Recommended Strategies for Physician Burnout, a Well-Recognized Escalating Global Crisis Among Neurologists

Several indexes are used to classify physician burnout, with the Maslach Burnout Inventory currently being the most widely accepted. This index measures physician burnout based on emotional exhaustion, detachment from work, and lack of personal achievement. The overall percentage of physicians with burnout is estimated to be around 40%, but the proportion varies between specialties. Neurology currently has the second-highest rate of burnout and is projected to eventually take the top position. The purpose of this review is to provide a comprehensive overview focusing on the causes and ramifications of burnout and possible strategies for addressing the crisis. Several factors contribute to burnout among neurologist, including psychological trauma associated with patient care and a lack of respect compared to other specialties. Various interventions have been proposed for reducing burnout, and this article explores the feasibility of some of them. Burnout not only impacts the physician but also has adverse effects on the overall quality of patient care and places a strain on the health-care system. Burnout has only recently been recognized and accepted as a health crisis globally, and hence most of the proposed action plans have not been validated. More studies are needed to evaluate the long-term effects of such interventions.

Autonomic Disturbances in Acute Cerebrovascular Disease / 神经科学通报·英文版

Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system. We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.

Application of computer-assisted system in surgery for pediatric solid pseudopapillary tumor / 中华实用儿科临床杂志

Objective@#To explore the value of Hisense computer-assisted surgical systems (CAS) for precise surgery of pediatric solid pseudopapillary tumor.@*Methods@#A total of 5 cases with pancreatic solid pseudopapi-llary tumor who were admitted at the Affiliated Hospital of Qingdao University from June 2015 to September 2018 were adopting.Upper abdominal 64-slice dynamic enhanced computed tomography (CT) scan was performed.3D models were created by computer-assisted surgery systems.Based on 3D model, surgical planning, preoperative simulated tumor resection, intraoperative assisted guidance were performed.Operation time, intraoperative blood loss volume, blood transfusion rate were analyzed.@*Results@#Hisense CAS three-dimensional reconstruction could clearly show the adjacent relationship between pancreas, tumor and peripheral vascular organs.According to the preoperative virtual resection, pancreatic tumor resection was more accurate.Postoperative pathological results were solid pseudopapillary tumor of the pancreas.Among them, 2 tumors were located in the head of the pancreas, 1 case was located in the pancreatic neck, and 2 cases in the tail of the pancreas.The operation time was 150-360 min, with an average of 279 min.The average intraoperative blood loss was 40 mL, of which the minimum amount of bleeding was 5 mL, and the blood transfusion rate was 40%(2/5 cases). Surgical tumor removal was achieved successfully in 5 cases.All children were followed up for 6 months to 3 years, and no recurrence or metastasis was observed.@*Conclusions@#Three-dimensional reconstruction of computer-assisted surgery system can clearly show the adjacent relationship between tumor and surroun-ding vascular organs, and help to make the best surgical plan before surgery to improve the accuracy and safety of the operation.

Crystal clear: visualizing the intervention mechanism of the PD-1/PD-L1 interaction by two cancer therapeutic monoclonal antibodies

Antibody-based PD-1/PD-L1 blockade therapies have taken center stage in immunotherapies for cancer, with multiple clinical successes. PD-1 signaling plays pivotal roles in tumor-driven T-cell dysfunction. In contrast to prior approaches to generate or boost tumor-specific T-cell responses, antibody-based PD-1/PD-L1 blockade targets tumor-induced T-cell defects and restores pre-existing T-cell function to modulate antitumor immunity. In this review, the fundamental knowledge on the expression regulations and inhibitory functions of PD-1 and the present understanding of antibody-based PD-1/PD-L1 blockade therapies are briefly summarized. We then focus on the recent breakthrough work concerning the structural basis of the PD-1/PD-Ls interaction and how therapeutic antibodies, pembrolizumab targeting PD-1 and avelumab targeting PD-L1, compete with the binding of PD-1/PD-L1 to interrupt the PD-1/PD-L1 interaction. We believe that this structural information will benefit the design and improvement of therapeutic antibodies targeting PD-1 signaling.

Relationship between serum aminotransferase levels and metabolic disorders in northern China

Increasing evidence suggests an association between ele-vated serum aminotransferase levels and metabolic disorders [metabolic syndrome, hyperlipemia and diabetes mellitus]. However, the significance of relatively low levels of aminotransferases in relation to metabolic disorders has not been fully investigated in the general population. We inves-tigated the association between serum amiontransferase levels and metabolic disorders using data from a survey in Jilin province, China. In 2007, a survey was conducted throughout Jilin, China, covering both urban and rural areas. A total of 3835 people, 18 to 79 years old including 1761 men and 2074 women, underwent real-time ultrasonography, blood tests including aspartate aminotransferase and alanine aminotransferase, and had interviews with a structured questionnaire. Serum aminotransferase levels within the normal range were asso-ciated with metabolic syndrome independent of age, occupation, cultural and educational level, income, body mass index, waist circumference, smoking, and alcohol intake. Compared with the lowest level [<20 IU/L], the adjusted odds ratios for ALT levels of 20-29, 30-39, 40-49 and>50 IU/L were 1.92, 2.50, 2.97, and 3.52 in men, and 1.38, 1.54, 3.06, and 2.62 in women, respectively. Near-normal serum aminotransferase levels asso-ciated with hyperlipemia, NAFLD, DM were also found in the study. Normal to near-normal serum aminotransferase levels are associated with metabolic disorders. Serum ALT levels of 21-25 IU/L for men and 17-22 IU/L for women are suggested as cutoff levels that detect metabolic disorders affecting the liver

