Objective:To Study the equity of Chinese health systems performance and provide evidence for strengthening health system.Methods:Based on WHO health systems performance evaluation framework,the provincial data of expanded pilots under the national health service investigation and relative concentration index (RCI) were used to study the inequality of Chinese health systems performance from regions,income and education,etc.Results:The RCI values were lower than 0.1 on health status and satisfaction dimensions.The RCI of financial risks protection was higher than 0.2,which was at a respective higher level.Conclusion:The health performance of people with lower education and wealth were fragility and these people usually with health shocks.Therefore,the national and regional government should pay more attention on vulnerable group and provide more healthcare management and security support.

Objective:To produce the mcAb specifically reacting with lung cancer and to purificate its antigen.Methods:The mice were immunized with A549, the mcAb 2B9 was screened by indirect cell ELISA and immunohistochemistry, and its antigen was purificated by immunoaffinity chromatography.Results:A mcAb was obtained, which could react to lung cancer but very little or not to normal lung tissue and other caner tissues, and the antigen of the mcAb was purificated from the cell lysate.Conclusion:A mcAb which can react to lung cancer have been obtained and its antigen was purificated, they may be useful on clinic for diagnosis and prognosis of lung cancer.

Objective To explore the efficiency of arterial perfusion chemotherapy combined with embolization for the treatment of giant carcinoma of the kidney. Methods Arterial perfusion chemotherapy combined with embolization was performed through the renal artery in 21 cases of giant carcinoma of the kidney from April 1992 to April 2006. The chemotherapeutic agents contained carboplatin(300 mg), mitomycin(20 mg) and cyclophosphamide(800 mg). The embolization was conducted with anhydrous alcohol, sodium morrhuate, and lipiodol plus gelatin sponge. Results The arterial perfusion with embolization was successfully obtained in all 21 cases. Surgical resection was accomplished in 15 cases, 1 - 8 weeks after the embolization; revealing severely less or no blood supply to the tumor. Pathological findings showed marked necrosis of tumor cells with peripheral inflammatory infiltration, fibrous proliferation as well as capillary embolization. The survival rates at 1-, 2-, and 3-, year were 80%(12/15), 53.33%(8/15) and 40%(6/15) respectively. Conclusions Combination of perfusion chemotherapy and embolization through the renal artery for the treatment of giant carcinoma of the kidney offers promising clinical effects.

Objective To construct the performance evaluation framework for China′s health system,and provide evidences for enhancement of such evaluation and the health system.Methods Literature review and empirical research were combined with expert consultation to construct such an evaluation index system.Results In view of both international experiences and China′s specifics,an evaluation index system is built based on the generalized concept model of the health system,consisting of 4 class-1 indicators, 1 5 class-2 indicators and 6 9 class-3 indicators.Conclusions The generalized framework of health system performance evaluation fits such evaluation in China,and indicator optimization and understanding of the shortcomings with cautious explanation are of critical importance.This evaluation remains in its infancy in China,and there is a long way to go before a health system performance evaluation system can be built in China.

The mammalian cell nucleus is highly structured and organized into various membrane-less nuclear compartments called nuclear bodies. Nuclear bodies are highly dynamic structures, with a variety of substances gathered inside to promote the more efficient conduct of certain biological reactions. It dynamically produces responses under different biological processes and stress conditions such as tumorigenesis, apoptosis, antiviral defense, and plays an important role in regulating cell homeostasis. Tumor is a major public health problem, and finding new targets is the key to tumor therapy. How the nuclear bodies are involved in the development of tumor has not been reported. This review aims to provide a new understanding of how the nuclear bodies regulates tumor progression and provide a new effective strategy for tumor prevention and treatment.

ObjectiveTo investigate the managements of complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).MethodsData of 119 EA patients who underwent POEM from October 2010 to July 2011 were collected.Complications during and after POEM and during follow-up were analyzed.Results Complications during operation included bleeding in 19 patients ( 16.0％ ),mucosa rupture in 9 (7.6％),mediastinal and subcutaneous emphysema in 27 (22.7％ ) and pneumothorax in 3 (2.5％ ).Complications occurred at the night of procedure included pain in 43 (36.1％ ) patients and pneumothorax in 7 ( 5.9％ ).Postoperative complications included asymptomatic pneumothorax in 23 patients (19.3％),delayed hemorrhage in 1(0.8％),pleural effusion in 58 (48.7％ ),minor pulmonary inflammation or segmental atelectasis in 59 (49.6％),emphysema of mediasti-na and subcutaneous tissue in 76 (63.9％ ),and gas under diaphragm or aeroperitoneum in 47 (39.5％ ).Complications during follow-up included one case of dysphagia caused by stricture of mucosa and one case of dehiscence at the tunnel entry with food retention.No POEM-correlated death occurred.All the complications were cured by conservative treatments.No additional surgery was needed.ConclusionMain complications as emphysema of mediastina and subcutaneous tissue,pneumothorax,aeroperitoneum and bleeding during and after POEM can be treated timely and effectively with conservative treatment.

