Objective To analyze the cost-effectiveness of integrated pharmaceutical care (IPC) in community-based patients with chronic obstructive pulmonary disease (COPD).Methods The COPD patients were divided randomly into intervention group (group A,n =79) and control group (group B,n =71).Group A received the IPC intervention measures,including serial lectures of pharmaceutical knowledge,home supervision and web-based communications for while group B group had none.Results As compared with group B,group A obviously improved on the knowledge of pharmaceutical treatment effect and side effect (95.1％,67.4％ vs.63.1％,21.9％,x2 =12.445,P=0.000 vs.x2 =55.557,P=0.000).There were notable differences between two groups [ ( 1.77 ± 1.23 ) vs.( 2.42 ± 1.66 ) s,t =2.583,P=0.011],pulmonary rales [ (0.01 vs.0.01)s,Z =2.370,P=0.018],6-min walk distance (6 MWD) [ (457 ± 67 ) vs.(425 ± 72) m,t =2.760,P =0.007 ],vital capacity ( VC ) [ ( 1.60 ± 0.25 ) vs.( 1.49 ± 0.23 ) L,t =2.718,P =0.007 ) ] andquality-of-life items ( 48 ± 10 vs.52 ± 11,t =2.624,P =0.010) after intervention.Analyze of cost-effectiveness show that groupA was superior to group B [ total effect total cost(TE/TC =764.6/4936,15.49％ )vs.(TE/TC =1509.4/4708),32.06％,x2 =6.183,P ＜ 0.01 ].Conclusion IPC can improve the disease condition and achieve excellent cost-effectiveness for community-based COPD patients.

The paper described the development stages of a hospital performance evaluation scale based on patient experience.An empirical application on 7 856 patients of 26 hospitals in four provinces in the country identified the challenges encountered in the course of its application.These include limits of patients experience,variations on the experience reports incurred by different services experienced by patients,and setting of the patient-inpatient ratio among others.Solutions proposed based on these studies aim at creating a patient experience scale tailored to Chinese patients.

OBJECTIVETo observe the therapeutic angiogenesis effect of naotai recipe (NR) on local ischemia/reperfusion (I/R) injury of rats by observing signaling pathway of hypoxia-inducible factor-lα (HIF-1α) and vascular endothelial growth factor (VEGF).

METHODSTotally 120 Sprague-Dawley (SD) rats were randomly divided into 4 groups, namely, the normal control group (n =12), the sham-operation group (n =12), the I/R model group (n =48), and the NR group (n =48). Cerebral I/R injury models were established using thread suture method. Rats in the I/R model group and the NR group were sub-divided into 4 sub-groups according to the 1st, 3rd, 5th, and 7th I/R day (n =12). The phenomenon of neovasculization was observed by immunofluorescence staining. The protein and mRNA expression levels of HIF-la, VEGF-A, and VEGFR II receptor were detected by RT-PCR.

RESULTSThere were a large amount of labels for neovasculization in the ischemic area of the NR group. Double-immunofluorescence labeling [vWF (red) and BrdU (green)] was observed in the NR group. Compared with the model group, the HIF-1α protein expression was obviously enhanced on the 1 st day of I/R (P <0.01), and the VEGF protein expression started to enhance on the 3rd day in the NR group (P <0.01). The VEGFR protein expression level was the highest in the NR group on the 5th day of I/R (P <0.01). The protein expression of VEGF and HIF-1α started to decrease on the 7th day of I/R.

CONCLUSIONNR could strengthen angiogenesis after I/R by elevating the expression of HIF-lα and activating HIF-lα/VEGF signaling pathway.

Animals ; Brain Ischemia ; metabolism ; Cerebral Infarction ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; metabolism ; Hypoxia-Ischemia, Brain ; metabolism ; Ischemia ; Neovascularization, Pathologic ; Rats, Sprague-Dawley ; Reperfusion Injury ; Signal Transduction ; Vascular Endothelial Growth Factor A ; biosynthesis

Objective To summarize the diagnostic and therapeutic experiences for multiple insulinoma. Methods Clinical data of 34 cKsefl of multiple insulinoma treated in Peking Union Medical College Hospital between 1984 and 2007 were analyzed retrospectively. Results Multiple insulinoma was identified in these 34 cases for 37 instances.Malignant insulinoma was found in 2 cases.Three cases suffered from postoperative recurrent multipie tumors.35.3% cases belonged to MEN1;13.5% cases were of insulinoma combined with islet hyperplasia;43.2% cases had 3 or more than 3 insulinomas;Fifteen cases (40.5%)had had a misdiagnosis.45.2%tumors were smaller than 1 cm in diameter:88.9%multiple insulinonla located at the body and tail of the pancreas.Enucleation of multiple tumors was performed for 48.7 percent of cases. Conclusions Most multiple insulinomas were small,it was difficult for preoperative examination to locate all the tumors therefore.Being on the alert against multiple insulinoma and such measures as careful exploration,intraoperative blood glucose determination.fine needle aspiration biopsy,frozen sections helps to avoid missing multiple imuhnoma.

