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Objective@#To explore the relationship between sedentary behavior with cardiorespiratory fitness and executive function in adolescents, and to provide some references for sedentary behavior prevention and executive function improvement.@*Methods@#From September to December 2022, a total of 5 018 adolescents aged 13 to 18 years were selected by stratified random sampling method in Shanghai, Suzhou, Taiyuan,Wuyuan, Xingyi, and Urumqi to conduct physical activity survey, as well as cardiorespiratory fitness and executive function assessment. Pearson s correlation was used to analyze the relationship between sedentary behavior, cardiorespiratory fitness and executive function. The mediation effect model was fitted by the bootstrap mediation procedure in the PROCESS (version 3.3 ) SPSS macro compiled by Haves, and the mediation effect of adolescents cardiorespiratory fitness in the relationship between static behavior and executive function was examined using model 4 in the PROCESS SPSS macro, where Boosrap method was used to compute the mediation effect of adolescents cardiorespiratory fitness. where the Boosrap method was used to calculate confidence intervals for the mediating effects.@*Results@#Adolescents daily sedentary time was positively correlated with both the refreshing function (1-back and 2-back) and the switch function reaction time ( r =0.05, 0.07, 0.05, P <0.01). Adolescent VO 2max was negatively correlated with both the refreshing function (1-back,2-back) and the switching function ( r =-0.09, -0.14 , -0.11, P <0.01). Adolescents daily sedentary time was negatively correlated with VO 2max ( r =-0.04, P <0.01); cardiorespiratory fitness mediated effect values between sedentary behavior and refreshing function (1-back and 2-back) and converted function were 0.20(95% CI =0.06-0.36), 0.43(95% CI =0.14-0.74) and 0.13 (95% CI =0.04-0.22), with mediating effect shares of 6.87%, 8.33% and 8.59%, respectively.@*Conclusion@#The duration of sedentary behavior in adolescents is related to executive function performance, and cardiorespiratory fitness may serve as a mediator to mediate the association between sedentary behavior and executive function in adolescents.
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Nucleic acid-based drugs, such as RNA and DNA drugs, exert their effects at the genetic level. Currently, widely utilized nucleic acid-based drugs include nucleic acid aptamers, antisense oligonucleotides, mRNA, miRNA, siRNA and saRNA. However, these drugs frequently encounter challenges during clinical application, such as poor stability, weak targeting specificity, and difficulties in traversing physiological barriers. By employing chemical modifications of nucleic acid structures, it is possible to enhance the stability and targeting specificity of certain nucleic acid drugs within the body, thereby improving delivery efficiency and reducing immunogenicity. Moreover, utilizing nucleic acid drug carriers can facilitate the transportation of drugs to lesion sites, thereby aiding efficient intracellular escape and promoting drug efficacy within the body. Currently, commonly employed delivery carriers include virus vectors, lipid nanoparticles, polymer nanoparticles, inorganic nanoparticles, protein carriers and extracellular vesicles. Nevertheless, individual modifications or delivery carriers alone are insufficient to overcome numerous obstacles. The integration of nucleic acid chemical modifications with drug delivery systems holds promise for achieving enhanced therapeutic effects. However, this approach also presents increased technical complexity and clinical translation costs. Therefore, the development of nucleic acid drug carriers and nucleic acid chemical modifications that are both practical and simple, while maintaining high efficacy, low toxicity, and precise nucleic acid delivery, has become a prominent research focus in the field of nucleic acid drug development. This review comprehensively summarizes the advancements in nucleic acid-based drug modifica-tions and delivery systems. Additionally, strategies to enhance nucleic acid drug delivery efficiency are discussed, with the aim of providing valuable insights for the translational application of nucleic acid drugs.
