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Objective:To investigate the awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai on the extended prescription policy of the family doctor contract service, and to analyze the influencing factors.Methods:From March to May, 2021, the cluster random sampling method was used to select one community health service center in Fengxian district, Shanghai, and a smart voice telephone assistant survey was conducted among the contracted residents aged 18 and above in the area, to understand their awareness of the extended prescription policy. χ2 Test was used for single factor analysis on the influence of different factors on the policy awareness of the contracted residents, while a multivariate analysis was performed by binary logistic regression, presenting P<0.05 as statistically significant. Results:A total of 13 495 " 1+ 1+ 1" contracted residents were surveyed via phone calls. Their awareness rate of extended prescription policy was 67.5% (9 115/13 495), while those with higher awareness rates were patients with ≥2 chronic diseases (92.3%), patients with 1 chronic disease (88.5%) and those aged 81 and above (88.4%). Logistic regression analysis showed that age, marital status, the number of chronic diseases and signing duration were all independent factors influencing the awareness of extended prescription policy (all P<0.05), while whether the residents were key population groups presented no significant influence on the awareness of extended prescription policy ( P=0.431). Conclusions:The awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai to the extended prescription policy needs to be further improved and publicity should also be strengthened to extend the policy benefit coverage.
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Objective:To investigate the intention of medical students to be vaccinated against COVID-19 and to analyze the influencing factors.Methods:A self-filled electronic questionnaire survey was conducted among medical students from a medical school in Shanghai randomly selected from June 21 to 29, 2021. The questionnaire contained items of basic information, intention for COVID-19 vaccination, awareness of COVID-19 prevention measures and awareness of COVID-19 vaccine. Logistic regression was used to analyze the influencing factors.Results:The average age of the 966 respondents was (20.4±2.9) years, and 63.6% (614/966) of them were female;23.7% (229/966) of them had family members or relatives who had participated in anti-pandemic work or volunteer service;90.6% (875/966) of the respondents expressed they were very willing or willing to be vaccinated against COVID-19. The majority of the respondents thought that “COVID-19 infection is very serious” (94.3%, 911/966), “good protection can effectively prevent COVID-19 infection” (92.4%, 893/966), and “they can fully implement all kinds of protection measures” (73.5%, 710/966). About half of the respondents (51.8%, 501/966) knew about the adverse reactions and contraindications of COVID-19 vaccine. The low protected capability (47.4%, 458/966), short duration of protection (50.6%, 489/966), and many side effects (48.7%, 470/966) were the major concerns about COVID-19 vaccine. Logistic regression analysis showed that people thought that “COVID-19 infection is very serious” ( OR=5.30, 95 %CI:2.60-10.81, P<0.001), thought that “good protection can effectively prevent COVID-19 infection” ( OR=2.46, 95 %CI:1.26-4.81, P=0.009), thought that “they can fully implement all kinds of protection measures” ( OR=2.55, 95 %CI:1.53-4.25, P<0.001) were more willing to receive COVID-19 vaccination. While those concerned about vaccine quality did the opposite ( OR=0.29, 95 %CI:0.13-0.65, P=0.003). Conclusions:Medical students have a high intention of vaccination against COVID-19. The vaccine-related knowledge quality should be emphasized in future publicity to further enhance the intention of COVID-19 vaccination.
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Remote teaching consultation is an online continuing medical education mode which combines medical practice with teaching and superimposes teaching functions on the basis of remote consultation. Based on the pilot experiences of collaboration between Zhongshan Hospital and Xidu Community Health Service Center, this article analyzes the strengths, weaknesses, opportunities and threats (SWOT)of the remote teaching consultation for general practitioners, and discusses strategies to improve the further implementation plan. The analysis showed that as a novel educational method, the remote teaching consultation should take the advantages of online education, make good use of the remote consultation platform, improve its teaching connotation, and form standardized implementation norms to meet the diversified needs of general practitioners for continuing medical education.
