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Objective To explore the establishment of a two-way referral system for the treatment of cervical diseases within a medical alliance. The two-way referral system was introduced to reduce the morbidity and mortality of cervical cancer through better management of patients'who have tested positive for cervical disease, screening effectively for early diagnosis and treatment of cervical precancerous lesions, and providing early interventions for cervical cancer patients. Methods The control group consisted of 2, 515 patients who had screened positive for cervical disease between January 2018 and December 2018 at one of four community health service centers that were not within the medical alliance. The experimental group consisted of 2, 384 patients who had screened positive for cervical disease at one of four community health service centers in the medical alliance. The control group was treated using the original management mode;the experimental group's treatment was managed within the two-way referral system, which included standardized screening, referral, follow-up, health education, and professional training. The hospital visit rates, time intervals from diagnosis to the start of interventions, detection rates, and treatment rates were observed for both groups of women. Results The hospital visit rates, detection rates, and treatment rates were higher for those in the experimental group than the control group. The time interval from receiving a diagnosis to the first hospital visit was (16.9±11.5) days for patients in the experimental group and (25.7±20.9)days for those in the control group. The difference was a statistically significant (-0.05). Conclusion The management of cases in a two-way referral system within a medical alliance facilitates patients receiving earlier diagnosis and treatment for cervical pre-cancerous lesions and malignant tumors. Such efficiency improvements may reduce morbidity and mortality as well as help control medical costs, all of which have long-term economic and social significance.
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Objective@#To study the efficacy and safety of sofosbuvir and daclatasvir regimens for patients who received kidney transplantation (KT) with hepatitis C virus (HCV) infection.@*Methods@#This study enrolled a prospective cohort of consecutive KT patients with HCV infection from March 2016 to January 2018 in the hepatology Department of the Second Hospital of Shandong University. They were given sofosbuvir combined with daclatasvir, with or without ribavirin. The course of treatment was 12 weeks or 24 weeks. Clinical assessment, conventional liver and kidney biochemical parameters, hemoglobin, serum HCV RNA, as well as the types of immunosuppressive drugs and their doses were assessed routinely as follows: at the beginning of treatment; 2, 4, and 8 wk post treatment; at the end of treatment (EOT); and at 12, 24 wk after the therapy was completed. Adverse events and adjustment of anti-rejection drugs were surveilled during the treatment period.@*Results@#A total of 13 patients were enrolled. All patients were naive to treatment. Their mean age was 46.84±7.79 years. There were 10 males and 3 females, 3 patients had cirrhosis (1 cases had decompensated cirrhosis), 10 patients had no cirrhosis. They were infected with HCV genotype 1 (6/13 GT1b), genotype 3 (2/13 GT3a) and genotype 6 (3/13 GT6a), and genotype 2 (2/13 GT2a). Twelve patients′ estimated glomerular filtration rate (eGFR) was > 30 ml/min per 1.73 m2 at the beginning of treatment, 1 patient′s eGFR was <30 ml/min·1.73 m2; 9 patients received 12 wk therapy, 4 patients received 24 wk therapy. Twelve patients had undetectable viral load by week 4 of treatment. All patients had undetectable HCV viral load at the end of treatment. Sustained virological response (SVR) 12 rate was achieved in 100% (13/13) of the recipients. The basic renal function remained stable during the course of treatment. No serious adverse events were observed during the treatment. Antiviral therapy was not discontinued due to side effects in any patient.@*Conclusions@#Sofosbuvir and daclatasvir for treatment of KT patients with HCV infection are highly effective and safe.
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Objective To clarify the relationship of p63 and CD44 expressions with age and ultraviolet irradiation in the process of skin aging.Methods Full-thickness skin samples were obtained from the normal skin at different sites,including 44 sun-exposed sites(face,neck,dorsal aspect of the forearm),46 sun-protected sites(abdomen,thigh),and 31 semi-exposed sites(back,flexor aspect of the forearm,upper arm,leg),of 121 volunteers(63 males and 58 females).Of all the volunteers,55 were 10 t0 30 vears of age (young),41 were 31 to 50 years of age(adult),and 25 were 51 to 79 years of age(old).Immunohistochemisty using antibodies to p63 and CD44 was applied to detect the expression of p63 and CD44 in these specimens.Imaging analysis software was utilized to calculate the percentage of p63-expressing cells in basal layer as well as the expression level of p63 and CD44.Results In stratum basale,the percentage of p63-expressing cells decreased with age(r=-0.218,P＜0.05),but showed no significant difference among sun-exposed skin,semi-exposed skin and sun-protected skin(P＞0.05).The correlation between the expression intensity of epidermal p63 and age was negative in sun-exposed sites(r=-0.389,P=0.010),positive in sun-protected sites(r=0.341,P＜0.05).but non-significant in semi-exposed sites(P＞0.05).With regard to the expression of epidermal p63,no significant difference was observed among sun-exposed sites,sun-protected sites and semi-exposed sites in volunteers aged from 10 to 30 years.while in those aged from 31 to 50 years and from 51 to 79 years.sun-protected sites was significantly higher than semi-exposed sites followed by sun-exposed sites(all P＜0.05).There was a weak correlation between the expression intensity of epidermal CD44 and age(r=-0.083,P＜0.05),but no significant difierence was noted among the three kinds of sites(P＞0.05).Conclusions In stratum basale,the percentage of p63.expressing cells and the expression intensity Of CD44 negatively correlate with age,but have no correlation with ultraviolet irradiation.In individuals aged from 31 to 50 years and from 51 t0 79 vears.the expression of epidermal p63 decreases with the accumulation of sun-exposure.
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At present, the administration about putin to output of intrinsic economical running in legionary hospitals is being improved constantly. Therefore, we should firmly grasp "the three key strongpoints" of financial administration of basic construction: First make final check on the demonstrating about item feasibility; The second, make final check on the planning about protocol of item inviting bids; The third, make final check on the auditing about item outlay plan.