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Objective To understand the status of the HR and payroll system at county public hospitals in Guangxi,and to put forward basic path and targeted policy suggestions of the reform.Methods In June 2016,a field survey was made on the HR and payroll status of county-level public hospitals in 14 prefecture level cities in Guangxi,along with descriptive and inferential analysis.Results During 2013 to 2015 period,the total income of the sample hospitals had increased to some extent, mainly due to rise of hospitals'business revenue.The multiple of medical workers''wages, given some rise, remained stable compared to average wages of urban employees,as their monthly after-tax income ranged but 3 001-5 000 yuan in most cases.A large salary gap was found between those within the staffing plan and those beyond, and the latter has higher turnover rate.The performance appraisal system is poorly accepted by medical workers,as only 1.34%of them hold their current pay as ideal.Conclusions The reforms should prioritize the payroll system, better the performance appraisal system, upgrade the staffing plan management and innovate HR recruitment mode.These measures should constitute the reform of the HR and payroll system at county public hospitals.
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OBJECTIVE:To provide unified standard for assessing the comprehensive ability of food and drug inspection and testing institutions in Guangxi Zhuang autonomous region. METHODS:The comprehensive ability evaluation index system for food and drug inspection and testing institutions in Guangxi Zhuang autonomous region was drafted by literature review. Indexes of the evaluation index system were determined by Delphi expert consultation,and the weights were calculated by analytic hierarchy pro-cess (AHP). RESULTS:Literature review and expert consultation had constructed the comprehensive ability evaluation index sys-tem for food and drug inspection and testing institutions in Guangxi Zhuang autonomous region,including 6 first-level indexes,16 second-level indexes and 35 third-level indexes. AHP had determined the weights of indexes at all levels,and the weights of the 6 first-level indexes as basic conditions,management system,testing ability,work performance,scientific research and satisfaction degree,were respectively 0.1898,0.1233,0.2280,0.1915,0.1551 and 0.1124,in which testing ability held the highest weight. CONCLUSIONS:A set of scientific and suitable evaluating index system for food and drug inspection and testing institu-tions in Guangxi Zhuang autonomous region has been constructed,and the weights of indexes at all levels have been determined, which can provide clear and unified standard for conducting comprehensive ability system evaluation in each inspection and testing institution in Guangxi Zhuang autonomous region.
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Peripheral neuropathy induced by human immunodeficiency virus (HIV) infection and antiretroviral therapy is not only difficult to distinguish in clinical practice, but also difficult to relieve the pain symptoms by analgesics because of the severity of the disease at the later stage. Hence, to explore the mechanisms of HIV-related neuropathy and find new therapeutic options are particularly important for relieving neuropathic pain symptoms of the patients. In the present study, primary cultured embryonic rat dorsal root ganglion (DRG) neurons were used to determine the neurotoxic effects of HIV-gp120 protein and/or antiretroviral drug dideoxycytidine (ddC) and the therapeutic actions of insulin-like growth factor-1 (IGF-1) on gp120- or ddC-induced neurotoxicity. DRG neurons were exposed to gp120 (500 pmol/L), ddC (50 micromol/L), gp120 (500 pmol/L) plus ddC (50 micromol/L), gp120 (500 pmol/L) plus IGF-1 (20 nmol/L), ddC (50 micromol/L) plus IGF-1 (20 nmol/L), gp120 (500 pmol/L) plus ddC (50 micromol/L) plus IGF-1 (20 nmol/L), respectively, for 72 hours. The results showed that gp120 and/or ddC caused neurotoxicity of primary cultured DRG neurons. Interestingly, the severity of neurotoxicity induced by gp120 and ddC was different in different subpopulation of DRG neurons. gp120 mainly affected large diameter DRG neurons (>25 microm), whereas ddC mainly affected small diameter DRG neurons (< or =25 microm). IGF-1 could reverse the neurotoxicity induced by gp120 and/or ddC on small, but not large, DRG neurons. These data provide new insights in elucidating the pathogenesis of HIV infection- or antiretroviral therapy-related peripheral neuropathy and facilitating the development of novel treatment strategies.
