Objective To provide baseline date for further research by retrospectively investigating the disease constitution of over-60-year old patients in the West China Hospital of Sichuan University in 2011. Methods The information of over-60-year old outpatients was extracted from HIS and their diagnoses were classified by ICD-10. The data of single disease among top 3 categories of diseases were rearranged and analyzed by Excel software. Results The total of over-60-year old outpatients was 895 123 person-time in 2011, accounting for 19.65%, including 716 826 person-time in specialist outpatient clinics. The specialist diagnoses of 683 491 person-time could be classified by ICD-10, accounting for 95.35% of specialist outpatients. The top 12 diseases were neoplasm, circulatory, digestive, factors influencing health status and contacting with health services, respiratory, musculoskeletal system and connective tissues, nervous, eyes, symptoms/signs and abnormal clinical and laboratory findings, non-classified, mental and behavioral disorders, endocrine, and genitourinary system diseases, and the cumulative constituent ratio was 92.96%. The main pathogenic sites of neoplasm were bronchus and lung (21.98%), esophagus (8.66%), stomach (8.10%), rectum (7.37%), prostate (5.86%), and liver and intrahepatic bile ducts (5.55%), with a cumulative constituent ratio of 57.72%. The main disease burden in circulatory system was hypertension (39.50%), chronic ischaemic heart disease (11.17%), and cerebral infarction (9.70%), and the cumulative constituent ratio was 60.38%. While the main disease burden in digestive system was gastritis and duodenitis (24.98%), other diseases of digestive system (9.26%), and other diseases of liver (8.90%), and the cumulative constituent ratio was 43.13%. There were more female than male among the over-60-year old outpatients (50.67% vs. 49.33%), and male was higher than female only in the incidence of neoplasm, respiratory, factors influencing health status and contacting with health services, and genitourinary system diseases. The disease constitution ratio of 60-69 years old patients was 58.21%. The top 3 neoplasm were the malignant tumors in digestive (38.20%), respiratory and intrathoracic organs (24.70%), and lymphoid, haematopoietic and related tissue (11.97%), with a cumulative constituent ratio of 74.87%. Conclusion The top 3 disease burden of over-60-year old outpatients in West China Hospital were neoplasm, circulatory and digestive diseases, which reflects the trend and law of treatment demands of old patients. It needs to deeply analyze the frequency and flow pattern of patients, and to provide evidence for preventing and treating geriatric diseases.
Objective To collect and analyze the data of emergency medicine supply for both Wenchuan and Lushan earthquakes victims in the West China Hospital, so as to provide evidence for scientifically and efficiently carrying out the logistical support for emergency rescue medicines supply, and improving the coping capacity for those similar public health emergencies. Methods Both medicine constituent ratios and DDDs were taken as evaluation indexes, and the data were input by Excel software. Then the following items were analyzed: the use and cost of emergency medicine for victims admitted in the hospital from one day to one month after earthquake, as well as, the acceptance, allocation and use of the donation medicines for both Wenchuan and Lusan earthquakes. Results During the first month after Lushan earthquake, the victims used 26 categories of medicines involving 455 drug specifications in the West China Hospital. The dosage and DDDs of therapeutic medicines were higher than those of ancillary medicines. The donation medicines for Lushan earthquake accepted by the hospital were in 8 categories involving 16 drug specifications, and they were all used to rescue the victims in the hospital. Based on the hospital emergency medicine supply system oriented by the information of victim’s medicine use, the drug specification and total drug cost of the donation medicines for Lushan earthquake decreased by 90.91% and 89.73%, respectively, indicating a more accurate and efficient system compared with those for Wenchuan earthquake. Conclusion The implementation of the hospital emergency medicine supply system oriented by the information of victim’s medicine use is helpful to improve the time efficiency and pertinence of earthquake medical rescue.
Objective To evaluate the quality of randomized controlled trials in otorhinolaryngology in China and provide to comprehend the possibility of its contribution in providing reliable, evidence in clinical practice; thus providing evidence to elevate the clinical treatment level. Methods Five Chinese clinical otorhinolaryngology journals were searched and randomized controlled trials were identified and analyzed according to the standards of evidence-based medicine. Results Two hundred and eighty seven issues were referred to and eighty-one randomized controlled trials were identified and analyzed. Of these randomized controlled trials, 34.57% (28/81) had definite diagnostic standards, 38.27% (31/81) had inclusion standards and 33.33% (27/81) had exclusion standards; only 1.23% (1/81) got the approval of the participants; 40.74% (33/81) had moderate sample size; 3.70% (3/81) had large sample size and no one mentioned sample size estimation; 81.48% (66/81) didn’t report the method of randomization and 38.27% (31/81) had baseline comparison; 18.52% (15/81) didn’t define the control interventions and 8.64% (7/81) even didn’t explicate the experimental interventions; 32.10% (26/81) used blank comparison; 86.42% (70/81) didn’t use blindness; 37.04% (30/81) didn’t mention the adverse effects; 23.46% (19/81) used accredited standards to evaluate the outcomes; l l.11% (9/81) mentioned the loss of participants and only 1.23% (1/81) treated the loss with statistics methods. Conclusions The quantity and quality of the otorbinolaryngologic randomized controlled trials in present review can not meet the clinical need. Higher quality of randomized controlled trials are required to improve the level of prevention and the treatment of otorhinolaryngologic diseases.
