October 2013, Volume 16, No.30 Abstracts

 Training System and Employment Situation of General Practitioner in Germany and Its Challenges

DAI Sha-baiHUANG Xiao-guang.Institute for Health Care Management and Research,University of Duisburg-Essen,Essen 45141,Germany

    Abstract  This paper summarized the general condition of general practitioner (GP) in Germany,introduced its GP training system and the GP employment situation,and analysed the opportunities and challenges they were facing.Germany is one of the countries that first established the GP system;However,since 21st century with the population ageing,the shortage of medical staff,the income gap between GP and other specialists,and the change of the occupational pursuit of young physicians,the shortage of GPs in rural areas has been a problem in Germany.In this paper,we described the employment distribution of GPs in Germany based on the data of national statistics report of physicians in Germany in 2010;Revealed the role of GPs in German basic services through introducing the GPs work and the special GP culture;And discussed the challenge of the GPs shortage by analysing the age distribution of GP in Germany,the value changes of young physicians and so on.

    Key words  GermanyGeneral practitionersEducation,medicalEmployment


Research Progress in Use of Aspirin for Tumor Patients

MA Li-li,ZHAO Li-ping.School of Nursing,Central South UniversityChangsha 410000,China

    Abstract  Aspirin,a common non-steroidal anti-inflammatory drug(NSAID),is mainly used as a drug for fever relief,pain relief,anti-inflammatory.Its main mechanism is inhibiting cycloxygenase(COX)activity,inducing apoptosis through activating death receptors(DR),and inhibiting nuclear factor-κBNF-κBfrom synthesis.In recent years,aspirin used in anti-tumor therapy has got more and more attention.It can prevent occurrence of a variety of cancers,reduce incidence of cancers,inhibit the growth of tumor cells,and its combination with other drugs can used for anti-tumor,increase the sensitivity of radiotherapy or chemotherapy.In addition,aspirin can also inhibit effectively platelet aggregation,improve patients hypercoagulable state,prevent thrombosis,reduce the risk of thrombosis.

    Key words  Antineoplastic agents;Molecular mechanisms of pharmacological action;Aspirin


Tissue Inhibitor of MetalloproteinasesA Potential Target for the Treatment of Pulmonary Arterial Hypertension

TANG Wei-liangCHI Ju-fangPENG Fanget al.Department of CardiologyShaoxing Peoples Hospital(Shaoxing Hospital of Zhejiang University)Shaoxing 312000China

    Abstract  Pulmonary arterial hypertension(PAH) is a fatal disease threatening human healthwhich is characterized by a progressive increase in pulmonary vascular resistanceand ultimately lead to right heart failure and death.The pathological changes of PAH include endothelium dysfunction and vascular remodeling in pulmonary arteries.In the process of disease progressionthe imbalance between matrix metalloproteinases(MMPs) and tissue inhibitors of metalloproteinases(TIMPs) played an important role.The overexpression of TIMPs at local area of vessel wall inhibits the activity of MMPsthus contribute to the occurrence of endothelium dysfunctionand promotes excessive accumulation of extracellular matrix (ECM)at last leads to vascular remodeling.Thenwhat would happen if the overexpression of TIMPs was weakened or inhibited in diseased pulmonary vessels? This paper put forward a new idea for PAH treatmentweakening TIMPs expression in pulmonary vessels where severe vascular remodeling existmight reverse vascular remodeling and improve repair capabilities of vascular endotheliumat last benefit the recovery of PAH.

    Key words  HypertensionpulmonaryEndotheliumvascularMatrix metalloproteinasesTissue inhibitor of metalloproteinasesTherapy


Evidence-based Treatment for A Case with Non-alcoholic Steatohepatitis

WANG LuDONG Wei-guoLV Xiao-guanget al.Department of Critical Care MedicalPeoples Hospital of Wuhan UniversityWuhan 430060China

    Abstract  Objective  To make an individualized treatment plan for a case of non-alcoholic steatohepatitis(NASH) by using methods of evidence-based medicine.Methods  A 37-year-old man was diagnosed as moderate NASH on April 23rd2012.After clinical problems were put forwardevidence from 1990 to 2012 was collected from the Cochrane libraryPubMedEmbase and Chinese Journal Full-text Database(CNKI).Treatment protocols were made according to the search resultscombined with patient preferences and physicians clinical experience.Results  A total of 12 meta-analysis or systematic reviews10 RCTs and 2 cohort studies were included.The results were analyzed and a therapy plan was formulated as followslow-fat and low-carbohydrate dietmoderate-intensity activities 200 min/weekbody weight loss to the goal of 79 kgtaking pioglitazone 30 mg/d.After a six-month follow upthe patients anorexia and hepatalgia were improvedand ultrasound showed mild fatty liver.Conclusion  Integration of lifestyle interventionweight controldrugs improving insulin resistance and drugs of liver protection can improve the outcome and life quality in non-alcoholic fatty liver patientbut long-term effect needs further observation.