OBJECTIVETo construct a directional differentiation model from mouse embryonic stem cells into leydig-like cells in vitro.

METHODSMouse ES-D3 cells were transfected with plasmid containing steroidogenic factor 1 (SF-1) gene, then treated with RA and 8Br-cAMP, while the cells transfected with empty plasmid were used as the negative controls. The morphology of leydig-like cells differentiated from ES-D3 cells was observed with light microscopy. The expression levels of StAR, P450scc and 3β-HSD were detected by RT-PCR, Western Blot and fluorescence microscopy analysis in leydig-like cells derived from the ES cells.

RESULTSES-D3 cells were transfected with plasmid containing SF-1 gene successfully, and SF-1 was expressed 24 h after transfection. The SF-1-transfected ES-D3 cells were induced by RA and 8Br-cAMP to differentiate into leydig-like cells. The differentiated cells showed spindle shape with tentacles, which expressed the specific protein marker for leydig cells 3β-HSD1 and P450scc. Meanwhile, in these leydig-like cells, the expression of StAR increased compared with control group. 3β-HSD1, P450scc and StAR were not detected in negative control group.

CONCLUSIONWhen the ES-D3 cells are transfected with SF-1 plasmid and then treated with RA and 8Br-cAMP, the cells are able to differentiate into leydig-like cells, indicating that the model of directional differentiation of ES cells into leydig-like cells has been constructed successfully.

Animals ; Cell Differentiation ; drug effects ; genetics ; Cell Line ; Embryonic Stem Cells ; cytology ; metabolism ; Leydig Cells ; cytology ; metabolism ; Male ; Mice ; Steroidogenic Factor 1 ; genetics ; Transfection

OBJECTIVETo carry out expert survey for traditional Chinese medicine (TCM) syndrome characteristics of different clinical types of coronary artery disease (CAD).

METHODSBy using Delphi method, we carried out two rounds of nationwide expert surveys for modern TCM characteristics of syndrome elements and syndrome types of CAD.

RESULTSBased on expert consensus, qi deficiency, blood stasis, phlegm turbidity, qi deficiency blood stasis, and intermingled phlegm and blood stasis are common TCM syndromes for different clinical types of CAD. Of them, qi stagnation, blood stasis, phlegm turbidity, heat accumulation, cold coagulation, yang deficiency, deficiency of both qi and yang were more often seen in patients with unstable angina than in those with stable angina. Qi deficiency, yin deficiency, and deficiency of both qi and yin were less seen. We could see more excess syndrome and less deficiency syndrome (such as qi deficiency, yin deficiency, etc.) in acute ST-segment elevation myocardial infarction (STEMI) than acute non-ST-segment elevation myocardial infarction (NSTEMI). Qi deficiency, blood stasis, water retention, yang deficiency, phlegm turbidity, yin deficiency, Xin-qi deficiency, and qi deficiency blood stasis induced water retention are the most common TCM syndrome types of CAD heart failure (HF). Blood deficiency, yin deficiency, heat accumulation, deficiency of both Xin and Pi, deficiency of both qi and blood, deficiency of both qi and yin, yin deficiency and fire hyperactivity were more often seen in CAD arrhythmias.

CONCLUSIONSTCM syndrome distributions of different clinical types of CAD have common laws and individual characteristics. Results based on the expert consensus supplied evidence and support for clinical diagnosis and treatment of CAD.

Angina Pectoris ; Angina, Unstable ; China ; Coronary Artery Disease ; diagnosis ; therapy ; Coronary Disease ; diagnosis ; Data Collection ; Heart Failure ; diagnosis ; Humans ; Medicine, Chinese Traditional ; methods ; Qi ; Syndrome ; Yang Deficiency ; diagnosis ; Yin Deficiency ; diagnosis

OBJECTIVETo study the clinical, radiologic and pathologic features of solitary plasmacytoma of spine.

METHODSThe clinical, radiologic and pathologic features, as well as treatment and follow-up data, of 13 solitary plasmacytoma of spine cases were retrieved and analyzed. Immunohistochemical study using EnVision method for LCA, CD19, CD20, CD79a, CD3, CD7, PC, MUM1, CD138, IgG, IgM, kappa, lambda and Ki-67 was carried out.

