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In recent years, public hospitals have been facing pressure from the reform of medical insurance payment methods. It is urgent to strengthen the operation and management of public hospitals. In June 2022, a tertiary public hospital utilized hospital intelligent agents to carry out refined cost management practices for medical service charging projects, sorted out medical service charging projects, designed management paths, and calculated project costs. The hospital conducted refined management on the cost of medical service charging items from three control dimensions of project unit cost with manpower, equipment and consumables, and two comparative directions with horizontal and vertical. The refined cost management practice not only pointted out the direction for global refinement cost control within the hospital, but also reduced the proportion of hospital consumption, which provided reference for improving the level of refined operation and management of public hospital hospitals.
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Application of new technical means and methods and in-depth exploration in medical service scenarios, for improving the efficiency and quality of diagnosis and treatment, improving the operation and management level and patient′s medical experience are the goals aimed by smart hospitals. Guangdong Second Provincial General Hospital, based on the technical framework of hospital intelligent twins, was exploring to build an all-scenario smart hospital. The hospital built an intelligent operations center, all-scenario smart wards and a smart security and fire protection integrated management center. These practices promoted the service synergy, provided efficient internet of everything experience, and promoted the integrated linkage management of security and fire protection. The hospital effective resolved such deficiencies as insufficient data connectivity, fragmented application scenarios, limited coverage and poor mobility, hence providing reference for the construction and application of whole-scenario smart hospitals.
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Objective: Trimethylamine oxide (TMAO) is a metabolite of intestinal flora and is known to promote the progression of atherosclerotic plaques. However, how TMAO works, including its effect on vascular endothelial cells, is not fully understood. This study aims to explore the biological role of TMAO in human umbilical vein endothelial cells (HUVECs) and the underlying mechanism. Methods: Cell pyroptosis and the loss of plasma membrane integrity were induced under TMAO stimulation in HUVECs. The plasma membrane integrity of the cells was measured by Hoechst 33342/propidium iodide (PI) staining and lactate dehydrogenase leakage assay, and the changes in cell morphology were observed by atomic force microscope. The expression of proteins related to pyroptosis was determined by Western blotting or immunofluorescence. Mitochondrial acetaldehyde dehydrogenase 2 (ALDH2) activity in HUVECs was measured by the ALDH2 activity assay kit, and the level of reactive oxygen species (ROS) was detected by fluorescent probe DCFH-DA. Results: TMAO induced pyroptotic cell death, manifesting by the presence of propidium iodide-positive cells, the leakage of lactate dehydrogenase, the production of N-terminal gasdermin D (GSDMD-N), and the formation of plasma membrane pores. Moreover, TMAO induced elevated expression of inflammasome components, nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3),apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC), and caspase-1 in cells. TMAO significantly inhibited ALDH2 activity and increased intracellular ROS production. However, the activation of ALDH2 by pharmacological manipulation attenuated TMAO-induced inflammasome activation and GSDMD-N production.Conclusion: TMAO induces pyroptosis of vascular endothelial cells through the ALDH2/ROS/NLRP3/GSDMD signaling pathway, which may be a potential therapeutic target for improving the treatment of atherosclerosis.
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In the new era, enhanced Party construction of public hospitals is the fundamental assurance for the success of Healthy China strategy. Based on field survey, in-depth interview, literature review and promotion of pilot practices, the Hospital Party Construction Guidance Committee of Guangdong Province staged a " Four Virtues" program to enhance Party construction at public hospitals in the healthcare system of the province. This program, featuring " leadership competency" , " Party branch capability" , " Party construction branding" , and " Unit showcases" , aims at the limited implementation and homogenization problems commonly found in Party construction at public hospitals. Promotion of successful pilot practices of several public hospitals effectively encouraged the " parallel development" of both medical service and Party construction, providing useful references for the hospitals in their reform/development and Party construction in the new era.
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Ultrasonic elasticity (UE) is a new type ultrasonic diagnosis technology able to directly measure elastic modulus and reflect muscle stiffness,which has gradually been applied to quantitatively evaluate the degree of post-stroke spasticity (PSS) and guide treatment. The research progresses of UE for evaluation PSS were reviewed in this article.
