Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital / 中华创伤杂志(英文版)

PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

Government Health Expenditure and Economic Growth: Analysis Based on Endogenous Growth Model / 中国卫生经济

Objective:To analyze the economic growth effect of government health expenditure and discuss the optimal decision about the proportion of govemment health expenditure.Methods:Based on the endogenous growth model with family and government,the optimal control method was used to deduce and analyze the theoretical model.Results:The government health expenditure has a nonlinear relationship of the impact on economic growth,the critical value of the optimal proportion depended on the output share of healthy,the output share of productive capital and the contribution share of government health expenditure to healthy.Conclusion:The government should determine the reasonable proportion of health expenditure according to the stage of economic development.

The Influence of Organizational External Factors on Construction Risk Management among Nigerian Construction Companies

BACKGROUND: Substantial empirical research has shown conflicting results regarding the influence of organizational external factors on construction risk management, suggesting the necessity to introduce a moderator into the study. The present research confirmed whether rules and regulations matter on the relationships between organizational external factors and construction risk management. METHODS: Based on discouragement and organizational control theory, this research examined the effects of organizational external factors and rules and regulations on construction risk management among 238 employees operating in construction companies in Abuja and Lagos, Nigeria. A personally administered questionnaire was used to acquire the data. The data were analyzed using partial least squares structural equation modeling. RESULTS: A significant positive relationship between organizational external factors and construction risk management was asserted. This study also found a significant positive relationship between rules and regulations and construction risk management. As anticipated, rules and regulations were found to moderate the relationship between organizational external factors and construction risk management, with a significant positive result. Similarly, a significant interaction effect was also found between rules and regulations and organizational external factors. Implications of the research from a Nigerian point of view have also been discussed. CONCLUSION: Political, economy, and technology factors helped the construction companies to reduce the chance of risk occurrence during the construction activities. Rules and regulations also helped to lessen the rate of accidents involving construction workers as well as the duration of the projects. Similarly, the influence of the organizational external factors with rules and regulations on construction risk management has proven that most of the construction companies that implement the aforementioned factors have the chance to deliver their projects within the stipulated time, cost, and qualities, which can be used as a yardstick to measure a good project.

Conductores en estado de embriaguez en Colombia y la implementación de la Ley 1696 de 2013 / Driving under the influence of alcohol in Colombia, and the implementation of Act (“Ley") 1696 of 2013 / Condutores no estado de intoxicação pelo álcool na Colômbia e a implementação da lei 1696 de 2013

La conducción en estado de embriaguez está ocasionando daños a la integridad física de conductores, pasajeros y terceros vinculados en los accidentes de tránsito, situación que demanda de forma oportuna la acción de las autoridades en esta materia. En diciembre del 2013 el Estado colombiano expidió la Ley 1696, por medio de la cual se dictaron disposiciones penales y administrativas para sancionar la conducción bajo el influjo del alcohol u otras sustancias psicoactivas, como el desarrollo de acciones preventivas, de control y de persecución a los infractores. El impacto parcial de esta norma se estudió durante los primeros semestres de los períodos 2010-2013 y 2014, teniendo en cuenta las variables de tiempo-lugar-modo, y se describieron las mismas desde la teoría del control e investigaciones sobre esta. Se desarrolló una investigación no experimental, mediante un estudio cuantitativo de tipo descriptivo. Los datos fueron obtenidos por bases estadísticas de la Policía Nacional de Colombia. Los resultados muestran que la implementación de la Ley 1696 no cambió la frecuencia en ninguna de las tres variables observadas, frente a los accidentes ocasionados por conductores en estado de embriaguez, y se concluye que el solo aumento punitivo no es suficiente para disminuir esta clase conducta.

Driving while intoxicated is causing serious damages to the physical integrity of drivers, passengers and third parties involved in traffic accidents. This occurrence demands the timely action of the relevant authorities, and in December 2013 the Colombian State issued Act (“Ley") 1696 whereby criminal and administrative provisions designed to impose both criminal and administrative penalties aimed at sanctioning individuals found driving under the influence of alcohol, drugs or other psychoactive substances were issued, including the development of measures of preventive and controlling nature, and making the pursuit of offenders easier. The partial impact of this rule was examined during the first 2010-2013 and 2014 bi-annual periods, taking time-place- and mode variables into account, as seen and described from the control theory and relevant researches. A non-experimental investigation was developed by means of a quantitative study of descriptive nature. Data were obtained by Colombian National Police statistical databases. The results show that the implementation of Act (“Ley") 1696 did not change the frequency in any of the three variables so observed vis-à-vis accidents caused by drink-driving offenders, and it is has been concluded that the simple increase of punitive measures is not sufficient to reduce this kind of behavior.

