Research on Restricting Factors and Countermeasures of Balanced Development between Fairness and Efficiency of Basic Medical and Health Service in China / 中国医学伦理学

This paper analyzed the problems existing in China’s basic medical and health services from the perspective of fairness and efficiency, and the main restricting factors of balanced developmen. The main factors were: the far-reaching influence of "dual economic structure" between urban and rural areas, the government’s low-efficiency intervention in the allocation of health resources, the efficiency of hierarchical diagnosis and treatment system has not been fully released, the level of basic medical security needs to be improved, and the reform of the management and operation mechanism of medical institutions is lagging. It is proposed to adhere to the value concept of appropriate balance between fairness and efficiency, give full play to the functions of the government and the market, and take concrete measures to improve the financing mode, optimize the allocation of resources and improve the service system.

Endovascular repair combined with fenestrated stent grafts in treating aortic arch lesions / 中华胸心血管外科杂志

Objective@#To evaluate endovascular repair combined with fenestrated stent grafts for the treatment of aortic dissection or aneurysm involving aortic arch.@*Methods@#From Jun 2017 to Dec 2018, 30 patients of complicated aortic arch lesions were treated with endovascular repair combined with fenestrated endografts. 26 male and 4 female, aged(53±16) years. All patients had hypertension. 12 cases were treated via needle based in situ fenestration, another 16 cases using physician modified stent grafts, while 2 cases combining these two methods to achieve optimal fenestration. Patients were followed by receiving CTA for mortality, patency of bridging stents, endoleaks and complications.@*Results@#Operations were performed successfully in all cases. The median follow-up is 8.5 months. There was no aorta-related mortality. 1 patient developed cerebral infarction and 1 had hydropericardium. Type Ⅲ endoleaks were observed in 5 patients, no reintervention. All target vessels were patent during the follow up.@*Conclusion@#Fenestrated stent grafts shows satisfactory short-term outcomes in treating aortic arch lesions.

Impact of different doses of dexmedetomidine on the anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy / 中国基层医药

Objective To explore the impact of different doses of dexmedetomidine on the anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy.Methods 90 patients with uterine fibroids with ASA class Ⅰ or Ⅱ who were going to undergoing general intravenous anesthesia laparoscopic hysterectomy were selected and they were divided into group A (dexmedetomidine 0.4μg·kg-1·h-1,n=30) and group B (dexmedetomidine 0.2μg·kg-1·h-1,n=30) and group C (no dexmedetomidine,n=30) by digital random method.The analgesia effect (VAS score) of group A,group B and group C preoperation and postoperative 1h,12h and 24h,and the sedation (Ramsay sedation score) were compared.General information,postoperative blood pressure,heart rate,pulse oxygen saturation,postoperative patients'' satisfaction on analgesic effect and the sedation effect and adverse reactions of the three groups were also compared.Results Age,body mass index and other basic information of three groups had no statistically significant differences (all P＞0.05).The preoperative VAS score of the three groups also had no statistically significant difference (F=0.625,P＞0.05).Postoperative 12h,24h,the VAS scores of group A and group B were lower than those of C group,which of group A were lower than group B (F=11.250,P＜0.05,F=21.181,P＜0.05).The Ramsay sedation score was higher than that of C group[(3.67±0.18) vs.(2.13±0.11)].The satisfaction of group A was significantly higher than group B and group C (96.67％ vs.73.33％,46.67％,χ2=25.953).The Ramsay sedation score and satisfaction were higher than those of group B (all P＜0.05).There were no significant differences in blood pressure (F=0.362,P＞0.05),pulse oxygen saturation (F=0.978,P＞0.05) and heart rate among the three groups before and after operation (F=1.268,P＞0.05).There was no obvious adverse reaction in the three groups.Conclusion Dexmedetomidine can promote anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy,and the dose 0.4μg·kg-1·h-1 of dexmedetomidine has better effect,feasibility and safety,it is worthy of clinical promotion.

Influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery / 中国医师进修杂志

Objective To discuss the influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery.Methods A total of 96 patients with gynecologic laparoscopic surgery were selected from January 2012 to October 2013.All patients were in propofol target controlled infusion anesthesia induction downward internal jugular vein retrograde through jugular vein ball tube,radial artery catheter.According to propofol target controlled infusion target concentrations,96 patients were divided into A group (32 cases,3 μ g/ml),B group (33 cases,5 μμg/ml) and C group (31 cases,7 μg/ml).Hemodynamic and Nacotrend index (NI) change were monitored in the process of surgery patients,with internal jugular vein and radial artery blood at pre-induction (To),intubation (T1),30 min after intubation (T2) and the end of the operation (T3) were detected and arterial blood oxygen saturation (PaO2),arterial oxygen content (CaO2),internal jugular vein ball blood oxygen saturation (SjvO2),internal jugular vein ball blood oxygen partial pressure (PjvO2) at different time points were compared among three groups.Artery-internal jugular vein ball low blood oxygen of components (Da-jvO2),brain oxygen uptake rate (CEO2),poor lactic acid content (Da-jvL) were calculated.Results The systolic blood pressure,heart rate and NI at T1,T2 was lower than that at To in three groups,and there was significant difference (P ＜ 0.05),but there was significant difference in NI at T1,T2 among three groups (P ＜ 0.05).Compared with T0,PaO2,PjvO2,SjvO2 and CaO2 at T1-T3 in three groups were increased significantly (P ＜ 0.05),and the highest was C group,and then B group and A group.In the process of propofol target controlled infusion,Da-jvO2,CEO2 and Da-jvL showed a trend of gradual decline,Da-jvL decline highest significantly (P ＜ 0.05).Conclusions Propofol target controlled infusion induced endotracheal intubation can decrease the laparoscopic surgery in patients with cerebral oxygen metabolism and the brain tissue of ischemia hypoxia tolerance,but will not lead to cerebral oxygen supply and demand imbalance,and 7 μ g/ml concentration of propofol anesthesia effect is the best.

Effects of carotid endarterectomy on cognitive function in patients with carotid stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the theraputic effects of carotid endarterectomy (CEA) on cognitive function in patients with carotid stenosis (CAS) and congnitive impairment.</p><p><b>METHODS</b>CEA was performed on 38 patients with CAS from December 2011 to July 2013. There were 26 male and 12 female patients, with an average age of (70 ± 7) years. Patients was underwent neuropsychological examinations (NPEs) including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 1 week before and 6 weeks after treatment. Cerebral perfusion was assessed with MR perfusion-weighted imaging and diffusion-weighted inmaging at 1 week before and 6 weeks after treatment.</p><p><b>RESULTS</b>All of the 38 patients completed NPEs and MRI at baseline and 6 weeks after CEA. After therapy, the parameters and the extents of abnormal perfusion was improved, including the decrease of time to peak (29 ± 9 vs. 23 ± 4), relative mean transit time (22 ± 8 vs. 14 ± 6), arrive time (21 ± 8 vs. 15 ± 4) and relative cerebral blood volume (11.6 ± 3.5 vs. 7.5 ± 3.2) (t = 1.31 to 5.24, all P < 0.05). Significant improvement in MoCA (20.4 ± 1.5 vs. 22.0 ± 1.6, t = -4.25, P = 0.000) but MMSE (26.16 ± 1.35 vs. 26.47 ± 1.52, t = -0.96, P = 0.341) was observed. CEA significantly improved the assessment of visuospacial/constructive abilities (2.4 ± 0.9 vs. 2.8 ± 0.7), naming (2.0 ± 0.7 vs. 2.3 ± 0.6), abstraction (1.2 ± 0.7 vs. 1.6 ± 0.6) and attention (2.3 ± 0.6 vs. 2.6 ± 0.5) (t = 0.015 to 0.029, P = 0.015).</p><p><b>CONCLUSION</b>CEA can improve the cognitive function of patients with carotid stenosis as well as the cerebral perfusion of patients and has therapeutic effects on vascular mild cognitive impairment.</p>

Combined iliac artery stenting and open femoral endarterectomy in the treatment of multi-level iliac and common femoral occlusive disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of hybrid procedure for the treatment of multi-level iliac and common femoral occlusive disease.</p><p><b>METHODS</b>From January 2008 to June 2011, 36 lower limbs with sever iliac and common femoral occlusive diseases were treated by iliac artery stenting combined with open femoral endarterectomy. The mean age of the whole study population was 65 years (range 49 to 87 years) with a male predominance (26 males, 72.2%). The early clinical results were determined by ankle brachial index and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analysis were used to assess the influence of various risk factors on primary patency.</p><p><b>RESULTS</b>All lower limbs underwent successful hybrid surgical and endovascular therapy. Clinical improvement was seen in 94.4% of patients. The mean duration of follow-up was 24.2 months, overall, the primary patency rates, primary assisted patency rates and second patency rates were 72.2%, 83.3% and 94.4% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P = 0.041, 0.012). Cox regression analysis did not reveal any independent predictor of primary patency.</p><p><b>CONCLUSION</b>Hybrid procedures provided an effective treatment management of multilevel iliac-femoral arterial occlusive disease.</p>

