Developing better health systems is the key to delivering optimal health services, although more evidence of effective strategies to do so is needed. Field surveys were conducted in Viet Nam and Cambodia to identify best practices in addressing health system bottlenecks to scale up disease control programs. The two countries were compared over time using a framework for analysis developed by the authors. In Viet Nam, a health system was in place for decades at the central to municipal levels, although it was fragile until the 1990s, when the government started taking measures. In Cambodia, the previous health system had been destroyed during previous internal conflict. In the post-conflict period, the health system was rebuilt with support for programs followed by centralization of health services. In different settings, different measures were taken to deal with similar bottlenecks. In Cambodia, vertical programs were dominant, so the government sought to centralize drug management to deal with shortages of essential drugs, while Viet Nam sought to mobilize resources to ensure drug distribution at all levels. This study shows there is no single successful approach to health systems, and a systemic approach needs to be taken because elimination of one bottleneck may reveal another. Efforts to enhance disease-specific programs may not always contribute to overall enhancement of the health system, and the best possible approach may not be the same in different countries. Further study is needed to explore common issues and principles for effective strategies to enhance health systems in different contexts.
This study investigated the pollution of dust mite allergens in the houses of 30 families and their infection to young allergic asthma patients in Shanghai. Medical records, family information, and dust samples were collected from the dwellings of 15 young allergic asthma patients and 15 healthy subjects. Der 1 allergen, which is a common allergen causing allergic asthma, was measured in collected dust samples using the Pharmacia Uni-CAP System. A significant correlation was found between the number of Der 1 allergens collected from floor surfaces and the number of Der 1 allergens collected from bed surfaces. Some factors influencing Der 1 allergen levels were found in this study. Relative humidity in dwellings was found to be most influential to the allergen levels. The findings suggested that traditional reduction methods for coarse particles, such as opening windows and periodic cleaning of beddings, may be effective in removing dust mite allergens.
The rapid increase in the population of the elderly has raised several social issues. The current study focused on sleep dissatisfaction in family caregivers to identify family caregivers with a heavy care burden. This study aimed to detect the characteristics of caregivers who are most likely to have sleep dissatisfaction. A chi-squared automatic interaction detection technique was used to analyze data collected from 92 research care managers who collected demographic and sleep dissatisfaction information from 280 caregivers and their care recipients. Caregivers whose care recipients were unstable and bedridden were most likely to have sleep dissatisfaction. When care recipients were not stable or non-bedridden, had severe dementia symptoms, and were physically independent, their caregivers were the second most likely to have sleep dissatisfaction. When care recipients were not stable or non-bedridden, had moderate dementia symptoms, and did not need help in transferring, their caregivers had the lowest risk of sleep dissatisfaction. Although many recent studies have found a high prevalence of insomnia among the elderly, describing the characteristics of caregivers who are most likely to have sleep dissatisfaction is a significant challenge. When care recipients are physically independent, the severity of the recipient's dementia symptoms relates to the caregiver's dissatisfaction with his/her sleep. In physically dependent care recipients, the severity of the recipient's dementia did not contribute to the caregiver's dissatisfaction with his/her sleep.
Doxorubicin (DOX) is one of the most effective chemotherapeutic agents, but cardiotoxicity limits its clinical use. Although the mechanisms are not entirely understood, reactive oxygen species (ROS) and cardiomyocyte apoptosis appear to be involved in DOX cardiotoxicity. Protection or alleviation of DOX cardiotoxicity can be achieved by administration of natural phenolic compounds via activating endogenous defense systems and antiapoptosis. Naringenin-7-O-glucoside (NARG), isolated from Dracocephalum rupestre Hance, could protect from cardiomyocyte apoptosis and induce endogenous antioxidant enzymes against DOX toxicity, but the effects on intracellular ROS generation and cell membrane stability were not demonstrated. In the present study, we investigated the effects of NARG on H9c2 cell morphology, viability, lactate dehydrogenase (LDH) and creatine kinase (CK) leakage, glutathine peroxidase (GSH-Px) activity, intracellular Ca2+ concentration, and ROS generation. Compared with DOX alone treatment group, the morphological injury of the cells in groups treated by DOX plus NARG was alleviated, cell viability was increased, the amount of released LDH and CK was significantly decreased, the activity of GSH-Px was increased, the content of intracellular Ca2+ and ROS generation was lowered remarkably. These results suggest that NARG could prevent cardiomyocytes from DOX-induced toxicity by their property of stabilizing the cell membrane and reducing ROS generation.
