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Objective:To survey the status quo of job burnout among rural general practitioners and to analyze its influencing factors.Methods:A total of 2 805 rural general practitioners in three counties in southwest Shandong province were enrolled in the study. The survey was conducted with a basic information questionnaire and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). The influencing factors of job burnout were analyzed by Pearson chi-square test (χ2) and binary logistic regression model.Results:A total of 2 272 rural general practitioners completed the survey with a completion rate of 81.0%. The rates of middle or high job burnout in the dimensions of emotional exhaustion, depersonalization and reduced personal sense of achievement were 55.1%(1 251/2 272), 34.0%(772/2 272) and 91.3%(2 075/2 272), respectively. Binary logistic regression model showed that working hours/week ≥ 60 h ( OR=1.341, 95 %CI:1.057-1.702, P<0.05), monthly shift times ≥20 ( OR=1.434, 95 %CI:1.182-1.739, P<0.05), daily consultation time≥13 h ( OR=1.294, 95 %CI:1.055-1.589, P<0.05), daily consultation of 11-20 patients ( OR=1.317, 95 %CI:1.075-1.614, P<0.05), no part-time job ( OR=1.583, 95 %CI:1.201-2.087, P<0.05), insomnia ( OR=2.638, 95 %CI:2.225-3.128, P<0.05), feeling depressed at work ( OR=3.170, 95 %CI:2.661-3.776, P<0.05) were risk factors for emotional exhaustion; participation in public health services ( OR=1.485, 95 %CI:1.155-1.910, P<0.05), being married ( OR=2.273, 95 %CI:1.198-4.313), no part-time jobs ( OR=1.677, 95 %CI:1.276-2.203, P<0.05), insomnia ( OR=1.487, 95 %CI:1.211-1.827, P<0.05), and feeling depressed at work ( OR=1.642, 95 %CI:1.339-2.015, P<0.05) were risk factors for depersonalization; working hours/week ≥ 60 h ( OR=2.089, 95 %CI:1.454-3.002, P<0.05), daily consultation time ≥ 9 h ( OR=2.495, 95 %CI:1.748-3.561, P<0.05), insomnia ( OR=2.061, 95 %CI:1.519-2.796, P<0.05), and feeling depressed at work ( OR=1.894, 95 %CI:1.383-2.593, P<0.05) were risk factors for reduced personal achievement. Protective factors included monthly income ≥3 000 Yuan ( OR=0.589, 95 %CI: 0.353-0.982, P<0.05) and monthly shift of 10-19 times ( OR=0.581, 95 %CI:0.411-0.820, P<0.05). Conclusion:The overall job burnout among rural general practitioners in southwest Shandong province is serious, especially the depersonalization and the reduction of personal sense of achievement. It is suggested to improve the salary, reduce the working intensity, optimize the working hours, and pay attention to their physical and mental health for rural general practitioners to alleviate the current situation of their occupational burnout.
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Early venous filling is a special imaging manifestation of cerebral angiography in patients with acute ischemic stroke. Endovascular therapy for acute ischemic stroke has been carried outwidely. However, reports involving disappearance of early venous filling and then confirming its reversibility during follow-up angiographic review are somewhat scarce. Here a case in which the early venous filling after emergency thrombectomy disappeared during follow-up examination is reported. A 71-year-old male was admitted with sudden onset of left-sided weakness for 42 minutes. Intravenous thrombolysis and bridging middle cerebral artery mechanical thrombectomy were performed. Early filling of the thalamostriate vein was visible in the digital subtraction angiography series immediately after recanalization and follow-up imaging revealed infarction of the basal ganglia. Follow up angiography showed that the phenomenon of early venous filling disappeared two weeks later.
ABSTRACT
Early venous filling is a special imaging manifestation of cerebral angiography in patients with acute ischemic stroke. Endovascular therapy for acute ischemic stroke has been carried outwidely. However, reports involving disappearance of early venous filling and then confirming its reversibility during follow-up angiographic review are somewhat scarce. Here a case in which the early venous filling after emergency thrombectomy disappeared during follow-up examination is reported. A 71-year-old male was admitted with sudden onset of left-sided weakness for 42 minutes. Intravenous thrombolysis and bridging middle cerebral artery mechanical thrombectomy were performed. Early filling of the thalamostriate vein was visible in the digital subtraction angiography series immediately after recanalization and follow-up imaging revealed infarction of the basal ganglia. Follow up angiography showed that the phenomenon of early venous filling disappeared two weeks later.
