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Huangqitang comes from the Taiping Huimin Hejiju Fang of the Song dynasty. It consists of four medicinal materials: Astragalus membranaceus var. mongholicus, Citrμs reticμlata, Cannabis sativa, and Apis cerana. It is a classic prescription for treating constipation in the elderly. This study systematically collated the literature records about Huangqitang in ancient Chinese medicine books and combined it with the current status of modern clinical applications to conduct in-depth analysis and research on the origin,composition, dosage, processing, preparation and administration, drug base, main symptoms, and other key information of the formula, so as to provide a strong reference for the development and clinical application of the classic Huangqitang compound preparation. Through systematic combing and textual research on the previous literature of Huangqitang, it can be seen that the formula of Huangqitang was first recorded in the Taiping Huimin Hejiju Fang, and the medical books of the past dynasties mostly adopted this formula. In terms of drug base, the dried roots of the leguminous plant Astragalus membranaceus var. mongholicus are used, and for tangerine, the dried outer peel of the Rutaceae plant Citrus reticμlata and its cultivated varieties are used. The Moraceae plant Cannabis sativa with the peel removed is selected, and the Apis cerana is selected from the honey brewed by Apis cerana, an insect of the Apidae family. In terms of dosage, although the dosage of some drugs changed during the Ming and Qing dynasties, the dosage records basically followed the original prescriptions from the Song dynasty. In terms of processing, preparation, and usage, although the drug processing, preparation, and usage of Huangqitang in the medical books of the past dynasties have changed slightly, they are basically the same as the original prescription of the Song dynasty. In terms of main symptoms, Huangqitang is designed to treat constipation in the elderly. From the Song dynasty to the Qing dynasty, it was mostly used to treat constipation, secret congestion, asthenia, etc. in the elderly. In modern times, it is clinically used to treat constipation due to Qi deficiency, functional constipation, irritable bowel syndrome, and other diseases in the elderly. No adverse reactions have been found yet. In the subsequent research and development, it is necessary to carry out mass spectrometry analysis of Huangqitang, in-depth exploration of its prescription efficacy and mechanism of action, and other multi-omics scientific research. At the same time, it is important to establish quality control standards to provide a reliable scientific basis for the research and development, clinical treatment, and drug supervision of Huangqitang compound preparations.
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OBJECTIVE: To explore the underlying mechanism of acupuncture on nerve repair by investigating its effect on the differentiation of glial cells and the repair of glial scars. METHODS: Sprague-Dawley rats were randomly allocated to three groups: normal group, model group, and acupuncture group. Acupuncture was applied at Renzhong (GV26), Baihui (GV20), Fengfu (GV16), Yamen (GV15) and Hegu (LI4) within 12 h after TBI modeling with a frequency of one session per day for 4 weeks. Neurobehavioral assessment, hematoxylin and eosin staining, immunofluorescence detection, and magnetic resonance imaging scanning were performed on days 3, 7, 14, and 28 after modeling of traumatic brain injury (TBI). RESULTS: Acupuncture promoted the proliferation of glial cells and glial scars at an early stage but inhibited the proliferation of glial cells and glial scars at a late stage. Morphological observations and immunofluorescence histochemistry showed that the morphology of the perilesional cortex in the acupuncture group was improved and the number of neurons was increased when compared with the model group. The lesion size of ipsilateral brain parenchyma in the acupuncture group was smaller than in the model group on days 7, 14, and 28 ( < 0.05) after TBI modeling. CONCLUSIONS: Acupuncture might have a bidirectional regulatory effect on glial scar repair after TBI by promoting the proliferation of glial cells and glial scars to limit the injured area and relieve nerve injury during the early stages, and by inhibiting glial scar hyperplasia to benefit the regeneration and repair of neurons and axons and promote neurological function recovery during the later stages.
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Terapia por Acupuntura , Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Ratas , Animales , Ratas Sprague-Dawley , Gliosis , Lesiones Traumáticas del Encéfalo/terapia , Lesiones Encefálicas/terapiaRESUMEN
Intracytoplasmic sperm injection (ICSI) is an important treatment option for male infertility at pre-sent.However, a few patients still suffer from repeated ICSI fertilization failure because their sperm is unable to activate oocytes.Artificial oocyte activation (AOA) technology can improve the fertilization rate, pregnancy rate, live birth rate, etc., but it remains unknown whether AOA has short- and long-term effect on offspring.In this article, recent literature about the effect of AOA technology on perinatal outcomes, genetics, physical development and neurological development of offspring was summarized.This paper aims to provide reference for reproductive medicine workers and pediatricians in clinical practice.
