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Objective:To analyze the input and output status of health resources in primary medical and health institutions and their allocation efficiency in different regions of China, and to provide an empirical basis for optimizing the allocation of primary medical and health resources in China among regions.Methods:The input index data (number of beds and number of health personnel) and output index data (number of primary medical and health institutions visits, number of family health services, number of hospital admissions) of primary medical and health institutions in China in 2020 were extracted from the China Health Statistical Yearbook 2021. Based on the BCC ( Banker, Charnes, Cooper) model of data envelopment analysis ( DEA), the Bootstrap- DEA method was used to correct bias, the allocation efficiency of primary medical and health resources in 31 provinces was calculated and the regional differences were analyzed. Results:After bias correction, the technical efficiency (TE) of resource allocation in primary medical and health institutions decreased by 0.102. The average TE score of all 31 primary medical and health institutions was 0.669, indicating a serious problem of ineffective use of technology. The TE of the eastern, central and western regions was 0.694, 0.663, and 0.649 respectively. There was obvious polarization in the central regions.Further analysis of the efficiency improvement of non DEA efficient provinces showed that 2 DEA weakly efficient provinces and 16 DEA ineffective provinces had several reference provinces for efficiency configuration improvement; The provinces that have been referenced more than 10 times were Zhejiang, Chongqing, Sichuan, and Ningxia, while the provinces that were listed as the first reference by other provinces were Ningxia, Chongqing, Zhejiang, and Tibet.Conclusions:The resource allocation efficiency of primary medical and health institutions in China is relatively low, and regional differences are obvious. The balance between different inputs and outputs should be considered when allocating the resources. Non DEA effective provinces can use DEA analysis to find the most suitable reference object and make reference improvements in the short term.
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BACKGROUND@#After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).@*METHODS@#This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.@*RESULTS@#Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.@*CONCLUSION@#Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.@*TRIAL REGISTRATION@#ChiCTR-INR-17013093.
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Humanos , Hepatectomía , Vena Cava Inferior/cirugía , Hígado , Laparoscopía , FluidoterapiaRESUMEN
In the wake of the COVID-19 pandemic, only through whole-hearted cooperation and joined efforts can medical institutions, governments, and social organizations cope with emergency, convert the crisis into opportunities, promote modern governance and accomplish high-quality development in the fight against the pandemic. Taking the First Affiliated Hospital of Xi’an Jiaotong University as an example, this paper analyzes the all-media communication matrix of "one network platform, 3W + N" that the hospital established during the pandemic by combining the authoritative official website with WeChat, Wesee, Weibo and that other publicity media. The study explores how to create a publicity brand that is mindful, poignant, compassionate and devoted and maintains its scientific and refined management, so as to achieve the professional goal of educating the public, shouldering the responsibility in the combat against the pandemic, and taking the lead in the research on the pandemic.
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With global warming and frequent heat waves, the incidence of heat-related-illness has gradually increased, and heatstroke is the most serious clinical syndrome, with high mortality and incidence of sequelae. Effective heatstroke warning aims to reduce the incidence and the harm of heatstroke by monitoring certain parameters and forecasting the possibility of suffering heat illness, however, there is no unified summary of the heatstroke early warning system at present. The occurrence of heatstroke involves two key aspects: climate environment and individual susceptibility, and individual susceptibility is manifested as the difference in heat tolerance ability. This article represents the current early warning system of heatstroke from climate environment, such as effective temperature, heat index, wet bulb globe temperature (WBGT) index, somatosensory temperature, etc., and individual susceptibility, for the reference of research and development in this field.
