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Objective To analyze the epidemiological characteristics of syphilis in Yichang City from 2011 to 2020, and provide a scientific basis for developing effective control measures. Methods The data of syphilis cases reported in Yichang City from 2011 to 2020 were collected and analyzed by descriptive epidemiological methods. Results A total of 8 107 cases of syphilis were reported in Yichang City from 2011 to 2020, with an average annual reported incidence rate of 19.76 per 100 000.The reported incidence of syphilis increased from 17.39/100 000 in 2011 to 24.49/100 000 in 2018 （APC=6.82%，95%CI：2.34%~11.49%， P＜0.05）, from 24.49/100 000 in 2018 Decline to 17.55/100 000 in 2020（P＞0.05）. Recessive syphilis is the main type, with 5 837 cases (72.00%), and the annual reported incidence rate is 14.23 per 100 000. The number of cases peaked in July, at 836 (10.31%), and 433 (5.34%) of the lowest in February . The top 3 counties with annual average reported incidence rates were Zigui County (28.51/100 000) , Xiling District (25.01/100 000), and Dangyang City (23.73/100 000). There were a statistically significant differences in reported incidence between counties (2 =933.92, P＜0.01). Gender ratio was 0.72. Cases mainly concentrated in people over 20 years old, 7901 cases (97.46%). The occupation distribution is mainly farmers, housework, unemployed, and retired people. Conclusion The incidence of syphilis in Yichang City has been on the rise in recent ten years, and there is still a long way to go to prevent and control syphilis. We suggested to continue to strengthen the prevention and control of syphilis and comprehensively prevent and control the spread of syphilis.
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Objective To provide reference for the development of prevention and control strategies for HIV/AIDS cases aged 50 and above in Yichang city from 2013 to 2020 by epidemiological characteristics anaylsing. Methods Descriptive epidemiological method was used to analyze the epidemic situation and epidemiological data. Results A total of 1 126 HIV/AIDS cases were reported during the monitoring period, and 296 cases were 50 years old and above, accounting for 26.29%. The proportion of cases aged 50 years and above to the total number of cases and the annual reported incidence rate both showed an upward trend (P＜0.01). The cases were mainly male (74.66%), and the older the age, the greater the proportion of males (P=0.02). The age of confirmed cases is mainly concentrated in 50-59 years (68.58%), of which 49.66% were married and 74.32% were at junior high school and below. Sexual contact (accounting for 99.66%) was the main route of infection, the proportion of non-marital heterosexual sex was relatively high, especially in female cases (accounting for 74.67%). Those who had been infected for more than 8 years accounted for 48.75%, and the proportion of infected age ≥50 years in the total number of cases showed an upward trend. Cases were found mainly from medical institutions (74.66%). Conclusion The HIV/AIDS epidemic situation of people aged 50 and above in Yichang City was relatively severe and has became a key population for prevention and control. Targeted and effective prevention and control measures should be taken to reduce the harm of AIDS to the population.
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Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.
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Objective:To investigate the effects of turning head to the opposite insertion side on catheter heterotopia and degree of comfort among PICC catheter patients.Methods:The inpatients with PICC catheter in Hepatological Surgery of Changzhi People′s Hospital from January 2018 to December 2019 were collected as research object, patients from January to December 2018 was assignment to the control group, patients from January to December 2018 was assignment to the experimental group, with 174 cases in each group. They were catheterized with turning head to the opposite insertion side and turning head to the PICC insertion side, respectively. The incidence of catheter heterotopia, complications as well as degree of comfort during the placement of PICC were compared between the two groups.Results:The successful cases of one-time delivery tube and occurred catheter heterotopia were 97.1% (169/174) and 1.2% (2/174) in the experimental group, the index mentioned above were 91.4% (159/174) and 7.5% (13/174) in the control group, the differences between the two groups were statistically significant ( χ2=5.30, 8.43, both P<0.05). The results from survival curve analysis demonstrated that the occurred of catheter-related venous thrombosis and catheter-related bloodstream infections were significantly lower in the experimental group compared to the control group ( χ2=15.23, 8.76, both P<0.05). The score of comfort during the placement of PICC was (15.00 ± 2.19) in the experimental group, which was significantly lower than (16.86 ± 1.88) points in the control group ( t=8.49, P<0.05). Conclusions:Adopting turning head to the opposite insertion side method can improve the success rate of one-time delivery tube, reduce the incidence of catheter heterotopia and reduce the discomfort of patients during PICC catheterization.