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Objective:To investigate the effect of oral glucocorticoid dose on maternal and infant outcomes in female patients with systemic lupus erythematosus(SLE), thus providing reference for clinical work.Methods:Clinical data of pregnant women with SLE admitted to Department of Obstetrics, Peking University People′s Hospital from July 2015 to June 2020 were retrospectively analyzed.According to the daily oral glucocorticoid dose during pregnancy(equivalent converted to Prednisone), pregnant women were divided into 2 groups: ≤7.5 mg group(67 cases) and >7.5 mg group(74 cases). The maternal and fetal outcomes of the 2 groups were analyzed by t-test or χ2 test or Fisher′ s exact probability method. Results:The neonatal birth weight, birth length, white blood cell count and platelet count in ≤7.5 mg group were significantly higher than those in >7.5 mg group[(2 990.69±532.20) g vs.(2 734.57±608.35) g, (48.97±2.34) cm vs.(47.43±3.38) cm, (17.69±6.16)×10 9/L vs.(15.11±6.00)×10 9/L, (276.92±74.51)×10 9/L vs.(240.05±69.29)×10 9/L], while the incidence of low birth weight and neonatal transfer rate were significantly lower(13.85% vs.30.43%, 12.31% vs.33.33%) ( t/ χ2=2.587, 3.068, 2.354, 2.841, 5.301, 8.321, all P<0.05). Meanwhile, the incidence of maternal complications like hypertension disorders in pregnancy and gestational diabetes mellitus in the ≤7.5 mg group were lower than those in the >7.5 mg group, but the incidence of anemia and postpartum hemorrhage increased, although no significant differences were detected (all P>0.05). Conclusions:The overall maternal and fetal outcomes of patients with SLE with oral Prednisone ≤7.5 mg/d were better those medicated >7.5 mg/d, but the incidence of anemia during pregnancy and postpartum hemorrhage was higher.An individual monitoring and treatment should be concerned to improve the maternal and infant outcomes.
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Objective:To compare the actual situation and measurement data of human resources deployment in public general hospitals in Pudong New Area, so as to provide a data basis for further optimizing the human resources deployment plan.Methods:The Pudong New Area Health Statistical Information System was used to collect the staffing information and business data of 9 public general hospitals in Pudong New Area, Shanghai in 2019. On such basis, the numbers of officially budgeted positions and actual positions were calculated. Descriptive analyses of the data were performed to compare the theoretical and actual quantities by paired t-test and Wilcoxn signed-rank sum test. Results:The actual number of officially budgeted positions of the 9 hospitals was less than the theoretical number( Z=-2.55, P=0.011), while the actual number of positions was less than that of theoretical number( t=3.36, P=0.010). The proportion of the officially budgeted position shortage at tertiary hospitals(72.77%)was higher than that of secondary hospitals(36.94%). The proportion of position shortage at tertiary hospitals(16.14%)was less than that at secondary hospitals(38.78%). Conclusions:Area-owned general hospitals are in shortage of human resources, while secondary and tertiary hospitals have different needs for human resources. The actual situation of a hospital should be comprehensively considered to develop an optimal deployment plan for human resources.
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Objective:To investigate the effect of reproduction on maternal and infant outcomes in female patients with systemic lupus erythematosus (SLE).Methods:Clinical data of SLE patients complicated with pregnancy admitted in the Peking University People′s Hospital from July 2015 to December 2019 were analyzed retrospectively.According to the history of live birth, SLE patients complicated with pregnancy were divided into primiparity group (94 cases) and reproduction group (32 cases). Maternal and infant outcomes of the 2 groups were analyzed.Results:A total of 126 SLE patients complicated with pregnancy were included in the present study.The proportion of using immunosuppressants was significantly lower in reproduction group than that of primiparity group [3 cases (9.38%) vs.27 cases (28.72%)] ( χ2=4.927, P=0.026). Complications like lupus nephritis, thyroid disease and postpartum hemorrhage significantly increased in the reproduction group (all P<0.05), and the adverse neonatal outcomes like preterm infants, low birth weight infants and small for gestational age infants in the reproduction group were lower than those in primiparity group, but no significant differences were detected(all P>0.05). There were no significant diffe-rences in the results of the first blood routine examination of newborns and the incidence of neonatal pathological jaundice between the 2 groups (all P>0.05). Conclusions:For SLE patients complicated with reproductive pregnancy, although the incidence of some pregnancy complications increases, the incidence of adverse neonatal outcomes decreases.In addition, reducing the use of immunosuppressants may have positive implications on neonatal outcomes.
