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August 2017, Volume 20, No.24 Abstracts

 Updates and Interpretations of the National Comprehensive Cancer Network Guidelines for Breast Cancer Screening and Diagnosis(Version 1,2017)

ZHANG Jin*,CHEN Wei,LIU Lei

The Third Department of Breast Cancer,Tianjin Medical University Cancer Institute & Hospital;National Clinical Research Center for Cancer;Breast Cancer Prevention and Treatment Research Center in Tianjin,China;Key Laboratory of Cancer Prevention and Treatment in Tianjin;Key Laboratory of Cancer Prevention and Treatment in Ministry of Education;Clinical Research Center for Malignant Tumor in Tianjin,Tianjin 300060,China

*Corresponding author:ZHANG JinProfessorChief physician;E-mailzhangjin@tjmuch.com

    Abstract  Updates of the National Comprehensive Cancer Network Guidelines for Breast Cancer Screening and Diagnosisversion 1,2017involved history-taking and physical examination,mammography,the application of ultrasonography in screening and diagnosis of breast cancer,magnetic resonance imaging of breast,evaluation tool Gail breast cancer risk assessment model,puncture and biopsy and so on.There is a huge gap in the device application and diagnosis and treatment level between China and the western countries of primary health care institutions.Based on the national conditions of our country,we should establish a screening model and evaluation system for high-risk groups of breast cancer for Chinese women,and to provide guidance for the early detection of breast cancer in China.

    Key words  Breast neoplasms;Guidebooks;Screening;Diagnosis

 

Collaborative Mode and Service Supply Mechanism of Medical and Elderly Care Institutions Based on Intelligent Community

CHEN Fei*,LEI Xue

School of Public Health and Management,Chongqing Medical University;Research Center for Medicine and Social Development;Collaborative Innovation Center of Social Risks Governance in Health,Chongqing 400016,China

*Corresponding author:CHEN Fei,Associate professor;E-mail:chenfei6639@126.com

    Abstract  In China,the systems for delivering elderly care services and medical services are self-contained.How to provide comprehensive and effective elderly care and medical services has become one of the biggest challenges of modern society.To solve this problem,the collaborative system for community-based services delivered by medical and elderly care institutions should be explored to promote the collaboration between medical and elderly care institutions.Based on the two core variables of goal and interests involved in the collaboration between medical and elderly care institutions,we constructed the collaborative mode for community-based services delivered by medical and elderly care institutions,proposed four types of collaborative relationship,different goals and interests,different goals but common interests,common goals and interests,and common goals but separate interests,and put forward four forms of collaboration,management collaboration,transactional collaboration,competitive collaboration and cooperative collaboration,and raised that the supply of all-around and one-stop services for the aged can be achieved by the jointly collaboration of medical and elderly care institutions by the support of intelligent community-based elderly care and medical services platform.

    Key words  Community health services;Aged;Service delivered by medical and elderly care institutions;Intelligent community;Supply mechanism

 

Discussion on the Service Contents of Community Health Service Center under the Mode of Medical and Nursing Integration--Based on the Investigation of Supply and Demand of Medical and Nursing Integration in Jiading District of Shanghai

CHEN Hong-zhu1,QIU Yan-qing1*,CHEN Ying1,GU Li-ya2,LIU Bing3,WANG Xiao-yan4

1.Nanxiang Community Health Service Center of Jiading District,Shanghai 201802,China

2.The First Social Welfare House of Jiading District,Shanghai 201802,China

3.Nanxiang Welfare House of Jiading District,Shanghai 201802,China

4.Yongle Village Bead House in Nanxiang Town of Jiading District,Shanghai 201802,China

*Corresponding author:QIU Yan-qing,Center director;E-mail:qyq79@126.com

    Abstract  Objective  To acquaint with the medical service demands of the elderly who lived in the pension institutions in the region and the service ability of the medical and nursing integration team,in order to determine the service content,provide the basis for medical and nursing integration service development,and provide reference for the determination of "medical and nursing integration" service content.

