目的 探讨鼠双微基因2(murine double mimute 2, MDM2)和多肿瘤抑制基因P16在大肠癌中的表达及临床意义。 方法 纳入2006年10月-2007年3月收治的67例大肠癌患者,另取距肿瘤10cm以上癌旁组织30例、腺瘤组织20例、正常黏膜20例作为对照。采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶(SP)法检测肠黏膜MDM2和P16基因蛋白表达。 结果 MDM2在大肠癌组织中的阳性表达率为71.6%(48/67)，明显高于结肠腺瘤组织、癌旁组织和正常黏膜(Plt;0.05)。P16在大肠癌组织中的阳性表达率为38.8%(26/67)，与结肠腺瘤组织75.0%，癌旁组织83.3%，正常黏膜组织90.0%比较，差异均有统计学意义(Plt;0.05)。大肠癌组织中MDM2在不同分化程度中表达差异无统计学意义(Pgt;0.05)。P16在不同分化程度中表达差异有统计学意义(Plt;0.05)，MDM2和P16在不同Dukes分期中，有无淋巴结转移之间表达差异有统计学意义(Plt;0.05)。MDM2与P16基因蛋白在不同年龄组，不同性别组中，表达差异无统计学意义(Pgt;0.05)。在大肠癌中MDM2蛋白与P16蛋白表达无明显相关性(Pgt;0.05)。 结论 MDM2和P16的异常表达与大肠癌的发生、发展有关，联合检测MDM2和P16对大肠癌的临床诊断、治疗和判断预后有实际意义。
Objective To investigate the rural residents’ payment will for disease control and its influencing factors, so as to provide evidence for the government to make policy of combing disease control and New Rural Co-operative Medical system (NRCMS). Methods The self-designed questionnaire was adopted to investigate 1 117 rural residents from 156 villages, 44 towns, 19 counties (cities, districts) in Henan province. The frequency analysis and the multiple logistic regression analysis were conducted by using SPSS 11.5 software. Results On the basis of NRCMS payment, 68.3% of the rural residents were willing to pay extra for disease control, 62.3% of whom were willing to pay RMB 1.00 or more, and the average willing payment were RMB 3.01±7.66. The multiple logistic regression analysis revealed that the people willing to pay extra were as follows: self-employed, graduates from a secondary technical school, dink family, and the respondents who believed NRCMS had relieved their medical financial burden. Conclusion In practicing the rural public health policy of combining disease control and NRCMS, it is suggested to ask rural residents to pay a little extra money on the basis of current NRCMS payment. The foundation of bringing this policy into force is to keep practicing NRCMS well so as to relieve more financial burdens for rural residents. During the implementation, low income families should be taken into consideration according to their occupation, educational level and family structure.
Abstract： Objective To summarize the clinical diagnostic and therapeutic experiences of infective endocarditis (IE). Methods From Jan. 2000 to Aug. 2006，60 IE patients underwent heart operation in PLA General Hospital. There were 46 male and 14 female patients, with an average age of 34.3 years old. Blood culture was positive in 25 cases (41.7%), Streptococcus was found in 12 cases, Staphylococcus in 6 cases and other bacteria in 7 cases. Ultrasonic cardiography(UCG) revealed vegetations or valve perforation in 42 cases, including 26 aortic valves, 9 mitral valves and 6 double valves. 28 cases had primary cardiac diseases，including 16 cases of congenital heart anomalies，9 cases of rheumatic heart disease and 3 cases of mitral valve prolapse. High dose of sensitive antibiotics were utilized all through the treatment in all IE patients. There were 55 selective surgeries and 5 emergent ones. Infected tissues were debrided radically，intracardiac malformation was corrected in 16 cases, valve replacement was performed in 41 cases, tricuspid plasty in 1 case. Results There were 3 patients of earlydeath. 51 patients(89.5%) were followedup for 5-71 months with norecurrence. Postoperative cardiac function (NYHA): class I was in 38 cases, class II in 13 cases. Conclusion Early diagnosis, optimal surgical timing, combined internal medicine and surgical treatment provided good therapeutic effect of IE.
Objective To evaluate the clinic outcomes of coronary artery bypass grafting （CABG） on patients of coronary artery disease complicated with chronic obstructive pulmonary disease（COPD）. Methods The data of 27 patients of coronary artery diseases complicated with COPD who had received CABG from Jan. 1998 to Dec. 2004, were retrospectively summarized. 18 patients received off-pump CABG （off-pump group）,and 9 cases received on- pump CABG （on-pump group）. All patients accepted the evaluation about clinical respiratory complications, oxygenation index （PaO2/FiO2）, related respiratory function index, plasma intercellular adhesion molecule 1 （ICAM-1） and the amount of neutrophil in pulmono-alveolar perfusion fluid at the different time point including the start of CPB （for off-pump group, the measurement accepted at the start of operation）, end of CPB （end of operation for off-pump group）, and at 2, 6, 12, and 24h after operation. Results There was no operation-related death in two groups. One died of respiratory failure 14 days after operation in the hospital in off-pump group, there were more respiratory complications in on-pump group than that in off-pump group, and PaO2/FiO2 in on-pump group was higher than that in off-pump group at CPB 30min （at the start of operation）, but lower than that in off-pump group postoperative at 6 h, 12 h（P〈0. 05）, the concentration of plasma ICAM-1 had obvious difference between two groups from CPB 30 min （at the start of operation） to post-operative 24 h （P 〈 0. 05）. The neutrophils in bronchoalveolar lavage in on-pump group was higher than that in off-pump group from CPB 30 min （at the start of operation） to 24 h after operation （P〈0. 05）. Conclusion Off-pump CABG seems more suitable than on-pump CABG for coronary artery disease patients with COPD due to less damage on oxygen-exchange capability and less respiratory complication.
