Based on the ongoing health reform and Wenzhou's economic and social developments,this article made a complete analysis on the policy packages initiated by Wenzhou government in August 2012,in an effort to encourage and involve private capital to launch medical institutions.These policies and measures released take into account the policy and legal environment for private capital in medical sector in China,and target the demands of deepening health reform and shortage of health development funding.Such efforts of Wenzhou are designed as breakthroughs in terms of market access,doctors mobility,return on investment,health insurance and fiscal policy.

Objective:To investigate the heterogeneity of epitopes recognized by anti-GBM autoantibodies in sera from a large cohort of Chinese patients with anti-GBM disease and its clinical significance.Methods: The present study included 108 patients with anti-GBM disease who were diagnosed in our hospital, between Jan 1991 and May 2009, with complete clinical and renal pathological data. Sera or plasma exchange of the patients were used to incubate with cryostat section of normal human renal tissue for indirect immunofluorescence (IIF) assay. The cryostat sections of normal renal tissue were pre-treated by 6 mol/L urea to unmask cryptic epitopes, and untreated cryostat sections were used to detect natural exposed epitopes. The sera were diluted from 1:2 to 1:512 to determine titers of anti-GBM autoantibodies Patients with anti-GBM autoantibodies against cryptic or exposed epitopes were further stratified;their clinical and pathological associations were analyzed. Results: Sera from all the 108 patients could recognize cryptic epitopes on normal renal tissue ( urea treated section). IIF showed IgG linear staining along GBM. However, sera from 56/108 patients (group A) could also recognize exposed epitopes on normal renal tissue (untreated section) ; sera from the rest 52/108 patients (group B) could not recognize exposed epitopes. In urea treated condition, the average titer of anti-GBM autoantibodies from sera of patients in group A was significantly higher than that in group B (P＜0.01) , ANCA-positive patients in group A were significant less than that in group B (P＜0.01) . There was no significant difference between the two groups in regard to other clinical data (including serum creatinine) and renal histopathologic data. Conclusion: Anti-GBM autoantibodies from some patients with anti-GBM disease could recognize natural exposed epitopes, however, their anti-GBM titer for cryptic epitopes was higher than that of those recognizing cryptic epitopes only and the prevalence of serum ANCA was significantly less.

OBJECTIVETo retrospective analyze the short- and long-term therapeutic effect of TCM treatment based on syndrome differentiation on bradyarrhythmia.

METHODSData of 116 patients with bradyarrhythmia treated by TCM based on syndrome differentiation from 1995 to 2005 were collected. The changes of clinical symptoms and their outcomes as well as the 24h-dynamic cardiogram were evaluated. And a 1-5 years follow-up study was conducted to survey the heart rhythm, heart rate, drugs applied and artificial cardiac pacemaker (ACP) installation in the patients.

RESULTSAfter 3 months' treatment, the total effective rate was 91.4%. During the 1-5 years of follow-up, except 6 patients received ACP installation, all the others were alive in stable condition, and no obvious side effect was found.

CONCLUSIONTCM treatment based on syndrome differentiation has reliable and stable therapeutic effects on bradyarrhythmia.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bradycardia ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Retrospective Studies

This cross-sectional, non-interventional, observational study evaluated depression in patients in China who presented to a general neurologist with chronic, medically unexplained, painful physical symptoms. Of the 402 patients enrolled, 197 patients (49.0%) met the criteria for a current major depressive episode (MDE+ group), as assessed using module A of the Mini International Neuropsychiatric Interview, and 205 patients (51.0%) did not (MDE- group). The mean pain severity visual analogue scale (VAS) score was signifi cantly higher in the MDE+ group than the MDE- group (65.3 vs 55.6 mm; p<0.001). The mean depression severity score, as assessed using the 9-item Patient Health Questionnaire (PHQ-9), was 8.4 units (95% CI: 7.3 to 9.5) higher in the MDE+ group than the MDE- group (mean PHQ-9 total score: 14.8 vs 6.4). Anxiety and perceived health state were signifi cantly worse, on average, in the MDE+ group (mean Hospital Anxiety and Depression Scale anxiety subscale score 10.7 vs 5.9 units; mean EuroQoL-5 Dimensions VAS score 56.4 vs 67.7 mm; each p<0.001). Only 14.2% of patients had received treatment for depression during the past 3 months. These results suggest depression was common and may have been under-treated in this group of Chinese patients with chronic, medically unexplained painful physical symptoms.

