Chemical constituents in different parts of Ixeris sonchifolia based on UPLC-LTQ-Orbitrap-MS~n / 中国中药杂志

The chemical constituents in stem leaf, root, and flower of Ixeris sonchifolia were identified by the ultra performance li-quid chromatography coupled with linear ion trap quadrupole-orbitrap mass spectrometry(UPLC-LTQ-Orbitrap-MS~n). The separation was performed on an Acquity UPLC BEH C_(18) column(2.1 mm×100 mm, 1.7 μm) with a mobile phase of water(containing 0.1% formic acid, A)-acetonitrile(B) with gradient elution. With electrospray ionization source, the data of 70% methanol extract from stem leaf, root and flower of I. sonchifolia were collected by high-resolution full-scan Fourier transform spectroscopy, data dependent acquisition, precursor ion scan, and selected ion monitoring in the negative and positive ion modes. The compounds were identified based on accurate molecular weight, retention time, fragment ions, comparison with reference standard, Clog P and references. A total of 131 compounds were identified from the 70% methanol extract of I. sonchifolia, including nucleosides, flavonoids, organic acids, terpenoids, and phenylpropanoids, and 119, 110, and 126 compounds were identified from the stem leaf, root and flower of I. sonchifolia, respectively. In addition, isorhamnetin, isorhamnetin-7-O-sambubioside and caffeylshikimic acid were discovered from I. sonchifolia for the first time. This study comprehensively analyzed and compared the chemical constituents in different parts of I. sonchifolia, which facilitated the discovery of effective substances and the development and application of medicinal material resources of I. sonchifolia.

Evaluation of adhesive bone conduction hearing aid in pediatric patients with unilateral congenital aural atresia / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the auditory efficacy and subjective satisfaction of adhesive bone conduction hearing aid in children with unilateral congenital aural atresia (UCAA). Methods: Ten subjects (5 males and 5 females) diagnosed with UCAA with an average age of 8.3 years old (ranged from 5 to 15) were included in Beijing Tongren Hospital, Capital Medical University from January to August 2019. The free sound field hearing threshold, word recognition score in quiet, speech reception threshold in noise and sound localization ability (results were measured by RMS error) tests were performed in unaided and aided situation, respectively. Subjective satisfaction questionnaires were also distributed to subjects. Paired t test and Wilcoxon signed rank test were used as statistical analysis methods. Results: The average hearing threshold in aided condition was improved by (21.9±4.4) dB (t=15.8，P<0.05). Speech recognition abilities were generally improved both under quiet and noise (P<0.05);however, when the binaural summation, squelch and head shadow effects were analyzed respectively, the binaural squelch effect was not statistically improved (P>0.05), while the other effects were improved in aided condition (P<0.05). In sound localization test, there was no significant difference of the RMS error value between the unaided and aided situation (P>0.05). The subjects got high satisfaction rates in three subjective questionnaires. Conclusion: The adhesive bone conduction hearing aid can provide significant audiological benefit for children with UCAA as well as raising the quality of their life.

Bonebridge implantation combined with simultaneous bilateral auricle reconstruction for bilateral congenital aural atresia / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the feasibility and safety of auricle reconstruction combined with Bonebridge implantation for bilateral aural atresia patients. Methods: A retrospective analysis was conducted for 36 cases(72 ears) who underwent Bonebridge implantation combined with bilateral auricle reconstruction from February 1, 2017 to January 15, 2020. All cases were bilateral congenital aural atresia and underwent Nagata auricle reconstruction for both sides simultaneously. Bonebridge implantations were performed during the second stage of auricle reconstruction. Results: All 36 patients healed well and had no surgical complications when discharged. The preoperative average bone conduction threshold of the patients was(8.5±5.8) dB HL and postoperative bone conduction threshold was (8.4±5.2) dB HL. There was no significant change after the implantation (P=0.724). The preoperative average air conduction threshold of was(64.9±7.4)dB HL and postoperative air conduction threshold was (24.0±5.3) dB HL, which had a significant change after the implantation (P<0.001). The hearing threshold with Bonebridge significantly decreased by 40.9 dB HL compared with the preoperative air conduction threshold(P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased by 62.5%, 63.5% and 72.2% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words and short sentences in noise environment were significantly increased by 55.9%, 58.9% and 69.9% respectively (P<0.001). After a follow-up of 18.3 months in average, the hearing results were stable and the aesthetic outcomes were satisfied. One patient had implant rupture and healed after revision surgery. Conclusions: With an integrated surgical procedure, patients with bilateral congenital aural atresia can complete bilateral auricle reconstruction and hearing implantation within six months. This integrated surgical procedure is safe and efficient, with a stable hearing improvement and good appearance.