ABSTRACT
Early venous filling is a special imaging manifestation of cerebral angiography in patients with acute ischemic stroke.Endovascular therapy for acute ischemic stroke has been carried outwidely.However,reports involving disappearance of early venous filling and then confirming its reversibility during follow-up angiographic review are somewhat scarce.Here a case in which the early venous filling after emergency thrombectomy disappeared during follow-up examination is reported.A 71-year-old male was admitted with sudden onset of left-sided weakness for 42 minutes.Intravenous thrombolysis and bridging middle cerebral artery mechanical thrombectomy were performed.Early filling of the thalamostriate vein was visible in the digital subtraction angiography series immediately after recanalization and follow-up imaging revealed infarction of the basal ganglia.Follow up angiography showed that the phenomenon of early venous filling disappeared two weeks later.
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Clinical students in 8-year program in the Zhejiang University School of Medicine carried out the "4+4" mode, namely, four undergraduate years of non-medical courses and four years of professional medical cultivation. During the professional cultivation, modular teaching of integrated medical courses was adopted for cultivating medical students with solid medical basis and broad thinking. With the background of integrated module of nerve, mind and exercise and according to students' characteristics and self-experience, teachers in neurology brought out measures focusing on "three basic courses" education when guiding students, diversifying teaching methods, utilizing Cloud Model to try new evaluation methods and so on, so as to cultivate more medical talents.
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Clinical students in 8-year program in the Zhejiang University School of Medicine carried out the "4+4" mode,namely,four undergraduate years of non-medical courses and four years of professional medical cultivation.During the professional cultivation,modular teaching of integrated medical courses was adopted for cultivating medical students with solid medical basis and broad thinking.With the background of integrated module of nerve,mind and exercise and according to students' characteristics and self-experience,teachers in neurology brought out measures focusing on "three basic courses" education when guiding students,diversifying teaching methods,utilizing Cloud Model to try new evaluation methods and so on,so as to cultivate more medical talents.
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Currently,the ideal anesthetic approach for the endovascular treatment of acute ischemic stroke remains unknown.Most retrospective studies and meta-analysis report worse outcomes from general anesthesia than from conscious sedation during endovascular treatment.However,series of randomized controlled trials have not shown the advantages of conscious sedation.The choice of anesthetic strategy should continue to be individualized in clinical practice.In order to provide references for clinician,the advantages and disadvantages of general anesthesia and conscious sedation for the endovascular treatment of acute ischemic stroke were reviewed.
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Carotid web is a rare risk factor of ischemic stroke.A total of 32 (0.54％) patients with carotid web were finally diagnosed in 5 943 patients who underwent carotid computerized tomography angiography (CTA) in two hospitals.Only one patient received carotid endarterectomy that pathological findings were fibrous tissue hyperplasia of vascular wall with mucinous degeneration.Stent implantation was administrated in two cases.Among 13 asymptomatic patients,the observational follow-up period was (20.9± 12.4) months without strokes.Carotid web is a rare aberration.Asymptomatic patients with carotid web are usually silent.Large sized cohort and long-term follow-up are further needed.