    Key words  Non-alcoholic fatty liver diseaseEvidence-based medicineMeta-analysisRandomized controlled trialTherapy


Association between Interleukin-12 Gene Polymorphisms and Cancer SusceptibilityA Meta-analysis of Case-control Studies

ZHANG XiongJIN Fen-shuZHANG Li-guoet al.Department of Laboratory MedicineHubei Wuchang HospitalWuhan 430063China

    Abstract  Objective  To investigate the association between the interleukin-12(IL-12) gene polymorphisms and cancer risk.Methods  PubMedEmbaseWeb of ScienceCBMWanfangVIP and CNKI databases were searched (January 1998 to January 2013) for all articles published that addressed IL-12 gene polymorphisms and cancer risk.Meta-analysis was performed by using STATA 12.0 software.Results were described as relative risk(RR) with 95% confidence intervals(CI).Results  18 case-control studies were included with a total of 6 463 cancer cases and 7 412 healthy controls.It was found that the 3UTR AC polymorphism of IL-12B gene was associated with significantly increased overall risk of cancers by using random effects modelC vs.ARR=1.0695%CI1.031.10),P0.001CA+CC vs.AARR=1.0595%CI1.021.08),P=0.001.Howeverthe 3UTR GAIVS2 TA and 5UTR TG polymorphisms of IL-12A gene did not appear to have an influence on cancer susceptibility(all P0.05).Further subgroup analyses showed that the 3UTR AC polymorphism of IL-12B gene was associated with increased cancer risks in the subgroups of AsiansC vs.ARR=1.0495%CI1.011.08),P=0.017CA+CC vs.AARR=1.0495%CI1.011.07),P=0.018〕,especially cervical cancerC vs.ARR=1.1195%CI1.011.22),P=0.032CA+CC vs.AARR=1.1095%CI1.101.19),P=0.023and nasopharyngeal cancerC vs.ARR=1.2895%CI1.161.40),P0.001CA+CC vs.AARR=1.2495%CI1.511.35),P0.001.Conclusion  The 3UTR AC polymorphism of IL-12B gene might be a potential biomarker for cervical and nasopharyngeal cancers among Asian populations.

    Key words  Interleukin-12Polymorphismsingle nucleotideNeoplasmsDisease susceptibilityMeta-analysis


The Influence of Breast-conserving Surgery with or without Radiotherapy on the Relapse of Ductal Carcinoma in SituA Meta Analysis

XU HaoWANG Jia-shengYANG Henget al.Department of General SurgeryYongchuan Hospital Affiliated to Chongqing Medical UniversityChongqing 402160China

    Abstract  Objective  In the treatment of ductal carcinoma in situ(DCIS)to investigate whether recurrence rate of breast-conserving surgery followed by radiotherapy is lower than that of pure breast conserving surgery.Methods  We searched in the PubMedEmbaseOVIDCochrane LibraryCBMCJFD and CSJD to identify studies on clinical controlled trials about breast-conserving surgery followed by radiotherapy(experimental group) and pure breast conserving surgery(control group).The quality of the included studies was assessed by the Cochraneand the data analyses were performed by the RevMan 5.0 software.Results  Five studies were includedinvolving 4 randomized controlled trials(RCTs) and 1 non-RCTs.Meta analysis results showed that the recurrence rate of ipsilateral breast cancer in experimental group was significantly lower than that in control groupRR=0.4695%CI0.390.54),P0.00001.Analysis was made to noninvasive and invasive breast cancer separatelythe recurrence rates of ipsilateral noninvasive and invasive breast cancer were significantly lower than those in control groupRR=0.4795%CI0.370.61),P0.00001RR=0.4595%CI0.350.57),P0.00001.The recurrence rate of contralateral breast cancer in experimental group was significantly higher than that in control groupRR=1.5195%CI1.052.18),P=0.03.There was no significant difference in the rate of metastasis between the two groupsRR=1.0595%CI0.661.67),P=0.82.Conclusion  The ipsilateral breast cancer recurrence rate of breast-conserving surgery followed by radiotherapy is significantly lower than that of pure breast conserving surgerybut contralateral breast cancer recurrence rate of breast-conserving surgery followed by radiotherapy is significantly higher than that of pure breast conserving surgerythere is no significant difference in the rate of metastasis between the two method.Due to the limitation of quality and sample size of the included trialsmore RCTs with high-quality and large sample size are needed to prove our conclusion.

