"Without the need for a second visit" initiative improves patient satisfaction with updated services of outpatient clinics in China.

BACKGROUND: To implement the "without the need for a second visit" (WNASV) initiative in our hospital by optimizing the outpatient clinic services via an upgraded information system, in order to increase the quality of outpatient medical services and improve patients' satisfaction. METHODS: An Internet-based care delivery approach was developed and applied to improve the delivery of health care services, simplify the treatment process, and reduce patient waiting time. The patient waiting time and consultation time in the outpatient clinics of our hospital during the peak service intervals and the proportions of various payment methods for outpatient services during the period from May 2017 to September 2019 were retrospectively analyzed. Also, the patients' satisfaction with the outpatient process was surveyed. RESULTS: The waiting time for consultation was shortened from 32.25 min to 28.42 min; the consultation time was shortened from 6.52 min to 3.15 min; and the waiting time for payment decreased from 7.40 min to 4.31 min. The proportion of payment via a counter was reduced from 86.80 to 21.79%, the proportion of self-service payment increased from 9.99 to 16.05%, and the proportion of payment during a consultation increased from 3.21 to 61.91%. The scores of the patients' satisfaction with the outpatient services increased from an average of 89.10 points in 2017 to an average of 90.26 points in 2019. CONCLUSION: The continuous improvement of the service process markedly increases the efficiency of the outpatient services, and effectively improves patient's satisfaction with the outpatient process, this initiative thus deserves further application.

Reconstitute the damaged heart via the dual reparative roles of pericardial adipose-derived flk-1+ stem cells.

BACKGROUND: The pericardial adipose derived stromal cells (pADSC) own a developmental origin from the "second heart field" and thus favor myogenic differentiation. The present experiments extended our previous observation by defining a subset of pADSC marked with the expression of flk-1, a type II receptor for VEGF to efficiently enhance cardiac repair. METHODS AND RESULTS: Immunofluorescence and flow cytometry showed that flk-1 positive cells represented about 12% in the pericardial tissue and the total isolated pADSC. The purified flk-1 positive pADSC by magnetic sorting (flk-1pospADSC) show the ability of forming spherical structure in which both myogenic (cTnT+) and angiogenic (vWF+) precursors were concurrently generated in culture. After being intramyocardially transplanted into the ischemic hearts, flk-1pospADSC yielded superior structural repair to PBS control or flk-1negpADSC, characterized by the thickening of the infarcted wall in which both myogenesis and angiogenesis of microvasculature (preferentially with ϕ<50 µm) were significantly ensured (p<0.01). The structure benefits were also translated into a functional restoration 28 days after transplantation (EF=44% vs. 62%, p<0.01). Further pulse-chase labeling experiments with BrdU revealed that neomyogenesis and neoangiogenesis contribute in the structural repair. The newly formed myocardium was resulted from the proliferation of pre-existing cardiomyocytes that re-entered cell cycle (ki-67 positive). CONCLUSION: Flk-1pospADSC are capable of concurrently giving rise to both myogenic and angiogenic precursors in vitro and, after transplantation in vivo, to reconstitute the damaged heart by the neoformation of microvasculature and of cardiomyocytes and thus represent an attracting donor cells for stem cell-based therapy.

[Study on the total activity of PKC and the quantity of PKC (alpha, beta) in left auricle tissues of the patients with mitral disease and atrial fibrillation].

OBJECTIVE: To investigate the possible relation of atrial fibrillation (AF) with the total activity of protein kinase C (PKC) and the quantity of PKC (alpha, beta) in the left auricle tissues of the patients with mitral disease. METHODS: Thirty-five patients hospitalized for valve replacement surgery were divided into four groups: group A (simple mitral stenosis with AF), group B(simple mitral stenosis with sinus rhythm), group C(simple mitral regurgitation with AF), group D (simple mitral regurgitation with sinus rhythm), The total PKC, activity and the quantity of PKC alpha and PKC beta were measured and compared in an attempt to find out whether significant difference exists between the groups. RESULTS: There was no significant difference in total PKC activity between the four groups (P > 0.05). The quantity of PKC alpha in patients with AF was lower than that in patients with sinus rhythm, the quantity of PKC beta in patients with AF was higher than in patients with sinus rhythm. But these differences were not statistically significant (P > 0.05). CONCLUSION: Under conditions of the same rhythm and the same heart disease, the total PKC activity and the quantity of PKC (alpha, beta) of the four groups showed no significant difference. No obvious relation was seen between the total activity of PKC in left auricle tissue and the occurrence of AF in patients with mitral disease, but more research on the relation between AF and the quantity of PKC isoforms in left auricle tissues would be needed.

[Impact of cardiopulmonary bypass on free amino acid spectrum in plasma for patients with prosthetic valve replacement during the perioperative period].

OBJECTIVE: To investigate the impact of cardiopulmonary bypass (CPB) on free amino acid spectrum in plasma for patients with prosthetic valve replacement. METHODS: The concentrations of the free amino acid in plasma for 22 patients with prosthetic valve replacement were measured with pre-column derivatization of high-performance liquid chromatography. RESULTS: Compared with the preoperative data, the concentrations of some free amino acid in plasma decreased after the operation of cardiopulmonary bypass (CPB), especially some of the glucogenic amino acid and branch chain amino acid decreased significantly (P<0.05). CONCLUSION: The operation of cardiopulmonary bypass (CPB) can decrease the concentrations of some free amino acid in plasma for patients with prosthetic valve replacement. It is essential to give these patients proper nutrition support during perioperative period.

Myogenic differentiation and reparative activity of stromal cells derived from pericardial adipose in comparison to subcutaneous origin.

INTRODUCTION: Adipose tissue-derived stromal cells (ADSCs) are abundant and easy to obtain, but the diversity of differentiation potential from different locations may vary with the developmental origin of their mesenchymal compartment. We therefore aim to compare the myogenic differentiation and reparative activity of ADSCs derived from the pericardial tissue to ADSCs of subcutaneous origin. METHODS: Pericardial and inguinal adipose tissues from Wistar rats were surgically obtained, and the stromal fraction was isolated after enzymatic digestion. The phenotypic epitopes of the resultant two types of ADSCs were analyzed with flow cytometry, and the expression of transcriptional factors was analyzed with immunostaining. Furthermore, their potential toward adipogenic, osteogenic, and myogenic differentiation also was compared. Finally, the reparative activity and the resultant functional benefits were examined by allograft transplantation into an infarcted model in rats. RESULTS: ADSCs from two adipose sources showed identical morphology and growth curve at the initial stage, but inguinal ADSCs (ingADSCs) sustained significantly vigorous growth after 25 days of cultivation. Although both ADSCs shared similar immunophenotypes, the pericardial ADSCs (periADSC) intrinsically exhibited partial expression of transcription factors for cardiogenesis (such as GATA-4, Isl-1, Nkx 2.5, and MEF-2c) and more-efficient myogenic differentiation, but less competent for adipogenic and osteogenic differentiation. After in vivo transplantation, periADSCs exhibited significantly vigorous reparative activity evidenced by thickening of ventricular wall and pronounced vasculogenesis and myogenesis, although the majority of prelabeled cells disappeared 28 days after transplantation. The structural repair also translated into functional benefits of hearts after infarction. CONCLUSIONS: Although two sources of ADSCs are phenotypically identical, pericADSCs constituted intrinsic properties toward myogenesis and vasculogenesis, and thus provided more potent reparative effects after transplantation; therefore, they represent an attractive candidate cell donor for cardiac therapy.