/L, 3.4 mg/L and 10.2 mg/L) respectively. The contractile tension and frequency of the small intestine smooth muscle of rats were recorded, and the effect of treatment was observed. Thirtytwo SD rats were randomly divided into control group (1 mL normal saline), morphine group (1.04 mg/kg), sufentanil group (2.08 mg/kg) and dezocine group (1.04 mg/kg), and the propulsive motility in intestinal tract was measured after intraperitoneal injection of three drugs in rats. Results After treatment with 10 mg/L and 30 mg/L morphine and 40 μg/L and 120 μg/L sufentanil, the contractile tension of the isolated small intestine smooth muscle of rats significantly increased (P<0.05), while 5 mg/L morphine, 20 μg/L sufentanil and different concentrations of dezocine (1.7 mg/L, 3.4 mg/L and 10.2mg/L) had no significant effect on the contractile tension of the isolated small intestine smooth muscle of rats (P>0.05). Different concentrations of morphine, sufentanil and dezocine had no significant effect on the contractile frequency of the isolated small intestine smooth muscle of rats (P>0.05). Compared with control group, the propulsive distance in intestinal tract significantly decreased after treatment with morphine, sufentanil and dezocine (P<0.05), and there was no significant difference in the propulsive distance among morphine, sufentanil and dezocine groups (P>0.05). Conclusion Morphine, sufentanil and dezocine all have an inhibitory effect on the intestinal motility of rat.

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    Original article (Clinical research)
    Relationship between mean platelet volume and myocardial bridging
    LI Shan-shan, CHEN Xin, ZHANG Wei-hua, et al
    2013, 33 (6):  791. 
    doi: 10.3969/j.issn.1674-8115.2013.06.019

    Abstract ( 803 )   PDF (379KB) ( 1047 )  

    Objective To investigate the correlation between mean platelet volume (MPV) and myocardial bridging (MB). Methods The data of MPV of patients with isolated MB confirmed by coronary angiography (MB group, n=326) and those with normal coronary angiographic findings (control group, n=334) were retrospectively analysed. All the study objectives were stratified by age and gender, and the differences in MPV were compared between subgroups. The risk factors of MB were explored by multivariate Logistic regression analysis. Results There was no significant difference in MPV between MB group and control group [(8.88±1.27) fl vs (8.78±1.27) fl, P>0.05], and there was also no significant difference in MPV between the same gender of two groups (P>0.05). The cutoff point of age was determined as 44 years with favorable sensitivity and specificity. In those aged no higher than 44 years, MPV in MB group was significantly higher than that in control group [(9.49±1.30) fl vs (8.62±1.31) fl, P<0.01], while there was no significant difference in MPV between two groups in the other age subgroups (P>0.05). In those aged no higher than 44 years, multivariate regression analysis revealed that MB was significantly related to MPV (OR=1.71, 95%CI 1.16-2.51, P<0.01), while was not related to gender, blood pressure and blood lipid (P>0.05). Conclusion MB may be associated with the increase of MPV, and the relevance may be more significant in young patients with MB.

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    Gene polymorphism and linkage disequilibrium of IL-13 and IL-4 in Chinese Han population with chronic periodontitis
    CHEN Dong, WANG Li-ming, ZHANG Jie, et al
    2013, 33 (6):  796. 
    doi: 10.3969/j.issn.1674-8115.2013.06.020

    Abstract ( 863 )   PDF (592KB) ( 1064 )  

    Objective To investigate the gene polymorphism of interleukin (IL)-13 and IL-4 in Chinese Han population with chronic periodontitis, and explore its potential relationship with chronic periodontitis. Methods Matrix-assisted laser desorption ionization time of flight mass spectrometer (MALDI-TOF-MS) was employed to detect the single nucleotide polymorphism (SNP) of rs2070874 and rs1800925 in IL-13 and rs2243248 in IL-14 in chronic periodontitis group (n=278) and healthy control group (n=324), the allele frequency and genotype distribution were calculated, and linkage disequilibrium and haplotype analysis was conducted. Results There were significant differences in the allelic frequency of rs1800925 TT genotype and T allele, as well as that of rs2243248 GG genotype and G allele between chronic periodontitis group and healthy control group (P<0.05). There were also significant differences in the distribution of rs2070874 T/rs1800925 T/rs2243248 G, rs2070874 T/rs1800925 C/rs2243248 G and rs2070874 T/rs1800925 T/rs2243248 T between two groups (P<0.05). Conclusion SNP of rs1800925 in IL-13 gene and rs2243248 in IL-4 gene may be correlated with the susceptibility to chronic periodontitis in Chinese Han population.

