Réformes économiques et activités des hôpitaux municipaux en zone rurale : une analyse dans la province de Shandong

Les vastes réformes entreprises en Chine dans le cadre de ce qu’il est convenu d’appeler le « socialisme de marché » ont eu d’importantes répercussions sur le fonctionnement du système de santé. Cette communication se propose d’en analyser certains effets sur l’activité et la performance d’un échantillon d’hôpitaux municipaux situés dans une zone rurale de la province de Shandong. Les données de base ont été recueillies lors d’une enquête en 2002 et complétées par des informations émanant des différents départements de l’administration concernés. Les déterminants de l’activité des hôpitaux ont été analysés à partir d’une analyse de panel sur la période 1986-2000. L’étude de leur performance a été faite en utilisant une analyse non paramétrique (DEA et indice de Malmquist). Les résultats obtenus suggèrent notamment que la contrainte de revenu de la population est un frein à l’augmentation de la fréquentation des hôpitaux municipaux et que les mécanismes d’assurance ne paraissent pas jouer en l’état de rôle significatif. L’activité s’avère influencée par des facteurs représentatifs de l’attractivité des hôpitaux. L’introduction d’un système de « gestion intégrée » a permis d’améliorer la qualité des soins des structures de santé de village placés sous la tutelle des hôpitaux municipaux tout en améliorant dans l’ensemble la situation financière de ces derniers. Dans l’ensemble, les hôpitaux municipaux de notre échantillon ont amélioré leur efficience durant la période d’étude sous l’influence de facteurs très variés selon les hôpitaux. Mais il apparaît que les hôpitaux financièrement contraints ont tendance à être comparativement plus efficients que les autres.activité et performance des hopitaux – efficience technique, Réformes économiques – décentralisation

Evolution de l’activité et de la performance d’un échantillon d'hôpitaux municipaux en Chine

La décentralisation en Chine a placé les hôpitaux municipaux (HM) au cœur du système sanitaire en zone rurale. Nous avons utilisé les informations collectées dans un échantillon de 21 HM de la province de Shandong et dans les administrations concernées pour analyser par des méthodes quantitatives les déterminants de leur activité, mesurer leur efficience et en rechercher les facteurs explicatifs pour la période 1986-2000. Nos résultats suggèrent entre autres que le revenu per capita de la zone de desserte des HM ainsi que leur attractivité perçue ont un effet positif sur leur activité, que les tarifs pratiqués en sont un frein et que les dispositifs de couverture maladie n’ont pas d’impact significatif sur leur fréquentation. L’intégration verticale partielle des HM avec les centres de santé villageois a freiné l’activité de ces hôpitaux. Leur efficience s’est globalement améliorée durant la période étudiée, mais selon une dynamique relativement hétérogène,. Cette évolution s’est faite en partie sous l’influence de facteurs institutionnels qui tiennent à des modalités de régulation sectorielle et à des questions de gouvernance liées aux relations entre les HM et la tutelle.

Jejunal Serrated Adenoma Diagnosed and Treated by Double-Balloon Enteroscopy

Serrated polyps are most commonly located in the colorectum and have been well recognized as an important precursor lesion for colorectal cancer. Serrated adenoma in the small intestine has been reported more rarely but may represent a distinct morphological and biological subtype with malignant potential. Here, we present the case of a 65-year-old female who underwent double-balloon enteroscopy due to obscure gastrointestinal bleeding. A polyp sized 3.5 × 2.0 cm with a long pedicle in the jejunum, located 50 cm distal to the Treitz ligament, was detected. Endoscopic mucosal resection was done. The pathological results revealed a traditional serrated adenoma sized 3.5 × 2.2 cm

Long-term outcomes of early childhood science education: insight from a cross-national comparative case study on conceptual understanding of science