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Nucleic Acids , RNA, Small Interfering/genetics , Drug Carriers , Drug Delivery Systems , Drug DevelopmentABSTRACT
The fatality rate of liver failure caused by fatal amanita poisoning is high, and there are no effective antidote drugs in China. On July 30, 2020, the department of infectious diseases and liver diseases of the First People's Hospital of Yunnan Province admitted a 67-year-old female patient with liver failure caused by fatal amanita poisoning. The patient went to the emergency department for treatment due to abdominal pain, vomiting and diarrhea after eating 350-400 g of amanita mushroom for 2 days, accompanied by fatigue for 1 day. There was no abnormality in physical examination. Laboratory indexes: alanine aminotransferase (ALT) 4 798 U/L, aspartate aminotransferase (AST) 10 030 U/L, activated partial thromboplastin time (APTT) 57.5 s, prothrombin time (PT) 72.1 s, international normalized ratio (INR) 8.66, prothrombinactivity (PA) 10%. Based on the patient's medical history, clinical manifestations and laboratory data, the diagnosis was amanita peptide mushroom poisoning and acute liver failure. According to the mechanism of amanita toxin poisoning as enterohepatic circulation, endoscopic retrograde cholangiopancreatography and ultrasound-guided gallbladder puncture and drainage for drainage of bile to discharge toxins were performed to interrupt the enterohepatic circulation of toxins. However, both methods failed, so open cholecystostomy was performed. Because the patient's coagulation function was very poor, artificial hepatic plasma exchange was given to improve coagulation function before open cholecystostomy, and eventually bile was drained successfully. After a total of 19 days of comprehensive medical treatment, the patient was cured and discharged from the hospital, and no sequelae was found after 1 year of follow-up. For such patients, early identification of the disease is required, and blocking the enterohepatic circulation of toxins as soon as possible according to the characteristics and toxicological mechanism of toxins may be the key treatment for rescuing patients with liver failure poisoned by amanita toxin, and it is necessary to combine comprehensive treatments such as active fluid replacement and blood purification to further improve the survival rate.
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Introduction: Customer agility (CA) and market orientation have been widely discussed in prior research. Also, the role of brand image in business making-decision has been emphasized. However, the current analysis lacks integrating the relationship among the three concepts. Thus, this study creatively creates a causal relationship model of CA, market orientation, and brand image. Methods: Finally, 289 valid samples from the managers in Chinese market was collected for further analysis by partial least squares structural equation modeling (PLS-SEM). Results: The results show that market orientation can positively affect CA (both customer-sensing capability and customer-responding capability), and CA will further have a positive influence on brand image. Also, market orientation has a direct impact on brand image. Additionally, CA (both customer-sensing capability and customer-responding capability) will mediate the impact of market orientation on brand image. Discussion: The research has both theoretical and practical contributions. From the theoretical perspective, the results contribute to enriching the brand theory, strategy management, and marketing research. From the practical perspective, the investigation enlightens managers to pay attention to the roles of CA implementation and market orientation strategies in enhancing their brand image.
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Objective:To evaluate the post-marketing safety and immunogenicity of a 23-valent pneumococcal polysaccharide vaccine (PPV23).Methods:From September 2020 to June 2021, a clinical trial of single-dose PPV23 was conducted in people ≥3 years old in Centers for Disease Control and Prevention of Guizhou, Hunan and Fujian provinces. Blood samples were collects from the subjects before and 30 d after vaccination. ELISA was used to quantitatively detect IgG antibodies against capsular polysaccharides of 23 Streptococcus pneumoniae serotypes in serum samples. The adverse events (AEs) were monitored within 7 d after vaccination. Results:A total of 409 subjects were enrolled and included in safety analysis. Except for one with antibody level inversion, the other 408 participants were included in immunogenicity analysis. The levels of antibodies against the 23 Streptococcus pneumoniae serotypes were all increased after vaccination by an average of 4.24 folds. The two-fold growth rates of the antibodies ranged from 51.72% to 96.81% with a total two-fold growth rate of 78.59%. The overall rate of AEs was 27.14% (111/409). Local AEs were mainly pain, induration, redness and swollen. No serious adverse events related to vaccination occurred. Conclusions:This study preliminarily demonstrated the good immunogenicity and safety of PPV23 vaccine.