Background:The role of local treatment in oligometastatic prostate cancer (PCa) is gaining interest with the oligometastases hypothesis proposed and the improvement of various surgical methods and techniques.This study aimed to compare the short-term therapeutic outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP) for oligometastatic prostate cancer (OPC) vs.localized PCa using propensity score matching.Methods:Totally 508 consecutive patients underwent RALP as a first-line treatment.The patients were divided into two groups according to oligometastatic state:the OPC group (n =41) or the localized PCa group (n =467).Oligometastatic disease was defined as the presence of two or fewer suspicious lesions.The association between the oligometastatic state and therapeutic outcomes of RALP was evaluated,including biochemical recurrence (BCR) and overall survival (OS).A Cox proportional hazards model was used to assess the possible risk factors for BCR.Results:Totally 41 pairs of patients were matched.The median operative time,the median blood loss,the overall positive surgical margin rate,the median post-operative hospital stays,and the post-operative urinary continence recovery rate between the two groups showed no statistical significance.The 4-year BCR survival rates of the OPC group and localized PCa group were 56.7％ and 60.8％,respectively,without a significant difference (P=0.804).The 5-year OS rates were 96.3％ and 100％,respectively (P =0.326).Additionally,the results of Cox regression showed that oligometastatic state was not an independent risk factor for BCR (P =0.682).Conclusions:Our findings supported the safety and effectiveness of RALP in OPC.Additionally,oligometastatic state and sites did not have an adverse effect on BCR independently.

The objective of this study was to explore the protective effects of human bone marrow mesenchymal stem cells (MSC) on hematopoietic organs of irradiated mice. Human bone marrow MSC were isolated, ex vivo expanded, and identified by cell biological tests. Female BALB/c mice were irradiated with (60)Co γ-ray at a single dose of 6 Gy, and received different doses of human MSC and MSC lysates or saline via tail veins. The survival of mice was record daily, and the femurs and spleens were harvested on day 9 and 16 for pathologic examination. The histological changes were observed and the cellularity was scored. The results showed that the estimated survival time of MSC- and MSC lysate-treated mice was comparable to that of controls. The hematopoiesis in the bone marrow of mice that received high-dose (5×10(6)) of MSC or MSC lysates was partially restored on day 9 and the capacity of hemopoietic tissue and cellularity scorings were significantly elevated as compared with that of controls (P < 0.05). Proliferative nudes were also obviously observed in the spleens of mice that received high-dose of MSC or MSC lysates on d 9 after irradiation. The histological structures of the spleen and bone marrow of the mice that received high-doses (5×10(6)) of MSC or MSC lysates were restored to normal, the cell proliferation displayed extraordinarily active. Further, the cellularity scores of the bone marrow were not significantly different between the high-dose MSC and MSC lysate-treated mice. It is concluded that the bone marrow MSC can promote the hematopoietic recovery of the irradiated mice, which probably is associated with the bioactive materials inherently existed in bone marrow cells.
Animals ; Bone Marrow Cells ; cytology ; Female ; Hematopoiesis ; Humans ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; cytology ; Mice ; Mice, Inbred BALB C ; Radiation Injuries, Experimental ; surgery ; Transplantation, Heterologous

OBJECTIVETo evaluate the safety and efficacy of individual cylindrical abdominoperineal resection (CAPR) for locally advanced low rectal cancer.

METHODSFrom June 2011 to February 2012, 11 patients with locally advanced low rectal cancer underwent individual CAPR. There were 7 male and 4 female patients, aged from 32 to 74 years with a median of 64 years. Forty-seven patients underwent classic CAPR from January 2008 to February 2012. Preoperative and postoperative parameters such as clinical information of patients, tissue morphometry and complications were compared.

RESULTSIn the individual surgical group, 6 patients were treated with one side levator ani muscle totally or partially reserved, 3 patients with sacrococcyx reserved, and 2 patients with dissection close to the anterior rectal wall. Compared with classical surgery, the individual surgical specimens of horizontal section area ((2197 ± 501) mm(2)) and intrinsic muscle layer outer area ((1722 ± 414) mm(2)) were small, but the difference was not statistically significant (P = 0.150 and 0.167). The operative time, intraoperative blood loss, circumferential resection margin, total cross sectional tissue area, cross sectional tissue area outside the muscularis propria and bowel perforation rate between the two groups were not significantly different. Individual CAPR showed less incidence of chronic perineal pain (2/11, χ(2) = 6.116, P = 0.013) and sexual dysfunction (2/9, χ(2) = 4.412, P = 0.036) compared with classic CAPR.

CONCLUSIONSIndividual CAPR has the potential to reduce the risk of chronic perineal pain and sexual dysfunction without influencing the radical effect when compare with classic CAPR for the treatment of low rectal cancer.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Perineum ; surgery ; Postoperative Complications ; epidemiology ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVETo fabricate a new composite scaffold material as an implant for sustained delivery of rifampicin and evaluate its performance of sustained drug release and biocompatibility.

METHODSThe composite scaffold material was prepared by loading poly(lactic-co-glycolic) acid (PLGA) microspheres that encapsulated rifampicin in a biphasic calcium composite material with a negative surface charge. The in vitro drug release characteristics of the microspheres and the composite scaffold material were evaluated; the in vivo drug release profile of the composite scaffold material implanted in a rat muscle pouch was evaluated using high-performance liquid chromatography. The biochemical parameters of the serum and liver histopathologies of the rats receiving the transplantation were observed to assess the biocompatibility of the composite scaffold material.

