25 research outputs found
Réformes économiques et activités des hÎpitaux municipaux en zone rurale : une analyse dans la province de Shandong
Les vastes rĂ©formes entreprises en Chine dans le cadre de ce quâil est convenu dâappeler le Ă« socialisme de marchĂ© Ă» ont eu dâimportantes rĂ©percussions sur le fonctionnement du systĂšme de santĂ©. Cette communication se propose dâen analyser certains effets sur lâactivitĂ© et la performance dâun Ă©chantillon dâhĂŽpitaux municipaux situĂ©s dans une zone rurale de la province de Shandong. Les donnĂ©es de base ont Ă©tĂ© recueillies lors dâune enquĂÂȘte en 2002 et complĂ©tĂ©es par des informations Ă©manant des diffĂ©rents dĂ©partements de lâadministration concernĂ©s. Les dĂ©terminants de lâactivitĂ© des hĂŽpitaux ont Ă©tĂ© analysĂ©s Ă partir dâune analyse de panel sur la pĂ©riode 1986-2000. LâĂ©tude de leur performance a Ă©tĂ© faite en utilisant une analyse non paramĂ©trique (DEA et indice de Malmquist). Les rĂ©sultats obtenus suggĂšrent notamment que la contrainte de revenu de la population est un frein Ă lâaugmentation de la frĂ©quentation des hĂŽpitaux municipaux et que les mĂ©canismes dâassurance ne paraissent pas jouer en lâĂ©tat de rĂŽle significatif. LâactivitĂ© sâavĂšre influencĂ©e par des facteurs reprĂ©sentatifs de lâattractivitĂ© des hĂŽpitaux. Lâintroduction dâun systĂšme de Ă« gestion intĂ©grĂ©e Ă» a permis dâamĂ©liorer la qualitĂ© des soins des structures de santĂ© de village placĂ©s sous la tutelle des hĂŽpitaux municipaux tout en amĂ©liorant dans lâensemble la situation financiĂšre de ces derniers. Dans lâensemble, les hĂŽpitaux municipaux de notre Ă©chantillon ont amĂ©liorĂ© leur efficience durant la pĂ©riode dâĂ©tude sous lâinfluence de facteurs trĂšs variĂ©s selon les hĂŽpitaux. Mais il apparaĂźt que les hĂŽpitaux financiĂšrement contraints ont tendance Ă ĂÂȘtre comparativement plus efficients que les autres.activitĂ© et performance des hopitaux â efficience technique, RĂ©formes Ă©conomiques â dĂ©centralisation
Evolution de lâactivitĂ© et de la performance dâun Ă©chantillon d'hĂŽpitaux municipaux en Chine
La dĂ©centralisation en Chine a placĂ© les hĂŽpitaux municipaux (HM) au cĆur du systĂšme sanitaire en zone rurale. Nous avons utilisĂ© les informations collectĂ©es dans un Ă©chantillon de 21 HM de la province de Shandong et dans les administrations concernĂ©es pour analyser par des mĂ©thodes quantitatives les dĂ©terminants de leur activitĂ©, mesurer leur efficience et en rechercher les facteurs explicatifs pour la pĂ©riode 1986-2000. Nos rĂ©sultats suggĂšrent entre autres que le revenu per capita de la zone de desserte des HM ainsi que leur attractivitĂ© perçue ont un effet positif sur leur activitĂ©, que les tarifs pratiquĂ©s en sont un frein et que les dispositifs de couverture maladie nâont pas dâimpact significatif sur leur frĂ©quentation. LâintĂ©gration verticale partielle des HM avec les centres de santĂ© villageois a freinĂ© lâactivitĂ© de ces hĂŽpitaux. Leur efficience sâest globalement amĂ©liorĂ©e durant la pĂ©riode Ă©tudiĂ©e, mais selon une dynamique relativement hĂ©tĂ©rogĂšne,. Cette Ă©volution sâest faite en partie sous lâinfluence de facteurs institutionnels qui tiennent Ă des modalitĂ©s de rĂ©gulation sectorielle et Ă des questions de gouvernance liĂ©es 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 Ă 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 Ă 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 studentsâ 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 studentsâ 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 (pâ=â0.002). There was a trend of increasing CFUs across the three groups with decreasing iron load (pâ=â0.011). The CFUs correlated with brachial FMD (pâ=â0.029) and arterial stiffness (pâ=â0.02), but not with serum ferritin level. Multiple linear regression showed that CFU was a significant determinant of FMD (pâ=â0.043) and arterial stiffness (pâ=â0.02) 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: The study evaluated the feasibility and safety of a novel left atrial appendage (LAA) occluder (LAmbre™, Lifetech Scienti fic Corp., China) in canines. Background: Transcatheter LAA occlusion is comparable towarfarin in preventing atrial fibrillation-related strokes. Methods: Twenty-two healthy dogs (28 ± 3 kg) received LAmbre implants. The device is delivered by an 8 –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 ficed in groups at Days 1–3 (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 fice. Results: The LAmbre was successfully implanted, retrieved, repositioned and re-implanted in all dogs. The mean implant size was 24 ± 3 mm and the device chosen was 36 ± 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 ficant pericardial effusion at Day 3 (n = 1). Complete healing on the atrial facing surface with optimal LAA obliteration was con firmed by gross andmicroscopic examinations in dogs that have been followed up ≥3 months (n=10). No infarctwas detected inmajor organs. Conclusions: Our preliminary data suggested the LAmbre™ device is feasible with high success rate in canines. Further studies are needed to evaluate its safety and ef ficacy.</p
Mobile emergency (surgical) hospital: Development and application in medical relief of â4.20â 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 âgolden hourâ 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 (74.4âŻÂ±âŻ8.3âŻyears; 66.7% men; CHA2DS2-VASc: 4.0âŻÂ±âŻ1.6, HAS-BLED score: 3.2âŻÂ±âŻ1.3) 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 6âŻmonths showed complete sealing of the LAA (residual jet flow of <5âŻmm) in 51/54 (94.4%) patients. No device-related thrombus was documented. At 12âŻmonths 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