Résumé
Objective:To construct an evaluation index system for the reform of public hospital salary system and conduct empirical research, for reference in deepening the reform of public hospital salary system.Methods:Based on the building blocks of health systems and the Guiding Opinions on Pilot Work of Public Hospital Salary System Reform (Human Resources and Social Security Ministry 〔2017〕 No. 10), a preliminary index system was constructed. And the expert consultation method was used to determine the evaluation index system for public hospital salary system reform. The authors selected representative hospitals in Chaoyang district of Beijing with reform experiences of such salary system, and applied this index system for empirical research. Objective indexes were extracted from the hospital information system, which were used to evaluate relevant data before the reform (from 2016 to 2017) and after the reform (from 2018 to 2019); a questionnaire was customized based on the subjective indexes in the index system, which was used for a questionnaire survey on hospital staff, outpatient patients, and inpatients. A descriptive analysis was made on such indexes as hospital revenue and expenditure, medical expenses, salary levels, and satisfaction. The comparison of relevant data before and after the reform was conducted using one-way ANOVA. Results:This study constructed a public hospital salary system reform evaluation system, comprising 4 first-level indexes, 8 second-level indexes, and 38 third-level indexes. second-level indexes were salary level and structure, salary governance and information construction, health manpower and service provision, medical products and technology. There were 28 objective indexes and 10 subjective ones. The evaluation results of 4 representative public hospitals showed that the proportion of labor costs, hygiene materials income, treatment income, nursing income, and physician service fees to the total income increased as compared to that before the reform, with statistical significance ( P<0.05); The average medical expenses of discharged patients and the proportion of drug income (excluding traditional Chinese medicine slices) to total income decreased compared to that before the reform, and the difference was statistically significant ( P<0.05); The difference between the average medical expenses per outpatient visit and the proportion of surgical income to total income was not statistically significant ( P>0.05). There was no statistically significant difference in salary levels among employees of different genders, seniority, and educational backgrounds ( P>0.05). On the other hand, there was a statistically significant difference in salary levels among employees of different ages, majors, professional and technical titles, and employment types ( P<0.05). The actual salary of 636 employee was only 56.26% of the expected salary, and their total score of salary satisfaction was (3.33 ± 0.86) points. The scores of public service motivation, medical service quality, and job satisfaction were (3.52 ± 0.78) points, (3.91 ± 0.77) points, and (3.72 ± 0.65) points, respectively. The satisfaction scores of outpatient and inpatient patients were (4.64 ± 0.23) and (4.82 ± 0.45), respectively. Conclusions:The evaluation system for the reform of the salary system in public hospitals constructed in this study can comprehensively evaluate the effectiveness of hospital reform from a multidimensional perspective, combining quantitative and qualitative, subjective and objective aspects. It proves scientific and practical.
Résumé
Objective This study aims to investigate the sex difference in the hippocampus and parahippocampus in patients with bipolar disorder. Methods We acquired T1-weighted structural MRI from 133 bipolar type I patients (60 males) and 144 normal controls (81 males). The General Linear Model was used to examine the relationship between sex and brain volumes of the hippocampus and parahippocampus, with age and intracranial volume as covariates. Results Patients showed significantly smaller volumes of the bilateral hippocampus and parahippocampus (P<0.01). There were sex-by-diagnosis interactions in the left parahippocampus gyrus (F=6.534, P=0.044). Male patients had significant smaller volumes of the left parahippocampus gyrus compared to the male normal controls (P<0.001) whereas the volumes were not significantly different between female patients and female normal controls (P>0.05). Conclusion The results suggest sex difference in the left parahippocampus gyrus volume in patients with bipolar type I disorder, which deserves further investigation in the future bipolar imaging researches.
