Equity of health service utilization of urban residents: data from a western Chinese city / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Getting medical treatment is still difficult and expensive in western China. Improving the equity of basic health services is one of the tasks of the new healthcare reform in China. This study aimed to analyze the parallel and vertical equity of health service utilization of urban residents and then find its influencing factors.</p><p><b>METHODS</b>In August 2011, a household survey was conducted at 18 communities of Baoji City by multi-stage stratified random sampling. Based on the survey data, we calculated a concentration index of health service utilization for different income residents and a difference index of different ages. We then investigated the influencing factors of health service utilization by employing the Logistic regression model and log-linear regression model.</p><p><b>RESULTS</b>The two-week morbidity rate of sampled residents was 19.43%, the morbidity rate of chronic diseases was 21.68%, and the required hospitalization rate after medical diagnosis was 11.36%. Among out-patient service utilization, the two-week out-patient rate, number of two-week out-patients, and out-patient expense had good parallel and vertical equity, while out-patient compensation expense had poor parallel and vertical equity. The inpatient service utilization, hospitalization rate, number of inpatients, days stayed in the hospital, and inpatient expense had good parallel equity, while inpatient compensation expense had poor parallel equity. While the hospitalization rate and number of inpatients had vertical equity, the days stayed in hospital, inpatient expense, and inpatient compensation expense had vertical inequity.</p><p><b>CONCLUSIONS</b>Urban residents' health was at a low level and there was not good health service utilization. There existed rather poor equity of out-patient compensation expense. The equity of inpatient service utilization was quite poor. Income difference and the type of medical insurance had great effects on the equity of health service utilization.</p>

Open reduction and mini-plate internal fixation for the treatment of fracture and dislocation of coccyx / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic methods of fracture and dislocation of coccyx and evaluate its curative effects.</p><p><b>METHODS</b>From May 2002 to March 2010,56 patients with fracture and dislocation of coccyx were divided into surgical treatment group and non-surgical treatment group. There were 7 males and 20 females in surgical treatment group with an average age of (48.1 +/- 0.6) years (ranged, 29 to 62 years), treated with open reduction and mini-plate internal fixation. There were 8 males and 21 females in non-surgical treatment group with an average age of (47.5 +/- 0.9) years (ranged, 19 to 54 years),treated with manipulative reduction. All patients were underwent X-ray examination and were finally diagnosed before treatment. Clinical symptoms and Visual Analogue Scales (VAS) of all patients were statistically analyzed before and after treatment.</p><p><b>RESULTS</b>There was no significant difference between two groups in gender, age, BMI index and VAS evaluation. All patients were followed up from 12 to 25 months with an average of 17.2 months. In surgical treatment group,there were 26 cases with I/a incision and 1 case with II/a incision; the excellent rate of clinical symptom was respectively 92.6% and 100% at leaving hospital and final follow-up; the improvement rate of VAS was 97.6% and was excellent result;internal fixtures were removed at the 1 to 2 years after treatment and no unwell symptoms occurred; VAS of all patients in the group was 0 point. In non-surgical treatment group,the excellent rate of clinical symptom was respectively 72.4% and 82.8% at leaving hospital and final follow-up; the improvement rate of VAS was 72.1% and was good result. There was significant difference in clinical results between two groups (P<0.05).</p><p><b>CONCLUSION</b>The results indicated that fracture and dislocation of coccyx should be treated in time. For the treatment of patients with manipulative reduction failures, instability reduction by X-ray examination and serious rectal irritation, open reduction and mini-plate internal fixation can obtain satisfactory results.</p>

Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The traditional lamina osteotomy replantation method is prone to nerve root injury and low back pain recurrence. Our team has proposed a modified approach that improves the osteotomy site and its fixation procedure. The aim of this study was to evaluate the clinical efficacy of traditional and modified lamina replantation methods in treating unstable lumbar disc herniation.</p><p><b>METHODS</b>From March 2008 to August 2011, 124 patients with unstable lumbar disc herniation were enrolled and randomly divided into the following two groups according to random digital table: group A (traditional group) consisting of 61 patients who underwent traditional laminectomy replantation, and group B (modified group) consisting of 63 patients who underwent modified lamina replantation. Both surgeries were performed by the same surgeons. The two groups had no significant difference in gender, age, symptoms, time of onset and the prominent segment. Visual analogue scale (VAS), Oswertry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores, operative time, blood loss, complication rate, radiographic healing rates, and low back pain recurrence rates were compared between the two groups.</p><p><b>RESULTS</b>There were 121 patients followed up for more than one year, and the follow-up rate was 97.6%. Nerve injury occurred in two patients (3.3%) in the modified group and 12 patients (20.0%) in the traditional group. Dural injury occurred in one patient (1.6%) in the modified group and seven patients (11.7%) in the traditional group. Pseudarthrosis occurred in two patients in the modified group and in 18 patients in the traditional group with 1-year fusion rates of 96.7% and 70.0%, respectively. Recurrence of lower back pain after one year was noted in three patients (4.9%) in the modified group, and in 15 (25.0%) in the traditional group. Leg pain recurrence was noted in one patient (1.6%) in the modified group and in three cases (5.0%) in the traditional group. The one-year healing rates of nerve injury, dural injury, replantation lamina and low back pain recurrence rates after one year were significantly different (P < 0.05) between the two groups. At two weeks, three months, six months and one year postoperatively, both groups had significant improvement in VAS, ODI, and JOA scores from their preoperative values (P < 0.05). No significant difference was detected between the short term postoperative scores between groups A and B (P > 0.05). However, a significant difference was found one year later (P < 0.05).</p><p><b>CONCLUSIONS</b>Compared to the traditional approach, the modified technique for lamina replantation showed lower rates of dural and nerve damage, a higher lamina healing rate, a lower back pain recurrence rate, and better clinical scores. It is a safe and effective operation for lumbar spine surgery.</p>