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Objective:To analyze the control status of ambulatory blood (BP) pressure and influencing factors among hypertensive patients in Shanghai Fengpu community.Methods:From April 2020 to February 2022, 318 hypertensive patients in Shanghai Fengpu community were enrolled in the study. The basic information and thropometric indicators of patients, course of hypertension, the medication, complications, life habits, and biochemical indicators as well as the ambulatory BP monitoring (ABPM) data were collected. Multivariate analysis was used to evaluate the risk factors for lack of 24-hour BP control.Results:Among 318 patients, 63 cases (19.8%) had an average 24-hour BP controlled; the control rate of daytime BP and nighttime BP was 23.3% (74 cases) and 15.7% (50 cases), respectively. The proportion of combined medication in the control group and non-control group was 46.0% (29/63) and 51.8% (132/255), respectively (χ 2=0.66, P=0.415). There were significant differences in gender, proportion of patients with hypertension>10 years, the office blood pressure control rate, the abnormal diastolic circadian rhythm, abdominal obesity, the level of fasting blood glucose, diabetes, physical activity levels, and smoking and drinking (all P<0.05) between the control group and non-control group. Multivariate analyses showed that male gender ( OR=2.00, 95 %CI:1.07-3.76) and abdominal obesity ( OR=2.04, 95 %CI:1.10-3.76) were risk factors for uncontrolled ambulatory BP. Conclusions:The control rate of ambulatory BP in patients with hypertension is relatively low in Shanghai Fengpu community. The ABPM should be enhanced and the management for hypertensive patients with abdominal obesity and lack of physical activity should be strengthened in the community.
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Objective:To investigate the psychological stress and related factors of community medical staff in Shanghai during infectious public health emergencies.Methods:Random cluster sampling, questionnaires combining general demographic information, self-rating anxiety scale(SAS), self-rating depression scale(SDS)and yale-brown obsessive compulsive scale(YB)were administrated to investigate the psychological stress of medical staff from 20 community healthcare centers in 10 Shanghai districts.Results:A total of 696 valid questionnaires were collected. 17.36% of the staff had SAS scores exceeding the boundary value. Nurses, staff with per capita monthly family income<5 000 yuan, or with below-average family relations presented higher SAS scores. 28.19% of the staff had SDS scores exceeding the boundary value. Staff with 5-10 years seniority, nurses, with per capita monthly family income<5 000 yuan, and with poor family relations presented higher SDS scores. 6.68% of the staff had YB score≥16. Nurses presented a higher YB score.Conclusions:Some community healthcare center staff experienced psychological stress during public health emergencies.Factors associated with psychological stress, such as 5-10 years′ seniority, nurses, per capita monthly family income<5 000 yuan, below-average or poor family relations, deserve more attention in order to prevent from or alleviate harmful psychological stress.
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Objective:To investigate the frailty state transition in the community-dwelling elderly undergoing health check-up, and related influencing factors.Methods:From September to October 2016, 3 833 residents aged ≥ 60 years undergoing health check-up in Xidu Community Health Center were enrolled in this prospective cohort study by multistage random sampling. All participants completed a questionnaire survey, health examinations, and frailty assessments as measured with the Fried frailty phenotype. A second assessment of frailty status was conducted from June to July 2020, the frailty state transition was analyzed by comparison between two assessments of frailty states. Logistic regression was used to analyze the influencing factors related to frailty progression.Results:The final cohort consisted of 3 061 participants. At the entering of the study, the median age of participants was 71.0 years, 41.0% were male, 1 563 (51.1%) were prefrail, and 156 (5.1%) were frail. At the follow-up, the frailty status of 1 304 (42.6%) participants was progressed and that of 395 (12.9%) participants was improved from their baseline levels, respectively. Logistic regression showed that age ( OR=1.170,95% CI:1.147-1.194), marital status (married: OR=0.377,95% CI:0.292-0.486), physical exercise (never vs. every day: OR=18.610,95% CI:14.461-23.950; sometimes vs. every day: OR=4.210,95% CI:2.186-8.107), baseline frailty state (robust vs. frail: OR=20.464,95% CI:11.779-35.553;prefrail vs. frail: OR=2.147,95% CI:1.270-3.632), stroke ( OR=2.195,95% CI:1.454-3.313) and diabetes ( OR=1.811,95% CI:1.346-2.437) were identified as independent factors influencing frailty progression (all P<0.05). Conclusions:Frailty state progression is common among older adults, and its related factors include age, unmarried status, physical exercise, baseline frailty state, stroke and diabetes. It is necessary to identify elderly at high risk for frailty progression and implement medical interventions.
