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Objective:To explore the impacts of workload and expected income index on the salary satisfaction of medical staff at public hospitals.Methods:From October 15th to November 10th, 2020, the salary system reform monitoring questionnaire for medical staff in public hospitals formulated by development center for medical science & technology National Health Commission was adopted to evaluate the workload, actual income, expected income and salary satisfaction of 120 pilot public hospitals for salary reforms in 21 cities (prefectures) in Sichuan province. The questionnaire survey was conducted among 8 651 medical staff of these hospitals. Descriptive analysis was carried out on the results of the questionnaire; the ratio of expected income to actual income, namely the expected income index, was used to reflect the relative difference between expected income and actual income; χ2 test and binary logistic regression were used to analyze the influencing factors of salary satisfaction. Results:8 133 valid questionnaires were recovered. The average working time per week of the survey subjects was 48.17 hours, and the average longest continuous working time was 15.30 hours; 85.63% (6 964) of the medical staff had expected income index greater than 1. The average score of salary satisfaction was 58.22 points and 57.72% (4 694) of the medical staff were dissatisfied. The longer the continuous working time (16-72 h versus 8-9 h, OR=0.755), the greater the expected income index (>1 versus =1, OR=0.522), and the lower the salary satisfaction. Conclusions:The workload of medical staff was heavy, the salary failed to meet the expected level, the sense of satisfaction was low. It is suggested to monitor in real time and dynamically adjust the workload of medical staff in combination with the actual situation, formulate the salary level in line with the technical labor value of different medical staff, and establish a comprehensive performance appraisal mechanism.
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Objective:To investigate the predictive value of regional leptomeningeal collateral (rLMC) score on CT angiography (CTA) for the outcome after endovascular therapy in patients with late window anterior circulation stroke.Methods:Patients with acute anterior circulation large vessel occlusive stroke received endovascular treatment 6 to 24 h after onset in the Department of Neurology, the First Affiliated Hospital of Soochow University from January 2018 to July 2021 were enrolled retrospectively. At 3 months after onset, the outcome was evaluated according to the modified Rankin Scale. A score of ≤ 2 was defined as good outcome, and a score of >2 was defined as poor outcome. The clinical data, non-enhanced CT and CTA parameters of the patients were collected. Multivariate logistic analysis was used to determine the independent influencing factors of poor outcomes after endovascular treatment. Results:A total of 74 patients with acute anterior circulation large vessel occlusive stroke treated with endovascular treatment in the late window were enrolled. Their age was 64.41±12.98 years, 43 were males (58.1%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.18±5.22, and the median time from onset to puncture was 527.5 min. Fifty-three patients (71.6%) chose direct thrombectomy and 21 (28.4%) chose intravenous thrombolysis and bridging thrombectomy. Thirty-six patients (48.6%) had a good outcome and 38 (51.4%) had a poor outcome, including 4 (5.4%) died. Univariate analysis showed that there were significant differences in age, atrial fibrillation, fasting blood glucose, NIHSS score, Alberta Stroke Program Early CT Score (ASPECTS), rLMC score and clot burden score between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher ASPECTS (odds ratio 0.352, 95% confidence interval 0.157-0.791; P=0.012) and rLMC score (odds ratio 0.550, 95% confidence interval 0.329-0.919; P=0.022) were the independent predictors of good outcomes after endovascular therapy. Conclusion:ASPECTS and rLMC scores were the independent predictors of clinical outcomes after endovascular therapy in patients with late window anterior circulation large vessel occlusive stroke. It had certain guiding value for the decision-making of endovascular treatment in such patients.
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Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.