The purpose of this research was to explore the long term outcomes of either participating or not participating in early childhood science education on Grade 6 students’ conceptual understanding of science. The research is situated in a conceptual framework that evokes Piagetian developmental levels as both potential curriculum constraints and potential models of efficacy. The research design was a multiple case study of Grade 6 children from three schools in China (n=140) who started formal science education in the third grade, and Grade 6 children from three matched schools in Australia (n=105) who started learning science in kindergarten. The students’ understanding was assessed by a science quiz and in-depth interview. The data showed that participating children from the high socio-economic schools in China and Australia had similar understandings of science. Divergence between the medium and low socio-economic schools, however, indicated that the grounding in early childhood science education in Australia may have placed these children at an advantage. Alternative explanations for the divergence including the nature of classroom instruction in the two countries are discussed

Circulating CD133+VEGFR2+ and CD34+VEGFR2+ cells and arterial function in patients with beta-thalassaemia major

Arterial dysfunction has been documented in patients with beta-thalassaemia major. This study aimed to determine the quantity and proliferative capacity of circulating CD133+VEGFR2+ and CD34+VEGFR2+ cells in patients with beta-thalassaemia major and those after haematopoietic stem cell transplantation (HSCT), and their relationships with arterial function. Brachial arterial flow-mediated dilation (FMD), carotid arterial stiffness, the quantity of these circulating cells and their number of colony-forming units (CFUs) were determined in 17 transfusion-dependent thalassaemia patients, 14 patients after HSCT and 11 controls. Compared with controls, both patient groups had significantly lower FMD and greater arterial stiffness. Despite having increased CD133+VEGFR2+ and CD34+VEGFR2+ cells, transfusion-dependent patients had significantly reduced CFUs compared with controls (p = 0.002). There was a trend of increasing CFUs across the three groups with decreasing iron load (p = 0.011). The CFUs correlated with brachial FMD (p = 0.029) and arterial stiffness (p = 0.02), but not with serum ferritin level. Multiple linear regression showed that CFU was a significant determinant of FMD (p = 0.043) and arterial stiffness (p = 0.02) after adjustment of age, sex, body mass index, blood pressure and serum ferritin level. In conclusion, arterial dysfunction found in patients with beta-thalassaemia major before and after HSCT may be related to impaired proliferation of CD133+VEGFR2+ and CD34+VEGFR2+ cells

Preclinical evaluation of a new left atrial appendage occluder (Lifetech LAmbre (TM) Device) in a canine model

Objectives: The study evaluated the feasibility and safety of a novel left atrial appendage (LAA) occluder (LAmbre (TM), Lifetech Scientific Corp., China) in canines. Objectives: &nbsp; The study evaluated the feasibility and safety of a novel left atrial appendage (LAA) occluder (LAmbre&trade;, Lifetech Scienti &nbsp; fic Corp., China) in canines. Background: &nbsp; Transcatheter LAA occlusion is comparable towarfarin in preventing atrial fibrillation-related strokes. Methods: &nbsp; Twenty-two healthy dogs (28 &plusmn; 3 kg) received LAmbre implants. The device is delivered by an 8 &nbsp; &ndash;10 French sheath and has full recapture and repositioning capabilities. All dogs received 1-week antibiotics and 4-week aspirin (80 mg daily) after implants and they were sacri &nbsp; ficed in groups at Days 1&ndash;3 (n = 5), 1- (n = 7), 3- (n = 4) and 6-months (n = 6) for pathological examinations. Transthoracic echocardiography (TTE) was performed immediately after implant, at Day 3 and before sacri &nbsp; fice. Results: &nbsp; The LAmbre was successfully implanted, retrieved, repositioned and re-implanted in all dogs. The mean implant size was 24 &plusmn; 3 mm and the device chosen was 36 &plusmn; 7% larger than the measured landing zone diameter. Improper device selection (only 21% oversizing) resulted in dislodgement and death of 1 dog on Day 3. Post-implant angiography and TTE showed well-positioned device without pericardial effusion or impingement on surrounding structures. Late complications included device-related thrombus at 1 month (n = 1) and clinically insigni &nbsp; ficant pericardial effusion at Day 3 (n = 1). Complete healing on the atrial facing surface with optimal LAA obliteration was con &nbsp; firmed by gross andmicroscopic examinations in dogs that have been followed up &nbsp; &ge;3 months (n=10). No infarctwas detected inmajor organs. Conclusions: &nbsp; Our preliminary data suggested the LAmbre&trade; device is feasible with high success rate in canines. Further studies are needed to evaluate its safety and ef &nbsp; ficacy.</p