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The Xidu Community Health Service Center has become the first general practice outskirt teaching site of Shanghai Zhongshan Hospital since May 2015; the Fudan University Shanghai Medical College Xidu General Practice Clinical Teaching and Training Base was formally established in May 2018. For last 6 years, with the cooperation with Zhongshan Hospital the Xidu Community Health Service Center has participated in teaching and training of general practice residents and general practitioners, which also greatly promoted the development of clinical service, disease prevention and scientific research of the center itself. This article introduces the "Fudan-Xidu" integrated model and its experiences in general practice teaching, focusing on the background, the organization, teaching implementation, achievements and future prospects, to provide a reference for talent training of general practice in grassroots institutions.
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Objective:To explore the value of improved sequential organ failure assessment (ISOFA) in predicting the prognosis of Klebsiella pneumoniae sepsis. Methods:The clinical data of 379 patients with Klebsiella pneumoniae sepsis admitted to the First Hospital of Jilin University from January 1, 2018 to June 30, 2019 were retrospectively analyzed.They were divided into survival group and death group according to the 28-day prognosis, and the age, gender, C-reactive protein, procalcitonin, grade of bacterial resistance, and the occurrence of septic shock of the two groups were compared.Statistical analysis was conducted by using independent sample t test, Mann-Whitney U test and chi-square test. Risk factors for the prognosis of the disease was analyzed by logistic regression analysis.The correlation between ISOFA and other scoring system including Charlson′s weighted index of comorbidities (WIC), national early warning system (NEWS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), simplified acute physiology scoreⅡ (SAPSⅡ), mortality in emergency department sepsis score (MEDS), sequential organ failure assessment (SOFA), acute gastrointestinal injury (AGI) was determined by Spearman correlation coefficient.The area under the receiver operating characteristic curve (AUROC) was used to compare the evaluation value of each scoring system for the prognosis of Klebsiella pneumoniae sepsis. The clinical significance of ISOFA risk stratification was evaluated by Kaplan-Meier survival curve. Results:Among the 379 patients with Klebsiella pneumoniae sepsis, 278 were in the survival group and 101 were in the death group.The differences of age, gender, the occurrence of septic shock, grade of bacterial resistance, C-reactive protein, procalcitonin, WIC, NEWS, APACHEⅡ, SAPSⅡ, MEDS, SOFA, AGI and ISOFA score between the two groups were all statistically significant ( t=-3.218; χ2=6.781, 24.374 and 27.208, respectively; Z=-3.689, -5.022, -4.396, -4.697, -7.438, -6.348, -6.358, -8.676, -6.680 and -11.658, respectively; all P<0.01). The calculation method of ISOFA was obtained by single factor analysis: ISOFA=SOFA+ 1.5×AGI.Multivariate logistic regression suggested that ISOFA, gender, SOFA, procalcitonin, C-reactive protein, and bacterial resistance were independent risk factors for the prognosis of the disease. The Spearman correlation coefficients of ISOFA and WIC, NEWS, APACHEⅡ, SAPSⅡ, MEDS and SOFA were 0.327, 0.371, 0.614, 0.564, 0.578 and 0.847, respectively. The AUROC and its 95% confidence interval for WIC, NEWS, MEDS, SAPSⅡ, APACHEⅡ, SOFA alone, SOFA plus AGI, and ISOFA to predict the prognosis of Klebsiella pneumoniae sepsis were 0.646 (0.584-0.708), 0.657 (0.597-0.716), 0.712 (0.654-0.771), 0.713 (0.653-0.773), 0.749 (0.693-0.806), 0.788 (0.737-0.838), 0.872 (0.826-0.917) and 0.891 (0.845-0.937), respectively.The results showed that ISOFA had the best predictive effect.The Kaplan-Meier survival curve suggested that there were statistical differences in survival rate among ISOFA low-risk level, medium-risk level, and high-risk level (all P<0.01). Conclusion:ISOFA has important clinical significance in predicting the prognosis of Klebsiella pneumoniae sepsis.