Objective To evaluate the clinical outcomes of total cavopulmonary connection (TCPC) and bidirectional Glenn shunt for treating complex congenital heart diseases with single functional ventricles. Methods From January 2002 to May 2004, twelve children, who had complex congenital heart diseases with single functional ventricles, underwent TCPC and bidirectional Glenn shunt. Among them, male was 3 and female was 9. Ages were from 4 to 13 years and body weights were from 14 to 34 kilograms. The diseases included mitral atresia 1 case, tricuspid atresia 3 cases, right ectopic heart with transposition of great arteries 3 cases, D-transposition of great arteries 3 cases, and single ventricle 2 cases. Results Eleven children survived and one child died in acute renal failure 19 hours after operation. The hospital mortality was 8.3%. Four children had chyle-thorax postoperatively, and eight children had uneventful recovery. In the follow-up period, one child died 12 months postoperatively for pulmomary arteriovenous fistula, and there were no complications like severe arrhythmia, thrombosis and cerebral problems. Conclusions TCPC and bidirectional Glenn shunt are safe and effective techniques for treating complex congenital heart diseases with single functional ventricles, and the clinical outcomes are satisfactory. The key points for the successful operation are big enough cava-pulmonary anastomosis as well as aggressive perioperative management.
Objective To investigate the attitude and its influencing factors of Henan provincial rural residents towards the partial usage of funds from the New Rural Co-operative Medical System (NRCMS) for the disease control and prevention, in order to provide evidence for policy making. Methods In Henan province, 1 117 rural residents were randomly sampled with questionnaire from the 156 villages distributing in 44 townships of 19 counties (cities, districts). The frequency analyses, the multiple linear regression analysis and the one-way analysis of variance were conducted. Results Among all the respondents, only 3.4% of the rural residents absolutely disagreed (Zero agreement degree score), 34.4% fully agreed (10 agreement degree scores), and 90.6% had agreement degree scores equal to or more than five. The agreement degree was direct proportional to NRCMS satisfaction degree. The agreement degrees from residents who were relieved from medical financial burdens by NRCMS were higher than the others. 13.2% of rural residents believed that NRCMS did not alleviate their medical financial burden. For the men and women who believed that their village general practitioner was timely at vaccination, their agreement degree was higher than the others who considered vaccination time was late or common. The “timely group” was alone a subset. The “late group” and the “common group” were homogeneous subsets. The proportion of those who answered that the vaccination timeliness at late or common reached 40.6%. Conclusion The proposition to pay funds from the existing NRCMS for disease control and prevention is in line with the will of the majority of rural residents. The combination of disease control and prevention and NRCMS is a strategy in rural healthcare management. A bettering NRCMS and disease control and prevention are the basis of this policy in the future. More attention should be paid to the timeliness of the village general practitioners’ disease control work. It is necessary to perfect the NRCMS policy focusing on residents who hasn’t been relieved from medical financial burdens, so that more population will be benefited.
Objective To survey the relations between the rural residents’ occupational satisfaction, the health policies and demographic factors in Henan province and then to confirm the health policy order and its key target populations. Methods The questionnaires were distributed to 1 117 rural residents in 156 villages among 44 townships in 19 counties (cities, districts). The frequency analysis, multivariate linear regression analysis and multiple comparisons were conducted. Results The average value of rural residents’ occupational satisfaction scored 68.23, among which the complete dissatisfaction scored 0 accounting for 1.9%, the complete satisfaction scored 100 accounting for 9.0%, the one scoring no more than 50 accounted for 20.9%, and the one scoreing equal 80 or more than 80 accounted for 37.5%. By regarding the occupational satisfaction as the dependent variable, the independent variables stayed in the model were as follows in order according to their influence from heavy to little on the dependent variable: new rural cooperative medical system (NRCMS), occupation, village general practitioner’s work, family formation, age, disease prevention and control efforts. The occupational satisfaction was much higher when there were the following conditions: the higher satisfaction with the NRCMS, the more financial burden relieved by the NRCMS, and the higher satisfaction with village general practitioners’ work. The occupational satisfaction was the highest when villagers lived with their spouses, while it was the lowest when villagers lived with their spouses and children, as well as they lived with their parents, spouses and children. The peasants’ occupational satisfaction was the lowest. The occupational satisfaction had significantly negative correlation with cultural level, and had positive correlation with age. Conclusion The occupational satisfaction is an important indicator for assessing the level of social harmony, and is the basis for policy decision-making, implementation, and evaluation. The overall occupational satisfaction of the rural residents in Henan is lower, so the social harmoniy and stability should be alerted. The priority order of the existing rural health policy should be the NRCMS policy, village general practitioner work policy, and village disease prevention and control policy. When we are formulating and implementing the rural health policy, the key target populations should be considered among the people whose families comprise two or three generations, whose occupations are farmers, whose cultural level is lower, and whose ages are younger.