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    Expression characteristics of WT1, PRAME and ERG genes in acute leukemia of children
    LIU Qing, JIANG Hui, YANG Yong-chen
    2013, 33 (6):  801. 
    doi: 10.3969/j.issn.1674-8115.2013.06.021

    Abstract ( 1202 )   PDF (979KB) ( 1025 )  

    Objective To investigate the expression characteristics of Wilm's tumor 1 gene (WT1), preferentially expressed antigen of melanoma (PRAME) and ETS related genes (ERG) in acute leukemia of children, and explore the significance in monitoring of minimal residual disease (MRD) of leukemia. Methods Ninety-two samples of acute leukemia (84 children) were collected. Twenty-eight samples were newly diagnosed ones, including 18 samples of acute lymphoblastic leukemia (ALL) and 10 samples of acute myeloid leukemia (AML). Sixty-three samples were complete remission ones, including 45 samples of ALL and 18 samples of AML. The other 1 sample was a relapse one. The expression of WT1, PRAME and ERG mRNA in bone marrow was detected by Real-time PCR. Another 10 cases of non-malignant hematological diseases of the same period were served as controls. Results The relative expression of WT1, PRAME and ERG mRNA in newly diagnosed group was significantly higher than that in complete remission group and control group (P<0.05), while there was no significant difference between complete remission group and control group (P>0.05), and the relative expression of PRAME mRNA in newly diagnosed AML group was significantly higher than that in newly diagnosed ALL group (P<0.05). The positive expression rates of WT1, PRAME and ERG mRNA in newly diagnosed group were 82.4%, 92.9% and 64.3% respectively, and there were significant differences among them (P<0.05). The positive rate of joint detection of 3 genes was 100%. The relative expression of 3 genes after induction chemotherapy was significantly lower than that before induction chemotherapy in 15 newly diagnosed patients (P<0.05). The expression of 3 genes in the patient with relapse was positive at the disease onset, negative after remission, and positive again at relapse. Conclusion Compared with patients without leukemia, WT1, PRAME and ERG mRNA is highly expressed in bone marrow of patients with newly diagnosed acute leukemia, and the joint detection of 3 genes may increase the positive rate. The expression of WT1, PRAME and ERG mRNA is related to the disease status in patients with acute leukemia, and may be a useful tool for monitoring MRD.

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    Relationship between HPV infection and expression of HIF-1alpha and VEGF in head and neck squamous cell carcinoma and its prognostic value
    LIU Kai, MA Ling-ling, WANG Duo-ming, et al
    2013, 33 (6):  806. 
    doi: 10.3969/j.issn.1674-8115.2013.06.022

    Abstract ( 819 )   PDF (968KB) ( 1243 )  

    Objective To investigate the relationship between human papillomavirus (HPV) infection and expression of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in tissues of head and neck squamous cell carcinoma (HNSCC), and explore its clinical significance. Methods The infection of HPV6/11, 16/18, 31/33 was examined by in situ hybridization in 43 samples of HNSCC, and the expression of HIF-1α and VEGF was determined by immunohistochemistry method. Spearman method was employed for rank correlation analysis, overall survival of patients was calculated by Kaplan-Meier method, and Cox regression model was used for multivariate analysis. Results In the 43 cases of HNSCC, the positive infection rate of HPV was 25.6%, and the positive expression rates of HIF-1α and VEGF were 65.1% and 51.2% respectively. The expression of HIF-1α was related to T stage, N stage and clinical stage (P<0.05), and the expression of VEGF was related to N stage and recurrence (P<0.05). The expression of HIF-1α was positively related with the expression of VEGF (r=0.359, P<0.05). There was no significant difference in the expression of HIF-1α and VEGF between HPV positive group and HPV negative group (P>0.05). The 3-year overall survival rates of HPV positive group and HPV negative group were 60.0% and 59.7% respectively (P>0.05), those of HIF-1α positive expression group and HIF-1α negative expression group were 49.9% and 80.0% respectively (P=0.06), and those of VEGF positive expression group and VEGF negative expression group were 41.2% and 81.0% respectively (P<0.05). Conclusion HIF-1α and VEGF may be considered as parameters in evaluation of progression, metastasis and prognosis of HNSCC, and the correlation between HPV infection and expression of HIF-1α and VEGF in tissues of HNSCC is undetermined.

