Objective: The aim of this paper is to identify the basic organizational structure and the key elements of integrated healthcare model of patients with Chronic Obstructive Pulmonary Disease (COPD) and propose an appropriate development strategy.Methods: Based on the literature review of research articles about integrated care on patients with COPD, an analysis was conducted with the help of the Chronic Care Model (CCM) which is a chronic disease management model.Results: From of a total 16 articles about 13 case studies were found.An integrated healthcare of COPD was carried out in 10 hospital-based or community-based care programs.Most of the patients were the elderly and health status were moderately severe or more severe.The components of healthcare programs varied from 4 to 12 included at least two CCM dimension.A coordinator or a case manager was appointed in all healthcare programs and a follow-up plan was made as well.Decision making was supported by clinic guideline and specialist resource in 9 integrated healthcare programs which community facilities involved.All programs included self-management with health education and individualized behavioral support was in 10 programs.The action plan was applied in 8 studies.8 studies using a clinical information system connected health care provider and patients.Conclusions: COPD integrated care program can be constructed according to the management model of chronic disease, and it is suggested that we can organize the COPD integrated care program based on CCM and the program comprises 4 organizational components of at least two CCM dimensions.The key elements of COPD integrated healthcare are to appoint a coordinator, to make a follow-up plan, and the necessity of community participation to support decision making, support self-management by education and individualized behavioral management with an action plan.

Objective To investigate Th1/Th2 pattern of response in psoriasis and to study the effects of CTLA4Ig on Th1/Th2 shift in psoriasis. Methods The levels of IL-2, IFN-?and IL-4 were assessed by ELISA in the supernatant of cultured peripheral blood mononuclear cells (PBMCs) from 33 patients with psoriasis vulgaris and 20 healthy blood donors. Cytokine synthesis was induced by activation with phytohemagglutinin (PHA) and staphylococcal enterotoxin B (SEB) with or without CTLA4Ig. Results Levels of IL-2, IFN-?and IL-4 were markedly increased by PBMCs from psoriatic patients incubated with SEB (P

Objective To investigate the status of expression and gene polymorphism of cytotoxic T lymphocyte-associated molecule4(CTLA4)on peripheral blood mononuclear cells(PBMCs)from patients with psoriasis.Methods Expression of CTLA4mRNA/antigen and polymorphism of CTLA4gene were analyzed in33and133patients with psoriasis confirmed clinically and/or pathologically,respectively.Expression of CT-LA4mRNA and antigen was detected by in situ hybridization and immmunohistochemistry.CTLA4exon1and3'untranslated region were amplified by polymerase chain reaction(PCR)and the amplified products were identified by single-stand conformation polymorphism(SSCP),restriction fragment length polymorphism(RFLP)or sequencing.Results Expression of both mRNA and antigen of CTLA4was significantly weaker on PBMCs induced by staphytococcal enterotoxin B(SEB)in patients with psoriasis than that in normal con-trols,without a regular pattern.The guanine49on exon1in association with fragment106bp of3'untranslat-ed region was shown to be linked to the susceptibility of psoriasis.Conclusion Defective translation and ex-pression of CTLA4take place in patients with psoriasis,which is possibly related to the polymorphism of CT-LA4.Our results suggest that CTLA4may be one of the candidate genes which cause autoimmunity in psoria-sis.

Objective To study the X-ray signs of forearm and leg in skeletal fluorosis and its diagnostic value,aim at finding the easy examination parts.Methods One thousand four hundred and forty subjects were examined using developed shield,darkroom and other portable dedicated device combined with a small X-ray machine.A total of 384 cases were diagnosed skeletal fluorosis.All patients were divided into different groups and the time,degree and range of X-ray to the forearm and calf elbow,knee,and long bone were compared.Results The X-ray change in the forearm elbow was earlier than that of the leg knee,and trabecular bone change was the earliest indicator,197 cases and 157 cases,respectively,and the difference was statistically significant (x2 =28.006,P ＜ 0.01).Membrane ossification of forearm backbone was earlier than that of the leg,and most of them were degree Ⅰ photos,213 cases and 126 cases respectively.The difference was statistically significant (x2 =17.626,P ＜ 0.01).The direction of the interosseous membrane ossification was from the forearm radius to the ulna,then to the fibula and tibia,and was accompanied by changes in the aggravation of forearm.A variety of indicators were observed,especially the membrane ossification in bone and joint trabecular bone and the long bone was the most active,and the forearm was more sensitive,obviously than that of the calf.Conclusion In the X-ray screening or detection of endemic fluorosis,the forearm radiography is a simple,economical,and effective diagnostic method.

