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1.
Article in Chinese | WPRIM | ID: wpr-932339

ABSTRACT

Objective:To investigate the clinical efficacy of posterolateral approach combined with anteromedial approach in the treatment of trimalleolus fracture.Methods:A retrospective analysis was performed of the 20 patients who had been admitted to The Second Department of Orthopedics, The First People's Hospital of Tianshui for trimalleolus fractures from January 2016 to August 2020. They were 16 men and 4 women, aged from 20 to 70 years (average, 49.6 years). The lateral malleolus, posterior malleolus and medial malleolus were treated with reduction and internal fixation using the posterolateral approach combined with the anteromedial approach. Postoperative complications were observed, and the foot function was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and pain visual analog scale (VAS).Results:In this cohort, the operation time ranged from 85 to 115 minutes, averaging 88.4 minutes and the intraoperative blood loss from 50 to 600 mL, averaging 120 mL. All patients were followed up for 12 to 20 months (mean, 14.5 months). The fracture healing time ranged from 3.2 to 5.4 months, averaging 3.8 months. Follow-ups observed no such complications as infection or necrosis of surgical incision, failure of internal fixation, nonunion, or malunion. The AOFAS ankle-hindfoot score at 12 months after operation (87.8±6.4) was significantly higher than that before operation (32.3±4.9) ( t=29.454, P<0.001); as for VAS, one case scored 0, 13 cases 1 to 3 points and 6 cases 4 points. Conclusion:In the treatment of trimalleolus fracture, a combination of posterolateral approach and anteromedial approach can lead to definitely positive efficacy because of a significant reduction in operation time, intraoperative bleeding and postoperative complications.

2.
Article in Chinese | WPRIM | ID: wpr-931076

ABSTRACT

Objective:To evaluate the effectiveness and safety of phacoemulsification cataract extraction combined with intraocular lens implantation (PEI) plus goniosynechilysis (GSL) and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG).Methods:An observational case series study was performed.Fifty eyes of 50 patients with advanced PACG were enrolled in Zhongshan Ophthalmic Center from August 2020 to June 2021.All the patients received PEI+ GSL+ GT and were followed up for over 6 months, with a mean follow-up of 7.5 (6, 10) months.Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer.Best corrected visual acuity (BCVA) was examined with an ETDRS chart and converted to logarithm of the minimum angle of resolution (LogMAR) units for analysis.Types and number of anti-glaucoma medications applied before and after surgery, and the surgical complications were collected.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) with a reduction of 20% from baseline without anti-glaucoma medication, no vision-threatening complications, no loss of light perception, and no reoperation.Qualified success was defined as an IOP of 5-18 mmHg with a reduction of 20% from baseline with or without anti-glaucoma medication, no vision-threatening complications, no loss of light perception, and no reoperation.This study adhered to the Declaration of Helsinki.This research protocol was approved by an Ethics Committee of Zhongshan Ophthalmic Center (No.2021KYPJ177). Written informed consent was obtained from each subject before entering the cohort.Results:The mean preoperative IOP was (28.81±7.81)mmHg, and the IOP at the end of follow-up was (13.41±4.10)mmHg, showing a statistically significant decrease ( t=12.260, P<0.001). The postoperative IOP was decreased by 13.80 (9.10, 19.40)mmHg, with a percentage decrease of 51.1% (38.6%, 67.1%). The mean preoperative and postoperative BCVA was (0.92±0.11) LogMAR and (0.88±0.10) LogMAR, respectively, and no significant difference was found ( t=-0.560, P=0.580). The number of anti-glaucoma medications was reduced from 2 (1, 3) before operation to 0 (0, 0) after operation.The complete success rate of surgery was 80% (40/50), and the qualified success rate was 94% (47/50). Surgical complications mainly included hyphema in 7 eyes, IOP spike in 7 eyes, and corneal edema in 3 eyes.No vision-threatening complication occurred. Conclusions:PEI+ GSL+ GT is preliminarily effective and safe for advanced PACG by reducing IOP and application of anti-glaucoma medications with few complications.