The construction of the appraisal index system for the full-time scientific research personnel in general hospitals / 中华医学科研管理杂志

Objective:To construct a performance appraisal index system for the full-time scientific research personnel in general hospitals.Methods:Appraisal indexes and weight coefficients are determined by Documentary Analysis, Delphi Method and Analytic Hierarchy Process.Results:Weight coefficients of performance appraisal index system for the full-time scientific research personnel are determined after 3 rounds of expert consultation by using Analytic Hierarchy Process and calculating weight coefficients of evaluation indexes and combined weight coefficients.Conclusions:This system can introduce new evaluation methods for human resource management in general hospitals, help to evaluate the research capacity and work performance of full-time scientific research personnel comprehensively, and improve the evaluation system for full-time scientific research personnel.

Effect of sakubatril/valsartan on left ventricular systolic dyssynchrony in young patients with dilated cardiomyopathy / 中国医师进修杂志

Objective:To investigate the effect of sakubatril/valsartan on left ventricular systolic dyssynchrony in young patients with dilated cardiomyopathy (DCM).Methods:Forty-nine patients with left ventricular systolic asynchronism DCM from July 2017 to July 2018 in Guangdong Medical University Affiliated Hospital were randomly divided into two groups. The experimental group was treated with sakubatra valsartan and the control group was treated with lotensin for 12 months. Left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVESd) and ejection fraction (EF) were measured by two-dimensional color Doppler echocardiography. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), ejection fraction (EF) and systolic dyssynchrony index (SDI) of 16 segments were measured by three-dimensional color Doppler ultrasound. Plasma NT-proBNP was tested before and after treatment.Results:After treated for 12 months, three-dimensional color Doppler ultrasonography showed the LVEDV in the experimental group decreased significantly: (180.5 ± 42.7) ml vs. (160.5 ± 45.6) ml, P<0.05. The left ventricular systolic asynchronism (SDI) of 16 segments in the experimental group significantly improved, and the value of left ventricular SDI significantly decreased compared with that of the control group: (8.2 ± 3.6)% vs. (10.8 ± 4.1)%, P<0.05. Plasma NT-proBNP decreased more significantly in the experimental group compared with that in the control group: (105.54 ± 13.25) ng/L vs. (137.27 ± 14.36) ng/L, P<0.05. Conclusions:Sakubatril/valsartan can effectively improve left ventricular systolic dyssynchrony in young patients with dilated cardiomyopathy.

Simultaneous operations of vibrant soundbridge implantation and auricular reconstruction for patients with microtia and atresia / 中华整形外科杂志

Objective@#To discuss the safety and efficacy of simultaneous procedures of vibrant soundbridge implantation and auricular reconstruction with congenital external and middle ear malformation.@*Methods@#This is a retrospective study, including 6 patients, 5 boys and 1 girl, aged 7-12 years. All patients received simultaneous operations of vibrant soundbridge implantation and auricular reconstruction. The mean preoperative air conduction threshold was 64.8 dB HL at 0.5, 1, 2, and 4 kHz. The VSB was placed in the third stage of auricle reconstruction, if the soft tissue expansion was performed; otherwise, the VSB was implanted in the second stage. The satisfaction with reconstructed auricle, surgical complications, hearing improvement and speech discrimination scores were evaluated 6 months after surgery.@*Results@#All patients and their families reported satisfaction with their reconstructed auricle. There was no complications, including cartilage framework exposion, infection, hematoma, skin flap necrosis, facial paralysis, tinnitus, vertigo or others. Post-operatively, mean VSB-aided hearing threshold was 36.7 dB HL, which was reduced by 28.1 dB HL. The mean speech discrimination scores measured in a sound field with a presentation level of 65 dB SPL and 80 dB SPL were improved.@*Conclusions@#The simultaneous operations of auricle reconstruction and Vibrant Soundbridge implantation is an alternative method for patients with congenital microtia and atresia.

New Thinking on Medical Ethics / 中国医学伦理学

The ultimate goal of ethics and medical ethics is to promote the harmonious coexistence of human beings, to help health and to enhance the happiness index of human beings. With the development of society, the progress of medical science and technology, the complication of the relationship among people, the diversification of factors that influence health, the change of health reform and policy and the advance of globalization, the ethical is-sues involved in medical practice are increasingly intricate. The contradiction between doctor and patient in medical ethics is the focus point of moral rule and also the focus of medical ethics research. At present, medical ethics need to face the contradiction between the growing human health needs and all kinds of factors that threaten human sur-vival. At the same time, it still deals with various ethical problems caused by the development and evolution of hu-man health and ecology. In reality, many ethical problems in medical practice and the scope of medical ethics re-search have been beyond the field of medical research. The evaluation and research of ethical issues in medicine are not just the tasks of medical workers and medical ethics scholars, and it should adopt the way of collaboration of multidisciplinary scholars and arouse the common concern of the whole society.