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Objective:To investigate the effect of nano lead oxide (nano-PbO) exposure on learning and memory as well as spatial exploration ability in the mice, and the role of leukocyte infiltration of brain tissue in neurobehavioral damage caused by nano-PbO exposure.Methods:A total of 60 male SPF grade Kunming mice were divided into control group, low-dose nano-PbO group, medium-dose nano-PbO group and high-dose nano-PbO group according to body mass matching method, with 15 mice in each group.Mice in low, medium and high dose groups of nano-PbO were intraperitoneally injected with 5 mg·kg -1, 10 mg·kg -1, 20 mg·kg -1 nano-PbO, respectively. And mice in the control group were intraperitoneally injected with the same volume of 0.9% normal saline.The frequency of intervention was once a day for 28 days.Morris water maze test and open field test were used to detect the ability of learning and memory and spatial exploration of mice. Western blot was used to detect the protein expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) in hippocampus of mice, intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) in mouse microvessels and lymphocyte function-associated antigen-1 (LAF-1) in mouse blood leukocyte. The proportion of leukocytes in mouse brain was detected by flow cytometry. All statistical analyses were performed by SPSS 20.0. Morris water maze data were analyzed by repeated measures ANOVA, the other data among multiple groups were compared by one-way ANOVA, and Tukey's test was used for further pairwise comparison.Pearson correlation analysis was performed to evaluate the correlation between neurobehavioral indexes and the proportion of white blood cells, TNF-α and IL-1β in brain tissue. Results:Morris water maze results showed that the escape latency of the four groups of mice had a significant interaction between group and time( F=3.21, P<0.05). The escape latencies of mice in middle and high dose groups of nano-PbO were higher than that in the control group (both P<0.05), and the numbers of crossing the platform of the two groups were lower than that in the control group (both P<0.05). The results of open field test showed that there was a statistically significant difference in the residence time of the mice in the four groups ( F=119.10, P<0.01). The total standing times of mice in the middle group and high dose group of nano-PbO were lower than that in the control group (both P<0.01). The results of Western blot showed that the levels of TNF-α and IL-1β in hippocampus tissue of mice were significant differences among the four groups ( F=7.21, 9.89, both P<0.05). The levels of TNF-α and IL-1β in the hippocampus of mice in the high-dose nano-PbO group were higher than those in the control group (TNF-α: (0.35±0.10), (1.03±0.30), P<0.05; IL-1β: (0.32±0.10), (0.50±0.15), P<0.05). The results of flow cytometry analysis showed that the proportions of leukocytes in the brain tissue of mice in the low, medium and high dose groups of nano-PbO were (9.99±1.09)%, (13.03±0.94)% and (16.51±3.89)%, respectively. Among them, the proportions of leukocytes in the middle and high dose groups of nano-PbO were significantly higher than that in the control group((8.13±1.29)%) (both P<0.05). The results of correlation analysis showed that the proportion of leukocytes, levels of TNF-α, IL-1β protein of hippocampus in the medium, high dose groups of nano-PbO were negatively correlated with the behavioral indexes ( r=-0.815, -0.744, -0.578, all P<0.01; r=-0.771, -0.836, -0.704, all P<0.05; r=-0.823, -0.876, -0.695, all P<0.05). The results of Western blot showed that the levels of ICAM-1 and VCAM-1 in cerebral microvessels of mice in the four groups were significantly different ( F=5.51, 16.19, both P<0.05). The levels of ICAM-1 and VCAM-1 in the middle and high dose groups of nano-PbO were higher than those in the control group(ICAM-1: (1.07±0.16), (1.21±0.35), (0.59±0.19), all P<0.05; VCAM-1: (0.68±0.12), (1.92±0.23), (0.23±0.05), both P<0.05). In addition, there was a significant difference in the level of LFA-1 protein in blood leukocytes of mice in the four groups ( F=41.80, P<0.05). The levels of LFA-1 in the middle and high dose groups of nano-PbO were higher than that in the control group((0.33±0.06), (0.89±0.23), (0.05±0.01), both P<0.05). Conclusion:The nano-PbO exposure can lead to cognitive impairment and increased inflammatory factors in the hippocampus of mice, which may be related to the increase of ICAM-1 and VCAM-1 in vascular endothelial cells, which promotes leukocyte infiltration into brain tissue.
