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Objective To understand employment directions and levels of the graduates majoring in health service management, so as to provide reference for talent cultivation and employment guidance for future graduates. Methods Collecting the data of employment directions of 244 graduates from 2014 to 2016 majoring in health service management from Nanjing Medical University and analyzing the dynamic trend of employment directions. Data were analyzed by SPSS 22.0. Results There was no significant dif-ference in the employment rate among graduates from 2014 to 2016. The proportion of female graduates choosing to do postgraduate work in mainland China was 19.7%( 34/173), higher than that of male 12.7% (9/71). The proportion of female graduates choosing directly to work was 65.3% (113/173), lower than that of male 76.1% (54/71), and the differences were statistically significant. The proportion of graduates working in upper first-class hospitals was relatively higher 39.1% (45/115), and the employment rate of that working in non-public general hospitals increased year by year. Conclusion In order to effectively ease the problem of employment imbalance, the related departments of the university should strengthen employment guidance, timely update the mentality about employment among graduates, and abandon the inherent employment orientation of large public hospitals and economically developed areas.
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Objective To study the outcomes and problems of comprehensive medical pricing reform in Jiangsu.Methods The business operations,drug proportion and patient′s expenses of 28 pilot hospitals in 1 5 counties of the province before and after the reform were compared,to learn the impacts of the pricing reform on both hospitals and patients.Results Medical revenue and medical service quantity of these hospitals during this period(January to June)of 2012—2014 maintain a fast growth,with lower drug proportions,and patients′expenditure unchanged.Compared with data of the same period in 2012, the total revenue growth rates of the hospitals in 2013 and 2014 were 13.4% and 1 1.1% respectively;and their drug proportions were 44.9% and 42.3%;and the expenditure growth rates for outpatient/emergency service were 5.9% and 3.1% respectively.Conclusions The reform has achieved an initial success.However the pricing system,needs to be further rationalized to build a better price formation mechanism,in line with relevant reforms.
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Objective To investigate the level Ⅰb contouring,dose analysis and regional recurrence in level Ⅰb lymph node-negative (Ⅰb-negative) nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT).Methods One hundred ninety newly-diagnosed,Ⅰb-negative NPC patients treated by IMRT were enrolled.Level Ⅰb contouring and dose prescribing in this cohort were classified into planned prophylactic irradiation (PPI) group (56 cases) and non-planned prophylactic irradiation (non-PPI) group (134 cases).The mean dose (Dmean) of the level Ⅰb bilaterally and submandibular glands (SMGs) was recorded for comparison.Results After a median follow-up of 47 months,there was no level Ⅰb regional recurrences noted in the entire group.The mean doses of level Ⅰb and the submandibular glands were significantly lower in the non-PPI group than those in the PPI group as follows:(50.81±5.37) Gy vs (59.68±3.32) Gy for the left level Ⅰb,(51.55±5.02) Gy vs (59.66±3.85) Gy for the left submandibular gland,(51.55±5.02) Gy vs (59.66±3.85) Gy for the right level Ⅰb and (57.25±4.69) Gy vs (63.41±2.88) Gy for the right submandibular gland (all P =0.000).Conclusion In this retrospective analysis of non-randomized single institute data,it seems unlikely that PPI to level Ⅰb is necessary in Ⅰb-negative NPC patients treated by IMRT.
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Objective:To explore the propagable experience and methods of controlling the rate of cesarean sec-tion through the summary of the innovative measures in four counties. Methods:The cases of natural birth and cesare-an section from 2009 to 2013 in four counties were analyzed respectively. The interventions of controlling cesarean section rate have been summarized. Results:The average cesarean section rate of four counties in five years is on the decline, since 2009 the rate were 60. 2%,62. 3%,59. 3%,51. 4%,48. 1%. Conclusions: The interventions really worked, but did not do the best. Improving the social attention on these innovative measures, strengthening surveil-lance mechanism, regulating the medical behaviors of delivery hospitals, enhancing the midwifery training and promo-ting the interventions under the coordination of local government can further reduce the rate of cesarean section.
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Because of the lymphatic drainage of the neck area level-Ⅰb of nasopharyngeal carcinoma is particular,and skip metastasis in the cervical lymph node is rare,the involved region of level-Ⅰb lymph node metastasis rate is low in nasopharyngeal carcinoma.In the three-dimensional radiotherapy era of precision radiotherapy,there is no consensus on whether level-Ⅰb need to be prophylactic irradiated in the clinic.
