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Objective:To analyze the relationship between perineural invasion and other clinicopathological factors and its effect on the prognosis of gastric cancer.Methods:The clinicopathological data of 665 patients with gastric cancer were retrospectively analyzed. According to the presence of perineural invasion, the patients were divided into perineural invasion positive group and perineural invasion negative group. The relationship between perineural invasion and other clinicopathological factors and its effect on the prognosis of gastric cancer were analyzed. After eliminating the potential confusion bias between the two groups by propensity score matching (PSM) , the differences of 5-year cumulative survival rate between the two groups of gastric cancer patients were compared.Results:The incidence of perineural invasion was 17.0% (113 cases) . The binary logistic regression analysis showed that the depth of tumor invasion and vascular tumor thrombus were independent factors influencing the occurrence of gastric cancer perineural invasion (all P<0.001) . Univariate analysis showed that age (>60 years) , tumor diameter (>4 cm) , borrmann classification, depth of invasion, lymph node metastasis, TNM stage, degree of differentiation, vascular tumor thrombus, perineural invasion, tumor nodule, tumor site, resection site, and surgical operation were the influencing factors for the prognosis of patients with gastric cancer ( P<0.05) , but multivariate analysis showed that age (>60 years) , tumor diameter (>4cm) , depth of invasion, lymph node metastasis, and positive vascular tumor thrombi were independent risk factors affecting the prognosis of gastric cancer patients ( P<0.05) .However, perineural invasion cannot be an independent factor influencing the poor prognosis of gastric cancer in a multivariate analysis. Survival analysis was performed after propensity matching scores, and it was found that there was no statistically significant difference in the five-year survival rate between the perineural invasion positive group and the perineural invasion negative group (34.6% vs 43.0%; χ2=1.713; P=0.191) ,and there was no significant difference in the survival curve analysis between the two. Conclusion:Most patients with gastric cancer of perineural invasion have poor prognosis, but perineural invasion cannot be an independent prognostic factor for the prognosis of gastric cancer.
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Objective:To analyze the efficacy and safety of cranial approach priority, counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy.Methods:From Jan. 2020 to Dec. 2020, 30 patients with right colon cancer in Department of Gastrointestinal Surgery were retrospectively analyzed. Laparoscopic radical right hemicolectomy was performed via the approach of complete mesocolic excision. The general clinicopathological data of the patients, perioperative data such as operation time, intraoperative blood loss, number of cases of hemorrhage caused by Henle trunk and subordinate branch injury, whether or not converted to open surgery, postoperative pathological data (TNM staging, total number of dissected lymph nodes and the number of metastatic lymph nodes) , postoperative recovery (exhaust time, the time of fluid intake, drainage tube removal and hospital stay) , and complications (such as bleeding, anastomotic leakage, secondary surgery, lymphatic leakage, pulmonary infection, abdominal infection, incision infection, etc) were recorded. Follow-up was performed by telephone or outpatient in 1 year after surgery.Results:The total operation time was (197.80±31.20) minutes, ranging from 150 to 275 minutes, and the intraoperative blood loss was (58.33±30.30) ml, ranging from 10 to 100 ml. There were no cases of intraoperative Henle stem and branch injury bleeding or conversion to open surgery. Postoperative exhaust time was (2.97±0.67) d, ranging from 2 to 4d; postoperative fluid intake time was (3.67±0.76) d, ranging from 3 to 5d; postoperative drainage tube removal time was (6.60±4.00) d, ranging from 4 to 25 days; postoperative hospital stay was (7.87±3.94) days, ranging from 5 to 26 days. pTNM staging: 9 cases of stage I, 5 cases of stage IIA, 1 case of stage IIB, 6 cases of stage IIIA, 4 cases of stage IIIB, and 5 cases of stage IIIC. The total number of lymph nodes dissected was (29.50±8.18) , ranging from 19 to 51; the number of metastatic lymph nodes was (1.40±1.77) , ranging from 0 to 6. Postoperative complications included incision infection in 1 case, anastomotic leakage in 1 case, lymphatic leakage in 2 cases, and lung infection in 1 case. No tumor recurrence or metastasis was found during follow-up, and no patient died.Conclusion:Cranial approach priority, counterclockwise sequential complete mesocolic excision is safe and effective in laparoscopic right hemicolectomy.