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Objective:To investigate the ultrasonographic and genetic features of Cri-du-chat syndrome (CDCS).Methods:In this retrospective study, cases with CDCS diagnosed in Wuxi Maternal and Child Health Care Hospital from 2004 to 2021 and with complete data were reviewed to describe and analyze the maternal serum prenatal screening, non-invasive prenatal testing (NIPT), ultrasound, genetic examination data, and pregnancy outcomes.Results:All cases were diagnosed by karyotype analysis, seven of them were diagnosed prenatally through amniotic fluid, and four were diagnosed after birth through peripheral blood. Five of the seven cases diagnosed prenatally had an abnormal serological screening, including two cases with 5p- indicated by NIPT. Of the 11 cases, prenatal ultrasonography showed cerebellar transverse diameter less than -2 SD in eight cases, including four with cerebellar hypoplasia (CH), two with fetal growth restriction, and two with cranial diameters less than -2 SD. One case was shown with an increased nuchal translucency, accompanying bilateral choroid plexus cysts of the lateral ventricles, and suspected persistent left superior vena cava. No obvious ultrasound abnormality was observed in the remaining two cases. Among the seven cases diagnosed prenatally, excluding one case that refused parental verification, further single nucleotide polymorphism array (SNP array) showed that all six cases inherited the de novo mutations from the parents. The cytogenetic analysis found the breakpoints at 5p13, 5p14, and 5p15 in five, three, and three cases. All seven pregnancies were terminated in the second trimester. Four children diagnosed postnatally presented with CDCS phenotype during the follow-up at three years old. Conclusions:Fetal CDCS should be considered with CH detected by prenatal ultrasonography, though the correlation between CH and CDCS still needs further investigation. Gene mapping with an SNP array is helpful for phenotypic profiling and genetic counseling.
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Isolated fornix infarction is very rare in cerebral infarction. A case of right column fornix infarction with acute anterograde amnesia as the only manifestation who was diagnosed in the Fifth Affiliated Hospital of Sun Yat-Sen University in March 2020 was presented. The clinical symptoms were the inability to recall recent events, repeated speech. Head magnetic resonance suggested right fornix column infarction and diffusion tensor imaging showed reduction of right fornix fiber bundles. The symptoms improved significantly after conventional treatment of cerebral infarction and improving intelligence treatment.
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OBJECTIVETo develop and validate a prognostic model for in-hospital mortality in COVID-19 patients using routinely collected demographic and clinical characteristics. DESIGNMulticenter, retrospective cohort study. SETTINGJinyintan Hospital, Union Hospital, and Tongji Hosptial in Wuhan, China. PARTICIPANTSA pooled derivation cohort of 1008 COVID-19 patients from Jinyintan Hospital, Union Hospital in Wuhan and an external validation cohort of 1031 patients from Tongji Hospital in Wuhan, China. MAIN OUTCOME MEASURESOutcome of interest was in-hospital mortality, treating discharged alive from hospital as the competing event. Fine-Gray models, using backward elimination for inclusion of predictor variables and allowing non-linear effects of continuous variables, were used to derive a prognostic model for predicting in-hospital mortality among COVID-19 patients. Internal validation was implemented to check model overfitting using bootstrap approach. External validation to a separate hospital was implemented to evaluate the generalizability of the model. RESULTSThe derivation cohort was a case-mix of mild-to-severe hospitalized COVID-19 patients (n=1008, 43.6% females, median age 55). The final model (PLANS), including five predictor variables of platelet count, lymphocyte count, age, neutrophil count, and sex, had an excellent predictive performance (optimism-adjusted C-index: 0.85, 95% CI: 0.83 to 0.87; averaged calibration slope: 0.95, 95% CI: 0.82 to 1.08). Internal validation showed little overfitting. External validation using an independent cohort (n=1031, 47.8% female, median age 63) demonstrated excellent predictive performance (C-index: 0.87, 95% CI: 0.85 to 0.89; calibration slope: 1.02, 95% CI: 0.92 to 1.12). The averaged predicted survival curves were close to the observed survival curves across patients with different risk profiles. CONCLUSIONSThe PLANS model based on the five routinely collected demographic and clinical characteristics (platelet count, lymphocyte count, age, neutrophil count, and sex) showed excellent discriminative and calibration accuracy in predicting in-hospital mortality in COVID-19 patients. This prognostic model would assist clinicians in better triaging patients and allocating healthcare resources to reduce COVID-19 fatality.
