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@#Objective To systematically evaluate the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Methods We searched the CNKI, SinoMed, Wanfang data, VIP, PubMed, Web of Science, EMbase, The Cochrane Library database from inception to September 2022. Case-control studies, and cohort studies on risk factors for postoperative delirium after surgery for Stanford type A aortic dissection were collected to identify studies about the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Quality of the included studies was evaluated by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by RevMan 5.3 software and Stata 15.0 software. Results A total of 21 studies were included involving 3385 patients. The NOS score was 7-8 points. The results of meta-analysis showed that age (MD=2.58, 95%CI 1.44 to 3.72, P＜0.000 01), male (OR=1.33, 95%CI 1.12 to 1.59, P=0.001), drinking history (OR=1.45, 95%CI 1.04 to 2.04, P=0.03), diabetes history (OR=1.44, 95%CI 1.12 to 1.85, P=0.005), preoperative leukocytes (MD=1.17, 95%CI 0.57 to 1.77), P=0.000 1), operation time (MD=21.82, 95%CI 5.84 to 37.80, P=0.007), deep hypothermic circulatory arrest (DHCA) time (MD=3.02, 95%CI 1.04 to 5.01, P=0.003), aortic occlusion time (MD=8.94, 95%CI 2.91 to 14.97, P=0.004), cardiopulmonary bypass time (MD=13.92, 95%CI 5.92 to 21.91, P=0.0006), ICU stay (MD=2.77, 95%CI 1.55 to 3.99, P＜0.000 01), hospital stay (MD=3.46, 95%CI 2.03 to 4.89, P＜0.0001), APACHEⅡ score (MD=2.76, 95%CI 1.59 to 3.93, P＜0.000 01), ventilation support time (MD=6.10, 95%CI 3.48 to 8.72, P＜0.000 01), hypoxemia (OR=2.32, 95%CI 1.40 to 3.82, P=0.001), the minimum postoperative oxygenation index (MD=−79.52, 95%CI −125.80 to −33.24, P=0.000 8), blood oxygen saturation (MD=−3.50, 95%CI −4.49 to −2.51, P＜0.000 01), postoperative hemoglobin (MD=−6.35, 95%CI −9.21 to −3.50, P＜0.000 1), postoperative blood lactate (MD=0.45, 95%CI 0.15 to 0.75, P=0.004), postoperative electrolyte abnormalities (OR=5.94, 95%CI 3.50 to 10.09, P＜0.000 01), acute kidney injury (OR=1.92, 95%CI 1.34 to 2.75, P=0.000 4) and postoperative body temperature (MD=0.79, 95%CI 0.69 to 0.88, P＜0.000 01) were associated with postoperative delirium after surgery for Stanford type A aortic dissection. Conclusion The current evidence shows that age, male, drinking history, diabetes history, operation time, DHCA time, aortic occlusion time, cardiopulmonary bypass time, ICU stay, hospital stay, APACHEⅡ score, ventilation support time, hypoxemia and postoperative body temperature are risk factors for the postoperative delirium after surgery for Stanford type A aortic dissection. Oxygenation index, oxygen saturation, and hemoglobin number are protective factors for delirium after Stanford type A aortic dissection.
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OBJECTIVE@#To analyze the long-term trends of the changes in the equity of China's health workforce allocation to provide a reference for the more balanced and orderly development of China's health system.@*METHODS@#The Gini coefficient was used to evaluate the degree of equity in the allocation of health workforce between regions, and the Gini coefficients for the allocation of doctors and nurses based on population and regional gross domestic product (GDP) distribution were calculated respectively.@*RESULTS@#In 2019, the number of licensed (assistant) physicians per 1 000 population in China was 2.77, and the number of registered nurses per 1 000 population was 3.18. The Gini coefficient for the distribution of licensed (assistant) physicians by population was 0.141 in 2002, decreasing to 0.081 by 2014 and then remained stable. The Gini coefficient for the distribution of registered nurses by population was 0.164 in 2002 and decreased to 0.066 in 2018. The Gini coefficient for the distribution of licensed (assistant) physicians by GDP was 0.236 in 2002, decreased to 0.169 in 2013, then increased to 0.183 and remained stable. The Gini coefficient for the distribution of registered nurses by GDP was 0.206 in 2002, decreased to 0.150 in 2013, and then increased each year to 0.180 in 2019. The equity of the allocation of registered nurses by population was worse than the equity of the allocation of licensed (assistant) physicians in 2002, and in 2016, for the first time, exceeded that of licensed (assistant) physicians.@*CONCLUSION@#Equity in the allocation of health workforce across China has improved, but the improvement in equity between regions has hit a bottleneck, with health workforce allocation in the western regions still relatively scarce. Although nursing workforce allocation equity caught up with licensed (assistant) physicians, the number of licensed (assistant) physicians is close to that of developed western countries, while there is a large gap in registered nurses. It is recommended that the relevant authorities make good long-term planning for health workforce, further increase the policy for the introduction of health workforce in the western region, and increase the supply of healthcare services in the western region with the help of digital transformation of healthcare and internet healthcare. At the same time, they should further increase investment in resources for higher nursing education and actively plan to cope with the ageing population.