3.
Article in Chinese | WPRIM | ID: wpr-885721

ABSTRACT

To investigate the clinical effect of pantoprazole combined with traditional Chinese medicine for gastroesophageal reflux. A total of 50 cases of gastroesophageal reflux selected from January 2019 to December 2019 in Aviation General Hospital were randomly divided into the control group and the observation group. The control group was given pantoprazole, and the observation group was given traditional Chinese medicine combined with pantoprazole. Both groups were treated for 28 days. The recovery of clinical symptoms, status of esophageal mucosa by endoscopy and the incidence of adverse reactions were compared between the two groups. The clinical symptoms and status of esophageal mucosa in both group were obviously improved. Efficiency of the observation group was significantly higher than that of the control group( P<0.05). No serious adverse reactions happened during treatment. Pantoprazole combined with traditional Chinese medicine has definite clinical effects in the treatment of gastroesophageal reflux, which can improve the clinical symptoms and the recovery of esophageal mucosa of patients with high safety.

4.
Article in Chinese | WPRIM | ID: wpr-885712

ABSTRACT

Objective:To investigate the features of common bile duct adenoma under endoscopic ultrasonography (EUS).Methods:Clinical data of 15 patients with common bile duct adenomas confirmed by pathology from January 2015 to January 2020 in Tianjin Nankai Hospital were analyzed retrospectively. The patients′ EUS features were summarized.Results:The common bile duct adenoma was characterized by homogeneous soft tissue mass with medium or low echo and clear boundary, floating in the bile duct with no movement under EUS. EUS diagnosis of 14 out of 15 patients was consitent with the pathology, and the diagnostic consistency was 93.3%. One patient with a movable lesion was misdiagnosed as cholestasis by EUS. One patient had two solitary adenomas, located in the middle and lower part of the common bile duct, and 14 others had single adenoma. There were 9 adenomas in the lower part, 4 in the ampulla, 2 in the upper part, and 1 in the middle of the common bile duct. The pathological findings were 7 cases of villous adenoma with high-grade intraepithelial neoplasia, 4 cases of local malignant changes; 6 villous tubular adenoma with high-grade intraepithelial neoplasia, 3 local malignant changes; 2 villous tubular adenoma with low-grade intraepithelial neoplasia; and 1 papillary adenoma.Conclusion:EUS, helpful for the qualitative diagnosis, can be used as an important technique to improve the diagnosis of common bile duct adenoma.

5.
Chinese Journal of Orthopaedics ; (12): 763-769, 2021.
Article in Chinese | WPRIM | ID: wpr-910657

ABSTRACT

Objective:To explore the safety and effectiveness of the Renaissance spine surgery robot in the middle and upper thoracic spine fractures.Methods:62 patients with middle and upper thoracic vertebra fractures from March 2015 to March 2019 were prospectively analyzed. These patients were randomly divided into robot group (Renaissance robot-assisted nailing) and free hand group (unarmed nailing under perspective). There were 32 patients in robot group, including 25 males and 7 females with an average age of 43.1±8.91 years (range, 18-65 years). Body mass index (BMI) was 26.15±3.97 kg/m 2 (range, 16.3-41.7 kg/m 2). The preoperative Cobb angle was 20.9 °±2.83° (range, 10.7 °-33.9°). In the free hand group, there were 30 cases, including 24 males and 6 females; Age 44.2±9.10 years (range, 20-67 years), BMI 25.97±4.02 kg/m 2 (range, 17.1-43.2 kg/m 2); The preoperative Cobb angle was 21.3°±3.01° (range, 11.6°-35.1°). The 2 groups were compared in terms of accuracy of screw placement, one-time success rate of screw placement, completion time of screw placement, time of total operation and penetration rate of anterior vertebral margin. The robot group also compared the consistency of screw placement angle with preoperative planning. Results:All patients completed the operation successfully. The number of fractured vertebrae in the robot group was 37; the screw placement time was 16.11±5.82 min; the total number of screws was 230, of which 227 were successfully placed at one time, with a success rate of 98.70% (227/230); 1 screw was inserted through the anterior edge of the vertebral body, and the penetration rate was 0.43% (1/230). The number of fractured vertebrae in the free hand group was 35; the nail placement time was 21.09±7.31 min; the total number of screws was 216, of which 195 were successfully placed at one time, with a success rate of 90.28% (195/216); 12 screws was inserted through the anterior edge of the vertebral body, and the penetration rate was 5.56% (12/216). There were significant differences in the time, success rate and penetration rate between the two groups. There was no significant difference in the total operation time between the robot group and the unarmed nail group 137.23±12.68 min and 140.23±13.13 min, respectively. There was no significant difference in the angle of screw placement between pre-operative planning image and post-operative CT scan in the robot group.Conclusion:Renaissance spinal surgery robot in the treatment of middle and upper thoracic vertebra fractures has the advantages of high accuracy, low intraoperative risk, high safety and satisfactory effect of pedicle screw placement.