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The ongoing coronavirus COVID-19 pandemic is caused by a new coronavirus (SARS-CoV-2) with its origin in the city of Wuhan in China. From there it has been rapidly spreading to many cities inside and outside China. Nowadays more than 33 millions with deaths surpassing 1 million have been recorded worldwide thus representing a major health issue. Rapid development of a protective vaccine against COVID-19 is therefore of paramount importance. Here we demonstrated that recombinantly expressed receptor binding domain (RBD) of the spike protein homologous to SARS binds to ACE2, the viral receptor. Higly repetitive display of RBD on immunologically optimized virus-like particles derived from cucumber mosaic virus (CuMVTT) resulted in a vaccine candidate that induced high levels of specific antibodies in mice which were able to block binding of spike protein to ACE2 and potently neutralized COVID-19 virus in vitro.
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Objective:To explore the effect of drug combined with CO2 laser minimally invasive surgery in the treatment of patients with vascularized vocal cord inflammation, and the influence on the voice function of patients.Methods:From April 2018 to July 2019, 74 patients with vascularized vocal cord inflammation admitted in the Affiliated Hospital of Yangzhou University were divided into two groups according to the random number table method, with 37 cases in each group.The patients in the control group were treated with oral medicine.The patients in the observation group were treated with medicine combined with CO 2 laser minimally invasive surgery.The voice quality, improvement of voice disorders, recurrence and patients' satisfaction were observed. Results:After treatment for 12 months, the total hoarseness(G), roughness(R) and breath(B) scores in the observation group were (1.60±0.13)points, (1.71±0.21)points and (1.42±0.12)points, respectively, which were significantly lower than those in the control group [(1.88±0.16)points, (1.98±0.10)points and (1.78±0.13)points] ( t=8.262, 7.061, 12.377, all P<0.05). After treatment, the functional, physiological and emotional scores of voice disorders index(VHI) and total score in the observation group were (10.10±1.03)points, (13.26±2.10)points, (7.30±1.10)points, (31.26±4.74)points, respectively, which were significantly lower than those in the control group [(11.63±2.16)points, (15.42±2.16)points, (8.86±1.05)points, (35.86±5.33)points] ( t=3.889, 4.361, 6.240, 19.103, all P<0.05). The recurrence rates at the first and third month after treatment in the observation group were 2.70%(1/37) and 8.11%(2/37), respectively, which were significantly lower than those in the control group [16.22%(6/37) and 27.03%(10/37)] (χ 2=3.945, 4.573, all P<0.05). The satisfaction rate of patients in the observation group was 94.59%(35/37), which was significantly higher than 78.38%(29/37) in the control group(χ 2=4.163, P<0.05). Conclusion:On the basis of conventional drug treatment, CO 2 laser microinvasive surgery can effectively improve the treatment effect, improve the voice function of patients, and significantly reduce the recurrence rate, the overall effect and prognosis are better.