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Objective:To evaluate the effect of paclitaxel on the mast cell-CCL2-macrophage axis in rats with pulmonary hypertension.Methods:Thirty SPF-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 180-220 g, were divided into 3 groups ( n=10 each) using a random number table method: control group (group C), pulmonary hypertension group (group PH), and paclitaxel group (group PTX). The model of pulmonary hypertension was established by subcutaneous injection of monocrotaline 60 mg/kg in rats.At 25 days after establishing the models, paclitaxel 2 mg/kg was injected via the tail vein once every four days, for 4 times in total in group PTX.The equal volume of normal saline was injected in the remaining 2 groups.The mean pulmonary artery pressure (mPAP) was performed at 40 days after establishing the model.The heart was removed and dried, the right ventricle (RV) and left ventricle plus ventricular septum (LV+ S) was weighed, and the Fulton index [RV/(LV+ S)] was calculated.The inferior lobe of left lung was taken, the ratio of media wall thickness of pulmonary vessels was calculated by HE staining, the number of Tryptase + , CD68 + , CD163 + , and Ki67 + cells was recorded by immunohistochemistry, the mean value was calculated, the percentage of Ki67-positive cells in blood vessels was recorded, and the proportion of muscularized blood vessels was calculated.The content of CCL2 was measured by enzyme-linked immunosorbent assay, and the expression of cleaved caspase-3 and Cyclin D1 was detected by Western blot. Results:Compared with group C, the mPAP, Fulton index, ratio of media wall thickness, proportion of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly increased, and the expression of cleaved caspase-3 was down-regulated in PH and PTX groups ( P<0.05), the expression of Cyclin D1 was significantly up-regulated in group PH ( P<0.05), and no significant change was found in group PTX ( P>0.05). Compared with group PH, the mPAP, Fulton index, ratio of media wall thickness, percentage of muscularized blood vessels, the number of Tryptase + , CD68 + and CD163 + cells and percentage of Ki67 + cells were significantly decreased, the expression of CCL2 and Cyclin D1 was down-regulated, and the expression of cleaved caspase-3 was up-regulated in group PTX ( P<0.05). Conclusion:The mechanism by which paclitaxel alleviates pulmonary hypertension is related to inhibiting the mast cell-CCL2-macrophage axis in rats.
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Objective To examine the effects ofulinastatin (UTI) on cardiac dysfunction in mice with heat stroke and its possible mechanism.Methods 20 mice were divided into four groups randomly:room temperature plus normal saline (Sham+NS),room temperature plus UTI (Sham+UTI),heat stress plus normal saline (HS+NS),heat stress plus UTI (HS+UTI),5 each.105U/kg UTI was delivered by intraperitoneal injection before the onset of the heat stress.Room temperature groups were housed at room temperature (23.0 ± 0.5 ℃),while heat stress groups were kept in an incubator at 36.5 ± 0.5 ℃ and humidity of 65.0％ ± 2.0％.The rectal temperature (Tr) reaching 42℃ was taken as severe heat stroke,and the time in two heat stress groups was recorded.The mice were transferred to the room temperature (23.0 ± 0.5 ℃) for natural cooling after the heat stroke onset.6 hours after the treatment,cardiac output (CO) was ultrasonographically detected,the myocardium was separated for histopathological examination and the expression of total p38 and phosphorylated p38 (p-p38) was determined by Western blotting.Results The time to reach 42℃ in HS+UTI group was significantly prolonged (P=0.044).Compared with the Sham+NS group,the CO in HS+NS and HS+UTI group decreased significantly (P=0.017),and the score of myocardial inflammation (P＜0.001) and p-p38/p38 ratio (P＜0.001) increased.The CO was significantly higher in HS+UTI group than in HS+NS group (P=0.030),and the score of myocardial inflammation (P＜0.001) and p-p38/p38 ratio (P=0.001) were significantly lower.Conclusion Ulinastatin might improve the cardiac function in mice with heat stroke by decreasing the p-p38 and alleviating the inflammation response.
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Objective To study influences of magnetic field on behavior of depressive rats under chronic unpredictable mild stress,and possible mechanisms under such phenomena.Methods Thirty-six Wistar rats were divided into model group,magnetic field group and control group (n =12 in each group) according to random number table.The model group and the magnetic field group received CUMS stimulation daily for 5 weeks,while the control group received no any treatment.At the end of the fifth week,rats in the magnetic field group were placed in the center of a magnetic machine (400 mT),and the model group was raised freely for4 weeks.The severity of depressive behaviors,cortisol levels and contents of C-reactive protein in blood and urine sample were tested pre-treatment,at the end of 5 weeks and 9 weeks.Results After 5 weeks,consumption of glucose solution of the control group was higher than the other two groups (P ＜ 0.05).After 5 and 9 weeks,body weights of the magnetic group and the model group were lower than the control group (P ＜ 0.05).At the end of 9 weeks,performance of the magnetic group as indicated by frequency of grid crossing,grooming time and suspending tail test were improved to a significantly greater extent than the other two groups (P ＜ 0.05).In addition,the urine content of cortisol in 24 hours in magnetic field and model groups was higher than the control group at the end of 5 weeks,and the serum level of cortisol in the magnetic field group were significantly higher than the model group at the end of 9 weeks (P ＜ 0.05).Conclusion The 400mT magnetic field can reduce the severity of behavior changes of rats with CUMS-induced depression,which might be attributable to its influence on the cortisol levels in blood and urine.