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Objective To analyze the clinical manifestation and genetic testing in a patient with Adams-Oliver syndrome (AOS) and summarize clinical and genetic characteristics of the dedicator of cytokinesis (DOCK) 6 gene related AOS through reviewing related references.Methods Information of the proband who was hospitalized in Affiliated Children Hospital of Capital Institute of Pediatrics in October 2016 and her family members as well as their DNA samples were collected.The gene sequencing was performed using next generation sequencing technology.Using "Adams-Oliver syndrome"and "DOCK6" as key words,the relevant articles were searched from the Pubmed,China National Knowledge Internet and Wanfang databases and reports of 19 cases were reviewed.Results The proband is an eight months old girl.She presented with severe developmental delay,terminal transverse limb defects and visual loss after birth,and then suffered from tonic seizures and myoclonic seizures at two months old.By physical examination she was found to have esotropia and visual loss.The distal phalanx and nail of the right second-fourth fingers were absent,while the phalangette of the left second-fourth fingers and bilateral distal phalanges of toes were short with small nails attachment.Thyroid function test showed hypothyroidism.The ocular fundus examination showed the residual vitreous artery in the left eye and the retinal pigment degeneration in the right eye.CT scan showed multiple bilateral periventricular calcification and cranial magnetic resonance imaging showed bilateral periventricular lesion.Two heterozygous mutations were identified in DOCK6 gene:one was a known pathogenic mutation (p.L1064Vfs*60),and the other was a novel splice site mutation (c.873+ 1G＞A).By analyzing this case and reported 19 cases,the common performances of DOCK6 gene related AOS included terminal transverse limb defects (20/20),aplasia cutis congenita (18/20),ocular abnormalities (13/20),seizures (12/20),mental retardation (12/20),microcephaly (10/20),cardiovascular malformations (10/20),intrauterine growth retardation (6/20).The mutation of the DOCK6 gene was found to be dominated by frameshift mutation and splice site mutation.Conclusions If either terminal transverse limb defects or aplasia cutis congenita was detected in a patient,AOS should be under consideration.In addition,autosomal recessive inheritance,nervous system and eyes involvement will further indicate DOCK6 gene related AOS.
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Objective To investigate the diagnostic value of combined detection of serum alpha fetoprotein (AFP),thymidine kinase 1(TK1)and secreted protein Dickkopf-1(DKK1)in patients with primary liver cancer(PHC).Methods 85 patients with PHC admitted to the hospital from August 2015 to October 2016 were selected as PHC group,and 73 patients with benign liver disease as benign liver disease group,and 80 ca-ses healthy subjects as the control group.The serum levels of AFP,TK1 and DKK1 were detected in three groups,and the differences in each group were compored,and the diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calcuated.The diagnostic value of each index was analyzed by logistic regression.Results The serum AFP,TK1 and DKK1 levels in PHC group were signifi-cantly higher than those in benign liver disease group and control group(P<0.05),the serum AFP TK1 and DKK1 levles in benign liver disease group were significantly higher than those in the control group(P<0.05);the sensitivity,accuracy and negative predictive value of AFP + TK1+ DKK1 joint detection were sig-nificantly higher than that in the single index detection(P<0.05);Logistic regression analysis showed that AFP,TK1 and DKK1 were closely correlated with the diagnosis of PHC(P<0.05).Conclusion The com-bined detection of serum AFP,TK1 and DKK1 can significantly improve PHC positive diagnosis rate,which is of great significance for clinical early diagnosis and effective treatment,and is worth popularizing.
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The credibility of the third-party mediation agencies in medical disputes lies in their own advantages of efficiency,neutrality,professionalism and objectivity.However,because of the differences of actual operation,the credibility of the third-party mediation agencies often is questioned by both doctors and patients and the public.Aiming at these,this paper would study the status and the pushing approach of the third-party mediation agencies credibility from the perspective of professionalism and neutrality,legislation,fundraising channels and supervision.
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After several in -depth investigations on the third party mediation mechanism of "Guangdong mode" in Guangdong Harmony Medical Dispute Mediation Committee and combined with the analysis of the domes-tic and foreign medical dispute disposal experience , this paper summed up five points that successful construction of harmonious mediation mechanism should grasp .The five points include the fairness of harmonious mediation thoughts , the feasibility of harmonious mediation paths , the justice of harmonious mediation mechanism , the suita-bility of harmonious mediation environment and the success of harmonious mediation results .Only when grasp these five points, couldit create a gradually harmonious doctor -patient relationship .