A new Amaryllidaceae alkaloid from the bulbs of Lycoris radiata / 中国天然药物

AIM@#To study the Amaryllidaceae alkaloids of the bulbs of Lycoris radiata.@*METHODS@#The chemical constituents were isolated and purified by various chromatographic techniques, and the chemical structures were elucidated on the basis of spectroscopic methods. In addition, the antiviral activities of alkaloids 1-10 were evaluated using flu virus A.@*RESULTS@#One new homolycorine-type alkaloid 2α-methoxy-6-O-ethyloduline (1), together with nine known alkaloids 2α-methoxy-6-O-methyloduline (2), trispherine (3), 8-O-demethylhomolycorine (4), homolycorine (5), 9-O-demethylhomolycorine (6), oduline (7), lycorenine (8), 6α-O-methyllycorenine (9) and O-ethyllycorenine (10) were obtained.@*CONCLUSION@#Alkaloid 1 is a new compound, and 1-3 were major alkaloids in this plant. Alkaloids 1-3 showed weak antiviral activities against flu virus A with IC50 values of 2.06, 0.69, and 2.71 μg·mL-1 and CC50 values of 14.37, 4.79, and 80.12 μg·mL-1, respectively.

Surgical treatment of carotid body tumour and postoperative complications / 中华普通外科杂志

Objective To discuss the experience in the diagnosis, treatment, complications and follow up of carotid body tumor. Methods All the 25 cases were diagnosised by DSA and CTA. The tumor was resected under carotid adventitial plane in 18 cases, with external carotid artery resection in 4cases, and in 3 cases, internal carotid artery (ICA) and external carotid artery (ECA) were resected simultaneously in which internal carotid artery was reconstructed in two cases including using self vein bypass in one and anastomosis between ICA and ECA in the other. ICA was ligated in the third case. Results No cases died perioperatively. ALL CBTs were treated successfully. Horner syndrome and trachyphonia were relieved after operation. Postoperative trachyphonia, bucking and lingual paralysis developed in 3 cases, and in one case with vagus resection caused dyspnea tracheotomy was performed. The rate of nerves injuries was 12% but no semiplegia and aphasia occurred. Follow up period was from 4 to 90 months (average 44 ±6 months) for 21 cases. The trachyphonia and bucking were improved during follow up but the lingual paralysis persists, and tumor recurred in two cases with one dying. Conclusions CBT treatment should include active surgery, sufficient preoperative preparation and avoiding the postoperative nervous complications.

Hybrid surgical and endovascular therapy in TASC type D atherosclerotic occlusive disease: a retrospective analysis of 48 cases / 中华外科杂志

<p><b>OBJECTIVE</b>to retrospectively analyze 4-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral TASC type D atherosclerotic occlusive disease.</p><p><b>METHODS</b>from January 2006 to December 2009, 48 lower limbs in 46 patients with TASC type D atherosclerotic occlusive disease were treated by hybrid surgical and endovascular therapy. There were 32 male and 16 female, age ranged from 54 to 85 years with an average of 67 years. The early clinical results were determined by ankle brachial index (ABI) and intermittent claudication distance. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency.</p><p><b>RESULTS</b>all lower limbs underwent successful hybrid surgical and endovascular therapy. The average ABI before and after hybrid therapy were 0.63 ± 0.18 and 0.24 ± 0.13 (P < 0.05). The average intermittent claudication distance significantly increased from (87 ± 48) m to (247 ± 62) m (P < 0.05). The mean duration of follow-up was 21.7 months (ranging 1 to 46 months). Over all, the primary patency rates, primary assisted patency rates and second patency rates were 79.2%, 83.3% and 95.8% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P < 0.05). Primary patency rates were lower in patients who underwent open surgery with both proximal and distal endoluminal procedures when compared with endovascular reconstruction proximal or distal to the site of open reconstruction (P < 0.05). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency rate (P = 0.013 and P = 0.008, respectively).</p><p><b>CONCLUSIONS</b>Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease.</p>