Methods  From November to December in 2016,with the elderly of three pension institutions in Jiading District of Shanghai as demander research objects and the "medical and nursing integration" teams of 11 community health service institutions of Jiading District Yingyuan Hospital of Shanghai Jiading District as the supplier research objects, the supplier-demander research of the "medical and nursing integration" service content was carried out. The questionnaire mainly included the basic information of supplier and demander,the needs of the demander/service capacity of the provider of 7 kinds of items of "medical andn ursing integration" service.  The demand levels of the demander(highest,higher,and general) and the service capability of supplier(higher,general and lower) were analyzed.

Results  The Cronbach's α coefficient of demander questionnaire was 0.980,and the Cronbach's α coefficient of the supplier questionnaire was 0.966. The overall demand degree for seven kinds of medical and nursing integration service of the elderly who lived in the pension institutions was 73.23%-96.80%. Among them,the highest overall demands were health examination(96.80%) and health promotion management(94.98%) secondly,and the lower three was chronic disease management(73.23%). The demand degree for single service item was 54.20%-98.70%. Among them,the lower three items were card establishment(54.20%),follow up(55.10%) and visit and rehabilitation instruction(55.10%) for tumor patients in chronic disease management. The total service capability of the medical and nursing integration service team was 50.00%-89.24%. Among them,the highest total service capabilities were nursing service(89.24%) and the other service(88.09%) secondly,and the lower two were rehabilitation service(50.00%) and clinical diagnosis-treatment service(70.85%). The service capability of single service item was 42.62%-100.00%. Among them,the lower three items were temporary round of sudden situation(severe) in clinical diagnosis-treatment service(42.62%),debridement and bandaging of trauma(large) in nursing service(44.44%) and B type ultrasonography in health examination(47.54%). In the seven kinds of the medical and nursing integration services,the single service items with highest demand and higher service capability were health promotion management(4/6,66.67%),health examination(7/13,53.84%),other service(5/8,62.50%). The single service item with higher or highest demand and higher service capability was nursing service(11/16,68.75%). The single service item with highest demand and general or lower service capability was clinical diagnosis-treatment(6/12,50.00%). The single service item with higher or general demand and general or higher service capability was chronic disease management(13/14,92.86%). The single service item with higher demand and lower service capability was  rehabilitation service(21/21,100.00%).

Conclusion  Limited by provision of the service capability,health promotion management,nursing service,chronic disease management and health service should be given priority to the elderly. The community health service center should strengthen the service ability of rehabilitation service and clinical diagnosis-treatment service,and ultimately gradually develop health management throughout the whole life cycle of the elderly.

    Key words  Community health services;Medical-nursing combined care mode;Pension institution;Medical service content

 

Research on the Mode of Community-based Care with Combination of Medical Service and Endowment Service under Network Governance--a Case Study of Zhongshan Park Street in Shahekou District of Dalian City

FENG Gui-ping*,BAO Han,LI Ru-yu

Department of Public Administration,College of Humanities,Dalian University of Technology,Dalian 116024China

*Corresponding author:FENG Gui-pingAssociate professorE-mailguiping.1971@163.com

    Abstract  Facing the increasing trend of population aging in China,the community pension service mode of combination of medical and nursing service provides a scientific and reasonable solution to the problem of providing service for the aged at the current stage.Based on the framework of network governance theory,this paper deeply analyzes the mode of community pension service of Zhongshan Park Street in Shahekou District of Dalian City from the network foundation,type,structure,initiation,operation,network effect and value analysis.On the basis of perspective and analysis of practical problems,it is suggested to provide the pension service by the multi subjects through the government guiding,to strengthen communication between each subject to avoid wasting resources,to cultivate professional nursing staffs,to build and improve the mode of community-based care with combination of medical service and endowment service through improving the profession level and other ways.