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An all-fiber laser using polarization-maintaining and ring-core fibers that are capable of automatically generating stable TE01 and TM01 modes is proposed and demonstrated experimentally. Two vector-mode coupling long-period fiber gratings (LPFGs) fabricated by a high-frequency CO2 laser are used in the fiber laser to realize efficient coupling between HE11 mode and TE01/TM01 mode. The polarization dependence of the LPFGs is simulated using the coupled-mode theory and verified by experiments. A ring-core fiber is employed to support the stable propagation of TE01 and TM01 modes. By carefully aligning the polarization direction of the input light, the mode coupling ratios of both LPFGs exceed 15 dB. The mode purities of TE01 and TM01 modes are 92.4% and 97.3%, respectively. Owing to the all-polarization-maintaining structure, the laser output is highly stable under environmental disturbance. This laser can be used as a stable cylindrical vector beam source for a wide range of applications, including surface plasmon excitation, optical tweezers, high-resolution metrology and so on.
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Objective@#To probe the prognostic value of consolidation chemotherapy in non-favorable acute myeloid leukemia (AML) patients who were candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT) with first complete remission (CR1) and negative minimal residual disease (MRD-) .@*Methods@#A retrospective analysis was conducted on 155 patients with non-favorable AML who received allo-HSCT in CR1/MRD- from January 2010 to March 2019. The survival data were compared between patients who received and those not received pre-transplant consolidation chemotherapy.@*Results@#A total of 102 patients received pre-transplant consolidation chemotherapy (consolidation group) , and 53 cases directly proceeded to allo-HSCT when CR1/MRD- was achieved (nonconsolidation group) . The median ages were 39 (18-56) years old and 38 (19-67) years old, respectively. Five-year post-transplant overall survival [ (59.3±7.5) % vs (62.2±6.9) %, P=0.919] and relapse-free survival [ (53.0±8.9) % vs (61.6±7.0) %, P=0.936] were not significantly different between the two groups (consolidation vs nonconsolidation) . There was a weak relationship between consolidation therapy and cumulative incidence of relapse [consolidation: (21.9±5.4) % vs nonconsolidation: (18.3±6.0) %, P=0.942], as well as non-relapse mortality [consolidation: (22.4±4.3) % vs nonconsolidation: (28.4±6.5) %,P=0.464]. Multivariate analysis indicated that pre-transplant consolidation and the consolidation courses (< 2 vs ≥2 courses) did not have an impact on allo-HSCT outcomes.@*Conclusion@#Allo-HSCT for candidate patients without further consolidation when CR1/MRD- was attained was feasible.
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Objective@#To observe the pharmacodynamic effect of Xiaobanxia Decoction (XBXD) and categorized formula on cisplatin-induced delayed chemotherapeutic vomiting in rats, and to explore its prevention and treatment mechanism.@*Methods@#Sixty Wistar rats were randomly divided into blank group, model group, ondansetron group, XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder group, with 10 rats in each group. The ondansetron group was given 2.6 mg/(kg•d) ondansetron, the XBXD group was given XBXD 22 g/(kg•d), the Ginger Pinellia Decoction group was given 31.5 ml/(kg•d) Ginger Pinellia Decoction, and Pinellia and Dried Ginger Powder group was given 0.63 g/(kg•d) Dried Ginger Powder. The blank group and the model group were intragastrically administered with normal saline. All the treattmens were last for three days and twice per day. After the first administration, except the blank group, the rats in all groups were intraperitoneally injected with 6 mg/kg cisplatin to establish chemotherapy-induced vomiting model. The kaolin intake of the chemotherapical rats were weighed every 24 h, and the ileum and medulla 5-HT, 5-HIAA, TPH and MAOA levels were detected by ELISA.@*Results@#Compared with the model group, the kaolin intake of the chemotherapy rats in each treatment group significantly decreased (P<0.05). The levels of ileum 5-HT (308.04 ± 29.90 ng/L, 355.97 ± 19.16 ng/L, 389.97 ± 24.86 ng/L vs. 498.95 ± 13.92 ng/L) and medulla 5-HT (375.32 ± 19.33 ng/L, 395.18 ± 16.12 ng/L, 406.68 ± 12.09 ng/L vs. 478.52 ± 13.88 ng/L) in the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). The levels of ileum TPH (35.14 ± 2.68 ng/L vs. 47.31 ± 0.83 ng/L) in the XBXD group significantly decreased (P<0.05). The levels of medulla TPH (33.68 ± 2.79 ng/L, 38.19 ± 1.74 ng/L vs. 43.68 ± 1.53 ng/L) in the Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). The levels of MAOA, 5-HIAA in the ileum and medulla of the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05).@*Conclusions@#XBXD and categorized formula can effectively prevent and treat delayed chemotherapy-induced vomiting in rats, and its mechanism may be related to decrease the TPH level and inhibiting 5-HT synthesis.
