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Objective@#To explore the predictive value of the timed "up and go" test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation.@*Methods@#A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed "up and go" test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients.@*Results@#The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95%CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05).While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05).@*Conclusions@#Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients.
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Objective To explore the predictive value of the timed "up and go" test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation. Methods A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed "up and go" test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients. Results The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95% CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05). While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05). Conclusions Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients.
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It analyzed the structure and details of disease-based score payment,taking payment policy scheme in Huai-an and Nanchang for example.Disease-based score payment combined the globe budget control,payment of disease and point system to help controlling costs and incentive mechanism,which had certain achievement in the pilot areas.According to the research,it found that there were insufficient in the practical implementation,proposed the precondition for the popularization were higher medical agency capacity,establishing the negotiation mechanism with medical institutions and having intelligentized information system as the technical support.
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Objective To investigate the effect of suberoylanilide hydroxamic acid (SAHA) on sufentanil postconditioning-induced cardioprotection in rats with type 2 diabetes mellitus (T2DM).Methods Male SPF Sprague-Dawley rats,weighing 250-300 g,aged 5-6 weeks,were used in the study.T2DM was induced by high-fat diet (4 weeks) and intraperitoneal 1％ streptozotocin 35 mg/kg,and confirmed by fasting blood glucose level≥ 16.7 mmol/L.Forty rats with T2DM were divided into 5 groups (n=8 each) using a random number table:sham operation group (grou T2DM-S);ischemia-reperfusion group (group T2DM-I/R);sufentanil postconditioning group (group T2DM-SP);SAHA group (group T2DM-SA);SAHA plus sufentanil postconditioning group (group T2DM-SASP).In T2DM-SA and T2DM-SASP groups,SAHA 25 mg/kg was injected intraperitoneally once a day for 5 consecutive days before operation.Their hearts were excised and retrogradely perfused in a Langendorff apparatus.The hearts were subjected to 30 min of global ischemia followed by 120 min of reperfusion to establish the model of ischemia/reperfusion injury.At 30 min of equilibration and 30,60 and 120 min of reperfusion,the left ventricular systolic pressure (LVSP),heart rate (HR),and the maximum rate of increase and decrease of ventricular pressure (±dp/dtmax) were recorded.At 120 min of reperfusion,the left ventricular mass (LVM) and infarct size (IS) were measured,and IS/LVM ratio was calculated.The expression of glycogen synthesis kinase 3β (GSK-3β) and phosphorylated GSK-3β (p-GSK-3β) in the myocardium was detected by Western blot.Results Compared with group T2DM-S,the LVSP,HR and ±dp/dtmax were significantly decreased,the IS and IS/LVM ratio were significantly increased,and the expression of myocardial p-GSK-3β was significantly down-regulated in group T2DM-I/R (P＜0.05).Compared with group T2DM-I/R,the ±dp/dtmax was significantly increased,the IS and IS/LVM ratio were significantly decreased,and the expression of myocardial p-GSK-3β was significantly up-regulated in group T2DM-SASP (P＜0.05),and no significant change was found in the parameters mentioned above in T2DM-SA and T2DM-SP groups (P＞0.05).Compared with group T2DM-SP,the ±dp/dt was significantly increased,the 1S and IS/LVM ratio were significantly decreased,and the expression of myocardial p-GSK-3β was significantly upregulated in group T2DM-SASP (P＜0.05).Conclusion SAHA can improve cardioprotection induced by sufentanil postconditioning to some extent in the rats with T2DM.