RESULTSThe encapsulation efficiency and drug loading efficiency of microspheres were (56.05±5.33)% and (29.80±2.88)%, respectively. The cumulative drug release rate of the microspheres in vitro was (94.19±5.4)% at 28 days, as compared with the rate of (82.23±6.28)% of composite scaffold material. The drug-loaded composite scaffold material showed a good performance of in vivo drug release in rats, and the local drug concentration still reached 16.18±0.35 µg/g at 28 days after implantation. Implantation of the composite scaffold material resulted in transient and reversible liver injury, which was fully reparred at 28 days after the implantation.

CONCLUSIONThe composite scaffold material possesses a good sustained drug release capacity and a good biocompatibility, and can serve as an alternative approach to conventional antituberculous chemotherapy.

Animals ; Biocompatible Materials ; chemistry ; Delayed-Action Preparations ; Drug Carriers ; chemistry ; Drug Liberation ; Lactic Acid ; chemistry ; Microspheres ; Polyglycolic Acid ; chemistry ; Rats ; Rifampin ; administration & dosage

Objective To understand the status of healthcare-associated infection(HAI)management in traditional Chinese medicine hospitals as well as integrated traditional Chinese and Western medicine hospitals in Fujian Pro-vince,analyze the existing problems and weak links,and put forward corresponding improvement measures.Methods A questionnaire was designed through literature and expert consultation,from March to April 2016,42 secondary and above traditional Chinese medicine hospitals as well as integrated traditional Chinese and Western medicine hos-pitals in 8 cities of Fujian Province were conducted on-site investigation,data were analyzed.Results A total of 42 hospitals participated in the investigation,92.86% were traditional Chinese medicine hospitals,7.14% were inte-grated traditional Chinese and Western medicine hospitals;all hospitals set up HAI management committees and HAI management groups of clinical departments,there were 100 HAI management professionals(66 were full-time,34 were part-time),nursing staff accounted for 63.00%,junior college and undergraduate personnel accoun-ted for 84.00%,staff with intermediate and senior professional titles accounted for 79.00%.There were significant differences in academic disciplines and education levels among administrators in secondary and tertiary hospitals(P<0.05). All hospitals carried out HAI case surveillance,only 2.38% achieved HAI informational software monito-ring,83.33% carried out comprehensive and targeted monitoring,42.86%,71.43%,and 80.95% of hospitals car-ried out targeted monitoring on multidrug-resistant organisms,surgical site infection,and intensive care unit respec-tively.Conclusion The environment of majority of Chinese medicine hospitals in Fujian Province improved signifi-cantly,organizations of HAI management is rational,staffing and quality of HAI management personnel is imbal-anced,HAI monitoring is still at preliminary stage,lack information management,HAI management in key depart-ments is not optimistic.

OBJECTIVE: To assess the clinical efficacy of Tri-Lock bio-short prosthesis in artificial total hip arthroplasty(THA) in young patients with Dorr type C femoral medullary cavity. METHODS: From January 2010 to January 2014, 35 young patients(37 hips) with in the chimney-like femoral medullary cavity received Tri-Lock BPS prosthesis of THA, including 18 males(20 hips) and 17 females with an average age of (32.2±3.0) years old ranging from 21.2 to 38.5 years old. There were 16 cases of rheumatoid hip arthritis (17 hips), 8 cases of rheumatoid arthritis (9 hips), and 11 cases of aseptic necrosis of femoral head (11 hips). All cases were complicated with different degrees of osteoporosis. According to Singh index, 26 cases were classified as Grade III and 9 cases as Grade II. Biological prostheses were used for the acetabulum, with ceramic lining and full ceramic femoral head. The proximal femoral medullary cavity was Dorr type C on anteroposterior X-ray. After replacement, X-ray examination was performed to locate the prosthesis stem. Engh and Harris criteria were used to evaluate the stability of bone-prosthesis interface and hip function, respectively. Changes of hip movement pre-operation and at last follow-up were compared. RESULTS: All patients were followed up for 18 to 45 months(means 33.8 months). Harris hip scores in 35 cases (37 hips) increased significantly from preoperative 61.8±3.0 (51.2 to 73.5) to 93.3±6.5 (92.5 to 98.8) points at last follow-up (=54.745, <0.01). The hip mobility increased from (46.5±8.0)°(0° to 55°) before surgery to(101.2±10.5)°(85° to 130°) at the last follow-up, the difference was statistically significant(=133.091, <0.01). Immediately after surgery, the prostheses were tightly packed with the medullary cavity. At the final follow-up, 17 hips had significant femur cortical bone thickening;12 hips had varying degrees of stress occlusal bone resorption at proximal femoral, including 9 degree I(low femur density, round and blunt) and 3 degree II(involving small rotor) hips. Meanwhile, 15 hips had significant femur cortical bone thickening without thigh pain. CONCLUSIONS The cone-shaped short Tri-lock biological short-stem can fill Dorr C chimney-like medullary cavity and effectively retain good proximal femoral bone mass. Titanium microporous coating on the surface can effectively increase the friction of the prosthesis. The short-stem end in the medullary cavity can effectively avoid the occurrence of coxa varus.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Female ; Femur ; Femur Head ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Treatment Outcome ; Young Adult