Antibiotic Resistance Analysis of Haemophilus Influenzae and Moraxella Catarrhalis Strains Isolated from Children in Sichuan Province from 2013 To 2016 / 现代检验医学杂志

Objective To investigate the changing antibiotic resistance profile of Haemophilus influenzae and Moraxella catarrhalis strains collected from children in Sichuan province from 2013 to 2016,provide some reference for rational utilization of clinical antimicrobial agents.Methods Collected the infection data of Haemophilus influenzae and Moraxella catarrhalis strains isolated from children which reported in Sichuan Province Drug Resistance Monitoring Report from 2013 to 2016.The experimental results were analyzed by WHONET5.6 software.Results The prevalence of H.influenzae increased with time from 8.95％ in 2013 to 16.6％ in 2016.The prevalence of M.catarrrhalis increased with time from 4.16％ in 2013 to 6.34％ in 2016.Among the 15 896 clinical strains of H.influenzae,the highest resistance rate was to ampicillin,which was 71.6％ in 2016.The resistance rate to cefaclor also increased from 26.1％ in 2013 to 59.5％ in 2016 for increase of 33.4％.The insensitivity rate to azithromycin increased from 8.3％ in 2013 to 25％ in 2016.However,the insensitivity rate to ceftriaxone and moxifloxacin decreased in recent years and the susceptibility rate to ceftriaxone,cefotaxime,levofloxacin and moxifloxacin were higher than 90％ in each year.The resistance rate of H.influenzae strains from children were higher than the stains from all patients.The insensitivity rate to azithromycin in strains from children and all patients increased from 8.3％,10.2％ in 2013 to 25％,22.1 ％ in 2016,respectively.The 5 625 clinical strains of M.catarrrhalis re mained highly susceptible to the amoxicillin-clavulanic acid,ceftriaxone,cefotaxime,levofloxacin,ciprofloxacin (greater than 90％).The resistance rate to cotrimoxazole increased from 15.1 ％ in 2013 to 59.1 ％ in 2016.Conclusion H.influenzae are still susceptible to the third generation cephalosporins (greater than 90 ％),which can be used as the first choice in clinical practice.Nearly 70 ％ of these strains were resistant to ampicillin and cotrimoxazole,which is inappropriate for clinical therapy.The resistance rate to cotrimoxazole in the M.catarrrhalis strains from children increased from 15.1％ in 2013 to 59.1 ％ in 2016,and the resistance rate to the other test drug in M.catarrrhalis did not change much in the-year period.

The implantation of Bonebridge in bilateral congenital malformation of external and middle ear / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the auditory efficacy of Bonebridge implantation in patients with bilateral congenital malformation of external and middle ear.@*Methods@#Eleven cases (6 males and 5 females) had unilateral Bonebridge implantation. The age ranged from 8 to 26 and the average age was 16.9. Seven to ten days after operation, the first fitting was undergone. In acoustic sound field, the average auditory thresholds were respectively measured for unaided ears and Bonebridge implanted ears by pure tone auditory (PTA, 0.25, 0.5, 1, 2 and 4 kHz). For the group over 12-year-old, MSTM was applied to evaluate speech discrimination score (SDS). For the other cases, MLNT was used as the test material. The auditory efficacy post Bonebridge implantation would be analyzed and evaluated by comparing the differences between unaided ears and Bonebridge implanted ears.@*Results@#The bone conduction audibility threshold after Bonebridge implantation was as well as the preoperative. The auditory threshold with Bonebridge aided was improved to 25-35 dB HL, when compared to that of the unaided ears in the sound field. The SDS in the group over 12-year-old was improved about 50%; the efficacy was slightly limited for the other two cases (both less than 12 years old). Statistical analysis showed that there were significant differences between unaided ears and Bonebridge implanted ears in the sound field and SDS(P<0.05).@*Conclusions@#The auditory efficacy of Bonebridge is significant and noticeable in patients with bilateral congenital malformation of external and middle ear. Bonebridge provides a new and effective way for patient with congenital malformation of external and middle ear to reconstruct hearing.

Determination of Th17-related cytokine interleukin17 in patients of chronic otitis media with effusion / 中国耳鼻咽喉头颈外科

OBJECTIVETo study the role of interleukin 17 (IL-17) in the pathogenesis of chronic otitis media with effusion (COME).METHODSThe expression of IL-17 in middle ear effusion (MEE) and blood plasma were measured in 30 patients (48 ears) by means of Cytometric Bead Array (CBA), as well as in 20 normal volunteers.RESULTSCompared with the control group, the level of IL-17 significantly increased in the peripheral blood of COME patients (P<0.05). What was more, the level of IL-17 in the MEE was higher than that in peripheral blood of COME patients (P<0.05).CONCLUSIONIL-17, as an important immunoregulatory mediator, may play an important role in chronic course of COME.