    Key words  Community pension service;Combination of medical and nursing service;Network governance;Shahekou District of Dalian City

 

1Self-perceived Body Weight Status and Its Associated Factors in Prediabetic Population

WANG Ji-hong1*,ZHANG Yi1,QI Meng-jun2,ZHANG Li-xia2

1.School of Medicine,Pingdingshan University,Pingdingshan 467000,China

2.The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China

*Corresponding author:WANG Ji-hong,LecturerE-mail:799981507@qq.com

    Abstract  Objective  To investigate the self-perceived body weight status in the prediabetic population undergoing physical examination at the Outpatient Department,with a focus on analyzing the underestimation of their body weight and associated factors.Methods  Using self-designed questionnaire,we surveyed the prediabetic subjects undergoing physical examination at the Outpatient Department of the Second Affiliated Hospital of Zhengzhou University between July and December 2014 for examining the self-perceived body weight status and its associated factors in them.Results  Among the 320 subjects,the prevalence of overweight/obesity and abdominal obesity was 32.5%(104/320),51.9%(166/320),respectively; only 41.6%(133/320) had non-distorted self-perceived body weight; 44.1%(141/320) underestimated their body weight.Multivariate Logistic regression analysis found that,the factors associated with the underestimation of body weight were unmarried status OR=3.76,95%CI(1.50,9.17),P=0.005,never tried to lose weight OR=6.92,95%CI(2.35,19.97),P0.001 and overweight/obesity OR=22.91,95%CI(8.30,63.07),P0.001.Conclusion  The self-perceived body weight status in the prediabetic subjects is low.Factors associated with underestimation of weight were unmarried status,never tried to lose weight and overweight/obesity.Therefore,this kind of population should be provided with information about how to perceive the weight properly in order to correct the distorted perception of weight and improve the awareness level of weight status.

    Key words  Prediabetic stateBody mass indexRoot cause analysis

 

1Effects of α-lipoic Acid on the Vascular Endothelial Cell Function and PI3K/Akt/GSK-3β Pathway in Rats with Type 2 Diabetes Mellitus and High Blood Glucose Fluctuation

WANG Jing-shang1,SUN Ming-yue2,HUANG Ye3*,YIN Hui-jun4

1.Department of Traditional Chinese Medicine,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China

2.GCP Center,Xiyuan Hospital CACMS,Beijing 100091,China

3.Department of Emergency,Xiyuan Hospital CACMS,Beijing 100091,China

4.School of Integrated Chinese and Western Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China

*Corresponding author:HUANG Ye,Associate chief physician;E-mail:yellow_926@126.com