Objective - - To analyze the prevalence and influencing factors of multi site work related musculoskeletal disorders （ ） Methods WMSDs in surgeons. A total of 102 surgeons from four hospitals were selected as study subjects by convenient sampling method. The Chinese version of Musculoskeletal Disorders Questionnaire was used to investigate the prevalence of ， Results WMSDs in the past one year the related individuals and occupational factors. The total prevalence of WMSDs among （ ）， （ ） （ ） surgeons was 54.9%. The top three sites were neck 48.0% lower back 35.3% and shoulder 32.4% . The prevalence of （ vs ，P ） WMSDs in multiple sites was higher than that in a single site 43.1% 11.8% <0.01 . Multivariate logistic regression ， ， analysis showed that surgeons who smoked were tired at work and had a bent back had a higher risk of developing WMSDs ［ （ - ）， （ - ）， （ - ）， P ］ odds ratios and 95% confidence intervals were 3.66 1.41 9.46 8.33 2.15 32.20 and 18.74 2.14 166.77 all <0.01 Conclusion - after excluding the influence of confounding factors. The prevalence rate of multi site WMSDs among surgeons is ， high and the influencing factors include bad living habits and occupational factors such as working load and working posture.

The study introduced the general evaluation indicator system for community health services in Shanghai and its characteristics,analyzing the results of the comprehensive evaluation from the aspects of regions and institutions.From six aspects of financial input,human resource construction, operation mechanism,family doctor system,information system construction and the application of the comprehensive evaluation results,the paper recommended on deepening the reform of community health services.

OBJECTIVETo investigate the treatment of postoperative chyle leak after surgery for digestive malignancies.

METHODSFrom December 2008 to February 2012, in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, clinical data of 19 patients with chyle leak after digestive system cancer surgery were retrospective analyzed.

RESULTSNineteen cases of chyle leak were all identified between the second and the fourth postoperative day and were all initially managed with conservative treatment including early fasting, parenteral nutrition(PN), 24-hour continuous infusion of somatostatin, and low pressure suction drainage. Eight patients were treated successfully for 6 to 10 days with a significant reduction of the daily drainage volume. Ten patients had enteral nutrition(EN) and their drain tubes were repeatedly washed with 30 ml of compound meglumine diatrizoate injection every day until the drainage volume decreased to 200 ml/day. The time to resolution of chyle leak in these ten patients ranged from 12 to 24 days. One patient had no significant decrease in fluid drainage and developed abdominal distension after one week of conservative treatment. Surgical closure of chyle leak was performed on the 11th postoperative day, abdominal cavity drainage tube was removed on the 4th postoperative day. The patient was discharged home in good condition.

CONCLUSIONMost postoperative chyle leak after surgery for digestive malignancies can be successfully managed with conservative treatment. Somatostatin and the drainage are the main therapeutic approaches. When chyle leak is not resolved with conservative treatment, surgical treatment should be considered to prevent serious complications.

Adult ; Aged ; Anastomotic Leak ; therapy ; Chyle ; Digestive System Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies

BACKGROUND:The mechanism underlying Wal erian degeneration fol owing peripheral nerve injury is complex. Immune regulation on Wal erian degeneration is beneficial for early repair of perpheral nerve injury.
OBJECTIVE:To investigate the effects of Tol-like receptor 4 (TLR4) antagonist on Wal erian degeneration and axonal regeneration after early peripheral nerve injury in rats.
METHODS:Fifty male Wistar rats were recruited and randomly divided into treatment group (n=20), model group (n=20) and sham group (n=10). The right sciatic nerves of rats in treatment and model groups were cut and sutured end-to-end, while the sciatic nerves of rats in sham group were only exposed. In the treatment group rats were intravenously injected with 0.15 mg/kg TAK-242 via tail vein 1 hour preoperatively and 7 days postoperatively, and the rats in the other two groups were given intravenous injection of the same volume of normal saline. The sciatic nerves were removed at 24 hours, 3, 4 and 7 days after surgery.
RESULTS AND CONCLUSION:Real-time PCR indicated that the mRNA expressions of interleukin-1βand monocyte chemoattractant-1 were significantly increased in the model group compared with the sham group at 24 hours after surgery (both P<0.001), while the expressions were significantly decreased after TAK-242 injection (both P<0.001). Immunofluorescence showed that compared with the model group, down-regulated expression of CD68+and iba1+cel s appeared in the treatment group at 3 days after surgery (P<0.01, P<0.05). Luxol fast blue staining revealed that demyelination at the sciatic nerve stump appeared in both model and treatment groups at postoperative 7 days, but myelin debris clearance in the treatment group was significantly reduced compared with the model group (P<0.05). Hematoxylin-eosin staining showed that a lot of inflammatory cel s, Schwann cells and regenerated nerve fibers at the sciatic nerve stump were found in the model group, while there were few inflammatory cells, Schwann cel s and regenerated nerve fibers in the treatment group at 7 days after surgery. Immunohistochemistry found that the expression of growth-associated protein-43 in the treatment group was significantly lower than that in the model group at 4 days postoperatively (P<0.05). Besides, compared with the model group, a significantly decreased sciatic functional index was found in the treatment group at 20, 30 and 40 days after surgery (P<0.05). These results show that TLR4 antagonists delay early nerve regeneration in rats after sciatic nerve injury probably by inhibiting the TLR4 signaling pathway.

Objective To evaluate the value of 3.0T susceptibility-weighted magnetic resonance imaging (SWI) in the diagnosis of cerebrovascular malformations. Methods Forty-six patients with cerebrovascular malformations, admitted to our hospital fiom May 2008 to December 2010, were examined with a 3.0T MR scanner. All patients were examined with MRI conventional sequences T1WI,T2WI, 3DTOF, and their results were compared with SWI sequence so as to evaluate the value of SWI in the diagnosis of cerebrovascular malformations.Results Twenty-five patients had arteriovenous malformation (AVM), 10 with cavernous hemangioma, 8 with venous malformations, and 3 with telangiectasis in the 46 patients with cerebrovascular malformations. SWI could delineate all the cerebrovascular malformation lesions, especially small lesions, but could not display all supplying artery in AVM. 3DTOF was a better technique in delineating large AVM lesions. Conclusion SWI is much more sensitive in showing small cerebrovascular malformations; and combined with other MR sequences,clear diagnosis of cerebral vascular malformations can be made by SWI.

OBJECTIVETo investigate the safety and feasibility of laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer in elderly patients.

METHODSClinical data of two elderly patients undergoing laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer were analyzed retrospectively.

RESULTSThe two cases were 78 and 75 years old respectively. Both were complicated with many medical conditions. One case suffered from stage II cancer in the gastric body and stage IB rectal cancer, and the other suffered from stage IIIA gastric cancer and stage IB rectal cancer. Both cases had received laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer, with 5 cm of incision. The operative time was 260 and 255 min and the intraoperative bleeding was 60 and 80 ml respectively. No complication occurred intraoperatively. Time to resume oral intake was 4 and 5 days and length of postoperative hospital stay was 13 and 14 days respectively. No postoperative complication occurred. The patients were followed up for 13 and 12 months and no postoperative recurrence or metastasis was noticed.

CONCLUSIONLaparoscopy-assisted combined radical resection for elderly synchronous rectal and gastric cancer is safe and feasible when performed by surgeons with plentiful experience in laparoscopic technology, and associated with less injury and faster recovery.

Aged ; Female ; Humans ; Laparoscopy ; methods ; Rectal Neoplasms ; complications ; surgery ; Retrospective Studies ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome