An evaluation of outpatient satisfaction based on the national standard questionnaire: a satisfaction survey conducted in a tertiary hospital in Shenyang, China.

Background: Patient satisfaction survey serves as a pivotal tool in evaluating the quality of healthcare services. China's nationwide standard patient satisfaction measurement tool was introduced in 2019. This study aimed to assess the model fit of the national standard outpatient satisfaction questionnaire in a tertiary hospital and evaluate the outpatient satisfaction levels using this tool. Method: A cross-sectional survey using the national outpatient satisfaction questionnaire was conducted via message links to all hospital outpatients who registered between April and July 2022. The data collected underwent descriptive analysis, comparative analysis, and confirmatory factor analysis (CFA). Results: A total of 6,012 valid responses were received and analyzed during this period, with 52.9% of the participants being women. The confirmatory factor analysis (CFA) model showed a good fit and identified doctor communication as having a positive effect and environmental factors as having a negative effect on outpatients' satisfaction, with standardized regression weights of 0.46 and 0.42, respectively. Despite the remarkably high satisfaction levels, patients' recommendation for using the services of this hospital surpassed the overall evaluation and total satisfaction scores. Conclusion: A disparity was identified between the expectations and real experiences of outpatients, leading to some extent of dissatisfaction. To enhance satisfaction levels, the hospital should improve the communication skills of all clinical staff, simplify the environment layout for first-time visitors, and manage patient overloads.

Bone marrow stromal cell antigen 2(BST2) suppresses the migration and invasion of trophoblasts in preeclampsia by downregulating matrix metallopeptidase 2(MMP2).

Preeclampsia is a grievous pregnancy-related complication with an incidence of approximately 5∼7% in pregnant women. Placental abnormalities and decreased placental perfusion associated with impaired trophoblast invasion are early pathological findings of preeclampsia. BST2 is a multifunctional transmembrane protein that plays critical roles in physiological and pathological processes, but its impacts and mechanisms of action in preeclampsia are inadequately understood. The aim of this manuscript was to investigate the functional impacts of BST2 and MMP2 on the biological behavior of trophoblast cells in preeclampsia. The expression of these proteins and their genes was analyzed by qRT-PCR, western blotting and immunohistochemistry. The results showed that the expression of BST2 and MMP2 was significantly downregulated in preeclampsia. The migration and invasion capacities of HTR-8/SVneo and JAR cells with overexpression or knockdown of BST2 were detected by wound healing assay and Transwell assays. It was found that BST2 overexpression could up-regulate MMP2 expression, and enhance the migration and invasion capacity of HTR-8/SVneo and JAR cells. BST2 knockdown could reverse these effects. MMP2 knockdown could downregulate the invasion capacity of HTR-8/SVneo cells, and MMP2 overexpression reversed these effects. Pearson correlation analysis demonstrated that the expression of MMP2 and BST2 were positively correlated. These results indicate that the downregulation of BST2 lowers MMP2 expression and restraint trophoblast functions, which probably explain its role in the pathogenesis of preeclampsia.

Inhibitory effects of JQ1 on listeria monocytogenes-induced acute liver injury by blocking BRD4/RIPK1 axis.

Listeria monocytogenes (LM) is a facultative intracellular bacterium that causes septicemia-associated acute hepatic injury. However, the pathogenesis of this process is still unclear, and there is still a lack of effective therapeutic strategy for the treatment of LM-induced liver injury. In this study, we attempted to explore the effects of necroptosis on bacterial-septicemia-associated hepatic disease and to explore the contribution of JQ1, a selective BRD4 inhibitor, to the suppression of necroptosis and inhibition of LM-triggered hepatic injury. The results indicated that hepatic BRD4 was primarily stimulated by LM both in vitro and in vivo, along with significantly up-regulated expression of receptor-interacting protein kinase (RIPK)-1, RIPK3, and p-mixed lineage kinase-like (MLKL), showing the elevated necroptosis. However, JQ1 treatment and RIPK1 knockout were found to significantly alleviate LM-induced acute liver injury. Histological alterations and cell death in hepatic samples in LM-infected mice were also alleviated by JQ1 administration or RIPK1 deletion. However, JQ1-improved hepatic injury by LM was abrogated by RIPK1 over-expression, suggesting that the protective effects of JQ1 took place mainly in an RIPK1-dependent manner. In addition, LM-evoked inflammatory response in liver tissues were also alleviated by JQ1, which was similar to the findings observed in mice lacking RIPK1. The anti-inflammatory effects of JQ1 were diminished by RIPK1 over-expression in LM-infected mice. Finally, both in vivo and in vitro experiments suggested that JQ1 dramatically improved hepatic mitochondrial dysfunction in LM-injected mice, but this effect was abolished by RIPK1 over-expression. In conclusion, these results indicated that suppressing BRD4 by JQ1 could ameliorate LM-associated liver injury by suppressing necroptosis, inflammation, and mitochondrial dysfunction by inhibiting RIPK1.

Biological nitrogen removal in a step-feed CAST with real-time control treating municipal wastewater.

The performance of a 18 L step-feed cyclic activated sludge technology (CAST) combined with real-time control treating real municipal wastewater was evaluated. The operation strategies employed pH and oxidation reduction potential (ORP) as on-line control parameters, which can control the durations of oxic and anoxic phases flexibly. The obtained results showed that the studied process had achieved advanced and enhanced nitrogen removal by several phases of consecutive oxic/anoxic periods. Total nitrogen in effluent was lower than 2 mg/L and the average TN removal efficiency was higher than 98%, while only requiring small amount of external carbon source. Unexpected characteristic points in pH and ORP profiles denoting the depletion of nitrate were also observed during the last anoxic phase. Denitrification rate was found to be more dependent on the system temperature compared to nitrification rate. Moreover, a stable and efficient phosphorus removal rate above 90% was achieved by using step-feed strategy which enabled the influent carbon source to be fully used and the favourable condition for phosphorus releasing to be created during the anoxic phases.

Feedforward-feedback control of dissolved oxygen concentration in a predenitrification system.

As the largest single energy-consuming component in most biological wastewater treatment systems, aeration control is of great interest from the point of view of saving energy and improving wastewater treatment plant efficiency. In this paper, three different strategies, including conventional constant dissolved oxygen (DO) set-point control, cascade DO set-point control, and feedforward-feedback DO set-point control were evaluated using the denitrification layout of the IWA simulation benchmark. Simulation studies showed that the feedforward-feedback DO set-point control strategy was better than the other control strategies at meeting the effluent standards and reducing operational costs. The control strategy works primarily by feedforward control based on an ammonium sensor located at the head of the aerobic process. It has an important advantage over effluent measurements in that there is no (or only a very short) time delay for information; feedforward control was combined with slow feedback control to compensate for model approximations. The feedforward-feedback DO control was implemented in a lab-scale wastewater treatment plant for a period of 60 days. Compared to operation with constant DO concentration, the required airflow could be reduced by up to 8-15% by employing the feedforward-feedback DO-control strategy, and the effluent ammonia concentration could be reduced by up to 15-25%. This control strategy can be expected to be accepted by the operating personnel in wastewater treatment plants.