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Objective:To analyze potential roles of mechanical stress in the formation of plantar melanoma.Methods:A retrospective analysis was conducted on 129 cases of plantar melanoma in Xiangya Hospital, Central South University between 2014 and 2021, and the distribution and clinical characteristics of plantar melanoma were analyzed. The goodness-of-fit test was used to compare the distribution of plantar melanoma between weight-bearing areas (the toes, forefoot, lateral midfoot, heel) and non-weight-bearing areas of the foot (the arch) , while t test, Fisher′s exact test and Wilcoxon rank sum test were used to analyze differences in clinicopathological characteristics of plantar melanoma between weight-bearing areas and non-weight-bearing areas of the foot. Results:Among the 129 patients with plantar melanoma, 66 (51.2%) were males and 63 (48.8%) were females, and their age at onset was 60.6 ± 13.1 years. Plantar melanoma mostly occurred on the heel (65 lesions, 1.31 lesions per square centimeter) , followed by the forefoot (31 lesions, 0.41 lesions per square centimeter) , the bottom of the toes (15 lesions, 0.43 lesions per square centimeter) , lateral midfoot (11 lesions, 0.38 lesions per square centimeter) and the arch of foot (7 lesions, 0.16 lesions per square centimeter) . The goodness-of-fit test showed that melanoma was more prone to occur in the weight-bearing areas than in the non-weight-bearing areas ( χ2 = 66.59, P < 0.001) ; compared with the arch of foot, a higher incidence density was observed in the heel and forefoot ( χ2 = 38.29, 5.23, P < 0.001, = 0.022, respectively) . There were no significant differences in the gender ratio, age and occupation of patients, prevalence rates of left/right foot involvement, Breslow thickness, ulceration status, Clark grades, lymph node metastasis rate, and stages between melanomas in the weight-bearing areas and those in non-weight-bearing areas (all P > 0.05) . Conclusion:Plantar melanoma was more prone to occur in the weight-bearing areas than in the non-weight-bearing areas, suggesting that mechanical stress may be related to the occurrence and development of melanoma.
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Objective:To discuss the application effect of enhance recovery after surgery (ERAS) combined with system nursing in patients with thoracolumbar fracture accompanied by nerve injury.Methods:A retrospective case-control study was conducted to analyze the clinical data of 84 patients with bilateral thoracolumbar fractures accompanied by nerve injury admitted to Henan Provincial People's Hospital from August 2017 to January 2020. All patients were treated with posterior thoracolumbar spinal canal decompression, bone grafting and internal fixation. There were 55 males and 29 females, aged 36-49 years [(43.2±5.2)years]. The injury segments were located at T 10-T 11 in 6 patients, T 11-T 12 in 38, T 12-L 1 in 31, and L 1-L 2 in 9. According to the Frankel classification of neurological function, 19 patients were rated as grade A, 22 grade B, 38 grade C, and 5 grade D. A total of 42 patients were treated by ERAS combined with system nursing (ERAS group), and 42 patients by routine rehabilitation nursing (routine nursing group). The hospitalization time, incidence of perioperative complications, and patients' satisfaction with nursing work were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated at postoperative 1 week and 3 months. The Frankel classification of neurological function and the MOS item short from health survey (SF-36) score were measured at postoperative 3 months. Results:All patients were followed up for 3-4 months [(3.2±1.7)months]. The hospitalization time in ERAS group was (10.9±1.6)days, significantly shorter than (14.4±1.2)days in routine nursing group ( P<0.05). The incidence of perioperative complications in ERAS group was 10%(4/42), significantly shorter than 29%(12/42) in routine nursing group ( P<0.05). The satisfaction rates in ERAS group and routine nursing group were 93%(39/42) and 76%(32/42), respectively ( P<0.05). At 1 week and 3 months after operation, the VAS in ERAS group [(1.7±0.4)points, (1.2±0.3)points]was significantly lower than those in routine nursing group [(4.8±0.9)points, (3.1±0.7)points]( P<0.05). At 1 week and 3 months after operation, the ODI in ERAS group [(13.5±1.8)points, (10.3±1.4)points] was significantly lower than those in routine nursing group [(17.9±2.0)points, (15.6±2.1)points]( P<0.05). At 3 months after operation, according to the Frankel classification, there were 2 patients with grade A, 9 with grade B, 13 with grade C, 13 with grade D and 5 with grade E in ERAS group, and there were 8 patients with grade A, 8 with grade B, 12 with grade C, 10 with grade D, and 4 with grade E in routine nursing group. The recovery rate of grade A or above in ERAS group was 95%(40/42), significantly higher than 81%(34/42) in routine nursing group ( P<0.05)]. At 3 months after operation, the SF-36 score in ERAS group was better than that in routine nursing group ( P<0.05). Conclusion:For patients with thoracolumbar fracture accompanied by nerve injury, ERAS combined system nursing can shorten the hospitalization time, reduce perioperative complications, improve patients' satisfaction, reduce pain, promote the recovery of nerve function, and improve the quality of life.