6.
Article in Chinese | WPRIM | ID: wpr-910551

ABSTRACT

Objective:To evaluate the accuracy of measurement of the output factor of high-energy photon small field (Scp) using commercial semi-diodes and ionization chambers in small fields in accordance with the IAEA-483 report, which has been proposed that all kinds of detectors should be revised for small field Scp measurement in clinical practice.Methods:EGSnrc of Monte Carlo (MC) software was utilized to simulate the treatment head of Varian Novalis Tx linear accelerator, and the profile curve and relative dose value were generated by simulation in DOSXYZnrc based on derived phase space file. Measurement of PDD and Profiles was used to adjust and validate the simulation mode. Detectors including ionization chambers A16, A14 sL, CC01, CC13, PFD and EFD and semi-diodes PFD, EFD and Razor under different radiation field settings (0.5 cm to 10.0 cm) were employed to measure the profile curves and Scp of FWHM equivalent rectangular fields, which were compared with data of Monte-Carlo simulation. The measurement of Scp was revised by data given in the IAEA-483 report. The data with or without correction were compared with the data of MC simulation.Results:A curve deviation o F<2.0% between MC simulation and PFD measurement was accepted. MC simulated Profiles were consistent with PFD, EFD and Razor measurements, when the field was<3.0 cm. Razor response in the out-field region was 2.3% higher than those of MC and PFD, and it increased with the increment of field and was 3.0% at 10.0 cm. The maximum 20.0%-80.0% penumbra width was detected as 3.0 mm for CC13 at 10.0 cm rectangular field. With the decrease of the radiation field, the deviation relative to MC simulation was increased as for Scp mean values of 7 detectors before correction. The standard deviation (SD) of the measured value was increased rapidly when it was close to 1.0 cm, ranging from 0.009-0.014 for the field of 5.0 cm-1.5 cm to 0.030-0.089 for the field of 1.0 cm-0.5 cm. The mean value of SD for the whole measurement before correction was 0.030. The mean SD of Scp measured by the six probes was 0.008, 0.013 at 0.8 cm and 0.021 at 0.6 cm after correction. When the equivalent field was ≥1.0 cm, the corrected Scp and MC simulation deviation was ranged from -3.6% to -0.5%. The error was between -6.9% and -1.3% when the radiation field was<1.0 cm. Conclusion:The SD of Scp measured by different detectors after correction in accordance to the IAEA-483 report is small, which is in good agreement with the data of MC simulation, suggesting that it could be applied in clinical dosimetry.