Dirigir um carro no estado de intoxicação pelo álcool está causando danos à integridade física dos motoristas, dos passageiros e do terceiros relacionados com os acidentes rodoviários, situação que exige medidas oportunas das autoridades nesta matéria. Em dezembro de 2013 o Estado Colombiano emitiu a lei 1696, por meio da qual as disposições penais e administrativas foram ditadas para penalizar a condução sob a influência do álcool ou de outras substâncias psicoativas, como o desenvolvimento de ações preventivas, de controle e de persecução aos infratores. O impacto parcial desta norma foi estudado durante os primeiros semestres dos períodos 2010-2013 e 2014, considerando as variáveis de tempo-lugar-modo, e elas foram descritas a partir da teoria de controle e investigações mesmas. Uma investigação não experimental foi desenvolvida, por meio de um estudo quantitativo de tipo descritivo. Os dados foram coletados por bancos estatísticos da Polícia Nacional da Colômbia. Os resultados mostram que a implementação da lei 1696 não mudou a frequência em nenhuma das três variáveis observadas, perante aos acidentes causados por condutores no estado de intoxicação, e conclui-se que o único aumento punitivo não é suficiente para diminuir este tipo de conduta.

The implementation of the Neuroid in the Gate Control System leads to new ideas about pain processing

INTRODUCTION: Several theories have been proposed to elucidate the mechanisms related with pain perception, among which, the Gate Control Theory (GCT) provides one of the most explicit explanations. This theory, as elegantly conceived, is unable to explain how the Frequency-Intensity (F-I) curves exhibited by Aβ- and C-fibres influence pain processing. In this paper, a novel neuron-model known as the Neuroid, which emphasizes the functional rather the physiological character of nerve cells, was used as the main building block to replicate the Gate Control System (GCS). METHODS: Two Aβ-fibre models were built: one model that preserved the paradoxical relation between the activation threshold and the F-I curve slope, and one model based on the hypothetical average response across the receptive field. RESULTS: The results suggest that the average response of the Aβ-fibres does not increase monotonically but reaches a plateau for high intensity stimuli. In addition, it was seen that activation of C-fibres does not necessarily imply the activation of projection neurons and, therefore, the onset of pain sensation. Also, we observed that the activation of Aβ-fibres may both, decrease and increase the activity of the projections neurons, an aspect which has not been directly described in previous works. CONCLUSION: Hypothetical implications arise as a consequence of the implementation of the Neuroid, specifically, about the correlation between the intensity of stimulation and the physiological pain threshold.

Application of theory of quality control in nursing of patients with acute cerebrovascular disease undergoing interventional therapy / 中国实用护理杂志

Objective To investigate the effect of the application of quality control theory in nursing of patients with acute cerebrovascular disease undergoing interventional therapy.Methods 64 cases of patients with acute cerebrovascular disease from November 2009 to October 2011 in our hospital undergoing interventional therapy were chosen as the research object.They were randomly divided into the control group and the observation group with 32 cases in each group.The control group was given routine care,while the observation group was given nursing intervention under the instruction of quality control theory.The hospital stay,complication rates,satisfaction and SAS score,SDS score between the two groups of patients were compared.Results The length of stay,complication rate,satisfaction degree,SAS scores and SDS scores after the intervention in the observation group were significantly better than those of the control group.Conclusions Application of the theory of quality control in nursing of patients with acute cerebrovascular disease has a better effect,demonstrating an evident advantage in reducing complications and improving patients' mental state.

Effects of Seifu on Blood Pressure, Pain and Edema / 日本温泉気候物理医学会雑誌

<B>Introduction</B><BR>  Seifu, devised in 1992 by Xu, is a method of treatment through “pulling the skin”, unlike the approaches of treatment adopted in Shiatsu, massage, or acupuncture. This paper reports our recent evaluations of the effects of Seifu on the blood pressure, pain, and edema.<BR><B>Materials and Methods</B><BR>  The blood pressure was measured before and after Seifu in 36 individuals (mean age : 78.6±6.6 years) who underwent Seifu for 5 sessions or more. The effects on edema were evaluated in 14 individuals aged 45-90. Changes in the severity of edema following Seifu were analyzed. The effects on pain were evaluated in two ways.<BR>1) Effects on acute pain<BR>  The effects on pain arising from injection into the knee were evaluated in three groups of patients with osteoarthritis of the knee: Group A (injection after the application of Seifu to the acupuncture point Gohkoku (LI4); n=7, mean age: 72.8±2.8 years), Group B (injection after the application of Seifu to the area around the knee; n=198, mean age: 75.3±9.1 years) and Group C (injection after the application of Seifu to the acupuncture point Saninkoh (SP6) ; n=62, mean age: 75.0±7.5 years).<BR>2) Effects on subcuate and chronic pain<BR>  Pain was evaluated before and after Seifu using a visual analog scale (VAS) in 103 patients with some subacute or chronic pain(n=594, mean age: 73.4±12.4 years).<BR><B>Results</B><BR>1. Blood pressure<BR>  The blood pressure decreased significantly in 5 and increased significantly in the normal range in 1 of the 36 subjects. No significant change in the blood pressure was noted in the other 30 subjects.<BR>2. Edema<BR>  Seifu was effective against pitting edema. However, in pateints followed for long periods of time after the surgical treatment of breast cancer, the skin hardness decreased but edema showed no marked reduction. Seifu exerted no effect on Quincke edema.<BR>3. Pain<BR>1) Acute pain<BR>  Pain at the time of injection was not alleviated in Group A. Pain at the time of injection was alleviated in 73.3% of the subjects from Group B and 69.4% from Group C. This percenatge did not differ significantly between Groups B and C.<BR>2) Subacute and chronic pain<BR>  Mean VAS±SD decreased significantly from 6.6±2.0 before to 3.4±1.8 after Seifu (p<0.001).<BR><B>Discussion</B><BR>  Seifu was shown to be effective against pitting edema. In cases where lymph ducts and vascular walls are intact, edema is expected to be alleviatedl by the Seifu-induced activation of lymph system autotransportation and its milking action on veins.<BR>Seifu seems to alleviate pain via the mechanism proposed in the gate control theory.<BR><B>Conclusion</B><BR>  Seifu is simple to apply and effective against pitting edema and pain, without exhibiting adverse effects on the blood pressure.