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    Relationship between serum bilirubin and diabetic nephropathy in patients with type 2 diabetes mellitus
    WU Jing-cheng, LI Xiao-hua, PENG Yong-de
    2013, 33 (6):  813. 
    doi: 10.3969/j.issn.1674-8115.2013.06.023

    Abstract ( 892 )   PDF (340KB) ( 1069 )  

    Objective To investigate the relationship between serum bilirubin and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods The clinical data of 461 patients with T2DM (T2DM group) were collected, and biochemical parameters such as fasting blood glucose, liver and renal function and blood lipid profile were recorded. Patients in T2DM group were subdivided into normal albuminuria group (NA group, n=221), microalbuminuria group (MA group, n=191) and overt albuminuria group (OA group, n=49) according to albumin to creatinine ratio (ACR). Besides, 301 healthy people were served as controls. Results The levels of serum total bilirubin (TBIL) and direct bilirubin (DBIL) in T2DM group were significantly lower than those in control group, and the differences still existed after adjustment of other influencing factors (P<0.01, P<0.05). The levels of serum TBIL and DBIL were highest in NA group and lowest in OA group, and there were significant differences among NA group, MA group and OA group (P<0.01). Patients in T2DM group were divided into three groups by the quartile of serum TBIL, and it was revealed that ACR decreased with serum TBIL (P<0.01) while glomerular filtration rate increased with serum TBIL (P<0.05). Multiple stepwise regression analysis indicated that TBIL was independently associated with ACR (β=-0.15, P<0.01). Conclusion Serum bilirubin is a protective factor in the onset and development of DN in patients with T2DM.

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    Ultrasonic imaging and pathological features of encapsulated papillary carcinoma and ductal carcinoma in situ of breast
    YU Yan-min, LV Jue, WANG Cheng, et al
    2013, 33 (6):  818. 
    doi: 10.3969/j.issn.1674-8115.2013.06.024

    Abstract ( 1075 )   PDF (793KB) ( 1181 )  

    Objective To investigate the ultrasonic imaging and pathological features of encapsulated papillary carcinoma and ductal carcinoma in situ of breast. Methods The clinical data of 7 cases of encapsulated papillary carcinoma and 12 cases of ductal carcinoma in situ were retrospectively analysed, and there were preoperative ultrasonic findings and images for all cases. The pathological features of tumor tissues were observed with HE staining, and the expression of estrogen receptor (ER), progesterone receptor (PR), p53, Ki67, p63 and CerbB-2 protein was detected by immunohistochemical method. Results The ultrasonic findings of encapsulated papillary carcinoma indicated that the masses were in irregular shape with unclear boundaries; internal echo was mixed echo; in case of no echo, high echo was found with papillae, and rear echo was enhanced; calcification was not found; and blood flow signals were visible around the tumor. The ultrasonic findings of ductal carcinoma in situ indicated that there was mammary duct ectasia; low echo was in the mammary duct ectasia, with irregular shape, unclear boundaries and no enhancement in the rear echo; calcification was found; and blood flow signals were visible around the tumor. Light microscopy with HE staining indicated that in encapsulated papillary carcinoma, fine fibrovascular cores were found, and neoplastic epithelial cells were of low or intermediate nuclear grades surrounded by a fibrous capsule. And in ductal carcinoma in situ, there was neoplastic proliferation cytological atypia of epithelial cells, and fibrovascular cores with no fibrous capsule were found in the nipple type ductal carcinoma in situ. Immunohistochemical detection revealed that in encapsulated papillary carcinoma, there was significantly positive expression of ER and PR and negative or weakly positive expression of p53, Ki67 and CerbB-2 in epithelial cells, and p63 was negative in myoepithelial cell layer within the papillae or at the periphery of the lesion. And in ductal carcinoma in situ, p63 was negative in myoepithelial cells within the papillae, but was positive in the cells at the periphery of the lesion. ConclusionThe unique ultrasonic imaging and pathological features are helpful in the diagnosis of encapsulated papillary carcinoma and ductal carcinoma in situ of breast.