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Objective To evaluate the effect of sufentanil postconditioning on acetylated histon H3 (Ac-H3) expression during myocardial ischemia-reperfusion (I/R) in rats.Methods Thirty-six adult male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (S group),I/R group,and sufentanil postconditioning group (SP group).Myocardial I/R was induced by 30 min occlusion of the left anterior descending branch of the coronary artery followed by 120 min reperfusion in anesthetized rats.Sufentanil 1 μg/kg was injected through the femoral vein at 5 min before reperfusion in group SP,while the equal volume of normal saline was given in S and I/R groups.The rats were sacrificed at 120 min of reperfusion,and the myocardial specimens were obtained from the anterior wall of the left ventricle for determination of myocardial infarct size and cell apoptosis (by TUNEL),and myocardial specimens were obtained from the apex for detection of Ac-H3 expression (using Western blot).Apoptotic index was calculated.Results Compared with S group,the myocardial infarct size and apoptotic index were significantly increased,and Ac-H3 expression was down-regulated in I/R and SP groups (P＜0.05).Compared with I/R group,the myocardial infarct size and apoptotic index were significantly decreased,and Ac-H3 expression was up-regulated in SP group (P＜ 0.05).Conclusion Sufentanil postconditioning attenuates myocardial I/R injury through up-regulating AcH3 expression and restoring histone acetylation in rats.
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Objective To evaluate the relationship between histone deacetylase 3 (HDAC3) expression and the mechanism underlying mitigation of remifentanil postconditioning-induced protection of diabetic cardiomyocytes.Methods H9c2 cells were cultured in DMEM/F12 culture medium supplemented with 10％ fetal bovine serum.The cells were seeded in 6-well plates (2 ml/well) at a density of 105 cells/ml.After the cells were cultured for 12 h,the cells were attached to the wall and cultured for 48 h in the normoglycemic (5.5 mmol/L) or hyperglycemic (25 mmol/L) DMEM culture medium.The cells were then randomly divided into 6 groups (n =18 each) using a random number table:control group (group CON),hypoxia/reoxygenation group (group H/R),remifentanil postconditioning group (group RPC),hyperglycemia group (group HG),hyperglycemia plus hypoxia/reoxygenation group (group HG-H/R),and hyperglycemia plus remifentanil postconditioning group (group HG-RPC).In H/R,RPC,HG-H/R and HG-RPC groups,the cells were exposed to 95％ N2-5％ CO2 in an incubator for 5 h after changing the culture medium for Tyrode solution.In H/R and HG-H/R groups,the culture medium was changed to the DMEM/F12 culture medium supplemented with 10％ fetal bovine serum and glucose at the corresponding concentration,and the cells were then incubated for 1 h.In RPC and HG-RPC groups,the cells were incubated in the DMEM culture medium containing remifentanil at the final concentration of 1 μmol/L,and the cells were then incubated for 1 h.At 1 h of reoxygenation,the cell viability was measured by CCK-8 assay,the cell apoptosis was detected by AnnexinV-FITC/PI flow cytometry,and the expression of HDAC3 and caspase-3 in cells was detected by Western blot.The apoptotic rate was calculated.Results Compared with group CON,the cell viability was significantly decreased,the cell apoptotic rate was significantly increased,and the expression of caspase-3 and HDAC3 was significantly up-regulated in group H/R (P＜ 0.05).Compared with group H/R,the cell viability was significantly increased,the apoptotic rate was significantly decreased,and the expression of caspase-3 and HDAC3 was significantly down-regulated in group RPC (P＜0.05).Compared with group HG,the cell viability was significantly decreased,the apoptotic rate was significantly increased,and the expression of cspase-3 and HDAC3 was significantly up-regulated in group HG-H/R (P＜0.05).There was no significant difference in the parameters mentioned above between group HG-RPC and group HG-H/R (P＞0.05).Conclusion The mechanism underlying mitigation of remifentanil postconditioning-induced protection of diabetic cardiomyocytes is associated with hyperglycemia-induced up-regulation of HDAC3 expression.
