Exploration and practice of the two-way referral path of medical alliances based on telemedicine / 中华医院管理杂志

" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.

Exploration and practice of the closed-loop health management system of the West China Women and Children Alliance / 中华医院管理杂志

As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.

Curcumin suppresses cigarette smoke extract-induced oxidative stress through PPARγ/ NF-κB pathway in human bronchial epithelial cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of curcumin against cigarette smoke extract (CSE)- induced oxidative stress in human bronchial epithelial cells and explore the underlying mechanism.</p><p><b>METHODS</b>Human bronchial epithelial cell line 16HBE was treated for 24 h with curcumin, CSE, CSE + curcumin, and CSE + curcumin with transfection by a short hairpin RNA targeting PPARγ (shPPARγ). MTT assay was used to observe the changes in the cell viability after the treatments. Quantitative real-time PCR was performed to detect the mRNA expressions of tumor necrosis factor- (TNF-), iNOS and PPARγ in the cells, and the protein expressions of iNOS, PPARγ and the phosphorylation of NF-κB p65 were detected using Western blotting.</p><p><b>RESULTS</b>The treatments did not cause significant changes in the cell viability. Exposure to CSE for 24 h significantly lowered PPARγ expression and increased TNF- and iNOS expressions and phosphorylation of NF-κB p65 in the cells. The effects of CSE were significantly suppressed by curcumin, but transfection of the cells with shRNA-PPARγ obviously abrogated the suppressive effects of curcumin.</p><p><b>CONCLUSIONS</b>Curcumin suppresses CSE-induced oxidative stress and inflammation via the PPARγ/NF-κB signaling pathway in 16HBE cells, suggesting the potential of curcumin in the treatment of chronic obstructive pulmonary disease.</p>

Distribution and drug sensitivity test of bacteria of patients on chronic rhinosinusitis with or without nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the distribution and drug sensitivity test of bacteria of patients on chronic rhinosinusitis with or without nasal polyps.@*METHOD@#The purulent discharges were collected from sinus of 175 patients with chronic rhinosinusitis with or without nasal polyps during endoscopic sinus surgery. The results of germiculture and drug sensitivity test were analyzed.@*RESULT@#From 175 specimens, 118 (67%) showed positive results in germiculture. Among them, 79 strains of gram positive bacteria and 39 strains of gram negative bacteria were detected. Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus were the most common pathogens in gram positive bacteria. The most common pathogens of gram negative bacteria were P. Aeruginosa, Enterobacter aerogenes, Enterobacter cloacae. The sensitive antibiotic on gram positive bacteria were amikacin, Daptomycin, Linezolid, vancomycin, teicoplanin, amoxicillin and clavulanate potassium, cefuroxime, respectively. The sensitive antibiotics on Gram negative bacteria were amikacin, Cefoperazone/sulbactam and imipenem, ceftazidime ceftazidime, aztreonam, levofloxacin, respectively.@*CONCLUSION@#Bacterial infection was common happened in the sinus cavity of patients with chronic rhinosinusitis with or without nasal polyps. Gram positive bacteria were the main pathogenic bacteria and gram positive bacteria and gram negative bacteria have great differences in the sensitivity of antibiotics. For patients with chronic rhinosinusitis, the using of antibiotics should depend on the drug sensitivity test.

Clinical pilot study on the rhinitis due to laryngopharyngeal reflux / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the relevance between nasal symptoms and laryngopharyngeal reflux disease in patients with allergic rhinitis.@*METHOD@#Thirty patients of laryngopharyngeal reflux disease were diagnosed in ENT outpatient department in our hospital. All patients have symptoms of sneeze, nasal discharge as chief complaint and they responded no effect for other normal treatment for nasal-sinusitis at least three months. Orally before meals, a dose of 5 mg Mosapride citrate each time, three times a day for 7 days. Orally before meals, a dose of 20 mg Esomeprazole each time, two times a. day for 2-3 months. Nasal spray, one spray of azelastine hydrochloride once, two times a day for 2 month.@*RESULT@#Laryngopharyngeal reflux symptom scores at four time points (the first visit, post treatment 15 days, 45 days, 75 days) were analyzed by repeated measures analysis of variance. There is a significant difference in four time points.@*CONCLUSION@#Laryngopharyngeal reflux disease has a strong association with allergic rhinitis. Patients who has allergic rhinitis nasal symptoms as chief complaint must be exclude, the laryngopharyngeal reflux disease first.

Analysis of the situation of pre-pregnancy health check in rural areas of Sichuan province / 重庆医学

Objective To investigate the situation of pre-pregnancy health check in rural areas of Sichuan province and get the key difficult points during the process of carrying out the work.Methods According to the economic situation in Sichuan province and geographic distribution,random eight areas in Sichuan province (Chengdu,Neijiang,Nanchong,Ziyang,Meishan,Zigong,Les-han and Suining),investigate pregnant women in maternal and child health care institutions and family planning service institutions at all all levels in the areas above.Results Only 334 people (33.26%)underwent the pre-pregnancy health check during the 974 pregnant women in rural areas.The rate of planned pregnancy is low;the rate of unintended pregnancy is close to 40.00%.55.29%of the planned pregnancy women didn′t undergo the pre-pregnancy health check.And the factors that affect their behavior of under-going pre-pregnancy health check are whether planned pregnancy and personal attitude towards pre-pregnancy health check.Conclu-sion The rate of pre-pregnancy health check is low in the pregnant women from rural areas of Sichuan province,the health sector needs to make efforts to promote and enhance the awareness of the rural pregnant women to prevent birth defects and the initiative in participation.