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    Effects of morphine, methylprednisolone and aminophylline on management of dyspnea in patients with advanced cancer
    LIU Feng, WANG Mei-ling, YUAN Hai-hua, et al
    2013, 33 (6):  823. 
    doi: 10.3969/j.issn.1674-8115.2013.06.025

    Abstract ( 802 )   PDF (289KB) ( 1114 )  

    Objective To investigate the effects of morphine, methylprednisolone and aminophylline on the management of dyspnea in patients with advanced cancer. Methods One hundred and seventy patients with advanced cancer suffering from dyspnea were randomly managed with morphine (5 to 10 mg, subcutaneous injection; morphine group, n=60), methylprednisolone (40 mg, intravenous administration; methylprednisolone group, n=55) and aminophylline (0.25 g, intravenous administration; aminophylline group, n=55), and the visual analogue scale (VAS) was adopted to evaluate the therapeutic effects. Results There was no significant difference in VAS among three groups before treatment (P>0.05). VAS after treatment was significantly lower than that before treatment in each group (P<0.01). VAS after treatment in morphine group, methylprednisolone group and aminophylline group were (12.82±11.40) mm, (24.58±17.51) mm and (34.25±17.75) mm respectively, and VAS in morphine group was significantly lower than those in methylprednisolone group and aminophylline group (P<0.01). The effective rate in control of dyspnea in morphine group (86.67%) was significantly higher than those in methylprednisolone group (67.27%) and aminophylline group (50.91%)(P<0.05 or P<0.01). Conclusion Morphine is more effective than methylprednisolone and aminophylline for dyspnea management in advanced cancer, and can improve the quality of life in patients with advanced cancer.

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    Correlation between body composition and nerve conduction velocity in patients with type 2 diabetes mellitus
    GU Ting, JIANG Bo-ren, REN Rong-liang, et al
    2013, 33 (6):  827. 
    doi: 10.3969/j.issn.1674-8115.2013.06.026

    Abstract ( 754 )   PDF (391KB) ( 1057 )  

    Objective To investigate the correlation between body composition and nerve conduction velocity in patients with type 2 diabetes mellitus. Methods One hundred and five patients with type 2 diabetes mellitus were enrolled, body composition related parameters including body mass index, body fat percent, body muscle percent and body water percent were measured by body composition analyzer, nerve conduction velocity related parameters including motor nerve conduction velocity, distal motor latency, amplitude of compound muscle action potential, sensory nerve conduction velocity, latency and amplitude of sensory nerve action potential were determined, and the correlation between body composition and nerve conduction velocity was explored. Results Body fat percent was positively correlated with nerve conduction velocity of motor-sensory ulnar nerve and motor peroneal nerve, and negatively correlated with distal latency of sensory ulnar nerve, sensory superficial peroneal nerve, motor peroneal nerve and motor amplitude of peroneal nerve. Body muscle percent was positively correlated with distal latency of sensory ulnar nerve, sensory superficial peroneal nerve, motor peroneal nerve and motor amplitude of peroneal nerve, and negatively correlated with nerve conduction velocity of motor-sensory ulnar nerve and motor peroneal nerve. Body water percent was positively correlated with distal latency of sensory ulnar nerve and sensory superficial peroneal nerve, and negatively correlated with nerve conduction velocity of sensory ulnar nerve. Body mass index and waist circumference were negatively correlated with sensory amplitude of median nerve and motor amplitude of tibial nerve. Conclusion Body mass index, waist circumference, body fat percent, body muscle percent and body water percent may be important influencing factors of nerve conduction velocity.

