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三甲综合医院多院区管理实践及相关问题探讨 被引量:6
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作者 李涛 王建六 王天兵 《医院管理论坛》 2023年第5期3-6,共4页
为加快优质医疗资源的均衡布局,“一院多区”发展模式成为医院未来的发展方向。在从单一院区向多院区的推进过程中,会遇到医疗质量同质化、人才储备、运行成本、信息共享等诸多问题与困惑。我院采用垂直化与扁平化管理相结合的管理模式... 为加快优质医疗资源的均衡布局,“一院多区”发展模式成为医院未来的发展方向。在从单一院区向多院区的推进过程中,会遇到医疗质量同质化、人才储备、运行成本、信息共享等诸多问题与困惑。我院采用垂直化与扁平化管理相结合的管理模式,通过对通州院区布局、学科进行科学设置,实行床位一体化管理、诊疗同质化管理、行政大部制管理、规范财务成本管理,完善激励机制,统一信息系统等系列措施,形成了医院与分院区协同发展的格局。 展开更多
关键词 综合医院 多院区管理模式 管理实践
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某三甲综合医院分院区建院初期运营模式探索 被引量:2
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作者 蒋丽蕾 王建六 +2 位作者 王天兵 李涛 郑建 《医院管理论坛》 2023年第4期24-27,共4页
目的探讨三级甲等综合医院分院区建院初期的运营模式和长效机制。方法对北京大学人民医院设立的通州院区开诊以来的运营数据进行分析,对管理方法进行讨论。结果门急诊工作量和医技科室工作量占全院工作量的比重稳步增长,而住院工作量和... 目的探讨三级甲等综合医院分院区建院初期的运营模式和长效机制。方法对北京大学人民医院设立的通州院区开诊以来的运营数据进行分析,对管理方法进行讨论。结果门急诊工作量和医技科室工作量占全院工作量的比重稳步增长,而住院工作量和手术量占全院工作量的比重逐月增加且增长幅度较大。结论为顺利实现分院区开诊初期的过渡,应因地制宜地制定管理架构,以科学管理助力分院区决策,动员科室参与建设,稳步推进工作开展,并通过完善后勤保障和制定激励政策增加员工的工作积极性。在合理运营和科学管理下,分院区能同时满足政府、患者和员工的需求。 展开更多
关键词 综合医院 分院区 运营模式
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子宫内膜癌分子特征指导术后辅助治疗选择 被引量:8
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作者 杨凤泊 王建六 周静怡 《国际妇产科学杂志》 CAS 2018年第6期621-627,共7页
子宫内膜癌是女性生殖道常见的恶性肿瘤,在我国发病率仅次于宫颈癌,治疗方式包括手术治疗及辅助治疗(放疗、化疗和内分泌治疗等),通常应用于Ⅰb~Ⅳ期患者。然而,过度治疗和无效治疗会导致部分Ⅰ~Ⅱ期患者治疗后复发,并导致高级别(grad... 子宫内膜癌是女性生殖道常见的恶性肿瘤,在我国发病率仅次于宫颈癌,治疗方式包括手术治疗及辅助治疗(放疗、化疗和内分泌治疗等),通常应用于Ⅰb~Ⅳ期患者。然而,过度治疗和无效治疗会导致部分Ⅰ~Ⅱ期患者治疗后复发,并导致高级别(grade 3,G3)子宫内膜样腺癌(endometrial endometroid carcinoma,EEC)临床结局差异显著。分子特征评价可指导病理疑难型和罕见型子宫内膜癌患者精准治疗,多聚酶ε基因(POLE)突变型子宫内膜癌铂类化疗耐药性高,部分抗细胞毒性T淋巴细胞相关抗原4/细胞程序性死亡蛋白1(CTLA4/PD1)及磷脂酰肌醇3激酶/有丝分裂原活化蛋白激酶(PI3K/MEK)治疗有效;错配修复基因表达缺陷型子宫内膜癌常规放化疗耐药性高,部分抗细胞程序性死亡蛋白配体1/融合蛋白(PD-L1/B7-H4)治疗有效;高拷贝数变异型子宫内膜癌PI3K及周期蛋白依赖性激酶(CDK)抑制剂联合应用效果较好,还可考虑降低区域扩增基因表达水平相关靶向治疗;低拷贝数变异型子宫内膜癌鼠双微体蛋白4(MDM4)抑制剂治疗可能有效。通过层次聚类分析发现预后相关基因与子宫内膜癌预后显著相关,检测其表达水平可与分子分型相结合预测患者预后。现就美国癌症基因组计划(The Cancer Genome Atlas,TCGA)分子分型与本课题组发现的预后相关基因在子宫内膜癌精准辅助治疗中的临床意义作一总结。 展开更多
关键词 子宫内膜肿瘤 抗肿瘤联合化疗方案 放射疗法 基因 肿瘤抑制
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女性盆底修复组织工程补片的研究现状 被引量:3
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作者 吴晓彤 王建六 孙秀丽 《国际妇产科学杂志》 CAS 2019年第4期378-381,共4页
盆底功能障碍性疾病是中老年女性的常见病、多发病,补片植入是其理想的手术治疗方式,临床上常用的聚丙烯补片力学性能好,但存在补片暴露、侵蚀等远期并发症,生物源性补片组织相容性好但力学性能不足。组织工程是应用生命科学与工程学的... 盆底功能障碍性疾病是中老年女性的常见病、多发病,补片植入是其理想的手术治疗方式,临床上常用的聚丙烯补片力学性能好,但存在补片暴露、侵蚀等远期并发症,生物源性补片组织相容性好但力学性能不足。组织工程是应用生命科学与工程学的原理与技术,在正确认识哺乳动物正常及病理两种状态下的组织结构与功能关系的基础上,研究、开发用于修复、维护、促进人体各种组织或器官损伤后的功能和形态的生物替代物的一门新兴学科。组织工程技术应用于盆腔器官脱垂的治疗,既能满足盆底支持的力学要求,而其生物相容性又优于传统聚丙烯补片,且能在一定程度上促进组织修复,是临床补片植入治疗的迫切需求。现针对组织工程的研究进展进行概述,了解组织工程在治疗盆腔器官脱垂的应用情况并指导治疗。 展开更多
关键词 组织工程 干细胞 种子细胞 生物支架材料 支架 生物相容性材料 盆底功能障碍性疾病
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高危型人乳头瘤病毒感染的不同级别子宫颈病变患者细胞免疫状态分析 被引量:5