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Animals , Humans , Rats , Analgesics , Diagnosis-Related Groups , Ganglia, Spinal , HIV , Insulin-Like Growth Factor I , Neuralgia , Neurons , Peripheral Nervous System Diseases , ZalcitabineABSTRACT
Objective To investigate the prognosis of two decompression approaches for cervical spondylotic myelopathy. Methods 86 cases were divided into two groups. 40 cases were underwent decompression by anterior decompression, fusion and internal fixation with titanium screws and plate and 46 cases underwent posterior single opendoor laminoplasty. To investigate the prognosis of two decompression approaches for single compressive segment, two compressive segments, three compressive segments and four compressive segments. Results All cases were followed up for 20 ～ 73 months with an average of 43 months. The mean JOA recovery rate was significant different between single compressive segment group (P ＜ 0.05), and no significant difference between two compressive segments and three compressive segments(P ＞ 0.05), and significant difference between four compressive segments groups (P ＜0.05). Conclusion For single compressive segment, the anterior surgery has a good surgical result,for two or three compressive segments, anterior and posterior surgery had same effect, for the four compressive segments, posterior surgical effect was good.
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Objective To develop pain assessment scale for cognifively impaired elderly (PACIE) and to test its reliabihty and validity. Methods Based on the foreign related pain assessment tools, the pain as-sessment scale for cognitively impaired elderly was developed. Five experts specialized in pain, anaesthesia and nursing were invited to evaluate the content validity of the pain assessment instrument and made modification. Reliability and validity of the pain assessment instruments was evaluated. Results PACIE had 8 items, index of content validity (CVI) of PACIE was 0.978, factor analysis demonstrated that two factors soluted in PACIE, that cumulative explained 69.008% of the total variability, the two factors were named pain objective factor and pain subjective factor. PACIE and NRS were significantly correlated, it could identify pain and painlessness patients overtly that demonstrate the discriminate validity was fine. Adequate levels of inter-rater reliability of PACIE was achieved between two raters with the intra-class correlation coefficient as 0.954 (95%CI=0.812～ 0.989). Satisfactory test-retest reliability was achieved with the Cronbach'α ot as 0.851. Conclusions The pain assessment scale for cognitively impaired elderly (PAC1E) has satisfactory validity and reliability, is suit-able for assessing the pain indentity of cognitively impaired elderly.
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BACKGROUND:There is no study about adjacent zygapophyseal joint stress distribution following two level artificial disc replacement (ADR) in China.OBJECTIVE:To explore cervical adjacent zygapophyseal joint stress distribution following two level ADR and anterior cervical discectomy and fusion (ACDF),so as to provide biomechanical reference for clinical application of two level ADR.DESIGN,TIME AND SETTING:In vitro contrast observation and biomechanical detection were performed at the National Key Laboratory of College of Material Science and Engineering,Central South University from January to February 2006.MATERIALS:A total of 11 fresh adult corpse cervical samples with intact cervical disc and ligament and the facet joint capsule ranged from C_3 to T_1 segment.METHODS:A total of 11 intact adult fresh-frozen multi-segmental cervical spine segments were utilized and biomechanically evaluated under the following C_(4～5),C_(5～6) cervical disc conditions:intact spine (intact group),Bryan disc prosthesis implantation (ACDR group) and intervertebral fusion (ACDF group).The testing was performed under axial load (25 N-150 N) on each group.The stress changes of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint was tested.MAIN OUTCOME MEASURES:The pressure of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint.RESULTS:Under axial loading,stress of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint increased with the load and showed no difference between the intact group and ACDR group (P>0.05).Under axial loading,the ACDF group resulted in significant increase of the stress of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint compared with intact group and ACDR group (P<0.05).CONCLUSION:Two level artificial cervical disc replacement can maintain stress in the caudad (C_(5～6),C_(6～7)) zygapophyseal joint,thus reconstruct biomechanical property of cervical spine.Two level cervical discectomy and fusion can increase stress in the caudad (C_(5～6),C_(6～7)) zygapophyseal joint,which may be one of the causes for adjacent cervical spondyiosis postoperatively.
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Objective To investigate the clinical value of 18 F-FDG PET CT scan in the diagnosis of thin lung nodules. Methods 56 solitary cases of nodules in the lungs,nodule size ranged from 1～3 cm,conducted 18 F-FDG PET/CT imaging and thin layer CT scan at the same time, 18 F-FDG PET imaging using visual measurement combined with semi-quantitative method to determine the degree of malignant of the lesions; conducted MPR recon-struction after thin layer CT scan, based on the lesions morphology to determine the degree of malignant. Then com-pared the results of above,and the results of the combination of 18 F-FDG PET imaging and thin layer CT scan,with the pathological results after surgery. Results The sensitivities of PET imaging alone,thln layer CT alone,joint ima-ging diagnosis of SPN are 92.6% ,88.2% ,96.4% ,specificity are 73.3% ,57.1% ,85.7% ,accuracy percentage rate are 89.3% ,80.4% ,94.6% ,the positive predictive values are 92.6% ,91.8% ,96.4% ,and negative predictive val-ues are 84.6% ,61.5% ,92.3% ,respectively. Conclusion 18 F-FDG PET combined with thin layer CT scanning is a very effective method to clinical diagnosis the malignant degree of SPN.