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Objective:To study the effect of enhanced recovery after surgery (ERAS) on intestinal function and gut microbiota changes in patients who underwent laparoscopic gastrectomy.Methods:From Aug. 2018 to Dec. 2019, 80 patients who underwent laparoscopic radical D2 gastrectomy for gastric cancer in the first Department of Gastrointestinal Surgery of Yantai Yuhuangding Hospital were selected. According to whether it adopts ERAS treatment or not, patients were divided into 2 groups (n=40) : ERAS group and traditional perioperative treatment group. The time of postoperative bowel sounds, the time of first exhaust and defecation, the proportion of antibiotic-related diarrhea and surgical site infection (SSI) were recorded. Stools were collected before operation, first time after operation, 1, 2 weeks and 1 month after operation. 16S rRNA sequencing method was used to identify the diversity and species of gut microbiota. The diversity index of intestinal flora in the perioperative period and changes in the proportion of probiotics (bifidobacterium and lactobacillus) were compared.Results:The appearance time of bowel sounds, the first exhaust and defecation time [ (16.25±6.41) h, (23.95±6.02) h, (34.95±9.34) h] in ERAS group were significantly earlier than those in the traditional treatment group [ (22.3±6.49) h, (28.45±7.12) h, (48.1±15.64) h], and the difference was statistically significant ( P<0.05) . The incidence of antibiotic-related diarrhea was higher in the traditional treatment group (3/40) than in ERAS group (1/40) , but the difference was not statistically significant ( P>0.05) . The ratio of postoperative SSI was slightly higher in ERAS group, but the difference was not statistically significant ( P>0.05) . In the perioperative period, the intestinal flora diversity index (Chao1 and Shannon index) and the proportion of probiotics (lactobacillus acidophilus and bifidobacterium) were not significantly different between the two groups before surgery ( P>0.05) ; while at the first time, one week, 2 weeks after the operation, and 1 month after the operation, ERAS group was higher than the traditional group ( P<0.05) ; and at each postoperative time point, the traditional group decreased significantly than the ERAS group. The first time decrease was the largest, ( P<0.05) ; With the passage of time after operation, the diversity of intestinal flora and the proportion of probiotics gradually recovered. By 1 month after operation, the two groups did not return to the preoperative gut microbiota diversity state or proportion. Conclusion:The concept of enhanced recovery after surgery (ERAS) promotes the recovery of intestinal function in patients with gastric cancer, does not reduce the proportion of antibiotic-associated diarrhea (AAD) or surgical site infections (SSI) , and maintains the diversity of gut microbiota balance and stability.
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Objective:To evaluate the efficacy and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy through endovascular arch approach for superior gastric cancer.Methods:From Oct. 2018 to Feb. 2019, 20 cases of upper gastric cancer underwent laparoscopic total gastrectomy in Gastrointestinal Surgery Ward 1 of Yantai Yuhuangding Hospital. The splenic hilar lymph nodes were dissected by endogastric omentum vascular arch approach. The total operation time, intraoperative bleeding volume, operation time and bleeding volume of splenic hilar lymph nodes dissection, total number of lymph nodes and metastatic lymph nodes, number of splenic hilar lymph nodes and metastatic lymph nodes, postoperative exhaust time, first feeding fluid time and postoperative hospital stay time, and postoperative complications such as abdominal infection, anastomotic leakage, pulmonary infection, incision infection and bleeding were recorded. The complications of splenic hilar lymph node dissection were bleeding, conversion to laparotomy, splenic ischemia and splenic necrosis. One year after operation, follow-up was carried out by telephone and outpatient.Results:Laparoscopic total gastrectomy and splenic hilar lymph node dissection were successfully performed in all cases. The total operation time ranged from 200 to 268 min, with an average of (240.8±31.7) min, intraoperative bleeding volume of 50 to 200 ml, with an average of (90.4±43.8) ml; the time of splenic lymph node dissection was (18.5±4.0) min; the amount of splenic lymph node dissection bleeding ranged from 5 to 20 ml, with an average of (10.2 ± 5.8) ml; the number of total lymph nodes dissection was 25 to 58, with an average of 37.68±3.89 and the number of metastatic lymph nodes 4.31±2.54; The number of splenic lymph nodes was 2 to 10, with an average of 3.51± 1.79; The number of metastatic lymph nodes was 0 to 4 lymph nodes, with an average of 0.98±1.19. The average time of anal exhaust was (3.5±1.9) days, the time of fluid intake was (4.5±1.7) days, and the postoperative hospital stay was (7.5±1.5) days. Postoperative complications were as following: one case had abdominal infection, one had pulmonary infection, one had anastomotic leakage and there were no complications related to splenic hilar lymph node dissection such as conversion to laparotomy, splenic ischemia or splenic necrosis. There was no recurrence or metastasis of the tumor and no death occurred one year after the operation.Conclusion:Laparoscopic spleen-preserving splenic hilar lymphadenectomy via endovascular arch approach is safe and effective.