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    Expression of p53 and Ki67 in triple negative breast cancer
    XU Ting, HE Qi, WU Ke-jin, et al
    2013, 33 (6):  833. 
    doi: 10.3969/j.issn.1674-8115.2013.06.027

    Abstract ( 1067 )   PDF (838KB) ( 1316 )  

    Objective To investigate the expression of p53 and Ki67 in breast cancer with negative estrogen receptor (ER), negative progesterone receptor (PR) and negative human epidermal growth factor receptor 2 (HER-2) (triple negative breast cancer), and explore its clinical significance. Methods A total of 233 cases of invasive breast cancer confirmed by pathology were collected, among which 44 (18.88%) were triple negative breast cancer. The expression of p53 and Ki67 in tissues of triple negative breast cancer was detected by immunohistochemical EnVision two-step methods. The tissues of 189 cases of non-triple negative breast cancer were served as controls. The correlation of expression of p53 and Ki67 in triple negative breast cancer with clinicopathological features and their relationship with prognosis were analysed. Results The positive expression rates of p53 and Ki67 in tissues of triple negative breast cancer were 45.5% and 68.2% respectively, which were significantly higher than those in tissues of nontriple negative breast cancer (20.6% and 47.1%) (P<0.05). In triple negative breast cancer, the expression of p53 correlated with tumor size, histological grade, lymph node status and vessel invasion (P<0.05), and the expression of Ki67 correlated with histological grade (P<0.05). The expression of p53 was significantly related to that of Ki67 in all the breast cancer cases (r=0.294, P=0.000), but the expression of p53 was not significantly related to that of Ki67 in triple negative breast cancer cases (r=0.134, P>0.05). In all the breast cancer cases, the overall survival of cases with positive expression of p53 was lower than that of cases with negative expression of p53 (P=0.000), and the overall survival of cases with positive expression of Ki67 was lower than that of cases with negative expression of Ki67 (P=0.000). In triple negative breast cancer cases, there was no significant difference in the overall survival between cases with positive expression of p53 and those with negative expression of p53 (P>0.05) and between cases with positive expression of Ki67 and those with negative expression of Ki67(P>0.05). Conclusion The expression of p53 and Ki67 is up-regulated in tissues of triple negative cancer, while the expression of p53 is not significantly related to that of Ki67. The expression of p53 and Ki67 may be related to the prognosis of breast cancer, while may not indicate the prognosis of triple negative breast cancer.

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    Expression of CD68 and its relationship with microvessel density in tissues of nasal polyps
    WU Ji-chang, WANG Shi-li, CAI Chang-ping
    2013, 33 (6):  838. 
    doi: 10.3969/j.issn.1674-8115.2013.06.028

    Abstract ( 738 )   PDF (881KB) ( 1032 )  

    Objective To detect the expression of macrophage surface antigen CD68 and microvessel density (MVD) in tissues of nasal polyps in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and explore their correlation. Methods The expression of CD68 and MVD in tissues of nasal polyps in 73 patients with CRSwNP (CRSwNP group) were determined by immunohistochemistry SP method, and 30 patients having nasal septal deviation without CRSwNP and history of allergic diseases were served as control group. The correlation of expression of CD68 with MVD in tissues of nasal polyps in CRSwNP group was explored. Results Immunohistochemical staining revealed that the expression of CD68 and MVD in tissues of nasal polyps in CRSwNP group were significantly higher than those in nasal septal mucosa in control group (P<0.01). There was a significantly positive correlation between the expression of CD68 and MVD in tissues of nasal polyps in CRSwNP group (r=0.871, P<0.01). Conclusion The development of CRSwNP may be associated with the activation of macrophages and angiogenesis.

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    Clinical effect of double tile muscle flap method in pouch orthopedics
    ZHU Li-li, LIN Wei-gang, ZHENG Jin-man, et al
    2013, 33 (6):  842. 
    doi: 10.3969/j.issn.1674-8115.2013.06.029

    Abstract ( 733 )   PDF (581KB) ( 954 )  