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@#Objective To investigate the effect of leg cycle ergometer on walking ability of stroke patients with hemiplegia at convalescent period.Methods Seventy patients with hemiplegia after stroke for 3 to 6 months with a certain walking capability were randomly divided into the treatment group and control group with 35 cases in each group.The control group was treated with routine rehabilitation training;the treatment group was added with leg cycle ergometer training.All patients in the two groups were assessed with simplified Fugl-Meyer Assessment(FMA),Berg Balance Scale(BBS),ambulation capacity(walking time in 10 meters and walking distance in 6 minutes and Holden's functional ambulance classification),changes of spasticity,and the ability of daily living(ADL)at the time of begin and 6 weeks later.Results The motor function of lower extremity,balance performance,walking capability and ADL of the patients in two groups improved(P<0.05)after 6 weeks' treatment,but the therapeutic effect of the treatment group was better than the control group(P<0.05).Conclusion The application of leg cycle ergometer combined with routine rehabilitation training can distinctly improve the motor function of lower extremity,balance performance,walking ability and ADL for patients after stroke.
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@#ObjectiveTo observe the effect of constraint-induced movement therapy (CIMT) combined with motor imagery therapy (MIT) on the upper extremity function of stroke patients with hemiplegia.Methods120 hemiplegic patients caused by brain injury were randomly divided into the control group, CIMT group, MIT group and combined therapy group with 30 cases in each group. The every group was treated with commensurate rehabilitation management respectively, 4 weeks as one course of treatment. All patients were assessed with the Simple Test for Evaluating Hand Function (STEF), the upper limb movement Fugl-Meyer Assessment (FMA), and Modified Barthel Index (MBI) before and after the treatment.ResultsBefore the treatment, there was no significant difference in STEF, scores of upper limb movement FMA and MBI among the four groups ( P>0.05). After the treatment, the STEF, scores of upper limb movement FMA and MBI of the CIMT group and MIT group improved ( P<0.05), that of the combined therapy group were superior to any other group ( P<0.01).ConclusionCIMT and MIT can promote the recovery of upper extremity function of hemiplegic patient, but the better therapeutic effect will be obtained when these two therapies combined.
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@#ObjectiveTo investigate the effect of early induced finger function training on motor function and activities of daily living (ADL) of stroke patients.Methods60 stroke patients with hemiplegia were randomly divided into the early induced finger function training group (treatment group) and control group with 30 cases in each group. The patients of the control group were treated with routine rehabilitation; while those of the treatment group were added with training of early induced flexion and extension of fingers. All patients of two groups were assessed with Brunnstorm Scale, Fugl-Meyer Assessment, scores of Neurological Functional Deficit, and Modified Barthel Index before and 8～12 weeks after treatment.ResultsAfter treatment, upper limb motor function, hand function and fingers' fine function in the sick side of the patients in the treatment group improved significantly better than that in the control group ( P<0.05～0.01).ConclusionThe early induced finger function training can obviously improve the upper limb motor function and ADL of stroke patients.
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@#ObjectiveTo investigate the effect of rehabilitation of attention on activities of daily living (ADL) in hemiplegics with disturbance of attention. Methods40 patients with brain injured were randomly divided into 2 groups: treatment group and control group. The control group was treated with conventional rehabilitation, while the treatment group was treated with conventional rehabilitation and strengthening training of attention.ResultsThe attention and ADL were significant improved after treatment in both groups(P<0.05).Compared with control group, the treatment group gained more improvement(P<0.05).ConclusionDisturbance of attention can influence the rehabilitation effect in hemiplegics after brain injured, so that is important to be treated during the rehabilitation.
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@#ObjectiveTo investigate the effect of rehabilitation of attention on activities of daily living (ADL) in hemiplegics with disturbance of attention. Methods40 patients with brain injured were randomly divided into 2 groups: treatment group and control group. The control group was treated with conventional rehabilitation, while the treatment group was treated with conventional rehabilitation and strengthening training of attention.ResultsThe attention and ADL were significant improved after treatment in both groups(P<0.05).Compared with control group, the treatment group gained more improvement(P<0.05).ConclusionDisturbance of attention can influence the rehabilitation effect in hemiplegics after brain injured, so that is important to be treated during the rehabilitation.