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Objective:To observe the pharmacodynamic effect of Xiaobanxia Decoction (XBXD) and categorized formula on cisplatin-induced delayed chemotherapeutic vomiting in rats, and to explore its prevention and treatment mechanism. Methods:Sixty Wistar rats were randomly divided into blank group, model group, ondansetron group, XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder group, with 10 rats in each group. The ondansetron group was given 2.6 mg/(kg?d) ondansetron, the XBXD group was given XBXD 22 g/(kg?d), the Ginger Pinellia Decoction group was given 31.5 ml/(kg?d) Ginger Pinellia Decoction, and Pinellia and Dried Ginger Powder group was given 0.63 g/(kg?d) Dried Ginger Powder. The blank group and the model group were intragastrically administered with normal saline. All the treattmens were last for three days and twice per day. After the first administration, except the blank group, the rats in all groups were intraperitoneally injected with 6 mg/kg cisplatin to establish chemotherapy-induced vomiting model. The kaolin intake of the chemotherapical rats were weighed every 24 h, and the ileum and medulla 5-HT, 5-HIAA, TPH and MAOA levels were detected by ELISA.Results:Compared with the model group, the kaolin intake of the chemotherapy rats in each treatment group significantly decreased ( P<0.05). The levels of ileum 5-HT (308.04 ± 29.90 ng/L, 355.97 ± 19.16 ng/L, 389.97 ± 24.86 ng/L vs. 498.95 ± 13.92 ng/L) and medulla 5-HT (375.32 ± 19.33 ng/L, 395.18 ± 16.12 ng/L, 406.68 ± 12.09 ng/L vs. 478.52 ± 13.88 ng/L) in the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased ( P<0.05). The levels of ileum TPH (35.14 ± 2.68 ng/L vs. 47.31 ± 0.83 ng/L) in the XBXD group significantly decreased ( P<0.05). The levels of medulla TPH (33.68 ± 2.79 ng/L, 38.19 ± 1.74 ng/L vs. 43.68 ± 1.53 ng/L) in the Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased ( P<0.05). The levels of MAOA, 5-HIAA in the ileum and medulla of the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased ( P<0.05). Conclusions:XBXD and categorized formula can effectively prevent and treat delayed chemotherapy-induced vomiting in rats, and its mechanism may be related to decrease the TPH level and inhibiting 5-HT synthesis.
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With the high prevalence of diabetes, its long-term treatment, and many complications, there is a need for a new diabetes self-management model in developing countries. Therefore, this study aimed to assess the implementation and effect of a new diabetes self-management model, known as the healthcare cloud information platform, in Shanghai, China. The implementation of the new model was evaluated in terms of the equipment coverage in community health service centres and the services provided. The effect was assessed according to the treatment rate and control rate from 2012 to 2017. Their correlations with the self-management rate were analysed using Spearman's test. It was found that the Shanghai healthcare cloud information platform had covered a total of 237 community health service centres in all of the 16 administrative districts, equipping them with 2489 health stations, by 2017. An average of 8966 people uploaded data to the healthcare cloud information platform every day, with the accumulated service up to 12 043 508 person-times and an average daily increase of 13 227.9. The treatment rate of diabetes patients in Shanghai increased from 42.9% in 2012 to 78.0% in 2017, and the control rate increased to 72% in 2017, compared with 63% in 2012. Furthermore, there was a significant correlation between the treatment rate, control rate, and self-management rate. The findings indicate that it is feasible to implement the new healthcare cloud information platform for diabetes self-management and that it is effective.
