October 2013, Volume 16, No.30 Abstracts
DAI Sha-bai，HUANG 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 GP′s 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】 Germany；General practitioners；Education,medical；Employment
Research Progress in Use of Aspirin for Tumor Patients
MA Li-li,ZHAO Li-ping.School of Nursing,Central South University，Changsha 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-κB（NF-κB）from 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 Metalloproteinases：A Potential Target for the Treatment of Pulmonary Arterial Hypertension
TANG Wei-liang，CHI Ju-fang，PENG Fang，et al.Department of Cardiology，Shaoxing People′s Hospital(Shaoxing Hospital of Zhejiang University)，Shaoxing 312000，China
【Abstract】 Pulmonary arterial hypertension(PAH) is a fatal disease threatening human health，which is characterized by a progressive increase in pulmonary vascular resistance，and 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 progression，the 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 MMPs，thus contribute to the occurrence of endothelium dysfunction，and promotes excessive accumulation of extracellular matrix (ECM)，at last leads to vascular remodeling.Then，what would happen if the overexpression of TIMPs was weakened or inhibited in diseased pulmonary vessels? This paper put forward a new idea for PAH treatment：weakening TIMPs expression in pulmonary vessels where severe vascular remodeling exist，might reverse vascular remodeling and improve repair capabilities of vascular endothelium，at last benefit the recovery of PAH.
【Key words】 Hypertension，pulmonary；Endothelium，vascular；Matrix metalloproteinases；Tissue inhibitor of metalloproteinases；Therapy
Evidence-based Treatment for A Case with Non-alcoholic Steatohepatitis
WANG Lu，DONG Wei-guo，LV Xiao-guang，et al.Department of Critical Care Medical，People′s Hospital of Wuhan University，Wuhan 430060，China
【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 23rd，2012.After clinical problems were put forward，evidence from 1990 to 2012 was collected from the Cochrane library，PubMed，Embase and Chinese Journal Full-text Database(CNKI).Treatment protocols were made according to the search results，combined with patient preferences and physicians′ clinical experience.Results A total of 12 meta-analysis or systematic reviews，10 RCTs and 2 cohort studies were included.The results were analyzed and a therapy plan was formulated as follows：low-fat and low-carbohydrate diet，moderate-intensity activities 200 min/week，body weight loss to the goal of 79 kg，taking pioglitazone 30 mg/d.After a six-month follow up，the patient′s anorexia and hepatalgia were improved，and ultrasound showed mild fatty liver.Conclusion Integration of lifestyle intervention，weight control，drugs improving insulin resistance and drugs of liver protection can improve the outcome and life quality in non-alcoholic fatty liver patient，but long-term effect needs further observation.
【Key words】 Non-alcoholic fatty liver disease；Evidence-based medicine；Meta-analysis；Randomized controlled trial；Therapy
Association between Interleukin-12 Gene Polymorphisms and Cancer Susceptibility：A Meta-analysis of Case-control Studies
ZHANG Xiong，JIN Fen-shu，ZHANG Li-guo，et al.Department of Laboratory Medicine，Hubei Wuchang Hospital，Wuhan 430063，China
【Abstract】 Objective To investigate the association between the interleukin-12(IL-12) gene polymorphisms and cancer risk.Methods PubMed，Embase，Web of Science，CBM，Wanfang，VIP 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 3′UTR A＞C polymorphism of IL-12B gene was associated with significantly increased overall risk of cancers by using random effects model〔C vs.A：RR=1.06，95%CI（1.03，1.10），P＜0.001；CA+CC vs.AA：RR=1.05，95%CI（1.02，1.08），P=0.001〕.However，the 3′UTR G＞A，IVS2 T＞A and 5′UTR T＞G polymorphisms of IL-12A gene did not appear to have an influence on cancer susceptibility(all P＞0.05).Further subgroup analyses showed that the 3′UTR A＞C polymorphism of IL-12B gene was associated with increased cancer risks in the subgroups of Asians〔C vs.A：RR=1.04，95%CI（1.01，1.08），P=0.017；CA+CC vs.AA：RR=1.04，95%CI（1.01，1.07），P=0.018〕，especially cervical cancer〔C vs.A：RR=1.11，95%CI（1.01，1.22），P=0.032；CA+CC vs.AA：RR=1.10，95%CI（1.10，1.19），P=0.023〕and nasopharyngeal cancer〔C vs.A：RR=1.28，95%CI（1.16，1.40），P＜0.001；CA+CC vs.AA：RR=1.24，95%CI（1.51，1.35），P＜0.001〕.Conclusion The 3′UTR A＞C polymorphism of IL-12B gene might be a potential biomarker for cervical and nasopharyngeal cancers among Asian populations.