Objective To analyze the risk factors for postoperative stricture after endoscopic submucosal dissection (ESD) for early stage esophageal cancer.Methods The data of 362 patients with early esophageal cancer treated by ESD from January 2007 to February 2012 were reviewed to investigate the risk factors of postoperative stricture.Results Esophageal stricture after ESD occurred in 42 patients (11.6％)with a mean time from ESD to stricture of (58.5 ± 12.3) days.The rates of mild,median and severe stricture were 16.7％ (7/42),38.1％ (16/42) and 45.2％ (19/42),respectively.Multivariate analysis revealed that lesion range ＞ 3/4 esophageal circumference (odds ration [OR]:44.2 ; 95％ confidence interval [CI]:4.4-443.6) and tumor invasion beyond m2 (OR:14.2; 95 ％ CI:2.7-74.2) were independent risk factors.Stricture level was related to lesion's circumferential extension (relational coefficient (φ) =0.47,P ＜ 0.05) and tumor invasion depth (relational coefficient (φ) =0.647,P ＜ 0.05).Conclusion Circumferential extension and invasion depth of early esophageal cancer were independent risk factors for post-ESD esophageal stricture and related with the degree of stricture.

ObjectiveTo evaluate the performance of computer-aided detection (CAD) system for detection of pulmonary nodules in 64-slice low-dose CT screening and to investigate whether CAD can improve the performance of radiologists in detecting pulmonary nodules.MethodsOne hundred low-dose screening CT examinations were randomly selected from the database containing 578 consecutive cases between Jun 2007 and Jun 2008.All the examinations were performed on a 64-MSCT scanner with the exposure of 120 kVp,30 or 40 mA,or automatic exposure control.Before the study started,the screening reports had been made with double reading by two radiologists.All the selected images were analyzed with the lung VCAR software from GE Healthcare with a nodule diameter threshold 3.0 mm.All discrepancies between the screening reports and the CAD results were reviewed and the true non-calcified nodules were determined in consensus by two experienced chest radiologists.Detected nodules were classified by density,size and location.The performance of the double reading and the CAD system were compared and analyzed statistically.McNemar-Bowker test was used for the statistical analysis.ResultsA total of 257 true noncalcified nodules were determined in all 100 low-dose screening CT examinations.The detection rate of CAD system was 91.1％ (234/257),with the missed rate of 8.9％ (23/257).Twenty three nodules were missed by CAD,in which 10 were solid with the diameter ranged from 2.4 to 6.0 mm,and 13 were nonsolid with the diameter ranged from 2.1 to 8.6 mm.Of the 23 nodules,17 were located in the outer zones of lungs and 6 in the inner zones.The double reading showed a detection rate of 59.1％ ( 152/257 )and a missed rate of 40.9％ ( 105/257),which was significantly lower than CAD.The diameter of all the 105 missed nodules by radiologists were ranged from 2.4 to 11.8 mm,in which 94 nodules were solid,10 were partly solid and 1 was nonsolid,with 69 located in outer zones of lungs and 36 in the inner zones. Conclusions The capability of the CAD system for detecting non-calcified pulmonary nodules is superior to double reading in low-dose screening CT examination,especially for the nodules located in the inner zone of the lung.When lung VCAR is used,nonsolid pulmonary nodules are more easily missed so that it should be paid more attentions by radiologists.

ObjectiveTo evaluate a second endoscopy for prevention of delayed bleeding after ESD.MethodsData of 67 patients with gastric epithelial neoplasms undergoing ESD from May to November 2011 were reviewed.The median age was 63 ( 31 ～ 84) years.All patients were followed up by endoscopy on the first and the third day after ESD.ResultsOf 67 lesions,5 were located at cardia,6 at gastric body,3 at fundus,35 at antrum,16 at gastric angle,and 2 at residual stomach.The mean maximum diameter of the lesions was 3.73±4 1.24 (2.0 ～ 7.0) cm.There were no intraoperative complications.Post-ESD delayed bleeding was detected by endoscopy in 6 (9.0％ ) patients,with 5 on the third day and 1 on the fourth day.Forrest grading showed 2 cases of Ⅰ b,and 4 of Ⅱ b.All 6 cases were cured by endoscopy.The incidence of postoperative bleeding was far more than that evaluated based on the patients' clinical manifestations only.But therapeutic effect and saffety were the same according to the follow-up results.ConclusionIncidence of post-ESD bleeding is high,but there are no symptoms or severe consequences,so a second endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding.

Objective To explore the clinical value of endoscopic treatment by summarizing the experience of endoscopic treatment of duodenal submucosal tumor (SMT).Methods The data of SMT patients with endoscopic treatment from May 2006 to May 2011 at Endoscopy Center of Zhongshan Hospital Fudan University were studied retrospectively,including the lesions characters,the procedure of performance,complications and recurrence after the treatment.Results A total of 67patients received 69 times of endoscopic treatment,including 36 males and 31 females.The median agewas 55 years,and the average maximum diameter of the lesions was (1.34±0.50) cm.Of these 69lesions,38 lesions located at the bulb,12 at the ball and descending junction,and 19 at the descending part.All lesions were treated by endoscopic treatment successfully.Eleven leisions were treated by polypectomy,12 by endoscopic mucosal resection (EMR),45 by endoscopic submucosal dissection (ESD) and 1 by nylon rope.Complication rate was 14.5％ (10/69),including 1 case of active bleeding,2 cases of perforation,3 cases of delayed bleeding,3 cases of transient increase in amylase level and 1 case of delayed perforation.Total 67 cases were with pathological diagnosis,and brunner′s glands adenoma (36 cases) was the most common.Sixty patients in all were followed up,and the median follow-up time was 13 months.After ESD,one carciniod case was indicated tumor cells in vascular by the pathologic diagnosis and then received extended resection.One case of brunner′s glands adenoma recurred 1 year after EMR and improved after ESD.Conclusion Endoscopic treatment is safe,minimally invasive and effective,which may be used of duodenal SMT.