Transluminal therapy for type B thoracic dissection / 中华普通外科杂志

Objective To investigate the technical details and therapeutic effect in treating StarIdford B aortic dissection by endovaseular aortic repair(EVAR). Methods We retrospectively review 115 type B aortic dissection cases undergoing the procedure of mini-traumatic EVAR from November 1998 to February 2009.There were 71 male patients and 44 female patients with a mean age of55.7 years and follow up period from 7 to 83 months for 75 cases. Results The procedure Was technically successful in 113 cases and 122 stent grafts were placed with hybrid surgery being carried out in 3 cases of carotid artery bypass.Severe perioperative complications included subclavian steal syndrome in 4 eases,pulmonaryinfections in 3 cases.arterial embolism in 2 cases,acute cerebral infarction in 2 cases,kidney tailure in 2 cases.alimentary tract hemorrhage,graft infection,acute intestinal ischemia and type A dissection occurred in one each case respectively.Five cases died perioperatively.Among the 75 cases that were fouowed up,there were 9 eases with type I endoleak and at last 5 cases redid endovaacular repmr.2 cases with secondary type A dissection accepted graft replacement.There were 6 deaths during the follow-up period,4 dying of acute myocardial infarction(2 cases),cerebral hemorrhage(1 case),type A dlssection (1 case)respectively,the causes of other2 deaths were not confirmed. Conclusion EVAR was effective for Standford B aortic dissection as shown by midterm follow up.

Tissue-engineered graft constructed by bone marrow mesenchymal stem cells and vascular acellular matrix / 中国组织工程研究

BACKGROUND: At present, the commercial artificial small vascular grafts (diameter < 6 mm) are still unsatisfactory, due to poor blocompatibility and low long-term patency rate. Therefore, finding a vascular substitute with normal biological function and studying construction and function of tissue-engineered blood vessel have become hot topics recently.OBJECTIVE: To construct a novel tissue-engineered blood vessel by rabbit bone marrow mesenchymal stem cells (MSCs) and vascular acellular matrix, and to investigate the biocompatibility and patency rate of tissue-engineered blood vessels.DESIGN, TIME AND SETTING: An in vitro randomized controlled study at level of cytology and histopathology was performed at the Laboratory of Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2006 to June 2008.MATERIALS: The decellularized vascular acellular matrix was obtained by a detergent-enzymatic procedure. MSCs from rabbits were isolated using density gradient centrifugation method and cultured in culture flasks coated with fibronectin. Subsequently, the expanded MSCs were seeded on the decellularized scaffolds, and then co-cultured in the self-made bioreactor to construct the tissue-engineered blood vessels.METHODS: Sixty rabbits were randomly divided into three groups. A1.0-cm abdominal aorta was sheared, and a tissue-engineered blood vessel was transplanted on the abdominal aorta using 8/0 polypropylene thread. Tissue-engineered blood vessel group: Tissue-engineered blood vessel was considered as the transplanted vessel; vascular acellular matrix group:Xenoma artery treated by vascular acellular matrix was considered as the transplanted vessel; xenoma artery group: Fresh xenoma artery was considered as the transplanted vessel.MAIN OUTCOME MEASURES: Immunocytochemical staining was used to identify the cultured MSCs. After 3 months of transplantation, the grafts were retrieved for digital subtraction angiography, pathological test and scanning electron microscope examination.RESULTS: Rabbits MSCs presented a whirlpool-like appearance at 8 days after culture. The immunocytochemistry results were consistent with the phenotype of MSCs. After high proliferation, MSCs were seeded onto the vascular acellular matrix for 12 days,and seed cells attached to well in the lumen of blood vessels. Three months after implantation, the patency rate was 90% of tissue-engineered blood vessel group and 80% of vascular acellular matrix group, which was superior to xenoma artery group (25%). At three months after transplantation, HE staining and scanning electron microscope demonstrated that internal, middle,and external membrane were clearly observed in the tissue-engineered blood vessel group, and the membrane morphology was similar to normal artery. The endothelial cells were covered completely. However, the endothelial cells were not covered completely in the vascular acellular matrix group, while mural thrombosis, mild proliferation of intima, and inflammatory cell infiltration were observed. The intima was thick and necrotic in the xenoma artery group, while lumens were stenotic and accompanied with a certain degree of thrombus organization.CONCLUSION: This study provides a new strategy to develop a tissue-engineered blood vessel with excellent biocompatibility and high patency rate constructed by rabbit MSCs and vascular acellular matrix.