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Sixty-three elderly patients with allergic rhinitis and symptoms of anxiety and depression attending in the Affiliated Hospital of Yangzhou University from August 2016 to August 2018 were randomly divided into two groups: 30 patients received deanxit combined with anti-allergic drugs for treatment (study group) and another 30 patients received anti-allergic drugs treatment alone (control group). Subjective nasal obstruction was evaluated by Visual Analogue Scale (VAS), and the quality of life of patients was assessed by Rhinoconjunetivitis Quality of Life Questionnaire (RQLQ).The anxiety and depression mood changes were assessed by Self-rating Anxiety Scale (SAS) sand Self-rating Depression Scale (SDS).The scores of symptoms and mood were compared after 4 weeks and 8 weeks of treatment. The clinical nasal symptoms VAS score, the total RQLQ scores and its 7 domains scores, SDS and SAS scores of patients in two groups were significantly reduced compared to those before treatment ( P<0.05). The VAS score, the total of RQLQ scores and its 7 domains scores, SDS and SAS scores were significantly lower in the study group than those in the control group after 4 weeks and 8 weeks of treatment.The total effective rate of study group was significantly higher than those of the control group (χ 2=6.922, P=0.031; χ 2=11.544, P=0.003). Deanxit combined with anti-allergic drugs shows significant clinical efficacy, it also can improve the symptoms of anxiety and depression, and the quality of life for elderly patients with allergic rhinitis.
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Prostate cancer (PCa) patients who progress to metastatic castration-resistant PCa (mCRPC) mostly have poor outcomes due to the lack of effective therapies. Our recent study established the orphan nuclear receptor ROR
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OBJECTIVE@#To analyze the association of preoperative C-reactive protein (CRP) level with postoperative complications in elderly patients undergoing surgeries for femoral neck fracture.@*METHODS@#We retrospectively analyzed the data of 147 elderly patients (median age 80 years; 73.5% of the patients were female) undergoing surgeries for femoral neck fracture. According to preoperative CRP level, the patients were divided into normal CRP (< 10 mg/L) group (31 patients), mild elevation group (CRP level of 10-40 mg/L; 51 patients), and severe elevation group (CRP ≥40 mg/L; 65 patients). The association of preoperative CRP levels with postoperative complications was analyzed.@*RESULTS@#Preoperative CRP level was significantly correlated with the occurrence of postoperative complications (=0.003). Compared with that in normal CRP group, the unadjusted ORs in mild and severe elevation groups were 0.97 (95%: 0.29-3.27) and 3.04 (95%: 1.03-8.98) with the adjusted ORs of 1.13 (95%: 0.33-3.90) and 4.89 (95%: 1.47-16.26), respectively.@*CONCLUSIONS@#Preoperative CRP level has a dose-response relationship with complications in elderly patients following arthroplasty for femoral neck fracture, and the patients with a preoperative CRP level ≥40 mg/L are exposed to a significantly increased risk for postoperative complications by 3.89 folds compared with the patients with a normal CRP level.
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Aged , Aged, 80 and over , Female , Humans , Male , C-Reactive Protein , Femoral Neck Fractures , Postoperative Complications , Retrospective StudiesABSTRACT
OBJECTIVE@#To assess the value of combined cytogenetic and molecular techniques for the prenatal diagnosis of a pregnant woman with intellectual disability (ID).@*METHODS@#The fetus and its parents were subjected to G-banding karyotyping analysis, single nucleotide polymorphism array (SNP-array) and fluorescence in situ hybridization (FISH) analysis.@*RESULTS@#G-banding karyotype analysis revealed that the woman has carried a chromosomal microdeletion 46,XX,del(11)(q24), and the fetus was a carrier of 46,XN,del(11)(q24)mat. Subsequent SNP-array and FISH analysis of the pregnant woman indicated that the microdeletion has mapped to 11q24.1-q25. Both the pregnant woman and her fetus were diagnosed with Jacobsen syndrome.@*CONCLUSION@#Combined use of cytogenetic and molecular genetic techniques can facilitate diagnosis of patients with intellectual disability.