Branches in the plant world.

It is more than 40 years ago that studies on the metabolism of microorganisms revealed the existence of isoenzymes in the allosteric regulation of branched pathways. Their role in the synthesis of amino acids derived from aspartate was especially well investigated in Escherichia coli, particularly from the point of view of their allosteric properties (Patte et al. 1964). The enzyme aspartokinase catalyses the phosphorylation of the amino acid aspartate, that being the fi rst step in the biosynthesis of three different aminoacids, threonine, methionine and lysine, as well as of a fourth, isoleceucine (from threonine). Animals lack these pathways, which is what makes these amino acids ‘essential’ for us – we have to get them from our diet. At that time the global regulation of entire metabolic networks had not been clarifi ed in a quantitative sense. Everyone seemed to take it for granted that there must be a logical reason behind the existence in E.coli for instance of three aspartokinases, each of them being regulated, meaning inhibited and/or repressed (at the level of gene activity), by its ‘corresponding’ amino acid. This was subsequently also found in plants but with a more complex pattern of regulation. It was not clear whether the more complex regulatory pattern refl ected the necessity of a multiplicity of metabolic responses or simply a ‘stratifi cation’ of different regulations during evolution. In other words, could a simpler system of regulation offer the same wealth of metabolic responses? The pattern in the thale cress Arabidopsis thaliana has been painstakingly deciphered over a ten-year period by Curien and co-workers; all the steps, including their regulatory properties, are known in detail. As shown in their most recent publication (Curien et al. 2009), today such questions can be answered by building a mathematical model to simulate the global functioning of the network. In order to obtain a steady state in the model as it occurs in vivo, it is necessary to add to the network the cellular demands of lysine, threonine and isoleucine in protein synthesis. Methionine is not a variable of the system because it is the precursor of S-adenosylmethionine (AdoMet) which in addition plays a regulatory role in the network (see below). The AdoMet concentration is set at its physiological value. The amino acid demand is adjusted in order to obtain a concentration of intermediate metabolites close to the ones measured in vivo. This steady state is called the reference state and is the starting point of all the other simulations. The authors use metabolic control theory (MCT, also known as Metabolic Control Analysis) (Kacser and Burns 1973; Heinrich and Rapoport 1974; Reder 1988) to identify the more sensitive steps and metabolites. In metabolic networks, controls at the ‘supply’ and ‘demand’ ends usually act in opposition (Hofmeyr and Cornish-Bowden 2000); most trivially, an increase in substrate tends to increase the fl ux through a pathway whereas an increase in the product will tend to decrease the fl ux. In the present case, most of the control is on the ‘demand’ steps in the amino acids’ biosynthetic pathways: that allows the network to respond directly to a change in protein synthesis. There is, however, a high control coeffi cient associated with the aspartate kinase isoform AK1, which is at the ‘supply’ end. The consequence is a signifi cant contribution of AK1 to the maintenance of a threonine steady-state. This, according to the authors, is one of the reasons why the threonine level is less stable than those of the other amino acids – both in the model and in planta. The fi rst important result obtained from the model is the calculation of the fl ux through the different branches of the network and their detailed assignment to the different isoforms. It appears from fi gure 3 of the paper (which very clearly shows the different fl uxes) that with regard to the fi rst (aspartate kinase) step catalysed by the four aspartokinases isoforms in A. thaliana, the fl ux is mainly accounted for by one of them, namely AK1 (73%). The second important result is that to a large extent the different pathways behave independently. This means that when, for instance, the demand for threonine is increased, lysine production is not affected even though the two biosynthetic pathways share common steps in the beginning. This nonintuitive result is due to the special features of the regulation pattern, particularly due to the presence of the.

Studying General Layout of Quality Control on Clinical Pharmacy Work in Xuzhou City by ISO9001 Process Control Theory / 中国药房

OBJECTIVE:To study the general layout on the quality control of clinical pharmacy work of Xuzhou city during the period of2005～2008.METHODS:The problems appeared in hospital clinical pharmacy were analyzed by adopting ISO9001process control theory,i.e.PDAC cyclical quality management method,and suggestions on the corresponding scheme and practices were raised.RESULTS&CONCLUSIONS:Studying the general layout on the quality control of clinical pharmacy work by means of ISO9001process control theory is conducive to the development of clinical pharmacy of Xuzhou city.