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In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.
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Objective@#This study aimed to analyze and summarize the implementation of the primary prevention program for stroke in Shanghai rural community and evaluate its preventive effect.@*Methods@#A cluster sampling method was used to select approximately 50 000 community natural population from a town in Fengxian District of Shanghai. A primary stroke prevention program was established and implemented in the community from 2008 to 2010 and from 2012 to 2015. The prevention program inclueded stroke health education for the whole population, screening of high risk population of stroke, and therapeutic intervention and management plan for individuals aged≥50 years. The intervention measures were followed up every 2 months. From 2008 to 2015, new stroke cases were monitored dynamically and reviewed annually with classification of stroke diagnosis. The effect of community primary prevention of stroke program was evaluated by the dynamic changes in stroke incidence.@*Results@#From 2008 to 2015, a total of 422 600 individuals were monitored, including 20 500 men and 217 600 women. In 2008, 7 828 individuals were screened and 2 129 individuals were at high risk of stroke were screened, with a high risk rate of 27.2%. In 2012, 2 877 individuals were screened, and 725 individuals were at high risk of stroke were screened, with a high risk rate of 25.2%. The standardized incidence of stroke in this community was 158.1, 105.4, 86.6, 77.6, 89.3, 77.4, 50.7, and 42.3 per 100 000 respectively. The overall incidence image roughly showed a downward trend except 2012(trend test P<0.01). There was no significant difference in the incidence of stroke between men and women in each year. The incidence of stroke increased significantly with age (trend test P<0.01). The age composition of stroke patients is slightly different between different sexes. The proportion of male patients with stroke aged <70 years was significantly higher than that of female patients with stroke, while the proportion of female patients with stroke age>70 years was significantly higher than that of male patients with stroke (P<0.01). Cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage accounted for 20.76%, 75.14%, and 4.10%, respectively.@*Conclusion@#Based on lifestyle intervention and treatment and control of risk factors, screening high-risk individuals for therapeutic intervention in community population can significantly reduce the incidence of stroke.
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A pilot mixed assessment method was used to evaluate the clinical and teaching ability of general practitioners (GPs) in a suburban district of Shanghai. In December 2018, 29 GPs from 20 community health centers in a suburban district of Shanghai were assessed by a mixed method consisting of 3 domains and 8 stations for one day. The average age of GPs was (37.8±4.7) years and 22 were females (75.9%). In 3 domains, the average score (66.8±9.7) and qualified rate (75.9%) of clinical thinking abilities were the lowest. In 8 stations, the average score [(53.8+13.4) points] and qualified rate (34.5%) of adult SOAP medical record writing station were the lowest. The average score of pediatric outpatients consult station of GPs with<15 years of community work experience was higher than that of GPs with >15 years of work experience [(68.6+10.2) vs. (58.5+9.4), t=2.787, P<0.05]. There was no significant difference in the scores among GPs with different teaching years and titles. The average scores of clinical thinking ability domain ( t=2.115) and adult outpatient consult station ( t=3.410); in the clinical operation ability domain the ophthalmoscopy and readings ( t=3.816) and otoscopy and reporting station ( t=2.286); clinical teaching abilities ( t=2.618) and simulated educational situation station ( t=2.452) and mini lectures station ( t=2.802) of GPs in the community teaching base were higher than those in non-community teaching base (all P<0.05). Mixed assessment method can be used as one of the important means for GPs′ ability assessment. The community teaching bases have effectively improved the clinical and teaching abilities of GPs in suburban areas, however, the clinical thinking abilities of them are still weak.
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In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.