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Female , Humans , Pregnancy , Chromosome Deletion , Fetus , In Situ Hybridization, Fluorescence , Intellectual Disability , Jacobsen Distal 11q Deletion Syndrome , Diagnosis , Karyotyping , Polymorphism, Single Nucleotide , Prenatal DiagnosisABSTRACT
OBJECTIVE: To evaluate the effects of Pharmacy Benefit Management (PBM) model on drug compliance, health outcomes, economic burden and satisfaction of patients in Wuhu city of Anhui province. METHODS: In cross-sectional study, the questionnaires were designed according to the National Health Service Survey. Through cluster sampling and convenient sampling, the questionnaire survey (including subjective evaluation) was conducted among hypertensive patients who participated in or did not participate in the PBM program in pilot area of Wuhu city. Descriptive analysis was used to analyze the general characteristics of the two groups. The Propensity Score Matching (PSM) was used to approximately randomize the included data to balance the baseline characteristics. Univariate linear regression or Logistic regression analysis were used to evaluate the relationship of whether to join PBM or not with drug compliance,QALY, hospitalization probability,monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases, etc. RESULTS: A total of 755 valid questionnaires were collected, including 405 in the PBM group and 350 in the non-participating group. There was statistical significance in patient’s gender, age, education degree, nature of household registration, type of medical insurance or usual visited medical institutions (P<0.05). About 95% patients (405 cases) satisfied with PBM program. 281 cases of PBM group and 193 cases of non-participating group were included through PSM. Results of regression analysis showed that lower one level at least of medication compliance in PBM group was 0.49 times as that in the non-participating group; the hospitalization probability in PBM group was 0.56 times as that in the non-participating group (P<0.05). There was no statistical significance of difference in control of blood pressure QALY, monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases between two groups (P>0.05). CONCLUSIONS: The implementation of PBM model in pilot areas can improve drug compliance and reduce hospitalization rate of patients. The most patients are highly satisfied. However, the effects of PBM on patients’ control of blood pressure, QALY and medical expense are not obvious, and its long-term effect needs more follow-up studies to verify.
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OBJECTIVE: To study direct medical expense and its influential factors, and to provide empirical reference for medical expenses control of pulmonary embolism and the adjustment of anticoagulant drug reimbursement strategy. METHODS: Based on the national urban basic medical insurance data in 2014, the data of patients with pulmonary embolism were extracted by equidistant sampling method to form a sample database. According to related therapy information and expense information of pulmonary embolism patients in sample database, descriptive analysis was performed for demographic characteristics of patients (including gender, age, type of medical insurance, region, type of medical institution, etc.), direct medical expenses and direct medical expenses of patients with different anticoagulants, etc. Multiple linear regression analysis was used to analyze potential influential factors for the medical expenses of patients. RESULTS: A total of 475 pulmonary embolism patients were included, a total of 1 090 visits were recorded, and the average length of stay was 12.37 days. The annual medical expense per capita of patients was 10 847.42 yuan (median was 4 113.00 yuan), hospitalization expense per capita was 19 056.30 yuan (median was 13 042.86 yuan), and outpatient expense per capita was 1 049.61 yuan (median was 418.70 yuan). Results of subgroup analysis showed that annual medical expense in eastern, central and western cities were 9 203.54, 16 931.99 and 15 891.21 yuan. Per capita annual medical expenses of patients in tertiary hospitals were the highest (11 733.40 yuan), followed by secondary hospitals, and the lowest was other medical related institutions. Among different anticoagulants treatment groups, the annual medical expense per capita (24 553.80 yuan) and annual drug expense per capita (12 088.96 yuan) were the highest in anticoagulant regimen of combined use of LMWH and UFH, while patients treated with warfarin alone had the lowest annual medical expense per capia (2 350.24 yuan) and annual drug expense per capita (1 163.67 yuan). The multiple linear regression showed that the factors affecting medical expense per visit were type of patient (inpatient or outpatient),type of medical institution and type of complications. CONCLUSIONS: Direct medical expense per capita of patients with pulmonary embolism is still high, and the economic burden of disease is still heavy. Patients with pulmonary embolism treated with combination of LMWH and UFH had the highest medical expense per capita. The types of visit, types of medical institutions and complications can influence medical expense of patients significantly.