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BACKGROUND: With the development of thrombolysis therapy in recent years, there has been an increasing focus on the protective effect of ischemic reperfusion injury (IRI) and its mechanism at home and abroad,and aspirin is of great importance in the treatment of thrombus diseases owing to its powerful antiplatelet aggregative activity.OBJECTIVE: To explore the protective effect of aspirin on the gerbil brains with IRI and its influence on the intercellular adhesion molecule (ICAM) and calcitonin gene-related peptide (CGRP) expressions.DESIGN: A randomized controlled animal experiments.SETTING: Department of Neurology, Jinan Municipal Central Hospital,College of Clinical Medicine, Shandong University.MATERIALS: The experiment was performed at the Physiological Laboratory of Taishan Medical University from December 2001 to June 2002.Sixty-three healthy male gerbils of Mongolian specimen were randomly assigned into sham group, IRI group and aspirin group with 21 in each group. And each group was further divided into three subgroups according to the time after IRI: 24 hours, 3 days and 7 days, with 7 gerbils for each.METHODS: The models of global brain IRI were established by bilateral carotid artery occlusion. Sham group: The unfolded bilateral carotid artery was not occluded; IRI group: The unfolded bilateral carotid artery was occluded by bulldog clamp for 7 minutes, and then the blood circulation was recovered by removing the clamp. Aspirin group: Before the operation,50 mg/kg enteric-coated aspirin was infused via gastric canal. And the same procedures as IRI group were performed. The gastric infusion of aspirin was given daily until the gerbils were executed at 24 hours, 3 days and 7 days after IRI for brain tissue examinations. The immunohistochemistry SABC method was applied to detect the changes of ICAM 1 and CGRP expressions as well as the influence of aspirin on the two.MAIN OUTCOME MEASURES: The expressions of ICAM and CGRP in brain tissues.RESULTS: A total of 63 gerbils were involved in the result analysis.①Changes of ICAM expression: In IRI group, the expression of ICAM began to increase at 24 hours after IRI,enhanced remarkably at 3 days and maintained at high levels at 7 days,with the significant difference compared with sham group [IRI group: (3.36±2.26)%, (5.68±3.13)%, (4.98±2.10)%; Sham group: (1.53±1.07)%, (1.56±1.23)%, (1.62±1.33)%, P ＜ 0.05];However,the ICAM expression was significantly lower in aspirin group than in IRI group at different time points [(0.96±0.83)%, (2.76±2.10)%,(1.96±1.09)%, P ＜ 0.05].②Changes of CGRP expression: At the different time points after IRI,the CGRP expression was weakly positive in IRI group [(3.12±2.26)%, (2.68±2.04)%, (2.57±1.97)%], but strongly positive in aspirin group [(4.98±2.47)%, (5.97±2.35)%, (6.04±2.40)%].CONCLUSION: IRI can increase the ICAM 1 expression while inhibit the CGRP expression; Aspirin can make great impacts on brain protection by inhibiting ICAM 1 expression and reinforcing the CGRP expression.
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BACKGROUND: The rehabilitative intervention accelerates the recombination and reconstruction of cerebral structure and function and then promotes the amelioration of function.OBJECTIVE: To evaluate the influence of early and late rehabilitative interventions on the motor function and activities of daily living (ADL) with neurologic deficit score (NDS), Fugl-Meyer assessment (FMA) and modified Barthel index in patients with cerebral infarction.DESIGN: A randomized controlled trial.SETTING: Department of Neurology, Qilu Hospital of Shandong University; Department of Rehabilitation, Jinan Great Wall Hospital; Department of Neurology, the Third People' s Hospital of Heze.PARTICIPANTS: Totally 216 inpatients with cerebral infarction (125 males and 91 females, aged 60-75 years), who were selected from Qilu Hospital of Shandong University, Jinan Great Wall Hospital and the Third People's Hospital of Heze from December 2000 to December 2003, were randomly divided into early rehabilitation group (n=108) and late rehabilitation group (n=108) after admission.INTERVENTIONS: In the early rehabilitation group, the patients began to receive rehabilitation at 48 hours to 14 days after the stability of vital signs and absence of the progress of neurological signs. In the late rehabilitation group, the patients began to receive rehabilitation at 15-30 days after attack. They were trained with Bobath method and motor relearning program, once a day, 45 minutes for each time, and 6 times every week.Before and 30 days after the rehabilitative treatment, the rehabilitation was evaluated with modified Barthel index (100 points as normal, 0-20 as extremely severe functional defect, 25-45 as severe functional defect, 50 -70 as moderate functional defect, 75-95 as mild functional defect), FMA (total score was 100 points, including the highest scores of upper and lower limb movement were 66 and 34 points respectively) and NDS (the highest and lowest scores were 45 and 0 point, 0-15 as mild, 16-30 as moderate, 31-45as severe).ter treatment.RESULTS: All the 216 patients with cerebral infarction were involved in obviously lower than that before treatment in both groups (P ＜ 0.01), lower in the early rehabilitation group than in the late rehabilitation group score at 30 days after treatment was obviously higher than that before treat ment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [upper limb: (32.43±21.52), (26.69±19.79)dex: The modified Barthel index at 30 days after treatment was obviously higher than that before treatment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [(54.23±30.33),(46.57±29.85) points, P ＜ 0.05].CONCLUSION: Both early and late rehabilitative interventions can obviously accelerate the recovery of neurological function, motor function and ADL, but the effect of early rehabilitative intervention is superior to that of the late one.