    Objective To explore the importance of design of incision, formation of double tile of orbicularis muscle flap and processing of orbital fat in extra-approach lower eyelid blepharoplasty, and observe the clinical effect of double tile of orbicularis muscle flap in pouch orthopedics. Methods Eyelid margin path (extra-approach) surgery was performed on 388 patients with obvious lower eyelid bags. The incision was paralleled with lateral canthus groove, and the orbital fat was removed or resected according to clinical manifestations. The eyelid margin orbicularis muscle flap and myocutaneous flap were sutured to form the double tile of muscle flap, and the wound was fit and sutured to close. Results Primary healing of incision was achieved in all the 388 patients, with satisfactory effect. There was obvious skin relaxation in 168 patients, zygomatic surface ditch sag in 62 patients, and prominent orbital fat in 158 patients. Double tile of orbicularis muscle flap was adopted, more lower eyelid strips of orbicularis muscle crest were retained, and no ectropion occurred after operation. Two hundred and sixty patients were followed up for 1 to 2 years, the morphous of the lower eyelid was natural, and no significant surgical scar and palpebral retreat was observed. Conclusion The design of incision, formation of double tile of orbicularis muscle flap and processing of orbital fat are critical steps for extra-approach lower eyelid blepharoplasty.

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    Clinical characteristics and surgical outcomes of 129 cases of persistent hyperplastic primary vitreous
    ZHU Yu-jie, ZHAO Pei-quan, ZHANG Qi
    2013, 33 (6):  846. 
    doi: 10.3969/j.issn.1674-8115.2013.06.030

    Abstract ( 1186 )   PDF (367KB) ( 1372 )  

    Objective To investigate the clinical characteristics and surgical outcomes of persistent hyperplastic primary vitreous (PHPV). Methods The clinical data of 129 children with PHPV were retrospectively analysed, including preoperative visual acuity, intraocular pressure, ocular axial length and PHPV types, and the contralateral eyes of the affected ones were served as normal control group. Surgical treatment was performed in children with indications, and the major surgical procedures were lensectomy and vitrectomy. Patients were followed up for 1 to 40 months. Results A total of 129 patients (138 eyes) were enrolled, among whom 82 were males (63.6%) and 47 were females (36.4%). The age of initial diagnosis ranged from 6 d to 13 years, with the average of (2.8±3.1) years. As to the PHPV types, anterior type accounted for 5.1% (7/138), combined type 79.7% (110/138) and posterior type 15.2% (21/138). Examinations before surgery indicated that the visual acuity of 33.3% (11/33) of the affected eyes was ≥0.1, that of 27.3% of the affected eyes was lower than finger counting, and that of the 28 normal control eyes was ≥0.1. The intraocular pressure was normal in 77.1% (37/48) of the affected eyes, and that was normal in 95.2% of the normal controls. The average ocular axial length of the 45 affected eyes was shorter than that of the 36 normal controls. Forty-seven children (49 eyes) were followed up, including 34 cases with surgery. After surgery, most complications of the affected eyes were eliminated, and visual acuity was detected in 10 eyes, including visual acuity ≥0.1 in 3 affected eyes and that lower than finger counting in 1 affected eye. Conclusion The age is big and the age span is large for initial diagnosis of children with PHPV, which are mainly presented as combined type and posterior type. Improvement in visual acuity is limited for surgical cases, but better results may be achieved in preservation of useful vision and prevention and treatment of complications.

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    Original article (Public health administration)
    Design and application of optimized algorithm of examination sequence to minimize total waiting time of patients
    DAI Xing, ZHANG Shao-ming, ZHOU Li-ming, et al
    2013, 33 (6):  851. 
    doi: 10.3969/j.issn.1674-8115.2013.06.031

    Abstract ( 582 )   PDF (491KB) ( 1110 )  

    Objective To propose the optimized algorithm to effectively reduce the total waiting time of patients as so to make full use of the hospital resources for medical service. Methods With total waiting time of outpatients as objective function, hybrid open flow shop model of outpatient examinations was established. The examination load of equipment of each examination department was calculated, and the bottleneck department was determined. The semi-online algorithm based on the bottleneck department was proposed to minimize the total waiting time of outpatients, and was performed on the data collected from 20 groups of outpatients in the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Results Through the semi-online algorithm based on the bottleneck department, the total waiting time of 20 groups of outpatients decreased by 10.5%. Conclusion Compared with the sequence generated randomly by the outpatients, the proposed algorithm can effectively reduce the total waiting time and improve the efficiency of hospital resources for medical service.