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Iron and calcium carbonate were added in wastewater treatments as the adjusting agents to improve the contaminant removal performance and regulate the variation of carbon source in integrated treatments. At different temperatures, the addition of the adjusting agents obviously improved the nitrogen and phosphorous removals. TN and TP removals were respectively increased by 29.41% and 23.83% in AC-100 treatment under 1-day HRT. Carbon source from dead algae was supplied as green microbial carbon source and Fe2+ was supplied as carbon source surrogate. COD concentration was increased to 30mg/L and above, so the problem of the shortage of carbon source was solved. Dead algae and Fe2+ as carbon source supplement or surrogate played significant role, which was proved by microbial community analysis. According to the denitrification performance in the treatments, dead algae as green microbial carbon source combined with iron and calcium carbonate was the optimal supplement carbon source in wastewater treatment.
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Calcium Carbonate/chemistry , Carbon/chemistry , Iron/chemistry , Wastewater/chemistry , Water Purification/methods , Bioreactors , Carbon/metabolism , Denitrification , Nitrogen/chemistry , Nitrogen/isolation & purification , Phosphorus/chemistry , Phosphorus/isolation & purification , TemperatureABSTRACT
Objective To explore the changes in inflammatory reactions in tail-suspension mice infected by Klebsiella pneumoniae from spaceflight.Methods Tail suspension was used to simulate the physiological effects of microgravity.C57BL/6 mice were randomly divided into control (Con),control+K.pneumoniae T16-169 (Con+T16-169),tail suspension (TS) and tail suspension+K.pneumoniae T16-169 (TS+T16-169) groups.The level of inflammatory cytokines TNF-α,IL-6 and IL-1β mRNA in lung tissue and the plasma cytokine concentration were detected by RT-qPCR and xMAP technology,and HE staining was used to represent the morphological changes in lung tissue.Results Compared with the control group,the expression of inflammatory cytokines in lung tissue and plasma concentrations of all experimental groups were increased,and the difference in TS+T16-169 group was the most significant (P<0.01 or P<0.001).HE staining showed that the lung tissues in Con+T16-169 and TS+T16-169 groups were damaged in different degrees,and the damage of TS+T16-169 group was the most serious.Conclusion The K.pneumoniae from spaceflight significantly increases the expression of inflammatory cytokines in lung tissue and plasma concentrations after infecting tail-suspension mice,and induces more serious damages to the lung tissue,which suggests that inflammatory reactions can be increased in tail suspension mice infected by K.pneumoniae from spaceflight.
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Objective To evaluate dose variations induced by gravity of multi-leaf collimator to provide references for clinical intensity-modulated radiotherapy.Methods Two-dimensional dose distributions in the central plane of IMRT fields were measured by use of a 2D ion chamber array.All measurements were repeated at two collimator angles (C=0 and 90°),for each of the following gantry angles:G=0 and 270°.Comparisons were made to dose distributions generated at G=0°and their differences were analyzed using gamma index analysis (3%/3 mm and 1%/1 mm).Results Under the radiation field of 10 cm×10 cm,the gamma passing rate was higher than 99% for 3% 3 mm anch close to 95% for 1%/1mm Under a 3%/3mm error standard,the average matching rate for step & shoot fields was (96.46±0.33)% and for DMLC fields was (94.67±0.54)% at C=0°;The average matching rate for step & shoot fields was (94.59±0.47)% and for DMLC fields was (92.60±0.52)% at C=90°.Under a 1%/1mm error standard,the average matching rate for step & shoot fields was (89.83 ±1.06)% and for DMLC fields was (85.84±0.57)% at C=0°;The average matching rate for step & shoot fields was (86.91 ±1.71)% and for DMLC fields was (83.89±0.69)% at C=90°.Concusion MLC weight effect affects IMRT delivery dose,and DMLC fields are more sensitive to gravity than step & shoot fields.