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Objective:To observe the distribution ratio of histiocytic necrotizing lymphadenitis(HNL) in the age of children, evaluate glucocorticoids and Hydroxychloroquine therapeutic effects, evaluate the meaning of lymph node excisional biopsy.Methods:The data of 70 cases of patients with the lymph node excisional biopsy in Tianjin Children′s Hospital from December 2010 to August 2019 were retrospectively analyzed.and summarized the treatment experience and prognosis.Results:HNL mostly occurs in children 7-12 years old.The male-female ratio was 1.12∶1.00, but over 13 years old was 0.6∶1.0.Eighteen point one six percent (13 cases) of HNL was relieved after the lymph node excisional biopsy.Thirty-five cases were treated with non-steroidal anti-inflammatory drugs (NSAIDs), and only 10 cases (14.2%) were improved with NSAIDs alone and the rest were improved in combination with glucocorticoids.Four patients with ineffective glucocorticoids therapy were improved in combination with Hydroxychloroquine.Conclusion:HNL in children was more common in school-age children.For children under 13 years old, the incidence among boys is slightly higher than that among girls; for children above 13 years old, the incidence among boys is slightly lower than that among girls.Lymph node biopsy is still the gold standard for diagnosis and is conducive to remission.The course of disease is self-limited, for the cases that NSAIDs is poor, the glucocorticoid treatment should be used.For refractory cases, combined Hydroxychloroquine treatment can be used.
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Objective To analyze the changes of CD4+ T cell numbers at different periods of antiviral therapy in HIV-infected and AIDS patients (HIV/AIDS) in Yichang City. Methods The relevant information was retrieved from the National AIDS Comprehensive Prevention Information System-Antiretroviral Treatment Management Database. Changes in the number of CD4+ T cells were analyzed in HIV/AIDS patients who started receiving highly active antiretroviral therapy (HAART) and continued the treatment for 3 years from January 1, 2003 to December 31, 2017 in Yichang. Results The number of CD4+T lymphocytes in 550 HIV/AIDS cases increased significantly at various time points within 3 years after treatment, and increased with the increase of treatment time（F=100.20，P<0.001）. The CD4+T cell counts of different baseline level groups were statistically different before and after treatment（F=8.57，P<0.01）. The CD4+ T cell counts of patients who started treatment at age of 15-30 years old increased faster than those who started treatment at age of over 30 years old（F=1.27，P<0.05）. Conclusion HAART has a significant effect on the increase of CD4+T cells, and the early treatment is more effective. Early detection, diagnosis and treatment should be promoted, and anti-viral treatment should be actively carried out.
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Objective@#To explore differences in the detection rate of elevated blood pressure (BP) in children aged 6-8 years old, and to verify the apparent existence of white-coat hypertension (BP) in children.@*Methods@#Based on census data(PROC), and three subsequent BP readings were taken during follow-ups which were carried out from October 2018 to June 2019. A total of 1 785 children were included in the present study. Using updating blood pressure reference for Chinese children aged 3-17 years, compared the BP detection rate at baseline, at the first follow-up, and the average value of the last two BP readings. Fluctuations in the detection rate of elevated BP in children at different time-points were analyzed.@*Results@#The detection rates of the three elevated BP measurements of 6-8-year-old children were 57.65%, 25.88% and 15.46%, respectively, and the detection rate was higher among boys than girls. The detection rate of baseline BP was higher than that of the first follow-up BP measurements and the average of the last two BP measurements(P<0.01). Given the agreement in the diagnosis of high SBP, high DBP, high BP at baseline, and the average of the last two follow-up BP measurements, elevated BP at baseline was the lowest among the three groups and SBP was higher than DBP.@*Conclusion@#Blood Pressure fluctuations might be caused by transient tension that was experienced during the baseline BP measurement and during the first of the three follow-ups. Therefore, the average value of last two BP measurements may better reflect the real BP level in children.