The anatomic study of tragal cartilage and its clinical application in ear surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Dissecting adult cadaver's tragal cartilage and researching its clinical application in ear surgery.@*METHOD@#Dissect the bilateral tragal cartilage of 22 adult cadavers immersed in formalin (both of male and female are 11). Measure and compute the average value of the length, width, thickness and area. Summarize autologous tragal cartilage's clinical application in ear surgery.@*RESULT@#The statistic values of male tragal cartilage were: length (22.55 ± 0.89) mm, width (19.00 ± 1.09) mm, thickness (1.04 ± 0.09) mm, and area (315.70 ± 32.57) mm2. The statistic values of female respectively were (19.36 ± 0.86) mm, (15.73 ± 0.69) mm, (0.93 ± 0.06) mm, and (229.64 ± 13.97) mm2. Tragal cartilages were utilized in 419 middle ear surgeries in my department, including tympanoplasty(type I 189 cases, type II and III 116 cases), atticotomy (65 cases), and the repair of the lateral skull base (3 cases). The postoperative effect was satisfactory.@*CONCLUSION@#Tragal cartilage is in the operation region, which is convenient to be harvested and shaped. Hence, the donor can satisfy the requirement of general ear surgery and it is suitable for widely application in ear surgery.

Clinical study for nasopharyngeal angiofi-bromas with intracranial or sinus cavernous extension / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the clinical feature and surgical treatment of large nasopharyngeal angiofibromas with intracranial orcavernous sinus extension.METHODS A total of 16 male patients were collected with a age ranged from 11 to 35 years(mean,17.21 years).All patients underwent resection of nasopharyngeal angiofibromas with intracranial or cavernous sinus extension.The procedure included lateral rhinotomy,craniofacial combined approach,median labiomandibulotomy combined with a trans-palatal,transmaxillary approach and middle face degloving approach.RESULTS Sixteen cases received 28 procedures.Seven patients had no recurrence but 9 patients had recurrence at least once.Twenty eight procedures include 11 times lateral rhinotomy,6 times craniofacial combined approach,2 times frontotemporal approach,4 times transpalatal approach,2 transmaxillary approach,1 median labiomandibulotomy combined with a trans-palatal and 2 times middle face degloving approaches.CONCLUSION Radical operative resection is the main treatment method for nasopharyngeal angiofibroma with intracranial or cavernous sinus extension.The first operation recurrence rate is 8/15(53.0%) and sphenoid tumor residual may often be ignored in the operation and it is the main site of tumor recurrence.Craniofacial,median labiomandibulotomy combined with a trans-palatal and middle face degloving approaches were the best choices for large nasopharyngeal angio fi broma with intracranial or cavernous sinus extension.

Dynamic monitoring of neural tube defects in China during 1996 to 2000 / 中华预防医学杂志

<p><b>OBJECTIVE</b>The database from Chinese Birth Defects Monitoring Network was used to describe the epidemiological features and secular trends of neural tube defects (NTDs) prevalence during Jan. 1996 to Dec. 2000, including anencephaly, spina bifida and encephalocele.</p><p><b>METHODS</b>Data were collected with hospital-based cluster sampling method. During the period, all live or still births with 28 weeks or more of gestation were assessed within seven days after delivery.</p><p><b>RESULTS</b>There were 2 873 case with NTDs identified from 2 281 616 births, with an overall prevalence rate of 12.95 per 10,000 births. And, the prevalence rates of anencephaly, spina bifida and encephalocele were 5.02 per 10,000, 6.30 per 10,000 and 1.64 per 10,000, respectively. Significant falls in overall prevalence rates of NTDs and of anencephaly were observed. The prevalence rates of NTDs were 9.75 per 10,000 and 15.96 per 10,000 in male and female births, respectively, 7.76 per 10,000 and 25.20 per 10,000 in the urban and rural areas, respectively, and 19.90 per 10,000 and 5.81 per 10,000 in north and south China, respectively. The prevalence was higher in the groups with maternal age of less than 20 years and more than 30 years than in those other maternal ages. Preterm babies and babies with low birth weight accounted for 50.9% and 50.6% of perinatal babies with NTDs, respectively, with a perinatal mortality of 77.8%.</p><p><b>CONCLUSIONS</b>In China, the occurrence of NTDs was higher in female births than in male births, higher in the rural than in the urban, and higher in the north than in the south. Annual prevalence rate of NTDs in China presented a declining trend, but still higher than that in the other countries at the same time period. Babies with NTDs were in poor birth quality, higher perinatal mortality and poor prognosis. Effective preventive measures and prenatal diagnosis should be strengthened to reduce the occurrences of neural tube defects.</p>