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Objective:To detect the expression of fibroblast-specific protein 1 (FSP1/S100A4) , ɑ-smooth-muscle actin (ɑ-SMA) and fibroblast-activated protein (FAP-ɑ) in tumor-associated fibroblasts (TAFs) in papillary thyroid carcinoma (PTC) , and to investigate its relationship with the origination and development of PTC.Methods:The expression of FSP1/S100A4, ɑ-SMA and FAP-ɑ in normal thyroid and PTC was determined by SP method of immunohistochemistry, and the relationship between these indicators and important clinicopathological parameters were analyzed.Results:The positive expression of FSP1/S100A4, ɑ-SMA and FAP-ɑ was observed in PTC, but not detected in the follicular epithelium or stromal cells of normal thyroid. In addition, the expression of FAP-ɑ was significantly related to tumor size, lymph node metastasis and TNM classification ( χ2=6.833, P<0.05; χ2=10.296, P<0.05; χ2=4.910, P<0.05) . The expression of ɑ-SMA was positively related to the invasion of capsule and lymph node metastasis ( χ2=6.008, P<0.05; χ2=11.766, P<0.05) . The expression of FSP1/S100A4 was negatively related to the clinicopathological parameters above ( P>0.05) in PTC. Conclusion:TAFs in PTC may indicate the infiltration and metastasis, which provideds new thinking for the treatment strategies of papillary thyroid carcinoma.
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Blue rubber bleb nevus syndrome (BRBNS) is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.
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Blue rubber bleb nevus syndrome(BRBNS)is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.
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Gastric cancer is a common malignant tumor in China.Carbon nanoparticles is widely used in the precise treatment of gastric cancer in recent years.It is more and more widely used in the precise lymph node dissection of gastrectomy,targeted lymphatic chemotherapy and intraperitoneal chemotherapy.However,there are still controversies about the types,doses,and timing of targeted chemotherapy drugs.Further clinical studies are still needed.
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Objective To explore the clinical significance of monitoring drainage fluid parathyroid hormone (dPTH) for estimating the in situ reserves and function of the parathyroid by analyzing the change of serum calcium,serum parathyroid hormone(sPTH) and dPTH after thyroid surgery.Methods According to the operative method,the total of 144 patients with thyroid disease were divided into five groups:unilateral lobectomy,unilateral lobectomy plus isthmectomy with unilateral lymph node dissection,total thyroidectomy,total thyroidectomy with unilateral lymph node dissection,and total thyroidectomy with bilateral lymph node dissection group.The blood calcium,sPTH and dPTH level of patients were tested before operation and on the 1st,2nd,3rd and 4th day after operation.The depression of serum calcium,hypocalcemia and hypoparathyroidism were observed after operation.The serum calcium,serum PTH and dPTH level were summarized and analyzed statistically in order to evaluate the in situ reserves and postoperative function of the parathyroid.Results Among the 114 cases,the decline of serum calcium level mostly happened on the 2nd day after operation(70 cases,61.4％).There were 36 patients with hypocalcemia (31.58％) and 34 patients with hypoparathyroidism (29.82％).Serum calcium level increased gradually in all of the patients.Although sPTH level swung,it had a rising trend on the whole.The level of serum calcium and sPTH was positively correlated.The level of dPTH was discrete and decreased along with time.The decline level of dPTH among different groups had statistical difference.Conclusions It is a promising method to evaluate the in situ reserves and function of the parathyroid by monitoring the level and changes of dPTH after thyroid surgery,and it is of value for preventive calcium supplementation after thyroid surgery.