Objective We searched for evidence on mycophenolate mofetil(MMF) as a treatment for patients with diffuse proliferative lupus nephritis. Methods We attempted to find the current best evidence by searching The Cochrane Library(Issue 4, 2005), MEDLINE(1990 to June 2007), CMB(1980 to December 2006), CNKI(1979 to October 2007). We critically appraised the available evidence. Results Four systematic reviews and 6 randomized controlled trials of high quality were available. MMF and prednisolone were found to be an effective continuous induction-maintenance treatment for diffuse proliferative lupus nephritis. MMF was associated with less drug toxicity. Conclusion Given the current evidence and our clinical experience, and considering the patient and the values and preferences of his family,MMF was given at 1 g daily in combination with steroids at the beginning. No obvious adverse effects occurred during 3 months of follow-up.
Objective To summarize the status of tumor stem cells investigations in gastrointestinal carcinoma. Methods Domestic and international publications online involving tumor stem cells of gastrointestinal carcinoma in recent years were collected and reviewed. Results There are a small quantity of cancer cells shown some stem cell characteristics. They are named tumor stem cell and play an important role in tumorigenesis, proliferation, metastasis and recurrence. And also, tumor stem cells can resist the effect of antineoplastic drugs and lead to tumor recurrence. These tumor-initiating cells are CD133-positive in the gastrointestinal carcinomas, especially in colorectal cancers. CD133-positive colorectal cancer cells have the abilities of clone, proliferation, differentiation and form metastases. And a high CD133 mRNA content was found in the blood of patients who suffered from bone metastases. Conclusion The characteristics of CD133-positive cancer cell and the mechanisms of stem cell-niche system are the basis of developing better methods to tumor diagnosis and treatment, and provide theoretical basis of new methods, such as targeted therapy.
Abstract: Objective To analyze the characteristics of pathogens isolated from patients with lung cancer after surgery, and provide instructions for the prevention and treatment of postoperative infection. Methods A retrospective investigation of the pathogenic microbiology data of 159 patients（142 males and 17 females with average age at 61.8±9.6 years) with lung cancer after surgery in West China Hospital from January 2009 to December 2011 was performed.We got the specimen from the patients by routine methods, identified the pathogens, and conducted drug susceptibility tests in vitro. Results The pathogens were mainly isolated from sputum of the patients （90.6%, 155/171）. Canidia albicans（25.7%, 44/171）, Klebsiella pneumonia（15.2%, 26/171）, Acinetobacter calcoaceticus-A. baumannii（13.4%, 23/171）and Pseudomonas aeruginosa（8.2%, 14/171） were the predominant species. Among A. calcoaceticus-A. baumannii isolates, 39.1%（9/23） of them were multidrug resistant strains. And 23.1%（6/26）of K. pneumonia isolates produced extended spectrum beta-lactamases. P. aeruginosa isolates showed high in vitro susceptibility to the antibacterial agents. Conclusion Pathogens are mainly isolated from sputum of patients after surgery for lung cancer. Canidia albicans and gram-negative bacilli are predominant isolates and should be the major targets for the prevention and treatment of postoperative infection.
Abstract： Objective To evaluate video-assisted thoracic surgery（VATS）and minimal incision thoracotomy（MIT）lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life（QOL）. Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group （57 patients）and MIT group（49 patients）, totally 106 patients，57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale （LCSS） before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit（1.04±0.71 vs.2.00±0.83, F=6.357，P=0.021）, fatigue （4.55±1.17 vs.10.19±2.10, F=4.721，P=0.043）, dyspnea（2.18±0.86 vs.10.26±2.05, F=10.020，P=0.005）, normal activity（5.16±1.70 vs.17.60±3.17, F=12.319，P=0.002）at the MIT group were deteriorated significantly at 1 month after the operation （P＜0.05）. Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.
Abstract： Objective To improve therapeutic outcomes for severe leftsided atrioventricular valve regurgitation (LAVVR) after repair of atrioventricular septal defect (AVSD) through discussing pathological changes of the valve and surgical management for these patients, and summarizing the medical experiences of perioperative managements. Methods We retrospectively analyzed the clinical data of 29 patients including 16 males and 13 females with LAVVR after repair of AVSD treated in Xinhua Hospital, Medical College of Shanghai Jiaotong University between January 1995 and December 2009. The age of these patients ranged from 4 to 62 years, averaging at 26.5. According the classification of New York Heart Association (NYHA), there were 10 patients of class Ⅱ, 17 of class Ⅲ and 2 of class Ⅳ before reoperation. Partial repair of AVSD had been carried out for 18 patients, and complete repair had been performed on 11 patients. At reoperation, valve rerepair was performed on 17 patients and mechanical valve replacement (MVR) was necessary in 12 patients. Results In the early period after operation, one patient died of multiple organ failure, one patient had a permanent pacemaker inserted because of complete atrioventricular block, and 1 patient aged 4 years got recovery after 56 hours of circulatory support for severe cardiac failure after reoperation. A mean follow-up of 8.2 years (6 months to 14 years) was done for 25 patients with 3 missing. During the follow-up for 14 patients undergone heart valve repair, there was no obvious acceleration of the forward blood flow of the leftside atrioventricular valve. Ten patients had mild or less LAVVR, 1 had moderate LAVVR and 3 underwent successful left atrioventricular valve replacement at 10 days, 3 years or 6 years after reoperation because of severe LAVVR. Clinical status, as assessed by the NYHA classification, improved after surgery for LAVVR in 25 patients who were followed up with 17 in NYHA class Ⅰ, 6 in class Ⅱ, and 2 in class Ⅲ. Podoid decreased significantly and cardiothoracic ratio was 0.53-0.67 (0.60±0.11) in chest Xray picture. There was no late death. Conclusion With timely surgical treatment, and appropriate surgical method, LAVVR after complete or partial AVSD repair can be managed with excellent shortterm and longterm outcomes.