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Objective@#To explore sex differences between weight and systolic blood pressure (SBP) changes among school-age children and adolescents in Beijing, and to provide a basis for priority intervention to control the rapid growth of body weight and blood pressure.@*Methods@#Anthropometric measurement data of 70 288 children and adolescents from primary and high schools in Shunyi District were collected from 2009 to 2018, and a longitudinal dataset with complete data related to weight and BP after individual data linkage was compiled. The age-specific weight and SBP growth rates were calculated, and a linear mixed-effects model was used to identify sex differences in chronological growth rates.@*Results@#Weight and SBP increased with age in both boys and girls, and the mean weight and SBP were higher in boys than in girls across all age groups. The result of the linear mixed-effects model indicated apparent sex differences in weight and SBP growth rates, with an age and sex interaction term(β=-0.35, -0.40, P<0.01). The age at peak weight velocity (PWA) was 12 years old and the age at peak SBP velocity was 13 years old in boys, which occurred one and three years later than for girls, respectively. In addition, the peak weight and SBP velocity were higher in boys than in girls. The curves of the SBP growth rate adjusted for the PWA, showed that the peak SBP velocity occurred two years before PWA and the second peak SBP velocity occurred at the PWA, which indicated "double peaks" in both boys and girls. The SBP growth rate was always higher in boys than in girls, and the rates declined after PWA.@*Conclusion@#Sex differences in weight and SBP growth rates were persistent and obvious in school-age children and adolescents in Beijing and the change in SBP was highly time synchronized with the increase in weight.
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OBJECTIVES@#To analyze the expressions and distributions of hypoxia-inducible factor-1α (HIF-1α), CD147, and glucose transporter 1 (GLUT1) in epidermis from psoriasis vulgaris and normal people, and to explore the associations among these proteins and their roles in hypoxic HaCaT cell line.@*METHODS@#The expression levels of HIF-1α, CD147, and GLUT1 were determined by immunohistochemistry staining in skin biopsies from 48 psoriasis vularis patients and 33 healthy subjects. Cobalt chloride (CoCl@*RESULTS@#HIF-1α, CD147, and GLUT1 were highly expressed and the glycolytic capacity was increased in lesions of psoriasis vulgaris; HIF-1α upregulated the expression of CD147 and GLUT1, increased the lactate production and decreased the ATP level in CoCl@*CONCLUSIONS@#Glycolytic capacity increases in the injured keratinocytes of psoriasis vulgaris, suggesting that HIF-1α, CD147, and GLUT1 are associated with glycolysis, which can be considered as the promising targets for psoriasis therapy.
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Humans , Basigin , Glucose Transporter Type 1 , Glycolysis , Hypoxia-Inducible Factor 1, alpha Subunit/genetics , Psoriasis/genetics , Transcriptional Activation , Up-RegulationABSTRACT
:To investigate the effect of transient receptor potential melastatin 2 （TRPM2） inhibitor A10 on oxygen glucose deprivation/reperfusion （OGD/R） injury in SH-SY5Y cells．:Human neuroblastoma SH-SY5Y cells were subject to OGD/R injury，and then were divided into blank control group，model control group and A10 group randomly. The cell survival rate was detected by cell counting kit 8 （CCK-8）; the level of cellular reactive oxygen species （ROS） was detected by reactive oxygen detection kit; the mitochondrial membrane potential was detected by tetramethylrhodamine （TMRM） method; the number of apoptotic cells was detected by TUNEL apoptosis assay kit; the protein expression level of cleaved caspase 3 was detected by Western blot．:Compared with 3，20，30，50， has lower cytotoxicity and better inhibition effect on channel activity. Compared with the model control group，ROS level was reduced，the mitochondrial membrane potential was improved，the number of apoptosis cells was reduced ，and the expression of cleaved caspase 3 was significantly reduced in the A10 group（all <0.05）. : A10 can alleviate cell damage after OGD/R by inhibiting TRPM2 channel function，reducing extracellular calcium influx，reducing cell ROS levels，stabilizing mitochondrial membrane potential levels，and reducing apoptosis.