Résumé
Objective To explore the relationship between cognitive function and oxidative stress biochemical markers in patients with bipolar disorder. Methods One hundred forty-six patients who met the DSM-Ⅳ bipolar disorder diagnostic criteria including 83 patients with stable phase,42 patients with manic episodes and 21 patients with depression and 115 normal controls were recruited. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function. Biochemical indicators were measured including superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), catalase (CAT), malonaldehyde (MDA), total antioxidant capacity (T-AOC) and nitric oxide (NO). Results The immediate memory, speech function, attention, time-delay memory, and total score of patients in biphasic stable phase, manic phase, and depression were lower than those in the control group (P<0.01). The visual breadth scores of patients in manic and depression were lower than those in the control group (P<0.01), and the attention scores and total scores were lower than those in the stable group (P<0.01). The delayed memory score of patients with depression was lower than that of stable group (P=0.04). The MDA level of patients with manic episode and depression was higher than that of stable group (P<0.01); the level of NO in manic, depression and control group was higher than that in stable group, and CAT level was low in the stable phase group (P<0.05). In the stable phase group, the visual breadth (r=-0.50, P=0.04), attention (r=-0.67, P<0.01), delayed memory (r=-0.61, P=0.01) were correlated with GSH-PX respectively; time-delay memory was negatively correlated with T-AOC (r=-0.54, P=0.03). The speech function of the biphasic mania phase group was negatively correlated with SOD (r=-0.46, P=0.01). The immediate memory of the biphasic depression group was positively correlated with NO (r=0.61, P=0.02); delayed memory was positively correlated with CAT (r=0.67, P=0.01); speech function (r=-0.76, P<0.01) and cognitive total score (r=-0.59, P=0.03) were negatively correlated with GSH-PX. Conclusion Patients with bipolar disorder have varying degrees of cognitive decline and oxidative stress changes, and some antioxidant enzyme systems are associated with cognitive function.
Résumé
Objective To investigate the association between Gal-3 and the effect of perindopril on ventricular remodeling in ischemic heart failure rabbit.Methods A rabbit model of ischemic heart failure was made by ligationof the anterior descending branch of the coronary artery.Thirty rabbits were divided into sham operation group,heart failure group and perindopril group.Determination of cardiac function by echocardiography after 4 weeks of treatment respectively;mRNA expression and protein content of Gal-3 were detected by Real-time PCR or Western-blob.Serum Gal-3 level was determinated by ELISA.Results Compared with sham operation group,mRNA expression and protein content of Gal-3,type Ⅰ collagen and type Ⅲ collagen increased and the serum level of Gal-3 increased in heart failure group(P<0.05);compared with heart failure group,mRNA expression and protein content of Gal-3,type Ⅰ collagen and type Ⅲ collagen decreased and the serum level of Gal-3 was reduced in perindopril group(P< 0.05).Gal-3 was negativelycorrelated with heart function(r=-0.925,P<0.05).Conclusion Effect of perindopril inhibiting myocardial fibrosis,slowing the ventricular remodeling and improving heart function associated with level of Gal-3.
Résumé
AIM: To investigate the relationship between galectin-3 (Gal-3) and myocardial fibrosis, and to clarify the role of Gal-3 in ventricular remodeling in rabbits with ischemic cardiac insufficiency.METHODS: A rabbit model of ischemic cardiac insufficiency was established by ligation of the anterior descending branch of the coronary artery.The 20 rabbits were randomly divided into sham operation group and cardiac insufficiency group by random number table method.After 4 weeks of coronary artery ligation, the cardiac function was measured by cardiac echocardiogram.Real-time PCR and Western blot were used to detect the expression of Gal-3, type I collagen and type III collagen at mRNA and protein levels in the myocardium.The serum Gal-3 contents were measured by ELISA.HE staining and Masson staining were used to observe the degree of fibrosis development in myocardial tissues after infarction.RESULTS: Compared with sham operation group, the mRNA expression of Gal-3 in cardiac insufficiency group was significantly increased.At the same time, type I collagen, type III collagen and collagen type I/III ratio were also increased significantly.The protein contents of Gal-3, type I collagen and type III collagen were increased significantly.The serum Gal-3 levels were significantly increased.The pathological changes were observed in cardiac insufficiency group as the myocardial cell morphological disorder and marked hyperplasia of fibrous tissue were seen.CONCLUSION: Gal-3 aggravates myocardial fibrosis in rabbits with ischemic cardiac insufficiency, and promotes the ventricular remodeling and the occurrence of heart failure.