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BACKGROUND: Platelet-rich plasma has been used in the treatment of wounds in orthopedics, burn and plastic surgery, and has achieved good results. But its therapeutic effect in diabetic foot ulcers is still controversial. OBJECTIVE: To systematically evaluate the efficacy and safety of platelet-rich plasma in diabetic foot ulcer. METHODS: PubMed, EMbase, The Cochrane Library, CBM, CNKI, and VIP databases were searched for a randomized controlled trial of platelet-rich plasma for treating diabetic foot ulcers published before September 2018. Meta-analysis was performed using RevMan 5.3 software after two investigators independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. RESULTS AND CONCLUSION: (1) Sixteen randomized controlled trials were included, including 925 patients. The trial group was treated with platelet-rich plasma alone or platelet-rich plasma combined with conventional therapy (debridement, vacuum sealing drainage, or dressing coverage) . The control group received routine treatment, blank control or placebo treatment. (2) Meta-analysis showed that the healing rate in the trial group was higher than that in the control group [OR=3.05, 95％CI (2.25, 4.13) , P < 0.000 01]; effective rate was higher than that in the control group [OR=3.84, 95％CI (2.44, 6.06) , P < 0.000 01]; the ulcer healing time was shorter than that in the control group [MD=-11.39, 95％CI (-13.45, -9.34) , P < 0.000 01]; the cost of treatment was lower than that in the control group [MD=-5 927.76, 95％CI (-10 413.04, -1 442.49) , P=0.010]; and the hospitalization time was less than that in the control group [MD=-14.77, 95％CI (-18.82, -10.73) , P < 0.000 01]. (3) Four studies reported adverse reactions, but adverse reactions were not associated with platelet-rich plasma. (4) These results suggest that platelet-rich plasma has a good clinical effect in promoting the healing of diabetic foot ulcers, and no adverse reactions occur. Due to limitations in the quantity and quality of the studies, the above conclusions are yet to be verified by more high-quality studies.
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Facial autologous fat transplantation is a common aesthetic procedure.Although this procedure is generally regarded as safe,several patients have experienced acute cerebral infarction after fat particles were incorrectly injected into the blood vessel.We report two cases of cerebral infarction following facial autologous fat transplantation:one patient suffered massive cerebral infarction due to the occlusion of internal carotid artery by fat embolus and died of stroke related complication,the other young women experienced acute ischemic stroke and ophthalmic artery embolism during this procedure and remained permanent blindness of right eye.Therefore,when a patient presents abrupt mental change,hemiplegia,blindness during autologous fat particle injection,doctors must consider the complication of cerebral infarction.
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Objective To investigate the clinical features,recanalization after medical treatment and clinical outcome of cerebral artery dissection.Methods We reviewed the clinical records of ischemic stroke patients with cerebral artery dissection who visited the First Affiliated Hospital of Zhejiang University between October 2010 and December 2013.We recorded patients' general information,neurological deficit,imaging and clinical treatment.We followed up the patients and statistically analyzed demographic data,recanalization and clinical outcome.Results Among 28 cases of cerebral artery dissection,carotid dissection was the most common (n =19,67.9％),followed by vertebral artery dissection (n =7,25.0％),while the combination of carotid and vertebral artery dissection was rare (n =2,7.1％).In the imaging of cerebral artery dissection,wire beads and occlusion were the most common signs (n =15,53.6％),followed by rat tail sign (n =7,25.0％),aneurysmal dilatation (n =4,14.3％) and dualchamber levy (n =2,7.1％).There were 18 cases of acute cerebral infarction in the 28 studied cases,but there was no significant difference between the degree of stenosis and cerebral infarction caused by cerebral artery dissection.All patients received standard antithrombotic therapy.The difference of the recanalization rate between using anti-platelet aggregation and anticoagulant therapy was not statistically significant (5/6 vs 9/13,P =0.37).Conclusions Although cerebral artery dissection is relatively rare clinically,the typical clinical manifestations of the disease and the characteristic imaging are helpful for the diagnosis.Standardization of antithrombotic treatment is still the first-line treatment of cerebral artery dissection.