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Humans , Apoptosis , Benzeneacetamides , Cell Survival , Glucose , Oxygen/metabolism , Piperidones , Reactive Oxygen Species/metabolism , Reperfusion , TRPM Cation ChannelsABSTRACT
Objective:To investigate the clinical efficacy and safety of domestic bortezomib in the treatment of patients with multiple myeloma (MM).Methods:The data of 60 MM patients treated with domestic bortezomib as the basic chemotherapy regimen in 5 medical centers of Qilu Hospital of Shandong University, Heze Municipal Hospital, Weifang People's Hospital, Binzhou Medical University Hospital, Zibo Central Hospital in Shandong Province from January 2018 to June 2019 were retrospectively analyzed, 52 of which were newly treated patients and 8 were relapsed and refractory patients. The patients received at least 2 courses of combined chemotherapy based on domestic bortezomib, and the efficacy was assessed and evaluated every 2 courses.Results:Follow-up until June 30, 2019 showed that some patients were unable to return to the hospital for regular treatment. All patients completed at least 2 courses of treatment, with an overall effective rate (ORR) of 76.7% (46/60); 42 patients completed 4 courses of treatment, with an ORR of 78.6% (33/42); 30 patients completed 6 courses of treatment, with an ORR of 86.7% (26/30); there was no significant difference in ORR of 2, 4 and 6 courses ( P > 0.05). The complete remission+very good partial remission rates of 2, 4 and 6 courses were 16.7% (10/60), 47.6% (20/42) and 66.7% (20/30), respectively, and the difference was statistically significant ( P < 0.01). During the treatment, the adverse events mainly included infection, peripheral neuropathy, herpes, digestive tract symptoms, hematologic toxicities and so on, which were light and moderate mostly, and most of them can be reversed. The total incidence of adverse events in patients who completed 2, 4 and 6 courses of treatment were 91.7% (55/60), 66.7% (28/42) and 36.7% (11/30), respectively. Conclusions:The domestic bortezomib-based chemotherapy regimens have good efficacy in the treatment of MM. The incidence of adverse events is similar to that of the original drug, and patients can tolerate the adverse events.
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Objective@#To investigate the expression of type Ⅰ collagen α1 chain protein (COL1A1) in triple negative breast cancer (TNBC), and its relationship with clinicopathological features and prognosis of TNBC.@*Methods@#A total of 148 TNBC specimens were collected from the Affiliated Cancer Hospital of Xinjiang Medical University from 2013 to 2015. The mRNA expression of COL1A1 was detected by fluorescence quantitative RT-PCR and the protein expression of COL1A1 was detected by Western blot. The expression of COL1A1 and α-smooth muscle actin (α-SMA) in TNBC were detected by immunohistochemistry. The relationship between the expression of COL1A1 and clinicopathological parameters and prognosis of TNBC patients was analyzed.@*Results@#The mRNA and protein expression of COL1A1 in MDA-MB-231 cells were 1.696±0.486 and 0.550±0.088, respectively, which were higher than those in MCF-10A cells (1.020±0.231 and 0.350±0.083, P=0.032, P=0.046). The mRNA and protein expression of COL1A1 in TNBC tissues were 1.632 ±0.598 and 0.733 ±0.068, respectively, which were higher than those in paracancerous tissues (1.041±0.316 and 0.612±0.016, P=0.003, P=0.039). The high expression rates of COL1A1 and α-SMA in TNBC tissues were 35.8% and 56.7% respectively, which were higher than those in paracancerous tissues (16.7% and 30.0%, P=0.041, P=0.037). The expression of COL1A1 was correlated with tumor size, TNM stage, lymph node metastasis, vascular invasion and α-SMA expression (all P<0.05). The median survival time in COL1A1 high expression group was 64 months, which was lower than that in low expression group (73 months, P<0.05). Multivariate analysis of Cox proportional hazard regression model showed that COL1A1 expression was an independent influencing factor for the survival of TNBC patients (HR=3.952, P=0.004).@*Conclusion@#The high expression of COL1A1 in TNBC is an independent prognostic factor of TNBC patients.