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Nube Computacional , Diabetes Mellitus/terapia , Autocuidado/métodos , Adulto , China/epidemiología , Servicios de Salud Comunitaria/métodos , Diabetes Mellitus/epidemiología , Humanos , Evaluación de Programas y Proyectos de SaludRESUMEN
Objective To investigate the perinatal independent risk factors and neonatal complications of discordant twins.Methods Clinical data of 152 (76 pairs) discordant twins and 552 (276 pairs) concordant twins were enrolled at the Obstetrics of Peking University People's Hospital from November 1,2011 to October 31,2016.The perinatal characteristics and the neonatal complications in 2 groups were analyzed and compared.Binary Logistic regression analysis was used to identify the independent risk factors associated with the occurrence of discordant twins.Results (1) The gestational age,the incidence of term infants and birth weight of the discordant twins were significantly lower than those of the concordant twins[(35.8 ±2.5) weeks vs.(36.7 ± 1.8) weeks,48.7% vs.60.2%,(2 277.1 ± 575.7) g vs.(2 545.0 ± 413.4) g],and the differences were statistically significant (all P < 0.05).The incidence of premature infants,the incidence of infants small for gestational age and the rate of transferring discordant twins to pediatric department were significantly higher than that of concordant twins (51.3% vs.39.9%,40.8% vs.13.2%,46.1% vs.26.8%),and the differences were statistically significant (all P < 0.05).(2) The incidence of neonatal asphyxia,neonatal respiratory distress syndrome,neonatal pneumonia,neonatal apnea,bronchopulmonary dysplasia,neonatal sepsis and neonatal intracranial hemorrhage were significantly higher than those of concordant twins (6.6% vs.2.5%,7.2% vs.3.1%,5.3% vs.1.3%,9.2% vs.3.3%,3.9% vs.0.9%,3.3% vs.0.7%,4.6% vs.O.7%),and the differences were statistically significant(all P < 0.05).(3) The birth weight in the twins with low body weight group was significantly lower than that in the twins with high body weight group [(1 926.7 ± 414.1) g vs.(2 618.7 ± 504.6) g],and the differences were statistically significant (P < 0.05).The incidence of small for gestational age,the rate of conversion to pediatrics and the incidence of neonatal intracranial hemorrhage in the twins with low body weight group were significantly higher than those in the twins with high body weight group (65.8% vs.6.6%,56.6% vs.35.5 %,9.2% vs.0),and the differences were statistically significant (all P < 0.05).(4) Logistic regression analysis showed that hypertensive disorder during pregnancy (OR =2.127,95% CI:1.392-3.253) and gestational diabetes mellitus (OR =1.684,95% CI:1.112-2.552) were independent risk factors for the occurrence of discordant twins.Conclusions Hypertensive disorder during pregnancy and gestational diabetes mellitus are independent risk factors for the occurrence of discordant twins,who are much more likely to develop various neonatal complications,particularly low-birth-weight infants.Timely surveillance and treatment of short-term complications and long-time follow-up are essential to discordant twins.
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Objective@#To understand the status quo and differences of the rights and interests of primary medical staff in a community, and to provide targeted suggestions for improving the rights of such staff.@*Methods@#From October to November 2018, a questionnaire survey was conducted on all the medical staff of 8 community health service centers in a district of Shanghai, and 562 valid samples were obtained.@*Results@#The primary medical staff had the highest demands for " pay rise" (4.783±0.598), " paid vacation" (4.569±0.873)and " additional reserve fund" (4.553±0.963); the lowest demands were placed on " education-based promotion" (3.797±1.382), " refresher training" (3.801±1.314), and " opinion feedback mechanism" (4.018±1.223). At the same time, the rights and interests of these staff in different occupational categories were significantly different(P<0.05)in " daily reimbursement" , " housing subsidy" , " refresher training" and " opinion feedback mechanism" .@*Conclusions@#The salary demands of the primary medical staff are the most obvious, and there are differences in the demands of medical staff in different occupational categories. It is suggested to establish a more reasonable salary system and pay attention to the differentiated appeals of different medical personnel.