Mobile emergency (surgical) hospital: Development and application in medical relief of “4.20” Lushan earthquake in Sichuan Province, China

In the 21st century, natural disasters and emergencies occur frequently worldwide, which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses. China has a vast territory frequently struck by natural disasters. However, the reality is not optimistic. Poor organization and management during the rescue actions, the lack of large-scale, systematic medical rescue equipment were all great barriers to the outcomes. Mobile hospitals are expected to provide better health care. We were inspired by the concept of mobile hospital. Chongqing Emergency Medical Center, has set up trauma care system since 1988, in which prehospital care, intensive care, and in-hospital treatment is fully integrated. As a major advantage, such a system provided assurance of “golden hour” rescue treatment. Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly. Based on the civilian experiences in Chongqing Emergency Medical Center, the mobile emergency (surgical) hospital was developed

Left atrial appendage occlusion with lambre in atrial fibrillation: Initial European experience

BACKGROUND We here report the first European experience with the novel LAmbre left atrial appendage (LAA) occluder, a self-expanding device consisting of an umbrella and a cover connected by a central waist. METHODS AND RESULTS A total of 60 patients (74.4 ± 8.3 years; 66.7% men; CHA2DS2-VASc: 4.0 ± 1.6, HAS-BLED score: 3.2 ± 1.3) with atrial fibrillation and contraindications to oral anticoagulation underwent left atrial appendage occlusion (LAAO) with the LAmbre device at two German centers between November 2013 and September 2015. Device success defined as correct placement of the device was achieved in all patients (100%). Resizing of the device was necessary in 3 (5%) patients. Device-related complications included 2 (3.3%) pericardial effusions on day 8 and 33 after the index procedure requiring pericardiocentesis. Transesophageal echocardiography at 6 months showed complete sealing of the LAA (residual jet flow of <5 mm) in 51/54 (94.4%) patients. No device-related thrombus was documented. At 12 months transient ischemic attack was observed in 1 patient (1.6%) and minor bleeding in 3 patients (5%). CONCLUSIONS Although minimizing procedure-related complications remains challenging, LAAO with the LAmbre showed high device success and good mid-term performance regarding prevention of stroke and bleeding

Cooperation between NSPc1 and DNA methylation represses HOXA11 expression and promotes apoptosis of trophoblast cells during preeclampsia

Accumulating evidence has shown that the apoptosis of trophoblast cells plays an important role in the pathogenesis of preeclampsia, and an intricate interplay between DNA methylation and polycomb group (PcG) protein-mediated gene silencing has been highlighted recently. Here, we provide evidence that the expression of nervous system polycomb 1 (NSPc1), a BMI1 homologous polycomb protein, is significantly elevated in trophoblast cells during preeclampsia, which accelerates trophoblast cell apoptosis. Since NSPc1 acts predominantly as a transcriptional inactivator that specifically represses HOXA11 expression in trophoblast cells during preeclampsia, we further show that NSPc1 is required for DNMT3a recruitment and maintenance of the DNA methylation in the HOXA11 promoter in trophoblast cells during preeclampsia. In addition, we find that the interplay of DNMT3a and NSPc1 represses the expression of HOXA11 and promotes trophoblast cell apoptosis. Taken together, these results indicate that the cooperation between NSPc1 and DNMT3a reduces HOXA11 expression in preeclampsia pathophysiology, which provides novel therapeutic approaches for targeted inhibition of trophoblast cell apoptosis during preeclampsia pathogenesis