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Objective:This study aimed to analyze and summarize the implementation of the primary prevention program for stroke in Shanghai rural community and evaluate its preventive effect.Methods:A cluster sampling method was used to select approximately 50 000 community natural population from a town in Fengxian District of Shanghai. A primary stroke prevention program was established and implemented in the community from 2008 to 2010 and from 2012 to 2015. The prevention program inclueded stroke health education for the whole population, screening of high risk population of stroke, and therapeutic intervention and management plan for individuals aged≥50 years. The intervention measures were followed up every 2 months. From 2008 to 2015, new stroke cases were monitored dynamically and reviewed annually with classification of stroke diagnosis. The effect of community primary prevention of stroke program was evaluated by the dynamic changes in stroke incidence. Results:From 2008 to 2015, a total of 422 600 individuals were monitored, including 20 500 men and 217 600 women. In 2008, 7 828 individuals were screened and 2 129 individuals were at high risk of stroke were screened, with a high risk rate of 27.2%. In 2012, 2 877 individuals were screened, and 725 individuals were at high risk of stroke were screened, with a high risk rate of 25.2%. The standardized incidence of stroke in this community was 158.1, 105.4, 86.6, 77.6, 89.3, 77.4, 50.7, and 42.3 per 100 000 respectively. The overall incidence image roughly showed a downward trend except 2012(trend test P<0.01). There was no significant difference in the incidence of stroke between men and women in each year. The incidence of stroke increased significantly with age (trend test P<0.01). The age composition of stroke patients is slightly different between different sexes. The proportion of male patients with stroke aged <70 years was significantly higher than that of female patients with stroke, while the proportion of female patients with stroke age>70 years was significantly higher than that of male patients with stroke ( P<0 .01). Cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage accounted for 20.76%, 75.14%, and 4.10%, respectively. Conclusion:Based on lifestyle intervention and treatment and control of risk factors, screening high-risk individuals for therapeutic intervention in community population can significantly reduce the incidence of stroke.
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Objective@#To develop the chimeric antibodies against neuraminidase (NA) of H7N9 and to identify their biological activity and function.@*Methods@#The genes of variable regions of the light chain (VL) and heavy chain (VH) obtained by mouse hybridoma technology were cloned respectively into the expression VH and VL vectors bearing human-derived Cγ1, and Cκ1 and co-transfected into 293T cells. The chimeric antibodies were purified and their functions were investigated.@*Results@#Two chimeric antibodies, 1E2 and 3E3 against neuraminidase (NA) of H7N9 were obtained. Both antibodies recognized similar antigenic epitopes. MAb 1E2 and 3E3 could prevent the infectivity with H7N9 and H11N9 virus and reduce their size of viral plaque.@*Conclusions@#The chimeric antibodies specific for N9 could prevent the infection of N9 subtype influenza virus as well as the NAI-resistant mutants and could be a potential immunotherapy approach for H7N9 treatment.
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Objective To apply objective structured teaching evaluation (OSTE) in teaching competence assessment for general practice preceptors in community training bases.Methods The teaching competency was assessed with OSTE for 28 general practice preceptors in Fengxian District of Shanghai in December 2017.The application of OSTE was evaluated with questionnaire among preceptors,examiners and standardized students(SS).Results Among 28 preceptors there were 23 females (82.1％),with an average age of (37.3±4.2) years.The average teaching duration was (2.8±2.1) years.In the five OSTE station,the highest total score was (88.1 ±2.7) points in the first station self-presentation,while the lowest was (70.8± 14.5) points of the second part physical examination feedback of the third station ambulatory care teaching.The total score in the fifth station (doctor-patient communication teaching) of participants with＜ 15 years of community practice was higher than those ≥15 years of community practice [(80.1±8.5) vs.(71.6± 7.1),t=2.092,P=0.007].Except"being able to adapt to this form of evaluation",the proportions of choosing "very good"were all more than 50％ in other 4 aspects.The overall willingness of "recommending OSTE as the main method to evaluate the teaching competence of GP trainers" was higher in examiners and SS than that inpreceptors (Z=2.836,P=0.005).Conclusion The innovative approach of OSTE has been widely recognized,but the professional capability,the cognition of general practice,the teaching competence and the willingness to use OSTE need to be strengthened for general practice receptors in community bases.