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Data were collected from national health statistics reports and grassroots health comprehensive reform monitoring reports to survey the workload, service efficiency and regional medical coordination in community health service centers in Shanghai Pudong New Area.The efficiency of basic medical services and basic public health services in Pudong New Area increased yearly from 2010 to 2016. The improved capacity of community health service institutions included: mutual recognition of investigation with superior hospitals, the sharing of test results and test equipment in the region, and achieving remote consultation with superior hospitals. With the continuous improvement, more medical services can be provided in community health centers in Shanghai Pudong New Area, resulting in the increased workload of medical staff. The coordination of regional institutions further promotes the implementation of tiered medical service system.
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Aptamers are DNA or RNA fragments that can specifically bind to target substances.Because of the excellent properties such as strong binding force,high specificity,small physical size,chemical synthesis and modification,good biocompatibility,and low immunogenicity aptamers show wide application propects in biomedical researches.Aptamers can also bind specifically to receptors on the surface of cell membranes,and mediate the endocytosis of nanoparticles into cells,making them ideal drug targeting ligands.Organic nanomaterials have excellent application value in nanodrug delivery system because of their good biocompatibility and degradability.In this paper,the recent research progress of aptamers and organic nanomaterials drug delivery systems was reviewed.
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Objective Under the linkage reform of family doctor service and medical insurance payment ,to study the family doctors′ career cognitive and expectations in order to improve the endogenous power of the family doctor system development ,and push forward the reform with sustainable effects .Methods All the family doctors in Changning were surveyed. There were 154 family doctors surveyed in the first phase of 2013 ,and 143 in the second phase of 2016 .The data were subject to descriptive statistics .Results About 80% of the family doctors had a clear understanding of the family doctor system in 2016 ,with the proportion of family doctors clearly understanding their duties risen from 55.26% (84/152)in 2013 to 61.27% (87/142)in 2016 .Self-assessment of their work value and professional reputation were more positive significantly .70% of them believed their social status as above average. The proportion of family doctors who were very confident/confident" in the development of community health services and family doctor system increased from 31.72% (46/145) to 47.20% (59/125)and from 31.72% (46/145)to 52.42% (65/124)respectively .Conclusions The occupational cognition and career expectations of family doctors in Changning district have been significantly improved ,which can guide their behavior towards reform objectives and propel the family doctor system progress smoothly .
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Objective To evaluate the motivation effect of family doctors′ contracting service and health insurance compensation mechanism from the perspective of income change and income satisfaction of family doctors .Methods The situation about salary compensation plan reform and the change of income level and structure were learnt from interviews on the management personnel and questionnaire surveys of family doctors in 2013 and 2016 .The data were subject to descriptive statistics .Results The proportion of family doctors earning between 8000 and 10000 yuan in 2016 rose to 67.16% (90/134 ) from 18.18% (26/143 ) in 2013.11.72% (15/128 ) of family doctors′contracting service fee amounted to over 50% of their income. The number of family doctors who were dissatisfied with their income has fallen by 28.52% .There were still 51.90% (68/131)of the family doctors who were not satisfied with their income and 24.64% (34/138)of them held the incentives of performance appraisal as a failure .Conclusions The income of family doctors has been greatly increased in the last three years.Contracting service fee plays a key role in motivating these doctors , but three risks also need to be prevented in the process of further reform .
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Objective To evaluate the present family doctors staffing and service capacity building in Changning under the linkage reform of contracting service and health insurance payment . Methods The staffing data of family doctors were collected from the 2013-2015 annual reports ,while the data on their qualifications ,training ,job stress and competence were collected from two follow-up investigations. These data were analyzed with descriptive statistics .Results in 2016 ,the number of family doctors totaled 27000 ,up to 2.75 doctors per 10000 people.Over 97% of the family doctors were qualification certificated.More than half of the family doctors participated in the standardized training .68.80% (97/141)of the family doctors complained overwork.More than 80% of the family doctors have encountered technical problems with medical services .Conclusions The number and quality of family doctors in Changning have been greatly improved to satisfy contracting services of the residents to a minimal extent. However ,more family doctors are needed ,as they still face much work stress. The family doctors call for standardized training ,better payroll and incentive mechanism ,better career development and coordinated support mechanism ,as well as better team building for greater performance .