Résumé
Objective To observe the expression pattern of galectin-3 in heart failure rabbits after myocardial infarction and to explore the effect of galectin-3 on myocardial fibrosis and ventricular remodeling.Methods The left anterior descending coronary arterys of the rabbits were ligatured for model preparation.Twenty male rabbits were randomly divided into control group and experimental group.The control group was treated by thoracotomy.Cardiac function were detected by cardiac uhrasonography before and after 2,4,6 weeks.Serum samples were collected and galectin-3 level of the samples were further tested with ELISA before and after 2,4,6 weeks.The expression of myocardial fibrosis was detected by Masson staining in the experimental group and the control group at 6 weeks after operation.galectin-3 and collagen Ⅰ,collagen Ⅲ mRNA level of myocardial of the infracted zone were determinated via Real-Time PCR after 6 weeks operation.Calculate the ratio of collagen Ⅰ and collagenⅢ.Left ventricular mass were analysis and left ventricular hypertrophy index was calculated.Results Compared with the control group,the EF,EDD and LVPWD of the experimental group at 2,4 and 6 weeks after operation were significantly different(P < 0.01).Serum galectin-3 level of the experimental group more than control group (P <0.05).correlation analysis showed that serum galectin-3 level was negatively correlated with EF (r =-0.84,P =0.009),and positively correlated with EDD(r =0.905,P =0.020).The mRNA expression of galectin-3,collagen Ⅰ and collagen Ⅲ were significantly increased in the experimental group(P <0.01).The mRNA expression of galectin-3,collagen Ⅰ and collagenⅢ were all higher in the experimental group than that in the non-infarcted area (P < 0.01).The left ventricular mass and left ventricular hypertrophy index of the experimental group were significantly higher than control group (P < 0.01).Under the optical microscope,the myocardial cells in the experimental group were disordered,necrosis,edema,hypertrophy and thickening of myocardial fibers.Microvascular wall thickening and visible around a large number of blue-green collagen fibers and surrounded by segmented myocardial cells,myocardial interstitial fibrosis,collagen deposition and accompanied by a large number of inflammatory cell infiltration.Conclusion Galectin-3 reflects the degree of myocardial fibrosis in heart failure,and is involved in the pathophysiology of ventricular remodeling,but the mechanism remains unclear.