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Objective To evaluate the relationship between endoplasmic reticulum stress and diabetes mellitus (DM)-caused influence on cardioprotection induced by remifentanil postconditioning in rats.Methods Adult male Sprague-Dawley rats,weighing 250-300 g,were used in the study.A model for type 1 DM was established by intraperitoneal streptozotocin 50 mg/kg and confirmed by blood glucose ≥ 16.7 mmol/L.Thirty six rats with type 1 DM were randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (DM-S group),myocardial ischemia-reperfusion (I/R) group (DM-I/R group) and remifentanil postconditioning group (DM-R group).Another 36 normal rats were exposed to single intraperitoneal injection of sodium citrate-hydrochloric acid buffer solution and served as control group.Two weeks later 36 normal rats with nondiabetes mellitus were also randomly divided into 3 groups (n =12 each) using a random number table:sham operation group (NDM-S group),myocardial I/ R group (NDM-I/R group) and remifentanil postconditioning group (NDM-R group).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch of coronary artery followed by 120 min reperfusion.Remifentanil postconditioning was induced by 10 min infusion of remifentanil 10 μg · kg-1 · min 1 via the femoral vein starting from 5 min before reperfusion.Before ischemia and at 30 and 120 min of ischemia,MAP,SP and HR were recorded and rate-pressure product (RPP) was calculated.At 120 min of reperfusion,arterial blood samples were collected for measurement of plasma cardiac troponin I (cTnI) concentration.The animals were then sacrificed and hearts were removed for determination of myocardial infarct size (IS).The left 6 rats from each group were sacrificed at 120 min of reperfusion,the specimens from their left ventricular apex were obtained to detect the expression of endoplasmic reticulum stress marker glucose-regulated protein 78 (GRP78),C/EBP homologous protein (CHOP) and caspase-12 by Western blot.Results MAP and RPP were significantly decreased,the plasma concentration of cTnI was increased,changes of cardiac infarction were found,and the expression of GRP78,CHOP and caspase-12 was up-regulated in diabetic and nondiabetic rats.Remifentanil postconditioning could inhibit the expression of GRP78,CHOP and caspase-12,increase MAP and RPP,decrease the plasma concentration of cTnI,and reduce myocardial infarct size in nondiabetic rats,but it had no such effects in the diabetic rats.The expression of GRP78,CHOP and caspase-12 was significantly higher after remifentanil postconditioning in diabetic rats than in nondiabetic rats.Conclusion Enhanced endoplasmic reticulum stress is involved in DM-caused loss of cardioprotection induced by remifentanil postconditioning in rats.
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Objective To evaluate the relationship between glucose-regulated protein 78 (GRP78) and diabetes mellitus-induced influence on myocardial protection provided by remifentanil postconditioning in vitro.Methods H9c2 cells were cultured in DMEM/F12 culture medium supplemented with 10％ fetal bovine serum.The cells were seeded in 96-well (100 μl/well) or 6-well (2 ml/well) plates at the density of l05 cells/ml.The cells were then randomly divided into 6 groups (n =24 each) using a random number table:normoglycemic control group (group NC),normoglycemic hypoxia/reoxygenation (H/R) group (group NHR),normoglycemic remifentanil postconditioning group (group NRP),hyperglycemic control group (group HC),hyperglycemic H/R group (group HHR),and hyperglycemic remifentanil postconditioning group (group HRP).In NC,NHR and NRP groups,the cells were cultured in normoglyccmic culture medium (5.5 mmol/L) for 48 h.In HC,HHR and HRP groups,the cells were incubated in hyperglycemic culture medium (25.0 mmol/L) for 48 h.In NHR,NRP,HHR and HRP groups,after changing the culture medium for Tyrode solution,the cells were exposed to 95％ N2-5％ CO2 in an incubator at 37 ℃ for 5 h.Subsequently,in NHR and HHR groups,the culture medium was changed to DMEM/F12 culture medium supplemented with 10％ fetal bovine serum and glucose at the corresponding concentration,and the cells were incubated for 1 h;in NRP and HRP groups,the cells were incubated for 1 h in the DMEM culture medium containing remifentanil at the final concentration of 1 μmol/L.At 1 h of reoxygenation,the cells of 9 wells in each group were selected to measure the cell viability by CCK8 assay,the cells of 12 wells in each group were selected to determine the activity of lactic dehydrogenase (LDH) released in the supernatant using colorimetric method,and the cells of 3 wells in each group were selected to detect the expression of GRP78 by Western blot.Results Compared with group NC,the cell viability was significantly decreased,the LDH activity was increased,and the expression of GRP78 was up-regulated in group NHR.Compared with group NHR,the cell viability was significantly increased,the LDH activity was decreased,and the expression of GRP78 was down-regulated in group NRP,and the cell viability was significantly decreased,the LDH activity was increased,and the expression of GRP78 was up-regulated in group HRP.Compared with group HC,the cell viability was significantly decreased,the LDH activity was increased,and the expression of GRP78 was up-regulated in group HHR.There was no significant change in the parameters mentioned above between group HRP and group HHR.Compared with group NRP,the cell viability was significantly decreased,the LDH activity was increased,and the expression of GRP78 was up-regulated in group HRP.Conclusion Up-regulation of GRP78 expression may be involved in the mechanism by which diabetes mellitus negates myocardial protection induced by remifentanil postconditioning in vitro.