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Objective To investigate the clinical,endoscopic and pathological features of gastritis cystica profunda (GCP).Methods A total of 40 patients with GCP confirmed by pathology who received endoscopic or surgical treatment at Renji Hospital,School of Medicine,Shanghai Jiaotong University from May 2013 to May 2018,were included in the retrospective analysis.The clinical data such as population composition,clinical manifestations,endoscopic findings and pathological results were summarized and analyzed.Results Among the 40 patients were predominantly males (75.0％,30/40),and the mean age of onset was 61.2 years.The most common sites were cardia (32.5％,13/40) and gastric antrum (30.0％,12/40).The clinical symptoms of the patients were atypical and it was difficult to diagnose GCP with routine endoscopy examination.The endoscopic findings were mostly type 0-Ⅱ (50.0％,20/40).GCP with neoplastic lesions accounted for 55％ (22/40).Unconditional logistic regression analysis showed that male (P =0.013,OR =31.093,95％ CI:2.079-464.976) and Helicobacter pylori infection (P =0.041,OR =10.225,95％ CI:1.096-95.411) were risk factors for GCP with neoplastic lesions.Conclusion GCP commonly occurs in middle-aged and elderly men,and varies in different manifestations under white light endoscopy.GCP is not a benign lesion,but can also coexist with neoplastic lesions,which are mostly differentiated intramucosal cancer.
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BACKGROUND AND OBJECTIVES: Previous studies have shown that integrins alpha5beta1 (ITGA5B1) gene-modified rat bone marrow mesenchymal stem cells (rBMSCs) could prevent cell anoikis and increase the nitric oxide (NO) production. Here we examined the capability of rBMSCs/ITGA5B1 on the phenotype modulation of Human Pulmonary Artery Smooth Muscle Cell (HPASMC) in vitro. METHODS AND RESULTS: The synthetic (dedifferentiated) phenotype of HPASMC was induced by monocrotaline (MCT, 1μM) for 24 h and then co-cultured with rBMSCs/ITGA5B1 in a transwell culture system. The activation of NO/cGMP (nitric oxide/Guanosine-3′, 5′-cyclic monophosphate) signaling was investigated in HPASMC. The changes of pro-inflammatory factors, oxidative stress, vasodilator, vasoconstrictor, contractile and synthetic genes, and the morphological changes of HPASMC were investigated. The results of this study showed that the NO/cGMP signal, endothelial nitric oxide synthase (eNOS) expression, the expression of the vasoprotective genes heme oxygenase-1 (HMOX1) and prostaglandin-endoperoxide synthase 2 (PTGS2) were increased, but the expression of transforming growth factor-β1 (TGF-β1), CCAAT/enhancer-binding proteins delta (Cebpd), Krüppel-like factor 4 (KLF4), and activating transcription factor 4 (ATF4) were reduced in MCT treated HPASMC co-cultured with rBMSCs/ITGA5B1. The synthetic smooth muscle cells (SMCs) phenotype markers thrombospondin-1, epiregulin and the vasoconstrictor endothelin (ET)-1, thromboxane A2 receptor (TbxA2R) were down-regulated, whereas the contractile SMCs phenotype marker transgelin expression was up-regulated by rBMSCs/ITGA5B1. Furthermore, rBMSCs/ITGA5B1 promoted the morphological restoration from synthetic (dedifferentiation) to contractile (differentiation) phenotype in MCT treated HPASMC. CONCLUSIONS: rBMSCs/ITGA5B1 could inhibit inflammation and oxidative stress related genes to promote the HPASMC cell differentiation by activation NO/cGMP signal.