Résumé
Objective To observe the expression pattern of galectin-3 in heart failure rabbits after myocardial infarction and to explore the effect of galectin-3 on myocardial fibrosis and ventricular remodeling.Methods The left anterior descending coronary arterys of the rabbits were ligatured for model preparation.Twenty male rabbits were randomly divided into control group and experimental group.The control group was treated by thoracotomy.Cardiac function were detected by cardiac uhrasonography before and after 2,4,6 weeks.Serum samples were collected and galectin-3 level of the samples were further tested with ELISA before and after 2,4,6 weeks.The expression of myocardial fibrosis was detected by Masson staining in the experimental group and the control group at 6 weeks after operation.galectin-3 and collagen Ⅰ,collagen Ⅲ mRNA level of myocardial of the infracted zone were determinated via Real-Time PCR after 6 weeks operation.Calculate the ratio of collagen Ⅰ and collagenⅢ.Left ventricular mass were analysis and left ventricular hypertrophy index was calculated.Results Compared with the control group,the EF,EDD and LVPWD of the experimental group at 2,4 and 6 weeks after operation were significantly different(P < 0.01).Serum galectin-3 level of the experimental group more than control group (P <0.05).correlation analysis showed that serum galectin-3 level was negatively correlated with EF (r =-0.84,P =0.009),and positively correlated with EDD(r =0.905,P =0.020).The mRNA expression of galectin-3,collagen Ⅰ and collagen Ⅲ were significantly increased in the experimental group(P <0.01).The mRNA expression of galectin-3,collagen Ⅰ and collagenⅢ were all higher in the experimental group than that in the non-infarcted area (P < 0.01).The left ventricular mass and left ventricular hypertrophy index of the experimental group were significantly higher than control group (P < 0.01).Under the optical microscope,the myocardial cells in the experimental group were disordered,necrosis,edema,hypertrophy and thickening of myocardial fibers.Microvascular wall thickening and visible around a large number of blue-green collagen fibers and surrounded by segmented myocardial cells,myocardial interstitial fibrosis,collagen deposition and accompanied by a large number of inflammatory cell infiltration.Conclusion Galectin-3 reflects the degree of myocardial fibrosis in heart failure,and is involved in the pathophysiology of ventricular remodeling,but the mechanism remains unclear.
Résumé
<p><b>OBJECTIVE</b>To assess the association of neural development-related genes LIS1and TSNAX with bipolar disorder in a Chinese Han population.</p><p><b>METHODS</b>Three hundred and eight five patients (including 188 males and 197 females) from Guangzhou Brain Hospital with bipolar disorder meeting the Diagnostic and Statistic Manual of Bipolar Disorder (BDI) (Fourth Edition) criteria and 475 healthy controls from the local community were recruited. Ten single nucleotide polymorphisms (SNPs) of the LIS1 and TSNAX genes were genotyped by GoldenGate genotyping assay on an Illumina Beadstation 500 machine. Association analyses of SNPs and haplotypes were performed with Plink 1.07 software.</p><p><b>RESULTS</b>Analysis of the total sample has failed to find any association of SNP or haplotype of the two genes with BDI (P> 0.05). When patients were divided into subgroups with or without psychotic symptom, no significant association of the two genes was found with psychotic BDI or non-psychotic BDI (P> 0.05). No significant association was found between any SNP and haplotype of two genes and female BDI or male BDI, nor were significant association found between age of onset and LIS1 and TSNAX gene polymorphisms.</p><p><b>CONCLUSION</b>Our results indicated that LIS1 and TSNAX genes are not associated with susceptibility to bipolar I disorder in Chinese Han population.</p>
Sujets)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , 1-Alkyl-2-acetylglycerophosphocholine esterase , Génétique , Asiatiques , Ethnologie , Génétique , Trouble bipolaire , Ethnologie , Génétique , Études cas-témoins , Protéines de liaison à l'ADN , Génétique , Prédisposition génétique à une maladie , Génotype , Protéines associées aux microtubules , Génétique , Polymorphisme de nucléotide simpleRésumé
Objective To estimate brain grey matter volume changes and location of abnormal brain regions cerebrum in early stage of bipolar disorder I (BD),in order to provided objective basis for diagnosing early stages BD.Methods 1 7 cases of BD with duration less than 2 years and 1 7 normal controls were recruited in this study.The volumetric difference of grey matter between two groups were analyzed by using voxel-based morphometry(VBM)software.Statistical threshold was voxel> 100,P <0.001 (uncor-rected).Results Compared to the normal controls,the grey matter volume of BD patients decreased in the left dorcial anterior cingu-late cortex(ACC),left insular,right sub-genu ACC,left superior temporal cortex,bilateral hippocampus-parahippocampus-amydala and left posterior lobe of cerebellum(P <0.001).Conclusion The grey matter volume of early stage BD patients is decreased,main-ly locating in the bilateral limbic system,the superior temporal gyrus and the cerebellar cortex,which probably is the morphological appearance of pathomechanism in early stages of BD.