7.
Article in Chinese | WPRIM | ID: wpr-932715

ABSTRACT

Objective:To study the risk factors of acute gallstone pancreatitis (AGP) caused by impaction of duodenal papilla stones based on ERCP findings to provide evidence on prevention of AGP caused by stone impaction.Methods:The data of 304 patients with duodenal papilla stone impaction who were treated by ERCP at the Integrated Chinese and Western Medicine Hospital of Tianjin University from January 2009 to December 2020 were analyzed retrospectively. There were 177 males and 127 females, with a median age of 65.0 years. These patients were divided into the AGP group ( n=174) and the non-AGP group ( n=130) according to whether they developed acute pancreatitis before hospitalization. The analysis was performed on perioperative data. Multivariate logistic regression analysis was used to detect risk factors of AGP in patients with duodenal papillary stone impaction. Results:Multivariate logistic analysis showed that acute cholangitis ( OR=2.114, 95% CI: 1.279-3.494, P<0.05) and impacted stones ≤5 mm ( OR=1.738, 95% CI: 1.064-2.840, P<0.05) were independent risk factors of duodenal papillary stone impaction complicated with AGP. No perforation and death related to ERCP treatment occurred in both groups. The symptom alleviating time of patients in the AGP versus the non-AGP groups was (2.67±1.19) versus (1.88±0.88) d respectively ( t=-6.321, P<0.001). Conclusion:Among patients with duodenal papilla impacted stones, acute cholangitis and impacted stones ≤5 mm were risk factors of developing AGP, and ERCP should be carried out as early as possible.

8.
Article in Chinese | WPRIM | ID: wpr-912147

ABSTRACT

Objective:To study the clinical value of endoscopic ultrasonography (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) in patients with non-deterministic choledocholithiasis.Methods:Data of 132 patients with unconfirmed common bile duct calculi diagnosed in Tianjin Nankai Hospital from January 2017 to December 2019, whose clinical manifestations were not consistent with magnetic resonance cholangiopancreatography (MRCP) results, were retrospectively analyzed. Patients were divided into two groups: group A showed calculi under MRCP with no suspicious clinical manifestations, while group B showed no calculi under MRCP with suspected clinical manifestations. All patients underwent EUS. Necessity of ERCP was determined according to EUS results, and the diagnostic accuracy of EUS was analyzed compared with ERCP results and follow-up results as the gold standard.Results:Of the 132 patients, 87 were confirmed as choledocholithiasis, and 45 had no common bile duct calculi by the golden standard. Forty-four (33.3%) cases were negative in EUS and were confirmed free of calculi by follow-up. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS for choledocholithiasis were 95.40% (83/87), 97.78% (44/45), 96.21% (127/132), 98.81% (83/84) and 91.67% (44/48), respectively.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRCP for choledocholithiasis were 66.67% (58/87), 82.22% (37/45), 71.97% (95/132), 87.88% (58/66) and 56.06% (37/66), respectively. There were significant differences in the sensitivity, accuracy, positive predictive value or negative predictive value between EUS and ERCP (all P<0.05). There was significant consistency between the EUS results and the final diagnosis ( Kappa=0.917, P<0.001), and good consistency between MRCP results and the final diagnosis ( Kappa=0.439, P<0.001). The detection rate of false positive MRCP in group A was higher than that of false negative MRCP in group B [8/8 VS 89.66% (26/29), P<0.001] under EUS. Conclusion:EUS is superior to MRCP in the diagnosis of uncertain choledocholithiasis, and EUS prior to ERCP can reduce unnecessary ERCP operations and avoid missing stones.