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Gliomas are the most common primary intracranial neoplasms among all brain malignancies, and the microtubule affinity regulating kinases (MARKs) have become potential drug targets for glioma. Here, we report a novel dual small-molecule inhibitor of MARK3 and MARK4, designated as PCC0208017. PCC0208017 strongly inhibited kinase activity against MARK3 and MARK4, and strongly reduced proliferation in three glioma cell lines. This compound attenuated glioma cell migration, glioma cell invasion, and angiogenesis. Molecular mechanism studies revealed that PCC0208017 decreased the phosphorylation of Tau, disrupted microtubule dynamics, and induced a G2/M phase cell cycle arrest. In an glioma model, PCC0208017 showed robust anti-tumor activity, blood-brain barrier permeability, and a good oral pharmacokinetic profile. Molecular docking studies showed that PCC0208017 exhibited high binding affinity to MARK3 and MARK4. Taken together, our study describes for the first time that PCC0208017, a novel MARK3/MARK4 inhibitor, might be a promising lead compound for treatment of glioma.
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Objective@#To identify the association of carotid intima-media thickness (cIMT) and visceral fat area (VFA) to inform prevention of cardiovascular disease in later life.@*Methods@#All the grade one students of six non-boarding primary schools in Shunyi District, Beijing were enrolled, based on population-based survey design, to establish the child cohort on sensitization, puberty, obesity and cardiovascular risk (PROC). Socio-demographic information survey and anthropometric measure, blood and urine test were carried out. Robust linear regression was used to determine the relationship between cIMT and other factors.@*Results@#Among 1 711 participants, a significant difference were observed between normal, overweight and obesity children on cIMT [(0.35±0.02)(0.36±0.02)(0.37±0.03)mm] (F=41.4, P<0.01) and VFA [16.2(13.6-19.3), 22.7(18.6-27.3), 51.5(33.9-73.0)cm2] (χ2=854.5, P<0.01). After adjusting age and sex, univariate robust linear regression showed that cIMT was associated with height, SBP, DBP, HDL-C, VFA (P<0.05) and TG (P=0.055). Multivariable robust linear regression indicated that in total and boys only included models, cIMT was associated with VFA and SBP(β=0.000 2, 0.000 2, 0.000 2, 0.000 2, P<0.05); while in girls only included model cIMT was associated with VFA and TG (β=0.000 2, 0.006 2, P<0.05).@*Conclusion@#VFA is stable to predict the increase of cIMT in children. We can use VFA to simplify the classification management of children and inform targeted early prevention of cardiovascular disease in adulthood.
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Nail diseases have similar clinical manifestations with a variety of causes. Dermoscopy, a non-invasive examination tool, can be used to rapidly and comprehensively evaluate changes of diseased nails at the early stage by observing nail cuticles, nail folds, nail plates, etc. It can be applied for diagnosis and treatment of nail diseases or evaluation of surgical performance. To improve clinicians′ understanding of nail diseases, the authors summarize dermoscopic manifestations of common nail diseases based on dermoscopic manifestations of definitely diagnosed nail diseases in Department of Dermatology, Xiangya Hospital, Central South University from June 2017 to February 2019.