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<p><b>OBJECTIVE</b>This study aims to investigate the expression levels of serum and urinary vascular endothelial growth factor-A (VEGF-A) and epidermal growth factor-like domain 7 (EGFL7) in proliferating infantile hemangioma patients under propranolol treatment.</p><p><b>METHODS</b>Propranolol (0.5-2 mg x kg(-1)) was orally administered to 30 infants every day for 4-8 months. The Achauer method was used to measure the tumor radius and thus evaluate the clinical curative effects of the treatment. Enzyme-linked immunosorbent assay was used to measure the serum and urinary concentrations of VEGF-A and EGFL7 at 0, 4, and 12 weeks after the treatment.</p><p><b>RESULTS</b>The treatment response was excellent in 2 patients, good in 11, moderate in 14, and poor in 3. Serum VEGF-A (335.692 pg x mL(-1) ± 136.146 pg x mL(-1)) was high before the treatment and then significantly decreased after 4 weeks (264.853 pg x mL(-1) ± 122.120 pg x mL(-1)) and 12 weeks (211.345 pg x mL(-1) ± 104.035 pg x mL(-1)) of treatment (P < 0.05). Urinary VEGF-A (76.234 pg x mL(-1) ± 24.169 pg x mL(-1)) was high before the treatment and then significantly decreased after four weeks (56.454 pg x mL(-1) ± l6.111 pg x mL(-1)) and twelve weeks (34.728 pg x mL(-1)) ± 12.656 pg x mL(-1)) of treatment (P < 0.05). Serum and urinary EGFL7 also decreased after the treatment, showing a positive relationship with VEGF-A.</p><p><b>CONCLUSION</b>Propranolol can be safely and effectively used to treat proliferating infantile hemangiomas. This treatment can reduce the peripheral serum and urinary concentrations of VEGF-A and EGFL7 in affected children.</p>
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Humans , Infant , EGF Family of Proteins , Enzyme-Linked Immunosorbent Assay , Hemangioma , Propranolol , Vascular Endothelial Growth Factor AABSTRACT
French hospital administrators have undergone several changes to meet the needs of economic and social development,resulting in the pattern of hospital administration by both the central government and regional organizations.This paper made descriptions and analysis of the French hospital administrators and came up with the following insights:Making public hospitals as the main health service provider benefits provision of public services; public and private hospitals can jointly meet public service needs under government regulation; the government should focus on controlling health care resources;medical service system needs an overall policy guidance; hospital management organizations should streamline in the reform.
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Objective To assess the influence of the risk factors of coronary heart disease(CHD) on the prognosis of pereutaneous coronary interventions (PCI). Methods The risk factors of CHD was retrospectively col-lected from 446 patients (mean age (SD) : 60.23(9.75) yrs,84.97% male )who were admitted to the First Affili-ated Hospital of Lanzhou University from January, 2007 to July, 2008. These patients were diagnosed as CHD and treated with PCI. Major adverse cardiac events (MACE) were followed up for 12 months after PCI,and its associatian with the risk factors of CHD was investigated. Results Among all the patients,2.24% (10/446) had family history of CHD, 20.63% (92/446) was complicated with diabetes, 52.26% (242/446) with hypertension, 42.15% (118/446) with dyslipidemia, 62.33% (278/446) of the patients was overweight, and 57.85% (258/446) was smoker. Within 12 months of follow-up, MACE incidence rate were 5.83%. Univariate analysis showed the propor-tions of female,family history of CHD, overweight, hypertension and smoker were significandy different between the patients with MACE and those without MACE (χ~2=4.133,6.848,3.997,3.939,4.120, respectively,P<0.05). Logistic regression analysis showed family history and overweight increased the risk of MACE (OR=7.383 and 10. 504,respectively,95% CI=1.639-33.246 and 1.231-59.598, P<0.05), being male protected against MACE (OR=0.058,95%CI=0.014-0.236,P<0.05). Conclusions The prognosis of patients of CHD under-went PCI was good. After PCI,the risk factors of CHD such as smoking,hypertension ,overweight,ete should be un-der control to decrease the occurrence of MACE.