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@#ObjectiveTo study effects of treating acute progressive cerebral infarction by the brain-located mild hypothermia therapy.Methods60 patients were randomly divided into the treatment group (30 cases) and the control group (30 cases). Drugs were used in both groups, and the located mild hypothermia therapy was only applied in the treatment group. After 72 hours and 7 days, the volume of cerebral infarction and the nerve function deficiency (NFD) scores of hemiplegic limbs were compared.ResultsThe volume of cerebral infarction of the treatment group was significantly smaller than that of the control group (P<0.01).There were significant differences on the neurological impairment scores between two groups (P<0.01).Conclusions The brain-located mild hypothermia therapy can reduce hydrocephalus of patients with acute progressive cerebral infarction, and have brain protection. These results provide an important theoretical foundation for the treatment of cerebral infraction with low-temperature therapy.
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Objective To investigate the expression of heat shock protein 70(HSP70) and c-fos,the presence of apoptosis and the neuroprotective effects of Cudrania tricuspidata root extrate(Ecr) after focal cerebral ischemic reperfusion in rats.Methods Models of middle cerebral artery occlusion(MCAO) were used in this study.The rats in Ecr pretreated ischemia reperfusion(IR) group were fed with Ecr(2 ml tid) for 5 days before MCAO.The brain specimen were took at different reperfusion times: 1 h,6 h,12 h,24 h,3 d and 7 d after recirculation.Then immunohistochemistry,insitu hybridization,terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) were used to detect the expression of HSP70,c-fos gene and cell apoptosis in the brains.Positive results were semiquantitatively analyzed.Results IR could induce the expression of HSP70 and c-fos.HSP70 was detected at 6 h following reperfusion and peaked at 24 h both in cortical and basal ganglia regions.c-fos was markedly expressed at 1 h and the level peaked at 6 h in the ischemic hemispheres,and then reduced gradually.The TUNEL positive cells were markedly observed at 6 h.After treatment with Ecr,the positive reaction cells both of HSP70 and c-fos were significantly increased(all(P
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Objective To study the protective effect and molecular mechanism of trypsin inhibitor on reperfusion injury after cerebral ischemia. Methods The model of ischemia for 1h and repufusion for 24h of rat cerebrum was set by ligating MCAO described by zea-longa. 24 male rats were divided randomly into the sham operation group, the control group and trypsin inhibitor group. The presence of neurological function deficit was measured by Zea-Longa method, and the immunohistochemical staining and TUNEL were used to detect p53 protein expression and cell apoptosis in the brain tissues respectively. Results The score of neurological function deficit was zero in the sham operation group, 2 8?1 0 in the control group and 1 3?0 7 in trypsin inhibitor group. There were 12 3?2 5 p53 immunostaining positive cells in the control group and 5 5?1 3 in trypsin inhibitor group. The number of apoptotic cells was zero in the sham operation group, 7 6?1 0 in the control group, and 3 5?0 9 in trypsin inhibitor group. There was a significant difference in all above observing indices between the control group and trypsin inhibitor group(P
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Objective To study the effects of flunarizine on the contents of SOD、 MDA、 NO、 NOS in serum and brain tissue and pathological changes in gerbils of ischemia-reperfusion cerebral injury. Methods Twentyone gerbils were randomly divided into three groups: ischemia-reperfusion group, flunarizine pretreatment group and control group. There were seven gerbils in each group. The levels of SOD, MDA, NO and NOS in the serum and brain tissue were determined, and pathological changes of brain were observed by microscopy. Results It was found that the group of ischemia-reperfusion had characteristic changes of ischemia-reperfusion injury. Compared with the control group, serum and brain contents of MDA, NO and NOS were higher but the content of SOD was lower,and the differences were significant(all P