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Objective:To investigate the therapeutic effect of Weichangning granule combined with compound Lactobacillus acidophilus tablet on diarrhea type irritable bowel syndrome and its effect on inflammatory factors, gastrointestinal hormones and intestinal mucosal barrier.Methods:From January 2017 to December 2019, 80 patients with diarrhea type irritable bowel syndrome admitted in the First People's Hospital of Fuyang District were selected, and they were divided into observation group and control group according to the random digital table method, with 40 cases in each group.The control group was treated with relapsed Lactobacillus acidophilus tablets, and the observation group was treated with Weichangning granules on the basis of the control group.The course of treatment in both two groups was 2 weeks.The changes of inflammatory factors, gastrointestinal hormones and intestinal mucosal barrier were compared before and after treatment.Results:The total effective rate of the observation group[92.50%(37/40)] was higher than that of the control group[70.00%(28/40)], the difference was significant (χ 2=6.646, P<0.05). The levels of TNF-α[(36.15±10.12)ng/L], IL-1β[(0.43±0.08)μg/L] and IL-6[(12.18±3.06)ng/L] in the observation group were lower than those in the control group[(54.36±15.73)ng/L, (0.79±0.12)μg/L and (18.53±2.19)ng/L]( t=6.157, 15.787, 10.673, all P<0.05). The serum levels of SS[(28.91±11.02)μg/L] and VIP[(185.46±17.34)ng/L] in the observation group were lower than those in the control group[(45.63±12.54)μg/L and (235.12±18.29)ng/L]( t=6.334, 12.462, all P<0.05). The levels of DAO[(1.05±0.19)U/L], endotoxin[(0.62±0.19)U/L] and D-lactate[(38.97±6.39)mg/L] in the observation group were lower than those in the control group[(1.53±0.28)U/L, (1.16±0.23)U/L and (49.81±4.25)mg/L]( t=8.972, 11.448, 8.934, all P<0.05). Conclusion:Weichangning granule combined with compound Lactobacillus acidophilus tablet has obviously curative effect on diarrhea type irritable bowel syndrome, which can reduce inflammatory reaction, improve gastrointestinal hormone and intestinal mucosal barrier function.
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Objective To explore the effects of probiotics on intestinal function, nutritional status and inflammatory response in critically ill patients with enteral nutrition (EN) support. Methods A total of 90 critically ill patients admitted to Intensive Care Unit (ICU) of the First Affiliated Hospital of Anhui Medical University from July 2016 to November 2018 were enrolled, and they were divided into a probiotics combined with EN group (27 cases) and an simple EN group (63 cases) according to random number table method. The patients in the simple EN group were treated with conventional nutrient preparations such as fresubin or fresubin energy fibre; the patients in probiotics combined with EN group were supplemented with probiotics on the basis of conventional EN support for consecutive 7 days in both groups. The changes of gastrointestinal function, nutritional index and inflammatory response index after treatment were observed in both groups. Results After treatment, the subjective global assessment (SGA) method was used to identify the gradation of the patients, it was shown that the proportion of SGA-B grade patients in simple EN group had an upward trend; while the proportion of SGA-B grade patients in probiotics combined with EN group had no significant change; and there was no significant difference in the proportion of SGA-B patients between simple EN group and probiotics combined with EN group after treatment [20.6% (13/63) vs. 7.4% (2/27),P > 0.05]. Compared with those before treatment, the levels of hemoglobin (Hb), white blood cell count (WBC), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukins (IL-6, IL-12) in both groups were significantly decreased, while the levels of albumin (Alb), pre-albumin (PA), total lymphocyte count (TLC) in both groups were increased after treatment, and the changes of Hb, TNF-α, IL-6 in probiotics combined with EN group were more significant than those in the simple EN group [Hb (g/L): 95.0 (78.0, 107.0) vs. 93.0 (80.0, 107.0), TNF-α (pg/L): 21.2±4.0 vs. 28.0±5.7, IL-6 (pg/L): 161.3±37.6 vs. 186.2±51.8];the differences in levels of Hb, CRP, TNF-α before and after treatment between the probiotics combined with EN group and simple EN group were statistically significant [Hb (g/L): 1.0 (-4.0, 12.0) vs. 11.0 (1.0, 20.0), CRP (mg/L): 44.3 (13.7, 57.7) vs. 7.5 (-20.1, 62.4), TNF-α (pg/L): 13.3±6.3 vs. 7.9±5.5, all P < 0.05]. There were no statistical significant differences in the other indicators between the two groups (all P > 0.05). Conclusion Probiotics can improve the gastrointestinal function and inflammatory status of critically ill patients with EN support, regretfully, in a short term, the improvement of nutritional status of such patients is not obvious, but probiotics has certain significance in preventing the risk of aggravation of malnutrition and reduction of Hb level.