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    Survey on related factors of compassion fatigue in clinical nurses
    HU Xiao-ying, ZHAO Yun-lan, Min-gui
    2013, 33 (6):  857. 
    doi: 10.3969/j.issn.1674-8115.2013.06.032

    Abstract ( 775 )   PDF (432KB) ( 1186 )  

    Objective To investigate the status of compassion fatigue in clinical nurses, and explore the related factors. Methods Convenience sampling was adopted, and a total of 644 nurses were investigated by self-designed demographic questionnaire and professional quality of life scale. The contents of demographic questionnaire included gender, age, marital status, years of working experience, personnel, professional title, level of education, department of working, years of working in current department and post. Professional quality of life scale consisted of 30 questions in 3 subscales: compassion satisfaction, secondary traumatic stress and burnout. Univariate and multivariate analysis was employed respectively to explore the influencing factors of compassion fatigue in nurses. Results Five hundred and ninety-two questionnaires were recovered, with the response rate of 91.9%, and there were 566 valid questionnaires, with the effective rate of 95.6%. Among the 566 nurses, 60 were nurses with standardized training, and the other 506 were clinical nurses. The survey of 506 clinical nurses revealed that the scores of compassion satisfaction, secondary traumatic stress and burnout were 3.15±0.57, 2.73±0.54 and 2.78±0.55 respectively. Univariate analysis indicated that there were significant differences in the scores of compassion satisfaction among nurses with different age, marital status, professional title, years of working experience, years of working in current department, and post (P<0.05 or P<0.01), there were significant differences in the scores of secondary traumatic stress among nurses with different department of working and years of working in current department (P<0.05), and there were significant differences in the scores of burnout among nurses with different age, years of working experience, department of working and post (P<0.05 or P<0.01). Multivariate analysis demonstrated that factors significantly influencing compassion satisfaction of clinical nurses were age (t=3.601,P=0.000), marital status (t=2.225,P=0.027)and years of working experience (t=-1.980,P=0.048), factor significantly influencing secondary traumatic stress was department of working (t=-2.821,P=0.005), and factors significantly influencing burnout were age (t=-4.289,P=0.000)and years of working in current department (t=2.649,P=0.008). Conclusion Nurses and nursing managers should pay attention to the influencing factors of compassion fatigue and take measures to improve the physical and psychological health of nurses.

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    Establishment of admission standard of teachers of community nurse of intervention by Delphi method
    HE Jing, XU Qing, XU Rong, et al
    2013, 33 (6):  863. 
    doi: 10.3969/j.issn.1674-8115.2013.06.033

    Abstract ( 761 )   PDF (324KB) ( 1098 )  

    Objective To establish the admission standard of  teachers of community nurse of intervention by Delphi method. Methods Twenty-four nursing experts were selected for two rounds of Delphi expert consultation. The survey was conducted with self-design questionnaire, which included the basic information of experts, admission standard of nurse of intervention and evaluation form on the familiarity of experts on the questionnaire. There were 5 first level parameters (executor of  teachers of nurse of intervention, moral quality, related professional level, related ability and main existing form), 22 second level parameters and 18 third level parameters (personal and professional quality of  teachers of nurse of intervention, and specific skills and other skills) in the admission standard of  teachers of nurse of intervention. Results The enthusiasm, authority degree and coordination degree of experts in two rounds of expert consultation were favorable. The modified admission standard of  teachers of community nurse of intervention were divided into three levels. No parameter in the first level was adjusted. The number of second level parameters increased to 23, and the item of other related majors was added. The number of third level parameters increased to 26, 4 items of humanity and ethics, legal, psychology and sociology were added, and the other 4 items of basic skills and special skills were also added, which were perineal care, comfortable lying for nursing, urine catheter nursing and feeding catheter nursing. Conclusion The established items may serve as admission standard of  teachers of community nurse of intervention for clinical practice.