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Objective To study the inhibition of berberine on organ anion transporters (OATs) and its bidirectional trans-membrane transport.Method The transgene cell lines of the organ anion transporters including OAT1,OAT2,OAT3,OAT4,OAT7,and URAT1 were constructed and selected by animal cell transgenic method mediated by transporter Lipo 3000.Wild type (WT) cells were used as control group,and activity of OATs was verified by adding their radiolabeled substrates and inhibitors.The inhibition of 100 μmol/L berberine on the transporters was investigated in vitro.The IC50 of berberine on URAT1 was also determined.The bidirectional transport of berberine was studied through the Caco-2 model.Result The results showed that 100 μmol/L berberine inhibited the activity of OAT1,OAT2,OAT3,OAT4,OAT7 and URAT1 to (70.48±4.23)％,(69.13±1.28)％,(72.12±3.28)％,(79.77±6.49)％,(69.51 ±5.99)％ and (38.4 ± 2.67)％ respectively,the IC50 of berberine to URAT 1 was 13.19 μmol/L,the Papp (A-B) of 50 μmol/L and 100 μmol/L berberine were separately 0.28 × 10-6 and 0.40 × 10-6 cm/s,and the effiux rates were separately 3.18 and 3.15.Conclusion Berberine shows a stronger inhibition to URAT1 compared to OAT1,OAT2,OAT3,OAT4 and OAT7.Berberine may be the substrate of some effiux transporters.This study provides theoretical basis for explaining the low bioavailability ofberberine and forecasting the possible drug-drug interaction.
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Objective To study the inhibitory effects ofberberine on human organic cation transporter (OCTs) including OCT1,OCT2,OCT3,OCTN1 and OCTN2.Methods Using animal cell transgenic method mediated by transporter Lipo 3000,the drug transporters over expression cell lines S2-OCT1,S2-OCT2,S2-OCT3,S2-OCTN1 and S2-OCTN2 were obtained by selective medium culture.The OCTs evaluation model was established by detecting the trans-membrane transport of radioactive substrate in vitro.Wild type (WT) cells were used as control group,activity of OCTs was verified by adding its inhibitor.The inhibition of berberine on the transporters was investigated in vitro.The IC50 of inhibitory effect of berberine on various drug transporters was also calculated.Result The transport activity of transporter cell lines was increased by more than 5 times compared to the WT cell line respectively,what's more,their transport activity decreased significantly by their corresponding inhibitor.The ICs0 of berberine to OCT1,OCT2,OCT3,OCTN1 and OCTN2 were respectively 7.63,6.80,2.25,4.66 and 210.34 μmol/L.Conclusion Berberine significant inhibition to OCT1,OCT2,OCT3,OCTN1 and OCTN2.The inhibition on OCT1,OCT2,OCT3,OCTN1 is stronger compared to OCTN2.
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Objective: To assess the trend of statin application for in-hospital acute myocardial infarction (AMI) patients with its impact factors in eastern urban China from 2001 to 2011. Methods: A 2-stage random sampling design was performed to extract representative AMI sample patients. In the ifrst stage, a simple random-sampling was used to identify participating hospitals. In the second stage, a systematic sampling was conducted in 2001, 2006 and 2011 to select the cases from participating hospitals, to take medical records and clinical information for calculating the in-hospital statin application rate. The impact factors for statin application was assessed by multi Logistic regression model with generalized estimating equations. Results: A total of 5940 AMI records from 32 hospitals were enrolled. From 2001 to 2011, the in-hospital statin use rate increased from 46.0% in 2001 to 82.2% in 2006 and to 93.7% in 2011,P3.37 mmol/L were more likely to receive statin therapy than those with LDL-C<1.81 mmol/L (OR=1.59, 95% CI 1.10-2.30,P=0.013); the patients with chest pain at admission (OR=1.82, 95% CI 1.14-2.91, P=0.012), combining hypertension (OR=1.44, 95% CI 1.02-2.03,P=0.038), with in-hospital PCI (OR=2.99, 95% CI 1.71-5.23, P<0.001) were also more likely to receive statin therapy. The application rate of statin was reduced by reduced LDL-C level accordingly and the patients without LDL-C examination, accounting for 21.3%, had the lowest statin application rate. Conclusion: Statin therapy for in-hospital AMI patients was dramatically increased from 2001 to 2011 in eastern urban China and the guideline was rapidly popularized in clinical practice. However, the improvement has been needed especially in patients without LDL-C examination or with low LDL-C levels; we emphasize that AMI patients should receive statin therapy regardless their LDL-C levels.