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Objective To investigate the association between 5-hydroxytryptamine 2A receptor (HTR2A)gene T102C locus polymorphism and schizophrenia,and to provide basis for evidence-based medicine for the genetic background of schizophrenia.Methods PubMed,EMbase,CNKI,WanFang and Vip information databases were used to search full text of all the relevant studies about the association between HTR2A gene T102C locus polymorphism and schizophrenia,which were published during 2003 to 2012.Based on reviewing full text,the data were selected, evaluated and accessed. RevMan 5.1 and Stata 1 2.0 were used to perform the statistical analysis of those studies that were in accordance with the inclusive criteria. According to the different ethnicities, the obj ects were divided into two subgroups as European and Asian to analyze respectively. Also, depending on different inheritances, the obj ects were divided into five patterns including C/T allele, CC/TT, CC/CT+TT, CC+CT/TT and CC+ TT/CT genotypes to analyze respectively, including heterogeneity inspection, effect consoliating and publication bias assessment. Results A total of 11 studies were available for this analysis, including 2 443 schizophrenia patients and 2 469 controls.The Meta-analysis results showed that the allele of all people were OR=1.12,95%CI=0.96-1.31,P>0.05;CC/TT of all people were OR=1.11,95%CI=0.80-1.53,P>0.05;CC/CT+TT of all people were OR=1.13,95%CI=0.99-1.30,P>0.05;CC+CT/TT of all people were OR=1.18, 95%CI=0.93-1.50,P>0.05;CC+TT/CT of all people were OR=0.95, 95%CI=0.84-1.06,P>0.05.Conclusion Current evidence is insufficient to show that HTR2A gene T102C locus polymorphism may be associated with schizophrenia, suggesting that the gene polymorphism has no significantly genetic association with schizophrenia.
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Objective To investigate the short-term prognosis of acute severe stroke patients treated with early partly of enteral nutrition followed by parenteral nutrition,only early enteral nutrition or only conventional family feeding.Methods According to stratified random method,97 severe acute stroke patients were divided into three groups,including early partly enteral nutrition and parenteral nutrition therapy group (study group,33 cases),only early enteral nutrition group (32 cases),and only conventional family feeding group (32 cases).The nutritional status,mortality,and incidence of infection were observed in the three groups at 21 days; NIH Stroke Scale (NIHSS) and Barthel Index at 21 days were compared among the three groups,and Modificied Rankin Scale (mRS) were compared at 90 days.Results At 21 days,the nutritional parameters including triceps skinfold thickness,mid-arm muscular circumference,hemoglobin,serum albumin,serum prealbumin and triglycerides in the study group were better than that in the other two groups.The incidence of malnutrition(10.0％ (3/30),37.5％ (9/24),12/19) and infection (18.2％ (6/33),40.6％ (13/32),56.3％ (18/32)) among the three groups were significantly different (x2 =15.2417,P =0.0005 ; x2 =10.1030,P =0.0064).The mortality (9.1％ (3/33),25.0％ (8/32),40.6％(13/32); x2 =8.6777,P =0.0131) and the NIHSS score (11.51 ±2.68,13.22 ±2.71,14.48 ± 2.55 ;F =7.86,P =0.0008) in the intervention group were lower than that in the other two groups.However,the Barthel Index had no significant difference among the three groups.At 90 days,the mRS grade 0 to l and the mRS grade 2 to 3 had no significant difference among the three groups; However,the mRS grade 4 to 5 among the three groups were statistical difference.Conclusion The early partly enteral nutrition combined with the stage of parenteral nutrition therapy can improve the short-term prognosis of severe acute stroke,though it cannot improve the Barthel Index on the 21th day.
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ObjectiveTo define the high intraarterial signals on conventional MRI. Methods Review the conventional MRI data in all of the acute ischemic stroke patients in the First Affiliated Hospital,School of Medicine, Zhejiang University from January 2010 to December 2010. ResultsIn year 2010,according to the diagnostic criteria of China, there were 280 cases of acute cerebral infarction, all underwent conventional MRI. Twenty six patients (9. 29％ ) showed high intraarterial signals on conventional MRI.There were 14 cases with high signals in the anterior circulation, including 11 cases in the carotid artery, 2 cases in the anterior cerebral artery, and 1 case in the middle cerebral artery combined with the anterior cerebral artery. In the 11 patients with high signals in the carotid artery, MRA confirmed 14 internal carotid arteries stenosis, with 100％ specificity and 78.6％ sensitivity. There were 12 cases with high signals in the posterior circulation, including 5 cases in the vertebral artery, 3 cases in the basilar artery, and 4 cases in the basilar artery with vertebral artery. One patient did not undergo MRA. MRA confirmed 14 arteries with stenosis, with 100％ specificity and 78.5％ sensitivity. ConclusionsIntravascular high signals showed by conventional MR sequences have high clinical specificity, and its vascular lesions are consistent with the results of MRA.