الموضوعات
Humans , China , Health Equity , Health Services , Health Workforce , Workforceالملخص
AIM: To evaluate the effect of 0.02% mitomycin-C(MMC)on the corneal density after transepithelial photorefractive keratectomy(Trans-PRK). METHODS: Retrospective case analysis. Selected 28 patients with 56 eyes in moderate myopia who underwent Trans-PRK surgery from January 2021 to June 2021 in our hospital. They were divided into MMC group in 28 eyes with a combination of 0.02% MMC 20s during the surgery and the control group in 28 eyes was not use MMC during the surgery. The Pentacam anterior segment analyzer was used to measured the corneal density in different diameter ranges and different thickness layers before and after surgery at 14d, and after surgery at 1 and 3mo.RESULTS: The total corneal density value of MMC group was 16.60(15.70,17.10 )before the surgery, after the surgery at 14d was 16.63(15.90,17.50 ), at 1mo was 16.57(15.10,16.70 ), at 3mo was 16.04(14.60,16.60 ). The total corneal density value of control group was 16.30(15.50,17.30 )before the surgery, after the surgery at 14d was 16.20(15.20,17.10 ), at 1mo was 16.08(14.90,16.40 )and at 3mo was 15.60(14.60,16.40 ). In the zone of 0-2mm diameter was centered on the corneal vertex, the corneal density of the two groups at 14d after the surgery was higher than those before surgery(P<0.001 ). In the zone of 2-6mm diameter, the corneal density of the two groups at 1mo and 3mo after surgery was higher than those before the surgery(P<0.001). In the zone of 6-10mm, the corneal density of the two groups at 14d, 1 and 3mo after surgery was higher than those before the surgery(P<0.001). In the layer of anterior 120 μm, the corneal density of the two groups at 1mo and 3mo after the surgery was decreased than that before surgery(P<0.01). In the middle layer, the corneal density of the two groups at 1mo after the surgery was decreased than those before surgery(P<0.01).CONCLUSION:The use of 0.02% MMC during the operation can reduce the corneal density and increase the corneal light transmittance in the early postoperative period. The occurrence and prognosis of haze can be effectively quantified by observing the changes of corneal optical density in different ranges in different time periods after operation.
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OBJECTIVE@#To study the economic burden of Crohn's disease and its related factors, and to provide opinions for reducing personal burden and improving reimbursement policy.@*METHODS@#Using a cross-sectional method, a self-created questionnaire based on the basic principles of health services research was used to survey Crohn's disease patients served by the Shanghai volunteer service foundation platform. Information collected included basic characteristics, therapy, and medical costs related to Crohn's disease in the past 12 months. Descriptive statistics were used to analyse the composition of inpatient and outpatient costs of Crohn's disease for treatment of the disease in the past year. Further, a logarithm-linear model was constructed to analyse the factors associated with the financial burden of Crohn's disease.@*RESULTS@#In the study, 820 questionnaires were distributed and 799 questionnaires were returned, of which 797 were valid. There were 528 (66.25%) males and 269 (33.75%) females. The mean age of the patients was (34.02±11.49) years, with a concentration between 18-39 years (510 cases, 63.99%) and a mean disease duration of (5.58±5.13) years. 10.7% of the patients did not receive continuous treatment, and the average annual treatment cost for the patients with continuous treatment was 54 246 Yuan, of which 30 279 Yuan (55.8%) was paid by the individuals and 23 966 Yuan (44.2%) was paid by the insurance. The personal financial burden was close to the national per capita disposable income in 2020, which was 32 189 Yuan (94.1%), exceeding the annual cost for type 2 diabetes in China in 2016, 8 245 Yuan. In terms of the distribution of outpatient and inpatient services, the average annual cost of inpatient services was 31 092 Yuan, of which 14 673 Yuan (48.5%) was paid out of pocket by the individuals and 16 418 Yuan (51.5%) was paid by the insurance; the average annual cost of outpatient services was 23 154 Yuan, of which 15 606 Yuan (65.1%) was paid out of po-cket by the individuals and 7 548 Yuan (34.9%) was paid by the insurance. The personal burden of outpatient care was higher than of inpatient care. The regression results of the logarithm-linear model showed that the total annual treatment cost was related to the duration of illness (β=0.03, P < 0.01), having complications (β=-0.68, P < 0.01), receiving surgical treatment (β=0.52, P < 0.01), using immunosuppressive drugs (β=0.51, P < 0.01), annual outpatient visits (β=0.02, P < 0.05), and number of hospitalizations per year (β=0.08, P < 0.01).@*CONCLUSION@#The annual financial burden for patients with Crohn's disease is heavy and rises significantly with the duration of illness, exceeding that of chronic diseases such as diabetes. The personal financial burden is close to the national per capita disposable income, and the medical security department should develop policies to reduce the financial burden. The inclusion of Crohn's disease as a special outpatient disease is a possible measure that could be considered in response to the fact that the outpatient personal financial burden is heavier than the inpatient's.
الموضوعات
Adult , Female , Humans , Male , Middle Aged , Young Adult , China/epidemiology , Cost of Illness , Crohn Disease/therapy , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Health Care Costsالملخص
Exposure to particulate matter 2.5 (PM2.5) potentially triggers airway inflammation by activating nuclear factor-κB (NF-κB). Sirtuin 2 (SIRT2) is a key modulator in inflammation. However, the function and specific mechanisms of SIRT2 in PM2.5-induced airway inflammation are largely understudied. Therefore, this work investigated the mechanisms of SIRT2 in regulating the phosphorylation and acetylation of p65 influenced by PM2.5-induced airway inflammation and bronchial hyperresponsiveness. Results revealed that PM2.5 exposure lowered the expression and activity of SIRT2 in bronchial tissues. Subsequently, SIRT2 impairment promoted the phosphorylation and acetylation of p65 and activated the NF-κB signaling pathway. The activation of p65 triggered airway inflammation, increment of mucus secretion by goblet cells, and acceleration of tracheal stenosis. Meanwhile, p65 phosphorylation and acetylation, airway inflammation, and bronchial hyperresponsiveness were deteriorated in SIRT2 knockout mice exposed to PM2.5. Triptolide (a specific p65 inhibitor) reversed p65 activation and ameliorated PM2.5-induced airway inflammation and bronchial hyperresponsiveness. Our findings provide novel insights into the molecular mechanisms underlying the toxicity of PM2.5 exposure. Triptolide inhibition of p65 phosphorylation and acetylation could be an effective therapeutic approach in averting PM2.5-induced airway inflammation and bronchial hyperresponsiveness.
الموضوعات
Animals , Mice , Inflammation , NF-kappa B/metabolism , Particulate Matter/toxicity , Signal Transduction , Sirtuin 2/metabolism , Transcription Factor RelA/metabolismالملخص
Objective:To clarify the long-term trend of nursing human resource allocation in China, and provide basis for relevant departments to optimize nursing human resource allocation.Methods:Data were extracted from China′s health statistical yearbook from 1990 to 2019. Six indicators of the number of registered nurses, the number of registered nurses per 1 000 population, the ratio of registered nurses to health technicians, doctor-nurse ratio, hospital bed-nurse ratio and nurse-patient ratio were used to make a descriptive statistical analysis on the changing trend of nursing human resources in China.Results:From 1990 to 2019, the number of registered nurses increased from 0.970 million to 4.445 million in China, with an average annual growth rate of 5.37%, the average annual growth rate was 2.23% from 1990 to 2005, 9.96% from 2006 to 2013, and 8.21% from 2014 to 2019. The number of registered nurses per 1 000 population increased from 0.85 to 3.18, with a 4.65% annual growth rate, the doctor-nurse ratio increased from 1∶0.55 to 1∶1.15, with a 2.58% annual growth rate, the hospital bed-nurse ratio increased from 1∶0.33 to 1∶0.50, and the average annual growth rate was 1.44%. The proportion of registered nurses to health technicians increased from 24.87% in 1990 to 43.84% in 2019, however, the number of registered nurses in hospitals accounted for about 73.00% of registered nurses in health institutions.Conclusions:From 1990 to 2019, the overall allocation efficiency of nursing human resources in China has been significantly optimized, and indicators such as doctor-nurse ratio and hospital bed-nurse ratio have improved, but the growth rate is slowing down. The relevant departments need to take necessary measures to further increase the absolute and relative number of nurses to cope with the increasing service demand.
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Objective To investigate the difference in behavioral and psychological symptoms among Al-zheimer's disease(AD)patients with different severity of white matter hyperintensity(WMH). Methods A total of 37 AD patients were enrolled and were followed-up for 4 weeks. They were checked by 3.0 T MRI at baseline, including T1,T2-weighted phase and fluid-attenuated inversion recovery sequence(FLAIR phase).The image pro-fessionals analyzed the images and process data.The Fazekas scale was used for WMH rating.Assessment tools in-cluded the Neuropsychiatric Inventory(NPI)、MMSE and ADAS-cog. Results There were 14 patients in none-mild WMH group and 23 patients in moderate-severe WMH group. The age of two groups were 71.3 ± 12.5 and 78.7 ± 6.1 years old respectively(P<0.05).The comparison of NPI,MMSE and ADAS-cog assessment results be-tween two groups show that there is significance difference in NPI baseline scoring and 4-week scoring.The score in moderate-severe group w is higher than that in the none-mild group(P < 0.05). However,the changed value of baseline-4-week NPI is not statistically significant. There is no significant difference between MMSE and ADAS -cog score and changed value.Conclusion Taken together,the severity of WMH may be related to behavioral and psychological symptoms of patients with Alzheimer's disease.
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Objective To observe the effect of postconditioning (PostC) on the expression of platelet-leukocyte aggregation (PLA) during the process of myocardial ischemia and reperfusion in rats, and to explore the mechanisms of ischemic postconditioning (PostC) alleviating myocardial ischemia-reperfusion injury (MIRI). Methods Sixty rats were randomly divided into six groups:sham,reperfusion injury(I/R),postconditioning(PostC),SP600125(inhibition of c-Jun N-terminal kinase,I-JNK),anisomycin and postconditioning(Ani+PostC)and anisomycin(Ani)groups.After constructing the model of myocardial ischemia reperfusion in rats,the levels of myocardial injury markers were detected by using the CK-MB kits and TnI kits. The levels of PLA at different time points were detected by using flow cytometry.The myocardial infarction area were measured by using 2.3.5-Triphenyte-trazoliumchloride(TTC)staining,and the level of phosphorylation of JNK(P-JNK) was determined by using Western blot method. Results (1) The levels of CK-MB, TnI and the infarct size were significantly higher in the I/R group than those in the Sham group(P<0.05).The levels of CK-MB,TnI and the infarct size were significantly lower in the PostC group and I-JNK group than those in the I/R group(P<0.05).Compared with the PostC group,the levels of CK-MB,TnI and the infarct size were significantly higher in the Ani+PostC group and Ani group(P<0.05).(2)Compared with the Sham group,the expression levels of PLA significantly increased in the I/R group at different time points after ischemia (P<0.05). At different time points of MIRI, the expressions of PLA increased gradually in I/R group, Ani+PostC group and Ani group (P<0.05). At the time point of reperfusion for 60 minutes and reperfusion for 3 hours,the expressions of PLA were significantly lower in the PostC group and I-JNK group compared with those of I/R group (P<0.05).Compared with the PostC group,the expressions of PLA were significantly higher in the Ani+PostC group and Ani group (P<0.05). (3) Compared with the Sham group, the expression levels of P-JNK were significantly higher in the I/R group(P<0.05).PostC and I-JNK inhibited the production of P-JNK(P<0.05),while Ani promoted the increase of P-JNK (P<0.05).Compared with the PostC group,the expression levels of P-JNK were significantly higher in the Ani+PostC group and Ani group (P<0.05). Conclusion PostC can reduce the expression of PLA during reperfusion by inhibiting the phosphorylation of JNK,thereby reducing myocardial ischemia-reperfusion injury.
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Objectives:To explore the possible mechanisms of ischemic postconditioning on alleviating myocardial ischemia-reperfusion injury, focusing on the inflammatory-thrombus related mechanisms. Methods:Rats were randomly divided into six groups (n=10 each):sham group, ischemia-reperfusion injury group, postconditioning group, SB203580 group, anisomycin+postconditioning (Ani+postconditioning) group and anisomycin (Ani) group. After establising the model of myocardial ischemia reperfusion in rats, the levels of myocardial injury markers troponin I (TnI) and creatine kinase isoenzyme (CK-MB), level of leukocyte-platelet aggregation (PLA) were detected by flow cytometry at different time points, myocardial infarction area was measured by using TTC staining and the level of phosphorylation of p38 MAPK (P-p38 MAPK) was determined by Western blot. Results:Compared with the I/R group, the levels of CK-MB, TnI, the infarct size and the expression of PLA at 60 min and 3 h reperfusion were significantly reduced in the postconditioning group and SB203580 group (P＜0.05). Compared with the postconditioning group, the levels of above parameters were significantly higher in the SB203580 group, Ani+postconditioning group and Ani group (P＜0.05). Compared with the I/R group, the expression of P-p38 MAPK in the postconditioning group, SB203580 group, Ani+postconditioning group was significantly reduced (P＜0.05), while it was significantly upregulated in the Ani group (P＜0.05). Furthermore, compared with the postconditioning group, the expression of P-p38 MAPK in the Ani+postconditioning group and Ani group was significantly upregulated (P＜0.05). SB203580 group presented the similar protection effect as the postconditioning group. Cardioprotective effects of postconditioning was partially reduced in the Ani+postconditioning group. Conclusions:Ischemia postconditioning can reduce the expression of PLA during reperfusion by inhibiting the phosphorylation of p38MAPK, thereby attenuating myocardial ischemia-reperfusion injury.
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Objective To discuss the clinical features of behavioral and psychological symptoms of demen-tia(BPSD)and the relation between different sub-clinical syndromes and cognition. Methods One hundred and sixteen dementia patients were assessed with neuropsychiatric inventory and mini-mental state examination (MMSE)and made factor analysis according to DSM-IV-R. Results Twelve common behavioral and psychological symptoms could be further divided into five sub-syndromes,including disinhibition behavior,psychosis,agitation, emotion and apathy factors. MMSE total score and years of education entered regression equation of apathy factor (P<0.05). Conclusion BPSD can be divided into five factors and apathy factor are related with cognitive function.
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AIM: To explore the long-term efficacy of Q-factor guided laser epithelial keratomleusis ( LASEK ) for myopia and astigmatism with positive Q-factor. METHODS: There were 158 eyes which were myopia and astigmatism with positive Q- factor taken in two groups randomly: 86 eyes accepted Q - factor guided LASEK as observation group and 72 eyes accepted routine LASEK as control group. The difference between the two groups about all data was similar. The uncorrected visual acuity ( UCVA ) and the best corrected visual acuity ( BCVA ) as well as diopter, ocular tension, corneal topography, Keratometry value K, aspherical factor Q, Higher-order aberrations ( HOA ) , corneal thickness by ultrasound and, contrast sensitivity ( CS ) , Haze were examined and compared before and after surgery. All the cased were followed up for 14d, 1, 3, 6, 12mo. And there were no statistical difference among the data before surgery. RESULTS: After 12mo there were no statistical difference between the two groups about UCVA and BCVA. But the safety index of observation group was 1.10, that of control group was 1. 07. The validity index of observation group was 1. 06, that of control group was 0.99. The HOA of observation group was 0. 45±0. 17μm, and that of control group was 0. 72±0.25μm, there was statistically significant difference (t=-8. 193,P=0. 000). Q factor of observation group was 0. 41±0. 17, that of control group was 0. 77±0. 22, there was significant difference (t=11. 377,P = 0. 028). The contrast sensitivity of 3mo post surgery of patients in the observation group returned to the level of before surgery. But in the control group the contrast sensitivity of the patients did not returned until 6mo. CONCLUSION:Q-factor guided LASEK for myopia and astigmatism with positive Q-factor is stable, safe and effective. The operation allow for reducing the high order aberrations, maintaining the most asphericity of cornea, saving more in corneal tissue, which cause faster recovery of contrast sensitivity, less haze and better visual quality.
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Objective To investigate the relationship between the 5-hydroxytryptamine (5-HT)1A receptor gene C(-1019)G polymorphism and geriatric depression and Alzheimer′s disease (AD) with depressive symptoms in Han Chinese. Methods The case control study was used in the study among 106 patients with geriatric depression, 72 AD patients with depressive symptoms and 150 healthy old individuals in China. The C(-1019)G polymorphism of 5-HT1A was analyzed with the technique of polymerase chain reaction-restriction fragment length polymorphism. Results The frequencies of 5-HT1A genotype C/G (39.6%), G/G(24.5%) and allele G (44.3%) in the patients with geriatric depression were significantly higher than those in the controls (respectively 35.3%, 13.3%, 31.0%, P 0.05). Conclusion The 5-HT1A gene C (-1019)G polymorphism may be associated with geriatric depression and AD with depressive symptoms and (-1019)G allele may be a risk factor for them.