The treatment of complications of endovascular repair of aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the experience with special consideration for the occurrence and management of complications after thoracic aortic stent-graft treatment (EVAR).</p><p><b>METHODS</b>Retrospectively review the 33 cases with complications following EVAR from July 2002 to March 2008. There were 21 male patients and 12 female patients with a mean age of 46.3 years and mean postoperative period of 12.3 d. There were 5 cases with left carotid artery covered, 5 cases with proximal or distal endoleak, 4 cases with limbs artery injuries, 3 cases with entire stent in false lumen, 3 cases with retrogression dissections, and 2 cases with Stanford A type dissection. In addition, there were 1 case of acute cerebral infarction during the procedure, 1 case of cerebral haemorrhage 2 d after endovascular repair and 1 case of pseudoaneurysm of the left brachial artery. The procedures for the complications included second stent grafts placement in 13 cases, right-left carotid and left carotid-subclavian bypass in 7 cases, iliac-femoral artery repair or graft implantation in 4 cases, abdominal aortic dissection windowing in 2 cases, one artery thrombectomy and one Beutall's procedure.</p><p><b>RESULTS</b>Follow-up consisted of a CTA, MRI and office visit at 1, 6, 12 months and yearly thereafter. All the endoleak and retrogression dissections disappeared after secondary endovascular procedure. The ischemic complication of limbs, central nervous system and intestinal were cured after artery bypass. One case died of cardiac tamponade due to Stanford A aortic dissection and another case died of cerebral hemorrhage.</p><p><b>CONCLUSIONS</b>The complication should be corrected as soon as possible and it might get more success to combine the endovascular approach and open surgery. Meanwhile, enhanced follow-up would help to find correlative complications in time.</p>

Focal adhesion kinase expression and angiogenesis in breast carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expression of focal adhesion kinase (FAK) in breast carcinoma tissues and its association with microvessel density (MVD), and explore the relationship between FAK-mediated cell signaling and angiogenesis in breast carcinoma.</p><p><b>METHODS</b>FAK and CD34 expressions were examined by immunohistochemistry with SP method in 88 breast carcinoma tissues and 30 tissues of benign breast disease. The correlations of FAK protein expression with MVD marked with CD34 and clinicopathological parameters were analyzed in breast carcinoma.</p><p><b>RESULTS</b>In the 88 breast carcinomas, the positivity rate of FAK was 68.2% (60/88) with MVD of (34.52-/+13.11) /HPE, showing significant differences from those of the benign disease group (P<0.01). FAK expression and MVD in breast carcinoma tissues were positively related to tumor size, axillary lymph node metastasis and clinical stage (P<0.05), but not to the patients' age or histopathological grade of the tumors (P>0.05). In breast carcinoma, the expression of FAK was positively related to MVD (P<0.01).</p><p><b>CONCLUSIONS</b>FAK protein expression and MVD are closely correlated with the invasion and metastasis of breast carcinoma. FAK expression can promote angiogenesis of breast carcinoma.</p>

Eversion carotid endarterectomy for carotid stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the effect of using eversion carotid endarterectomy (eCEA) for carotid stenosis.</p><p><b>METHODS</b>Twenty four patients with carotid stenosis (stenosis grade 65% approximately 95%), of which 18 were symptomatic and 6 were asymptomatic, were treated by eCEA under regional anesthesia. All patients underwent preoperative cervical duplex and DSA, CT or MRA scanning examination. The eversion technique involved an oblique transection of the internal carotid artery at the carotid bulb and a subsequent endarterectomy by everting the internal carotid artery over the atheromatous plaque.</p><p><b>RESULTS</b>There was no perioperative mortality and stroke. Transient ischemic attacks (TIA) disappeared, cerebral ischemia symptom improved in our patients. But there were mini chronic symptom of cerebral ischemia in 4 patients with both carotid arterial stenosis.</p><p><b>CONCLUSION</b>Carotid eversion endarterectomy appears to be a universally applicable, safe, and durable operative technique.</p>