【Key words】 Interleukin-12；Polymorphism，single nucleotide；Neoplasms；Disease susceptibility；Meta-analysis
The Influence of Breast-conserving Surgery with or without Radiotherapy on the Relapse of Ductal Carcinoma in Situ：A Meta Analysis
XU Hao，WANG Jia-sheng，YANG Heng，et al.Department of General Surgery，Yongchuan Hospital Affiliated to Chongqing Medical University，Chongqing 402160，China
【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 PubMed，Embase，OVID，Cochrane Library，CBM，CJFD 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 Cochrane，and the data analyses were performed by the RevMan 5.0 software.Results Five studies were included，involving 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 group〔RR=0.46，95%CI（0.39，0.54），P＜0.00001〕.Analysis was made to noninvasive and invasive breast cancer separately，the recurrence rates of ipsilateral noninvasive and invasive breast cancer were significantly lower than those in control group〔RR=0.47，95%CI（0.37，0.61），P＜0.00001；RR=0.45，95%CI（0.35，0.57），P＜0.00001〕.The recurrence rate of contralateral breast cancer in experimental group was significantly higher than that in control group〔RR=1.51，95%CI（1.05，2.18），P=0.03〕.There was no significant difference in the rate of metastasis between the two groups〔RR=1.05，95%CI（0.66，1.67），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 surgery，but contralateral breast cancer recurrence rate of breast-conserving surgery followed by radiotherapy is significantly higher than that of pure breast conserving surgery，there 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 trials，more RCTs with high-quality and large sample size are needed to prove our conclusion.
【Key words】 Breast neoplasms；Carcinoma，ductal，brease；Radiotherapy；Breast conserving surgery；Recurrence；Meta-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 Surgery，Beijing 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 You′an 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 (P＜0.05).The age,history of high blood pressure,deviation of nasal septum,blood platelet count,PT,APTT and FIB showed no statistically significant difference (P＞0.05).Multiple Logistic regression analysis indicated that male,decompensated hepatitis cirrhosis and rhinitis sicca were closely related with epistaxis (P＜0.05).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 cirrhosis；Epistaxis；Risk factors
Correlation between Diabetes and Benign Prostatic Hyperplasia
MENG Xian-qin，LIU Wei，QU Xiao-bing，et al.Department of Geriatrics，163 Hospital of PLA，Changsha 410003，China
【Abstract】 Objective To explore the correlation between diabetes mellitus（DM）and benign prostatic hyperplasia（BPH）.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 DM，BPH and vital signs were collected with the questionnaire on BPH associated with DM，the International Prostate Symptom Score（IPSS），and physical examinations.After grouping the outpatients，we analyzed the relationships between DM and BPH.Results Compared with the BPH group，BPH with DM group also had significantly higher levels of prostate volume（PV）and serum prostate specific antigen（PSA）level（P＜0.05）.The levels of PV and PSA in the group with elevated FBG level were significantly higher than those in the normal FBG group（P＜0.05）.Compared with the group with abnormal HbA1c，the group with normal HbA1c had a significantly higher value of PV（P＜0.05）.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 sensitivity（P＜0.05）.Taking the progression of BPH as the dependent variable，FBG，2 hPBG，HbA1c，FINS，HOMA-IR as independent variables，the Logistic regression analysis showed that FBG and FINS entered the equation.Conclusion Diabetes can promote the growth of PV and extend the course of BPH，and FBG and FINS are the risk factors of the progression of BPH，which the clinicians must watch out for.
【Key words】 Diabetes mellitus；Prostatic hyperplasia；Questionnaires
Clinical Study on QT Dispersion and Cardiac Arrhythmia in Patients with Sleep Apnea Hypopnea Syndrome
ZHU Ling-xia，TONG Guang-ming，YOU Tao，et al.Department of Cardiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004，China
【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