RESULTSAll the tumours were primarily located in the vertebrae (including 9 cases in thoracic vertebrae and 4 cases in lumbar vertebrae). The male-to-female ratio was 3.3:1. The age of the patients ranged from 42 to 69 years (mean age = 56 years). The commonest symptom was pain in the surrounding regions. The degree of neurologic disturbance mostly depended on the extent of vertebral destruction and structural instability of the spine. Radiologic examination showed mainly osteolytic lesions in vertebrae. Magnetic resonance imaging demonstrated the presence of heterogeneous intensity inside the involved vertebrae (low in T1 weighted and high in T2 weighted images). Histologic examination showed diffuse infiltration by malignant cells. In well-differentiated plasmacytomas, the tumor cells resembled normal plasma cells. In poorly differentiated examples, the cellular morphology mimicked that of the centroblasts. The interstitial stroma was scanty and contained plenty of vessels, sometimes with formation of blood lakes. Amyloid deposition was present in some of the cases. Immunohistochemical study showed that the tumor cells were positive for CD79a and negative for CD20. Light chain restriction was detected in all the 13 cases studied. Plasma cell marker PC was expressed in all cases, while IgG was positive in 5 cases, IgM in 1 case, MUM1 in 10 cases and CD138 in 8 cases. Ki-67 index varied from 10% to 50%. All cases were operated, with adjuvant chemotherapy and radiotherapy given.

CONCLUSIONSCorrelation of clinical, radiologic and pathologic features is important in diagnosis of solitary plasmacytoma of spine. The possibility of multiple myeloma needs to be excluded. Early detection by radiologic examination, local surgical resection, post-operative chemoradiotherapy and long-term follow-up are prudent for successful management of this condition.

Adult ; Aged ; CD79 Antigens ; metabolism ; Chemotherapy, Adjuvant ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; Lymphoma, Large B-Cell, Diffuse ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Plasmacytoma ; diagnosis ; metabolism ; pathology ; surgery ; Radiotherapy, Adjuvant ; Spinal Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Thoracic Vertebrae ; Tomography, X-Ray Computed

OBJECTIVETo assess the reliability and validity of Chinese version of the Abbreviated Burn Specific Health Scale (BSHS-A).

METHODSBSHS-A was translated into Chinese and revised. Eighty-two former burn patients discharged from the Second Affiliated Hospital of Kunming Medical College, and now in rehabilitation stage, were surveyed with the Chinese version of BSHS-A according to the simple random sampling. The psychometric properties of the scale, including internal consistency, test-retest reliability, content validity and discriminant validity, were analyzed.

RESULTSOne hundred and sixty-seven scales were sent to 82 participants and all of them were completed and returned. The rate of eligible questionnaire was 98.2% after eliminating 3 ineligible questionnaires. The Crobach's alpha coefficient of total score of questionnaire was 0.97, and in all domains and sub-domains ranged from 0.83 to 0.96. The test-retest coefficients from 20 participants retested within one week were between 0.74 and 0.98 (P < 0.05 or P < 0.01). Forty-eight participants surveyed within 6 months after burn were divided into mild/moderate burn group and severe burn group. The total scores of questionnaire, scores in all domains and sub-domains of patients in the latter group were lower than those in the former group (P < 0.05 or P < 0.01).

CONCLUSIONSThe Chinese version of BSHS-A shows satisfactory reliability and validity, and it can be used to investigate quality of life of Chinese burn patients in rehabilitation stage.

Adolescent ; Adult ; Burns ; rehabilitation ; Female ; Humans ; Injury Severity Score ; Male ; Quality of Life ; Reproducibility of Results ; Surveys and Questionnaires ; Young Adult

Objective To explore the correlation between induced abortion and reproductive tract infections (RTIs). Methods On the basis of keeping the representation of cities under study,53 652 fertile women aged 15-49 were surveyed by using a stratified-cluster-random sampling.Investigation and gynecological examination were conducted by two steps - firstly converging at the clinics, and then visiting those households for someone who did not show up at the clinics. Results Among all the 32.0% (n=16 800) women ever having experienced the history of induced abortion,21.1%(n= 11 090) of them had one, 7.6%(n=3976) women had two, and 4.1%(n=1734) women had at least three events. 59.0%(n=30 959) women among our studied samples had ever had RTI,with 30.9% ( n = 16 215 ) of them had only one 20.0% (n = 10 494 ) women had two and 8.1% (n =4250) had three or more RTIs. Data from x2 text and ordinal regression analysis revealed that the rural married women who underwent more induced abortions were more likely to suffer from RTIs,especially cervical infection and PID. Conclusion Our study showed that the rates of induced abortion and reproductive tract infections among married women in Anhui province were both high.Women who underwent induced abortions had a higher prevalence rate of reproductive tract infections.

Objective To explore the approach in relieving intestinal tympanites in severe hepatitis and cirrhosis patients. Methods The reformed 8# anal tube was linked to a simple negative pressure aspirator to carry out negative pressure blind enema. Abdomen massage was conducted at the same time. The effects 15 minutes and 30 minutes after the therapy were compared between the hepatitis group and the liver cirrhosis group. Results There were good effects in the two groups. But there was no obviously significant meaning in each index for the two groups treated for 15 minutes and 30 minutes. Conclusions Negative pressure rectal tube suction in combination with abdomen massage could effectively relieve intestinal tympanites in severe hepatitis and cirrhosis pateints. The therapy generally takes effect after 15 minutes of treatment.