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Objective To investigate the clinical utility of critical nutrients nutrition risk assessment (Nutric score) in neurological critical ill patients,laying the foundation for clinical nutrition support.Methods From July 2016 to March 2017,59 ICU patients with neurological critical ill in the First Affiliated Hospital of Anhui Medical University were divided into low score group (Nutric score 0-4) and high score group (Nutric score 5-9) according to Nutric score system.On the first and seventh day after ICU admission,the body mass index(BMI),triceps skinfold thickness (TSF),mid-upper ann circumference (MAC) and mid-upper ann muscle circumference (MAMC) were measured.The serum albumin(ALB),prealbumin (PA),hemoglobin (Hb) and lymphocyte (LY) were detected as nutritional indicators.And at the same time,recorded the 28-day outcomes,and made the SGA evaluation.Results At the first day admission in ICU,there were no statistically significant differences between the two groups in TSF,MAC and MAMC (all P ＞0.05).But at the seventh day,the TSF,MAC,MAMC of the high score group were (0.943 ± 0.484) cm,(24.143 ± 3.203) cm,(21.187 ± 2.625) cm,respectively,which were significantly lower than those of the low score group [(1.185 ± 0.403) cm,(26.981 ± 2.731) cm,(23.265 ± 2.327) cm],there were statistically significant differences between the two groups (t =2.090,3.672,3.223,all P ＜ 0.05).At the first day after admission,the serum levels of ALB and Hb in the high score group were (34.5 ± 7.3)g/L,(103.68 ± 13.5)g/L,which of the low score group were (39.0 ± 6.9) g/L,(122.29 ± 20.4) g/L,respectively,and there were statistically significant differences between the two groups(t =2.466,4.168,all P ＜ 0.05).And at the seventh day after admission,the serum levels of ALB,PA,Hb and Ly in the high score group were (30.6 ± 5.1) g/L,(146.0 ± 77.0) mg/L,(83.9 ± 11.9) g/L,(1.123 ± 0.535) x 109/L,respectively,which were significantly lower than those in the low score group [(35.8 ± 5.5) g/L,(209.9 ± 105.1) mg/L,(105.8 ± 19.2) g/L,(1.709 ± 1.377) x 109/L].Compared with the first day after admission,the ALB,Hb levels in the two groups at the seventh day after admission were significantly decreased (t =2.29,2.002,5.817,3.286,all P ＜0.05);the PA level in the low score group had no statistically significant difference at the seventh day after admission,but the PA level in the high score group was decreased significantly (t =2.024,P ＜ 0.05).The incidence rate of malnutrition,mortality of the high score group were 32.1％,32.1％,respectively,which were significantly higher than those in the low score group (9.7％,6.5％) (x2 =4.583,6.402,all P ＜ 0.05).Conclusion The Nutric score system can be used in the purpose of early nutrition assessment in neurological critical ill patients,and it is benefit for clinical early nutritional support.
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Objective To observe the changes of blood lipid and intestinal short-chain fatty acids in rats with non-alcoholic fatty liver disease (NAFLD) induced by high-fat diet,and to explore the role of intestinal short-chain fatty acids in the pathogenesis of NAFLD.Methods Male SD rats (n =12) were randomly divided into control group and high-fat group according to the random number table.The control group was fed with normal diet,while the high-fat group was fed with high-fat diet.The rats were sacrificed at the end of eighth week after experiment.HE staining was used to observe the pathological changes of the liver in the two groups,the changes in serum lipid profile were measured,and the changes of the contents of feces short-chain fatty acids in the two groups of rats were determined by gas chromatography.Results The levels of serum alanine transaminase [(139.6 ± 17.29) U/L vs.(37.67 ±5.28) U/L],aspartate transaminase [(367 ±49.36) U/Lvs.(97.67 ±13.92) U/L],triglyceride [(0.83±0.08) mmol/Lvs.(0.60± 0.04) mmol/L],totalcholesterol [(6.34±0.53) mmol/Lvs.(1.77±0.29) mmol/L],andvery-lowdensity lipoprotein [(0.31 ±0.03) mmol/L vs.(0.22 ±0.01) mmol/L] in the high-fat group were significantly higher than those in the control group (P ＜ 0.05).Compared with the control group,the contents of acetic acid,propionic acid and total short-chain fatty acids in the high-fat group were significantly lower [(0.16 ± 0.03) ng/μlvs.(0.21±0.04) ng/μl;(0.05±0.01) ng/μlvs.(0.08±0.01) ng/μl;(0.25±0.05) ng/μl vs.(0.33 ± 0.05) ng/μl;all P ＜ 0.05).Conclusions The level of intestinal short-chain fatty acids is reduced in the NAFLD rats induced by high-fat diet.Monitoring of feces short-chain fatty acids may play an important role in the diagnosis and treatment of NAFLD.