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Objective To measure the financial burden incurred by hypertension to urban patients in Beijing, Nanjing and Hangzhou cities. Methods Two communities were sampled from the three cities randomly, and 300 hypertension patients were sampled randomly from hypertension control files in each community for questionnaire survey. Results Health expenditure of the families with hypertension patients accounts for 14. 4% of the family's income, and 18. 2% of the family's expenditure, a ratio far beyond the national average (10.6 %). However, the majority of them report the burden as affordable.The basic medical insurance for urban residents helps alleviate the financial burden of hypertension patients and the extent of such burden has a close bearing on the outcome of hypertension treatment and prevention. Conclusion Effective community-based blood-pressure monitoring and control system is key to reducing the financial burden of hypertension. The reimbursement policy for hypertensive patients within the basic medical insurance is expected to be further improved.
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Objective To investigate the clinical and pathological features of 21 elderly patients with tuberculosis detected at autopsy. Methods Retrospectively analyzed the data of underlying diseases,clinical characteristics,clinical diagnosis,and causes of death for these 21 elderly patients with tuberculosis detected at autopsy. Results All the 21 patients were man,mean age was(88.0±6,9)years and had one or more concomitant diseases.Cough,sputum and fever were frequent due to other complicated respiratory infection.Anemia,hypoalbuminemia,decreased body mass index,increased erythrocyte sedimentation rate were very common in elderly patients,sputum acid-fast bacillus was positive in 11.8%cases.There was no primary tuberculosis.There were 9 secondary tuberculosis,3 disseminated pulmonary tuberculosis,19 tuberculous pleurisy and 9 non-pulmonary tuberculosis detected at autopsy.Compared with the result of autopsy,the clinical and radiography diagnosis accuracies were poor.Only 5 patients were clinically diagnosed as tuberculosis.All 5patients received antitubereulous chemotherapy,2 of them ceased therapy due to liver or renal toxicity. Conclusions Tuberculosis is a systemic disease in elderly patients.Because of medical aspects of ageing,co-morbid states,ignorance and mis-perception of symptoms,and atypical manifestation of disease,the diagnosis is difficult in this population.Our study confirms the importance of considering tuberculosis as a diagnosis in elderly even in the absence of typical clinical radiological presentations.
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Objective To explore the causes of misdiagnosis of lung abscess and its clinical pathological characters. Methods The clinical data of autopsy-proven lung abscess in Beijing Hospital from 1980 to 1995 were reviewed. Results Twelve patients consisted of 11 males and 1 female. Their age ranged from 60 to 88 years. None of them was clinically diagnosed lung abscess before death. Concomitant dieases were severe and complex, mostly coronary disease, hypertension, COPD, cerebrovascular disease and diabetes mellitus. The clinical presentation and chest X-ray of lung abscess in the elderly were deceptively nonspecific and variable. Over 2 types of pathogens were isolated from sputum culture, mostly klebsiella pneumoniae, pseudomonas aeruginosa, candida. The autopsy showed 3 cases with a isolated lung abscess and 9 cases with lung multi-abscess. Conclusions The reasons for misdiagnosis of lung abscess in the elderly might be the variability of clinical presentation, the other concomitant disease. Frequent pursuit of chest CT scan in suspected cases is guarranted .