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Objective: To analyze economic operation situation of public hospital of traditional Chinese medicine in Jiangsu. Methods: Through the investigation and analysis, to collect situation of hospital health resources, medical service, the resources utilization efficiency and balance. Based on the actual data on the present situation and the development of hospitals of traditional Chinese medicine, the systematic analysis of the income and expenditure was made. Results: The problems in the development of Chinese medicine hospitals and the countermeasures are found, references for the medical institution managers and the basis for policy makers are provided. Conclusion: Hospitals of traditional Chinese medicine need to continue deepening the reform, and actively developing the features of TCM advantages, finding their own positioning goals, trying to explore development service of traditional Chinese medicine and Chinese medicine products, so as to cultivate the self-core competitiveness.
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Objective To investigate the effect of intermedin (IMD) on renal ischemia/ reperfusion (I/R) injury after the up-regulation of IMD. Methods A total of 24 healthy Wistar male rats were randomly divided into four groups,sham-operated group,I/R group,IMD gene transfection +I/R group and empty plamid +I/R group.All the animals were killed at the end of 24 h of reperfusion.Histological changes and renal function were estimated.The expression and site of IMD were determined by Immunohistochemistry method,semi-quantitative RT-PCR and Western blotting.The protein expressions of endothelin 1 (ET-1),tumor necrosis factor αt (TNF-α) were detected by Western blotting. Results Compared with sham-operated group,tubulointerstitial pathological injury was significant aggravated in I/R group (7.6±2.3) and empty plamid +I/R group (7.0±1.8),and such injury was improved in IMD+I/R group (1.5±0.8) (P＜0.05).Compared with I/R group and empty plamid +I/R group,the renal dysfunction of IMD +I/R group was obviously lessened [BUN:(7.73±1.03) mmol/L vs (10.13±2.14) mmol/L,(9.77±1.92) mmol/L; Scr:(58.50±3.27) μmol/L vs (80.33±7.15) μmol/L, (75.67±7.58) μmol/L,all P＜0.05].IMD expression was weak in the plasma of tubulointerstitial cells in sham-operated group,and was up-regulated in I/R group. Compared with I/R group, immunohistochemical IMD expression increased obviously (262.03±67.89 vs 175.57±48.06,P＜0.01).The mRNA expression of IMD in IMD+I/R group was up-regulated significantly by 60.7％,66.1％ and the protein expression of IMD in IMD+I/R group increased significantly by 51.4％,55.9％ as compared to I/R and empty plasmid +I/R group.Meanwhile,the protein expressions of ET-1 and TNF-αt in IMD+I/R group were obviously lower compared with those in I/R group (ET-1:0.08±0.02 vs 0.17±0.02; TNF-α:0.21±0.04 vs 0.35± 0.02,all P＜0.05). Conclusion IMD gene transfected into kidneys of rats prior to I/R surgery can attenuate the over-expressions of both ET-1 and TNF-o in I/R injured rat kidneys as well as the damages to the structure and function of the kidneys.
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Objective To observe the effects of intermedin (IMD) on nitric oxide synthetase (NOS) in renal ischemia-reperfusion (IR) rat models and the action mechanism.Methods A total of 24 rats were divided into four groups (n =6 each).Group Ⅰ underwent right nephrectomy one week prior to the exposure of left renal pedicles,but did uot receive any I/R.Group Ⅱ underwent right nephrectomy one week prior to left renal I/R surgery.Group Ⅲ underwent right nephrectomy and left renal IMD-pCDNA3.1 ( + ) transfection by ultrasound-mircobubbles and renal I/R surgeries were performed one week after gene transfection.Group Ⅳ was treated with the same way as group Ⅲ except that empty control vector was transfected.All the animals were killed at the end of 24 h of reperfusion.The expression and site of IMD were determined by using immunohistochemistry.Serum levels of BUN and creatinine were determined.The kidney formaldehyde-fixed and paraffin-embedded sections were stained with HE and PAS by standard methods and then histological changes were analyzed semiquantitatively.The mRNA expression levels of endothelial NOS (eNOS),inducible NOS (iNOS) and neuronal NOS (nNOS) in the kidneys of the four groups were detected by using RT-PCR.The protein expression levels of the three NOS mentioned above in the kidneys were semiquantitatively analyzed by Western blotting.Results IMD was weakly expressed in the plasma of tubulointerstitial cells in sham-operated group; whereas IMD expression in the kidneys subject to I/R was increased.Moreover,as compared with I/R group,IMD expression levels were obviously increased (P＜0.01 ).The degree of morphological changes as well as renal dysfunction in group Ⅲ was obviously lessened as compared with group Ⅱ.The mRNA and protein expression levels of eNOS in group Ⅲ were notably increased as compared with group Ⅱ,while the mRNA and protein expression levels of iNOSin group Ⅲ were obviously reduced as compared with I/R group not transfeeted with IMD (P＜0.05).Meanwhile,there were no significant differences in the mRNA and protein expression levels of nNOS among groups Ⅱ,Ⅲ and Ⅳ.Conclusion IMD gene in the kidneys of rats can promote the expression of eNOS and attenuate over-expression of iNOS in the kidneys following I/R,thus protecting against tubulointerstitial damages and renal dysfunction in rat I/R models.
