ABSTRACT
Chinese government launched National Essential Public Health Services Program since 5 years ago;a program of which the progress, achievement, challenges and a knowhow for a better implementation are concerned by the related policy makers, implementers and researchers. Based on the years of experience in this area, combining literatures and reports relevant to this program, this paper summed up its background and progress, analyzed prob-lems and challenges as well as put forward the policy recommendations for a better implementation of the work. The results were mainly described in three different ways as follows:firstly, the public health service delivery system was formed;secondly, services types and target population were annually increased; and thirdly, there were remarkable health and social benefits. However, for such a big program that is related to multiple government departments and health institutions, contradictions may emerge during implementation. Therefore, it is important to deal with its dif-ferent relationships. Recommendations for further implementation of the work in the coming “Thirteenth-Five-Year”plan are enlightened to deepen a perfect essential public health service delivery mechanism from the financing and management, service package scoping, service delivery system and approach, and performance evaluation facets.
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BACKGROUND:The risk of lower extremity deep venous thrombosis was high in patients with bone metastases. Major surgery is a major risk factor for thrombosis. There was no standard prophylactic regimen available. OBJECTIVE:To investigate the efficacy and safety of low molecular weight heparins versus rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis in patients with bone metastases. METHODS:From January 2010 to December 2013, a total of 73 patients with bone metastasis in spine, pelvis and lower extremities, who underwent open surgery in the Department of Musculoskeletal Tumor, Third Hospital, Hebei Medical University, China, were retrospectively analyzed. The patients were divided into low molecular weight heparins group (n=41) and rivaroxaban group (n=32) according to the prophylactic drugs after surgery. RESULTS AND CONCLUSION:Nine cases (22%) in the low molecular weight heparins group were found lower extremity deep venous thrombosis, and six cases (19%) in the rivaroxaban group suffered from lower extremity deep venous thrombosis, showing no significant differences (χ2=0.11, P=0.74). The incidences of bleeding events in both groups were respectively 7.32%and 6.25%, showing no significant differences (correctionχ2=0.083, P>0.05). There were no significant differences regarding the levels of platelet, activated partial thromboplastin time and prothrombin time between both groups preoperatively or postoperatively (P>0.05). Therefore, the efficacy and safety of low molecular weight heparins and rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis were similar. Both could effectively reduce the incidence of deep venous thrombosis, with a relative low risk of bleeding.
ABSTRACT
<p><b>OBJECTIVE</b>To analyze the risk factors for deep vein thrombosis (DVT) of the lower extremity in patients with bone metastases.</p><p><b>METHODS</b>Ninety patients with bone metastases were admitted to our hospital From January 2010 to December 2011, and their clinical data were retrospectively analyzed. There were 57 males and 33 females with a mean age of 61 years (range, 27 to 78 years). On admission, all cases were detected by color Doppler ultrasonography for DVT of bilateral lower extremities. Univariate and multivariate analyses were performed to determine the probable risk factors including gender, age, body weight, tumor location, bed confinement and etc.</p><p><b>RESULTS</b>Among the 90 patients, DVT was found in 24 patients on admission and the DVT incidence was 26.7% (24/90). The univariate analysis showed that bed confinement, multiple metastasis, pathological fracture, primary lesion detected, blood group, fibrinogen and hematocrit were significantly related to the incidence of DVT (P < 0.05). The logistic multivariate regression analysis showed that bed confinement, pathological fracture and fibrinogen were independent risk factors for the incidence of DVT.</p><p><b>CONCLUSIONS</b>Bed confinement, pathological fracture and fibrinogen are independent risk factors for the incidence of DVT for patients with bone metastases. Patients with bed confinement >3 days, pathological fracture or fibrinogen >4 g/L should be routinely screened for lower extremity DVT on admission. Once identified, the DVT patients should be treated as early as possible.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bone Neoplasms , Epidemiology , Incidence , Lower Extremity , Neoplasm Metastasis , Retrospective Studies , Risk Factors , Ultrasonography, Doppler, Color , Venous Thrombosis , EpidemiologyABSTRACT
BACKGROUND: The aseptic loosening of prosthesis has become one of the most obvious matters after operation of prosthesis replacement. OBJECTIVE: To verify the effect of ibandronate on early fixation of implants by local application. METHODS: Forty-four Zelanian rabbits were used in the experiment. A standard animal model of the rabbits' both tibia was embedded with metal screw into the proximal end. Ibandronate at 1 mg/L was sprinkled locally in the left tibia of every rabbit (experimental group), while saline solution was given in the right tibia (control group). (P < 0.001). These findings indicate that, local application of ibandronate solution can obviously promote new bone formation at the earlier period, improve early fixation of implants and decrease the incidence of aseptic loosening of prosthesis.