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Objective To analyse effect of dobutamine on C-reactive protein,D-dimer,BNP and blood gas analysis in children with neonatal pulmonary hypertension.Methods 46 patients who were diagnosed with neonatal pulmonary hypertension in our hospital were collected.All patients were randomly divided into experimental group and control group, 23 cases in each group.Control group was treated with sedation, maintenance of water electrolyte balance, blood pressure, anti-infection,experiment group was treated with dobutamine hydrochloride injection 5μg/(kg· min) intravenous infusion, continuous for 48 h on the basis of conventional therapy, after treatment,the levels of peripheral blood C-reactive protein, D-dimer and BNP and blood gas analysis effect were detected in all patients.Results Compared with control group post-treatment, the serum level CRP,D-dimer, BNP were lower in experimental group ( P <0.05 );the PaO2 and SpO2 levels were higher, the PAH level was lower in experimental group ( P <0.05 ) . Conclusion The dobutamine can significantly reduce the serum CRP, plasma D-dimer and BNP levels in children with neonatal pulmonary hypertension, reduce pulmonary hypertension.
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A total of 121 patients with metabolic syndrome (MS) and 120 normal subjects were recruited for exploring the association of serum adipokines with MS. The levels of resistin and adipocyte fatty acid-binding protein (A-FABP) increased, while adiponectin decreased gradually ( all P<0.05 ) in normal control group, MS without abdominal obesity group, and MS with abdominal obesity group. In MS group, resistin was positively correlated with body mass index ( BMI), waist circumference, systolic blood pressure, fasting plasma glucose, and A-FABP ( P<0.05 or P<0.01 ). Adiponectin was positively correlated with high-density lipoprotein-cholesterol and negatively correlated with BMI, waist circumference, fasting insulin, triglyceride, and homeostasis assessment of insulin resistant index.
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@#Objective To explore the mechanism about the expression of the hyperphosphorylated p38MAPK in the central nervous system (CNS) of experimental autoimmune encephalomyelitis (EAE) mouse and its relationship to the axonal damage, and investigate the potential regulation of SB203580 to the damaged axons in the CNS of EAE mouse.Methods SJL/J mice were used to establish the EAE model. Brain and spinal cord of EAE mice in the model group, SB203580 group and control group were used respectively at different time points. Stained with HE and Luxol Fast Blue (LFB), also the immunohistochemical detection was conducted with parallel phosphorylation of p38MAPK antibody staining and APP staining at the same time. By image analysis system, the number of positive signals, the coverage and the average density value in the cytoplasm of neuron in white matter lesions were measured.Results The model of EAE mice induced by PLP peptide manifested significant neurological symptoms, signs and features of relapse and remitting. Demyelinating change was observed in local regional white matter region. Compared with the model group, SB203580 group changed lighter, with its behavioral observations and had a significant weight gain (P<0.01). In addition to the control group, amyloid precursor protein (APP) expression was detected in other groups at various time points. Compared to the model group, APP expression was slighter than in SB203580 group. The number of positive cells and strength was significantly lower in the SB203580 group (P<0.01); expression of p38MAPK in EAE mice was observed at the earlier 7th day after immunization. Compared to the model group, expression of SB203580 group was lighter, positive number and intensity decreased markedly (P<0.01).Conclusion p38MAPK blockers SB203580 can not only inhibit activation of the p38MAPK in EAE mice, but also effectively reduce expression of APP which is symbolic target of EAE axonal injury, it is confirmed that the p38MAPK is indeed involved in the EAE axonal injury.