    Abstract  Objective  To explore the effects and mechanism of α-lipoic acid (α-LA) on the vascular endothelial cell function and PI3K/Akt/GSK-3β pathway in rats with type 2 diabetes mellitus (T2DM) and high blood glucose fluctuation.Methods  Fifty male Sprague Dawley (SD) rats of pathogen-free were involved from July to December 2013.All the rats were fed adaptively for 2 weeks with routine diet first.Then 10 rats were chosen as normal group (NOR group) by random number table method.The other 40 rats were fed by high lipid diet for 6 weeks and then were induced by only one intraperitoneal injection of streptozotocin (STZ,35 mg/kg),then were fed with routine diet for 2 weeks.During the 10th week of intervention,fasting blood glucose (FBG) levels of rats were measured every morning by collecting blood samples from their caudal veins,meanwhile fasting blood glucose coefficient of variation (FBG-CV) were calculated.The rats,of which FBG levels higher than 16.7 mmol/L,were thought to be successful T2DM rats,and here were 36 rats.The NOR rats were induced by only one intraperitoneal injection of citric acid-trisodium citrate buffer solution after 6 weeks of intervention with routine diet,then continued to be fed with routine diet.During the 10th week of intervention,the measurement of their FBG levels was performed as the same as the other rats,and FBG-CV was calculated as well.And then the T2DM rats with higher FBG-CV value (at least 2 times of NOR group) were divided into blowing high blood glucose group (BHG group,24 rats,20 rats with higher FBG-CV were chosen for experiment),the others (NOR groupFBG-CV value2 times of NOR group) were steady high blood glucose group (SHG group,12 rats,10 rats with lower FBG-CV were chosen for experiment).Then BHG rats were divided into α-LA group (10 rats) and fluctuant high blood glucose control group (FHG group,10 rats) by random number table method.α-LA group was fed with high lipid diet,and intragastric administration with α-LA suspension.FHG group was fed with high lipid diet and intragastric administration with constant volume distilled water.NOR group was fed with routine diet and intragastric administration with constant volume distilled water.SHG group was fed with high lipid diet and intragastric administration with constant volume distilled water.Eight weeks later,levels of FBG,fasting insulin (FINS),markers of vascular endothelial cell damagehepatocyte growth factor (HGF),nitric oxide (NO),oxidative stress indexes superoxide dismutase (SOD) and malondialdehyde (MDA) and advanced glycation end products (AGEs) were examined,expression of PI3K/Akt/GSK-3β pathway proteins (Akt,p-Akt,GSK-3β,p-GSK-3β) were measured,and markers indicating the activation degree of Akt and GSK-3β(p-Akt/Akt,p-GSK-3β/GSK-3β) were calculated.Results  SHG group and FHG group had lower body weight and FINS levels but higher FBG levels than NOR group (P0.05).α-LA group had lower body weight but higher FBG levels than NOR group (P0.05).α-LA group had lower FBG levels but higher FINS levels than FHG group (P0.05).SHG group and FHG group had higher HGF,NO,MDA,AGEs levels but lower SOD levels than NOR group (P0.05).SHG group and α-LA group had lower HGF,NO,MDA,AGEs levels but higher SOD levels than FHG group (P0.05).α-LA group had lower SOD levels but higher MDA levels than NOR group (P0.05).SHG group and FHG group had lower p-Akt levels,p-GSK-3β levels,p-Akt/Akt,p-GSK-3β/GSK-3β than NOR group (P0.05).α-LA group had lower p-Akt levels,p-Akt/Akt but higher GSK-3β levels,p-GSK-3β levels than NOR group (P0.05).SHG group had higher p-Akt levels,p-Akt/Akt than FHG group (P0.05).α-LA group had higher p-Akt levels,GSK-3β levels,p-GSK-3β levels,p-Akt/Akt,p-GSK-3β/GSK-3β than FHG group (P0.05).Conclusion  α-LA could alleviate the vascular endothelial cell damage in T2DM rats with high glucose fluctuations obviously.The protective mechanism is closely related to its effects of relieving oxidative stress and modulation of the expressions of PI3K/Akt/GSK-3β signaling pathway proteins.

    Key words  Diabetes mellitus,type 2;Thioctic acid;Blood glucose;Endothelial cells;Phosphatidylinositol 3-kinase;Protein kinases;Glycogen synthase kinases

 

Clinical Value of Continuous Quality Improvement in Shortening the DNT of Acute Ischemic Stroke Patients with Intravenous Thrombolysis

FU Xiao1,ZHAO Xi-yao2*,WANG Li2,LI Xiang-xin2,LIU Lan-qin1,WU Hui-ping1

1.Department of Emergency,the Second Affiliated HospitalJiande Branch,School of Medicine,Zhejiang University,Hangzhou 311600,China

2.Department of Neurology,the Second Affiliated HospitalJiande Branch,School of Medicine,Zhejiang University,Hangzhou 311600,China

*Corresponding author:ZHAO Xi-yao,Attending physician;E-mail:zhaoxiyao-1980@163.com