9.
Article in Chinese | WPRIM | ID: wpr-866330

ABSTRACT

Objective:To analyze the effect and safety of levonorgestrel-releasing intrauterine system(LNG-IUS) for the premenopausal patients with breast cancer who took tamoxifen as adjuvant therapy.Methods:From June 2014 to June 2016, 84 patients with breast cancer who met the inclusion criteria in the First People′s Hospital of Xiaoshan District were randomly divided into two groups according to the digital table.The treatment group (39 cases) underwent LNG-IUS insertion, while the control group (45 cases) received no LNG-IUS insertion.The general condition of patients before the use of tamoxifen and LNG-IUS was evaluated.Transvaginal ultrasound was used to measure the thickness of endometrium, hysteroscope was used for pathological examination of endometrium and the measurement of ER/PR expression, and blood lipid level was also detected.All above was done before the treatment of tamoxifen and LNG-IUS, 1 year after treatment and 2 years after treatment.Results:Before the therapy, there were no statistically significant differences between the two groups in general condition and uterine cavity condition(all P>0.05). After 1 year, the incidences of endometrial polyp, endometrial hyperplasia/secretion, benign lesion and endometrial atrophy in the treatment group were 2.6%, 5.1%, 15.4%, 76.9%, respectively, which in the control group were 6.7%, 20.0%, 17.8%, 55.6%, respectively.the differences between the two groups were statistically significant(χ 2=4.06, 4.22, all P<0.05). After 2 years, the incidences of endometrial polyp, endometrial hyperplasia/secretion, benign lesion and endometrial atrophy in the treatment group were 0.0%, 2.6%, 84.6%, respectively, which in the control group were 11.1%, 15.6%, 60.0%, respectively, the differences between the two groups were statistically significant(χ 2=4.608, 4.092, 6.203, all P<0.05). Conclusion:LNG-IUS can prevent the benign endometrial lesions of breast cancer patients caused by tamoxifen therapy after surgery, and can decrease the incidence of endometrial polyp and endometrial hyperplasia/secretion, while increase the incidence of endometrial atrophy, without increasing the recurrence risk of breast cancer.

10.
Article in Chinese | WPRIM | ID: wpr-863943

ABSTRACT

Autologous fat grafting (AFG) is a new postoperative plastic technique for breast cancer. The safety of this technique in oncology is a controversial issue in academic circles. In some basic experiments, it was found that adipocytes could promote the proliferation of surrounding cancer cells through autocrine and paracrine. However, clinical trial data show that this procedure does not increase the risk of postoperative recurrence or metastasis of breast cancer. Nowadays, there are variety of researches on the safety of this technique, but many limitations are found in these trials. Therefore, to accurately assess the relevance of these studies to any realistic clinical risk, it is necessary to include large sample of clinical studies. In this paper, the data of basic experiments and clinical trials in recent ten years were collected, and the safety of oncology was further analyzed and discussed, which will provide reference for clinical decision-making of postoperative breast reconstruction.

11.
Article in Chinese | WPRIM | ID: wpr-872379

ABSTRACT

Objective:To provide countermeasures and suggestions for the current operation and management of public hospitals by analyzing the impacts of COVID-19 on public hospitals′ operation.Methods:Collection of operation data of 44 public hospitals in Wenzhou from January to March in both 2019 and 2020. By means of descriptive analysis and financial analysis, we analyzed the impacts of the pandemic on the hospitals′ business, revenue and expenditure structure.Results:As of April 2020, even the outpatients visits and inpatient at Wenzhou public hospitals had significantly rebounded, and the downrange for the same periods of 2019 was as high as 23.12% and 17.37% respectively. April witnessed the total medical service revenue of 44 hospitals business totaled 17.44 billion yuan, down 15.43%from the previous year and up 17 percentage points compared to the decline in the first quarter(at 32.54%). As the pandemic moves into a normalized state for epidemic prevention and control, the recovery of medical business was slow, while expenditure of manpower costs and epidemic prevention costs had increased instead. Capital pressure would be the biggest pressure for most hospitals.Conclusions:The hospitals need to further strengthen their operation of fine management and cost control, for sustainable development. It is suggested that government departments should continue to increase effective investment in public health, reduce hospitals′ social insurance premiums in stages, further promote the implementation of online medical service pricing policies, especially Internet hospitals, and relax hospitals′ working capital loan access to ensure liquidity turnover.