The Impact of Universal Coverage Policy on Catastrophic Health Payments in Thailand / 中国卫生经济

Before 2002, the three existing basic medical security systems of Thailand covered 30% of the population, and the surplus population participated in the universal coverage(UC)policy of medical security system which promulgated in 2002. Since the implement of UC policy, it has improved the equity of medical service application and health financing, reduced Catastrophic Health Payments and low-income groups have obtained more benefits. The incidence rate of Catastrophic Health Payments decreased and the spending burden of catastrophic health expenditure in low-income groups decreased from 6.11%(2000)to 4.65%(2002).

Survey on the study habits of medical postgraduates in basic courses / 中华医学教育探索杂志

Objective To understand the study habits of medical postgraduates in basic cours-es so as to provide references for the reformation of teaching methods. Methods Totally 250 postgra-duates of grade 2010 in our university were investigated with self-made questionnaire. The contents of the questionnaire included basic condition of postgraduates, study methods and suggestions for teaching methods. Rate, percentage and Chi-square test were applied to do statistical analysis. Results Accor-ding to the results of the collected 246 copies of questionnaire, 91.5%(225/246) did not preview lessons before class, 93.5%(230/246) took notes in class, 78.9%(194/246) simply took notes in the book, 60.6%(149/246) preferred more detailed courseware and 27.2%(67/246) reviewed lessons after class. The percentage of simply taking notes in the book of local students (86.5%) was significantly higher than that of army ones (73.2%) (P=0.030), but the percentages of preferring more detailed courseware and reviewing lessons after class of local students were significantly lower than those of army ones (P=0.008, P=0.016). Conclusions The proportion of previewing before class is low among postgrauates. Postgraduates depend heavily on teachers and do not review after class in time. There are differences between local students and army students in taking notes and review habits. It is important to cultivate postgraduates’good study habits.

A comparison of four methods for laparoscopic hysterectomy / 中国微创外科杂志

0 05). No postoperative pyrexia and severe complications occurred in all the four groups. Conclusions The four procedures are all safe and feasible. The selection of these procedures is based on the patient’s individual conditions.

Analysis on the occurance rate of pneumothorax after percutaneous pneumocentesis / 介入放射学杂志

Objective　To analyze the influence of multiple variable factors on the occurance rate of pneumothorax associated with transthoracic needle aspiration biopsy of the lung. Methods　Fluoroscopically guided lung biopsies were performed in 46 patients. Variable factors were analyzed including lesion size, location, number of puncture, presence of emphysema and patients position after needle biopsy of the lung. Results　Pneumothorax occurred at 9 (19.6%) of 46 patients and that occurred at 4 (44.4%) of 9 emphysematous patients. Among them 2 necessitated chest drainage tube placement. The pneumothorax occurance rate was 30% (3/10) for lesions of diameter 3cm or less in size. In the dependent group, pneumothorax occurred in 4 of 20 patients (20%). In the nondependent group, pneumothorax occurred in 5 of 26 patients (19.2%). Conclusion　The correlation showed that increasing frequency of pneumothorax with decreasing size of lesions. An increased rate of pneumothorax was correlated with presence of emphysema. Patients with emphysema are more likely to have a symptomatic pneumothorax. No significant differences were found in the incidence of pneumothorax between patients placed with the puncture site dependent after biopsy and those placed with the puncture site nondependent.

Factors influencing health insurance patients hospitalization expenses for three disease entities / 中华医院管理杂志

Objective To identify the chief factors influencing health insurance patients' hospitali-zation expenses so as to provide basis for the control of irrational increase in medical expenses and reform in the mode of medical insurance payment. Methods All the medical insurance cases involving the three disease entities in two hospitals of a certain city for the past three years, which totaled 647, were collected and a statistical analysis was made of the possible influencing factors using multi-stepwise regression analysis. Results The factors influencing the health insurance patients' hospitalization expenses included choice of hospitals, length of stay, performance of operations, proportion of drug fees, and province- wide readjustment of medical service prices. Reducing length of stay and lowering proportion of drug fees were the key to controlling expenses. Conclusion It is imperative to formulate scientific diagnostic and treatment routines and expense standards for single disease entities, speed up and deepen reform in the medical insurance system, and, on the basis of trying out payment based on certain single disease entities, implement payment based on disease entities.