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After several in -depth investigations on the third party mediation mechanism of "Guangdong mode" in Guangdong Harmony Medical Dispute Mediation Committee and combined with the analysis of the domes-tic and foreign medical dispute disposal experience , this paper summed up five points that successful construction of harmonious mediation mechanism should grasp .The five points include the fairness of harmonious mediation thoughts , the feasibility of harmonious mediation paths , the justice of harmonious mediation mechanism , the suita-bility of harmonious mediation environment and the success of harmonious mediation results .Only when grasp these five points, couldit create a gradually harmonious doctor -patient relationship .
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The paper described efforts made by Guangdong province to achieve a goal of the healthcare reform Serious diseases can be treated within the county.In this reform,the province attempts such operation mechanisms as autonomous type,guided type and trusted type for the purpose of elevating the service capabilities of county-level public hospitals.To this end,four independent operation mechanisms have also been built for talent development,remuneration incentive,specialty development,and cost control.All these efforts aim at encouraging the hospitals to improve service capability and quality.
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Objective To identify the risk factors for the development of hypotension during craniotomy in patients with severe traumatic brain injury (TBI).Methods One hundred and seventy-five patients,aged ≥ 18 yr,undergoing emergency craniotomy for TBI,were selected.According to the occurrence of intraoperative hypotension (systolic pressure ＜ 90 mm Hg or the decreased amplitude ＞ 30％ of the baseline),all the patients were divided into 2 groups:hypotension group and non-hypotension group.The data including gender,age,preoperative Glasgow Coma Scale (GCS) score,pupils,preoperative systolic pressure,application of mannitol,hyperventilation,methods for induction of anesthesia,and decrease in intracranial pressure were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the independent risk factors for intraoperative hypotension.Results Fifty patients developed intraoperative hypotension,and the incidence was 28.57％.There was significant difference in preoperative systolic pressure,GCS score and changes in pupils between hypotension group and non-hypotension group (P ＜ 0.05).Logistic regression analysis showed that preoperative systolic pressure was the independent risk factor for hypotension during craniotomy in patients with severe TBI (P ＜ 0.05),and OR value (95％ confidence interval) was 1.019 (1.005-1.033),and regression coefficient was 0.019.Conclusion Preoperative systolic pressure is the independent risk factor for hypotension during craniotomy in patients with severe TBI.
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Objective To study the characteristics and regularities of Chinese drugs preparations ADR in order to improve the rational drug use.Methods A total of 112 cases of TCM ADR reports collected in 2009～2011 which have been presented to the Guangzhou ADR Monitoring Center.Results Of the 112 cases,26 kinds of drugs were involved,quinquagenarian were the main crowd,intravenous infusion was the main route of administration,the main types of TCM ADR were lesions of skin and accessories.Conclusion Great importance should be attached to TCM ADR monitoring to promote rational drug use in the clinic.
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OBJECTIVE@#To investigate the variation of senescent endothelial function by regulating the sphingosine-1-phosphate receptor type 2 (S1P2) expression in cultured human umbilical vein endothelial cells (HUVECs).@*METHODS@#The S1P2 receptor expression was regulated by transfecting the cDNA or shRNA of S1P2 in cultured HUVECs. The expression levels of S1P2 receptor in HUVECs were detected by RT-PCR and Western blot. EC chemotaxis was measured by the transwell migration assay. The wound healing assay was performed by a scratch wound model on EC monolayer. Matrigel morphogenesis assay was employed to assess the in vitro angiogenic responses.@*RESULTS@#After up-regulating the S1P2 expression in young ECs, the S1P-stimulated formation of a tubular-like network in Matrigel was dramatically diminished in transfected ECs (P<0.05). Quantification of the wound healing assay showed that transfected ECs grew much slower than young ECs (P<0.05). The chemotactic capability was significantly decreased in transfected ECs (P<0.05). Furthermore, the senescent-associated impairments were revoked by the downregulation of S1P2 receptor in senescent HUVECs.@*CONCLUSION@#The impaired functions (chemotactic, wound-healing and morphogenetic responses) in senescent HUVECs in vitro are mediated by S1P2 receptor.
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Humanos , Células Cultivadas , Senescencia Celular , Genética , Células Endoteliales de la Vena Umbilical Humana , Biología Celular , Fisiología , Interferencia de ARN , ARN Interferente Pequeño , Genética , Receptores de Lisoesfingolípidos , Genética , Metabolismo , Receptores de Esfingosina-1-Fosfato , Transfección , Regulación hacia ArribaRESUMEN
@#Objective To analyze the blood flow velocities in middle cerebral artery with Rasmussen encephalitis. Methods8 patients with Rasmussen encephalitis were detected bilateral middle cerebral artery in both period of onset and intermission during simple partial seizures with Transcranial Doppler. ResultsThe mean velocity variance between focus side and non-focus side was minimums among the 3 indexes observed. The mean velocity of MCA displayed uneven increase during seizures. ConclusionThe mean velocity was the most stable index for judging.