The inhibitory effect of aspisol on human breast cancer cells in vitro and its mechanism / 肿瘤

Objective: To investigate the effects of aspisol on expressions of cyclooxygenese-2 (COX-2), matrix metalloproteinaseses-9 (MMP-9) proteins in human breast cancer MDA-MB-231 cells. Methods: MDA-MB-231 cells were incubated with aspisol at various concentrations for 24 h. The morphological changes of MDA-MB-231 cells were evaluated by HE staining. The inhibitory effects of aspisol on the proliferation of MDA-MB-231 cells were determined by MTT assay. The effects of aspisol on the expressions of COX-2 and MMP-9 in MDA-MB-231 cells were measured by Western blotting. Results: Under light microscope the cells in aspisol treatment groups showed decreased density, round shape, and light staining of nucleus. Aspisol significantly inhibited the proliferation of MDA-MB-231 cells (P < 0.01). Compared with the control group, aspisol dose-dependently inhibited the expressions of COX-2 and MMP-9 protein in MDA-MB-231 cells (P < 0.05). Conclusion: This study suggested that aspisol inhibited the expressions of COX-2 and MMP-9 protein in breast cancer MDA-MB-231 cells.

Effects of ketamine-midazolam anesthesia on the expression of NMDA and AMPA receptor subunit in the peri-infarction of rat brain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Activation of N-methyl-D-aspartate (NMDA) receptors and alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptors play an important role in the neurons death induced by ischemia. The mitigating effect of intravenous anesthetics on ischemic neuron injury is related to their influence on NMDA receptors. This study was performed to investigate the effect of ketamine-midazolam anesthesia on the NMDA and AMPA receptor subunits expression in the peri-infarction of ischemic rat brain and explore its potential mechanism of neuroprotection.</p><p><b>METHODS</b>Thirty Sprague Dawley (SD) rats were subjected to permanent middle cerebral artery occlusion under ketamine/atropine (100/0.05 mg/kg) or ketamine-midazolam/atropine (60/50/0.05 mg/kg) intraperitoneal anesthesia (n=15 each). Twenty-four hours after ischemia, five rats in each group were killed by injecting the above dosage of ketamine or ketamine-midazolam intraperitoneally and infarct size was measured. Twenty-four and 72 hours after ischemia, four rats in each group were killed by injecting the above dosage of ketamine or ketamine-midazolam intraperitoneally. After staining the brain tissue slices with toluidine blue, the survived neurons in the peri-infarction were observed. Also, the expression level of NMDA receptors 1 (NR1), NMDA receptors 2A (NR2A), NMDA receptors 2B (NR2B) and AMPA (GluR1 subunit) were determined by grayscale analysis in immunohistochemical stained slices.</p><p><b>RESULTS</b>Compared with ketamine anesthesia, ketamine-midazolam anesthesia produced not only smaller infarct size [(24.1+/-4.6)% vs (38.4+/-4.2)%, P<0.05], but also higher neuron density (24 hours: 846+/-16 vs 756+/-24, P<0.05; 72 hours: 882+/-22 vs 785+/-18, P<0.05) and lower NR2A (24 hours: 123.0+/-4.9 vs 95.0+/-2.5, P<0.05; 72 hours: 77.8+/-4.1 vs 54.2+/-3.9, P<0.05) and NR2B (24 hours: 98.5+/-2.7 vs 76.3+/-2.4, P<0.05; 72 hours: 67.2 +/-7.5 vs 22.2+/-2.6, P<0.05) expression level in the peri-infarction following ischemia.</p><p><b>CONCLUSION</b>The protective effects of ketamine-midazolam anesthesia on ischemic brain injury may related to decreasing NR2A and NR2B expression.</p>