The dominant-negative inhibition of KCNJ2-encoded inward rectifier potassium channels (Kir2) is currently considered the best approach to biological pacemakers. We hypothesized that inhibition of the inward rectifier potassium current (IK1) in ventricular myocytes by RNA interference (RNAi) would convert ventricular myocytes into pacemaker cells. Five pieces of short hairpin RNA (shRNA) were designed to target the KCNJ2 gene and then plasmids incorporating shRNA and green fluorescent protein (GFP) as a marker were constructed for transfection into rat ventricular myocytes. The levels of KCNJ2 mRNA were analyzed with real-time quantitative RT-PCR to screen for pieces of shRNA that were effective at inhibiting the expression of the KCNJ2 gene. The activity of potassium ionic channels was then studied in the transfected ventricular myocytes. In the recombinant plasmids, LYS2 transfection significantly inhibited the mRNA of the KCNJ2 gene in comparison to other groups (p < 0.05), and the beating frequency of ventricular myocytes increased after LYS2 transfection. The open probability of IK1 potassium ion channels of cardiac myocytes transfected with the LYS2 plasmid was significantly down-regulated (p < 0.05) and the IK1 of ventricular myocytes was also significantly suppressed compared to the negative group (p < 0.05). Our study demonstrated that IK1 was clearly inhibited after the inhibition of KCNJ2 gene expression by RNAi, and this may represent a new approach to the study of biological pacemakers.
Oxidative stress markers including pentosidine and homocysteine were examined comparing them with inflammation markers including highly sensitive C-reactive protein (hsCRP) and matrix metalloproteinase-9 (MMP-9) in serum from patients with Werner syndrome (WS) and healthy individuals. Elevation of serum pentosidine correlated significantly with normal aging in healthy individuals (p < 0.0004). Serum pentosidine in WS increased significantly compared with age-matched healthy individuals (p < 0.05). Serum homocysteine levels increased insignificantly with normal aging in healthy individuals and in WS compared with age-matched healthy individuals. As both pentosidine and homocysteine levels did not correlate with hsCRP nor MMP-9, both oxidative stress markers may be differentially regulated by inflammation.
Respiration variation in arterial pulse pressure (ΔPP) and pulse oximetry plethysmographic waveform amplitude (ΔPOP) are accurate predictors of fluid responsiveness in mechanically ventilated patients. We hypothesized that stroke volume variation (SVV) and pleth variability index (PVI) can predict fluid responsiveness in prospective study consisted of fifty-five Hans Chinese patients undergoing resection of primary retroperitoneal tumors (PRPT). During the surgical procedures, hemodynamic data [central venous pressure (CVP), cardiac index (CI), stroke volume index (SVI), SVV, and PVI] were recorded before and after volume expansion (VE) (8 ml•kg−1 of 6% hydroxyethyl starch 130/0.4). Fluid responsiveness was defined as an increase in SVI ≥ 10% after VE. Four patients were excluded from analysis for arrhythmia or obvious CVP, PI (p <0.05). The best threshold values to predict fluid responsiveness were more value of SVV, and PVI correlated significantly with volume-induced changes in SVI (p<0.01). Both SVV and PVI could be used to predict intraoperative fluid responsiveness mechanically ventilated patients during major surgical procedures in Hans Chinese. This SVV, and PVI] were recorded before and after volume expansion (VE) (8 ml•kg−1 of 6% hydroxyethyl starch 130/0.4). Fluid responsiveness was defined as an increase in SVI ≥ hemorrhage during VE. Baseline SVV correlated well with baseline PVI, and the changes in SVV was correlated with the changes in PVI (p < 0.01) after VE. There were significant increases of CI, SVI and decreases of SVV, PVI in responder (Rs) after VE. ROC results showed that the areas for SVV, PVI were significantly higher than the areas for CI, MAP, than 12.5% for SVV and more than 13.5% for PVI in the real surgical setting. The baseline during resection of PRPT in Hans Chinese.
Duodenal adenocarcinoma is a relatively rare malignancy and pancreaticoduodenectomy would be a standard procedure to achieve curative resection. We report a case of resection of the 2nd portion of the duodenum with nodal dissection preserving the pancreas. The patient was a 75-year-old man with right-sided paresis suffering from early cancer in the 2nd portion of the duodenum. Despite 3 times of endoscopic mucosal resections, mucosal local recurrence was found. The depth of the tumour involvement continued to be limited within the mucosal layer. We performed segmental duodenal resection with nodal dissection sacrificing the minor papilla, while preserving the pancreas and the major papilla. The pathological diagnosis was primary intramucosal adenocarcinoma; the surgical margin was negative for cancer and there was no nodal metastasis. This procedure can be an alternative to pancreaticoduodenectomy in patients with early-stage adenocarcinoma in the 2nd portion of the duodenum when the major papilla can be spared, especially in high-risk patients.
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