    Key words  Breast neoplasmsCarcinomaductalbreaseRadiotherapyBreast conserving surgeryRecurrenceMeta-analysis


Risk Factors for Epistaxis in Patients with Hepatitis Cirrhosis

SHAO Shan,BAO Shi-ping,LIU Yong-gang,et al.Department of Otolaryngology Head and Neck SurgeryBeijing Youan Hospital,Capital Medical University,Beijing 100069,China

    Abstract  Objective  To investigate the risk factors of epistaxis in patients with hepatitis cirrhosis.Methods  48 hepatitis cirrhosis patients with epistaxis and 48 hepatitis cirrhosis patients without epistaxis admitted to Beijing Youan Hospital from April 2010 to December 2012 were retrospectively analyzed.Univariate and multivariate analysis were used to screen the risk factors including gender,age,classification of liver cirrhosis,history of high blood pressure,deviation of nasal septum,rhinitis sicca,blood platelet count,prothrombin time (PT),activated partial thromboplastin time (APTT) and fibrinogen (FIB) for epistaxis in patients with hepatitis-related cirrhosis.Results  Etiology of hepatitis cirrhosis:in the control group there were 38 cases of hepatitis B and 10 cases of hepatitis C,while in the epistaxis group there were 39 cases of hepatitis B,7 cases of hepatitis C and 2 cases of hepatitis B combined with hepatitis C,and the difference was not statistically significant (χ2=2.542,P=0.280).The gender composition,classification of liver cirrhosis and rhinitis sicca between two groups showed statistically significant differences (P0.05).The age,history of high blood pressure,deviation of nasal septum,blood platelet count,PT,APTT and FIB showed no statistically significant difference (P0.05).Multiple Logistic regression analysis indicated that male,decompensated hepatitis cirrhosis and rhinitis sicca were closely related with epistaxis (P0.05).Conclusion  Male,decompensated hepatitis cirrhosis and rhinitis sicca are the risk factors for the occurrence of epistaxis in patients with hepatitis cirrhosis.Early intervention of these factors is of great importance for the prevention of epistaxis in patients with hepatitis cirrhosis.

    Key words  Liver cirrhosisEpistaxisRisk factors


Correlation between Diabetes and Benign Prostatic Hyperplasia

MENG Xian-qinLIU WeiQU Xiao-binget al.Department of Geriatrics163 Hospital of PLAChangsha 410003China

    Abstract  Objective  To explore the correlation between diabetes mellitusDMand benign prostatic hyperplasiaBPH.Methods  The subjects consisted of 117 outpatients with BPH treated in Geriatrics departments in Central South University Xiangya Second Hospital in February 2008 and in 163 Hospital of PLA in March 2009.The information on DMBPH and vital signs were collected with the questionnaire on BPH associated with DMthe International Prostate Symptom ScoreIPSS),and physical examinations.After grouping the outpatientswe analyzed the relationships between DM and BPH.Results  Compared with the BPH groupBPH with DM group also had significantly higher levels of prostate volumePVand serum prostate specific antigenPSAlevelP0.05.The levels of PV and PSA in the group with elevated FBG level were significantly higher than those in the normal FBG groupP0.05.Compared with the group with abnormal HbA1cthe group with normal HbA1c had a significantly higher value of PVP0.05.BPH patients with NINS and insulin resistance had a larger prostate and a longer course of the disease than BPH patients with  normal FINS and insulin sensitivityP0.05.Taking the progression of BPH as the dependent variableFBG2 hPBGHbA1cFINSHOMA-IR as independent variablesthe Logistic regression analysis showed that FBG and FINS entered the equation.Conclusion  Diabetes can promote the growth of PV and extend the course of BPHand FBG and FINS are the risk factors of the progression of BPHwhich the clinicians must watch out for.

    Key words  Diabetes mellitusProstatic hyperplasiaQuestionnaires


Clinical Study on QT Dispersion and Cardiac Arrhythmia in Patients with Sleep Apnea Hypopnea Syndrome

ZHU Ling-xiaTONG Guang-mingYOU Taoet al.Department of Cardiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004China

    Abstract  Objective  To investigate the variations of QT dispersion (QTd) and the incidence rate of cardiac arrhythmia in sleep apnea hypopnea syndrome (SAHS) patients.Methods  From December 2011 to December 2012,132 suspected cases of SAHS receiv


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