12.
Article in Chinese | WPRIM | ID: wpr-871410

ABSTRACT

Objective:To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) and LC plus laparoscopic common bile duct exploration and primary suture (LBEPS) in treatment of cholecystolithiasis combined with choledocholithiasis.Methods:The clinical data of 161 patients of concomitant cholecystolithiasis and choledocholithiasis treated in Tianjin Nankai Hospital from January 2018 to December 2018 were retrospectively analyzed. Of the patients, 101 cases received ERCP followed by LC (ERCP+ LC group), and 60 cases received LC plus LBEPS (LC+ LBEPS group). The stone clearance rate, complications related to the operation, length of hospital stay, hospitalization expenses, postoperative residual stone rate and postoperative quality of life were compared between the two groups.Results:The ERCP+ LC group and LC+ LBEPS group had no statistical difference in the stone clearance rate [99.01% (100/101) VS 98.31% (59/60), P>0.05] and surgery related complications [5.94% (6/101) VS 6.67% (4/60), P>0.05]. The length of hospital stay of the ERCP+ LC group was significantly longer than that of the LC+ LBEPS group [15.00 (13.00, 19.00) days VS 11.00 (9.50, 13.00) days, P<0.001], and the same of hospitalization cost [57 655.00 (51 237.47, 63 674.32) yuan VS 33 904.18 (28 201.96, 41 785.93) yuan, P<0.001]. The residual stone rate showed significant difference between the ERCP+ LC group and LC+ LBEPS group [16.83% (17/101) VS 0 (0/60), P=0.001]. Both groups were followed up for 3 to 12 months. No long-term complications occurred, and three were no significant differences in the quality of life scores between the two groups ( P>0.05). Conclusion:ERCP followed by LC and LC plus LBEPS are both safe and effective to treatment of cholecystolithiasis combined with choledocholithiasis. The clinicians should select the appropriate method in accordance with the actual condition of the patients.

13.
Article in Chinese | WPRIM | ID: wpr-752012

ABSTRACT

Objective To investigate the clinical pathological characteristics and the prognosis of the invasive micropapillary carcinoma (IMPC) of breast cancer.Methods The clinical pathological characteristics of 47 IMPC patients treated in the Second Hospital of Jilin University from Jan.2010 to Dec.2016 were retrospectively analyzed.A long term survival has been followed.Results 47 IMPC patients were all female.The median age was 56(34-76) years old.The median diameter of the tumor was 1.9(0.8-7.0) cm.The rate of axillary lymph node metastasis was 66.7% (30/44),the median number of axillary lymph node metastasis was 9.5 (1-55),and the metastasis number of 1 to 3 accounted for 43.3% (13/30),the metastasis number of 4 to 9 accounted for 6.7% (2/30),and the metastasis number more than 10 accounted for 50% (15/30).The lymphatic invasion rate was 40.2%(39/97),and the skin and (or) the nipple invasion rate was 15.6%(7/45).The positive rate of ER,PR,HER2,E-Cadherin was 95.7%(44/46),91.3%(42/46),10.5%(4/38),100%(40/40),respectively.The tumor cell growth index marked by Ki-67 was 1%-80%,and 78.3% patients' tumor cell growth index marked by Ki-67 were more than 20%.Conclusions IMPC is a relatively rare special type of breast cancer,which typically occurs at middle-aged and old female.The expression of ER,PR,E-Cadherin is high and the expression of HER2 is low.It has strong ability and high positive rate of lymph node metastasis,lymphatic invasion,and poor prognosis.

14.
Article in Chinese | WPRIM | ID: wpr-743406

ABSTRACT

Objective To investigate the surgical procedure,complication and cosmetic effects of tissue expander in immediate breast reconstruction after nipple sparing mastectomy(NSM).Methods From Jul.2014 to Apr.2018,the clinical data of 23 breast cancer patients (two patients were bilateral) undergoing NSM and expander immediate breast reconstruction were analyzed retrospectively.Results All of the 25 procedures were NSM plus expander based immediate breast reconstruction.The overall complication rate was 12%,including:one seroma,one mild nipple necrosis and one nipple malposition.The median follow up period was 12 months,no grade Ⅲ or Ⅳ contractures were found.Appearance satisfaction was applied to the Harvard scoring system,doctor score:fair(2 cases;8%),good(2 cases;8%),excellent(21 cases;84%);patient score:good(4 cases;16%),excellent(21 cases;84%).No local recurrence was observed.Conclusion NSM with lateral incision and immediate reconstruction was found to be technically feasible and associated with few complications and satisfactory esthetic outcomes.