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Objective@#To observe the efficacy and safety of de novo combination of Lamivudine(LAM) and Adefovir Dipivoxil (ADV) therapy counter to Entecavir (ETV) monotherapy in patients with chronic hepatitis B (CHB)- related compensated liver cirrhosis.@*Methods@#Patients with chronic hepatitis B-related compensated cirrhosis who were initially treated with LAM and ADV for more than 1 year were randomly assigned to two groups, one half replaced with ETV monotherapy, and the other half continued LAM and ADV co-therapy. Liver biochemistry, renal biochemistry, estimated glomerular filtration rate, alpha-fetoprotein, HBV serology markers and serum HBV DNA were measured every 3 months. Urine β2-microglobulin was measured every 6 months And retinol binding protein, followed up for 3 years. The mean values of the two groups were compared with t-test, and the rate of comparison was analyzed by x2 test.@*Results@#A total of 580 cases were collected, 290 cases were replaced with ETV monotherapy, the other 290 patients continued to LAM and ADV combination therapy. In the ETV group, the rates of HBV DNA negative conversion at 1 year, 2 years and 3 years were 77.6%, 84.5% and 94.5% respectively, while the HBV DNA negative conversion rates at 1, 2 and 3 years in the LAM and ADV combination groups were 69.3%, 73.4% and 80.3% respectively. Among them, the negative rates of HBV DNA in the second year and the third year were P < 0.05, the difference was statistically significant. The 3-year cumulative gene-resistant rate in the ETV group was 1.4%, while the combined treatment was as high as 8.6%, and the difference was statistically significant in the two groups. The estimated value of serum creatinine and glomerular filtration rate in ETV group was followed by 3 years, and the baseline level was maintained, in the same group, the serum creatinine was higher than baseline, and the estimated value of glomerular filtration rate decreased. The results showed that there were 6.2%, 12.1%, 22.1% and 0, 0.3%, 1%, respectively, in 1, 2 and 3 years for the group of consecutive treatment and the replacement of ETV Group. The estimated glomerular filtration rate decreased by more than 30% compared with the baseline. The difference was statistically significant; the proportion of serum creatinine in the 1 year, 2 years and 3 years of the combined treatment group was 1.7%, 4.5% and 6.6%, compared with the baseline rise of > 50 μmol/l, and the ETV group was replaced in the 1 year, The values of 2 and 3 years were 0,0,0.7%, of which the 2nd and 3rd years were statistically significant; the proportion of microalbuminuria and retinol-binding protein in patients with combined treatment group was also significantly higher than that of Β2-m ETV Group.@*Conclusion@#The initial combination of LAM and ADV therapy is inferior in terms of ETV monotherapy. Single therapy with ETV increase the rate of viral response, reduce the incidence of drug resistance, and also reduce the incidence of renal impairment in patients with chronic hepatitis B -related compensated liver cirrhosis.
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Objective The aim of our study was to explore the relationship between prostate cancer and four serum markers,including Prostate specific antigen (PSA),Beta 2 Microglobulin (β2M),Neutrophil-to-lympochyte ratio (NLR) and Lactic dehydrogenase (LDH),and their variation rules in development of prostate cancer.Then to find one or more markers that can increase the sensitivity and specificity of diagnosis to provide reference for clinic.Methods A total of 149 prostate cancer patients,40 patients with benign prostatic hyperplasia,80 healthy subjects in our hospital were analyzed,and subsequent the T-PSA,F-PSA,β2M,LDH and NLR were measured.The correlation between these markers and prostate cancer as well as its different types and Gleason score was assessed statistically.We determined the cut-off point of the NLR and T-PSA according to the specificity and sensitivity levels derived from area under receiver operator characteristic (ROC) curve.Results The level of T-PSA was significantly higher in patients of prostate cancer and benign prostatic hyperplasia,and the level of NLR was higher only in patients of prostate cancer.Based on the area under ROC,the cut-off value of T-PSA was determined to be 4.625 ng/ml,and NLR was 2.11,and combined NLR and T-PSA can increase the specificity of diagnose.There is a statistical difference in Gleason scores in patients with different NLR of prostate cancer (P =0.030).Conclusions It could increased the specificity when combined NLR and T-PSA to diagnose prostate cancer.And NLR has positive correlation with the prognosis of patients of prostate cancer as well.