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@#ObjectiveTo discuss clinical significance of changes in cerebral blood flow velocities with Rasmussen encephalitis. Methods8 cases diagnosed as Rasmussen encephalitis were measured the blood flow velocities in middle cerebral artery (MCA) with transcranial Doppler in ictal and interictal seizures. ResultsIctal mean flow velocity in the ipsilateral MCA to the epileptogenic foci increased 14.02%～48.14% to interictal one, while it was -0.74%～22.63% in the contralateral MCA. ConclusionAn increased flow velocity has been found in the ipsilateral MCA to the epileptogenic foci during seizure in Rasmussen encephalitis patients.
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OBJECTIVE@#To determine the value of treadmill exercise test in predicting patients with moderate OSAHS treated by uvulopalatopharyngoplasty (UPPP) and tone base reduction or oral appliance.@*METHOD@#Sixty-six patients were treated by UPPP and tone base reduction or oral appliance. The data including PSG (AHI, SaO2) and treadmill exercise test (METs) was analysed.@*RESULT@#The success rate (percentage of patients with at least 50% reduction in AHI) of UPPP and tone base reduction was 86.7%, and 84.8% in oral appliance. The difference (AHI, SaO2, METs or the success rate) between the groups of postoperation or oral appliance was nonsignificant (P > 0.05).@*CONCLUSION@#As to moderate OSAHS, the UPPP and tone base reduction or oral appliance may be one of the effective therapy. The data including PSG (AHI, SaO2) and METs may be very useful in predicting effectiveness of treatment to OSAHS.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Prueba de Esfuerzo , Hueso Paladar , Cirugía General , Faringe , Cirugía General , Polisomnografía , Valor Predictivo de las Pruebas , Apnea Obstructiva del Sueño , Metabolismo , Cirugía General , Resultado del Tratamiento , Úvula , Cirugía GeneralRESUMEN
AIM:To investigate the influence of ovariectomy and estrogen replacemeot treatment on profile of gene expression in myocardium by cDNA microarray,and to characterize the targeting genes of estrogen.METHODS:cDNA microarray containing 1 400 rat cDNAs was used to study the genes differentially expressed in myocardium between sham(Ⅰ),ovariectomy(Ⅱ,OVX)and estrogen replacement treatment(Ⅲ,OVX+E2)group.Then down-regulated genes in myocardium of OVX rats were further confirmed by RT-PCR.RESULTS:177 genes were differentially expressed in myocardium between sham and OVX rats,with 91 genes up-regulated and 86 genes down-regulated in OVX rats.164 genes were differentially expressed in myocardium between OVX and OVX+E2 rats,with 113 genes up-regulated and 54 genes down-regulated in OVX rats.There were 54 genes differentially expressed in OVX compared to sham and OVX+E2.They are involved in membrane channels and transporters(18),cell receptors(9),intracellular transducers/effectors/modulator(7)and metabolism(6).Most of the genes(45)were down-regulated in OVX rats and up-regulated in OVX+E2 rats.RT-PCR test confirmed the results of cDNA microarray.CONCLUSIONS:Long-term estrogen replacement may influence the expression of genes involved in membrane channels and transporters,cell receptors,intracellular transducers/effectors/modulator and metabolism.Long-term estrogen replacement has some beneficial effects on ionic concentration and cardiac function which partially comes from the results of influence of expression on Na+,K+-ATPase and Na+/H+ exchanger.Estrogen has an inhibitory effect on the expression of dopamine receptor,which partially clarify the myocardial protection of estrogen.
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AIM: To study the molecular mechanism in modulation of expression of insulin receptor substrate-1 and-2 (IRS-1,-2) by estrogen and high concentration of insulin. METHODS: The 5′-regulatory regions of IRS-1 and IRS-2 gene were cloned into the pGL3 plasmid with luciferase reporter, and the clones were transfected into HeLa cells. The cells were incubated with estradiol (1 nmol/L) and high concentration of insulin (100 nmol/L). The relatively transcriptional activity of the 5′-regulatory regions of IRS-1 and IRS-2 gene was detected. RESULTS: It was found that the relatively transcriptional activity of the 5′-modulatory regions of IRS-2 reduced markedly after cells were incubated with 100 nmol/L insulin (P