15.
Article in Chinese | WPRIM | ID: wpr-746349

ABSTRACT

Large medical equipments feature complex technology,high investment and operational costs,bearing major impacts on medical expenses.Curbing overinvestment and excessive growth of such expenses at public hospitals hence becomes one of the government key goals in regulatory control for these equipments.Based on data of provincial hospitals in Zhejiang and core variants as regulatory measures for large medical equipments,the authors came to important findings.For example,when such influencing factors as the supplier and customer characteristics of provincial public hospitals,and the equipment investment and medical expenses of other public hospitals are under control,the administrative licensing control of such equipments can lower the investment of medical equipments and medical expenses by 32.2% and 78.2% respectively,in comparison with the approval mechanism.It is therefore important to strengthen the regulation on large medical equipments at provincial level,and encourage human capital investment of public hospitals with service quality as orientation.These efforts can lower excessive supply of medical technology of provincial hospitals,and help the government to improve its regulatory effects for large medical equipments.

16.
Article in Chinese | WPRIM | ID: wpr-776739

ABSTRACT

OBJECTIVE@#To assess the value of non-invasive prenatal testing (NIPT) for the identification of fetal chromosomal aneuploidies.@*METHODS@#For 9470 pregnant women with a moderate-to-high risk by conventional serological screening or advanced maternal age, peripheral venous blood samples were collected and, following extraction of free fetal DNA, subjected to large-scale parallel sequencing on a Illumina Hiseq2000 platform. Those with a high risk by NIPT were validated by invasive prenatal diagnosis.@*RESULTS@#Out of the 9470 samples, 194 cases (2.0%) were positive by NIPT testing. These included 50 trisomy 21, 11 trisomy 18, 17 trisomy 13, 44 other autosomal aneuploidies, 55 sex chromosomal aneuploidies, and 17 chromosomal copy number variations. As validated by amniotic fluid or umbilical blood chromosomal karyotyping analysis, NIPT has a false positive rate of 2.0%, 18.2%, 41.2%, 97.7%, 81.8%, 94.1%, respectively. The test has a sensitivity of 100% and a specificity of 98.79%.@*CONCLUSION@#For common chromosomal aneuploidies such as trisomy 21 and trisomy 18, NIPT has a good sensitivity and specificity, therefore has good value for clinical application.


Subject(s)
Aneuploidy , Chromosome Disorders , Diagnosis , DNA Copy Number Variations , Female , Humans , Pregnancy , Prenatal Diagnosis , Sensitivity and Specificity , Trisomy , Trisomy 18 Syndrome
17.
Chinese Journal of Epidemiology ; (12): 559-564, 2019.
Article in Chinese | WPRIM | ID: wpr-805203

ABSTRACT

Objective@#To understand the medical expenditure and related household economic burden of pulmonary tuberculosis (TB) patients receiving full course treatment in designated TB hospitals in China and identify the related factors.@*Method@#A cross-sectional study was conducted in 535 consecutive TB patients receiving TB treatment from April 2017 to June 2017 in 5 designated TB hospitals in eastern and western China selected through stratified cluster sampling. A questionnaire was used to collect the information about patients’ social economic characteristics and TB diagnosis and treatment expenditure.@*Results@#The average total medical expenditure for TB treatment was 12 635.5 yuan (RMB), in which the direct medical expenditure accounted for 65.3% of the total. Nearly half of the total medical expenditure occurred in pre-treatment period. The expenditure in pre- treatment period was higher in the patients with low education level, newly treated patients, and initial sputum negative patients. The median (quartile) for the ratio of total medical expenditure to annual household income was 22%(10%-57%). Ordinal logistic regression analysis showed that low-level education background, lower household income, hospitalization and suffering from other chronic disease might increase the ratio of medical expenditure to annual household income.@*Conclusions@#Medical expenditure for full course TB treatment is still high in patients in designated TB hospitals. It is suggested to strengthen the capability building of timely found and referral of TB patients in non- designated hospitals and improve fee reduction and exemption policy for some patients.