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Serum adipocyte fatty acid-binding protein (A-FABP) was raised in metabolic syndrome (MS)patients (n= 121) as compared with age-matched healthy subjects [n = 120, (14.7±4.8 vs 6.8 ±3. 0) μg/L,P<0.001]. It reached higher level in MS subjects with visceral obesity [(15.7±4.2 vs 12.6±5.1) μg/L, P<0.001]. Serum A-FABP concentration was positively correlated with body mass index, waist circumference, waist-tohip ratio, fasting insulin, homeostasis assessment for insulin resistance (HOMA-IR), fasting glucose, triglycerides,total cholesterol,and mean arterial blood pressure, whereas negatively correlated with HDL-C (r =-0. 448, P< 0.001).
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Objective To study the correlation between serum level of antiendothelial cells auto-antibodies (AECA) and anticardiolipin antibodies (ACA) and the roles in the pathogenesis of Behcet′s disease (BD). Methods Thirty two BD patients were randomly selected from our outpatients and inpatients. Thirty-three healthy controls were studied in parallel. AECA/ACA were examined by indirect immunoflourescence technique and enzyme linked immunosorbent assay (ELISA) respectively, IgG-AECA and IgM-AECA antibodies were detected, too. Results The positivity rates of AECA, IgG-AECA and IgM-AECA in BD patients were 81.3%, 71.9% and 53.1%, respectively. Increased serum AECA levels were observed in all BD patients compared with those of normal controls. There was some significant positive correlation in the positivity rate of AECA between erythema nodosum, nodular vasculitis and rapid erythrocyte sedimentation rate. The positivity rate of ACA was 53.1%, A significant difference in the positivity rate of ACA compared with those of normal controls. Neither of these two kinds antibodies was significantly correlated with oral ulcers, clinical manifestations of skin and external genital organ, anemia or erythrocyte sedimentation rate. Conclusion The detection of AECA level is useful to identify cutaneous vasculitis and the activity of disease in BD, but the value of ACA in the diagnosis of the condition of BD needs further study. [
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To measure the rotating speed and temperature of the centrifuge, an equipment and method are developed in this paper. They prove to meet the requirements of measuring. The equipment and method can be used to measure the rotating speed or temperature of the operating centrifuge easily and accurately. That is also the main excellence of them.
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Objective To provide research means for study of buccal cavity vitodynamics and design of optimized dental prosthetic restoration and prosthesis,give model for virtual surgery effectiveness analysis of the varied mandible surgery program.Methods A middle-aged man with normotrophic temporomandibular system was chosen and 123 widths of two-dimensional CT scan images were obtained through scanning his mandible by spiral CT scanner.The precise shaped mandible CAD mode was established through surface fitting by CATIA of three-dimensional spot-cloud transformed from two-dimensional CT images by image processing software,and the finite element model required for mandible surgery program was established by MSC.Patran.Results The full dentition mandible CAD models and three-dimensional finite element models were established.Conclusion The normal three-dimensional finite element mandible model can really reflect the geometrical feature of mandible and has good similarity to physical mandible and it can be used as a research means for biomechanical studies.The model can be also provided pre-operative designed quantitative method for the variety of mandible surgeries.
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Objective To improve the freeze-dryer shelf temperature control effect.Methods The fuzzy-PID control algorithm that's adjusting the PID parameters in real-time in the control process,was adopted to control the shelf temperature,expecting to adapt the changing of process parameters of shelf.Results In the process of freeze-drying temperature control shelves,the shelf temperature static performance and dynamic performance were improved,and the effect of shelf temperature control was archived satisfyingly.Conclusion In the freeze-drying process,the process parameters of shelf are changed along with the drying time and the working environment.The conventional PID control is difficult to obtain satisfactory results.The fuzzy-PID controller,which can adjust PID parameters on real-time in the controlling process,be used in the shelf temperature control,and the result is satisfied.