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作者 唐志坚 赵超 +3 位作者 李明珠 李静然 王建六 魏丽惠 《中国实用妇科与产科杂志》 CAS CSCD 北大核心 2023年第10期1024-1029,共6页
目的探索高危型人乳头瘤病毒(HR-HPV)感染的不同级别子宫颈病变患者外周血T淋巴细胞亚群的表达情况及意义。方法选取2020年12月至2021年10月于北京大学人民医院拟行子宫颈锥切手术的194例子宫颈高级别鳞状上皮内病变(HSIL)患者(子宫颈H... 目的探索高危型人乳头瘤病毒(HR-HPV)感染的不同级别子宫颈病变患者外周血T淋巴细胞亚群的表达情况及意义。方法选取2020年12月至2021年10月于北京大学人民医院拟行子宫颈锥切手术的194例子宫颈高级别鳞状上皮内病变(HSIL)患者(子宫颈HSIL组)、30例子宫颈癌患者(子宫颈癌组)和同期病房的230例子宫颈低级别鳞状上皮内病变(LSIL)患者及子宫颈息肉、子宫内膜息肉患者(对照组)。用流式细胞仪检测各组患者外周血的NK细胞、B细胞、CD8^(+)T细胞、CD4^(+)T细胞、总T细胞、总淋巴细胞计数及CD4^(+)T细胞计数与CD8^(+)T细胞计数的比值(CD4^(+)/CD8^(+))并进行比较。结果子宫颈HSIL组及子宫颈癌组HR-HPV阳性率达95.9%。对照组、子宫颈HSIL组、子宫颈癌组患者外周血NK细胞逐渐升高,差异具有统计学意义(P=0.012)。HR-HPV阳性患者外周血中NK细胞计数及总淋巴细胞计数比HR-HPV阴性者高,差异具有统计学意义(P值分别为0.007和0.036)。亚组分析中,在HR-HPV感染而未出现HSIL及以上子宫颈病变时,淋巴细胞亚群未见显著改变。而HPV16/18持续性感染相关的HSIL或子宫颈癌,患者CD8^(+)T细胞、总淋巴细胞计数显著高于HPV阴性的HSIL或子宫颈癌患者,且CD4^(+)T细胞、T总淋巴细胞计数有升高趋势,但差异无统计学意义。结论HR-HPV感染是子宫颈HSIL及子宫颈癌的高危因素,与外周血NK细胞及总淋巴细胞计数升高有关。HPV 16/18感染相关的HSIL及以上病变,CD8^(+)T细胞计数显著升高。HPV高危型感染与淋巴细胞亚群变化关系密切。 展开更多
关键词 子宫颈鳞状上皮内病变 人乳头瘤病毒 NK细胞 T淋巴细胞 细胞免疫
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盆腔廓清术在复发性妇科恶性肿瘤治疗中的应用进展 被引量:7
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作者 邓浩 王建六 《中国计划生育和妇产科》 2019年第10期20-23,29,共5页
妇科恶性肿瘤复发部位,可以出现在盆腔、阴道断端、淋巴结、腹腔甚至腹腔外,临床上处理起来非常棘手,无论再次手术治疗、化疗或者放疗,都有一定的局限。如果肿瘤复发仅局限在盆腔内,可通过盆腔廓清术彻底切除肿瘤,提高无瘤生存和总生存... 妇科恶性肿瘤复发部位,可以出现在盆腔、阴道断端、淋巴结、腹腔甚至腹腔外,临床上处理起来非常棘手,无论再次手术治疗、化疗或者放疗,都有一定的局限。如果肿瘤复发仅局限在盆腔内,可通过盆腔廓清术彻底切除肿瘤,提高无瘤生存和总生存率。但盆腔廓清术手术风险大,并发症多,医疗费用高,且有较高的复发率及死亡率,临床应用有限。另外,盆腔廓清术后是否辅助治疗,以及辅助治疗的效果,尚有争议。因此,本文复习相关文献,对盆腔廓清术在复发性妇科恶性肿瘤中的应用进行论述。 展开更多
关键词 妇科恶性肿瘤 盆腔廓清术
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Blockage of PI3K/PKB/P27^(kip1) signaling pathway can antagonize 17β-estradiol-induced Ishikawa proliferation and cell cycle progression 被引量:15
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作者 GUO Rui-xia WEI Li-hui +2 位作者 QIAO Yu-huan wang jian-liu TANG Jian-min 《Chinese Medical Journal》 SCIE CAS CSCD 2006年第3期242-245,共4页
It is well-known that risk for endometrial adenocarcinoma increases in patients with high level ofestrogen that is unopposed by progestin. And activation of extracellular signal-regulated kinase (ERK) and phosphatid... It is well-known that risk for endometrial adenocarcinoma increases in patients with high level ofestrogen that is unopposed by progestin. And activation of extracellular signal-regulated kinase (ERK) and phosphatidylinositol 3 kinase/protein kinase B (PI3K/PKB) pathway are responsible for hormone-dependent cell growth in endometrial carcinoma. PI3K produces phosphatidylinositol- 3-phosphates by phosphory-lating the D3 hydroxyl of phosphoinositides, leading to membrane translocation of PKB, 展开更多