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    Review
    Research progress of exosomes in stem cells
    HU Guo-wen, WANG Yang, SHEN Xiao-li, et al
    2013, 33 (6):  868. 
    doi: 10.3969/j.issn.1674-8115.2013.06.034

    Abstract ( 1265 )   PDF (450KB) ( 2098 )  

    Exosomes are small secreted vesicles, which play key roles in cell-to-cell communication. Exosomes can be released by different types of cells, and help to exchange membrane and transfer proteins, mRNA, microRNA and organelles between cells. Exosomes modulate normal physiological processes by transforming gene regulatory network or epigenetic reorganization. Recent studies have found that exosomes secreted by stem cells can transport mRNA, microRNA and proteins effectively, and play an important role in regulating tissue regeneration. The generation of exosomes and the research progress of exosomes in stem cells are reviewed in this paper.

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    Research progress of candidate gene of age at natural menopause
    SUN Dong-mei, TAO Min-fang
    2013, 33 (6):  874. 
    doi: 10.3969/j.issn.1674-8115.2013.06.035

    Abstract ( 860 )   PDF (386KB) ( 1126 )  

    Age at natural menopause (ANM) is a complex trait which is determined by genes and environment, and the genetic effects are prominent. Early or delayed menopause is associated with female-related diseases. Exploring genetic factors of ANM can help to predict the potential health problems of postmenopausal women, and may provide appropriate health guidance. It has been found by genome-wide association studies and candidate gene association studies that several genes are associated with ANM. The research progress of candidate genes of ANM is reviewed in this paper.

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    Cellular proliferation regulations by tumor suppressor gene PTEN
    XIONG Zhong, CHEN Guo-qiang
    2013, 33 (6):  878. 
    doi: 10.3969/j.issn.1674-8115.2013.06.036

    Abstract ( 753 )   PDF (607KB) ( 1150 )  

    Phosphatase and tensin homolog deleted on chromosome ten (PTEN), one of the mostly investigated tumor suppressor genes, has a close correlation with tumorigenesis. The activation of PI3K-AKT pathway caused by abnormal PTEN is one of the major mechanisms underlying tumor occurrence. Therefore, PTEN regulation is important for uncovering new mechanisms of tumor occurrence and establishing novel therapeutic strategies. The cellular PTEN regulations including transcriptional regulation, post-transcriptional modulation, post-translation modification and protein-protein interaction are reviewed in this paper.

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    Research progress of aldehyde dehydrogenase superfamily
    LI Cai-xia, WU Zhao-xia, WANG Li-shun
    2013, 33 (6):  886. 
    doi: 10.3969/j.issn.1674-8115.2013.06.037

    Abstract ( 905 )   PDF (640KB) ( 1455 )  

    Aldehydes are highly reactive molecules. A lot of enzyme systems participate in the metabolism of aldehydes, and one of the most important enzyme systems is aldehydes dehydrogenase (ALDH) superfamily, which is composed of NAD (P) +-dependent enzymes that catalyze aldehyde oxidation. This paper presents a review of what is currently known about each member of human ALDH superfamily, including the pathophysiological significance of these enzymes, in hopes of providing information for future studies on comparison of roles among ALDH members and roles of ALDH superfamily in development of cancers.

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    Brief original article
    Clinical analysis of interventional therapy for pulmonary sequestration in 6 patients
    WANG Cheng, PAN Xin, LU Jing, et al
    2013, 33 (6):  894. 
    doi: 10.3969/j.issn.1674-8115.2013.06.038

    Abstract ( 854 )   PDF (461KB) ( 1132 )  

    Objective To investigate the feasibility, efficacy and safety of interventional therapy for pulmonary sequestration. Methods The clinical data of 6 patients with pulmonary sequestration undergoing interventional therapy were retrospectively analysed. Pulmonary arteriography and aortography were performed during the treatment. Embolization using Amplatzer Plug was conducted in patients with single aberrant artery and diameter of proximal blood vessel < 12 mm, and membrane tectoria stent sequestration was carried out in those with multiple aberrant arteries and/or diameter of proximal blood vessel > 12 mm. Results Pulmonary arteriography revealed the absence of bottom left pulmonary artery in all the 6 patients. Aortography demonstrated 8 aberrant arteries originating from descending aorta. The interventional therapy was successfully performed in all the 6 patients. Patients were followed up for 1 to 5 years, the symptom of haemoptysis disappeared, and chest enhancement CT indicated that the bottom left lung ischemically shrinked or vanished. Conclusion Interventional therapy is safe and effective for pulmonary sequestration.

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