    Abstract  Objective  To explore the clinical value of continuous quality improvementCQI in shortening the Door-to-needle timeDNT of acute ischemic strokeAISpatients with intravenous thrombolysis(IVT),in order to  improve the clinical prognosis of patients with AIS.Methods  From January 2010 to June 2016,88 patients with AIS who were treated by IVT,met the inclusion criteria and admitted to the Second Affiliated Hospital(Jiande Branch),School of Medicine,Zhejiang University were enrolled.Nine non-emergency patients were excluded,and 79 patients were included in the study finally.They were grouped according to the implementation of CQI or not.That was,patients before January 2015 were divided into before improvement group(46 cases),patients after April 2015 were divided into the after improvement group(33 cases).From January 2010 to December 2014,the average DNT of AIS patients was 101.2 minutes in our hospital,which was higher than the 60 minutes required by the American Heart Association/American Stroke Association guidelines in 2013.Therefore,from January to April in 2015,the processes of the diagnosis and treatment AIS patients were managed by using CQI concepts and methods,so that the AIS patients eligible for IVT were given IVT within 60 minutes of arriving in the emergency room.The observation time ended 3 months after the patient accepted intravenous thrombolysis.The main evaluation indicators of the two groups were compared,including the door-to-CT scan time,CT scan-to-needle times,DNT,score of the National Institute of Health Stroke Scale(NIHSS)24 hours and 7 days after IVT,the incidence of symptomatic deterioration and symptomatic intracranial hemorrhage(ICH) within 7 days after IVT,the score of Modified Rankin Scale(mRS) 3 months after IVT,the rates of good prognosis and case fatality.Results  In order to ensure the comparability of age,the incidence of diabetes and NIHSS between the two groups' patients,some patients were excluded and 35 cases of the before improvement group and 20 cases of the after improvement group were enrolled finally.The CT scan-to-needle time and DNT of the after improvement group were shorter than those of the before improvement group(P0.05).There were no statistically significant differences in the door-to-CT scan timethe scores of NIHSS 24 hours and 7 days after IVTthe incidence of symptomatic deterioration and symptomatic ICH within 7 days after IVT,the score of mRS 3 months after IVT,the rates of good prognosis and case fatality between the two groups(P0.05).Conclusion  The clinical value of CQI in shortening DNT of AIS patients with IVT is significant,and it can bring better economic and social benefits.It is worth further promotion in primary hospitals.

    Key words  InfarctionThrombolytic therapyDoor-to-needle timeContinuous quality improvement

 

The Expression of Angiotensin ,Angiotensin 1-7 and Their Receptors in Patients with Polycystic Ovary Syndrome

CHEN Li-hua1,WANG Xiu-li2CHEN Jing3,LIU Jie2,LI Xiao-dong2*LI Yan-fei4,ZHANG Ming-le2ZHANG Yuan2WANG Yu2WANG Hui-ying2DUAN Xiao-fen2

1.The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000China

2.The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China

3.Harrison International Peace Hospital,Hengshui 053000China

4.Cangzhou Central Hostipal,Cangzhou 061000China

*Corresponding author:LI Xiao-dong,Chief physician,Master supervisor;E-mail709866384@qq.com

    Abstract  Objective  To detect the expression levels of Angiotensin(Ang) and Ang-(1-7)in the follicular fluid and Ang receptors on granulosa cells in patients with polycystic ovary syndrome(PCOS),and to investigate the role of ovarian rennin-angiotensin system(RAS) in the pathogenesis of PCOS.Methods  From November 2011 to November 2013,89 female patients who received in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ETtreatment in the Reproductive Medicine Center of the Second Hospital of Hebei Medical University were selected,including 66 case of PCOS patients(PCOS group) and 23 cases of infertility female patients due to bilateral fallopian tube obstruction or male factors(control group).The relevant data of two groups were collected:body mass index(BMI)basal serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2) and LH/FSH before entering the IVF/ICSI cycles;the serum FSH,LH,E2 and LH/FSH after down regulation;the day number of controlled ovarian hyperstimulation(COH);the levels of E2 on the day of human chorionic gonadotropin(HCG) injection;the numbers of fertilization,cleavage,transplantable embryos,eggs obtained and the rate of pregnancy after transplantation.The blood β-HCG was measured 14 days after transplantation.B type ultrasonography was performed 4 weeks after transplantation to determine whether the pregnancy occurred or not.The two groups were subdivided into pregnancy subgroup and non pregnancy subgroup.The levels of Ang,Ang-(1-7) in human follicular fluid were determined by ELISA.The expression levels of mRNA of AT1R,AT2R,MAS in the granulosa cells were detected by Real-time PCR.Results  The BMI of PCOS group was higher than that of control groupP0.05;the level of basal serum FSH in PCOS group was lower than that in control group,the basal serum LH level,LH/FSH in PCOS group were higher than those in control groupP0.05.After transplantation,the numbers of fertilization,cleavage,transplantable embryos in PCOS group were more than those in control groupP0.05.The levels of Ang and Ang-(1-7) in follicular fluid on the day of follicular aspiration in PCOS group were higher than those in control groupP0.05.In control group,there were no statistically significant differences in the levels of Ang and Ang-(1-7) in follicular fluid between pregnancy subgroup and non pregnancy subgroup(P

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