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Objective To construct eukaryotic expression vector encoding rat IMD gene and deliver it into rat renal tissue via ultrasound-mircobubbles. Methods IMD gene was inserted into pCDNA3.1 ( + )between Hind Ⅲ and EcoRI enzyme sites. The recombinant plasmid designated as IMD-pCDNA 3.1 wasconfirmed by restrictive enzyme digestion and sequencing. Eighteen male Wistar rats were randomized into 3groups, which were treated with no transfection, empty vector transfection and IMD transfection, respectively, in renal tissue via ultrasound-microbubbles. RT-PCR and Western blotting were applied to detect the expression level of IMD. Results Enzyme- digestion and sequencing data showed that IMD-pCDNA 3.1 was correctly constructed. The differences in ALT, AST, BUN and SCr were not significant; No obvious damage in the glomerular, tubular and interstitial was observed in all the treated groups;Compared with non-transfection group and empty vector-transfection group, IMD mRNA and protein expression in IMD transgenic renal tissue were significantly increased. Conclusion IMD-pCDNA 3.1 expression vector was successfully constructed and well expressed in rat kidney.
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Objective To investigate the protective effect of intermedin(IMD)on renal ischemia reperfusion injury(IRI)and its mechanism. Methods A total of twenty-four male Wistar rats were randomly divided into four groups: control group, IRI group, empty plasmid group and IMD group. After remove of right kidney, plasmid was transfected into the kidney by ultrasonic microbubbles technology, and IRI model was made after 1 week. Renal pathology was observed by PAS staining. Renal tissue superoxide dismutase(SOD), myeloperoxidase(MPO), caspase-3 activity, and malondialdehyde(MDA)content were detected by colorimetric method. The intercellular cell adhesion molecule-1(ICAM-1), endothelin 1(ET-1)and P-selection expression of renal tissue were detected by immunohistochemical method. Apoptosis of renal tubular cell was detected by TUNEL.Results Compared with control group, tubulointerstitial pathological injury was significant aggravated in IRI group(P<0.01);compared with IRI group, IMD pretreatment significantly alleviated the degree of renal injury(P<0.01). Compared with control group, in IRI group, SOD activity was significantly decreased(P<0.05), MPO activity, caspase-3 activity, MDA production and the expression of ICAM-1, P-selection, ET-1 were increased significantly(all P< 0.01). Compared with IRI group, IMD pretreatment significantly increased SOD activity(P <0.05), decreased the MPO activity, caspase-3 activity, MDA production and the expression of ICAM-1, P-selection, ET-1 (all P<0.01). The apoptosis rate of renal tubular epithelial cells in IRI group was significantly higher than that in control group(34.83%±8.75% vs 3.33%±0.47%, P<0.01), while the apoptosis rate of IMD group(20.67%±7.71%)was significantly lower than that of IRI group. There was no difference of above indexes between empty plasmid group and IRI group. Conclusions IMD pretreatment protects against renal IRI. The mechanism may be at least partly related to the clearance of oxygen free radicals, the improvement of lipid peroxidation, inflammatory cell infiltration and cell apoptosis, leading to the decrease of the production of reactive oxygen species caused by oxidative stress.