关键词 endometrial neoplasms ESTROGENS signal transduction pathway cell cycle cell proliferation
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Nifedipine induced autophagy through Beclinl and mTOR pathway in endometrial carcinoma cells 被引量:11
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作者 BAO Xiao-xia XIE Bu-shan +3 位作者 LI Qi LI Xiao-ping WEI Li-hui wang jian-liu 《Chinese Medical Journal》 SCIE CAS CSCD 2012年第17期3120-3126,共7页
Background Endometrial carcinoma is one of the most common female tract genital malignant tumors. Nifedipine, an L-type calcium channel antagonist can inhibit cell proliferation of carcinomas. Recent studies indicated... Background Endometrial carcinoma is one of the most common female tract genital malignant tumors. Nifedipine, an L-type calcium channel antagonist can inhibit cell proliferation of carcinomas. Recent studies indicated that a rise in the free cytosolic calcium ([Ca2±]c) was a potent inducer of autophagy. Here, we investigated the relationship between nifedipine and autophagy in Hec-IA cells. Methods Cells were cultured with nifedipine (10 μmol/L) and harvested at different times for counting cell number. MTT assay was applied to evaluate the cell viability and transwell assay to reveal cell migration. Apoptotic cells were detected with annexin V/PI assay. Then cells were treated with 3-methyladenine (3-MA) (2.5 mmol/L) for 0, 5, 15, 30, 60, and 120 minutes and the expression of the L-type calcium channel alphalD (Cavl.3) protein was detected. At last, cells were cultured and assigned to four groups with different treatment: untreated (control group), 10 μmol/L nifedipine (N group), 2.5 mmol/L 3-MA (3-MA group), and 10 μmol/L nifedipine plus 2.5 mmol/L 3-MA (N±3MA group). Autophagy was detected with GFP-LC3 modulation by fluorescent microscopy, and expression of the autophagy-associated proteins (LC3, Beclinl and P70s6K) by Western blotting and monodansylcadaverine (MDC) labeled visualization. Results Proliferation of Hec-lA cells was obviously suppressed by nifedipine compared with that of the untreated cells for 24, 48, and 96 hours (P=0.000 for each day). The suppression of migration ability of the nifedipine-treated cells (94.0±8.2) was significantly different from that of the untreated cells (160.00±9.50, P=0.021 ). The level of early period cell apoptosis induced by nifedipine was (2.21_±0.19)%, which was (2.90±0.13)% in control group (P=-0.052), whereas the late period apoptosis level reached (10.38_±0.96)% and (4.40_±0.60)% (P=0.020), respectively. The 3-MA group induced a slight increase in the Cavl.3 levels within 15 minutes, but significantly attenuated the Cavl.3 levels after 30 minutes. There were more autophagic vacuoles labeled by MDC in the N group (20.63_±3.36) than the control group (6.29_±0.16, P=-0.015). GFP-LC3 localization revealed that the LC3 levels of cells in 3-MA group, N±3MA group, 3-MA group were 2.80_±0.29, 2.30_±0.17, and 1.80±0.21, respectively. Cells in the N group showed significant augmentation of autophagy (P 〈0.05). Western blotting analysis confirmed the down-regulation of LC3 levels in 3-MA group (0.85±0.21) and N±3MA group (1.21±0.12) compared with nifedipine treatment (2.64±0.15, P 〈0.05). The annexin-V-FITC/PI assay showed that the level of early period cell apoptosis induced in the N+3-MA group ((11.22±0.91)%) differed significantly from that of the control group ((2.51±0.70)%) and N group ((3.47±0.39)%). Similarly, the late period level of the N+3-MA group ((55.19±2.51)%) differed significantly from that of the control group((15.81±1.36)%) and the N group ((22.09±2.48)%, P 〈0.05). The down-regulated expression of P70s6k and up-regulated expression of the Beclinl revealed significant differences between the N+3-MA group and control group (P=0.025; Beclinl: P=-0.015). Conclusions Proliferation and migration in vitro of endometrial carcinoma Hec-lA cells are significantly suppressed by nifedipine. The nifedipine leads autophagy to oppose Hec-lA cells apoptosis. Autophagy inhibition by 3-MA leads down-regulation of Cavl.3 and enhances nifedipine-induced cell death. The nifedipine-induced autophagy is linked to Beclinl and mTOR pathways. 展开更多
关键词 NIFEDIPINE L-TYPE AUTOPHAGY endometrial carcinoma
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Histone deacetylase inhibitors inducing human cervical cancer cell apoptosis by decreasin~ DNA-methyltransferase 3B 被引量:5
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作者 LIU Ning ZHAO Li-jun +3 位作者 LI Xiao-ping wang jian-liu CHAI Guo-lin WEI Li-hui 《Chinese Medical Journal》 SCIE CAS CSCD 2012年第18期3273-3278,共6页
Background Histone deacetylase (HDAC) inhibitors are a group of small chemical molecules that inhibit histone deacetylase. At cell level, HDAC inhibitors have multiple biological effects such as cell cycle arrest, a... Background Histone deacetylase (HDAC) inhibitors are a group of small chemical molecules that inhibit histone deacetylase. At cell level, HDAC inhibitors have multiple biological effects such as cell cycle arrest, apoptosis, cell differentiation and auotophagy. At molecular level, HDAC inhibitors cause histone and nonhistone acetylation and induce gene expression. HDAC inhibitors are widely used in cancer therapy because of its function of inducing apoptosis. However, the mechanisms of apoptosis effect are not fully understood. TSA is a classical HDAC inhibitor and widely used in epigenetic and anti-cancer research. In this study, we selected Trichostatin A (TSA) to investigate the mechanisms of HDAC inhibitors