Pharmacokinetics of dl-praeruptorin A after single-dose intravenous administration to rats with liver cirrhosis

As a novel drug in the treatment of cardiac diseases, dl-praeruptorin A [Pd-Ia] is the major active component of traditional herbal medicine Peucedanum praeruptorum Dunn and is metabolized primarily via cytochrome P450 isozymes [CYP] 3A1 and 3A2 in rats. In the present study, the influence of liver cirrhosis on pharmacokinetics of Pd-Ia and hepatic mRNA expression of CYP3A1 and 3A2 in rats with experimental liver cirrhosis [LC rats] were evaluated. Pd-Ia was given intravenously [5 mgúkg-1] to LC rats induced by dimethylnitrosamine and pharmacokinetic variables were measured. Enzyme kinetic metabolism of Pd-Ia in rat hepatic microsomes was also investigated and hepatic mRNA expression of CYP3A1 and 3A2 were measured by real-time PCR. After intravenous administration in LC rats, the area under the plasma concentration-time curve from time zero to infinity [AUC0-infinity] was significantly greater than that in control rats, which might be due to slower rate of the hepatic blood flow and significant slower hepatic intrinsic clearance [CL int] in rats. The decreased metabolic clearance of Pd-Ia in LC rats might be at least partly caused by the decreased levels of CYP3A1 and 3A2 responsible for Pd-Ia metabolism. These findings may provide new insights into the inter- and intra-individual pharmacokinetic variability of Pd-Ia

Study on the transport of sediment oxygen demand-related organic matter in bottom sediment system

Approach of organic material anaerobic biodegradation and species of organic matter in sediment are discussed, and then a classifying method of the species is proposed on a new viewpoint. The pore water sediment oxygen demand [SOD] numerical model in bottom sediment system is proposed originally, which differs from other advection-dispersion-sorption [ADS] model in adding a SOD-creating term. The model was preliminarily validated via pilot experiment. Finally, this model was used to simulate SOD concentration of pore water in bottom sediment, and the sensitivity of parameters in the model was analyzed. The results indicate that SOD-creating factor at beginning stage and pore water SOD-attenuating factor in bottom sediment are the most important coefficients in the new model and should be estimated accurately. Because of the assumption of equilibrium of sorption/desorption, the new model appears to be valid only with less than 5 m/d vertical velocity of pore water

Remediation of soil co-contaminated with pyrene and cadmium by growing maize [Zea mays L.]

Sites co-contaminated with organic and metal pollutants are common and considered to be a more complex problem as the two components often causes a synergistic effect on cytotoxicity. Phytoremediation has been proposed as a cost-effective technology for treating heavy metal or organic contamination and may be suitable for remediation of co-contaminated soil. This study investigated theconcurrent removal of pyrene and cadmium in co-contaminated soil by growing maize in a pot experiment. At the end of 60 day culture, pyrene in spiked soil diminished significantly, accounting for 21-31% of the initial extractable concentration in unplanted soil and 12-27% in planted soil. With the increment of cadmium level, the residual pyrene both in unplanted and planted soil tended to increase. Although the presence of cadmium increased the accumulation of pyrene in maize, plant accumulation only account for less than 0.30% of the total amount of the dissipated pyrene in vegetated soils. It implied that plant-promoted microbial biodegradation was the predominant contribution to the plant-enhanced dissipation of pyrene in co-contaminated soil. Unlike pyrene, heavy metal cadmium cannot be degraded. It was observed that maize can concurrently removed about on the average 0.70% of the total cadmium amount in soil by plant uptake, but Cd phytoextraction would be inhibited under contamination of pyrene. Maize CT38 can normally grow in the co-contaminated soil with high level Cd and pyrene and can effectively remedy the sites co-contaminated with these two types of contamination, which suggest the possibility of simultaneous phytoremediation of two different contaminant types

Grid: a location dependent intensity modulated radiotherapy for bulky tumors

Grid radiation therapy, using the megavoltage X-ray beam, has been proven to be an effective method for management of large and bulky malignant tumors. This treatment modality is also known as Specially Fractionated Radiation Therapy [SFRT]. In this treatment technique a grid block converted the open radiation field into a series of pencil beams. Dosimetric characteristics of an external beam grid radiation field have been investigated using experimental and Monte Carlo simulation technique. Dose distributions [%DD as well as the beam profiles] of a grid radiation field have been determined using experimental and Monte Carlo simulation technique, for 6- and 18 MV X-ray beams from a Varian Clinics 2100C/D. The measurements were performed using LiF TLD and film in Solid Water phantom Material. Moreover, the MCNP Monte Carlo code was utilized to calculate the dose distribution in the grid radiation field in the same phantom material. The results of the experimental data were compared to the theoretical values, to validate this technique. Upon the agreement between the two techniques, dose distributions can be calculated for the grid field with different patterns and sizes of holes, in order to find an optimal design of the grid block. The results of dose profiles for 6 MV X-ray beams obtained with the Monte Carlo simulation technique was in good agreement with the measured data. In addition, the 3D dose distribution of the grid field generated by the Monte Carlo simulation gave more detailed information about the dose pattern of the grid. The grid block can be used as a boost for treatment of bulky tumors. The Monte Carlo simulation technique can be utilized to optimize the pattern, size and spacing between the holes, for optimal clinical results