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OBJECTIVE： To investigate the current status of pharmacists in public hospitals from Chongqing after the comprehensive reform of public hospitals， to put forward countermeasures and suggestions. METHODS： In questionnaire survey， pharmacists were selected from 33 public hospitals of secondary grade and above in Chongqing as survey objects. The current status of pharmacists in public hospitals of Chongqing from Sept. to Aug. 2018 was collected and surveyed in respects of the basic situation of pharmacists， the impact of medical reform policies， acceptance and professional development requirements of pharmacists. RESULTS： Totally 33 medical institutions included 13 third-grade hospitals and 20 secondary hospitals. A total of 838 questionnaires were distributed and 702 questionnaires were effectively recovered with effective recovery rate of 83.8％. According to the survey results， the majority of pharmacists in public hospitals of Chongqing were 25-35 years old （50.6％）； 8 （1.1％） had doctor’s degree， 86 （12.3％） had master’s degree， and 25.9％ had junior college and technical secondary schools. The number of master’s and doctor’s degrees in third-grade hospitals was higher than that of secondary hospitals， but there were still junior college and technical secondary school degrees in third-grade hospitals. Pharmacists were mainly referred to as middle and junior titles， 217 of which were middle-level titles （30.9％）， and 434 were primary titles（61.8％）； the majors were mainly pharmacy （64％）， followed by traditional Chinese pharmacology （18.7％）. Most of the working years were within 10 years （54.9％）. There were 274 people （39.0％） with an annual income of less than 50 000 yuan， 342 people （48.7％） with an annual income of 50 000- 100 000 yuan and only 86 people （12.3％） with an annual income of more than 100 000 yuan. After the implementation of new medical reform， 430 people （61.3％） thought that the workload had increased significantly or slightly， 99 people （14.1％） thought that the scope of work was significantly expanded， and 433 people thought that the annual income after medical reform was slightly reduced or significantly reduced （61.7％）； 253 people （36.0％） believed that hospital leaders did not pay attention to and did not pay much attention to pharmacists； 294 （41.9％） believed that medical staffs relatively accepted or highly accepted pharmacists. The reasons why pharmaceutical staffs thought that they were not valued mainly included five aspects， including that patients did not understand them； clinical medical staff did not agree with them； leaders did not pay attention to them； corresponding systems and regulations lacked； professional quality lacked. The main work content of pharmacists was mainly based on drug dispensing， and there were fewer people carrying out clinical pharmaceutical care， pharmacy management， pharmaceutical administration and quality control， preparation， pharmaceutical research. The jobs that they hoped to engage in were clinical pharmaceutical care， drug dispensing， pharmaceutical administration and quality monitoring， etc. Pharmacists believed that drug dispensing and delivery， reviewing medical orders， medication education guidance， consultation and medication counseling， drug management were important skills. The pharmaceutical staffs were good at skills， such as medical order review， medication education guidance， drug management. CONCLUSIONS： At present， the pharmacists in public hospitals of Chongqing have some problems， such as low education level， few clinical pharmaceutical professionals， low overall income and not recognized. It is suggested to protect the role and position of pharmacists in the medical treatment process from the perspective of introducing highly educated personnel of clinical pharmacy， improving the professional and educational structure of pharmacists， changing the pharmaceutical care mode， and improving their own ability and treatment.
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A 23-year-old male patient developed vesicles on the scrotum 5 years prior to this presentation.Then,vesicles gradually affected the whole scrotum,whick easily ruptured due to friction.Physical examination showed diffuse millet-sized vesicles on the scrotum with milky white fluids,and exudates with chyle-like appearance.Histopathological examination revealed proliferating and dilated lymphatic vessels with different sizes of lumens in the dermis.Immunohistochemical study showed positive staining for D2-40 and CD31.The patient was diagnosed with scrotal lymphangioma,and received photodynamic therapy with aminolevulinic acid.After the treatment,the number of vesicles markedly decreased,and no obvious exudates were observed.During 1 year of follow up,no scars or other complications occurred,and no obvious relapse was found.
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To construct an intelligent assistant diagnosis model based on the clinical images of basal cell carcinoma (BCC) and pigmented nevi in Chinese by using the advanced convolutional neural network (CNN). Methods: Based on the Xiangya Medical Big Data Platform, we constructed a large-scale clinical image dataset of skin diseases according to Chinese ethnicity and the Xiangya Skin Disease Dataset. We evaluated the performance of 5 mainstream CNN models (ResNet50, InceptionV3, InceptionResNetV2, DenseNet121, and Xception) on a subset of BCC and pigmented nevi of this dataset. We also analyzed the basis of the diagnosis results in the form of heatmaps. We compared the optimal CNN classification model with 30 professional dermatologists. Results: The Xiangya Skin Disease Dataset contains 150 223 clinical images with lesion annotations, covering 543 skin diseases, and each image in the dataset contains support for pathological gold standards and the patient's overall medical history. On the test set of 349 BCC and 497 pigmented nevi, the optimal CNN model was Xception, and its classification accuracy can reach 93.5%, of which the area under curve (AUC) values were 0.974 and 0.969, respectively. The results of the heatmap showed that the CNN model can indeed learn the characteristics associated with disease identification. The ability of the Xception model to identify clinical images of BCC and Nevi was basically comparable to that of professional dermatologists. Conclusion: This study is the first assistant diagnosis study for skin tumor based on Chinese ethnic clinical dataset. It proves that CNN model has the ability to distinguish between Chinese ethnicity's BCC and Nevi, and lays a solid foundation for the following application of artificial intelligence in the diagnosis and treatment for skin tumors.