Subject(s)
Animals , Humans , Rats , Activating Transcription Factor 4 , Anoikis , Bone Marrow , Cell Differentiation , Endothelins , Epiregulin , Genes, Synthetic , Heme Oxygenase-1 , In Vitro Techniques , Inflammation , Integrins , Mesenchymal Stem Cells , Monocrotaline , Muscle, Smooth, Vascular , Myocytes, Smooth Muscle , Nitric Oxide Synthase Type III , Nitric Oxide , Oxidative Stress , Phenotype , Prostaglandin-Endoperoxide Synthases , Pulmonary Artery , Receptors, Thromboxane A2, Prostaglandin H2ABSTRACT
Objective To survey on the intention of seeking pediatric service in primary care institutions among parents in Shanghai rural area .Methods A survey on the intention of pediatric care-seeking was conducted during June to December in 2016 using simple random sampling method in Fengxian District of Shanghai.Subjects were choosen from the parents visiting pediatric department in Xidu Community Health Center ( CHC) (289 ), parents having kids in the local kindergarten ( 121), and medical staff working in this district with children under age 14 (205).Results Total 615 individuals were surveyed and 572 responded with a response rate of 93.0%.The age of participants was (32.1 ±6.4) years, and they were 191 males and 381 females.Among all responders, 88.4%(505/571) wanted to have pediatric service in CHC, 9.5%(54/571) did not care and 2.1%(12/571) did not want.If the CHC had service provided by pediatric specialists , 81.5%( 466/572) intended to seek pediatric care in CHC , 10.8%(62/572) did not care and 7.7%(44/572) did not want.If the general practitioner provided pediatric service, the rates were 51.9%(297/572), 12.1%(69/572) and 36.0%(206/572), respectively.In comparison, the intention to seek care provided by pediatric specialists was stronger (Z ＝-12.553, P ＜0.001). Parents who were not medical professionals preferred to set pediatric clinic in CHC ( OR ＝6.849, P ＝0.026); parents who were not Shanghai residents preferred to see pediatric specialists (OR＝2.732, P＝0.033).Parents who were older than 30 years (OR＝1.770, P＝0.013), who were medical professionals (OR＝2.093, P＝0.003) or having children aged 0-3 years (OR＝2.154, P＝0.001) preferred to visit general practice clinics .Only 11.7%(66/562) would choose CHC when their children were ill . Parents who were older than 30 years (OR＝2.083, P＝0.038) or whose family income was less than 8 000 yuan/m (OR＝1.967, P＝0.030) preferred to choose CHC.The reason for choosing CHC was close to home for 93.8%(61/65) and good treatment effect for only 18.5%(12/65).The expectations of pediatrics in CHC included more comprehensive medical equipment (82.2%, 466/567), higher service level (77.8%,441/567), more complete medicine stock (74.8%, 424/567)and regular expert outpatient service (70.0%, 397/567).Conclusion Parents have strong demands of providing pediatric care in CHC, but the pediatric skills of general practitioners are not trusted .The CHC should upgrade related facilities and medicine stock for further improving the quality of pediatric service .
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Objective To explore the risk factors for cesarean section after induction of late-term pregnancy. Methods This study enrolled 275 primiparas with a single cephalic fetal presentation,admitted to our hospital between December 2010 and December 2016 for induction of late-term pregnancy. After induction,80 underwent cesarean section and 195 had a normal vaginal delivery. Clinical data were collected and analyzed retrospectively. Single factor analysis and two categories of logistic regression analysis were used to determine the independent risk factors for cesarean section after induction of late-term pregnancy. Results Single factor analysis showed that the differences between the two groups in maternal height,cervical Bishop score before induction of labor,latent phase,intrapartum amniotomy,intrapartum oxytocin,meconium stained amniotic fluid,and birth weight were statistically significant (P < 0. 05). Multivariate analysis showed that maternal height,cervical Bishop score before induction of labor,and latent phase were independent risk factors for cesarean section after induction of late-term pregnancy. Conclusion Late-term pregnant primiparas with short stature,low Bishop score,or a long latent phase should have comprehensive prenatal maternal-fetal assessment,and a reasonable delivery mode should be chosen to avoid adverse outcomes.
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Traumatic optic neuropathy (TON) is commonly associated with blunt ocular trauma and craniofacial injuries,leading irreversible visual impairment.Like other mammalian mature central nerve system (CNS) neurons,retinal ganglion cell (RGC) is normally unable to regenerate axon spontaneously after optic nerve injury.The failure of axon regeneration has been attributed to the apoptosis of RGC,loss of intrinsic growth capacity of mature neurons,lack of suitable stimuli,and inhibition of extracellular environment.Via activating the intrinsic growth capacity of mature RGC,overcoming the inhibitory extracellular environment of damaged optic nerve,and providing appropriate inflammatory stimuli to initiate the regeneration process,mature RGC can be transformed into an active regenerative state allowing these neurons to survive axotomy and to regenerate axons in the injured optic nerve.Moreover,exploiting gene therapy based on adeno-associated virus may be a promising translatable treatment strategy for TON.