apoptotic effect on cancer cells. Methods Cervical cancer cell lines such as Hela, Caski and normal human keratinocyte line HaCaT were treated with various concentrations of TSA. Crystal violent assay and 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay were performed to determine cell number. PARP cleavage and FITC-AnexinV were performed to determine apoptosis. DNA-methyltransferase (DNMT)I, DNMT3A and DNMT3B were determined by regular PCR, qPCR and Western Blotting. Small interfering RNA (SiRNAi) was used to knock down DNMT3B. Results HDAC inhibitors only induce cervical cancer cell apoptosis. At 1 Iumol/L of TSA, 86% of Hela cell and 76% of Caski went apoptosis. For normal cells, HDAC inhibitors have no cytotoxic effect at therapeutic dosage, (90.0+8.4)% of normal cell survive after treated with 1 IJmol/L of TSA. We compared 1 pmol/L group with untreated control with t-test. There was no significance between 1 pmol/L group and untreated control for normal cell (P 〉0.05). HDAC inhibitors decreased DNMT3B in cancer cell but not in normal cell. Manually knock-down of DNMT3B induced Hela and Caski cell apoptosis. More than 99% of Hela and Caski cell went apoptosis after deprived of DNMT3B. Conclusions DNMT3B was essential to cervical cancer cell survival. Down-regulated DNMT3B by HDAC inhibitors may play an important role in the toxicity of HDAC inhibitors on cervical cancer cells. 展开更多
关键词 histone deaeetylase inhibitors human cervical cancer apoptosis DNA-methyltransferase 3B Trichostatin A DNA methyl transferase
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Evaluation of whether serum tumor markers in patients with epithelial ovarian carcinoma change following chemotherapy 被引量:3
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作者 Li Xiao-ping Xu Qi-ying +3 位作者 wang jian-liu wang Shi-jun Zhao Yan Wei Li-hui 《Chinese Medical Journal》 SCIE CAS CSCD 2012年第3期410-415,共6页
Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate wh... Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma (EOC) or primary serous peritoneal carcinoma (PSPC).Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay (ELISA)-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20% (7/35) demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma (57.1%,4/7) showed resistance to chemotherapy.In the 37 recurrent patients,51.4% (19/37) had changed serum tumor markers,of whom 57.9% (11/19) presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5% (6/17) had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also be monitored during chemotherapy and follow-up. 展开更多
关键词 epithelial ovarian carcinoma primary serous peritoneal carcinoma tumor marker CHEMOTHERAPY recu rrence
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