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Objective: To assess trends of β-blocker use within 24h of admission in ideal candidates with acute myocardial infarction (AMI) in eastern urban China from 2001 to 2011. Method: A 2-stage random sampling design was performed. In the first stage, a simple random-sampling was used to identify participating hospitals. In the second stage, a systematic sampling was conducted in 2001, 2006 and 2011 to select cases from the participating hospitals. Data was obtained by central medical record abstraction. 10-year trend and predictors of early β-blocker application were assessed with weighted calculation for each year to represent the overall situation of eastern urban China. Results: 35 hospitals were sampled and 32 of them were finally participated. With necessary exclusion, 1399 ideal candidates were included in this analysis. The early weighted β-blocker application rates in 2001, 2006 and 2011 were 64.7%, 69.7%, and 60.9% respectively, P=0.0447 for trend. Patients with chest pain at admission (OR=2.22, 95% CI 1.19-4.13), higher systolic blood pressure (OR=1.40, 95% CI 1.11-1.77) or faster heart rate (OR=2.01, 95% CI 1.58-2.55) were more likely to use β-blocker; in contrast, compared with NSTEMI patients, STEMI patients seemed less likely to receive such treatment (OR=0.55, 95% CI 0.37-0.81). Conclusion: The early β-blocker therapy in eastern urban China is suboptimal for ideal AMI patients who could benefit from it. The application pattern has not been changed from 2001 to 2011 which might be related to physicians' misunderstanding of relevant evidence or guidelines. Our study may help to create an important target to improve the quality of AMI care.
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Objective China is experiencing increasing disease burden and economic burden of acute myocardial infarction(AMI),while the healthcare resources are limited and unevenly distributed.Hospitalization duration is an important measure of health resource utilization index.This study aims to describe the time trend of Length of stay(LOS) for AMI inpatient care in eastern urban areas of China,and to identify potential hospital-level factors associated with the LOS,which is an important indicator of resource utilization.Methods The study randomly selected a representative sample of patients admitted for AMI in 2001,2006 and 2011,from urban hospitals in eastern China.After central data abstraction from medical records,patients' characteristics,treatments and outcomes were compared between 3 hospital groups that were divided according to their median of LOS.Results Five thousand and forty-seven AMI cases were included in the analyses.The average LOS were (15.3±10.2),(13.5±8.7) and (12.2±7.8) d in 2001,2006 and 2011 respectively,with a decreasing trend(F=10.93,P<0.001).After adjusted for patients' characteristics,there were no significant different in LOS between years.Patients' characteristics were similar between high-,middle-and low-LOS hospitals,however,in high-LOS hospitals,use rates of aspirin,clopidogrel and statins were even lower(P≤0.001).LOS were longer 1.9 d in the hospitals with relatively small AMI inpatient treatment volumes(30-80 annually,t=2.97,P<0.01).Conclusions The average LOS for AMI in eastern urban areas of China is much longer than in western countries.Conclusion between hospitals have highlighted the gaps in care quality and efficiency.Standardized clinical pathways and hierarchical medical system are essential strategies in the new healthcare reform.
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<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>
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Objective To investigate the situation of iodized salt practicing measures, the nutritional status of iodine and the trend of iodine deficiency disorders in Futian District of Shenzhen City, and to evaluate the effectiveness of preventive measures. Methods Every year from 2011 to 2015 in Futian District, five sub-districts were selected according to their position of the east, the west, the south, the north and the center, one school was selected in each sub-district, then sixty students were selected from each school to detect iodine content of their household salt samples;over twenty children (half males and half females) aged 8-10 of those sixty students were selected randomly to measure their thyroid volumes and detect their urinary iodine content;one or two drinking water samples were collected in each sub-district to test iodine content. Thyroid volume was examined by ultrasound method; the salt iodine was tested by the method of direct titration; iodine content in urine and drinking water samples was tested by arsenic cerium catalytic spectrophotometry. Results Between 2011 and 2015, totally one thousand four hundred and eighty-eight edible salt samples were tested. The iodized salt coverage rate, the qualification rate of iodized salt and the consumption rate of qualified iodized salt was 96.1%(1 430/1 488), 99.2%(1 419/1 430), and 95.4%(1 419/1 488), respectively . Four hundred and sixty-one children aged 8-10 were examined;nine children were diagnosed goiter, and the goiter rate was 1.95%. A total of 661 children urine samples were collected. The median urinary iodine was 229.5 μg/L; urinary iodine in 100 - 199 μg/L accounted for 29.8%(197/661), and in 200 - 299 μg/L accounted for 31.0%(205/661). Forty-eight drinking water samples were tested, the iodine content of the drinking water was 10.3 - 22.1 μg/L, and the median water iodine was 16.8 μg/L. Conclusions The iodine deficiency disorders surveillance indicators in Futian District of Shenzhen City all meet the national standards for elimination of the disease. Yet, the level of iodine nutrition needs to be further observed, and both the iodized salt market supervision and the health education should be strengthened.