18.
Article in Chinese | WPRIM | ID: wpr-756656

ABSTRACT

Objective To analyze the economical operation and technical efficiency of Zhejiang provincial hospitals, and give references for deepening public hospitals reform.Methods We compiled data from 17 provincial public hospitals from 2013 to 2017 in Zhejiang, then used descriptive analysis to study hospitals′operating performance, and used stochastic frontier analysis( SFA) to analyze hospitals′ technical efficiency.Results From 2013 to 2017, the 17 provincial hospitals′ annual growth rate of outpatients and discharges were 5.2% and 9.5% , the number of outpatients and discharges at the general hospitals were 1.8 times and 2.5 times of those in specialized hospitals respectively.In these hospitals, service efficiency had been improved, and the income structure had become more reasonable.However, internal and external factors of the hospitals lowered technical inefficiency in their economic operation. Conclusions The economic operation mechanism of provincial hospitals should be further strengthened, and their external environment be improved as well.Only in this way can the hospitals achieve their operational goal of " doing the right thing and in the right way".

19.
Article in Chinese | WPRIM | ID: wpr-800861

ABSTRACT

Objective@#To assess the value of non-invasive prenatal testing (NIPT) for the identification of fetal chromosomal aneuploidies.@*Methods@#For 9470 pregnant women with a moderate-to-high risk by conventional serological screening or advanced maternal age, peripheral venous blood samples were collected and, following extraction of free fetal DNA, subjected to large-scale parallel sequencing on a Illumina Hiseq2000 platform. Those with a high risk by NIPT were validated by invasive prenatal diagnosis.@*Results@#Out of the 9470 samples, 194 cases (2.0%) were positive by NIPT testing. These included 50 trisomy 21, 11 trisomy 18, 17 trisomy 13, 44 other autosomal aneuploidies, 55 sex chromosomal aneuploidies, and 17 chromosomal copy number variations. As validated by amniotic fluid or umbilical blood chromosomal karyotyping analysis, NIPT has a false positive rate of 2.0%, 18.2%, 41.2%, 97.7%, 81.8%, 94.1%, respectively. The test has a sensitivity of 100% and a specificity of 98.79%.@*Conclusion@#For common chromosomal aneuploidies such as trisomy 21 and trisomy 18, NIPT has a good sensitivity and specificity, therefore has good value for clinical application.

20.
Article in Chinese | WPRIM | ID: wpr-796485

ABSTRACT

The salary reform in public hospital is not only related to the interests of medical staffs, but also to the health care reform. Based on data of 17 provincial public hospitals in Zhejiang province from 2012 to 2017, and having calculated such factors as drug markup rate, hospital scale and general/specialized hospital characteristics, the authors analyzed the effectiveness of public hospitals salaries reform from the perspectives of public duties performance, service quantity, medical expenditure, cost containment, service efficiency, implementation of insurance policies, among others. The growth rate of performance salary in Zhejiang provincial hospitals was less than 15%, and the performance salary accounted for less than 70% of the total compensation. Such factors as cost containment, improvement of efficiency, service quantity and public welfare duties performance impose, though having minimal impact, were found to be significantly positively correlated to such compensation. Given the minimum impact of reforms in health care expenditure and insurance policy on public hospital salaries, lower medical expenditure and insurance refusal rates are conducive to raising such salaries. The salary reform of provincial public hospitals has achieved initial success, yet their salary system calls for further improvement.

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