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Objective: To assess the trends of clinical characteristics, diagnostic and treatment conditions and outcomes for in-hospital patients with ST-segment elevation myocardial infarction (STEMI) in eastern rural China from 2001 to 2011. Methods: Through a two-stage random sampling, a representative in-hospital STEMI patient group in eastern rural China of 2001, 2006 and 2011 were enrolled. In 1st step, a simple random-sampling procedure was conducted to identify the collaborating hospitals and in 2nd step, a systematic sampling procedure was performed to select representative patients from those admitted to each collaborating hospital for STEMI during the study period. Then we obtained patients’ clinical information from their medical records. Finally, we weighted the ifndings for each year to represent the overall situation. Results: A total of 2820 STEMI medical records from 32 collaborating hospitals were enrolled. From 2001 to 2011, the median age of STEMI patients increased from 66 to 68 years, P Conclusion: From 2001 to 2011, application of PCI grew from nothing and effective medication was improved for in-hospital STEMI patients in eastern rural China. However, there were still obvious gaps for diagnosis and treatment from the guideline requirement;the patient outcomes have not been improved.
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Objective: To assess the trends in clinical characteristics and treatments for in-hospital patients with ST-segment elevation myocardial infarction (STEMI) in western rural China from 2001 to 2011. Methods: A two-stage random sampling procedure was used in our study. In 1st stage, stratiifed random sampling was applied to identify the participating hospitals and in 2nd stage, random sampling was applied to determine the patients to be studied. Taking 2001, 2006 and 2011 as 3 time points to study the in-hospital records for STEMI treatments. The results in each year were analyzed by weighted calculation in order to adjust the proportional impact by different sampling and therefore, to relfect the entire condition in western rural area. Results: A total of 32/35 hospitals with 1028 STEMI records were enrolled. From 2001 to 2011, the admitted STEMI patients from 64 (54-70) years of age increased to 67 (56-75) years,Ptrend<0.05, while gender composition was similar, the risk factors for cardiovascular disease such as hypertension, dyslipidemia and smoking substantially increased. Among patients without contraindications, the ues of following medications increased from 2001 to 2011: aspirin from 73.6% to 89.9%, clopidogrel from 0% to 66.5%, β-blockers from 25.4% to 64.3% and statins from 7.5% to 89.8%, allPtrend<0.01. From 2001 to 2011, the rates of primary PCI application were from 0% to 0.3%,Ptrend=0.51, the rates of thrombolytic therapy increased from 33.4% to 55.4%,Ptrend<0.01. At the year of 2001, 2006 and 2011, the reperfusion rates were 33.4%, 50.7% and 55.4%, Ptrend<0.01; the mortality within 7 days of admission were 3.0%, 10.1% and 6.7%, the rates of death or treatment withdrawal because of terminal status were 5.3%, 12.3% and 10.9%, there was no signiifcant trend in the above 2 rates after adjustments. Conclusion: The quality of medical care for STEMI was signiifcantly improved in western rural China from 2001 to 2011, while there are still gaps between western rural area and other regions.
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The paper presented the thoughts and steps taken by the National Center for Cardiovascular Diseaes in biobank quality management system.By means ofprocess approach,the organizational structure,identification and analysis process were established,along with the management mechanism and normalized documentation.Centering onPlan,Do,Check and Act(PDCA),a complete set of quality management system was established.This system enables normalized management of biobanks in China,and provides practice guidelines for development industry standards of the country as well.